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Ten frequently asked questions concerning cure of spinal cord injury

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    Jawaid,

    I have not visited the Nan Shen hospital. I have seen their web sites but don't know what they are transplanting and the results of their work. I will try to visit them sometime to find out.

    Based on the patients and information that I received from Kunming, I am not confident that the procedure is producing much functional recovery in patients with chronic spinal cord injury. Some of the patients did get some recovery after the surgery but it was not clear that it was due to the transplants, as opposed to the decompressive surgery that they did. On the other hand, on my last visit, I saw several patients who appeared to have gotten some recovery when they were transplanted in the first few weeks after injury.

    The main issues that you and others should consider regarding the fetal transplants is that the cells are not matched for the patients and, in my opinion, are likely to be rejected within a few months. Some of the Chinese doctors believe that fetal cells are not rejected and there may be some basis for this belief since fetal neurons are transplanted into patients for Parkinson's disease and, in some of the patients, there is evidence that the cells may survive for years after transplantation. This may be because neurons are not as immunogenic as other cells, such as Schwann cells.

    The work that Chinese doctors are doing with fetal transplants in China is not yet convincing, even to most Chinese doctors. In my visits to many hospitals in China, I have heard many of the Chinese doctors tell me that they are not doing fetal cell transplants because their experience is that it is not helping the patients as much as they would like. The exceptions are places like the ShiShan hospital where Dr. Hongyun Huang is transplanting fetal olfactory ensheathing glia and the Chengdu Army General Hospital in Kungming where Dr. Zhu is transplanting fetal Schwann cells. Even in China, the fetal transplantation work is very controversial and most Chinese doctors are quite skeptical that they do much.

    Wise.

    Originally posted by Jawaid
    Dear Young

    Thanks for giving contact numbers. I have contacted Dr. Zhu through my good friend in china. She said that i will try to get permission for your treatment from the authorities as she said that hospital is army related. I will be able to find out her answer in few days. Hope for the best and will tell you. In case if Dr. Zhu is unable to get positive reply from the authorities then what should i do? I need your help and please reply for my below given concerns.

    1. I have heard about a Bio Company Beike. They are treating SCI Patients with fetal schwaan cells too at Nan Shen hospital china with some results. Dr. HU is doing this treatment. They have treated about 10 patients now but patient's injury was two years old while mine six years. Tell me in case if Dr. Zhu is not treating whom should i go? Either Dr. HU or Huang for OEC?

    As i am incomplete L1 and walking very easily so i want to get the treatment. May be i can improve some of condition? What you suggest me wise? I will follow you only? You can email me if any personal.

    Sincerely

    Jawaid

    Comment


      Dear Dr. Young


      Thanks again for all the info. Now please tell me what i do and where to go for treatment? Dr. Zhu or Hongyun Huang? As you know i have only lost bladder, bowel and sexual function so keeping this all before you please tell me what i do? You can suggest it through emailing to me at muradjawaid@hotmail.com.

      Or if there is any treatment at any other place i will wel come your advise.

      God bless you.

      Jawaid

      Comment


        Sorry Dr. Young

        Dear Dr. Young

        Sorry to tell you but Beike is using Umbilical Cord Blood Cells to treat SCI Patients at Nan Shen hospital. I came to know today through stemcellschina.com. Please Dr. Young tell me some thing about these cells? Can these cells prove to be safe and having such good results on SCI Patients? Should i try these injections or look for Dr. Zhu and Huang?

        Hope you will advise me in best.

        Jawaid

        Comment


          Jawaid, we will be testing umbilical cord blood stem cell transplants in ChinaSCINet. On their own, I am not sure that they will do so much. Wise.

          Originally posted by Jawaid
          Dear Dr. Young

          Sorry to tell you but Beike is using Umbilical Cord Blood Cells to treat SCI Patients at Nan Shen hospital. I came to know today through stemcellschina.com. Please Dr. Young tell me some thing about these cells? Can these cells prove to be safe and having such good results on SCI Patients? Should i try these injections or look for Dr. Zhu and Huang?

          Hope you will advise me in best.

          Jawaid

          Comment


            Dear Young


            I am waiting your suggession regarding treatment option. Please tell me where i should try my luck? Dr. Zhu, Dr. Huang or Nan Shen Hospital for Cord Blood Cell treatment?

            As i was Medical Student before injury so i know little and am not much hopeful about the recovery but i just want to have a chance. Actually i am getting help of my Government being a medical student. Though i could not continue my studies due to injury and financial crisis but i don't want to miss chance for being treated. May be i can get some function back.

            Please advise me.

            Jawaid

            Comment


              Dr Young,

              Wise,

              I read a post somewhere (sorry, could'nt find to quote from) in which you mentioned that you plan to test therapies to restore hand function to quads at chinascinet. Whilst very admirable, please can you reassure me that the ultimate goal is for more return than that - my 25 yr old sister is C6 and only 2 years post injury - i think this slightly disheartened her as her aim is to walk again, to have her hands back would be nowhere near enough and surely possible?

              Many, many thanks

              Adam

              Comment


                Adam,

                I think that I was responding to another person who thought that the goal of the clinical trials was just to make people walk without restoring their hand functions. I had written to assure that person that it is likely that the treatments would not only have effects but are likely to affect arms and hands first. Don't worry, we are not planning to stop with the arms and hands.

                Wise.

                Originally posted by Ads32
                Wise,

                I read a post somewhere (sorry, could'nt find to quote from) in which you mentioned that you plan to test therapies to restore hand function to quads at chinascinet. Whilst very admirable, please can you reassure me that the ultimate goal is for more return than that - my 25 yr old sister is C6 and only 2 years post injury - i think this slightly disheartened her as her aim is to walk again, to have her hands back would be nowhere near enough and surely possible?

                Many, many thanks

                Adam

                Comment


                  dido !

                  Comment


                    Could spinal cord cyst removal return certain functions?

                    Hello,

                    My 25 year old daughter, who was very physically fit, had a rock climbing accident June 2004. She is now a T8 complete paralysis injury. She experiences lots of pin prick and finger touch sensations in both legs. There is a large amount of leg tone but no voluntary leg control. She has no pain with her injury. She has had an MRI that shows a cyst at her T8 injury. She was not receptive to the oral dosages of Baclofen and another medication and is going to be scheduled for an implanted Baclofen pump. The leg tone inhibits her from being more independent with her hygiene and dressing herself.

                    I would like to have the cyst removed to see if some voluntary leg control returns; however, the neurosurgeon waves this off like it is nonsense. He prefers to just monitor it for future growth and to proceed with implanting the pump. Should I just go along with this or seek another neurosurgeon who would be willing to try reducing the size of the cyst or even removing it?

                    Thanks for any response.

                    Comment


                      Tampa Daddy,

                      In my opinion there is no way of physically "removing" a syringomyelic cyst cyst without damaging the spinal cord and eliminating what little function that she may have and causing significantly true scarring at the injury site. There are two ways to reduce the size of the cyst. One is to shunt it by placing a catheter inside the cyst. The other is, if there is significant arachnoid adhesions to the spinal cord blocking cerebrospinal fluid flow, meticulous removal of these adhesions should collapse the cyst. Shunting alone usually will collapse the cyst but it usually recurs within a year. Removal of adhesions will eliminate the cyst in 80% of the cases. Most American neurosurgeons are reluctant to operate on the chronic injured spinal cord because of the fear that they may damage the cord and because they are not convinced that this would restore any function.

                      Wise.

                      Originally posted by Tampa Daddy'O
                      Hello,

                      My 25 year old daughter, who was very physically fit, had a rock climbing accident June 2004. She is now a T8 complete paralysis injury. She experiences lots of pin prick and finger touch sensations in both legs. There is a large amount of leg tone but no voluntary leg control. She has no pain with her injury. She has had an MRI that shows a cyst at her T8 injury. She was not receptive to the oral dosages of Baclofen and another medication and is going to be scheduled for an implanted Baclofen pump. The leg tone inhibits her from being more independent with her hygiene and dressing herself.

                      I would like to have the cyst removed to see if some voluntary leg control returns; however, the neurosurgeon waves this off like it is nonsense. He prefers to just monitor it for future growth and to proceed with implanting the pump. Should I just go along with this or seek another neurosurgeon who would be willing to try reducing the size of the cyst or even removing it?

                      Thanks for any response.

                      Comment


                        Dear Dr. Young

                        Hope you will be fine.

                        Let me know will any doctor be using Embryonic Stem Cells in ChinaSCINet clinical trial 2006 as i have heard that these cells have more potential for the regeneration. When and where these clinical trials are starting? Can we paticipate?

                        Sincerely

                        Jawaid

                        Comment


                          Originally posted by Jawaid
                          Dear Dr. Young

                          Hope you will be fine.

                          Let me know will any doctor be using Embryonic Stem Cells in ChinaSCINet clinical trial 2006 as i have heard that these cells have more potential for the regeneration. When and where these clinical trials are starting? Can we paticipate?

                          Sincerely

                          Jawaid
                          Jawaid, there are no plans to use embryonic stem cells in ChinaSCINet in 2006. Wise.

                          Comment


                            Originally posted by QuadPro
                            If at least neuropathic pain can be cured completely I will be much happier.

                            Can I look forward to this?
                            Would you mind sharing what this entails? I had sensations of burning and such before but I don't have much pain, just discomfort. Why do some have "pain" and others do not?

                            Comment


                              Neuropathic pain

                              Originally posted by Le Type Français
                              Would you mind sharing what this entails? I had sensations of burning and such before but I don't have much pain, just discomfort. Why do some have "pain" and others do not?
                              For many years, doctors did not take neuropathic pain seriously. They use to call it "phantom limb" when it occurred after amputation so that the person apparently felt the pain in the absent limb. It turns out that neuropathic pain is a very common phenomenon that is associated with loss of sensory input to the brain. This can occur as a result of damage to a peripheral nerve (which of course occurs with an amputation or brachial plexus avulsion) but also with injury to the spinal cord or multiple sclerosis.

                              Traditional pain medications such as opioids did not seem to help. Certain antidepressants seemed to take the edge off the pain but only certain classes of such antidepressants helped, particularly those of that inhibited monoamine oxidase (MAO), an enzyme that breaks down catecholamine neurotransmitters, suggesting that catecholamines since as epinephrine, norepinephrine, and serotonin may play a role.

                              Several groups have shown that rats that are treated with antibodies against nerve growth factor (a neurotrophin) are less likely to develop neuropathic pain, suggesting that abnormal sprouting of remaining afferent fibers (these are fibers that carry incoming signals that were not damaged) may contribute to neuropathic pain. Recently, we discovered that methylprednisolone treatment of rats after spinal cord contusion reduced the incidence of autophagia, a behavior that is likely to reflect neuropathic pain. There is evidence that the nervous system that remains after spinal cord injury will sprout, not only during the period that immediately follow injury but for many months or even years after injury.

                              Neuropathic pain can take many forms, ranging from abnormal vibratory, cold, hot, aching, pressure and other sensations (called dysesthesia) to hypersensitivity to touch or temperature (called allodynia) to very unpleasant pain. They are usually not present during the first weeks after injury but can develop several weeks, months, or even years after injury. Several surveys suggest that as many as 50% of people with spinal cord injury have some form of neuropathic pain.

                              Most neuropathic pain occurs in parts of the body where sensation is abnormal or absent (e.g. below the injury site). Most neuropathic pain occur close to the neurological level. Areas that have recovered sensory function may show allodynia. Neuropathic pain can occur in deeper organs, sometimes called visceral neuropathic pain. Finally, in a small percentage of patients, neuropathic pain occurs above the injury level, often associated with abnormal spastic or movement disorders, perhaps a consequence of sprouting of both motor and sensory systems above the injury site.

                              Several treatments have been found to reduce neuropathic pain in some people.
                              • MAO inhibitors. MAO inhibitors have been used as anti-depressants. The first of these shown to have some effect on neuropathic pain is a drug called amitriptyline or Elavil (an MAO inhibitor anti-depressant drug but given in 20 mg/day doses that are lower than traditionally given to reverse depression). Amitriptyline, however, usually just reduces the dysesthesia.
                              • Baclofen. Baclofen activates the GABA-B receptor. Although primary used to reduce spasticity, some people find that it can reduce neuropathic pain, particulary when given in very high doses intrathecally. It is often used to treat neuropathic pain that is associated with severe spasticity.
                              • Gabapentin. Several anti-epileptic drugs appear to reduce neuropathic pain. The best and most frequently used of these is gabapentin or neurontin. This drug was initially controversial because people accomodated to the drug but when higher doses of as much as 4-5 grams per day were given, the effects often stabilized. Other possible anti-epileptic drugs include valproic acid.
                              • Ketamine. This is a glutamate receptor blocker that has long been used to treat children. In high doses, it tranquilizes and causes amnesia. It has been used to treat cancer pain. In low doses, it may have some effects on neuropathic pain.
                              • Epidural stimulation. Stimulation of the spinal cord itself may help. The electrodes are put on top of or close to the spinal cord and different frequency and amplitudes of stimulation can be tried until a combination is found that reduces neuropathic pain.
                              • Opioids. Although opioids were originally thought to be ineffective in controlling neuropathic pain, it turned out that it was largely a matter of dose. Unfortunately, of course, opioids are highly addictive and have serious side effects. A number of new drugs have come out that combine both MAO inhibition and opioid effects.

                              There is intense research underway around the world to find better drugs for neuropathic pain. One of the fears of regenerative therapies is that it may stimulate aberrant connections that foster the onset of neuropathic pain. To date, this has not turned out to be the case although some of the experience in OEG transplants in China have suggested that recover of sensory dermatomes close to the injury site may be transiently associated with allodynia and dysesthesias. This is something that should be closely watched for.

                              In many ways, I view neuropathic pain as the flip side of the coin to spasticity and spasms. Most people know about spasticity which is abnormal muscle tone or spasms which are abnormal muscle movements. For many years, neurology textbooks taught that spasticity is a result of removal of inhibitory influences of the brain on the lower spinal cord. While disconnection of the brain from the spinal cord does release motor reflexes in the lower spinal cord, often causing conditions such as cerebrate posturing, both the time course of development and manifestations of spasticity and spasms after spinal cord injury suggest that it is more than just disinhibition and that spasticity is probably associated with aberrant reconnections of the spinal cord below the injury site. I think that neuropathic pain is a form of "sensory spasticity".

                              Comment


                                Dr.Young,

                                At the Society for Neuroscience conference in 2005 in Washington D.C. Drs. Plant and Hodgetts presented results from their human bone marrow stromal cell study on acute spinal cords in rats. If you were there and heard these results, could you kindly please give me your opinion about this work that was done. Thank you kindly in advance.

                                Comment

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