Page 79 - NNS 2014 Program & Abstract Book

Fasting glucose 10.13%; Folate (serum) 5.02%; RBC folate 8.74%;
Vitamin B12 2.06%; Methylmalonic acid 0.44%; Vitamin D insuffi-
ciency (25-OH vitamin D < 30 ng/mL) 65.37%; Vitamin D deficiency
(25-OH vitamin D < 10 ng/mL) 2.37%, and C-reactive protein (CRP)
6.12%.
Neuroendocrine dysfunction (NED) was identified in a minority of
SMs. Compared to the estimated incidence (15% to 30%) of NED in
patients with persistent symptoms following TBI without PH diag-
noses, NED was less frequent in this study cohort. No abnormalities in
IGF-1 were identified in this cohort, which is in contrast to the lit-
erature on growth hormone deficiency in patients with TBI. Secondary
hypogonadism in this cohort will require further study regarding
concurrent conditions, including obstructive sleep apnea, PTSD, and
elevated prolactin levels. Nutritional abnormalities were frequent,
especially Vitamin D. Nutritional abnormalities represent treatable
sequellea of TBI.
Key words
chronic TBI, military, nutrition, trauma
B1-08
DOSE RESPONSE EFFECTS OF ACUTE ADMISTRITATION
OF INTRATHECAL BACLOFEN (ITB) ON TBI-INDUCED
SPASTICITY
Bose, P.K.1,2, Hou, J.1,2, Nelson, R.1, Mustafa, G.2, Sinharoy, A.1,
Pandey, R.2, Wilkie, Z.2, Tsuda, S.2, Page, L.3, Thompson, F.J.1,2
1North Florida/South Georgia Veterans Health System, Gainesville,
USA
2University of Florida, Gainesville, USA
3Medtronic Neuromodulation, Targeted Drug Delivery R & D, Min-
neapolis, USA
Spasticity is a major health problem for patients with moderate to
severe traumatic brain injury (TBI) with a high incidence of inducing
orthopedic disability. The use of anti-spastic medications, particularly
ITB, can decrease the severity of spasticity produced by TBI. However,
current federal guidelines preclude the use of ITB therapy during the
first year following TBI due to insufficient data to assess risk of early
therapies on cognitive, balance, and motor recovery. Therefore, an
objective of the present study was to determine the safety, feasibility,
and efficacy of early intervention treatments (initiated at one week and
continued for 4 weeks) on the long-term outcome of spasticity, cog-
nition, and balance recovery. Three doses were tested: low (0.4 lg/hr),
medium (0.8 lg/hr), and high (1.6 lg/hr) of ITB (Lioresal ) treatments
using Alzet osmotic mini-pumps in a TBI-induced spastic rodent lab-
oratory model (Bose et al, 2012). Velocity dependent ankle torque &
ankle extensor muscle EMGs (as measures of spasticity), rotorod bal-
ance performance, and the Morris water maze (MWM) for spatial
learning were used to quantitate the dose-response effects of these early
ITB treatment doses. Our data to date indicate that ITB treatment can
significantly reduce spasticity in a dose-dependent manner. The me-
dium dose (0.8 lg/hr) provided blockade of early onset spasticity, at-
tenuated late onset spasticity, with minimal negative impact on balance
and cognitive performances. These findings are consistent with mini-
mum effective dose therapy that can provide a potent spasticity re-
duction while significantly decreasing the unintentional influence of
medication on non-target CNS tissues that influence cognitive acuity or
balance. Supported by Medtronic Inc. and VA Merit Review B6570R.
Key words
GABAb agonist, spasticity, therapeutic intervention, traumatic brain
injury
B1-09
THERAPEUTIC TMS REDUCES TBI SPASTICITY, ANXIETY,
AND PAIN
Thompson, F.J.1,2, Hou, J.1,2, Mustafa, G.2, Wilkie, Z.2, Tsuda, S.2,
Nelson, R.1 , Bose, P.K.1,2
1North Florida/South Georgia Veterans Health System, Gainesville,
USA
2University of Florida, Gainesville, USA
TBI can initiate disabilities in cognitive performance, spasticity,
anxiety, and pain that significantly impact the quality of life. Urgently
needed are therapies that can provide safe and effective reduction in
these long-term disabilities without negatively impacting cognitive
recovery. We inadvertently observed potentially significant thera-
peutic benefits induced by an evaluation protocol that used TMS. The
current studies were performed to systematically evaluate the poten-
tial therapeutic benefits induced by this TMS protocol following TBI
in adult rats. Closed head (weight drop acceleration) TBIs were pro-
duced by a modification of the Marmarou procedure (450g x 1.25 m
drop height). The TMS treatments consisted of single pulse TMS
delivered to the surface of the cranium through a 25 mm figure 8 coil.
An intensity ladder using 10% increments from 30% through 70%
maximal intensity was delivered three times per week for one month.
At the completion of treatment, cognitive performance was assessed
using a serial learning paradigm in a Morris water maze (MWM).
Spasticity was quantitated using velocity dependent ankle torque
(VDAT) and triceps surae EMGs. Anxiety was assessed using an
elevated plus maze. A test for thermal hypersensitivity was performed
using a behavioral apparatus to quantitate facial contact to a thermode
during drinking. Compared with intact animals, the TBI animals re-
vealed significant increases in MWM escape latency, significant in-
creases VDAT and TS EMGs, significant increases in time spent in
closed arms of the plus maze, and significantly decreased facial
contact with a thermode during drinking. Compared with the untreated
TBI animals, the TMS treated TBI animals revealed a mean 83.1%
reduction in spasticity, A 92% decrease in anxiety, and 95% decrease
in thermal sensitivity. No changes in serial learning were detected
between treated and untreated animals. These preliminary studies
indicate a significant therapeutic reduction in three long-term TBI
disability measures. (Supported by RR&D Merit B78071 & RR&D
RCSA B7345S).
Key words
anxiety, pain, spasticity, TMS, traumatic brain injury
B1-10
COMBINING ENRICHED ENVIRONMENT, PROGESTER-
ONE, AND EMBRYONIC NEURAL STEM CELL THERAPY
IMPROVES RECOVERY FOLLOWING BRAIN INJURY
Salois, G.J., Searles, M., Nudi, E., Jacqmain, J., Geeck, K., Dubbs,
K., Smith, J.S.
Saginaw Valley State University, Saginaw, USA
Enriched environments (EE), progesterone (PROG), and embryonic
neural stem cells (eNSC) have been investigated as treatments for
traumatic brain injury (TBI). Post-injury EE increases cortical volume
and increases the rate of eNSC survival. Progesterone has been shown
to reduce cellular edema and apoptosis. Transplanted eNSCs reduce
functional losses and have been shown to survive, migrate, and ex-
press neuronal characteristics. Since each approach hypothetically
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