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Ten frequently asked questions concerning cure of spinal cord injury

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    Originally posted by nicotico
    i heard something about blue shark stem cell implants in Tijuana, MEX.

    any good news about it or is it all just bull......shark?
    They are no longer doing shark embryo transplants, to my knowledge. I heard that they are doing umbilical cord blood transplants but that is only hearsay. Do a search for Tijuana. Wise.

    Comment


      wise young when the HP 184 will be in phase 3? thank you

      Comment


        I was just at the Rehab Institute of Chicago asking that same question about HP184. The researcher didn't have any current info. She believes she will be recieving some information very soon. I'm interested in the results from the last trial and when the next trial will start.

        Wise, what level of injury do you feel this treatment is most suited for? If you have any information on the next trial, will it be different from the previous trials? Thanks for your help.
        "Our lives begin to end the day
        we become silent about things that matter."
        - Martin Luther King Jr

        Comment


          Originally posted by fti
          wise young when the HP 184 will be in phase 3? thank you
          Originally posted by IMHopeful
          I was just at the Rehab Institute of Chicago asking that same question about HP184. The researcher didn't have any current info. She believes she will be recieving some information very soon. I'm interested in the results from the last trial and when the next trial will start.

          Wise, what level of injury do you feel this treatment is most suited for? If you have any information on the next trial, will it be different from the previous trials? Thanks for your help.
          fti and IMHopeful, I really don't know when HP184 will be in phase 3. Aventis keeps things close to their vests and I have not talked to any of the investigators. I don't think that there is any restrictions of level of injury.

          Wise.

          Comment


            wise Young to think you that the treatment of novartis, biogen, acorda, bioaxone is effective for the chronic lesion thank you

            Comment


              Originally posted by fti
              wise Young to think you that the treatment of novartis, biogen, acorda, bioaxone is effective for the chronic lesion thank you
              FTI, these are clinical trials and I don't know whether they are effective or not. The information is not yet available. Wise.

              Comment


                expensive wise Young when could you entered one of it is group in your tests private clinic. acorda,novartis,biogen,bioxane thank you

                Comment


                  Wise Young,

                  Do you travel and speak on the topic of SCI Research?

                  Dan

                  Comment


                    Originally posted by danhanz
                    Wise Young,

                    Do you travel and speak on the topic of SCI Research?

                    Dan
                    Dan, I give dozens (perhaps hundreds) of lectures each year on spinal cord injury research all over the world. Wise.

                    Comment


                      Hi Wise,

                      I'm just curious as to your thoughts about someone with Anterior Cord Syndrome, C5/6 15 years post injury, and what hypothetical treatment you would suggest.

                      I have now grown used to my injury, and really don't intend on persuing "The Cure", but I'd still be really interested on your thoughts of possible therapies for the above.

                      Many thanks

                      Simon.

                      Comment


                        Originally posted by Apparelyzed
                        Hi Wise,

                        I'm just curious as to your thoughts about someone with Anterior Cord Syndrome, C5/6 15 years post injury, and what hypothetical treatment you would suggest.

                        I have now grown used to my injury, and really don't intend on persuing "The Cure", but I'd still be really interested on your thoughts of possible therapies for the above.

                        Many thanks

                        Simon.
                        Simon,

                        I assume that you have good sensation all over your body but little movement? I decided to write a summary of the different spinal cord injury syndromes while answering your question.

                        Wise.

                        The Incomplete Spinal Cord Injury Syndromes
                        by Wise Young, Ph.D., M.D.
                        W. M. Keck Center for Collaborative Neuroscience
                        Rutgers, the State University of New Jersey, Piscataway, NJ 08540-8082
                        last updated: 30 June 2006
                        Let me start by talking about the four syndromes of "incomplete" spinal cord injury and then return back to anterior cord syndrome at the end.

                        • Brown-Séquard Syndrome. This was described by Charles Édouard Brown-Séquard in 1861 at the Institute of Neurology at Queen's Square (Source). This results from an injury to one side of the spinal cord, preserving one side. The symptoms are a classical demonstration of the separation of the sensory pathways for pain/temperature and proprioception. Those with the Brown-Séquard syndrome lose proprioception and have volutnary motor weakness on the side of the spinal cord injury and loss of pain-temperature on the other side. However, a majority of people with this injury recover ability to walk because the locomotor pattern generator can be activated by descending axons from both sides of the cord and the generator itself than can initiate bilateral walking.

                        • Central Cord Syndrome. This is a cervical spinal cord injury where the arms appear to be more affected than the legs. For a long time, this was thought be related to an injury that primary affected the middle of the spinal cord with preservation of an outer rim of white matter. However, in the 1990's, Richard Bunge and his colleagues challenged this concept with their examinations of the spinal cord of people with so-called central cord syndrome, showing that this was an injury to the corticospinal tracts, which are located in the lateral columns of humans. The arms are more dependent on the corticospinal tract than the legs and therefore are more effected. A majority of people recover substantially from central cord syndrome.

                        • Posterior Cord Syndrome. This is condition due to damage to the posterior part of the spinal cord, affecting proprioception and often leaving some motor function. While it is said to be quite rare because the original description stipulated that the patient has lost proprioception, light touch, and voluntary motor control but retains temperature-pain function (Source). However, in my opinion, a much more reasonable definition is a person who has lost proprioception but retains temperature-pain sensation and motor function. If so, in my experience, this is quite a common condition. Many people with so-called "incomplete" spinal cord injury recover significant motor function in their arms and legs but they do not recover their proprioceptive function.

                        • Anterior Cord Syndrome. This is a relatively rare condition that has been attributed to the damage to the anterior part of the spinal cord, affecting motor function but leaving sensory function largely intact. Originally described by Schneider in 1951 (J. Neurosurgery 8: 360-370), who presented two cases of patients who had ruptured, herniated discs and bone fragment in the spinal canal that pressed on the front (anterior) of the spinal cord. He decompressed these patients and they recovered substantial motor function. The reason why this is a relatively rare condition is because a majority of such patients recover substantial motor function due to preservation of the corticospinal tracts in the lateral columns. However, people may have difficulties walking due to the loss of the vestibulospinal and reticulospinal tracts that run in the anterior column and are responsible for standing and locomotor reflexes. Thus, such people may be able to voluntarily move their legs but do not walk as well.

                        Very few people have pure anterior, posterior, central, or Brown-Sequard syndromes. Most have mixtures. However, all of these conditions are "incomplete" spinal cord injuries and most people can recover substantial motor function. A recent study by Dobson, et al. (2006) indicated that over 90% of people with "incomplete" spinal cord injury can recover walking with intensive exercise. The study was designed compare the effects of treadmill weight-supported ambulation training and more standard rehabilitation overground and standing. To their surprise, they found that both courses of therapies resulted in 90% of the people walking. These are all in people during the first year after injury.

                        These results are very surprising because the Model Systems Database which have tracked over 25,000 patients since the 1970's suggest that only about 40% of people with "incomplete" spinal cord injuries recover ability to walk. While studies are still going on to assess whether ambulation training will restore walking in people who have chronic "incomplete" spinal cord injury, already several groups have reported that weight-supported treadmill ambulation training of people who are more than 10 years after "incomplete" spinal cord injury can recover independent locomotion. Since more than half of spinal cord injured people are "incomplete", this suggests that intensive ambulation training can restore walking in a majority of people after spinal cord injury.

                        One question is why this was not discovered earlier. Well, at least 40% of the people with incomplete spinal cord injury did know and did recover. One possibility is that this resulted from physicians telling patients that they will not recover walking and people did not make an attempt to undergo intensive ambulation training. A second possibility is that this may be a result of the widespread use of methylprednisolone which began in the early 1990's and continues today. A third possibility is that better emergency care and earlier decompression of injured spinal cords may be making "incomplete" patients more incomplete.

                        It is important to note, however, that many people who recover walking, e.g. walking quads and walking paras, are not "normal" walkers. Many can walk stand and walk for only short distances. Walking may be strenuous and quite wearing. Many people lack proprioception and both unsteadiness and poor balance often limits ability to walk on different kinds of surfaces, grades, and conditions. One important discovery about five or six years ago was the discovery that electrical stimulation of the L2 cord (around T10) will activate the locomotor pattern generator. Several studies have shown that the L2 stimulation allows people to walk longer distances with less effort. This is likely to play a major role, in my opinion, in locomotor training in the future.

                        Paradoxically, it seems that walking is probably the most likely function to return after incomplete spinal cord injury in the cervical and upper thoracic levels. Because the locomotor pattern generator is usually intact in such people and very few descending axons are necessary and sufficient to activate walking, probably more than half of people will recover locomotion after spinal cord injury. However, many people continue to have some bladder problems, resulting from bladder spasticity and detrusor-sphincter dyssynergia. Sensory loss may contribute to sexual dysfunction. Spasticity is often a significant problem. Walking therefore is often laborious, inefficient, and less useful.

                        In summary, there are four different incomplete spinal cord syndromes. These syndromes are often not talked about today because most incomplete spinal cord injuries are mixtures of the four syndromes and most people recover substantially. Although for many years, less than half of such people recover locomotor function, recent studies suggest that as many as 90% of people with incomplete spinal cord injuries will be able to recovery ability to walk with intense ambulation training. This is in large part because the locomotor pattern generator is usually still intact and relatively few descending axons are necessary and sufficient to activate the neural circuitry for walking. However, the walking is often difficult, limited, and laborious.

                        Comment


                          Hi Wise,

                          Many thanks for the article, it was very interesting.

                          I am a C5/6 complete motor, incomplete sensory.

                          I can feel touch all over my body and deep pain. My toes are especially sensitive, not sore, but I hate it when my nails are cut as they seem hypersensitive, and I can sense the lightest touch on them.

                          I cannot feel teperature, pin prick pain, or joint position. However, I can sometimes tell limb position due to which muscles are tight/ slack.

                          I had my accident back in 1992, and was told like most that there would be no return of function. It's a shame the exercises/rehab which may help return wasn't practiced back then, but 15 years on, I guess we'll never know now if they would of made a difference.

                          Many thanks for your time.

                          Simon.

                          Comment


                            Originally posted by Apparelyzed
                            Hi Wise,

                            Many thanks for the article, it was very interesting.

                            I am a C5/6 complete motor, incomplete sensory.

                            I can feel touch all over my body and deep pain. My toes are especially sensitive, not sore, but I hate it when my nails are cut as they seem hypersensitive, and I can sense the lightest touch on them.

                            I cannot feel teperature, pin prick pain, or joint position. However, I can sometimes tell limb position due to which muscles are tight/ slack.

                            I had my accident back in 1992, and was told like most that there would be no return of function. It's a shame the exercises/rehab which may help return wasn't practiced back then, but 15 years on, I guess we'll never know now if they would of made a difference.

                            Many thanks for your time.

                            Simon.
                            Simon,

                            Did you recover your sensation late or were they always present?

                            Wise.

                            Comment


                              Hi Wise,

                              I've always had sensation, I was told that was the reason my muscle spasms were so bad.

                              I had to have a Baclofen pump implanted 6 months post injury, as I couldn't do anything, and the spasms were a real danger to my health.

                              I know the consultant didn't really want to put the pump in so soon after my injury, but there really wasn't any other options at the time, as even high doses of oral medication didn't help.

                              Simon.

                              Comment


                                Originally posted by Wise Young
                                pjflash, because of the wide range recovery by people from spinal cord injury, it is difficult to tell how effective the treatment is. The phase 1 study that they completed last year showed that the treatment was safe and that about 20% of the patients in the study recovered from ASIA A to ASIA C. Compared to historical data from the model systems database, suggesting that only about 5% of people make this transition, this is promising. However, given the small number of patients (about 20) and the trend for better recovery of patients in recent years, perhaps due to more aggressive rehabilitation and ambulatory exercise, it may not have been due to the treatment. On the other hand, it is sufficient to warrant a further phase 2 trial. I think that they are increasing the dose of the cells that they are transplanting.

                                According to Michal Schwartz who originally discovered the beneficial effects of macrophages, the macrophages must be properly activated in order to be beneficial. Proneuron uses a piece of skin to condition the macrophages before transplanting them into the spinal cord. I have known a number of people who have received activated macrophage transplants. All were ASIA A at the time of surgery. Nobody got worse after surgery but at the same time I did not know anybody who walked as a result of the treatment (i.e. had ASIA D). Those patients that had the surgery also were definitively decompressed. Thus, whether the modest recovery was a result of the macrophages or not is unclear.

                                Wise.
                                A major flaw of the proneuron trial is that progress during the first year might occur anyway. On the other hand, if therapies are tried only at the plateau phase, optimal intervention in the acute setting would never be elucidated. Trials need to find a way to address these issues.

                                Comment

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