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Weisbrod LJ, Nilles-Melchert TT, Bergjord JR, Surdell DL. Safety and Efficacy of Riluzole in Traumatic Spinal Cord Injury: A Systematic Review With Meta-Analyses. Neurotrauma Rep 2024; 5:117-127. [PMID: 38414779 PMCID: PMC10898229 DOI: 10.1089/neur.2023.0114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024] Open
Abstract
Traumatic spinal cord injury (SCI) is a cause of significant morbidity, often resulting in long-term disability. We aimed to compare outcomes after riluzole versus patients who received placebo or standard of care with no specific intervention. MEDLINE, Embase, Scopus, and Cochrane Library database searches yielded 92 records, and five met the study inclusion criteria. Fixed-effect and random-effects models were used to establish odds ratios (ORs) and mean difference (MD) with 95% confidence intervals (CIs) for each outcome. The results of the pooled analysis showed that in patients with acute traumatic SCI, riluzole resulted in increased American Spinal Injury Association (ASIA) motor scores at 3 months (MD 0.26, 95% CI [-0.10,0.61], I2 = 0%; p = 0.157) and 6 months (MD 0.21, 95% CI [-0.17,0.60], I2 = 0%; p = 0.280) and change in ASIA Impairment Scale (AIS) at 3 months (OR 0.59, 95% CI [-0.12,1.30], I2 = 0%, p = 0.101) and 6 months (OR 0.28, 95% CI [-0.50,1.06], I2 = 0%, p = 0.479) in comparison to the control groups, though not to a level of statistical significance. Riluzole resulted in fewer adverse events than the control groups (OR -0.12, 95% CI [-1.59,1.35], I2 = 0%, p = 0.874) and lower mortality (OR -0.20, 95% CI [-1.03,0.63], I2 = 0%, p = 0.640), though also not to a level of statistical significance. These meta-analyses suggest that riluzole for the treatment of traumatic SCI is safe and results in improved neurological outcomes when compared to controls, though not to a level of statistical significance. More robust prospective, randomized studies are necessary to help inform the safety and efficacy of riluzole for traumatic SCI.
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Affiliation(s)
- Luke J Weisbrod
- Department of Neurosurgery, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | | | | | - Daniel L Surdell
- Department of Neurosurgery, University of Nebraska Medical Center, Omaha, Nebraska, USA
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Sterner RC, Sterner RM. Immune response following traumatic spinal cord injury: Pathophysiology and therapies. Front Immunol 2023; 13:1084101. [PMID: 36685598 PMCID: PMC9853461 DOI: 10.3389/fimmu.2022.1084101] [Citation(s) in RCA: 30] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 12/19/2022] [Indexed: 01/09/2023] Open
Abstract
Traumatic spinal cord injury (SCI) is a devastating condition that is often associated with significant loss of function and/or permanent disability. The pathophysiology of SCI is complex and occurs in two phases. First, the mechanical damage from the trauma causes immediate acute cell dysfunction and cell death. Then, secondary mechanisms of injury further propagate the cell dysfunction and cell death over the course of days, weeks, or even months. Among the secondary injury mechanisms, inflammation has been shown to be a key determinant of the secondary injury severity and significantly worsens cell death and functional outcomes. Thus, in addition to surgical management of SCI, selectively targeting the immune response following SCI could substantially decrease the progression of secondary injury and improve patient outcomes. In order to develop such therapies, a detailed molecular understanding of the timing of the immune response following SCI is necessary. Recently, several studies have mapped the cytokine/chemokine and cell proliferation patterns following SCI. In this review, we examine the immune response underlying the pathophysiology of SCI and assess both current and future therapies including pharmaceutical therapies, stem cell therapy, and the exciting potential of extracellular vesicle therapy.
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Affiliation(s)
- Robert C. Sterner
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
| | - Rosalie M. Sterner
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States,*Correspondence: Rosalie M. Sterner,
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Mattiassich G, Gollwitzer M, Gaderer F, Blocher M, Osti M, Lill M, Ortmaier R, Haider T, Hitzl W, Resch H, Aschauer-Wallner S. Functional Outcomes in Individuals Undergoing Very Early (< 5 h) and Early (5–24 h) Surgical Decompression in Traumatic Cervical Spinal Cord Injury: Analysis of Neurological Improvement from the Austrian Spinal Cord Injury Study. J Neurotrauma 2017; 34:3362-3371. [DOI: 10.1089/neu.2017.5132] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Affiliation(s)
- Georg Mattiassich
- Trauma Center Linz, Teaching Hospital of the Paracelsus Medical University Salzburg, Linz, Austria
- Ludwig-Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria
- Department of Orthopaedic Surgery, Ordensklinikum Barmherzige Schwestern Linz, Vinzenzgruppe Center of Orthopaedic Excellence, Teaching Hospital of the Paracelsus Medical University Salzburg, Linz, Austria
| | - Maria Gollwitzer
- Department of Neurosurgery, Neuromed Campus, Kepler University Linz, Linz, Austria
| | - Franz Gaderer
- Department of Trauma Surgery, Medcampus III, Kepler University Linz, Linz, Austria
| | - Martina Blocher
- Department of Orthopaedics and Traumatology, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Michael Osti
- Department for Trauma Surgery and Sports Traumatology, Academic Hospital Feldkirch, Feldkirch, Austria
| | - Markkus Lill
- Trauma Center Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Reinhold Ortmaier
- Department of Orthopaedic Surgery, Ordensklinikum Barmherzige Schwestern Linz, Vinzenzgruppe Center of Orthopaedic Excellence, Teaching Hospital of the Paracelsus Medical University Salzburg, Linz, Austria
- Research Unit for Orthopaedic Sports Medicine and Injury Prevention, ISAG/UMIT, Hall in Tyrol, Austria
| | - Thomas Haider
- Department of Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | - Wolfgang Hitzl
- Research Office of Biostatistics, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Herbert Resch
- Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Stephanie Aschauer-Wallner
- Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria
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Anderson KD, Guest JD, Dietrich WD, Bartlett Bunge M, Curiel R, Dididze M, Green BA, Khan A, Pearse DD, Saraf-Lavi E, Widerström-Noga E, Wood P, Levi AD. Safety of Autologous Human Schwann Cell Transplantation in Subacute Thoracic Spinal Cord Injury. J Neurotrauma 2017; 34:2950-2963. [PMID: 28225648 DOI: 10.1089/neu.2016.4895] [Citation(s) in RCA: 170] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The rationale for implantation of autologous human Schwann cells (SCs) in persons with subacute spinal cord injury (SCI) is based on evidence that transplanted SCs are neuroprotective, support local axonal plasticity, and are capable of myelinating axons. A Phase I clinical trial was conducted to evaluate the safety of autologous human SC transplantation into the injury epicenter of six subjects with subacute SCI. The trial was an open-label, unblinded, non-randomized, non-placebo controlled study with a dose escalation design and standard medical rehabilitation. Participants were paraplegics with neurologically complete, trauma-induced spinal lesions. Autologous SCs were cultured in vitro from a sural nerve harvested from each participant and injected into the epicenter of the spinal lesion. Outcome measures for safety were protocol compliance, feasibility, adverse events, stability of neurological level, absence of detectable mass lesion, and the emergence of clinically significant neuropathic pain or muscle spasticity no greater than expected for a natural course cohort. One year post-transplantation, there were no surgical, medical, or neurological complications to indicate that the timing or procedure for the cell transplantation was unsafe. There were no adverse events or serious adverse events related to the cell therapy. There was no evidence of additional spinal cord damage, mass lesion, or syrinx formation. We conclude that it is feasible to identify eligible candidates, appropriately obtain informed consent, perform a peripheral nerve harvest to obtain SCs within 5-30 days of injury, and perform an intra-spinal transplantation of highly purified autologous SCs within 4-7 weeks of injury.
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Affiliation(s)
- Kim D Anderson
- 1 The Miami Project to Cure Paralysis, The University of Miami Miller School of Medicine , Miami, Florida.,2 Department of Neurological Surgery, The University of Miami Miller School of Medicine , Miami, Florida
| | - James D Guest
- 1 The Miami Project to Cure Paralysis, The University of Miami Miller School of Medicine , Miami, Florida.,2 Department of Neurological Surgery, The University of Miami Miller School of Medicine , Miami, Florida.,3 The Neuroscience Program, The University of Miami Miller School of Medicine , Miami, Florida
| | - W Dalton Dietrich
- 1 The Miami Project to Cure Paralysis, The University of Miami Miller School of Medicine , Miami, Florida.,2 Department of Neurological Surgery, The University of Miami Miller School of Medicine , Miami, Florida.,3 The Neuroscience Program, The University of Miami Miller School of Medicine , Miami, Florida.,4 Department of Cell Biology, The University of Miami Miller School of Medicine , Miami, Florida.,5 Department of Neurology, The University of Miami Miller School of Medicine , Miami, Florida.,6 Department of The Interdisciplinary Stem Cell Institute, The University of Miami Miller School of Medicine , Miami, Florida
| | - Mary Bartlett Bunge
- 1 The Miami Project to Cure Paralysis, The University of Miami Miller School of Medicine , Miami, Florida.,2 Department of Neurological Surgery, The University of Miami Miller School of Medicine , Miami, Florida.,3 The Neuroscience Program, The University of Miami Miller School of Medicine , Miami, Florida.,4 Department of Cell Biology, The University of Miami Miller School of Medicine , Miami, Florida.,5 Department of Neurology, The University of Miami Miller School of Medicine , Miami, Florida.,6 Department of The Interdisciplinary Stem Cell Institute, The University of Miami Miller School of Medicine , Miami, Florida
| | - Rosie Curiel
- 7 Department of Psychiatry, The University of Miami Miller School of Medicine , Miami, Florida
| | - Marine Dididze
- 1 The Miami Project to Cure Paralysis, The University of Miami Miller School of Medicine , Miami, Florida.,2 Department of Neurological Surgery, The University of Miami Miller School of Medicine , Miami, Florida
| | - Barth A Green
- 1 The Miami Project to Cure Paralysis, The University of Miami Miller School of Medicine , Miami, Florida.,2 Department of Neurological Surgery, The University of Miami Miller School of Medicine , Miami, Florida.,5 Department of Neurology, The University of Miami Miller School of Medicine , Miami, Florida.,8 Department of Orthopaedics, The University of Miami Miller School of Medicine , Miami, Florida.,9 Department of Rehabilitation Medicine, The University of Miami Miller School of Medicine , Miami, Florida
| | - Aisha Khan
- 1 The Miami Project to Cure Paralysis, The University of Miami Miller School of Medicine , Miami, Florida.,6 Department of The Interdisciplinary Stem Cell Institute, The University of Miami Miller School of Medicine , Miami, Florida
| | - Damien D Pearse
- 1 The Miami Project to Cure Paralysis, The University of Miami Miller School of Medicine , Miami, Florida.,2 Department of Neurological Surgery, The University of Miami Miller School of Medicine , Miami, Florida.,3 The Neuroscience Program, The University of Miami Miller School of Medicine , Miami, Florida.,6 Department of The Interdisciplinary Stem Cell Institute, The University of Miami Miller School of Medicine , Miami, Florida.,11 Bruce W. Carter Department of Veterans Affairs Medical Center , Miami, Florida
| | - Efrat Saraf-Lavi
- 10 Department of Radiology, The University of Miami Miller School of Medicine , Miami, Florida
| | - Eva Widerström-Noga
- 1 The Miami Project to Cure Paralysis, The University of Miami Miller School of Medicine , Miami, Florida.,2 Department of Neurological Surgery, The University of Miami Miller School of Medicine , Miami, Florida.,3 The Neuroscience Program, The University of Miami Miller School of Medicine , Miami, Florida.,9 Department of Rehabilitation Medicine, The University of Miami Miller School of Medicine , Miami, Florida.,11 Bruce W. Carter Department of Veterans Affairs Medical Center , Miami, Florida
| | - Patrick Wood
- 1 The Miami Project to Cure Paralysis, The University of Miami Miller School of Medicine , Miami, Florida.,2 Department of Neurological Surgery, The University of Miami Miller School of Medicine , Miami, Florida
| | - Allan D Levi
- 1 The Miami Project to Cure Paralysis, The University of Miami Miller School of Medicine , Miami, Florida.,2 Department of Neurological Surgery, The University of Miami Miller School of Medicine , Miami, Florida.,8 Department of Orthopaedics, The University of Miami Miller School of Medicine , Miami, Florida
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Grossman RG, Fehlings MG, Frankowski RF, Burau KD, Chow DSL, Tator C, Teng A, Toups EG, Harrop JS, Aarabi B, Shaffrey CI, Johnson MM, Harkema SJ, Boakye M, Guest JD, Wilson JR. A prospective, multicenter, phase I matched-comparison group trial of safety, pharmacokinetics, and preliminary efficacy of riluzole in patients with traumatic spinal cord injury. J Neurotrauma 2013; 31:239-55. [PMID: 23859435 DOI: 10.1089/neu.2013.2969] [Citation(s) in RCA: 139] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
A prospective, multicenter phase I trial was undertaken by the North American Clinical Trials Network (NACTN) to investigate the pharmacokinetics and safety of, as well as obtain pilot data on, the effects of riluzole on neurological outcome in acute spinal cord injury (SCI). Thirty-six patients, with ASIA impairment grades A-C (28 cervical and 8 thoracic) were enrolled at 6 NACTN sites between April 2010 and June 2011. Patients received 50 mg of riluzole PO/NG twice-daily, within 12 h of SCI, for 14 days. Peak and trough plasma concentrations were quantified on days 3 and 14. Peak plasma concentration (Cmax) and systemic exposure to riluzole varied significantly between patients. On the same dose basis, Cmax did not reach levels comparable to those in patients with amyotrophic lateral sclerosis. Riluzole plasma levels were significantly higher on day 3 than on day 14, resulting from a lower clearance and a smaller volume of distribution on day 3. Rates of medical complications, adverse events, and progression of neurological status were evaluated by comparison with matched patients in the NACTN SCI Registry. Medical complications in riluzole-treated patients occurred with incidences similar to those in patients in the comparison group. Mild-to-moderate increase in liver enzyme and bilirubin levels were found in 14-70% of patients for different enzymes. Three patients had borderline severe elevations of enzymes. No patient had elevated bilirubin on day 14 of administration of riluzole. There were no serious adverse events related to riluzole and no deaths. The mean motor score of 24 cervical injury riluzole-treated patients gained 31.2 points from admission to 90 days, compared to 15.7 points for 26 registry patients, a 15.5-point difference (p=0.021). Patients with cervical injuries treated with riluzole had more-robust conversions of impairment grades to higher grades than the comparison group.
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Affiliation(s)
- Robert G Grossman
- 1 Houston Methodist Research Institute , Department of Neurosurgery, Houston Methodist Hospital, Houston, Texas
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Abstract
BACKGROUND Acute spinal cord injury is a devastating condition typically affecting young people, mostly males. Steroid treatment in the early hours after the injury is aimed at reducing the extent of permanent paralysis during the rest of the patient's life. OBJECTIVES To review randomized trials of steroids for human acute spinal cord injury. SEARCH METHODS We searched the Cochrane Injuries Group Specialised Register (searched 02 Aug 2011), The Cochrane Central Register of Controlled Trials 2011, issue 3 (The Cochrane Library), MEDLINE (Ovid) 1948 to July Week 3 2011, EMBASE (Ovid) 1974 to 2011 week 17, ISI Web of Science: Science Citation Index Expanded (SCI-EXPANDED) 1970 to Aug 2011, ISI Web of Science: Conference Proceedings Citation Index- Science (CPCI-S) 1990 to Aug 2011 and PubMed [www.ncbi.nlm.nih.gov/sites/entrez/] (searched 04 Aug 2011) for records added to PubMed in the last 90 days). Files of the National Acute Spinal Cord Injury Study (NASCIS) were reviewed (NASCIS was founded in 1977 and has tracked trials in this area since that date). We also searched the reference lists of relevant studies and previously published reviews. SELECTION CRITERIA All randomized controlled trials of steroid treatment for acute spinal cord injury in any language. DATA COLLECTION AND ANALYSIS One review author extracted data from trial reports. Japanese and French studies were found through NASCIS and additional data (e.g. SDs) were obtained from the original study authors. MAIN RESULTS Eight trials are included in this review, seven used methylprednisolone. Methylprednisolone sodium succinate has been shown to improve neurologic outcome up to one year post-injury if administered within eight hours of injury and in a dose regimen of: bolus 30mg/kg over 15 minutes, with maintenance infusion of 5.4 mg/kg per hour infused for 23 hours. The initial North American trial results were replicated in a Japanese trial but not in the one from France. Data was obtained from the latter studies to permit appropriate meta-analysis of all three trials. This indicated significant recovery in motor function after methylprednisolone therapy, when administration commenced within eight hours of injury. A more recent trial indicates that, if methylprednisolone therapy is given for an additional 24 hours (a total of 48 hours), additional improvement in motor neurologic function and functional status are observed. This is particularly observed if treatment cannot be started until between three to eight hours after injury. The same methylprednisolone therapy has been found effective in whiplash injuries. A modified regimen was found to improve recovery after surgery for lumbar disc disease. The risk of bias was low in the largest methyprednisolne trials. Overall, there was no evidence of significantly increased complications or mortality from the 23 or 48 hour therapy. AUTHORS' CONCLUSIONS High-dose methylprednisolone steroid therapy is the only pharmacologic therapy shown to have efficacy in a phase three randomized trial when administered within eight hours of injury. One trial indicates additional benefit by extending the maintenance dose from 24 to 48 hours, if start of treatment must be delayed to between three and eight hours after injury. There is an urgent need for more randomized trials of pharmacologic therapy for acute spinal cord injury.
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Affiliation(s)
- Michael B Bracken
- Department of Epidemiology & Public Health, Yale University Medical School, Box 20834, 60College Street, New Haven, CT, 06520-8034, USA.
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Sayer FT, Kronvall E, Nilsson OG. Methylprednisolone treatment in acute spinal cord injury: the myth challenged through a structured analysis of published literature. Spine J 2006; 6:335-43. [PMID: 16651231 DOI: 10.1016/j.spinee.2005.11.001] [Citation(s) in RCA: 157] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2005] [Revised: 10/20/2005] [Accepted: 11/12/2005] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Methylprednisolone has evolved during the 1990s, through the results obtained from the National Acute Spinal Cord Injury Studies NASCIS II and III, as a standard treatment in acute spinal injury. PURPOSE To evaluate the scientific basic for the use of methylprednisolone in acute spinal cord injury. STUDY DESIGN Systematic review of the accumulated literature. METHODS Critical evaluation of the data obtained in the NASCIS II and III studies plus other accumulated literature. RESULTS Analyses have been made on subgroups of the study populations, and the results were based on statistical artefacts. Furthermore, improved functional recovery shown by these studies was not clinically significant. CONCLUSION There is insufficient evidence to support the use of methylprednisolone as a standard treatment in acute spinal cord injury.
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Affiliation(s)
- Faisal T Sayer
- Department of Neurosurgery, Lund University Hospital, Lund 221 85, Sweden.
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Abstract
BACKGROUND Acute spinal cord injury is a devastating condition typically affecting young people with a preponderance being male. Steroid treatment in the early hours of the injury is aimed at reducing the extent of permanent paralysis during the rest of the patient's life. OBJECTIVES To review randomized trials of steroids for acute spinal cord injury. SEARCH STRATEGY The review draws on the search strategy developed by the Cochrane Injuries Group. In addition, files of the National Acute Spinal Cord Injury Study have been reviewed and a Medline search conducted. SELECTION CRITERIA All published or unpublished randomized controlled trials of steroid treatment for acute spinal cord injury in any language. DATA COLLECTION AND ANALYSIS Data have been abstracted from original trial reports. For the NASCIS, Japanese and French trials, additional data (e.g. SDs) have been obtained from the original authors. MAIN RESULTS There are few trials in this area of medical care. Only one steroid has been extensively studied, methylprednisolone sodium succinate, which has been shown to improve neurologic outcome up to one year post injury if administered within eight hours of injury and in a dose regimen of: bolus 30mg/kg administered over 15 minutes with a maintenance infusion of 5.4 mg/kg per hour infused for 23 hours. The initial North American trial was replicated in a Japanese trial but not in the one from France. Data has been obtained from the latter studies to permit appropriate meta-analysis of all three trials. This analysis indicates significant recovery in motor function after methylprednisolone therapy when administration commences within eight hours of injury. A more recent trial indicates that if methylprednisolone therapy is given for an additional 24 hours (for a total of 48 hours), additional improvement in motor neurologic function and functional status is observed. This is particularly observed if treatment cannot be started until between three to eight hours after injury. The same methylprednisolone therapy has been found effective in whiplash injuries and a modified regimen found to improve recovery after surgery for lumbar disc disease. REVIEWER'S CONCLUSIONS High dose methylprednisolone steroid therapy is the only pharmacological therapy shown to have efficacy in a Phase Three randomized trial when it can be administered within eight hours of injury. A recent trial indicates additional benefit by extending the maintenance dose from 24 to 48 hours if start of treatment must be delayed to between three and eight hours after injury. There is an urgent need for more randomized trials of pharmacological therapy for acute spinal cord injury.
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Affiliation(s)
- M B Bracken
- Department of Epidemiology and Public Health, Yale School of Medicine, 60 College street, Box 20834, New Haven, Connecticut, 06520-8034, USA.
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Abstract
OBJECTIVES Randomized trials are widely recognized as providing the most reliable evidence for assessing efficacy and safety of therapeutic interventions. This evidence base is used to evaluate the current status of methylprednisolone (MPSS) in the early treatment of acute spinal cord injury. METHODS Medline, CINAHL, and other specified databases were searched for MeSH headings "methylprednisolone and acute spinal cord injury." The Cochrane Library and an existing systematic review on the topic were also searched. RESULTS Five randomized controlled trials were identified that evaluated high-dose MPSS for acute spinal cord injury. Three trials by the NASCIS group were of high methodologic quality, and a Japanese and French trial of moderate to low, methodologic quality. Meta-analysis of the final result of three trials comparing 24-hour high-dose MPSS with placebo or no therapy indicates an average unilateral 4.1 motor function score improvement (95% confidence interval 0.6-7.6, P = 0.02) in patients treated with MPSS. This neurologic recovery is likely to be correlated with improved functional recovery in some patients. The safety of this regimen of MPSS is evident from the spinal cord injury trials and a systematic review of 51 surgical trials of high-dose MPSS. CONCLUSION High-dose MPSS given within 8 hours of acute spinal cord injury is a safe and modestly effective therapy that may result in important clinical recovery for some patients. Further trials are needed to identify superior pharmacologic therapies and to test drugs that may sequentially influence the postinjury cascade.
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Affiliation(s)
- M B Bracken
- Department of Epidemiology, Yale University School of Medicine, 60 College Street, New Haven, Connecticut 06520, USA.
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Abstract
This article provides a substantive review and synthesis of major areas of emphasis in spinal cord injury (SCI) research. Comprehensive examination of the current status and future implications for SCI research includes consideration of investigations from the following arenas: epidemiology, functional classification and prediction, neurophysiologic testing, models of injury and recovery, psychosocial considerations, surgical strategies, animal laboratory research, economic implications, life expectancy, complication rates, gender differences, pharmacological management, and prevention. Synthesis of these research conclusions from a broad spectrum of laboratory, clinical, and scientific domains provides opportunity for improving SCI prevention, treatment, and adaptation.
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Affiliation(s)
- J Sullivan
- Thomas Jefferson University & Hospital, Philadelphia, Pennsylvania, USA
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