I believe I have properly synthesized the available information
about 4-AP. It may provide improved motor and/or sensory function
in up to 1/3 of patients, but may produce some negative side
effects. These side effects can be minimized if use of the drug
is ramped up to the recommended dose. Most importantly (at least
for the question I pose below), these side effects will disappear
once use of 4-AP is discontinued (ramping down the dose is also

In light of the above, one has to ask the question:
“Why isn’t 4-AP universally prescribed by every SCI practitioner?”

If a person determined that the benefits he obtained outweigh the
side effects, then he would continue with the drug. If the side
effects outweigh the benefits, he can discontinue the drug
without any lasting detriment.

As my 17 year old is completely pain free and independent (T-12
neurological level), the fact that “the side effects will
disappear once use of 4-AP is discontinued” is the most
significant factor in determining whether or not to try 4-AP.

Any confirmation or clarification you can lend would be most