Spinal cord recovery after injury Recent advances and management as well as ongoing trials.

1. Recent advances in recovery
after Spinal Cord Injury

2. Etiology
• Spinal cord Injury (SCI) causes a loss of sensorimotor function
due to the compromise of neural tissue integrity in the spinal
cord.
• Traumatic events (automobile accidents, fall, sports injuries
etc), diseases (e.g. cancer) and infections can lead to a SCI.
• Depending on the severity and location of the injury, SCI can
lead to incomplete or complete lower-limb (paraplegia), or
both upper- and lower-limb paralysis

4. • Interruption of the spinal pathways
below the lesion after a SCI
compromises the body’s ability to
execute and coordinate movements
along with its ability to provide sensory
feedback.
• Despite the disrupted connection
between the brain and spinal cord, the
brain can still generate appropriate
motor commands.
(Serruya et al., 2002; Collinger et al., 2013a)

5. • This phenomenon has inspired treatments
that bypass cortical commands over the
lesion site to the appropriate descending
motor pathways.
• A neuro-prosthesis using a brain-machine-
spinal-cord interface (BMSCI) aims to build
such a bypass to electronically route this
information in real-time.
• Recent experiments show proof of concept
of these bypasses by using brain intention to
directly stimulate the limb or spinal cord to
reanimate or mimic motor functions
(Collinger et al., 2013c; Lobel and Lee, 2014; Bouton et al.,
2016)

6. Brain-Machine Interface
• The integration of brain-machine
interfaces (BMIs) to neuro-prostheses
provides an innovative approach to aid
patients with sensorimotor deficits.
• BMI works on the principle that neural
activities in the brain are associated
with intended movement trajectories,
even in absence of actual movement.
(Georgopoulos et al., 1986).

7. • Using multichannel neural signal
recordings and advanced computer
algorithms, it is possible to translate
these neuronal activities into
executable motor commands.
(Wessberg et al., 2000)

9. • In this paper spinal epidural
stimulation used to bypass the
effected segment which helps in
patient to walk again with
intensive training for 43 weeks
patient were able to walk on
treadmill independent of
assistance and body weight
support system.

11. • This paper also demonstrate how
epidural stimulation can help
paraplegics to walk again, this also
follows the same procedure of
first assisted walking then patient
starts to walk on their own.

15. Pharmacologic treatment in spinal cord injury
• Pharmacologic treatment as an
adjunct to spinal cord injury has
always been a topic of debate,
their role has been proven
controversial and in many ongoing
trial their role has negative effect
in treatment of spinal cord injury.
• Class 3 studies need randomized
trial for its clinical application in
spinal cord injury.

16. LEVEL 1 Evidence
• Methylprednisolone:
• Administration of
methylprednisolone (MP) for
the treatment of acute spinal
cord injury (SCI) is not
recommended. Clinicians
considering MP therapy
should bear in mind that the
drug is not Food and Drug
Administration (FDA)
approved for this application.
There is no Class I or Class II
medical evidence supporting
the clinical benefit of MP in
the treatment of acute SCI.

17. LEVEL 1 Evidence • GM-1 ganglioside:
• Administration of GM-1 ganglioside (Sygen) for the
treatment of acute SCI is not recommended.
• Acidic fibroblast growth factor:
• The trial initially enrolled 60 patients (30 cervical and
30 thoracolumbar SCI), but only 46 (21 cervical- and
25 thoracolumbar-SCI) completed the follow-up. The
ASIA impairment scales, motor, pin prick, light touch,
and FIM motor subtotal scores were all improved in
both groups, except that the ASIA scores of light touch
only demonstrated tendency of increase in the
cervical-SCI group. All patients had a decrease in
dependence, and there were no major adverse events
or other oncological problems throughout the follow-
up.

18. LEVEL 2 Evidence • Buspiron:
• The combined effects of cervical electrical stimulation
alone or in combination with the monoaminergic
agonist buspirone on upper limb motor function were
determined in six subjects with motor complete (AIS
B) injury at C5 or above and more than one year from
time of injury. Improvement seen in this patient after
discontinuation of this therapy.
• Leuprolide Acetate, an Agonist of GnRH
• Treatment with LA induces improvements in
sensitivity, motor activity and independence in
patients with chronic SCI. One advantage of this
protocol is that it is a non-invasive method of easy
and safe application, with few side effects.

19. LEVEL 3 Evidence • There are many chemical substances that help prevents
further progression of spinal cord injury and in some
instances improve those injuries. As they are level 3
evidence their reliability is much lower than that of level 1
and level 2 evidence.
• Paclitaxel Inosine
• Testosterone Derived FGF 10
• Aminopyridine Riluzole
• Baclofen CX3CL1(Fractalkine)
• Astrocytic Transglutaminase 2 Curcumin
• Lycium barbarum polysaccharides molybdenum
Disulphide

20. Stem cells in spinal cord injury
• Use of mesenchymal stem cells in
spinal cord injury is an ongoing
area of research.
• Clinical trials are had yet not
produced any significant result,
but further research is still going
on in this field.

21. • In future we may be able to treat
all debilitating spinal cord injuries
with the help of stems cells as
well.