title: Theophylline for bradycardia secondary to cervical spinal cord injury.
abstract: BACKGROUND
  Spinal cord injury (SCI) is a devastating disease process that can occur as a consequence of motor vehicle collisions, falls, or other traumatic injuries. Persistent bradycardia was found to be universally present in all high cervical SCI patients. Limited data exists to suggest the most effective therapy for the bradycardia associated with high cervical SCI. Treatment includes atropine, epinephrine, dopamine, and even implantable cardiac pacemakers, all of which have their risks and side effects. There are no prospective studies to evaluate methylxanthines for the treatment of bradycardia secondary to cervical SCI.
  
  
  METHODS
  We report on four patients in whom Theophylline was successfully used enterally as a second line agent to treat bradycardia secondary to cervical SCI. We also reported on two patients in whom Theophylline was successfully used as a first line agent. Bradycardia resolved in all patients
  
  
  RESULTS
  Theophylline levels were below toxic levels in all of the patients and no side effects from theophylline were observed.
  
  
  CONCLUSIONS
  Theophylline's use via enteral route can successfully and safely treat SCI-related bradycardia, and may help avoid the long term use of inotropic and chronotropic infusions and pacemakers and their associated risks and complications. We strongly recommend further studies to establish the role of this agent as a first line therapy in this specific patient population. Optimal dosing and duration of therapy will also need to be established.
authors.affiliation: St. John's Mercy Medical Center, St. Louis University, 621 S. New Ballas Rd, suite 4006B, St. Louis, MO 63141, USA. farid.sadaka@mercy.net
authors.forename: Farid
authors.initials: F
authors.lastname: Sadaka
authors.forename: Soophia Khan
authors.initials: SK
authors.lastname: Naydenov
authors.forename: John J
authors.initials: JJ
authors.lastname: Ponzillo
mesh_terms: D000293:Adolescent; D000328:Adult; D001919:Bradycardia / Q000188:drug therapy* / Q000209:etiology*; D003422:Critical Care / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D058915:Purinergic P1 Receptor Antagonists / Q000627:therapeutic use*; D012189:Retrospective Studies; D013119:Spinal Cord Injuries / Q000150:complications*; D013806:Theophylline / Q000627:therapeutic use*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D058915:Purinergic P1 Receptor Antagonists; D013806:Theophylline