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. Author manuscript; available in PMC: 2011 Jun 18.
Published in final edited form as: Spinal Cord. 2010 Mar 9;48(10):718–733. doi: 10.1038/sc.2010.14

Table 9.

Pharmacological Agents

Author Year; Country
Score
Research Design
Total Sample Size		 Methods Outcome
Rosman et al. 2008;47 USA
PEDro = 8
RCT
N = 7		 Population: Mean age 46.9, range 30 – 56 yrs; Level of injury: cervical and thoracic.
Treatment: Injections of neostigmine and glycopyrrolate for 1 week, wash-out period for 1 week, and placebo for 1 week.
OM: Total bowel evacuation time; time to first flatus, beginning of stool flow, end of stool flow.

  1. Injections significantly reduced total bowel evacuation time, time to first flatus, time to beginning and end of stool flow.
Geders et al. 1995;42 USA
PEDro=8
RCT
N=9		 Population: Mean age: SCI group 58.8; Controls 63.4; 2 paraplegics, 7 tetraplegics
Treatment: Cisapride or placebo administered in oral doses.
OM: CTT, questionnaire on type, frequency, and severity of clinical symptoms.

  1. CTT was significantly longer in SCI group.

  2. Subjects with a normal CTT demonstrated no benefit to the administration of cisapride.

  3. Five quadriplegic subjects with initial abnormal total CTT improved their left CTT following treatment.
Rajendran et al. 1992;41 USA
PEDro=8
RCT
N=14		 Population: Age range: 19–71; Level of injury: C4-L2; 7 tetraplegics and 7 paraplegics.
Treatment: Oral administration of cisapride four times per day for four days, and placebo.
OM: Gastric emptying or MCTT.

  1. No delay or improvement in gastric emptying was observed after the administration of cisapride.

  2. Cisapride resulted in normalization of the tetraplegic subjects’ MCTT.
Krogh et al. 2002;44 Denmark
PEDro=7
RCT
N=22		 Population: Mean age: 34.7 (placebo group), 36.5 (1mg group), 44.3 (2mg group).
Treatment: Prucalopride 1mg or placebo, taken once daily for four weeks; and Prucalopride 2mg or placebo for four weeks.
OM: Constipation; urinary habit; constipation severity and symptoms; CTT.

  1. Constipation severity increased with placebo; decreased with prucalopride.

  2. Improvement in frequency of bowel movements over 4 weeks in the 2 mg group.

  3. Four patients (2 mg group) reported moderate/severe abdominal pain.
Korsten et al. 2005;46 USA
PEDro score=6
RCT
N=13		 Population: Mean age: 46; range 25–69; Level of injury C4-T12; 5 tetraplegic, 8 paraplegic, 12 motor complete, 5 sensory complete.
Treatment: Normal saline, 2 mg neostigmine, or combination of 2 mg neostigmine and 0.4 mg glycopyrrolate.
OM: Bowel evacuation.

  1. Normal saline was least effective for bowel evacuation.

  2. Mean time to evacuation was 11.5 min after neostigmine and 13.5 min after the combination of neostigmine and glycopyrrolate.
Cardenas et al. 2007;48 USA
PEDro score=6
RCT
N=91		 Population: Group 1: Mean age: 44, range 23–66; Group 2: Mean age: 42, range 21–67; Group 3: Mean age: 38, range 19–61; Level of injury: 73 cervical, 18 thoracic.
Treatment: 8 weeks; group 1: Fampridine, sustained release, 25 mg twice a day; group 2: 40 mg twice a day; group 3: Placebo.
OM: Number of days with bowel movement.

  1. Significantly larger number of subjects in groups 1 and 2 had an increase in the number of days with bowel movements compared to subjects in the placebo group. Number of days increase not reported.
De Both et al. 1992;43 Netherlands
PEDro score=5
RCT
N=10		 Population: Mean age: 35.8, range 19–63; Level of injury: C6-L1.
Treatment: Group 1: Cisapride 10 mg four times daily; Group 2: placebo
OM: Defecation frequency, consistency of stools, percentage of defecations preceded by digital stimulation or suppository, CTT

  1. No difference in number of defecations per week.

  2. Significant improvement in ease of evacuation in both the cisapride and placebo, and reduction in CTT with cisapride.

  3. Consistency of stools changed significantly with cisapride.

  4. Cisapride and placebo had no effect on digital reflex stimulation or suppository use.
Binnie et al. 1988;49 UK
Downs & Black score=12
Pre-post
N=10		 Population: Mean age: 34.1, range 20–45yrs; Level of injury: C4-T10, all complete.
Treatment: Intravenous injection of 10 mg cisapride. After at least 48 hours subjects were administered cisapride orally.
OM: CTT.

  1. CTT was reduced from 185±86.3 to 123±77.0 hours.
Longo et al. 1995;50 USA
Downs & Black score =9
Pre-post
N=15		 Population: Mean age: n/a; Level of injury: 12 tetraplegics, 3 paraplegics.
Treatment: 20mg cisapride, three times per day for one month.
OM: Anorectal manometry; bowel movements; intestinal transit time.

  1. 6/12 had improved symptoms of constipation. 9/12 had reduced the time needed for a bowel movement.

  2. No worsening of constipation.

  3. 6/12 had a 10% or more increase in resting anal canal pressure.
Segal et al. 1987;35 USA
Downs & Black score=9
Prospective Controlled Trial
N=20, Control N=8		 Population: Age range 20–55; Level of injury: 11 tetraplegic, 9 paraplegic, all complete.
Treatment: Liquid meal, then within 2 weeks, ingested 2nd liquid meal with intravenously administered metoclopramide.
OM: Half time of gastric emptying, GE patterns in the early and later phases.

  1. Mean GE half time for a liquid meal decreased in the quadriplegic subjects from 104.8 min to 18.8 min after treatment.

  2. In the paraplegic subjects, a pretreatment mean GE of 111.5 min decreased to 29.1min.

OM = Outcome measures; CTT = Colonic transit time; MCTT = mouth to cecum transit time; GE = gastric emptying