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The neuroprotective pharmacology of methylprednisolone
Abstract
✓ A 24-hour intensive intravenous dosing regimen with the glucocorticoid steroid methylprednisolone has recently been shown to be effective in enhancing neurological recovery in spinal cord-injured patients when initiated within 8 hours after injury. The state of knowledge concerning the neuroprotective pharmacology of methylprednisolone, including mechanism(s) of action, dosing requirements, and time-action considerations is reviewed, as are the results of studies with high doses in experimental and clinical head injury, subarachnoid hemorrhage, and cerebral ischemia. A primary neuroprotective mechanism of action in each of these cases is hypothesized to involve the ability of high doses of methylprednisolone to inhibit oxygen free radical-induced lipid peroxidation, although additional mechanisms may contribute. Unresolved issues are also addressed, including the therapeutic window, optimum duration of treatment, and rational combination with other neuroprotective agents. A newer methylprednisolone pro-drug with improved solution stability is discussed, together with a brief consideration of novel nonglucocorticoid steroids that surpass methylprednisolone's lipid antioxidant effects without unwanted glucocorticoid properties.
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Cited by
The cellular inflammatory response in human spinal cords after injury
Fleming, J. C., Norenberg, M. D., Ramsay, D. A., Dekaban, G. A., Marcillo, A. E., Saenz, A. D., Pasquale-Styles, M., Dietrich, W. D., & Weaver, L. C. (2006) · Brain · doi:10.1093/brain/awl296 · Cited by 847
Bracken, M. B., Shepard, M. J., Holford, T. R., Leo-Summers, L., Aldrich, E. F., Fazl, M., Fehlings, M. G., Herr, D. L., Hitchon, P. W., Marshall, L. F., et al. (1998) · Journal of Neurosurgery · doi:10.3171/jns.1998.89.5.0699 · Cited by 538
Degenerative and regenerative mechanisms governing spinal cord injury
Profyris, C., Cheema, S. S., Zang, D., Azari, M. F., Boyle, K., & Petratos, S. (2004) · Neurobiology of Disease · doi:10.1016/j.nbd.2003.11.015 · Cited by 458
Chapter 4 Cell death in models of spinal cord injury
Beattie, M. S., Hermann, G. E., Rogers, R. C., & Bresnahan, J. C. (2002) · Progress in Brain Research · doi:10.1016/s0079-6123(02)37006-7 · Cited by 453
Tymianski, M., & Tator, C. H. (1996) · Neurosurgery · doi:10.1097/00006123-199606000-00028 · Cited by 313
Metadata
- Authors
- Hall, E. D.
- Venue
- Journal of Neurosurgery
- Published
- 1992-01
- Volume
- 76
- Issue
- 1
- Pages
- 13-22
- ISSN
- 0022-3085 (ISSN-L)
- OpenAlex
- W1996449070
- Cited by
- 474
- References
- 0
- FWCI
- 16.07
- Type
- journal article
- Language
- en
- Open access
- closed
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Contains information from the Semantic Scholar Academic Graph Datasets, made available under the ODC Attribution License (ODC-BY 1.0).
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