Therapeutic approaches for spinal cord injury induced spasticity

Abstract

Spasticity is evident in both humans and animals following spinal cord injury (SCI) and can contribute to significant functional limitation and disruption in quality of life of patients with this disorder. This mini-review describes a number of preclinical and clinical studies that promise to improve outcomes for, especially in terms of spasticity and hyper-reflexia, patients with SCI. A gold standard for the quantification of spasticity has proved elusive, but the combination of H-reflex frequency dependent depression and a novel stretch reflex (SR) windup protocol have the potential to provide new insights. As the pathophysiology of hyper-reflexia and spasticity continue to be investigated, the documented onset in the animal model of SCI provides critical time points for further study into these complex mechanisms. The positive effects of a passive exercise protocol and several potential pharmacological interventions are reviewed as well as a novel potential mechanism of action. Further work is needed to determine additional mechanisms that are involved in SCI, and how to optimize multiple therapies to overcome some of the deficits induced by SCI.

Experience of a tertiary referral center in managing bladder cancer in conjunction with neurogenic bladder

“…We registered a very high rate of surgical complications (90%) [39]. This was due to the limited functional reserve to cope with surgical stress [40]. The current treatment guidelines for BCa have been developed for the general population without considering the challenges and needs of this population.…”

Acute adaptive responses of central sensorimotor neurons after spinal cord injury

“…Indeed, the impact of SCI can range from complete or partial paralysis of the body below the lesion site, to sometimes partial or complete recovery [1,2]. The incidence of SCI in the world ranges between 10.4 and 83 cases per million people per year, depending on the region analyzed [8][9][10]. However, in world regions affected by war, the incidence of SCI transiently multiplies [10].…”

“…Some of these reorganizational events contribute to functional recovery, but some may also provoke erroneous or maladaptive functions, resulting in chronic pain and/or spasticity [1,2,8]. Indeed, the impact of SCI can range from complete or partial paralysis of the body below the lesion site, to sometimes partial or complete recovery [1,2].…”

“…Furthermore, care for people affected by SCI is predominantly given at home, the cost of which can run into millions of dollars and is a great strain on the patient and the caregiver. Moreover, due to limited capabilities of the CNS for repair, the effectiveness in precise regeneration after an SCI throughout postnatal life is minimal [1,2,8].…”