Next Open House at Rutgers January 7, 2005

[Wise Young]

The next Open House at Rutgers is scheduled for January 7. People and families with spinal cord injury, transverse myelitis, ischemic spinal cord injuries, amyotrophic lateral sclerosis, and other conditions are very welcome to come. We typically start with a tour of the lab between 5-6 pm so that families can talk to our students and staff. At 6 pm, we show a short video and then I summarize the latest research in the field. From 7 pm on until late, you can discuss the research and situation with me and other people. Everything that we know is at your disposal. To get directions and to sign up for the Open House, please call 732-445-2061.

Wise.

Directions

the W. M. Keck Center for Collaborative Neuroscience is located on the second floor of the Nelson Biological Laboratories, 604 Allison Road, Busch Campus, Piscataway, New Jersey 08854.

Piscataway is about 34 miles south of Newark, exit 9 on the New Jersey Turnpike (Interstate 95). It is just across the river from New Brunswick. So, you would head south from Newark airport on the New Jersey Turnpike, get off on Exit 9, take Routh 18 North past New Brunswick, across a bridge over the Raritan River (about 3.7 miles), and follow signs for the Busch campus. http://maps.rutgers.edu/directions/nb.aspx

When you get to the Bush campus, you will get to a small traffic circle. On that circle go past one road and the Sonny Werblin Recreation Center, and turn right on Freilinghusen Rd. This road runs between the Golf Course and several buildings that include the Math Science Library, the Hill Center, the Physics Building. The first road that you can turn right onto is Allison
Road. Make a right turn on Allison and go about 100 meters. You will see a new building on your right under construction called Life Science Building. The sprawling building on your left is Nelson Biological Laboratories. Allison Road should end and you make a left turn on Bevier Road. Go about 20 meters and you will see a small parking lot on your left. Go into that parking lot and park. There will be a doorway into the building called Smithers Hall. That is part of the Nelson Biological Laboratories. Go into that building, second floor, and the W. M. Keck Center occupies most of the second floor of that building. There should be signs. The following are some maps.

http://maps.rutgers.edu/maps/default...mpus=4?900,300

http://maps.rutgers.edu/directions/nb.aspx

[This message was edited by Wise Young on 12-27-04 at 04:52 AM.]

[tvot]

I'll only go if you tell me I'll leave walking [img]/forum/images/smilies/biggrin.gif[/img]

[NoDecafPlz]

I need to go to these. Being in south jersey and
not going I'm sure looks very lame. Unfortunetly I work every single Friday night from 12 until 8.

:-(

Joe

[sbdspray]

Dr. Young-
Sounds like a plan. One question though, in your opinion what is a more severe injury to the spinal cord-
A deep laceration due to a broken verterbrae, causing swelling and bleeding, but quickly relieved of compression due to obvious nature of injury and the doctors ability to get the verterbrae of the spinal cord.
or-
Intense, but very localized swelling of the spinal cord due to a vascular lesion, compromising blood flow due to venous congestion on the cord's anterior surface. Due to rarity of this presentation of symptoms, and because of it's nontraumatic origins, doctors wait, while swelling continues until correct diagnosis is made weeks later.

sherman brayton

[Wise Young]

Originally posted by brayton:

Dr. Young-
Sounds like a plan. One question though, in your opinion what is a more severe injury to the spinal cord-
A deep laceration due to a broken verterbrae, causing swelling and bleeding, but quickly relieved of compression due to obvious nature of injury and the doctors ability to get the verterbrae of the spinal cord.
or-
Intense, but very localized swelling of the spinal cord due to a vascular lesion, compromising blood flow due to venous congestion on the cord's anterior surface. Due to rarity of this presentation of symptoms, and because of it's nontraumatic origins, doctors wait, while swelling continues until correct diagnosis is made weeks later.

sherman brayton

I have spent the past two weeks writing a long and detailed review of transverse myelitis, probably one of the most misunderstood forms of spinal cord injury. I will post the article soon; it has taken me perhaps over 100 hours to write it. There is a little more that needs to be done. But, let me comment on the difference between traumatic spinal cord injury and transverse myelitis here because it may answer your question.

Traumatic spinal cord injury usually damages one level of the spinal cord. This type of injury damages spinal tracts and the neurons at a given level of the spinal cord but the spinal cord above and below the injury is not directly damaged. Although the surrounding spinal cord undergoes some atrophy as a result of the injury, due to the degeneration of spinal axons that have been cut off from the cell bodies that originated them, most of the neurons above and below the injury site remain intact. Note that the axons that are still connected to neurons remain alive and able to regrow. Thus, most spinal cord injury research has aimed at getting these axons to regrow across the injury site and to reconnect with neuronal targets on the other side of the injury site. The spinal cord has remarkable abilities to recover if even 10% of the spinal cord is preserved at the injury site. A majority of people who suffer spinal cord injury who are admitted to hospital with "incomplete" spinal cord injury will recover substantially from the injury, including walking. One of the greatest sources of hope for therapies that can restore function in chronic spinal cord injury is the realization that one does not have to regenerate the spinal cord completely in order to attain substantial functional recovery. In fact, there is some evidence suggesting that many people with spinal cord injury have not recovered as much as they could have because they have been told that they will not recover or did not have access to the intensive rehabilitative exercise that is necessary to maximize recovery.

Transverse myelitis is non-traumatic form of spinal cord injury that is probably caused by ischemia. The original cause of may be thrombosis due to vascular inflammation (resulting from auto-immune, infection, or other causes), embolization, or arteriovenous malformation. People with transverse myeltis often have widespread damage to both gray and white matter of the spinal cord. However, because the damage to the spinal cord is typically incomplete at any given level, a majority of people who get transverse myelitis will recover substantially, including walking. In recent years, especially with the routine use of early and high-dose methylprednisolone therapy, 50-70% of people who have had a severe episode of transverse myelitis will recover walking. However, even those who recovery walking often continue to have significant bladder and rectal problems, as well as as spasticity and neuropathic pain. This may well be because of damage to neurons in the lower spinal cord.

For people who have had spinal cord injuries damaging crucial gray matter structures such as phrenic nucleus or the lower thoracic and upper lumbar cord, neuronal replacement therapies may be necessary. Gray matter damage can involve one or more of the following four populations of neurons in the spinal cord:
• Motoneurons. These are the neurons in the ventral (anterior) gray matter that directly innervate muscles. Damage to motoneurons cause atrophy of muscles that they innervate. These are traditionally been considered the most difficult neurons to replace because one has to not only replace the neurons but also get them to regrow their axons out the ventral roots to muscles that may have atrophied.
• Motor interneurons. These are most inhibitory neurons that control the excitability of motor reflexes. They receive input from the brain and also from sensory input. When these neurons are damaged or have lost their input from the brain, spasticity frequently may result. These neurons typically express two kinds of neurotransmitters (GABA and glycine).
• Sensory relay neurons. These are neurons that receive sensory signals from dorsal axons that enter the spinal cord. They then relay sensory signals to the brain. For example, the best known example are the neurons that form the spinothalamic tract. They receive information from sensory input and then send axons that cross over to the other side of the spinal cord up to the thalamus, carrying mostly pain and temperature sensations.
• Sensory interneurons. These are neurons that control the sensory processing. Like the motor interneurons, most of these tend to be inhibitory and control sensory. When these interneurons are damaged, neuropathic pain may result.

At the present, only two types of cell transplants has been shown to replace neurons in the spinal cord: embryonic stem cells or fetal neural precursor cells. While other stem cells such as umbilical cord blood and bone marrow stem cells have been reported to be beneficial when applied to acutely injured spinal cord, no study to date has shown that these cells will replace neurons in the spinal cords of animals. In theory, adult neural stem cells should be able to replace neurons as well although, to my knowledge, this has not yet been shown in animal models. However, progress is being made in understanding how stem cells can make neurons and I believe that there should be studies showing that adult stem cells can produce neurons. There is also an open question concerning therapies that stimulate endogenous stem cells in the spinal cord. After all, if there are adult stem cells in the spinal cord, we should be able to stimulate them to grow in the spinal cord to replace neurons. To date, this has not been demonstrated in animals.

Regeneration alone may not be sufficient to restore function completely to people with transverse myelitis or ischemia. That is one of the reason why I have become a much more vocal advocate of stem cell therapies in recent years. I believe that neuronal replacement will be needed to address all the problems of spinal cord injury. The earlier we commit to developing therapies that can achieve neuronal replacement, the earlier we will see these therapies come to fruition in clinical practice. So, in answer to your question, much depends on the severity of injury. The cause of the injury is not as important as the consequences of the injury. Most people with transverse myelitis recover walking and other motor functions. However, many continue to have problems with spasticity and neuropathic pain, even though they may recover walking. Depending on the level of their injury, people with traumatic spinal cord injury may also require neuronal replacement. Both regeneration and neuronal replacement therapies will be necessary to restore function completely.

Wise.

[rdf]

Hi Wise, Merry Christmas.

Is it possible you might film the "lab tour" portion of the open house and make it availabe online? It's easily done. It'd be great for those of us on the west coast, or who live far away from N.J. I'd love to see the lab you work in.

If it's too much of a hassle, no biggie.

One more thing. Do you think the problems with pain meds recently in the news, and the tie-in with the FDA, will make it that much more longer before the FDA approves any drug/therapy for sci?
Thanks

\/

[Wise Young]

rdf, I don't think that the Vioxx situation will affect FDA policies. While there are many aspects of the FDA that I disagree with it, their safety policy is not one of them. They have had an incredible safety record in the past three decades and none of the information has changed my confidence in the agency. I hope that they do not use the excuse to slow down drug approvals in the United States.

Wise.

[lynnifer]

Excellent question and awesome reply Dr Young. Can't wait to see your exposition on Transverse Myelitis.

I have an extremely difficult time understanding it as well. Sometimes I go over my history that summer and fret about every little thing. Some kid punched me in the back - ironically right where my 'injury' is - in June of 1985, just before summer. I was paralyzed by the end of July. I'd hate to think that caused a bruising of some sort on my spinal cord - it was my darn cousin!

[perda-10]

Dear Dr. Wise,
I am from Europe and would like to come to "Open House". Could you give the precise adress,city etc. Where is the nearest airport?

Kind regards,

paraglider

[bigbob]

The nearest airport is in Newark, NJ. It is called Liberty International Airport and the airport code is EWR.
I do not know the exact location of the lab, but at least you can make your flight reservations. The ride from the airport to the lab should only take about 30 to 40 minutes. Another alternative if because of schedule or a better fare would be JFK international, it is about 50min to and hour and a half away depending on traffic.

[perda-10]

BigB, thank you very much. If I miss this one, is the next open house sheduled once again this year or is it usuallyonly once a year?

Kind Regards,

[Wise Young]

paraglider, I posted some directions... we hold Open Houses every month... usually the first Friday of every month. We occasionally change to a Wednesday because some people cannot make it on a Friday. I will announce the Open Houses on CareCure. Wise.

[bigbob]

Must have been a great open house-do you have any new info Dr. Young?

[rbk47]

When you have a world class researcher who says on one thread that methylprednisolone should not be a standard of care for TM and on another thread says with the routine use of steroids with TM many people with TM are walking you start to wonder. If one person didn't get steroids cause of that announcement thrown around by a prominent researcher, that would be a catastrophe, I wish someone had spoken up even more than bigbob did. But, can you do that here, without being called disrespectful, or a dissenter, or someone who needs anger management? Was the doctor more concerned about a flood of lawsuits against doctors that didn't administer the steroids in the proper time? At least he could have said it still is not a Standard of Care, but recommends its use as an option, just as the authority on TM says on the John Hopkins website. Dr. Young, in my opinion is sometimes more concerned with clearing doctors of wrong doing then making sure patients get the best possible treatment.

Based on so many anecdotal cases, you would think that the data is pretty strong that methylprednisolone should be given to all transverse myelitis cases. However, as more studies appeared, it became clear that the situation and data is not so simple. In 1999, Kalita, et al. did evoked potentials and found pronounced recovery associated with methylprednisolone treatment. But in 2001, the same authors (Kalita & Misra, 2001) published a study in the journal Spinal Cord, asking "Is methylprednisolone useful in acute transverse myelitis?" They examined 21 patients and compared 12 consecutive patients that did not receive the drug versus 9 that did. They found no beneficial effect of methylprednisolone.

Defresne, et al. (2001) studied 12 children with acute transverse myelitis treated with methylprednisolone, compared against 17 children (historical controls) that did not get the drug. They found that a significantly higher proportion of treated patients walked independently at 1 month and at 1 year, with no difference in complication rats between the two groups. However, Miyazawa, et al. (2003), however, reported in 2003 that age at onset and neruologic features were important for outcome prediction in acute transverse myelitis and that steroid therapy did not associate with better outcome. They reviewed the cases of 50 Japanese children who had acute transverse myelitis between 1987 and 2001.

This evidence base is not sufficient to justify methylprednisolone treatment as a "standard" of therapy of transverse myelitis. No randomized clinical trials were carried out. The few controlled trials based on historical comparisons suggest conflicting results. The problem is the difficulty and lack of funding of clinical trials to obtain reliable evidence of treatment efficacy. Without such data, the current trend for evidence-based medicine will shackle the ability of doctors to make decisions when evidence is incomplete and standards are not available. I hope that you agree with me that this is not a good situation. That is why I oppose the concept of strict adherence of medical practice to standards or practice guidelines. Please let good doctors be good doctors.

Wise.

Transverse myelitis is non-traumatic form of spinal cord injury that is probably caused by ischemia. The original cause of may be thrombosis due to vascular inflammation (resulting from auto-immune, infection, or other causes), embolization, or arteriovenous malformation. People with transverse myeltis often have widespread damage to both gray and white matter of the spinal cord. However, because the damage to the spinal cord is typically incomplete at any given level, a majority of people who get transverse myelitis will recover substantially, including walking. In recent years, especially with the routine use of early and high-dose methylprednisolone therapy, 50-70% of people who have had a severe episode of transverse myelitis will recover walking. Wise.

[rbk47]

I'm waiting for Dr. Youngs post to wiggle out of this one!