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Thread: ASIA B Incomplete Recovery Chances?

  1. #1

    ASIA B Incomplete Recovery Chances?

    I've read that a fairly large percentage of persons, ASIA C incomplete shortly after injury who were given methylprednisone treatment within 6 hours of injury recover walking. Dr. Young, can you comment on the possibilities for ASIA B incomplete? This was the diagnosis for our daughter within 18 hours of her accident. She received the methylprednisone within 1 hour of injury and decompression surgery within 4 hours of injury. Her level is C6-7. She can write with a pen and has regained some tricep. She's 3 months post injury.

  2. #2
    dglosek,

    ASIA B's are relatively rare, constituting probably less thatn 5% of the spinal cord injuries seen. That is because the difference between ASIA B and C are relatively small and the presence of even slight motor control below the injury site would make a person an ASIA C. In my opinion, most people with ASIA B status during the first week after injury will get to ASIA C within 3-6 months. The real question is whether or not they recover to ASIA D (useful motor function in over 50% of the muscles below the injury site). Conversion from ASIA A or B to C is supposed to be abouut 5%(at least according to the model system database that has tracked patients from 1970's to now) but the database does not take into account those people who have taken methylprednisolone, surgical decompression, and exercise.

    The NASCIS 2 study showed that patients who were admitted to hospital with ASIA B or C classification typically recoverd 59% of their motor function below their injury level when they did not receive MP and 75% of the motor function they had lost if they did get methylprednisolone (MP). In paients treated between 3-8 hours after injury, NASCIS 3 showed that a 48-hour course of MP on average restored more than twice the amount of function than patients who received a 24-hour course of MP.

    I think that it is a very good prognostic factor for a person to become ASIA B or C within 24 hours after injury and that this portends further motor and sensory recovery. It takes a long time and a lot of work, however. I know one person who may have been an ASIA B (her father told me that she could feel him squeezing her leg just before she was placed in the ambulance but she was an ASIA A by the time she was admitted to hospital and received methylprednisolone). She is now walking normally.

    Wise.

  3. #3
    Thank you so much. While I know there are no guarantees for my daughter's recovery, your response is very encouraging for us. We'd be thrilled at the prospect of her being able to walk around the house with the aid of a walker or cane, and then using a chair for longer distances. She's working very hard and also spent 2 weeks at Shriner's Children's Hospital for an evaluation and urodynamics testing.

    She will be returning to Shriner's in January to participate in a 14 week FES cycling study, so we're hoping that somehow the nerves below the injury will jump start. She has good feeling all over, so we're very optimistic.

  4. #4
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    I can walk with canes, and my motor skils are 4 out 5 in one leg, 3 in the other but I have very diminished sensations. I thought that made me an incomplete. However, I have been told I might be considered complete because my sphincter has been rated 0 out of 5. Is that correct?

    gretchen 1

  5. #5
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    Gretchen-
    that says it all... you can walk with a cane but since you have no sacral sparing, you are labeled an ASIA A complete. This just proves once again that no one knows what they are doing. I was given this label due to the location of my spinal avm, on the Conus, which wiped out my Sacral area, and I was pretty much kicked out of general rehab for other SCI patients with incomplete injuries, and placed, alone, in the complete part of the gym, where I was taught by some of the brightest minds at Mt. Sinai the different ways I can sit on a mat!! I am just curious as to why I didn't see any recovery after receiving oral and intravenous steroids several hours after weakness started, and given them for 3 months.

    sherman brayton

  6. #6
    brayton, please... The long term steroids that your received for your ischemia did not help. This is well known and of course why we have always recommended that the methylprednisolone NOT be given for over 24-48 hours. The definition of ASIA has been known for a long time and I have posted over and over again on this topic. In my opinion, the concept of "complete" spinal cord injury is inappropriate. It has caused so much grief and probably contributed to worse recovery in millions of people who have been deprived of hope by the term.

    Wise.

  7. #7
    I am complete - what hope have I been denied - there is no hope

  8. #8
    Senior Member KDK513's Avatar
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    Based upon our experience I believe you have much reason for hope. My husbands original diagnosis almost 5 years ago was ASIA A complete at T4. He was given steroids 7 hours after the onset of injury for 24 hours. He has never had surgery. Within 3 months there was some discussion that his injury was considered incomplete. Fourteen months later he walked with a walker in therapy. Fifteen months ago he was considered incomplete, ASIA B minus at T7. His recent checkup left his Doctor stunned. He had improved to ASIA D , now at T10. We attribute this to his exercise program which includes swimming laps, pool exercises, regular workouts at the healthclub and PT once a week. You see, you have much to hope for.

    You also have youth on your side. My husband is now 55 and also has to find time to work at his family owned business. (Find a swimming pool)

  9. #9
    dglosek, I have a C6 injury; I was ASIA B at 24 hours post-injury. At two weeks I improved to ASIA C when I could move a big toe. At a year I was classed ASIA D and could walk short distances with a walker and a KAFO (full leg brace) on my right leg. Today almost four years post I walk with a cane and continue to push for all I can get. Just my experience, every injury is different. I wish your daughter the best.

    KDK, your husband's recovery is remarkable, to get the gains you mention so long after injury. Exercise and therapy can help some of us, even long after injury.

    Gretchen, your case shows a limitation of the ASIA classification system, not that no one knows what they are doing. Because of your lack of sphincter sensation, you would be classed ASIA A, but you are functioning like an ASIA D. So equating ASIA A with "complete" is not necessarily correct.

  10. #10
    When has the window closed to use methylprednisolone for recovery? My husband was injured almost 2 years ago. He is a c-6 incomplete. Since injury he has regained use of his arms. His right arm returned in the first month the left arm took about 6 months to return. He now has sone ab muscles and pecs. He has feeling all the way to his toes. Any help or rehab suggestions will be greatly appreciated!

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