Abstract

Traumatic Spinal Cord Injury is a neurological condition characterized by partial or complete sensory/motor loss below the level of lesion. Definitive treatment directed towards repair, regeneration of the severed cord has not been established. The recovery of these patients is quite slow and in some cases it attains a plateau. Here we present a case report of a 23 year old male with traumatic quadriplegia at C6 level. He was administered autologous bone marrow mononuclear cells intrathecally, followed by intensive neurorehabilitation. Prior to this intervention, the patient was assessed on Functional Independence Measure (FIM) and other neurological assessments. He scored 58/126 on FIM and exhibited weakness on the left side and loss of sensations on the right. He was completely dependent on all his Activities of Daily Living (ADL’s) except for communication and social cognition. Six months post cellular therapy, there was improvement in the functional status with FIM score 76 /126. He improved in bed mobility, static and dynamic balance, transfers and ADL’s. He was able to walk with walker and AFO with push knee splint on left independently. His vocational status also improved. This case report contributes to the literature as one of the preliminary evidence suggesting that cell therapy along with neurorehabilitation may fasten the recovery processes in patients with traumatic spinal cord injuries. Read more...

Abstract

Spinal cord injury often results into severe neurological deficits. Currently, there is no treatment available which can reverse the damage. Cell transplantation is a novel treatment strategy which has shown promising results in animal models of spinal cord injury. We administered fifty six chronic cervical spinal cord injury patients with autologous bone marrow mononuclear cells, intrathecally. As a part of the protocol, all the patients also underwent rehabilitation along with cell transplantation. On a mean follow up of 2 years ± 1 month, symptoms such as trunk stability, sitting balance, trunk muscle strength, upper limb strength, standing balance, deep touch sensation, bladder sensation, spasticity and walking balance demonstrated improvements. On performing McNemars test, a significant association was found between the improvements in these symptoms and the intervention. The improvement in Functional Independence Measure (FIM) scores was statistically significant using Wilcoxon Signed Rank test. A detailed analysis of factors such as age, cause of injury, chronicity of injury and rehabilitation before the intervention was performed. Here, we also compare this chronic cervical SCI group with chronic thoracolumbar SCI patients of our previous study. Though functional improvements were observed at greater extent in chronic thoracolumbar SCI group, the results in chronic cervical SCI group were also significant. Cell transplantation may promote neurofunctional recovery and improve the quality of life of the patients with chronic cervical spinal cord injury. Read more...

Abstract

Spinal cord injury (SCI) at an early age can be debilitating for the child’s growth. Current treatments show a level of stagnancy, after which the recovery is minimal. Cellular therapy is an emerging area of research and has been found to possess many benefits in the previous studies. Transplantation of autologous bone marrow mononuclear cells (BMMNCs) has demonstrated therapeutic potential for many neurological conditions, including spinal cord injury. Here we report a case of 6-year-old girl with traumatic SCI at the level of C7-D1 4 years back, who underwent 2 doses of cell transplantation with autologous BMMNCs with an interval of 6 months along with standard rehabilitation. The patient did not have any major or minor side effects. The patient showed clinical improvements throughout the 6 months after transplantation, which was assessed using Functional Independence Measure (before: 82, after: 101 out of 126). There were patchy areas of sensory gain in bilateral feet recorded, with improvements in the bladder sensation and control. Improved gait was seen as a result of better strength in abdominals and back extensors. The fact that there was functional improvement in the chronic plateau phase indicates the potential of cell therapy in chronic SCI. Further clinical studies are warranted. Read more...

Abstract

Cell therapy is amongst the most promising treatment strategies in spinal cord injury (SCI) because it focuses on repair. There are many published animal studies and a few  human trials showing remarkable results with various cell types. The level of SCI determines  whether paraplegia or quadriplegia is present, and greatly influences recovery. The purpose of this study was to determine the significance of the clinical effects and long-term safety of intrathecal administration of autologous bone marrow-derived mononuclear cells, along with changes in functional independence and quality of life in patients with thoracolumbar SCI. We undertook a retrospective analysis of a clinical study in which a nonrandomized sample of 110 patients with thoracolumbar SCI underwent autologous bone marrow-derived mononuclear cell transplantation intrathecally and subsequent neurorehabilitation, with a mean follow-up of 2 years ± 1 month. Changes on any parameters  were recorded at follow-up. The data were analyzed using the Wilcoxon’s signed-rank test and McNemar’s test. Functional Independence Measure and American Spinal Injury Association (ASIA) scores were recorded, and a detailed neurological assessment was performed. Overall improvement was seen in 91% of patients, including reduction in spasticity, partial sensory recovery, and improvement in trunk control, postural hypotension, bladder management, mobility, activities of daily living, and functional independence. A significant association  of these symptomatic improvements with the cell therapy intervention was established by the  statistical analysis. Some patients showed a shift on the ASIA scale and changes in electrophysiological studies or functional magnetic resonance imaging. No major side effects were noted. In patients with thoracolumbar SCI, there were statistically significant beneficial  effects, both symptomatic and functional, from intrathecal autologous bone marrow-derived mononuclear cell therapy and rehabilitation. This was a safe and viable therapeutic option with no long-term side effects at 2 years. This analytical study is an early documentation of cell therapy, and can be used as a guide to devise larger more refined clinical trials. Read more...

Abstract

Spinal cord injury results in paralysis and loss of sensation below the level of injury. At present, there is no cure or effective treatment for spinal cord injury (SCI). Studies in SCI patients have shown that for a treatment to be effective it must primarily improve their quality of life. We report a case of incomplete spinal cord injury (L1-L2 compression fracture) with paraperesis, with approximately 6 months of follow-up who was administered bone marrow derived mononuclear cells (BMNCs) intrathecally. After the therapy, the patient had no side effects and underwent intensive neurorehabilitation. She showed some immediate improvements within a week and few improvements over a period of six months, which were quantified using Functional Independence Measure (FIM) and Manual Muscle Testing. The detailed case report is presented here with. Read more...

Abstract

Functional Magnetic Resonance Imaging (fMRI) is a non-invasive technique to monitor brain activity that provides detailed maps of the brain areas. A number of task-induced fMRI studies have demonstrated rearrangement of cortical activation patterns in the secondary brain areas in SCI patients. Chronic spinal cord injury (SCI) is a devastating disorder afflicting millions across the world. Cellular transplantation is one of the recent strategies to treat chronic complete SCI through its neuroregenerative and neurorestorative property. In this case we administered autologous bone marrow mononuclear cells intrathecally. The follow up assessment was conducted at three and seven months after the cellular therapy. Improvements in gross and fine motor activities, ambulation, bed mobilities, transfers, gait and bladder management were noted over a period of 7 months after the intervention. Spinal Cord Independence Measure (SCIM) improved from 27 to 64/100 and Functional Improvement Measure (FIM) improved from 64 to 83 within seven months of cellular therapy. fMRI showed activation of multiple regions in the sensory and associated areas which was not seen prior to the cellular therapy. No adverse events were reported post cellular therapy. This case study suggests clinical benefits of cellular therapy with multidisciplinary neurorehabilitation especially in chronic SCI. We recommend that its effectiveness should be established in a more comprehensive randomised controlled study for chronic SCI. Read more...

Abstract

Spinal cord injury (SCI) in the pediatric population is a rare incidence and has devastating consequences. Cellular transplantation is one of the emerging strategies in the treatment of SCI. Here, we present a case report of an 8-year-old female who sustained traumatic incomplete SCI at the level of D10-D11 four years ago. Two years after the accident, she underwent 2 doses of cell transplantation with autologous bone marrow mononuclear stem cells (BMMNCs) administered intrathecally (injection into the sub-arachnoid space), followed by intensive neuro-rehabilitation. Over the span of 18 months’ post -cellular therapy, there was improvement in the functional status with FIM (Functional Independence Measure) score improving from 108 to 113. She improved in transfer mobility, static and dynamic balance in sitting and standing positions, ambulation and activities of daily living (ADLs). The bowel and bladder control improvement was significant. There was a shift from A to B on the American Spinal Injury Association (ASIA) scale. Spinal Cord Independence Measure (SCIM) score increased from 73 to 96 after the two cellular therapies. No adverse events related to the transplantation procedure were observed. This case is a “proof of concept study” based on the fact that transplantation of autologous bone marrow mononuclear cells along with rehabilitation may augment the recovery processes in patients with chronic traumatic spinal cord injuries. Further, randomized controlled clinical studies are warranted to prove it’s the therapeutic efficiency. Read more...

Abstract

Often spinal cord injury is more frequent in younger age groups. Mostly they result from damage caused by traumatic events such as motor vehicle accidents, falls, or gunshot wounds. The physical, personal, financial and social impact of injury is such that most patients are lost in follow ups or succumb to life-threatening complications associated with spinal cord injury.Thus, Spinal cord injury is a low incidence, high costing disability requiring tremendous changes in an individual's lifestyle. Here presented is a case of a 22 year old girl who had suffered spine injury due to a road traffic accident 3 years back. She was given Neuroregenerative Rehabilitation Therapy (NRRT) using autologous bone marrow derived mononucleocytes. Detailed report of her evaluations and therapy is discussed further. Read more...