The potential of stem cell therapies for neurological diseases

As a novel neurotherapeutic strategy, stem cell transplantation has received considerable attention, yet little of this attention has been devoted to the probabilities of success of stem cell therapies for specific neurological disorders. Given the complexities of the cellular organization of the nervous system and the manner in which it is assembled during development, it is unlikely that a cellular replacement strategy will succeed for any but the simplest of neurological disorders in the near future. A general strategy for stem cell transplantation to prevent or minimize neurological disorders is much more likely to succeed. Two broad categories of neurological disease, inherited metabolic disorders and invasive brain tumors, are among the most likely candidates.     

神经干细胞移植治疗小儿脑性瘫痪及所存在的问题

脑性瘫痪是儿童时期最常见且终生存在的运动性残疾,目前尚无有效治疗手段,细胞移植和基因治疗技术的飞速发展为治疗此类疾病带来了希望。近两年国内外出现有关神经干细胞移植治疗脑性瘫痪的报道,这给脑性瘫痪的治疗研究提供了新的思路。文章阐述了小儿脑性瘫痪的神经干细胞机制,并回顾近年来国内外关于神经干细胞移植在动物实验及临床中的有效应用,为神经干细胞治疗小儿脑性瘫痪的可行性提供依据。但神经干细胞移植治疗脑性瘫痪还存在一些问题：移植仍然存在免疫排斥反应;如何促进神经干细胞的快速增殖;如何实现神经干细胞的定向诱导分化;如何评价神经干细胞移植以后患儿的改善情况,移植时机,移植量,移植部位,移植方式等一系列问题均有待于基础和临床学科的共同研究和探讨。     

Progress in clinical trials of stem cell therapy for cerebral palsy

Cerebral palsy is the most common disease in children associated with lifelong disability in many countries.Clinical research has demonstrated that traditional physiotherapy and rehabilitation therapies cannot alone cure cerebral palsy.Stem cell transplantation is an emerging therapy that has been applied in clinical trials for a variety of neurological diseases because of the regenerative and unlimited proliferative capacity of stem cells.In this review, we summarize the design schemes and results of these clinical trials.Our findings reveal great differences in population characteristics, stem cell types and doses, administration methods, and evaluation methods among the included clinical trials.Furthermore, we also assess the safety and efficacy of these clinical trials.We anticipate that our findings will advance the rational development of clinical trials of stem cell therapy for cerebral palsy and contribute to the clinical application of stem cells.     

80例头部立体定向间充质细胞移植治疗脑瘫疗效分析

目的 头部立体定向间充质细胞移植治疗脑瘫临床疗效分析.方法 对80例脑瘫患儿行头部立体定向间充质细胞移植治疗,并进行术前、术后半年、术后1年粗大运动功能评定（GMFM）、儿童精细运动功能评估量表（FMMF）、日常生活能力评定（ADL）Barthel指数、Ashworth痉挛分级评估运动功能改善情况评分.结果 患儿感觉功能、运动功能、日常生活能力明显改善,P＜0.01.结论 头部立体定向间充质细胞移植治疗可以显著改善脑瘫换患儿症状,改善运动、言语、智力等症状,促进脑功能恢复.     

The potential impact of the recovery movement on family interventions for schizophrenia: opportunities and obstacles

Many types of family interventions have been found to be effective in reducing exacerbations in schizophrenia; some also improve consumer social functioning and reduce family burden. Regardless of their origins, these interventions share a number of common features, such as showing empathy for all participants, providing knowledge about the illness, assuming a nonpathologizing stance, and teaching communication and problem-solving skills. Importantly, these family interventions have many characteristics that are consistent with the growing recovery movement in mental health in that they are community-based, emphasize achieving personally relevant goals, work on instilling hope, and focus on improving natural supports. Nevertheless, these interventions are generally reflective of older models of serious and persisting psychiatric illnesses that are grounded in a "patient being treated for a chronic illness" rather than a "consumer assuming as much responsibility as possible for his/her recovery" stance. These interventions could be made more consistent with recovery principles by (1) expanding the definition of family to include marital, parenting, and sibling relationships, (2) identifying better ways to match consumers with treatments, (3) broadening the research focus to include systems change that promotes making family members a part of the treatment team (with the consumer's consent), and (4) overcoming implementation obstacles that preclude access to effective family interventions for most consumers and their relatives.     

Pain in adults with cerebral palsy: impact and solutions

Studies of health in adults with cerebral palsy (CP) have identified pain as a significant concern. Investigations regarding incidence, intensity, and location in adults with CP found that increasing age and inactivity appeared to be related to pain. Activity and participation in adults with CP seem to be only moderately affected by presence of pain. Various sources of pain have been identified in adults with CP but have not been well studied. These include orthopedic issues, poor bone mineral density and related fractures, dental and jaw problems, and nutrition-related pain. Limited healthcare utilization studies suggest that adults with CP use healthcare services, especially preventative and rehabilitative services less, and do not consult physicians regarding pain. Medication solutions for chronic pain are not well studied. Botulinum toxin and intrathecal baclofen have been demonstrated to minimize pain; however, the impact of other medications needs further investigation. Other interventions for pain include small studies examining the use of biofeedback and exercise. Larger studies are needed to establish effectiveness. In order to prevent future generations of adults with CP from experiencing high levels of pain, environmental sources of pain need more specific study, as do interventions that are affordable and easily accessed.     

Controversial treatment of spasticity: exploring alternative therapies for motor function in children with cerebral palsy

The treatment and management of children with cerebral palsy is an ever-evolving story. In the past 20 years, a number of exciting innovations in treatment have expanded the opportunities to help children. At the same time, the field has experienced a remarkable proliferation of "alternative" therapies-approaches based on ideas about the biologic basis of neurodevelopmental disabilities and their management that differ considerably from conventional thinking in Western medicine. Professionals working with children with cerebral palsy and their families are frequently asked for an opinion about or even endorsement of these new and "promising" approaches to therapy. These can be very difficult to provide when the evidence is limited, peer-reviewed reports are scarce, and the primary source of information is the World Wide Web. The purposes of this article are to discuss briefly why it can be difficult to ascertain whether any treatment--conventional or alternative--does more harm than good, and to consider what rules of evidence can be applied to make a sound judgment about a new treatment. The article then discusses several current controversial alternative therapies, reviewing the available literature and offering a critical appraisal of each. Topics addressed include hyperbaric oxygen therapy, conductive education, the Adeli suit, and therapeutic (subthreshold) electrical stimulation because these approaches have been applied to children with cerebral palsy.     

自体骨髓间充质干细胞回输对脑性瘫痪儿童运动功能发育的影响

背景：自体骨髓干细胞对神经系统疾病具有一定的治疗作用,但对脑瘫治疗缺乏系统有对照的临床研究。 目的：分析自体骨髓间充质干细胞移植对脑性瘫痪儿童运动功能发育的影响。 方法：将34例脑性瘫痪者按其家长是否同意使用自体骨髓干细胞移植治疗分为治疗组和对照组,治疗组采取自体骨髓间充质干细胞移植结合康复训练,对照组只采用康复训练,分别在治疗前和治疗后3个月做粗大运动功能测试量表(GMFM)评估并进行对比。 结果与结论：与治疗前比较,2组治疗后3个月GMFM评分均增高,而GMFM评分增加量均降低,差异均有显著性意义 (P < 0.05)。治疗组GMFM评分增加量高于对照组(P < 0.05)。 提示自体骨髓间充质干细胞移植治疗脑性瘫痪是有效的,对促进脑性瘫痪患儿运动功能发育有积极作用。     

Functional therapy for children with cerebral palsy: an ecological approach

The aim of this pilot study was to evaluate functional training for children with cerebral palsy (CP). The outcomes examined were goal-achievement, gross motor function, performance of everyday activities, caregiver assistance, parents' perception of family-centredness, and preschool assistants' feeling of competence in the care of the children. The outcome measures used were goal attainment scaling, Gross Motor Function Measure, Pediatric Evaluation of Disability Inventory (functional skills and caregiver assistance scales), Measure of Processes of Care, and a questionnaire. The intervention was carried out in the context of daily life settings, i.e. in an ecological framework. Fourteen children (three females, 11 males; age range 1y 6mo to 6y) with diplegia and tetraplegia, classified at Gross Motor Function Classification System levels II-V, participated in the five-month intervention. Frequency of training towards a specific goal varied between twice a day and 23 times a day, depending on the type of goal. Seventy-seven per cent of goals were fully attained. Gross motor function and performance of daily activities, including social function, improved significantly. A decrease in caregiver assistance was noted in relation to the children's mobility. Parents' perception of family-centredness improved in all domains. Furthermore, the children's preschool assistants felt more competent in their care of the children.     

Intraoperative anaphylaxis due to allergy to latex in children who have cerebral palsy: a report of six cases

Healthcare professionals caring for children with cerebral palsy should lie aware of an association between it and latex anaphylaxis. Between 1989 and 1992 we had 22 patients with intraoperative anaphylactic reactions to latex at our institutions. Of these, six had cerebral palsy. The case histories of these six children are reported here. Most had had multiple operations and ventriculoperitoneal shunts. Preoperative recognition is key to prevention. If suspected from a patient's history, latex antibody testing is available. If needed, anesthesia for these individuals should be given using a latex-free environment with or without medical prophylaxis.     

Animal models of multiple sclerosis for the development and validation of novel therapies – potential and limitations

Journal of Neurology - Various types of experimental autoimmune encephalomyelitis (EAE) reflect some of the pathogenetic, clinical, and therapeutic features of the different forms of multiple...     

The child with cerebral palsy: diagnosis and beyond

Cerebral palsy (CP) is one of the most common conditions we follow in our pediatric neurology offices. This review will hopefully convince you that the care of children with CP extends far beyond the diagnosis. The review addresses issues surrounding diagnosis, coimpairments, prognosis, and family-centeredness of care. It will also deal with routine office follow-up to prevent or identify complications, management of spasticity and other morbidities, alternative and complementary therapies, and finally transition.