Posts from ‘Treatment’
Study results published recently in the online journal Nature Medicine reveal the discovery of the specific mechanism responsible for the death of brain cells in stroke victims. Researchers had already known that brain cells continue to die even after blood flow had been returned to the brain due to a complex cascade of chemical reactions flows through the brain. What they didn’t know was exactly how and why the brain cells continued to die.
The study¾conducted by researchers at the Brain Research Center of British Columbia¾revealed in animal models that the over-activation of NMDA receptors on the surface of brain cells activates a protein known as SREBP-1, the main culprit responsible for the death of the cells. SREBP-1 is normally found throughout the brain, but is kept in check by another protein, Insig-1.
In the aftermath of a stroke, NMDA receptors become over activated, which leads to a fast breakdown of Insig-1 proteins. The decrease in the mediating presence of Insig-1 forces an increase and activation of SREBP-1, which was shown to be instrumental in the post-stroke death of brain cells. By inhibiting SREBP-1, the scientists involved in the study were able to halt further brain cell death in the animal models.
Dr. Max Cyander, the co-lead of the study, said of the study results, “We developed a drug that can stabilize Insig-1, which in turn inhibits the activity of SREBP-1,” … “By doing so, we were able to prevent cell death,” a EurekAlert article reported.
Previous research focused on blocking the NMDA receptors but yielded limited results. The current study demonstrated in animal models that the new drug led to a decrease in the rate and quantity of brain cell death after one month when compared to the levels exhibited in a control group.
The research¾funded by the Heart and Stroke Foundation of BC and Yukon, the Canadian Institutes of Health Research, and the Cure Huntington’s Disease Initiative Foundation¾will be further explored to determine exactly how SREBP-1 leads to cell death, to identify other roles the protein may play in disorders such as Lou Gehrig’s disease, and to develop highly effective treatments for human stroke victims based on the results.
BHR Pharma has recently announced plans for a study to begin in early 2010. The study will be a multi-clinic trial to test the power and effectiveness of BHR-100, an intravenous progesterone infusion product, as an outcome-enhancing treatment option for patients with severe traumatic brain injury.
Currently, there are no FDA approved medications for use in improving the outcome for those suffering with traumatic brain injuries. The BHR Pharma study, if successful, will lead to the production and dissemination of the BHR-100 progesterone product as a neuroprotective substance for treating traumatic brain injury.
The study will span over 100 clinics in the U.S., Europe, Israel, and elsewhere about the globe, and will treat over 1200 traumatic brain injury patients. BHR-100 will be administered for 5 days to randomly selected patients with “severe closed head trauma” type traumatic brain injuries. BHR-100, unlike previous progesterone infusions, has been tailored to meet all U.S. Food and Drug Administration requirements for approval for use in humans.
BHR Pharma is cooperating with the American Brain Injury Consortium (ABIC) and the European Brain Injury Consortium (EBIC) to locate trial clinics and to help with the final design of the study. BHR has hired PRA International as a Contract Research Organization to assist in conducting the massive trial.
A Reuters article on the study described traumatic brain injury as, “a non-degenerative, non-congenital insult to the brain from an external mechanical force, possibly leading to permanent or temporary impairments of cognitive, physical and psychosocial functions with an associated diminished or altered state of consciousness.”
Most traumatic brain injuries happen during sporting and automobile accidents. Over 1.5 million Americans per year suffer from traumatic brain injuries. Over 50,000 of them lead to fatalities, while the vast majority of survivors suffer a wide spectrum of short and long-term symptoms, from loss of cognitive function to paralysis and coma.
Previous progesterone studies conducted by BHR Pharma showed promising results in the form of lower mortality rates and improved brain functionality following progesterone treatment. The company hopes that the new study will show even more exciting results and will lead to the release of BHR-100 for use in treating traumatic brain injuries around the world.
BHR Pharma holds the exclusive rights to patents on the use of progesterone-based drugs for use in treatment of traumatic brain injuries.
(pic from itech.dickinson.edu)
Doctors and researchers at the Albert Einstein College of Medicine of Yeshiva University recently made novel use of diffusion tensor imaging (DTI) in order to scan the brains of 20 concussion patients to determine once and for all whether or not concussions involve traumatic injury to the brain. The DTI scans revealed subtle brain damage in 15 of the 20 patients. The team of researchers reported their results in the August 26, 2009 issue of the journal Radiology.
The results of the DTI study hold much promise for the over 1 million Americans who get concussions each year. Most concussion patients experience a full recovery and return to full mental functioning over time, but upwards of 30% of concussion patients suffer long term symptoms such as personality change and inability to perform complex planning and organizational tasks.
Doctors currently diagnose concussions by examining patients’ accident histories and checking for the most common symptoms, which include headaches, shifts in behavior and personality, and dizziness. This approach has proven ineffective since it does not allow doctors to distinguish between which patients will recover fully, and which patients will exhibit long-term symptoms.
DTI scanning may now provide more objective diagnosis of concussion and allow doctors to more accurately diagnose actual brain injury following a concussion. The DTI scans may also give doctors the ability to predict whether or not concussion patients will suffer from a loss of the ability to make decisions, organize complex tasks, and efficient management of their time. In the Radiology study, the 15 patients whose brains showed actual damage also performed more poorly than the control group and the 5 non-brain-damaged patients on executive function tests.
Researchers hope that DTI diagnosis will allow doctors to begin treating more severe concussion-based brain injuries immediately following the injury, which could decrease the chances of long term loss of executive functioning. By initiating cognitive rehabilitation therapy early in the brain injury treatment process, doctors may be able to reduce the amount of sustained long-term damage.
Doctors have long suspected, but have never before been able to objectively demonstrate, a link between concussions and actual brain tissue damage. Now that this link has been clearly demonstrated and understood, researchers can focus on developing more efficient and useful treatments for serious concussions.
Medical tourism⎯a term created by travel agencies and mass media outlets to describe the process of traveling across international borders to receive health care⎯offers spinal cord injury (SCI) and traumatic brain injury (TBI) patients a global buffet of treatment options, usually at a fraction of the cost of similar treatments in the United States.
Over 50 nations, including Cuba, South Africa, Canada, Panama, China, Korea, Brazil, Mexico, and India, recognize medical tourism as a national industry. In 2007 over 750,000 Americans traveled outside of the U.S. seeking medical procedures in other nations, while the number of American medical tourists will likely number in the millions in 2009.
The reasons behind traveling internationally to receive care are many; however, most medical tourists seek foreign care due to vastly higher costs of care in their home country, restrictive insurance coverage and lack of coverage for certain procedures, and excessively long wait times for local care. These motivators, in addition to improvements in technology, increasing standards of care in many countries, and increasingly cheap and easy travel, make medical tourism appealing to millions of patients each year.
Humans have engaged in medical tourism since the times of ancient Greece, when Greek travelers sought spas and health care in their travels around the Mediterranean. Modern patients seeking international medical care usually engage in the following process. First, a patient seeks a medical tourism provider and provides them with their medical history. Then, a team of health care professionals reviews the case and gives a recommendation for a location, procedure, and a medical visa. Finally, the patient travels to their destination, receives their treatment, and either stays in the country or returns home for recovery.
While medical tourism offers many benefits, including massively cheaper prices for care, a wider range of treatment options, and much faster service, critics raise important concerns about the potential problems involved in medical tourism. Some of the downsides to medical and health tourism include: heightened exposure to exotic and foreign diseases, lower quality of care, travel-related stress for recovering patients, difficulty in filing international malpractice suits, unethical organ harvesting practices, first world preferential treatment and loss of care for local citizens, loss in revenue for first world medical care providers, uncertain and/or lacking regulatory and legal oversight, and widely varying standards of patient safety and care.
A litany of international accreditation and regulatory bodies have cropped up to provide consumers with a sense of safety and security while traveling abroad for medical purposes. The Joint Commission International (JCI), Trent International Accreditation Scheme, the Society for International Health Care Accreditation (SOFIHA), Health Care Tourism International, the International Medical Travel Association, and the Alliance for Patient Safety provide regulatory services for both patients and health care professionals worldwide, to insure patients receive safe, high quality, state-of-the-art patient care when traveling internationally.
These organizations provide assistance to foreign hospitals in raising their levels of care to receive accreditation, as well as assisting patients in connecting with the best possible facilities at the lowest prices available worldwide.
Wooridul Spine Hospital in Seoul, Korea has recently presented itself as one of the most advanced and high quality hospitals in the world. The hospital offers innovative treatments for a range of conditions including advanced spinal surgeries, treatments for metastatic spinal cancers, and other advanced treatment and technology for spinal injuries.
Since many advanced forms of treatment and rehabilitation strategies for TBI and SCI are not covered by domestic insurance plans, medical tourism offers a vast expansion of treatment options for SCI and TBI patients. Medical tourism offers a way around the formerly insurmountable obstacles presented by extremely high treatment costs and restrictive insurance coverage. While medical tourism is not without risk, millions of patients worldwide receive high quality medical care they may not have otherwise been able to afford.
Medical tourism has also had an effect on the development on insurance policy and modernization of medical care around the globe. Many U.S. insurance companies offer international health care options, and hospitals and clinics in prime medical tourist destinations have drastically improved their technology, staff, and facilities to meet the high standards of care first world patients have come to expect.
Links specific to SCI and TBI patients:
A highly qualified Indian Neurosurgeon:
http://www.healthbase.com/resources/doctors/neurosurgery/dr-s.s.praharaj.html
Neurosurgery in Panama: http://www.hospitalpuntapacifica.com/specialties/neurosurgery.php?specialties=open&cat=self
Neurological Treatments in Thailand:
http://www.meditourinternational.com/medicalpartners/thailand_bhmc.php
Neurosurgery in Israel:
http://www.shemere.co.il/treatment.php?actions=show&id=194&instance_id=6
Neurosurgery in Kerala
http://www.keralatraveltourism.com/medical-tourism-in-kerala/neurosurgery-in-kerala.html
A new study published in the July 15 issue of the Journal of Neuroscience reported that researchers from UC Berkeley, California (UCB) and Ben Gurion University (BGU) discovered a treatment to prevent the development of post brain-damage epilepsy in rats.
The team of researchers built their hypothesis on earlier award winning studies, performed by Alon Friedman and Daniela Kaufer at The Hebrew University, which determined that breaches of the blood-brain barrier are the cause of epilepsy in patients who have sustained traumatic brain injuries.
The current study was conducted by first inducing epilepsy in rats by breaching the blood-brain barrier with serum albumin, which not only triggers the expression of latent genes that diminish the brain’s ability to prevent inflammation and inhibition of the firing of neurons, but also binds to transforming growth factor-beta (TGF-beta) receptors.
The earlier research demonstrated a correlation between epilepsy and the uninhibited firing of neurons after the blood-brain barrier had been breached. After initiating the breach of the protective blood-brain barrier, the scientists used drugs to block the TGF beta pathways, thereby preventing the physiological chain reaction that leads to epilepsy.
This research holds promise for reducing symptoms and preventing further brain damage in patients with persistent epilepsy, including that which results from a traumatic brain injury.
Brain and spinal cord injuries are two common results of automobile accidents. A large number of lawsuits have been filed against General Motors by persons suffering from brain and spinal cord injuries sustained in accidents involving defective GM vehicles or parts, and many of those cases are currently pending. On June 1, 2009, GM filed for protection from creditors in the Bankruptcy Court for the Southern District of New York, resulting in all pending lawsuits being stayed until the bankruptcy is finalized. The case was assigned to Judge Robert E. Gerber who is holding hearings on GM’s proposed reorganization at the time of this post.
One of the issues Judge Gerber is expected to rule on this week is whether persons injured by defective GM products will retain their rights to sue or continue lawsuits pending against GM. There are three categories of injured people whose rights will be affected by the Court’s rulings. The first are people who had filed lawsuits against GM and received judgments prior to the bankruptcy, but had not yet been paid. These people are considered unsecured creditors of GM. The second category are those who were injured by GM products and filed lawsuits that were not resolved before the bankruptcy, so their claims are pending subject to the stay. The final group, are those who will be injured in the future by GM products sold before bankruptcy. Under pressure from consumer groups and Attorney’s General from more than ten states, , GM agreed in negotiations leading up to this week’s hearings to allow people injured by GM products in the future to retain their rights to sue. GM has not, however, capitulated on recognizing pending claims and judgments.
An example of the types of claims that would be extinguished if the court approves GM’s proposed plan is the claims of four year old Alyssa Perrino. Alyssa was a healthy, intelligent little girl who sustained catastrophic brain injuries requiring removal of a large portion of her skull when a weak seat in the GM vehicle in which she was riding failed rearward and struck her head. At the time of the accident, Alyssa was properly strapped into her car seat in the rear of the vehicle. Prior to the accident, Alyssa spoke three languages, but as a result of her brain injuries, she is now only able to speak ten to fifteen words. Her mobility is severely limited. Alyssa was lucky to survive the accident, but her life and the life of the Perrino family has been forever changed. While the Perrino family’s lawsuit against GM was resolved prior to GM’s bankruptcy, it is typical of cases in which defective vehicles caused irreversible brain and spinal cord injuries.
The bankruptcy plan proposed by GM would transfer automotive brands Chevrolet, Cadillac, Buick and GMC to a new company called Vehicle Acquisition Holdings LLC (Newco). Under the plan, the United States Government would own 60 percent of Newco, the Canadian government would get 12.5 percent, the United Auto Workers Union, 17.5 percent and unsecured creditors, 10 percent. Existing GM shareholders are not expected to receive any interest in Newco. Technically, People whose lawsuits the bankruptcy court does not extinguish will proceed against Newco. Those lawsuits that do not survive the bankruptcy can continue against the “old GM”, but the old GM is not expected to have assets to pay claims even it the lawsuits were successful.
While the proposed reorganization plan submitted by General Motors, would extinguish claims for injuries like Alyssa Perrino’s if they were pending at the time the bankruptcy was filed, ironically, GM has agreed that the new owner of GM would assume GM’s liability for warranty claims. Thus, approval of the plan would lead to the illogical result that if a GM part fails under warranty, the new GM would be liable for the repair, but if the same part killed or injured a person prior to the bankruptcy, the new GM would have no liability at all.
On June 19, 2009, the deadline for filing objections to the proposed GM sale, consumer groups, unions and creditors filed objections to the GM bailout. Philadelphia attorney Barry Bessler is represented a number of consumer groups in the Chrysler bankruptcy and is representing them in the GM proceedings, as well. During the Chrysler proceedings, Chrysler successfully washed its hands of all past and future product liability claims involving Chrysler products sold prior to the bankruptcy. Bressler had argued that the GM case is distinguishable from the Chrysler case in terms of the proper way to treat product liability claimants. Bressler was quoted in Law.Com as saying “[i]n GM, there is no third-party buyer. Hopefully, that means there’s a stronger case [for successor liability].” Attorneys for people with pending asbestos products liability lawsuits against GM, have filed objections to the proposed plan, as well.
In addition to consumer groups, attorneys general from at least eleven states filed objections to the “no successor liability” provisions of the bankruptcy plan proposed by GM. Attorneys general from Connecticut, Kentucky, Maryland, Minnesota, Missouri, Nebraska, North Dakota, Montana, Ohio, West Virginia and Vermont filed objections arguing that GM’s plan to extinguish liabilities for injuries cased by safety defects would take key legal rights away from victims. Attorney General Richard Blumenthal of Connecticut referred to GM’s proposal as “very unfair and unwise “. In an interview, Blumenthal stated “[s]o much is at stake. We have fought repeatedly for repair or recall of vehicles and parts that are defective so that people can be spared injury, and there are far-reaching ramifications of failing to apply accountability to the New GM.”
Attorneys general from a number of states also filed objections to GM’s proposed plan due to the impact it would have on GM dealers in their states. In his statement regarding Montana’s objections to the GM proposal, Montana’s Attorney General Steve Bullock said that GM is attempting to circumvent state laws designed to protect auto dealers. According to Bullock, GM has insisted that current GM dealers sign new dealership agreements that force these dealers to waive state laws that were enacted to protect them. Bullock further stated that, if his state lost dealerships, some consumers in rural areas would have to drive hundreds of miles just to get their cars or trucks serviced.
In addition to objections on behalf of consumers and dealers, objections to the GM restructuring were also filed by various bondholders who argued that they were treated unfairly vis a vis other creditors. Finally, the Steelworkers Union filed objections on behalf of retired steelworkers and engineers who said the plan would leave GM without funds to pay health benefits to union-represented retirees and their families. In their objections, the Steelworkers and Engineers said that “GM has been not only unfair, but cruel” in its treatment of the steelworkers and engineers, and that GM was attempting to renege on a deal to create a health care trust for current workers and to protect the health and life insurance benefits of retirees.
A multi-day hearing on GM’s proposed sale began June 30, 2009 . At the time this article was posted, proceedings were ongoing and Judge Gerber had not ruled on the objections of injured consumers. Persons interested in following the proceedings in near real time can do so at http://dealbook.blogs.nytimes.com.
The outcome of the negotiations and court proceedings will affect many people who stand to lose jobs, benefits or investments, but none will be more profoundly affected than persons who have suffered catastrophic injuries such as brain and spinal cord injuries caused by defective GM products. With many millions of GM vehicles on U.S. roads, it is impossible to estimate the number of people who will be injured, and lack the resources to obtain essential medical and other services. Given that many of these people will become medical wards of the States, U.S. taxpayers will continue bailing out and GM and Chrysler long after the astounding infusion of public funds during the current bankruptcy proceedings has been forgotten.
Bangalore’s BGS Global Hospital claims to have successfully used transplanted bone marrow stem cells to reactivate brain cells.
Madhumalika, 27, suffered a “diffuse axonal brain injury” after a “road accident” on December 14, 2008. Due to the severity of her head trauma, Madhumalika was in a coma for more than three months and had been given a 20 percent chance of survival. Diffuse axonal injuries are one of the most common types of traumatic brain injuries (TBI). They tend to affect a larger portion of the brain, and are one of the leading causes of death in those with a TBI.
“The patient was suffering from altered sensorium, severe cognitive dysfunction and lack of movement in limbs. Following the surgery, she has now regained full consciousness, memory, communication abilities and purposive movements in limbs,” N K Venkataramana, Chief neurosurgeon of BGS Hospitals, told reporters.
According to Venkataramana, this was the first procedure of its kind in India and only the second in the world. China made the first attempt, but if they showed similar results, they have stayed pretty quiet about it. (There are studies, such as this one and this one performed on rats, showing different types of brain injuries improving with stem cell transplants.)
A month after transplanting more than four million stem cells into the patient’s brain, Madhumalika regained her ability to talk, move her limbs, and recognize her family and friends.
Dramatic results? We think so! However, as with any new procedures, it’s smart to watch for further tests and examples of its effectiveness. There is very little data available at this point, and until more extensive research is provided, we curbing our excitement.
Venkataramana says that Madhumalika’s recovery has proven that brain injuries are curable, “Since 2004, there has been a pressing need to help the rising number of people who were disabled following road accidents. Stem cell therapy was one of the means to face the situation,” he said. He also notes that there are plans for a pilot study in the future.
We will be keeping our eyes open for more developments – the potential for a “brain injury cure”, while sounding almost too good to be true, is worth watching.
Image from here.
Researchers at the Eli and Edythe Broad Center for Regeneration Medicine and Stem Cell Research at UCSF have developed a way to reverse the age of adult stem cells (fibroblast cells), using microRNAs to effectively turn them back into embryo-like cells. While not quite a Benjamin Button scenario, these new findings have the potential to aid in brain injury repair by replacing damaged cells in areas affected by a traumatic impact.
These newly “young” cells have the ability to do what the controversial cells from embryos can – they are able to become any cell type (a state known as “pluripotency”). This makes it possible for scientists to stop their use of retroviruses that have been employed to create this cell flexibility, making stem cell therapy safer.
According to the study, previous methods for creating cells similar to embryonic stem cells used DNA to influence the production. The issue with this method is that three of the four genes promote an uncontrolled growth reaction in the cells, much like cancer.
The use of microRNAs has further benefits as reprogramming a patients cell instead of introducing a foreign one prevents it from being rejected, an issue that scientists have long been working to find a way around.
You can read more in the April 12, 2009 advanced online edition of the journal Nature Biotechnology.
Image from emergentarchitecture.com.
Recovering from a brain or spinal cord injury is a complex process with many steps. And one of the most important steps is finding the right rehabilitation center. The quality and type of care the survivor receives will have a significant impact on the rare of recovery, the ability of the survivor to reintegrate into society and work, and the long-term outcome. By following three steps, the patient and his or her loved ones can ensure the right rehabilitation facility is found…
