Sharma Alok, Gokulchandran Nandini, Kulkarni Pooja, Mullangi Sandhya Kiran, Bhagawanani Khushboo, Ganar Vishal, Sane Hemangi, Badhe Prerna
Drs. Sharma and Gokulchandran are with the Department of Medical Services and Clinical Research at NeuroGen Brain and Spine Institute in Navi Mumbai, India.
Ms. Kulkani and Drs. Mullangi and Sane are with the Department of Research and Development at NeuroGen Brain and Spine Institute in Navi Mumbai, India.
Innov Clin Neurosci. 2020 Oct 1;17(10-12):31-34. eCollection 2020 Oct-Dec.
Cerebral palsy (CP) is a chronic childhood disorder that is characterized by a group of motor and cognitive impairments, resulting in abnormal movement patterns, loss of motor control, incoordination, and unbalanced posture. It can also have an impact on fine motor skills, gross motor skills, and oral motor functioning. Currently, the treatment of CP is palliative and does not cure the disease pathology. Hence, there is a need for an intervention that might be able to alter the core pathology. Autologous bone marrow mononuclear cells (BMMNC) transplantation is one of the novel treatment strategies in recent years. In this study, we presented the case of a 4-year-old male child with spastic diplegic CP who underwent two intrathecal transplantations at interval of seven months with autologous BMMNC along with neurorehabilitation program. During an overall 16-month follow-up, significant improvements were observed in motor control, coordination, balance, sitting tolerance, and memory. The abnormal 'W' sitting posture and scissoring gait pattern of the patient resolved. Started sitting with good head, trunk, and pelvic alignment and attained regular gait pattern; the patient started to walk independently without support as well. On objective scale, Gross Motor Functional Measure score improved from 60.67 to 81.78. The patient's Gross Motor Functional Classification System grade improved from Level 3 to Level 2, and Functional Independent Measure score improved from 97 to 99. A comparative positron emission tomography-computed tomography (PET CT) brain scan was performed before and seven months after the first intervention, which revealed improvement in the metabolism of the anterior cingulate lobe, parietal cortex, medial temporal cortex, thalamus, basal ganglia, and cerebellum. No adverse events were recorded throughout the study. Thus, multiple cellular therapies, along with neurorehabilitation, might be a novel safe, feasible option to enhance recovery in CP.
脑瘫（CP）是一种儿童慢性疾病，其特征为一组运动和认知障碍，导致异常运动模式、运动控制丧失、不协调和姿势失衡。它还会影响精细运动技能、粗大运动技能和口腔运动功能。目前，脑瘫的治疗是姑息性的，无法治愈疾病病理。因此，需要一种可能能够改变核心病理的干预措施。自体骨髓单个核细胞（BMMNC）移植是近年来的新型治疗策略之一。在本研究中，我们报告了一名4岁痉挛性双瘫型脑瘫男童的病例，该患儿在七个月的间隔期内接受了两次自体BMMNC鞘内移植，并接受了神经康复治疗。在总共16个月的随访期间，观察到运动控制、协调、平衡、坐位耐力和记忆力有显著改善。患者异常的“W”坐姿和剪刀步态模式消失。开始能够良好地抬头、躯干和骨盆对齐坐着，并获得了正常的步态模式；患者也开始能够独立行走而无需支撑。在客观评分上，粗大运动功能测量评分从60.67提高到81.78。患者的粗大运动功能分类系统等级从3级提高到2级，功能独立性测量评分从97提高到99。在第一次干预前和七个月后进行了对比正电子发射断层扫描-计算机断层扫描（PET CT）脑部扫描，结果显示前扣带回、顶叶皮质、颞叶内侧皮质、丘脑、基底神经节和小脑的代谢有所改善。在整个研究过程中未记录到不良事件。因此，多种细胞疗法与神经康复相结合，可能是一种促进脑瘫恢复的新型安全、可行选择。
