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Clinical Autonomic Research
Published in: Clinical Autonomic Research 5/2015

01-10-2015 | Research Article

Prevention of recurrent autonomic dysreflexia: a survey of current practice

Authors: Deborah Caruso, David Gater, Christopher Harnish

Published in: Clinical Autonomic Research | Issue 5/2015

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Abstract

Objective

There is a dearth of literature on the treatment of chronic recurrent autonomic dysreflexia (AD), a well-known complication of spinal cord injury that can have life-threatening implications. This study sought to identify clinical practices regarding the treatment of AD, both acute and recurrent, in patients with spinal cord injury (SCI).

Methods

Online survey regarding AD management in SCI composed of 11 questions designed to obtain information on respondent characteristics, AD treatment options, and causes of AD.

Setting

Veterans Administration health care system.

Participants

Veterans Health Administration National SCI Staff Physicians were sent an electronic email to participate in the anonymous web-based survey.

Intervention

None applicable.

Results

The response rate was 52 %. The most commonly prescribed medications for minor and severe acute manifestations of AD were nitrates. For recurrent AD, clonidine was the most commonly prescribed medication.

Interpretation

Anti-hypertensive medications continue to be the mainstay in the management of both acute and chronic recurrent AD. Current literature is lacking in prospective randomized controlled trials investigating the relative efficacy of AD interventions. Evidence-based practice guidelines are necessary to improve clinical care.
Literature
1.
Krassioukov A, Warburton D, Teasell R, Eng J (2009) A systematic review of the management of autonomic dysreflexia after spinal cord injury. Arch Phys Med Rehabil 37:383–391
2.
Curt A, Nitsche B, Rodic B, Schurch B, Dietz V (1997) Assessment of autonomic dysreflexia in patients with cord injury. J Neurol Neurosurg Psychiatry 62:473–477PubMedCentralCrossRefPubMed
3.
Elliot S, Krassioukov A (2006) Malignant autonomic dysreflexia in spinal cord injured men. Spinal Cord 44:386–392CrossRef
4.
5.
Braddom R, Rocco J (1991) Autonomic dysreflexia—a survey of current treatment. Am J Phys Med Rehabil 70(5):234–241CrossRefPubMed
6.
Weaver L (2002) What causes autonomic dysreflexia after spinal cord injury? Clin Auton Res 12:424–426CrossRefPubMed
7.
Leman S, Sequeira H (2002) Activation of adrenal preganglionic neurons during autonomic dysreflexia in the chronic spinal cord-injured rat. Auton Neurosci 98:94–98CrossRefPubMed
8.
Consortium for Spinal Cord Medicine (2002) Acute management of autonomic dysreflexia: adults with spinal cord injury presenting to health care facilities. J Spinal Cord Med 25:S67–S88
9.
Erickson RP (1980) Autonomic hyperreflexia: pathophysiology and medical management. Arch Phys Med Rehab. 61:431–440
10.
Rabchevsky A, Kitzman P (2011) Latest approaches for the treatment of spasticity and autonomic dysreflexia in chronic spinal cord injury. Neurotherapeutics 8:274–282PubMedCentralCrossRefPubMed
11.
12.
Grossman E, Messerli FH, Grodzicki T, Kowey P (1996) Should a moratorium be placed on sublingual nifedipine capsules given for hypertensive emergencies and pseudoemergencies? JAMA 276(16):1328–1331CrossRefPubMed
13.
14.
Crassous PA, Denis C, Paris H, Sénard JM (2007) Interest of alpha2-adrenergic agonists and antagonists in clinical practice: background, facts and perspectives. Curr Top Med Chem 7(2):187–194CrossRefPubMed
15.
16.
Chancellor MB, Erhard MJ, Hirsch IH, Stass WE Jr (1994) Prospective evaluation of terazosin for treatment of autonomic dysreflexia. J Urol 151:111–113PubMed
17.
Luther RR (1989) Terazosin: a new antihypertensive with a favorable effect on lipids. Int J Clin Pharmacol Ther Toxicol 27(7):313–319PubMed
18.
19.
Dessì-Fulgheri P, Bandiera F, Rubattu S et al (1987) Comparison of sublingual and oral captopril in hypertension. Clin Exp Hypertens 9(2–3):593–597
20.
Esmail Z, Shalansky KF, Sunderji R et al (2002) Evaluation of captopril for the management of hypertension in autonomic dysreflexia: a pilot study. Arch Phys Med Rehabil 83(5):604–608CrossRefPubMed
21.
Braddom RL, Johnson EW (1969) Mecamylamine in control of hyperreflexia. Arch Phys Med Rehabil 50:448–453PubMed
22.
Frishman WH (2009) Smoking cessation pharmacotherapy. Ther Adv Cardiovasc Dis 4:287–308CrossRef
23.
Hall PA, Young JV (1983) Autonomic hyperreflexia in spinal cord injured patients: trigger mechanism-dressing changes of pressure sores. J Trauma 23:1074–1075CrossRefPubMed
24.
Wright KD, Agre JC, Wilson BC, Theologides A (1986) Autonomic dysreflexia in a paraplegic man with catecholamine secreting neuroblastoma. Arch Phys Med Rehabil 67:566–567PubMed
25.
Vaidyanathan S, Soni BM, Sett P, Watt JW, Oo T, Bingley J (1998) Pathophysiology of autonomic dysreflexia: long-term treatment with terazosin in adult and pediatric spinal cord injury patients manifesting recurrent dysreflexic episodes. Spinal Cord 36:761–770CrossRefPubMed
26.
Krum H, Louis WJ, Brown DJ, Howes LG (1992) A study of the alpha-1 adrenoreceptor blocker prazosin in the prophylactic management of autonomic dysreflexia in high spinal cord injury patients. Clin Auton Res 2(2):83–88CrossRefPubMed
27.
Lindan R, Leffler E, Kedia K (1985) A comparison of the efficacy of an alpha 1 adrenergic blocker in the slow calcium channel blocker in the control of autonomic dysreflexia. Paraplegia 23:34–38CrossRefPubMed
28.
McGuire EJ, Wagner FM, Weiss RM (1977) Treatment of autonomic dysreflexia. J Urol 118:70–72
29.
Sizemore GW, Winternitz WW (1970) Autonomic hyper-reflexia—suppression with alpha-adrenergic blocking agents. N Engl J Med 282(14):795CrossRefPubMed
30.
Shessel FS, Carrion HM, Politano VA (1978) Phenoxybenzamine and sweating in the spinal cord injury patient. J Urol 120(1):60–61PubMed
31.
Guyton AC, Hall JE (2000) Textbook of medical physiology. W.B. Saunders Company, Philadelphia
32.
Scott MB, Morrow JW (1978) Phenoxybenzamine in neurogenic bladder dysfunction after spinal cord injury. J Urol 199:483–484
33.
Dykstra DD, Sidi AA, Scott AB, Pagel JM, Goldish GD (1988) Effects of botulinum A toxin on detrusor-sphincter dyssynergia in spinal cord injury patients. J Urol 139:919–922PubMed
34.
Gamé X, Castel-Lacanal E, Bentaleb Y et al (2008) Botulinum toxin A detrusor injections in patients with neurogenic detrusor overactivity significantly decrease the incidence of symptomatic urinary tract infections. Eur Urol 53(3):613–618 Epub 2007 Aug 28 CrossRefPubMed
35.
Giannantoni A, Di Stasi SM, Stephen RL, Bini V, Costantini E, Porena M (2004) Intravesical resiniferatoxin versus botulinum-A toxin injections for neurogenic detrusor overactivity: a prospective randomized study. J Urol 172:240–243CrossRefPubMed
36.
MacDonald R, Fink HA, Huckabay C, Monga M, Wilt TJ (2007) Botulinum toxin for treatment of urinary incontinence due to detrusor overactivity: a systematic review of effectiveness and adverse effects. Spinal Cord 45(8):535–541 Epub 2007 Apr 24 CrossRefPubMed
37.
Giannantoni A, Di Stasi SM, Stephen RL et al (2002) Intravesical capsaicin versus resiniferatoxin in patients with detrusor hyperreflexia: a prospective randomized study. J Urol 167(4):1710–1714CrossRefPubMed
38.
Igawa Y, Satoh T, Mizusawa H et al (2003) The role of capsaicin-sensitive afferents in autonomic dysreflexia in patients with spinal cord injury. BJU Int 91(7):637–641CrossRefPubMed
39.
Barton CH, Khonsari F, Vaziri ND, Byrne C, Gordon S, Friis R (1986) The effect of modified transurethral sphincterotomy on autonomic dysreflexia. J Urol 135(1):83–85PubMed
40.
Perkash I (2007) Transurethral sphincterotomy provides significant relief in autonomic dysreflexia in spinal cord injured male patients: long-term followup results. J Urol 177(3):1026–1029CrossRefPubMed
41.
Ricottone AR, Pranikoff K, Steinmetz JR, Constantino G (1995) Long-term follow-up of sphincterotomy in the treatment of autonomic dysreflexia. Neurourol Urodyn 14(1):43–46CrossRefPubMed
42.
Teichman JM, Harris JM, Currie DM, Barber DB (1998) Malone antegrade continence enema for adults with neurogenic bowel disease. J Urol 160(4):1278–1281CrossRefPubMed
43.
Hohenfellner M, Pannek J, Botel U (2001) Sacral bladder denervation for treatment of detrusor hyperreflexia and autonomic dysreflexia. Urology 58:28–32CrossRefPubMed
44.
Pannek J, Göcking K, Bersc U (2010) Sacral rhizotomy: a salvage procedure in a patient with autonomic dysreflexia. Spinal Cord 48:347–348CrossRefPubMed
45.
Kofler M, Poustka K, Saltuari L (2009) Intrathecal baclofen for autonomic instability due to spinal cord injury. Auton Neurosci 146:106–110CrossRefPubMed
46.
Creasey GH, Grill JH, Korsten M et al (2001) Implanted Neuroprosthesis Research Group: an implantable neuroprosthesis for restoring bladder and bowel control to patients with spinal cord injuries: a multicenter trial. Arch Phys Med Rehabil 82:1512–1519CrossRefPubMed
Metadata
Title
Prevention of recurrent autonomic dysreflexia: a survey of current practice
Authors
Deborah Caruso
David Gater
Christopher Harnish
Publication date
01-10-2015
Publisher
Springer Berlin Heidelberg
Published in
Clinical Autonomic Research / Issue 5/2015
Print ISSN: 0959-9851
Electronic ISSN: 1619-1560
DOI
https://doi.org/10.1007/s10286-015-0303-0

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