What types of neuroprotection are there?

Author: SCIRE Community Team | Reviewer: Chris S. Bailey | Published: 22 January 2018 | Updated: ~

‘Neuroprotection’ refers to a wide range of different treatments, including medications and other treatments like cooling the body that aim to reduce secondary injury. It is sometimes used to describe surgical decompression and blood pressure control after SCI, although these treatments are not discussed on this page.

While there are many different neuroprotective treatment options being explored, below we briefly outline the most promising treatments currently being studied.

Currently, there are no widely accepted treatments used for neuroprotection. With the exception of methylprednisolone (see below), most of the potential treatments are currently being tested in research studies. Because of the experimental nature of these treatments, most of the treatments outlined below are not available for most people or used outside of research settings.

For details about the progress of ongoing clinical trials, please visit ClinicalTrials.gov.

The steroid medication Methylprednisolone is the most well-known neuroprotective treatment. It is also the only treatment that is currently used outside of research studies. High doses of methylprednisolone may affect many different aspects of secondary injury, including reducing inflammation and damage from free radicals that are thought to help prevent cells from dying after injury.

Three large-scale clinical trials were completed during 1980’s and 1990’s, which established methylprednisolone as a standard treatment that all patients with SCI should receive. However, later debate among experts criticized conclusions made in these studies and questioned the value of methylprednisolone as a treatment. It has been argued that methylprednisolone has shown only limited benefits for recovery, but well-established risk of side effects like infections.

At this time, methylprednisolone continues to be a controversial treatment among experts. It may be used in some clinical settings in certain groups of people with SCI.

Riluzole is a drug that blocks sodium from entering into nerve cells, which may help to reduce excitotoxicity. Riluzole is currently used to treat the degenerative neurological condition amyotrophic lateral sclerosis (ALS).

Animal studies have shown that Riluzole is effective as a neuroprotection treatment in rats with SCI. One preliminary study supported that Riluzole is safe and has potential to provide neuroprotection after SCI in humans. Currently, a large-scale clinical trial is in progress to determine whether Riluzole is effective as neuroprotection after SCI.

Minocycline is an antibiotic medication that is most commonly used to treat bacterial infections. Minocycline may also have neuroprotective effects after SCI. Animal studies have shown that minocycline may suppress immune cells involved in inflammation, cell death and the release of damaging chemicals. An early clinical trial has shown that IV minocycline is safe for use after acute SCI, and has potential as neuroprotection in people with incomplete SCI. Currently, a large-scale study is ongoing to investigate whether minocycline is effective as neuroprotection after SCI.

Cooling the body, known as therapeutic hypothermia, is a treatment that involves reducing the temperature of the body to help protect against further damage. The body is cooled by inserting a cooling catheter into a blood vessel, which cools blood moving through circulation by a few degrees. Reducing body temperature slows metabolism, which can reduce inflammation and minimize further damage. This procedure is currently used to help prevent neurological damage after cardiac arrest.

A small preliminary study has shown that therapeutic hypothermia is safe and has potential as neuroprotection after SCl. Currently, a clinical trial is underway to determine whether spinal cord cooling is effective as neuroprotection for SCI in humans.

Cerebrospinal fluid (CSF) drainage is a technique that involves inserting a small catheter through the coverings of the spinal cord to drain a small amount of the fluid that surrounds the spinal cord and brain (called cerebrospinal fluid). Draining the cerebrospinal fluid is thought to help relieve pressure and reduce further injury to the spinal cord.

Animal studies have shown that cerebrospinal fluid drainage may help improve spinal cord blood flow when combined with careful blood pressure management. One small research study has shown that cerebrospinal fluid drainage was safe for use in people with acute SCI. A larger study has been completed to determine whether cerebrospinal fluid drainage is effective as neuroprotection after SCI. However, the results have not yet been published.

Magnesium has been proposed as a neuroprotective treatment because it can help to reduce excitotoxicity and inflammation. Animal studies have shown benefits for magnesium as neuroprotection.

Cethrin (VX-210) is a medication that reduces the effects of Rho, a protein that is present in inflammation. Rho causes damage to nerve cells and prevents nerve cell regrowth. Cethrin reverses the action of Rho, which may help protect nerve cells and allow neurons to regrow. An early study has shown that Cethrin is safe. A clinical trial testing whether it is effective has been completed with the results pending publication.

A wide range of other treatments have been or are currently being studied. These include:

• Fibroblast growth factor
• Hepatocyte growth factor
• Erythropoetin (EPO)
• GM-1 Ganglioside (Sygen)
• Granulocyte-colony stimulating factor (G-CSF)
• Thyrotropin-releasing hormone (TRH)
• Glibenclamide or glyburide
• Special diets such as intermittent fasting

Research evidence on the following treatments has suggested that they are not effective for use as neuroprotection after SCI. These include:

• Naloxone
• Tirilazad mesylate (was not more effective than methylprednisolone, but had more side effects)
• Nimodipine
• Gacyclidine