Stem cell therapy for Cerebral Palsy
Cerebral palsy (CP) is a disorder of the brain and muscle damage and weakness are the main cerebral palsy symptoms . There are several types of cerebral palsy each having different cerebral palsy causes. CP treatment options now offer an alternative in the form of stem cell therapy for cerebral palsy .
Cerebral Palsy (CP) is a non progressive disorder of the brain that leads to inability in performing movements due to lack of muscle co-ordination or excessive tightness of the muscles. Cerebral Palsy symptoms are mainly characterized by muscle spasticity, muscle weakness, uncontrolled movements, impaired mobility, speech problems and challenges in dressing, bathing and other activities depending on the area of the brain affected. As such Cerebral Palsy causes could be attributed to factors before birth, at the time of birth, during birth or during early childhood. Conventional treatment for cerebral palsy focuses on addressing the symptoms and revolves around the use of drugs, rehabilitation and surgical procedures. With the revolution in the field of medicine, has evolved the field of stem cells offering a new hope for cerebral palsy patients. Stem cell therapy for Cerebral Palsy has emerged as an up and coming treatment option for the affected individuals with promising results.
Cerebral Palsy – An Overview
Cerebral Palsy is a leading cause of childhood disabilities. CP is known to affect 2/1000 live births. In India 3 in every 1000 births are diagnosed with cerebral palsy.
Cerebral Palsy is permanent disorder of the brain and affects children for life. The damage to the brain is neither progressive nor reversible, meaning the damaged part will not get worse nor will it repair completely.
There are various types of cerebral palsy. The management of children with cerebral palsy depends greatly upon the type of cerebral palsy. The types of cerebral palsy are based on the kind of movement abnormality and the areas of the body affected.
Cerebral palsy causes:-
- Prenatal (before birth) causes of cerebral palsy could be due to abnormal development of brain and other structural malformations.
- Premature delivery, low birth weight, delayed cry, injury or multiple births could be attributed to cause cerebral palsy during birth
- Perinatal (immediately after birth) cause of cerebral palsy could be due to lack of oxygen, pathological jaundice or episodes of seizures.
- Alternatively, a traumatic brain injury, certain infections to the brain such as meningitis or epilepsy may lead to increased risk of cerebral palsy in early childhood.
Types of Cerebral Palsy:-
- Spastic Cerebral Palsy occurs due to the damage to the cerebral cortex of the brain. This is the area responsible for bringing about movements in the body by altering the tension in various muscles. The word spasticity relates to increased tension in the muscles. Children with spastic cerebral palsy type will exhibit stiffness in their body parts.
- Dyskinetic cerebral palsy is another cerebral palsy type that occurs when the basal ganglia is affected and causes a hindrance in voluntary muscle movements. This can be further classified as dystonic where the movements are sluggish and wriggly or jumpy and nervous and as athetoid where the movements are very jerky and uncontrollable.
- Ataxic cerebral palsy is caused due to the damage to the cerebellum and the main cerebral palsy symptoms exhibited here are clumsy movements and poor balance. Children with ataxic cerebral palsy may not be able to perform rapid alternating movements with their hands and legs, along with a general slowness in movements. They often lose balance and walk in zig-zag pattern.
- Hypotonic cerebral palsy also occurs when there is injury to the cerebellum. However as opposed to spastic cerebral palsy there is reduced tension in the muscles. Children with hypotonic cerebral palsy are not able to perform voluntary movements and achieve sitting, standing and balancing postures very late during growth years.
- Mixed cerebral palsy is when cerebral palsy symptoms of two or more the above types co-exist. This is a rare form of CP and difficult to diagnose.
Clinical Signs and Symptoms of cerebral palsy:-
- Delayed milestones
- Incordination with voluntary muscle movements
- Rigidity or weakness in limbs
- Criss cross or scissor pattern of walking
- Difference in muscle tone
- Problems in speech, swallowing and so on
- Abrupt involuntary movements
- Incordination with fine motor movements such as buttoning, writing, eating and so on.
- Vision and intellectual movements may be affected in some individuals
Cerebral palsy treatment options
Most of the current treatment options available focus on making cerebral symtoms managle. Rehabilitation plays an important role in managing a child with cerebral palsy as soon as the child is diagnosed. Depending on the symptoms, the physical therapy program is planned uniquely for each child.
- Physiotherapy helps to improve independence by improving mobility, strengthening the muscles, improve ability to move the parts of the body, prevent joints to become tight or contractures to develop. Exercises help the child learn how to sit, stand and walk.
- Occupational therapy focuses on helping the individual to gain independence in all areas of daily life. An occupational therapist works with CP patients using various neurological treatment approaches aiming for complete neurological integration, bridging developmental gaps, refinement in motor performance and improving learning abilities.
- Along with physical therapy, other vocational therapies like aquatic therapy, speech therapy, nutritional guidance, psychological intervention and others may help the child gain independence.
- Assisted devices, medical and surgical management of symptoms and Botox are some currently used interventions for management of cerebral palsy.
Stem cells and Cerebral Palsy
Injury to the brain at the time of birth or during birth, leads to damage of certain parts of the brain including the stem cells in the brain. This leads to loss of the inherent regenerative or resources of the brain.
Stem cells stimulate repair process by homing to the injured site of the brain and by carrying out regeneration. Hence, stem cell therapy for cerebral palsy restores the lost cells and helps form newer cells and connecting cells. It may also support their survival by introducing other cell types able to restore certain enzymes from the environment. The therapy therefore has potential to address those factors enlisted for cerebral palsy causes.
Stem cells also help to reduce the levels of harmful chemicals released during injury, protecting the surrounding tissues from further damage. These cells also secrete certain chemical messengers such as connective tissue growth factor, fibroblast growth factors, interleukins and others which are responsible for cell multiplication, protection of brain cells and angiogenesis/ formation of new blood vessels and retrieving the lost tissue function.
Recent advances in stem cell therapy for cerebral palsy provide the hope of developing more effective interventions in treating (CP).
Clinical results of Stem Cell Therapy at NeuroGen Brain and Spine Institute:-
At NeuroGen BSI, we have treated over 150 CP cases. In an analysis of 108 patients with maximum follow up of 4 years, stem cell therapy was found to be safe and effective in 92.6% of the patients. Improvements were in seen in symptoms like oromotor/speech, balance, trunk activity, upper limb activity, lower limb activity, muscle tone, ambulation and activities of Daily Living.
Out of the 108 patients, 15.74% showed significant improvements, 48.14% of patients showed moderate improvements and 28.7 % showed mild improvements.
Graph representing improvements seen after stem cell therapy for cerebral palsy
Progressive improvements seen after stem cell therapy:-
After stem cell therapy, immediate improvements were observed within a week in muscle tone, involuntary movements of the limbs, head control and drooling.
Improvements seen after stem cell therapy for cerebral palsy over a period of 1week to one year
- Opening and closing of fingers
- Trunk control
- Sitting balance
- Oromotor movements
- Gross motor movements of limbs
- eye hand coordination
- Maintaining upright position,
- Initiation of steps while walking with support and/or assistive devices was also seen in patients who were not able to walk previously.
- Muscle tone and motor control
- Independence for daily activities improved.
- Cognitive skills and understanding
- Cognition improved with respect to awareness, understanding, response time and command following.
Published international clinical work as well as our own experience clearly establishes the safety and efficacy of stem cell therapy for cerebral palsy. Improvements are seen in over 90% of the patients treated. These clinical improvements are seen on PET-CT Scans of the brain done before and after the stem cell therapy.