Methylprednisolone may improve lumbosacral radiculoplexus neuropathy

Objective: To report on an open trial of intravenous methylprednisolone (IV MP) in nondiabetic lumbosacral radiculoplexus neuropathy (LSRPN). Backgrou nd. Lumbosacral radiculoplexus neuropathy is a subacute, unilateral or asym metric syndrome of pain, weakness, and paresthesia of the lower extremity, which is attributed to ischemic injury from microvasculitis in lumbosacral roots, plexus, and nerves. Methods: Eleven nondiabetic patients with worsen ing LSRPN were treated - ten with infusions of IV NIP (1 gm/wk) for 8 to 16 weeks and one with an equivalent dosage of oral prednisone. The main endpo ints evaluated were: 1) the Neuropathy Impairment Score (NIS), and 2) the N europathy Symptoms and Change (NSC) scores. Results: The median age of our patients was 67 years, range 49 to 86 years. Seven patients were women. All 11 patients reported improvement during treatment - nine reported marked i mprovement. The median NIS improved from 42 points (range 9 to 106 points) before treatment, to 20 points (range 5 to 57 points) (p = 0.005) after tre atment. Pain was completely resolved in four patients and much improved in seven. The change subscore and the severity subscore of the NSC were statis tically significantly improved after treatment. Prior to treatment, all pat ients had significant weakness with six confined to wheelchairs and four us ing mechanical devices to aid in ambulation. After treatment, the weakness was markedly improved in nine patients; only one still required a wheelchai r and six walked independently (p = 0.03). Conclusions: 1) In LSRPN, pain a nd neurological deficits improved (often dramatically) with IV MP treatment . 2) Although our results should be interpreted with caution since this tri al is uncontrolled, IV MP may favorably affect the natural history of LSRPN . 3) The results are sufficiently promising to provide a rationale for pros pective, sham controlled, double blind trials.