Spinal cord injury patients

The results of the second National Acute Spinal Cord Injury Study (NASCIS II) constitutes a major milestone in the search for therapeutic interventions that will interfere significantly with secondary post-traumatic spinal-cord degeneration and thereby ameliorate the devastating neurological consequences of spinal-cord injury [64,65]. In that study, methylprednisolone was demonstrated to improve the 6- and 12-month recovery of spinal-cord injury patients, compared to placebo-treated patients, when administered in an intensive 24-hour intravenous antioxidant dosing regimen beginning within 8 hours after injury. NASCIS II is... 

Vaidyanathan S, Watt JW, Singh G, Soni BM, Sett P. Dosage of once-daUy gentamicin in spinal cord injury patients. Spinal Cord 2000 38(3) 197-8. 

Vaidyanathan S, Soni BM, Singh G, Sett P, Krishnan KR. Prolonged penile erection association with terazosin in a cervical spinal cord injury patient. Spinal Cord 1998 36(11) 805. 

Hagenbach U, Gafoor N, Brenneisen R, et al (2001) Clinical investigation of delta-9-tetra-hydrocannabinol (THC) as an alternative therapy for overactive bladders in spinal cord injury patients. Congress on Cannabis and Cannabinoids, Cologne, Germany. International Association for Cannabis as Medicine, p 10... 

Papaverine topical gel for Sexual dysfunction in spinal cord injury patients... 

Hoshimiya, N., Naito, N., Yajima, M., and Handa, Y., A multichannel FES system for the restoration of motor functions in high spinal cord injury patients a respiration-controUed system for multijoint upper extremity, IEEE Trans. Biomed. Eng. BME-36 754—760,1989. 

Erectile dysfunction is noted in patients with neurological disorders such as Parkinson s and Alzheimer s diseases, stroke, and cerebral trauma, often secondary to a decrease in libido or inability to initiate the erectile process. Spinal cord injury patients have varying degrees of erectile dysfunction largely dependent on the location and extent of the lesion. Sensory input from the genitalia is essential to achieve and maintain reflexogenic erection, and this input becomes more important as the effect of... 

Guzelkucuk U, Duman I, Yilmaz B, Tan AK. Reversible post-pregabalin peripheral edema in a spinal cord injury patient. Spinal Cord June 2012 50(6) 472. ... 

Pressures sores, also known as decubitous ulcers or bedsores, affect 1.5 to 3 million Americans annually.35 The cost of healing pressure sores can be substantial, with current estimates ranging from 2000 to 70,000 per wound.35 Although the prevalence of pressure sores is highest in long-term care facilities, 57% to 60% of new pressure sores actually develop in the hospital, most commonly in intensive-care and orthopedic patients. Elderly patients and those with spinal cord injuries are most at risk36... 

Fatigue accompanies viral infection, sepsis, trauma or major surgery. The cause of this fatigue is not known it may be peripheral, central or both. Studies on biopsy samples of patients with trauma show a reduction in the muscle ATP concentration, which could be responsible for peripheral fatigue, as explained above (Chapter 18 Table 13.3). Central fatigue has been identified in three different clinical conditions, post-polio syndrome, multiple sclerosis and after spinal cord injury, but has not been investigated in other conditions. 

Signs of muscle spasticity have been shown in disseminated sclerosis and other spinal disorders. It may be useful to patients with muscle spasms resulting from spinal cord injuries. A synonym of this dmg is lioresal. 

Prevention of abrupt discontinuation of intrathecal baclofen requires careful attention to programming and monitoring of the infusion system, refill scheduling and procedures, and pump alarms. Advise patients and caregivers of the importance of keeping scheduled refill visits and educate them on the early symptoms of baclofen withdrawal. Give special attention to patients at apparent risk (eg, spinal cord injuries at T-6 or above, communication difficulties, history of withdrawal symptoms from oral or intrathecal baclofen). Consult the technical manual of the implantable infusion system for additional postimplant clinician and patient information (see Warnings). 

Oral baclofen may be of some value in patients with spinal cord injuries and other spinal cord diseases. 

Oral - For the control of clinical spasticity resulting from upper motor neuron disorders such as spinal cord injury, stroke, cerebral palsy, or multiple sclerosis. It is of particular benefit to the patient whose functional rehabilitation has been retarded by the sequelae of spasticity. Such patients must have presumably reversible spasticity where relief of spasticity will aid in restoring residual function. 

Baclofen is a GABA agonist at GABA B receptors and it has a presynaptic inhibitory function by reducing calcium influx. Its indication is increased extensor tone and clonus. Intrathecal administration may control severe spasticity pain. It is used for the treatment of spastic movement, especially in instances of spinal cord injury, spastic diplegia, multiple sclerosis and amyotrophic lateral sclerosis. Its central nervous system effects include drowsiness, somnolence and seizure activity in epileptic patients. 

Succinylcholine produces muscle fasciculation, which may result in myoglobinuria and postoperative muscle pain. The amount produced depends on the level of physical fitness. Succinylcholine causes contractions of extraocular muscles, posing the danger of transient elevated intraocular pressure. Succinylcholine may produce hyperkalemia in patients with large masses of traumatized or denervated muscle (e.g., spinal cord injury). Denervated muscle is especially sensitive to depolarizing drugs because of the increased number of AChRs on the sarcolemma (denervation supersensitivity). Succinylcholine also causes prolonged contraction of the diseased muscles of patients with myotonia or amyotrophic lateral sclerosis. 

Hayes K. C., Hull T. C., Delaney G. A., Potter P. J., Sequeira K. A., Campbell K., and Popovich P. G. (2002). Elevated serum titers of pioinflammatory cytokines and CNS autoantibodies in patients with chronic spinal cord injury. J. Neurotrauma 19 753-761. 

Korenkov Al, Niendorf WR, Darwish N, et al. Continuous intrathecal infusion of baclofen in patients with spasticity caused by spinal cord injuries. Neurosurg Rev. 2002 25 228-230. 

Other factors. A number of additional factors may alter the predicted response of the patient to a drug. As discussed earlier, environmental and occupational hazards may produce certain toxins that alter drug absorption and metabolism. 9 62 Factors such as cigarette smoking and alcohol consumption have been shown to influence the metabolism of specific compounds.39,49 Drug distribution and metabolism may be altered in the obese patient,6 or in response to chronic and acute exercise.7,43 Individuals with spinal cord injuries have a decreased ability to absorb cer-... 

Segal JL, Hayes KC, Brunnemann SR, et al. Absorption characteristics of sustained-release 4 aminopyri-dine (fampridine SR) in patients with chronic spinal cord injury. J Clin Pharmacol. 2000 40 402-409. 

Finally, gastrointestinal distress in the form of nausea and vomiting is quite common with many of the narcotic analgesics. Because of their antiperistaltic action, these drugs can also cause constipation.48 Because this constipating effect can be quite severe, laxatives and stool softeners (see Chapter 27) can be used to prevent opioid-induced constipation in certain people, such as with patients who are at risk for fecal impaction (e.g., people with spinal cord injuries), or with people who are taking opioids for an extended period of time (e.g., patients receiving opioids for treatment of cancer-related pain).36,70... 

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