Walsh & Hoyt: Traumatic Optic Neuropathies: Pharmacology - Clinical Experience

The application of corticosteroids to the treatment of brain and spinal cord trauma is based on the demonstrated efficacy of treating edema associated with brain tumors. However, translating the success of treating experimental spinal cord and brain trauma to the clinical setting represents a decade of frustration. Until the results of the second National Acute Spinal Cord Injury Study (NASCIS II) in 1990, the value of methylprednisolone treatment was questioned. The first National Acute Spinal Cord Injury Study (NASCIS I) compared the effect of high dose methylprednisolone therapy (1 gram bolus followed by 1 gram per day for the next 10 days) to standard dose therapy (100 mg initial bolus followed by 100 mg per day for the next 10 days). The high dose treatment in this protocol for a 70-kg adult equates to 14 mg/kg of methylprednisolone in a 24-hour period. This study failed to demonstrate a beneficial effect of the higher dose of methylprednisolone and lacked a placebo control.