Professor of Physiology University of Kentucky Lexington, Kentucky, United States
Disclosure(s):
Alexander Rabchevsky: No financial relationships to disclose
Spinal cord injury (SCI) at T6 or higher leads to injury-induced changes in both central and peripheral neurons that underlie the development of chronic, uncontrolled muscle spasms and autonomic dysreflexia, to be discussed from neuroanatomical and physiological viewpoints. Compared to traditional anti-spasmodic treatments, there is now evidence among different species that high-dose gabapentin treatment acutely after injury can abate spasticity while also limiting the incidence and severity of autonomic dysreflexia by blocking intraspinal glutamatergic signaling via α2δ1 receptors. Alternatively, electrical epidural and transcutaneous spinal cord stimulation have been shown to alleviate both orthostatic hypotension and autonomic dysreflexia in both animal models and humans with SCI. While mechanisms of action are still being investigated, alterations in the properties of spinal cord primary afferent fibers and sympathetically correlated interneurons have been proposed. Importantly, the use of any of these approaches comes with caveats regarding side effects and potentially adverse events which will be discussed in relation to clinical trial and usage development.
Learning Objectives:
Describe injury-induced changes that occur in central and/or peripheral neurons that lead to uncontrolled muscle spasms and/or manifest in autonomic dysreflexia after spinal cord injury at T6 or higher.
Understand how high-dose gabapentin can effectively abate spasms and why it is also being considered for clinical management of autonomic dysreflexia; based on studies conducted in different species.
Discuss novel applications of transcutaneous and/or epidural spinal cord electrical stimulation to alleviate orthostatic hypotension and autonomic dysreflexia in animal models and humans with SCI.
