ChinaSCINet Update

[Geoman]

We will be starting a two-center trial of lithium in China on 60 subjects with severe neuropathic pain. The trial will start in March, after the Chinese New Year (nothing happens in China for weeks before and a week or two after the Chinese New Year which happens to be on February 10, 2013). When that trial (which is double-blind, randomized, and placebo-controlled) is completed, we will of course publish the results and I will report it as soon as I can on these forums.

Wise.

That's great news Wise. Thanks.

Clayton

[ay2012]

Some people can initiate spasms. For example, I have a friend with spinal cord injury whose legs would go into a spasm when he laughed or I would tell him a dirty joke.

Yea, I've wondered about this...physical stimulation (touching a certain area) below the level of injury is one thing, but I couldn't wrap my head around how I can initiate spasticity by just thinking about the area.

[PaidMyDues]

Do you remember the recent reports from Suzy Harkema at Louisville, Kentucky, where she reported being able to get one person with complete spinal cord injury to walk after putting electrodes into the spinal cord to stimulate the lower cord (presumably the CPG)? Apparently, she has gotten two people to walk like that now. Do you remember the posts that I did about Dr. Richard Herman of the Good Samaritan Hospital Hospital in Phoenix Arizona, where he showed that stimulation of the CPG will help a man who was just a "household" walker who took 150 seconds to walk 10 meters to a person who can walk a kilometer are near normal speeds?

Wise,

If I understand you correctly, you indicate that it is possible to have near normal ambulation via the CPG even with minimal to no volitional control via the CST. If that is true, then why are those who have incomplete AIS C injuries and who do have some volitional control (e.g. easily tap their toes) unable to ambulate via activation of the CPG? Would it be reasonable to hypothesize that most such pts. would be able to go from being household ambulators to becoming community ambulators with epidural stimulation?

[paolocipolla]

Paolo,

Your central pattern generator (CPG) has to receive some input from descending axons from your brain in order for your brain to activate walking movements. When you walk, you don't tell each of your individual muscles to move in sequence, e.g. left psoas, left quadriceps, left anterior tibialis, left gastrocnemius, right psoas, right quadriceps, right anterior tibialis, left gastrocnemius, etc. To walk, you activate your CPG to a given level of excitation and it generates walking patterns. If you activate more, you take longer steps. If you turn your body to one side, the CPG will lengthen its stride on that side to keep balance and your other side pivots. If you activate the CPG to even higher levels, you start trotting. And so on. The CPG contains the motor programs not only for walking, trotting, but galloping, skipping, cantering, hopping, and other movements that most children show when they play. You don't need the brain for such movements. In fact, if you cut the head off a chicken and put it on its feet, the chicken can run around and around until it falls or dies from blood loss. If some of the regrowing fibers have reached the CPG and can activate it somehow, it can result in stepping activity.

Do you remember the recent reports from Suzy Harkema at Louisville, Kentucky, where she reported being able to get one person with complete spinal cord injury to walk after putting electrodes into the spinal cord to stimulate the lower cord (presumably the CPG)? Apparently, she has gotten two people to walk like that now. Do you remember the posts that I did about Dr. Richard Herman of the Good Samaritan Hospital Hospital in Phoenix Arizona, where he showed that stimulation of the CPG will help a man who was just a "household" walker who took 150 seconds to walk 10 meters to a person who can walk a kilometer are near normal speeds?

Why do you say that Patrick is not a good example of somebody who walks. Have you seriously talked to him? He tells me that he has no feelings in his legs below the knees. He has a difficult time tap-dancing. By the way, a paper will be published later this year, reporting DTI findings on Pat Rummersfield. He has a thin strand of white matter growing down his spinal cord across the white matter gap, very similar to what we found in two patients from the five that we did DTI studies of in Hong Kong. By the way, white matter growth alone may not be sufficient to allow walking... Walking training may be necessary to get the CPG to operate. After years of not walking, the CPG itself may not function well unless it is repetitively activated. That is one of the reasons why we decided to do part of the study at Kunming where intensive locomotor training is available.

Wise.

Wise,

please don't confuse things, I was focusing on what you have repoted, i.e. few people are walking, but they have not recovered voluntary movments of the legs.
No e-stim applied.
My point is that before I can start walking I need to stand, how can I stand if I don't have any voluntary control of my legs?

One more thing, at the end of your presentation at the bedford workshop you say that you know no one is going to believe what you had presented, so if you know that why should people here believe/trust what you had presented?

Paolo

[Lyerly]

Isn't standing not a contraction or a different kind? It's not like I use to flex my leg muscles when I was rising from bed or a chair. Your fingers can remain fairly straight without you doing anything.

[swh2007]

[QUOTE=paolocipolla;1621409]Wise,

please don't confuse things, I was focusing on what you have repoted, i.e. few people are walking, but they have not recovered voluntary movments of the legs.
No e-stim applied.
My point is that before I can start walking I need to stand, how can I stand if I don't have any voluntary control of my legs?

One more thing, at the end of your presentation at the bedford workshop you say that you know no one is going to believe what you had presented, so if you know that why should people here believe/trust what you had presented?

Paolo[/

I trust what he says because he is the expert who I know has dedicated many years to cure SCI. Plus, I have read what he says and what you are saying and I understand the fine distinctions being made.

But honestly there really isn't anything constructive left to say. It is now to the badgering state and I don't think you really intend to badger.

[JoeMonte]

Hello Dr. Wise,
Has there been any positive indicators with return of bowel and blatter functions? I feel that alone would change many of our lives for the better.

[khmorgan]

Wise,

please don't confuse things, I was focusing on what you have repoted, i.e. few people are walking, but they have not recovered voluntary movments of the legs.

Right. Don't confuse things with lots of facts and examples.

No e-stim applied.
My point is that before I can start walking I need to stand, how can I stand if I don't have any voluntary control of my legs?

I don't remember him saying they stood up and walked. I do remember seeing the patients in harnesses with family members helping them. Perhaps the patients were put in the harnesses, they were started walking, and then they continued unassisted.

One more thing, at the end of your presentation at the bedford workshop you say that you know no one is going to believe what you had presented, so if you know that why should people here believe/trust what you had presented?

Paolo

I believe him because he has no reason to lie. Oh yeah, I forgot about all the money we gave him for his research. HA!! I guessing he would be a lot richer just teaching or just doing surgery.

Frankly, I think Dr. Young could offer us a speculative opinion about why some people could walk without voluntary control, e.g. a small about of axons are active, but not enough for voluntary control. Lots of scientists can speculate about the cause and effect of their experiments. However, medical doctors must be more careful.

I don't know if UCB+Lithium will have positive results or not, but I'm not going to accuse Dr. Young of being untruthful or incompetent because he believes it will. Of course, I sincerely hope he is right! It would be a giant step for SCI-kind!

[Han Solo]

I don't understand the whole walking without it being voluntary. I'm curious what good is moving if u can't control it? I need to read up more cause I just checked in and saw this but it seems kinda pointless. If I can't wake up, roll out of bed, walk down the steps eat then walk out to my car and drive then what's the excitement about? Like I said I just caught what was being said and haven't taken time to read previous posts or reports but if that is that's all to it then the hell with that b.s., its a waste of time and money.

[paolocipolla]

[QUOTE=swh2007;1621450]

Wise,

please don't confuse things, I was focusing on what you have repoted, i.e. few people are walking, but they have not recovered voluntary movments of the legs.
No e-stim applied.
My point is that before I can start walking I need to stand, how can I stand if I don't have any voluntary control of my legs?

One more thing, at the end of your presentation at the bedford workshop you say that you know no one is going to believe what you had presented, so if you know that why should people here believe/trust what you had presented?

Paolo[/

I trust what he says because he is the expert who I know has dedicated many years to cure SCI. Plus, I have read what he says and what you are saying and I understand the fine distinctions being made.

But honestly there really isn't anything constructive left to say. It is now to the badgering state and I don't think you really intend to badger.

Yes I don't really intend to badger even if it looks like that...

In my post #1281 I was specifically asking about a situation of "no voluntary movements of the legs" and I got an answer that in my personal opinion was once more confusing, so I got pissed off. I think my reaction was appropriate as I consider necessary and usefull to get pissed off in life sometimes...

Paolo

[paolocipolla]

I don't understand the whole walking without it being voluntary. I'm curious what good is moving if u can't control it? I need to read up more cause I just checked in and saw this but it seems kinda pointless. If I can't wake up, roll out of bed, walk down the steps eat then walk out to my car and drive then what's the excitement about? Like I said I just caught what was being said and haven't taken time to read previous posts or reports but if that is that's all to it then the hell with that b.s., its a waste of time and money.

Thanks for bringing some common sense in this discussion.. I was starting to think I am crazy.

Paolo

[swh2007]

Thanks for bringing some common sense in this discussion.. I was starting to think I am crazy.

Paolo

You are getting pissed off because you want to jump all the way to the end stage of the cure.

[Moe]

Dr. Wise, I liked and understood the comparison ‘chicken running with no head’ it was funny but clear and made sense, to whom that never experienced farm life, to kill a chicken or turkey the easy way was to chop off its head off with an axe… completely decapitated, in most cases the bird will still stand up and run all over the place in panic for a few minutes before dying, hitting anything on its way with full walking/running sequences… so that would be the CPG working since the brain was disconnected completely…
I want to thank you deeply for all your dedication, hard work and patience.

[cripwalk]

Wise,

please don't confuse things, I was focusing on what you have repoted, i.e. few people are walking, but they have not recovered voluntary movments of the legs.
No e-stim applied.
My point is that before I can start walking I need to stand, how can I stand if I don't have any voluntary control of my legs?

One more thing, at the end of your presentation at the bedford workshop you say that you know no one is going to believe what you had presented, so if you know that why should people here believe/trust what you had presented?

Paolo

If my understanding of Wise is correct, he is basically saying that patients can't 'flex' their quads or hams on command, but the CPG allows them to remember and activate a walking pattern.

The brain has shown significant, and if I understand correctly, neuroplasticity in other circumstances which do not make a lot of sense. For instance, many people who stutter can sing without stuttering.

Wise, please advise if I am misinterpreting.

[khmorgan]

CPG versus voluntary movement

Let's say voluntary movement was somehow restored, but CPG was not working. You can voluntarily move each muscle, but there is no coordination of the muscle groups. You are like a tiny baby who is trying to learn to move each leg in concert, except even babies have CPG.

I think Dr. Young is saying that some patients have everything they need to stand and walk normally once voluntary control is restored. Now, he is hoping that will happen once the axons reach their targets. CPG is not all you need, but it is a significant milestone.