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Ten frequently asked questions concerning cure of spinal cord injury

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    Originally posted by Cripply
    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.
    Cripply, in acute studies, controlled studies are necessary. This is of course because people not only recover but the recovery extent is very different depending on injury severity. It is not enough, for example, to have a placebo-control group. One must also segregate patients with complete or incomplete spinal cord injury. Since the latter recover substantially while the former does not, even slight differences in the ratio of complete to incomplete patients in the treatment or placebo group may lead to very big treatment effects. These can be quite misleading.

    In studies of chronic spinal cord injury, the problem of spontaneous recovery is likewise not as simple as or straightforward as people thought. Many people would have thought that it was not possible for a person who has been injured and who has not been able to walk for 5 years to recover walking again. It turns out that this is not true. Several studies have now suggested that a majority of so-called "incomplete" spinal cord injury can be trained to ambulate independently even though they have not been able to do so for many years after injury.

    When Acorda Therapeutics first started their trials of 4-aminopyridine, I thought that there would be relatively few cases of "placebo" response in people with chronic spinal cord injury. But, the trial actually showed that there is a substantial placebo response by people with chronic spinal cord injury. The difference in the placebo response between those with "complete" and those with "incomplete" spinal cord injury is the magnitude of the placebo effect. Those with "incomplete" injuries tend to show greater placebo effect. This is in itself a very interesting phenomenon and suggest that the placebo effect is not a psychological but a biological phenomenon.

    Wise.

    Comment


      Originally posted by Wise Young
      In studies of chronic spinal cord injury, the problem of spontaneous recovery is likewise not as simple as or straightforward as people thought. Many people would have thought that it was not possible for a person who has been injured and who has not been able to walk for 5 years to recover walking again. It turns out that this is not true. Several studies have now suggested that a majority of so-called "incomplete" spinal cord injury can be trained to ambulate independently even though they have not been able to do so for many years after injury.


      Wise.
      Can we name 10 people or are there 10 people on this forum that can vouch for this A. and B. what hope does this give complete chronic 5 years down the line? ...which is what a majority of the peeps on this forum are..( not including myself ) - i am actually going on my 9th month. and C. Can we even name 10 people who have recovered from restorative therapy? As far as Rummerfield is concerned i have my doubts as to his initial diagnosis.
      Birds Fly in Flocks, but Eagles Fly Alone...

      Comment


        Originally posted by spidergirl
        Can we name 10 people or are there 10 people on this forum that can vouch for this A. and B. what hope does this give complete chronic 5 years down the line? ...which is what a majority of the peeps on this forum are..( not including myself ) - i am actually going on my 9th month. and C. Can we even name 10 people who have recovered from restorative therapy? As far as Rummerfield is concerned i have my doubts as to his initial diagnosis.
        Spidergirl,

        I was referring to incomplete spinal cord injury. The Model Systems Databse which now includes nearly 30,000 people with spinal cord injury suggests that only 40% of people with ASIA B or C recover walking. Since B is less frequent (less than 10%), most of the patients should be C. Several studies now have shown that a majority of people who were ASIA C shortly after injury will be able to recover locomotion. In fact, one study indicates that 90% of such people will be able to recover.

        People with "complete" spinal cord injury (ASIA A) rarely recover walking. It can happen but only when the patient becomes "incomplete" fairly early after the injury. For example, I have a good friend who had broken her neck about 6 years ago in a horse-riding accident. Her father called me and I told him to make sure that she gets methylprednisolone. She did get the drug. She was ASIA A when she was admitted to the hospital. At 3 months, I saw her. She was walking.

        In my experience, people who have had ASIA A or ASIA B for more than a year are very unlikely to spontaneously recover locomotion. I don't think that I have ever seen a convincing case. I had one good friend who was ASIA B for nearly a year before he started recovering motor function and eventually got back his walking. Both of the people referred to above had cervical spinal cord injury (C4/5) and recovered to the point that most people would not know or believe that they once were quadriplegic.

        Please, it is important that people do not misinterpret what I say. Spontaneous locomotor recovery from chronic "complete" spinal cord injury is very rare. It may happen if there is something pressing on the spinal cord and the cord is decompressed. It may happen in somebody who has head injury and then recovered from the head injury. But, it is rare. This is of course the reason why I strongly advocate spinal cord injury research and developing treatments for chronic spinal cord injury.

        Wise.

        Comment


          Originally posted by Wise Young
          Spidergirl,

          I was referring to incomplete spinal cord injury. The Model Systems Databse which now includes nearly 30,000 people with spinal cord injury suggests that only 40% of people with ASIA B or C recover walking. Since B is less frequent (less than 10%), most of the patients should be C. Several studies now have shown that a majority of people who were ASIA C shortly after injury will be able to recover locomotion. In fact, one study indicates that 90% of such people will be able to recover.

          People with "complete" spinal cord injury (ASIA A) rarely recover walking. It can happen but only when the patient becomes "incomplete" fairly early after the injury. For example, I have a good friend who had broken her neck about 6 years ago in a horse-riding accident. Her father called me and I told him to make sure that she gets methylprednisolone. She did get the drug. She was ASIA A when she was admitted to the hospital. At 3 months, I saw her. She was walking.

          In my experience, people who have had ASIA A or ASIA B for more than a year are very unlikely to spontaneously recover locomotion. I don't think that I have ever seen a convincing case. I had one good friend who was ASIA B for nearly a year before he started recovering motor function and eventually got back his walking. Both of the people referred to above had cervical spinal cord injury (C4/5) and recovered to the point that most people would not know or believe that they once were quadriplegic.

          Please, it is important that people do not misinterpret what I say. Spontaneous locomotor recovery from chronic "complete" spinal cord injury is very rare. It may happen if there is something pressing on the spinal cord and the cord is decompressed. It may happen in somebody who has head injury and then recovered from the head injury. But, it is rare. This is of course the reason why I strongly advocate spinal cord injury research and developing treatments for chronic spinal cord injury.

          Wise.
          Thank you for the clarification Dr. Young. Actually I knew exactly what u were sayin, I must have interpreted myself wrong. I knew u were speakin of "incompletes"...and I'm assuming now the 90% that now recover thru the decompression and ambulation training are for initial C's. However, I have a couple concerns....

          #1 I may have to ask my attorney if I have a potential lawsuit against the hospital that did my surgery bc I was not given meth and if people have recovered that substantially I may have to rest my case and donate to SCI.

          # 2 concern....is that Kennedy Krieger and MCdonalds have based there whole multi million dollar facility and programs on restorative therapy w Rummerfield being a big part of this. He claimed to be a complete and a miracle. I wondered if there was 10 people who can come forward and claim mobility do to restorative therapy. Considering they told u that u had 8 days to live when u had an SCI back than....who in their right mind had a clue as to what his diagnosis was. This is not morally correct as well. Now I can be totally wrong about all this but I feel as a disabled community we should command the truth and not be told otherwise.
          Last edited by spidergirl; 14 Jul 2006, 5:24 AM.
          Birds Fly in Flocks, but Eagles Fly Alone...

          Comment


            Dear Wise Young, I would like to know if you already seen studies about combined Schwann and oeg cells on animals? or humans? If so, what are the results? I am really interested in the clinics experiencesof Doctor Huang and I would like your view on this, and your opinion on the Schwann and OEG Cells potencial on spinal cord injury; Thanks a lot, Best regards; A.Guerdener

            Comment


              Dr. Young,

              I remember u posted somewhere ( and i really couldn't remember where for the life of me ) that u were going to start a new 10 questions about sci thread bc this one was getting outdated. Is this still happening? i need to come off this roller coaster, there is way too many loops & i am getting dizzy.
              Last edited by spidergirl; 17 Jul 2006, 1:35 AM.
              Birds Fly in Flocks, but Eagles Fly Alone...

              Comment


                Dr. Young,

                Because we did not get the ESCR funding does this mean that your timelines will be extended some more years or does it not matter?

                Science does not move without funding correct? or does it?

                Superman was told 7 years. People think it's funni that making the late "Superman" walk could have been achieved.

                i think it is all very very sad and i wish we had some more answers. Can you please tell us if we are being jerked around with timelines or if we are really going to see a cure in the future for chronics- because NOBODY on this sight is an acute.

                i know i would like to go back to living my life and maybe come back to care cure in 5 to 7 years because i think that this sight is a whirlwind of opinions and continuous redundancy and i was hoping maybe you can set the record straight so some of us can be more at peace.
                Last edited by spidergirl; 21 Jul 2006, 12:54 AM.
                Birds Fly in Flocks, but Eagles Fly Alone...

                Comment


                  Originally posted by fti
                  Dear Wise Young, I would like to know if you already seen studies about combined Schwann and oeg cells on animals? or humans? If so, what are the results? I am really interested in the clinics experiencesof Doctor Huang and I would like your view on this, and your opinion on the Schwann and OEG Cells potencial on spinal cord injury; Thanks a lot, Best regards; A.Guerdener
                  1. Fouad K, Schnell L, Bunge MB, Schwab ME, Liebscher T and Pearse DD (2005). Combining Schwann cell bridges and olfactory-ensheathing glia grafts with chondroitinase promotes locomotor recovery after complete transection of the spinal cord. J Neurosci 25: 1169-78. Numerous obstacles to successful regeneration of injured axons in the adult mammalian spinal cord exist. Consequently, a treatment strategy inducing axonal regeneration and significant functional recovery after spinal cord injury has to overcome these obstacles. The current study attempted to address multiple impediments to regeneration by using a combinatory strategy after complete spinal cord transection in adult rats: (1) to reduce inhibitory cues in the glial scar (chondroitinase ABC), (2) to provide a growth-supportive substrate for axonal regeneration [Schwann cells (SCs)], and (3) to enable regenerated axons to exit the bridge to re-enter the spinal cord (olfactory ensheathing glia). The combination of SC bridge, olfactory ensheathing glia, and chondroitinase ABC provided significant benefit compared with grafts only or the untreated group. Significant improvements were observed in the Basso, Beattie, and Bresnahan score and in forelimb/hindlimb coupling. This recovery was accompanied by increased numbers of both myelinated axons in the SC bridge and serotonergic fibers that grew through the bridge and into the caudal spinal cord. Although prominent descending tracts such as the corticospinal and reticulospinal tracts did not successfully regenerate through the bridge, it appeared that other populations of regenerated fibers were the driving force for the observed recovery; there was a significant correlation between numbers of myelinated fibers in the bridge and improved coupling of forelimb and hindlimb as well as open-field locomotion. Our study tests how proven experimental treatments interact in a well-established animal model, thus providing needed direction for the development of future combinatory treatment regimens. University of Alberta, Faculty of Rehabilitation Medicine, Edmonton, Canada T6G 2G4. karim.fouad@ualberta.ca http://www.ncbi.nlm.nih.gov/entrez/q..._uids=15689553
                  2. Takami T, Oudega M, Bates ML, Wood PM, Kleitman N and Bunge MB (2002). Schwann cell but not olfactory ensheathing glia transplants improve hindlimb locomotor performance in the moderately contused adult rat thoracic spinal cord. J Neurosci 22: 6670-81. Cultured adult rat Schwann cells (SCs) or olfactory ensheathing glia (OEG), or both, were transplanted in the adult Fischer rat thoracic (T9) spinal cord 1 week after a moderate contusion (10 gm, 12.5 mm, NYU impactor). Rats received either a total of 2 x 10(6) cells suspended in culture medium or culture medium only (controls). At 12 weeks after injury, all grafted animals exhibited diminished cavitation. Although in medium-injected rats 33% of spinal tissue within a 5-mm-long segment of cord centered at the injury site was spared, significantly more tissue was spared in SC (51%), OEG (43%), and SC/OEG (44%) grafted animals. All three types of glial grafts were filled with axons, primarily of spinal origin. SC grafts contained more myelinated axons than SC/OEG and OEG grafts. Both types of SC-containing grafts expressed more intense staining for glial fibrillary acidic protein and chondroitin sulfate proteoglycan compared with OEG-only grafts. Retrograde tracing demonstrated that the number of propriospinal and brainstem axons reaching 5-6 mm beyond the grafted area was significantly higher with SC and SC/OEG grafts but not with OEG-only grafts compared with controls. Corticospinal fibers terminated closer to the lesion epicenter in all grafted animals than in controls. With SC-only grafts, a modest but statistically significant improvement in hindlimb locomotor performance was detected at 8-11 weeks after injury. Thus, in addition to this functional improvement, our results show that an SC graft is more effective in promoting axonal sparing/regeneration than an SC/OEG or OEG graft in the moderately contused adult rat thoracic spinal cord. The Chambers Family Laboratory of Electron Microscopy, The Miami Project to Cure Paralysis, University of Miami School of Medicine, Miami, Florida 33136, USA. http://www.ncbi.nlm.nih.gov/entrez/q..._uids=12151546

                  Comment


                    Originally posted by spidergirl
                    Dr. Young,

                    Because we did not get the ESCR funding does this mean that your timelines will be extended some more years or does it not matter?

                    Science does not move without funding correct? or does it?
                    Hey Spider. All is not lost. Researchers can get funding through the Christopher Reeve Paralysis Act Bill which will require the NIH to allocate 100 million over the next 4 years for SCI research. We need to get this bill passed. It's our last hope for federal funding as the NIH will be cutting its budget.

                    Comment


                      Originally posted by spidergirl
                      Dr. Young,

                      Because we did not get the ESCR funding does this mean that your timelines will be extended some more years or does it not matter?

                      Science does not move without funding correct? or does it?

                      Superman was told 7 years. People think it's funni that making the late "Superman" walk could have been achieved.

                      i think it is all very very sad and i wish we had some more answers. Can you please tell us if we are being jerked around with timelines or if we are really going to see a cure in the future for chronics- because NOBODY on this sight is an acute.

                      i know i would like to go back to living my life and maybe come back to care cure in 5 to 7 years because i think that this sight is a whirlwind of opinions and continuous redundancy and i was hoping maybe you can set the record straight so some of us can be more at peace.
                      spidergirl,

                      Gosh, it would be really sad not to see you on carecure for 5-7 years! I really don't have a crystal ball. All that I know is that I don't want to wait that long.

                      Wise.

                      Comment


                        Originally posted by spidergirl
                        Dr. Young,

                        Because we did not get the ESCR funding does this mean that your timelines will be extended some more years or does it not matter?

                        Science does not move without funding correct? or does it?

                        Superman was told 7 years. People think it's funni that making the late "Superman" walk could have been achieved.

                        i think it is all very very sad and i wish we had some more answers. Can you please tell us if we are being jerked around with timelines or if we are really going to see a cure in the future for chronics- because NOBODY on this sight is an acute.

                        i know i would like to go back to living my life and maybe come back to care cure in 5 to 7 years because i think that this sight is a whirlwind of opinions and continuous redundancy and i was hoping maybe you can set the record straight so some of us can be more at peace.
                        spidergirl,

                        Gosh, it would be really sad not to see you on carecure for 5-7 years! I really don't have a crystal ball. All that I know is that I don't want to wait that long. I also don't think that embryonic stem cells are the only hope.

                        Wise.

                        Comment


                          Thank-you for the reply Dr. Young

                          i know that u know we are suffering and it's not easy and it's not fun.

                          The ailments that are accompanied with this injury are worse than the injury!!

                          I need care cure to help me get thru but sometimes it's so hard.
                          Birds Fly in Flocks, but Eagles Fly Alone...

                          Comment


                            Originally posted by Wise Young
                            I really don't have a crystal ball. All that I know is that I don't want to wait that long. I also don't think that embryonic stem cells are the only hope.
                            hmm... spidergirl, i think you've heard this before.

                            Comment


                              Originally posted by Scott Pruett
                              hmm... spidergirl, i think you've heard this before.
                              It never hurts to hear things again from a scientist that know's when ur hurting for freedom.

                              BTW- DO u have emails saved from 1994?
                              Birds Fly in Flocks, but Eagles Fly Alone...

                              Comment


                                true that. not sure what you're getting at re: the email thing though.

                                Comment

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