The neuroprotective pharmacology of methylprednisolone

J Neurosurg. 1992 Jan;76(1):13-22. doi: 10.3171/jns.1992.76.1.0013.


A 24-hour intensive intravenous dosing regimen with the glucocorticoid steroid methylprednisolone has recently been shown to be effective in enhancing neurological recovery in spinal cord-injured patients when initiated within 8 hours after injury. The state of knowledge concerning the neuroprotective pharmacology of methylprednisolone, including mechanism(s) of action, dosing requirements, and time-action considerations is reviewed, as are the results of studies with high doses in experimental and clinical head injury, subarachnoid hemorrhage, and cerebral ischemia. A primary neuroprotective mechanism of action in each of these cases is hypothesized to involve the ability of high doses of methylprednisolone to inhibit oxygen free radical-induced lipid peroxidation, although additional mechanisms may contribute. Unresolved issues are also addressed, including the therapeutic window, optimum duration of treatment, and rational combination with other neuroprotective agents. A newer methylprednisolone pro-drug with improved solution stability is discussed, together with a brief consideration of novel nonglucocorticoid steroids that surpass methylprednisolone's lipid antioxidant effects without unwanted glucocorticoid properties.

Publication types

  • Review

MeSH terms

  • Animals
  • Brain Injuries / drug therapy*
  • Cerebrovascular Disorders / drug therapy*
  • Humans
  • Methylprednisolone / therapeutic use*
  • Spinal Cord Injuries / drug therapy*
  • Spinal Cord Injuries / physiopathology


  • Methylprednisolone