Journal of neurotrauma
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Journal of neurotrauma · Sep 2014
Multicenter Study Observational StudyMinimizing errors in acute traumatic spinal cord injury trials by acknowledging the heterogeneity of spinal cord anatomy and injury severity: An observational Canadian cohort analysis.
Clinical trials of therapies for acute traumatic spinal cord injury (tSCI) have failed to convincingly demonstrate efficacy in improving neurologic function. Failing to acknowledge the heterogeneity of these injuries and under-appreciating the impact of the most important baseline prognostic variables likely contributes to this translational failure. Our hypothesis was that neurological level and severity of initial injury (measured by the American Spinal Injury Association Impairment Scale [AIS]) act jointly and are the major determinants of motor recovery. ⋯ Stratifying clinical trial cohorts using a joint distribution of these two variables will enhance a study's chance of identifying a true treatment effect and minimize the risk of misattributed treatment effects. Clinical studies should stratify participants based on these factors and record the number of participants and their mean baseline motor scores for each category of this joint distribution as part of the reporting of participant characteristics. Improved clinical trial design is a high priority as new therapies and interventions for tSCI emerge.
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Journal of neurotrauma · Sep 2014
The Epidemiology of Childhood and Adolescent Traumatic Spinal Cord Injury in the United States: 2007-2010.
The burden of acute traumatic spinal cord injury (TSCI) among U. S. children and adolescents was last described over a decade ago using inpatient data. We describe cumulative incidence, mortality, discharge disposition, and inflation-adjusted charges of childhood and adolescent TSCI in the U. ⋯ RTA-related TSCI disproportionately affects young children, while firearm-related TSCI is most common among adolescents. These findings inform TSCI prevention strategies. Prevention may be key in mitigating rising healthcare cost.
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Neuropathic pain develops in up to two-thirds of people following spinal cord injury (SCI). Opioids are among the most effective treatments for this pain and are commonly prescribed. There is concern surrounding the use of these analgesics, however, because use is often associated with the development of addiction. ⋯ Instead, these animals administered nearly the full amount of morphine available each session. This amount of morphine did not affect recovery of locomotor function but did cause significant weight loss. We suggest caution is warranted when prescribing opioids for the treatment of neuropathic pain resulting from SCI, as the addictive potential is not reduced in this model.
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Journal of neurotrauma · Sep 2014
FGF-2-responsive and spinal cord-resident cells improve locomotor function after spinal cord injury.
The adult central nervous system has only a limited capacity for axonal regeneration. In this study, fibroblast growth factor-2 (FGF-2) was injected once into the spinal cord tissue around the injury site immediately after complete spinal cord transection in rats. This treatment markedly improved the locomotor function of the animals. ⋯ The FIFs could also be cultured from the intact spinal cord tissue, demonstrating that they were resident in the non-injured spinal cord. They had a spindle-shaped morphology and enhanced expression of mRNAs of N-cadherin and neurotrophic factors, suggesting the beneficial properties of the FIFs for axonal regeneration. Thus, these results argue for the continual use of autologous transplantation as a novel and promising cell therapy for the treatment of spinal cord injury.
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Journal of neurotrauma · Sep 2014
ReviewSympathetic skin responses and autonomic dysfunction in spinal cord injury.
Sympathetic skin responses (SSRs), a measure of sympathetic cholinergic sudomotor function, have been used in the assessment of autonomic dysfunction in patients with spinal cord injury (SCI). This review highlights the basic mechanisms underlying SSRs as well as their application to the SCI population. ⋯ Overall, SSRs are a rapid, convenient and non-invasive method illustrating that the severity of autonomic impairment can be independent from sensorimotor impairment. We suggest that SSRs be used in conjunction with other validated autonomic tests in order to predict or document autonomic dysfunction in SCI.