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Int J Urol 2021 Jun 1. Epub 2021 Jun 1.

Clinical Development (Specialty), Japan Medical and Development, GlaxoSmithKline K.K., Tokyo, Japan.

Objective: To assess the efficacy and safety of botulinum toxin treatment (onabotulinumtoxinA 200 units) for Japanese patients with neurogenic detrusor overactivity caused by spinal cord injury or multiple sclerosis.

Methods: Patients with urinary incontinence refractory to pharmacological treatment were enrolled and randomized in a phase III trial. A single dose of onabotulinumtoxinA (n = 11) or placebo (n = 10) was given in the double-blind phase, and repeat injections of onabotulinumtoxinA were given in the subsequent open-label phase. Read More

Spinal Cord Ser Cases 2021 May 28;7(1):47. Epub 2021 May 28.

Spinal Cord Injury Centre of Western Denmark, Department of Neurology, Regional Hospital, Viborg, Denmark.

Introduction: Autonomic dysreflexia is an uninhibited sympathetic response evoked by a strong sensory input below the level of the injury in patients with spinal cord injury. As presented in this case, autonomic dysreflexia can be associated with unusual symptoms such as Horner's syndrome.

Case Presentation: An 18-year-old man with a traumatic spinal cord injury (C7 AIS A) experienced symptoms of unilateral Horner's syndrome: miosis, ptosis and anhidrosis which occurred simultaneously with symptoms of autonomic dysreflexia: severe headache accompanied by increasing right-sided diaphoresis, flushing, blurred vision, and increased blood pressure. Read More

J Spinal Cord Med 2021 May 13:1-4. Epub 2021 May 13.

College of Pharmacy, University of Tennessee Health Science Center, Memphis, Tennessee, USA.

Context: Pyocystis is an infection of the epithelium of the bladder and a frequent complication of anuria. Patients with spinal cord injury (SCI) at the sixth thoracic vertebra (T6) or higher are at a greater risk for autonomic dysreflexia (AD), which can be induced by infections such as pyocystis. Cases of pyocystis treatment with aminoglycoside instillations have been reported in the literature. Read More

BMJ Case Rep 2021 Apr 8;14(4). Epub 2021 Apr 8.

Anesthesiology and Critical Care Medicine, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA

Pregnancy in patients with spinal cord injury presents unique challenges to their care teams. While spinal cord injury alters the function of several organ systems, one of the most important consequences is autonomic dysreflexia. Anaesthesia providers must be familiar with the pathophysiology and management of gravid patients with spinal cord injury to manage their deliveries successfully. Read More

BMJ Case Rep 2021 Apr 7;14(4). Epub 2021 Apr 7.

Oncology Department, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK

A 49-year-old consultant medical oncologist, with a medical history of complete T5 spinal cord injury (March 1992) and long-term paralysis from the chest down, presented with shingles affecting the T7 dermatome. He also had a dull frontal headache, a feeling of agitation and increased blood pressure of 135/90 on a home blood pressure machine (higher than his usual blood pressure of 90/70). Having been taught about autonomic dysreflexia at the time of his initial spinal cord injury, he self-diagnosed autonomic dysreflexia caused by the noxious stimulus of shingles below his level of spinal cord injury. Read More

Acta Neurol Belg 2021 Jun 7;121(3):817-820. Epub 2021 Apr 7.

Department of Neurology, Damiaan Hospital, Ostend, Belgium.

Neurotherapeutics 2021 Mar 31. Epub 2021 Mar 31.

International Collaboration On Repair Discoveries (ICORD), University of British Columbia, Vancouver, Canada.

Spinal cord injury (SCI) leads to severe impairment in cardiovascular control, commonly manifested as a rapid, uncontrolled rise in blood pressure triggered by peripheral stimuli-a condition called autonomic dysreflexia. The objective was to demonstrate the translational potential of noninvasive transcutaneous stimulation (TCS) in mitigating autonomic dysreflexia following SCI, using pre-clinical evidence and a clinical case report. In rats with SCI, we show that TCS not only prevents the instigation of autonomic dysreflexia, but also mitigates its severity when delivered during an already-triggered episode. Read More

Obstet Gynecol Surv 2021 Mar;76(3):159-165

Professor, University of Arkansas for Medical Sciences, College of Medicine, Department of Obstetrics and Gynecology, Little Rock, AR.

Importance: Spinal cord injury (SCI) may result in temporary or permanent loss of sensory, motor, and autonomic function, presenting unique medical and psychosocial challenges in women during their childbearing years.

Objective: The aim of this study was to review the literature and describe the spectrum of pregnancy considerations, complications, and evidence-based obstetric practices in women with SCI.

Evidence Acquisition: A literature search was undertaken using the search engines of PubMed and Web of Science using the terms "spinal cord injury" or "spinal cord complications" and "pregnancy outcomes" or "pregnancy complications. Read More

Spinal Cord Ser Cases 2021 Mar 19;7(1):23. Epub 2021 Mar 19.

Inova Alexandria Hospital, Department of Medicine, Alexandria, VA, USA.

Introduction: Osteoporosis is a common secondary complication of spinal cord injury, with fragility fractures typically occurring in the lower body and management often is conservative.

Case Presentation: We present a 52-year-old male with chronic complete tetraplegia who presented to the emergency room with unremitting autonomic dysreflexia (AD). He was admitted for medical management of the AD when a source of the AD could not be identified. Read More

Fertil Steril 2021 May 10;115(5):1344-1346. Epub 2021 Mar 10.

Department of Urology, University of Miami, Miller School of Medicine, Miami, Florida.

Objective: To demonstrate the proper technique to perform electroejacuation (EEJ) in men with spinal cord injury (SCI) for the purpose of inducing ejaculation.

Design: A video demonstration of the proper technique to perform EEJ in men with SCI using the Seager model 14 electroejaculation machine.

Setting: Major university medical center. Read More

J Neurol 2021 Feb 25. Epub 2021 Feb 25.

Autonomic Center (NeuroTek), San Juan de Dios Hospital, Santurtzi, Spain.

Autonomic dysreflexia (AD) is a life-threatening condition for individuals with cervical or high-thoracic spinal cord injury (SCI). The profile of autonomic dysfunction in AD using validated clinical autonomic tests has not been described so far, although it could be useful to identify SCI patients at greater risk of developing AD non-invasively. With this objective, 37 SCI patients (27% female) were recruited, and hemodynamic and cardiac parameters were continuously monitored to determine the presence of AD, defined as an increase of systolic blood pressure of 20 mmHg or higher after bladder filling with saline. Read More

Anesthesiol Clin 2021 Mar;39(1):127-138

Department of Anesthesiology, Yale School of Medicine, Yale University, PO Box 208051, 333 Cedar Street, TMP 3, New Haven, CT 06510, USA.

The spinal cord extends from the base of the skull to the first lumbar vertebrae from which it continues as cauda equina. Injuries to the spinal cord can lead to significant short- and long-term morbidities. Depending on the level of injury, morbidities may include acute hemodynamic changes, weakness of respiratory muscles and ventilator dependence, and loss of bowel and bladder function. Read More

Prog Urol 2021 Feb 1. Epub 2021 Feb 1.

Service de chirurgie urologique, centre hospitalier universitaire de Nantes, site Hôtel Dieu, 1, place Alexis-Ricordeau, 44093 Nantes, France.

Background: To evaluate in the short and mid-term the success of external sphincterotomy (ES) in neurological patients with detrusor sphincter dyssynergia (DSD).

Methods: Retrospective, monocentric study, conducted in 51 patients who had a first ES between January 2003 and June 2018, with at least two years of follow-up. The success of ES was defined by maintenance of reflex voiding mode at the end of follow-up. Read More

J Spinal Cord Med 2021 Jan 29:1-6. Epub 2021 Jan 29.

International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia (UBC), Vancouver, Canada.

Context: Autonomic dysreflexia (AD), characterized by a transient increase in systolic blood pressure (BP), is experienced by individuals with spinal cord injury (SCI) and can be purposefully induced ('boosting') to counteract autonomic dysfunction that impairs cardiovascular responses to exercise. Herein, we demonstrate the impact of unintentional boosting observed during cardiopulmonary exercise testing (CPET) in an inactive male with SCI (C5, motor-complete).

Findings: On two separate occasions the individual performed a standard arm-crank CPET (1-min stages, 7W increase in resistance) following by a longer CPET (4-min stages, 12W increase in resistance), both to volitional exhaustion. Read More

Cell Rep 2021 Jan;34(4):108667

Department of Neuroscience, Belford Center for Spinal Cord Injury, The Ohio State University, Columbus, OH 43210, USA. Electronic address:

After spinal cord injury (SCI), normally innocuous visceral or somatic stimuli can trigger uncontrolled reflex activation of sympathetic circuitry, causing pathological dysautonomia. We show that remarkable structural remodeling and plasticity occur within spinal autonomic circuitry, creating abnormal sympathetic reflexes that promote dysautonomia. However, when mice are treated early after SCI with human-equivalent doses of the US Food and Drug Administration (FDA)-approved drug gabapentin (GBP), it is possible to block multi-segmental excitatory synaptogenesis and abolish sprouting of autonomic neurons that innervate immune organs and sensory afferents that trigger pain and autonomic dysreflexia (AD). Read More

Front Syst Neurosci 2020 5;14:614691. Epub 2021 Jan 5.

Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, United States.

Spinal cord injury (SCI) results in profound neurologic impairment with widespread deficits in sensorimotor and autonomic systems. Voluntary and autonomic control of bladder function is disrupted resulting in possible detrusor overactivity, low compliance, and uncoordinated bladder and external urethral sphincter contractions impairing storage and/or voiding. Conservative treatments managing neurogenic bladder post-injury, such as oral pharmacotherapy and catheterization, are important components of urological surveillance and clinical care. Read More

Spinal Cord Ser Cases 2021 Jan 19;7(1). Epub 2021 Jan 19.

Spinal Cord Injury Unit, Department of Physical Medicine and Rehabilitation, Hospital Santo António, Medical School, Instituto de Ciências Biomédicas Abel Salazar, Porto University, Porto, Portugal.

Introduction: Spinal cord injury (SCI) often leads to impairment of the respiratory system. In fact, respiratory insufficiency is a significant cause of mortality and morbidity following SCI, related to the extent and level of the neurologic injury and its effects on the respiratory muscles (reduction in respiratory muscle strength and fatigue due to a reduction in inspiratory capacity, atelectasis and ineffective coughing). Less commonly recalled is the fact that autonomic dysreflexia (AD) is the result of parasympathetic imbalance. Read More

J Endourol Case Rep 2020 29;6(4):336-338. Epub 2020 Dec 29.

Anesthesiology Department, Centro Hospitalar Tondela-Viseu, Viseu, Portugal.

Transurethral resection of the prostate (TURP) syndrome is a rare, but extremely dangerous complication. We present an even rarer case of a spinal cord injured patient who developed "TURP-like syndrome" after cystoscopy with Double-J replacement, under general anesthesia. A 39-year-old man, American Society of Anesthesiologists III, tetraplegic, was scheduled for cystoscopy with bilateral Double-J replacement. Read More

Int Neurourol J 2020 Dec 31;24(4):301-312. Epub 2020 Dec 31.

Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Tzu Chi University, Hualien, Taiwan.

Patients with neurogenic lower urinary tract dysfunction (NLUTD) experience urinary incontinence with or without difficult urination, which might promote recurrent urinary tract infection (UTI) and exacerbate upper urinary tract function. Nonetheless, appropriate bladder management has been shown to reduce urological complications and improve quality of life. In addition to pharmacological therapy and surgical intervention, botulinum toxin A (BoNT-A) has been widely utilized in NLUTD. Read More

J Neurotrauma 2021 Feb 1. Epub 2021 Feb 1.

Department of Neurobiology and Anatomy, Marion Murray Spinal Cord Research Center, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA.

After a severe, high-level spinal cord injury (SCI), plasticity to intraspinal circuits below injury results in heightened spinal sympathetic reflex activity and detrimentally impacts peripheral organ systems. Such sympathetic hyperreflexia is immediately apparent as an episode of autonomic dysreflexia (AD), a life-threatening condition characterized by sudden hypertension and reflexive bradycardia following below-level sensory inputs; for example, pressure sores or impacted fecal matter. Over time, plasticity within the spinal sympathetic reflex (SSR) circuit contributes to the progressive intensification of AD events, as the frequency and severity of AD events increase greatly beginning ∼2 weeks post-injury (wpi). Read More

BMJ Case Rep 2020 Dec 17;13(12). Epub 2020 Dec 17.

Spinal Injuries, Southport and Ormskirk Hospital NHS Trust, Southport, UK.

A 44-year-old male person with tetraplegia (C-5 AIS-A (American Spinal Cord Injury Association Standard Neurological Classification of Spinal Cord Injury Impairment Scale)) developed urinary tract infection and received appropriate antibiotic. Subsequently, he started sweating and shivering when he was sitting up; these symptoms resolved while lying on his back. Autonomic dysreflexia triggered by truncal movements continued to occur for 3 months. Read More

Disabil Rehabil 2020 Dec 17:1-12. Epub 2020 Dec 17.

Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.

Background And Purpose: In 1994, the International Paralympic Committee (IPC) established the IPC Sport Science Committee in an effort to bring Paralympic Movement relevant research questions to the academic world. In 1996, the IPC Sport Science Committee put an application system in place, allowing scholars to conduct research at the Paralympic Games. The aim of this perspective paper is to overview the main outcomes of the fifty-six research projects conducted from Atlanta 1996 until PyeongChang 2018 during Paralympic Games' time; and to discuss the state-of-the-art of the IPC Research Strategic Goals. Read More

Spinal Cord 2021 Apr 8;59(4):389-397. Epub 2020 Dec 8.

Swiss Paraplegic Research, Nottwil, Switzerland.

Study Design: Longitudinal community survey.

Objectives: To describe the treatment for secondary health conditions as reported by individuals living with spinal cord injury (SCI) and to identify potential predictors of treatment.

Setting: Community (people with SCI living in Switzerland). Read More

Auton Neurosci 2021 01 16;230:102741. Epub 2020 Nov 16.

Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, MI, USA; Department of Biotechnology, University of Rijeka, Rijeka, Croatia.

The purinergic receptor ligand, ATP, may participate in reflex induced vasoconstriction through sympathetic efferent and sensory afferent mechanisms. However, the role of the purinergic system in contributing to autonomic dysreflexia following spinal cord injury is unclear. The present study investigates the involvement of P2X receptors in contributing to pressor responses during autonomic dysreflexia. Read More

J Spinal Cord Med 2020 Oct 15:1-4. Epub 2020 Oct 15.

Department of Rehabilitation Medicine, MedStar Georgetown University, Washington, DC, USA.

Osteoporosis is a known complication in spinal cord injury patients and can result in an increased risk of fractures and associated morbidity. Bone demineralization is most common in long bones below the level of injury. The pathogenesis is complex and not fully understood. Read More

Rev Med Liege 2020 Oct;75(10):660-664

Département d'Anesthésie-Réanimation, CHU Liège, Belgique.

Spinal cord injury can have widespread consequences beyond the disruption of sensory and motor functions. Injury at or above the sixth thoracic spinal cord segment frequently leads to dysregulation of the autonomic nervous system, which results in a syndrome called autonomic hyperreflexia or dysreflexia. It is a hypertensive crisis triggered by visceral or somatic stimuli below the level of the injury and caused by sympathetic spinal reflexes not modulated by regulatory centers in the brain. Read More

Br J Community Nurs 2020 Oct;25(10):496-501

Senior Lecturer Advanced Practice, University of South Wales, Pontypridd.

Autonomic dysreflexia (AD) is an uncontrolled increase in systolic blood pressure (by 20 mmHg or more) that occurs in those with spinal cord injuries at or above the 6th thoracic vertebrae. It usually occurs in the chronic phase of injury, at between 3 and 6 months after the injury is sustained. Most affected patients live in the community with varying levels of independence and will have contact with community nurses due to potential issues with bladder and bowel management. Read More

BMJ 2020 10 2;371:m3596. Epub 2020 Oct 2.

London Spinal Cord Injury Centre, Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK.

Intern Med 2021 Mar 30;60(5):817. Epub 2020 Sep 30.

Neurology, Internal Medicine, Sakura Medical Center, Toho University, Japan.

Spinal Cord Ser Cases 2020 09 3;6(1):83. Epub 2020 Sep 3.

Spinal Cord Injury Centre of Western Denmark, Regional Hospital Viborg, Viborg, Denmark.

Introduction: Blood flow-restricted exercise (BFRE) appears to hold considerable potential in spinal cord injury (SCI) rehabilitation, due to its ability to induce beneficial functional changes and morphological alterations from low-intensity, low-load exercise. However, it remains unclear if this training approach is feasible and safe in individuals with autonomic dysreflexia (AD).

Case Presentation: A 23-year-old male with traumatic, cervical (C6), motor-complete (AIS: B) SCI and diagnosed AD completed eight sessions of BFRE for the upper extremities over 4 weeks. Read More