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The Journal of Spinal Cord Medicine Jan 2020
Topics: Humans; Research; Spinal Cord Injuries
PubMed: 31935170
DOI: 10.1080/10790268.2020.1696647 -
Medecine Sciences : M/S 2022Spinal cord injuries induce motor and sensory deficits. The development of therapies aimed to improve these functions after spinal cord injury is therefore necessary....
Spinal cord injuries induce motor and sensory deficits. The development of therapies aimed to improve these functions after spinal cord injury is therefore necessary. Repeated magnetic stimulation (rMS) is an innovative and non-invasive technique which has been used to modulate the activity of neuronal networks in various diseases such as bipolar disorder or Parkinson's disease. rMS could therefore display beneficial functional effects in people with spinal cord injury. Studies carried out in vitro, in vivo and ex vivo have made it possible to partly understand the mechanisms underlying the modulation of neuronal activity induced by rMS protocols. Its use in preclinical models of spinal cord injury has also shown beneficial functional effects. Thus, rMS seems to be a promising therapy in the recovery of lost functions after spinal cord injury.
Topics: Humans; Magnetic Phenomena; Recovery of Function; Spinal Cord Injuries
PubMed: 36094238
DOI: 10.1051/medsci/2022108 -
International Journal of Molecular... Dec 2016Spinal cord injury (SCI) is a devastating condition that usually results in sudden and long-lasting locomotor and sensory neuron degeneration below the lesion site.... (Review)
Review
Spinal cord injury (SCI) is a devastating condition that usually results in sudden and long-lasting locomotor and sensory neuron degeneration below the lesion site. During the last two decades, the search for new therapies has been revolutionized with the improved knowledge of stem cell (SC) biology. SCs therapy offers several attractive strategies for spinal cord repair. The transplantation of SCs promotes remyelination, neurite outgrowth and axonal elongation, and activates resident or transplanted progenitor cells across the lesion cavity. However, optimized growth and differentiation protocols along with reliable safety assays should be established prior to the clinical application of SCs. Additionally, the ideal method of SCs labeling for efficient cell tracking after SCI remains a challenging issue that requires further investigation. This review summarizes the current findings on the SCs-based therapeutic strategies, and compares different SCs labeling approaches for SCI.
Topics: Animals; Cell Tracking; Humans; Nerve Regeneration; Neural Stem Cells; Neurogenesis; Spinal Cord Injuries
PubMed: 28035961
DOI: 10.3390/ijms18010006 -
Cell Stem Cell Jun 2018We tested the feasibility and safety of human-spinal-cord-derived neural stem cell (NSI-566) transplantation for the treatment of chronic spinal cord injury (SCI). In...
We tested the feasibility and safety of human-spinal-cord-derived neural stem cell (NSI-566) transplantation for the treatment of chronic spinal cord injury (SCI). In this clinical trial, four subjects with T2-T12 SCI received treatment consisting of removal of spinal instrumentation, laminectomy, and durotomy, followed by six midline bilateral stereotactic injections of NSI-566 cells. All subjects tolerated the procedure well and there have been no serious adverse events to date (18-27 months post-grafting). In two subjects, one to two levels of neurological improvement were detected using ISNCSCI motor and sensory scores. Our results support the safety of NSI-566 transplantation into the SCI site and early signs of potential efficacy in three of the subjects warrant further exploration of NSI-566 cells in dose escalation studies. Despite these encouraging secondary data, we emphasize that this safety trial lacks statistical power or a control group needed to evaluate functional changes resulting from cell grafting.
Topics: Adult; Animals; Cell Line; Chronic Disease; Female; Humans; Male; Neural Stem Cells; Rats; Rats, Nude; Spinal Cord Injuries; Stem Cell Transplantation; Young Adult
PubMed: 29859175
DOI: 10.1016/j.stem.2018.05.014 -
Journal of Neuroinflammation Aug 2014Spinal cord injuries remain a critical issue in experimental and clinical research nowadays, and it is now well accepted that the immune response and subsequent... (Review)
Review
Spinal cord injuries remain a critical issue in experimental and clinical research nowadays, and it is now well accepted that the immune response and subsequent inflammatory reactions are of significant importance in regulating the damage/repair balance after injury. The role of macrophages in such nervous system lesions now becomes clearer and their contribution in the wound healing process has been largely described in the last few years. Conversely, the contribution of neutrophils has traditionally been considered as detrimental and unfavorable to proper tissue regeneration, even if there are very few studies available on their precise impact in spinal cord lesions. Indeed, recent data show that neutrophils are required for promoting functional recovery after spinal cord trauma. In this review, we gathered recent evidence concerning the role of neutrophils in spinal cord injuries but also in some other neurological diseases, highlighting the need for further understanding the different mechanisms involved in spinal cord injury and repair.
Topics: Animals; Humans; Neutrophils; Recovery of Function; Regeneration; Spinal Cord Injuries; Wound Healing
PubMed: 25163400
DOI: 10.1186/s12974-014-0150-2 -
The Journal of Spinal Cord Medicine Nov 2011
Topics: Humans; International Classification of Diseases; Neurologic Examination; Spinal Cord Injuries
PubMed: 22330108
DOI: 10.1179/204577211X13207446293695 -
Neurotherapeutics : the Journal of the... Jul 2018Glial cell types were classified less than 100 years ago by del Rio-Hortega. For instance, he correctly surmised that microglia in pathologic central nervous system... (Review)
Review
Glial cell types were classified less than 100 years ago by del Rio-Hortega. For instance, he correctly surmised that microglia in pathologic central nervous system (CNS) were "voracious monsters" that helped clean the tissue. Although these historical predictions were remarkably accurate, innovative technologies have revealed novel molecular, cellular, and dynamic physiologic aspects of CNS glia. In this review, we integrate recent findings regarding the roles of glia and glial interactions in healthy and injured spinal cord. The three major glial cell types are considered in healthy CNS and after spinal cord injury (SCI). Astrocytes, which in the healthy CNS regulate neurotransmitter and neurovascular dynamics, respond to SCI by becoming reactive and forming a glial scar that limits pathology and plasticity. Microglia, which in the healthy CNS scan for infection/damage, respond to SCI by promoting axon growth and remyelination-but also with hyperactivation and cytotoxic effects. Oligodendrocytes and their precursors, which in healthy tissue speed axon conduction and support axonal function, respond to SCI by differentiating and producing myelin, but are susceptible to death. Thus, post-SCI responses of each glial cell can simultaneously stimulate and stifle repair. Interestingly, potential therapies could also target interactions between these cells. Astrocyte-microglia cross-talk creates a feed-forward loop, so shifting the response of either cell could amplify repair. Astrocytes, microglia, and oligodendrocytes/precursors also influence post-SCI cell survival, differentiation, and remyelination, as well as axon sparing. Therefore, optimizing post-SCI responses of glial cells-and interactions between these CNS cells-could benefit neuroprotection, axon plasticity, and functional recovery.
Topics: Animals; Cell Shape; Humans; Neuroglia; Oligodendroglia; Spinal Cord Injuries
PubMed: 29728852
DOI: 10.1007/s13311-018-0630-7 -
NeuroImage. Clinical 2023Cervical spinal cord atrophy occurs after spinal cord injury. The atrophy and how level of injury affects atrophy differs between studies. A systematic review and... (Meta-Analysis)
Meta-Analysis Review
Cervical spinal cord atrophy occurs after spinal cord injury. The atrophy and how level of injury affects atrophy differs between studies. A systematic review and metaanalysis were done after systematic searches of PubMed, CINAHL, APA PsycInfo and Web of Science. English language original studies analyzing MRI cervical spinal cord cross-sectional area in adults with spinal cord injury were included. Atrophy and correlation between injury level and atrophy were estimated with random-effects models, standardized mean differences, and 95% confidence intervals. 24 studies were identified. 13/24 studies had low risk of bias. Cord atrophy meta-analysis of 18 articles corresponded to a standardized mean difference of -1.48 (95% CI -1.78 to -1.19) with moderate to large interstudy heterogeneity. Logarithmic time since injury influenced heterogeneity. Longitudinal atrophy was best described by a logarithmic model, indicating that rate of spinal atrophy decreases over time. Meta-correlation of eight studies indicated more severe atrophy in more rostral injuries (0.41, 95% CI 0.20-0.59). Larger and preferably longitudinal studies, data sharing, and standardized protocols are warranted.
Topics: Adult; Humans; Spinal Cord Injuries; Spinal Cord; Magnetic Resonance Imaging; Cervical Cord; Atrophy
PubMed: 36931004
DOI: 10.1016/j.nicl.2023.103372 -
Chinese Journal of Traumatology =... Jan 2023Pediatric and adult spinal cord injuries (SCI) are distinct entities. Children and adolescents with SCI must suffer from lifelong disabilities, which is a heavy burden... (Review)
Review
Pediatric and adult spinal cord injuries (SCI) are distinct entities. Children and adolescents with SCI must suffer from lifelong disabilities, which is a heavy burden on patients, their families and the society. There are differences in Chinese and foreign literature reports on the incidence, injury mechanism and prognosis of SCI in children and adolescents. In addition to traumatic injuries such as car accidents and falls, the proportion of sports injuries is increasing. The most common sports injury is the backbend during dance practice. Compared with adults, children and adolescents are considered to have a greater potential for neurological improvement. The pathogenesis and treatment of pediatric SCI remains unclear. The mainstream view is that the mechanism of nerve damage in pediatric SCI include flexion, hyperextension, longitudinal distraction and ischemia. We also discuss the advantages and disadvantages of drugs such as methylprednisolone in the treatment of pediatric SCI and the indications and timing of surgery. In addition, the complications of pediatric SCI are also worthy of attention. New imaging techniques such as diffusion tensor imaging and diffusion tensor tractography may be used for diagnosis and assessment of prognosis. This article reviews the epidemiology, pathogenesis, imaging, clinical characteristics, treatment and complications of SCI in children and adolescents. Although current treatment cannot completely restore neurological function, patient quality of life can be enhanced. Continued developments and advances in the research of SCI may eventually provide a cure for children and adolescents with this kind of injury.
Topics: Adult; Child; Humans; Adolescent; Diffusion Tensor Imaging; Quality of Life; Spinal Cord Injuries; Prognosis; Athletic Injuries; Spinal Cord
PubMed: 35478089
DOI: 10.1016/j.cjtee.2022.04.007 -
World Neurosurgery 2014Effective treatments for acute neurologic illness and injury are lacking, particularly for spinal cord injury (SCI). The very structure of clinical trials may be... (Review)
Review
Effective treatments for acute neurologic illness and injury are lacking, particularly for spinal cord injury (SCI). The very structure of clinical trials may be contributing to this because assumptions made during trial planning preclude additional learning within residual important areas of uncertainty, such as dose, timing, and duration of treatment. Adaptive clinical trials offer potential solutions to some of the factors that may be slowing the pace of discovery. Broadly defined, one can consider an adaptive clinical trial as any sort of clinical trial that makes use of information from within the trial to make decisions about how the trial is conducted going forward; however, it is important to emphasize that regardless of the degree of flexibility or complexity of an adaptive clinical trial design, the types of designs being described are only those in which all potential changes to the conduct of the trial are prospectively defined before the first patient is enrolled. Within this review, we describe the structure of flexible adaptive clinical trial designs, the process by which they are developed and conducted, and potential opportunities and drawbacks of these approaches. We must accept that there are some uncertainties that remain when both exploratory and confirmatory trials are designed. The process by which teams carefully consider which uncertainties are most important and most likely to potentially compromise the ability to detect an effective treatment can lead to trial designs that are more likely to find the right treatment for the right population of patients.
Topics: Clinical Trials as Topic; Humans; Hypothermia, Induced; Neuroprotective Agents; Research Design; Spinal Cord Injuries
PubMed: 23851207
DOI: 10.1016/j.wneu.2013.06.017