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Thread: Questions for Dr. Wise Young

  1. #1

    Questions for Dr. Wise Young

    Dr Young, I have a few questions about incomplete and complete for SCI. I was considered incomplete when have a schawnomas tumor removed from T-11 to S-2 on April 11, 2006. My questions are :

    1. What is the different of incomplete and complete ? If only 10% of spinal cord is needed to walk, then how many percent is incomplete?
    2. Who will be eligible for your trail, incomplete or complete or both? And up to how long after the post injury would qualify?
    3. Do you think the incomplete has a better chance of improving the condition than the complete?

    Thanks for all your help and great works.

    Steve

  2. #2
    all these questions have been answered, there is a search button up top
    C5/C6 Complete since 08/22/09

  3. #3
    Senior Member khmorgan's Avatar
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    Yeah, let's try not to ask Dr. Young to answer the same questions time and time again. See: http://www.sci-info-pages.com/levels.html

  4. #4
    Quote Originally Posted by khmorgan View Post
    Yeah, let's try not to ask Dr. Young to answer the same questions time and time again. See: http://www.sci-info-pages.com/levels.html
    Thank you for the informations.

  5. #5
    Quote Originally Posted by steve nguyen View Post
    Dr Young, I have a few questions about incomplete and complete for SCI. I was considered incomplete when have a schawnomas tumor removed from T-11 to S-2 on April 11, 2006. My questions are :

    1. What is the different of incomplete and complete ? If only 10% of spinal cord is needed to walk, then how many percent is incomplete?
    2. Who will be eligible for your trail, incomplete or complete or both? And up to how long after the post injury would qualify?
    3. Do you think the incomplete has a better chance of improving the condition than the complete?

    Thanks for all your help and great works.

    Steve
    Steve,

    Incomplete spinal cord injury is defined clinically from presence of function below the injury site. If you have sacral sparing, i.e. motor function (sphincter contraction) or sensation (anal sensation) in your lowest sacral segment, you are incomplete. If you don't have sacral sparing, you are classified as American Spinal Injury Association (ASIA) Impairment Scale A. If you are incomplete but only have sensation below the injury site, you are AIS B. If you are incomplete but have ≤50% of the motor score below the injury site, you are AIS C. If you are incomplete but have >50% of the motor score above the injury site, you are AIS D. If you have normal motor and sensory scores, you are AIS E.

    In the U.S. trial, we are thinking of including only those patients that are AIS A. However, we are considering including AIS B's. In China, however, we are planning to include AIS A, B, and C. We have not yet decided for SCINet India or SCINet Norway.

    I don't know whether complete or incomplete spinal cord injuries will benefit more from the umbilical cord blood mononuclear cells (UCBMC) and lithium therapies. That is why we are doing the trials.

    Wise.

  6. #6
    Wise, thank you very for explaining once again ASIA scale. May be that's a great classification, but for me, in terms of clinical trials - I mean being involved in it - it means nothing because I guess someone who's L1 ASIA B has less chances to be involved in trials and get better than a D5 ASIA A.
    I would rather prefer to classify injuries in another way: those who need remyelination, those who need axons sprout on short distance, those who need axons sprout long distance, those who need neurons replacement, those who have spasticity, those who don't have...
    What do you think ?..
    Thanks a lot
    G78

  7. #7
    Quote Originally Posted by George78 View Post
    Wise, thank you very for explaining once again ASIA scale. May be that's a great classification, but for me, in terms of clinical trials - I mean being involved in it - it means nothing because I guess someone who's L1 ASIA B has less chances to be involved in trials and get better than a D5 ASIA A.
    I would rather prefer to classify injuries in another way: those who need remyelination, those who need axons sprout on short distance, those who need axons sprout long distance, those who need neurons replacement, those who have spasticity, those who don't have...
    What do you think ?..
    Thanks a lot
    G78
    George,

    As you know, it is not easy to tell whether a person needs sprouting, regeneration (of axons), remyelination, or replacement (of neurons). The ASIA classification system was not intended for this purpose. It was developed as a means of doctors to describe their patients. The classification does provide a clear prognostication for recovery when made early after injury. So, for example, 90% of people with ASIA B, C, D recover unassisted walking within a year whereas <10% of ASIA A cases recover unassisted walking.

    Acute spinal cord injury trials, in my opinion, must stratify their subjects by ASIA classification. As you know, comparing acute ASIA A and C spinal-injured patients is like comparing blackberries seeds and watermelon seeds. They grow into very different fruits. You must stratify and compare members of each classification separately. If you mix the two, the proportion of A and C's in the randomized groups will confound the results.

    For chronic spinal cord injury, however, the differences between ASIA A, B, and C are not so stark. For example, Christopher Reeve became ASIA C over several years. His prognosis for walking recovery as person who became an ASIA C at 2-3 years after injury is not the same as a person who was an ASIA C at 72 hours after injury. The decision for inclusion or exclusion of A, B, C really depends on how much money you have for the trials. If you have all three groups, you need to study more patients.

    On the other hand, as you point out, it is not difficult to segregate patients by other criteria. For example, if you are ASIA B with an L1 level, that suggests that you will probably need neuronal replacement as well as regeneration. If you have a Brown-Sequard syndrome (i.e. an incomplete spinal cord injury that is greater on one side than the other), therapies that enhance sprouting of the remaining tracts (i.e. nogo-A antibody) may help accelerate or improve recovery.

    As you know and as I have pointed out many times here in these forums, levels of injury is very important and will require different treatments. Cervical injuries will require regeneration and replacement. Thoracic injuries require regeneration. Lumbosacral injuries will require neuronal replacement and axonal regeneration. Cauda equina injuries will require treatments that allow axons to enter back into the spinal cord.

    People need to understand their injuries and be able to make appropriate decisions concerning which clinical trials they want to participate in. Just plugging in stem cells may not be the answer. Stem cells don't know what to do and in fact may not be good for the spinal cord if they do the wrong thing. Too many people are thinking that stem cells are not just pluripotent but omnipotent. They are just cells that have to instructed to make the proper number and type of cells.

    In many cases, the scientists or clinicians doing the trial may not know how their therapies may work, if they work. For example, Geron is transplanting oligodendroglial progenitor cells into people with ASIA A subacute spinal cord injury. On the surface, one might think that their goal is to remyelinate axons. But, if so, ASIA A spinal cord injury might not be the best population to see any effects since people with ASIA A injuries presumably have the fewest number of axons to remyelinate. If they see beneficial effects, it may be because the cells are secreting growth factors that improve repair and remyelination of the spinal cord.

    Stem Cell Inc is transplanting fetal neural stem cells into the thoracic spinal cord, starting with ASIA A in the first four patients, then ASIA B in the second three patients, and then ASIA C in the third group of 2 patients. As I understand it, the patients will be between 6-12 months after injury. And, I believe that they are focusing on thoracic spinal cord injury. The trial is starting with ASIA A thoracic spinal cord injury because clinicians believe that such patients have the least to lose. I think that their goal is to remyelinate.

    ChinaSCINet is transplanting umbilical cord blood mononuclear cells and into the spinal cord above and below the injury site of patients with C5 through T10 injuries. Half of the patients will get a 6-week course of lithium. In the U.S. and Norway, the patients will be ASIA A only. In China and possibly in India, we are planning to study patients with ASIA A, B, and C. The treatment is intended to regenerate long tracts. We are very interested in and working with several groups to develop iPS cells, neural stem cells derived from adult stem cells, and other cells to replace neurons.

    Wise.
    Last edited by Wise Young; 06-16-2011 at 11:44 AM.

  8. #8
    Quote Originally Posted by Wise Young View Post

    As you know and as I have pointed out many times here in these forums, levels of injury is very important and will require different treatments. Cervical injuries will require regeneration and replacement. Thoracic injuries require regeneration. Lumbosacral injuries will require neuronal replacement and axonal regeneration. Cauda equina injuries will require treatments that allow axons to enter back into the spinal cord.

    People need to understand their injuries and be able to make appropriate decisions concerning which clinical trials they want to participate in. Just plugging in stem cells may not be the answer.
    I know you often have to reiterate the basic spinal cord injury verbiage. Two quick questions: Are cervical and lumbar/sacral injuries similar because they both require neuronal replacement and axonal regeneration? I'm just trying to clarify what you've written above.

    Also, you stated in the past that 90% of patients diagnosed as incomplete within the first 24 hours of injury can recover unassisted walking. I probably need to reread the study, did this study include intensive locomotion therapy. I know that within the first 24 hours of my injury I was diagnosed as incomplete ASIA B. I have some voluntary movement in my lower extremities but nothing even remotely close to walking. So I'll assume that I'm in the 10%?

  9. #9
    Thanks Dr Wise for the informations. I wish you well and success on your clinical trails .

  10. #10
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    Dear Wise will Lumbar injuries need both neuronal replacement and axonal regeneration therapies? Which therapies will be or should be used as axonal regeneration in lumbar injuries?
    What you are planning for lumbosacral trials which u plan to start?
    In old lumbar injuries with compression, will u be doing decompression first before cell and axonal regeneration treatment?

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