Methylprednisolone and neurological function 1 year after spinal cord injury

Results of the National Acute Spinal Cord Injury Study

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✓ A multi-center double-blind randomized clinical trial was conducted by the National Acute Spinal Cord Injury Study Group to examine the efficacy of high-dose methylprednisolone (1000-mg bolus and 1000 mg daily thereafter for 10 days) compared with that of a standard dose (100-mg bolus and 100 mg daily for 10 days). No significant difference was observed in neurological recovery of motor function, pinprick response, or touch sensation 1 year after injury between the two treatment groups, after adjustment for other potentially confounding factors. Analyses that specifically took into account the patients' total steroid dose and relative weight confirmed the lack of a steroid treatment effect. The case fatality rate was 10.7% during the 1st year after injury, and this was not associated with the steroid treatment protocol or the patient's gender. Deaths did occur significantly more frequently among patients who were completely (15.3%) and partially (8.6%) plegic than among those who were paretic (2.5%, p = 0.0005), and among patients aged 50 years or older (38.6%, p = 0.0001).

Article Information

Address reprint requests to: Michael B. Bracken, Ph.D., National Spinal Cord Injury Study, Department of Epidemiology and Public Health, Yale University Medical School, 60 College Street, New Haven, Connecticut 06510.

© AANS, except where prohibited by US copyright law.

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Figures

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    Motor function, pinprick response, and touch sensation scores determined by neurological examination in the emergency room (ER) and at 6 weeks, 6 months, and 1 year. For scoring system see text. L = low-dose group; H = high-dose group.

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    Patient survival during the 1st year after injury in relation to steroid treatment (left) and extent of injury (right). MPSS = methylprednisolone sodium succinate.

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