Article

Methylprednisolone and acute spinal cord injury: an update of the randomized evidence.

Department of Epidemiology, Yale University School of Medicine, 60 College Street, New Haven, Connecticut 06520, USA.
Spine (Impact Factor: 2.16). 01/2002; 26(24 Suppl):S47-54.
Source: PubMed

ABSTRACT 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.
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.
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.
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.

0 Bookmarks
 · 
64 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: This study investigated the outcome of combined therapy with irradiation and methylprednisolone (MP) after a traumatic spinal cord injury (SCI). To evaluate the neurologic outcomes as well as the antiapoptotic and anti-inflammatory effects on traumatic SCI in rats after combined therapy. Although irradiation carries the risk of secondary SCI, it has been effective for the regeneration of the axons of nerve cells by reducing gliosis. Thus, to minimize apoptosis and irradiation risks after SCI, this study investigated the effects of steroid injections before irradiation. Thirty-two rats were used for the experimental procedure. After a traumatic SCI, they were divided into 4 groups of 8 rats each: (1) a control group that only had rats with a SCI (Group 1); (2) a group that received MP at 30 minutes, 6 hours and 24 hours, and then received irradiation 2 days after the SCI (Group 2); (3) a group that received MP at 30 minutes, and irradiation 2 days after the SCI (Group 3); and (4) a group that received irradiation 2 days after the traumatic SCI (Group 4). The degree of recovery using the inclined plane climbing test was greatest in Group 2, followed by Group 3, Group 4, and Group 1. The cavitation lesions, Terminal Deoxynucleotidyl Transferase dUTP Nick End Labeling -positive apoptosis, glial fibrillary acidic protein-positive astrocyte count, and CC-1-positive oligodendrocyte count significantly decreased in the irradiated groups (Groups 2, 3, 4) compared to the control group (Group 1). In particular, they decreased considerably more in the group that received MP 3 times (Group 2) compared to the group that received MP only once (Group 3). These results suggest that the combined therapy was effective and might provide synergistic effects for neurologic recovery after a traumatic SCI.
    Spine 03/2011; 36(6):434-40. · 2.16 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: spinal cord injury (SCI) continues to be a problem without a definitive cure. Research based on improved understanding of the immunological aspects of SCI has revealed targets for treating and ameliorating the extent of secondary injury. Hypertonic saline (HTS), a substance both easy to create and to transport, has been investigated as an immunologically active material that can be used in a clinically relevant interval after injury. In this pilot study, HTS was investigated in a murine model for its abilities to ameliorate secondary injury after a severe spinal cord contusion. female C57Bl/6 mice with severe T8-10 contusion injuries were used as the model subjects. A group of 41 mice were studied in a blinded fashion. Mice received treatments with HTS (HTS, 7.5%) or normal saline solution (NSS, 0.9%) at 2 discreet time points (3 and 24 hours after injury.) A separate group of 9 untreated animals were also used as controls. Animals were assessed for autonomic outcome (bladder function). In a group of 33 mice, histological assessment (cellular infiltration) was also measured. bladder function was found to be improved significantly in those treated with HTS compared with those who received NSS and also at later treatment times (24 hours) than at earlier treatment times (3 hours). Decreased cellular infiltration in each group correlated with bladder recovery. the increased effectiveness of later administration time of the more osmotically active and immunomodulatory substance (HTS) suggests that interaction with events occurring around 24 hours after injury is critical. These events may be related to the invasion of leukocytes peaking at 8-24 hours postinjury and/or the peak benefit time of subject rehydration.
    Journal of neurosurgery. Spine 01/2011; 14(1):131-8. · 1.61 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: La pharmaco-résistance des épilepsies du lobe temporal serait étroitement liée à une perte de neurones dans l’hippocampe qui pourrait résulter d’une inflammation. Chez le rat soumis à une épileptogenèse expérimentale, nous avons caractérisé la réponse inflammatoire de l’hippocampe. Celle-ci précède la mise en place de la neurodégénérescence et consiste en une forte production de cytokines pro-inflammatoires par la microglie activée ainsi qu’en une infiltration de monocytes/ macrophages. La progression des monocytes dans le parenchyme cérébral serait facilitée par la dégradation des chaînes de sulfate d’héparane qu’ils portent à leur surface, sous l’action de l’héparanase, spécifiquement exprimée par les neurones. Il se pourrait que le blocage des sites de liaison de l’héparanase aux chaînes de sulfate d’héparane réduise l’infiltration cérébrale des monocytes, et permette de prévenir la dégénérescence neuronale associée aux épilepsies.
    01/2007;