Influence of alcohol intake on the course and consequences of spinal cord injury

Liver inflammation at the time of spinal cord injury enhances intraspinal pathology, liver injury, metabolic syndrome and locomotor deficits

The current high obesity rates mean that neurological injuries are increasingly sustained on a background of systemic pathology, including liver inflammation, which likely has a negative impact on outcomes. Because obesity involves complex pathology, the effect of hepatic inflammation alone on neurological recovery is unknown. Thus, here we used a gain-of-function model to test if liver inflammation worsens outcome from spinal cord injury (SCI) in rats. Results show liver inflammation concomitant with SCI exacerbated intraspinal pathology and impaired locomotor recovery. Hepatic inflammation also potentiated SCI-induced non-alcoholic steatohepatitis (NASH), endotoxemia and insulin resistance. Circulating and cerebrospinal levels of the liver-derived protein Fetuin-A were higher in SCI rats with liver inflammation, and, when microinjected into intact spinal cords, Fetuin-A caused macrophage activation and neuron loss. Thus, liver inflammation functions as a disease modifying factor to impair recovery from SCI, and Fetuin-A is a potential neuropathological mediator. Since SCI alone induces acute liver inflammation, the liver may be a novel clinical target for improving recovery from SCI.

Changes in alcohol use after the onset of spinal cord injury

OBJECTIVE

Identify the prevalence of alcohol consumption and binge drinking at time of spinal cord injury (SCI) onset, compare these rates to data from the general population, and identify changes in alcohol use at an average of 17 months post-injury.

DESIGN

Cross sectional, mailed self-report assessment.

SETTING

A specialty hospital in the southeastern United States.

PARTICIPANTS

Five hundred sixty-six inpatients completed the baseline measure. After eliminating those under age 18, there were 524 participants at baseline. 410 were approached for follow-up, with 201 of those responding.

INTERVENTIONS

N/A.

OUTCOME MEASURES

Self-reported assessments were completed during inpatient rehabilitation and at follow-up approximately 17 months later. The two primary outcomes were the number of days consuming 5 or more drinks (binge drinking) and the number of days consuming any alcoholic beverages within the 30 days prior to the assessment. Comparison data were taken from the Behavioral Risk Factor Surveillance System.

RESULTS

At SCI onset, the prevalence of alcohol use, particularly binge drinking, was substantially higher than the general population (SCI = 44.9%; general population = 13%). Drinking rates decreased by 17 months post-injury.

CONCLUSION

Alcohol use and binge drinking are elevated over the general population at the time of injury. Drinking patterns reflect a decrease following injury but remain slightly elevated, signifying a need for interventions to minimize long-term health consequences.

Use of psychoactive substances in persons with spinal cord injury: a literature review

OBJECTIVE

To undertake a critical review of literature on use of legal and illegal psychoactive substances (PAS) in persons with spinal cord injury (SCI) before and after trauma.

MATERIAL AND METHODS

Hundred and five articles published between 1980 and 2014 on alcohol and drug use in persons with SCI before and after trauma were retrieved from the PubMed and PsycInfo search engines.

RESULTS

Before injury, 25% to 96% of people with SCI reported using alcohol, while 32% to 35% had used illegal drugs. At the time of injury, 31% to 50% of individuals with SCI were intoxicated with alcohol, 16% to 33% with drugs and 26% with a combination of drugs and alcohol. Among those reporting PAS use before injury, up to 50% stated that they had reduced their use during active rehabilitation, during which time only 6% consumed psychoactive substances for the first time. A variety of risk factors are associated with consumption subsequent to spinal cord injury: personality alteration (impulsiveness, aggressiveness), posttraumatic depression, poor coping skills, lack of social support and pain. PAS use can affect the process of rehabilitation, diminish the effectiveness of medication and result in various medical complications.

DISCUSSION/CONCLUSIONS

Few studies have explored the use of alcohol, drugs and psychoactive medications before SCI and during active rehabilitation. To our knowledge, no study has analyzed the evolution of PAS use after hospital discharge, even though return home is associated with new stressors that may trigger risky behaviors. It should be a priority, as early as possible during rehabilitation, to detect persons at risk of developing PAS abuse.

Do preinjury alcohol problems predict poorer rehabilitation progress in persons with spinal cord injury?

OBJECTIVE

To determine whether a history of alcohol-related problems is associated with inpatient rehabilitation progress.

DESIGN

Cross-sectional cohort survey.

SETTING

Acute inpatient rehabilitation program in a level I trauma center.

PARTICIPANTS

Seventy-six of 104 consecutive patients with spinal cord injury (SCI) who met inclusion criteria and had completed interviews and functional outcome data. Participants were on average 38 years old; 84% were white, and 86% were men. Forty-two percent had tetraplegia and 39% had a history of problem drinking.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

FIM instrument admission, discharge, and efficiency scores as well as rehabilitation length of stay (LOS).

RESULTS

The group with a history of problem drinking had significantly lower FIM admission, discharge, and efficiency scores and longer rehabilitation LOS. After controlling for potential confounding factors, a history of problem drinking accounted for a significant proportion of the variance in FIM efficiency scores.

CONCLUSIONS

A history of problem drinking may be a risk factor for poorer rehabilitation progress among patients with SCI. They may be more costly to rehabilitate and may be discharged before attaining an adequate level of independence. Despite this, the current rehabilitation prospective payment system does not recognize this common comorbid condition.

Factors contributing to the increased threat to life following spinal cord injury

An analysis of the mortality rate of 3486 spinal injured patients treated in the early posttraumatic period in the years 1965-1989 in Konstancin, Poland is presented. The data show that the life of the spinal cord injured is threatened by several factors, the most important of which appear to be: the level and degree of the spinal cord lesion; certain causes of injury predisposing to severe nervous system injury; advanced age; and to some extent, concomitant injuries and methods of treatment. The significance of age is demonstrated by a nearly tenfold increase in mortality in the oldest age group of patients with complete spinal cord lesions as compared to the youngest age group of up to 20 years with the same degree of spinal cord damage.