Bruce H Dobkin1. 1. Department of Neurology, University of California Los Angeles, Los Angeles, CA 90095, USA. bdobkin@mednet.ucla.edu
Abstract
BACKGROUND: Cellular transplantation for subacute and chronic spinal cord injury (SCI) continues to proceed around the world, but clinicians and patients have only 10 English language publications of case reports and self-serving Web page anecdotes to guide them. METHODS: Recent publications about the use of olfactory ensheathing, bone marrow stromal, and fetal tissue stem cells in human subjects are examined to assess the adequacy of their designs, conclusions, and interpretation. RESULTS: Case series reports to date reveal adverse responses to cellular therapy when clinicians look for these and no clear functional effects when a matched group that is not treated is compared. Rehabilitation that focuses on potential targets for sensorimotor and functional gains must precede a transplantation until a plateau of change is reached and then continue for at least 6 months if not a year. CONCLUSION: Criteria are listed as the minimum requirements for any further case series reports to be considered by journals in regard to cellular interventions for SCI. Based on available reports, the published interventions should not be given to additional patients. One or two of the strategies can be considered for testing in a randomized trial with blinded assessors and an independent data monitoring committee to examine for biological activity in patients with motor complete SCI of greater than 4 to 6 months duration.
BACKGROUND: Cellular transplantation for subacute and chronic spinal cord injury (SCI) continues to proceed around the world, but clinicians and patients have only 10 English language publications of case reports and self-serving Web page anecdotes to guide them. METHODS: Recent publications about the use of olfactory ensheathing, bone marrow stromal, and fetal tissue stem cells in human subjects are examined to assess the adequacy of their designs, conclusions, and interpretation. RESULTS: Case series reports to date reveal adverse responses to cellular therapy when clinicians look for these and no clear functional effects when a matched group that is not treated is compared. Rehabilitation that focuses on potential targets for sensorimotor and functional gains must precede a transplantation until a plateau of change is reached and then continue for at least 6 months if not a year. CONCLUSION: Criteria are listed as the minimum requirements for any further case series reports to be considered by journals in regard to cellular interventions for SCI. Based on available reports, the published interventions should not be given to additional patients. One or two of the strategies can be considered for testing in a randomized trial with blinded assessors and an independent data monitoring committee to examine for biological activity in patients with motor complete SCI of greater than 4 to 6 months duration.
Authors: Gerard G Fluet; Alma S Merians; Qinyin Qiu; Maryam Rohafaza; Anita M VanWingerden; S V Adamovich Journal: Top Stroke Rehabil Date: 2015-01-22 Impact factor: 2.119