• A 35 year old male with stroke from the past two years, shows functional improvement after stem cell therapy.
  • A 65 year old man with stroke started living independently only after six months of stem cell therapy.

What is a stroke?

A stroke is a very serious medical emergency. A stroke sometimes also called as a ‘brain attack’ occurs when; the blood supply to the brain is interrupted or severely reduced, depriving the brain tissue of oxygen and glucose. Such a situation causes the brain cells to die within minutes leading to very serious clinical manifestations. Prompt actions and early treatment can minimize the damage that occurs in the brain and potential complications.

What are the causes of stroke?

A stroke may be caused by a blocked artery (ischemic stroke) or a leaking or bursting of a blood vessel (hemorrhagic stroke). Some people may experience a temporary disruption of blood flow through their brain (transient ischemic attack, or TIA). These can be described as follows:-

Ischemic stroke- An ischemic stroke is the most common type of stroke, which occurs when blood clots block the flow of blood to the brain. Blood clots typically form in areas where the arteries have been narrowed or blocked by fatty cholesterol-containing deposits known as plaques. As we get older, our arteries narrow down but certain factors can increase the risk associated with the occurrence of stroke. Smoking, high blood pressure, high cholesterol levels, excessive uptake of alcohol and a family history of diabetes and heart attack can dangerously accelerate the process. Another possible cause of ischemic stroke is an irregular heartbeat (atrial fibrillation), which can lead to the formation of blood clots that become lodged in the brain.

Hemorrhagic stroke- A hemorrhagic stroke occurs when a blood vessel in the brain bursts and bleeds into the brain. The main cause of hemorrhagic stroke is high blood pressure (hypertension), which can weaken the arteries in the brain and making them prone to split or rupture and brain aneurysm which is weakness or thinning of the wall of the blood vessel. A traumatic brain injury can also cause bleeding in the brain leading to the formation of a blood clot. Other risk factors such as being overweight, smoking, excessive alcohol intake, lack of exercise and stress can also lead to a stroke.

Transient ischemic attack- A transient ischemic attack also called as a ‘mini stroke’ is a brief period of symptoms similar to stroke. Temporary decreases in the blood supply to a part of the brain often less than five minutes can lead to TIA. Like an ischemic stroke, a TIA occurs when a clot or debris blocks blood flow to part of your brain. A TIA doesn't leave lasting symptoms because the blockage is temporary.

What are the symptoms associated with stroke?

A person having a stroke may exhibit may the following symptoms:-

  • Weakness or numbness of the face, arm, or leg on one side of the body
  • Loss of vision or dimming (like a curtain falling) in one or both eyes
  • Loss of speech, difficulty talking, or understanding what others are saying
  • Sudden, severe headache with no known cause
  • Loss of balance or unstable walking, usually combined with another symptom

The extent of neurological involvement may range from mild motor deficit to gross involvement of various functions namely; sensorimotor, perceptual, emotional, behavioral, memory intelligence, speech and language function, ultimately affecting daily activities.

What are the treatment options available for stroke?

If a stroke has occurred, treatment should begin as soon as the stroke is diagnosed to ensure that no further damage to the brain occurs. Initially, the doctor may administer oxygen and insert an intravenous drip to provide the affected person with adequate nutrients and fluids.

In cases of ischemic stroke, it is common to give aspirin to reduce the risk of death or of a second stroke. If the cause of the stroke was a clot, it is possible that the quick administration of certain clot-dissolving drugs, such as alteplase, may prevent some symptoms such as paralysis. Where there is a blockage in a neck artery, surgery may be performed to remove the build-up of plaque in order to prevent a future stroke. This operation is called a carotid endarterectomy.

Once a stroke has permanently damaged the brain, the damage can't be undone. Rehabilitation following a stroke is very important to restore daily activities of the affected individual. Physiotherapy, occupational therapy and speech and language therapy is needed to improve muscle coordination, language and hand and eye coordination, respectively.

Complete recovery is unusual but not impossible and most patients will improve to some extent: proper diet and exercise are known to help the brain to recover.

With the current treatment approaches, be it medical, surgical or rehabilitative, the patho physiological processes and the resultant damage occurring at the microcellular level cannot be reversed. This calls for newer and more effective treatment approaches to improve not just the symptoms of stroke but to repair and restore activities of the damaged neural tissue. Researchers and scientists are therefore considering stem cell therapy as a potential approach for stroke. Stem cells with their unique properties of self multiplication, differentiation into specialized cells and migration to the affected area, regenerate and repair the affected tissues in stroke.

How stem cell therapy works in stroke

Recent experimental studies raised the possibility of using mesenchymal stem cells (MSCs) for stroke therapy. There is increasing evidence that MSCs promote functional recovery in animal models of ischemic stroke. In specific culture conditions, human MSCs can differentiate into cells that express markers of neuronal progenitor cells and can engraft and migrate along paths that resemble those of neuronal progenitor cells. Furthermore, the mononuclear fraction obtained from the bone marrow contains several cells including stem cells and their precursors, which can produce large amounts of cytokines and trophic factors that promote blood and oxygen supply, neuroprotection and neuroregeneration in the affected area.

MSCs are eminently suitable for human trials because these cells can be obtained readily from bone marrow under local anesthesia, are easily expanded by culture, and potentially could be delivered to injured brain tissue without the need for invasive operations. Moreover, the use of patients' own bone marrow cells should prevent the problems of immune rejection.

This had led doctors, researchers and scientists to believe that stem cell therapy has tremendous potential in improving the condition of the people affected with stroke.

The NeuroGen Outcome :-

Despite the best medical management, newer neuro protective drugs and extensive rehabilitation, we are still not able to give these paralyzed patients symptomatic relief from their paralysis. It is for recovery of this that we at NeuroGen are offering stem cell therapy as a new beacon of hope.

With the ardor to do better and bring about positive transformations in the lives of our patients, we at NeuroGen BSI have treated over 27 patients with stroke. Majority of the patients who had approached us, had reached a plateau stage in their symptomatic and functional improvements After stem cell therapy, our patients show remarkable improvements in several of the symptoms that they experience before the therapy such as upper limb activity/hand functions, lower limb activity, trunk activity, balance, higher mental functions/speech, ambulation and activities of daily living. This gives them a possibility to fall back on to their daily routine and to maintain their independence.

Our patient studies illustrated that 51.8% of patients showed significant improvements, 29.6% of patients showed moderate improvements, mild improvements were observed in 11.1% of the patients, promising a future they always deserved.

These improvements are not just restricted to the functional and symptomatic changes that are seen in our patients but also go a step further. The stem cells administered during the course of the therapy work wonders in repairing the damage in the stroke affected regions of the brain by increasing their metabolism as observed in the PET-CT scans.

Objective Radiological evidence of improvement after stem cell therapy in a case of stroke:

Pre and Post stem cell therapy PET-CT scans of a 68 year old man with stroke

Pre stem cell therapy PET CT scan showing green area is the area of normal metabolism, blue area is the penumbral area, which is the area around the main area of stroke and shows hypo metabolism. The black area is the gliotic area, which is the main stroke area.

Post stem cell therapy PET CT scan showing reduction in the black gliotic area in the left hemisphere and is turning towards blue, depicting improved metabolism than before. There is increase in the green are and reduction of the blue area, which tells us that there is increased metabolism occurring in the areas affected by stroke.

What causes a stroke?

Strokes sometimes are called brain attacks because they often occur suddenly and result in loss of blood flow to the brain or bleeding into the brain that causes cells to die. Because injury that cell death causes to the brain progresses over time, it is vital to seek help immediately if someone you know is having a stroke.

Are there different types of stroke?

There are two major kinds of stroke. An ischemic stroke is one that is caused by an artery or blood vessel that is blocked. Approximately 80% of strokes are ischemic. Making up the other 20% are hemorrhagic strokes, which occur when a blood vessel or artery bursts and leaks into the brain.

What are the risk factors for a stroke?

The common risk factors are: high blood pressure (uncontrolled), chronic smoking, obesity/ being overweight, poor dietary habits, sedentary lifestyle/physical inactivity, chronic uncontrolled diabetes, high cholesterol and triglyceride levels.

What are the symptoms of a stroke?

Generally there is a sudden onset of the "worst headache of your life." The following symptoms can occur together, or only one or two symptoms may occur:

Sudden numbness or weakness of face, arm, or leg on one side of the body, Sudden confusion, trouble speaking or understanding, Sudden difficulty seeing or loss of vision, Sudden trouble walking, dizziness, or imbalance. There could also be sudden unconsciousness associated with it.

These symptoms may be mild or severe in nature and may be temporary or permanent. If they are temporary (i.e., typically lasting 5-15 minutes), the episodes are referred to as transient ischemic attacks (TIAs). TIAs are important warning signs of a possible impending stroke and require urgent evaluation.

A simple test can help you recognize if someone has had a stroke:

Face-has their face fallen on one side? Can they smile?

Arms-Can they raise both arms and keep them there?

Speech-is their speech slurred?

This is called the FAST (ACT FAST…when these signs are seen)

What is the extent of recovery that can be achieved after the stroke?

The extent of recovery varies. A stroke damages the brain cells. The extent of the brain damage and the size of the stroke are directly related to the extent of the impairments/paralysis . People who suffer a minor stroke may have only slight impairments/problems, such as a weak arm or leg. A massive stroke, however, can cause a person to lose the ability to read, write, or speak. It also can cause paralysis. Fortunately, with rehabilitation therapy(physiotherapy, occupational therapy, speech therapy), about 25% of victims recover with slight impairments and an additional 10% recover almost completely.

What kind of treatment is available for stroke patients?

The type of treatment provided depends on the type and severity of the stroke. If the victim has suffered an ischemic stroke, immediate therapies may include medications to dissolve the clot, surgery, and/or interventional neurosurgery, such as stenting and so on. If the victim has suffered a hemorrhagic stroke, immediate therapies may include medications and/or surgery. REMEMBER: The sooner the victim receives treatment, the better his or her chances are of survival and recovery.

What kind of rehabilitation is available for stroke victims?

Rehabilitation is a very important aspect of stroke care. NeuroGen Brain and Spine Institute offers patients the most comprehensive and holistic stroke rehabilitation in Mumbai and India. Our rehabilitation program includes speech therapy, physical therapy, and occupational therapy, with experienced staff who specialize in helping stroke and patients with neurological disorders regain their independence.

How does stem cell therapy help in stroke, especially in comparison with regular rehabilitation?

Stem cell therapy helps repair the damage to the brain and stimulates the parts of brain, which are functioning less (after the brain stroke). It works complimentary to the rehabilitation. Stem cell therapy along with a comprehensive rehabilitation program helps in accelerating the process of recovery.

Stem cell is not a substitute for rehabilitation, it works hand in hand with the exercises.

At NeuroGen Brain and Spine Institute, the best of neurorehabilitation is combined with the newest technology of stem cell therapy, which makes treatment for stroke patients more effective.

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).

Is the treatment painful?

The therapy is done under local anesthesia and a mild sedation. There is no significant pain or discomfort during or after the procedure.

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.

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 and 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. Blood thinners like aspirin, clopidrogel, warfarin, etc needs to be stopped. 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.

At NeuroGen Brain and Spine Institute, we have treated over 30 patients of with stem cell therapy along with rehabilitation. All these patients had attained a plateau stage with respect to symptomatic and functional improvements. The symptoms they presented with included upper limb activity/hand functions, lower limb activity, trunk activity, balance, higher mental functions/speech, ambulation and Activities of Daily Living.

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 treatment.

Functional Improvements Seen In Stroke Patient

Stroke or paralysis is a lifestyle disease. The burden of these lifestyle diseases is increasing day by day. Cardiac disorders are also a part of this group. There are many risk factors and contributing factors for these diseases but it is impossible to pin point a single cause. The major contributors are family history, urban lifestyle and co-morbidities like high blood pressure, obesity, sedentary lifestyle, high blood cholesterol and smoking. Owing to all these factors such diseases occur at a relatively younger age. Our patient suffered from stroke only at the age of 35 years. Two years after suffering the stroke for the first time, he visited NeuroGen.

When we examined him he had abnormalities of the tone of muscles and voluntary control of movements. Various investigations showed the brain areas with abnormalities. A new diagnostic tool called Positron Emission Tomography showed reduced FDG brain metabolism in right basal ganglia, bilateral mesial temporal structures including bilateral anterior and middle cingulated gyri, parahippocampal gyrus, amygdale as well as hippocampus, left hemicerebellum , secondary to crossed cerebellar diasschisis. On psychological assessment he showed mild mood disturbances.

Within 7 days of his treatment he could feel his wrist movements and the movement control was better. He could open up his fingers and the rigidity of the fingers had reduced. His shoulder movements were gaining better control. The walking pattern was slowly changing and he found himself much more stable. 3 months after treatment he could walk much better, his toes did not curl he could wear and hold onto the footwear. His hand movements and functions had improved. Six months later he could walk independently. He was also more independent in carrying out the functions of daily living. Nine months after the treatment the physical improvement was consistent and functionally he was much better and was confident he could travel in train on his own.

Stroke Patient Living Independently

Our next patient who also suffered from stroke and paralysis was a 65 year old man. In the May of 2010 he visited NeuroGen to take treatment for stroke he had suffered in the year before. When we examined him he showed some abnormalities of tone in the muscles. His speech was unclear and he had to repeat himself a couple of times so others could understand clearly. His movement control was affected. He had profound weakness in the muscles of his left side and reduced shoulder control. His foot muscles did not function at all and he suffered from a foot drop. He therefore walked with the help assistive device called Ankle Foot Orthosis and a support of cane. He was almost independent in performing his day to day activities but needed some assistance in dressing the lower body.

With the impairment caused by stroke he had pinned a lot of hope in stem cell therapy. Within 7 days after stem cell therapy he reported reduction in shoulder pain and improved range of motion. When we saw him a month later, he had travelled all the way from his home to NeuroGen on his own and did not feel tired or breathless. His walking ability had significantly improved. His hand movements were much better and did not need as much assistance for dressing. His movements were more controlled and faster than before. He could stand independently for more than 5 min now. Within next two months he could walk independently without assistive devices, indoors. His stamina had improved. The tone abnormalities of the muscles had reduced. Six months after stem cell therapy his improvement was consistent and he was functionally independent for his day to day activities. He was very eager to be independent again. He was very driven and motivated and complied with rehabilitation.

He wanted to be on his own as soon as possible and looking at the results from the first stem cell therapy he decided to do it again. 7 months after the first stem cell therapy he underwent stem cell therapy once again. Although there wasn’t a significant change in him 3 months after second treatment, he did show improvement in his hand and shoulder function. Six months later however the hand function was significantly better. 15 months after taking the treatment the second time he lives on his own and he is functionally completely independent.