This article just to help me in giving my evidence during management of traumatic SCI
Methylprednisolone is the only treatment that has been suggested in clinical trials to improve outcomes in patients with acute traumatic, nonpenetrating SCI. It has been shown that in animal studies, glucocorticoids reduces edema, prevents intracellular potassium depletion, and improves neurologic recovery.
Two blinded randomized controlled trials studied the efficacy of glucocorticoid therapy in patients with acute SCI.
1. The National Acute Spinal Cord Injury Study (NASCIS) II compared methylprednisolone (30mg/kg I.V., followed by 5.4mg/kg/hr over 23hours), Naloxone and placebo in 427 acute SCI patients. (J.Neurosurgery 1992;76(1))
At one year, there was no significant difference in neurologic function among treatment groups. However, within the subset of patients treated within eight hours, those who received methylprednisolone had a modest improvement in motor recovery compared with those who received placebo. Wound infections were somewhat more common in patients who received methylprednisolone.
2. NASCIS III compared three treatment groups: methylprednisolone administered for 48h, methylprednisolone administered for 24h, and tirilizad mesylate (a potent lipid peroxidation inhibitor) administered for 48 hours in patients with acute complete or incomplete TSCI. (J Neurosurg. 1998;89(5)). All 499 patients received an initial IV bolus of 30mg/kg methylprednisolone and were treated within 8 hours of TSCI. For patients treated between three hours, there was no difference in outcomes among treatment groups at one year. For patients treated between 3 to 8 hours, 48 hours of methylprednisolone was associated with a greater motor but no functional recovery, compared to other treatments. Patients who received the longer duration infusion of methylprednisolone had more severe sepsis and severe pneumonia compared with the shorter duration of infusion; mortality was similar in all treatment groups.
Data analysis led to the conclusion that the risk of high dose steroids outweight their benefits, and this therapy has been abandoned by many medical centres. A Consortium for Spinal Cord medicine concluded that no clinical evidence exists to definitely recommend the use of steroid therapy. (www.pva.org paralysed veterans of America)
Methylprednisolone is the only treatment that has been suggested in clinical trials to improve outcomes in patients with acute traumatic, nonpenetrating SCI. It has been shown that in animal studies, glucocorticoids reduces edema, prevents intracellular potassium depletion, and improves neurologic recovery.
Two blinded randomized controlled trials studied the efficacy of glucocorticoid therapy in patients with acute SCI.
1. The National Acute Spinal Cord Injury Study (NASCIS) II compared methylprednisolone (30mg/kg I.V., followed by 5.4mg/kg/hr over 23hours), Naloxone and placebo in 427 acute SCI patients. (J.Neurosurgery 1992;76(1))
At one year, there was no significant difference in neurologic function among treatment groups. However, within the subset of patients treated within eight hours, those who received methylprednisolone had a modest improvement in motor recovery compared with those who received placebo. Wound infections were somewhat more common in patients who received methylprednisolone.
2. NASCIS III compared three treatment groups: methylprednisolone administered for 48h, methylprednisolone administered for 24h, and tirilizad mesylate (a potent lipid peroxidation inhibitor) administered for 48 hours in patients with acute complete or incomplete TSCI. (J Neurosurg. 1998;89(5)). All 499 patients received an initial IV bolus of 30mg/kg methylprednisolone and were treated within 8 hours of TSCI. For patients treated between three hours, there was no difference in outcomes among treatment groups at one year. For patients treated between 3 to 8 hours, 48 hours of methylprednisolone was associated with a greater motor but no functional recovery, compared to other treatments. Patients who received the longer duration infusion of methylprednisolone had more severe sepsis and severe pneumonia compared with the shorter duration of infusion; mortality was similar in all treatment groups.
Data analysis led to the conclusion that the risk of high dose steroids outweight their benefits, and this therapy has been abandoned by many medical centres. A Consortium for Spinal Cord medicine concluded that no clinical evidence exists to definitely recommend the use of steroid therapy. (www.pva.org paralysed veterans of America)
No comments:
Post a Comment