Methylprednisolone is a corticosteroid that was proposed to inhibit the inflammatory cascades contributing to secondary spinal cord damage after TSCIs, but its clinical utility remains controversial 1) 2).

Administration of methylprednisolone (MP) for the treatment of acute spinal cord injury (SCI) is not recommended. Clinicians considering MP therapy should bear in mind that the drug is not Food and Drug Administration (FDA) approved for this application.

There is no Level of Evidence 1 or Level of Evidence 2 supporting the clinical benefit of MP in the treatment of acute SCI. Scattered reports of Class III evidence claim inconsistent effects likely related to random chance or selection bias. However, Class I, II, and III evidence exists that high-dose steroids are associated with harmful side effects including death.

• Administration of GM-1 ganglioside (Sygen) for the treatment of acute SCI is not recommended.

Three substances, naloxone, thyrotropin release hormone, and tirilazad, have been studied less extensively 3) 4) 5).

Further research to define their therapeutic roles in SCI is necessary but because of modest results is unlikely to occur. In 2002, the guidelines author group of the Joint Section on Disorders of the Spine and Peripheral Nerves of the American Association of Neurological Surgeons (AANS) and the Congress of Neuro- logical Surgeons (CNS) 6) published a medical evidence-based guideline on the use of MP and GM-1 ganglioside in the setting of acute cervical spinal cord injury.

Studies in animal models indicate that recombinant human erythropoietin (rhEPO) is very effective in enhancing neurological recovery after spinal cord injury (SCI).

Early administration of medications after injury increases the hope of attenuating secondary damage and maximizing an improved outcome.

Methylprednisolone sodium succinate (MPSS) plus rhEPO started within 6 hours after acute spinal injury may be more effective than MPSS plus placebo in improvement of neurologic dysfunction. More studies with larger sample sizes are warranted 7).

Kwon B.K., Tetzlaff W., Grauer J.N., Beiner J., Vaccaro A.R. (2004). Pathophysiology and pharmacologic treatment of acute spinal cord injury. Spine J. 4, 451–464
Lenzer J. (2013). Why we can't trust clinical guidelines. BMJ. 346, f3830.
Bracken MB, Shepard MJ, Collins WF, et al. A randomized, controlled trial of methylprednisolone or naloxone in the treatment of acute spinal-cord injury. Results of the Second National Acute Spinal Cord Injury Study. N Engl J Med. 1990;322(20):1405-1411.
Pitts LH, Ross A, Chase GA, Faden AI. Treatment with thyrotropin-releasing hormone (TRH) in patients with traumatic spinal cord injuries. J Neurotrauma. 1995;12(3):235-243.
Bracken MB, Shepard MJ, Holford TR, et al. Administration of methylprednis- olone for 24 or 48 hours or tirilazad mesylate for 48 hours in the treatment of acute spinal cord injury. Results of the Third National Acute Spinal Cord Injury Randomized Controlled Trial. National Acute Spinal Cord Injury Study. JAMA. 1997;277(20):1597-1604.
Pharmacological therapy after acute cervical spinal cord injury. In: Guidelines for the management of acute cervical spine and spinal cord injuries. Neurosurgery. 2002;50(3 suppl):S63-S72.
Alibai E, Zand F, Rahimi A, Rezaianzadeh A. Erythropoietin plus Methylprednisolone or Methylprednisolone in the Treatment of Acute Spinal Cord Injury: a Preliminary Report. Acta Med Iran. 2014 Apr;52(4):275-279. PubMed PMID: 24901857.
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