• 34- Year old man who suffered a head injury shows improvement in cognition after stem cell therapy.
  • 18 year old Patient with head injury following a fall from a train shows Improvements after Stem Cell Therapy.

What is a traumatic brain injury?

Traumatic Brain Injury (TBI) is an injury to the brain caused by a trauma to the head (head injury). In other words, a brain injury is caused initially by an outside force, but includes the complications which follow, such as damage caused by lack of oxygen, rising pressure and swelling in the brain. TBI can result when the head suddenly and violently hits an object, or when an object pierces the skull and enters brain tissue.

TBI can be classified based on severity, mechanism, or other features (e.g., occurring in a specific location or over a widespread area). A mechanism-related classification divides TBI into closed and penetrating head injury. A closed (also called non- penetrating, or blunt injury) occurs when the brain is not exposed. A penetrating, or open, head injury occurs when an object pierces the skull and breaches the Dura mater, which is the outermost membrane surrounding the brain.

What causes a traumatic brain injury?

The causes of a traumatic brain injury can be enlisted as follows:-

  • Falls- Falling out of bed, slipping in the bath, falling down steps, falling from ladders and related falls
  • Vehicle collisions- Collisions involving cars, motorcycles or bicycles and pedestrians involved in such accidents are a common cause of traumatic brain injury.
  • Violence- Violence, such as gunshot wounds, domestic violence or child abuse can also lead to violence
  • Extreme Sports- Traumatic brain injuries may be caused by injuries from a number of sports, including soccer, boxing, football, baseball, lacrosse, skateboarding, hockey, and other high-impact or extreme sports.

    A traumatic brain injury can be seen as a chain of events:-

  • The first injury occurs in seconds after the accident
  • The second injury happens in the minutes and hours after this, depending on when skilled medical intervention occurs
  • A third injury can occur at any time after the first and second injuries, and can cause further complications.

What are the symptoms associated with a traumatic brain injury?

A traumatic brain injury can have wide-ranging physical and psychological effects. Some signs or symptoms may appear immediately after the traumatic event, while others may appear days or weeks later. An individual suffering from mild traumatic injury may show loss of consciousness, headache, nausea or vomiting, fatigue and loss of balance. The individual may also exhibit sensory and cognitive problems such as blurred vision, ringing in the ears, a bad taste in the mouth or changes in the ability to smell and memory loss, concentration problems and mood swings. Moderate to severe traumatic brain injuries can include any of the signs and symptoms of mild injury, as well as the following symptoms that may appear within the first hours to days after a head injury:-

  • Convulsions and seizures
  • Dilation of one or both pupils
  • Weakness and numbness in the toes and fingers
  • Loss of coordination
  • Agitation, combativeness or other unusual behavior
  • Slurred speech
  • Coma

What are the treatment options available for a traumatic brain injury?

Emergency care for moderate to severe traumatic brain injuries focuses on making sure the person has an:-

  • Adequate oxygen
  • Blood supply
  • Maintaining blood pressure
  • Preventing any further injury to the head or neck.

Certain medications like anti diuretics, anti seizure drugs and coma inducing drugs are often administered to limit the secondary damage that occurs immediately after the injury. Emergency surgery such as those involved in removing blood clots and repairing skull fractures may also be needed. Besides, adequate rehabilitation including physical therapy, occupational therapy, speech and language pathologists and other recreational therapies are required post surgery to improve the abilities of the individuals to perform their daily activities.

Although, these therapies help to enhance the quality of life of the patients, they do not repair the underlying nervous system damage.

Despite advances in medical technology a significant number of patients with a head injury are left with debilitating neurological deficits for which there was no treatment so far. Recent research states that stem cell transplantation can be an adjunct along with other treatment options for patients with head injury. Some clinical trials using stem cells have shown improved neurological function compared to the control groups.

How stem cells work in a head injury

With the potential of the brain to regenerate the neurons as a result of neuroplasticity, cellular therapy is aimed at carrying out the process of regeneration by neurorestorative mechanisms and reinforcing the ongoing neuroplasticity.

Stem cells derived from various sources can be used for therapy. Several studies have indicated that bone marrow derived stem cells have the capability to form neural cells in the host’s brain. Stem cells migrate towards the damaged areas of brain and initiate a repair process and promote the development of new blood vessels, initiate sprouting of new axons, neurogenesis and initiate the formation of new communication networks between the existing neurons which may to an extent help in repairing the damage caused by a head injury. The various growth factors and neurotrophic factors stimulate repair and help in neuro protection. The transplanted cells replace the lost cells by proliferation and differentiation in to neurons and certain non neuronal brain tissue cells like astrocytes, oligodendrocytes and endothelial cells which help in re-establishment of functional neuronal circuitry. The formation of these neural networks translates clinically in the form of functional improvement.

Thus stem cell therapy provides a newer, more effective treatment option for head injury that helps to repair the damage that occurs at the tissue level.

The NeuroGen Outcome

Anyone who has had a loved one survive traumatic brain injury knows that leaving the hospital is just the beginning, because an injury to the brain changes you physically, mentally, and emotionally. The availability of Stem Cell therapy now offers new hope to these patients.

At NeuroGen BSI, we have treated over 20 cases of head injury with 94.22% of our patients showing overall improvement.

Following our treatment protocol, which includes stem cell therapy along with comprehensive physical therapies our patients have reported relief from the distress that they faced earlier. Improvements were seen in higher mental functions, posture, trunk activity, upper limb activity, lower limb activity, coordination, oromotor skills, ambulation and Activities of Daily Living.

The clinical improvements that our patients exhibits are co related with the affirmative changes that are seen in the damaged nervous tissues as demonstrated by the PET-CT scan of our patients.

Pre stem cell therapy PET-CT scans showing blue areas which are areas of reduced metabolism or damage.

Post stem cell therapy PET-CT scan showing reduction in blue areas which have been replaced by green areas indicating improvement in metabolism/function

Stem cell therapy along with neurorehabilitation may help in rebuilding the neuronal network by replacing the lost neurons and other cells in the brain tissue with the new ones and also stimulates the endogenous repair of the brain. This therefore offers a new hope to patients suffering from the crippling neurological sequelae of severe head injury in improving the quality of their lives.

What is a Traumatic Brain Injury (TBI)?

Traumatic brain injury (TBI) occurs when a sudden trauma, often a blow or jolt to the head, causes damage to the brain. The severity of TBI can range from mild (a conclusion) to severe (coma). A conclusion may cause temporary confusion and headache, while a severe TBI can be fatal.

Is TBI completely curable/recoverable?

The recovery in TBI depends on the degree of injury/damage to the brain. Also, which parts of the brain are injured, will also be the deciding factor in prognosis of the patients.

Does it have long-term effect?

Long-term neurological sequelae or neurodeficts are possible. They may range from severe (patient remaining in coma), to paralysis of hands/legs, speech issues, swallowing issues, memory or cognitive issues. Damage to the occipital lobe can cause blindness (known as cortical blindness).

Would my life be normal?

There are some patients, who recover completely. But there are equal numbers, who suffer long term problems. The severity can be reduced by doing proper rehabilitation (physiotherapy, occupational therapy, speech therapy, cognitive therapy, etc). These can help improve quality of life and take the patient a step towards functional independence.

What are the possible long term complications seen?

A) In a comatose patient: complications that any bedridden patient will have are possible, such as bedsores, deep vein thrombosis, chest infections, etc.

B) Deformities/contractures, due to disuse of limbs are possible, if rehabilitation is not done regularly

C) Myositis ossificans: Calcium and bone deposits in the joints are a common problem in TBI, which restricts joint movements and ambulation. Deep massages, hence, should be avoided.

D) Fits/seizures: Some patients, who have suffered a Head injury/TBI, also have potential of seizures. Hence, are generally started on antiepileptic.

What is the role of stem cell therapy in a patient with TBI?

As in other incurable neurological disorders, stem cell therapy along with rehabilitation helps in recovery of neurological deficits. It also helps in improving other problems, which are not improved by rehabilitation alone.

Our experience suggests that, aggression reduces, memory improves, and Speech improves along with other motor/physical functions.

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.

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.

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. However from our past clinical results show that 94.22% of patients showed overall improvement. Improvements were seen in higher mental functions, posture, trunk activity, upper limb activity, lower limb activity, coordination, oromotor, 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.

18 year old Patient with head injury following fall from train shows Improvements after Stem Cell Therapy

An 18 year old male, after fall from a train was in coma for 6 months. When he approached NeuorGen BSI,he was found to be hypertonic and hyper reflexic , was not oriented in time, place and person, had an aggressive behavior, had severe motor weakness in all limbs, had no bowel and bladder control and could not follow simple commands. His MRI showed reduction in the density of the posterior callosal fibers especially on the right side. Gliotic changes in the bilateral anterior temporal, basifrontal, right insular right parietal and right peritrigonal regions and in splenium of corpus callosum with innumerable peticheal foci of hemosiderin straining in both cerebral hemispheres represent sequalae of diffuse axonal injury. His PET CT Scan showed reduced metabolic activity in precentral, broca’s, sensory, motor, wernicke’s, Insula, Lateral, Temporal, Caudate and Putamen, Parietal, Cerebellum, Lobulus Quadrilatare, Medial Temporal Lobe. He underwent Stem Cell Therapy at NeuroGen Brain and Spine Institute.

Following improvements were seen after Stem Cell Therapy,

  • There was an improvement in his eye contact
  • He could indicate his need for water and food with gestures
  • He could roll independently
  • There was an improvement in his perception
  • There has been a significant improvement in his command following
  • Spasticity had reduced drastically
  • Improvement in his sitting and standing balance
  • An improvement in his right hand voluntary control
  • Changes in his behavior especially in his aggressiveness and understanding
  • Improvement in his emotional response
  • Drooling stopped completely
  • He started eating by himself using his left hand
  • There was also an improvement in his FIM score from 19 to 30.

After six months of silence, the fact that he started to slowly regain his activities, was more than he had hoped for!

Cognitive Improvements in Head Injury Patient

A 34 year old man was diagnosed as a case of Head Injury due to fall of a heavy object, following which he suffered a subarachnoid hemorrhage and parietal bone fracture. He was operated twice and had a residual right sided hemi paresis. On examination he was hypertonic and hyperreflexic and had grade 2 spasticity in right upper extremity and grade 1 spasticity in the lower extremity, walks with a circumductory gait, he had slight memory affection, had slurred speech and right sided facial paralysis. His MRI suggested large cystic encephlomalacia/ glosis in left fronto parietal and left superior temporal lobes with marked ex-vacuo dilatation of left lateral ventricle. Wallerian degeneration of left cerebral peduncle and left hemipons. His PET CT Brain: Showed gliosis in left front parietal cortex with areas of severe hypo metabolism. He underwent stem cell therapy at Neurogen Brain and Spine Institute and follow-up after 6 months showed the following improvements:

  • His level of confidence in regular activities improved
  • His sitting and standing posture improved
  • There was an improvement in his gait pattern
  • There was also reduction in his spasticity in his right upper extremity
  • His range of motion also improved
  • His sensations on right side also improved
  • His facial expressions also improved
  • There was an improvement in his remote and recent memory also improved
  • There was also an improvement in his planning, organization, sequencing and decision making skills
  • His speech and orientation improved
  • His tongue flexibility and speech clarity also improved
  • There was also a reduction in his semantic paraphasias

Apart from the clinical improvement there were also changes in his post SCT PET CT scan which showed better metabolic activity in the left parieto- occipital cortex at the periphery of the gliotic lesion and contributed to his overall improvements.