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PubMedDate not supplied

Role of calpain in spinal cord injury: increased mcalpain immunoreactivity in spinal cord after compression injury in the rat.

Spinal cord injury was induced in rats by compression technique using 10 or 20 g compression for 5-10 min. Calpain immunoreactivity was examined in the lesion as well as in the adjacent areas of the cord at different times following injury. Elevated calpain immunoreactivity was found in the lesion compared to sham control. The increase in calpain immunoreactivity was dependent on the time and the degree of trauma. Areas adjacent posterior or caudal to the lesion also showed increased calpain immunoreactivity. Most of the cells in the dorsal and ventral funiculi with increased calpain staining were astrocytes and microglia. Proliferation of microglia and/or activation of astrocytes in the lesion, identified with lectin binding GSA and glial fibrillary acidic protein staining, was seen at 1 and 3 days after trauma, respectively. Eccentric nuclei and shrunken neurons with increased calpain staining were seen in the ventral horn. The extent of increase in calpain immunoreactivity in the lesion was also proportional to the degree of trauma. The elevated calpain immunoreactivity suggests increased calpain expression (mRNA), synthesis (protein level), and activity in the lesion of cord following injury as compared to sham control. This finding supports a pivotal role for calpain in tissue degeneration in spinal cord trauma.

Animals↗
PubMed1990

A randomized, controlled trial of methylprednisolone or naloxone in the treatment of acute spinal-cord injury. Results of the Second National Acute Spinal Cord Injury Study.

Studies in animals indicate that methylprednisolone and naloxone are both potentially beneficial in acute spinal-cord injury, but whether any treatment is clinically effective remains uncertain. We evaluated the efficacy and safety of methylprednisolone and naloxone in a multicenter randomized, double-blind, placebo-controlled trial in patients with acute spinal-cord injury, 95 percent of whom were treated within 14 hours of injury. Methylprednisolone was given to 162 patients as a bolus of 30 mg per kilogram of body weight, followed by infusion at 5.4 mg per kilogram per hour for 23 hours. Naloxone was given to 154 patients as a bolus of 5.4 mg per kilogram, followed by infusion at 4.0 mg per kilogram per hour for 23 hours. Placebos were given to 171 patients by bolus and infusion. Motor and sensory functions were assessed by systematic neurological examination on admission and six weeks and six months after injury. After six months the patients who were treated with methylprednisolone within eight hours of their injury had significant improvement as compared with those given placebo in motor function (neurologic change scores of 16.0 and 11.2, respectively; P = 0.03) and sensation to pinprick (change scores of 11.4 and 6.6; P = 0.02) and touch (change scores, 8.9 and 4.3; P = 0.03). Benefit from methylprednisolone was seen in patients whose injuries were initially evaluated as neurologically complete, as well as in those believed to have incomplete lesions. The patients treated with naloxone, or with methylprednisolone more than eight hours after their injury, did not differ in their neurologic outcomes from those given placebo. Mortality and major morbidity were similar in all three groups. We conclude that in patients with acute spinal-cord injury, treatment with methylprednisolone in the dose used in this study improves neurologic recovery when the medication is given in the first eight hours. We also conclude that treatment with naloxone in the dose used in this study does not improve neurologic recovery after acute spinal-cord injury.

Acute Disease↗
PubMed1985

Methylprednisolone and neurological function 1 year after spinal cord injury. Results of the National Acute Spinal Cord Injury Study.

A multi-center double-blind randomized clinical trial was conducted by the National Acute Spinal Cord Injury Study Group to examine the efficacy of high-dose methylprednisolone (1000-mg bolus and 1000 mg daily thereafter for 10 days) compared with that of a standard dose (100-mg bolus and 100 mg daily for 10 days). No significant difference was observed in neurological recovery of motor function, pinprick response, or touch sensation 1 year after injury between the two treatment groups, after adjustment for other potentially confounding factors. Analyses that specifically took into account the patients' total steroid dose and relative weight confirmed the lack of a steroid treatment effect. The case fatality rate was 10.7% during the 1st year after injury, and this was not associated with the steroid treatment protocol or the patient's gender. Deaths did occur significantly more frequently among patients who were completely (15.3%) and partially (8.6%) plegic than among those who were paretic (2.5%, p = 0.0005), and among patients aged 50 years or older (38.6%, p = 0.0001).

Clinical Trials as Topic↗
PubMed2002

Spinal cord injury medicine. 2. Medical complications after spinal cord injury: Identification and management.

UNLABELLED: This is a self-directed learning module that reviews medical complications associated with spinal cord injury (SCI). It is part of a chapter on SCI medicine in the Self-Directed Physiatric Educational Program for practitioners and trainees in physical medicine and rehabilitation. This article includes discussion of common medical complications that impact rehabilitation and long-term follow-up for individuals with SCI. Issues addressed include the rehabilitation approach to SCI individuals with pressure ulcers, unilateral lower-extremity swelling (deep venous thrombosis, heterotopic ossification, fractures), along with the pathophysiology, assessment, and treatment of spasticity, autonomic dysreflexia, orthostatic hypotension, and pain. OVERALL ARTICLE OBJECTIVE: To describe diagnostic and treatment approaches for medical complications common to individuals with SCI.

Adult↗
PubMed1987

[Quantitative analysis of spinal cord injury using the isopotential spinal cord surface mapping].

To evaluate spinal cord injury quantitatively and qualitatively, distribution of spinal cord surface potentials were analyzed using a isopotential mapping technique. The segmental spinal evoked potential was recorded simultaneously with 21-42 silver ball electrodes applied to the dorsal and ventral surface of the lumbar spinal cord of 37 anesthetized cats. The severity of spinal cord lesion was divided into 5 grades from 100 gcf to 500 gcf according to Allen's weight drop method. An analysis of isopotential map was made up to 24 hours after trauma. The results showed that N3 which was considered as the interneuron activity projecting from the dorsal horn to the anterior horn, revealed no shift of localization. It was therefore appeared appropriate for use as a parameter for quantitative analysis, especially in subtract and variation maps. The data provided not only amplitude and latency but also two dimensional surface spreads of electricity.

Animals↗
PubMed1978

Evaluation of experimental spinal cord injury by measuring spontaneous spinal cord potentials.

The relationship between the spontaneous spinal electrogram and the degree of spinal cord injury was studied in anesthetic-free, surgically decerebrate cats that received experimental blunt trauma by the graded weight-drop method. It was found that the characteristic spontaneous slow negative potential of the spinal electrogram showed a frequency dependency that correlated positively with the intensity of the injury (impulse expressed in gm-sec). Graphs of the frequency of occurrence of the slow negative potentials as a function of time following initial injury indicated that both the slope and shape of the curve were dependent on the severity of the injury measured in gm-sec at the time of the injury and confirmed histologically. These results indicate that the spontaneous spinal electrogram may serve as a sensitive indicator of the degree of spinal cord injury and may be useful in the assessment of various treatment modalities.

Animals↗
PubMed1994

High-dose methylprednisolone after acute spinal cord injury.

The spinal cord-injured patient has presented a dilemma for nursing care since the earliest survivor of such an injury. Recent research has identified a means of improving neurologic recovery for these patients. Proper administration of high-dose MP within 8 hours after injury provides the patient with the best potential for improvement. Ensuring immobilization and prevention of the complications of immobility are the next most significant actions the nurse can undertake to assist such a patient through a devastating injury toward optimal functional outcome. With continued research and education of caregivers, the residual effects of spinal cord injury may be further abated.

Drug Administration Schedule↗
PubMed1984

Functional paralysis mimicking spinal cord injury resulting in admission to a spinal cord injury center.

From 1978 through 1982, five patients with final diagnoses of nonorganic functional paraplegia or quadriplegia were seen and treated at the Northern California Regional Spinal Cord Injury Center. The patients ranged in age from 13 to 26 years and four were males. All had normal bowel and bladder function with otherwise complete motor and sensory paralysis, shifting sensory findings, and normal deep tendon reflexes early after injury. In each patient, a retrospective analysis demonstrated that structural anatomic lesion could be ruled out by a neurologic examination. Clinical and investigatory studies are discussed with respect to the diagnostic process.

Adolescent↗
PubMed1986

Spinal epidural hematoma and ankylosing spondylitis.

A typical case of ankylosing spondylitis (AS) in a 53-year-old man illustrates the high risk of spinal injury. When compared to the healthy subjects, patients with ankylosing spondylitis are at risk even after trivial injury. Spinal epidural hematoma is rare and generally associated with significant osseous spinal column involvement. Although rare, hematoma should be considered in ankylosing spondylitis patients, when a patient develops progressive neurologic symptoms and signs. An aggressive approach, including early decompression, affords the best chance for recovery.

Accidents, Traffic↗
PubMed1985

Occult head injury: its incidence in spinal cord injury.

This study investigated the suspicion that a significant proportion of individuals having spinal cord injury (SCI) also sustain a concomitant undiagnosed occult head injury during the trauma accident. The criteria for high risk of head injury included the following: (1) quadriplegia with high energy deceleration accident, (2) loss of consciousness at time of injury, (3) brainstem or cortical neurologic indicators, or (4) respiratory support required at time of injury. In this study, 67 patients admitted to the rehabilitation unit were given a neuropsychologic evaluation a median of 48 days after injury. Motor free scales used were the Galveston Orientation and Amnesia Test (GOAT), Quick Test, Raven Progressive matrices, serial 7s, Shipley Hartford, Stroop Color/Word Interference, and the Wechsler Memory Scale Associate Learning Tests. Forty-three of the 67 patients (64%) scored mildly to profoundly impaired on the test battery. Evidence of poor premorbid academic history was present in 19 (44%) of those with impaired performance on the neurologic evaluation and in only three (13%) of those scoring unimpaired. Consequently, 56% (24/43) of the impaired had no previous record of scholastic difficulties, presumably acquiring cognitive impairment at the time of injury. The implications of this high incidence of impaired cognitive functioning for treatment of individuals with SCI are significant.

Adolescent↗
PubMed1977

[Inseparable prognostic value of spinothalamic and corticospinal functions in severe spinal cord injuries].

In severe spinal cord trauma with initial complete paraplegia or tetraplegia, even the smallest recovery of sensibility to pain or motor function has an obvious prognostical value as it results from the study of 112 spinal injuries. For the motor aspect it is well known from experimental work and in man that even a small part of a single pyramidal tract in the spinal cord can take in charge the bilateral motricity of the limbs. It remains exceptional in severe spinal cord injury that recovery of motricity is not followed by a return of pain sens. In the lateral funiculus of the cord the sensitive and pyramidal tracts belongs to a same anastomotic vascular area between the central and peripherical circulatory streams. In physiological conditions this intermediate circulatory stream is poorly functional. But in severe spinal cord trauma with reduction of central blood flow the adjacent spinothalamic and corticospinal tracts survive in couple on the basis of the same anastomotic vascular area: from this results the prognostical unity that belongs to pain sens and motricity.

Adult↗
PubMed1988

Closed head injury in acute traumatic spinal cord injury: incidence and risk factors.

Investigators estimate that 15% to 50% of all patients with spinal cord injury (SCI) also incur a closed head injury (CHI), but studies have been hampered by design flaws, including retrospective assessment and inconsistent definition of CHI. We conducted a prospective study of combined CHI and SCI among 82 SCI patients consecutively admitted at two hospitals within 24 hours of injury. The purpose of the study was to determine the incidence and duration of loss of consciousness and posttraumatic amnesia (PTA), and to establish the risk factors for combined CHI and SCI. The overall incidence of CHI as defined by the presence of PTA of any duration was 49%. There was a significantly increased risk of CHI for patients involved in traffic accidents (risk ratio = 3.7; 95% confidence interval 1.8 to 7.2). There was no increased risk associated with level of injury (quadriplegic vs paraplegic; risk ratio = 1.2; 95% confidence interval = 0.8 to 1.8). All SCI patients, regardless of level of injury, deserve systematic evaluations for CHI in their acute care evaluations.

Adult↗
PubMed2004

The effect of a repeat bout of exercise on muscle injury in persons with spinal cord injury.

Following an initial bout of damaging exercise, a successive bout of similar exercise typically results in less injury, known as the "protective effect". Unloading due to spinal cord injury (SCI) increases the susceptibility to contraction-induced muscle injury. We tested the hypothesis that two bouts of isometric actions would evoke the same damage in the quadriceps femoris (QF) of patients with SCI. Six male subjects [32 (5) years old, 182 (9) cm, 81 (21) kg, injury level C6-T7, 6 (2) years post-injury, mean (SD)] were tested at two time points (Time1, Time2), separated by 8 weeks. Magnetic resonance images were taken of the QF prior to, immediately after, and 3 days after electromyostimulation (EMS) that evoked isometric knee extension. EMS (50 Hz) consisted of five sets of ten contractions (2 s on/6 s off, 1 min b/t sets) followed by three sets of ten contractions (1 s on/1 s off, 30 s b/t sets). Relative cross-sectional area of stimulated and injured skeletal muscle was obtained by quantifying pixels with an elevated T2. Relative area of stimulated QF was the same for both time points [92 (6)% and 89 (7)%] as was torque loss (approximately 55%). Three days post-EMS, the relative area of stimulated QF injured was not different between time points [30 (14)% vs 29 (17)%, P>0.05]. These results indicate an absence of a protective effective for repeat exercise bouts separated by 8 weeks in SCI patients using EMS.

Adult↗
PubMed2003

Effect of spinal cord injury on urinary bladder spinal neural pathway: a retrograde transneuronal tracing study with pseudorabies virus.

OBJECTIVES: To determinate the effect of acute and chronic spinal cord injury (SCI) resulting from thoracic cord transection on the urinary bladder spinal neural pathway. METHODS: Seventy-six adult Sprague-Dawley rats were randomly divided into four groups, non-SCI (normal rats undergoing no surgical procedure except pseudorabies virus [PRV] injection), SCI(b) (SCI and PRV injected immediately after SCI), SCI(c) (SCI and PRV injected at 3 weeks after SCI), and SCI(d) (SCI and PRV injected at 3 months after SCI). Transcardiac perfusion fixation was done at appropriate survival periods after PRV injection into the bladder wall tissue. Sections of the dorsal root ganglion, spinal cord, and brain were processed for visualization of the virus by the streptavidin-peroxidase immunohistochemical procedure. RESULTS: The bladder weight of the non-SCI, SCI(b), SCI(c), SCI(d) rats was 144 +/- 9 mg, 142 +/- 8 mg, 486 +/- 51 mg, and 656 +/- 69 mg, respectively. The time-ordered flow charts of PRV tracing were similar in the non-SCI and SCI rats. The cross-sectional area of the labeled dorsal root ganglion cell profiles increased significantly after SCI (P <0.001): 593 +/- 40 microm2, 588 +/- 39 microm2, 815 +/- 53 microm2, and 902 +/- 57 microm2 in the non-SCI, SCI(b), SCI(c), SCI(d) rats, respectively. The number of labeled cells in the dorsal horn in the L6 and S1 segments 3 days after PRV injection markedly increased in chronic SCI rats, as did the number of labeled motor neurons 4 days after injection. CONCLUSIONS: Acute and chronic SCI have no effect on the process of virus transneuronal transport below the level of the lesion. Subsequent to chronic SCI, reorganization of the micturition reflex pathways may occur.

Acute Disease↗
PubMed2004

Relationship between regional bone density measurements and the time since injury in adults with spinal cord injuries.

OBJECTIVES: To determine the bone mineral density (BMD) of the legs, arms, and trunk region of a group of adults with spinal cord injury (SCI) and to determine the relationship between regional BMD values and the time since injury. DESIGN: BMD measurements were determined by total-body, dual-energy x-ray absorptiometry scans and percentage values (percentage-matched BMD), based on manufacturer-supplied normative data for age, sex, body weight, and ethnic group. The relationship between percentage-matched BMD values and time since injury was determined by linear regression analyses. SETTING: Research laboratories in a university setting. PARTICIPANTS: Twenty-nine subjects (21 men, 8 women; mean age, 38.5 y) who had sustained an SCI a mean of 10.6 years earlier (range, 0.6-35.3 y). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The relationship between percentage-matched BMD values and the time since injury. RESULTS: There was a significant inverse relationship between percentage-matched BMD leg (r2 = -.76), arm (r2 = -.45), and trunk (r2 = -.38) values and the log of time since injury. CONCLUSION: Despite the varying levels of SCI and other relevant BMD contributing factors, the regional percentage-matched BMD values were significantly inversely related to the log of time since injury.

Absorptiometry, Photon↗
PubMed2004

Ischemic preconditioning does not improve neurological recovery after spinal cord compression injury in the rat.

Ischemic preconditioning (IPC) has been defined as the endogenous cellular protective mechanism evoked by brief ischemic periods. IPC renders the tissue of the central nervous system more resistant to subsequent lethal ischemic insults, and similar protective effect of IPC has been observed after experimental traumatic brain injury. Spinal cord trauma differs from cerebral trauma in that the secondary processes are damaging mostly the white matter. In the present study, we have tested the hypothesis that a transient non-lethal ischemic insult would improve outcomes after subsequent traumatic spinal cord injury (SCI). In the IPC group, 5-min spinal cord ischemia has been induced by aortic occlusion combined with hypotension. Forty-eight hours after IPC, moderate spinal cord injury has been induced by epidural balloon inflation at T8 level. Control group underwent identical surgical procedures without ischemia followed by SCI after 48 h. During the 4-week survival, locomotor performance of all rats was repeatedly tested and evaluated according to BBB scale. After 4 weeks, the animals were perfusion-fixed for histopathology, and morphometric analyses were performed in order to quantify the extent of the spinal cord lesion. All animals were completely paraplegic after SCI, and showed partial neurological recovery during their survival period. No significant differences were detected either in neurological scores or in morphometric measurements after 4 weeks' survival. These results indicate that in contrary to cerebral trauma, IPC does not improve the outcome after SCI.

Animals↗