Neurophysiological Changes in the First Year After Cell Transplantation in Sub-acute Complete Paraplegia
| Autor: | James D. Guest, Aisha Khan, Allan D. Levi, W. Dalton Dietrich, Kimberly D Anderson, Andrea J. Santamaria, Francisco D. Benavides, Pedro M. Saraiva |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
medicine.diagnostic_test business.industry level of injury Physical examination Sensory system Neurophysiology medicine.disease Schwann cell (SC) spinal cord injury lcsh:RC346-429 Transplantation Clinical trial Electrophysiology Cell transplantation Physical medicine and rehabilitation Neurology medicine Neurology (clinical) neurophysiology business Spinal cord injury lcsh:Neurology. Diseases of the nervous system Original Research transplantation |
| Zdroj: | Frontiers in Neurology, Vol 11 (2021) Frontiers in Neurology |
| ISSN: | 1664-2295 |
| Popis: | Neurophysiological testing can provide quantitative information about motor, sensory, and autonomic system connectivity following spinal cord injury (SCI). The clinical examination may be insufficiently sensitive and specific to reveal evolving changes in neural circuits after severe injury. Neurophysiologic data may provide otherwise imperceptible circuit information that has rarely been acquired in biologics clinical trials in SCI. We reported a Phase 1 study of autologous purified Schwann cell suspension transplantation into the injury epicenter of participants with complete subacute thoracic SCI, observing no clinical improvements. Here, we report longitudinal electrophysiological assessments conducted during the trial. Six participants underwent neurophysiology screening pre-transplantation with three post-transplantation neurophysiological assessments, focused on the thoracoabdominal region and lower limbs, including MEPs, SSEPs, voluntarily triggered EMG, and changes in GSR. We found several notable signals not detectable by clinical exam. In all six participants, thoracoabdominal motor connectivity was detected below the clinically assigned neurological level defined by sensory preservation. Additionally, small voluntary activations of leg and foot muscles or positive lower extremity MEPs were detected in all participants. Voluntary EMG was most sensitive to detect leg motor function. The recorded MEP amplitudes and latencies indicated a more caudal thoracic level above which amplitude recovery over time was observed. In contrast, further below, amplitudes showed less improvement, and latencies were increased. Intercostal spasms observed with EMG may also indicate this thoracic “motor level.” Galvanic skin testing revealed autonomic dysfunction in the hands above the injury levels. As an open-label study, we can establish no clear link between these observations and cell transplantation. This neurophysiological characterization may be of value to detect therapeutic effects in future controlled studies. |
| Databáze: | OpenAIRE |
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