Pharmacological prospects of treatment of spinal cord injury in acute and early periods
DOI:
https://doi.org/10.15587/2519-4798.2018.139760Keywords:
glutamatergic excitotoxicity, spinal cord injury, riluzole, MRIAbstract
Glutamatergic excitotoxicity is the main factor affecting the formation of edema, ischemia with a spinal cord injury. In our clinical studies, we analyzed the effectiveness of standard complex treatment - surgical and medicamentous with the use of riluzole as an inhibitor of glutamate release.
The aim of the study was to investigate the clinical efficacy of riluzole in patients with spinal and spinal cord injury in acute and early periods.
Materials and methods. On treatment in KU "Dnepropetrovsk Regional Clinical Hospital named after I.I. Mechnikov", from January 2013 to January 2017 there were 15 patients with complicated spinal cord injury of the cervical spine, which in the complex standard therapy used riluzole. The age of the patients was 18-70 years. The degree of severity of neurological disorders of patients on the ASIA scale corresponded to A-D. The use of riluzole started as early as possible, but no later than 7 days, at a dose of 50 mg every 12 hours for 3 weeks per os.
Results. In a group of patients with ASIA-A neurological disorders (6 patients), a neurological improvement in the ASIA scale was noted in one patient. In patients with ASIA-B (5 patients), in 2 cases a transition to group "C" was noted. The evaluation was carried out for 21 days. Movement in the key muscle groups corresponded to 1-2 points. Neurogenic shock was absent in all cases.
In 3 observations with violation of ASIA-C on day 21, movements were restored to 4 points in 2 patients. In 1 patient on the ASIA scale, the disorders corresponded to level "D". When examined after 3 weeks, there was no convincing difference in muscle strength.
Conclusions:
1. The use of riluzole limits the development of secondary changes in the spinal cord in the acute and early periods of spinal cord injury.
2. The medicine reduces the manifestation of muscle spasticity in the early period of trauma.
3. Neurogenic shock when taking riluzole is less prolonged.
4. The complex approach in treatment with the use of riluzole opens significant prospects in the treatment of this pathology
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