Acute myelitis (AM) can lead to sudden sensory, motor and autonomic nervous dysfunction, which negatively affects their daily activities and quality of life, so it is necessary to explore optimization from a therapeutic perspective to curb the progression of the disease.

To investigate the effect of ganglioside (GM) combined with methylprednisolone sodium succinate (MPSS) on the curative effect and neurological function of patients with AM.

First, we selected 108 AM patients visited between September 2019 and September 2022 and grouped them based on treatment modality, with 52 patients receiving gamma globulin (GG) + MPSS and 56 patients receiving GM + MPSS, assigned to the control group (Con) and observation group (Obs), respectively. The therapeutic effect, neurological function (sensory and motor function scores), adverse events (AEs), recovery (time to sphincter function recovery, time to limb muscle strength recovery above grade 2, and time to ambulation), inflammatory factors (IFs) [interleukin (IL)-6, C-reactive protein (CRP), and tumor necrosis factor (TNF)-α] and other data of the two groups were collected for evaluation and comparison.

The Obs had: (1) A significantly higher response rate of treatment than the Con; (2) Higher scores of sensory and motor functions after treatment that were higher than the baseline (before treatment) and higher than the Con levels; (3) Lower incidence rates of skin rash, gastrointestinal discomfort, dyslipidemia, osteoporosis and other AEs; (4) Faster posttreatment recovery of sphincter function, limb muscle strength and ambulation; and (5) Markedly lower posttreatment IL-6, CRP and TNF-α levels than the baseline and the Con levels.

From the above, it can be seen that GM + MPSS is highly effective in treating AM, with a favorable safety profile comparable to that of GG + MPSS. It can significantly improve patients’ neurological function, speed up their recovery and inhibit serum IFs.

Acute myelitis (AM), also known as acute transverse myelitis, is an acute focal inflammatory disease occurring in the spinal cord (SC) that can cause sudden sensory, motor and autonomic dysfunction, reducing daily mobility and quality of life[1,2]. The nosogenesis of the disease is complex and diverse, as a variety of autoimmune reactions and infectious agents, such as herpesvirus, enterovirus, and varicella zoster virus, can be contributing factors[3]. According to epidemiological data, the disease mostly occurs in young and middle-aged groups, and its incidence is rising[4,5]. Prompt treatment of AM can help protect neurological function and prevent the disease from further progressing[6]. Our research mainly seeks effective treatment strategies for AM patients, which would carry great clinical implications for improving the condition of these patients and speeding up their recovery.

Ganglioside (GM) is mainly found in the brain tissues of all mammals and can help the molecular recognition of various glycan-binding proteins and mediate the activity of plasma membrane proteins through transverse binding, thus playing a regulatory role in the body’s neurodevelopment, differentiation and pathological changes[7,8]. In one animal experiment, intrathecal administration of GM showed significant therapeutic efficacy against bupivacaine-associated nerve injury and torsion dysfunction compared to the intravenously administered route[9]. Methylprednisolone sodium succinate (MPSS) is an anti-inflammatory corticosteroid that is beneficial to the recovery of damaged SCs[10] and can protect SC function by inhibiting lipid peroxidation and avoiding ischemia-induced tissue damage[11]. Research on the effect of GM + MPSS has been limited. This study mainly aimed to fill this research gap, seeking a new clinical exploration for the improvement of the condition and symptom recovery of patients with AM.

AM is a common and rapidly occurring neurological disorder that is essentially an autoimmune demyelinating condition[15]. It can lead to clinical symptoms such as difficulty urinating and defecating, nerve root pain, lower limb paralysis, and low fever, which seriously worsen patients’ everyday lives[16,17]. The early pathological changes of AM involve SC shock, increased muscle tone, active tendon reflex, etc. In severe cases, complications such as pressure sores and pulmonary and urinary tract infections may occur[18,19]. Therefore, providing timely and effective treatment to AM patients is of great significance to curb disease development and improve patient prognosis.

Our research data showed that the ORRs of Obs and Con were 89.29% and 73.08%, respectively. The significantly higher ORR in the Obs suggests that AM patients receiving GM + MPSS have obvious advantages in symptom recovery, self-care and complication control. GM is a structural component of the human nerve cell membrane that can not only mediate the growth, repair and reconstruction of damaged cranial nerves but also effectively modulate brain nerve conduction and the activities of various enzymes in cell membranes[20]. As a systemic immunosuppressive drug, MPSS can not only inhibit SCI-associated neuroinflammation through its immunomodulatory function but also avoid systemic immune responses, which may help explain its therapeutic mechanism in AM[21]. From the aspects of sensory and motor functions, the neurological function of the two groups was evaluated. The Obs were found to have obviously elevated sensory and motor function scores after treatment that were higher than the baseline and the Con, indicating that GM + MPSS used in the Obs was more beneficial to sensory and motor function recovery. In the study by Shen et al[22], the recovery of GM on neurons of SCI rats seemed to be linked to the increased secretion of GM in rat SC after CXCL14 silencing. A clinical study pointed out that MPSS can enhance the neurological function and activities of daily living of patients with acute SCI and cauda equina injury with sensory and motor dysfunction[23]. Our results of three recovery indices revealed that the times to sphincter function recovery, limb muscle strength recovery above grade 2 and ambulation were significantly shorter in the Obs group than in the Con group, suggesting that GM + MPSS was helpful in promoting the functional recovery of sphincters, limb muscle strength and ambulation in AM patients. Zhai et al[24] suggested that GM plus systematic rehabilitation training for SC patients is more conducive to limb function rehabilitation. In our safety evaluation, we found that the incidences of AEs such as rash, gastrointestinal discomfort, DL and OS in the Obs group were significantly lower than those in the Con group (7.14% vs 21.15%), indicating that GM + MPSS is safer for AM patients. Finally, we used ELISA to detect IFs. The posttreatment IL-6, CRP and TNF-α levels were markedly reduced in the Obs compared with the baseline and Con groups, demonstrating that GM + MPSS can inhibit excessive inflammation in AM patients. As reported by Hu et al[25], GM can significantly lower IL-1β, IL-6, TNF-α and other inflammatory proteins in the SC tissue of SCI rats, similar to our results. Consistent with these findings, Schmidt et al[26] found that MPSS can significantly inhibit the secretion of systemic inflammatory cytokines such as CRP and TNF-α in patients undergoing liver resection.

There are several areas in this study that need further improvement. First, since this is a small sample single-center analysis, it is necessary to expand the sample range and sample size in the future to improve the accuracy of the study results and to minimize or even avoid the bias of information collection. Second, the addition of follow-up analysis will enable in-depth evaluation of the long-term efficacy of GM + MPSS in the treatment of AM. Third, basic experiments related to GM + MPSS treatment of AM should be supplemented, which will be conducive to revealing the underlying mechanisms. In the future, we will make improvements based on the above points.

GM + MPSS can enhance the curative effect, neurological function, and functional recovery of patients’ perception, movement, sphincter function, limb muscle strength and ambulation, with favorable safety and anti-inflammatory action. These findings provide novel insight and clinical reference for the management and treatment of patients with AM.