Page 4 of 7 FirstFirst 1234567 LastLast
Results 31 to 40 of 67

Thread: Methylprednisolone soon to be replaced as treatment of choice for Acutes???

  1. #31
    Quote Originally Posted by canuck
    Hypothetically would EPO be of any benefit in in-utero treatment of spina bifida Wise? for that matter has anybody tried in-utero transplant of stem cells to correct sb lesions?
    I don't think that it has been used to treat spina bifida. There are relatively few good models of spina bifida in animals. It seems to be a stretch, however, to expect EPO to be useful for in utero therapy of spinal bifida. Wise.

  2. #32
    Senior Member canuck's Avatar
    Join Date
    Mar 2003
    Location
    BC Canada
    Posts
    2,710
    Thanks Wise I just thought I would toss the idea out there

  3. #33
    Banned Faye's Avatar
    Join Date
    May 2003
    Location
    Jacksonville, FL
    Posts
    6,839
    Quote Originally Posted by Wise Young
    Faye, dozens or perhaps even hundreds of papers have reported that MP improves many outcomes in a variety of spinal cord injury models. The dose, timing, and duration of treatment, as well as the spinal cord injury model, are very important when interpreting the studies. Just because a study does not show statistical significance of a treatment does not mean that the treatment is ineffective.

    MP has modest effect on recovery of rats after severe spinal cord injuries. Even the best spinal cord injury models require 12-20 rats to detect a 10% effect on recovery of function. The model could be variable so that it could not detect the beneficial effects of the treatment. The dose could have been given late. Rat time is 4 or more times faster than human time. In rats, the dose must be given within 30 minutes or even earlier to be effective. The human dose and duration is inappropriate for rats.
    I would hope these factors would have been considered by consciencious scientists.
    If any on CC are interested in the MP protocol for humans, here it is:
    SPINAL CORD INJURY DRUG THERAPY PROTOCOL


    Dosage and Administration Guidelines

    Methylprednisolone Sodium Succinate:

    Start within 8 hours of injury

    30 mg/kg body weight administered as an IV bolus over 15 minutes

    45-minute pause

    23-hour continuous infusion of 5.4 mg/kg per hour

    The National Acute Spinal Cord Injury Study (NASCIS) used methylprednisolone sodium succinate
    reconstituted and diluted with bacteriostatic water for injection to a concentration of 50 mg/ml. The
    final volume included an additional amount of methylprednisolone to prime the administration set. IV
    lines were kept open between bolus and maintenance infusion with normal saline.

    Benefit was seen only when methylprednisolone was administered within 8 hours of injury.

    Exclusion Criteria

    Cauda equina

    Gunshot wounds

    Life Threatening Morbidity

    Pregnancy

    Narcotic Addiction

    Maintenance steroids

    < 13 years of age

    Source

    Bracken MB, Shepard MJ, Collins WF, et al. A randomized, controlled trial of methylprednisolone
    or naloxone in the treatment of acute spinal-cord injury. New England Journal of Medicine.
    1990;322:1405-1411.

    "There’s far too much unthinking respect given to authority,” Molly Ivins explained; “What you need is sustained outrage.”
    Kerr, Keirstead, McDonald, Stice and Jun Yan courageously work on ESCR to Cure SCI.

    Divisiveness comes from not following Christopher Reeve's ESCR lead.
    Young does ASCR.
    [I]I do not tear down CRPA, I ONLY make peopl

  4. #34
    Banned Faye's Avatar
    Join Date
    May 2003
    Location
    Jacksonville, FL
    Posts
    6,839

    MP may not be recommended treatment for acute SCI

    Others have also looked at the efficacy of MP and found it not to be effective:

    May 2000, Volume 38, Number 5, Pages 273-286Table of contents Previous Abstract Next Article PDFScientific ReviewHigh dose methylprednisolone in the management of acute spinal cord injury - a systematic review from a clinical perspectiveD J Short1, W S El Masry1,a and P W Jones2,b1Midlands Centre for Spinal Injuries, Robert Jones & Agnes Hunt Orthopaedic & District Hospital NHS Trust, Oswestry, Shropshire, SY10 9DP, UK
    2Department of Mathematics, Keele University, Staffordshire, ST5 5BG, UK
    Correspondence to: D J Short, Midlands Centre for Spinal Injuries, Robert Jones & Agnes Hunt Orthopaedic & District Hospital NHS Trust, Oswestry, Shropshire, SY10 9DP, UK
    aSenior Lecturer University of Keele
    bProfessor of Statistics, Keele University
    AbstractStudy design: Systematic literature review for primary data using predefined inclusion, exclusion and validity criteria. Primary outcome measure was standardised neurological examination or neurological function. Secondary outcomes; acute mortality, early morbidity.
    Objectives: To access the literature available to clinicians systematically and evaluate the evidence for an effect of high dose methylprednisolone (MPSS) on neurological improvement following acute spinal cord injury (ACSI).
    Methods: Information retrieval was based on Medline search (1966 through December 1999) using the strategy `spinal cord injury' and `methylprednisolone' (or `dexamethasone') with no other restrictions. Primary data publications using high dose steroids given within 12 h following spinal cord injury and reporting outcome measures separately for steroid and non-steroid treated groups were selected. Evaluation followed the guides of Guyatt et al (for the Evidence Based Working Group in Canada). Studies with questionable validity were excluded. Level of evidence and treatment recommendation utilised the Canadian Task Force on the Periodic Health Examination criteria. Experimental spinal cord injury studies on larger animals were included; small mammal experiments were considered beyond evaluation.
    Results: Three clinical trials and six cohort study publications were found to satisfy the review criteria. The evidence they provide supports `the recommendation that the manoeuvre (high dose methylpredisolone) be excluded from consideration as an intervention for the condition' (acute spinal cord injury). Twelve larger animal publications were detailed. Validity and the functional significance of results was of concern in many. The weight of evidence lay with those studies demonstrating no definite effect of MPSS on functional outcome. In cat experiments with higher level cord damage, deaths in the MPSS treated groups were notable.
    Conclusion: The evidence produced by this systematic review does not support the use of high dose methylprednisolone in acute spinal cord injury to improve neurological recovery. A deleterious effect on early mortality and morbidity cannot be excluded by this evidence.
    Spinal Cord (2000) 38, 273-286.
    Last edited by Faye; 12-24-2005 at 11:51 PM.

    "There’s far too much unthinking respect given to authority,” Molly Ivins explained; “What you need is sustained outrage.”
    Kerr, Keirstead, McDonald, Stice and Jun Yan courageously work on ESCR to Cure SCI.

    Divisiveness comes from not following Christopher Reeve's ESCR lead.
    Young does ASCR.
    [I]I do not tear down CRPA, I ONLY make peopl

  5. #35
    Banned Faye's Avatar
    Join Date
    May 2003
    Location
    Jacksonville, FL
    Posts
    6,839

    Journal of Neurosurgery: MP an inappropriate Standard of Care for Acutes

    Yet another 2000 write-up in the Journal of Neurosurgery casting doubts on the usefulness of MP:


    J. Neurosurg: Spine / Volume 93 / July, 2000
    J Neurosurg (Spine 1) 93:
    1–7, 2000
    Methylprednisolone for acute spinal cord injury:
    an inappropriate standard of care*
    R. J
    OHN
    H
    URLBERT
    , M.D., P
    H
    .D., F.R.C.S.(C)
    University of Calgary Spine Program, Foothills Hospital and Medical Centre,
    Calgary, Alberta, Canada
    Object. Since publication in 1990, results from the National Acute Spinal Cord Injury Study II (NASCIS II) trial
    have changed the way patients suffering an acute spinal cord injury (SCI) are treated. More recently, recommendations
    from NASCIS III are being adopted by institutions around the world. The purpose of this paper is to reevaluate care-
    fully the results and conclusions of these studies to determine the role they should play in influencing decisions about
    care of the acutely spinal cord–injured patient.

    Methods. Published results from NASCIS II and III were reviewed in the context of the original study design,
    including primary outcomes compared with post-hoc comparisons. Data were retroconverted from tabular form back
    to raw form to allow direct inspection of changes in treatment groups. These findings were further analyzed with
    respect to justification of practice standards.
    Although well-designed and well-executed, both NASCIS II and III failed to demonstrate improvement in primary
    outcome measures as a result of the administration of methylprednisolone. Post-hoc comparisons, although interest-
    ing, did not provide compelling data to establish a new standard of care in the treatment of patients with acute SCI.
    Conclusions. The use of methylprednisolone administration in the treatment of acute SCI is not proven as a stan-
    dard of care, nor can it be considered a recommended treatment. Evidence of the drug’s efficacy and impact is weak
    and may only represent random events. In the strictest sense, 24-hour administration of methylprednisolone must still
    be considered experimental for use in clinical SCI. Forty-eight-hour therapy is not recommended. These conclusions
    are important to consider in the design of future trials and in the medicolegal arena.

    http://www.thejns-net.org/spine/issues/v93n1/pdf/s0930001.pdf
    Last edited by Faye; 12-25-2005 at 02:05 AM.

    "There’s far too much unthinking respect given to authority,” Molly Ivins explained; “What you need is sustained outrage.”
    Kerr, Keirstead, McDonald, Stice and Jun Yan courageously work on ESCR to Cure SCI.

    Divisiveness comes from not following Christopher Reeve's ESCR lead.
    Young does ASCR.
    [I]I do not tear down CRPA, I ONLY make peopl

  6. #36
    Banned Faye's Avatar
    Join Date
    May 2003
    Location
    Jacksonville, FL
    Posts
    6,839

    Dec, 2005 article: MP clinical gains questionable

    The use of high-dose methylprednisolone in nonpenetrating acute SCI has become the standard of care in North America. Nesathurai and Shanker revisited these studies and questioned the validity of the results. These authors cited concerns about the statistical analysis, randomization, and clinical endpoints used in the study. Even if the benefits of steroid therapy are valid, the clinical gains are questionable. Other reports have cited flaws in the study designs, trial conduct, and final presentation of the data. The risks of steroid therapy are not inconsequential. An increased incidence of infection and avascular necrosis has been documented.
    A number of professional organizations have revised their recommendations pertaining to steroid therapy in SCI. The Canadian Association of Emergency Physicians is no longer recommending high-dose methylprednisolone as the standard of care. The Congress of Neurological Surgeons has stated that steroid therapy "should only be undertaken with the knowledge that the evidence suggesting harmful side effects is more consistent than any suggestion of clinical benefit." The American College of Surgeons has modified their Advanced Trauma Life Support guidelines to state that methylprednisolone is "a recommended treatment" rather than "the recommended treatment."
    From:
    Spinal Cord Injuries

    Last Updated: December 5, 2005 Rate this Article Email to a Colleague Get CME/CE for article Synonyms and related keywords: spinal cord injury, SCI, anterior cord syndrome, Brown-Séquard syndrome, central cord syndrome, conus medullaris syndrome, cauda equina syndrome, incomplete SCI syndromes, spinal cord concussion, spinal cord injury syndromes, SCIWORA, spinal cord injury without radiologic abnormality

    &nbspAUTHOR INFORMATION Section 1 of 11 <A href="http://www.emedicine.com/emerg/topic553.htm#section~introduction">Author Information Introduction Clinical Differentials Workup Treatment Medication Follow-up Miscellaneous Pictures Bibliography

    Author: Donald Schreiber, MD, CM, Associate Professor of Surgery, Stanford University School of Medicine; Consulting Staff, Division of Emergency Medicine, Stanford University Medical Center
    Donald Schreiber, MD, CM, is a member of the following medical societies: American College of Emergency Physicians
    Editor(s): Daniel J Dire, MD, FACEP, FAAP, FAAEM, Clinical Associate Professor, Department of Emergency Medicine, University of Texas-Houston; Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine; Tom Scaletta, MD, Assistant Professor, Department of Emergency Medicine, Rush Medical College; John Halamka, MD, Chief Information Officer, CareGroup Healthcare System, Assistant Professor of Medicine, Department of Emergency Medicine, Beth Israel Deaconess Medical Center; Assistant Professor of Medicine, Harvard Medical School; and Charles V Pollack, Jr, MD, MA, FACEP, Associate Professor of Emergency Medicine, University of Pennsylvania School of Medicine; Chairman, Department of Emergency Medicine, Pennsylvania Hospital
    Disclosure


    &nbspINTRODUCTION Section 2 of 11 Author Information Introduction Clinical Differentials Workup Treatment Medication Follow-up Miscellaneous Pictures Bibliography


    Background: Patients with spinal cord injury (SCI) usually have permanent and often devastating neurologic deficits and disability. According to the National Institutes of Health, "among neurological disorders, the cost to society of automotive SCI is exceeded only by the cost of mental retardation."
    The goals for the emergency physician are to establish the diagnosis and initiate treatment to prevent further neurologic injury from either pathologic motion of the injured vertebrae or secondary injury from the deleterious effects of cardiovascular instability or respiratory insufficiency.
    Pathophysiology: The spinal cord is divided into 31....

    http://www.emedicine.com/emerg/topic553.htm


    "There’s far too much unthinking respect given to authority,” Molly Ivins explained; “What you need is sustained outrage.”
    Kerr, Keirstead, McDonald, Stice and Jun Yan courageously work on ESCR to Cure SCI.

    Divisiveness comes from not following Christopher Reeve's ESCR lead.
    Young does ASCR.
    [I]I do not tear down CRPA, I ONLY make peopl

  7. #37
    Banned Faye's Avatar
    Join Date
    May 2003
    Location
    Jacksonville, FL
    Posts
    6,839

    Well, now I even regret the MP Jason was given

    Continuous brain-derived neurotrophic factor (BDNF) infusion after methylprednisolone treatment in severe spinal cord injury.

    Medscape Newsletters




    Sign Up To Receive
    Medscape Best Evidence
    Key journal articles ranked for newsworthiness and clinical relevance in each specialty, linked to Medline abstracts.






    J Korean Med Sci. 2004; 19(1):113-22 (ISSN: 1011-8934)

    Kim DH; Jahng TA
    Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA. spine@snuh.org
    Although methylprednisolone (MP) is the standard of care in acute spinal cord injury (SCI), its functional outcome varies in clinical situation. Recent report demonstrated that MP depresses the expression of growth-promoting neurotrophic factors after acute SCI.
    http://www.medscape.com/medline/abstract/14966352

    "There’s far too much unthinking respect given to authority,” Molly Ivins explained; “What you need is sustained outrage.”
    Kerr, Keirstead, McDonald, Stice and Jun Yan courageously work on ESCR to Cure SCI.

    Divisiveness comes from not following Christopher Reeve's ESCR lead.
    Young does ASCR.
    [I]I do not tear down CRPA, I ONLY make peopl

  8. #38
    Faye,

    Let me try to summarize the NASCIS results. These were three clinical trials carried out from 1979-1983, 1984-1989, and 1992-1997.

    • NASCIS 1 randomized approximately 300 patients to low-dose MP (100 mg/day) vs. high-dose MP (1000 mg/day of MP). It found no difference between the two doses of MP. The treatments were started within 24 hours after injury and continued for 10 days. We thought that the reason we saw no difference between the two doses of MP was because we gave too little drug, too late, and for too long. For that reason, we designed NASCIS 2 to test a much higher dose (approximately 10 grams over 24 hours, compared to 1 gram per day in the high dose MP in NASCIS 1), stratified the patients by treatment time to see whether or not earlier treatment would be more effective, and shortened the duration of treatment to 1 day (as opposed to 10 days).

    • NASCIS 2 randomized approximately 500 patients to placebo vs. MP (30 mg/kg bolus plus 5.4 mg/kg/hour for 23 hours) vs. naloxone (5.4 mg/kg x 3 mg/kg/hour x 23 hours). The patients were stratified into those treated within 8 hours and from 8-24 hours after injury (8 hours was the median time of treatment so that half of the patients were treated early and half were treated late). The study results indicated that in patients treated within 8 hours after injury, the 24-hour course of MP significantly improved recovery compared to placebo. This was not true in patients where treatment was started more than 8 hours after injury. We wondered whether a longer course of therapy would be more effective, whether earlier than 8 hours would be more effective, and whether a drug called tirilazad mesylate (which has no corticosteroid activity but is a more potent antioxidant) is effective. Therefore, NASCIS 3 compared a 24-hour and 48-hour course of MP.

    • NASCIS 3 randomized approximately 500 patients to 24h MP (30 mg/kg bolus within 8 hours after injury, followed by 5.4 mg/kg/hour for 23 hours) vs. 48h MP (30 mg/kg bolus within 8 hours after injury followed by 5.4 mg/kg/hour for 47 hours) vs. MP plus tirilazad mesylate (30 mg/kg of MP bolus followed by tirilazad mesylate 3 mg/kg every 6 hours). This study showed no difference in all three treatment groups when the treatment was started with in 3 hours. However, in patients where treatment started more than 3 hours after injury, those receiving the 48-hour MP course had significantly more neurological improvement

    All three trials were rigorously randomized and blinded studies. NASCIS 2 and NASCIS 3 stratified patients by the median time of treatment (median time of treatment means that half of the patients were treated within that time and half behond that time) and compared the effects of the treatments based on the timing of therapy. This was because we planned to assess the timing of treatment, to test the hypothesis that earlier treatment is more effective than delayed therapy. This is a well-accepted and rigorous approach to assessing the therapeutic time window, a concept that we introduced in 1990 with NASCIS 2, to emphasize the importance of giving treatment early. In summary, the NASCIS trials showed that early with high-dose MP for 24 hours modestly improved neurological function of patients with spinal cord injury, a 48-hour course of MP is more effective than 24-hour course of MP, when treatment was started more than 3 hours after injury. Both naloxone and tirilazad mesylate may have had some beneficial effects but neither was statistically significant and MP was significantly better.

    The main complaint by Hurlburt and El Masri, et al. in their papers seems to be that the NASCIS studies carried out post hoc analyses. The term post hoc means after the event, suggesting that we had tailored the analysis to suit the results of the study. This is false. In NASCIS 2 and 3, We planned the comparison of early and late therapies to test the a priori hypothesis that early treatment would be more effective than delayed therapy. Please note that the only evidence that they had to support their study was a clinical trial in France that randomized 100 patients to 24h MP, nimodipine, and placebo, finding no difference in the recovery of the three groups.

    Wise.
    Last edited by Wise Young; 12-25-2005 at 03:44 AM.

  9. #39
    Banned Faye's Avatar
    Join Date
    May 2003
    Location
    Jacksonville, FL
    Posts
    6,839
    Quote Originally Posted by Wise Young
    Faye,

    Please note that the only evidence that they had to support their study was a clinical trial in France that randomized 100 patients to 24h MP, nimodipine, and placebo, finding no difference in the recovery of the three groups.

    Wise.
    I will check this out.

    Nevertheless from what I've read, I think Neurosurgery Today summarizes the situation with MP in this quote quite well:
    Steroid Therapy
    Methylprednisolone, a steroid drug, became available as a treatment for acute SCI in 1990 when a multicenter clinical trial showed better neurological change scores in patients who were given the drug within the first eight hours of injury. These studies have been criticized in part because this increase in scores has never been shown to translate into better functional outcomes for patients. This area remains controversial. Perhaps clinicians should consider methylprednisolone infusion if its potential benefits are felt to outweigh the risks of potential associated complications.
    http://www.neurosurgerytoday.org/wha...t_e/spinal.asp

    "There’s far too much unthinking respect given to authority,” Molly Ivins explained; “What you need is sustained outrage.”
    Kerr, Keirstead, McDonald, Stice and Jun Yan courageously work on ESCR to Cure SCI.

    Divisiveness comes from not following Christopher Reeve's ESCR lead.
    Young does ASCR.
    [I]I do not tear down CRPA, I ONLY make peopl

  10. #40
    NASCIS 2 was carried out between 1985 and 1989, when there were no validated so-called "functional" scores. We used the only validated system that was available, the NASCIS neurological scores. These eventually became the ASIA and now the International Classification scores, endorsed by all the major spinal cord injury organizations around the world. Please note that most clinical trials around the world use the ASIA scores, which is a subset of the NASCIS scores. NASCIS 3 was carried out in 1992-1997 and we showed a significant difference in FIM score (a functional index) between the 24h and 48h treatments in the >3 hour treatment group.

    Evidence-based medicine requires evidence. I don't argue with those who want to say that 5-8 point differences due to treatment is no functionally significant. On the other hand, I do think that people who criticize the NASCIS trials should come up with some data to refute our findings. By the way, the following abstracts should be relevant as well. The Cochrane Database Systematic Review is the most respected and rigorous analysis of clinical trial results. Bracken has published two of them:

    Bracken MB (2000). Pharmacological interventions for acute spinal cord injury. Cochrane Database Syst Rev. 2: Summary: BACKGROUND: Acute spinal cord injury is a devastating condition typically affecting young people with a preponderance of males. Pharmacological treatment in the early hours of the injury is aimed at reducing the extent of permanent paralysis during the rest of the patient's life. OBJECTIVES: To review randomized trials of pharmacological therapies for acute spinal cord injury. SEARCH STRATEGY: The review draws on the search strategy developed by the Cochrane Injuries Group. In addition, files of the National Acute Spinal Cord Injury Study have been reviewed. SELECTION CRITERIA: All published or unpublished randomized controlled trials of pharmacological treatment for acute spinal cord injury in any language. DATA COLLECTION AND ANALYSIS: Data have been abstracted from original trial reports. For the NASCIS, Japanese and French trials, additional data (e.g. SDs) have been obtained from the original authors. MAIN RESULTS: There are few trials in this area of medical care. Only one therapy has been extensively studied, methylprednisolone sodium succinate, which has been shown to improve neurologic outcome up to one year post injury if administered within 8 hours of injury and in a dose regimen of: bolus 30mg/kg administered over 15 minutes with a maintenance infusion of 5.4 mg/kg per hour infused for 23 hours. The initial North American trial was replicated in a Japanese trial but not in the one from France. Data has been obtained from the latter study to permit appropriate meta-analysis of all three trials. This analysis indicates significant recovery in motor function after methylprednisolone therapy. A more recent trial indicates that if methylprednisolone therapy is given for an additional 24 hours (for a total of 48 hours), additional improvement in motor neurologic function and functional status is observed. This is particularly observed if treatment cannot be started until between 3 to 8 hours after injury. The same methylprednisolone therapy has been found effective in whiplash injuries and a modified regimen found to improve recovery after surgery for lumbar disc disease. REVIEWER'S CONCLUSIONS: High dose methylprednisolone steroid therapy is the only pharmacological therapy shown to have efficacy in a Phase Three randomized trial when it can be administered within 8 hours of injury. High dose methylprednisolone has been accepted as standard therapy in many countries. A recent trial indicates additional benefit by extending the maintenance dose from 24 to 48 hours if start of treatment must be delayed to between 3 and 8 hours after injury. There is an urgent need for more randomized trials of pharmacological therapy for acute spinal cord injury. <http://www.ncbi.nlm.nih.gov/htbin-po...uid=0010796741
    http://www.update-software.com/abstracts/ab001046.htm> Department of Epidemiology and Public Health, Yale School of Medicine, 60 College street, Box 20834, New Haven, Connecticut 06520-8034, USA. brackenmb@maspo3.mas.yale.edu
    [*] Bracken MB (2002). Steroids for acute spinal cord injury. Cochrane Database Syst Rev CD001046. BACKGROUND: Acute spinal cord injury is a devastating condition typically affecting young people with a preponderance being male. Steroid treatment in the early hours of the injury is aimed at reducing the extent of permanent paralysis during the rest of the patient's life. OBJECTIVES: To review randomized trials of steroids for acute spinal cord injury. SEARCH STRATEGY: The review draws on the search strategy developed by the Cochrane Injuries Group. In addition, files of the National Acute Spinal Cord Injury Study have been reviewed and a Medline search conducted. SELECTION CRITERIA: All published or unpublished randomized controlled trials of steroid treatment for acute spinal cord injury in any language. DATA COLLECTION AND ANALYSIS: Data have been abstracted from original trial reports. For the NASCIS, Japanese and French trials, additional data (e.g. SDs) have been obtained from the original authors. MAIN RESULTS: There are few trials in this area of medical care. Only one steroid has been extensively studied, methylprednisolone sodium succinate, which has been shown to improve neurologic outcome up to one year post injury if administered within eight hours of injury and in a dose regimen of: bolus 30mg/kg administered over 15 minutes with a maintenance infusion of 5.4 mg/kg per hour infused for 23 hours. The initial North American trial was replicated in a Japanese trial but not in the one from France. Data has been obtained from the latter studies to permit appropriate meta-analysis of all three trials. This analysis indicates significant recovery in motor function after methylprednisolone therapy when administration commences within eight hours of injury. A more recent trial indicates that if methylprednisolone therapy is given for an additional 24 hours (for a total of 48 hours), additional improvement in motor neurologic function and functional status is observed. This is particularly observed if treatment cannot be started until between three to eight hours after injury. The same methylprednisolone therapy has been found effective in whiplash injuries and a modified regimen found to improve recovery after surgery for lumbar disc disease. REVIEWER'S CONCLUSIONS: High dose methylprednisolone steroid therapy is the only pharmacological therapy shown to have efficacy in a Phase Three randomized trial when it can be administered within eight hours of injury. A recent trial indicates additional benefit by extending the maintenance dose from 24 to 48 hours if start of treatment must be delayed to between three and eight hours after injury. There is an urgent need for more randomized trials of pharmacological therapy for acute spinal cord injury. Department of Epidemiology and Public Health, Yale School of Medicine, 60 College street, Box 20834, New Haven, Connecticut, 06520-8034, USA. brackenmb@maspo3.mas.yale.edu http://www.ncbi.nlm.nih.gov/entrez/q..._uids=12137616

    Finally, I want to point out this one paper in 1998 that is really quite interesting because it suggests that MP may be beneficial for whiplash as well.
    [*] Pettersson K and Toolanen G (1998). High-dose methylprednisolone prevents extensive sick leave after whiplash injury. A prospective, randomized, double-blind study. Spine 23: 984-9. STUDY DESIGN: A prospective, randomized, double-blind study comparing high-dose methylprednisolone with placebo. OBJECTIVES: To evaluate the efficacy of high-dose methylprednisolone when administered within 8 hours after whiplash injury. SUMMARY OF BACKGROUND DATA: Whiplash injury often results in chronic symptoms. The management of whiplash injuries is controversial, and pharmacologic therapy has received little evaluation. In recent reports, dysfunction of the central nervous system has been indicated in several cases. Methylprednisolone administered within 8 hours after the injury to patients with acute spinal cord injury has been demonstrated to improve the outcome. This procedure was also adopted in a randomized study of cases of whiplash injury in car accidents. METHODS: Forty patients, 22 men and 18 women with a mean age of 35 years (range, 19-65), were included in the study, 20 in each of two groups. They were treated for whiplash injury, which they had sustained in car accidents. The patients were enrolled if their diagnoses were complete and treatment had begun within 8 hours after injury. Disabling symptoms severe enough to prevent the patient from returning to work, number of sick days before and after injury, and sick-leave profile after injury were used as parameters for the evaluation of the effects of the treatment. Baseline demographic data were controlled for when statistical analysis had been performed. RESULTS: At the follow-up examination 6 months after initial treatment, there was a significant difference in disabling symptoms between the actively treated patients and the placebo group (P = 0.047), total number of sick days (P = 0.01), and sick-leave profile (P = 0.003). CONCLUSIONS: The results of this study indicate that acute treatment with high-dose methylprednisolone may be beneficial in preventing extensive sick leave after whiplash injury. However, the number of patients studied was small, and therefore further prospective, controlled studies are needed. Department of Orthopaedics, Umea University, Sweden. http://www.ncbi.nlm.nih.gov/entrez/q...t_uids=9589535

Similar Threads

  1. Dr.Kleinbloesem
    By emmy in forum Cure
    Replies: 1120
    Last Post: 03-08-2011, 10:24 PM
  2. Replies: 26
    Last Post: 05-05-2006, 02:07 PM
  3. Replies: 1
    Last Post: 02-24-2006, 05:41 PM
  4. Replies: 0
    Last Post: 01-31-2003, 04:13 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •