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Case Analysis : Stem Cell Therapy for Brain Injury

by Drs.Like Wu, Xiaojuan Wang and Bo Cheng

Introduction:

The morbidity and severity of brain trauma are both on the top of the list in many kinds of nervous system diseases. According to the American Association of Trauma statistics, there are about 500,000 people admitted to a hospital suffering from craniocerebral trauma every year, 75000-90000 of them die, and most of patients are healthy young people who were left with a permanent disability.

Definition
Sequelae of traumatic brain injury (sTBI) is a group of long-standing motor nerve dysfunctions and imbalance of the autonomic nervous system function or mental symptoms which are caused by nervous necrosis, loss or/and disorder after convalescence. Symptoms include: paralysis, sensory attention disorder, headache, irritability, neuroticism, concentration, memory barriers, obstacles, insomnia, dizziness etc. There are no new focuses and progressing abnormalities that could be found in the neurologic check and in the neuro-radiological examinations. If this group of symptoms persist and have not improved after 3 months then they become the sTBI.

Type
All of the below can cause sequelae; basal skull fracture, brain contusion, intracranial hematoma, subdural or epidural hematoma, an injury of the cranial nerve, carotid cavernous fistula, pneumocephalus emphysema and rhinorrhea, concussion of the brain and so on.

Pathological changes of brain trauma
Besides brain contusion, extradural, subdural, subarachnoid and intracerebral hemorrhage, most of the brain trauma may cause tissue edema and vasogenic edema and have an infarction zone as well. This is a result in vasospasm which is caused by subarachnoid hemorrhage around the basal vascular. Above pathological changes are the source of the neural cell apoptosis and necrosis and the loss of the nerve cells are basic of persistent disability.

Symptoms of sequelae of traumatic brain injury
Symptoms of Persistent disability: movement disorders (paralysis), sensory disorder, aphasia, balance disorder, ataxia, epilepsy, dementia and so on. Classification: awake patients; soon restored patients (headache and dizziness after mild head trauma); delayed syncope after head trauma; sleepiness; headache and trance; dementia; temporary traumatic paraplegia, blindness and migraine; traumatic permanent paralysis, delayed paralysis; persistent coma; post-traumatic epilepsy and psychiatric disorders, post-traumatic extrapyramidal and cerebellar disease; Boxing - drunk encephalopathy (boxer dementia), post-traumatic hydrocephalus; cognitive and psychiatric disorder after trauma etc; all of above may cause persistent symptoms.

Treatment
Many factors affect treatment of the sTBI. It is generally thought that the longer time dysfunction persists and/or the age older the possibility of recovery becomes smaller. Only the correct treatment can ease the patients' suffering. The newest definition of disease recovered from WHO is:"The most fundamental way to treat sTBI is to repair the cells, improve the cell metabolism, and activate the cell function."

Our research found that the neural stem cell implantation that treats sTBI have good treatment outcome, and the stem cells can start the repair process again (brain tissue repair time window was closed in sequela period), increased the number of effective neural cells, improved movement sensation, spiritual intelligence of patients, improved life quality and prevented delayed neural degeneration.

Following medical development, people realize that the cells are the foundation and guarantee of life; healthy cells are the foundation of a healthy body. "Stem cells implantation" is a hot topic for the medical area, "The new discovery of stem cell research" is Top 1 in the "The world achievements of Science TOP 10, 1999". As far as we know, besides good treatment outcomes in leukemia, diabetes and in tumors, stem cell implantation gradually attracts people's attention in brain areas which can treat sTBI and sequelae of stroke.

The neural stem cell implantation that treats sTBI has a good outcome because the neurons and glial cells, which differentiate from stem cells, can secrete many kinds of neurotrophic factors to improve microenvironment of brain and start sequential expression of regeneration genes, damaged axonal re-growth again. Meanwhile, they produce a variety of extracellular matrix; fill the cavity left from the brain injury, provide support for the regeneration of axons; supplement the neurons and glial cells which are lost after injury. Then the remaining demyelination nerve fibers and newborn nerve fibers form a new medullary sheath; maintaining a completeness of nerve fibers function. Then they assist in a rehabilitation training to promote the growth and repair of stem sells which were implanted into the body, which significantly reduce sequelae and improve sequelae symptoms, improving the life quality of the patients.

Stem cell implantation into the body via IV or lumbar puncture to avoid patient undergoing the craniotomy operation, and reduce the occurrence of complications, shorten the patient's hospitalization, then reduces the hospitalization expense. Neural stem cell implantation treatment is a kind of safety, economic, effective treatment for sTBI. Stem cell is an undifferentiated immature cell which shows weak cell surface antigen expression, patient's own immune system has low recognition ability for this kind of immature cell, they can not determine stem cells' properties, and this is why stem cells implantation can avoid organ transplant immune rejection and allergic reaction, to ensure implantation is safe for patients.

Case analysis:

Drs. Freda Peng, Xiaojuan Wang and Like Wu

The patient is a 24-year-old girl and was presented with cognitive impairment, quadriplegia and paroxysmal convulsion attack for 7 months post cardio-pulmonary resuscitation. She was diagnosed as "severe anoxic encephalopathy." Patient received an appendectomy 10 months ago, and after the operation the patient had a cardiac arrest for about 20 minutes in the ICU room. The doctors gave her cardio-pulmonary resuscitation and she regained cardiac and breathing gradually. Then the patient had a series of complications such as Iance-Adam syndrome, systemic inflammatory response syndrome (SIRS), pneumonia, sinus tachycardia, Takotsubo syndrome, central hyperpyrexia and repeated urinary tract infection. Patient's condition was much more stable after active treatment in Austria, and her infection was controlled. But the patient lost consciousness, had no response to pain, lost stimulation to noise and light. She had repeated seizure attacks, and her 4 limbs had paroxysmal convulsions and spasms. About 2 months ago, she started to show some response to pain, the spasms and convulsions on the left side of her body alleviated slightly, she had little vocals, accompanied with grand mal epilepsy.

Admission PE: Her vital signs are all stable and she had gatsrostomy. The heart, lungs and abdomen are all normal by physical examination.

Neural system examination: Patient is in twilight state with poor conscious content. She had few vocals, the bilateral pupils are equal and round, diameter is about 3.0mm, she had clumsy response to light, and corneal reflex was remaining. There is paroxysmal when staring upwards on the left side of both eyes. The eyes cannot move freely to the right side or downwards. Eye socket- pressing reflex is ok. She cannot cooperate examination of other cranial nerves. Muscle force of 4 limbs is 3-4 degrees, muscle tone is higher than normal, tendon reflex of 4 limbs are decreased more than normal. Bilateral Babinski signs are positive; she cannot cooperate medical examination of her sensor system and coordinate movement.

Electroencephalogram (EEG 08.3.26): Iregular EEG showed abnormal bilateral cerebral hemispheres, without signs of accurate lesion and constructional irritation.

Brain MRI (08.9.3): There is obvious broadening and enlargement of the bilateral temporal horns, with obvious hippocampi atrophy. There is no clear border of signal change of supratentorial below the tentorium. No signal change of the thalamencephalon area.

Case analysis: Patient is a young female and was healthy before. She had cognitive impairment, quadriplegia and paroxysmal convulsion attacks for 7 months post cardio-pulmonary resuscitation. Patient had poor conscious content; there is limited eyeball movement. She had mixed aphasia. Patient has abnormal muscle tone in her 4 extremities. Patient cannot cooperate medical examination of her bilateral pathological signs and sensor system. EEG and Brain MRI indicated impaired bilateral cerebral hemispheres. After her admission, she received a diagnosis of severe anoxic encephalopathy (convalescent stage).

Patient received basic treatment to improve the blood circulation in her brain, and to nourish the brain cells, clear away the free radicals to improve her brain microenvironment. The doctors gave the patient 4 stem cells activation treatments, combined with daily rehabilitation to give the physical signal stimulation to train her neural system and help the neuron's reparation.

After treatment, the patient's condition improved greatly: she has more motion response, her eyeballs can move more flexibly than before, she can chew food by herself, and her facial expressions are more natural. Now the patient's neck is much more relaxed, and she can lift and shake her head. Patient has voluntary movement, but she cannot control it freely. Muscle tone is normal, and the bending status is alleviated after treatment.

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