Using Nutraceuticals to Help Manage Traumatic Spinal Cord Injury.

Traumatic spinal cord injury (TSCI) is a significant public health challenge that has an adverse impact on functional independence, quality of life, and life expectancy. Management of people's chronic conditions is a key aspect of contemporary medical practice. Our study was an open label, single arm, prospective pilot study to evaluate the feasibility of treating people with TSCI. The study intervention was treatment with oral selenium and vitamin E. Participants were 18 years or older and experienced a TSCI at least one year prior to enrollment. Daily doses of 50 mcg of selenium and 400 IU of vitamin E were administered. Participants had radiologic (MRI tractography) and clinical (ASIA) assessments prior to initiating treatment, and these assessments were repeated after one year of treatment. Four subjects completed the full twelve-month study. Adherence, based on pill counts, was approximately 75% in all subjects. There were no adverse events related to study medications. During the treatment period, subjects reported improvement in certain symptoms. There was no significant difference in ASIA scores before and after the intervention. Combination treatment with vitamin E and selenium has been demonstrated as safe for TSCI patients. It is possible to use DTI values to locate the epicenter of a lesion as well as gauge the extent of injury. MRI tractography may serve as a meaningful surrogate endpoint. The results of this study suggest that it is feasible to conduct a larger long-term clinical trial to evaluate the efficacy of combination treatment of TSCI.

Levodopa/carbidopa to improve motor function subsequent to brain tumor excision.

OBJECTIVE: The aim of this study was to evaluate the role of levodopa/carbidopa as an augmenting agent to improve motor recovery after brain tumor excision. DESIGN: This case report is structured as an n-of-1 style trial. The study patient was an outpatient with residual hemiparesis secondary to removal of benign oligoastrocytoma seen in an outpatient physiatry practice at an academic center. The study intervention was levodopa/carbidopa vs. placebo, combined with a structured 6-wk physiotherapy regimen. Outcomes were measured using the motor subscale of the Fugl-Meyer Assessment to assess for motor recovery. RESULTS: The mean motor Fugl-Meyer Assessment score for the levodopa/carbidopa weeks was 6.90 points greater than the mean score for placebo. The results were significant at P < 0.05. CONCLUSIONS: Levodopa/carbidopa may have a beneficial effect on improving motor recovery after sustaining a brain injury as a result of tumor excision.

Poststroke pain - but multiple pain mechanisms.

A 42-year-old man presented with acute left hemiplegia due to a right frontotemporal hemorrhagic stroke and left-sided pain. While the initial presentation suggested central poststroke pain, subsequent investigations also implicated heterotopic ossification of the left hip and amplification of previous low back pain by the new central pain. While heterotopic ossification has been commonly associated with brain injury, spinal cord injury or osseous injury, it is only rarely associated with stroke. Poststroke pain may be multifactorial, and discovering the pain mechanisms has important implications for treatment.