Spinal cord injury: another step forward.

Around the world, spinal cord injury (SCI) is a common and devastating long-term complication of trauma that can result in lifelong disability or even death. There are frequent media reports of treatments that may help patients with SCI walk again and these range from new drugs, to robotic devices to new developments in stem cell research. Despite the hype, the fact remains that there are no treatments that have been proven to definitively alter outcomes in this condition.

One of the major problems with drug trials in SCI is finding a way to measure the response to the drug. Many drugs that are potentially useful may fail in clinical trials because we are not able to accurately determine which patients benefit the most. In other neurological conditions such as multiple sclerosis, the ability to use biomarkers such as MRI has revolutionised our diagnostic and treatment approach, leading to significant gains for patients.

In the current issue of JNNP, Kuhle and colleagues http://jnnp.bmj.com/content/86/3/273.abstract have published a paper which demonstrates that measuring levels of neurofilaments, structural proteins that are present in neurons, may be useful in determining the degree of spinal cord injury. The exciting fact about this paper is that neurofilament levels correlated closely with acute severity of SCI and with the eventual neurological outcomes. The other benefit with this assay was that levels were measured in the blood of patients with SCI, rather than in the cerebrospinal fluid. This makes the assay for more acceptable in the clinical setting. The authors also provide some evidence that neurofilament levels may be responsive to drug treatments and in this case, they have assessed how levels vary according to treatment with minocycline, a medication that has been previously trialled in SCI.

This is a well-designed study. It represents an important step forward in diagnostic methods and treatments for SCI.

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