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: 2.3). 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.

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    • "Proponents of the use of MPSS for SCI argue that the evidence for MPSS administration supports modest neurological benefit although the strength of this evidence is moderate. They argue that when the entire body of literature is viewed as a whole, it more strongly supports MPSS administration than any individual study[1,5]. Moreover they feel that the small neurological benefits found with MPSS administration are important for SCI patients and justify associated risks. "

    Full-text · Dataset · Jan 2016
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    • "Proponents of the use of MPSS for SCI argue that the evidence for MPSS administration supports modest neurological benefit although the strength of this evidence is moderate. They argue that when the entire body of literature is viewed as a whole, it more strongly supports MPSS administration than any individual study[1,5]. Moreover they feel that the small neurological benefits found with MPSS administration are important for SCI patients and justify associated risks. "
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    ABSTRACT: Methylprednisolone sodium succinate (MPSS) for treatment of acute spinal cord injury (SCI) has been associated with both benefits and adverse events. MPSS administration was the standard of care for acute SCI until recently when its use has become controversial. Patients with SCI have had little input in the debate, thus we sought to learn their opinions regarding administration of MPSS. A summary of the published literature to date on MPSS use for acute SCI was created and adjudicated by 28 SCI experts. This summary was then emailed to 384 chronic SCI patients along with a survey that interrogated the patients' neurological deficits, communication with physicians and their views on MPSS administration. 77 out of 384 patients completed the survey. 28 respondents indicated being able to speak early after injury and of these 24 reported arriving at the hospital within 8 hours of injury. One recalled a physician speaking to them about MPSS and one patient reported choosing whether or not to receive MPSS. 59.4% felt that the small neurological benefits associated with MPSS were 'very important' to them (p<0.0001). Patients had 'little concern' for potential side-effects of MPSS (p = 0.001). Only 1.4% felt that MPSS should not be given to SCI patients regardless of degree of injury (p<0.0001). This is the first study to report SCI patients' preferences regarding MPSS treatment for acute SCI. Patients favor the administration of MPSS for acute SCI, however few had input into whether or not it was administered. Conscious patients should be given greater opportunity to decide their treatment. These results also provide some guidance regarding MPSS administration in patients unable to communicate.
    Full-text · Article · Jan 2016 · PLoS ONE
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    • "In addition, secondary neurodegeneration takes place in the surrounding tissue site due to inflammatory factors and modifies substantially the prognosis (Andrade et al., 2008). High dose corticosteroid injection within 48 h after damage is the only accepted clinical method to reduce consequences of spinal damages (Bracken, 2001). Cell therapy is an issue that has raised much hope in regeneration of CNS and PNS. "

    Full-text · Dataset · Dec 2014
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