AUTONOMIC DYSREFLEXIA IN TETRAPLEGIA AFTER SPINAL CORD INJURY: ORIGINAL ARTICLE

Cover Page

Cite item

Full Text

Abstract

Aim. To study the autonomic dysreflexia (AD) and to assess changing in the vegetative nervous system according it in patients with chronic tetraplegia. Materials and methods. The study included 40 patients with tetraplegia, patients were assessed using heart rate variability, ambulatory blood pressure monitoring; ADFSC-questionnaire of frequency and severity of the symptoms episodes of AD and both sinus arrhythmia, cardio-respiratory synchronization were estimated too. Results. It was found that 80% patients with AD had complete spinal cord, in 40% cases AD had a latent form, in 70% of cases AD was due to urological reasons, the frequency of episodes of AD was 8 (5.0; 9.0) per day, and a strong correlation was found between the frequency of AP episodes and the severity and frequency of its symptoms (r=0.83); AD-patients did not have nightly decreasing in blood pressure - BP (daytime 119/72 and nighttime 118/68), they had a higher BP values in daytime hours (median): 119/72 versus 103/60, in night hours: 118/66 versus 101/56, in 24-hours: 118/73 per day versus 103/60 mm Hg, a higher variability of systolic BP 14 (7.0; 16.0) versus 8 (6.0; 12.0); a higher value of the normalized sympatho-vagal index 0.9 (0.69; 1.39) versus 0.6 (0.42; 0.87), and less the cardio-respiratory synchronization index 8 (6.7; 12.2) vs. 11 (7.9; 17.5). Conclusions. AD is a frequent problem in tetraplegia patients that requires using an integrated approach in diagnosis and monitoring, accompanied by sever dysregulation of the autonomic nervous system.

About the authors

Fedor A. Bushkov

Rehabilitation center “Preodolenie”

Email: bushkovfedor@mail.ru
канд. мед. наук, врач-невролог, АО «Реабилитационный центра “Преодоление"» Москва, Россия

Roman V. Salyukov

Rehabilitation center “Preodolenie”

канд. мед. наук, врач-уролог, АО «Реабилитационный центра “Преодоление"» Москва, Россия

References

  1. Krassioukov AV, Karlsson AK, Wecht JM et al. Joint Committee of American Spinal Injury Association and International Spinal Cord Society. Assessment of autonomic dysfunction following spinal cord injury: rationale for additions to International Standards for Neurological Assessment. J Rehabil Res Dev 2007; 44 (1): 103-12.
  2. Braddomand RL, Rocco JF. Autonomic dysreflexia. A survey of current treatment. Am J Physical Med Rehabil 1991; 70 (5): 234-41.
  3. Curt A, Nitsche B, Rodic B et al. Assessment of autonomic dysreflexia in patients with spinal cord injury. J Neurol Neurosurg Psychiatry 1997; 62: 473-7.
  4. Popok DW, West CR, Hubli M et al. Characterizing the Severity of Autonomic Cardiovascular Dysfunction after Spinal Cord Injury Using a Novel 24-Hour Ambulatory Blood Pressure Analysis Software. J Neurotrauma 2017; 34 (3): 559-66. doi: 10.1089/neu.2016.4573
  5. Teasell RW, Malcolm OA, Krassioukov A, Delaney GA. Cardiovascular consequences of loss of supraspinal control of the sympathetic nervous system after spinal cord injury. Arch Phys Med Re-habil 2000; 81: 506-16.
  6. Claydon VE, Elliott SL, Sheel AW, Krassioukov A. Cardiovascular responses to vibrostimulation for sperm retrieval in men with spinal cord injury. J Spinal Cord Med 2006; 29 (3): 207-16.
  7. Lee BY, Karmakar MG, Herz BL, Sturgill RA. Autonomic dysreflexia revisited. J Spinal Cord Med 1995; 18: 75-87.
  8. Stjenberg L, Blumberg H, Wallin BG. Sympathetic activity in man after spinal cord injury: outflow to muscle below the lession. Brain 1986; 109: 695-715.
  9. Gao SA, Ambring A, Lambert G, Karlson AK. Autonomic control of the heart and renal vascular bed during autonomic dysreflexia in high spinal cord injury. Clin Autom Res 2002; 12:457-64.
  10. Yeoh M, McLachlan EM, Brock JA. Tail arteries from chronically spinalized rats have potentiated responses to nerve stimulation in vitro. J Physiol 2004; 556: 545-55.
  11. Karlsson AK, Friberg P, Lonnroth P et al. Regional sympathetic function in high spinal cord injury during mental stress and autonomic dysreflexia. Brain 1998; 121 (9): 1711-9.
  12. Lee ES, Joo MC. Prevalence of Autonomic Dysreflexia in Patients with Spinal Cord Injury above T6. Biomed Res Int 2017; 2017: 2027594. doi: 10.1155/2017/2027594
  13. Karlsson AK. Autonomic dysreflexia. Spinal Cord 1999; 37 (6): 383-91.
  14. Giannantoni A, Di Stasi SM, Scivoletto G et al. Autonomic dysreflexia during urodynamics. Spinal Cord 1998; 36 (11): 756-60.
  15. Kirshblum SC, House JG, O’Connor KC. Silent autonomic dysreflexia during a routine bowel program in person with traumatic spinal cord injury: preliminary study. Arch Phys Med Rehabil 2002; 83: 1774-6.
  16. Гапеева Л.С., Еселевич Э.И. О спинальных вегетативных пароксизмах. Клиническая медицина. 1973; 9: 80-4. [Gapeeva L.S., Eselevich E.I. O spinal'nykh vegetativnykh paroksizmakh. Klinicheskaya meditsi-na. 1973; 9: 80-4 (in Russian).]
  17. Claydon VE, Krassioukov AV. Clinical correlates of frequency analyses of cardiovascular control after spinal cord injury. Am J Physiol Heart Circ Physiol 2008; 294 (2): 668-78.
  18. Elliott S, Krassioukov A. Malignant autonomic dysreflexia in spinal cord injured men. Spinal Cord 2006; 44: 386-92.
  19. Yarcony GM, Katz RT, Wu Y Seizures secondary to anatonomic dysreflexia. Arch Phys Med Rehabil 1986;67:834-5.
  20. Pine ZM, Miller SD, Alonso JA. Atrial fibrillation associated with autonomic dysreflexia. Am J Phys Med Rehabil 1991; 70 (5): 271-3.
  21. Eltorai I, Kim R, Vulpe M et al. Fatal cerebral hemorrhage due to autonomic dysreflexia in a tetrap-legic patients: case report and review. Paraplegia 1992; 30: 355-60.
  22. Marino RJ, Barros T, Biering-Sorensen F et al. ASIA Neurological Standards Committee 2002. International standards for neurological classification of spinal cord injury. J Spinal Cord Med 2003; 26 (Suppl. 1): S50-6.
  23. Hubli M, Gee CM, Krassioukov AV. Refined assessment of blood pressure instability after spinal cord injury. Am J Hypertens 2015; 28 (2): 173-81. doi: 10.1093/ajh/hpu122
  24. Hubli M, Krassioukov AV. Ambulatory blood pressure monitoring in spinal cord injury: clinical practicability. J Neurotrauma 2014; 31 (9): 789-97. doi: 10.1089/neu.2013.3148
  25. Михайлов В.М. Вариабельность ритма сердца: опыт практического применения метода. Изд. 2-е, перераб. и доп. Иваново: Иван. Гос. Мед. Академия, 2002. [Mikhailov V.M. Heart rate variability: experience of practical application of the method. Izd. vtoroe, pererab. i dop. Ivanovo: Ivan. Gos. Med. Akademiya, 2002. (in Russian).]
  26. Nitsche B, Perschak H, Curt A, Dietz V. Loss of circadian blood pressure variability in complete tetraplegia. J Hum Hypertens 1996; 10 (5): 311-7.
  27. Krassioukov A, Biering-Sorensen F, Donovan W et al; Autonomic Standards Committee of the American Spinal Injury Association/International Spinal Cord Society. International standards to document remaining autonomic function after spinal cord injury. J Spinal Cord Med 2012; 35 (4): 201-10. doi: 10.1179/1079026812Z.00000000053
  28. Бутуханов В.В. Особенности регуляции сердечно-сосудистой и дыхательной систем у больных с травмой спинного мозга. Ортопедия, травматология и протезирование. Медицина. 1983; 7: 21-4. [Butukhanov V.V. Osobennosti reguliatsii serdechno-sosudistoi i dykhatel'noi sistem u bol'nykh s travmoi spinnogo mozga. Ortopediia, travmatologiia i protezirovanie. Meditsina. 1983; 7: 21-4 (in Russian).]
  29. Grasso R, Schena F, Gulli G, Cevese A. Does low-frequency variability of heart period reflect a specific parasympathetic mechanism? J Auton Nerv Syst 1997; 63: 30-8.

Copyright (c) 2019 Consilium Medicum

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies