Methylprednisolone or tirilazad mesylate administration after acute spinalcord injury: 1-year follow up - Results of the third National Acute SpinalCord Injury randomized controlled trial

Object. A randomized double-blind clinical trial was conducted to compare n eurological and functional recovery and morbidity and mortality rates 1 yea r after acute spinal cord injury in patients who had received a standard 24 -hour methylprednisolone regimen (24MP) with those in whom an identical MP regimen had been delivered for 48 hours (48MP) or those who had received a 48-hour tirilazad mesylate (48TM) regimen. Methods. Patients for whom treatment was initiated within 3 hours of injury showed equal neurological and functional recovery in all three treatment g roups. Patients for whom treatment was delayed more than 3 hours experience d diminished motor function recovery in the 24MP group, but those in the 48 MP group showed greater I-year motor recovery (recovery scores of 13.7 and 19, respectively, p = 0.053). A greater percentage of patients improving th ree or more neurological grades was also observed in the 48MP group (p = 0. 073). In general, patients treated with 48TM recovered equally when compare d with those who received 24MP treatments. A corresponding recovery in self care and sphincter control was seen but was not statistically significant. Mortality and morbidity rates at 1 year were similar in all groups. Conclusions. For patients in whom MP therapy is initiated within 3 hours of injury, 24-hour maintenance is appropriate. Patients starting therapy 3 to 8 hours after injury should be maintained on the regimen for 48 hours unle ss there are complicating medical factors.