English

Cerebral Palsy Male, 10 months old, October 2018

Summary

Diagnosis Sex Age Nationality
Cerebral Palsy Male 10 months British
Injections Cell type Admission date Discharge date
6 UCBSC 2018-10-02 2018-10-27

Medical history

This is a 10 months old baby who suffered from long and complicated labor. An emergency Cesarean section was performed after failure to proceed with natural delivery and there was no heartbeat at birth. Despite prolonged resuscitation (30+ minutes), given the lack of response, care was withdrawn and the baby was given back to his parents. Shortly after, unexpected signs of life started to appear and he was intubated and taken care of in an intensive care unit. The MRI scan examination performed at 7 days of life confirmed the diagnosis of neonatal ischemic hypoxic encephalopathy.

Condition On Admission

The patient had good neck and trunk control, good hearing and eye tracking, mild muscle tightness in lower extremities and mild hypertonicity in the lower extremities predominantly affecting the right side. In terms of functional ability, he was able to roll over with minimal guidance. He could sit without support for up to 5 minutes. In ring sitting, his trunk was slightly slouched, but he could sit without support. Prior to our treatment program, the patient was having 3 sessions of Bobath physiotherapy per week (45 minutes per session).

Treatment Schedule

The patient received 6 umbilical cord blood-derived stem cell (UCBSC) packets by intravenous (IV) and intrathecal injections, as per the schedule below. In addition to stem cell injections, the patient received a daily rehabilitation therapy program that included physiotherapy, aquatic therapy, transcranial magnetic stimulation, acupuncture and hyperbaric oxygen therapy.

Number Date Cell Type Delivery Method Side Effects
1 2018-10-03 UCBSC Intravenous Injection none reported
2 2018-10-08 UCBSC Intravenous Injection none reported
3 2018-10-12 UCBSC Intrathecal Injection none reported
4 2018-10-16 UCBSC Intrathecal Injection none reported
5 2018-10-19 UCBSC Intrathecal Injection none reported
6 2018-10-22 UCBSC Intravenous Injection none reported

Condition at discharge

During our 3 weeks treatment program, the patient has gradually shown some improvement in terms of movements. For instance, his spasticity has decreased to a nearly normal tone. As a consequence, his pattern of gross movement control is better. He can also open his left hand better compared to our initial assessment. He tends to open both hands more to grasp objects and fully push on his hand in crawling position. Recently he started to have full elbow extension while crawling for nearly 2 meters (he initially needed moderate support for his elbows when crawling). The patient is now able to sit with his back fully straight in a ring sitting position while trying to reach an object above his head.

Condition 3 months after treatment

During our 3 weeks treatment program, the patient has gradually shown some improvement in terms of movements. For instance, his spasticity has decreased to a nearly normal tone. As a consequence, his pattern of gross movement control is better. He can also open his left hand better compared to our initial assessment. He tends to open both hands more to grasp objects and fully push on his hand in crawling position. Recently he started to have full elbow extension while crawling for nearly 2 meters (he initially needed moderate support for his elbows when crawling). The patient is now able to sit with his back fully straight in a ring sitting position while trying to reach an object above his head.

Condition 12 months after treatment

Please see an excerpt from the patient’s 12 month assessment below (assessment made by the patient’s parents):

Symptom Assessment of Improvement
Appetite Moderate improvement
Balance Moderate improvement
Crawling Small improvements
Drooling Not applicable
Involuntary movements Moderate improvement
Limb muscle strength Moderate improvement
Range of movement Moderate improvement
Spasticity Moderate improvement
Speech (babbling for infants) Moderate improvement
Standing up Moderate improvement
Swallowing Moderate improvement
Trunk muscle strength Moderate improvement
Walking Moderate improvement

References

  1. Intravenous grafts recapitulate the neurorestoration afforded by intracerebrally delivered multipotent adult progenitor cells in neonatal hypoxic-ischemic rats
  2. Umbilical cord blood cells and brain stroke injury: bringing in fresh blood to address an old problem
  3. Marrow stromal cells migrate throughout forebrain and cerebellum, and they differentiate into astrocytes after injection into neonatal mouse brains
  4. Human cord blood transplantation in a neonatal rat model of hypoxic-ischemic brain damage: functional outcome related to neuroprotection in the striatum
  5. Li Huang, Che Zhang et al (2018). A Randomized, Placebo-Controlled Trial of Human Umbilical Cord Blood Mesenchymal Stem Cell Infusion for Children With Cerebral Palsy. Cell Transplantation (2018) Vol. 27(2) 325-334
  6. F. Ramirez, ET AL. Umbilical Cord Stem Cell Therapy for Cerebral Palsy. Med Hypotheses RES 2006.3: 679-686.
  7. James E Carroll & Robert W Mays. Update on stem cell therapy for cerebral palsy. Expert Opin. Biol. Ther. (2011) 11.
  8. David T. Harris. Cord Blood Stem Cells: A Review of Potential Neurological Applications. Stem Cell Rev (2008) 4:269–274.