Archive for September, 2009
Hundreds of thousands of CT scans are conducted every year on children who have hit their heads. The CT scans have been traditionally used to determine whether or not the children have incurred more serious brain injuries. A recently published study as well as recent discoveries of several more effective methods of diagnosing brain injuries may prove a vast number of CT scans to be unnecessary.
Previous studies mentioned in earlier blog posts on this site explored the use of monitoring NSE protein levels in the blood and DTI scans as possible diagnostic tools that reveal subtle data undetectable by the high radiation CT scans. Monitoring NSE protein levels in the blood enabled doctors to uncover subtle forms of brain damage in long-time boxers, while DTI scans revealed brain damage undetectable by CT scans in military personnel exposed to non-impact explosive blasts.
The recent CT scan research a vast study including over 42,000 children less than 19 years old evaluated the effectiveness of CT scans in detecting traumatic brain injury. The children had all bumped their heads or had accidents involving head impacts. About 15,000 of the sample group received CT scans, but less than a thousand of them actually detected signs of traumatic brain injury.
The results of the study were published online in the September issue of The Lancet. The authors of the study included six signs to use when determining whether or not a traumatic brain injury may be suspected and tested for traumatic brain injury using a CT scan. The New York Times article on the study reported the indicators as signs of a fractured skull, altered mental states, loss of consciousness, vomiting, headaches, and out-of-character behavior.
The principal investigator of the study, Dr. Nathan Kupperman, urged doctors to search for one or more of the six indicators of traumatic brain injury before blindly prescribing thousands more of unnecessary CT scans.
(pic from dbtechno.com)
Anthony Russell, a professor at the University of Calgary, and his colleague, Tim Higham from Clemson University in South Carolina, observed movement in gecko tails after they were severed and were inspired to explore possible ramifications and applications to humans paralyzed by complete spinal cord injuries. The professors noted that there is a great similarity between the neural cells in gecko tails and neural cells in human tailbones. Complete spinal cord injuries refer to injuries in which the spinal cord has been completely severed.
Russell noted in the article that the severed gecko tails moved somehow without physical connection or communication from the brain. He was quoted as saying, “Something in the tail is saying to the tail, ‘Lets use this muscle to move a lot, then take a break, then move again.’ ”
He speculated that the movement in the tail arises as a response to environmental stimuli such as temperature or pressure, which elicit a response in the muscles without prompting from the brain. Humans also reportedly experience movements in their paralyzed limbs after spinal cord injuries.
Other studies released last week reported that rats with severed spinal cords were able to walk on treadmills and support their own weight after a combination treatment of drugs administered below the spinal cord injury, locomotor training, and electrical stimulation.
The movement in severed gecko tails could hold further secrets behind how movement can occur without direct communication from the brain. These studies move scientists and doctors ever closer to a cure for paralysis. The basic implication of the rats studies and gecko observations is the hypothesis that movement is not completely dependent on messages from the brain.
The two professors, Russell and Higham, hope to inspire and collaborate with doctors and scientists on potential research into spinal cord injury applications of their knowledge and observations.
Integration between observations of various professors and scientists with research data and knowledge gathered by surgeons and researchers holds a potential key toward medical advances far beyond the prospects and possibilities presented in singular isolated studies. Integrated thinking across disciplines may lead to more holistic approaches to research and disease prevention, and give realistic hope to those currently suffering from irreversible paralysis.
(pic from herper.com/)
Neuralstem Incorporated recently received Food and Drug Administration approval for a Phase 1 trial to treat Lou Gehrig’s disease (ALS) with their proprietary neural stem cells injected directly into the human spinal cord. They are the first business to conduct a stem cell treatment study for ALS patients.
ALS currently has no cure and no effective treatment options. Neuralstem hopes to develop both a powerful treatment and a potential cure for ALS with their research. World renowned doctors from the University of Michigan Health System ALS Clinic, the Emory Neuromuscular Lab, and the Emory ALS Center have been contracted to conduct the study.
ALS is a neurodegenerative disease that kills its victims by way of the degeneration and death of motor neurons, which control muscle movement, in the human spinal cord. Thirty thousand people in the United States currently suffer from ALS. Dr. Eva Feldman, the proposed director of Neuralstem’s clinical trial, reported in the article that previous stem cell studies on animals with ALS showed promising results.
In the animal studies, the spinal cord stem cells made connections with muscle-controlling neurons and protected other potentially endangered motor neurons. Feldman warned against premature celebration of animal trial results before human trials demonstrate the effectiveness of the treatment in human subjects.
The Neuralstem trial consists of treating ALS patients with injections of Neuralstem’s patented spinal cord stem cells into their spinal cords. 12 patients will receive the treatment and will be monitored and examined over the following 2 years to determine the results of the treatment. Eva Feldman will most likely conduct the study at Emory University with colleagues from the University of Michigan Health System and the Emory ALS Center.
Neuralstem is the first company in the world to produce commercial quantities of viable neural stem cells for use in the human brain and spinal cord. Rats injected with Neuralstem’s spinal cord stem cells lived longer than rats in a control group not injected with the stem cells. It remains unclear whether or not the stem cell treatment will translate to human subjects, but the results of the animal studies show great promise.
In addition to developing treatments for ALS, Neuralstem plans to direct its stem cell research toward finding treatments and/or cures for Ischemic Spastic Paraplegia, Traumatic Spinal Cord Injury, and Huntington’s disease.
Scientists at the David Geffen School of Medicine at UCLA and researchers from the University of Zurich in Switzerland have discovered stunning information on how nerves in the spinal cord, even in cases of paralysis, can be stimulated to elicit a walking response, without communication between the brain and the nerves. The researchers used a combination of treatments to enable rats with severed spinal nerves to bear the full weight of their bodies and run for up to 30 minutes.
The treatment consisted of drugs known as serotonergic agonists, electrical stimulation applied to nerves below the spinal cord injury, and rehabilitation on a slow moving treadmill. When the nerves were activated with electrical currents, it activated evolutionarily primitive nerve connections in the spinal cord to elicit movement in the rats’ limbs without information from the brain.
At first, the rats were only able to move their back legs for a small amount of time. Over a week, the rats could run and walk without support. After a few weeks, the rats were able to fully support their own weight and run forward, backward, and sideways for up to 30 minutes. However, the rats remained dependent on the mix of drugs and electrical stimulation to make their legs work.
Researchers from the University of Zurich also reported that they are developing a series of electrodes for insertion along the spinal cord. They expect to begin human trials in about four years.
Previously, scientists have been able to generate movement in the legs of paralyzed human subjects in the past. Until the most recent study, published in the most recent online edition of Nature Neuroscience, they had never been able to elicit continuous walking and full weight bearing in the paralyzed rats.
The Christopher and Dana Reeve Foundation and many other contributors funded the study. Scientists and support foundations hope to inspire further research leading to a cure for paralysis for patients with severe spinal cord injuries. One of the most remarkable implications of the study is that, “nerve fibers do not need to regrow in order for a paralyzed patient to walk again.”
Combined with neuroprosthetic devices, which may allow a communication bridge from the brain across the injured spinal cord, the data from the current study has brought scientists one step closer to finding a cure for paralysis.
(pic from cdn-write.demandstudios.com)
Patients suffering from loss of consciousness due to traumatic brain injuries and other forms of brain damage may find promise in the results of a new study by scientists at the Hebrew University of Jerusalem. A team of scientists from the University discovered an area of the brain that controls and monitors what they have called the brain’s “alert status.”
The scientists made the discovery while studying the mechanisms by which surgical anesthesia works to suppress conscious awareness and painful stimuli in the brain. It was formerly believed that the changes to the brain under anesthesia which also include a shift to a sleep-like brainwave state, slowed brain metabolism, a sharp decrease in muscle tone, and suppression of behavioral functions were caused by general neuronal suppression due to the drugs used, or lack of oxygen and nutrients.
The new report shows a dramatically different mechanism at work in the brain. A part of the brain called the mesopontine tegmentum contains a small group of neurons near the base of the brain. The neuron group exerts full control of the activity of the cerebral cortex and the spinal cord. The neural structure can also remove pain sensations, lead to a collapse of body posture, and even coma-like loss of consciousness.
The current study was focused on rats and involved injecting the neuron group in the mesopontine tegmentum, referred to by the scientists as the “center of consciousness,” with a tiny dose of anesthetic drugs. The drugs had a massive suppressive effect on cerebral activity in the rats’ brains.
The results, if they prove to translate to the structure of the human brain, promise a wide range of new developments in the treatment and possible cure of patients suffering from coma and other losses of consciousness. The scientists also hope to discover and understand more clearly how consciousness arises out of what they referred to as a “biological machine,” the human brain.
The researchers also speculate that it may be possible to introduce an electrical charge to the center of consciousness in order to draw a patient out of a coma. They also hope to develop more effective treatments for oversleeping and insomnia from analysis and further study.
Peter Wildetrotter, President and CEO of the Christopher and Dana Reeve Foundation, sent a letter to brainandspinalcord.org to show his appreciation and to share with our readers some of the recent breakthroughs in spinal cord injury and brain injury research. The Reeve Foundation funds projects dedicated to finding a cure for paralysis.
The letter brings up many important discoveries and advances, including a recent experiment on rats with severed spinal cords. The rats were able to walk again after a complex, three-part treatment. The rats had completely severed spinal cords. They were given a dose of the drug quipazine, electrical stimulation below the spinal cord injury site, and then locomotor training.
Surprisingly, the rats were able to walk on treadmills while fully supporting their own weight. Previous to this experiment, it was widely believed that movement was impossible below the site of severed spinal cord. Wildetrotter added that the physical movements of the rats was nearly identical to their walking motions before their spinal cord injury.
Even more importantly, the study proves that movement is still possible even when the line of communication between the brain and spinal cord is severed. In order to make such advanced studies possible, many forces must harmonize and collaborate with one another. New research often must confront dated and obsolete ways of thinking, and it is the determination and hard work of countless scientists, universities and medical facilities, public and private funding sources like the Reeve Foundation, and sites such as this one that are necessary to make the formerly impossible possible.
It is not only the scientists and foundations that make a difference, it is every individual who donates time, energy, and money toward paralysis research. Wildetrotter wrote of the recent paralysis breakthrough, “Every time you and other Reeve Foundation supporters donated your hard earned money, contacted your Congressperson or Senator to fund paralysis research, participated in a Team Reeve event, attended a comedy night or other event, you helped make this happen.”
He also expressed gratitude for the public and private support that make possible the Reeve Foundation’s International Research Consortium, as well as the NeuroRecovery network, where spinal cord injury survivors receive locomotor training.
Wildetrotter concluded his letter with a promise to continue the Reeve Foundation’s noble efforts toward a cure for paralysis and expressed enthusiasm that, “Science is fulfilling Christopher’s vision.”
You can donate to the cause by visiting the Reeve Foundation’s website: www.christopherreeve.org/
John Asfora, inventor and surgeon, recently received FDA approval on a novel device and the tools and methods used to implant it into patients suffering from spinal cord injuries and back pain. According to the Argus Leader, surgical trials on the device and approach began in 1999, finally culminating in August 2009 with FDA approval.
The device in question is called a “bullet cage,” named such because it looks like a hollow bullet with screw threads around it. In order to relieve pressure between vertebrae, the bullet cage is inserted into a drilled-out space in the bones. The device acts as a replacement for the intervertebral discs, which can become worn over time or damaged in accidents resulting in spinal cord injuries.
One patient, Jackie McNamara, had the bullet cage implanted into her lumbar spine in Autumn of 2006 and reports that her once severe pain has vanished since then.
The prototype for the current bullet cage was developed in Hawaii in the 1940s as a way of relieving soldiers of back pain. Later, veterinarians experimented with similar devices on horses. Since then, the device and techniques used to implant it have come a long way. Asfora’s bullet cage consists of an inch long piece of titanium with screw threads along the outside to keep it secured in the bones.
Previously, back surgeries such as the insertion of a bullet cage would have been attempted by accessing the lower back through the patients’ bellies. Asfora devised a set of tools, combined with the use of a microscope, by which he could accomplish the implant of bullet cages through an inch-long incision in the back. His FDA approved methods and tools promise much less risk of complications, and far less chance of nerve damage to the spinal cord.
While the procedure and necessary hospital care can cost as much as $70,000, patients like McNamara have found that the cost is worth the benefits of a far less painful life. McNamara is currently training to run a marathon, and she hadn’t been a runner at all before her surgery.
Another recipient of the bullet cage, Tom Lambert, was brought to his knees by debilitating back pain. After getting 4 bullet cages and 2 plates inserted into his back by Asfora, Lambert is back to walking 4 miles a day and lifting as much as 150 pounds. He reported that the surgery might have even made him taller.
(pic from sanfordhealth.org)
A chance meeting between two people involved in a terrible accident and a bold, successful rescue has resulted in the foundation of the WillWalk Foundation. Jared Dunten and Marty Butler were camping near the Rio Grande when Jared dove into the river and hit a sand bar head first, breaking his neck at the C4-5 vertebrae. Marty dove in, pulled Jared out of the water, and resuscitated him.
The accident left Jared paralyzed as a quadriplegic.
Jared refused to succumb to a life of paralysis. Both he and Marty decided to combine their love for art and their refusal to accept paralysis as a permanent condition to found WillWalk, a nonprofit organization based in Austin, TX, whose goal is to fund stem cell research dedicated to finding a cure for paralysis. The foundation is using art exhibits and sales to fund the novel stem cell research.
The first study WillWalk plans to fund will be conducted in conjunction with the Lone Star Paralysis Foundation, the University of Texas, University of Brackenridge in Austin, TX, the Brackenridge Brain and Spine Center, and the Keck Institute in New Jersey.
The first trials will involve 30 patients in Austin who will receive a combination of stem cell treatments for spinal cord injuries and lithium to promote neural growth at the injury site. The patients will also undergo extensive rehabilitation programs.
This research marks the beginning of a new era in stem cell and paralysis research. Since the stem cells to be used are derived from umbilical cord blood. Up until this groundbreaking study, stem cells have come from controversial sources, such as human fetuses. Until now, stem cells have not been used for treating patients with spinal cord injury and/or paralysis.
WillWalk plans to raise 3 million dollars to fund the stem cell trials to assist, improve the condition of, and finally, to cure patients with spinal cord injuries and paralysis.
(pic from flickr.com/photos/multiget)
Blanchette Rockefeller Neurosciences Institute (BRNI) announced an agreement of collaboration with the neuroscience specialists of the Brain Injury Group. The groups of scientists and researchers plan to compare their data on brain injuries, including strokes, head trauma, and other areas of research. They also plan to determine any links between brain injuries and later developments of other neurological dysfunctions, disorders, and diseases such as Alzheimer’s disease.
BRNI is a nonprofit institute dedicated to the study of memory and diseases of memory. It is the only nonprofit institute of its kind. Of the recent agreement between BRNI and the Brain Injury Group, Dr. Daniel Alkon of BRNI was reported as saying, “Together, we will uncover the potential links between brain injury and diseases and disorders of human memory, including Alzheimer’s disease.”
A huge area of focus for the two groups will be chronic traumatic encephalopathy (CTE), which is a repeated chronic swelling of the brain suffered commonly by boxers, football players, and soldiers who experience brain injuries as a result of being near explosions in combat zones. Some scientists believe that the high rate of traumatic brain injury among U.S. soldiers returning from Iraq could lead to an equally increasing rate of CTE cases in the injured soldiers.
BRNI and the Brain Injury Group plan have set high aims at understanding all there is to know about the functioning of the brain and human memory. Their collaboration holds much promise for patients suffering with brain injuries and CTE. The groups plan to study the mechanisms by which CTE arises following traumatic brain injuries.
Future research and collaboration such as this may allow radical new developments in the treatment, diagnosis, rehabilitation, and prevention of traumatic brain injury.
A recent story in the Chicago Tribune caught our attention, and is worth repeating:
George Flores is a 39-year-old paraplegic harp technician from Chicago. He remains one of only a dozen or so harp technicians in America. Flores crashed his motorcycle on September 12, 2004 on Highway 55 in the suburbs of Chicago. The crash left him mangled and hidden in the tall grass on the side of the highway overnight. Two men in a truck looking for scrap metal found him the next morning in the grass near the wreckage of his motorcycle.
The crash left Flores with a severe spinal cord injury, broken ribs, a punctured lung, and internal and external bleeding and bruises. The spinal cord injury left Flores in a paraplegic condition. Now, four surgeries and countless doctor visits later, Flores’ experiences have led him to become an outspoken critic of the flaws of the U.S. health care system.
Flores speaks of the health care system’s tendency toward institutionalization instead of rehabilitation and broader research. He also speaks of the problems he witnessed in the American health care system in terms of doctors receiving more profit the more procedures they conduct. Flores argues that patients suffer when it is more profitable for a doctor to have ill rather than healthy patients.
As a paraplegic with a severe spinal cord injury, Flores still has achieved a great measure of success. He uses a stand-up wheelchair that allows him to stand in front of and work on harps. While his spinal cord injury did not take away his life, Flores still has his doubts about whether or not he received the best possible care he could have.
Flores raises questions about how much economics, insurance, and legal pressures influence the actions and decisions of doctors, hospitals, and medical staff, especially concerning spinal cord injuries. He wonders if he had been a wealthy white man whether or not the doctors would have treated him immediately with steroids to slow down his spinal cord injury.
While Flores remains grateful for the lifesaving care he received, he remains critical of the current structure and paradigm of health care in the United States. He is pushing for these and other fundamental changes in the health care system in America.
(pic from flickr.com/photos/quinnanya)
