Treatment of postprandial hypotension with acarbose in an adult with cervical spinal cord injury: a case report.

INTRODUCTION: Postprandial hypotension is a type of autonomic dysfunction where there is a decrease in systolic blood pressure of >20 mm HG within 2 h after eating thought to be due to poor cardiovascular compensation for splanchnic blood pooling that occurs with meals. This form of autonomic dysfunction is underdiagnosed in patients with spinal cord injury, likely in part because it can be asymptomatic. CASE PRESENTATION: 26-year-old with complete cervical spinal cord injury (SCI) presented with neck pain described as severe 10/10 pain, which felt like "a rope around his neck." Pain came on during and after meals and was associated with a feeling of pressure behind his eyes, white spots in his vision along with feeling as if he was going to pass out. The caregiver noted a systolic blood pressure drop by about 30-40 points with meals and lost weight due to avoiding eating. A diagnosis of post-prandial hypotension (PPH) was made and Acarbose was started at a low dose 25 mg three times per day with meals. During follow up, the patient reported complete resolution of drops of blood pressure, neck pain, and all associated symptoms. The patient was able to eat comfortably and gained weight. DISCUSSION: There are few case reports on PPH in SCI and none looking at acarbose on a young, nondiabetic person with SCI. Clinicians should be aware that PPH can occur in young otherwise healthy people with SCI. Further research is needed on PPH, including the use of acarbose, in the SCI population.

Examining the Use of a Rest-Activity Ratio in a Pediatric Rehabilitation Setting.

OBJECTIVE: To examine the relationship between an estimate of sleep-wake regulation derived from actigraphy and determine whether it would be sensitive to neurocognitive dysfunction associated with acquired brain injury (ABI) in a pediatric rehabilitation sample. DESIGN: Cross-sectional design. SETTING: Inpatient pediatric rehabilitation facility. PARTICIPANTS: A sample (N=43) of 31 males (72.1%) and 12 females (27.9%) admitted to a pediatric rehabilitation hospital wore an actigraph (wrist accelerometer) for 1 week. Participant ages ranged from 8 to 17 years (mean, 13.1y; SD, 2.7y). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Raw actigraphy activity counts in 1-minute epochs were used to derive a rest-activity ratio over each 24-hour period; a 5-day average value was calculated for Monday through Friday. Brain injury status was derived through medical record review, resulting in the formation of 3 groups: traumatic brain injury (n=14), nontraumatic brain injury (n=16), and a non-ABI control group (n=13). Functional status was measured using FIM for children (WeeFIM) Cognitive and Motor scores extracted from the medical records. RESULTS: Unadjusted models showed a significant main group effect for brain injury status (P=.012). Compared with controls, the rest-activity ratio was significantly lower in both the traumatic brain injury (P=.005), and nontraumatic brain injury (P=.023) groups. However, the main group effect was no longer significant in an adjusted model controlling for WeeFIM Cognitive and WeeFIM Motor scores at admission. In the context of the adjusted model, there was a significant relationship between the rest-activity ratio and WeeFIM Cognitive scores at admission. CONCLUSIONS: Individuals with lower functional status at admission, especially in the cognitive domain, had lower rest-activity ratios, suggesting poorer sleep-wake regulation. Similar to findings in adults with ABI, this ratio may have utility in tracking sleep-wake regulation in the pediatric rehabilitation setting. Future studies should investigate sensitivity to change over the course of recovery and responsiveness to clinical interventions to improve sleep.

Onabotulinum Toxin A Injections Into the Salivary Glands for Spinal Muscle Atrophy Type I: A Prospective Case Series of 4 Patients.

OBJECTIVE: The aim of the study was to investigate the safety and efficacy of onabotulinum toxin A injection to the salivary glands under ultrasound guidance for the treatment of sialorrhea in patients with spinal muscular atrophy type I. DESIGN: Prospective case series with four patients with spinal muscular atrophy type I who received onabotulinum toxin A injection to parotid and submandibular glands for sialorrhea as part of clinical care. All four patients received validated surveys for measuring drooling, including objective measures of number of bib changes, and number of mouth wipes before injection and 4-6 wks after injection. Research was limited to survey completion. Scales included the Drooling Severity and Frequency Scale and the Drooling Impact Scale as well as a new scale used in our clinic, the Posterior Drooling Scales looking at coughing/choking and number of aspiration pneumonias. RESULTS: There were no adverse events. All four patients showed clinically significant improvements. The improvement in drooling using the Drooling Impact Scale was statistically significant (paired t test, t = 3.243, P = 0.048). All patients improved with number of mouth wipes. CONCLUSION: Ultrasound-guided onabotulinum toxin A injections to the salivary glands may be a safe and effective method of decreasing drooling in patients with spinal muscular atrophy type I.