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Thread: Ten frequently asked questions concerning cure of spinal cord injury

  1. #141
    Senior Member Tim C.'s Avatar
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    Dr Young, there's no secret that you control the attention of the sci world, and far beyond. It is for this, and many other reasons I'm sure, that you must chose your words carefully..
    It is soon reaching the 1st anniversary of this thread. Unless previously posted elsewhere, to which I offer my apologies, I thought it only appropriate to keep you infinitely haunted by the only quandry that really matters to us: can we expect moderate recoveries by 2010?
    RULES OF RESPONSE:
    Cannot use the word; "depends".
    Cannot ask why I used the date; 2010.
    Cannot respond with another question.
    Cannot disappoint us.
    Cannot use the term "research money" more than once.

    Yes, we are trying our best too.

  2. #142
    Tim,

    Without putting any caveats on my comments, the answer is yes, I believe that there will be therapies that will restore more than "modest" amounts of function. First generation therapies produce some function or some people. Second generation therapies as those that produce more function in more people. What you received was the first generation therapy. The second generation therapies are beginning to be tested in clinical trials.

    Wise.

  3. #143
    Senior Member Schmeky's Avatar
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    Tim C., good question.

    Dr. Y, good answer.

    Dr. Y, one more question: I have read that lower cervical and mid-thoracic injuries (above T-8) may respond to second generation therapies favorably since there is no loss of motorneurons. Is it possible that second generation could get some of these injury levels up on their feet?

    I assume third generation will consist of replacement of lost/damaged motorneurons, correct?

  4. #144
    Schmekey,

    I think that second generation therapies will help all spinal cord injured people. It is true that some people will need neuronal replacement and that will take stem cells or other therapies to produce that outcome. However, most people will benefit from axonal regeneration.

    Wise.

  5. #145
    Dr. Young,
    I keep reading the term "axonal regeneration". Is this currently available? Sally's problem is axonal loss. No injury, no tumors, little inflamation(controlled by IVIG). She needs axons. Some have regenerated since the onset of her illness (critical illness poyneuropathy). She continues to make very small gains 7 years post, but still not walking or weight bearing, except fullly supported on standing frame.

    Is there any treatment currently available, anywhere in the world, that will help to hasten the regeneration of her axons?

    Thanks,
    Sandi

  6. #146
    Quote Originally Posted by linnburg1
    Dr. Young,
    I keep reading the term "axonal regeneration". Is this currently available? Sally's problem is axonal loss. No injury, no tumors, little inflamation(controlled by IVIG). She needs axons. Some have regenerated since the onset of her illness (critical illness poyneuropathy). She continues to make very small gains 7 years post, but still not walking or weight bearing, except fullly supported on standing frame.

    Is there any treatment currently available, anywhere in the world, that will help to hasten the regeneration of her axons?
    Regenerating axons is what most of spinal cord injury research has been all about. There are literally dozens, perhaps even hundreds, of treatments that have been reported to produce some regeneration in animal spinal cord injury models. I summarize these in many articles and posts that I have written for this site over the past three years. If you are having trouble finding them on the site, i can try to point some out.

    Regarding Sally's situation, I assume that you are talking about her peripheral nerves and not spinal cord injury when you say "critical illness polyneuropathy". The reasons for peripheral neuropathy are not well understood. For example, it is not clear (at least to me, even though I follow the literature pretty carefully) why peripheral neuropathy occurs and what exactly happens when a person gets polyneuropathy, diabetic neuropathy, or even Guillian-Barre neuropathy. One of the reasons why we do not know is because rarely do we ever get to see the pathology of the nerves when this is happening. Few doctors would consider taking a biopsy of a peripheral nerve while neuropathy is happening. When we do see the nerves, it is usually long after the initial acute event. While there are animal models, we really don't know how closely the animal models mimic various human neuropathies.

    There are several excellent web sites that explain peripheral neuropathy. One of the best is http://www.aafp.org/afp/980215ap/poncelet.html. Diagnoses of neuropathies try to distinguish between three conditions:

    1. Axonopathy. In this case, the axon itself is damaged but the neuron that gives rise to the axon remains intact. Generally, axonopathy affects the most distal part of the axon first and the axon dies back some distance. The axon must regrow back to restore function. Peripheral nerves do regenerate but it is much more limited is generally conceded. Recovery, however, can occur with about 10% of the peripheral axons regenerating.

    2. Neuronopathy. In this case, the neurons that gave rise to the axons are damaged or have died. This can refer to either motoneurons (which are located in the gray matter of the spinal cord) or sensory neurons (which are located in the dorsal root ganglia just outside the spinal column). Note that when a dorsal root ganglion neuron dies, both the peripheral axon and the central axon (that goes into the spinal cord and up to the brain) die.

    3. Myelinopathy. In this case, the cells that myelinate (ensheathes) axons die. For peripheral nerves, these cells are Schwann cells. If the axons are spared, recovery from remyelination by Schwann cells is often rapid, on the order of weeks, at most months, unless of course there is continuing demyelination.

    Of course, a peripheral neuropathy can include all three of these components. All three cause loss of peripheral nerve function and a clinical neurological examination often is not sufficient but some obvious clinical important findings are sensory loss versus motor loss, the distribution of the neurological deficits, and the presence or absence of muscle atrophy. Nerve conduction studies can detect some partially demyelinated axons. The presence of pain or sensory hypersensitivity developing afterward would be suggestive of damage and regrowth of small and thin fibers that conduct pain. Finally, one frequently overlooks the sympathetic and parasympathetic peripheral nervous system effects of neuropathy and it is important that these be assessed in the clinical examination, including respiratory, bowel, bladder, and other autonomic functions.

    Treatments for neuropathies to date have focused on prevention of further damage or compliations (Source), as opposed to enhancing recovery or regeneration. Many experimental treatments, however, have been shown to enhance peripheral nerve regeneration, including hormones (pregnenolone and others), growth factors (nerve growth factor or NGF, neurotrophin-3 or NT3), vitamins (B12, methylcobalmin), artemin, insulin-like growth factor or IGF-1, erythropoietin, and many other treatments.

    Wise.

  7. #147
    Senior Member Tim C.'s Avatar
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    Response to my post

    Dr Young,
    Of couse I showed utter disrespect to you and the professional world of neurology by posting such a bush question.
    Please accept my apologies, I know you know me not to place such a desperate post.

    But then again, you answered! ? !
    You are remarkable.
    Just to be sure, I have a team of lawyers carefully combing your response as we speak. lol. you have learned to choose your words carefully to say the least.
    I also know recoveries will be available for us within the time projections you speak. I hope we can live up to your expectations too.
    You already have inspired many blog-fuls of heroes within the CC community.

  8. #148
    .....
    Last edited by Christopher Paddon; 07-07-2005 at 04:33 AM.

  9. #149
    Tim,

    Please, I don't think that you are showing disrespect at all. You should understand, however, that I don't have a crystal ball. My guess is as good as yours. All the information that I have is available on this site. You can judge as well as i can.

    The main obstacle to progress in achieving restorative therapies for spinal cord injury has not been science but economics and politics. While I can talk about science until I am blue in the face, if the funding is not available to translate the science into therapies for people and there is political obstruction of therapies, the implementation of therapies may be delayed. That would be a shame.

    As Christopher Reeve once said (paraphrasing from memory), "I think that I can accept it if scientists tell me that it is very difficult or impossible to regenerate the spinal cord but I cannot tolerate it when scientists say that it can be done but it is not happening because of funding or politics."

    Two days ago, Senator Jon Corzine (who is running for governor of the state of New Jersey) announced his commitment to stem cell research and to making New Jersey the "cure corridor". I asked him what we can do to help him win the hearts and minds of New Jersey voters to this cause. He said to me that scientists must be careful not to take sides in politics because one cannot predict elections. He said that support of stem cell research and science that can help people should be bipartisan and should not be a political issue. He commented further that scientists may lose credibility is they take sides in politics.

    I have been reflecting on his comment to me for the last day or so. As some people on these forums may have witnessed, over the past few years, I have become slowly but surely convinced that scientists must take a much greater role in educating society and our government. We must speak out or else those who are against science will eat our lunch. There is so much misinformation out there and I have come to realize that there are politicians who are against cure and science. The last four years in particular have convinced me that misguided politicians can do a great deal of harm people that I care very much about. We have lost four years in stem cell research because scientists hesitated to speak out strongly.

    Scientists can no longer bury themselves in the laboratory and ignore what is happening outside. For 20 years, I did bury myself in the laboratory, believing that good science was necessary and sufficient. I still believe that it is necessary but I no longer think that good science alone is sufficient. If we discover therapies that work in animals but society and government does not do what is necessary to get the therapies to people, scientists must become involved in the process of moving the therapies to people.

    Wise.
    Last edited by Wise Young; 07-08-2005 at 07:46 AM.

  10. #150
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    siringomielia and future terapy

    dear Dr.Wise

    first i have no words for your work in the forum ; thank you very much for all you are doing for us in the world.

    Second i have a dilemma : i'm t 5 complete asia A
    my M.R N. show a big cavity at T6 with a syrinx from t5 to c3 ; my T-A.C.XRAY show about 20% anterior compression of the cord at T5 level- seven years ago i had posterior laminectomy with stabilitation by two Hurrington . Now ì'm in good shape i work eight hours day in my office and i do FES bycicle every day 20minuts in the pause and parastep one day a week. I would wait for the best terapy with an anterior decompression in one time but in your opinion is better to do now a anterior decompresiion and later future terapy . I have neuropatic pain but no loss function .

    thank you so much!

    Paolo

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