Effect of subcutaneous injection of botulinum toxin A on spinal cord injury-associated neuropathic pain.

STUDY DESIGN: Case report. OBJECTIVE: To present a case of spinal cord injury (SCI)-associated neuropathic pain treated with botulinum toxin A injection. SETTING: Outpatient SCI clinic. CASE REPORT: Description of a case in the context of relevant literature on the subject. RESULTS: A 51-year-old man with C3 AIS B tetraplegia (American Spinal Injury Association Impairment Scale B) visited our outpatient clinic due to severe ongoing neuropathic pain and associated allodynia and dysesthesia of the lower limbs. He had previously tried combinations of pregabalin, gabapentin and oxycontin but all failed to alleviate his neuropathic pain during the 2 years post trauma. With the patient's consent, he was treated with subcutaneous injections of clostridium type A botulinum toxin. Ten units of type A botulinum toxin subcutaneously injected into 10 most painful sites of each sole. The patient was reassessed at 4 and 8 weeks after his injection with botulinum toxin with significant improvement of his neuropathic pain. CONCLUSION: Subcutaneous injection of type A botulinum toxin was effective without side effects, on one case of refractory neuropathic pain due to SCI. This is the first article to report the use of type A botulinum toxin in neuropathic pain related to traumatic SCI.

Comparison of bacterial strains and antibiotic susceptibilities in urinary isolates of spinal cord injury patients from the community and hospital.

STUDY DESIGN: A one-year epidemiological survey. OBJECTIVE: To compare bacterial strains and antimicrobial susceptibilities of urinary isolates from hospital and community spinal cord injury (SCI) patients. SETTING: A specialized SCI unit in a freestanding rehabilitation hospital. METHODS: From June 2012 through May 2013, urine cultures were obtained from all of the newly admitted patients. Bacterial strains and antimicrobial susceptibilities were compared between patients from community and hospital settings. RESULTS: The proportion of Enterobacteriaceae in the total urinary isolates from hospital-dwelling patients was smaller than that from community-dwelling patients (66.0 vs. 85.5%, P<0.001), while the proportions of Pseudomonas, Acinetobacter and Enterococcus species were relatively larger (8.7%, 6.0% and 12.0% vs. 2.8%, 0.7% and 2.8%, respectively, P<0.05). The isolates from hospital-dwelling patients showed lower susceptibility to ampicillin, amoxicillin-clavulanic acid, trimethoprim-sulfamethoxazole and all generations of cephalosporin (P<0.05), and a higher prevalence of extended-spectrum beta-lactamase (ESBL)-producers (41.7 vs. 5.4%, P<0.001), compared with those from community-dwelling patients. The susceptibility rates to levofloxacin were lower than 50% in both community and hospital-dwelling patients. CONCLUSION: Broader-spectrum antibiotics should be considered in treating nosocomial urinary tract infection (UTI) of SCI patients because of the relatively wide variety of organisms and higher frequency of antibiotic-resistant strains, including ESBL-producing Enterobacteriaceae in hospital-derived specimens. Furthermore, in areas with high prevalence of fluoroquinolone resistance, fluoroquinolones should be used with caution during empirical treatment for UTI in SCI patients.

Fos expression in serotonergic midbrain neurons projecting to the paraventricular nucleus of hypothalamus after noxious stimulation of the stomach: a triple labeling study in the rat.

Horseradish peroxidase (HRP) was stereotaxically injected into the paraventricular nucleus of the hypothalamus (PVH) and visceral noxious stimulation was given by an administration of formalin into the stomach. The brain sections were subjected to HRP histochemistry and immunostained with Fos and serotonin antibodies. The periaqueductal gray (PAG) and dorsal raphe nucleus (DR) contained single-labeled (Fos, 5HT, HRP), double-labeled (Fos/HRP, Fos/5HT, HRP/5HT) and triple-labeled (HRP/Fos/5HT) neurons. Triple-labeled neurons were mainly observed in the DR and in discrete areas of the PAG ipsilateral to side of the HRP injection. These findings suggest that a population of serotonergic midbrain neurons receive nociceptive visceral information and project to the PVH.