Effect of transcranial direct current stimulation on supernumerary phantom limb pain in spinal cord injured patient:A case report

BACKGROUND Supernumerary phantom limb(SPL)sensation is the experience of additional limbs,either single or a pair of limbs.Unique to traumatic spinal cord injuries,we report effect of transcranial direct current stimulation(tDCS)on SPL pain in a patient with cervical cord injury.CASE SUMMARY The subject was a 57-year-old man who was diagnosed with complete spinal cord injury(C6/C5,motor level;C5/C5,sensory level;AIS-A)approximately three months ago.After a period of 2 wk,we administered anodal tDCS over the motor cortex for 15 minutes at an intensity of 1.5 mA.Following that treatment,the patient experienced a decrease of SPL pain intensity and frequency,which lasted for 1 week after the end of treatment.CONCLUSION Targeting the motor cortex through neuromodulation appears to be a promising option for the management of SPL pain.

Research progress of traditional Chinese medicine in the treatment of complications related to spinal cord injury

Spinal cord injury is one of the common neurological diseases in clinical practice.It has the characteristics of high incidence rate,high disability rate and high cost.It brings great pain and mental stress to patients.Spinal cord injury patients with neurological impairment,slow recovery,in the process of disease treatment is easy to produce a series of complications,such as respiratory complications,neurogenic bladder,spasm,deep vein thrombosis,pressure sores and so on.At present,western medicine and auxiliary equipment are mainly used in the treatment of related complications,but traditional Chinese medicine also plays a very important role.Traditional Chinese medicine is not only economical,cheap and has little side effects,but also can promote the functional rehabilitation of patients with spinal cord injury and reduce the incidence of complications.In this paper,through searching the literature reports on the treatment of spinal cord injury related complications with traditional Chinese medicine at home and abroad,we review the treatment of neurogenic bladder,spasm,venous embolism,neuropathic pain,neurogenic intestinal dysfunction,pressure sores,respiratory complications with traditional Chinese medicine,in order to provide reference for the clinical treatment of spinal cord injury related complications.

Effects of combined rTMS and visual feedback on the rehabilitation of supernumerary phantom limbs in a patient with spinal cord injury:A case report

BACKGROUND Supernumerary phantom limb(SPL)caused by spinal cord injury(SCI)has previously been reported in several studies.However,the mechanisms and management of SPL in SCI patients are still not fully understood.Herein,we report a rare case of SPL in a patient with incomplete SCI.CASE SUMMARY A 46-year-old man complained of four hands 7 d after SCI.He was diagnosed with SPL complicated with actual limb neuropathic pain.Following a period of treatment with neurotrophic agents and Chinese traditional and analgesic medications,SPL symptoms and actual limb pain did not improve.However,his symptoms gradually lessened after combined treatment with high-frequency repetitive transcranial magnetic stimulation(rTMS),a promising neuromodulation technique,over the M1 cortex and visual feedback.After 7 wk of this treatment,SPL disappeared completely and actual limb pain was significantly relieved.CONCLUSION Cerebral plasticity changes may be a mechanism underlying the occurrence of non-painful SPL in SCI patients,and high-frequency rTMS applied to the M1 cortex could be a promising treatment method for SPL.

Effects of cortical intermittent theta burst stimulation combined with precise root stimulation on motor function after spinal cord injury: a case series study

Activation and reconstruction of the spinal cord circuitry is important for improving motor function following spinal cord injury.We conducted a case series study to investigate motor function improvement in 14 patients with chronic spinal cord injury treated with 4 weeks of unilateral(right only)cortical intermittent theta burst stimulation combined with bilateral magnetic stimulation of L3-L4 nerve roots,five times a week.Bilateral resting motor evoked potential amplitude was increased,central motor conduction time on the side receiving cortical stimulation was significantly decreased,and lower extremity motor score,Berg balance score,spinal cord independence measure-III score,and 10 m-walking speed were all increased after treatment.Right resting motor evoked potential amplitude was positively correlated with lower extremity motor score after 4 weeks of treatment.These findings suggest that cortical intermittent theta burst stimulation combined with precise root stimulation can improve nerve conduction of the corticospinal tract and lower limb motor function recovery in patients with chronic spinal cord injury.

Tanshinone ⅡA improves functional recovery in spinal cord injury-induced lower urinary tract dysfunction

Tanshinone ⅡA, extracted from Salvia miltiorrhiza Bunge, exerts neuroprotective effects through its anti-inflammatory, anti-oxidative and anti-apoptotic properties. This study intravenously injected tanshinone ⅡA 20 mg/kg into rat models of spinal cord injury for 7 consecutive days. Results showed that tanshinone ⅡA could reduce the inflammation, edema as well as compensatory thickening of the bladder tissue, improve urodynamic parameters, attenuate secondary injury, and promote spinal cord regeneration. The number of hypertrophic and apoptotic dorsal root ganglion（L6–S1） cells was less after treatment with tanshinone ⅡA. The effects of tanshinone ⅡA were similar to intravenous injection of 30 mg/kg methylprednisolone. These findings suggested that tanshinone ⅡA improved functional recovery after spinal cord injury-induced lower urinary tract dysfunction by remodeling the spinal pathway involved in lower urinary tract control.

Neurorehabilitation using a voluntary driven exoskeletal robot improves trunk function in patients with chronic spinal cord injury: a single-arm study

Body weight-supported treadmill training with the voluntary driven exoskeleton(VDE-BWSTT) has been shown to improve the gait function of patients with chronic spinal cord injury. However, little is known whether VDE-BWSTT can effectively improve the trunk function of patients with chronic spinal cord injury. In this open-label, single-arm study, nine patients with chronic spinal cord injury at the cervical or thoracic level(six males and three females, aged 37.8 ± 15.6 years, and time since injury 51.1 ± 31.8 months) who underwent outpatient VDE-BWSTT training program at Keio University Hospital, Japan from September 2017 to March 2019 were included. All patients underwent twenty 60-minute gait training sessions using VDE. Trunk muscular strength, i.e., the maximum force against which patient could maintain a sitting posture without any support, was evaluated in four directions: anterior, posterior, and lateral(right and left) after 10 and 20 training sessions. After intervention, lateral muscular strength significantly improved. In addition, a significant positive correlation was detected between the change in lateral trunk muscular strength after 20 training sessions relative to baseline and gait speed. The change in trunk muscular strength after 20 training sessions relative to baseline was greatly correlated with patient age. This suggests that older adult patients with chronic spinal cord injury achieved a greater improvement in trunk muscle strength following VDE-BWSTT. All these findings suggest that VDE-BWSTT can improve the trunk function of patients with chronic spinal cord injury and the effect might be greater in older adult patients. The study was approved by the Keio University of Medicine Ethics Committee(IRB No. 20150355-3) on September 26, 2017.

Chronic complications of spinal cord injury

Spinal cord injury(SCI) is a serious medical condition that causes functional, psychological and socioeconomic disorder. Therefore, patients with SCI experience significant impairments in various aspects of their life. The goals of rehabilitation and other treatment approaches in SCI are to improve functional level, decrease secondary morbidity and enhance health-relatedquality of life. Acute and long-term secondary medical complications are common in patients with SCI. However, chronic complications especially further negatively impact on patients' functional independence and quality of life. Therefore, prevention, early diagnosis and treatment of chronic secondary complications in patients with SCI is critical for limiting these complications, improving survival, community participation and health-related quality of life. The management of secondary chronic complications of SCI is also important for SCI specialists, families and caregivers as well as patients. In this paper, we review data about common secondary longterm complications after SCI, including respiratory complications, cardiovascular complications, urinary and bowel complications, spasticity, pain syndromes, pressure ulcers, osteoporosis and bone fractures. The purpose of this review is to provide an overview of risk factors, signs, symptoms, prevention and treatment approaches for secondary long-term complications in patients with SCI.

Survey of spinal cord injury-induced neurogenic bladder studies using the Web of Science

OBJECTIVE：To identify global trends in research on spinal cord injury-induced neurogenic bladder, through a bibliometric analysis using the Web of Science. DATA RETRIEVAL：We performed a bibliometric analysis of studies on spinal cord injury-induced neurogenic bladder using the Web of Science.Data retrieval was performed using key words＂spinal cord injury＂,＂spinal injury＂,＂neurogenic bladder＂,＂neuropathic bladder＂,＂neurogenic lower urinary tract dysfunction＂,＂neurogenic voiding dysfunction＂,＂neurogenic urination disorder＂and ＂neurogenic vesicourethral dysfunction＂. SELECTION CRITERIA：Inclusion criteria：（a）published peer-reviewed articles on spinal cord injury-induced neurogenic bladder indexed in the Web of Science;（b）type of articles：original research articles and reviews;（c）year of publication：no limitation.Exclusion criteria：（a）articles that required manual searching or telephone access;（b）Corrected papers and book chapters. MAIN OUTCOME MEASURES：（1）Annual publication output;（2）distribution according to journals; （3）distribution according to subject areas;（4）distribution according to country;（5）distribution according to institution;and（6）top cited publications. RESULTS：There were 646 research articles addressing spinal cord injury-induced neurogenic bladder in the Web of Science.Research on spinal cord injury-induced neurogenic bladder was found in the Science Citation Index-Expanded as of 1946.The United States,Ireland and Switzerland were the three major countries contributing to studies in spinal cord injury-induced neurogenic bladder in the 1970s.However,in the 1990s,the United States,the United Kingdom,the Netherlands,Germany and Japan published more papers on spinal cord injury-induced neurogenic bladder than Switzerland,and Ireland fell off the top ten countries list.In this century,the United States ranks first in spinal cord injury-induced neurogenic bladder studies,followed by France,the United Kingdom,Germany,Switzerland and Japan.Subject categories including urology, nephrology and clinical neurology,as well as rehabilitation,are represented in spinal cord injury-induced neurogenic bladder studies. CONCLUSION：From our analysis of the literature and research trends,we conclude that spinal cord injury-induced neurogenic bladder is a hot topic that will continue to generate considerable research interest in the future.

Strategies to avoid a missed diagnosis of co-occurring concussion in post-acute patients having a spinal cord injury

Research scientists and clinicians should be aware that missed diagnoses of mild-moderate traumatic brain injuries in post-acute patients having spinal cord injuries may approach 60-74% with certain risk factors, potentially causing clinical consequences for patients, and confounding the results of clinical research studies. Factors leading to a missed diagnosis may include acute trauma-related life-threatening issues, sedation/intubation, subtle neuropathology on neuroimaging, failure to collect Glasgow Coma Scale scores or duration of posttraumatic amnesia, or lack of validity of this information, and overlap in neuro-cognitive symptoms with emotional responses to spinal cord injuries. Strategies for avoiding a missed diagnosis of mild-moderate traumatic brain injuries in patients having a spinal cord injuries are highlighted in this perspective.

Does repair of spinal cord injury follow the evolutionary theory?

Lower vertebrates, such as fish and amphibians, and higher vertebrates in embryonic development can acquire complete regeneration of complex body structures, including the spinal cord, an important part of the central nervous system. However, with species evolution and development, this regenerative capacity gradually weakens and even disappears, but the cellular and molecular mechanisms remain poorly understood. We explored the differences in mechanisms of spinal cord regeneration capability between lower and higher vertebrates, investigated differences in their cellular and molecular mechanisms and between the spinal cord structures of lower vertebrates and mammals, such as rat and monkey, to search for theoretical evidence and therapeutic targets for nerve regeneration in human spinal cord.

Advance in Nutritional Status and Intervention after Spinal Cord Injury

Spinal cord injury(SCI)is a common disease in spinal surgery.SCI affects the metabolism of patients and changes their lifestyle.Nutritional problems may occur,which may be manifested as insufficient or overnutrition.Nutrition status is related to many complications and final outcome after SCI.In this paper,the nutritional status of patients with SCI and the progress of nutritional intervention were reviewed by comprehensive domestic and foreign literature.Medical staff should routinely screen and evaluate the nutrition of patients after SCI operation,and provide comprehensive nutritional intervention such as diet,exercise and dietary supplement.

Thoracic Unilateral Spinal Cord Syndrome Following Neuraxial Anaesthesia for Periprosthetic Knee Fracture: A Case Report

Neuraxial anaesthesia is widely used in surgical procedures;overall, epidural and intrathecal techniques. Nevertheless, several outcomes should be considered. The incidence of neurologic complications after neuraxial anaesthesia is not perfectly clear (0% - 0.08%), although there are several described cases of spinal cord ischemia. We present a case of thoracic unilateral spinal cord syndrome following lumbar spinal anaesthesia for periprosthetic knee fracture. Our patient suffered monoparesis in her left lower limb as well as decreasing of muscle strength and loss of tendon reflexes. The MNR showed left hyperintense intra-cord images from T7 to T12 attributed to spinal cord oedema and a lineal hypointensity related to minimal haematic component. What made this case surprising was the fact that spinal anaesthesia was performed between L3 and L4 and the patient did not suffer paraesthesia associated with local anaesthetic injection. She was treated with glucocorticoids, gabapentin and amitriptyline. She also was checked by physical rehabilitators, neurologists and Pain Unit physicians. We have found another case reported in the literature about thoracic cord injury after lumbar spinal puncture. In this paper, we report possible aetiologies according to a review and neurological evolution of the patient seven months later.

Initial Experience with Mirabegron for the Treatment of Neurogenic Lower Urinary Tract Dysfunction

Background: Though anticholinergic drugs are considered the standard treatment for neurogenic detrusor overactivity, it is far from an ideal tool, because of their adverse effects such as Constipation or not respond sufficiently for a substantial proportion of patients. Recently mirabegron has become a commonly used overactive bladder medication in the general population, but few studies about mirabegron for the treatment of neurogenic detrusor overactivity. Objective: To evaluate the efficacy and safety of mirabegron for the treatment of neurogenic lower urinary tract dysfunction. Study Design: Prospective study. Methods: This prospective study included 13 adult patients with neurogenic lower urinary tract dysfunction as a result of spinal cord injury. All patients receiving mirabegron treatment (50 mg once daily) at least 6 weeks. The effective outcomes included the mean urine volume per catheterization, urinary incontinence episodes and Incontinence Specific Quality of Life Instrument. We monitored the blood pressure and heart rate to assess the cardiovascular safety, other adverse events were also recorded. Results: A total of 13 patients were included. After 6 weeks of treatment, all patients experienced a significant increase in the mean volume of per catheterization from 238.46 ± 65.43 ml to 327.69 ± 59.04 ml (p = 0.001). There is a significant reduction in the volume of urine leakage (463.85 ± 247.98 ml VS 180.00 ± 190.96 ml, p = 0.003) and incontinence episodes per 24 h (4.46 ± 2.03 VS 1.92 ± 1.50, p = 0.001). Significant improvement in mean Incontinence Specific Quality of Life Instrument was also found (p = 0.001). No patients reported dry mouth during the study, and the cardiovascular safety were acceptable. Conclusion: Mirabegron is safe and effective in the treatment of neurogenic lower urinary tract dysfunction. It might be a good choice for reducing the cessation of clean intermittent catheterization.

电针联合功能性电刺激在促进不完全性脊髓损伤患者下肢运动功能中的应用

目的:观察电针联合功能性电刺激在不完全性脊髓损伤中的应用效果。方法:将90例不完全性脊髓损伤患者随机分为对照组(n=45)与观察组(n=45),对照组采用功能性电刺激治疗,观察组联合电针治疗。观察2组肌力、下肢运动评分、下肢感觉评分、脊髓损伤步行指数Ⅱ(WISCIⅡ)、改良Ashworth量表(MAS)等级、步态参数、临床疗效及治疗安全性。结果:观察组总有效率高于对照组(P<0.05);治疗后,观察组肌力、下肢运动评分、下肢感觉评分、WISCIⅡ、MAS等级、步态参数均优于对照组(均P<0.05)。2组均未发生严重不良事件。结论:电针联合功能性电刺激治疗不完全性脊髓损伤疗效显著,能够促进下肢运动功能恢复。

急性颈脊髓损伤围手术期临床护理常见问题专家共识

为规范急性颈脊髓损伤患者救治过程中的护理操作,指导临床实践,促进临床对急性颈脊髓损伤患者的规范化护理。通过查阅国内外文献,拟定临床急性颈脊髓损伤救治过程中的护理常见问题专家共识初稿,结合专家意见修改相应条目,评定证据等级和推荐等级,形成共识终稿。本共识总结了急性颈脊髓损伤患者的院前急救、病史采集与评估、病情监测与观察、用药指导,颈部固定、呼吸道护理、消化道护理、泌尿系护理、皮肤护理、疼痛护理、体位护理、心理护理、功能锻炼等方面的最新证据,内容覆盖救治过程中的各个关键环节。共识条目简单明了,易于执行,能够为临床护理实践提供指引,有助于解决临床问题,但仍需要进一步的理论和实证研究验证。

呋喃妥因对脊髓损伤伴耐甲氧西林金黄色葡萄球菌复杂性尿路感染的临床疗效分析

目的分析呋喃妥因对脊髓损伤伴耐甲氧西林金黄色葡萄球菌(MRSA)复杂性尿路感染的临床疗效。方法选择广东省工伤康复医院2022年1月~12月收治的脊髓损伤伴有MRSA复杂性尿路感染患者33例为研究对象。采用自身对照试验,分别于呋喃妥因治疗前、治疗7 d和治疗14 d进行血清炎症指标、尿常规指标检测,并观察药物不良反应和评估疗效。结果治疗7 d或14 d后,血清炎症指标白细胞(WBC)、中性粒细胞百分比(NEUT%)、C反应蛋白(CRP)和降钙素原(PCT)均比治疗前降低,差异有统计学意义(P<0.05);尿常规指标中的亚硝酸盐(U-NIT)、白细胞脂酶(LE)和尿细菌培养数的阳性率均比治疗前降低,差异有统计学意义(P<0.001);治疗7 d和14 d的不良反应发生率比较,差异无统计学意义(P>0.05);治疗14 d的总有效率达92.3%,高于治疗7 d的总有效率(85.0%),但差异无统计学意义(P>0.05),治疗后总有效例数29例(87.9%)。结论呋喃妥因可减轻脊髓损伤伴MRSA复杂性尿路感染患者的炎症反应,有效抑制MRSA,可治疗复杂性尿路感染。

改良气道护理在颈脊髓损伤预防呼吸道并发症中的应用

目的:探讨改良气道护理在颈脊髓损伤患者中预防呼吸道并发症的疗效。方法:选取2019年1月至2022年1月脊柱外科救治的30例颈脊髓损伤患者,按入院时间分为2组,对照组14例,试验组16例。对照组采用常规护理方法,试验组采用改良气道护理方法,比较2组患者肺活量(Vital capacity,VC)和呼吸道并发症发生情况。结果:治疗前2组VC差异无统计学意义(P>0.05),治疗后试验组VC[(61.13±3.81)%]较对照组[(51.73±2.47)%]大,差异有统计学意义(P<0.05)。试验组出现1例腹部感染、1例肺不张,对照组出现3例肺部感染、4例肺不张,2组并发症发生率比较差异有统计学意义(P<0.05)。结论:改良气道护理在颈脊髓损伤患者预防呼吸道并发症改善呼吸功能方面有较好的疗效。

Treatment with NADPH oxidase inhibitor apocynin alleviates diabetic neuropathic pain in rats

Increased reactive oxygen species by the activation of NADPH oxidase（NOX） contributes to the development of diabetic complications.Apocynin,a NOX inhibitor,increases sciatic nerve conductance and blood flow in diabetic rats.We investigated potential protective effect of apocynin in rat diabetic neuropathy and its precise mechanism of action at molecular level.Rat models of streptozotocin-induced diabetes were treated with apocynin（30 and 100 mg/kg per day,intragastrically） for 4 weeks.Mechanical hyperalgesia and allodynia were determined weekly using analgesimeter and dynamic plantar aesthesiometer.Western blot analysis and histochemistry/immunohistochemistry were performed in the lumbar spinal cord and sciatic nerve respectively.Streptozotocin injection reduced pain threshold in analgesimeter,but not in aesthesiometer.Apocynin treatment increased pain threshold dose-dependently.Western blot analysis showed an increase in catalase and NOX-p47 phox protein expression in the spinal cord.However,protein expressions of neuronal and inducible nitric oxide synthase（n NOS,i NOS）,superoxide dismutase,glutathion peroxidase,nitrotyrosine,tumor necrosis factor-α,interleukin-6,interleukin-1β,aldose reductase,cyclooxygenase-2 or MAC-1（marker for increased microgliosis） in the spinal cord remained unchanged.Western blot analysis results also demonstrated that apocynin decreased NOX-p47 phox expression at both doses and catalase expression at 100 mg/kg per day.Histochemistry of diabetic sciatic nerve revealed marked degeneration.n NOS and i NOS immunoreactivities were increased,while S-100 immunoreactivity（Schwann cell marker） was decreased in sciatic nerve.Apocynin treatment reversed these changes dose-dependently.In conclusion,decreased pain threshold of diabetic rats was accompanied by increased NOX and catalase expression in the spinal cord and increased degeneration in the sciatic nerve characterized by increased NOS expression and Schwann cell loss.Apocynin treatment attenuates neuropathic pain by decelerating the increased oxidative stress-mediated pathogenesis in diabetic rats.

Paraplegia after transcatheter artery chemoembolization in a child with clear cell sarcoma of the kidney:A case report

BACKGROUND Transcatheter arterial chemoembolization(TACE)is a common treatment for inoperable malignant renal tumors.However,a series of complications may follow the TACE treatment.Spinal cord injury caused by the embolization of intercostal or lumbar arteries is extremely rare.CASE SUMMARY We describe a case with quite uncommon spinal cord injury after TACE in a 3-year-old child with clear cell sarcoma of the kidney.Sensory impairment beneath the T10 dermatomes and paraplegia on the day after TACE were found in this patient.Unfortunately,sustained paraplegia still existed for more than 2 mo after TACE despite the large dose of steroids and supportive therapy.CONCLUSION We should draw attention to an uncommon complication of paraplegia after TACE treatment in malignant renal tumors.Although it is rare,the result is disastrous.

Influence of the intelligent standing mobile robot on lower extremity physiology of complete spinal cord injury patients

Background:Spinal cord injury(SCI)remains a high rate of disability.In order to improve the quality of their lives,the application of robots in rehabilitation is increasing.However,few studies have assessed the applicability and the effect of robots in patients with complete injury.Objective:The current study aims to assess the efficacy of robots training on the lower extremity physiology in complete SCI patients.Methods:24 patients were recruited and randomly divided into experimental and control group.The two groups spent the same amount of time on regular training.Besides,a 1-h standing training twice daily was offered to both groups five days per week,for four weeks.The experimental group used robot for standing training,while the control group used standing frame.Before and after the experiment,muscle girth and bone mineral density(BMD)were measured as lower extremity physiology.Results:The experimental group showed increased muscle girth differences(left=0.08±0.40 cm,right=0.75±0.72 cm),while the control group showed decreased girth differences(left=-0.78±0.54 cm,right=-0.56±0.54 cm).The increases in the experimental group showed significant differences compared with the control group(left,P=0.0002;right,P=0.023).Both groups showed decreased BMD.The decreases in the experimental group were significantly smaller than those in the control group.Conclusions:Training with aid of robots combined with the regular rehabilitation treatment can benefit complete SCI patients,in aspect of postponing amyotrophy of lower extremities and reducing bone loss and osteoporosis.