From the Research
Treatment for central pontine myelinolysis (CPM) primarily focuses on supportive care, and gabapentin is a recommended medication for managing neuropathic pain, with a dosage of 300-1200 mg three times daily 1. The most important step in managing CPM is to correct sodium levels slowly, aiming for no more than 8-10 mEq/L increase per day to prevent osmotic demyelination. Once CPM has developed, there is no specific medication that can reverse the damage. Treatment includes supportive measures such as:
- Maintaining proper nutrition
- Preventing complications like pneumonia or deep vein thrombosis
- Providing physical, occupational, and speech therapy as needed Some physicians may try corticosteroids like methylprednisolone (typically 500-1000 mg IV daily for 3-5 days) or plasma exchange, though evidence for these approaches is limited. Medications to manage symptoms may include:
- Baclofen (10-25 mg three times daily) or tizanidine (2-4 mg three times daily) for spasticity
- Gabapentin (300-1200 mg three times daily) for neuropathic pain, as it has been shown to be effective in reducing pain intensity in patients with neuropathic pain 1 Recovery can take weeks to months, and some patients may have permanent neurological deficits. The key to managing CPM is prevention through careful correction of sodium abnormalities, especially in high-risk patients such as those with alcoholism, malnutrition, or liver disease. Recent studies have also highlighted the importance of a personalized, stepwise, and multimodal approach to managing chronic pain, including pharmacotherapy, psychotherapy, integrative treatments, and interventional procedures 2. However, in the context of CPM, the primary focus remains on supportive care and managing symptoms, rather than reversing the underlying damage. Gabapentin, in particular, has been shown to be effective in reducing neuropathic pain, with a number needed to treat (NNT) of 6.7 for substantial pain relief (at least 50% pain relief or PGIC very much improved) 1. Overall, the treatment of CPM requires a comprehensive and multidisciplinary approach, with a focus on supportive care, symptom management, and prevention of further damage.