Treatment of Brown-Séquard

Treatment of Brown-Séquard syndrome varies depending on the source of the condition.

Most commonly, this entails treatment of a traumatic spinal cord injury.  This treatment is begun at the injury site, where paramedics carefully immobilize the spine to prevent any further damage.  Patients are carefully evaluated for other sources of injury, since patients with pain and sensory deficits may be unaware of the significance of other injuries.    Most patients will be admitted to the hospital’s Intensive Care Unit, where their vital signs are carefully monitored due to the likelihood of spinal shock.  In some cases, surgery may be performed to stabilize and correct damage to the vertebral column, even if surgery will not help repair damage to the spinal cord itself.

Some studies have demonstrated improved outcomes in patients given high dose steroids like methylprednisolone very early in the hospital course.  It is thought that this might prevent some secondary damage due to inflammation and swelling.  Individuals are usually given some type of anticoagulation therapy, such as heparin, to lessen the possibility of deep vein thrombosis and pulmonary embolism.  Patients are also usually given a proton-pump inhibitor drug such as omeprazole to lessen the possibility of aspirated gastric fluid damaging the lungs.  (A nasogastric tube to suction out gastric contents may be necessary as well.)  Other medications may be given as needed, such as antibiotics, pain medications, medications decreasing muscle tightness (spasticity), and laxatives.  Many of these medications are not needed long-term as the patient recovers function.

Treatment is more varied for the other non-traumatic causes of Brown-Séquard.  Sometimes these patients are operated on immediately if the spinal cord appears to be compressed, say from a tumor, herniated disc, or blood clot.  When these conditions onset gradually, early intervention is crucial—ideally a patient would be operated on at the first sign of sensory or motor symptoms, before reaching the classic Brown-Séquard syndrome.   These operations should at the very least halt loss of neurological function, and if the tissue is not permanently damaged, it may restore previously lost function.  Conditions like multiple sclerosis and transverse myelitis that are more inflammatory in nature may be treated with high dose steroids.   Infection related causes may require antibiotics or antiviral drugs, depending on the origin.  Again, supportive treatment is warranted, as it is for traumatic cases of Brown-Séquard.

Most cases of Brown-Séquard will require long-term care and rehabilitation.  A mainstay of this is physical therapy, which begins in the very early phases of treatment and continues for months or years.  Therapists seek to maintain strength in unaffected muscles and maintain normal range of motion in joints.  They also utilize breathing exercise to improve respiratory function, and they help prevent skin breakdown through proper weight shifting.  Past the acute phase of treatment, the patient progresses to wheelchair mobility, and often, self-ambulation.  This usually requires the use of orthotic devices such as braces.  Therapists also provide educational support for the patient and family about their condition.  .

Occupational therapy helps enable patients to regain independence in the activities of daily living.   The occupational therapist may teach the patient new techniques for oral hygiene, dressing, etc., sometimes utilizing adaptive equipment.  This therapy is continued as long as a patient continues to show improvement.

Research for new treatments in treatment for spinal cord injuries is ongoing, and some new therapies offer promise in animal models, though no other medicinal therapy is currently approved for use in humans.   Clinical trials are ongoing: for example, as of this writing a clinical trial is planned for the drug riluzole.   The National Institute of Neurological Disorders and Stroke provides links to ongoing clinical trials in this area (http://www.ninds.nih.gov/disorders/sci/sci.htm).  There is some evidence that deliberately lowering the body’s temperature immediately after injury may lead to improved outcomes in spinal cord injury, those this is not standard treatment at this time.

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