The potential benefits of riluzole for treating spinal cord injury
Dr Ralph Stanford. Originally published in NeuRA Profile Magazine 2018
Recovery of function after acute traumatic spinal cord injury is limited, but the concept of using drugs to protect injured nerve cells offers hope of improving outcomes.
NeuRA’s Dr Ralph Stanford has partnered with AOSpine in North America to establish a clinical trial of the drug riluzole in the early treatment of spinal cord injury in Australia.
Three hospitals in NSW (Prince of Wales, Royal North Shore and John Hunter) and the Royal Adelaide Hospital in South Australia have joined 20 other sites in the USA and Canada in an international collaboration to enrol suitable participants in the trial.
Many sites are needed because of the relative rarity of severe spinal cord injury and the stringent selection criteria of the protocol, the principal one being able to initiate trial treatment within 12 hours of injury.
Once a potential participant has consented, they are given a full course of tablets that may contain either active agent or placebo based on a random sequence. Whether they are one or the other is concealed from them and the investigators, which rules-out the possibility of biased recording of outcomes.
The potential benefits of riluzole in treating spinal cord injury were discovered by Professor Michael Fehlings of the University of Toronto, Canada, who is the world lead investigator of the trial. The drug acts to dampen the toxic effects of inflammation within the spinal cord following a compression injury and is given by mouth twice a day for two weeks.
Investigators record neurological function at the time of admission and at scheduled intervals for up to one year afterwards. NeuRA’s Dr Claire Boswell-Ruys performs neurological examinations for all cases in Sydney. The effects of treatment will be measured in recovery of muscle strength six-months after injury, as well as indicators of hand function and overall independence.
The trial is ongoing, and 351 cases are required for completion. Of 129 enrolled so far, Australia has been very efficient and contributed 32 at a rate double that of North America. This is testament to the streamlined trauma services in this country and the dedication of the research personnel at all the participating hospitals.