Recovery of bladder function in patients with acute spinal cord injury: significance of ASIA scores and somatosensory evoked potentials

Curt, Armin; Rodic, Biljana; Schurch, Brigitte; Dietz, Volker

doi:10.1038/sj.sc.3100423

Cited by 53 publications

(22 citation statements)

References 13 publications

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“…In conus/cauda lesion the patient will develop a¯accid, atrophic muscle paresis with neurogenic bladder dysfunction due to impaired lower spinal cord motoneurones (are¯exive detrusor muscle function). 12 In contrast, an epiconal lesion is associated with spastic paraparesis and bladder dysfunction due to impairment of upper motoneurones.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic and prognostic value of compound motor action potential of lower limbs in acute paraplegic patients

2000

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Objectives: To evaluate the diagnostic and prognostic contribution of motor nerve conduction studies (NCS) in addition to neurological examination in patients with acute paraplegia. Methods: In 79 patients with acute onset of paraplegia due to traumatic or ischaemic damage of the conus medullaris/cauda equina (conus/cauda) or lesion of the mid-thoracic spinal cord (epiconal) neurological (initial and follow-up clinical motor and sensory scores; outcome of ambulatory capacity determined at least 6 months post-trauma) and electrophysiological examinations (motor nerve conduction velocity (MNCV) and compound motor action potential (CMAP) of tibial and peroneal nerves) were performed in parallel. Results: Severe axonal motor neuropathies were signi®cantly caused by conus/cauda lesions (loss of tibial CMAP in 71% and of peroneal CMAP in 68%) compared to patients with epiconal lesion (no loss of tibial CMAP and abolished peroneal CMAP in 14%). The CMAPs were deemed acutely pathological 4 ± 14 days post-trauma and were indicative of the severity of conus/cauda lesion while the MNCV remained normal. Follow-up recordings (up to 1 year post trauma) revealed no signi®cant change in the CMAP values. The clinical examination according to the American Spinal Injury Association (ASIA protocol) in contrast to the CMAP values was signi®cantly related to the outcome of ambulatory capacity. Conclusions: In contrast to patients with an epiconal SCI almost all patients with damage of the conus/cauda present a severe axonal neuropathy of the tibial and peroneal nerves. Pathological CMAPs develop as early as 1 ± 2 weeks after onset of acute paraplegia. They allow, at an early stage, to di erentiate between conus/cauda or epiconal lesion and to assess the severity of conus/cauda lesion. Thereafter follow-up examinations remain stable and a developing worsening of peripheral nerve or spinal cord function, eg due to post-traumatic syringomyelia, may be indicated by a secondary deterioration of CMAP values. The clinical examination, according to the ASIA protocol, in acute paraplegia patients, in contrast to the motor nerve conduction studies, is of prognostic value in predicting the outcome of ambulatory capacity.

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Section: Discussionmentioning

confidence: 99%

Diagnostic and prognostic value of compound motor action potential of lower limbs in acute paraplegic patients

2000

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“…[8][9][10][11][12] Others have studied the relationship between motor and sensory scores and bladder recovery, 13 the recovery patterns of muscle strength and sensation in vascular injuries, 14 and the relationship between muscle strength/ motor scores and functional recovery. [15][16][17][18][19][20] The ISCSCI motor and sensory exams have also been used as inclusion criteria for entry into drug and device trials.…”

Section: Introductionmentioning

confidence: 99%

The International Standards for Neurological Classification of Spinal Cord Injury: reliability of data when applied to children and youths

et al. 2006

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Study design: Intra-rater reliability study, cross-sectional design. Objectives: To determine reliability of the International Standards for Neurological Classification of Spinal Cord Injury (ISCSCI) motor and sensory exam in children. Setting: Nonprofit pediatric hospital. Methods: In all, 74 subjects had two trials of the motor and sensory exams. Intraclass correlation coefficients (ICC), 95% confidence intervals (CI) were generated for total motor (TM), pin prick (PP) and light touch (LT) scores for the entire sample, four age groups, severity and type of injury.

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“…Residual corticospinal tracts may not be revealed if cortical thresholds for TMS to elicit an MEP in iSCI are high, beyond the acceptable levels of stimulation or the maximum output of the stimulator [9]. False negative pudendal SSEPs have been noted in a study of recovery of bladder function in patients with acute SCI [27] and, indeed, all subjects in the present study could sense the pudendal afferent stimulus albeit with above normal perceptual threshold in some subjects. Recently, neuromodulation of spinal circuitry has resulted in recovery of voluntary movement in individuals with clinically complete motor and sensory paralysis [28] suggesting that residual and latent spinal pathways can affect neural plasticity.…”

Section: Discussionmentioning

confidence: 84%

Effects of Pudendal and Cortical Paired Associative Stimulation on Plasticity of Sphincter Responses after Incomplete Spinal Cord Injury: A Feasibility Study

Vásquez¹

2017

Phys Med Rehabil Int

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Objectives: To assess whether paired associative stimulation of the dorsal penile nerve and the motor cortex produces change in anal sphincter muscle responses in incomplete spinal cord injury (iSCI). Methods:This was a prospective experimental study. Eighteen male iSCI subjects with neuropathic bladder history were recruited. Incontinence was assessed using the International Consultation on Incontinence Modular Questionnaire (ICIQ). Electromyographic activity of the external anal sphincter was recorded. Pudendo-anal reflexes (PAR) were elicited by electrical stimulation of the dorsal penile nerve (DPN) and anal sphincter motor evoked potentials (MEP) by transcranial magnetic stimulation (TMS). Paired associative stimulation (PAS) (DPN and TMS, interval 40ms) was applied for 8 min at 0.25Hz using either real or sham TMS of the motor cortex. Pudendal somatosensory evoked potentials (pSSEPs) were recorded.Results: A PAR could be recorded in all subjects and an MEP in 12 subjects. The PAR was facilitated by prior (30ms) conditioning TMS. Group mean amplitudes of the PAR, the conditioned PAR and MEP, and ICIQ scores showed no change after real or sham PAS. However, 13 subjects individually showed significant changes (increases or decreases) in one or more sphincter responses to real or sham PAS. Individual responses were not correlated with the presence or latency of pSSEPs. Conclusions:Paired pudendal nerve and cortical stimulation altered the excitability of cortico-spinal and reflex circuitry controlling the anal sphincter in iSCI individuals. Future work should investigate whether such changes in individuals might lead to altered neural circuitry accompanied by functional restoration of continence.

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Recovery of bladder function in patients with acute spinal cord injury: significance of ASIA scores and somatosensory evoked potentials

Cited by 53 publications

References 13 publications

Diagnostic and prognostic value of compound motor action potential of lower limbs in acute paraplegic patients

Diagnostic and prognostic value of compound motor action potential of lower limbs in acute paraplegic patients

The International Standards for Neurological Classification of Spinal Cord Injury: reliability of data when applied to children and youths

Effects of Pudendal and Cortical Paired Associative Stimulation on Plasticity of Sphincter Responses after Incomplete Spinal Cord Injury: A Feasibility Study

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