加巴喷丁类药物使用时机与脊髓损伤后运动功能恢复的关系。
Association of timing of gabapentinoid use with motor recovery after spinal cord injury.
机构信息
From the School of Kinesiology (F.M.W., J.L.K.K.), International Collaboration on Repair Discoveries (ICORD) (F.M.W., J.J.C., J.L.K.K.), and Faculty of Pharmaceutical Sciences (J.J.C.), University of British Columbia, Canada; Department of Biosystems Science and Engineering (C.R.J.), ETH Zurich, Switzerland; Department of Neurosurgery (L.G.), Medical University Innsbruck; Institute of Molecular Regenerative Medicine (L.G.), Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University, Austria; Spinal Cord Injury Center (L.G., O.M., D.D.M., B.M.), Trauma Center Murnau; Clinical and Experimental Spinal Cord Injury Research (Neuroparaplegiology) (J.M.S., M.A.K.), Department of Neurology and Experimental Neurology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; and QUEST-Center for Transforming Biomedical Research (M.A.K.), Berlin Institute of Health, Germany. Dr. Kramer is currently affiliated with the Department of Anesthesiology, Pharmacology, and Therapeutics, Faculty of Medicine, University of British Columbia, Canada.
出版信息
Neurology. 2020 Dec 15;95(24):e3412-e3419. doi: 10.1212/WNL.0000000000010950. Epub 2020 Sep 28.
OBJECTIVE
To explore the hypothesis that earlier administration of acute gabapentinoids is beneficial to motor recovery after spinal cord injury in humans.
METHODS
This is an observational study using a cohort from the European Multi-Centre Study about Spinal Cord Injury. Patient charts were reviewed to extract information regarding the administration and timing of gabapentinoid anticonvulsants. The primary outcome measure was motor scores, as measured by the International Standards for Neurological Classification of Spinal Cord Injury, collected longitudinally in the first year after injury. Sensory scores (light touch and pinprick) and functional measures (Spinal Cord Independence Measure) were secondary outcomes. Linear mixed effects regression models included a drug-by-time interaction to determine whether exposure to gabapentinoids altered recovery of muscle strength in the first year after injury.
RESULTS
A total of 201 participants were included in the study and had a median age of 46 and baseline motor score of 50. Participants were mostly men (85%) with sensory and motor complete injuries (50%). Seventy individuals (35%) were administered gabapentinoids within the first 30 days after injury, and presented with similar demographics. In the longitudinal model, the administration of gabapentinoids within 30 days after injury was associated with improved motor recovery when compared to those who did not receive gabapentinoids during this time (3.69 additional motor points from 4 to 48 weeks after injury; = 0.03). This effect size increased as administration occurred earlier after injury (i.e., a benefit of 4.68 points when administered within 5 days).
CONCLUSIONS
This retrospective, observational study provided evidence of the beneficial effect of gabapentinoid anticonvulsants on motor recovery after spinal cord injury. More critically, it highlighted a potential time dependence, suggesting that earlier intervention is associated with better outcomes.
CLASSIFICATION OF EVIDENCE
This study provides Class IV evidence that gabapentinoids improve motor recovery for individuals with acute spinal cord injury.
目的
探索在人类脊髓损伤后早期给予急性加巴喷丁类药物是否有利于运动功能恢复的假说。
方法
这是一项使用欧洲多中心脊髓损伤研究队列的观察性研究。查阅患者病历以提取有关加巴喷丁类抗惊厥药物的使用和时间的信息。主要结局测量指标为损伤后第一年进行的国际脊髓损伤神经分类标准测量的运动评分。次要结局测量指标包括感觉评分（轻触觉和刺痛觉）和功能测量（脊髓独立性测量）。线性混合效应回归模型包括药物-时间相互作用，以确定暴露于加巴喷丁类药物是否会改变损伤后第一年肌肉力量的恢复。
结果
共有 201 名参与者纳入研究，中位年龄为 46 岁，基线运动评分为 50。参与者主要为男性（85%），且损伤完全为感觉运动性（50%）。70 人（35%）在损伤后 30 天内给予加巴喷丁类药物，且这些人的人口统计学特征相似。在纵向模型中，与未在此期间使用加巴喷丁类药物的患者相比，损伤后 30 天内给予加巴喷丁类药物与运动功能恢复改善相关（从损伤后 4 周到 48 周时，运动评分增加 3.69 分； = 0.03）。这种作用大小随着损伤后时间的推移而增加（即，在 5 天内给药时，可获得 4.68 分的益处）。
结论
这项回顾性观察性研究为加巴喷丁类抗惊厥药物对脊髓损伤后运动功能恢复的有益作用提供了证据。更重要的是，它强调了潜在的时间依赖性，表明早期干预与更好的结局相关。
证据分类
本研究提供了 IV 级证据，表明加巴喷丁类药物可改善急性脊髓损伤患者的运动功能恢复。
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