Recovery of motor function after spinal-cord injury - a randomized, placebo-controlled trial with GM-1 ganglioside

Article Abstract:

Although the development of specialized centers for the treatment of spinal cord injuries has reduced associated mortality and illness, and increased the restoration of functional abilities, most patients never recover completely. Only the Second National Acute Spinal Cord Injury Study (NASCIS 2) has demonstrated improved recovery from or reversal of neurological damage after drug therapy. Gangliosides, which form a major part of central nervous system cell membranes, remain relatively mysterious, although there is evidence that they induce regeneration and sprouting of neurons, and restore neuronal function. Of 351 patients considered for entry into this study of drug treatment for spinal-cord injuries, 34 qualified. Women of childbearing age were excluded, as were many other categories. Sixteen of the patients were treated with GM-1 ganglioside, and 18 received a placebo. The initial injury to the spinal cord is seldom the cause of the neurological damage; inadequate blood flow and small hemorrhages result in local tissue death during the days following the injury. Among those receiving GM-1, the recovery of motor (movement) functions improved in the arms, and was enhanced over time in the legs as well. Although methodological differences make direct comparison with the NASCIS 2 study difficult, it seems that there was a similar degree of improvement among the patients with spinal-cord injuries in both studies. The improvement achieved in this study is dramatic, with most of the patients progressing from paralytic to ambulatory status. Concomitant early and aggressive treatment may be required for drug therapy to be effective. (Consumer Summary produced by Reliance Medical Information, Inc.)

Paralysis, Gangliosides

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Treatment of spinal-cord injury

Article Abstract:

Because of improvements in medical and surgical care, many more people who sustain traumatic injury to their spinal cords survive. Mortality has dropped from 30 percent in the 1960s to 6 percent in the 1980s. Bowel, bladder and cardiovascular problems can now be managed. However, injury to the spinal cord is tragic and devastating. A recent clinical trial demonstrated that patients with spinal-cord injuries who received glucocorticoid steroids experienced improved recovery if they were given the medication within eight hours of trauma to the spinal cord. The high dose given was shown to be more effective than the lower doses which were previously used. If the glucocorticoid steroids were given for short periods of time, for 24 hours as the clinical trial reported, the adverse effects associated with corticosteroids were avoided. Improvements were seen in patients with various degrees of injury. For patients with quadriplegia (paralysis), the improvements from glucocorticosteroid treatment could mean independent living and independent transfer from bed to chair and to toilet facilities. For patients with quadriparesis (partial paralysis), these improvements could mean the ability to get around with the use of crutches or a walker. Although this advance is not a cure, it is a welcomed step in the management of patients with spinal-cord injuries. Continued research is necessary to find a cure for spinal-cord damage. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Methylprednisolone, editorial

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TTP - desperation, empiricism, progress

Article Abstract:

Thrombotic thrombocytopenic purpura (TTP) and hemolytic uremic syndrome are closely related blood diseases that cause bleeding into the tissues, destruction of red blood cells, and neurologic abnormalities. There are kidney abnormalities in half or more of the patients with TTP. Although the diseases are rare, they are discussed in two articles in the August 8, 1991 issue of The New England Journal of Medicine. The causes of these diseases are unknown, but TTP sometimes follows the administration of certain drugs, including mitomycin, cyclosporine, and chemotherapeutic agents. In children, it may follow an intestinal infection caused by Escherichia coli or Shigella bacteria. Since the widespread use of plasma infusion or plasma exchange, up to 90 percent of patients now survive. Most of them never have a second episode, and there is no permanent damage to the organs. The physiological aspects of the disease and various types of treatment are discussed. At this time physicians do not know how many plasma exchanges after normal blood values are obtained are required to prevent relapse. Although better treatment is still needed for the more difficult cases of TTP and hemolytic uremic syndrome (which does not respond as well to plasma manipulation), TTP has been transformed from a nearly always fatal disease into one that is curable or manageable in almost three fourths of patients. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Editorial, Hemolytic-uremic syndrome, Plasma exchange (Therapeutics), Purpura (Pathology), Purpura

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