What do we currently know about treatment of AIDS - related myelopathy ?

Objective: To evaluate the effectiveness and safety of various interventions for treating AIDS-associated myelopathy. Methods: This is a systematic review of randomised controlled trials. Predefined criteria were used to select randomised controlled trials comparing use of any intervention aimed at treating AIDS-associated myelopathy with placebo or another intervention in any language. Two assessors independently reviewed each trial, and disagreements were resolved by consensus. Results: One trial with 58 participants met the inclusion criteria that compared L-methionine with placebo. No difference was detected for clinical improvement -mean central conduction time (weighted mean difference (WMD) -2.4; -5.78 to 0.98), strength (WMD 1.8; -10.77 to 14.37), spasticity (WMD 0.7; -3.97 to 5.37), or urinary function (WMD -0.2; -1.59 to 1.19), after 12 weeks of treatment, and there was no difference detected in adverse events. One death was reported in the L-methionine group (relative risk (RR) 3.0; 95% CI 0.13 to 70.64) Conclusion: We found no evidence of benefit of L-methionine for AIDS-related myelopathy after 12 weeks of treatment. There is insufficient reliable research on AIDS related myelopathy. A well designed, adequately powered randomised controlled trial and validated scale is needed. Neurology Asia 2007; 12 : 77 – 80 Address correspondence to: Olalekan A. Uthman, Center for Evidence-Based Global Health, P.O.Box 5146, Ilorin, Kwara State, Nigeria; e-mail: [email protected] INTRODUCTION Vacuolar myelopathy (VM) is the most common cause of spinal cord disease in patients with AIDS, with prevalence between 22% and 55% in autopsy series.1-3 The primary clinical features of VM are slowly progressive, usually painless; and include weakness in the lower extremities, gait ataxia, sensory abnormalities in the legs, urinary frequency, sphincter dysfunction, and impotence in men.1 The clinical diagnosis of AIDS-associated myelopathy is primarily one of exclusion and often remains unrecognized during life.4 We evaluated the evidence from available randomised controlled trials in order to evaluate the effectiveness and safety of intervention for treating AIDS associated myelopathy.