Drug reduces paralysis after spinal injury.

Drug reduces paralysis after spinal injury

An anti-inflammatory drug, commonly prescribed for a variety of allergic and arthritic conditions, can significantly reduce the degree of paralysis from spinal injury if given in huge doses within hours after injury, researchers report.

The inexpensive drug, methylprednisolone, is the first to show a clear benefit for spinal injury victims, says lead investigator Michael B. Bracken of Yale University School of Medicine. Moreover, he says, the 10-center study provides the first direct evidence that the loss of sensation and function accompanying these injuries stems not so much from the initial trauma but rather from a cascade of biochemical events in the hours following the accident.

The study assessed long-term neurological recovery, up to six months after injury, in 487 patients. It compared the usefulness of methylprednisolone -- given at 10 to 100 times the standard doses -- with that of a placebo and of the drug naloxone, which previously had shown some promise against injury-induced paralysis. Only methylprednisolone provided any benefit in the new study.

Although benefits varied among patients, timely use of the drug could mean the difference between a lifetime in a wheelchair and being able to walk with leg braces, says Yale's Mary Jo Shepard, who coordinated the study. The NEW ENGLAND JOURNAL OF MEDICINE, which will publish the results next month, allowed early announcement of the findings at a press conference in order to speed word of the positive results to physicians.

Patients must receive intravenous methylprednisolone for 24 hours, starting no later than eight hours after injury -- a finding that leads some physicians to suggest authorizing emergency medical personnel to begin the treatment. The drug's mechanism of action remains unknown, but the Yale researchers hypothesize that it helps maintain blood flow to oxygen-craving nerve cells during the hours after injury, when tissue swelling can choke local blood vessels. It may also interrupt a nerve-killing chain reaction triggered by the release of toxic chemicals from neighboring cells after injury.

Each year, more than 10,000 people in the United States suffer some degree of paralysis due to acute spinal cord damage. Most are men under age 30 involved in automobile accidents. Specialized care for these injuries costs the federal government more than $4 billion per year, according to the National Institute of Neurological Disorders and Stroke.