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Neurorehabilitation and Neural Repair Jan 2020Epidural spinal electrical stimulation at the lumbar spinal level evokes rhythmic muscle activation of lower-limb antagonists, attributed to the central pattern...
Epidural spinal electrical stimulation at the lumbar spinal level evokes rhythmic muscle activation of lower-limb antagonists, attributed to the central pattern generator. However, the efficacy of noninvasive spinal stimulation for the activation of lower-limb muscles is not yet clear. This review aimed to analyze the feasibility and efficacy of noninvasive transcutaneous spinal cord stimulation (tSCS) on motor function in individuals with spinal cord injury. A search for tSCS studies was made of the following databases: PubMed; Cochrane Registry; and Physiotherapy Evidence Database (PEDro). In addition, an inverse manual search of the references cited by the identified articles was carried out. The keywords [Mesh term], and were used. A total of 352 articles were initially screened, of which 13 studies met the inclusion criteria for systematic review. The total participant sample comprised 55 persons with spinal cord injury. All studies with tSCS provided evidence of induced muscle activation in the lower and upper limbs, and applied stimulation at the level of the T11-T12 and C4-C7 interspinous space, respectively. All studies reported an increase in motor response measured by recording surface electromyography, voluntary movement, muscle strength, or function. Although this review highlights tSCS as a feasible therapeutic neuromodulatory strategy to enhance voluntary movement, muscle strength, and function in patients with chronic spinal cord injury, the clinical impact and efficacy of electrode location and current intensity need to be characterized in statistically powered and controlled clinical trials.
Topics: Humans; Motor Activity; Muscle, Skeletal; Outcome Assessment, Health Care; Recovery of Function; Spinal Cord Injuries; Spinal Cord Stimulation
PubMed: 31858871
DOI: 10.1177/1545968319893298 -
Cell and Tissue Research Aug 2019Axonal regeneration and formation of tripartite (axo-glial) junctions at damaged sites is a prerequisite for early repair of injured spinal cord. Transplantation of stem...
Axonal regeneration and formation of tripartite (axo-glial) junctions at damaged sites is a prerequisite for early repair of injured spinal cord. Transplantation of stem cells at such sites of damage which can generate both neuronal and glial population has gained impact in terms of recuperation upon infliction with spinal cord injury. In spite of the fact that a copious number of pre-clinical studies using different stem/progenitor cells have shown promising results at acute and subacute stages, at the chronic stages of injury their recovery rates have shown a drastic decline. Therefore, developing novel therapeutic strategies are the need of the hour in order to assuage secondary morbidity and effectuate improvement of the spinal cord injury (SCI)-afflicted patients' quality of life. The present review aims at providing an overview of the current treatment strategies and also gives an insight into the potential cell-based therapies for the treatment of SCI.
Topics: Animals; Humans; Neural Stem Cells; Recovery of Function; Spinal Cord; Spinal Cord Injuries; Spinal Cord Regeneration
PubMed: 31065801
DOI: 10.1007/s00441-019-03039-1 -
Clinical Rehabilitation Jan 2015To summarize the evidence for the effectiveness of exercise training in promoting recovery of upper extremity function after cervical spinal cord injury. (Review)
Review
OBJECTIVE
To summarize the evidence for the effectiveness of exercise training in promoting recovery of upper extremity function after cervical spinal cord injury.
DATA SOURCES
Medline, Cochrane, CINAHL, EMBASE and PEDro were used to search the literature.
REVIEW METHODS
Two reviewers independently selected and summarized the included studies. Methodological quality of the selected articles was scored using the Downs and Black checklist.
RESULTS
A total of 16 studies were included, representing a total of 426 participants. Overall, the internal validity and reporting of the studies was fair to good, while power and external validity were poor. Interventions included exercise therapy, electrical stimulation, functional electrical stimulation, robotic training and repetitive transcranial magnetic stimulation. Most of the studies reported improvements in muscle strength, arm and hand function, activity of daily living or quality of life after intervention.
CONCLUSIONS
Training including exercise therapy, electrical stimulation, functional electrical stimulation of the upper limb following cervical spinal cord injury leads to improvements in muscle strength, upper limb function and activity of daily living or quality of life. Further research is needed into the effects of repetitive transcranial magnetic stimulation and robotic training on upper limb function.
Topics: Activities of Daily Living; Adult; Cervical Cord; Databases, Bibliographic; Electric Stimulation Therapy; Exercise Therapy; Humans; Middle Aged; Muscle Strength; Outcome and Process Assessment, Health Care; Physical Therapy Modalities; Quality of Life; Recovery of Function; Robotics; Spinal Cord Injuries; Transcranial Magnetic Stimulation; Upper Extremity; Young Adult
PubMed: 25575932
DOI: 10.1177/0269215514536411 -
Multiple Sclerosis and Related Disorders Jun 2021Spinal cord complications associated with coronavirus infectious disease of 2019 (COVID-19) are being widely reported. The purpose of this systematic review was to...
BACKGROUND
Spinal cord complications associated with coronavirus infectious disease of 2019 (COVID-19) are being widely reported. The purpose of this systematic review was to summarize so far available pieces of evidence documenting de novo novel severe acute respiratory syndrome coronavirus (SARS-CoV-2) mediated spinal cord demyelinating diseases. Indeed, the spinal demyelinating disorders that have been reported in those patients who have suffered from COVID-19 rather than on the people already living with diagnosed or undiagnosed primary demyelinating disorders.
METHODS
We used the existing PRISMA consensus statement. Data were collected from PubMed, NIH Litcovid, EMBASE and Cochrane library databases, as well as Pre-print servers (medRxiv, bioRxiv, and pre-preints.org), until September 10, 2020, using pre-specified searching strategies.
RESULTS
The 21 selected articles were all case reports and included 11 (52%) men and 10 (48%) women. The mean age was of 46.7 ± 18.0. The neurological manifestations included weakness, sensory deficit, autonomic dysfunction and ataxia. In most cases, elevated cerebrospinal fluid protein as well as lymphocytic pleocytosis were found. SARS-CoV-2 was detected in five (24%) patients, meanwhile in 13 (62%) patients, the testing was negative. Testing was not performed in two cases and, in one, data were unavailable. Nearly half of the cases (N = 9) were associated with isolated long extensive transverse myelitis (LETM), whereas a combination of both LETM and patchy involvement was found in two. Only five patients had isolated short segment involvement and two patchy involvement. Furthermore, concomitant demyelination of both brain and spine was reported in six patients. Concerning the prognosis, most of the patients improved and the mortality rate was low (N = 2, <10%).
CONCLUSION
Spinal cord demyelination should be added to the plethora of immune mediated neurologic complications associated with COVID-19.
Topics: COVID-19; Communicable Diseases; Female; Humans; Male; Nervous System Diseases; SARS-CoV-2; Spinal Cord
PubMed: 33845350
DOI: 10.1016/j.msard.2021.102917 -
NeuroImage. Clinical 2023Cervical spinal cord atrophy occurs after spinal cord injury. The atrophy and how level of injury affects atrophy differs between studies. A systematic review and... (Meta-Analysis)
Meta-Analysis Review
Cervical spinal cord atrophy occurs after spinal cord injury. The atrophy and how level of injury affects atrophy differs between studies. A systematic review and metaanalysis were done after systematic searches of PubMed, CINAHL, APA PsycInfo and Web of Science. English language original studies analyzing MRI cervical spinal cord cross-sectional area in adults with spinal cord injury were included. Atrophy and correlation between injury level and atrophy were estimated with random-effects models, standardized mean differences, and 95% confidence intervals. 24 studies were identified. 13/24 studies had low risk of bias. Cord atrophy meta-analysis of 18 articles corresponded to a standardized mean difference of -1.48 (95% CI -1.78 to -1.19) with moderate to large interstudy heterogeneity. Logarithmic time since injury influenced heterogeneity. Longitudinal atrophy was best described by a logarithmic model, indicating that rate of spinal atrophy decreases over time. Meta-correlation of eight studies indicated more severe atrophy in more rostral injuries (0.41, 95% CI 0.20-0.59). Larger and preferably longitudinal studies, data sharing, and standardized protocols are warranted.
Topics: Adult; Humans; Spinal Cord Injuries; Spinal Cord; Magnetic Resonance Imaging; Cervical Cord; Atrophy
PubMed: 36931004
DOI: 10.1016/j.nicl.2023.103372 -
Regional Anesthesia and Pain Medicine Jun 2023Spinal cord stimulation (SCS) has emerged as an important treatment for chronic pain disorders. While there is evidence supporting improvement in pain intensity with SCS... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Spinal cord stimulation (SCS) has emerged as an important treatment for chronic pain disorders. While there is evidence supporting improvement in pain intensity with SCS therapy, efforts to synthesize the evidence on physical functioning are lacking.
OBJECTIVE
The primary objective of this meta-analysis was to assess long-term physical function following 12 months of SCS for chronic back pain.
EVIDENCE REVIEW
PubMed, EMBASE, Scopus, and CENTRAL databases were searched for original peer-reviewed publications investigating physical function following SCS. The primary outcome was physical function at 12 months following SCS therapy for chronic back pain compared with baseline. A random effects model with an inverse variable method was used. The Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) framework was used to determine the certainty of evidence.
FINDINGS
A total of 518 studies were screened, of which 36 were included. Twenty-two studies were pooled in the meta-analysis. There was a significant reduction in Oswestry Disability Index (ODI) scores at all time frames up to 24 months following implantation. Pooled results revealed significant improvement in ODI scores at 12 months with a mean difference of -17.00% (95% CI -23.07 to -10.94, p<0.001). There was a very low certainty of evidence in this finding as per the GRADE framework. There was no significant difference in subgroup analyses based on study design (randomised controlled trials (RCTs) vs non-RCTs), study funding, or stimulation type.
CONCLUSION
This meta-analysis highlights significant improvements in physical function after SCS therapy. However, this finding was limited by a very low GRADE certainty of evidence and high heterogeneity.
Topics: Humans; Spinal Cord Stimulation; Chronic Pain; Back Pain; Treatment Outcome; Spinal Cord
PubMed: 37080578
DOI: 10.1136/rapm-2022-104295 -
Pain Practice : the Official Journal of... Nov 2023Spinal cord stimulation (SCS) is conventionally placed at either cervical or thoracic spinal regions to treat chronic pain. However, for patients with multiarea pain,... (Review)
Review
OBJECTIVES
Spinal cord stimulation (SCS) is conventionally placed at either cervical or thoracic spinal regions to treat chronic pain. However, for patients with multiarea pain, concomitant cervical and thoracic SCS (ctSCS) may be necessary to provide sufficient coverage. It remains unknown whether ctSCS is effective and safe. Thus, we aimed to survey the existing literature and assess the efficacy and safety of ctSCS.
METHODS
A systematic review of the literature was performed according to the 2020 PRISMA guidelines to investigate pain, functional, and safety outcomes related to ctSCS. Articles between 1990 and 2022 available through PubMed, Web of Science, Scopus, and Cochrane Library databases were included if they assessed these outcomes in the context of ctSCS. Data extracted from articles included study type, number of ctSCS implantations, stimulation parameters, indications for implantation, complications, and frequency. The Newcastle-Ottawa scale was used to assess risk of bias.
RESULTS
Three primary studies met our inclusion criteria. Overall, ctSCS was effective in providing analgesia. Pain severity was captured with patient-reported pain scales and changes in analgesic requirements. Various metrics were used to quantify quality of life and functional outcomes. Failed back surgery syndrome was the most common indication for ctSCS implantation. Implanted pulse generator pocket pain was the most common postoperative adverse event.
CONCLUSIONS
Despite the limited evidence available, ctSCS seems to be effective and generally well tolerated. The dearth of relevant primary literature illustrates a knowledge gap, and future studies are needed to better clarify the efficacy and safety profile of this SCS variant.
Topics: Humans; Chronic Pain; Spinal Cord Stimulation; Quality of Life; Pain Management; Analgesics; Spinal Cord; Treatment Outcome
PubMed: 37409553
DOI: 10.1111/papr.13264 -
Neuromodulation : Journal of the... Jan 2023Spinal cord stimulation (SCS) is a last-resort treatment for patients with chronic neuropathic pain. The mechanism underlying SCS and pain relief is not yet fully... (Review)
Review
OBJECTIVES
Spinal cord stimulation (SCS) is a last-resort treatment for patients with chronic neuropathic pain. The mechanism underlying SCS and pain relief is not yet fully understood. Because the inflammatory balance between pro- and anti-inflammatory molecules in the spinal nociceptive network is pivotal in the development and maintenance of neuropathic pain, the working mechanism of SCS is suggested to be related to the modulation of this balance. The aim of this systematic review is to summarize and understand the effects of different SCS paradigms on the central inflammatory balance in the spinal cord.
MATERIALS AND METHODS
A systematic literature search was conducted using MEDLINE, Embase, and PubMed. All articles studying the effects of SCS on inflammatory or glial markers in neuropathic pain models were included. A quality assessment was performed on predetermined entities of bias.
RESULTS
A total of 11 articles were eligible for this systematic review. In general, induction of neuropathic pain in rats results in a proinflammatory state and at the same time an increased activity/expression of microglial and astroglial cells in the spinal cord dorsal horn. Conventional SCS seems to further enhance this proinflammatory state and increase the messenger RNA expression of microglial markers, but it also results in a decrease in microglial protein marker levels. High-frequency and especially differential targeted multiplexed SCS can not only restore the balance between pro- and anti-inflammatory molecules but also minimize the overexpression/activation of glial cells. Quality assessment and risk of bias analysis of the studies included make it clear that the results of these preclinical studies must be interpreted with caution.
CONCLUSIONS
In summary, the preclinical findings tend to indicate that there is a distinct SCS paradigm-related effect in the modulation of the central inflammatory balance of the spinal dorsal horn.
Topics: Rats; Animals; Spinal Cord Stimulation; Neuralgia; Pain Management; Spinal Cord; Spinal Cord Dorsal Horn
PubMed: 35931643
DOI: 10.1016/j.neurom.2022.04.049 -
Journal of Neurology Feb 2023Preventive treatment for refractory chronic cluster headache (rCCH) is challenging and many therapies have been tried. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Preventive treatment for refractory chronic cluster headache (rCCH) is challenging and many therapies have been tried.
OBJECTIVE
To study what could be considered the therapy of choice in rCCH through a systematic review and meta-analysis.
METHODS
This review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The protocol was registered in PROSPERO (ID CRD42021290983). A systematic search was performed in MEDLINE, Embase, Cochrane, clinicaltrials.gov, and the WHO's-International-Clinical-Trials-Registry-Platform. Studies on the preventive treatment for rCCH as defined by the European Headache Federation consensus statement were included. A meta-analysis of the pooled response rate was conducted for the different therapies.
RESULTS
Of 336 results, 45 were eligible for inclusion. Most articles studied the effect of neuromodulation as a preventive treatment for rCCH. The most studied neuromodulation technique was occipital nerve stimulation (ONS), with a pooled response rate in the meta-analysis of 57.3% (95% CI 0.481-0.665). Deep brain stimulation (DBS) was the second most studied treatment with a pooled response rate of 77.0% (95% CI 0.594-0.957). DBS results were more heterogeneous than ONS, which could be related to the different stimulation targets in DBS studies, and reported more serious adverse events than in ONS studies. The remaining therapies (anti-CGRP pathway drugs, warfarin, ketamine-magnesium infusions, serial occipital nerve blocks, clomiphene, onabotulinum toxin A, ketogenic diet, sphenopalatine ganglion radiofrequency or stimulation, vagus nerve stimulation, percutaneous bioelectric current stimulation, upper cervical cord stimulation, and vidian neurectomy) present weaker results or have less quality of evidence.
CONCLUSIONS
The results of this systematic review and meta-analysis suggest that ONS could be the first therapeutic strategy for patients with rCCH based on the current evidence.
Topics: Humans; Cluster Headache; Electric Stimulation Therapy; Headache; Vagus Nerve Stimulation; Spinal Cord
PubMed: 36310189
DOI: 10.1007/s00415-022-11436-w -
Spinal Cord Jan 2017This is a systematic literature review. (Review)
Review
STUDY DESIGN
This is a systematic literature review.
OBJECTIVES
The objectives of this study were to investigate, first, the proportion of spinal cord injury (SCI) caused by suicidal behaviour; second, the proportion of deaths in the SCI population caused by suicide; and third, the risk factors associated with suicidal behaviour.
SETTING
This study was conducted in the UK.
METHODS
AMED, EMBASE, HMIC, BNI, Medline, PsycInfo, CINAHL and HEALTH BUSINESS ELITE were searched between January and February 2016, identifying a total of 404 articles published between 1990 and 2016. Full articles, written in English, looking at suicide before and after SCI were selected. On the basis of the inclusion criteria, 22 relevant articles were included in this literature review.
RESULTS
Studies reported that between 0 and 6.8% of individuals with SCI had acquired their injury as a result of attempted suicide. The predominant method used in these attempts was deliberate falling/jumping from buildings and bridges. Suicidal behaviour post SCI was frequently reported as a cause of death; studies reported that between 5.8 and 11% of deaths were a result of suicide. The predominant methods used were gunshot and overdose. Psychiatric diagnoses were identified to be a major risk factor for suicidal behaviour.
CONCLUSION
Individuals with SCI are at risk of attempting suicide; this risk is increased by the presence of a psychiatric diagnosis. There is a crucial need for risk assessment and psychological intervention for individuals with mental health issues following SCI.
Topics: Humans; Risk Factors; Spinal Cord Injuries; Suicide
PubMed: 27670807
DOI: 10.1038/sc.2016.135