Wise ? 4-AP - benefit from remyelination.

tucker · 11-23-2004, 10:43 AM

Hi Wise,
is it a reasonable assumption that my injury at C7 T1 which on an MRI is only a very small bruise may suggest that I may have a good probability of benefiting from remyelination. I have pretty good sensation all over and can walk well in parallel bars (I am one of those people whom after my injury almost 20 years ago underwent intensive weight-baring treadmill training which enabled me to walk well in parallel bars even though I had no noticable voluntary movement and still don't). Since my moter function is severely limmited but the injury / contusion / bruise appears so small, is it probable that the primary damage was demyelination? In summary, does an injury with little "apparent" damage suggest that demyelination is the likely source of motor function loss? I am considering trying 4 AP again, this time with intensive exercise.

Wise Young · 11-23-2004, 03:36 PM

tucker, sounds reasonable to me. Wise.

gretchen · 11-24-2004, 05:12 AM

Dr. Young,

I am confused again. My injury was on T 10,and my MRI doesn't show any residual trace of the mass. I can walk with canes, even take a few steps without canes but I have limited sensations in the left leg and almost none on the right side ( I have deep sensations but none to the touch)and my sphincter is at 0. I had an avm that went undetected for five years, does that mean the damage killed neurons and that I would not benefit from remyelination? I would have liked to try 4AP : (

gretchen 1

Wise Young · 11-24-2004, 05:53 AM

Gretchen, it is difficult to ascertain from your description the extent of your injury. As I have pointed out before, AVM's and ischemic injuries of the spinal cord don't have consistent patterns like traumatic injury where the damage is localized to one limited area. On the other hand, T10 is reasonably far away from the lumbar enlargement at T12-L1. I suspect that you probably have damaged axons, oligodendroglia (myelin-forming cells), and neurons in your spinal ccrd. When 4-AP was first started in clinical trial, we were thinking that it may have most of its effects on demyelinated axons. While that may be true, I still don't have a very good understanding of the type of lesion produced by an AVM. In any case, it is relatively straightforward too try 4-AP. If it has a significant effects, this would suggests that you would benefit from remyelination therapy.

Wise.

gretchen · 11-24-2004, 06:18 AM

Thank you. I am going to try and I will keep you informed of my results. Can you tell me if I am considered complete or incomplete? Someone told me I was complete in spite of the motor skills I have regained because my sphincter was rated at 0?

gretchen 1

Wise Young · 11-24-2004, 06:19 AM

Gretchen, if you have no anal sensation or sphincter control, that means that you are at least "complete" at S4/5, the lowest level of the spinal cord. Wise.

gretchen · 11-24-2004, 06:22 AM

I am sorry I have another question for you. You imply that avms are more problematic than traumatic injury. Dr. Huang told me I could be a good candidate for his procedure, would you agree that it might help me and people with vascular injuries?

gretchen 1

gretchen · 11-24-2004, 06:25 AM

If I am complete, then it means 4 AP and other treatments available to incomplete injury patients will not work for me? How can I be complete and have almost normal sensations on the left side of my vagina?

gretchen 1

gretchen · 11-24-2004, 07:19 AM

You wrote that if someone can feel their bladder is full, they were or would be incomplete. I have no anal sensation but I can feel that my bladder is full. (I have to push to void though) In which category am I?

gretchen 1

gretchen · 11-27-2004, 09:04 AM

I can feel when my bladder is full, but I have to push to void. That came back one month past injury.

I would like to know if anyone has regained anal sensations, bowel and/or bladder functions past the two-year marker.

gretchen 1

11-23-2004, 10:43 AM	#1
tucker Senior Member Join Date: Jul 2003 Posts: 119	Wise ? 4-AP - benefit from remyelination. Hi Wise, is it a reasonable assumption that my injury at C7 T1 which on an MRI is only a very small bruise may suggest that I may have a good probability of benefiting from remyelination. I have pretty good sensation all over and can walk well in parallel bars (I am one of those people whom after my injury almost 20 years ago underwent intensive weight-baring treadmill training which enabled me to walk well in parallel bars even though I had no noticable voluntary movement and still don't). Since my moter function is severely limmited but the injury / contusion / bruise appears so small, is it probable that the primary damage was demyelination? In summary, does an injury with little "apparent" damage suggest that demyelination is the likely source of motor function loss? I am considering trying 4 AP again, this time with intensive exercise.

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11-23-2004, 03:36 PM	#2
Wise Young Administrator Join Date: Jul 2001 Location: New Brunswick, NJ, USA Posts: 37,975	tucker, sounds reasonable to me. Wise.

11-24-2004, 05:12 AM	#3
gretchen Senior Member Join Date: Mar 2004 Location: Warner Robins, GA, US Posts: 223	Dr. Young, I am confused again. My injury was on T 10,and my MRI doesn't show any residual trace of the mass. I can walk with canes, even take a few steps without canes but I have limited sensations in the left leg and almost none on the right side ( I have deep sensations but none to the touch)and my sphincter is at 0. I had an avm that went undetected for five years, does that mean the damage killed neurons and that I would not benefit from remyelination? I would have liked to try 4AP : ( gretchen 1

11-24-2004, 05:53 AM	#4
Wise Young Administrator Join Date: Jul 2001 Location: New Brunswick, NJ, USA Posts: 37,975	Gretchen, it is difficult to ascertain from your description the extent of your injury. As I have pointed out before, AVM's and ischemic injuries of the spinal cord don't have consistent patterns like traumatic injury where the damage is localized to one limited area. On the other hand, T10 is reasonably far away from the lumbar enlargement at T12-L1. I suspect that you probably have damaged axons, oligodendroglia (myelin-forming cells), and neurons in your spinal ccrd. When 4-AP was first started in clinical trial, we were thinking that it may have most of its effects on demyelinated axons. While that may be true, I still don't have a very good understanding of the type of lesion produced by an AVM. In any case, it is relatively straightforward too try 4-AP. If it has a significant effects, this would suggests that you would benefit from remyelination therapy. Wise.

11-24-2004, 06:18 AM	#5
gretchen Senior Member Join Date: Mar 2004 Location: Warner Robins, GA, US Posts: 223	Thank you. I am going to try and I will keep you informed of my results. Can you tell me if I am considered complete or incomplete? Someone told me I was complete in spite of the motor skills I have regained because my sphincter was rated at 0? gretchen 1

11-24-2004, 06:19 AM	#6
Wise Young Administrator Join Date: Jul 2001 Location: New Brunswick, NJ, USA Posts: 37,975	Gretchen, if you have no anal sensation or sphincter control, that means that you are at least "complete" at S4/5, the lowest level of the spinal cord. Wise.

11-24-2004, 06:22 AM	#7
gretchen Senior Member Join Date: Mar 2004 Location: Warner Robins, GA, US Posts: 223	I am sorry I have another question for you. You imply that avms are more problematic than traumatic injury. Dr. Huang told me I could be a good candidate for his procedure, would you agree that it might help me and people with vascular injuries? gretchen 1

11-24-2004, 06:25 AM	#8
gretchen Senior Member Join Date: Mar 2004 Location: Warner Robins, GA, US Posts: 223	If I am complete, then it means 4 AP and other treatments available to incomplete injury patients will not work for me? How can I be complete and have almost normal sensations on the left side of my vagina? gretchen 1

11-24-2004, 07:19 AM	#9
gretchen Senior Member Join Date: Mar 2004 Location: Warner Robins, GA, US Posts: 223	You wrote that if someone can feel their bladder is full, they were or would be incomplete. I have no anal sensation but I can feel that my bladder is full. (I have to push to void though) In which category am I? gretchen 1

11-27-2004, 09:04 AM	#10
gretchen Senior Member Join Date: Mar 2004 Location: Warner Robins, GA, US Posts: 223	I can feel when my bladder is full, but I have to push to void. That came back one month past injury. I would like to know if anyone has regained anal sensations, bowel and/or bladder functions past the two-year marker. gretchen 1