Cerebral palsy is a condition with several neurological complications that affects the brain development in infants. The worldwide prevalence of CP is 1.5 to 4 per 1000 live births.
You might think, “Is this the end?", when your child is diagnosed with CP. We at NeuroGen Brain and Spine Institute believe that there is no ‘The End' only a ‘Happily Forever After'. With the introduction of Stem Cell Therapy for Cererbal Palsy, we have seen great improvements in over 300 children diagnosed with CP, giving them a chance to live independently.
To all the parents, its time you let go of your worries and look forward to a world of Endless possibilities!
OUR SUCCESS STORIES
- Stem cell therapy gives a ray of hope to worried parents.
- Little Master takes his first step towards independence, from complete dependence.
- Girl with cerebral palsy shows improvement in functional independence measure from 46 to 52.
What is Cerebral palsy?
Cerebral palsy is a condition in which there may be abnormal brain development or injury to the brain as it develops. This can occur before, during, after birth or during early childhood. Cerebral palsy is often referred to as an “umbrella term" as it applies to a collection of conditions where there is primarily a disorder of voluntary movement and/or co-ordination. Children with cerebral palsy have difficulties in controlling movements as they grow and develop. The nature and extent of these difficulties may change as children grow but cerebral palsy itself is not progressive: the injury or impairment in the brain does not change.
No two people will be affected by cerebral palsy in the same way and thus, it is important to ensure the focus of treatments and therapies are tailored to individual needs.
In general we talk about three main types of cerebral palsy - spastic, dyskinetic (often known as athetoid or dystonic) and ataxic cerebral palsy. These describe effects on the body and muscle tone, which is dependent upon the area of the brain affected. Many people with cerebral palsy will have a mixture of these types.
What causes Cerebral palsy?
The cause of CP is brain injury or brain malformation that occurs while the brain is developing — before, during, or after birth. This is due in part by the type of injury and the timing of the injury to the developing brain. The occurrence of CP in infants can be attributed to the following causes:-
- Reduced oxygen supply to the brain during the birth of the child, which may be caused as a result of the cord stuck around the neck.
- Infections during pregnancy or physical injury can cause damage to the brain
- Complications of premature birth
- Critical illness at birth ( neonatal encephalopathy) that decreases the supply of oxygen to the brain
- Development of the brain in an unusual shape or structure
- Genetic mutations in the brain cell that affect brain development
These changes affect different areas of the brain in different children, thus leadin g to different types of cerebral palsy observed. In some cases, various parts of the brain or the brain as a whole fail to develop normally during the fetal growth. In others, the damage is a result of injury to the brain either before, during, or after birth.
What are the symptoms associated with cerebral palsy?
The damage that occurs in CP is often not repairable, and the disabilities that occur are permanent. The signs and symptoms that children suffering from CP exhibit include:-
- Lack of muscle coordination when performing voluntary movements (ataxia)
- Stiff or tight muscles and exaggerated reflexes (spasticity)
- Weakness in one or more arm or leg
- Walking on the toes, a crouched gait, or a “scissor" gait
- Variations in muscle tone, either too stiff or too floppy
- Excessive drooling or difficulties swallowing or speaking
- Shaking (tremor) or random involuntary movements
- Delays in reaching motor skill milestones
- Difficulty with precise movements such as writing or buttoning a shirt.
Besides, some cases of CP may also exhibit intellectual disability, seizure, delayed growth and development, impaired vision and hearing loss. The symptoms of CP differ in type and severity from one person to other, and may even change in an individual over time.
What are the treatment options available for Cerebral palsy?
Currently, there is no cure for cerebral palsy. With early and ongoing treatment, however, the disabilities associated with cerebral palsy can be reduced. Many children go on to enjoy near-normal adult lives if their disabilities are properly managed. In general, the earlier the treatment begins the better chance children have of overcoming developmental disabilities or learning new ways to accomplish the tasks that challenge them.
- Rehabilitation which includes physical therapy, occupational therapy, speech therapy and other recreational therapies play a very important rolein developing the overall quality of life of the children.
- Oral medications such as diazepam, baclofen, dantrolene sodium, and tizanidine are usually used as the first line of treatment to relax stiff, contracted or overactive muscles.
- Orthopedic surgery, assisted devices and additional therapies are also being used most often to reduce the spasticity seen in these patients.
- Recent advances in the management of cerebral palsy include the use Hyperbaric Oxygen Therapy (HBOT) that aims to restore the oxygen level in the brain, especially in the damaged areas. The use of Botulinum toxin A has been recommended in the management of spasticity in ambulant children with cerebral palsy (CP) to improve function and to delay the development of fixed deformity.
The treatment options that are currently available help the patients in managing the symptoms to some extent, but they do not repair the underlying brain damage. Therefore developing a standard therapeutic approach is the need of the hour. Scientists and researchers worldwide are now considering stem cell therapy as a potential treatment option for patients suffering from cerebral palsy.
How stem cell therapy works in cerebral palsy
Till very recently, it was believed that brain damage during birth is irreversible .However, now with emerging research; we understand that it is possible to repair the damaged brain tissue using cell therapy.
Stem cells obtained from various sources can be used for stem cell therapy. Our approach, at NeuroGen BSI makes use of autologous bone marrow derived mononuclear cells (BMMNCs) for transplantation. The transplanted stem cells have the ability to migrate to the area of the damaged tissue in the brain and home in those affected areas to help repair the damage. They release several trophic factors that decrease the process of damage in those areas and also differentiate into several cell types of the nervous system such as oligodendrocytes, glial cells and other cells of the nervous system. The main mechanisms that help tissue repair and regeneration include:-
- Prevention of cell death in neuronal population
- Establishment of new blood vessels
- Cell multiplication and integration
- Establishment of new neuronal maps in the brain in order to learn new functions.
These mechanisms repair and regenerate the damaged tissue, restoring activity in the affected area, which translates into clinical improvements .This plays a great role in improving the overall quality of life. Also autologous BMMNCs do not show any adverse side effects and they do not face any immune rejection. Also, they are obtained from the same patient and thus are free of the ethical issues surrounding the use of stem cells.
The NeuroGen Outcome:-
With our comprehensive approach and our aim to guide and support our patients through thick and thin, we have successfully treated over 150 patients with cerebral palsy. The patients who had reached a plateau stage, after stem cell therapy have shown colossal improvements in their symptoms. Most of the symptoms that are seen in cerebral palsy are oromotor/speech, balance, trunk activity, upper limb activity, lower limb activity, muscle tone and ambulation. Together, they affect activities of day to day life.
Following stem cell therapy and subsequent rehabilitation p programs that we conduct; our patients show improvements in a vast majority of these symptoms easing out their discomfort.
In our study analysis, 92.6% of our patients found stem cell therapy to be a safe and effective therapy option.
Out of the 108 patients that we examined with a follow up record of up to 4 years, 15.74% showed significant improvements, 48.14% of patients showed moderate improvements and 28.7 % showed mild improvements.
The positive changes that we record in our patients are not just restricted to their symptomatic improvements, but also bring about a constructive change in their brain metabolism as observed in their PET-CT scans.
Objective radiological evidence of improvement in a patient with cerebral palsy
Pre stem cell and Post stem cell PET-CT scan of a 14 year old male, diagnosed with quadriplegic cerebral palsy.
Pre stem cell therapy PET CT scan shows the blue/black area in the neural tissue indicating the damage that occurs to the brain due to cerebral palsy
Post stem cell therapy there is reduction in the blue and the black areas and more active areas are seen. This indicates reduction in damage and improved brain function.
Intrathecally autologous stem cell therapy is safe, feasible and effective treatment strategy for children with cerebral palsy. This repairs the underlying brain damage which can also be objectively seen on PET CT scan of brain along with improvement in functional and achievement of milestones in children. Stem cell therapy along with standard treatment augments the development and improves the quality of life of these children.
My child has been diagnosed with Cerebral Palsy. Can my child get better?
Cerebral Palsy refers to a permanent condition and problems related to this condition remain throughout the lifetime, however these children can cope up with the condition as they grow. Various treatments available often bring out improvement in the condition, though it is not a cure.
Will my Child’s condition deteriorate further?
No your child’s condition won’t deteriorate further unless there are any underlying factors like any illness or infection, may cause the child’s progress to come to stand still.
Why do the muscles become weak in Cerebral palsy or why do deformities happen?
Stiffness in the muscles is due to spasticity, contractures or both. It is difficult to distinguish between spasticity and shortening and during growth spurts the child’s bones will grow more rapidly than muscles, which lead to tightening and activities like walking or standing makes it more apparent. Treatment for spasticity and shortening is different.
Will my child learn how to walk?
Every child with cerebral palsy is different from each other, and so it is not possible to come to a conclusion. As parents you are always curious and worried about your child’s walking progress. However children with mild Cerebral Palsy can learn to walk independently, children with moderate Cerebral Palsy may walk with a stick or walker and children with severe Cerebral Palsy are generally wheelchair bound.
Will my child learn how to talk?
Yes and no. Children with CP may not have any difficulties to talk, while few may have controlling the movements around the mouth or delay in developing learning skills. Children with cerebral palsy will need help from a speech therapist to learn how to use alternative methods of communication or develop speech.
Can my child be independent?
The aim of all the treatment is to encourage these children to learn to be as independent as possible. As parents it is always important for you to encourage your child to do as much as possible. Children with mild Cerebral Palsy may not have any problems achieving independence but the ones with severe Cerebral Palsy may require assistance from others throughout their lives. Always be there for your children, don’t give up!
Can my child develop behavior problem?
Some children with Cerebral Palsy may have behavioral issues, which can be difficult to manage. They may also be frustrated, due to inability to move, talk and to express their feelings. Clinical psychologists play an important role in addressing behavioral issues and help develop and motivate and encourage child to feel good about them and be happy.
Will my child have a normal life expectancy?
Most children with Cerebral Palsy are healthy and lead a normal life. Children with severe brain damage associated conditions such as epilepsy may be a risk of reduced life expectancy.
If am planning a second child, will my second baby be affected as well?
Studies have shown that there is a 6-9 fold increase in the incidence of Cerebral Palsy in case of an affected sibling, mainly during instances of complications during pregnancy or complications at birth. “6-9 fold” appears large in terms of percentage; but it translates to an incidence of 0.6-1%. With due precautions for the preventable causes, this incidence can be reduced in individual cases.
What can I do to prevent a recurrence of Cerebral Palsy in my second child?
Not all the causes of CP are known or preventable. However, there are certain associated factors which if prevented can help reduce the risk of CP in the child.
- low birth weight
- meconium aspiration syndrome
- birth asphyxia
- low blood sugar in the baby
- injuries etc
Should I go for cord blood/umbilical cord banking ?
Regarding umbilical cord blood storage, the potential for use in the future is huge.
Having said that, the must store scenarios are:
a) In case of blood related disorders in siblings, cord blood can be a potential source of stem cells, instead of allogenic bone marrow.
b) In our practice now, we have increasing seen cases of Cerebral Palsy and autism on the rise. For such instances also, cord blood cells are a good source of stem cells. But their use in neurological disorders has not yet been approved.
In absence of the above, Umbilical Cord Blood Bank storage would be more like a insurance policy, we hope never to use it!! If money/finances is not an issue, then cord blood storage can be chosen
In absence of cord blood cells, autologous cells (bone marrow derived) are available at any age and infact are a much more easy to use source.
How does stem cell therapy work?
The biological task of stem cells is to repair and regenerate damaged cells. Stem cell therapy exploits this function by administering these cells in high concentrations directly in and around the damaged tissue, where they advance its self healing and repair.
Are there ethical concerns surrounding adult stem cell research and therapy?
Bone marrow transplantation has been used successfully for genetic disorders of blood, such as sickle cell anemia, thalessemia, as well as cancers such as leukemia. Since our therapy uses these very cell, which are harvested from the patient’s own body (autologous cells), there are no major ethical concerns. Ethical concerns are primarily on the use of embryonic stem cells (which we do not use).
Does the treatment have any side effects?
Stem cell therapy is minimally invasive and reasonably safe. None of our patients have shown any neurological deterioration so far in connection with the stem cell therapy itself. Some side effects, such as headache (spinal headache) lasting 3-4 days which is generally self limiting, neck/back pain, vomiting, some mild rash or pain at the site of bone marrow aspiration/stem cell injection may occur. However, like any other medical or surgical treatment unexpected complications are always a possibility. These complications may be related to the medicines given, the stem cell procedure, the anesthesia, and the rehabilitation or to any of the preexisting medical or neurological conditions.
In case of children with seizures, or previous history of seizures or an abnormal EEG, a small possibility of triggering seizures can be there. However, proper antiepileptic cover/drugs, could circumvent this problem.
How long will it take me to know that I have benefitted from the treatment?
Maximal improvements are seen around 3-6 months after the treatment. However, in many patients there are slow progressive improvements that continue for several months/years later. Most patients do show some immediate improvements also i.e. before the discharge, in some of their symptoms.
Is the transplantation of the stem cells done once or more than once?
The decision to do the therapy a second time is taken after seeing the progress/improvements after the first therapy. If the patients show some encouraging improvement, then the case is reviewed by the entire medical and rehabilitation team. Certain special imaging tests, such as PET CT Scan of the brain, would be repeated and then a second treatment may be recommended. This may be done anytime between 3-6 months of the first therapy.
Can other treatments be taken at the same time?
We will review what other medications the patient is already on. In most cases we do not discontinue any already going on treatment. However this is decided on a case by case basis. Please inform us about any medications you are taking beforehand.
How much improvement will the patient have?
This is difficult to predict, since this a new therapy. It depends on multiple factors such as age of patient, type of illness, duration of illness and extent of rehabilitation taken after the treatment. It is important to note that at NeuroGen we give no assurances or guarantees of any definitive improvements or results.
At NeuroGen Brain and Spine Institute, 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.
Our data is regularly published in various medical and scientific journals (available for reading on our website). You are strongly advised to study these before proceeding with the treatment.
From Complete Dependence, a Step towards Independence.
The child's mother had smooth delivery of her 1st child. But during her 2nd pregnancy, at 2 months, she had bleeding and was advised complete bed rest for next 7 months. She delivered preterm (31 weeks) with normal delivery but the baby developed jaundice on the 4th day of his birth. For this, he was given phototherapy. He didn't achieve any of his milestones till the age of 1 year and was on constant rehabilitation since then.
Their family physician informed about Stem Cell Therapy.
At NeuroGen, he was examined neurologically he was hypotonic and hyporeflexic. He had all sensations intact, normal cognition, vision, hearing, oromotor control with slurred speech. He had fair voluntary control in the upper extremities and poor in the lower extremities. He could stand with help of bilateral AFO and walker and walk a few steps independently.
MRI brain was done as a routine investigations. Functionally, he was dependent for all his daily activities and mobility. He scored 49 on functional Independence Measure.
After Stem Cell Therapy & rehabilitation, within a week, dystonic movements reduced considerably. His neck control improved and he could hold the neck properly for longer period of time. His posture in sitting and standing improved and he could keep his posture more erect. His hand to mouth coordination improved as he was able to bring the chapatti to his mouth. His joint flexibility especially around the knee improved and he could stretch it further. Parents report that his speech was clearer than before.
After 3 months of Stem Cell Therapy, his Speech improved especially in spontaneous speech and he could say a full sentence. His dystonic movements reduced considerably. Neck control with voluntary control of all four extremities improved further. He started using hand to eye coordination especially while playing with toys.
After 6 months of Stem Cell Therapy, his dystonic movements reduced further because of which he started using his right upper limb more often during daily activities or while playing. He could sit without support for few seconds thus showing his sitting balance and neck control had improved further. He could maintain cross legged sitting from long sitting as his adductors spasticity reduced considerably. He was able to do bilateral activities like clapping, catching the ball thus improvement seen in doing midline activities.
Seeing all these improvements, they decided to undergo a second Stem Cell Transplantation and noticed that his dystonic movements reduced further especially on the left side, more than the right. Voluntary movements of knees have improved. He could come to kneel sitting position from prone on elbows maintaining his neck erect. His eye hand coordination improved and now he can hold the bottle and can drink the water from his water bottle. Improved speech was sustained.
Thus it shows after Stem Cell Therapy, his improvements are sustained and ongoing.
Improvement In Functional Independence Measure From 46 to 52
Premature female child was born with low body weight and later on developed jaundice for which phototherapy was given and she was put on ventilator. Once she was stabilized, parents noticed that till the age of 2 years, she didn't develop any milestones. On the basis of clinical symptoms and investigations she was diagnosed as a case of Cerebral Palsy. Functionally, she was completely dependent for all her activities of daily living. At the age of 14 yrs, she got operated forcongenital hip dislocation and knee adductor contracture but couldn't find any improvements post surgery. She was under regular rehabilitation, but there was no improvement hence it was discontinued.
At the age of 22years, they came to know about Stem Cell Therapy and NeuroGen through an old patient and they decided to opt for the treatment. When she was examined, her tone was hypertonic and hyper-reflexic with intact sensations. Cognitively, she was well oriented to time, place and person but had poor learning and memory. Her speech was normal with poor oromotor control, with no vision and hearing affection. She had poor voluntary control of all limbs. She became dependent for the daily activities and also wheelchair bound for mobility. Her functional independence measure (FIM) score was 49.
When she was investigated with MRI Brain, it showed perinatal hypoxic ischaemic insult in the bilateral frontopareital periventricular area. NeuroPet showed reduced functioning in many areas of the brain.
After the Stem Cell Therapy, her bed mobility improved and she could get up on her own from lying position which she couldn't do before. Her flexibility around the elbow joint and wrist joint improved especially on the right side. Her hand to mouth activities also improved and could eat by herself which she couldn't do before. Her legs got stretched and she could stand on the standing frame for longer period of time. She could perform transfer activities independently and shift herself. Her speech improved and became clearer. She could wear clothes independently. Her functional independence measure improved from 49 to 52.
After 3 months follow up, she could come from kneeling position to standing with one hand support and stand with walker with one person' assistance. Her flexibility around the joint improved and now can bend and straighten the leg. She can write from 1 to 100.
After 6 months of follow up, her bed mobility improved like she could do rolling independently and could come to crawling position with minimal support. Her sitting balance has improved and she could perform activities with both the hands. Speech improved further, it became clearer and more fluent. She could write from 1 to 100.
In view of these improvements, second stem cell transplantation was carried out. As a result of this, they noticed that spasticity further reduced in both the lower limbs, she could perform rolling independently and also could perform kneel walking with 20% assistance of her father. Her hand functions improved and she was able to unlatch the door. Her hand writing has improved. Speech improved and she could speak loudly and clearly. Her memory and concentration improved and has memorized her Father's mobile number, shlokas etc. Her skin texture improved and a glow could be seen on her face. She underwent significant weight reduction because of extensive rehabilitation.
Stem Cell Therapy gives a ray of hope to worried parents
A young girl who had normal birth, however suffered from delayed milestones was brought to NeuroGen by her parents. A couple of months after their daughter were born, they realized that she is having difficulty sucking and swallowing. Slowing normal developmental milestones like neck control, turning in bed, crawling, sitting walking etc. were all delayed.
When we examined her at NeuroGen, her muscle tone had increased and her reflexes were exaggerated. She could feel everything and had a good bladder and bowel awareness. She could turn in the bed herself, she could sit independently however could not use her arms to reach out for objects as the trunk control and balance was not very good. She could not crawl or walk even at the age of 3 when children of her age can easily run. Her arm control was good and movements were voluntary, the legs however had increased tone and the movements therefore showed a spastic pattern. Increased tone of the muscles and inability to control the movements of her feet had led to tiptoe walking when made to walk with support.
Her cognition was unaffected, she could understand all the commands and followed the commands as well. She could not however swallow solid food and was only fed semisolid diet.
With this developmental delay her parents were worried about her future and how this will affect her life. They decided to undergo Stem Cell Therapy and Rehabilitation at our center.
After she underwent the Stem Cell Therapy, She could sit independently and use her arms in sitting to reach for various objects. Her trunk control improved. She could also come up on her knees keeping her back straight raising her arms overhead to clap. She could open her fists. She could stand in a standing frame, bend down to pick up an object from the floor on her own and then could stand up without any support. Her tiptoe walking pattern was slowly changing and she now could walk touching her sole to the floor. With the support of ankle foot orthosis she could also stand straight and take a few steps on her own.
Her parents were very happy looking at their daughter's progress. They continued the rehabilitation therapy which is the key to exploiting maximum benefits from the stem cell therapy.