Q & A with Garrett Riggs, M.D., Ph.D., about spinal cord Injuries

[manouli]

Posted: 11:40 AM Oct 16, 2009

Q & A with Garrett Riggs, M.D., Ph.D., about spinal cord Injuries

Garrett Riggs, M.D., Ph.D., Assistant Professor of Neurology at the University of Central Florida in Orlando, Fla., talks about whether retraining neurons can benefit patients with spinal cord injuries.




Garrett Riggs, M.D., Ph.D., Assistant Professor of Neurology at the University of Central Florida in Orlando, Fla., talks about whether retraining neurons can benefit patients with spinal cord injuries.

Can retraining the neurons somehow regenerate the spinal cord so that patients can not only get better movement than doctors thought, but they may even be able to walk again?

Dr. Garrett Riggs: The research is promising, but it's far from conclusive. There are some studies looking at patients who undergo physical rehabilitation of varying intensities. We know that physical rehab helps, we know that it improves overall function, but whether a more intensive regimen works for all patients is not really clear yet.

What's the conventional wisdom about recovering from spinal cord injuries?

Dr. Riggs: The conventional wisdom is that once the spinal cord is injured, you're pretty much done. As the swelling decreases, you may have some mild return of function, but basically, once the cord is injured, that's it. However, we now know that contrary to what we used to think, that nerve cells never grow, nerve cells do grow. The problem is getting them to grow from the right spot and make the right connections. Exactly how that's going to be facilitated is ultimately probably going to be a combination of molecular techniques and also rehabilitation.

Currently, the research doesn't back up the fact that you can just go in there on an extensive regimen of physical therapy and that's going to regenerate, is that right?

Dr. Riggs: Correct. We don't really see clear evidence in humans of regeneration based on intensive therapy, but it's something that certainly merits further investigation.

Is it creating a false hope for these people that there's something out there saying that if you do all this intensive physical therapy, you may be able to walk again or you may be able to be a lot more mobile than you think you are?

read...

http://www.wtvynews4.com/4yourhealth.../64511932.html

[bamajeff61]

Originally Posted by manouli

Posted: 11:40 AM Oct 16, 2009

Q & A with Garrett Riggs, M.D., Ph.D., about spinal cord Injuries

Garrett Riggs, M.D., Ph.D., Assistant Professor of Neurology at the University of Central Florida in Orlando, Fla., talks about whether retraining neurons can benefit patients with spinal cord injuries.




Garrett Riggs, M.D., Ph.D., Assistant Professor of Neurology at the University of Central Florida in Orlando, Fla., talks about whether retraining neurons can benefit patients with spinal cord injuries.

Can retraining the neurons somehow regenerate the spinal cord so that patients can not only get better movement than doctors thought, but they may even be able to walk again?

Dr. Garrett Riggs: The research is promising, but it's far from conclusive. There are some studies looking at patients who undergo physical rehabilitation of varying intensities. We know that physical rehab helps, we know that it improves overall function, but whether a more intensive regimen works for all patients is not really clear yet.

What's the conventional wisdom about recovering from spinal cord injuries?

Dr. Riggs: The conventional wisdom is that once the spinal cord is injured, you're pretty much done. As the swelling decreases, you may have some mild return of function, but basically, once the cord is injured, that's it. However, we now know that contrary to what we used to think, that nerve cells never grow, nerve cells do grow. The problem is getting them to grow from the right spot and make the right connections. Exactly how that's going to be facilitated is ultimately probably going to be a combination of molecular techniques and also rehabilitation.

Currently, the research doesn't back up the fact that you can just go in there on an extensive regimen of physical therapy and that's going to regenerate, is that right?

Dr. Riggs: Correct. We don't really see clear evidence in humans of regeneration based on intensive therapy, but it's something that certainly merits further investigation.

Is it creating a false hope for these people that there's something out there saying that if you do all this intensive physical therapy, you may be able to walk again or you may be able to be a lot more mobile than you think you are?

read...

http://www.wtvynews4.com/4yourhealth.../64511932.html

This is true you can exercise until your red faced it still want regenerate the spinal cord. I thought I was going to walk again after my injury what a big let down. it crushed my dreams cost me my business, traumatized my kids and cost me a divorce. I live with extreme spasms and pain, with no help in sight. My story: http://www.jeffreylramsey.com god bless.

[Wise Young]

Originally Posted by bamajeff61

This is true you can exercise until your red faced it still want regenerate the spinal cord. I thought I was going to walk again after my injury what a big let down. it crushed my dreams cost me my business, traumatized my kids and cost me a divorce. I live with extreme spasms and pain, with no help in sight. My story: http://www.jeffreylramsey.com god bless.

Jeffrey,

I am sorry that exercise did not help you. On the other hand, I disagree with Dr. Garrett Riggs. There is substantial evidence indicating that people who have "incomplete" spinal cord injury can and will benefit from intensive locomotor training. The problem is that the evidence does not tell us what the best exercise is. The study by Dobkins, et al. in 2006 indicates that one can get similar benefits from both overground walking and weight-supported treadmill training.

Dr. Riggs is probably right regarding people with so-called "complete" spinal cord injury. However, these represent less than a third of the population of people with spinal cord injury. There is little evidence that intensive locomotor training would restore walking to people who were ASIA A early after injury and remained that way. Several studies, however, suggest that there may be other benefits to locomotor training besides walking. It improves postural tone, reduces spasticity (while the training is going on), and improves bowel function.

I also agree with Dr. Riggs that not much is known about the correct type, duration, and intensity of exercise. Weight-supported treadmill training is very labor-intensive (and consequently expensive) and is limited (due to the risks of being weight-supported in a harness) to an hour a day or less. It is, however, useful for step training and produces less wear and tear of the physical therapists and trainers who must help train the stepping. Once a person starts to step, however, overground walking is far better. Most groups agree that it is important to get people to do overground walking as quickly as possible. In China, they go directly to overground walking.

Several academic groups are trying to assess the role of training techniques, duration, and intensity of locomotor training (UCLA, Louisville). There are many non-medical groups offering training programs. There is no consensus in the field right now. The most intensive program that I know is in Kunming (China) where they train 6 hours a day 6 days a week for 6 months. I am not sure that such intensity is necessary. Many rehabilitation centers in the United States would consider 1 hour a day 3 days a week to be intensive. I suspect that it is probably something in between.

In my opinion, I think that it is counterproductive for people to do training full-time for years. I think that people with chronic spinal cord should do 6-12 weeks of intensive training once a year and then maintain their gains by training an hour a day for the rest of the year. I have known some other people who have hurt their careers and families by overtraining and making it their only goal in life. People should not overdo it.

Wise.

[znop]

as a highly functional c-7 incomplete walking quad post 18 years I wish someone would discuss how science is going to reverse myoclonus, clonus, NP, spasticity, chronic joint pain, muscle atrophy, bowel and bladder problems and so forth. I do not complain about my difficult situation as many would die to get where I am at, but with the above complications I am worse off than a lot of sci's in that I cannot hold a job, have terrible sleep patterns, and fogginess that has not gone away since the injury. NP and myoclonus run my life. Requip works nicely for the myoclonus, on my 3rd baclofen pump(1995-2009) and tried every med for np with no avail.
I forgot to mention I have fallen over 400 times luckily with no serious injury but that could change at any time
I have an excellent exercise routine and most of my walking is now down in my fitness center's pool.

I love life and will never give up, but a lot of you don't realize that with functional recovery alot of these complications may happen to you

I am open to help anyone
ponz59@yahoo.com

John Ponziano
chicago

[Wise Young]

Originally Posted by znop

as a highly functional c-7 incomplete walking quad post 18 years I wish someone would discuss how science is going to reverse myoclonus, clonus, NP, spasticity, chronic joint pain, muscle atrophy, bowel and bladder problems and so forth. I do not complain about my difficult situation as many would die to get where I am at, but with the above complications I am worse off than a lot of sci's in that I cannot hold a job, have terrible sleep patterns, and fogginess that has not gone away since the injury. NP and myoclonus run my life. Requip works nicely for the myoclonus, on my 3rd baclofen pump(1995-2009) and tried every med for np with no avail.
I forgot to mention I have fallen over 400 times luckily with no serious injury but that could change at any time
I have an excellent exercise routine and most of my walking is now down in my fitness center's pool.

I love life and will never give up, but a lot of you don't realize that with functional recovery alot of these complications may happen to you

I am open to help anyone
ponz59@yahoo.com

John Ponziano
chicago

John, I am not sure that I understand what you are referring to when you say "myoclonus" and how you think that this may be different from clonus. Clonus is a form of spasticity. Neither Baclofen nor tizanidine usually will not reduce clonus unless the doses of these drugs are so high that they are also weakening the muscle. This of course has been the main problem with anti-spasticity drugs.

Many of us hoped that Fampridine would be the solution to spasticity. Early studies suggested that Fampridine reduced spasticity (both the stiffness and the clonus) without weakening the muscle. In fact, it should increase muscle strength and reduce fatigue at the same time. Unfortunately, the clinical trial did not show a significant effect. So, the approval of Fampridine will be primarily for people with MS.

Atrophy as you know is due to denervation or lack of use. Electrical stimulation of the muscles can prevent or even reverse atrophy but it is not clear how much this improves voluntary function. I wish that there were more people working on subthreshold central pattern generator (CPG) stimulation because the few studies that have been done to date suggests that it can substantially improve both coordination and reduce fatigue associated with walking.

Finally, as you know, solutions for neuropathic pain are at best limited and partly effective. We are working on it and hope to report some progress soon.

Wise.

[znop]

clonus I understand, but myoclonus is a twitching that is either in my ankle, quad or hip muscle. It comes in intervals of 15 seconds and it's a quick annoying twitch that almost put me in an insane asylum because if left me sleep deprived. Klonopin and narcotics were so so in effectiveness. It was not until I did a sleep study in 06 that not only did I have myoclonus but restless leg syndrome. Requip has done wonders, my sleep is better and I can now keep the myoclonus at bay

Dr Chen told me that myoclonus happens to a small % of incompletes and unfortunately I am one of them.

I,m sorry if I did not explain myself that clearly.

http://en.wikipedia.org/wiki/Myoclonus
http://www.mdvu.org/library/disease/...us/myo_cls.asp

Physiologic Classification: Spinal
Spinal myoclonus is typically associated with a focal lesion, with little spread of myoclonic activity from spinal-generator sites. The lesion may directly damage the cord or may cause changes in the afferent signaling from peripheral and supraspinal structures. The duration of the jerks is often longer and more variable than is seen in cortical or subcortical myoclonus. Segmental spinal myoclonus is usually rhythmic and not stimulus sensitive, and the movements are limited to those arising from contiguous segments of the cord. The spinal generator of propriospinal myoclonus is usually at the thoracic level and recruits axial muscles via slowly conducting polysynaptic propriospinal pathways both rostrally and caudally from the generator. The movements are usually more extensive than those seen with segmental spinal myoclonus and can be rhythmic or arrhythmic. They are typically slow, bilateral, synchronous jerks of flexion muscles of the trunk and lower limbs, have a frequency between 20 and 180 per minute, have a duration of 50 to 200 milliseconds, and persist during sleep. The usual cause is a focal spinal lesion, such as multiple sclerosis, syringomyelia, trauma, ischemic myelopathy, or an infection (for example, from herpes zoster, Lyme's disease, Escherichia coli, or HIV).

[keeping on]

Wise, given all this uncertainty, is there still REAL hope with your proposed therapy. I still hope that stem cell therapy offers hope for recovery for our conditions. I too exercise hoping some nerve recovery will occur. IS THERE hope of some improvement with all these studies being done?

Thanks,
T.J.

[Wise Young]

Originally Posted by keeping on

Wise, given all this uncertainty, is there still REAL hope with your proposed therapy. I still hope that stem cell therapy offers hope for recovery for our conditions. I too exercise hoping some nerve recovery will occur. IS THERE hope of some improvement with all these studies being done?

Thanks,
T.J.

T. J.

Evidence is what counts. Opinions without evidence is just wishful thinking. The following are the evidence that gives me confidence that umbilical cord blood mononuclear cells and lithium will help restore function to people with spinal cord injury. Of course, until we do the trials, I don't know whether the treatments will be beneficial. That is why I am pushing so hard to get the clinical trials going.

1. Several independent laboratories have reported the umbilical cord blood cell transplants into the spinal cord improve recovery.
2. Lithium has been reported by several groups to stimulate axonal regeneration in injured spinal cords, stimulate neural stem cells to proliferate and produce neurons in the brain and spinal cord, and has shown to improve neurological recovery after spinal cord contusion.
3. We have shown that lithium strongly stimulates umbilical cord blood mononuclear cells to proliferate and produce neurotrophins, particularly NGF, NT3, and GDNF that have been reported to stimulate regeneration in the spinal cord.

Our upcoming phase 2 clinical trials is examining the outcomes of patients who have received four 4, 8, or 16 µliter injections of umbilical cord blood mononuclear cells into the spinal cord above and below the injury site, followed by four 16 µliter injections and a single bolus of methylprednisolone (to improve the survival of the ransplanted cells), and finally the cell transplants plus methylprednisolone and a 6-week course of lithium taken orally.

If the phase 2 trial shows that the treatment is safe and the subjects show some neurolotical improvement, this would be storng impetus to go forward with a phase 3 trial. We would carry this trial in China and the U.S. In addition, we will be doing some phase 2 trials in children (age 8-17) and older subjects (age 65-80).

I can't give you what you are asking for. You ask me for "REAL hope". I don't know whether the therapy will work. That is what the clinical trials are supposed to tell us. It may or may not improve function. If it does, that would be great of course and we will recommend the therapy. However, if it does not improve functional recovery, then we will recommend against its use.

Wise.

[rob4974]

It says in this paragraph that those suffering from Chronic Spinal cord, should do 6 to 12 weeks of intense training once a year. Is there anyplace in NJ that has such intense training? Or can someone here point me in the right direction of what intense training would be for a guy like myself that has an atrophied left leg and partial right. I do walk and I can do leg press's, but i am starting to realize if i want to get back to me, i am going to have to train hard and make a life change. I will be taking the advice and training for 6 to 12 weeks of intense training but I am looking for a course to follow. Thank you.

Originally Posted by Wise Young

Jeffrey,

I am sorry that exercise did not help you. On the other hand, I disagree with Dr. Garrett Riggs. There is substantial evidence indicating that people who have "incomplete" spinal cord injury can and will benefit from intensive locomotor training. The problem is that the evidence does not tell us what the best exercise is. The study by Dobkins, et al. in 2006 indicates that one can get similar benefits from both overground walking and weight-supported treadmill training.

Dr. Riggs is probably right regarding people with so-called "complete" spinal cord injury. However, these represent less than a third of the population of people with spinal cord injury. There is little evidence that intensive locomotor training would restore walking to people who were ASIA A early after injury and remained that way. Several studies, however, suggest that there may be other benefits to locomotor training besides walking. It improves postural tone, reduces spasticity (while the training is going on), and improves bowel function.

I also agree with Dr. Riggs that not much is known about the correct type, duration, and intensity of exercise. Weight-supported treadmill training is very labor-intensive (and consequently expensive) and is limited (due to the risks of being weight-supported in a harness) to an hour a day or less. It is, however, useful for step training and produces less wear and tear of the physical therapists and trainers who must help train the stepping. Once a person starts to step, however, overground walking is far better. Most groups agree that it is important to get people to do overground walking as quickly as possible. In China, they go directly to overground walking.

Several academic groups are trying to assess the role of training techniques, duration, and intensity of locomotor training (UCLA, Louisville). There are many non-medical groups offering training programs. There is no consensus in the field right now. The most intensive program that I know is in Kunming (China) where they train 6 hours a day 6 days a week for 6 months. I am not sure that such intensity is necessary. Many rehabilitation centers in the United States would consider 1 hour a day 3 days a week to be intensive. I suspect that it is probably something in between.

In my opinion, I think that it is counterproductive for people to do training full-time for years. I think that people with chronic spinal cord should do 6-12 weeks of intensive training once a year and then maintain their gains by training an hour a day for the rest of the year. I have known some other people who have hurt their careers and families by overtraining and making it their only goal in life. People should not overdo it.

Wise.