Medications with anticholinergic properties could delay recovery from brain or spinal cord injury

From University of East Anglia Press Release:

Common medications could delay brain injury recovery

 

Drugs used to treat common complaints could delay the recovery of brain injury patients according to research led by University of East Anglia (UEA) scientists working with other UK universities including Aston and the NHS, published today in Brain Injury.

Prescribed for up to 50 per cent of older people, medications with anticholinergic properties are used to treat a broad range of common conditions including bladder problems, depression and insomnia.

Anticholinergics are already known to have side effects such as temporary cognitive impairment, dizziness and confusion. But their effects on people with pre-existing brain and spinal injuries have not been investigated until now.

Medications with anti-cholinergic properties are often used on neuro-rehabilitation units frequently to manage symptoms from urinary incontinence to pain.

The study of 52 patients with acquired brain or spinal injury at a neuro-rehabilitation unit showed that the average length of stay was longer in patients with a higher level of anticholinergic drugs in their system, known as the anticholinergic drug burden, or ACB.

Results showed that the change in ACB correlated directly to the length of hospital stay. A higher ACB score on discharge, compared with on admission, was associated with a longer stay in hospital and a lower ACB on discharge saw on average a shorter stay. The team cautioned however that as an observational study, cause-and-effect relationship cannot be implied.

Dr Chris Fox, Professor of Clinical Psychiatry at the Norwich Medical School at UEA and lead author on the paper, said: “The findings suggest there may be a statistically significant relationship between ACB score and length of stay in a neuro-rehabilitation unit following traumatic brain or spinal cord injury”.

He added: “This pilot study demonstrates the need for larger studies to confirm the results and need for further investigation into what long-term effects these common medications are having on the recovery of these patients.”

“While medications with ACB are often needed to treat common complications of brain or spinal cord injuries, cognitive impairment due to the medication may adversely affect a patient’s ability to engage in the rehabilitation process, potentially increasing their length of stay in hospital.”

Length of patient stay is used a performance indicator for hospitals, with financial incentives in place for units to discharge patients as soon as is safe.

Dr Ian Maidment, Senior Lecturer in Clinical Pharmacy at Aston University said: “This work adds to the evidence that anticholinergics should be avoided in a wide-range of populations, when possible. Regular medication review by a nurse, doctor or pharmacist may be a way of ensuring that medicines with anti-cholinergic effects are used appropriately.”

 

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SEE ALSO:

Where Can I Find A List of Anticholinergic Drugs?

ABC Anticholinergic Burden Scale

Commonly used drugs with moderate to high anticholinergic properties

Combination of bone marrow stem cells and antioxidant lipoic acid improves recovery in brain-injured mice

From RUVID:

Research team led by CEU-UCH professor Soria treats brain injuries in mice using bone marrow stem cells and antioxidants

21 November 2014 Asociación RUVID

Researchers of CEU Cardenal Herrera University (CEU-UCH) for the first time transplanted bone marrow stem cells into damaged brain tissue while applying lipoic acid (a potent antioxidant), with the aim of improving neuroregeneration in the tissue. This new way of repairing brain damage, which combines cellular treatment with drug therapy, has shown positive results, especially in forming blood vessels (a process called angiogenesis) in damaged areas of the brains of adult laboratory mice. Angiogenesis is a process that is essential to the recovery of damaged neural tissues. The investigation was led by José Miguel Soria López, deputy director of the Institute of Biomedical Sciences at CEU-UCH, and its results were published in the international medical journal Brain Injury.

Professor Soria, who is affiliated to the Department of Biomedical Sciences at CEU-UCH, heads the investigative group ‘Strategies in Neuroprotection and Neuroreparation’, which carried out the investigation in cooperation with the Andalusian Molecular Biology and Regenerative Medicine Centre (CABIMER), located in Sevilla, and the Mediterranean Ophthalmological Foundation, located in Valencia. The research team used the experience they obtained from their previous investigations on the neuroregenerative efficiency of lipoic acid to develop a new remediation strategy for patients of brain damage. This new therapy combines the transplantation of bone marrow stem cells into the brain – in this case, the brains of adult rats – with the administration of the potent antioxidant lipoic acid.

The image above shows the transplant of bone marrow stem cells from transgenic mice under the effects of cerebral cortex after suffering local brain damage. Also visible is a neuroprotective drug therapy.

Lipoic acid is already used in the treatment of degenerative diseases such as multiple sclerosis or diabetic neuropathy. Professor Soria concluded from previous researches he conducted at CEU-UCH that it has the ability to increase the creation of blood vessels, which speeds up cerebral immune response after an injury and stimulates the restoration of damaged tissues. Several other researches, for their part, proved that after brain damage stem cell therapies using a patient’s own bone marrow induce functional improvements. The two therapies – one cellular; the other one pharmacological – were both applied in this research so as to evaluate their combined effect.

New blood vessels

Angiogenesis – the process that forms new blood vessels – in the treated neuronal tissue began only eight days after the application of this new, combined therapy. CEU-UCH professor Soria says that “although bone marrow stem cells disappear from the brain tissue where they were transplanted after only 16 days, new cells keep forming. To put it another way, brain tissue is regenerated by new cells that appear in the brain as a result of stem cell transplantation. This proves the regenerative efficiency of the new combined therapy.”

The research also shows how the blood vessels that formed after the treatment grow into the damaged area of the brain. “They act as a kind of scaffolding to that area that allows microglia cells to migrate,” professor Soria says. “In the damaged area, they contribute to regeneration.” He adds that “the application of both treatments results into high angiogenic activity, which is crucial for an efficient recovery of the damaged brain area.” According to Soria, “the laboratory mice that recovered fastest from brain injuries were those that had a higher density of regenerated blood vessels.”

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