HOPE FOR SPINAL-INJURED PATIENTS! A paralysed man with a completely severed spinal cord has learnt to walk again in a “historic” British-led breakthrough that raises the prospect of treatment for a condition previously believed to be permanent. The patient, a firefighter, was left with no movement or feeling from the waist down after being stabbed four years ago. In a revolutionary procedure, cells from his nose were transplanted into the damaged part of his spine. He recovered the ability to walk with a frame, learnt to drive again and has been hunting with friends. The patient, Darek Fidyka, 38, from Poland, said that the experience was like being reborn. “It’s an incredible feeling, difficult to describe,” he said. “You’re at a certain moment in your life when you think it will never happen again and yet... it’s possible.” His remarkable recovery suggests that the transplanted cells formed a “bridge” across the damaged portion of his spinal cord, reopening communication lines between his lower body and brain. The advance is the culmination of more than a decade of fundraising and determination by David Nicholls, a British hotelier whose son, Daniel, was paralysed as a teenager when he dived into a sandbank on Bondi Beach, Australia, in 2003. Mr Nicholls set a goal of finding a treatment for paralysis, but a consultant said that he risked harming his son with false hope. He now wants Daniel to benefit from the cell therapy. Geoffrey Raisman, of University College London, who pioneered the latest technique, said: “Spinal cord injury is quite easy to do and utterly devastating for the people who have it. This opens a door that was not open before. I think we’re looking at something historic.” Until now, complete spinal cord injuries have been broadly regarded as permanent and incurable. More patients must be treated to ensure that the finding — published today in the peer-reviewed journal Cell Transplantation — is not a one-off, Professor Raisman added. About 1,000 people sustain a spinal cord injury each year in the UK and Ireland, and about 50,000 people are living with paralysis. Sixty per cent of all spinal injuries are incomplete — they do not involve a severing of the spinal cord — and retaining even a flicker of feeling or movement gives a good chance of learning to walk again. Previously, scientists have shown that electrical stimulation of the spinal cord below the injury site can restore some movement and feeling, but in these cases it is thought that the patients had some surviving connections across the injury site. The actor Christopher Reeve eventually regained movement in his fingers and some sensation, having been told after a horse-riding accident in 1997 that he would never again have movement below his shoulders. He did not learn to walk. Robin Franklin, who successfully demonstrated the same technique in dachshunds at the University of Cambridge, described the latest result as “quite spectacular”. “The real efficacy of the technique will only be known once there is a fully randomised clinical trial,” he said. “That said, this is very, very encouraging and it certainly continues the forward momentum.” Mr Fidyka, who was paralysed from wounds inflicted by his partner’s ex-husband in July 2010, was among the first patients to be given the treatment. Although patients with incomplete spinal injuries often recover, there is little hope in cases such as Mr Fidyka’s when the spinal nerves are completely severed. After six months of physiotherapy, he had not improved. Pawel Tabakow, the neurosurgeon who carried out the treatment in Wroclaw, Poland, said: “Prior to the transplantation, we estimated that without this treatment, [his] recovery chances were less than 1 per cent.” While many hopes for regenerative treatments have focused on stem cells, the latest method relies on mature cells that occur within the nasal cavity. The so-called olfactory ensheathing cells (OECs) cover the nerves that convey smells to the brain. Olfactory nerves have a lifespan of about 30 days and are continually regenerated, meaning that the OECs provide a pathway along which cells grow and reroute themselves. It appears that the cells can serve the same function in the spine, allowing nerves to span across an injury site. The patient had an initial operation to remove one of his brain’s two olfactory bulbs, from which the OECs were harvested. Two weeks later, the cells were transplanted into the spine, using 100 microinjections across the injury site. A small piece of nerve tissue from the ankle was also grafted on to the injury site to act as a scaffold for the spinal neurons to extend, guided by the OECs, and reconnect at the other side. A few months after the operation, Mr Fidyka began gaining muscle in his left leg and was also beginning to get pins and needles and hot and cold sensations. About a year after the surgery he could walk between parallel bars and with a walker with short callipers locked at the ankles. He has some sensation in his bladder and bowel
Posted on: Tue, 21 Oct 2014 06:48:28 +0000
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