Temporal course of motor recovery after Brown-Sequard spinal cord injuries

Little, James W.; Halar, Eugen M.

doi:10.1038/sc.1985.7

Cited by 57 publications

(42 citation statements)

References 15 publications

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“…26 Data for this conclusion were based on direct findings from two subjects and a review of the literature. 27 Late conversion to 'incomplete' status following initial, complete quadriplegia was reported in six of 61 subjects; three of these subjects recovered minimal levels of lower-limb motor function, but the specific muscles in which contraction was seen were not specified. 13 In a study of 23 subjects with motor-incomplete and acute SCI, quadriceps recovery was compared to that in 'toe flexors and toe extensors' 28 or just 'toe extensors'.…”

Section: Discussionmentioning

confidence: 97%

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Abductor hallucis for monitoring lower-limb recovery after spinal cord injury in man

2004

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Study design: Electromyogram (EMG) study on patients with acute spinal cord injury (SCI). Objectives: We hypothesized that subjects with mild to moderate acute SCI would have a higher probability of recovering function in intrinsic muscles of the foot compared to more proximal lower-limb muscles, based on the relative density of corticospinal tract innervation to these different motoneuron pools. Setting: Miami and Syracuse, USA. Methods: We conducted repeated measures of EMG during voluntary contractions from lower-limb muscles in subjects with acute traumatic SCI. For this study, analysis was restricted to those subjects who had either no recruitment (ie 'motor-complete') or limited recruitment (ie 'motor-incomplete') in any lower-limb muscle of either leg during the initial evaluation, and all of whom had converted to a motor-incomplete status in one or both legs at the time of final evaluation. Recruitment of the abductor hallucis (AbH) muscle during contraction attempts was judged as being either 'present' or 'absent', based upon the presence or absence of EMG-based volitional motor unit recruitment. Results: A total of 70 subjects were included in this study. Of these, 58 had motor-incomplete injury at or rostral to the T10 vertebral level, and another 12 had injury caudal to T10. In the former group, the AbH muscle showed a recovery probability that was considerably higher than that of other lower-limb muscles. Quite the opposite pattern was seen in persons with injury caudal to T10. In these subjects, recruitment was more common in proximal muscles of the thigh (psoas and quadriceps), and least common in the AbH muscle. Discussion: For persons with SCI at or rostral to the T10 vertebral level, the AbH muscle proved to be an earlier and more sensitive indicator of lower-limb contraction recovery following acute SCI compared to other lower-limb muscles. Including this intrinsic muscle of the foot as part of a neurologic assessment of muscle function after SCI should increase the test's sensitivity to preserved (or restored) supraspinal motor influence over lower-limb motoneuron pools, and is recommended.

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Section: Discussionmentioning

confidence: 97%

“…This aspect of standard evaluations may account for the conflict between findings of the present study and those of several previous studies. 13,[26][27][28][29] Specifically, a review of recovery after traumatic SCI stated that 'Proximal extensors recover weeks before distal flexors.' after Brown-Se´quard syndrome SCI.…”

Section: Discussionmentioning

confidence: 99%

Abductor hallucis for monitoring lower-limb recovery after spinal cord injury in man

2004

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“…During overground locomotion, ipsilesional forelimbs and hindlimbs showed nearly complete recovery of rhythmicity; the body weight supported by the forelimb was, however, less than in the intact situation. Patients with Brown-Séquard syndrome often regain their ability to walk, with minimal external support, after lesions at either cervical (Taylor and Gleave, 1957;Roth et al, 1991) or thoracic (Little and Halar, 1985) spinal segments. These similarities validated the cervical lateral hemisection injury in rodents as a model for understanding BrownSéquard syndrome in humans.…”

Section: Discussionmentioning

confidence: 99%

“…Ipsilesional limbs are severely dysfunctional without mechanoception and proprioception, but they retain their perception of pain and temperature. Interestingly, significant functional recovery of crude movements, especially of the legs, enables the patients to walk with minimal support (Taylor and Gleave, 1957;Little and Halar, 1985). The adaptations of the sensory-motor cortex that accompany the overuse of contralesional limbs and the recovery of the ipsilesional leg remain unknown.…”

Section: Introductionmentioning

confidence: 99%

Functional and Anatomical Reorganization of the Sensory-Motor Cortex after Incomplete Spinal Cord Injury in Adult Rats

Ghosh¹,

Sydekum²,

Haiss³

et al. 2009

J. Neurosci.

164

112

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A lateral hemisection injury of the cervical spinal cord results in Brown-Séquard syndrome in humans and rats. The hands/forelimbs on the injured side are rendered permanently impaired, but the legs/hindlimbs recover locomotor functions. This is accompanied by increased use of the forelimb on the uninjured side. Nothing is known about the cortical circuits that correspond to these behavioral adaptations. In this study, on adult rats with cervical spinal cord lateral hemisection lesions (at segment C3/4), we explored the sensory representation and corticospinal projection of the intact (ipsilesional) cortex. Using blood oxygenation level-dependent functional magnetic resonance imaging and voltage-sensitive dye (VSD) imaging, we found that the cortex develops an enhanced representation of the unimpaired forepaw by 12 weeks after injury. VSD imaging also revealed the cortical spatio-temporal dynamics in response to electrical stimulation of the ipsilateral forepaw or hindpaw. Interestingly, stimulation of the ipsilesional hindpaw at 12 weeks showed a distinct activation of the hindlimb area in the intact, ipsilateral cortex, probably via the injury-spared spinothalamic pathway. Anterograde tracing of corticospinal axons from the intact cortex showed sprouting to recross the midline, innervating the spinal segments below the injury in both cervical and lumbar segments. Retrograde tracing of these midline-crossing axons from the cervical spinal cord (at segment C6/7) revealed the formation of a new ipsilateral forelimb representation in the cortex. Our results demonstrate profound reorganizations of the intact sensory-motor cortex after unilateral spinal cord injury. These changes may contribute to the behavioral adaptations, notably for the recovery of the ipsilesional hindlimb.

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“…Braakman and Penning, 1976; Cushing, 1898; Cabezudo et al, 1980;Gentleman and Harrington, 1984;Holmes, 1915;Koehler and Endtz, 1986;Lipschitz and Block, 1962;Little and Halar, 1985;Peacock et al, 1977;Preston, 1896;Rand and Patterson, 1929;Taylor and Gleave, 1957) have documented pathological, aetiological, and clinical features in patients with this syndrome. However, only a limited number of patients have the 'pure' form of Brown-Sequard syndrome (BSS).…”

mentioning

confidence: 99%

Traumatic cervical Brown-Sequard and Brown-Sequard-plus syndromes: the spectrum of presentations and outcomes

Roth

Park²,

Pang³

et al. 1991

Spinal Cord

101

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SummaryBrown-Sequard syndrome (BSS) and Brown-Sequard-plus syndrome (BSPS) are characterised by asymmetrical paresis with hypalgesia more marked on the less paretic side. This study examined the clinical features of 38 patients (30 males and 8 females; mean age =32 years) with traumatic cervical BSS or BSPS who underwent comprehensive in patient rehabilitation. Twenty two injuries were caused by road traffic accidents, 8 by penetrating injuries, 5 by diving injuries, and 3 by other causes. After an average of 35 days in acute care and 79 days in rehabilitation, 37 patients had increased muscle strength, all 38 patients improved functional abilities, 29 patients walked independently, 34 had spontaneous bladder emptying, 36 were discharged home, and 14 were employed. Statistically significant increases (p

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Temporal course of motor recovery after Brown-Sequard spinal cord injuries

Cited by 57 publications

References 15 publications

Abductor hallucis for monitoring lower-limb recovery after spinal cord injury in man

Abductor hallucis for monitoring lower-limb recovery after spinal cord injury in man

Functional and Anatomical Reorganization of the Sensory-Motor Cortex after Incomplete Spinal Cord Injury in Adult Rats

Traumatic cervical Brown-Sequard and Brown-Sequard-plus syndromes: the spectrum of presentations and outcomes

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