Biological interventions for spinal cord injury

Spinal cord injury is frequently followed by the loss of supraspinal contro l of sensory, autonomus and motor functions at sublesional level. To enhanc e recovery in patients with spinal cord injuries, three fundamental strateg ies have been developed in experimental models. These strategies involve th ree different time points for postlesional intervention in the spinal cord. Neuroprotection soon after injury uses pharmacological tools to reduce the progressive secondary injury processes that follow during the first week a fter the initial lesion occurs, in order to limit tissue damage. A second s trategy, which is initiated shortly after the lesion occurs, aims at promot ing axonal regeneration by acting pharmacologically on inhibitors or barrie rs of regeneration, or by the application of cell or gene therapy as a sour ce of neurotrophic factors or as a bridge or support to enhance the regener ation of lesioned axons. Finally, a mid-term substitutive strategy is the m anagement of the sublesional spinal cord by sensorimotor stimulation or the supply of missing key afferents, such as monoaminergic systems. These thre e strategies are reviewed. Only a combination of these different approaches can provide an optimal basis for potential therapeutic interventions aimed at functional recovery after spinal cord injury. Curr Opin Neurol 11:647-6 54 (C) 1998 Lippincott Williams & Wilkins.