Effect of Gender on Recovery After Spinal Cord Injury
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REVIEW ARTICLE
Effect of Gender on Recovery After Spinal Cord Injury Wai-Man Chan & Yahya Mohammed & Isabel Lee & Damien D. Pearse
Received: 18 December 2012 / Accepted: 26 December 2012 / Published online: 23 January 2013 # Springer Science+Business Media New York 2013
Abstract Spinal cord injury (SCI) is a debilitating condition that affects thousands of new individuals each year, the majority of which are males. Males with SCI tend to be injured at an earlier age, mostly during sports or motor vehicle accidents, whereas females tend be injured later in life, particularly in the age group 65 and older. In both experimental and clinical studies, the question as to whether gender affects outcome has been addressed in a variety of patient groups and animal models. Results from experimental paradigms have suggested that a gender bias in outcome exists that favors females and appears to involve the advantageous or disadvantageous effects of the gonadal sex hormones estrogen and progesterone or testosterone, respectively. However, other studies have shown an absence of gender differences in outcome in specific SCI models and work has also questioned the involvement of female sex hormones in the observed outcome improvements in females. Similar controversy exists clinically, in studies that have examined gender disparities in outcome after SCI. The
Isabel Lee is a visiting summer research student from Kalamazoo College, Kalamazoo, MI 49006, USA. W.-M. Chan : Y. Mohammed : I. Lee : D. D. Pearse Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, FL 33136, USA D. D. Pearse Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL 33136, USA D. D. Pearse Neuroscience Program, University of Miami Miller School of Medicine, Miami, FL 33136, USA D. D. Pearse Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA D. D. Pearse (*) Lois Pope LIFE Center, P.O. Box 016960, Mail locator R-48, Miami, FL 33101, USA e-mail: [email protected]
current review examines the experimental and clinical evidence for a gender bias in outcome following SCI and discusses issues that have made it difficult to conclusively answer this question. Keywords Male . Female . CNS . Trauma . Estrogen . Testosterone . Progesterone . Clinical . Functional recovery . Pain
Spinal Cord Injury Etiology and Pathophysiology Initial damage to the spinal cord often occurs as a result of mechanical trauma, producing a contusive, compressive or lacerating injury with instantaneous tissue damage. Subsequent to the primary injury, secondary tissue damage follows in response to the release of a variety of neurotoxic molecules including inflammatory cytokines, excitotoxic neurotransmitters, oxidative metabolites and degradative enzymes [1–4]. Neurological damage resulting from these two phases of spinal cord injury (SCI) produces either partial or complete injury to the spinal cord at the level of the insult as well as dysfunction within those
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