Spinal Motor Conduction and Recovery After Human SCI

描述（由申请人提供）：该项目的目的是更好地了解创伤性损伤后人类脊髓可塑性的自然史，特别关注自主神经系统的变化以及这些变化如何影响痉挛的发展。进一步的目标是更好地理解神经不完全性脊髓损伤（SCI）患者皮质脊髓束轴突内传导恢复的机制。随着治疗人类脊髓损伤的新干预措施进入临床试验，这些信息可能有利于受试者的选择、结果测量的选择和结果的解释。我们将招募150名被锡拉丘兹大学医院收治的急性创伤性脊髓损伤患者。整个研究将持续5年。每个课题将被反复研究大约2年。在每次评估中，将通过手动肌肉测试和表面肌电测量来评估自主收缩能力。脊髓兴奋性将通过各种反射来测量。应用特定的感觉输入并记录心率变异性、血压和其他测量将检查交感神经活动。我们将特别强调建立自主神经反射障碍发展的时间过程，这是颈椎和高位胸椎脊髓损伤的潜在致命后果，其机制尚不清楚，但我们认为这是由于脊髓异常发芽造成的。皮质脊髓束传导将使用一种新型的超高频经颅磁刺激装置进行检查，并结合对单个运动单元放电特性的详细分析。在某些情况下，将测试k通道阻滞剂4-氨基吡啶的缓释制剂对传导的影响。

DESCRIPTION (provided by applicant): The purpose of this project is to gain a better understanding of the natural history of plasticity within the human spinal cord following traumatic injury, paying particular attention to changes within the autonomic nervous system and how these influence the development of spasticity. A further goal is to better understand the mechanisms underlying the recovery of conduction within axons of the corticospinal tract in persons with neurologically-incomplete spinal cord injury (SCI). This information may benefit subject selection, choice of outcome measures, and interpretation of findings as new interventions for treating human SCI make their way to clinical trials. We will recruit 150 subjects who have been admitted to University Hospital in Syracuse with acute, traumatic SCI. The overall study will last 5 years. Each subject will be studied repeatedly for a period of approximately 2 years. At each evaluation, voluntary contraction ability will be assessed with manual muscle testing and surface EMG measures. Spinal cord excitability will be measured with a variety of reflexes. Applying specific sensory inputs and recording heartrate variability, blood pressure, and other measures will examine sympathetic activity. Special emphasis will be placed on establishing the time-course of autonomic dysreflexia development, a potentially-lethal consequence of cervical and high-thoracic SCI whose mechanism is poorly understood, but which we believe is due to aberrant sprouting in the spinal cord. Corticospinal tract conduction will be examined using a novel ultra high frequency transcranial magnetic stimulation device coupled with detailed analysis of single motor unit discharge properties. A slow-release formulation the K-channel blocker 4-aminopyridine will be tested for its effects on conduction in some cases.