Double-Blinded, Placebo-Controlled Trial Of Midodrine For Exercise Performance Enhancement In Tetraplegia:A Pilot Study

Nieshoff, Edward; Birk, Thomas J.; Birk, C.; Hinderer, Steven R.; Yavuzer, Güneş

doi:10.1080/10790268.2004.11753752

Cited by 39 publications

(14 citation statements)

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“…110 Increases in salt and fluid intake can help to expand intravascular volume and improve blood pressure in response to orthostasis, and there is evidence that this relatively simple dietary alteration can lessen the need for sympathomimetic medication in persons with SCI. 111,112 Several sympathomimetic agents have been tested for use to treat conditions of low blood pressure in the SCI population, including ergotamine, 113 ephedrine, 112 midodrine hydrochloride, [114][115][116][117][118] and droxidopa. 119,120 We recently reported the results from a randomized, placebo-controlled, double-blinded clinical trial to determine the effects of a single 10 mg dose of midodrine on seated SBP, mean CBF velocity, and global cognitive function in hypotensive participants with SCI.…”

Section: Managementmentioning

confidence: 99%

Cardiovascular Autonomic Dysfunction in Spinal Cord Injury: Epidemiology, Diagnosis, and Management

et al. 2020

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Spinal cord injury (SCI) disrupts autonomic circuits and impairs synchronistic functioning of the autonomic nervous system, leading to inadequate cardiovascular regulation. Individuals with SCI, particularly at or above the sixth thoracic vertebral level (T6), often have impaired regulation of sympathetic vasoconstriction of the peripheral vasculature and the splanchnic circulation, and diminished control of heart rate and cardiac output. In addition, impaired descending sympathetic control results in changes in circulating levels of plasma catecholamines, which can have a profound effect on cardiovascular function. Although individuals with lesions below T6 often have normal resting blood pressures, there is evidence of increases in resting heart rate and inadequate cardiovascular response to autonomic provocations such as the head-up tilt and cold face tests. This manuscript reviews the prevalence of cardiovascular disorders given the level, duration and severity of SCI, the clinical presentation, diagnostic workup, short- and long-term consequences, and empirical evidence supporting management strategies to treat cardiovascular dysfunction following a SCI.

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Section: Managementmentioning

confidence: 99%

Cardiovascular Autonomic Dysfunction in Spinal Cord Injury: Epidemiology, Diagnosis, and Management

et al. 2020

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“…The effect of increasing arterial pressure on exercise capacity and/or performance has been examined in 4 studies, of which, 3 induced autonomic dysreflexia in a laboratory setting [53‐55], and one used a 10‐mg dose of midodrine [57]. In the midodrine trial, blood pressure during exercise was increased with all the participants; however, only 50% of the participants exhibited an increased maximal oxygen uptake.…”

Section: Effect Of Impaired Autonomic Cardiovascular Control On Exercmentioning

confidence: 99%

The Role of Autonomic Function on Sport Performance in Athletes With Spinal Cord Injury

Krassioukov

West

2014

PM&R

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Devastating paralysis, autonomic dysfunction, and abnormal cardiovascular control present significant hemodynamic challenges to individuals with spinal cord injury (SCI), especially during exercise. In general, resting arterial pressure after SCI is lower than with able-bodied individuals and is commonly associated with persistent orthostatic intolerance along with transient episodes of life-threatening hypertension, known as "autonomic dysreflexia." During exercise, the loss of central and reflexive cardiovascular control attenuates maximal heart rate and impairs blood pressure regulation and blood redistribution, which ultimately reduces venous return, stroke volume, and cardiac output. Thermoregulation also is severely compromised in high-lesion SCI, a problem that is compounded when competing in hot and humid conditions. There is some evidence that enhancing venous return via lower body positive pressure or abdominal binding improves exercise performance, as do cooling strategies. Athletes with SCI also have been documented to self-induce autonomic dysreflexia before competition with a view of increasing blood pressure and improving their performance, a technique known as "boosting." For health safety reasons, boosting is officially banned by the International Paralympics Committee. This article addresses the complex issue of how the autonomic nervous system affects sports performance in athletes with SCI, with a specific focus on the potential debilitating effects of deranged cardiovascular control.

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“…OH is an important clinical problem for patients with SCI since it interferes with ability to perform exercises and activities of daily living (11). It is impossible to take steps without solving the OH problem in the rehabilitation of SCI.…”

Section: Intruductionmentioning

confidence: 99%

Midodrine Treatment of Orthostatic Hypotension in Patients With Acute Tetraplegia

...

2012

Tftr

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© Tur kish Jo ur nal of Physi cal Me di ci ne and Re ha bi li ta ti on, pub lis hed by Ga le nos Pub lis hing. / © Tür ki ye Fi zik sel Tıp ve Re ha bi li tas yon Der gi si, Ga le nos Ya yı ne vi ta ra fın dan ba sıl mış tır. IntruductionOrthostatic hypotension (OH) is one of the complications in patients with spinal cord injury (SCI) particularly in the acute stage. Impairment in the autonomic nervous system, usually in patients with cervical and high thoracic SCI, causes OH that is defined as decrease in systolic blood pressure of at least 20 mm Hg or diastolic blood pressure of at least 10 mm Hg upon changing body position from supine to upright posture. It results from an inefficient response to postural changes in blood pressure. OH may be symptomatic or asymptomatic. Symptoms of OH include dizziness, light-headedness, fainting, blurred vision, muscle weakness, fatigue, nausea, palpitations, and headache (1-4).Non-pharmacological interventions that have been used are salt and fluid regulation, pressure to the abdominal region, upper body exercise, functional electrical stimulation (FES) applied to the legs, compression bandages and/or pressure stockings and tilt training program (3,5). Pharmacological treatment includes agents acting on blood vessels, on blood volume or on other pressor mechanisms. The medications used are fludrocortisone, pyridostigmine, ergotamine, ephedrine, desmopressin, erythropoietin and midodrine (3,4,6).We experienced two cases of tetraplegia having OH treated with midodrine that did not respond to conventional nonpharmacological interventions. Both of the patients were women. One of them was 33-year-old with C4 tetraplegia AIS-A and the other was 19-year-old with C5 tetraplegia AIS-A. The subjects were in acute stage of SCI that were in the first 3 months postinjury. They continued to have OH during transfer to wheelchair or tilt table exercises despite use of antiembolic compression bandage, abdominal binder, and progressive exercises with tilt table. Five mg/d midodrine in two divided doses was started. Improvement in symptoms was observed in both of the patients after 20 days, thus, the dosage was decreased to 2.5 mg/d in two divided doses. One month later, patients' tolerated tilt angle was 90 degrees, so midodrine was stopped in both of the patients. Midodrine was not continued in one of the patients. In the other patient, midodrine 2.5 mg/d was started again one week later because OH continued occasionally. Autonomic dysreflexia (AD) was not observed. No side effects were observed.The predisposition to OH following SCI is not fully understood, but it is thought to be multifactorial (3). Following SCI, the low level of efferent sympathetic activity and the loss of reflex vasoconstriction are among the major causes of OH. OH is more common in tetraplegia than in paraplegia. OH persisting during the first month following SCI was reported to occur in 74% of cervical and in 20% of upper thoracic motor complete SCI patients (7). Both of our two patients had complete tetraplegia. We...

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Double-Blinded, Placebo-Controlled Trial Of Midodrine For Exercise Performance Enhancement In Tetraplegia:A Pilot Study

Cited by 39 publications

References 0 publications

Cardiovascular Autonomic Dysfunction in Spinal Cord Injury: Epidemiology, Diagnosis, and Management

Cardiovascular Autonomic Dysfunction in Spinal Cord Injury: Epidemiology, Diagnosis, and Management

The Role of Autonomic Function on Sport Performance in Athletes With Spinal Cord Injury

Midodrine Treatment of Orthostatic Hypotension in Patients With Acute Tetraplegia

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