Journal of neurotrauma
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Journal of neurotrauma · Dec 2018
Multicenter StudyElectrophysiological multimodal assessments improve outcome prediction in traumatic cervical spinal cord injury.
Outcome prediction after spinal cord injury (SCI) is essential for early counseling and orientation of the rehabilitative intervention. Moreover, prognostication of outcome is crucial to achieving meaningful stratification when conceiving clinical trials. Neurophysiological examinations are commonly employed for prognostication after SCI, but whether neurophysiology could improve the functional prognosis based on clinical predictors remains an open question. ⋯ Adding neurophysiological variables to the model, the AUC increased significantly: 0.956 (95% CI: 0.930-0.982; p = 0.019). More patients could be correctly classified by adding the electrophysiological data. Our study demonstrates that neurophysiological assessment improves the prediction of functional prognosis after traumatic cervical SCI, and suggests the use of neurophysiology to optimize patient information, rehabilitation, and discharge planning and the design of future clinical trials.
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Journal of neurotrauma · Dec 2018
Minocycline Reduces the Severity of Autonomic Dysreflexia after Experimental Spinal Cord Injury.
Spinal cord injury (SCI) is a devastating neurological condition for which there is no effective treatment to restore neurological function. The development of new treatments for those with SCI may be hampered by the insensitivity of clinical tools to assess motor function in humans. Treatments aimed at preserving neuronal function through anti-inflammatory pathways (i.e., neuroprotection) have been a mainstay of pre-clinical SCI research for decades. ⋯ Neuroanatomical correlates (lesion area, descending sympathoexcitatory axons) were assessed, in addition to an assessment of cardiovascular control (hemodynamics, autonomic dysreflexia) and motor behavior. Here, we show that minocycline reduces lesion area, increases the number of descending sympathoexctitatory axons traversing the injury site, and ultimately reduces the severity of autonomic dysreflexia. Finally, we show that autonomic dysreflexia is a more sensitive marker of treatment stratification than motor function.
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Journal of neurotrauma · Dec 2018
Systemic and Cerebral Hemodynamic Contribution to Cognitive Performance in Spinal Cord Injury.
Cognitive deficits are prevalent in the spinal cord injury (SCI) population, and consensus suggests that concomitant traumatic brain injury or comorbid conditions are primarily responsible for these deficits. However, mounting evidence supports the possibility that systemic and cerebral hemodynamic dysfunction may contribute to the cognitive deficits reported in persons with SCI. We sought to determine the contribution of changes in blood pressure (BP) and changes in cerebral blood flow velocity (CBFv) to test performance on the Symbol Digit Modalities Test (SDMT) in persons with SCI compared with matched non-SCI controls. ⋯ Further, change in SBP accounted for a significant amount of variance in change in DFV in the total study sample (r2 = 0.090; p = 0.002). These results support previous findings of cognitive deficits in persons with SCI and indicate that inadequate systemic and cerebral hemodynamic responses to testing contribute to test performance. Therefore, clinical treatment of cognitive dysfunction in the SCI population should consider focusing on increasing systemic BP to improve CBFv, particularly in individuals with lesions above T1.
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Journal of neurotrauma · Dec 2018
Clinical TrialVisibility Graph Analysis of Intraspinal Pressure Signal Predicts Functional Outcome in Spinal Cord Injured Patients.
To guide management of patients with acute spinal cord injuries, we developed intraspinal pressure monitoring from the injury site. Here, we examine the complex fluctuations in the intraspinal pressure signal using network theory. We analyzed 7097 h of intraspinal pressure data from 58 patients with severe cord injuries. ⋯ In a multivariate logistic regression model, age, neurological status on admission, and average node eccentricity were independent predictors of neurological improvement. We conclude that analysis of intraspinal pressure fluctuations after spinal cord injury as graphs, rather than as time series, captures clinically important information. Our novel technique may be applied to other signals recorded from injured central nervous system (CNS); for example, intracranial pressure, tissue metabolite, and oxygen levels.
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Journal of neurotrauma · Dec 2018
Progressive Ventricles Enlargement and Cerebrospinal Fluid Volume Increases as a Marker of Neurodegeneration in Patients with Spinal Cord Injury: A Longitudinal Magnetic Resonance Imaging Study.
Next to gray and white matter atrophy, cerebrospinal fluid (CSF) volume and ventricular dilation may be surrogate biomarkers for brain atrophy in spinal cord injury (SCI). We therefore aimed to track brain atrophy by means of CSF volume changes and ventricular enlargements over two years after SCI. Fifteen patients with SCI and 18 healthy controls underwent a series of T1-weighted scans during five time points over two years. ⋯ Sample size estimation for six-month trials with CSF volume requires 25 patients per treatment arm to detect a hypothetical treatment effect in terms of slowing of atrophy rate of 30%. This study shows that SCI-induced changes in CSF/ICV ratio and ventricular expansion rate provide additional information on the neurodegenerative processes after injury. The sensitivity to scoring treatment effects speaks to its potential to serve as a sensitive biomarker in addition to local atrophy measures.