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A Curt

Publications and source records attributed to A Curt.

At least 19 recordsLinked to original sources
PubMed2006

Guidelines for the conduct of clinical trials for spinal cord injury as developed by the ICCP panel: spontaneous recovery after spinal cord injury and statistical power needed for therapeutic clinical trials.

The International Campaign for Cures of Spinal Cord Injury Paralysis (ICCP) supported an international panel tasked with reviewing the methodology for clinical trials in spinal cord injury (SCI), and making recommendations on the conduct of future trials. This is the first of four papers. Here, we examine the spontaneous rate of recovery after SCI and resulting consequences for achieving statistically significant results in clinical trials. We have reanalysed data from the Sygen trial to provide some of this information. Almost all people living with SCI show some recovery of motor function below the initial spinal injury level. While the spontaneous recovery of motor function in patients with motor-complete SCI is fairly limited and predictable, recovery in incomplete SCI patients (American spinal injury Association impairment scale (AIS) C and AIS D) is both more substantial and highly variable. With motor complete lesions (AIS A/AIS B) the majority of functional return is within the zone of partial preservation, and may be sufficient to reclassify the injury level to a lower spinal level. The vast majority of recovery occurs in the first 3 months, but a small amount can persist for up to 18 months or longer. Some sensory recovery occurs after SCI, on roughly the same time course as motor recovery. Based on previous data of the magnitude of spontaneous recovery after SCI, as measured by changes in ASIA motor scores, power calculations suggest that the number of subjects required to achieve a significant result from a trial declines considerably as the start of the study is delayed after SCI. Trials of treatments that are most efficacious when given soon after injury will therefore, require larger patient numbers than trials of treatments that are effective at later time points. As AIS B patients show greater spontaneous recovery than AIS A patients, the number of AIS A patients requiring to be enrolled into a trial is lower. This factor will have to be balanced against the possibility that some treatments will be more effective in incomplete patients. Trials involving motor incomplete SCI patients, or trials where an accurate assessment of AIS grade cannot be made before the start of the trial, will require large subject numbers and/or better objective assessment methods.

Clinical Trials as Topic↗
PubMed2006

Guidelines for the conduct of clinical trials for spinal cord injury (SCI) as developed by the ICCP panel: clinical trial outcome measures.

An international panel reviewed the methodology for clinical trials of spinal cord injury (SCI), and provided recommendations for the valid conduct of future trials. This is the second of four papers. It examines clinical trial end points that have been used previously, reviews alternative outcome tools and identifies unmet needs for demonstrating the efficacy of an experimental intervention after SCI. The panel focused on outcome measures that are relevant to clinical trials of experimental cell-based and pharmaceutical drug treatments. Outcome measures are of three main classes: (1) those that provide an anatomical or neurological assessment for the connectivity of the spinal cord, (2) those that categorize a subject's functional ability to engage in activities of daily living, and (3) those that measure an individual's quality of life (QoL). The American Spinal Injury Association impairment scale forms the standard basis for measuring neurologic outcomes. Various electrophysiological measures and imaging tools are in development, which may provide more precise information on functional changes following treatment and/or the therapeutic action of experimental agents. When compared to appropriate controls, an improved functional outcome, in response to an experimental treatment, is the necessary goal of a clinical trial program. Several new functional outcome tools are being developed for measuring an individual's ability to engage in activities of daily living. Such clinical end points will need to be incorporated into Phase 2 and Phase 3 trials. QoL measures often do not correlate tightly with the above outcome tools, but may need to form part of Phase 3 trial measures.

Activities of Daily Living↗
PubMed2006

Guidelines for the conduct of clinical trials for spinal cord injury as developed by the ICCP Panel: clinical trial inclusion/exclusion criteria and ethics.

The International Campaign for Cures of Spinal Cord Injury Paralysis established a panel tasked with reviewing the methodology for clinical trials for spinal cord injury (SCI), and making recommendations on the conduct of future trials. This is the third of four papers. It examines inclusion and exclusion criteria that can influence the design and analysis of clinical trials in SCI, together with confounding variables and ethical considerations. Inclusion and exclusion criteria for clinical trials should consider several factors. Among these are (1) the enrollment of subjects at appropriate stages after SCI, where there is supporting data from animal models or previous human studies; (2) the severity, level, type, or size of the cord injury, which can influence spontaneous recovery rate and likelihood that an experimental treatment will clinically benefit the subject; and (3) the confounding effects of various independent variables such as pre-existing or concomitant medical conditions, other medications, surgical interventions, and rehabilitation regimens. An issue of substantial importance in the design of clinical trials for SCI is the inclusion of blinded assessments and sham surgery controls: every effort should be made to address these major issues prospectively and carefully, if clear and objective information is to be gained from a clinical trial. The highest ethical standards must be respected in the performance of clinical trials, including the adequacy and clarity of informed consent.

Clinical Trials as Topic↗
PubMed2006

Guidelines for the conduct of clinical trials for spinal cord injury as developed by the ICCP panel: clinical trial design.

The International Campaign for Cures of Spinal Cord Injury Paralysis established a panel tasked with reviewing the methodology for clinical trials for spinal cord injury (SCI), and making recommendations on the conduct of future trials. This is the fourth of four papers. Here, we examine the phases of a clinical trial program, the elements, types, and protocols for valid clinical trial design. The most rigorous and valid SCI clinical trial would be a prospective double-blind randomized control trial utilizing appropriate placebo control subjects. However, in specific situations, it is recognized that other trial procedures may have to be considered. We review the strengths and limitations of the various types of clinical trials with specific reference to SCI. It is imperative that the design and conduct of SCI clinical trials should meet appropriate standards of scientific inquiry to insure that meaningful conclusions about efficacy and safety can be achieved and that the interests of trial subjects are protected. We propose these clinical trials guidelines for use by the SCI clinical research community.

Clinical Trials as Topic↗
PubMed2006

Impaired scaling of responses to vestibular stimulation in incomplete SCI.

Patients with incomplete spinal cord injury (iSCI) have impaired postural control leading to a high danger of falling. Clinically, it is impossible to assess the extent to which postural instability due to sensorimotor deficit is influenced by a disturbance in the vestibulospinal pathways. Galvanic vestibular stimulation (GVS) was applied to investigate changes in the vestibular spinal responses and their potential influence on postural stability in iSCI patients. Six chronic iSCI patients and age-matched controls were stimulated with a bipolar binaural stimulus. The centre of pressure (CoP) and soleus EMG responses during free standing with closed eyes on firm and compliant ground were measured. The impairment in postural stability was assessed by the mean amplitude of CoP deflections during two minutes undisturbed standing. Although iSCI patients were significantly less stable than controls, direct GVS responses of the soleus EMG and postural sways tended to be increased on firm ground. The GVS responses increased when changing from firm to compliant ground, showing a close correlation between the extent of postural instability and the response amplitudes. Therefore, challenging proprioceptive feedback induced a significant up-modulation of the GVS responses. However, when we took the postural instability in iSCI patients into account, the EMG and CoP responses to GVS were reduced compared to controls. The combined assessment of EMG and CoP responses to GVS complements the clinical examination and permits evaluation of the preservation and modulation of vestibulospinal responses in iSCI.

Aged↗
PubMed2005

Improving walking assessment in subjects with an incomplete spinal cord injury: responsiveness.

STUDY DESIGN: Prospective longitudinal study. OBJECTIVES: To investigate the responsiveness of the Walking Index for Spinal Cord Injury II (WISCI II), 6-Min Walk (6MWT) and 10-Meter Walk Tests (10MWT) for the assessment of walking capacity in incomplete spinal cord injury (iSCI) and to validate these tests with the lower extremity motor score (LEMS). SETTING: European Multicenter Study of Human Spinal Cord Injury. METHODS: The walking tests of 22 iSCI subjects who achieved functional ambulation and could stand or walk within 1 month after iSCI were analyzed at 3, 6 and 12 months after injury. Responsiveness was assessed by determining differences between the time intervals, and Spearman's correlation coefficient was calculated to quantify validity. RESULTS: All walking tests were able to assess the improvement of walking capacity within the first 3 months after injury. Between 3 and 6 months, only the 10MWT and 6MWT were responsive to the ongoing improvement in locomotor capacity. Overall, correlations between the tests were good within the first month, but became poorer over time. CONCLUSION: The 6MWT and 10MWT were more responsive in demonstrating an improvement in walking capacity compared to the WISCI II. The testing of functional outcome after iSCI as provided by the ordinal ASIA motor score can be improved by interval scaled measures. This allows increasing the responsiveness of functional outcome measures and should be advantageous in assessing therapeutical approaches in iSCI subjects. In iSCI subjects with walking ability, we recommend the additional use of timed tests to monitor improvement in locomotor capacity.

Adolescent↗
PubMed2005

Motor evoked potentials (MEP) and evoked pressure curves (EPC) from the urethral compressive musculature (UCM) by functional magnetic stimulation in healthy volunteers and patients with neurogenic incontinence.

AIMS: The aim of this study is to assess neurogenic lesions of the somatomotor efferent nervous pathway to the urethral compressive musculature (UCM) by means of motor evoked potentials (MEP) and simultaneously recorded evoked pressure curves (EPC). METHODS: Nine healthy subjects and 33 patients (15 spinal cord injury, 14 cauda equina lesion, and 4 multiple sclerosis (MS)) with neurogenic urinary incontinence were prospectively examined by means of urodynamics and electrophysiology. MEP responses from the UCM were evoked after transcranial (tc) and lumbosacral (ls) single pulse magnetic stimulation. A ratio out of tx/ls latencies was calculated to distinguish between central (i.e., spinal) and peripheral lesions. The mechanical UCM pressure responses (=EPC) were recorded simultaneously with electromyographic (EMG) recordings using a microtip pressure transducer catheter with integrated bipolar surface electrodes. RESULTS: In nine healthy subjects the central latency was 19.0 msec, the peripheral latency was 4.25 msec, and the ratio was 4.4. In patients with incomplete spinal cord lesion the central latency was significantly delayed (22.7 msec), whereas the peripheral responses were normal. The ratio (5.5) was increased. Thirteen of these 15 patients suffered from neurogenic incontinence. Patients with a complete spinal lesion showed no UCM reaction after tc stimulation, whereas peripheral responses were normal. Patients with MS showed significantly prolonged central latencies (25.5 msec). The increased ratio of 6.0 indicated a spinal lesion. Ten patients with incomplete cauda equina lesions and urinary incontinence had normal central latencies but prolonged peripheral latencies of 6.7 msec. The ratio of 3.4 indicated a lesion of the sacral caudal roots. In patients with complete cauda injury neither central nor peripheral responses could be evoked. Tc evoked mechanical pressure responses (i.e., contractions) from the UCM could only be recorded in intact or incompletely injured spinal and peripheral motor nervous pathways, whereas they could be evoked after ls stimulation only in cases with partially preserved sacral caudal roots independent of a spinal lesion. CONCLUSIONS: MEP and EPC from the UCM proved to be a well tolerated disgnostic tool in patients with neurogenic incontinence that distinguished central and peripheral lesions of the motor efferent pathways to the UCM.

Adult↗
PubMed2005

[Neurological and functional recovery from spinal cord injury. Progress and evaluation standards in paraplegic medicine].

Today, there is accumulating evidence from animal experiments that axonal regeneration and an enhanced level of functional repair can be induced after a spinal cord injury (SCI). Consequently, in the near future, new therapeutic approaches will be developed for the treatment of patients with SCI. The aim of the project presented here is to provide the required clinical basis for the implementation of novel interventional therapies. Refined and combined clinical and neurophysiological measures are needed for a precise qualitative and quantitative assessment of spinal cord function in patients with SCI at an early stage. This represents a basic requirement for recognizing any improvement in the recovery of function and to monitor any significant effect of a new treatment. The paper presents objective and refined tools as a basis for monitoring the effects of new treatment strategies.

Germany↗
PubMed2005

Transcutaneous functional electrical stimulation for grasping in subjects with cervical spinal cord injury.

STUDY DESIGN: Case series. OBJECTIVES: To evaluate the benefit, shortcomings and acceptance of a new transcutaneous functional electrical stimulation (FES) technology aimed at improving the grasp function in tetraplegic subjects in acute and postacute rehabilitation. SETTING: Spinal cord injury (SCI) centre, university hospital. METHODS: : Subjects (N=11) with complete or incomplete SCI at C4/5-C7 who started FES 1-67 months after their accident were included. Hand function tests, analysis of video recordings and of written documentation of FES sessions, status of muscle strength, and follow-up query were used as outcome measures. RESULTS: Nine subjects used FES as a neuroprosthesis. Eight demonstrated improved grasp function and performance in activities of daily living. In one subject, no benefit from FES was observed. Two other subjects showed improvements in muscle strength and facilitation of active movement with FES. Four subjects successfully integrated FES as neuroprosthesis in everyday life within the rehabilitation centre. Three received the system for home use. The most relevant reasons for stopping the FES application were: (i) improvement of voluntary grasp function, (ii) physical and psychological problems, (iii) no available stimulator for home use, and (iv) insufficient assistance for electrode placement at home. Shortcomings related to the transcutaneous surface technology (eg pain or coactivation of neighbouring muscles) could usually be reduced, or did not limit the efficiency or acceptance of FES. Individually designed digital or analogue control devices were preferred. CONCLUSION: Tetraplegic subjects in acute and postacute rehabilitation can profit from a new transcutaneous FES system with respect to functional use and independence. It can be implemented in the rehabilitation programme for muscle strengthening and facilitation of voluntary activity. For a successful application of FES, there is a need for individual electrode placement, stimulation programmes, and FES control devices.

Activities of Daily Living↗
PubMed2004

Providing the clinical basis for new interventional therapies: refined diagnosis and assessment of recovery after spinal cord injury.

Today, there is accumulating evidence from animal experiments that axonal regeneration and an enhanced level of functional repair can be induced after a spinal cord injury (SCI). Consequently, in the near future, new therapeutic approaches will be developed for the treatment of patients with SCI. The aim of the project presented here is to provide the required clinical basis for the implementation of novel interventional therapies. Refined and combined clinical and neurophysiological measures are needed for a precise qualitative and quantitative assessment of spinal cord function in patients with SCI at an early stage. This represents a basic requirement to recognise any improvement in the recovery of function and to monitor any significant effect of a new treatment. To this aim, five European Spinal Cord Injury Centres involved in the rehabilitation of acute SCI patients have built up a close clinical collaboration to develop a standardised protocol for the assessment of the outcome after SCI and the extent of recovery achieved by actually applied therapies in a larger population of SCI patients. The project's aim is to establish objective, refined tools as a basis for monitoring the effects of new treatment strategies.

Animals↗
PubMed2004

Apomorphine sublingual as primary or secondary treatment for erectile dysfunction in patients with spinal cord injury.

OBJECTIVES: To evaluate the effectiveness of apomorphine sublingual (SL) 3 mg, as a primary or secondary treatment for erectile dysfunction (ED) in patients with spinal cord injury (SCI), and to determine possible differences in efficacy considering clinical, urodynamic and neurophysiological findings. PATIENTS AND METHODS: The study included 22 patients with chronic SCI and neurogenic ED who were examined physically and by a video-urodynamic evaluation. A neurophysiological evaluation included somatosensory evoked potentials of the pudendal nerve, palmar and plantar sympathetic skin responses and bulbocavernous reflex recordings. Thereafter the patients received 8 tablets of apomorphine SL 3 mg and were asked to complete the International Index of Erectile Function questionnaire before and after treatment. Side-effects, subjective efficacy compared with other treatments and satisfaction with the SL administration were recorded. RESULTS: Of the 22 men, 11 had upper motor neurone lesions (six complete, five incomplete), eight lower motor neurone lesions (seven complete, one incomplete) and three had mixed lesions. In all, 12 patients took sildenafil citrate and five alprostadil intracavernosally beforehand, and five had used nothing to treat their ED. Seven patients had some response and reported that the drug helped them to obtain an erection, but only two reported erections sufficient for intercourse and would agree to continue apomorphine SL as their standard treatment; all the others reported being disappointed. Nine patients reported side-effects. There were no significant correlations for electrophysiological or urodynamic findings and treatment success. Of the 22 patients 20 preferred SL rather than the normal administration. CONCLUSIONS: Apomorphine SL, a D1/D2 dopamine agonist, facilitates erectile function in a heterogeneous group of patients with no significant relationship with any of the assessed urodynamic or electrophysiological variables. The overall low rates of response either for primary or secondary treatment suggests that apomorphine will have limited applicability in patients with SCI.

Administration, Sublingual↗
PubMed2003

Clinical value of combined electrophysiological and urodynamic recordings to assess sexual disorders in spinal cord injured men.

AIMS: To assess the significance of combined neurophysiological and neurourological examinations for diagnosis of neurogenic male sexual dysfunction. METHODS: This is a prospective study of 32 spinal cord injured men. Each underwent clinical and neurophysiological examinations (sympathetic skin responses (SSR), pudendal somato-sensory evoked potentials (P-SSEP), bulbocavernosus reflex (BCR)) and neuro-urological measurements (urodynamic examination (UE), reflex erections (RE), psychogenic erections (PE) and nocturnal penile tumescence recordings (NPTR)). RESULTS: Erectile dysfunction due to impairment of RE was associated with loss of BCR and detrusor areflexia (P > 0.001), whereas that due to impairment of PE was associated with loss of perineal SSR (P < 0.001). P-SSEP corresponded in 94% with impairment of penile sensibility and duration of erections in NPTR. The NPTRs were less related to functional sexual impairment. NPTRs in complete and incomplete suprasacral (level > T10) spinal lesion showed sufficient erections despite strongly disturbed PE. NPTRs in lumbosacral lesion revealed significant reduction in or absent erections and underestimated the presence of well excitable PE. CONCLUSIONS: Combined neurophysiologic and neurourologic testing provides highly relevant diagnostic informations about sexual dysfunction in men with spinal cord injury. Loss of the BCR and detrusor areflexia imply loss of somatic and parasympathetic reflex activity and correlate with loss of RE. Loss of PE correlates with loss of perineal SSR (sympathetic denervation).

Adolescent↗
PubMed2003

Electrophysiological assessment of sensations arising from the bladder: are there objective criteria for subjective perceptions?

PURPOSE: Initial bladder filling sensation, first and strong desire to void are subjective perceptions that occur periodically during the urine storage mode of bladder function, representing sensory input from the lower urinary tract. To our knowledge methods for evaluating sensory bladder function are not available. We studied a simple electrophysiological procedure for the objective assessment of bladder sensations using sympathetic skin responses and surface pelvic floor electromyography. MATERIALS AND METHODS: Informed consent was provided by 8 healthy male subjects, who were administered 20 mg. furosemide and 1 l. fluid to drink. Palmar and plantar sympathetic skin responses, and surface pelvic floor electromyogram were continuously recorded during bladder filling, voluntary pelvic floor contraction and voiding. RESULTS: First desire to void evoked simultaneous sympathetic skin responses and pelvic floor contractions. This pattern appeared periodically with the desire to void sensation as well as with strong desire to void at maximum bladder capacity and it correlated well with the subjective sensation of the subjects. Voluntary pelvic floor contraction decreased the subjective intensity of the desire to void sensation as well as sympathetic skin response activity for the same short period. During voiding sympathetic skin responses almost complete absence of sympathetic skin responses was observed. CONCLUSIONS: Sensations arising from the bladder induce combined activation of sympathetic skin responses and pelvic floor activity. This coherence indicates synchronized activation and inactivation of the autonomic and somatic pathways necessary for appropriate urine storage and coordinated voiding. Our observations may introduce a new approach for objectively assessing subjective sensations arising from the urinary tract.

Adult↗
PubMed2003

Reliability of perioperative SSEP recordings in spine surgery.

OBJECTIVE: The reproducibility and clinical reliability of perioperative somatosensory-evoked potentials (SSEP) were prospectively evaluated in uneventful scoliosis surgery. The influence of anesthesia owing to induction of total intravenous anesthesia (TIVA) upon preoperative SSEP and the variability of intraoperative SSEP were calculated. The potential effect of spine surgery was assessed by comparing pre- to postoperative SSEP. METHODS: A total of 2,143 pre-, intra- and postoperative tibial and median SSEP recorded in 25 patients undergoing spine surgery owing to idiopathic scoliosis were analyzed. The anesthesia protocol consisted of a computerized target controlled infusion (TCI) device for propofol and intravenous application of an opioid. RESULTS: Anesthesia induced a significant and comparable prolongation of the tibial SSEP onset, P40 and P60 latencies, while the N50 latency was less changed. Throughout anesthesia, latencies of median (onset, N20, P25 and N35) and tibial (onset, P40, N50 and P60) SSEP showed mean variations of less than 6%. The intraoperative SSEP amplitudes were less stable with a relative standard deviation of 30-40%. In uneventful spine surgery, the postoperative tibial SSEP were not significantly changed in comparison to preoperative recordings. CONCLUSIONS: By using a standardized anesthesia protocol, the impact of anesthesia on preoperative SSEP can be predicted. Furthermore, the controlled application of sedatives and analgesics allows recording of stable SSEP parameters for intraoperative monitoring purposes. As in uneventful spine surgery pre- to postoperative SSEP are unchanged the latter comparison can be applied as an additional perioperative neuromonitoring procedure to assess the influence of spine surgery or other invasive interventions on spinal cord function.

Adolescent↗
PubMed2003

Autonomic dysreflexia in response to pudendal nerve stimulation.

STUDY DESIGN: Pudendal nerve stimulation in complete spinal cord injury (SCI). OBJECTIVE: To evaluate the influence of pudendal nerve stimulation on the cardiovascular system in SCI patients in order to assess the underlying neuronal mechanism and the potential risk during stimulation. SETTING: Swiss Paraplegic Center, and University Hospital, Zurich. METHODS: A total of 22 male patients with a complete SCI were divided into two groups according to the level of lesion: group A (C6-T6, n=15) and group B (T7-L2, n=7). A total of 66 stimulations using biphasic rectangular impulses (0.2 ms, 10 Hz) with intensities up to 100 mA were applied to the dorsal penile nerve. Of these, 15 stimulations in five patients were repeated after intravenous application of 7 mg of phentolamine. Heart rate (HR) and blood pressure (BP) were recorded by a Finapres cuff applied to the right index finger. RESULTS: Significant increased diastolic and systolic BP accompanied by significant decreased HR suggested the occurrence of autonomic dysreflexia (AD) during pudendal nerve stimulation. These cardiovascular changes corresponded with the subjective sensation of AD symptoms in patients of group A. Intravenous phentolamine lowered the resting BP and prevented severe hypertension during stimulation. Patients in group B presented with mild HR and BP changes in response to pudendal nerve stimulation and reported no AD symptoms. CONCLUSION: Our results show a considerable effect of electrical pudendal nerve stimulation on HR and BP in patients with high SCI. This may indicate that sacral somatic afferent fibers of the pudendal nerve are involved in the neuronal mechanism of AD in SCI patients with high neurological level. Intravenous phentolamine enables pudendal nerve stimulation without the risk of severe hypertension.

Adrenergic alpha-Antagonists↗
PubMed2002

Electrophysiological recordings during the peripheral nerve evaluation (PNE) test in complete spinal cord injury patients.

Up until now, the exact mechanism by which neuromodulation using sacral nerve stimulation works still remains unknown. Recent studies of pelvic floor contraction during peripheral nerve evaluation (PNE) have shown that several muscle responses are reflexly mediated. However, whether these reflexes originate from a segmental level within the sacral spinal cord or from supraspinal neuronal centers involving spino-bulbospinal pathways remains to be determined. Therefore, recordings of external anal sphincter reflexes during PNE in complete spinal cord injury (SCI) patients was performed. Three patients with complete SCI (two female and one male) suffering from neurogenic incontinence underwent the first stage of a stimulator implant (peripheral nerve evaluation). Stimulation was obtained through an electrode placed in the S3 foramen. Concomitantly, the latency of the response of the striated anal sphincter was measured using a concentric needle electrode placed in the striated part of the anal sphincter. Repeated measurements within an interval of 30 min were performed to confirm the reliability of the responses. In all subjects, reflex responses of early and late latencies could be recorded. The early response showed a mean latency of 41.2 ms (range 33.3-62 ms), which corresponds to a segmental reflex, similar to the pudendo-anal reflex. The late response appeared with a mean latency of 189.4 ms (range: 183.3-197.8 ms) and with high variability and fatigability, suggesting a reflex response organized at polysegmental spinal levels. Despite successful foramina lead placement, none of our complete SCI patients showed any improvement of neurogenic incontinence after 5 days of treatment by sacral nerve stimulation. The findings confirm that the anal contractions observed during peripheral nerve evaluation are reflex responses mediated by afferent pathways. Both the early and late reflex responses are of spinal origin, since they were obtained in complete SCI patients in whom all spino-bulbo spinal loops are supposed to be interrupted. The finding that neuromodulation is working in non-neurogenic patients but is less successful in complete SCI patients could give evidence that preserved spino-bulbo spinal loops contribute to the positive effects of neuromodulation. The role of an eventual spino-bulbo spinal loop acting during neuromodulation in non-neurogenic patients has to be assessed in further studies.

Adolescent↗
PubMed2002

[Persistent neurological deficit of the upper extremity after a shoulder operation under general anesthesia combined with a preoperatively placed interscalene catheter].

For correction of a shoulder instability (Bankart's operation) in a 33-year-old woman, a combined regional and general anaesthesia was chosen. An interscalene catheter to block the brachial plexus was placed preoperatively without complication. The following day this resulted in an upper extremity almost without motor function and with complete hypoesthesia of the dermatomes C5-C7. Surgical exploration of the plexus was performed 41/2 months later. Stimulation of the three truncs of the brachial plexus was possible and showed electrophysiological signs of recovery of distal parts of the plexus. After 2 years no clinical corresponding recovery could be observed. Despite all investigations (electroneuromyography, evoked potentials, etc.) no clear etiology could be established to explain this adverse outcome.

Adult↗