Methylprednisolone Mixup

lway2002 · 03-15-2002, 06:07 AM

I asked my son's Dr. if my son received methylprednisole when he first was injured. He wasn't sure as my son was transferred to his hospital. He said that he doesn't believe that this drug does anything and would never use it for spinal cord injuries. Before my son went into surgery with this doctor, I asked him to treat my son like his own. He was very understanding and said he would. If methylprednisolone is now a suppossed first treatment, why wouldn't this doctor treat his own son with it?

Wise Young · 03-15-2002, 06:16 AM

I am saddened by this. Why don't you ask the doctor what evidence leads him to his rather extreme view?

Wise.

lway2002 · 03-15-2002, 06:28 AM

Dr. Young. I have sent out an e-mail to him and will post his reply. I will also try to track him down at the hospital today.

foster · 03-15-2002, 01:08 PM

Dr Young my son dr said that he doesn't think it helps but they will contine with it. This was at major sci center in phila.

Emi2 · 03-15-2002, 02:12 PM

I'm sorry to hear that your son didn't get methypredisolone. I was taken off it as soon as I arrived in Alberta, and many of my friends from rehab were denied it as well. It's a crazy situation here, if Canada was more lawsuit friendly my friends say they would sue.
I wish you are your family the best.

"Each moment in time we have it all, even when we think we don't."
--Melody Beattie, writer and counselor

lway2002 · 03-15-2002, 11:20 PM

EMI I am not positive that my son did not receive methyl.. at the onset. the doctor I was talking to was the man who stabalized his spine. Thanks for the info for the rehab in Edmonton. Steven was and is more than willing to have us there when jord gets out of here... we need a place to stay when we get there...are you going for sup. amb. yet?

lway2002 · 03-15-2002, 11:24 PM

Quote:

if Canada were more lawsuit friendly

as Gretzty said," When we hate them as much as they hate us...." We are not a nation that will sue if the coffee is too hot...that is our nature.

Wise Young · 03-16-2002, 03:48 PM

Iway,

Neurosurgeons are often not the people who make the decision regarding methylprednisolone treatment. It is most often given at the emergency room of the hospital. In some states, such as Texas, it may actually be started before helicopter transportation. Often, by the time the neurosurgeon gets there, the drug is already going and the neurosurgeon may not know if and when it was started.

Edmunton has one of the best rehabilitation centers in Canada. I have visited and know some of the people there.

Wise.

lway2002 · 03-18-2002, 03:30 PM

Dr. Young. I was told today that methylprednisolone is being discontinued as a treatment for spinal cord injuries. Is this true? Is the medical community now finding out that methylprednisolone actually does more harm than good?

Wise Young · 03-18-2002, 04:19 PM

Iway,

At least three randomized clinical trials have shown that methylprednisolone when given properly (in the recommended dose, limited to 24-48 hours, and within 8 hours after injury) does not increase morbidity or mortality rates of people with spinal cord injury. Claims that methylprednisolone has complications such as joint damage, gastric ulcer, etc. have not been supported by clinical trial data. Here are two recent literature summaries.

Quote:

• Bracken MB (2000). Pharmacological interventions for acute spinal cord injury. Cochrane Database Syst Rev. (2): CD001046. 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. 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.update-software.com/abstracts/ab001046.htm
http://www.ncbi.nlm.nih.gov/entrez/q...uids=10796741>

• Bracken MB (2001). Methylprednisolone and acute spinal cord injury: an update of the randomized evidence. Spine. 26 (24 Suppl): S47-54. Summary: OBJECTIVES: Randomized trials are widely recognized as providing the most reliable evidence for assessing efficacy and safety of therapeutic interventions. This evidence base is used to evaluate the current status of methylprednisolone (MPSS) in the early treatment of acute spinal cord injury. METHODS: Medline, CINAHL, and other specified databases were searched for MeSH headings "methylprednisolone and acute spinal cord injury." The Cochrane Library and an existing systematic review on the topic were also searched. RESULTS: Five randomized controlled trials were identified that evaluated high-dose MPSS for acute spinal cord injury. Three trials by the NASCIS group were of high methodologic quality, and a Japanese and French trial of moderate to low, methodologic quality. Meta-analysis of the final result of three trials comparing 24-hour high-dose MPSS with placebo or no therapy indicates an average unilateral 4.1 motor function score improvement (95% confidence interval 0.6-7.6, P = 0.02) in patients treated with MPSS. This neurologic recovery is likely to be correlated with improved functional recovery in some patients. The safety of this regimen of MPSS is evident from the spinal cord injury trials and a systematic review of 51 surgical trials of high-dose MPSS. CONCLUSION: High-dose MPSS given within 8 hours of acute spinal cord injury is a safe and modestly effective therapy that may result in important clinical recovery for some patients. Further trials are needed to identify superior pharmacologic therapies and to test drugs that may sequentially influence the postinjury cascade. Department of Epidemiology, Yale University School of Medicine, 60 College Street, New Haven, Connecticut 06520, USA. michael.bracken@yale.edu.
<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&li st_uids=11805609>

03-15-2002, 06:07 AM	#1
lway2002 Senior Member Join Date: Feb 2002 Posts: 223	Methylprednisolone Mixup I asked my son's Dr. if my son received methylprednisole when he first was injured. He wasn't sure as my son was transferred to his hospital. He said that he doesn't believe that this drug does anything and would never use it for spinal cord injuries. Before my son went into surgery with this doctor, I asked him to treat my son like his own. He was very understanding and said he would. If methylprednisolone is now a suppossed first treatment, why wouldn't this doctor treat his own son with it?

03-15-2002, 02:12 PM	#5
Emi2 Senior Member Join Date: Jan 2002 Location: Canada Posts: 3,205	What a bummer I'm sorry to hear that your son didn't get methypredisolone. I was taken off it as soon as I arrived in Alberta, and many of my friends from rehab were denied it as well. It's a crazy situation here, if Canada was more lawsuit friendly my friends say they would sue. I wish you are your family the best. "Each moment in time we have it all, even when we think we don't." --Melody Beattie, writer and counselor

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03-15-2002, 06:16 AM	#2
Wise Young Administrator Join Date: Jul 2001 Location: New Brunswick, NJ, USA Posts: 37,975	I am saddened by this. Why don't you ask the doctor what evidence leads him to his rather extreme view? Wise.

03-15-2002, 06:28 AM	#3
lway2002 Senior Member Join Date: Feb 2002 Posts: 223	Dr. Young. I have sent out an e-mail to him and will post his reply. I will also try to track him down at the hospital today.

03-15-2002, 01:08 PM	#4
foster Senior Member Join Date: Dec 2001 Location: bensalem Pa usa Posts: 261	Dr Young my son dr said that he doesn't think it helps but they will contine with it. This was at major sci center in phila.

03-15-2002, 11:20 PM	#6
lway2002 Senior Member Join Date: Feb 2002 Posts: 223	EMI I am not positive that my son did not receive methyl.. at the onset. the doctor I was talking to was the man who stabalized his spine. Thanks for the info for the rehab in Edmonton. Steven was and is more than willing to have us there when jord gets out of here... we need a place to stay when we get there...are you going for sup. amb. yet?

03-16-2002, 03:48 PM	#8
Wise Young Administrator Join Date: Jul 2001 Location: New Brunswick, NJ, USA Posts: 37,975	Iway, Neurosurgeons are often not the people who make the decision regarding methylprednisolone treatment. It is most often given at the emergency room of the hospital. In some states, such as Texas, it may actually be started before helicopter transportation. Often, by the time the neurosurgeon gets there, the drug is already going and the neurosurgeon may not know if and when it was started. Edmunton has one of the best rehabilitation centers in Canada. I have visited and know some of the people there. Wise.

03-18-2002, 03:30 PM	#9
lway2002 Senior Member Join Date: Feb 2002 Posts: 223	Dr. Young. I was told today that methylprednisolone is being discontinued as a treatment for spinal cord injuries. Is this true? Is the medical community now finding out that methylprednisolone actually does more harm than good?