Until now, there really has been, from a clinical
standpoint, from a treatment standpoint, very
little that we can proactively give or treat
with someone who has a spinal cord injury
to optimize their potential for neurologic
return. High-dose steroids, or methylprednisolone,
for about 18-19 years, had been administered
after it was found in a large study that it
might have the potential to improve neurologic
outcomes in individuals with spinal cord injuries.
Now the goal of methylprednisone, or steroids,
was to try to minimize the swelling, or inflammatory
process that took place after a spinal cord
injury, with the hopes that by minimizing
the swelling, decreasing the swelling, that
it would enhance the opportunity for nerve
function to recover. Over the years, it’s
become clear that, although it was recognized
previously that there are risks with high-dose
steroids. There are risks to individuals who
require ventilators to breath; that it might
increase their risk for pneumonias. High-dose
steroids can increase the risks for infections
and poor wound healing. And as with any treatment
that is proposed, you need to find the balance
between risks and potential harm, and the
benefits that come with it. As time has gone
on, we’ve also further looked at the results
of those initial studies that were done, in
terms of their benefit to helping individuals
with spinal cord injury. And there are many
who’ve believed that perhaps the benefits
of it were not quite as great as we’d initially
thought, in terms of neurologic outcomes.
And certainly when you balance that against
the risks of other medical complications,
it’s become more clear that perhaps the
use of steroids needs to be confined to a
particular period of time after injury. Many
centers now will only use high-dose steroids
if an individual comes to their care between
three hours and eight hours from the time
of injury. If a person comes to their care
at a period of time later than that, the belief
is that the benefits of it may not be as great,
and the risks and complications that can sometimes
come with high-dose steroids, may far outweigh
those benefits.
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