Intrathecal steroid treatment for progressive MS

Are you willing to have 5 lumbar punctures to improve your progressive MS? #MSBlog #MSResearch

"If you have progressive MS you may find this study compelling. The administration of a long-acting steroid into the spinal fluid, alternate days, for 10 days results in a significant improvement in function and a reduction in markers associated with inflammatory damage. Wow!"

"When you read the paper, however, you will realise that this is a small study involving 21 MSers and it was open-labelled. In other words all subjects received the therapy so that both MSers and investigators knew what the study subjects were getting. Therefore the treatment response could have been due to a bias; i.e. MSers wanting to get better and the assessors wanted to find a positive result. This is why we have to do randomized double-blind placebo-controlled trials to try and minimize any bias in the results."

"This study, however, provides pilot data and hopefully it will be taken forward into the next phase as a randomized double-blind placebo-controlled study to see if these results can be reproduced in a blinded way. I like this study because it investigates spinal fluid and study subjects were prepared to have 5 lumbar punctures. The latter indicates to me, in combination with our surveys, that if you have progressive MS most progressive MSers are willing to have multiple lumbar punctures to assess new treatments for progressive MS."

"I would like to congratulate these investigators on a difficult study and I would encourage them to take it forward with a further study. They owe it to the field and to the MSers who volunteered for this study to do another study. If not we should debate the ethics of studies like this. Is it right to consent MSers to participate in a study that involves an invasive procedure and exposes them to risks, if a positive result doesn't trigger a more definitive clinical study?"

Müller et al. Reduction in the free radical status and clinical benefit of repeated intrathecal triamcinolone acetonide application in patients with progressive multiple sclerosis. Clin Neuropharmacol. 2014;37(1):22-5

BACKGROUND: Previous open trials performed repeated intrathecal application of the sustained release steroid triamcinolone acetonide every third day in MSers with progressive multiple sclerosis and described enhanced walking abilities.

OBJECTIVES: 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.

SUBJECTS/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 MSers 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.

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