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Update on pharmaceutical trials in acute spinal cord injury
1Craig Hospital, Englewood, Colorado 80113-2811, USA. dlammertse@craighospital.org
Objective:
To review the major pharmacological trials in acute spinal cord injury (SCI) that have been conducted over the past 25 years.
Methods:
Review article.
Results:
The publication of the first National Acute Spinal Cord Injury (NASCIS) trial in 1984 ushered in the era of pharmacological trials of therapies intended to improve neurologic outcome in acute SCI. Subsequent trials of methylprednisolone sodium succinate (MPSS) and GM-1 have added to the evidence basis that informs the current management practices for acute SCI.
Conclusion:
The last 50 years have seen a conceptual shift from the pessimism of the past to a cautious optimism that the meager prognosis for neurologic recovery in acute SCI will yield to the progress of medical science. Major advances in the understanding of primary and secondary injury mechanisms have led to the preclinical study of many promising pharmacological therapies, all with the goal of improving neurologic outcome. A few of these drugs have stood the test of animal model experiments and have made it to the forum of human clinical trials. The NASCIS trials of methylprednisolone have been acknowledged widely as the first human studies to claim improved neurologic outcome. Although the results of these trials remain controversial, the MPSS therapy that they reported has been adopted widely by clinicians around the world as the best currently available, even if not a consensus "standard of care." Clearly, the challenge for medical science remains. The search for effective treatment has only begun.
Insights
Pharmacological trials for acute spinal cord injury (SCI) have evolved significantly. While methylprednisolone sodium succinate (MPSS) is widely used, research continues for better treatments to improve neurologic outcomes.
Area of Science:
- Neuroscience
- Pharmacology
- Clinical Medicine
Background:
- Acute spinal cord injury (SCI) has historically had a poor prognosis for neurologic recovery.
- Understanding of primary and secondary injury mechanisms has advanced.
- Preclinical studies have explored numerous pharmacological therapies for SCI.
Purpose of the Study:
- To review major pharmacological trials in acute spinal cord injury (SCI) over the past 25 years.
- To assess the evidence base informing current acute SCI management practices.
Main Methods:
- Review article summarizing key clinical trials.
- Analysis of pharmacological interventions for acute SCI.
Main Results:
- The National Acute Spinal Cord Injury (NASCIS) trials marked the beginning of pharmacological research in acute SCI.
- Subsequent trials involving methylprednisolone sodium succinate (MPSS) and GM-1 have contributed to the evidence base.
- MPSS therapy, despite controversy, is widely adopted in clinical practice for acute SCI.
Conclusions:
- There is a shift towards cautious optimism regarding neurologic recovery in acute SCI.
- While MPSS is the current best available treatment, it is not a universal standard of care.
- The search for more effective treatments for acute SCI is ongoing.
