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Neuromodulation : Journal of the... Aug 2023Spinal cord injury (SCI) treatment is still a challenge and new treatments that help these patients are being considered. Recent studies showed that the use of... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Spinal cord injury (SCI) treatment is still a challenge and new treatments that help these patients are being considered. Recent studies showed that the use of self-assembled peptide (SAP) can be useful in SCI treatment.
MATERIALS AND METHODS
In this meta-analysis, we investigated the effect of SAP administration on locomotion recovery after SCI. Records were obtained from a comprehensive search of data bases. Articles were scrutinized for inclusion and exclusion criteria. Data were analyzed and results were reported as standardized mean difference (SMD) with 95% CI. Subgroup analysis was also performed.
RESULTS
A total of 14 studies and 17 separate experiments were included in the final analysis. Treatment with SAP structures after SCI resulted in a significant improvement in animal motor function (SMD = 1.13; 95% CI: 0.68-1.58; p < 0.0001). SAP treatment facilitated axon sprouting (SMD = 0.76; 95% CI: 0.33-1.18; p < 0.0001) and reduction of glial scar (SMD = -1.02; 95% CI: -1.94 to -0.09; p = 0.03). The difference in SAP type, its concentration, follow-up time, and SCI model had no effect on SAP effectiveness. In addition, SAP administration had a similar effect on improving locomotion in all three immediate, acute, and subacute phases which gives the good news of using this treatment for patients who are in the chronic phase.
CONCLUSION
SAP treatment can be considered as a potential treatment to help the motor recovery of SCI and axon regeneration.
Topics: Animals; Axons; Nerve Regeneration; Spinal Cord Injuries; Peptides; Locomotion; Recovery of Function; Spinal Cord
PubMed: 35227580
DOI: 10.1016/j.neurom.2022.01.011 -
Neurosurgical Focus Oct 2022Neuropathic pain is undertreated in children. Neurosurgical treatments of pediatric chronic pain are limited by the absence of both US Food and Drug Administration... (Meta-Analysis)
Meta-Analysis
Spinal cord stimulation for treatment of chronic neuropathic pain in adolescent patients: a single-institution series, systematic review, and individual participant data meta-analysis.
OBJECTIVE
Neuropathic pain is undertreated in children. Neurosurgical treatments of pediatric chronic pain are limited by the absence of both US Food and Drug Administration approval and pediatric-specific hardware, as well as weak referral patterns due to a lack of physician education. This study presents a single-institution retrospective case series of spinal cord stimulation (SCS) in children ≤ 19 years of age and a systematic review of SCS in children. The authors' findings may further validate the role of SCS as an effective treatment modality for varied neuropathic pain syndromes found in pediatric patients.
METHODS
The study was a single-center, single-surgeon, retrospective case series of individuals treated between July 2017 and May 2022. The outcomes for pediatric patients with chronic neuropathic pain syndromes indicated by the multidisciplinary pain clinic for evaluation for SCS were cataloged. A systematic review and individual participant data (IPD) meta-analysis was performed for cases treated until May 2022, using PubMed, EMBASE, and Scopus to characterize outcomes of children with neuropathic pain treated with SCS.
RESULTS
Twelve patients were evaluated and 9 were indicated for percutaneous or buried lead trials. Seven female and 2 male patients between the ages of 13 and 19 years were implanted with trial leads. Eight of 9 (89%) patients went on to receive permanent systems. The average trial length was 6 days, and the length of stay for both trial and implant was less than 1 day. Complication rates due to CSF leaks were 22% and 0% for trial and implant, respectively. Visual analog scale pain scores decreased from 9.2 to 2.9 (p = 0.0002) and the number of medications decreased from 4.9 to 2.1 (p = 0.0005). Functional status also improved for each patient. A systematic review identified 13 studies describing pediatric patients with SCS, including 12 providing IPD on 30 patients. In the IPD meta-analysis, pain was reduced in 16/16 (100%) of patients following surgery and in 25/26 (96.2%) at last follow-up. Medication use was decreased in 16/21 (76.2%), and functional outcomes were improved in 29/29 (100%). The complication rate was 5/30 (16.7%).
CONCLUSIONS
SCS effectively decreases pain and medication use for pediatric neuropathic pain syndromes. Patients also report improved functional status, including improved matriculation, gainful employment, and physical activity. There is minimal high-quality literature describing neuromodulation for pain in children. Neuromodulation should be considered earlier as a viable alternative to escalating use of multiple drugs and as a potential mechanism to address tolerance, dependence, and addiction in pediatric patients.
Topics: Adolescent; Adult; Child; Chronic Pain; Female; Humans; Male; Neuralgia; Retrospective Studies; Spinal Cord; Spinal Cord Stimulation; Syndrome; Treatment Outcome; Young Adult
PubMed: 36183181
DOI: 10.3171/2022.7.FOCUS22330 -
Expert Review of Medical Devices Jul 2015In recent years, software development has been key to the next generation of neuromodulation devices. In this review, we will describe the new strategies for electrical... (Review)
Review
In recent years, software development has been key to the next generation of neuromodulation devices. In this review, we will describe the new strategies for electrical waveform delivery for spinal cord stimulation. A systematic literature review was performed using bibliographic databases, limited to the English language and human data, between 2010 and 2014. The literature search yielded three articles on burst stimulation and four articles on high-frequency stimulation. High-frequency and burst stimulation may offer advantages over tonic stimulation, as data suggest improved patient tolerance, comparable increase in function and possible success with a subset of patients refractory to tonic spinal cord stimulation. High-frequency and burst stimulation are new ways to deliver energy to the spinal cord that may offer advantages over tonic stimulation. These may offer new salvage strategies to mitigate spinal cord stimulation failure and improve cost-effectiveness by reducing explant rate.
Topics: Humans; Spinal Cord; Spinal Cord Stimulation
PubMed: 25846152
DOI: 10.1586/17434440.2015.1026805 -
Brain Research Sep 2015We performed here a systematic review of the studies using transcranial magnetic stimulation (TMS) as a research and clinical tool in patients with spinal cord injury... (Review)
Review
We performed here a systematic review of the studies using transcranial magnetic stimulation (TMS) as a research and clinical tool in patients with spinal cord injury (SCI). Motor evoked potentials (MEPs) elicited by TMS represent a highly accurate diagnostic test that can supplement clinical examination and neuroimaging findings in the assessment of SCI functional level. MEPs allows to monitor the changes in motor function and evaluate the effects of the different therapeutic approaches. Moreover, TMS represents a useful non-invasive approach for studying cortical physiology, and may be helpful in elucidating the pathophysiological mechanisms of brain reorganization after SCI. Measures of motor cortex reactivity, e.g., the short interval intracortical inhibition and the cortical silent period, seem to point to an increased cortical excitability. However, the results of TMS studies are sometimes contradictory or divergent, and should be replicated in a larger sample of subjects. Understanding the functional changes at brain level and defining their effects on clinical outcome is of crucial importance for development of evidence-based rehabilitation therapy. TMS techniques may help in identifying neurophysiological biomarkers that can reliably assess the extent of neural damage, elucidate the mechanisms of neural repair, predict clinical outcome, and identify therapeutic targets. Some researchers have begun to therapeutically use repetitive TMS (rTMS) in patients with SCI. Initial studies revealed that rTMS can induce acute and short duration beneficial effects especially on spasticity and neuropathic pain, but the evidence is to date still very preliminary and well-designed clinical trials are warranted. This article is part of a Special Issue entitled SI: Spinal cord injury.
Topics: Animals; Evoked Potentials, Motor; Humans; Motor Activity; Motor Cortex; Muscle Spasticity; Muscle, Skeletal; Neuralgia; Psychomotor Disorders; Pyramidal Tracts; Recovery of Function; Spinal Cord Injuries; Transcranial Magnetic Stimulation
PubMed: 25251591
DOI: 10.1016/j.brainres.2014.09.036 -
Amyotrophic Lateral Sclerosis :... Sep 2012Despite considerable involvement of the spinal cord in amyotrophic lateral sclerosis (ALS), current biomarker research is primarily centred on brain imaging and CSF... (Review)
Review
Despite considerable involvement of the spinal cord in amyotrophic lateral sclerosis (ALS), current biomarker research is primarily centred on brain imaging and CSF proteomics. In clinical practice, spinal cord imaging in ALS is performed primarily to rule out alternative conditions in the diagnostic phase of the disease. Quantitative spinal cord imaging has traditionally been regarded as challenging, as it requires high spatial resolution while minimizing partial volume effects, physiological motion and susceptibility distortions. In recent years however, as acquisition and post-processing methods have been perfected, a number of exciting and promising quantitative spinal imaging and electrophysiology techniques have been developed. We performed a systematic review of the trends, methodologies, limitations and conclusions of recent spinal cord studies in ALS to explore the diagnostic and prognostic potential of spinal markers. Novel corrective techniques for quantitative spinal cord imaging are systematically reviewed. Recent findings demonstrate that imaging techniques previously used in brain imaging, such as diffusion tensor, functional and metabolic imaging can now be successfully applied to the human spinal cord. Optimized electrophysiological approaches make the non-invasive assessment of corticospinal pathways possible, and multimodal spinal techniques are likely to increase the specificity and sensitivity of proposed spinal markers. In conclusion, spinal cord imaging is an emerging area of ALS biomarker research. Novel quantitative spinal modalities have already been successfully used in ALS animal models and have the potential for development into sensitive ALS biomarkers in humans.
Topics: Amyotrophic Lateral Sclerosis; Animals; Biomarkers; Diagnostic Imaging; Disease Models, Animal; Humans; Spinal Cord; Transcranial Magnetic Stimulation
PubMed: 22329869
DOI: 10.3109/17482968.2011.649760 -
Atherosclerosis Feb 2014Lipid optimization comprises a therapeutic cornerstone of primary and secondary cardiovascular disease prevention. This systematic review and meta-analysis sought to... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Lipid optimization comprises a therapeutic cornerstone of primary and secondary cardiovascular disease prevention. This systematic review and meta-analysis sought to clarify patterns of lipid profiles in spinal cord injury (SCI) patients compared to able-bodied individuals as well as among subgroups of SCI patients stratified by sex, activity level, race, and level of injury.
METHODS
Searches were conducted in PubMed, CINAHL, PsycINFO, and EMBASE. The initial literature search broadly identified peer-reviewed studies that examined cardiovascular risk factors in SCI. A total of 50 studies were ultimately identified that focused on lipid levels in SCI. Demographic data (including subject age, duration of injury, height, weight, and body mass index [BMI]) and lipid values were extracted for able-bodied individuals and subjects with SCI. Statistical analyses included t-testing and analysis of variance (ANOVA).
RESULTS
Compared with controls, individuals with SCI had significantly lower total cholesterol (TC) (183.4 mg/dL versus 194.9 mg/dL, p = 0.019) and high-density lipoprotein cholesterol (HDL-C) (41.0 mg/dL versus 49.6 mg/dL, p < 0.001) and higher TC/HDL-C ratios (4.5 versus 4.0, p = 0.002), though no significant differences were found for triglyceride (TG) and non-HDL-C values.
CONCLUSIONS
SCI represents an increasingly common chronic condition, now secondarily characterized by heightened CVD risk potentially in part due to unique lipid profiles characterized primarily by low HDL-C and an increased TC/HDL-C ratio. As other at-risk patient populations have received increased acknowledgment with more stringent lipid panel screening at earlier ages and increased frequency, we would propose that the same be implemented for the SCI population until more-specific CVD risk stratification guidelines are established for this population.
Topics: Adolescent; Adult; Analysis of Variance; Body Mass Index; Cardiovascular Diseases; Cholesterol; Cholesterol, LDL; Comorbidity; Female; Humans; Lipids; Male; Middle Aged; Risk Factors; Spinal Cord; Spinal Cord Injuries; Young Adult
PubMed: 24468143
DOI: 10.1016/j.atherosclerosis.2013.11.028 -
European Journal of Physical and... Feb 2018Spasticity is associated with various diseases of the nervous system. Current treatments such as drug therapy, botulinum toxin injections, kinesitherapy, and... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Spasticity is associated with various diseases of the nervous system. Current treatments such as drug therapy, botulinum toxin injections, kinesitherapy, and physiotherapy are not sufficiently effective in a large number of patients. Transcranial magnetic stimulation (TMS) can be considered as an alternative method of treatment. The purpose of this article was to conduct a systematic review and meta-analysis of all available publications assessing the efficacy of repetitive TMS in treatment of spasticity.
EVIDENCE ACQUISITION
Search for articles was conducted in databases PubMed, Willey, and Google. Keywords included "TMS", "spasticity", "TMS and spasticity", "non-invasive brain stimulation", and "non-invasive spinal cord stimulation". The difference in scores according to the Modified Ashworth Scale (MAS) for one joint before and after treatment was taken as the effect size.
EVIDENCE SYNTHESIS
We found 26 articles that examined the TMS efficacy in treatment of spasticity. Meta-analysis included 6 trials comprising 149 patients who underwent real stimulation or simulation. No statistically significant difference in the effect of real and simulated stimulation was found in stroke patients. In patients with spinal cord injury and spasticity, the mean effect size value and the 95% confidence interval were -0.80 and (-1.12, -0.49), respectively, in a group of real stimulation; in the case of simulated stimulation, these parameters were 0.15 and (-0.30, -0.00), respectively. Statistically significant differences between groups of real stimulation and simulation were demonstrated for using high-frequency repetitive TMS or iTBS mode for the M1 area of the spastic leg (P=0.0002).
CONCLUSIONS
According to the meta-analysis, the statistically significant effect of TMS in the form of reduced spasticity was demonstrated only for the developed due to lesions at the brain stem and spinal cord level. To clarify the amount of the antispasmodic effect of repetitive TMS at other lesion levels, in particular in patients with hemispheric stroke, further research is required.
Topics: Humans; Muscle Spasticity; Spinal Cord; Transcranial Magnetic Stimulation
PubMed: 28004906
DOI: 10.23736/S1973-9087.16.04433-6 -
World Neurosurgery Sep 2017The prognosis in cervical spinal cord injury is poor, and surgical and neurointensive care management need further improvement. Monitoring of the intraspinal pressure... (Review)
Review
OBJECTIVE
The prognosis in cervical spinal cord injury is poor, and surgical and neurointensive care management need further improvement. Monitoring of the intraspinal pressure (ISP) at an early stage after traumatic spinal cord injury (tSCI) is useful clinically.
MATERIALS AND METHODS
Obtaining continuous spinal cord perfusion pressure (SCPP) measurements based on the difference between mean arterial pressure and ISP allows offering best medical and surgical treatment during this critical phase of tSCI. A search was carried out with PubMed, Embase, and Google Scholar up to January 10, 2017. Articles resulting from these searches and relevant references cited in those articles were reviewed.
RESULTS
The optimal SCPP was found to be between 90 and 100 mm Hg and mean arterial pressure of 110-130. Laminectomy alone was found to be ineffective in the reduction of ISP because it does not lower the pressure exerted by dura on the swollen spinal cord. Therefore, bony decompression with durotomy or duroplasty seems to be the procedure of choice to reduce the ISP less than 20 mm Hg.
CONCLUSIONS
A randomized controlled trial is required to determine whether laminectomy with durotomy and monitoring of ISP with SCPP optimization improve neurological recovery after tSCI.
Topics: Cerebrospinal Fluid Pressure; Decompression, Surgical; Humans; Laminectomy; Spinal Cord; Spinal Cord Injuries; Thoracic Vertebrae
PubMed: 28578120
DOI: 10.1016/j.wneu.2017.05.138 -
Journal of Biophotonics Aug 2022This systematic review investigated the repercussions of photobiomodulation using low-level laser therapy (LLLT) for the treatment of spinal cord injury (SCI) in... (Review)
Review
This systematic review investigated the repercussions of photobiomodulation using low-level laser therapy (LLLT) for the treatment of spinal cord injury (SCI) in experimental models. Studies were identified from relevant databases published between January 2009 and December 2021. Nineteen original articles were selected and 68.4% used light at an infrared wavelength. There was a considerable variation of the power used (from 25 to 200 mW), total application time (8-3000 s) and total energy (0.3-450 J). In 79% of the studies, irradiation was initiated immediately after or within 2 h of the SCI, and treatment time ranged continuously from 5 to 21 days. In conclusion, LLLT can be an auxiliary therapy in the treatment of SCI, playing a neuroprotective role, enabling functional recovery, increasing the concentration of nerve connections around the injury site and reducing pro-inflammatory cytokines. However, there is a need for standardization in the dosimetric parameters.
Topics: Attention; Humans; Low-Level Light Therapy; Radiometry; Recovery of Function; Spinal Cord; Spinal Cord Injuries
PubMed: 35484784
DOI: 10.1002/jbio.202200059 -
The Spine Journal : Official Journal of... Jul 2024Spinal cord compression is a source of pathology routinely seen in clinical practice. However, there remain unanswered questions surrounding both the understanding of... (Review)
Review
BACKGROUND CONTENT
Spinal cord compression is a source of pathology routinely seen in clinical practice. However, there remain unanswered questions surrounding both the understanding of pathogenesis and the best method of treatment. This arises from limited real-life testing of the mechanical properties of the spinal cord, either through cadaveric human specimens or animal testing, both of which suffer from methodological, as well as ethical, issues.
PURPOSE
To conduct a review of the literature on the mechanical properties of the spinal cord.
STUDY DESIGN/SETTING
A systematic review of the literature on the mechanical properties of the spinal cord is undertaken.
PATIENT SAMPLE
All literature reporting the testing of the mechanical properties of the spinal cord.
OUTCOME MEASURES
Reported physiological mechanical properties of the spinal cord.
METHODS
The methodological quality of the studies has been assessed within the ARRIVE guidelines using the CAMARADES framework and SYRCLE's risk of bias tool. This paper details the methodologies and results of the reported testing.
RESULTS
We show that (1) the research quality of previous work does not follow published guidelines on animal treatment or risk of bias, (2) no standard protocol has been employed for sample preparation or mechanical testing, (3) this leads to a wide distribution of results for the tested mechanical properties, not applicable to the living human or animal, and (4) animal testing is not a good proxy for human application.
CONCLUSIONS
The findings summarize the sum of current knowledge inherent to the mechanical properties of the spinal cord and may contribute to the development of a physical model which is applicable to the living human for analysis and testing in a controlled and repeatable fashion. Such a model would be the basis for further clinical research to improve outcomes from spinal cord compression.
Topics: Humans; Spinal Cord; Spinal Cord Compression; Animals; Biomechanical Phenomena
PubMed: 38432298
DOI: 10.1016/j.spinee.2024.02.022