Systemic Effects by Intrathecal Administration of Triamcinolone Acetonide in Patients With Multiple Sclerosis

Abstract

In patients suffering from multiple sclerosis (MS), intrathecal injection of triamcinolone acetonide (TCA) has been shown to improve symptoms of spasticity. Although repeated intrathecal injection of TCA has been used in a number of studies in late-stage MS patients with spinal cord involvement, no clinical-chemical data are available on the distribution of TCA in cerebrospinal fluid (CSF) or serum. Moreover, the effects of intrathecal TCA administration on the concentrations of endogenous steroids remain poorly understood. Therefore, we have quantified TCA and selected endogenous steroids in CSF and serum of TCA-treated MS patients suffering from spasticity. Concentrations of steroids were quantified by LC-MS, ELISA, or ECLIA and compared with the blood-brain barrier status, diagnosed with the Reibergram. The concentration of TCA in CSF significantly increased during each treatment cycle up to >5 µg/ml both in male and female patients (p < 0.001). Repeated TCA administration also evoked serum concentrations of TCA up to >30 ng/ml (p < 0.001) and severely depressed serum levels of cortisol and corticosterone (p < 0.001). In addition, concentrations of circulating estrogen were significantly suppressed (p < 0.001). Due to the potent suppressive effects of TCA on steroid hormone concentrations both in the brain and in the periphery, we recommend careful surveillance of adrenal function following repeated intrathecal TCA injections in MS patients.

Decreased Intrathecal Concentrations of Free Light Chains Kappa in Multiple Sclerosis Patients Taking Very High Effective Disease-Modifying Treatment

“…Intrathecal TCA is a therapeutic option for MS patients with predominantly spinal symptoms, such as spasticity. In addition to its antispastic effect, it is also believed to have regenerative effects [38]. Thus far, there is no data on possible changes in the humoral immune response by TCA.…”

Clinical research progress on intrathecal glucocorticoids in the treatment of infections: A review

“…In addition, corticosterone and estrogen will also be significantly reduced, which may cause irreversible damage to adrenocortical function. [ 48 ] Therefore, adrenal function in these patients should be carefully monitored during intrathecal glucocorticoid injection therapy.…”

Development of a Sensitive Bioassay for the Analysis of IGF-Related Activation of AKT/mTOR Signaling in Biological Matrices

“…Human serum and human cerebrospinal fluid (hCSF) samples were collected at the Department of Neurology from the University Medical Center in Rostock, Germany. The samples were from multiple sclerosis patients undergoing a triamcinolone therapy between 2009 and 2012 and stored at -80 °C before use [16]. Concentrations of IGFs and IGFBPs in serum and CSF were published recently [17].…”