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    #46
    Originally posted by Wise Young
    Nonetheless, it is progress. Why denigrate it? A lot more people are walking after spinal cord injury. Incomplete spinal cord injuries now are over 60% of the newly injured. So, a majority of the people with spinal cord injury are recovering walking. This happened in the past decade.

    While I too believe that a nocebo effect may have contributed, it is also true that intensive locomotor training, exercise, and functional electrical stimulation have contributed as well. I don't know about methylprednisolone but basically, it restored 20% more function.

    Wise.
    Where did I denigrate it? It seems everything that is posted these days turns into some type of political argument, perhaps I have been designated as one of the undesirables on this site.
    For the record I just think that it cannot be compared to the medical advances made for various types of cancer.

    Comment


      #47
      Originally posted by IanTPoulter
      Where did I denigrate it? It seems everything that is posted these days turns into some type of political argument, perhaps I have been designated as one of the undesirables on this site.
      For the record I just think that it cannot be compared to the medical advances made for various types of cancer.
      Ian, come on. There is no politics meant. You are being over-sensitive.

      I don't think that you intend to denigrate but you were nevertheless be-littling the significance of a big advance in the spinal cord injury field and continue to do so.

      If 90% of people with a certain type of cancer all of a sudden recovered from the cancer, compared to only 45% twenty years ago, whatever the reason, everybody would be cheering it as a major advance. This is essentially the advance that has occurred with recovery of people from spinal cord injury. Twenty years ago, 45% of people with incomplete spoinal cord injury walked and now 90% are walking.

      So, why do you say that "it cannot be compared to medical advances made from various types of cancer".

      Wise.

      Comment


        #48
        Originally posted by Wise Young
        Ian, come on. There is no politics meant. You are being over-sensitive.

        I don't think that you intend to denigrate but you were nevertheless be-littling the significance of a big advance in the spinal cord injury field and continue to do so.

        If 90% of people with a certain type of cancer all of a sudden recovered from the cancer, compared to only 45% twenty years ago, whatever the reason, everybody would be cheering it as a major advance. This is essentially the advance that has occurred with recovery of people from spinal cord injury. Twenty years ago, 45% of people with incomplete spoinal cord injury walked and now 90% are walking.

        So, why do you say that "it cannot be compared to medical advances made from various types of cancer".

        Wise.
        Anything I say now will result in animosity so I wont.

        Comment


          #49
          Originally posted by Wise Young
          Ian, come on. There is no politics meant. You are being over-sensitive.

          I don't think that you intend to denigrate but you were nevertheless be-littling the significance of a big advance in the spinal cord injury field and continue to do so.

          If 90% of people with a certain type of cancer all of a sudden recovered from the cancer, compared to only 45% twenty years ago, whatever the reason, everybody would be cheering it as a major advance. This is essentially the advance that has occurred with recovery of people from spinal cord injury. Twenty years ago, 45% of people with incomplete spoinal cord injury walked and now 90% are walking.

          So, why do you say that "it cannot be compared to medical advances made from various types of cancer".

          Wise.
          I neither denigrated nor belittled. To be quite honest I think you got your defensive medical hackles up. None of those things you mentioned are a cure for sci and the statistics you quote are debatable. Is it progress, yes and I dont deny this. Is any of this a cure? No. The prescription for sci as far as conventional medical practise goes is still a wheelchair. This can not be compared to cancer imo because if a person has cancer thay can seek and be prescribed conventional medical treatment with in many cases the possibility of a cure.
          This does not mean I am pessimistic about yourself or others finding a cure where a cure may be defined as a treatment that provides enough functional return that a person may regain b/b, ambulation and sexual function.

          Comment


            #50
            Originally posted by IanTPoulter
            I neither denigrated nor belittled. To be quite honest I think you got your defensive medical hackles up. None of those things you mentioned are a cure for sci and the statistics you quote are debatable. Is it progress, yes and I dont deny this. Is any of this a cure? No. The prescription for sci as far as conventional medical practise goes is still a wheelchair. This can not be compared to cancer imo because if a person has cancer thay can seek and be prescribed conventional medical treatment with in many cases the possibility of a cure.
            This does not mean I am pessimistic about yourself or others finding a cure where a cure may be defined as a treatment that provides enough functional return that a person may regain b/b, ambulation and sexual function.
            Ian,

            I don't think my medical hackles are up at all. Many people (not just you), including doctors, don't give the spinal cord injury field enough credit for progress. Worse, because doctors don't know the progress in the field, they are giving patients false information and the patients are not getting the best information for deciding their treatments. After 20 years of interacting with people with spinal cord injury and working in a neurosurgery department at Bellevue Hospital, I can speak from first hand experience that major therapeutic advances are not adopted by the doctors and not recognized by people in the community. Let me give you just two examples.

            In 1985, McAffee, Bohlman, and Yuan published a landmark paper in which they decompressed 70 patients with “incomplete” injury secondary to a thoracolumbar fracture, often as late as 3 months after injury. They followed 48 of these patients for an average of 3.4 years. 37 of 42 patients with motor deficits showed a significant improvement in their motor function. 14 of 32 who were unable to walk before the surgery regained full independent walking ability. 12 of these 32 patients recovered bladder and bowel recovery. They concluded that decompression has a favorable effect on neurological function. Despite this remarkable 1985 study showing that surgical decompression can restore independent locomotion in as many as 43% of the patients, surgical decompression has not been adopted as a standard of care in all parts of the country and many patients still have cord compression.

            In 1990, the second National Acute Spinal Cord Injury Study (NASCIS 2) showed that a 24-hour course of high-dose methylprednisolone significantly improved motor and sensory scores by at average of 20% compared to people treated with placebo, but only when it was given within 8 hours after injury. In a followup study (NASCIS 3), the group showed that people treated between 3-8 hours after injury with a 48 hour course of methylprednisolone had significantly better neurological scores than those treated with a 24-hour course. There was no difference between the 24- and 48-hour course in patients treated with 3 hours. NASCIS recommended treating patients with the 24-hour course of methylprednisolone if they can be treated within 3 hours and the 48-hour course if they are treated between 3-8 hours. The drug is cheap and had no significant side-effects. Despite the NASCIS 2 study published in the New England Journal of Medicine, less than 50% of Americans who were spinal-injured between 1990-1993 received the drug. There are still places in Canada and the United States where a person with spinal cord injury will not receive methylprednisolone.

            You would think that these two therapies would have been embraced by the doctors who have few other therapies to apply to their patients. In the past decade, several neurosurgical societies in the United States and Canada issued recommendations saying that methylprednisolone is an optional treatemnt for spinal cord injury and not a standard of care. These recommendations cite retrospective studies and one small randomized French clinical trial that was too underpowered to detect any effect of methylprednisolone and did not segregate complete and incomplete injuries or the timing of therapies for their analyses. The strange thing is that the doctors who say they are not convinced by NASCIS or beleive that a 20% improvement in motor and sensory scores is not “functionally significant”, would not hesitate to give therapies that have never been tested in randomized clinical trials.

            Walking Recovery in Incompletes

            In 1979, Fred Maynard published a landmark article in the Journal of Neurosurgery, reporting that only 8% of people with ASIA A recovered walking compared to 87% of people with “incomplete” spinal cord injury. Despite this publication in the premier neurosurgical journal, neurosurgeons were so pessimistic in those days that they did not decompress the spinal cord, particularly in people with so-called “complete” spinal cord injury because they did not think that there would be any recovery. In the 1970's and 1980's, I use to argue with my colleagues that we should decompress people, especially if they were “complete”, because we might have a chance to make them incomplete. Despite the 1979 Maynard study, for the last 30 years, most doctors told even incomplete spinal-injured patients that they were unlikely to recover walking.

            In 1997, I was a member of the National Advisory Board for Medical Rehabilitation Research at NIH that recommended that the National Center for Medical Rehabilitation Research fund a clinical trial to assess weight-supported ambulation training. At that time, most doctors were still quite pessimistic about the prospect of locomotor recovery after spinal cord injury and there had been a study from Germany (see Wernig, 2000) indicating that weight-supported treadmill locomotor training restored locomotion in over 50% of people who had never walked even years after spinal cord injury. In 1998, NIH issued a request for proposal and funded Bruce Dobkin from UCLA and a consortium of spinal cord injury centers to carry out the study starting in 1999.

            Several studies in mid 1990's had suggested less than 50% incidence of walking recovery in patients with incomplete spinal cord injury. In 1996, Helweg-Larsen did a prospective study of 153 patients who were paralyzed by tumor compression of the spinal cord, finding that 12 of the 74 non-walking patients recovered walking. In 1996, Waters, et al. studied 19 subjects with motor incomplete lesions from cervical spondylosis. At one year followup, 12 of the 19 (63%) were unable to walk. However, in 1997, Burns, et al. reported that 91% (30/33) of patients with ASIA C younger than 50 years became ambulatory by the time they were discharged from the hospital, compared to 42% (13/31) of ASIA C patients older than 50, and 100% (41/41) of patients with ASIA D.

            Dobkin, et al. designed a study to compare weight-supported treadmill and over-ground ambulation training after acute incomplete spinal cord injury. They studied 146 subjects that were ASIA B, C, or D after injury. In 2006, Dobkin, et al. reported that 35% of ASIA B, 92%of ASIA C, and 100% of ASIA D patients recovered independent locomotion by the end of a year. There was no difference between weight-supported treadmill trained or overground walking trained subjects. The control results came as a surprise to the group who had expected only 45% of patients with incomplete spinal cord injury to recover locomotion, based on an analysis of the Model Systems SCI Database.

            Do you think that doctors are now telling patients this data? How many people here were told shortly after injury that if they were ASIA B, they had a 35% chance of recovering independent locomotion or that if they had an ASIA C, they had a 92% chance of walking? Based on the comments from people posting on New SCI, I am not sure that most doctors are giving patients this information even now. In fact, this information has been known since the Maynard study in 1979 but the dogma that spinal-injured patients rarely recover walking is so strong that most doctors in the field either don't know or are not telling patients with incomplete injuries that they have >90% chance of recovering walking.

            Scientists parrot the clinical dogma. Many spinal cord injury scientists have never met, much less examined, a person with spinal cord injury. For the past 15 years, over 60% of spinal cord injuries in the United States have been incomplete. If >90% of people with incomplete spinal cord injury recover walking, isn't it fair and accurate to say that recovery of walking is the rule and not the exception after spinal cord injury. But, how many scientists or clinicians say this? Most research articles on spinal cord injury start with the statement that people do not recover from spinal cord injury, or something to this effect. Even clinicians who know better often parrot the dogma to patients. And, of course, we hear it from patients.

            Reference
            1. Maynard FM, Reynolds GG, Fountain S, Wilmot C and Hamilton R (1979). Neurological prognosis after traumatic quadriplegia. Three-year experience of California Regional Spinal Cord Injury Care System. J Neurosurg 50: 611-6. Between January, 1974, and December, 1976, 123 patients with traumatic quadriplegia were admitted to the California Regional Spinal Cord Injury Care System. The spinal cord injury resulted from gunshot wounds in five, from a stab wound in one, from neck injuries with no bone damage seen on x-ray studies in 10, and from fracture dislocations of the cervical spine in 107. One-year following-up information was available on 114 patients. Neurological impairment using the Frankel classification system was compared at 72 hours postinjury to the 1-year follow-up examination. Fifty of 62 patients with complete injury at 72 hours were unchanged at 1 year. Five of these 62 patients had developed motor useful function in the legs or became ambulatory by 1 year, but all had sustained serious head injuries at the time of their trauma making initial neurological assessment unreliable. Ten percent of all cases had combined head injury impairing consciousness. Among 103 cognitively intact patients, none with complete injury at 72 hours were walking at 1 year. Of patients with sensory incomplete functions at 72 hours postinjury, 47% were walking at 1 year; 87% of patients with motor incomplete function at 72 hours postinjury were walking at 1 year. Spinal surgery during the first 4 weeks postinjury did not improve neurological recovery. A method of analyzing neurological and functional outcomes of spinal cork injury is presented in order to more accurately evaluate the results of future treatment protocols for acute spinal injury. http://www.ncbi.nlm.nih.gov/entrez/q...st_uids=430155
            2. McAfee PC, Bohlman HH and Yuan HA (1985). Anterior decompression of traumatic thoracolumbar fractures with incomplete neurological deficit using a retroperitoneal approach. J Bone Joint Surg Am 67: 89-104. Between 1973 and 1981, seventy patients with a spinal cord injury secondary to a thoracolumbar fracture were treated by anterior spinal-canal decompression through a retroperitoneal approach. All of these patients had an incomplete neurological deficit caused by retropulsed vertebral-body fragments and intervertebral disc material in the spinal canal. Forty-eight patients have been followed for an average of 3.4 years (range, two to 8.6 years). Either computed tomography or lateral tomography, or both, was performed after surgery on these forty-eight patients, and confirmed the successful removal of the cause of compression in all of them. No patient lost further cord or cauda equina function after the anterior decompression. Thirty-seven of the forty-two patients who had a motor deficit improved by at least one class in motor strength. Fourteen of the thirty patients whose quadriceps and hamstrings were too weak to permit walking regained full independent walking ability. Twelve of the thirty-two patients who had a conus medullaris injury demonstrated neurogenic bowel and bladder recovery. The degree of neurological recovery of spinal cord injury after anterior spinal decompression of thoracolumbar fractures appears more favorable than after other, previously reported techniques that do not decompress the spinal canal. http://www.ncbi.nlm.nih.gov/entrez/q...t_uids=3881448
            3. Helweg-Larsen S (1996). Clinical outcome in metastatic spinal cord compression. A prospective study of 153 patients. Acta Neurol Scand 94: 269-75. BACKGROUND: Despite many reports on metastatic spinal cord compression, only very few prospective studies of the clinical outcome of spinal cord compression have been carried out. METHODS: 153 consecutive patients with a known malignant solid tumor and a myelographically verified diagnosis of spinal cord compression were followed with regular neurological examination. RESULTS: At time of diagnosis 79 patients were walking, while the remaining were bedridden. In total 21 of the 74 initially non-walking patients began walking after therapy. There was a need for urinary catheter in 57 (37%) patients at the time of diagnosis. During follow-up, 10 of 57 patients (18%) dispensed with the catheter. A total of 116 patients experienced radicular pain at the time of diagnosis, while in 95 of 116 patients (83%) the pain disappeared after therapy. CONCLUSION: the present study confirms, that early diagnosis, i.e., while the patients are still ambulatory, is most important, but the prognosis for recovery of ambulatory function is not as pessimistic as earlier described. In addition the results indicate that supplementary systemic therapy, when available, may have a positive influence on recovery. Department of Neurology, Rigshospitalet, Copenhagen, Denmark. http://www.ncbi.nlm.nih.gov/entrez/q...t_uids=8937539
            4. Waters RL, Adkins RH, Sie IH and Yakura JS (1996). Motor recovery following spinal cord injury associated with cervical spondylosis: a collaborative study. Spinal Cord 34: 711-5. A prospective multicenter study was conducted within the National Model Spinal Cord Injury System program to examine neurological deficits and recovery patterns following spinal cord injury (SCI) in individuals with cervical spondylosis and without a spinal fracture. Nineteen patients were evaluated. Sixty-eight percent presented initially with motor incomplete lesions. Of those who presented with motor incomplete injuries at their initial examination, 69 percent had less deficit in the lower than in the upper extremities, indicative of a central cord syndrome. At follow-up, 12 subjects were unable to ambulate, four required assistance and three were able to ambulate independently. On the average, subjects doubled their initial Asia Motor Score (AMS) scores by one year following injury. Residual upper extremity weakness, however, limited the ability to ambulate. Recovery of motor strength in this group is comparable to that of individuals with incomplete tetraplegia in general but the proportion who regain ambulatory function is less. Rancho Los Amigos Medical Center, Downey, California 90242, USA. http://www.ncbi.nlm.nih.gov/entrez/q...t_uids=8961427
            5. Wernig A, Nanassy A and Muller S (2000). Laufband (LB) therapy in spinal cord lesioned persons. Prog Brain Res 128: 89-97. Department of Physiology, University of Bonn, Germany. wernig@physio.uni-bonn.de http://www.ncbi.nlm.nih.gov/entrez/q..._uids=11105671
            6. Burns SP, Golding DG, Rolle WA, Jr., Graziani V and Ditunno JF, Jr. (1997). Recovery of ambulation in motor-incomplete tetraplegia. Arch Phys Med Rehabil 78: 1169-72. OBJECTIVE: To determine the effect of age and initial neurologic status on recovery of ambulation in patients with motor-incomplete tetraplegia. STUDY DESIGN: Inception cohort study. SETTING: Urban, tertiary care hospital with Regional Spinal Cord Injury Center. PATIENTS: One hundred five patients with American Spinal Injury Association (ASIA) C or D tetraplegia at admission or within 72 hours of injury. MAIN OUTCOME MEASURE: Ambulatory status at time of discharge from inpatient rehabilitation. RESULTS: Ninety-one percent (30/33) of ASIA C patients younger than 50 years of age became ambulatory by discharge, versus 42% (13/31) ASIA C patients age 50 or older (p < .0001). All (41/41) patients initially classified as ASIA D became ambulatory by discharge. CONCLUSION: For patients with ASIA D tetraplegia, prognosis for recovery of independent ambulation is excellent. For patients with ASIA C tetraplegia, recovery of ambulation is significantly less likely if age is 50 years or older. Department of Rehabilitation Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, USA. http://www.ncbi.nlm.nih.gov/entrez/q...t_uids=9365343
            7. Dobkin B, Apple D, Barbeau H, Basso M, Behrman A, Deforge D, Ditunno J, Dudley G, Elashoff R, Fugate L, Harkema S, Saulino M and Scott M (2006). Weight-supported treadmill vs over-ground training for walking after acute incomplete SCI. Neurology 66: 484-93. OBJECTIVE: To compare the efficacy of step training with body weight support on a treadmill (BWSTT) with over-ground practice to the efficacy of a defined over-ground mobility therapy (CONT) in patients with incomplete spinal cord injury (SCI) admitted for inpatient rehabilitation. METHODS: A total of 146 subjects from six regional centers within 8 weeks of SCI were entered in a single-blinded, multicenter, randomized clinical trial (MRCT). Subjects were graded on the American Spinal Injury Association Impairment Scale (ASIA) as B, C, or D with levels from C5 to L3 and had a Functional Independence Measure for locomotion (FIM-L) score < 4. They received 12 weeks of equal time of BWSTT or CONT. Primary outcomes were FIM-L for ASIA B and C subjects and walking speed for ASIA C and D subjects 6 months after SCI. RESULTS: No significant differences were found at entry between treatment groups or at 6 months for FIM-L (n = 108) or walking speed and distance (n = 72). In the upper motor neuron (UMN) subjects, 35% of ASIA B, 92% of ASIA C, and all ASIA D subjects walked independently. Velocities for UMN ASIA C and D subjects were not significantly different for BWSTT (1.1 +/- 0.6 m/s, n = 30) and CONT (1.1 +/- 0.7, n = 25) groups. CONCLUSIONS: The physical therapy strategies of body weight support on a treadmill and defined overground mobility therapy did not produce different outcomes. This finding was partly due to the unexpectedly high percentage of American Spinal Injury Association C subjects who achieved functional walking speeds, irrespective of treatment. The results provide new insight into disability after incomplete spinal cord injury and affirm the importance of the multicenter, randomized clinical trial to test rehabilitation strategies. Department of Neurology, University of California Los Angeles, Neurologic Rehabilitation and Research Program, Reed Neurologic Research Center, Los Angeles, CA 90095, USA. bdobkin@mednet.ucla.edu http://www.ncbi.nlm.nih.gov/entrez/q..._uids=16505299
            8. Dobkin B, Barbeau H, Deforge D, Ditunno J, Elashoff R, Apple D, Basso M, Behrman A, Harkema S, Saulino M and Scott M (2007). The evolution of walking-related outcomes over the first 12 weeks of rehabilitation for incomplete traumatic spinal cord injury: the multicenter randomized Spinal Cord Injury Locomotor Trial. Neurorehabil Neural Repair 21: 25-35. BACKGROUND: The Spinal Cord Injury Locomotor Trial (SCILT) compared 12 weeks of step training with body weight support on a treadmill (BWSTT) that included overground practice to a defined but more conventional overground mobility intervention (CONT) in patients with incomplete traumatic SCI within 8 weeks of onset. No previous studies have reported walking-related outcomes during rehabilitation. METHODS: This single-blinded, randomized trial entered 107 American Spinal Injury Association (ASIA) C and D patients and 38 ASIA B patients with lesions between C5 and L3 who were unable to walk on admission for rehabilitation. The Functional Independence Measure (FIM-L) for walking, 15-m walking speed, and lower extremity motor score (LEMS) were collected every 2 weeks. RESULTS: No significant differences were found at entry and during the treatment phase (12-week mean FIM-L = 5, velocity = 0.8 m/s, LEMS = 35, distance walked in 6 min = 250 m). Combining the 2 arms, a FIM-L >or= 4 was achieved in < 10% of ASIA B patients, 92% of ASIA C patients, and all of ASIA D patients. Walking speed of >or= 0.6 m/s correlated with a LEMS near 40 or higher. CONCLUSIONS: Few ASIA B and most ASIA C and D patients achieved functional walking ability by the end of 12 weeks of BWSTT and CONT, consistent with the primary outcome data at 6 months. Walking-related measures assessed at 2-week intervals reveal that time after SCI is an important variable for entering patients into a trial with mobility outcomes. By about 6 weeks after entry, most patients who will recover have improved their FIM-L to >3 and are improving in walking speed. Future trials may reduce the number needed to treat by entering patients with FIM-L < 4 at > 8 weeks after onset if still graded ASIA B and at > 12 weeks if still ASIA C. Department of Neurology, University of California Los Angeles, Los Angeles, CA 90095, USA. bdobkin@mednet.ucla.edu http://www.ncbi.nlm.nih.gov/entrez/q..._uids=17172551
            Last edited by Wise Young; 22 Jul 2007, 2:41 PM.

            Comment


              #51
              The question still is.....How much longer???
              T6 complete (or so I think), SCI since September 21, 2003

              Comment


                #52
                Originally posted by paramoto
                The question still is.....How much longer???
                the answer...until the scientists will find one.when?is hard to predict,but never say never.
                einstein from transylvania[adi].

                Comment


                  #53
                  Do you think that doctors are now telling patients this data? How many people here were told shortly after injury that if they were ASIA B, they had a 35% chance of recovering independent locomotion or that if they had an ASIA C, they had a 92% chance of walking? Based on the comments from people posting on New SCI, I am not sure that most doctors are giving patients this information even now. In fact, this information has been known since the Maynard study in 1979 but the dogma that spinal-injured patients rarely recover walking is so strong that most doctors in the field either don't know or are not telling patients with incomplete injuries that they have >90% chance of recovering walking.

                  Scientists parrot the clinical dogma. Many spinal cord injury scientists have never met, much less examined, a person with spinal cord injury. For the past 15 years, over 60% of spinal cord injuries in the United States have been incomplete. If >90% of people with incomplete spinal cord injury recover walking, isn't it fair and accurate to say that recovery of walking is the rule and not the exception after spinal cord injury. But, how many scientists or clinicians say this? Most research articles on spinal cord injury start with the statement that people do not recover from spinal cord injury, or something to this effect. Even clinicians who know better often parrot the dogma to patients. And, of course, we hear it from patients.
                  That deserves reiteration...

                  Comment


                    #54
                    if i could regain bladder and bowel [as a first step]i will be more than happy to wait few more years to walk again.ahhhh i forget...the neuropain [spasms] to be gone.haleluya .....

                    Comment


                      #55
                      Originally posted by Keith
                      We keep on talking about stem cells, cord blood, all the money going into private funding, clinical trials going on, lots of things happening. When are we going to hear the magic words that they can repair sci??? And getting to be too much like work to stay in shape & expensive. Well any positive thoughts would be appreciated.

                      keith I found this article which it might give you an idea why it takes so long for the cure. See what doctors have to face.


                      Stem Cell Promise, Interrupted: How Long Do US Researchers Have to Wait?

                      The summer of 2006 was a heady time for neurologist Douglas Kerr. As Director of the Johns Hopkins Transverse Myelitis Center in Maryland, Kerr studies the mechanisms of neurodegenerative diseases in the hope of developing therapies to treat them. He sees patients with transverse myelitis, amyotrophic lateral sclerosis, and spinal muscular atrophy (SMA), an inherited disorder that in its most severe form renders newborns limp and “floppy,” unable to suck, swallow, or breathe. Kerr's voice tightens as he describes the fate of these babies, many of whom will die before their second birthday. He's convinced that embryonic stem cells will one day help people with progressive, motor-neuron-destroying disorders recover control of their movements, and their lives.
                      For six long years, Kerr's team pursued the elusive elixir that would restore mobility to the paralyzed adult rats he uses to model neurodegeneration in humans. The researchers had cleared two major technical hurdles early on: they managed to derive spinal motor neurons from mouse embryonic stem cells in sufficient numbers to transplant in the rats' spinal cords, and they ensured the transplanted neurons' survival. But they struggled for years to prod the spinal motor neurons to send their axons out of the spinal cord and form functional neuromuscular junctions with the lame muscle.

                      Finally, in 2005, they hit the mark. Growth factors injected into the spinal cord induced the transplanted motor neurons to form connections with resident neurons. A second set of growth factors overcame inhibitors in myelin (the protective sheath around nerves that blocks axon growth in adult animals), allowing the motor neurons to send their axons out of the spinal cord toward skeletal muscle. And yet another growth factor injected into the muscle stimulated functional connections between the neurons and muscle. Kerr watched his rats—immobilized with a motor-neuron-destroying virus—move hind limbs that had been paralyzed for nearly four months. (Watch before and after videos of the rats on the Johns Hopkins Web site, http://www.hopkinsmedicine.org/Press...ousevideo.html.)

                      When Kerr and his colleagues reported their results in the June 2006 online version of Annals of Neurology, the work was widely hailed as the first evidence that stem-cell-based therapy could recapitulate early developmental signals and rewire a damaged neural circuit. Elias Zerhouni, Director of the US National Institutes of Health (NIH), which funded part of the research, called the work a “remarkable advance” demonstrating the power of stem cells to treat neurodegenerative diseases. All those years of frustration had finally paid off. But would the technique work in humans?

                      To find out, Kerr must use motor neurons derived from human embryonic stem cells (hESCs) and show that they can establish functional connections with skeletal muscle over the longer distances found in a larger animal. (He's settled on pigs.) He must also show that the treatments are safe. If the pig experiments generate the necessary safety and efficacy data, he will submit his results to the US Food and Drug Administration, seeking approval for a clinical trial to use the hESC-derived motor neurons in babies with fatal SMA.

                      Kerr chose babies with SMA for the first clinical trials, he explains, because infants have less myelin to inhibit axon growth, so the chance of re-innervation is greater. Their neurons need travel just a short distance compared to adults, and the developmental cues that guide axon growth toward their appropriate targets are still in place. And because no treatment or cure exists for these babies, an experimental treatment represents their only hope. Kerr had planned to use federally approved hESCs until he found out that the federal lines could not reliably yield motor neurons with anywhere near the efficiency of newer lines generated with private funds. (In the rat experiments, each animal had 60,000 motor neurons transplanted into their spinal cord.)

                      more:

                      http://www.pubmedcentral.nih.gov/art...?artid=1769442

                      Comment


                        #56
                        Originally posted by manouli
                        keith I found this article which it might give you an idea why it takes so long for the cure. See what doctors have to face.

                        Stem Cell Promise, Interrupted: How Long Do US Researchers Have to Wait?

                        http://www.pubmedcentral.nih.gov/art...?artid=1769442
                        Further down the morality conumdrum....ESC to save infants. Good article!

                        Comment


                          #57
                          No one thinks 'how much longer' is dependent upon how we demand the need?

                          My latest venture is still trying to get the Ontarian government to donate millions+ to the Rick Hansen Foundation. Last year, in Ontario alone, our government sent 471 overweight patients to the US for bariatric surgery (completely preventable). How much did that cost the taxpayers? $21,000,000!

                          None of that could have been used more wisely? Pah-leese.

                          Gotta find the loopholes and call them on it.
                          Roses are red. Tacos are enjoyable. Don't blame immigrants, because you're unemployable.

                          T-11 Flaccid Paraplegic due to TM July 1985 @ age 12

                          Comment


                            #58
                            Originally posted by Schmeky
                            Dann21,

                            Your comments are poignant and hit at the heart and soul of many with SCI. You are perceptive and wise beyond your years. I have the utmost respect for anyone working to reverse paralysis, but no one able bodied can relate to watching the clock on the wall ticking, seeing everyone around you living their lives, and feeling the emptiness of missing out on the many joys of life others take for granted.

                            Like you, I have watched the "time lines" for cures come and go. Like you, I feel the next generation will probably not have to endure the imprisonment of the body and soul as we now know it.

                            I truly wish you could at least recover to a paraplegic level in your lifetime.
                            Thanks for your kind words. A cure for me is not normalcy like preinjury, but just enough to give me what I need in order to take care of myself and be dependent. It sucks knowing that you're going to live a life like this... day to day.

                            Comment


                              #59
                              Originally posted by Wise Young
                              Several studies suggest that 90% of people with incomplete spinal cord injuries are able to recover walking. Only 45% of such people walked in the 1980's.

                              Wise.
                              I'm a complete injury. Do you know what the percentages are of complete spinal cord injuries are able to recover walking versus now and then?

                              Comment


                                #60
                                And now I know why I don't do many postings, and I always open a big can of worms. I believe they do have all the pieces of the puzzle to repair sci, it's just trying to get them in the right order or fit in the right place. We need to demand more. Funding clinical trials. Having a C3 complete injury sucks. I was lucky enough to have that steroid and 96 they saved because of that I came off a ventilator. And I still want everything back to work in my body again. It's getting way too expensive. $90,000 a year. It would be cheaper and five was a para, but I want to complete repair of my injury. Still awaiting as usual. My general practitioner tells me to forget about it. Don't know what to believe. I would pay $500,000 easy to get out of this wheelchair. Oh well it's like sand going through an hourglass, these are the days of our lives.
                                Tomorrow is another day, and I will be here reading again still looking for those magic words. Repair for sci
                                keiffer66

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