A Nationawide Epidemiological Study of Spinal Cord Injuries in Taiwan and Treatment of Spinal Cord Injury by An Oxygen Radicals and Lipid Hydroperoxide Scavenger

• Main Authors: Chen, Hsin - Ying, 陳信穎
• Other Authors: Shun - Sheng Chen
• Format: Others
• Language: zh-TW
• Published: 1997
• Online Access: http://ndltd.ncl.edu.tw/handle/88782457401165379240

博士 === 高雄醫學院 === 醫學研究所 === 85 === In 1976, Sir Ludwig Guttmann pointed out that of the many forms of disability which can beset mankind, a severe injury of the spinal cord undoubtedly constitutes one of the most devastating calamities in human life. In Taiwan, spinal cord injury remains one of the major causes of physical disability. A nationwide epidemiological study of spinal cord injuries will provide the basis of effective prevention policy. This prospective epidemiological survey of spinal cord injury (SCI) in Taiwan was carried out among patients attended by physicians from various medical centers and general hospitals all over Taiwan from July 1992 to June 1996. In all 1,586 new cases of SCI were registered. The results represented 70% of the scope of SCI in Taiwan. The observed average annual incidence of SCI in Taiwan was 18.8 per million population , whereas it was 47.5 for the geriatric section. The mean age was 46.1 years old with a plateau distribution after 20 years and older. Geriatric victims (297 cases, 18.7%, group II) formed a major section of SCI cases in Taiwan. Another group of younger SCI patients (15 to 64 years old, 1,232 cases, group I) was selected for comparison. The results showed that the male to female ratio was 3 to 1. The leading causes of SCI were traffic accidents and falls. Motorcycle collisions accounted for 62% of the traffic accidents, and as most of the motorcycle riders were not helmet users, head injury became the major associated injury of SCI in Taiwan. The effectiveness of the comprehensive care system for SCI patients in Taiwan was relatively good, as reflected by the low rates of complications of SCI, the low mortality rate (6.6%), and the high percentage (67.4%) of SCI patients achieving self-care ultimately at home after rehabilitation. The analysis of PDHLL (person-days healthy life loss) and QAST (quality adjusted survival time) revealed that SCI patients in Taiwan required 4 years to cope with the morbidity, and in average, could return to the main stream of life for another 30 years. The mean residual life of geriatric SCI patients was about 4.6 years. Among geriatric SCI patients, the male to female ratio, pattern of neurological deficits, and causes of injury and death differed significantly from those of the younger SCI group. Elderly women were exposed to a higher risk of SCI than younger women (M/F ratio 1.7:1 in group II, 3.5:1 in group I). Falls were the leading cause of geriatric SCI, and two thirds of them occurred on level ground. Traffic accidents accounted for a third of geria- tric SCI cases, half of which involved motorcycle accidents, a fifth of them pedestrians. Quadriplegia and quadriparesis occurred more frequently among elderly cases of SCI than in the younger group and a higher proportion of them died of SCI complications. Although the effectiveness of the comprehensive care system for SCI patients in Taiwan was relatively good, the effort of early management of SCI patients in acute stage remains inadequate. During the past two decades, the secondary injury mechanisms of SCI had been the focus of advanced researches. It is well documented that vasospasm and cell membrane damage of neurones induced by lipid hydro- peroxide are the final common pathways of secondary injury to the spinal cord. Lipid peroxidation is the result of the attack of hydroxyl radicals on unsaturated fatty acid of the organ. The production of hydroxyl radicals is associated with iron-dependent Fenton reaction, Harber-Weiss reaction and iron-independent reaction of superoxide and nitric oxide radicals. Funda- mentally, an oxygen radicals and lipid hydroperoxide scavenger will be able to intervene the cascade of secondary injury to the spinal cord. In the early 90''s in Taiwan, the use of antioxidant or free radical scavenger in clinical setting was very rare. In 1992, a liquid form natural antioxidant compound "Raffinee" was available. By ESR spectrometric study, the superoxide radical scavenging ability of Raffinee is 38000 units per gram, and the hydroxyl radical scavenging ability is 790 units per gram. Raffinee can also inhibit lipid peroxidation (IC50=0.0153 mg/ ml), and one of its major content phytic acid can metabolize lipid hydroperoxide to be harmless fatty acid, aldehyde, ethane, and pentane. The molecular weights of flavonols range from 300 to 500, and that of phytic acid is 660, so the absorption through alimentary tract is very easy. The toxicity test showed that Raffinee is very safe and there is no major side effect. From October 1992 to August 1993, 10 newly spinal cord injured patients admitted to Kaohsiung Medical College Hospital were selected for clinical trial in the effect of Raffinee on subacute SCI. Their ages ranged from 18 to 63 years old with a mean of 46 years old. Four cases suffered from in- complete cervical cord injury and 6 cases from complete thoracic cord injury. The intervals between onset of injury and Raffinee therapy ranged from 19 to 60 days with a mean of 35.4 days. Assessment of motor function, sensory function, and ADL were done on admission and in each week during therapy for 6 weeks. The dosage of Raffinee was two potions 30 minutes before meal, three times a day for 6 weeks. In all, the daily superoxide radical scavenging potency was 2280000 units, and hydroxyl radical scavenging potency 47400 units. The results showed that improvement of motor function, sensory func- tion, and ADL could be noted in incomplete cases but not in complete cases. MRI studies of one quadriparetic case revealed that cord edema subsided after Raffinee therapy. There was no report of side effect or change of blood and biochemical data. This clinical trial of Raffinee on subacute SCI showed that the use of adequate amount of oxygen radicals and lipid hydroperoxide scavenger one month after injury would still be beneficial to the improvement of neuro- logical functions. However, the sample size was too small and there was no control group, so that the possibility of spontaneous recovery could not be ruled out yet. Further larger scale, randomized, placebo-controlled, double- blind, cross-over clinical trial will be necessary to verify the effect of Raffinee on subacute spinal cord injury.