Riluzole for Motor Recovery in Patients With Traumatic Spinal Cord Injury

Introduction: Spinal cord injury (SCI) results from insult to the spinal cord leading to impairments in motor function below the level of injury. No pharmacologic agents have demonstrated efficacy in promoting neuroprotection in SCI, and current management focuses on spinal cord perfusion by preventing systemic hypotension. Neuroprotection from riluzole in SCI may arise from sodium channel blockade and reduced excitotoxicity. While some studies have shown that riluzole may enhance motor recovery, particularly in incomplete cervical SCIs, larger randomized controlled trials have shown minimal neurological improvement across broader SCI populations. The purpose of this study was to evaluate the impact of riluzole on motor outcomes across all types of SCI.


Methods: This was a retrospective pre/post study completed at a large academic level 1 trauma center. All adult patients with a SCI admitted to the SICU and on discharge transferred to the inpatient rehabilitation unit (IPR) were included. Patients receiving riluzole (Jan 2020-Dec 2023), were compared to those treated prior to its acquisition (Jan 2018-Dec 2019). Riluzole was dosed at 100 mg twice daily for one day, followed by 50 mg twice daily for 13 days. The primary outcome was change in American Spinal Cord Association (ASIA) score from SICU admission to discharge from IPR.


Results: A total of 129 patients (44 pre-riluzole, 85 post-riluzole) were included in the analysis. The median age was 44 years in both groups; 79.5% vs 71.8% male, 45.5% vs 51.8% cervical SCI, and complete (ASIA A) vs incomplete (B–D) SCI was 47.7% and 52.3% vs 49.9% and 50.6% in the pre- and post-groups, respectively. A higher proportion of patients in the post-riluzole group received corticosteroids (7% vs 29%; p=0.007). There was no difference in change in ASIA scores between groups (p=0.9711). Patients in the post group had higher MAP targets (p=0.035), and longer ICU stays (p=0.017). No significant differences were found in other secondary outcomes. Multivariable regression demonstrated that no factors, including riluzole, independently predicted improvement in motor recovery.


Conclusions: Riluzole administration in patients with SCI was not associated with statistically or clinically significant improvements in motor recovery.