From the Research
The treatment for Brown-Sequard syndrome should prioritize a multidisciplinary approach, including high-dose methylprednisolone, surgical intervention if necessary, physical therapy, and rehabilitation, as supported by the most recent and highest quality study 1. The goal of treatment is to address the underlying cause while providing supportive care to manage symptoms and prevent complications.
- Initial management typically includes high-dose methylprednisolone (typically 30 mg/kg loading dose followed by 5.4 mg/kg/hr for 23 hours) if the syndrome is caused by acute spinal cord injury, administered within 8 hours of injury to reduce inflammation and potentially improve neurological outcomes.
- Surgical intervention may be necessary if the syndrome results from a compressive lesion such as a tumor, herniated disc, or hematoma, as seen in cases where rapid and accurate diagnosis and immediate decompressive surgery increased the possibility of a good surgical outcome 2.
- Physical therapy and rehabilitation are essential components of treatment, beginning as soon as the patient is medically stable, to maintain muscle strength, prevent contractures, and optimize functional recovery, with daily physical therapy resulting in good neurologic recovery 3.
- Occupational therapy helps patients adapt to any persistent deficits in daily activities.
- Pain management often requires a multimodal approach, including medications like gabapentin or pregabalin for neuropathic pain.
- Spasticity may be treated with baclofen, tizanidine, or botulinum toxin injections for focal spasticity.
- Bladder and bowel dysfunction require specialized management, potentially including intermittent catheterization, anticholinergics for bladder hyperreflexia, and bowel regimens. The prognosis varies depending on the cause, extent of injury, and timing of treatment, with incomplete lesions like Brown-Sequard syndrome generally having a more favorable prognosis than complete spinal cord injuries, as supported by the most recent study 1.