Neuroprotection after spinal cord injury: state of the science

Advances in the basic and clinical sciences are improving our ability to alter the course of injury that occurs after acute spinal cord trauma. Methylprednisolone, naloxone, GM-1 ganglioside, tirilazad mesylate and other agents have been or are currently being subjected to rigorous testing to determine their ability to protect compromised but viable cellular elements and improve the functional outcome of survivors. The authors summarize mechanisms of secondary (spinal cord) injury, discuss derivative pharmacotherapy, review clinical trial findings and raise issues related to future research. Special attention is directed to the Maryland studies of GM-1 ganglioside and the National Acute Spinal Cord Injury trials. Preliminary work regarding the roles of excitatory amino acids, endogenous opioid peptides, calcium channel blockers and nerve growth factors in secondary injury are also outlined.