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Ten frequently asked questions concerning cure of spinal cord injury

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    Cervical v Thoracic/Lumbar/Sacral

    Dr Young,

    Was wondering if you could comment - I read somewhere that a Cervical injury will be enevitably easier to 'cure' / 'regenerate' than that of the same lesion but at T, L OR S level. Is this simply because of the smaller surface area, for example

    thanks in advance

    Comment


      Dr Young,
      I remember one of your replies mentioned 3 out of 4 people who undergo OEG treatment have shown a result of 1 or 2 levels of improvement in motor and sensory function. Does it follow on that a c4/5 quad has a 75% chance of improving to c6 or c6/7, therefore having a real chance of becoming almost fully independent. $25,000 seems a small price to pay for such a result.
      Thank you for all your help and information

      Comment


        Originally posted by smithpl
        Dr Young,
        I remember one of your replies mentioned 3 out of 4 people who undergo OEG treatment have shown a result of 1 or 2 levels of improvement in motor and sensory function. Does it follow on that a c4/5 quad has a 75% chance of improving to c6 or c6/7, therefore having a real chance of becoming almost fully independent. $25,000 seems a small price to pay for such a result.
        Thank you for all your help and information

        Go to http://carecure.org/forum/showthread.php?t=18100 for the poll results of 18 people from this site who went to Beijing. The sensory return averaged at least 4 dermatomes (levels) but motor recovery was more modest. Many of the people also reported better trunk stability. Longer term (>1 year followup) on about 20% of the patients suggest that the functional return does not recede with time. Since most of his patients are chronic (>1 year) and he did not expose the injury site in the last 400 or so patients that he did, this suggests that the effects are not due to decompression of the sinal cord. As Dr. Huang pointed out, this treatment is not a cure. For some people, it is not enough.

        Wise.

        Comment


          Thanks for the info Dr Young, however I would like to know what you would do if you were a totally dependent c4/5 quad with an opportunity to take a risk to become independent, immensely decreasing your wife's workload and while increasing her's (and yours) quality of life.
          I hope this question is not impertinent. It's not meant to be.
          Regards

          Comment


            Dear Dr. Young

            Can you bring me in contact with doctors who are doing some good work at Army Kunming Hospital and you are too impressed by their results. As i have just compression at my injury level so may be i can get some good chances for recovery? Please tell me if any other doctors are doing stem cell treatments in china having good results. I am really desperate to go china for treatment.

            Jawaid

            Comment


              Originally posted by smithpl
              Thanks for the info Dr Young, however I would like to know what you would do if you were a totally dependent c4/5 quad with an opportunity to take a risk to become independent, immensely decreasing your wife's workload and while increasing her's (and yours) quality of life.
              I hope this question is not impertinent. It's not meant to be.
              Regards
              smithpl, your question is entirely appropriate. I use that question to check my bearings all the time. If I were spinal-injured, my decision would depend on my situation. At the present, none of the treatments being offered in China offers independence. Although I think that they may restore some sensory function, improve motor function by perhaps one level, and bring back some truncal stability, the benefits of the treatment depend on the person. The risk of not gaining any function is also significant.

              Finally, it is important to compare treatments. Let me give one example. Tendon transfer is a well-established approach to restoring some hand function for people who are C7 or higher. While the benefits are modest, they are reliable and the risks of surgery are low. At the present, the motor improvements due to olfactory ensheathing glia transplants may be equivalent to tendon transfer while the sensory improvements are greater. The risks of complication or no motor function are higher.

              Another treatment is treadmill training. At the present, if a person has incomplete spinal cord injury, the data suggests strongly that treadmill ambulation training may restore locomotion to as many as 50-70% of people. While the treatment is expensive and not currently supported by many insurance companies, I think that the benefits of treadmill training currently exceed those shown by any cell transplant therapy.

              Of course, you might equally conclude from looking at the data that a combination of cell transplant and treadmill training would be better than either alone. That is certainly possible but there is no data that currently supports this view. That is one of the reasons why it is important to have clinical trials that include both cell transplants and intensive rehabilitation, to see if this is true.

              I personally would wait until a treatment is shown to have more benefit, less risk, and greater reliability.

              Wise.

              Comment


                Jawaid, I am indeed impressed by the doctors in Kunming. You will have a chance to see for yourself at the ISCITT symposium in Hong Kong in December where they will be presenting. We are working hard to make it possible for people who are not going to the symposium to view some of the presentations over internet. http://www.iscitt.org/ Wise.

                Originally posted by Jawaid
                Can you bring me in contact with doctors who are doing some good work at Army Kunming Hospital and you are too impressed by their results. As i have just compression at my injury level so may be i can get some good chances for recovery? Please tell me if any other doctors are doing stem cell treatments in china having good results. I am really desperate to go china for treatment.

                Jawaid
                Last edited by Wise Young; 16 Nov 2005, 10:35 AM.

                Comment


                  Dr. Young i will look forward towards you for my best treatment option from Hong Kong. Am sure that you will be able to find some good treatment for my kind of injury which will cure my deficits.

                  Sincerely

                  Jawaid

                  Comment


                    what's happened?

                    Dr. Young,

                    Back in 2002 I read an article in a esteemed medical journal that clinical trials for SCI would be under way by 2004. And back then they explained why it would take an additional 2 years to get things off the ground. But today, tell me if I'm wrong, there is minimal applications for SCI anywhere to be found in this country. What do you and your fellow researchers do now, when most of this research doesn't pan out, with disappointing results, and little interest. If I'm not mistaken, nothing has been proced to be even slightly effective in reversing paralysis and no sensation from chronic SCI. And when I say reversing, I mean restoring big things like bowel, bladder, sexual function. it seems to me that the dogma holds true to this very date and time, severe SCI cannot be fixed and/or cured! I was naive thinking that help may arrive by the end of this decade. It looks as though for people like me, paralyzed completley for more than 5 years, nothing can still be done. Why? Because even receiving modest improvements hasn't come to fruition, and at the rate we're going at, 20 years is also quite an unrealistic goal.

                    Comment


                      Question for Young

                      I would love to contact doctor at Kunming. Can you bring me in contact with the doctor who is doing stem cell treatments there? Also you will have in mind some other doctors who will be treating SCI patients? Tell me some thing about others too. My Govt: is ready to send me china for treatment so i dont want to miss the opportunity and you can be the best judge for my kind of injury and treatment.

                      Only reason that i am desperate to go china is that there is no guarantee when Govt: can be changed in pakistan. Once this happens i will not be able to go any where for treatment because myself i am not wealthy person. Hope you will understand my problems and emotions well.

                      As i have only compression lesion so i would like to go for stem cell treatment as i will have some more chance for recovery.

                      Waiting your reply and suggession.

                      Sincerely

                      Jawaid

                      Comment


                        DG,

                        Please do take the time to read posts here before you assume that there are no clinical trials going on. There are several clinical trials going on today in the United States and around the world. I think that there are not enough trials but there are some clinical trials going on:

                        Subacute spinal cord injury clinical trials
                        • Activatef macrophage transplants (first 2 weeks after injury): Israel, USA
                        • Cethrin (in surgery during first weeks after injury): Canada, USA
                        • Alternating electrical current (during first weeks after injury): Purdue

                        Chronic spinal cord injury clinical trials
                        • Weight-supported locomotor training (for incompletes): many countries
                        • Olfactory ensheathing glia (for completes): Beijing, Portugal
                        • Bone marrow stem cell transplants (for completes): China, Turkey, Korea
                        • Anti-Nogo antibody (IN-1, for completes): Switzerland
                        • Schwann cell transplants (for completes): China
                        • Umbilical cord blood transplants (for completes): Korea
                        • Growth factor cocktail and peripheral nerve transplants: Taiwan
                        • Peripheral nerve bridges: Shanghai, Italy, England

                        Treatments that need to go to clinical trials
                        • Chondroitinase
                        • Lithium
                        • GDNF
                        • Combination therapies.

                        We need clinical trial funding in the United States. Without cllinical trials in the United States, there is no possibility that any therapy will be used in the United States or covered by insurance. For reasons that I do not yet understand, the spinal cord injury community has never come together to support such trials. It has been difficult to get the spinal cord injury community together to support even something as simple as the Christopher Reeve Paralysis Act. One possibility is that people don't know. But, I am not sure that this is the whole explanation because we can't people to agree on clinical trial research funding in the United States even on this web site, where the information is available.

                        Wise.

                        Originally posted by damagedgoods
                        Dr. Young,

                        Back in 2002 I read an article in a esteemed medical journal that clinical trials for SCI would be under way by 2004. And back then they explained why it would take an additional 2 years to get things off the ground. But today, tell me if I'm wrong, there is minimal applications for SCI anywhere to be found in this country. What do you and your fellow researchers do now, when most of this research doesn't pan out, with disappointing results, and little interest. If I'm not mistaken, nothing has been proced to be even slightly effective in reversing paralysis and no sensation from chronic SCI. And when I say reversing, I mean restoring big things like bowel, bladder, sexual function. it seems to me that the dogma holds true to this very date and time, severe SCI cannot be fixed and/or cured! I was naive thinking that help may arrive by the end of this decade. It looks as though for people like me, paralyzed completley for more than 5 years, nothing can still be done. Why? Because even receiving modest improvements hasn't come to fruition, and at the rate we're going at, 20 years is also quite an unrealistic goal.

                        Comment


                          SCI caused by a hernia

                          Dr Young,
                          I am looking for information regarding SCI due to hernia, especially :
                          - the risk of moving from an incomplete to a complete SCI in case of a removal surgery [deemed as risky]
                          - the risk of aggravating the SCI or preventing further recovery [from an existing incomplete SCI] in case of no surgery .

                          Would you please let us know where to find specific data on the subject ? Are there any recognized experts in that field ? What should be the key criteria for decision ?
                          Thank you for your input.
                          Corinne
                          Last edited by Corinne Jeanmaire; 23 Nov 2005, 1:13 PM.
                          www.endparalysis.org!

                          Comment


                            A disk herniation is a compression injury of the spinal cord. In my opinion, the spinal cord should be decompressed. There is probably no other part of the body or central nervous system where we would allow compression to continue as it has been for the spinal cord. For example, if something is pressing on the eyeball, a peripheral nerve, the heart, or any organ, the first thing that the doctor does is to decompress.

                            Decompression surgery is not very risky. Of course, appropriate care should be taken to ensure that the spinal column is stable and the spinal cord is minimally disturbed during the decompression. And yes, there is some risk, as there is always with any surgery. However, the risk of leaving something compressed is far greater than doing surgery to decompress.

                            If you have something that is compressing your spinal cord and it is causing neurological deficit, it should be removed. I have written several articles summarizing the literature on this subject. One of them is linked in a post below.

                            If you have something that is compressing your spinal root and it is causing neurological deficit, it should be removed as soon as possible. There is some data suggesting that leaving the spinal root compressed for more than 3 months will significantly reduce the probability of recovery associated with decompression.

                            The first criterion is of course the presence of cord compression. It there is no compression, there is no decompression. The question is what is compression. Some people say 10% of the diameter of the cord while others say 25%. The second criterion is presence of neurological deficits. If there is no neurological deficit, then you can afford to wait. However, if there is neurological deficit and you have cord compression, it should be operated relatively soon. Many neurosurgeons and orthopedic surgeon, however, will not decompress just because of pain alone. This is because decompressive surgery often will not eliminate pain. Third, while pain alone is not sufficient to warrant surgery, it should b considered if it is combined with neurological deficits (such as motor and sensory loss).

                            If you are incomplete, that is good news because decompression helps people with their neurological deficits much than that it would help somebody with a sefere injury.

                            Wise.

                            Originally posted by Corinne Jeanmaire
                            Dr Young,
                            I am looking regarding SCI due to hernia, especially :
                            - the risk of moving from an incomplete to a complete SCI in case of a removal surgery [deemed as risky]
                            - the risk of aggravating the SCI or preventing further recovery [from an existing incomplete SCI] in case of no surgery .

                            Would you please let us know where to find specific data on the subject ? Are there any recognized experts in that field ? What should be the key criteria for decision ?
                            Thank you for your input.
                            Corinne

                            Comment


                              I have been doing FES for about 8 months now. But I am not doing gluts. Is it important to do gluts to prepare for the cure?

                              Comment


                                Originally posted by Zemuron
                                I have been doing FES for about 8 months now. But I am not doing gluts. Is it important to do gluts to prepare for the cure?
                                The gluts are important for walking. There is another reason for building the gluteus maximus. They provide padding for your butt and reduce the likelihood of sacral decubiti. Wise.

                                Comment

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