(C) 30 mg/kg/body weight# STEROID THERAPY IN SPINAL CORD INJURY: Steroid have verified significant improvement in motor function and sensation in patients with complete or incomplete spinal cord injuries (SCIs) who were treated with high doses of methylprednisolone within 8 hours of injury. High doses of steroids or Tirilazad are thought to minimize the secondary effects of acute SCI.> 30-mg/kg bolus of methylprednisolone administered within 8 hours of injury, whereas the study evaluated methylprednisolone 5.4 mg/kg/h for 24 or 48 hours versus tirilazad 2.5 mg/kg q6h for 48 hours. (Tirilazad is a potent lipid preoxidation inhibitor.)> Between the 2 studies, it was determined that: (1) in patients treated earlier than 3 hours after injury, the administration of methyl- prednisolone for 24 hours was best; (2) in patients treated 3-8 hours after injury, the use of methylprednisolone for 48 hours was best; (3) Tirilazad was equivalent to methylprednisolone for 24 hours.> Both NASCIS studies evaluated the patients' neurologic status at baseline on enrollment into the study, at 6 weeks, and at 6 months and found absolutely no evidence suggests that giving the medication earlier (eg, in the first hour) provides more be nefit than giving it later (eg, between hours 7 and 8).> The authors concluded that there was only a benefit if methylprednisolone or tirilazad were given within 8 hours of injury.> Use of high-dose methylprednisolone in non-penetrating acute SCI had become the standard of care in North America.An increased incidence of infection and avascular necrosis has been documented.> Revised recommendations pertaining to steroid therapy in SCI:- The American College of Surgeons (ACS) has modified their advanced trauma life support (ACLS) guidelines to state that methylprednisolone is "a recommended treatment" rather than "the recommended treatment." Updated guidelines issued in 2013 by the CNS and the American Association of Neurological Surgeons (AANS) recommend against the use of steroids early after an acute SCI. Guidelines recommend that methylprednisolone not be used for the treatment of acute SCI within the first 24-48 hours following injury. Previous standard was revised because of a lack of medical evidence supporting the benefits of steroids in clinical settings and evidence that high-dose steroids are associated with harmful adverse effects. Overall, the benefit from steroids is considered modest at best, but for patients with complete or incomplete quadriplegia, a small improvement in motor strength in one or more muscles can provide important functional gains. Administration of steroids remains an institutional and physician preference in spinal cord injury. Administration of high-dose steroids within 8 hours of injury for all patients with acute spinal cord injury is practiced by most physicians. Current recommendation is to treat all patients with spinal cord injury according to the local/regional protocol. If steroids are recommended, they should be initiated within 8 hours of injury with the following steroid protocol: Methylpred- nisolone 30 mg/kg bolus over 15 minutes and an infusion of methylprednisolone at 5.4 mg/kg/h for 23 hours beginning 45 minutes after the bolus.