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Abstract: Objective: To develop clinical practice guidelines for the identification, evaluation and treatment of chronic neuropathic pain in spinal cord injury patients. Methods and results: the methodology was developed by the SOFMER (the French Society for Physical Medicine and Rehabilitation) and incorporates both guidelines for clinical practice and an expert consensus meeting. Following the creation of a Steering Committee and a Scientific Committee, twelve relevant questions were developed. Two experts from different medical specialties were assigned to each question. The scientific literature was assessed according to the grading scale used by the French Agency for Accreditation and Evaluation in Healthcare (ANAES). The conclusions from the experts’ literature analysis were presented at the 2007 SOFMER congress. Lastly, a multidisciplinary expert panel validated the guidelines. Conclusion: Each question generated a number of good practice guidelines, based on the available scientific level of proof and expert opinion. [Copyright &y& Elsevier]

Introduction: Neurotization of lumbar roots with lower intercostal nerves is a potential way to treat neurological deficits after spinal cord injury. The anatomical feasibility of such neurotizations in humans has already been reported. We propose to assess axonal regrowth after intercostal to lumbar neurotization in a sheep model. Materials and methods: Ten sheep had a left T11-L2, T12-L3, and T13-L4 neurotization. In 5 sheep, a L1 level left hemisection of the spinal cord was performed. The sheep had clinical and electrophysiological monitoring with a 6 mon follow-up. Results: A flaccid paralysis with clinical asymmetry of the left abdominal wall was noted three months after surgery. This asymmetry improved in all the cases at the 6 mon follow-up. Motor potentials were detected without difficulty for the 3 neurotized nerves (L2, L3, and L4) in 5 sheep. In another sheep, motor potentials of the L3 root remained undetected. Eight sheep had postoperative complications responsible for the animals'' death in 5 cases. Conclusions: The current study demonstrates the technical feasibility of intercosto-lumbar neurotizations in a sheep model. We proved in all the animals—except in the case of 1 neurotized root—the ability of motor axon to regenerate through neurotization area down to the muscular effectors; however, we noted a high rate of postoperative complications in this animal model. [Copyright &y& Elsevier]

The article discusses a study concerning the hospital care of patients with postacute spinal cord lesion in Italy. The study, which examines the characteristics of hospital readmissions of individuals with spinal cord lesion, uses a two-year survey in 32 spinal cord lesion centers in the nation. It includes the number of readmissions, their causes and complications on admission as the main outcome measures. It is concluded that readmissions score more than half of total admissions to centers for spinal cord lesion in Italy.

Abstract: Domoic acid (DA) is an excitatory amino acids (EAAs) analog which induced excitotoxicity lesion to central nervous system, but whether induced adult animal spinal cord is not known, furthermore, previous studies have shown that EAAs play an important role in spinal cord lesion, however, the molecular pathways in spinal cord lesion are not fully known. Therefore, a motor neuron-like cell culture system and a DA-induced spinal cord lesioned mice model were used to study the effect of DA on spinal cord in adult mice and the possible molecular pathways of EAAs in spinal cord lesions. Exposure of motor neuron-like cells NSC34 to DA dramatically increased reactive oxygen species (ROS) production by the DCF fluorescent oxidation assay, reduced mitochondrial function by MTT assay, cell viability by trypan blue exclusion assay, and was accompanied by an increase of cell apoptosis by histone protein release assay. In DA-induced spinal cord lesioned mice model, we showed that the decrease of proteasome activity, increase of UCP4 expression by immunohistochemistry and neural cell apoptosis by TUNEL staining, and was accompanied by an decrease of motor disturbance grade during the different stages of DA treatment. Taken together, the in vitro and in vivo data presented in the current report demonstrated that DA induces spinal cord lesions in adult mice, and the multiple molecular pathways promoted by EAAs in spinal cord lesions, at least partially was associated with ROS generation increase, mitochondrial dysfunction, proteasome activity decrease and UCP4 expression increase. [Copyright &y& Elsevier]

Abstract: The present study describes in primates the effects of a spinal cord injury on the number and size of the neurons in the magnocellular part of the red nucleus (RNm), the origin of the rubrospinal tract, and evaluates whether a neutralization of Nogo-A reduces the lesioned-induced degenerative processes observed in RNm. Two groups of monkeys were subjected to unilateral section of the spinal cord affecting the rubrospinal tract; one group was subsequently treated with an antibody neutralizing Nogo-A; the second group received a control antibody. Intact animals were also included in the study. Counting neurons stained with a monoclonal antibody recognizing non-phosphorylated epitopes on neurofilaments (SMI-32) indicated that their number in the contralesional RNm was consistently inferior to that in the ipsilesional RNm, in a proportion amounting up to 35%. The lesion also induced shrinkage of the soma of the neurons detected in the contralesional RNm. Infusing an anti-Nogo-A antibody at the site of the lesion did not increase the proportion of SMI-32 positive rubrospinal neurons in the contralesional RNm nor prevent shrinkage. [Copyright &y& Elsevier]

Study design:Data extraction from a state-wide, population-based, health-administration database of hospital admissions.Objective:To determine the incidence of non-traumatic spinal cord injury (NTSCI).Setting:Victoria, Australia.Methods:All patients admitted to hospital with a new onset of NTSCI, or who developed NTSCI after hospitalization, between 1 July 2000 and 30 June 2006, were identified using a population-based database. Age and gender of NTSCI patients were recorded.Results:The number of adults aged 15 years and older with NTSCI in each of the 12-month periods was 82, 111, 96, 108, 133 and 101. The average age-adjusted incidence rate of NTSCI in adults was 26.3 cases per million per year. There was no statistically significant increase in the age-adjusted incidence of NTSCI over the study period (Spearman's ρ=0.35, P=0.5). The incidence of NTSCI was significantly greater than the reported incidence for traumatic spinal cord injury (χ2 1=19.5, P<0.0000). There was a very strong correlation between age and the incidence of NTSCI, for both men (Spearman's ρ=1, P<0.0000) and women (Spearman's ρ=0.98, P=0.0000). Men had a statistically significantly (χ2 1=13.1, P=0.000) higher incidence of NTSCI (30.5 million adults per year) compared to women (22.9 million adults per year). The average incidence of NTSCI in children <15 years was 0.7 cases per million per year.Conclusion:NTSCI is strongly correlated with age and is more common than traumatic spinal cord injury. The method used in this study to calculate the incidence of NTSCI can be used to monitor the anticipated increase in the incidence of NTSCI in the years ahead, and can be used to in comparative studies.Spinal Cord (2008) 46, 406–411; doi:10.1038/sj.sc.3102152; published online 11 December 2007 [ABSTRACT FROM AUTHOR]

This issue presents a review of research about coping with a spinal cord lesion (SCL) in the last thirty years, since the introduction of the stress theory in the rehabilitation psychology. We have reviewed this concept in the rehabilitation context, the research results as well as the methodological limitations for study. Coping has demonstrated to be a very relevant variable to understanding the adaptation process to SCL, in interaction with other psychological variables as personality and locus of control, offering support to the individual differences model. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Determine long-term effect of English botulinum neurotoxin type A (BoNTA; Dysport®) for refractory neurogenic detrusor overactivity (NDO) for possible reduction of BoNTA efficacy after repeated injections. Methods: Between 1999 and 2005, 199 patients with spinal cord lesions with refractory NDO were treated with Dysport. All patients underwent a clinical examination, urinalysis, and videourodynamic study at baseline and at 3, 6, and 12 mo after each treatment, as well as a visual analogue scale (VAS) assessment and a bladder diary checked for 1 wk before each visit. We used 1000, 750, 500 IU BoNTA at the beginning of our experience, and thereafter we mainly used 750 IU. Outcome measures included frequency of urge urinary incontinence (Incontinence Episode Frequency [IEF] test); urodynamic parameters including maximum cystometric bladder capacity (MCBC), reflex volume (RV), bladder compliance (BC); number of pads/condoms; antimuscarinic drug consumption; short- and long-term side-effects; and quality of life measured with VAS. Results: No statistically significant differences were found in efficacy duration with the three Dysport doses (p =0.5274). The difference between the intervals of injections was not statistically significant (p =0.2659). MCBC, RV, and BC improved significantly after treatment compared with baseline values (p <0.001) and there were no statistically significant differences after each retreatment or regarding Dysport dose (p >0.05). There was a significant improvement in patient satisfaction after each retreatment as expressed on the VAS (p <0.001). There was a significant reduction in IEF score and pads/condoms use in the first 4 wk after each treatment (p <0.0001). Conclusion: After repeated injections the effect of BoNTA remained constant. [Copyright &y& Elsevier]

We describe the histopathologic features of spinal cord lesions in 10 cases of progressive supranuclear palsy (PSP) and review the literature. Histologic examination revealed atrophy with myelin pallor in the anterior funiculus and anterolateral funiculus in the cervical and thoracic segments in eight of the 10 cases, whereas the posterior funiculus was well preserved. The degrees of atrophy of the anterior funiculus and the anterolateral funiculus correlated with that of the tegmentum of the medulla oblongata. Myelin pallor of the lateral corticospinal tract was observed in two of the 10 cases. Microscopic observation of the spinal white matter, particularly the cervical segment, revealed a few to several neuropil threads, particularly in the white matter surrounding the anterior horn after Gallyas-Braak (GB) staining or AT-8 tau immunostaining. However, the posterior funiculus was completely preserved from the presence of argyrophilic or tau-positive structures. In the spinal gray matter, widespread distribution of neurons with cytoplasmic inclusions and neuropil threads was observed, particularly in the medial division of the anterior horn and intermediate gray matter, especially in the cervical segment. Globose-type neurofibrillary tangles and pretangles were found. The distribution of GB- or AT-8 tau-positive small neurons and neuropil threads resembled that of the spinal interneurons. In conclusion, the spinal cord, especially the cervical segment, is constantly involved in the pathologic process of PSP. We speculate that spinal interneurons and their neuronal processes, particularly in the medial division of the anterior horn and intermediate gray matter of the cervical segment, are most severely damaged in the PSP spinal cord. [ABSTRACT FROM AUTHOR]

Summary: 1. Emerging clinical studies of treating brain and spinal cord injury (SCI) led us to examine the effect of autologous adult stem cell transplantation as well as the use of polymer scaffolds in spinal cord regeneration. We compared an intravenous injection of mesenchymal stem cells (MSCs) or the injection of a freshly prepared mononuclear fraction of bone marrow cells (BMCs) on the treatment of an acute or chronic balloon-induced spinal cord compression lesion in rats. Based on our experimental studies, autologous BMC implantation has been used in a Phase I/II clinical trial in patients (n=20) with a transversal spinal cord lesion. 2. MSCs were isolated from rat bone marrow by their adherence to plastic, labeled with iron-oxide nanoparticles and expanded in vitro. Macroporous hydrogels based on derivatives of 2-hydroxyethyl methacrylate (HEMA) or 2-hydroxypropyl methacrylamide (HPMA) were prepared, then modified by their copolymerization with a hydrolytically degradable crosslinker, N,O-dimethacryloylhydroxylamine, or by different surface electric charges. Hydrogels or hydrogels seeded with MSCs were implanted into rats with hemisected spinal cords. 3. Lesioned animals grafted with MSCs or BMCs had smaller lesions 35 days postgrafting and higher scores in BBB testing than did control animals and also showed a faster recovery of sensitivity in their hind limbs using the plantar test. The functional improvement was more pronounced in MSC-treated rats. In MR images, the lesion populated by grafted cells appeared as a dark hypointense area and was considerably smaller than in control animals. Morphometric measurements showed an increase in the volume of spared white matter in cell-treated animals. In the clinical trial, we compared intraarterial (via a. vertebralis, n=6) versus intravenous administration of BMCs (n=14) in a group of subacute (10–33 days post-SCI, n=8) and chronic patients (2–18 months, n=12). For patient follow-up we used MEP, SEP, MRI, and the ASIA score. Our clinical study revealed that the implantation of BMCs into patients is safe, as there were no complications following cell administration. Partial improvement in the ASIA score and partial recovery of MEP or SEP have been observed in all subacute patients who received cells via a. vertebralis (n=4) and in one out of four subacute patients who received cells intravenously. Improvement was also found in one chronic patient who received cells via a. vertebralis. A much larger population of patients is needed before any conclusions can be drawn. The implantation of hydrogels into hemisected rat spinal cords showed that cellular ingrowth was most pronounced in copolymers of HEMA with a positive surface electric charge. Although most of the cells had the morphological properties of connective tissue elements, we found NF-160-positive axons invading all the implanted hydrogels from both the proximal and distal stumps. The biodegradable hydrogels degraded from the border that was in direct contact with the spinal cord tissue. They were resorbed by macrophages and replaced by newly formed tissue containing connective tissue elements, blood vessels, GFAP-positive astrocytic processes, and NF-160-positive neurofilaments. Additionally, we implanted hydrogels seeded with nanoparticle-labeled MSCs into hemisected rat spinal cords. Hydrogels seeded with MSCs were visible on MR images as hypointense areas, and subsequent Prussian blue histological staining confirmed positively stained cells within the hydrogels. 4. We conclude that treatment with different bone marrow cell populations had a positive effect on behavioral outcome and histopathological assessment after SCI in rats; this positive effect was most pronounced following MSC treatment. Our clinical study suggests a possible positive effect in patients with SCI. Bridging the lesion cavity can be an approach for further improving regeneration. Our preclinical studies showed that macroporous polymer hydrogels based on derivatives of HEMA or HPMA are suitable materials for bridging cavities after SCI; their chemical and physical properties can be modified to a specific use, and 3D implants seeded with different cell types may facilitate the ingrowth of axons. [ABSTRACT FROM AUTHOR]

Abstract: Aims: 1- To demonstrate the pertinence of regular physical activity practice from a physiological point of view and -2, to formulate recommendations for physical activities that are accessible to persons with a spinal cord injury. Current knowledge: Traumatic spinal cord lesions generally affect young and healthy people. Approximately 80% of the spinal cord lesions are the consequence of road or work accidents, while some 20% result from medical causes. The most obvious outcome is the loss of motor control in body regions below the lesion level, but the person also encounters sensitivity problems in those body parts, as well as disturbances of the autonomic nervous system. Currently the aim of rehabilitation following the acute post-traumatic phase reaches far beyond the mere survival of the patient and his/her discharge from hospital. Modern rehabilitative intervention seeks to optimise the person''s physical and psychological potential, to maximise functional independence and thus to facilitate familial, social and socioeconomical reintegration. In short, the objective is to develop the patient''s quality of life into an acceptable standard. Many persons with a spinal cord injury state that regular physical activity represents an effective means to contribute to their functional independence and quality of life. Increasingly numerous studies tend to validate scientifically this point of view. [Copyright &y& Elsevier]

Study design:Retrospective analysis.Objectives:To evaluate long-term efficacy and complications of AMS 800 (American Medical Systems®) artificial urinary sphincter (AUS) in treatment of urodynamic stress incontinence (USI) in male patients with spinal cord lesion (SCL).Setting:London Spinal Injuries Unit, Stanmore, UK and Institute of Urology and Nephrology, London, UK.Patients and methods:A retrospective analysis identified nine males with SCL (five thoracic, three lumbar, one cervical) with USI, who underwent AMS 800 AUS implantation by a single surgeon at a specialist spinal injuries unit. The mean age was 38.2 years (range 27–47 years), with the mean time since injury of 13.8 years (range 6–26 years). In all, seven were complete and two were incomplete SCL (traumatic spinal injury eight, tranverse myelitis one). All implants were inserted with the urethral cuff around the bulbar urethra with a 61–70 cm water pressure reservoir in the retropubic space. Implant activation was carried out at 6 weeks postoperatively. All patients were regularly followed up in outpatient clinics at the interval of 3 months, 6 months and yearly thereafter. An ultrasound examination for the upper tracts and a video-cystometrogram (VCMG) was carried out at 3 months postsurgery and then yearly.Results:The follow-up ranged from 3 to 133 months (mean 70.2 months). All implants were activated successfully with no intra- or immediate-postoperative complications. At activation all patients reported total urinary continence with seven out of nine implants (77%) currently working well. Two patients reported significant recurrent incontinence at 3 month follow-up, one of whom underwent a removal of the entire implant at the end of 3 months and the other was continent after a pump and cuff revision. The implant removed at 3 months was due to erosion and infection while the second was removed at 24 months due to secondary implant infection. Three out of seven (43%) successful implants required one revision each. One patient continues to report minimal leakage only during transfers with no leak demonstrated on postoperative VCMG. One patient with indwelling urethral catheter, two with suprapubic catheter and one voiding on urge have changed their bladder management to intermittent catheterisations postoperatively. All removals and revision procedures were carried out in the first 53 months of follow-up and four out of seven implants (57%) required no revisions.Conclusion:On a long term, AMS 800 is a viable option to treat USI in men with SCL. Mechanical revisions are frequent but effective. Strict patient selection, optimum preoperative bladder management and regular follow-up ensure low complication and high efficacy rates in the long term.Spinal Cord (2006) 44, 297–300. doi:10.1038/sj.sc.3101843; published online 25 October 2005 [ABSTRACT FROM AUTHOR]

We examined spinal cord lesions in eight patients with a pathological diagnosis of corticobasal degeneration (CBD). Using Gallyas-Braak (G-B) staining or AT-8 tau immunostaining, a few neuropil threads were identified in the white matter of the CBD spinal cords, mainly in the anterior funiculus, whereas the posterior funiculus was well preserved without threads. In the gray matter of the CBD spinal cords, particularly in the intermediate gray matter, there were widespread neuropil threads and neuronal inclusions. Large motor neurons in the anterior horn, neurons in the intermediolateral column, and Clarke’s column were relatively well preserved from neuronal loss and gliosis. Neuronal inclusions were of the globose type, suggestive of neurofibrillary tangles (NFTs), or showed diffuse granular accumulations of cytoplasmic tau, suggestive of pretangles. No typical NFTs, recognized by Bodian silver staining, were identified. The distribution of neuropil threads and G-B- or AT-8 tau-positive small neurons resembled that of interneurons. No astrocytic plaques were present in any of the CBD spinal cords, and only a few coiled bodies were seen. Neuropil threads in the white and gray matter and neuronal inclusions in the gray matter were prominent in cervical segments, and their density decreased caudally. We suggest that the presence of neuropil threads, particularly in the cervical intermediate gray matter, and the presence of neuronal inclusions, particularly in cervical interneurons, is an essential pathological feature of CBD. [ABSTRACT FROM AUTHOR]

Stem cells are a promising tool for treating brain and spinal cord injury. Magnetic resonance imaging (MRI) provides a noninvasive method to study the fate of transplanted cells in vivo. We studied implanted rat bone marrow stromal cells (MSCs) and mouse embryonic stem cells (ESCs) labeled with iron-oxide nanoparticles (Endorem®) and human CD34+ cells labeled with magnetic MicroBeads (Miltenyi) in rats with a cortical or spinal cord lesion. Cells were grafted intracerebrally, contralaterally to a cortical photochemical lesion, or injected intravenously. During the first week post transplantation, transplanted cells migrated to the lesion. About 3% of MSCs and ESCs differentiated into neurons, while no MSCs, but 75% of ESCs differentiated into astrocytes. Labeled MSCs, ESCs, and CD34+ cells were visible in the lesion on MR images as a hypointensive signal, persisting for more than 50 days. In rats with a balloon-induced spinal cord compression lesion, intravenously injected MSCs migrated to the lesion, leading to a hypointensive MRI signal. In plantar and Basso-Beattie-Bresnehan (BBB) tests, grafted animals scored better than lesioned animals injected with saline solution. Histologic studies confirmed a decrease in lesion size. We also used 3-D polymer constructs seeded with MSCs to bridge a spinal cord lesion. Our studies demonstrate that grafted adult as well as embryonic stem cells labeled with iron-oxide nanoparticles migrate into a lesion site in brain as well as in spinal cord. [ABSTRACT FROM AUTHOR]

Abstract: Lumbosacral cord motoneurons innervating the pubococcygeus muscle (Pcm) at the pelvic floor of male rats were analyzed. We showed previously that these motoneurons participate in sexual functions and are sensitive to fluctuations of systemic androgen and estrogen. Though estrogen receptors have not been identified in Lamina IX at these spinal areas, the release of oxytocin from the paraventricular nucleus of the hypothalamus (PvN) has been found to control pelvic sexual physiology. We therefore worked on the hypothesis that steroid hormones in the PvN induce the release of oxytocin at the lumbosacral level to modulate the function of Pcm motoneurons. Four experiments were developed, and results were observed with the retrograde staining of motoneurons with horseradish peroxidase. Data indicated that morphometric parameters of Pcm motoneurons were significantly reduced after castration or blocking of the steroids at the PvN site, or following complete transection of the spinal cord at the T8 level. In each case, the reduction of the stain was recovered after intrathecal treatment with oxytocin. Thus, present results show that Pcm motoneurons respond to spinal oxytocin. The conclusive model that we propose is that steroids stimulate the PvN, causing the nucleus to release oxytocin at the level of the lumbosacral spinal cord, and the release of the peptide regulates the spread of the stain of Pcm motoneurons. This work also shows that motoneurons distal to a transected area in the spinal cord could respond to exogenous oxytocin, an important finding for the research of spinal cord lesioned subjects. [Copyright &y& Elsevier]

Chronic myelitis from Whipple's disease of the spinal cord is extremely rare. The differential diagnosis includes chronic inflammatory lesions, viral or bacterial infections, and tumours of the spinal cord. Here we present a 50-year-old man with mild sensory deficits because of a large lesion of the cervical spinal cord who markedly showed improvement during probatory antibiotic therapy. PCR and jejunal biopsy were initially negative and only later confirmed the diagnosis of Whipple's disease. Clinical and neuroradiological criteria are suggested which may be of help in the early diagnosis of spinal Whipple's disease before confirmation by molecular biology or histology. [ABSTRACT FROM AUTHOR]

STUDY DESIGN::Retrospective study and data analysis. OBJECTIVE::To investigate and analyse the main features of spinal cord injuries due to diving accidents accepted in our Centre from June 1978 to December 2002. SETTING::Regional Spinal Unit of Florence, Italy. INTRODUCTION::Diving accidents mostly occur in a young and healthy population and most of the patients develop tetraplegia with a severe lifelong disability. From 1978 to 2002, 65 patients with spinal injuries due to diving accidents were admitted to the Regional Spinal Unit of Florence. MATERIAL AND METHODS::A retrospective study was conducted by analysing data stored in our local computerized database. We considered the vertebral injury, ASIA-ISCOS neurological classification on admission and discharge, gender, age at the time of injury, month of injury, treatment of vertebral lesion, length of stay in the Spinal Unit, neurological outcome, and complications. Data were analysed statistically by using the Fisher's exact test and logistic regression. RESULTS::In all, 62/65 patients were males (95%). Mean age at injury time: 22 years. On admission, 35/65 were neurologically complete ASIA A (54%), while 16 were classified ASIA B, 7 ASIA C and 7 ASIA D, according to the ASIA-ISCOS neurological standard of classification. C6 was the most common neurological motor level (40%) and C5 the most common vertebral injury level. In all, 36/65 (55%) patients underwent surgical treatment. Mean hospitalization time was 5 months. No neurological deterioration was recorded. In all, 20/65 (31%) patients improved neurologically and 16/20 (80%) of those had received surgical treatment. In all, 15/65 (23%) patients had complications and one patient died during the hospitalization period. CONCLUSIONS AND DISCUSSION::Patients whose vertebral lesions were surgically treated had a better neurological outcome than conservatively treated ones. Teardrop fractures showed worse neurological outcome as compared with burst fractures. Neurological improvement was more present in initially incomplete lesions. Treatment with high dose methylprednisolone during the first 8?h after trauma seemed to influence the neurological outcome positively. Age was also an important factor in influencing the neurological outcome.Spinal Cord (2005) 43, 109-116. doi:10.1038/sj.sc.3101695; Published online 23 November 2004 [ABSTRACT FROM AUTHOR]

STUDY DESIGN::Retrospective examination. OBJECTIVES::To compare the Walking Index for Spinal Cord Injury (WISCI) and current scales for their sensitivity to walking changes in subjects with a spinal cord lesion (SCL) and further validate the WISCI for use in clinical trails. SETTING::A large rehabilitation hospital in the center of Italy. PATIENTS AND METHODS::Retrospective review was performed on 284 patient records with an SCL. Measurements included neurological evaluation with Lower Extremity Motor Scores (LEMS) according to the American Spinal Injury Association (ASIA) and walking status assessed by Barthel Index (BI (0-15)), Rivermead Mobility Index (RMI (three levels)), Functional Independence Measure (FIM (1-7)), Spinal Cord Independence Measure (SCIM (0-8)), and WISCI (0-20). The WISCI is a 21-level hierarchical scale which incorporates gradations of physical assistance and devices required for walking. Improvement in walking is based on the change of scores from admission to discharge. Statistical analysis included Spearman rank correlation and?2 test; P<0.05. RESULTS::There was a significant positive correlation between WISCI and other scales (WISCI and BI r=0.67, P<0.001; WISCI and RMI r=0.67, P<0.001; WISCI and SCIM r=0.97, P<0.001; WISCI and FIM r=0.7, P<0.001). The initial ASIA grade was predictive of mobility outcome on the WISCI: of the 78 ASIA A patients, only five achieved independent walking versus 4/17 ASIA B (P=0.02), 56/109 ASIA C (P<0.001) and 39/44 ASIA D (P<0.001). The correlation of LEMS to the WISCI was 0.58 (P<0.001). At discharge, patients were distributed into 12 WISCI levels versus four FIM, three BI, two RMI and five SCIM levels. The most frequent WISCI levels at discharge were 13 (walker, no braces or assistance), 16 (two crutches, no braces or assistance) and 20 (no devices or assistance). CONCLUSIONS::Similar correlation between the WISCI and the other scales indicates that all these measures address the same concept, mobility, which is a measure of concurrent validity. The correlation is not 100%because of conceptual differences (the WISCI incorporates gradations of physical assistance and devices required for walking while most of the other scales focus on burden of care or mobility in the environment). The WISCI is more detailed and appears more sensitive to walking recovery than the other scales, as demonstrated by our patients'score distribution at discharge. Within each of the most frequent WISCI levels (13, 16, 20) LEMS and other walking features varied; therefore the scale would benefit from further refinement based on speed, distance and energy cost.Spinal Cord (2005) 43, 27-33. doi:10.1038/sj.sc.3101658; Published online 2 November 2004 [ABSTRACT FROM AUTHOR]

BACKGROUND::Little information is available about the survival, neurological recovery, and length of stay in hospital for rehabilitation (LOS) of patients with spinal neurological deficit following disc herniation (DH). STUDY DESIGN::Retrospective cohort study. OBJECTIVE::To report on outcomes and factors affecting these. SETTING::The Spinal Research Laboratory, Loewenstein Rehabilitation Hospital, Israel. SUBJECTS::A total of 158 patients with DH spinal neurological lesions (DHSNL). METHOD::Data were collected retrospectively. Survival was assessed using the Kaplan-Meier method; relative mortality risk by the Cox proportional hazard model. Neurological recovery was evaluated by calculating the change in Frankel grades, and factors that affect it were assessed by logistic regression. LOS associations were analyzed with ANOVA. RESULTS::The median age at lesion onset was 48 years, and the median survival 29 years. Age and gender had a significant effect on survival, but not so lesion severity, level, or decade of onset. Of the 69 patients who had Frankel grades A, B, or C on admission, 72%achieved useful recovery to grades D or E. The severity and level of the spinal neurological lesion (SNL) had a significant effect on recovery. The mean LOS was 87 days; it was significantly affected by lesion severity and level and by the decade of admission to rehabilitation, and decreased with time. CONCLUSIONS::Patients with DHSNL who were admitted for rehabilitation have favorable survival and recovery rates compared with previously studied patients with other types of SNL. Their LOS is probably a function of medical requirements, but is decreasing with time.Spinal Cord (2004) 42, 621-626. doi:10.1038/sj.sc.3101642; Published online 3 August 2004 [ABSTRACT FROM AUTHOR]

Upregulating the operation of spinal locomotor networks is one mechanism to restore, at least partially, lesion-impaired locomotion. We investigated if the K+ channel blocker 4-aminopyridine (4-AP) could facilitate spinal locomotor networks in addition to its well-known effect on motor nerve conduction. Fictive locomotor patterns were recorded from ventral roots (VRs) of the isolated spinal cord of the neonatal rat. 4-AP (0.1–50 μM) produced synchronous VR oscillations which did not develop into fictive locomotion. These oscillations had network origin, required intact glutamatergic transmission and were probably amplified via electrotonic coupling because of their depression by the selective gap junction blocker carbenoxolone. 4-AP (5 μM) slightly increased input resistance of lumbar motoneurons without affecting their action or resting potentials. Dorsal root (DR) evoked synaptic responses were enhanced (217±65%) by 5 μM 4-AP without changes in axon conduction. 4-AP (5 μM) accelerated fictive locomotion induced by N-methyl-d-aspartate (NMDA) and serotonin (5-HT) without altering cycle amplitude and facilitated the onset of fictive locomotion in the presence of sub-threshold concentrations of NMDA and 5-HT. Furthermore, in the presence of 4-AP, weak DR stimuli, previously insufficient to activate locomotor patterns, generated alternating VR discharges. Thus, although 4-AP per se could not directly activate the locomotor network of the spinal cord, it could strongly facilitate the locomotor program initiated by neurochemicals or electrical stimuli. These data suggest that the reported improvement by 4-AP in locomotor activity of spinal-injury patients may include activation of locomotor networks when low concentrations of this drug are administered in coincidence with appropriate stimuli. [Copyright &y& Elsevier]

Significant morphological modifications in the layout of primate-specific (interlaminar) astroglia were found in somatosensory areas 3a, 3b, 1 and 2 eleven to thirteen months after transection of the posterior spinal cord in adult Macaca monkeys. These observations plus lack of evidence of a persistent reactive astrocytosis suggest that changes in the spatial arrangement of interlaminar glia may be an integral part of the long-term process of structural reorganization of the cerebral cortex following cortical deafferentation. [Copyright &y& Elsevier]

Functional electrical stimulation (FES) of upper limbs can be used for the recovery of some hand functions on patients with CNS lesions. This study deals with the control of FES by means of myoelectrical activity detected from voluntarily activated paretic muscles. The specific aim of this paper is to evaluate the accuracy of myoelectrical control in terms of produced force and movement. For this purpose, a specific device called myoelectrical controlled functional electrical stimulator (MeCFES) has been developed and applied to six tetraplegic patients with a spinal cord lesion and one stroke hemiplegic patient. Residual myoelectric signals from the paretic wrist extensor (m. extensor carpi radialis, ECR) have been used to control stimulation of either the wrist extension (i.e., the same muscle) or thumb flexion. A tracking test based on a visual feedback of the produced force or movement compared to a reference target trajectory was used to quantify control accuracy. A comparison was made between the tracking performances of each subject with and without the MeCFES and the learning process for two of the subjects were observed during consecutive sessions. Results showed that the wrist extension was improved in three out of five C5 SCI patients and the thumb flexion was largely increased in one incomplete C3 SCI patient. The hemiplegic patient showed limited thumb control with the MeCFES but indicated the possibility of a carry over effect. It was found that a low residual natural force resulted in a less accurate movement but also with a large increase (up to ten times) of the muscle output. On the contrary, persons with a medium residual force obtained a smaller amplification of muscle force with a higher tracking accuracy. [ABSTRACT FROM PUBLISHER]

Hemidystonia is usually associated with a structural lesion in the contralateral basal ganglia. We report a patient with definite multiple sclerosis, according to Poser’s criteria, presenting with an acute-onset sustained left hemidystonia. Cranial T2-weighted magentic resonance imaging (MRI) showed several hyperintense lesions in the centri semiovali and in the periventricular area without basal ganglia involvement. Moreover cervical spinal cord T2-weighted MRI showed two hyperintense lesions in the left posterolateral spine at C2 and C3, and one lesion in the right posterolateral spine at C4 levels. The hemidystonia improved completely after daily treatment with 1000 mg of methylprednisolone, and cervical MRI was performed after the improvement which showed that the lesions had become smaller and less intense. Finally we consider that the hemidystonia may be caused by the cervical spinal cord lesions of multiple sclerosis. [ABSTRACT FROM AUTHOR]

The intention of this study was to examine the surgical care and the possibilities of rehabilitation in geriatric patients with cervical spinal cord injuries with regard to the postoperative and outpatient course. Thirty-nine patients (aged at least 66 years) with cervical spinal cord injuries were studied over a 6.5-year period (January 1, 1993 to June 30, 1999). Mean age was 75 years. Thirteen patients had a complete sensomotoric lesion of the spinal cord. Seven of them died in hospital during the postoperative period. Only 2 patients are still alive. Three out of the 26 patients with incomplete lesions of the cervical spinal cord were discharged and sent to nursing homes, 22 patients could be discharged into home care. One patient die in hospital. The period of primary rehabilitation was 204 days in patients with complete and 105 days in those with incomplete lesions compared to 85 days in quadriplegic patients overall. In conclusion, a high mortality rate in geriatric patients with complete paraplegia was seen, with only one third of these patients still alive after 1 year. In contrast, 68% of the patients with incomplete lesions survived for more than 1 year, with the majority living in their own houses. [ABSTRACT FROM AUTHOR]

Recent studies have demonstrated that coordinated stepping movements can be induced in patients with complete para-/tetraplegia, when they were standing on a moving treadmill with their body weight partially unloaded and external assistance. The aim of this study was to determine which part of the spinal cord generated the locomotor pattern. In patients with complete paraplegia due to lesions at different levels of the spinal cord, the locomotor pattern was compared with that of healthy subjects. Any similarities in electromyographic (EMG) activity of gastrocnemius and tibialis anterior muscles between the patients and healthy subjects were reflected by the analysis of the variation ratio and amplitudes of the EMG activity. It was found that the higher the level of spinal cord lesion the more ”normal” was the locomotor pattern. This suggests that neuronal circuits underlying locomotor ”pattern generation” in man are not restricted to any specific level(s) of the spinal cord, but that an intricate neuronal network contributing to bipedal locomotion extends from thoracolumbal to cervical levels. [ABSTRACT FROM AUTHOR]

We trained cats to walk on a moving treadmill belt, then subjected them to partial transverse sections of the thoracic spinal cord. Afterwards, we observed their ability to walk on the treadmill, over a period of several weeks, using gait analysis techniques to describe the resultant deficits. The extent of the lesions was verified histologically, and the identity of the spared descending axons from the brain stem was demonstrated by retrograde labeling with horseradish peroxidase. We found that significant sparing or recovery of hindlimb locomotor function is closely linked to sparing of axons in at least one ventrolateral quadrant of the cord. The essential elements probably belong to vestibulospinal and reticulospinal systems. [ABSTRACT FROM AUTHOR]

Motor evoked potentials (MEP) were recorded in a total of 110 patients with tumorous ( n=39) and non-tumorous ( n=71) lesions of the cervical ( n=59), thoracic ( n=37) and thoracolumbar ( n=14) spinal cord. In all cases MEP were elicited by electrical stimulations, and in 50 of them also by magnetoelectric stimulation, of the motor cortex. The peripheral conduction time was determined by electrical stimulation of the lumbar nerve roots. It was the aim of this study to determine whether 1. MEP are sensitive for detection of lesions along the spinal cord and 2. whether they allow quantitative assessment of motor function. To achieve this goal, we compared potential and clinical findings of our patients, each divided into seven categories. Our results clearly showed the high sensitivity of MEP for semi-quantitative evaluation of motor function, as there were no false negative results in our series. Moreover, unilaterally accentuated motor deficits correlated significantly with changes in MEP, which were affected more strongly on the corresponding side (Student's t-test, α=0.05). However, clinical and electrophysiological findings did not correlate in the quantitative evaluation of the motor status as established by variance analysis (F=0.52). There was no difference in results with respect to the electrical and magnetoelectric stimulation technique. Our results lead to the following conclusions. MEP are sensitive for semiquantitative evaluation of spinal motor function; however, MEP do not allow quantification of the clinical motor status. We hypothesize that MEP changes are related more closely to the type of spinal cord damage (demyelination vs axonotmesis) and the duration of disease than to the actual clinical motor function. [ABSTRACT FROM AUTHOR]

This study was designed to describe the frequency and severity of colorectal problems among patients with spinal cord lesions and to determine whether these problems are associated with age, gender, time since the lesion, and level and severity of the lesion.A detailed questionnaire describing colorectal and bladder function was sent to all 589 members of The Danish Paraplegic Association; 424 responded (72 percent).Only 19 percent felt a normal desire to defecate, whereas the remaining patients felt no desire to defecate (38 percent) or a combination of abdominal discomfort (37 percent) and headache, physical uneasiness, and perspiration (25 percent). Digital stimulation of the anal canal before defecation or digital evacuation of the rectum was used regularly by 65 percent of patients. Fecal incontinence was experienced by 75 percent of patients; however, most patients only had a few episodes of fecal incontinence each month (15 percent) or each year (56 percent). Overall, 39 percent of patients reported that colorectal dysfunction caused some or major restrictions on social activities or on their quality of life, and 30 percent regarded colorectal complaints to be worse than both bladder and sexual dysfunction. The severity of most symptoms was significantly correlated with the severity of the lesion, and the self-reported impact on social activities or quality of life was significantly more severe among women than men.Colorectal dysfunction is very common among spinal cord-injured patients, often causing restriction on social activities and quality of life. Therefore, these problems deserve more attention in the treatment of spinal cord-injured patients. [ABSTRACT FROM AUTHOR]

Motor evoked potentials (MEP) were examined in 50 patients with space-occupying lesions of the brain stem and spinal cord. MEP findings were correlated with the motor status as established by clinical examination. The results clearly show the high sensitivity of MEP for detection of motor deficits: 17 recordings (77%) from the thenar muscle and 42 (84%) from the anterior tibial muscle correlated correctly with the clinical motor status. False-positive results were found in 5 (23%) thenar recordings and 8 (16%) and anterior tibial recordings. False-negative correlation was not observed. The high rate of false-positive results appears to indicate that MEP detect subclinical motor deficits. This electrophysiological test is therefore recommended, especially when involvement of the descending pathways is suspected and clinical examination reveals no abnormality. [ABSTRACT FROM AUTHOR]