Sexual activity and satisfaction in men with traumatic spinal cord lesion.

OBJECTIVE: To estimate sexual activity and sexual satisfaction in men with spinal cord lesion. DESIGN: Cross-sectional study. SUBJECTS: All adult citizens in Helsinki with traumatic spinal cord lesion were identified. The final study group comprised 92 male subjects, corresponding to a participation rate of 79%. METHODS: A structured questionnaire was sent to all subjects and they were invited for a clinical visit. Clinical examination was based on the manual of the American Spinal Injury Association (ASIA). Examinations were performed on all subjects by the same experienced physician and physiotherapist. RESULTS: In total, 86% of the subjects experienced sexual desire and 68% had been sexually active during the last 12 months. A total of 65% of subjects reported experiencing orgasm since the injury, but most subjects rated it as weaker than before the injury. There were no statistically significant differences between the ASIA Impairment Scale groups. Men with paraplegia reported a more satisfactory sex life (p = 0.05) than those with tetraplegia. CONCLUSION: This study confirms the earlier findings that the ability to reach orgasm is deficient in men with spinal cord lesion. The completeness of the lesion had no effect. The more severe locomotory disability might adversely affect the sex life of persons with tetraplegia compared with those with paraplegia.

Functional independence in persons with spinal cord injury in Helsinki.

OBJECTIVE: To estimate the functional independence of persons with spinal cord injury according to the Functional Independence Measure motor items. DESIGN: The study design was cross-sectional. SUBJECTS: All adult citizens of Helsinki with traumatic spinal cord injury were identified. The final study group consisted of 121/152 subjects (80%). METHODS: Functional Independence Measure assessments and American Spinal Cord Association examinations were performed on all subjects by the same experienced group including a physician and a physiotherapist. RESULTS: The most assistance-craving items were climbing stairs and bladder management. There were no significant differences between the genders. Subjects with tetraplegia needed significantly more assistance in all motor items except walking/wheelchair locomotion, where there was no significant difference. Subjects with tetraplegia in American Spinal Injury Association Impairment Scale D had higher Functional Independence Measure scores, more functional independence, than subjects in American Spinal Injury Association Impairment Scale A-C, the difference being significant. CONCLUSION: Because of new information, the results of this study may provide better possibilities for planning and coordinating rehabilitation measures and social services.

Serum insulin and leptin levels in valproate-associated obesity.

PURPOSE: Weight gain is an important adverse effect of valproate (VPA) therapy, and it is associated with hyperinsulinemia and hyperandrogenism in women with epilepsy. Leptin is considered a signaling factor regulating body weight and energy metabolism. In human subjects, obesity is in general associated with elevated serum leptin levels, suggesting decreased sensitivity to leptin. The present study aimed at evaluating the role of insulin and leptin in VPA-related obesity. METHODS: Body mass index (BMI) was calculated, and serum insulin and leptin levels were measured in 81 patients with epilepsy taking VPA and in 51 healthy control subjects. RESULTS: Forty (49%) of the patients taking VPA and 25 (49%) of the control subjects were obese. The mean insulin levels were higher in VPA-treated patients than in the control subjects despite similar BMI values, when all subjects were included in the comparison. Both obese male and female patients taking VPA had higher serum insulin levels than the respective control subjects with similar BMI values. Serum insulin levels also were higher in lean male and lean female patients compared with the lean control subjects of same sex. Serum leptin levels did not differ between the VPA-treated patients and the control subjects. CONCLUSIONS: Both obese and lean patients taking VPA for epilepsy have hyperinsulinemia, suggesting development of insulin resistance. This may be one of the factors leading to weight gain during VPA treatment. However, the results of the present study do not suggest an independent role for leptin in the pathogenesis of VPA-related obesity.