A randomized, controlled trial of methylprednisolone or naloxone in the treatment of acute spinal-cord injury

Article Abstract:

It is difficult to successfully treat injuries to the spinal cord. The effectiveness and safety of the glucocorticoid drug methylprednisolone and the narcotic antagonist naloxone were examined in a randomized, controlled trial of 487 patients with spinal cord injuries. Ninety-five percent of the cases were treated within 14 hours after injury. Neurologic examinations were conducted on admission to the hospital, and at six weeks and six months after injury. Movement and sensory functions (the latter measured by the response to pinprick and light touch) were significantly improved in patients who were treated with methylprednisolone within eight hours of their injury, compared with patients treated with naloxone and a control group, who received a placebo or inactive substance. The degree of neurologic recovery was related to the severity of the injury, but improvement was seen in patients with various degrees of spinal cord damage. Patients treated with methylprednisolone eight or more hours after injury, or those who were treated with naloxone did not show any improvement in their movement or sensory functions; mortality and morbidity were the same in patients treated with methylprednisolone, naloxone, or placebo. Methylprednisolone is thought to inhibit the breakdown of cellular membranes. This study examines the neurologic changes that occurred after treatment, which should reflect the biologic changes in the spinal cord that lead to the patient's ability to recover during rehabilitation. These findings demonstrate that treatment with methylprednisolone improves the recovery of patients with spinal cord injuries, but must be given within eight hours of injury. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Corticosteroids, Adrenocortical hormones, Naloxone, Narcotic antagonists

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A multicomponent intervention to prevent delirium in hospitalized older patients

Article Abstract:

It is possible to prevent episodes of delirium in hospital patients. Researchers attempted to do this for 852 patients 70 years old or older by giving some patients usual care and assigning others to an extensive intervention aimd at preventing intellectual decline, sleep deprivation, immobility, vision and hearing impairment and dehyration. Fewer patients in the intervention group developed an episode of dementia and the episodes were shorter compared to the patients receiving usual care. However, the intervention did not reduce the severity of the episode or the recurrence rate.

Psychological aspects, Prevention, Dementia, Hospital patients, Aged patients, Elderly patients

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Administration of methylprednisolone for 24 or 48 hours or tirilazad mesylate for 48 hours in the treatment of acute spinal cord injury: results of the Third National Acute Spinal Cord Injury randomized controlled trial

Article Abstract:

Patients with spinal cord injury should receive a methylprednisolone infusion for at least 24 hours and preferably 48 hours if their treatment began 3 to 8 hours after injury. This was the conclusion of a study that compared a 24-hour infusion of methylprednisolone, a 48-hour infusion and a 48-hour infusion of tirilazad mesylate. The 48-hour infusion of methylprednisolone was most effective in improving motor function at 6 weeks and 6 months in those patients treated between 3 and 8 hours after injury.

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