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  1. #1
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    Acute SCI treatment

    My cervical cord is very fragile--atrophied, and exposed post decompression--and banging it falling damaged it enough to destroy my functional life. I’m interested in knowing what they do for acute SCI, if it’s easy to just say, or if there is info you could point me to. I’m pretty sure I’ve heard methylprednisone and wonder if that is specific vs any steroid, and how much.

    I was already somewhat disabled--walking with a crutch or two--so the ER diagnosed no broken bones, told me to see an orthopedist for MRIs, and sent me on my way. Nobody noted cord damage on my MRI, but the neurosurgeon now says it’s hard to see on an already atrophied cord. I’m wondering if it might have changed my life to do a course of IV steroids then, and more importantly what I should do if it ever happens again. What kind of doctor should I make them call? What should I ask him or her to do?

    Also, any chance steroids might still help me, five years out?

  2. #2
    Methylprednisilone treatment, which must start within 8 hours after the injury, continuous to be controversial, and is not standard of care everywhere, esp. outside of the USA. It does not appear to be helpful for those with chronic SCI.

    I will ask Dr. Young to address this in more detail, as he is considered an authority on this topic.

    (KLD)

  3. #3
    Randy,

    As you know, the high-dose methylprednisolone protocol that we developed was for acute spinal cord injury. For multiple sclerosis, they do use methylprednisolone for relapses. They typically give lower doses of 1 gram per day and continue the treatment for several days, in the form of oral prednisone. It seems to blunt to episodes and speeds recovery, which is understandable considering that the relapses are presumably due to auto-immune attacks.

    I don't know whether methylprednisolone would help in your situation. It is an anti-inflammatory and it will reduce inflammatory edema and immune attack on the spinal cord. Unfortunately, long-term use of glucocorticoids have a number of undesirable side-effects. The most serious of these side-effects include breakdown of the large joints on the body, particularly the hip and shoulders.

    --------------ooooo---------------

    KLD,

    Regarding methylprednisolone for acute spinal cord injury being or not being a "standard of care", I want to point out that the term "standard of care" is really meaningless in the case of spinal cord injury. Due to fear of lawsuits, surgeons are very leary of making anything a "standard of care" because if they don't adhere to that standard, they will expose themselves to lawsuits. So, they prefer the term "option for care".

    Most of the doctors who are against methylprednisolone use in spinal cord injury may have been sued at one point or another by people who did not receive methylprednisolone. Burned by these experiences, I think that the doctors have gone out of their way to ensure that the drug is not recommended for spinal cord injury. Most of these doctors have little experience with clinical trials and constantly use therapies that are not based on any clinical trial evidence whatsoever.

    In my opinion, much of the so-called "controversy" is bogus. For example, there are claims that the analyses of the trial were "post-hoc". In other words, critics of the National Acute Spinal Cord Injury Study suggest that we made up the criteria for the data analyses after the trial was done, i.e. segregating the subjects by median time of treatment (8 hours) and injury severity (complete vs. incomplete). This is not true. These were a priori hypotheses.

    By the way, do people seriously think that the NIH would have funded this study and the New England Journal of Medicine would have published the study, if it were based on post-hoc analyses? The trial was designed to test the hypothesis that early treatment is better than later treatment and that the drug has different effects on "complete" and "incomplete" spinal cord injury. The trial showed that only early treatment was effective and that the drug had significant effects on both complete and incomplete spinal cord injury.

    Another criticism is that we used neurological scores rather functional measures. When we did the NASCIS 2 in 1985-1989, there was no validated functional score. We developed and established the first neurological measure and the difference due to methylprednisolone was statistically highly significant. In NASCIS 3, we used the FIM scores which is a validated functional measure and showed that the FIM scores correlated with neurological scores.

    A third criticism was that there were side-effects that we did not report, such as aggravation of pimples and muscle atrophy. We looked at over 40 potential complications of methylprednisolone. Admittedly pimples and muscle atrophy were amongst these. The NASCIS 2 study examined 487 patients, of which about a third received methylprednisolone. None of the complications were statistically significantly different amongs the treatment groups. This was confirmed with the NASCIS 3 study which had over 500 patients and 2/3 of which received methylprednisolone.

    Probably over a million people have now received the so-called high-dose NASCIS methylprednisolone protocol since 1990, not only for spinal cord injury but many other conditions. If there were really any serious complications from the use of the 24-hour course of the drug, we would know about it by now. By the way, methylprednisolone is the standard of care for animal spinal cord injury.

    So, in my opinion, methylprednisolone should be the standard of care until people provide convincing evidence that there is a better therapy. It is not an expensive therapy and it does restore about 20% more function. It may make the difference between a complete and an incomplete. It may make the difference in the extent of recovery for an incomplete. If I had spinal cord injury, I would want to get this drug.

    Wise.
    Last edited by Wise Young; 06-25-2007 at 09:17 PM.

  4. #4
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    sir my eyes are on tears .....when you said ...if i had a sci ...i would like to get this drug.
    they did not give this drug to me ........you know my story [neurological intact ...16 hrs ,corruption and discrimination ,malpractice].
    • Dum spiro, spero.
      • Translation: "As long as I breathe, I hope."

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    Thanks Wise. I actually have every confidence that the new symptoms I felt immediately to within a week of falling--new in my 13 years (at that time) of MS symptoms--had nothing to do with MS. Maybe MS contributed to my cord atrophy--or maybe stenosis--but I know that my cord suffered an insult when I fell. Trauma was indisputable--I also herniated a couple cervical (as well as lumbar) discs and sprained my interspinous ligament, as well as suffered new wicked pain--and my symptoms were somewhat positional, and a flexion/extension CT made me immediately very worse.

    I don’t mean to be dogmatic but it has become necessary habit. I have a healthy impatience for easy diagnoses that can’t be treated. It took only one visit to a new doctor in NYC to be able to come back to my doctor in the burbs and share that the reason I got breathless and sinking standing was not just because people with MS get tired but because my standing blood pressure was 72/58, and my intestinal distress was not IBS but cryptosporidium, banished with a course of antibiotics.. So I was unnecessarily miserable for a couple years, but I got lot of book material.

    So if I suffer neck trauma again, I’m pushing for methylprednisolone. What kind of doctor would do this?

  6. #6
    Pimples as a side effect? Who cares about pimples at the point when you need the drug?
    If you can't handle me at my worst, then you sure as hell don't deserve me at my best.


    Sometimes it is easier to widen doors than it is to open minds.

  7. #7

    Smile Baclofen pump?

    Have you tried the baclofen pump yet? It really works wonders for SCI patients. If you need any additional information, please let me know..

    Best of luck to you..

    T.J.



    Quote Originally Posted by Random
    My cervical cord is very fragile--atrophied, and exposed post decompression--and banging it falling damaged it enough to destroy my functional life. I’m interested in knowing what they do for acute SCI, if it’s easy to just say, or if there is info you could point me to. I’m pretty sure I’ve heard methylprednisone and wonder if that is specific vs any steroid, and how much.

    I was already somewhat disabled--walking with a crutch or two--so the ER diagnosed no broken bones, told me to see an orthopedist for MRIs, and sent me on my way. Nobody noted cord damage on my MRI, but the neurosurgeon now says it’s hard to see on an already atrophied cord. I’m wondering if it might have changed my life to do a course of IV steroids then, and more importantly what I should do if it ever happens again. What kind of doctor should I make them call? What should I ask him or her to do?

    Also, any chance steroids might still help me, five years out?

  8. #8
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    Quote Originally Posted by hatixhe
    Have you tried the baclofen pump yet? It really works wonders for SCI patients. If you need any additional information, please let me know..

    Best of luck to you..

    T.J.
    Thanks T.J. I would be very interested in knowing your experience. I could not tolerate oral baclofen at all; even low doses made me weak and dopey. I hesitate to consider the pump because I fear weakness will further hinder recovery. But the tone and spasms keep me from doing much anyway, so maybe I would do better at a happy medium.

    Did you try both oral and intrathecal, and notice a difference that might make me more hopeful about my prospects with the pump?

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