Acetyl-L-carnitine to enhance nerve regeneration in carpal tunnel syndrome; a randomized controlled trial

• Author / Creator

  Curran, Matthew

• Background Carpal tunnel syndrome (CTS) is the most common form of peripheral nerve injury, involving approximately 3% of the population. While surgery is effective in mild and moderate cases, neurologic and functional recovery are often not complete in severe cases. Therefore, there is a need for adjuvant methods to improve nerve regeneration in those cases. Acetyl-l-carnitine (ALCAR) a small molecule involved in lipid transport, has been shown to be effective in various forms of neuropathies. However, it has not been used in compressive peripheral nerve injury. Purpose To test the hypothesis that ALCAR can promote peripheral nerve regeneration and improve function in patients with severe CTS. Methods In this pilot study we utilized a double-blind randomized placebo controlled design. Inclusion criteria included adult patients with severe CTS, confirmed by nerve conduction studies and motor unit number estimation (MUNE). Eligible patients were randomized to receive 3000mg/day of ALCAR orally or placebo following carpal tunnel release surgery for 2 months. The primary outcome was MUNE with supplementary secondary outcome measures that focus on sensation and hand function. To follow post treatment recovery and monitor safety, patients were seen post-operatively at 3 months, 6 months and 1 year. The outcome measures were analyzed using two-way ANOVA with treatment assignment and time points being the independent factors. Results Twenty patients were enrolled in the study. Patients were predominantly female (60%) with an average age of 59.9±2.2 (Mean±SD). Demographic data and baseline measures were similar between the two groups. There was no difference in the primary outcome MUNE between the groups at 12 months follow-up. Similarly, there was no difference in any of the secondary outcomes between the treatment groups at 12 months. Both groups improved with time over the course of the study. The treatment was well tolerated. There was no difference between vital signs or blood work parameters in each treatment arm. There were only 4 adverse events, with no difference in either group. Conclusion ALCAR did not improve nerve regeneration nor functional recovery in patients with CTS. The use of ALCAR to enhance peripheral nerve regeneration in compression neuropathy is therefore not supported.

• Subjects / Keywords

  • Peripheral Nerve Regeneration
  • MUNE
  • Carpal Tunnel Syndrome
  • Acetyl-L-Carnitine

• Graduation date

  Fall 2017

• Type of Item

  Thesis

• Degree

  Master of Science

• DOI

  https://doi.org/10.7939/R3XW48940

• License

  This thesis is made available by the University of Alberta Libraries with permission of the copyright owner solely for non-commercial purposes. This thesis, or any portion thereof, may not otherwise be copied or reproduced without the written consent of the copyright owner, except to the extent permitted by Canadian copyright law.