Serotonergic Modulation of Motor Function in Subacute and Chronic SCI

This is an interventional treatment trial for Spinal Cord Injury focused on measuring Gait training, Lexapro, Tizanidine Read More

Inclusion Criteria:

• age of subjects between 18 and 65 years of age, due to the effects of greater age on functional recovery of ambulation (Penrod et al. 1990);
• medically stable with medical clearance from the subject's primary internist or physiatrist to participate;
• level of the lesion between C5-T10 spinal cord level due to non-progressive etiology;
• <6 months or >1 yr since initial injury. Range of motion requirements include: ankle dorsiflexion ankle to 10 degrees and plantarflexion to 30 degrees, knee flexion from 0 to 120 degrees, hip flexion to 90 degrees, and hip extension to 10 degrees.

Exclusion Criteria:

• presence of concurrent severe medical illness, including unhealed decubiti, existing infection, cardiovascular disease, significant osteoporosis (as indicated by history of fractures following injury)
• active heterotrophic ossification in the lower extremities
• known history of peripheral nerve injury in lower legs
• history of known traumatic head injury
• a history of cardiovascular or pulmonary complications, including significant obstructive and/or restrictive lung diseases
• inability to tolerate 30 minutes of standing without orthostasis (decrease in blood pressure by 20 mmHg systolic and 10 mmHg diastolic)
• individuals who are undergoing concurrent physical therapy will be excluded to eliminate confounding effects
• women of childbearing potential will not be excluded, although women who are pregnant will be excluded due to the lack of proven safety of pharmacological agents in pregnant women
• cranial stimulation exclusions: history of epilepsy or a seizure event, metal implants in the head or face, unexplained and recurring headaches, skull abnormalities or fractures, implanted cardiac pacemaker or suffered a concussion within the last 6 months
• interactions with other medications or previous sensitivity to SSRIs, 5-HT antagonists or anti-histamines
• patients prescribed medications for alleviation of spastic motor behaviors, anti-depressant medications, or other medications with known interactions to SSRIs will be excluded from participation unless both attending physician and patient agree to cease all such medications during the evaluation and training period. A 14-day minimum washout period for all such medications will be utilized
• patients with known liver, renal, or other metabolic disease that may interfere with drug action and/or clearance will be excluded from the proposed study. The low daily dosage of the agent to be used (10 mg Lexapro and 16 mg Cypro) has shown very little side effects with patients with hepatic or renal disease
• patients who are diagnosed or previously diagnosed with depression will be excluded. A preliminary screening tool (Center for Epidemiological Studies - Depression Scale) will be administered to all patients. Scores > 16 indicate symptoms of depression. For those patients, a physician will be required to evaluate the subject to determine eligibility.