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Klinische Erfahrungen und Ergebnisse der hochdosierten Methylprednisolontherapie bei Rückenmarkstrauma von 1991 bis 1993

Clinical results of high-dose methylprednisolone therapy in spinal-cord injuries from 1991 to 1993

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Zusammenfassung

Tierstudien und vor allem auch NASCIS II haben die neuroprotektive Wirkung des Methylprednisolons mit hoher Sicherheit belegt, sie sind jedoch nicht unumstritten. An der Universitätsklinik für Unfallchirurgie, Wien, erhielten vom 13. 4. 1991 bis 30. 11 1993 31 Patienten mit Wirbelsäulentrauma und Querschnittssymptomatik Methylprednisolon in Megadosis mit einem Bolus von 30 mg/kg Körpergewicht, gefolgt von einer Erhaltungsdosis von 5,4 mg/kg KG/h für 23 Studen. Bei 27 dieser Patienten wurde innerhalb von acht Stunden die primäre operative Reposition und Stabilisierung durchgeführt. Der Nachuntersuchungszeitraum lag zwischen ein bis 3,2 Jahren. Es fand sich bei allen Patienten (100%) mit inkompletter Querschnittssymptomatik (n=18) eine deutliche Besserung und immerhin bei drei Patienten (23.1%) mit komplettem Querschnitt (n=13). Im Vergleich dazu überblicken wir 113 Patienten mit kompletter oder inkompletter Querschnittssymptomatik, die in den Jahren 1980 bis 1990 an der ehemaligen I. Universitätsklinik für Unfallchirurgie aufgenommen wurden und nach unseren derzeitigen Kriterien Methylprednisolon hätten erhalten sollen.

Abstract

Studies in animals and especially the NASCIS II study illustrated the neuroprotective effects of methylprednisolone, but they are disputed. At the University Clinic of Traumatology, Vienna, 31 patients with spinal cord injuries were given methylprednisolone as a bolus of 30 mg/kg body weight followed by a maintenance dose of 5.4 mg/kg body weight/h for another 24 hours. Twenty-seven patients were stabilised within 8 hour, 2 patients were not operated on, because of their low prognosis. Two patients could be treated conservatively, because the spinal fractures were supposed to be stabile. Then follow-up studies of these patients were between 1 and 3,2 years. All patients (100%) with incomplete neurologic deficits (n=18) showed a significant recovery and even 3 patients (23.1%) with primarily a complete tetraplegia (n=13) showed a nearly entire recovery. Compared to these results we look back at 113 patients with complete and incomplete neurologic deficits who were treated at the I. University Clinic of Traumatology, Vienna, and would have got methylprednisolone following our current management procedures.

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Literatur

  1. Anderson, D. K., E. D. Means, D. R. Waters et al.: Microvascular perfusion and metabolism in injured spinal cord after methylprednisolone treatment. J. Neurosurg. 56 (1982), 106–113.

    PubMed  CAS  Google Scholar 

  2. Antal, E. J., E. Wright, W. R. Gillespie, K. S. Albert: Influence of route of administration on the pharmacokinetics of methylprednisolone. J. Pharmacokinet. Pharmaceut. 11 (1983), 561–576.

    CAS  Google Scholar 

  3. Bracken, M. B., W. F. Collins, D. F. Freeman et al.: Efficacy of methylprednisolone in acute spinal cord injury. J. Amer. med. Ass. 251 (1984), 45–52.

    Article  CAS  Google Scholar 

  4. Bracken, M. B., M. J. Shepard, W. F. Collins et al.: A randomized, controlled trial of methylprednisolone or naloxone in the treatment of acute spinal-cord injury. New Engl. J. Med. 322 (1990), 1405–1411.

    Article  PubMed  CAS  Google Scholar 

  5. Bracken, M. B., M. J. Shepard, W. F. Collins et al.: Methylprednisolone or naloxone treatment after acute spinal cord injury: 1-year follow-up data. J. Neurosurg. 76 (1992), 23–31.

    PubMed  CAS  Google Scholar 

  6. Bracken, M. B.: Pharmacological treatment of acute spinal cord injury: current status and future prospects. Paraplegia 30 (1992), 102–107.

    PubMed  CAS  Google Scholar 

  7. Braughler, J. M., E. D. Hall: Uptake and elimination of methyl-prednisolone from contused cat spinal cord following intravenous injection of the sodium succinate ester. J. Neurosurg. 58 (1983), 538–542.

    PubMed  CAS  Google Scholar 

  8. Braughler, J. M., E. D. Hall: Effects of multi-dose methylprednisolone sodium succinate administration on injured cat spinal cord neurofilament degradation and energy metabolism. J. Neurosurg. 61 (1984), 290–295.

    PubMed  CAS  Google Scholar 

  9. Braughler, J. M., E. D. Hall: Current application of “high-dose” steroid therapy for CNS injury. J. Neurosurg. 62 (1985), 806–810.

    PubMed  CAS  Google Scholar 

  10. Braughler, J. M., E. D. Hall, J. M. McCall, J. M. Means: The 21-aminosteroids: potent inhibitors of lipid peroxidation for the treatment of central nervous system trauma and ischemia, Drugs Future 14 (1989), 143–152.

    Google Scholar 

  11. Demopoulos, H. B., E. S. Flamm, D. D. Pietronigro et al.: The free radical pathology and the microcirculation in the major central nervous disorders. Acta physiol. scand. 492, Suppl. 111 (1980), 1–119.

    Google Scholar 

  12. Demopoulos, H. B., E. S. Flamm, M. L. Seligman et al.: Further studies on free-radical pathology in the major central nervous disorders: effects of very high doses of methylprednisolone on the functional outcome, morphology, and chemitry of experimental spinal cord impact injury. Canad. J. Physiol. Pharmacol. 60 (1982), 1415–1424.

    CAS  Google Scholar 

  13. Emerson, T. E., W. J. Bryon: Regional cerebral blood flows in endotoxin shock with methylprednisolone treatment. Proc. Soc. exp. Biol. Med. 156 (1977), 378–381.

    PubMed  CAS  Google Scholar 

  14. Fox, J. L., M. G. Yargasil: The relief of intracranial vasospasm: an experimental study with methylprednisolone and cortisol. Surg. Neurol. 3 (1975), 214–218.

    PubMed  CAS  Google Scholar 

  15. Geisler, F. H., F. C. Dorsey, W. P. Coleman: Recovery of motor function after spinal-cord injury—a randomized placebo controlled trial with GM-1 ganglioside. New Engl. J. Med. 26 (1991), 1829–1837.

    Article  Google Scholar 

  16. Gianotta, S. L., M. H. Weiss, M. L. J. Apuzzo et al.: High dose glucocorticoids in the management of severe head injury. Neurosurgery 15 (1984), 497–501.

    Article  Google Scholar 

  17. Hall, E. D., T. Baker: Acute effects of methylprednisolone sodium succinate on spinal reflexes. Exp. Neurol. 63 (1979), 476–484.

    Article  PubMed  CAS  Google Scholar 

  18. Hall, E. D. et al: Further studies of glucocorticoid effects on spinal cord function: single and repetitive monosynpatic transmission and apparent Ia afferent transmitter turnover. J. Pharmacol. exp. Ther. 210 (1979), 112–115.

    PubMed  CAS  Google Scholar 

  19. Hall, E. D., D. L. Wolf, J. M. Braughler: Effects of a single large dose of methylprednisolone sodium succinate on experimental posttraumatic spinal cord ischemia. Dose-response and time-action analysis. J. Neurosurg. 61 (1984), 124–130.

    PubMed  CAS  Google Scholar 

  20. Hall, E. D., D. L. Wolf: A pharmacological analysis of the pathophysiological mechanisms of posttraumatic spinal cord ischemia. J. Neurosurg. 64 (1986), 951–961.

    PubMed  CAS  Google Scholar 

  21. Hall, E. D.: The neuroprotective pharmacology of methylprednisolone. J. Neurosurg. 76 (1992) 13–22.

    PubMed  CAS  Google Scholar 

  22. Hanigan, W. C., R. J. Anderson: Commentary on NASCIS-2. J. spinal Disord. 5 (1992), 125–131.

    PubMed  CAS  Google Scholar 

  23. Hilton, G., J. Frei: High-dose methylprednisolone in the treatment of spinal cord injuries. Heart and Lung 20 (1991), 675–680.

    PubMed  CAS  Google Scholar 

  24. Melo-Gomes, J. A.: Problems related to systemic glucocorticoid therapy in children. J. Rheum. 20 Suppl. 37 (1993), 35–39.

    Google Scholar 

  25. Möllmann, H., P. Rohdewald, J. Barth et al.: Comparative pharmacokinetics of methylprednisolone phosphate and hemisuccinate in high doses. Pharmaceut. Res. 5 (1988), 509–513.

    Article  Google Scholar 

  26. Schnell, L., M. E. Schwab: Axonal regeneration in the rat spinal cord produced by an antibody against myelin-associated neurite growth inhibitors. Nature 343 (1990), 269–272.

    Article  PubMed  CAS  Google Scholar 

  27. Schwab, M. E.: Entwicklung, Stabilisierung und Regeneration von Faserverbindungen in Gehirn und Rückenmark: Die Rolle von Nervenwachstumschemmstoffen. In: Zäch, G. A., Rehabilitation beginnt am Unfallort. Springer, Berlin-Heidelberg-New York 1992.

    Google Scholar 

  28. Soejima, T., Y. L. Yamamoto, E. Meyer et al.: Protective effects of steroids on the cortico-microcirculation injured by cold. J. Neurosurg. 51 (1979), 188–200.

    Article  PubMed  CAS  Google Scholar 

  29. Woodbury, D., W. G. Bingham: Effects of steroids on the central nervous system. In: Dorfman, R. I.: Steroidal activity in experimental animals an man. Part C. Methods in hormone research. Academic Press, New York-London 1966.

    Google Scholar 

  30. Young, W.: Therapy of acute spinal cord injury. 7th Congress of the Western Pacific Association of Critical Care Medicine, 12–15th March 1993, Hongkong 1993.

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  1. C. Gäbler

    Present address: Universitätsklinik für Unfallchirurgie, Währinger Gürtel 18-20, A-1090, Wien

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  1. Universitätsklinik für Unfallchirurgie, Währinger Gürtel 18-20, A-1090, Wien

    R. Maier

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Gäbler, C., Maier, R. Klinische Erfahrungen und Ergebnisse der hochdosierten Methylprednisolontherapie bei Rückenmarkstrauma von 1991 bis 1993. Unfallchirurgie 21, 20–29 (1995). https://doi.org/10.1007/BF02588347

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