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Review
. 2016 Jun;11(6):882-5.
doi: 10.4103/1673-5374.184450.

Methylprednisolone for acute spinal cord injury: an increasingly philosophical debate

Christian A Bowers  1 , Bornali Kundu  1 , Gregory W J Hawryluk  1
Affiliations
Review

Methylprednisolone for acute spinal cord injury: an increasingly philosophical debate

Christian A Bowers et al. Neural Regen Res. 2016 Jun.

Abstract

Following publication of NASCIS II, methylprednisolone sodium succinate (MPSS) was hailed as a breakthrough for patients with acute spinal cord injury (SCI). MPSS use for SCI has since become very controversial and it is our opinion that additional evidence is unlikely to break the stalemate amongst clinicians. Patient opinion has the potential to break this stalemate and we review our recent findings which reported that spinal cord injured patients informed of the risks and benefits of MPSS reported a preference for MPSS administration. We discuss the implications of the current MPSS debate on translational research and seek to address some misconceptions which have evolved. As science has failed to resolve the MPSS debate we argue that the debate is an increasingly philosophical one. We question whether SCI might be viewed as a serious condition like cancer where serious side effects of therapeutics are tolerated even when benefits may be small. We also draw attention to the similarity between the side effects of MPSS and isotretinoin which is prescribed for the cosmetic disorder acne vulgaris. Ultimately we question how patient autonomy should be weighed in the context of current SCI guidelines and MPSS's status as a historical standard of care.

Keywords: MPSS; autonomy; debate; methylprednisolone; misconceptions; philosophy; spinal cord injury; steroids.

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Figures

Figure 1
Figure 1
Timeline illustrating key academic events related to the administration of methylprednisolone sodium succinate for acute spinal cord injury. AANS: American Association of Neurological Surgeons; CNS: Congress of Neurological Surgeons; SCI: spinal cord injury.
See this image and copyright information in PMC

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