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Posttraumatic Syringomyelia Medication

  • Author: Lance L Goetz, MD; Chief Editor: Stephen Kishner, MD, MHA  more...
 
Updated: Dec 21, 2015
 

Medication Summary

Medical therapy is only for symptomatic control. Definitive treatment to date is surgical in nature.

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Centrally acting antispasticity agents

Class Summary

Antispasticity agents are indicated when spasticity interferes with function, causes pain, or interferes with sleep.

Baclofen (Lioresal)

 

May induce the hyperpolarization of afferent terminals and inhibit both monosynaptic and polysynaptic reflexes at the spinal level.

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Tricyclic antidepressants

Class Summary

Although not an FDA-labeled use, TCAs are considered first-line treatment by specialists to treat many types of neuropathic pain. Doses used generally are less than those required to treat depression.

Amitriptyline (Elavil)

 

Analgesic for certain chronic and neuropathic pain.

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Anticonvulsants

Class Summary

Although not an FDA-labeled use, anticonvulsants are used commonly by specialists to treat neuropathic pain. Gabapentin has the advantage of reduced toxicity and side effects.

Gabapentin (Neurontin)

 

Has anticonvulsant properties and antineuralgic effects; however, the exact mechanism of action is unknown. Structurally related to GABA but does not interact with GABA receptors. Titration to effect can take place over several days (300 mg on day 1, 300 mg bid on day 2, and 300 mg tid on day 3).

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Anticholinergics

Class Summary

Reduce gastrointestinal, salivary, and sudomotor (sweat gland) activity and can alleviate excess sweating in patients with PTS.

Scopolamine (Transderm Scop)

 

Blocks action of acetylcholine at parasympathetic sites in smooth muscle, secretory glands, and the CNS. Antagonizes histamine and serotonin action.

Transdermal scopolamine may be the most effective agent for motion sickness. Its use in vestibular neuronitis is limited by its slow onset of action.

Anticholinergic activity used in the treatment of nausea but also can inhibit the secretion of saliva and sweat.

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Narcotic analgesics

Class Summary

May be necessary in patients whose pain is not controlled with other agents. Long-acting agents are preferred for chronic use.

Oxycodone SA (OxyContin)

 

Indicated for the relief of moderate to severe pain.

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Contributor Information and Disclosures
Author

Lance L Goetz, MD Staff Physician, Spinal Cord Injury and Disorders, Hunter Holmes McGuire Veterans Affairs Medical Center; Associate Professor, Director, Spinal Cord Injury Medicine Fellowships, Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University School of Medicine

Lance L Goetz, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, Academy of Spinal Cord Injury Professionals, American Spinal Injury Association, Association of Academic Physiatrists, International Spinal Cord Society

Disclosure: Nothing to disclose.

Coauthor(s)

Revati Mummaneni, MD Chief Resident, Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University School of Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Patrick M Foye, MD Director of Coccyx Pain Center, Professor and Interim Chair of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School; Co-Director of Musculoskeletal Fellowship, Co-Director of Back Pain Clinic, University Hospital

Patrick M Foye, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, International Spine Intervention Society, American Association of Neuromuscular and Electrodiagnostic Medicine, Association of Academic Physiatrists

Disclosure: Nothing to disclose.

Chief Editor

Stephen Kishner, MD, MHA Professor of Clinical Medicine, Physical Medicine and Rehabilitation Residency Program Director, Louisiana State University School of Medicine in New Orleans

Stephen Kishner, MD, MHA is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine

Disclosure: Nothing to disclose.

Additional Contributors

Robert L Sheridan, MD Assistant Chief of Staff, Chief of Burn Surgery, Shriners Burns Hospital; Associate Professor of Surgery, Department of Surgery, Division of Trauma and Burns, Massachusetts General Hospital and Harvard Medical School

Robert L Sheridan, MD is a member of the following medical societies: American Academy of Pediatrics, American Association for the Surgery of Trauma, American Burn Association, American College of Surgeons

Disclosure: Received research grant from: Shriners Hospitals for Children; Physical Sciences Inc<br/>Received income in an amount equal to or greater than $250 from: SimQuest Inc -- consultant on burn mapping softwear ($1,500).

Acknowledgements

Michael Priebe, MD Associate Professor, Department of Physical Medicine and Rehabilitation, Mayo Clinic of Rochester, Minnesota

Michael Priebe, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Congress of Rehabilitation Medicine, American Paraplegia Society, American Spinal Injury Association, International Society of Physical and Rehabilitation Medicine, and International Spinal Cord Society

Disclosure: Nothing to disclose.

References
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  9. Lam S, Batzdorf U, Bergsneider M. Thecal shunt placement for treatment of obstructive primary syringomyelia. J Neurosurg Spine. 2008 Dec. 9(6):581-8. [Medline].

  10. Cacciola F, Capozza M, Perrini P, et al. Syringopleural shunt as a rescue procedure in patients with syringomyelia refractory to restoration of cerebrospinal fluid flow. Neurosurgery. 2009 Sep. 65(3):471-6; discussion 476. [Medline].

  11. Kunert P, Janowski M, Zakrzewska A, et al. Syringoperitoneal shunt in the treatment of syringomyelia. Neurol Neurochir Pol. 2009 May-Jun. 43(3):258-62. [Medline].

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  14. Aghakhani N, Baussart B, David P, Lacroix C, Benoudiba F, Tadie M, et al. Surgical treatment of posttraumatic syringomyelia. Neurosurgery. 2010 Jun. 66(6):1120-7; discussion 1127. [Medline].

  15. Ghobrial GM, Dalyai RT, Maltenfort MG, Prasad SK, Harrop JS, Sharan AD. Arachnolysis or cerebrospinal fluid diversion for adult-onset syringomyelia? A Systematic review of the literature. World Neurosurg. 2015 May. 83 (5):829-35. [Medline].

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This illustration shows a T1-weighted, cervical magnetic resonance imaging (MRI) scan of multiple syrinx cavities (arrows). Note the lowest thin cavity extending into the thoracic spinal cord.
This T2-weighted magnetic resonance imaging (MRI) scan (same patient as above) delineates the syrinx cavity. Note the spinal cord edema extending rostrally from the upper limit of the cavity.
T2-weighted magnetic resonance imaging (MRI) scan (same patient as above) after patient underwent expansile duraplasty. Note dramatic reduction in size of the main syrinx cavity (white).
T2-weighted sagittal image of large, multiloculated cervical syrinx extending into brainstem. Patient had preserved functional status.
T1-weighted magnetic resonance imaging (MRI) scan of a slender syrinx (arrow) extending from the C5 vertebral level. This syrinx extends beyond the image to an area of spinal cord disruption at the T3 vertebral level.
Same patient as in image above, with the magnetic resonance imaging (MRI) scan slightly farther down the cervicothoracic region of the spine
T2 proton density magnetic resonance imaging (MRI) scan demonstrating syrinx cavity (arrow) extending from approximately C6-C7 to T2. The syrinx cavity is 9 mm at its widest dimension. The spinal cord is reduced to a thin membrane at this level and is atrophic below.
T1-weighted image demonstrating a large, multiloculated cervical syrinx cavity. This is a recurrent syrinx, having come back despite an attempt at drainage utilizing expansile duraplasty.
 
 
 
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