Brain stroke

Treatment.

Immature (stem) cells are implanted into a subarachnoid space of a patient via a lumbar puncture patent of RF ¹ 2160113).The grafted cells release a variety of axonal growth-stimulating, neurotrophic factors, but also participate immediately in restoring affected nervous communications.

A patient firstly undergoes two cell transplantations at an interval of 10-to-14 days. The further treatment regimen is determined depend on changes in neurological status of the patient.

The treatment is conducted in the neurosurgical department.

Infectious safety.

A donor material is subjected to 3-level testing for infection (2 immunoenzyme analyses and 1 PCR examination).

Side effects.

Rise in temperature until 390, meningisms, nausea and vomiting are possible during first 2 days after a cell transplantation procedure. Those effects are reduced by the appropriate drug therapy. No long-term complications are registered.

Clinical effect.

The long-term stimulation of both regenerative and functional brain activity by the grafted cells is capable of providing significant amelioration of neurological defects.

STEM CELL TRANSPLANTATION FOR CEREBRAL STROKE

Cerebral stroke is one of main reasons for both mortality and disability among residents of the developed countries. Medical interventions aimed at improving a cerebral blood flow give appreciable results at acute stage of disease. Long-term consequences of brain injury are frequently refractory to medicamentous interventions, because pharmaceuticals fail to affect substantially reparative abilities of adult nervous tissue. A stem cell transplantation (CT) technology represents a feasible approach to stimulate reparative processes in injured brain. When grafted in brain, immature (stem) cells are able to elaborate multiple growth and neurotrophic factors. Moreover, those cells, themselves, may be implicated in forming new nervous communications. Thus, the grafted cells are capable of greatly ameliorating stroke-related, neurological defects.

In the Centre 17 patients with consequences of brain stroke have received in sum 23 subarachnoidal cell graftings. Appreciable benefits from such treatment were noted in 13 (76%) patients.

Eleven patients (5 females and 6 males) aged from 35 to 56 years were entered onto controlled study (see Table 1). On admission of patients, the times after cerebral stroke varied from 4 to 24 months. Significant both memory and intellectual defects were observed in all patients. The following symptoms were noted: hemiparesis or hemiplegia (10 cases), high-grade sensormotor aphasia (5 cases), and coordination disorders (5 cases). Permanent dysuria was noted in 1 patient. Before cell-based treatment all patients were given a comprehensive rehabilitative therapy, the results of which, however, were unapparent. Fife patients have received one subarachnoidal cell transplantation, whereas the remaining 6 patients were cell-grafted twice.

The control group was formed from 11 patients aged from 45 to 65 years, who were comparable with the trial patients in severity and location of brain injury, in follow-up time, as well as in previous therapy (see Table 2).

Table 1. Characteristics of the trial patients

The used abbreviations are: HI, hemorrhagic stroke; IB, ischemic stroke; ACA, anterior cerebral artery; MCA, medial cerebral artery; FPO, functions of pelvic organs.

Table 2. Characteristics of the control patients

The abbreviations are same as those in table 1.

Figure 1. Functional activity of patients before and at 6 months after treatment

The case of applying cell-based therapy is described in detail below.

A 39 year-old male patient was admitted to the clinic with acute hypertensive hemorrhagic stroke on 19 February 2004. The patient received a complex standard therapy that, however, gave no appreciable results. At 1 month after cerebral stroke, computer tomography revealed a hemorrhagic lesion in size of 20 x 39 mm with marked perifocal edema. Dislocation of middle brain structures to the left was also noted (see Figure 2).

In May 2004 the patient exhibited significant mental disorders. Contacts with him were labored. There was also motor disability due to both a flaccid hemiplegia/ hemiparesis ( muscle strength was not more than 1 point) and profound vestibulocoordinative disorders. The severity of patient’s state, but also his refractory to medicamentous therapy, became indications for conducting cell-based therapy. The patient was cell-grafted twice at a 3-week interval. This treatment was well-tolerated.

At 3 months after cell-based therapy initiation the patient demonstrated a regress of Korsakoff's syndrome, regress of hemiparesis ( muscle strength increased to 3 points). Marked improvements were also observed in his mental sphere. As revealed by computer tomography, the paraventricular cyst was reduced in its size upto 18-11 mm (see Figure 3).

At 1 year after cerebral stroke, the patient was able to walk without support, completely service himself. He was adequate in contacting with surrounding people.

Figure 2. Computer tomography scans of patient D at 1 month after developing brain stroke.

Figure 3. Computer tomography scans of the patient D at 6 months after developing brain stroke.

For more information see the publications .

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