ChinaSCINet Update

[Wise Young]

Originally Posted by debbie1341

Thank you for your answer, doctor.
I wish this had been an option 3 years ago when my husband was injured. He never had any kind of decompression, his doctor said he didn't need it.
Every chronic is an acute at one time.
If injuries could be lessened with this type of procedure, that could mean more resources for chronic injuries.
Debbie

Yes, and every acute becomes a chronic.

I had spent the first half of my career doing clinical trials of therapies for acute spinal cord injury, including methylprednisolone, naloxone, and tirilazad mesylate. Of these, methylprednisolone was the best and had the most significant effects. Since 1997, although I have focused most of my effort on chronic spinal cord injury. However, in recent years, I have become quite distressed by the lack of progress in the acute spinal cord injury therapy field. Methylprednisolone is a drug that I started testing in 1979.

To have no other treatment for acute spinal cord injury better than methylprednisolone in 35 years is a travesty. Fortunately, at the recent Neurotrauma Society meeting in Phoenix, it appears that several therapies are beginning to emerge. Clinical trials testing minocycline and riluzole are beginning to show positive results. Even more interesting, the STASCIS trial showed that the best results are in patients that were treated with decompression and methjylprednisolone.

Acute spinal cord injury therapies are important for one other perspective and that is to protect the cell transplant and the spinal cord during the transplant procedure. A single bolus of 30 mg/kg methylprednisolone significantly improves survival of transplanted cells in animal spinal cords. So, one of the arms of our clinical trial was looking at this.

Wise.

[paolocipolla]

Originally Posted by Wise Young

Yes, and every acute becomes a chronic.

I had spent the first half of my career doing clinical trials of therapies for acute spinal cord injury, including methylprednisolone, naloxone, and tirilazad mesylate. Of these, methylprednisolone was the best and had the most significant effects. Since 1997, although I have focused most of my effort on chronic spinal cord injury. However, in recent years, I have become quite distressed by the lack of progress in the acute spinal cord injury therapy field. Methylprednisolone is a drug that I started testing in 1979.

To have no other treatment for acute spinal cord injury better than methylprednisolone in 35 years is a travesty. Fortunately, at the recent Neurotrauma Society meeting in Phoenix, it appears that several therapies are beginning to emerge. Clinical trials testing minocycline and riluzole are beginning to show positive results. Even more interesting, the STASCIS trial showed that the best results are in patients that were treated with decompression and methjylprednisolone.

Acute spinal cord injury therapies are important for one other perspective and that is to protect the cell transplant and the spinal cord during the transplant procedure. A single bolus of 30 mg/kg methylprednisolone significantly improves survival of transplanted cells in animal spinal cords. So, one of the arms of our clinical trial was looking at this.

Wise.

Wise,

are you saying that your focus shifted back to acute SCI?

I have seen/heard you talking a lot about acute SCI in the last few years and I have been wondering why you paid so much attention to acute SCI...

An SCI researcher recently told me that, at the moment, doing chronic studies the chances of success are very low and since scientists need to show some success to stay in business they tend to stay on acute SCI where at least some limited recovery is easy to show... especially when dealing with a mild SCI..

I think that if chronic SCI had been studied as much as acute SCI we could be walking since the chronic setting is less complex therefore, possibly, easyer to solve.

Paolo

[Wise Young]

Originally Posted by paolocipolla

Wise,

are you saying that your focus shifted back to acute SCI?

I have seen/heard you talking a lot about acute SCI in the last few years and I have been wondering why you paid so much attention to acute SCI...

An SCI researcher recently told me that, at the moment, doing chronic studies the chances of success are very low and since scientists need to show some success to stay in business they tend to stay on acute SCI where at least some limited recovery is easy to show... especially when dealing with a mild SCI..

I think that if chronic SCI had been studied as much as acute SCI we could be walking since the chronic setting is less complex therefore, possibly, easyer to solve.

Paolo

Paolo,

We are doing chronic spinal cord injury clinical trials. I am saying that the field also needs acute spinal cord injury trials. It is terrible that after 30 years, the treatment that we discovered in 1979, i.e. methylprednisolone, for acute spinal cord injury is still the only one. I encourage acute spinal cord injury studies as well as chronic spinal cord injury.

In my opinion, I think that you are wrong to attack scientists who do acute spinal cord injury work. By the way, I don't know who the scientist is who said that acute spinal cord injury therapies are easier to achieve. If it were so easy, you would think that we would have dozens of therapies besides methylprednisolone after 30 years. In fact, acute spinal cord injury clinical trials are very difficult to do.

If confirmed, the intradural decompression of the spinal cord is potentially the best acute spinal cord injury therapy to date. It restores walking to about 50% of people with ASIA A spinal cord injury. Many neurosurgeons in the United States don't believe these results and the only way to convince them is to do a rigorous multicenter clinical trial. We are helping our colleagues in China do this.

This does not change my commitment to chronic spinal cord injury.

Wise.

[Jim]

I moved several posts to the Members Only Forum that had nothing to do with ChinaSCINet.

[momo3]

Dr. Young,
Your above post talks about the intradural decompression. I had a bone fragment pressing on my spinal cord that was removed about 24 hours after my injury. My dura was torn and repaired. Is this the surgery you are talking about?

[Cielo]

Off topic : momo, as the term "intra-dural" states, what dr. Young is talking about, is a surgical method to open the outer layer of spinal cord(named dura) and "remove" the scar tissue that forms days/weeks after SCI occurred. From my known, only few chinese doctors are performing this kind of surgery.

[khmorgan]

Originally Posted by Cielo

Off topic : momo, as the term "intra-dural" states, what dr. Young is talking about, is a surgical method to open the outer layer of spinal cord(named dura) and "remove" the scar tissue that forms days/weeks after SCI occurred. From my known, only few chinese doctors are performing this kind of surgery.

Cielo, I think you misread Dr. Young's explanation. He said nothing about removing scar tissue. See http://sci.rutgers.edu/forum/showpos...postcount=1055 As a matter of fact, I think that is a fundamental argument he has with other doctors. Until the dura mater is cut, there can be no scar tissue inside the spinal cord.

[Cielo]

Maybe mr. Wise will explain "for dummy's" what exactly is this procedure; attached is a slide from mr. Wise presentation :

[khmorgan]

Originally Posted by Cielo

Maybe mr. Wise will explain "for dummy's" what exactly is this procedure; attached is a slide from mr. Wise presentation :

All I was saying is that no where did I see Dr. Young mention removing scar tissue as a part of intradural decompression. As a matter of fact, you might like to read a related post of his about the definition of scar tissue:

http://sci.rutgers.edu/forum/showpos...12&postcount=6

If I'm wrong, it won't be the first time.

[Cielo]

Morgan, I'm not saying I'm right and you are wrong ... In fact, if I read more carefuly the slide posted by me earlier, you are 99.9% right ... It says nothing about the scar that forms in the damaged area. Maybe Mr. Wise will make it 100% sure
My apologies for mistake I've made