Gangliosides are naturally occurring molecules in nerve cell membranes. They are thought to have a role in neural development, as well as cellular recognition and neuronal communication (Yu et al. 2012). Synthetic versions of these molecules, such as monosialotetrahexosylganglioside GM1 sodium salt (commonly referred to as GM-1 ganglioside), have been used in the treatment of other neurological conditions such as stroke (Candelise & Ciccone, 2002) and Parkinson’s disease (Schneider, 1998). Although their exact mechanism of action is unknown, it is currently thought that gangliosides prevent cellular apoptosis, elicit anti-excitotoxic activity, and help initiate neurogenesis in the central nervous system (Mocchetti, 2005).
After two clinical trials using GM-1 ganglioside as a treatment option for acute SCI, it is still unclear whether this drug truly elicits significant benefits. The first small scale trial (Geisler et al. 1991, 1992) reported significant motor improvement compared to a placebo group; however, when the same authors later conducted a large scale multicenter trial, no effects were seen after the study period had ended, although the administration of GM-1 ganglioside appeared to expedite the recovery process (Geisler et al. 2001a, 2001b, 2001c). One potential reason could be the delay in treatment between the two studies; patients from the second trial did not begin to receive the drug until 24 hours after the injury to accommodate the initial mandatory dose of MP (Geisler et al. 2001c). It is possible that the results varied between these two studies because GM-1 ganglioside was administered following the optimal therapeutic window in the latter clinical trial.
Currently, there are no major adverse effects that result from using GM-1 ganglioside, although sporadic cases of Guillain-Barre syndrome have been reported (Chinnock & Roberts, 2009). At this time, it is impossible to reach a conclusion regarding its effectiveness on improving feeling, movement, or quality of life for those who have acquired a SCI.
There is level 1b evidence (from one RCT; Geisler et al. 2001a, 2001b, 2001c) that GM-1 ganglioside is not effective in promoting neurological recovery in acute SCI individuals; However, there is level 1b evidence (from one RCT; Geisler et al. 1991, 1992) that GM-1 ganglioside may be effective in promoting neurological recovery in acute SCI individuals.
There is conflicting evidence regarding the effectiveness of GM-1 ganglioside for neurological recovery during the acute phase post SCI.