4-AMINOPYRIDINE AND SPINAL-CORD INJURY - A REVIEW

Demyelination of axons within the spinal cord represents a significant component of the pathology of contusive and compressive spinal cord i njury (SCI) and the associated conduction deficits most probably contr ibute to the paralysis and sensory loss experienced by SCI patients. 4 -Aminopyridine (4-AP) is a potassium (K+) channel blocking agent that has been shown capable of restoring conduction across demyelinated int ernodes in neurons of the spinal cord. Recent clinical trials of 4-AP provide evidence that limited and transient neurological gain may be d erived by some SCI patients with longstanding injury. The present revi ew traces the historical development of 4-AP, describes the mechanism of action and rationale for use in SCI, and provides an overview of th e clinical trials conducted to date. The early trials give rise to opt imism that pharmaceutical management of conduction deficits may have a role to play in restoring neurological function in some patients with SCI.