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The use of nasal material shows how a paralysed man walked again in Poland. Story 2.

Monday, October 27th, 2014

NASAL CELL MATERIAL USED TO GET A MAN WALKING AGAIN AFTER DEBILITATING SPINAL INJURIES

This 38-year-old Bulgarian patient, who suffered his injury in 2010, is believed to be the first person in the world to recover from the complete severing of the spinal nerves.image www.newcures.info

FIRST STEPS: Darek Fidyka walks with the aid of leg-braces and a walking frame at the Akron Neuro-Rehabilitation Center in Wroclaw, Poland. Photo: AFP

A paralysed man has begun to walk again after pioneering surgery injected cells from his nasal cavity into his spine. How was this possible – and what does it mean for others with spinal injury? Kate Hagan stitches together the evidence.

Darek Fidyka sounds as though he has been through a lot. How did he lose his ability to walk?

A Bulgarian firefighter, Mr Fidyka’s spinal cord was severed after he was repeatedly stabbed in the back during a knife attack in 2010. It left the 40-year-old paralysed from the chest down. Despite two years of intensive physiotherapy he had showed no sign of recovery.

Why did scientists think he might be able to walk again?

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Scientists have long recognised the potential of particular cells in the olfactory bulb, at the top of the nasal cavity, to stimulate growth of nerve fibres. Called olfactory ensheathing cells, they act as pathway cells to enable nerve fibres in the olfactory system to be constantly renewed throughout a person’s life, preserving the senses of smell and taste.

The role of the cells in the olfactory bulb has led scientists to explore their potential in the spinal cord, where regeneration of nerve fibres fails after spinal injury.

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Mr Fidyka had two operations. In the first, Polish surgeons removed one of his olfactory bulbs and grew the olfactory cells in culture in a laboratory. Two weeks later they injected the cells above and below Mr Fidyka’s spinal injury. They also transplanted nerve tissue from his ankle into his injured spinal cord to form a bridge for nerve fibres to grow.

How has the operation changed his life?

Three months after the treatment Mr Fidyka noticed that he was developing muscle on his left thigh. After six months, he took steps along parallel bars using leg braces. Two years later he can walk with a frame and drive a car. He has also recovered some bladder, bowel and sexual function.

Mr Fidyka said walking again was an incredible feeling. “When you can’t feel almost half your body, you are helpless, but when it starts coming back it’s like you were born again,” he told the BBC. Mr Fidyka says he tires quickly when walking, but believes it is realistic to believe he will one day become independent.

What does this mean for paralysed people – will this treatment be broadly applicable? In short, will they be able to walk again?

Researchers involved in Mr Fidyka’s case say the treatment will need to be successfully repeated to definitively show the approach can repair a severed spinal cord. They hope to treat another 10 patients over coming years and have said they will consider patients from anywhere in the world who would likely have a similar injury to Mr Fidyka.

Florey Institute head of spinal research Stephen Davies warned the treatment may not work for all types of spinal injury. He said it was “too early to claim that the experimental therapy represents a silver bullet” and a clinical trial with large numbers of patients was needed to determine its benefits.

And Griffith University group leader of olfactory and brain repair James St John said Mr Fidyka’s case had demonstrated that transplanting olfactory cells into the spinal cord could restore sensation and some motor control in humans – but stressed there was still a long way to go.

“Each patient’s injuries are different and we don’t yet understand why there is recovery in some situations but not in others,” Dr St John said. “It is also important to understand that there are many types of olfactory [cells] and the correct combination of cells has not yet been determined.”

Does the scientific community have any reservations about what appears to be groundbreaking research?

The response has generally been: it is very early days for this form of treatment; let’s not get ahead of ourselves; expect mixed results as further trials are run.

Simone Di Giovanni, the chair in restorative neuroscience at Imperial College London, is among those urging caution about raising false hope for patients with spinal cord injury.

“One case of a patient improving neurological impairment after spinal cord knife injury following nerve and olfactory cell transplantation is simply anecdotal and cannot represent any solid scientific evidence to elaborate on. In fact there is no evidence that the transplant is responsible for the reported neurological improvement,” he said.

And Dusko Ilic, a senior lecturer in stem cell science at King’s College London, said transplantation of olfactory ensheathing cells in animal studies had varied results.

University of Nottingham professor of advanced drug delivery and tissue engineering Kevin Shakesheff added: “At best I’d expect to see quite a lot of variability in the clinical success because of the complexity of the tissue they are trying to repair and the different extent of damage in each patient.”

Henry Sapiecha

Paralysed man with a completely severed spinal cord walks again after world-first surgery

Friday, October 24th, 2014

Paralysed man now walks again

A Bulgarian man, who became paralysed from the chest down in a knife attack, is now able to walk again after receiving a pioneering cell transplant therapy.

In 2010, an assailant attacked Darek Fidyka with a knife, repeatedly stabbing the bald, broad firefighter in the back, and altered his life forever. One of the strikes cleanly sliced through Fidyka’s mid-spine. Doctors at the time told the Bulgarian there was only a one per cent chance he would recover. He had lost all motor and sensory control over his legs.

Fidyka went into intensive physiotherapy, but nothing worked. He showed no signs of recovery.

But now, following a surgery scientists hail as a “breakthrough” and a world first, life has changed for the 38-year-old Fidyka. He can walk with a frame, drive and live with greater independence.

This 38-year-old Bulgarian patient, who suffered his injury in 2010, is believed to be the first person in the world to recover from the complete severing of the spinal nerves.image www.newcures.info

This 38-year-old Bulgarian patient, who suffered his injury in 2010, is believed to be the first person in the world to recover from the complete severing of the spinal nerves. Photo: AFP/BBC

As described by the BBC, which was granted special access to the project and to the rehabilitation over the course of a year, Polish surgeons put into practice a technique developed at University College London. There, research by Geoffrey Raisman revealed damaged nerve cells can form new connections with a little help from special cells in the nasal cavity called olfactory ensheathing cells.

The surgeons took nerve cells from Fidyka’s nose, used them to culture new ensheathing cells, and transplanted them into the spinal cord stumps above and below his injury. The hope was they would connect and form a bridge or pathway across the gap caused by the injury. And that’s exactly what happened.

Within months after the procedure, Fidyka developed feeling in one of his legs and today can move around on his own. In an interview with the BBC, he described it as an “incredible feeling. … When you can’t feel almost half your body, you are helpless, but when it starts coming back it’s like you were born again.”

Darek Fidyka can now walk with a frame, giving him greater independence image www.newcures.info

Darek Fidyka can now walk with a frame, giving him greater independence. Photo: AFP/BBC

Scientists were cautious about the promising procedure, stressing only one patient has so far been treated. “Determination of the precise mechanisms of action, repetition in more patients and more long-term follow up are all necessary to help validate whether this promising procedure is of clinical relevance,” John Sladek of the University of Colorado told the Independent.

Still, if just for Fidyka, the scientists are rejoicing at what the BBC calls a “world first” in medicine, the full narrative of which is published in the journal Cell Transplantation. “Prior to the transplantation, we estimated that without this treatment, our patient’s recovery chances were less than one per cent,” Pawel Tabakow of the Wroclaw Medical University said in a statement. “However, we observed a gradual recovery of both sensory and motor function that began four months after the surgery.”

“He can get around with a walker and he’s been able to resume much of his original life, including driving a car,” Raisman, one of the study’s authors, told the Guardian. “He’s not dancing, but he’s absolutely delighted.”

He added to the Independent: “I believe this is the first time that a patient has been able to regenerate severed long spinal nerve fibres across an injury and resume movement and feeling. I believe we have now opened the door to a treatment of spinal cord injury which will get patients out of wheelchairs. Our goal is to develop the first procedure to a point where it can be rolled out as a worldwide general approach.”

That goal, however, is clearly a long way off. Right now, he’s working to raise funds to treat several more patients in Poland in the next five years. Those tests may help show whether this treatment can help an estimated 3 million people paralysed across the world.

“Paralysis is something that most of us don’t know very much about, because we are not affected by it,” David Nicholls, the founder of the Nicholls Spinal Injury Foundation told the Guardian. But “the scientific information relating to this significant advancement will be made available to other researchers around the world so that together we can fight to finally find a cure for this condition which robs people of their lives.”

The English chef started the charity after his 18-year-old son Daniel, on a gap year in Australia, became paraylsed after diving into a sandbank below the surface at Bondi Beach in 2003.

“I got call telling me that Dan had had a swimming accident and that he had broken his neck,” Nicholls told the BBC. “I promised Dan that we would get him walking – I had no idea at that time that paraysis was incurable.”

“This [breakthrough] gives us enormous hope. The catalyst of setting of that charity: there was an 18-year-old Australian boy in the next bed to Dan whose parents came to see him and never came back – they abandoned him and that’s just not acceptable.”

The Washington Post

Henry Sapiecha

NEUROPROSTHESIS GIVES MONKEY FEELINGS BACK INTO PARALYSED HAND

Wednesday, May 2nd, 2012

NEUROPROSTHESIS AND RESTORATION OF MOVEMENT IN PARALYZED HAND

Researchers at Northwestern University have developed a neuroprosthesis that restores complex movement in the paralyzed hands of monkeys. By implanting a multi-electrode array directly into the brain of the monkeys, they were able to detect the signals that generate arm and hand movements. These signals were deciphered by a computer and relayed to a functional electrical stimulation (FES) device, bypassing the spinal cord to deliver an electrical current to the paralyzed muscles. With a lag time of just 40 milliseconds, the system enabled voluntary and complex movement of a paralyzed hand.

The experiments were carried out on two healthy monkeys, whose electrical brain and muscle signals were recorded by the implanted electrodes when they grasped, lifted and released a ball into a small tube. Using these recordings, the researchers developed an algorithm to decode the monkeys’ brain signals and predict the patterns of muscle activity that occurred when they wanted to move the ball.

The monkeys were then given an anesthetic to locally block nerve activity at the elbow, resulting in temporary paralysis of the hand. The multi-electrode array and FES device – which combine to form the neuroprosthesis – allowed the monkeys to regain movement in the paralyzed hand and pick up and move the ball with almost the same level of dexterity as they did before the paralysis.

“The monkey won’t use his hand perfectly, but there is a process of motor learning that we think is very similar to the process you go through when you learn to use a new computer mouse or a different tennis racquet. Things are different and you learn to adjust to them,” said Lee E. Miller, the Edgar C. Stuntz Distinguished Professor in Neuroscience at Northwestern University Feinberg School of Medicine and the lead investigator of the study.

Dr. Miller’s team also performed grip strength tests, and found that the neuroprosthesis enabled voluntary and intentional adjustments in force and grip strength – key factors in successfully performing everyday tasks naturally.

The multi-electrode array implant detects the activity of about 100 neurons in the brain, which is just a fraction of the millions of neurons involved in making the hand movements. However, Miller points out that the neurons they are detecting are output neurons normally responsible for sending signals to the muscles.

“Behind these neurons are many others that are making the calculations the brain needs in order to control movement. We are looking at the end result from all those calculations,” Miller said.

Miller added that, while the temporary nerve block used in the study is a useful model of paralysis, it doesn’t replicate the chronic changes that occur after prolonged brain and spinal cord injuries. For this reason, the next test for the system will be in primates suffering long-term paralysis to study how the brain changes as it continues to use the device.

However, the ultimate aim for the team is for the system to restore movement in human paralysis sufferers. “This connection from brain to muscles might someday be used to help patients paralyzed due to spinal cord injury perform activities of daily living and achieve greater independence,” said Miller.

The results of the Northwestern University team’s study, which was funded by the National Institutes of Health (NIH), appears in the journal Nature.

Sourced & published by Henry Sapiecha

PARALYSED PEOPLE GET ELECTRICAL IMPLANT TO WALK AGAIN

Friday, May 20th, 2011

Paralysed man stands again

after electrical implant

May 20, 2011 – 1:21PM


After Rob Summers was paralysed below the chest in a car accident in 2006, his doctors told him he would never stand again. They were wrong.

Despite intensive physical therapy for three years, Mr Summers’s condition had not improved. So in 2009, doctors implanted an electrical stimulator on to the lining of his spinal cord to try waking up his damaged nervous system.

Within days, Mr Summers, 25, stood without help. Months later, he wiggled his toes, moved his knees, ankles and hips and was able to take a few steps on a treadmill.

Walking again ... Rob SummersA few steps … Rob Summers. Photo: AFP / Courtesy of Rob Summers

“It was the most incredible feeling,” said Mr Summers, of Portland, Oregon. “After not being able to move for four years, I thought things could finally change.”

Still, despite his renewed optimism, Mr Summers cannot stand when he is not in a therapy session with the stimulator turned on, and he normally gets around in a wheelchair. Doctors are limiting his use of the device to several hours at a time.

His case is described in a paper published today in the journal Lancet. The research was paid for by the US National Institutes of Health and the Christopher and Dana Reeve Foundation.

Building up his strength ... Rob Summers.Building up his strength … Rob Summers. Photo: AFP / Courtesy of Rob Summers

For years, certain people with incomplete spinal cord injuries, who have some control of their limbs, have experienced some improvement after experiments to stimulate their muscles electrically. But such progress had not been seen before in someone with a complete spinal cord injury.

“This is not a cure, but it could lead to improved functionality in some patients,” said Gregoire Courtine, head of experimental neurorehabilitation at the University of Zurich. He was not connected to Mr Summers’s case.

He cautioned that Mr Summers’s recovery so far had not make any difference to his daily life and that more research was needed to help paralysed people regain enough mobility to make a difference in their normal routines.

Before the accident ... Rob Summers.Before the accident … Rob Summers. Photo: AFP / Courtesy of Rob Summers

The electrical stimulator surgeons implanted on to Mr Summers’s spinal cord is usually used to relieve pain and can cost up to $US20,000.

Mr Summers’s doctors implanted it lower than normal, on to the very bottom of his vertebrae.

“The stimulator sends a general signal to the spinal cord to walk or stand,” said Susan Harkema, rehabilitation research director at the Kentucky Spinal Cord Injury Research Centre in Louisville and the Lancet study’s lead author.

Dr Harkema and her colleagues were surprised that Mr Summers was able to move his legs voluntarily. “That tells us we can access the circuitry of the nervous system, which opens up a whole new avenue for us to address paralysis,” Dr Harkema said. She said prescribing drugs might also speed recovery.

John McDonald, director of the International Centre for Spinal Cord Injury at Kennedy Krieger Institute in Baltimore, said the strategy could be adopted rapidly for the 10 to 15 per cent of paralysed patients who might benefit. He was not connected to the Summers case.

“There is no question we will do this for our patients,” Dr McDonald said.

He added that, since the electrical stimulators were already approved for pain relief, it should not be difficult to study them to help some patients regain movement.

For now, Mr Summers does about two hours a day of physical therapy.

“My ultimate goal is to walk and run again,” he said. “I believe anything is possible and that I will get out of my wheelchair one day.”

AP  Sourced & published by Henry Sapiecha