*3.2.1 Methylprednisolone*

Methylprednisolone (MP) is a synthetic glucocorticoid, with anti-inflammatory and anti-oxidant effects [83, 84]. MP blocks the inflammatory cascade and disrupts neuron regeneration by inhibiting immunological cells [85, 86]. The potential neuroprotective effects of MP have been reported especially in the acute phase of SCI. According to some investigations, MP is capable of reducing FR production, Ca+2 influx, excitotoxicity, and immune-mediated phagocytosis over the course of hypoperfusion of SCI [87]. In addition, MP appears to have effect in apoptosis and autophagy regulation; however, the mechanisms are not clear [84]. While it remains the only option for acute SCI treatment in clinical settings, a debate regarding optimal dose, time of administration, efficacy, and adverse effects has dominated the field for years. There are three National Acute SCI Studies (NASCIS) and other clinical or biomedical investigations, in which the safety and efficacy of MP were assessed (**Table 2**) [88]. Despite the intense investigation, currently there is an important controversy regarding the real utility of this drug.
