Shepherd Center

About: Shepherd Center is a healthcare organization based out in Atlanta, Georgia, United States. It is known for research contribution in the topics: Spinal cord injury & Rehabilitation. The organization has 268 authors who have published 461 publications receiving 15304 citations.

Glatiramer acetate in primary progressive multiple sclerosis: Results of a multinational, multicenter, double-blind, placebo-controlled trial

Abstract: Objective To determine whether glatiramer acetate (GA) slows accumulation of disability in primary progressive multiple sclerosis. Methods A total of 943 patients with primary progressive multiple sclerosis were randomized to GA or placebo (PBO) in this 3-year, double-blind trial. The primary end point was an intention-to-treat analysis of time to 1- (entry expanded disability status scale, 3.0–5.0) or 0.5-point expanded disability status scale change (entry expanded disability status scale, 5.5–6.5) sustained for 3 months. The trial was stopped after an interim analysis by an independent data safety monitoring board indicated no discernible treatment effect on the primary outcome. Intention-to-treat analyses of disability and magnetic resonance imaging end points were performed. Results There was a nonsignificant delay in time to sustained accumulated disability in GA- versus PBO-treated patients (hazard ratio, 0.87 [95% confidence interval, 0.71–1.07]; p = 0.1753), with significant decreases in enhancing lesions in year 1 and smaller increases in T2 lesion volumes in years 2 and 3 versus PBO. Post hoc analysis showed that survival curves for GA-treated male patients diverged early from PBO-treated male subjects (hazard ratio, 0.71 [95% confidence interval, 0.53–0.95]; p = 0.0193). Interpretation The trial failed to demonstrate a treatment effect of GA on primary progressive multiple sclerosis. Both the unanticipated low event rate and premature discontinuation of study medication decreased the power to detect a treatment effect. Post hoc analysis suggests GA may have slowed clinical progression in male patients who showed more rapid progression when untreated. Ann Neurol 2007;61:14–24

Influence of complete spinal cord injury on skeletal muscle cross-sectional area within the first 6 months of injury.

Abstract: In this study we examined the influence of complete spinal cord injury (SCI) on affected skeletal muscle morphology within 6 months of SCI. Magnetic resonance (MR) images of the leg and thigh were taken as soon as patients were clinically stable, on average 6 weeks post injury, and 11 and 24 weeks after SCI to assess average muscle cross-sectional area (CSA). MR images were also taken from nine able-bodied controls at two time points separated from one another by 18 weeks. The controls showed no change in any variable over time. The patients showed differential atrophy (P = 0.0001) of the ankle plantar or dorsi flexor muscles. The average CSA of m. gastrocnemius and m. soleus decreased by 24% and 12%, respectively (P = 0.0001). The m. tibialis anterior CSA showed no change (P = 0.3644). As a result of this muscle-specific atrophy, the ratio of average CSA of m. gastrocnemius to m. soleus, m. gastrocnemius to m. tibialis anterior and m. soleus to m. tibialis anterior declined (P = 0.0001). The average CSA of m, quadriceps femoris, the hamstring muscle group and the adductor muscle group decreased by 16%, 14% and 16%, respectively (P< or =0.0045). No differential atrophy was observed among these thigh muscle groups, thus the ratio of their CSAs did not change (P = 0.6210). The average CSA of atrophied skeletal muscle in the patients was 45-80% of that of age- and weight-matched able-bodied controls 24 weeks after injury. In conclusion, the results of this study suggest that there is marked loss of contractile protein early after SCI which differs among affected skeletal muscles. While the mechanism(s) responsible for loss of muscle size are not clear, it is suggested that the development of muscular imbalance as well as diminution of muscle mass would compromise force potential early after SCI.

Skeletal muscle atrophy and increased intramuscular fat after incomplete spinal cord injury.

Abstract: Cross-sectional and longitudinal design. (1) To quantify skeletal muscle cross-sectional area (CSA) after correcting for intramuscular fat (IMF) in thigh muscle groups 6 weeks after incomplete spinal cord injury (SCI), (2) to monitor the changes in muscle CSA and IMF after 3 months from the initial measurement. Academic institution Athens, GA, USA. Six incomplete SCI patients (28±4 years, 178±5 cm and 78±6 kg, mean±SE, C7 to L3, American Spinal Injury Association B or C) were tested at 5±1 weeks and 3 months after the initial measurement. T1-weighted magnetic resonance images were taken of both thighs. Six able-bodied (AB) controls were matched in age, sex, height and weight (29±4 years, four male and two female subjets, 179±5 cm and 77±6 kg). At 6 weeks post-injury, muscle CSA was 82±4 cm2 in incomplete SCI and 123±21 cm2 in AB controls (P=0.04). IMF CSA was 5.2±1.3 and 2.3±0.6 cm2 in incomplete SCI and AB controls, respectively (P=0.03). Relative IMF was three-fold higher (P=0.03) in the SCI group versus AB controls (5.8±1.4 versus 2.0±0.6%). After 3 months, IMF increased 26% in the SCI group compared to the initial measurement (P=0.02). Skeletal muscle atrophy is associated with greater IMF accumulation in SCI group 6 weeks post-injury compared to AB controls. Moreover, IMF continues to increase over time in incomplete SCI.