1144 - The Use of Riluzole in Treatment of Central Cord Syndrome

A 63-year-old male with cirrhosis due to hepatocellular cancer (status post liver transplant), history of meningitis, diabetes, and hypertension presented to the ER after a syncopal fall with weakness and sensory changes in his upper extremities. Initial exam showed decreased bilateral grip strength and decreased sensation in the C5 dermatome on the right and C8 bilaterally.

MRI cervical spine revealed severe stenosis with cord signal change, ALL disruption at C5-C6, and STIR signal in the disc consistent with spinal cord injury, specifically central cord syndrome. The patient underwent posterior C3-C6 laminectomy and fusion. Neurosurgery started a 2-week course of riluzole for bilateral hand tingling and weakened grip before transfer to acute rehab. His rehab course showed marked improvement in grip strength, sensation, and decreased paresthesias in both upper extremities.

Discussions: Riluzole is typically used in ALS treatment though it has shown promise in improving outcomes in central cord syndrome and other spinal cord injuries. It can significantly reduce weakness, numbness, and paresthesias that impair therapy and rehab progress. Studies suggest patients receiving riluzole demonstrate faster neurologic recovery and greater functional independence compared to those not treated, who often experience slower gains and persistent sensory or motor deficits. This is thought to result from its neuroprotective effects via inhibition of pathologic glutamatergic transmission and blockade of voltage-gated sodium channels. This mechanism reduces excitotoxicity, a key contributor to secondary neuronal injury after spinal cord trauma. While not yet standard of care, its use may enhance neurologic recovery and long-term quality of life in spinal cord injury patients.

Conclusions: In patients with spinal cord injury who have significant deficits or pain that may potentially deter rehab, riluzole has been shown to improve clinical outcomes, including motor recruitment and pain reduction, and may be helpful in improving symptoms and accelerating recovery.