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

  1. #591

    Angry

    Quote Originally Posted by Aleks Z View Post
    Help solve the problem. I am a masseur and friend of mine, had endured four months ago, surgery to remove a herniated intervertebral, asks him to do a back massage with honey. Is it acceptable is in this case?
    oh boy!
    "I'm manic as hell-
    But I'm goin' strong-
    Left my meds on the sink again-
    My head will be racing by lunchtime"

    <----Scott Weiland---->

  2. #592
    2004+8=2012 third generation therapies

    If the cord blood/ lithium treatment proves to restore function then could this prediction be pretty accurate?

  3. #593
    Quote Originally Posted by Christopher Paddon View Post
    2004+8=2012 third generation therapies

    If the cord blood/ lithium treatment proves to restore function then could this prediction be pretty accurate?
    I hope. Wise

  4. #594

    Placebo Testing Possible for Stem Cell Therapies

    Dr Young,

    Is it possible, or does it make sense, to involve placebo testing as part of Stem Cell Clinical trials? If so, at what stage trial would this take place and how would it be done? If not, why does it not make sense for Stem Cell trials?

    My husband and I have had a lot of discussion on this point (with differing opinions!) Thank you!

  5. #595
    Hello Dr. Young,

    What do you think is the main reason a cure for SCI hasn't been found out yet (and does not seem to be coming in the near future)?

    1. Lack of money.
    2. The issue is just very complicated scientifcally.
    3. Governement regulations (e.g. requirements for clinical trials).
    4. Other?

    Thank you very much for all your help!

  6. #596
    Quote Originally Posted by KYLady View Post
    Dr Young,

    Is it possible, or does it make sense, to involve placebo testing as part of Stem Cell Clinical trials? If so, at what stage trial would this take place and how would it be done? If not, why does it not make sense for Stem Cell trials?

    My husband and I have had a lot of discussion on this point (with differing opinions!) Thank you!
    KYLady,

    I agree with both of you. If possible, one should have a placebo control arm in trials because they are the most convincing. There are times when you can't have placebo controls and you have to make do with other approaches. For example, we are planning a phase 3 trial in China where we will be transplanting umbilical cord blood mononuclear cells (UCBMC) into 400 subjects with chronic ASIA A, B, or C spinal cord injury (SCI) and then randomizing the subjects to a 6-week course of lithium or placebo.

    In this trial, everybody will get a transplant therapy and randomized to lithium or placebo. Strictly speaking, the trial will tell us whether lithium enhances the effects of UCBMC transplants in chronic SCI but actually we will gain much more information. If both treatment groups show no improvement compared to pre-injury levels, we can conclude that neither UCBMC or UCBMC plus lithium improve function and recommend against both. If both treatments show improvements and do not differ significantly from each other, the trial would suggest that UCMBC improve function but we would need to rule out possible effects of surgery alone (which is associated with the transplants). Finally, if UCBMC+lithium treated subjects have significantly better neurological scores than subjects that received UCBMC alone, as well of course as pre-treatment levels, we would be able to recommend the combination therapy.

    Wise.

  7. #597
    Quote Originally Posted by Wise Young View Post
    KYLady,

    If both treatment groups show no improvement compared to pre-injury levels, we can conclude that neither UCBMC or UCBMC plus lithium improve function and recommend against both. If both treatments show improvements and do not differ significantly from each other, the trial would suggest that UCMBC improve function but we would need to rule out possible effects of surgery alone (which is associated with the transplants). Finally, if UCBMC+lithium treated subjects have significantly better neurological scores than subjects that received UCBMC alone, as well of course as pre-treatment levels, we would be able to recommend the combination therapy.

    Wise.
    Even if the finding were to be you could not recommend either it would be success in making one more step toward the goal.

  8. #598
    Quote Originally Posted by Wise Young View Post
    KYLady,

    I agree with both of you. If possible, one should have a placebo control arm in trials because they are the most convincing. There are times when you can't have placebo controls and you have to make do with other approaches. For example, we are planning a phase 3 trial in China where we will be transplanting umbilical cord blood mononuclear cells (UCBMC) into 400 subjects with chronic ASIA A, B, or C spinal cord injury (SCI) and then randomizing the subjects to a 6-week course of lithium or placebo.

    In this trial, everybody will get a transplant therapy and randomized to lithium or placebo. Strictly speaking, the trial will tell us whether lithium enhances the effects of UCBMC transplants in chronic SCI but actually we will gain much more information. If both treatment groups show no improvement compared to pre-injury levels, we can conclude that neither UCBMC or UCBMC plus lithium improve function and recommend against both. If both treatments show improvements and do not differ significantly from each other, the trial would suggest that UCMBC improve function but we would need to rule out possible effects of surgery alone (which is associated with the transplants). Finally, if UCBMC+lithium treated subjects have significantly better neurological scores than subjects that received UCBMC alone, as well of course as pre-treatment levels, we would be able to recommend the combination therapy.

    Wise.
    Thank you for the clear explanation. It shows how well thought out trials and constant tweaking based on the results is the right way to move forward. Good scientific minds, relentless hard work, dedication, patience, hopefully a little luck, and doggedly evolving towards a solution is the right path. Thank you for what you do so well!

  9. #599

    Decompression?

    I am 25 years post-injury, and really trying to get a clue, get myself as best as I can be, after years of just "living" with SCI...This concept of decompressing the spinal cord - where do you go to do something like that? How do I know if I'm a "good candidate"/what are the criteria/where can I find out more info?
    Thanks!!!

    Quote Originally Posted by Wise Young View Post
    Schmeky, I always feel strange about making predictions. You should perhaps regard it as an achievable goal rather than a prediction.

    Regarding your spinal cord, I would recommend that it be decompressed. Although there are some doctors who feel that there is no point to decompressing the spinal cord in a chronic patient, because they are pessimistic regarding any return, I feel that any compression of the spinal cord (even 15%) should be removed for the following reasons:
    1. It is touching your spinal cord. There should be nothing touching your cord. Every time you move, it is pushing on your cord.
    2. It may be compressing your cord by 15% while you are laying prone but it may do so more when you are moving or twisting your back.
    3. It is very likely to obstruct some cerebrospinal fluid flow. That will predispose you to the formation of a syringomyelic cyst.

    What you should do, however, is balance the risks and benefits of the surgery. I assume that the compression is from the anterior direction and that it is in the thoracic cavity. If so, this means that the surgery has to go through the chest. The surgery will not be trivial. It will be a long procedure and your chest will need to be opened. A decade ago, I probably would have said that such surgery would have been too risky. On the other hand, opening of the chest cavity is so commonly done today and many hospitals have extensive experience with heart surgery that they can crack open a chest, put in four bypasses, and the patient is out of the hospital in 3 days. The risk of such surgery is much lower today than it was a decade ago. So, if your doctor feels comfortable about it and his/her hospital has good support and experience in the procedures, I would go ahead with the procedure if I were you.

    Wise.

  10. #600

    umbilical cord blood?

    I am wondering what the "real" benefits/potential may be in storing umbilical cord blood (well, first having a baby!) in terms of eventual cure? It's a mighty expensive undertaking, but if there were some real potential benefit, I would find a way. Could you shed some light on this? Thanks!!

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