Efficacy of repeated intrathecal triamcinolone acetonide application in progressive multiple sclerosis patients with spinal symptoms.
BACKGROUND
There are controversial results on the efficacy of the abandoned, intrathecal predominant methylprednisolone application in multiple sclerosis (MS) in contrast to the proven effectiveness in intractable postherpetic neuralgia.


METHODS
We performed an analysis of the efficacy of the application of 40 mg of the sustained release steroid triamcinolone acetonide (TCA). We intrathecally injected in sterile saline dissolved TCA six times within three weeks on a regular basis every third day in 161 hospitalized primary and predominant secondary progressive MS patients with spinal symptoms. The MS patients did not experience an acute onset of exacerbation or recent distinct increased progression of symptoms. We simultaneously scored the MS patients with the EDSS and the Barthel index, estimated the walking distance and measured somatosensory evoked potentials. Additionally the MS patients received a standardized rehabilitation treatment.


RESULTS
EDSS score and Barthel index improved, walking distance increased, latencies of somatosensory evoked potentials of the median and tibial nerves shortened in all MS patients with serial evaluation (p < 0.0001 for all variables). Side effects were rare, five patients stopped TCA application due to onset of a post lumbar puncture syndrome.


CONCLUSIONS
Repeated intrathecal TCA application improves spinal symptoms, walking distance and SSEP latencies in progressive MS patients in this uncontrolled study. Future trials should evaluate the long-term benefit of this invasive treatment.
Hellwig
Kerstin
K
Department of Neurology, St, Josef Hospital, Ruhr University Bochum, Gudrunstrasse 56, 44791 Bochum, Germany. zirkuszelt@hotmail.com <zirkuszelt@hotmail.com>
Stein
Franz Josef
FJ
Przuntek
Horst
H
Müller
Thomas
T
D000328:Adult; D000368:Aged; D003692:Delayed-Action Preparations; D004334:Drug Administration Schedule; D005073:Evoked Potentials, Somatosensory; D005938:Glucocorticoids / Q000008:administration & dosage; D006801:Humans; D007278:Injections, Spinal; D007902:Length of Stay; D008475:Median Nerve / Q000503:physiopathology; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000188:drug therapy* / Q000534:rehabilitation; D011930:Reaction Time; D013122:Spinal Diseases / Q000209:etiology / Q000517:prevention & control*; D013979:Tibial Nerve / Q000503:physiopathology; D014222:Triamcinolone Acetonide / Q000008:administration & dosage*; D016138:Walking
D003692:Delayed-Action Preparations; D005938:Glucocorticoids; D014222:Triamcinolone Acetonide