Posttraumatic Syringomyelia Medication
- Author: Lance L Goetz, MD; Chief Editor: Stephen Kishner, MD, MHA more...
Medical therapy is only for symptomatic control. Definitive treatment to date is surgical in nature.
Centrally acting antispasticity agents
Antispasticity agents are indicated when spasticity interferes with function, causes pain, or interferes with sleep.
May induce the hyperpolarization of afferent terminals and inhibit both monosynaptic and polysynaptic reflexes at the spinal level.
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.
Analgesic for certain chronic and neuropathic pain.
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.
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).
Reduce gastrointestinal, salivary, and sudomotor (sweat gland) activity and can alleviate excess sweating in patients with PTS.
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.
Svircev JN, Little JW. Syringomyelia. Lin V, ed. Spinal Cord Medicine: Principles and Practice. 2nd ed. New York, NY: Demos; 2010. 569-575/42.
Berkouk K, Carpenter PW, Lucey AD. Pressure wave propagation in fluid-filled co-axial elastic tubes. Part 1: Basic theory. J Biomech Eng. 2003 Dec. 125(6):852-6. [Medline].
Carpenter PW, Berkouk K, Lucey AD. Pressure wave propagation in fluid-filled co-axial elastic tubes. Part 2: Mechanisms for the pathogenesis of syringomyelia. J Biomech Eng. 2003 Dec. 125(6):857-63. [Medline].
Elliott NS, Lockerby DA, Brodbelt AR. The pathogenesis of syringomyelia: a re-evaluation of the elastic-jump hypothesis. J Biomech Eng. 2009 Apr. 131(4):044503. [Medline].
Krebs J, Koch HG, Hartmann K, Frotzler A. The characteristics of posttraumatic syringomyelia. Spinal Cord. 2015 Dec 1. [Medline].
Jackson K, Ramadorai U, Abell B, Devine J. Charcot arthropathy of the wrist associated with cervical spondylotic myelopathy. Global Spine J. 2012 Dec. 2(4):227-30. [Medline].
Sixt C, Riether F, Will BE, et al. Evaluation of quality of life parameters in patients who have syringomyelia. J Clin Neurosci. 2009 Oct 7. [Medline].
Hayashi T, Ueta T, Kubo M, Maeda T, Shiba K. Subarachnoid-subarachnoid bypass: a new surgical technique for posttraumatic syringomyelia. J Neurosurg Spine. 2013 Apr. 18(4):382-7. [Medline].
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].
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].
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].
Ewelt C, Stalder S, Steiger HJ, Hildebrandt G, Heilbronner R. Impact of cordectomy as a treatment option for posttraumatic and non-posttraumatic syringomyelia with tethered cord syndrome and myelopathy. J Neurosurg Spine. 2010 Aug. 13(2):193-9. [Medline].
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].
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].
Bonsanto MM, Metzner R, Aschoff A. 3D ultrasound navigation in syrinx surgery - a feasibility study. Acta Neurochirurgica. 2005. 147(5):533-41.
Carroll AM, Brackenridge P. Post-traumatic syringomyelia: a review of the cases presenting in a regional spinal injuries unit in the north east of England over a 5-year period. Spine. 2005. 30(10):1206-10. [Medline].
Laxton AW, Perrin RG. Cordectomy for the treatment of posttraumatic syringomyelia. Report of four cases and review of the literature. Journal of Neurosurgery Spine. 2006. 4(2):174-8.
Lee TT, Alameda GJ, Camilo E. Surgical treatment of post-traumatic myelopathy associated with syringomyelia. Spine. 2001. 26(24 Suppl):S119-27.
Nogues MA. Spontaneous electromyographic activity in spinal cord lesions. [Review]. Muscle & Nerve. 2002. Suppl. 11:s77-82.
Rittenberg JD, Burns SP, Little JW. Worsening myelopathy masked by peripheral nerve disorders. J Spinal Cord Med. 2004. 27(1):72-7.
Silber JS, Vaccaro AR, Green B. Summary statement: chronic long-term sequelae after spinal cord injury: post-traumatic spinal deformity and post-traumatic myelopathy associated with syringomyelia.[comment]. Spine. 2001. 26(24 Suppl):S128.
Vannemreddy SS, Rowed DW, Bharatwal N. Posttraumatic syringomyelia: predisposing factors. Br J Neurosurgery. 2002. 16(3):276-83.