eMedicine Specialties > Physical Medicine and Rehabilitation > Spinal Cord Injury
Brown-Sequard Syndrome: Treatment & Medication
Updated: Jul 31, 2008
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
- Multimedia
Treatment
Rehabilitation Program
Physical Therapy
Physical therapy intervention starts in the acute care phase of treatment.11 Goals for therapy include the following:
- Maintaining strength in neurologically intact muscles
- Maintaining range of motion in joints
- Preventing skin breakdown by proper positioning and weight shifting
- Improving respiratory function by positioning and breathing exercises
- Achieving early mobilization to increase tolerance of the upright position
- Providing emotional and educational support for the patient and his/her family
As a person with SCI advances through acute rehabilitation, physical therapy addresses mobility issues. Functional movement starts with bed mobility, followed by transfers, wheelchair mobility, and in many cases of Brown-Séquard syndrome, ambulation. Appropriate equipment must be prescribed, and proper use of the equipment should be taught to the patient and caregivers. Prior to discharge, the patient's home is evaluated for accessibility and modifications, as well as for the need for adaptive equipment. The need for orthotics is assessed and recommended. After fitting, training with the device is vital to functional use. Patients and caregivers should be instructed in home exercise programs that are designed to maintain strength, flexibility, and balance.
Because neurologic recovery often continues following discharge from acute inpatient rehabilitation, physical therapy should continue in the outpatient setting. Frequent reassessments are indicated to set new functional goals and to modify treatment as needed.
Occupational Therapy
Occupational therapy is essential for regaining as much independence as possible in activities of daily living. Upper extremity function is assessed carefully and then is used to learn new techniques, with or without the use of adaptive equipment, for the performance of oral-facial hygiene, feeding, and dressing. Head control, upper extremity strength, and trunk balance are developed to enable the patient to accomplish these tasks. Transfers and wheelchair mobility are addressed in conjunction with the physical therapist. Driving assessment, adaptations, and training are performed when appropriate.
Patients with Brown-Séquard syndrome typically show neurologic improvement over the course of the first year after onset and may advance through several stages of independence in performing activities of daily living. Occupational therapy should be continued as long as the patient shows improvement in functional status.
Recreational Therapy
A person's leisure and recreational needs often increase after a significant change in physical function. Although patients with Brown-Séquard syndrome may regain more function than do most patients with SCI, recreational needs are important. Premorbid interests are assessed and incorporated into the development of adaptive sports, leisure activities, and a recreational program. The recreational therapist re-introduces a person with a disability into the community to develop the confidence needed for re-integration into society. The therapist also serves as a source of information and as a liaison to community programs for the disabled.
Medical Issues/Complications
Any SCI, regardless of degree of completeness, results in significant alterations of function of the respiratory, cardiovascular, digestive, urinary, musculoskeletal, and integumentary systems. Decreased pulmonary function, altered cardiovascular dynamics, neurogenic bowel and bladder dysfunctions, hypercalcemia, osteoporosis, heterotopic ossification, and insensate skin may not be avoidable, but secondary medical complications often are preventable with expert care. Secondary complications that need to be addressed with aggressive preventive measures and early treatment are:
- Development of pulmonary infections and respiratory insufficiency
- Uncontrolled autonomic dysreflexia
- Bowel impaction
- Urinary tract infections
- Pressure ulcers
Surgical Intervention
Surgical intervention in traumatic SCI has been controversial, focusing primarily on spinal stability.12,13 The need for prompt reduction of any spinal deformity is well accepted. The reduction can be achieved either posturally or operatively. Stabilization of the reduced spine to prevent further injury to the cord is more controversial. Stability may come from direct surgical repair with bone grafting and (often) instrumentation or from natural healing or autofusion in an orthosis. Most stable spinal injuries are treated nonoperatively, while unstable injuries are treated surgically. Surgical decompression of the spinal canal may be indicated for an incomplete syndrome in which residual compression is present.
Nontraumatic etiologies of Brown-S é quard syndrome usually involve mechanical compression or herniation of the spinal cord and require surgical decompression.9
Consultations
Acute consultations are based on patient symptomatology and the etiology of the Brown-Séquard syndrome. Although patients with Brown-Séquard syndrome frequently regain bladder function, consultation with a urologist is required most commonly for evaluation of neurogenic bladder dysfunction.14 Other specialists that should be available for consultation over the course of the patient's rehabilitation include the following:
- Orthopedist
- Neurosurgeon
- General surgeon
- Hematologist-oncologist
- Infectious disease specialist
- Pulmonologist
- Cardiologist
- Gastroenterologist
- Neurologist
- Psychiatrist
- General medicine specialist
- Dentist
Medication
The use of medications for Brown-Séquard syndrome is dependent on the etiology and acuity of onset. Acute treatment of traumatic SCI involves immediate dosing of methyl prednisolone. Acute immobility that is unrelated to a bleed requires anticoagulation therapy, if not contraindicated. GI protection is strongly recommended. Other medications are used to manage symptoms and complications as needed, including antibiotics, antispasmodics, pain medications, and laxatives. Full discussions of medications and other treatment options for the associated conditions can be found in articles on the specific medical complication.
Corticosteroids
These have anti-inflammatory properties and cause profound and varied metabolic effects. Corticosteroids modify the body's immune response to diverse stimuli.
Methylprednisolone (Adlone, Medrol, Solu-Medrol, Depo-Medrol, Depopred)
Decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reversing increased capillary permeability.
Adult
2-60 mg/d PO in 1-4 divided doses followed by gradual reduction to lowest level that maintains clinical response
Pediatric
0.5-1.7 mg/kg/d or 5-25 mg/m2/d PO/IV/IM divided q6-12h
Co-administration with digoxin may increase digitalis toxicity secondary to hypokalemia; estrogens may increase levels; phenobarbital, phenytoin, and rifampin may decrease levels (adjust dose); monitor patients for hypokalemia when taking concurrently with diuretics
Documented hypersensitivity; viral, fungal, or tubercular skin infections
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Hyperglycemia, edema, osteonecrosis, peptic ulcer disease, hypokalemia, osteoporosis, euphoria, psychosis, growth suppression, myopathy, and infections are possible complications of glucocorticoid use
More on Brown-Sequard Syndrome |
| Overview: Brown-Sequard Syndrome |
| Differential Diagnoses & Workup: Brown-Sequard Syndrome |
 Treatment & Medication: Brown-Sequard Syndrome |
| Follow-up: Brown-Sequard Syndrome |
| Multimedia: Brown-Sequard Syndrome |
| References |
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Further Reading
Keywords
Brown-Séquard syndrome, Brown-Séquard's syndrome, Brown-Séquard-plus syndrome, hemisection of the spinal cord, hemisection syndrome, partial spinal sensory syndrome
