Amy N Nevin1, Khanh Nguyen2, Sridhar Atresh2, Angela Vivanti1,3, Ingrid J Hickman1,4. 1. Department of Nutrition and Dietetics, Princess Alexandra Hospital, Queensland, Australia. 2. Spinal Injuries Unit, Princess Alexandra Hospital, Queensland, Australia. 3. School Human Movement and Nutrition Sciences, University of Queensland, Queensland, Australia. 4. Mater Research Institute, University of Queensland, Translational Research Institute, Queensland, Australia.
Abstract
INTRODUCTION: The impact of muscle spasticity on weight change and energy expenditure after spinal cord injury (SCI) is not well understood. CASE PRESENTATION: This case study reports changes to body weight and resting energy expenditure (REE) in a 36-year-old female (T3 AIS A SCI; 80 kg; body mass index=28 kg m-2 at injury) requiring escalating therapies to manage severe spasticity. Body weight, spasticity medications and fasted REE (measured using indirect calorimetry, canopy hood) were recorded at 4, 16, 17, 20 and 44 months post injury. Spasticity was assessed at each time point using the Modified Ashworth Scale (MAS). At 4 months post injury, REE was high (1710 kcal per day) corresponding with severe spasticity in the lower limbs (4 on the MAS). Over the following 12 months, the patient experienced an 8 kg weight loss, visible lower limb muscle wasting and a 30% reduction in REE while requiring increasing drug therapies for spasticity. With insertion of an intrathecal Baclofen pump at 17 months and cessation of other medications, spasticity improved markedly and weight increased by 6 kg in 27 months without any significant change to REE (mean=1260 kcal±2%). DISCUSSION: Effective management of spasticity with intrathecal Baclofen appears to be associated with weight gain but not REE. Without body composition and activity energy expenditure data, this observation is difficult to explain. Regardless, routine weight monitoring with appropriate dietary counselling should be considered in this patient group to help prevent unintentional weight gain.
INTRODUCTION: The impact of muscle spasticity on weight change and energy expenditure after spinal cord injury (SCI) is not well understood. CASE PRESENTATION: This case study reports changes to body weight and resting energy expenditure (REE) in a 36-year-old female (T3 AIS A SCI; 80 kg; body mass index=28 kg m-2 at injury) requiring escalating therapies to manage severe spasticity. Body weight, spasticity medications and fasted REE (measured using indirect calorimetry, canopy hood) were recorded at 4, 16, 17, 20 and 44 months post injury. Spasticity was assessed at each time point using the Modified Ashworth Scale (MAS). At 4 months post injury, REE was high (1710 kcal per day) corresponding with severe spasticity in the lower limbs (4 on the MAS). Over the following 12 months, the patient experienced an 8 kg weight loss, visible lower limb muscle wasting and a 30% reduction in REE while requiring increasing drug therapies for spasticity. With insertion of an intrathecal Baclofen pump at 17 months and cessation of other medications, spasticity improved markedly and weight increased by 6 kg in 27 months without any significant change to REE (mean=1260 kcal±2%). DISCUSSION: Effective management of spasticity with intrathecal Baclofen appears to be associated with weight gain but not REE. Without body composition and activity energy expenditure data, this observation is difficult to explain. Regardless, routine weight monitoring with appropriate dietary counselling should be considered in this patient group to help prevent unintentional weight gain.
Authors: Ashraf S Gorgey; Anthony E Chiodo; Eric D Zemper; Joseph E Hornyak; Gianna M Rodriguez; David R Gater Journal: J Spinal Cord Med Date: 2010 Impact factor: 1.985
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