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Acute improvement in exacerbating multiple sclerosis produced by intraenous administration of mannitol
Author(s) -
Stefoski D.,
Davis F. A.,
Schauf C. L.
Publication year - 1985
Publication title -
annals of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 4.764
H-Index - 296
eISSN - 1531-8249
pISSN - 0364-5134
DOI - 10.1002/ana.410180406
Subject(s) - medicine , multiple sclerosis , mannitol , placebo , adrenocorticotropic hormone , sodium bicarbonate , anesthesia , gastroenterology , endocrinology , hormone , immunology , pathology , chemistry , alternative medicine , organic chemistry
The mode of action of adrenocorticotropic hormone (ACTH) treatment in exacerbating multiple sclerosis was studied by short‐term infusions of agents that mimic specific and limited pharmacological actions of ACTH and observing for temporally phase‐locked clinical changes. The study was double blinded, and agents were administered while the patients were being treated with a standard course of 10‐day intramuscular ACTH therapy (40 U twice daily). Antiedema, alkalotic–hypocalcemic, extraadrenal, and sodium‐retaining actions were studied using infusions of mannitol, sodium bicarbonate, ACTH, and sodium chloride, respectively. Seven of 8 patients receiving placebo infusions (2.5% glucose) showed no significant clinical change and 1 exhibited an equivocal improvement. Five of 9 patients receiving mannitol showed definite signs of clinical improvement phase‐locked to drug administration, with subsequent gradual reversal to baseline. Similar improvements occurred with infusions of NaHCO 3 in 5 of 8 patients and of ACTH in 4 of 8 patients. Three of 7 patients given NaCl infusion showed possible mild improvements. The results indicate that mannitol and NaHCO 3 induced transient acute improvement in signs at the 95% confidence level in patients with exacerbating multiple sclerosis, with ACTH having a similar effect at the 90% confidence level. These agents mimic some of the known effects of ACTH, which may be important in the therapeutic action of ACTH in multiple sclerosis. A possible role for mannitol and high‐dose ACTH in the treatment of demyelinating disease warrants further study.