Drugs Used to Treat Spinal Cord Injury

When Dr. Wise Young began his studies, spinal injuries were considered untreatable. But his dogged efforts to find cures have brought hope to thousands of people  with debilitating spinal injuries.

A quarter of a million Americans suffer spinal cord injuries each year. Currently, 90,000 people are paralyzed from the neck down. But that number would be even higher without the efforts of New York University's Dr. Young.

His research led to the discovery that a synthetic steroid, methylprednisolone, given shortly after an accident, can help lessen spinal cord damage and allow some patients to regain movement and function.

Born in Hong Kong, Dr. Young was raised in Japan. He came to the United States at 18 to pursue a pre-med degree at Reed College in Oregon. A Ph.D. from the University of Iowa and a M.D. from Stanford University followed.

He traveled to New York City in 1977 and began what he thought would be a short stint at NYU. That "year or two, perhaps" became his lifetime work. Here's a Q and A with Dr. Young:

Q. How did you get involved in the field of spinal cord injuries?

Dr. Young: One of my first patients in 1979 was a 17-year-old boy who had been injured in a wrestling accident. It was a frustrating experience. I think the worst thing a doctor can do is not be able to do anything.

Q: What was the standard course of treatment two decades ago?

Dr. Young: In those days, it was a vale of tears. People believed that doing nothing was better than doing something. You could keep people alive, but that was all. My medical advisor told me not to stay with spinal cord injuries because it was a dead-end field.

Q. When did you begin to see hope for spinal cord injury patients?

Dr. Young: Very early it was clear that something could be done. A half-hour after an injury, the spinal cord looks almost normal. After three hours, there is bleeding within the spinal cord, and it looks much worse. There is a progression of damage within the spinal cord, so we have several hours to do something. In 1981, we did a study at New York University, treating 30 patients with ethylprednisolone. To our surprise, a lot of the patients did much, much better. One patient, a dancer, recovered completely. He was probably one of our most spectacular examples. But you have to give what I call an industrial-strength dosage within eight hours of the injury, or it doesn't work.

Q : Have there been other studies?

Dr. Young: From 1985 to 1990, we had the National Acute Spinal Cord Injury Study (NASCIS), in which 487 patients were studied. It took a lot of effort to get this trial going, because nobody believed you could improve the recovery rate in spinal cord injury patients. There were many people working together in teams to get this project to work. It took 10 years, almost to the day [from when he discovered that methylprednisolone works] that a paper was published, showing that methylprednisolone significantly improves recovery.

Q: Are there other promising medical developments?

Dr. Young: Two. These focus on efforts to regenerate the spinal cord and remyelinate (restore myelin, the sheathing around neurons -- nerve cells -- that help conduct nerve signals). In 1977, it was discovered that a drug called 4-aminopyridine, or 4-AP, significantly improves animals whose spinal cords are missing myelin sheaths. And just recently, according to a Swedish study, doctors were able to repair severed spinal cords in rats, regenerating nerves and restoring function. A couple of years ago, everybody believed regeneration of the spinal cord was impossible, but now we know that this is not true.

Q: How will 4-AP reach those with spinal injuries?

Dr. Young: In 1990, it became very clear that we would not be able to find the next generation of drugs for the spine unless we changed the way we did things. There has to be a commercial, industrial component to the research, or it's not going to reach patients. A year and a half ago, I helped found Acorda Therapeutics, based in New York, which is helping to support 4-AP trials at spinal cord injury centers around the country. This is the first large-scale chronic spinal cord injury study in the United States. 

Q: Is there hope that research may someday provide a cure?

Dr. Young: We're working very hard on it right now. We have to deliver because many people have had their hopes raised. It took 10 years for methylprednisolone to become available to those with spinal injuries. It will take about seven to 10 years for the next step. I'm going to work as hard as I can during the next seven years. We are so close. I've dropped all other priorities.