Acetyl-L-carnitine to Enhance Peripheral Nerve Regeneration in Carpal Tunnel Syndrome; A Randomized Control Trial
Matthew WT Curran, MD, MSc1; Akiko Hachisuka, MD, PhD.2; Michael J Morhart, MD, M.Sc3; Jaret Olson, MD3; K. Ming Chan, MD4
1Plastic and Reconstructive Surgery, University of Alberta, Edmonton, AB, Canada, 2Division of Physical Medicine and Rehabilitation, University of Alberta, Edmonton, AB, Canada, 3Division of Plastic and Reconstructive Surgery, University of Alberta, Edmonton, AB, Canada, 4Division of Physical Medicine & Rehabilitation, University of Alberta, Edmonton, AB, Canada
Purpose Carpal tunnel syndrome (CTS) is the most common form of peripheral nerve injury. While surgery is effective in milder cases, recovery can be incomplete in severe CTS. Therefore, there is a need for adjuvant methods to improve nerve regeneration. Acetyl-L-carnitine (ALCAR) has been shown to be efficacious in various neuropathies. However, it has not been studied in compressive neuropathies. This randomized control trial examines the effect of ALCAR on peripheral nerve regeneration in CTS.
A proof of principle study was completed utilizing a double-blind randomized placebo controlled design. Inclusion criteria included adult patients with severe CTS, confirmed by nerve conduction studies. Patients were randomized to receive ALCAR or placebo following carpal tunnel release surgery for 2 months. The primary outcome was functional improvement using the Boston Carpal Tunnel Questionnaire (BCTQ), with secondary outcomes that focus on physiological function. To follow recovery and monitor safety, patients were seen post-operatively at 3 months, 6 months and 1 year. Demographics and baseline data were analyzed using Student's t-test and chi square analysis. Outcomes were analyzed using two-way ANOVA.
Results: Of the 20 patients enrolled, 18 completed the study. Demographics and baseline measures were similar between the two groups. There was no significant difference in BCTQ scores between the placebo and ALCAR groups at 12 month follow-up. Most importantly, the magnitude of improvement in BCTQ with ALCAR was well below the minimal clinically important difference. There was also no difference in any of the secondary outcomes between groups at 12 month follow-up. Both groups improved with time over the course of the study and the treatment was well tolerated.
ALCAR did not improve nerve regeneration or functional recovery in patients with CTS. The use of ALCAR to enhance function and nerve regeneration in compression neuropathy is therefore not supported.
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