Recovery from spinal cord injuries can be predicted

Injuries to the spinal cord result in tissue loss in the spinal cord and brain. These neuro-degenerative changes can be analyzed in detail using neuro-imaging methods.

How well patients recover from a spinal cord injury can be reliably predicted. Marc Bolliger iIllustration

University of Zurich 8 March 2018

UZH researchers have now for the first time been able to reliably predict the extent of functional recovery in patients suffering from a spinal cord injury two years after a trauma based on the extent and progression of neuro-degenerative changes within the first six months after injury.

A trauma to the spinal cord, quickly leads to a progressive loss of nerve tissue. This not only affects the injured area, but over time affects also other parts of the spinal cord and even the brain. These neuro-degenerative changes can be explored in detail using magnetic resonance imaging. An international team of researchers headed up by Patrick Freund from the Spinal Cord Injury Center of the University of Zurich and the Balgrist University Hospital has now for the first time investigated the extent and progression of microstructural changes over the first two years after a spinal cord injury.

The smaller the initial nerve loss, the better the long-term recovery
In their study, the scientists examined 15 patients who had suffered acute traumatic injuries to the spinal cord as well as 18 healthy study participants after 2, 6, 12, and 24 months. In the brain as well as spinal cord, they determined the anatomical extent of neuro-degeneration, the loss of myelin (the insulating layer surrounding nerve cells), as well as the accumulation of iron in the nerve tissue as a result of degeneration and inflammation.

It then emerged that there was a direct link between the recovery levels of patients after two years and the extent of neuro-degenerative change within the first six months after injury. “The smaller the overall loss of nerve tissue across the neuro-axis at the beginning, the better the patients’ long-term clinical recovery,” summarizes Patrick Freund.

Predicting long-term recovery by measuring early changes
What the researchers found surprising was the fact that the recovery was steepest within the first six months but neuro-degenerative changes greatest within the same time period with no signs of deceleration over two years in the spinal cord and brain. This indicates a fierce competition between compensatory and neuro-degenerative changes early after injury.

The battle seems to be lost in favor of neuro-degeneration over time. Nevertheless, the magnitude of early microstructural changes is predictive of the long term recovery of patients suffering from a spinal cord injury. Crucially, non-invasive, high-resolution neuro-imaging provides a mean to predict recovery trajectories and distinguish between neuro-degeneration caused by the spinal cord injury itself and beneficial changes resulting from therapy.

“We have now a tool to reliably predict recovery and determine the effects of treatments and rehabilitation measures as opposed to spontaneous neuro-degeneration in humans” adds neuro-imaging specialist Freund. “Clinical studies can thus be carried out more efficiently and cost-effectively in the future.”

Clinical studies into the influence of arm and leg exercises planned
The patients who took part in the study will be examined again after five years using the same method. The scientists want to determine whether the neuro-degenerative changes will have ceased by then or whether they will still be ongoing.

Patrick Freund and his team are also planning training studies that aim to show whether the high-intensity exercising of arm and leg functions helps to slow down or stop the loss of nerve tissue.

Source University of Zurich
via Science Daily

Progressive neurodegeneration following spinal cord injury – Implications for clinical trials, Gabriel Ziegler, Patrick Grabher, Alan Thompson, Daniel Altmann, Markus Hupp, John Ashburner, Karl Friston, Nikolaus Weiskopf, Armin Curt and Patrick Freund. Neurology Mar 2018, 10.1212/WNL.0000000000005258; DOI: 10.1212/WNL.0000000000005258

Tracking Changes following Spinal Cord Injury – Insights from Neuroimaging, Patrick Freund, Armin Curt, Karl Friston, and Alan Thompson. Neuroscientist. 2013 Apr; 19(2): 116–128. doi: 10.1177/1073858412449192

Also see
Brain-Computer Interface Therapy Triggers Some Recovery From Spinal Cord Injury in IEEE Spectrum
Bypass commands from brain to legs through computer in Science Daily
Important control mechanisms for walking identified in Medical University Vienna
MRI Analysis with Machine Learning Can Predict Motor Impairment after Spinal Cord Injury, Study Shows in American Roentgen Ray Society, ARRS 2018 Annual Meeting

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