Abstract
Methylprednisolone sodium succinate (MPSS) for treatment of acute spinal cord injury (SCI) has been associated with both benefits and adverse events. MPSS administration was the standard of care for acute SCI until recently when its use has become controversial. Patients with SCI have had little input in the debate, thus we sought to learn their opinions regarding administration of MPSS. A summary of the published literature to date on MPSS use for acute SCI was created and adjudicated by 28 SCI experts. This summary was then emailed to 384 chronic SCI patients along with a survey that interrogated the patients’ neurological deficits, communication with physicians and their views on MPSS administration. 77 out of 384 patients completed the survey. 28 respondents indicated being able to speak early after injury and of these 24 reported arriving at the hospital within 8 hours of injury. One recalled a physician speaking to them about MPSS and one patient reported choosing whether or not to receive MPSS. 59.4% felt that the small neurological benefits associated with MPSS were ‘very important’ to them (p<0.0001). Patients had ‘little concern’ for potential side-effects of MPSS (p = 0.001). Only 1.4% felt that MPSS should not be given to SCI patients regardless of degree of injury (p<0.0001). This is the first study to report SCI patients’ preferences regarding MPSS treatment for acute SCI. Patients favor the administration of MPSS for acute SCI, however few had input into whether or not it was administered. Conscious patients should be given greater opportunity to decide their treatment. These results also provide some guidance regarding MPSS administration in patients unable to communicate.
Highlights
The use of methylprednisolone sodium succinate (MPSS) has been extensively investigated for its putative neuroprotective properties, the reduction in secondary injury that results from acute spinal cord injury (SCI)
We subjected this document to a peer review by 28 SCI experts to ensure it was neutral, free of bias, and of high quality. We provided it to SCI patients and asked them to complete an online survey after reading it
The opinion of SCI patients regarding MPSS administration has not been sought despite the significant controversy surrounding its use following acute SCI
Summary
The use of methylprednisolone sodium succinate (MPSS) has been extensively investigated for its putative neuroprotective properties, the reduction in secondary injury that results from acute spinal cord injury (SCI). Following the publication of the second National Acute SCI Study (NASCIS II), MPSS administration was considered a standard of care[1,2,3,4,5]. MPSS administration for acute SCI has become controversial. Spinal Cord Injured Patients Favor Methylprednisolone the 2002 Guidelines for the Treatment of Acute SCI recommended MPSS administration at the option level, the 2013 update of these guidelines[6] provides a Level 1 recommendation against the use of MPSS for acute SCI despite little change in the available evidence[6,7,8]. This guideline has been subject to much debate and consensus amongst clinicians has not been achieved on this topic[7, 8]
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