Review article (meta-analysis)A Systematic Review of the Management of Autonomic Dysreflexia After Spinal Cord Injury
Section snippets
Methods
A keyword literature search of original articles, previous practice guidelines, and review articles was conducted to identify all English-language literature, published from 1950 to 2007, evaluating the efficacy of any intervention related to AD in the SCI population. Population key words—spinal cord injury, paraplegia, tetraplegia, and quadriplegia—were individually paired with autonomic dysreflexia, autonomic, dysreflexia, blood pressure, nifedipine, phenazopyridine, beta-blockers, detrusor
Results
The 31 selected articles were categorized according to (1) preventative strategies to reduce episodes and symptoms of AD from common triggers (eg, from the urogenital system, gastrointestinal system, general surgery, exercise)31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48; and (2) therapeutic management strategies, either acute or chronic, for AD.45, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61 The management of AD included both nonpharmacologic and pharmacologic
Discussion
The objective of this review was to evaluate the latest evidence from clinical literature on present strategies in the management and prevention of AD, as well as to present latest basic science and clinical data on the mechanisms and pathophysiology of this condition. The very small number of RCTs (n=6)33, 40, 41, 48, 58, 61 demonstrates the difficulty of applying this type of review to assessing AD. In many instances (eg, acute life-threatening episodes of AD), it would be unethical to have a
Conclusions
There is a severe lack of controlled trials in the management and prevention of AD. A variety of options are available to prevent AD (eg, surgical, pharmacologic), but only intersphincteric anal block with lidocaine when undergoing anorectal procedures had evidence using a control group (level 1). The identification and elimination of specific triggers for AD (eg, distended bladder) are considered the first line of treatment based on physiologic rationale and expert consensus, but there are
References (101)
- et al.
Cardiovascular consequences of loss of supraspinal control of the sympathetic nervous system after spinal cord injury
Arch Phys Med Rehabil
(2000) - et al.
Silent autonomic dysreflexia during voiding in men with spinal cord injuries
J Urol
(1996) - et al.
The clinical problems in cardiovascular control following spinal cord injury: an overview
Prog Brain Res
(2006) Segmental organization of spinal reflexes mediating autonomic dysreflexia after spinal cord injury
Prog Brain Res
(2006)- et al.
Morphological changes in sympathetic preganglionic neurons after spinal cord injury in rats
Neuroscience
(1996) - et al.
Evidence for physiotherapy practice: a survey of the Physiotherapy Evidence Database (PEDro)
Aust J Physiother
(2002) - et al.
Effects of botulinum A toxin on detrusor-sphincter dyssynergia in spinal cord injury patients
J Urol
(1988) - et al.
Botulinum-A toxin for treating detrusor hyperreflexia in spinal cord injured patients: a new alternative to anticholinergic drugs?preliminary results
J Urol
(2000) - et al.
Intravesical capsaicin versus resiniferatoxin in patients with detrusor hyperreflexia: a prospective randomized study
J Urol
(2002) - et al.
Sacral bladder denervation for treatment of detrusor hyperreflexia and autonomic dysreflexia
Urology
(2001)
The effect of modified transurethral sphincterotomy on autonomic dysreflexia
J Urol
Nifedipine pretreatment for autonomic dysreflexia during electroejaculation
Urology
Incidence and management of autonomic dysreflexia and other intraoperative problems encountered in spinal cord injury patients undergoing extracorporeal shock wave lithotripsy without anesthesia on a second generation lithotriptor
J Urol
The effect of nifedipine on cystoscopy-induced autonomic hyperreflexia in patients with high spinal cord injuries
J Urol
Evaluation of captopril for the management of hypertension in autonomic dysreflexia: a pilot study
Arch Phys Med Rehabil
The effect of terazosin on bladder function in the spinal cord injured patient
J Urol
Prospective evaluation of terazosin for the treatment of autonomic dysreflexia
J Urol
Epidemiology and risk factors for urinary tract infection following spinal cord injury
Arch Phys Med Rehabil
Recent trends in mortality and causes of death among persons with spinal cord injury
Arch Phys Med Rehabil
Urethral reconstruction in spinal cord injury patients
J Urol
A multicenter study of women's self-reported reproductive health after spinal cord injury
Arch Phys Med Rehabil
Female sexual function after spinal cord injury
Prog Brain Res
Autonomic hyperreflexia: a mortal danger for spinal cord-damaged women in labor
Am J Obstet Gynecol
Functional electrical stimulation effect on orthostatic hypotension after spinal cord injury
Arch Phys Med Rehabil
Antihypertensive therapy, nifedipine, and autonomic dysreflexia
Arch Phys Med Rehabil
Management of autonomic hyperreflexia with magnesium sulfate during labor in a woman with spinal cord injury
Am J Obstet Gynecol
Management of life-threatening autonomic hyper-reflexia using magnesium sulphate in a patient with a high spinal cord injury in the intensive care unit
Br J Anaesth
Cardiovascular control in spinal man
Annu Rev Physiol
Autonomic disturbances in spinal cord lesions
Cardiovascular responses to vibrostimulation for sperm retrieval in men with spinal cord injury
J Spinal Cord Med
Incidence of autonomic dysreflexia and silent autonomic dysreflexia in men with SCI undergoing sperm retrieval: implications for clinical practice
J Spinal Cord Med
Seizures secondary to autonomic dysreflexia
Arch Phys Med Rehabil
Atrial fibrillation associated with autonomic dysreflexia
Am J Phys Med Rehabil
Fatal cerebral hemorrhage due to autonomic dysreflexia in a tetraplegic patient: case report and review
Paraplegia
Cerebral hemorrhage due to autonomic dysreflexia in a spinal cord injury patient
Spinal Cord
Autonomic dysreflexia and sudden death in people with traumatic spinal cord injury
Am J Forensic Med Pathol
The cardiovascular system in tetraplegia and paraplegia
Assessment of autonomic dysreflexia in patients with spinal cord injury
J Neurol Neurosurg Psychiatry
Autonomic dysreflexia in acute spinal cord injury: an under-recognized clinical entity
J Neurotrauma
Early autonomic dysreflexia
Spinal Cord
Malignant autonomic dysreflexia in spinal cord injured men
Spinal Cord
Sympathetic-sensory coupling in the peripheral nervous system may contribute to autonomic dysreflexia following spinal cord injury
J Spinal Cord Med
Neutralizing intraspinal nerve growth factor blocks autonomic dysreflexia caused by spinal cord injury
J Neurosci
Sensitivity of sympathetically correlated spinal interneurons, renal sympathetic nerve activity, and arterial pressure to somatic and visceral stimuli after chronic spinal injury
J Neurotrauma
Descending vasomotor pathways in humans: correlation between axonal preservation and cardiovascular dysfunction after spinal cord injury
J Neurotrauma
Calcitonin gene-related peptide immunoreactivity in chronic human spinal cord injury
Spinal Cord
The changes in human spinal sympathetic preganglionic neurons after spinal cord injury
Spinal Cord
Autonomic dysreflexia in tetraplegic patients: evidence for alpha-adrenoceptor hyper-responsiveness
Clin Auton Res
Diversity of sympathetic vasoconstrictor pathways and their plasticity after spinal cord injury
Clin Auton Res
Spinal cord injury rehabilitation evidence: method of the SCIRE systematic review
Top Spinal Cord Inj Rehabil
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Supported by the Rick Hansen Man in Motion Foundation and the Ontario Neurotrauma Fund, the Michael Smith Foundation for Health Research, and the Canadian Institutes of Health Research.
No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.