Over the past 2 decades, advances in understanding the pathophysiology of
spinal cord injury (SCI) have stimulated the recent emergence of several therapeutic strategies that are being examined in Phase I/II clinical trials. Ten randomized controlled trials examining
methylprednisolone sodium succinate, tirilizad
mesylate, monosialotetrahexosylganglioside,
thyrotropin releasing hormone,
gacyclidine,
naloxone, and
nimodipine have been completed. Although the primary outcomes in these trials were laregely negative, a secondary analysis of the North American
Spinal Cord Injury Study II demonstrated that when administered within 8 hours of injury,
methylprednisolone sodium succinate was associated with modest clinical benefits, which need to be weighed against potential complications.
Thyrotropin releasing hormone (Phase II trial) and monosialotetrahexosylganglioside (Phase II and III trials) also showed some promise, but we are unaware of plans for future trials with these agents. These studies have, however, yielded many insights into the conduct of clinical trials for SCI. Several current or planned clinical trials are exploring interventions such as early
surgical decompression (Surgical Treatment of Acute
Spinal Cord Injury Study) and electrical field stimulation, neuroprotective strategies such as
riluzole and
minocycline, the inactivation of myelin inhibition by blocking Nogo and Rho, and the
transplantation of various cellular substrates into the injured cord. Unfortunately, some experimental and poorly characterized SCI
therapies are being offered outside a formal investigational structure, which will yield findings of limited scientific value and risk harm to patients with SCI who are understandably desperate for any intervention that might improve their function. Taken together, recent advances suggest that optimism for patients and clinicians alike is justified, as there is real hope that several safe and effective
therapies for SCI may become available over the next decade.