Ten frequently asked questions concerning cure of spinal cord injury

[Wise Young]

Originally posted by walkanotherday:

I am very interested in this FES and how it doesn't do a thing for me. At least I don't see anything moving or contracting.

My legs and muscles have been totally flacid since day 1 of injury. I do have neurological pain that can get pretty intense at times. I don't like using the word pain because usually I can block it out if I just don't think about it.

I've never had anything as much as a twitch. Weird huh? I've used FES all the way down to my feet with no success. Does this mean I'm probably not going to have success with the Ferticare. I'm getting married in March and plan on having kids.

• WAD, your description suggests that you have had significant damage to the gray matter in your spinal cord, including some or many of the motoneurons that innervate the muscles of your leg. There is no way of knowing for sure without detailed neurophysiological testing of your leg reflexes. Many people assume that flaccidity means that the muscles have been completely denervated but it may also be a result of decreased excitability of the lower spinal cord as a result of partial losses of neurons. The spinal cord neurons that control muscles are distributed in gray matter columns that span several segments. Only a few places in the world have the experience and the instrumentats needed to test the neurophysiology of the spinal cord rigorously. Milan Dimitrijevic in Houston had set up such a facility but unfortunately has partly retired. He is now spending only part of his effort in Houston and is working mostly in Vienna. I know that he has established a clinic in Taiwan. I will try to contact him to see if he can provide more information about the status of these facilities and whether or not they are set up to take patients from the outside.

Regarding your sexual function, do you get erections at all? You need to work with a fertility clinic that is experienced in spinal cord injury to address issues of having kids. There are many ways of getting the sperm besides ejaculation.

Here's some background info.
6/23/02 on vacation surfin in Oahu with gf. I had been lying face down paddling in water for about 20 minutes. On the first wave I tried to catch, I stood up on the board and felt a sharp pain shoot down to my legs. The sharp pain went away after a few minutes and then came a dull pain that felt like I hyperextended my lower back. Went back on shore 20 minutes later because pain was too bad. Very lucky I didn't drown. Lost all movement and sensation somewhere between beach and ER.

In ER they told me it was just inflammation since I didn't fall or get hit by a wave.
First week or so I go hit hard with 3 different kind of steroids (methyl, decadrone, prednisone). Paralysis seemed to have slightly moved up when they gave me a break from the roids so they put me right back on it.

By 3rd week on the big island, doctors were stumped. Nothing to operate on because no trauma, no flu-like symptoms, no clues. All they could do was wait for a spinal tap analysis to come back from LA. At the time a stroke nuerologist I was assigned to suspected spinal cord stroke, infarcation if that's not the same, and transverse myelitis.

Spinal tap showed some higher levels of glycoprotein and also alarming levels of myelin basic protein. They went with TM solely based on the myelin basic protein levels. The stroke neuro still says it could still be spinal cord stroke.

I eventually got a consult from Dr. Douglas Kerr in Hopkins TM center who said he didn't think it was TM and that it could have been from disc movement while surfing. He said either way what ever happened is very rare.

The way that you got the spinal cord injury is really strange. Because you did not have trauma, it suggests that you had an ischemic episode or transverse myelitis (inflammation-mediated loss of function) in your spinal cord. If you are flaccid, it does suggest that you had some kind of ischemic episode or compression of the spinal cord. The rise in myelin basic protein suggests that you had demyelination. I agree with Doug Kerr that this is not the typical presentation of transverse myelitis. I am stumped.

Wise.

[Wise Young]

Originally posted by Isildur:

dr young, i started to go gym 2hours/day and did powerlifting 4 years before my injury. now im a 22 years old c6 quad, and i want to know if the exercise before injury means have better recovery in a case of cure [img]/forum/images/smilies/confused.gif[/img]
excuse my english.

In my experience, athletes often recover more than non-athletes. But much depends on the severity of your injury.

[chasb]

^

[walkanotherday]

Dr. Young,
Thanks for the reponses. It does sound slightly discouraging I have to say. Whether it's damage to the gray matter or total denervation, it seems like a procedure such as Dr. Lima's would not help me. Does that sound right?

I did have a test in Taiwan where they put this plate that sent some kind of pulse throughout my body. They started at the head and my arms would swing up without my control. The moved down the my lower spine stopping at various level and sent the impulses. Nothing happened with my legs. I take it that that's not good.

I also did a test were they stuck needles into various muscles. I remeber the result of that test was not very good either.

Regarding erection, Viagra required high doses and was not consistent, Muse was much better but required high doses, Caverject works great but of cours injections are no fun.

For some reason I do have some bladder sensation as well as spotty sensation around the boys. I don't require the use of a catheter but downside is I am pretty incontinent.

Thanks again. Sorry that you're stumped. It's not the first time I have heard that.

[Wise Young]

WAD, the more you describe your condition, the more it sounds like you had an ischemic episode that resulted in damage to your lower spinal cord. The fact that you have some sensation is consistent because axons are less susceptible to ischemia than neurons. Please don't be discouraged, however. For the first time, I am beginning to see glimmers of hope regarding neuronal replacement. I was particularly encouraged by the recent work by Doug Kerr's group showing that mouse embryonic stem cells produces some neurons in the spinal cords of paralyzed rats (see below). This is just the beginning.

Wise.

• Harper JM, Krishnan C, Darman JS, Deshpande DM, Peck S, Shats I, Backovic S, Rothstein JD and Kerr DA (2004). Axonal growth of embryonic stem cell-derived motoneurons in vitro and in motoneuron-injured adult rats. Proc Natl Acad Sci U S A. 101: 7123-8. Department of Neurology, Johns Hopkins University School of Medicine, Pathology 627C, 600 North Wolfe Street, Baltimore, MD 21287, USA. We generated spinal motoneurons from embryonic stem (ES) cells to determine the developmental potential of these cells in vitro and their capacity to replace motoneurons in the adult mammalian spinal cord. ES cell-derived motoneurons extended long axons, formed neuromuscular junctions, and induced muscle contraction when cocultured with myoblasts. We transplanted motoneuron-committed ES cells into the spinal cords of adult rats with motoneuron injury and found that approximately 3,000 ES cell-derived motoneurons (25% of input) survived for >1 month in the spinal cord of each animal. ES cell-derived axonal growth was inhibited by myelin, and this inhibition was overcome by administration of dibutyryl cAMP (dbcAMP) or a Rho kinase inhibitor in vitro and in vivo. In transplanted rats infused with dbcAMP, approximately 80 ES cell-derived motor axons were observed within the ventral roots of each animal, whereas none were observed in transplanted rats not treated with dbcAMP. Because these cells replicate many of the developmental and mature features of true motoneurons, they are an important biological tool to understand formation of motor units in vitro and a potential therapeutic tool to reconstitute neural circuits in vivo.

[Chaz19]

Thank You, Dr. Young!
I usually don't add to the"cure" thread because I find that many of my questions are answered by your posts and other members.but,I really appreciate your clarification on these topics,and I will try my best to spread the word in the spinal cord injury community outside of "carecure" in hopes to drum up political support and advocacy.I sent this post my local SCI chapters and will be posting it on my web site. My family and friends are filled with gratitude and hope from your article.
all good things,
chaz

[poonsuzanne]

Originally posted by Chaz19:

Thank You, Dr. Young!
I usually don't add to the"cure" thread because I find that many of my questions are answered by your posts and other members.but,I really appreciate your clarification on these topics,and I will try my best to spread the word in the spinal cord injury community outside of "carecure" in hopes to drum up political support and advocacy.I sent this post my local SCI chapters and will be posting it on my web site. My family and friends are filled with gratitude and hope from your article.
all good things,
chaz

Hey Chaz, me too, I'll do the same! I will pass Dr. Young's posts on to the doctors in Hong Kong. As I understand, apparently, some of them are reading Dr. Young's posts from time to time most recently! Suzanne

[Christopher Paddon]

Excellent summary Wise -

An old fogey like me with a 21 year old T7 injury may walk "normally" in eight years time? (I'm glad you said long distance walking because the ability to walk only 100 metres is still quite a severe handicap)

I'm getting myself as fit as I can and having as much fun as I can - eight years ago is 1996; that seems like just yesterday!

Thanks Wise

[Pinkbubbles]

Originally posted by Chris 2:

I'm getting myself as fit as I can and having as much fun as I can - eight years ago is 1996; that seems like just yesterday!

And eight more years will feel like tomorrow!

pink bubbles

[Wise Young]

Chris2, you sound like you are feeling better. I am so glad. Wise.

[poonsuzanne]

Originally posted by Wise Young:

We transplanted motoneuron-committed ES cells into the spinal cords of adult rats with motoneuron injury and found that approximately 3,000 ES cell-derived motoneurons (25% of input) survived for >1 month in the spinal cord of each animal. ES cell-derived axonal growth was inhibited by myelin, and this inhibition was overcome by administration of dibutyryl cAMP (dbcAMP) or a Rho kinase inhibitor in vitro and in vivo. In transplanted rats infused with dbcAMP, approximately 80 ES cell-derived motor axons were observed within the ventral roots of each animal, whereas none were observed in transplanted rats not treated with dbcAMP.

Dr. Young,

Under the above description, as a rough estimation, how many motoneuron-committed ES cells are needed to regenerate 10% of the axons of the spinal cord in order to regain ambulation and most bodily functions as well?

Suzanne

[This message was edited by Suzanne Poon on 07-24-04 at 06:39 AM.]

[Wise Young]

Suzanne, mouse and human numbers are obviously different. A more relevant figure is the 25% number. They found that the transplanted cells replaced as much as a quarter of the motoneurons. If true, this is quite a significant number.

The 10% number that I referred to was the number of axons in the spinal cord necessary and sufficient to support functions such as walking. The paper refers to the number of motoneurons that control the muscles.

Wise.

[QuadPro]

Originally posted by Wise Young:

Suzanne, mouse and human numbers are obviously different. A more relevant figure is the 25% number. They found that the transplanted cells replaced as much as a quarter of the motoneurons. If true, this is quite a significant number.

The 10% number that I referred to was the number of axons in the spinal cord necessary and sufficient to support functions such as walking. The paper refers to the number of motoneurons that control the muscles.

Wise.

Dr. Young if this procedure would be done on a c5 quad complete what kind of results do you think we would see? At least in levels of function.

[Wise Young]

quadpro, I don't know. This study at least shows the potential of embryonic stem cells to replace lost motoneurons in the spinal cord. Wise.

[Jessecj7]

posted by Wise Young

People should avoid procedures that cause irreversible loss of peripheral nerve and other functions.

Dr. Wise, what type of procedures are you talking about??