title: Reduction in the free radical status and clinical benefit of repeated intrathecal triamcinolone acetonide application in patients with progressive multiple sclerosis.
abstract: BACKGROUND
  Previous open trials performed repeated intrathecal application of the sustained release steroid triamcinolone acetonide every third day in patients with progressive multiple sclerosis and described enhanced walking abilities.
  
  
  OBJECTIVE
  The objectives of this study were to demonstrate the efficacy of 5 triamcinolone administrations every other day and to describe their effects on the amount of inducible free radicals in cerebrospinal fluid.
  
  
  METHODS
  Clinical ratings, determinations of maximum walking distance, and execution of an instrumental peg insertion test were performed at baseline and on each day after a triamcinolone injection in 21 patients with progressive multiple sclerosis. Induction of free radicals was assessed in cerebrospinal fluid before each triamcinolone application by electron spin resonance spectroscopy.
  
  
  RESULTS
  Scores for multiple sclerosis improved, walking distance increased, and necessary intervals for the peg insertion procedure were shortened. The amount of inducible free radicals decreased.
  
  
  CONCLUSIONS
  Repeat triamcinolone application improves dysfunction of upper and lower extremities even when administered 5 times only and in series every other day. The declined potential for free radical synthesis may be caused by the anti-inflammatory effect of triamcinolone. It may contribute to suppress the smoldering, chronic inflammation, particularly in spinal lesions of patients with progressive multiple sclerosis. The enhanced arm function hypothetically reflects the effect on cervical and brain lesions due to the hypobaric features of triamcinolone.
authors.affiliation: *Department of Neurology, St Joseph Hospital; and †Gematria Test Lab GmbH, Berlin, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Müller
authors.forename: Thomas
authors.initials: T
authors.lastname: Herrling
authors.forename: Sven
authors.initials: S
authors.lastname: Lütge
authors.forename: Matthias
authors.initials: M
authors.lastname: Küchler
authors.forename: Lutz
authors.initials: L
authors.lastname: Lohse
authors.forename: Hartmut
authors.initials: H
authors.lastname: Rothe
authors.forename: Thomas
authors.initials: T
authors.lastname: Haas
authors.forename: Marion
authors.initials: M
authors.lastname: Marg
authors.forename: Gabi
authors.initials: G
authors.lastname: Öhm
authors.forename: Katinka
authors.initials: K
authors.lastname: Jung
mesh_terms: D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D004185:Disability Evaluation; D004334:Drug Administration Schedule; D004578:Electron Spin Resonance Spectroscopy; D005260:Female; D005609:Free Radicals / Q000134:cerebrospinal fluid*; D006801:Humans; D007278:Injections, Spinal; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009069:Movement Disorders / Q000188:drug therapy / Q000209:etiology; D020528:Multiple Sclerosis, Chronic Progressive / Q000134:cerebrospinal fluid* / Q000150:complications / Q000188:drug therapy*; D011597:Psychomotor Performance / Q000187:drug effects; D014222:Triamcinolone Acetonide / Q000008:administration & dosage*; D016138:Walking
chemical_list: D000893:Anti-Inflammatory Agents; D005609:Free Radicals; D014222:Triamcinolone Acetonide