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Thread: Brown-Sequared Syndrome type SCI

  1. #1

    Brown-Sequared Syndrome type SCI

    Does anyone have any info on Brown-Sequared Syndrome type SCI? Also, if anyone has found 4-AP(Frampridine-SR) to be helpful in getting back strength, I would appreciate advice regarding it.
    Thanks, Benjamin

  2. #2
    userben,

    The Brown-Sequard syndrome refers to the symptoms that occur when the spinal cord is hemisected. A famous British neurologist (Brown-Sequard) described this syndrome from patients that he saw at the turn of the last century, people who had been punished by the Mafia by inserting a stileto at about C7, cutting half of the spinal cord. He was very interested in recovery from spinal cord injury (Aminoff, 1996).

    The syndrome clearly illustrates several anatomical pathways of the spinal cord. Pain and temperature pathways (the spinothalamic tract) cross over in the lower spinal cord and then ascend to the thalamus. Touch and position pathways ascend on the same side of the spinal cord (ipsilateral) to the brainstem and then cross over to the thalamus. Motor pathways descend ipsilaterally to the brainstem where it crosses over to the other side. When the spinal cord is cut on the left side, for example, a person loses touch and position sensations, as well as motor control, on the left but loses pain and temperature sensation on the right leg.

    Most people with Brown-Sequard syndrome will regain substantial motor function, sufficient for walking. This is also true in cats (Eidelberg, 1986) and rats in some studies that we did (Saruhashi, et al. 1994; 1996). This is because the axons from the uncut side will grow across the midline in the lower spinal cord and innervate motoneurons. Also, having some descending motor tracts to the lower spinal cord is sufficient to activate the spinal locomotor pattern generator and this generator activates locomotor reflexes in both legs. However, the person may continue to show weakness of voluntary control of one leg. That leg may also continue to show impaired touch and position sense. In my experience, most people with Brown-Secquard syndrome recover substantially and will continue to recover as they walk.

    The degree to which 4-aminopyridine will help you depends on the cause of the injury and the extent of demyelination you have. If your injury was caused by a contusion (as opposed to a sharp knife cut or bullet), demyelination may be present. In such a case, 4-AP may help. In any case, it probably does not hurt for you to try 4-AP at some time. If it helps, that is great. If not, then you can always stop the drug. Please look up previous postings on the subject, on dosing and ramping up/down when taking the drugs.

    Relatively little is known about other effects of spinal cord hemisection. So, I just did a literature search regarding the effects of Brown-Sequard on other functions, such as bladder and sexual function. Sakakibara, et al. (2001) studied micturation and report that some patients are have void difficulties and urinary incontinence. Winchester, et al. (2000) reports that people with Brown-Sequard syndromes show the greatest increases in blood pressure and heart rate when they tried to move the weak side. The side of the hemisection often show continued poor somatosensory evoked potentials (Bloom & Goldberg, 1989). People with Brown-Sequard syndrome also develop osteoporosis that can be treated with alendronate (Sniger & Garshick, 2002). Finally, some people with Brown-Sequard syndrome develop a vascular problem and one-sided migraine headaches (Koehler, 1995).

    Although Brown-Sequard syndrome is most commonly due to penetrating wounds of the spinal cord (McCarron, et al. 2001; Larsen, et al. 2001; Gueye, et al. 1998), it can happen also with contusive injuries of the spinal cord (Oller & Boone, 1991), spinal cord herniation (Massicotte, et al. 2002), and even post-traumatic arachnoiditis (Ramli, et al., 2001).

    I hope that this is more than you ever wanted to know about this condition.

    Wise.

    • Aminoff MJ (1996). Brown-Sequard and his syndrome. J Hist Neurosci. 5 (1): 14-20. Summary: The contributions of Charles Edouard Brown-Sequard (1817-1894) to the advancement of medical science included his emphasis on functional processes in the integrative action of the nervous system, his discovery of the vasomotor nerves, his experimental demonstration that the adrenal glands are esential to life, and his pioneering work on hormone replacement therapy. He is best remembered, however, for his work in delineating the sensory pathways in the spinal cord. His later work on the sensory function of the cord emphasized dynamic spinal mechanisms that may well have major implications for the rehabilitation of patients with cord injuries. School of Medicine, University of California, San Francisco, 94143, USA.

    • Eidelberg E, Nguyen LH and Deza LD (1986). Recovery of locomotor function after hemisection of the spinal cord in cats. Brain Res Bull. 16 (4): 507-15. Summary: Cats were subjected to high lumbar hemisection of the spinal cord, on the right side. The initial paralysis of the right hindlimb became rapidly attenuated, and they walked again in one week or less after surgery. Minor residual deficits in gait remained, that may be permanent. Electrical stimulation of the bulbar reticulospinal formation showed residual crossed connections reaching the right lumbosacral cord via the left hemicord. Recovery from Brown-Sequard's syndrome may be primarily due to the survival of low crossing descending projections to the spinal cord.

    • Saruhashi Y and Young W (1994). Effect of mianserin on locomotory function after thoracic spinal cord hemisection in rats. Exp Neurol. 129 (2): 207-16. Summary: To study the role of serotonin (5-HT) in spinal cord injury, we observed the effects of mianserin (a 5-HT1c and 5-HT2 receptor antagonist) on rat locomotory function after thoracic spinal cord hemisection. Three groups of rats were studied: sham, A, and B. The sham group (n = 4) received laminectomy and a 3-day course of mianserin (5 mg/kg ip); group A (n = 12) had laminectomy, hemisection, and weekly 3-day courses of saline or mianserin; group B (n = 12) was identical to group A except that the rats received saline. The rats were evaluated every other day for 6 weeks using a 0-14 point scale. Hemisection markedly reduced mean ipsilateral hindlimb scores from 14.0 to 4.0 +/- 0.4 and 4.6 +/- 0.2 (mean +/- standard deviation) in groups A and B, respectively. The saline-treated rats recovered to scores of 9 or 10 by Day 7, 12 or 13 by Day 14, and normal by Day 21. Mianserin significantly but transiently depressed mean locomotory scores, from 12.1 +/- 0.6 to 10.0 +/- 0.4 (P < 0.05, Mann-Whitney U test) in the second week and from 14.0 +/- 0.0 to 12.1 +/- 0.6 [P < 0.05, Mann-Whitney U test) in the fourth week after hemisection. Locomotory scores of mianserin-treated rats did not differ significantly from control saline-treated rats by 7 days after treatment. Immunohistological studies of the spinal cords revealed a marked reduction of 5-HT-containing terminals in ipsilateral but not contralateral lumbosacral cord by 2 weeks after hemisection. By 4 weeks after hemisection, 5-HT-immunoreactive fibers and terminals partly returned to the ipsilateral lumbosacral cord, corresponding temporally with locomotory recovery. Thus, 5-HT may play a role in recovery after hemisection. Anti-serotonergic drugs should be cautiously administered to patients recovering from spinal cord injury. Department of Neurosurgery, New York University Medical Center, New York 10016.

    • Saruhashi Y, Young W and Perkins R (1996). The recovery of 5-HT immunoreactivity in lumbosacral spinal cord and locomotor function after thoracic hemisection. Exp Neurol. 139 (2): 203-13. Summary: To determine the role of serotonin (5-HT) in recovery from spinal cord injury, we examined spinal cord 5-HT immunohistologically and assessed locomotor recovery after thoracic (T8) spinal cord hemisection in 68 rats. Forty eight rats had laminectomy and hemisection, while the remaining 20 rats received laminectomy only. All rats were evaluated every other day for 4 weeks, using a 0-14 point scale open field test. Hemisection markedly reduced mean hindlimbs scores from 14 to 1.5 +/- 0.32 and 5.6 +/- 0.31 (mean +/- standard error of mean) in the ipsilateral and contralateral side, respectively. The rats all recovered apparently normal walking by 4 weeks. The 5-HT immunohistological study revealed a marked reduction of 5-HT-containing terminals in the ipsilateral but not the contralateral lumbosacral cord by 1 week after hemisection. By 4 weeks after hemisection, 5-HT immunoreactive fibers and terminals returned to the ipsilateral lumbosacral cord, with many 5-HT fibers crossing over the central canal at thoracic level. We estimated the recovery of 5-HT neural elements in lumbosacral ventral horn by ranking 5-HT staining intensity and counting 5-HT terminals. The return of 5-HT immunoreactivity of the lumbosacral ventral horn correlated with locomotor recovery. Locomotory recovery invariably occurred when the density of 5-HT terminals approached 20% of control values. These results indicate that return of 5-HT fibers and terminals predict the time course and extent of locomotory recovery after thoracic spinal cord hemisection. Department of Neurosurgery, New York University Medical Center, New York 10016, USA.

    • Sakakibara R, Hattori T, Uchiyama T and Yamanishi T (2001). Urinary dysfunction in Brown-Sequard syndrome. Neurourol Urodyn. 20 (6): 661-7. Summary: Brown-Sequard syndrome (BS) is a rare but well documented condition of the spinal cord hemisection, comprising hemiparesis with crossed superficial sensory disturbance. However, little is known of micturitional function in BS, although some patients with BS are troubled with severe voiding difficulty and urinary incontinence. We performed urinary questionnaire and urodynamic studies in eight patients with BS, including seven men and one woman, mean age of 41 years. Detailed questionnaire showed that five of the eight patients (63%) had micturitional symptoms, including voiding difficulty in three, urinary retention in two, urinary frequency in two and urge urinary incontinence in one. Urodynamic abnormalities were noted in all five patients with micturitional symptoms, including post-micturition residuals in four (average 149 mL), high urethral closure pressure in two, increased bladder volume at first sensation in one, detrusor hyperreflexia in four, detrusor areflexia on voiding in three and unrelaxing sphincter on voiding in four. Three asymptomatic patients showed normal urodynamic finding. Micturitional symptoms were more common in patients with severe motor paresis (100%) than in those with mild motor paresis (40%), and there was no relation between micturitional disturbance with superficial or deep sensory disturbance. A combination of treatments for the underlying disorders with alpha-adrenergic blocking agent and clean, intermittent self-catheterization ameliorated the urinary dysfunction in all patients together with neurological dysfunction. In conclusion, micturitional disturbance was not uncommon in our patients with BS, particularly in those with severe motor paresis, which could ameliorate by appropriate therapies. Department of Neurology, Chiba University School of Medicine, Chiba, Japan. sakaki@med.m.chiba-u.ac.jp.

    • Winchester PK, Williamson JW and Mitchell JH (2000). Cardiovascular responses to static exercise in patients with Brown-Sequard syndrome. J Physiol. 527 Pt 1: 193-202. Summary: 1. The purpose of this study was to determine the contributions of central command and the exercise pressor reflex in regulating the cardiovascular response to static exercise in patients with Brown-Sequard syndrome. In this rare condition, a hemisection of the spinal cord typically leaves one side of the body with diminished sensation and normal motor function and the other side with diminished motor function and normal sensation. 2. Four, otherwise healthy, patients with Brown-Sequard syndrome and varying degrees of motor and sensory dysfunction were studied during four isometric knee extension protocols involving both voluntary contraction and electrically stimulated contractions of each leg. Heart rate, blood pressure, force production and ratings of perceived exertion were measured during all conditions. Measurements were also made during post-contraction thigh cuff occlusion and during a cold pressor test. 3. With the exception of electrical stimulation of the leg with a sensory deficit, protocols yielded increases in heart rate and blood pressure. Cuff occlusion sustained blood pressure above resting levels only when the leg had intact sensation. 4. While voluntary contraction (or attempted contraction) of the leg with a motor deficit produced the lowest force, it produced the highest ratings of perceived exertion coupled with the greatest elevations in heart rate and blood pressure. 5. These data show that the magnitude of the heart rate and blood pressure responses in these patients was greatly affected by an increased central command; however, there were marked cardiovascular responses due to activation of the exercise pressor reflex in the absence of central command. Department of Physical Therapy and The Harry S. Moss Heart Center, The University of Texas Southwestern Medical Centre at Dallas, Dallas, TX 75235, USA. patrcia.winchester@email.swmed.edu.

    • Bloom KK and Goldberg G (1989). Tibial nerve somatosensory evoked potentials in spinal cord hemisection. Am J Phys Med Rehabil. 68 (2): 59-65. Summary: Somatosensory evoked potentials (SEPs) have been studied in many disease states since they were first described by Dawson in 1947. However, there have been very few reports of SEP findings in patients with spinal cord hemisection. On the basis of clinical correlation, Giblin first postulated that the activity giving rise to the initial cortical components of the SEP travels through the dorsal column-lemniscal system. However, the pathway through which these evoked potentials are transmitted has recently been questioned. This paper examines the results of tibial nerve SEPS performed on four patients with spinal cord hemisection (Brown-Sequard syndrome). In all four cases presented, the impairment of cortical SEP components was consistently associated with stimulation of the leg ipsilateral to the side of cord injury. We conclude that the most likely mechanism of transmission is through the ipsilateral dorsal columnlemniscal system. Electrodiagnostic Center, Moss Rehabilitation Hospital, Philadelphia, PA 19141.

    • Sniger W and Garshick E (2002). Alendronate increases bone density in chronic spinal cord injury: a case report. Arch Phys Med Rehabil. 83 (1): 139-40. Summary: Over the first 6 to 16 months after spinal cord injury (SCI), up to a third of bone mass may be lost because of demineralization, resulting in an increased risk for fractures. Studies in postmenopausal women have shown the efficacy of oral alendronate, an aminobisphosphonate, in increasing bone mass. However, the efficacy of alendronate in reversing bone density loss has not been shown in patients with chronic SCI. This article reports on the efficacy of alendronate in increasing bone mass in a patient with neurologically incomplete American Spinal Injury Association class D SCI and Brown-Sequard's syndrome. Bone mass change over 2 years while taking alendronate is compared for a weak extremity (majority of muscles grade 2/5) and strong extremity (majority of muscles grade 4/5) and spine. There was a greater increase in bone mineral density in the weaker lower extremity compared with the stronger one; the spine had the greatest increase overall. Spinal Cord Injury Medicine Service, VA Boston Healthcare System, West Roxbury, MA, USA. drsniger@massmed.org.

    • Koehler PJ (1995). Brown-Sequard's comment on Du Bois-Reymond's "hemikrania sympathicotonica". Cephalalgia. 15 (5): 370-2. Summary: In 1859 the famous physiologist Du Bois-Reymond, a migraine sufferer, stated that migraine could be due to an increased sympathicotonic influence on the blood vessels of one side of the head. Migraine, he thought, was not a disease of the brain or cranial blood vessels, but of the cilio-spinal center in the spinal cord. The physician and physiologist Brown-Seqard, who, independently from Claude Bernard, discovered and interpreted the action of the vasomotor nerves in the early 1850s, commented on Du Bois-Reymond's paper, stating that irritation of the cervical sympathetic does not cause pain. From his great experience from animal experiments and clinical observations he had concluded that stimulation of the cervical sympathetic would cause epileptic seizures, rather than migraine attacks. He felt that Du Bois-Reymond's observations would better fit a sympathico-paralytic model of migraine. He was seconded by other physicians like Mollendorff, until Latham tried to unify both theories. Department of Neurology, Ziekenhuis de Wever & Gregorius, Heerlen, The Netherlands.

    • McCarron MO, Flynn PA, Pang KA and Hawkins SA (2001). Traumatic Brown-Sequard-plus syndrome. Arch Neurol. 58 (9): 1470-2. Summary: BACKGROUND: In the 1840s Brown-Sequard described the motor and sensory effects of sectioning half of the spinal cord. Penetrating injuries can cause Brown-Sequard or, more frequently, Brown-Sequard-plus syndromes. OBJECTIVE: To report the case of a 25-year-old man who developed left-sided Brown-Sequard syndrome at the C8 level and left-sided Horner syndrome plus urinary retention and bilateral extensor responses following a stab wound in the right side of the neck. RESULTS: Magnetic resonance imaging demonstrated a low cervical lesion and somatosensory evoked potentials confirmed the clinical finding of left-side dorsal column disturbance. At follow-up, the patient's mobility and bladder function had returned to normal. CONCLUSION: This patient recovered well after a penetrating neck injury that disturbed function in more than half the lower cervical spinal cord (Brown-Sequard-plus syndrome). Department of Neurology, Quin House, Royal Victoria Hospital, Belfast BT12 6BA, Northern Ireland. mark.mccarron@royalhospitals.n-i.nhs.uk.

    • Larsen LB, Tollesson G and Solgaard T (2001). [Spinal cord injury following knife stab wound]. Tidsskr Nor Laegeforen. 121 (4): 434-5. Summary: BACKGROUND: Problems about penetrating injuries are well known, but spinal cord damage is rare. Stab wounds to the spinal cord may be a new type of injury in our society. MATERIAL AND METHODS: We describe two patients brought to our hospital with stab wounds to the cervicothoracic region and major neurologic injury. One was treated initially only with cleaning and primary closure of the skin. After two weeks the intraspinal damage was repaired in our neurosurgical unit. The second patient was immediately brought to neurosurgery. The intraspinal damage was explored and the dural tear was closed. RESULTS: The first patient got a superficial infection and spinal fluid leakage after initial treatment. This resolved when the dura was closed. There were no wound complications in the second patient. Both demonstrated Brown-Sequard's syndrome. Neurologic recovery was much better in the first than in the second patient. INTERPRETATION: Minor penetrating wounds in the neck region may represent damage to the spinal cord with major neurologic injury. Further investigation with MR is preferable and we recommend immediate surgical treatment with closure of the dural tear. Nevrokirurgisk avdeling Ulleval sykehus 0407 Oslo.

    • Gueye EM, Sakho Y, Badiane SB, Ba MC, Diene MS, Diop AA and Gueye M (1998). [Spinal cord injuries in Senegal: 16 cases]. Dakar Med. 43 (2): 238-42. Summary: Penetrating spinal cord injuries (P.S.C.I.) are rarely described in Sub Saharian countries in spite of an increasing number of wars. To study epidemiology management and prognosis of P.S.C.I. in Senegal, population of 16 patients collected from Fann Hospital in Dakar has been studied. 9 cases were related on gunshot or shrapnel injuries and 6 were stab-wounded. 8 came from war practice and 7 from civilian practice. The point of entry was at the posterior or lateral part of the body and continuous leaking of cerebral spinal fluid from this point was founded only in one patient. Patients showed a clinical picture of a complete spinal cord section syndrome, 3 spinal cord hemisection Brown Sequard syndromes, 3 cauda equina syndromes and 1 monoradicular syndrome. Spinal X-rays or myelography may lead to an accurate evaluation of the extent of bone tissue destruction. Anatomical evaluation of roots and spinal cord lesions were more difficult when C.T. scan or R.M.I. is not available. Penetrating spinal cord injury with foreign body included or myelography stop or showing cauda equina syndrome should be operated on. 9 of our patients has benefited of spine surgical posterior approach (laminectomy). Immediate vital prognosis is good regarding the fact that visceral associated lesions were rare (2 cases). Functional recovery is fair only 46.6% of patients expressed partial or complete recovery. Prognosis factors such as injuring agent and initial neurological status has been discussed. Prognosis of penetrating spinal cord injuries could be improved by immediate and multidisciplinary management. Service de Neurologie, CHU Fann, Dakar, Senegal.

    • Oller DW and Boone S (1991). Blunt cervical spine Brown-Sequard injury. A report of three cases. Am Surg. 57 (6): 361-5. Summary: Cervical spinal cord Brown-Sequard syndrome was diagnosed in three recent victims of blunt injury at the authors' Level II Trauma Center. While anatomic hemisection of the cord, resulting in ipsilateral motor and proprioception loss and contralateral pain and temperature deficit, is a fully understandable concept, in the context of the acute trauma evaluation, these findings may be confusing because they are unexpected. Penetrating trauma is far more likely to cause this uncommon syndrome than vehicular crash, fall, or crushing injury. Pediatric victims frequently have no fracture. Early neurosurgical consultation, computed tomography (CT), and magnetic resonance imaging (MRI) if plain film radiography is uninformative, and consideration for rapid decompression if the deficit and pathologic anatomy warrant, are the recommended approaches. Motor function recovery from blunt injury may be expected within six months, a better prognosis than for penetrating injury causing the syndrome. University of North Carolina, Chapel Hill.

    • Massicotte EM, Montanera W, Ross Fleming JF, Tucker WS, Willinsky R, TerBrugge K and Fehlings MG (2002). Idiopathic spinal cord herniation: report of eight cases and review of the literature. Spine. 27 (9): E233-41. Summary: STUDY DESIGN: A case series of eight patients with idiopathic spinal cord herniation and a review of the literature. OBJECTIVE: To report on this rare entity, provide insight on its natural history, and propose an optimal management strategy. SUMMARY OF BACKGROUND DATA: Idiopathic spinal cord herniation is a rare disease with 50 cases reported before the current study. METHODS: Eight cases (follow-up 1 month to 8 years) are reported using available information from patient charts, interviews, and assessments. All imaging studies are reviewed. The review of the literature was performed using PUBMED. RESULTS: Four patients, followed without surgical intervention, have not progressed. Of the three patients who underwent surgical repair by one of the authors, two improved and one was unchanged. A fourth patient, who was initially treated by another surgeon who failed to identify the dural defect and herniation, had a poor outcome. CONCLUSION: The pathophysiology of the dural defect is still uncertain. The typical presentation is Brown-Sequard syndrome. Microsurgical repair in cases with progression of neurologic deficits is usually successful in achieving recovery of function or arrest of progression. Division of Neurosurgery and; Neuro-radiology, University of Toronto, Toronto, Ontario, Canada.

    • Sniger W and Garshick E (2002). Alendronate increases bone density in chronic spinal cord injury: a case report. Arch Phys Med Rehabil. 83 (1): 139-40. Summary: Over the first 6 to 16 months after spinal cord injury (SCI), up to a third of bone mass may be lost because of demineralization, resulting in an increased risk for fractures. Studies in postmenopausal women have shown the efficacy of oral alendronate, an aminobisphosphonate, in increasing bone mass. However, the efficacy of alendronate in reversing bone density loss has not been shown in patients with chronic SCI. This article reports on the efficacy of alendronate in increasing bone mass in a patient with neurologically incomplete American Spinal Injury Association class D SCI and Brown-Sequard's syndrome. Bone mass change over 2 years while taking alendronate is compared for a weak extremity (majority of muscles grade 2/5) and strong extremity (majority of muscles grade 4/5) and spine. There was a greater increase in bone mineral density in the weaker lower extremity compared with the stronger one; the spine had the greatest increase overall. Spinal Cord Injury Medicine Service, VA Boston Healthcare System, West Roxbury, MA, USA. drsniger@massmed.org.

    • Ramli N, Merican AM, Lim A and Kumar G (2001). Post-traumatic arachnoiditis: an unusual cause of Brown-Sequard syndrome. Eur Radiol. 11 (10): 2011-4. Summary: Brown-Sequard syndrome (BSS) is a unilateral cord injury characterised by an ipsilateral motor deficit with contralateral pain and temperature hypoaesthesia. Although there are a variety of causes, the majority of cases are generally of neoplastic origin or are traumatic in origin. We describe a rare cause of Brown-Sequard syndrome as a result of post-traumatic arachnoiditis. Magnetic resonance imaging with the use of thin-slice high-resolution constructive interference in steady state (CISS) and T2-weighted spin-echo sequence were used to demonstrate the cause and appearance of the lesion in the spinal canal and was useful in the assessment and management of the patient. This case illustrates the usefulness of the CISS sequence in MRI for elucidating arachnoiditis. Department of Radiology and Orthopaedic Surgery, University Malaya Medical Centre, 59100 Kuala Lumpur, Malaysia. norlisah@medicine.med.um.edu.my.

  3. #3
    Wise's definition sure seems to fit my condition. My life side has been my weaker side, though the gap does seem to be closing. My right side from the waist down has less sensation, difficulty distinguishing hot/cold and pain.

    I'm c5/6 incomplete nearly 11 months post and have had substantial motor recovery, walking, etc. I've not tried 4-ap yet...

  4. #4
    Senior Member kate's Avatar
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    Brown-sequard

    Ben, my husband also has this syndrome. His injury is 17months old, and he walks with crutches. His left side is the strong one, but as gvinton said, the other seems to be catching up, though very slowly. He works really hard at regaining function, or as hard as his body will let him on any given day, and sometimes it seems this will take forever. He's probably going to try 4ap in a few weeks, depending on whether he can still get into the phase 3 trials. Are you? Do you have Brown-Sequard?

    Kate

  5. #5

    Brown-Sequared & 4AP

    Kate,
    I do have Brown-Sequared since '96. I crushed c-5 in a diving accident.


    I would like to know some results from people who have taken 4AP. I am suppost to be contacted about the phase 3 trials and I have alot of
    questions before I would go through with a trial. Benjamin

  6. #6

    Same injury

    I also have this syndrome, with a near normal right leg and a weak and spastic left leg. Of course, sensation is reversed. I get around with a single-point cane. I don't walk that well, but I do get around well enough that people usually think I "hurt my leg." I tried 4-AP, but it was a weak and old compounding immediate release formula, and it didn't help much. I look forward to trying the SR formula.

  7. #7

    THANKS!

    THANKS Dr. Young for the info it has been helpful.

  8. #8
    Senior Member alan's Avatar
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    There's a fellow on the Mass. General Braintalk forums who has Brown-Sequard.

  9. #9
    I'm the Brown-Sequard husband Kate refers to below. As she said, I do walk with lofstrand crutches. I am, though, a theraputic walker, as my sit-to-stand is still weak. I can stand from my wheelchair to a walker without assistance, but I cannot yet stand from a regular chair. I'm tall, which is a definite disadvantage in terms of leverage.

    I also have trouble with spasticity in the muscles in my low back on my weak side, which often travel down my leg as I straighten out my body. For example, last Friday Kate and I were at a Seattle Mariners game. I usually bring my walker to the ballpark as there are some fine places for walking there. This particular evening I was on the third deck with a view of Puget Sound and the sunset over the Olympic Mountains in the distance. I stood up and got about three feet from my chair when my back went off and my legs collapsed. I melted into a heap, to the consternation of a number of onlookers. I got back into my chair, stood up again and enjoyed a fine walk with no further incidents.

    Wise, thank you for the info and citations about Brown-Sequard syndrome. I'm still digesting all the information.

    - Bruce

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