Freda M Warner1,2, Catherine R Jutzeler1,2,3, Jacquelyn J Cragg2, Bobo Tong2, Lukas Grassner4,5,6, Frank Bradke7, Fred Geisler8, John K Kramer9,10. 1. School of Kinesiology, University of British Columbia, Vancouver, BC, Canada. 2. International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Blusson Spinal Cord Centre, 818 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada. 3. Spinal Cord Injury Center, University Hospital Balgrist, University of Zurich, Zurich, Switzerland. 4. Department of Neurosurgery and Center for Spinal Cord Injuries, Trauma Center Murnau, Murnau, Germany. 5. Department of Neurosurgery, Medical University Innsbruck, Innsbruck, Austria. 6. Institute of Molecular Regenerative Medicine, Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University, Salzburg, Austria. 7. Axon Growth and Regeneration Group, German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany. 8. Department of Medical Imaging, University of Saskatchewan, Saskatoon, SK, Canada. 9. School of Kinesiology, University of British Columbia, Vancouver, BC, Canada. kramer@icord.org. 10. International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Blusson Spinal Cord Centre, 818 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada. kramer@icord.org.
Abstract
BACKGROUND: Recent observational studies have shown an association between gabapentinoid anticonvulsants and greater motor recovery after spinal cord injury. There is preclinical evidence to suggest that other anticonvulsants, such as sodium channel blockers, may also confer beneficial effects. PURPOSE: The aim of the current study was to determine if non-gabapentinoid anticonvulsants were associated with neurological recovery after acute, traumatic spinal cord injury. METHODS: This was an observational cohort study using data from the Sygen clinical trial. The primary outcome was total motor score recovery in the first year after injury. Anticonvulsant use was extracted from concomitant medication records; individuals were classified based on early administration (within 30 days of injury), or late/no administration. Motor recovery was compared using linear mixed effects regression models with a drug-by-time interaction, and adjustment for confounders. A secondary analysis incorporated a propensity score matched cohort. RESULTS: Of the cohort (n = 570), 6% received anticonvulsants (carbamazepine, phenytoin, clonazepam, phenobarbital, and valproic acid) early after injury. After adjustments for initial injury level and severity, early exposure to non-gabapentinoid anticonvulsants was not associated with motor neurological outcomes (p = 0.38 for all anticonvulsants, p = 0.83 for sodium channel blockers, p = 0.82 in propensity-matched cohort). CONCLUSION: Non-gabapentinoid anticonvulsant exposure was not associated with greater or lesser neurological recovery. This suggests that these medications, as administered for the acute management of spinal cord injury, do not impact long-term neurological outcomes.
BACKGROUND: Recent observational studies have shown an association between gabapentinoid anticonvulsants and greater motor recovery after spinal cord injury. There is preclinical evidence to suggest that other anticonvulsants, such as sodium channel blockers, may also confer beneficial effects. PURPOSE: The aim of the current study was to determine if non-gabapentinoid anticonvulsants were associated with neurological recovery after acute, traumatic spinal cord injury. METHODS: This was an observational cohort study using data from the Sygen clinical trial. The primary outcome was total motor score recovery in the first year after injury. Anticonvulsant use was extracted from concomitant medication records; individuals were classified based on early administration (within 30 days of injury), or late/no administration. Motor recovery was compared using linear mixed effects regression models with a drug-by-time interaction, and adjustment for confounders. A secondary analysis incorporated a propensity score matched cohort. RESULTS: Of the cohort (n = 570), 6% received anticonvulsants (carbamazepine, phenytoin, clonazepam, phenobarbital, and valproic acid) early after injury. After adjustments for initial injury level and severity, early exposure to non-gabapentinoid anticonvulsants was not associated with motor neurological outcomes (p = 0.38 for all anticonvulsants, p = 0.83 for sodium channel blockers, p = 0.82 in propensity-matched cohort). CONCLUSION: Non-gabapentinoid anticonvulsant exposure was not associated with greater or lesser neurological recovery. This suggests that these medications, as administered for the acute management of spinal cord injury, do not impact long-term neurological outcomes.
Authors: M B Bracken; M J Shepard; W F Collins; T R Holford; D S Baskin; H M Eisenberg; E Flamm; L Leo-Summers; J C Maroon; L F Marshall Journal: J Neurosurg Date: 1992-01 Impact factor: 5.115
Authors: J D Steeves; J K Kramer; J W Fawcett; J Cragg; D P Lammertse; A R Blight; R J Marino; J F Ditunno; W P Coleman; F H Geisler; J Guest; L Jones; S Burns; M Schubert; H J A van Hedel; A Curt Journal: Spinal Cord Date: 2010-08-17 Impact factor: 2.772
Authors: J W Fawcett; A Curt; J D Steeves; W P Coleman; M H Tuszynski; D Lammertse; P F Bartlett; A R Blight; V Dietz; J Ditunno; B H Dobkin; L A Havton; P H Ellaway; M G Fehlings; A Privat; R Grossman; J D Guest; N Kleitman; M Nakamura; M Gaviria; D Short Journal: Spinal Cord Date: 2006-12-19 Impact factor: 2.772
Authors: Armin Curt; Catherine R Jutzeler; Lucie Bourguignon; Bobo Tong; Fred Geisler; Martin Schubert; Frank Röhrich; Marion Saur; Norbert Weidner; Rüdiger Rupp; Yorck-Bernhard B Kalke; Rainer Abel; Doris Maier; Lukas Grassner; Harvinder S Chhabra; Thomas Liebscher; Jacquelyn J Cragg; John Kramer Journal: BMC Med Date: 2022-06-14 Impact factor: 11.150
Authors: Freda M Warner; Jacquelyn J Cragg; Catherine R Jutzeler; Lukas Grassner; Orpheus Mach; Doris D Maier; Benedikt Mach; Jan M Schwab; Marcel A Kopp; John L K Kramer Journal: Neurology Date: 2020-09-28 Impact factor: 9.910