2025 Southeastern Residency Conference

Title: Riluzole for Motor Recovery in Patients with Traumatic Spinal Cord InjuryAuthors: Autumn Locke, PharmD; Kenji Leonard, MD; April Quidley, PharmD, BCCCP, BCPS, FCCM, FCCP; Elizabeth Langenstroer, PharmD, BCCP

Objective: The purpose of this study was to determine the impact of riluzole on motor recovery function in patients with spinal cord injury.

Self-Assessment Question: Which statement best summarizes the findings of this study on riluzole for acute spinal cord injury?

Background: Studies on the effect of riluzole have demonstrated conflicting results in improving functional outcomes for patients with spinal cord injury. The most recent study demonstrates benefit only in cervical spinal cord injuries when considering motor recovery scores. This analysis aims to address the uncertainty of riluzole use in all types of spinal cord injuries and determine if there is improvement in functional motor scores with the use of riluzole.

Methods: This was a single-center, retrospective analysis at East Carolina University Health Medical Center (ECUHMC) of adult patients with a documented spinal cord injury admitted to the surgical intensive care unit (SICU) and transferred to ECUHMC inpatient rehabilitation facility. Patients that received riluzole from January 1, 2020 to December 31, 2023 were compared to standard of care prior to riluzole acquisition from January 1, 2018 to December 31, 2019. Data was obtained from electronic health records. The primary objective of this study was to compare the change in American Spinal Cord Association (ASIA) score from admission to discharge from inpatient rehabilitation.

Results:  A total of 129 patients were included in the analysis, with 85 patients in the post-riluzole group and 44 in the pre-riluzole group. Baseline characteristics between groups were similar; however, a significantly higher proportion of patients in the post-riluzole group received concomitant corticosteroids compared to those in the pre-riluzole group (29% vs. 7%; p = 0.007). Change in ASIA score from IPR admission to discharge, did not differ between groups (0 ± 0.605 vs. 0 ± 0.424; p = 0.9711).  Patients in the post-riluzole group demonstrated significantly higher mean arterial pressure (MAP) targets (82.83 mmHg vs. 80.78 mmHg; p = 0.035) and a longer ICU length of stay (8 days vs. 5 days; p = 0.017). Other secondary outcomes, including duration of MAP push, hospital length of stay, mortality, and change in Glasgow Coma Score showed no difference between groups. Riluzole administration was associated with a significant increase in alanine aminotransferase (ALT) levels from baseline (30 ± 55.43 units/L) to day 7 of therapy (45 ± 49.5 units/L)(p = 0.039). Multivariable regression analysis revealed that none of the variables assessed, including riluzole exposure, age, neurological injury level, and MAP range, were independently associated with increased motor function recovery.

Conclusion: Riluzole was not associated with a statistically significant improvement in motor recovery as measured by ASIA scores.