Methylprednisolone and neurological function 1 year after spinal cord injury

TLDR

A multicenter double‑blind randomized trial compared high‑dose methylprednisolone (1000‑mg bolus followed by 1000 mg daily for 10 days) to a standard dose (100‑mg bolus and 100 mg daily for 10 days) in acute spinal cord injury patients. At 1 year, high‑dose methylprednisolone did not improve motor, pinprick, or touch recovery, and analyses adjusting for total steroid dose and weight confirmed no treatment effect; the 10.7 % case‑fatality rate was unrelated to steroid protocol but was higher among patients with complete or partial plegia and those aged ≥50 years.

Abstract

✓ 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).