What is Stroke?
Stroke is a condition in which there is an interruption in the blood supply to the brain causing damage to the brain tissue by cutting off the supply of oxygen and nutrients. This causes the brain cells to die within minutes leading to very serious clinical manifestations. The damage that occurs in the brain and potential complications can be minimized if given an immediate medical intervention.
Ischaemic Stroke: It is the most commonly occurring type of stroke. When the interruption of the blood supply is due to a blockage in the blood vessel by a clot or thickening of the artery walls, then it is called as an Ischaemic Stroke. There are two types of Ischaemic Stroke viz. Thrombotic Stroke and Embolic Stroke. Thrombotic Stroke occurs when a blood clot impairs blood flow in an artery that supplies blood to the brain. An Embolic Stroke occurs when a blood clot that forms elsewhere in the body (embolus) breaks loose and travels to the brain via the bloodstream. Eventually, the clot lodges in a blood vessel and blocks the flow of blood, causing a stroke. Blood clots typically form in areas where the arteries have been narrowed or blocked by fatty cholesterol-containing deposits known as plaques.
Haemorrhagic Stroke: This is caused when a weakened blood vessel ruptures and splits causing it to bleed in the brain. This interrupts with the blood flow leading to a Haemorrhagic Stroke. There are two types of weakened blood vessels viz., aneurysms and arteriovenous malformations (AVMs). An aneurysm is a ballooning of a weakened region of a blood vessel. If left untreated, the aneurysm continues to weaken until it ruptures and bleeds into the brain. An arteriovenous malformation (AVM) is a cluster of abnormally formed blood vessels. Any one of these vessels can rupture, also causing bleeding into the brain.
Temporary Ischaemic Attack: When there is a temporary disruption in the flow of the blood supply, it is termed as Temporary Ischaemic Attack. It is also called as a 'mini stroke'. It usually recovers within 24 hours. Like an ischemic stroke, a TIA occurs when a clot or debris blocks blood flow to part of your brain. A TIA doesn't leave lasting symptoms because the blockage is temporary.
The extent of neurological involvement may range from mild motor deficit to gross involvement of various functions namely; sensorimotor, perceptual, emotional, behavioral, memory intelligence, speech and language function, ultimately affecting daily activities. The commonly seen symptoms are:
- Weakness of the face, arm, or leg on one side of the body
- Imbalance while sitting or standing
- Lack of coordination while doing activities
- Loss of vision or dimming (like a curtain falling) in one or both eyes
- Loss of speech, difficulty in talking, or understanding what others are saying
- Sudden, severe headache with no known cause
- Problems associated with hearing
- Behavioral issues
A brain stroke is a medical emergency and the patient should be taken to a hospital as soon as possible to prevent further damage to the brain. Investigations such as Computed Tomography (CT) Scan help in confirming the type of stroke. In case of ischemic stroke, it is common to give aspirin to reduce the risk of death or of a second stroke. If the cause of the stroke was a clot, it is possible that the quick administration of certain clot-dissolving drugs, such as tissue plasminogen activator (tPA), may prevent some symptoms such as paralysis. Another option is mechanical removal of clot, which should be performed within six hours of onset of symptoms of stroke. In case of hemorrhagic stroke the aim is to control bleeding and reduce pressure in brain. Where there is a blockage or rupture in an artery, surgery may be performed to repair the artery to prevent future stroke.
Once a stroke has permanently damaged the brain, the damage can't be undone. Rehabilitation following a stroke is very important to restore independence in their daily activities. Physiotherapy, occupational therapy, psychology and speech and language therapy is needed to improve muscle coordination, hand function, speech and cognitive function. To prevent future episodes of stroke it is important to follow life style modification, diet modification and regular intake of prescribed medicines. Medically it is recommended to have regular check-up of heart and vessel function.
Complete recovery is unusual but not impossible and most patients will improve to some extent with the help of healthy lifestyle, various therapies and emotional support and motivation from the family members are help to recover the brain.
With the current treatment approaches, be it medical, surgical or rehabilitative, the pathophysiological processes and the resultant damage occurring at the microcellular level cannot be reversed. This calls for newer and more effective treatment approaches to improve not just the symptoms of stroke but to repair and restore activities of the damaged neural tissue. Researchers and scientists are therefore considering stem cell therapy as a potential approach for stroke. Stem cells with their unique properties of self-multiplication, differentiation into specialized cells and migration to the affected area, regenerate and repair the affected tissues in stroke.
Recent experimental studies raised the possibility of using mesenchymal stem cells (MSCs) for stroke therapy. There is increasing evidence that MSCs promote functional recovery in animal models of ischemic stroke. In specific culture conditions, human MSCs can differentiate into cells that express markers of neuronal progenitor cells and can engraft and migrate along paths that resemble those of neuronal progenitor cells. Furthermore, the mononuclear fraction obtained from the bone marrow contains several cells including stem cells and their precursors, which can produce large amounts of cytokines and trophic factors that promote blood and oxygen supply, neuroprotection and neuroregeneration in the affected area.
MSCs are eminently suitable for human trials because these cells can be obtained readily from bone marrow under local anesthesia, are easily expanded by culture, and potentially could be delivered to injured brain tissue without the need for invasive operations. Moreover, the use of patients' own bone marrow cells should prevent the problems of immune rejection.
This had led doctors, researchers and scientists to believe that stem cell therapy has tremendous potential in improving the condition of the people affected with stroke.
Despite the best medical management, newer neuro-protective drugs and extensive rehabilitation, we are still not able to give these paralyzed patients symptomatic relief from their paralysis. It is for recovery of this that we at NeuroGen are offering stem cell therapy as a new beacon of hope.
With the ardor to do better and bring about positive transformations in the lives of our patients, we at NeuroGen BSI have treated over 137 patients with stroke. Majority of the patients who had approached us, had reached a plateau stage in their symptomatic and functional improvements after stem cell therapy, our patients show remarkable improvements in several of the symptoms that they experience before the therapy such as upper limb activity/hand functions, lower limb activity, trunk activity, balance, higher mental functions/speech, ambulation and activities of daily living. This gives them a possibility to fall back on to their daily routine and to maintain their independence.
Our patient studies illustrated that 51.8% of patients showed significant improvements, 29.6% of patients showed moderate improvements, mild improvements were observed in 11.1% of the patients, promising a future they always deserved.
These improvements are not just restricted to the functional and symptomatic changes that are seen in our patients but also go a step further. The stem cells administered during the course of the therapy work wonders in repairing the damage in the stroke affected regions of the brain by increasing their metabolism as observed in the PET-CT scans.
What is the extent of recovery that can be achieved after the stroke?
The extent of recovery varies. A stroke damages the brain cells. The extent of the brain damage and the size of the stroke are directly related to the extent of the impairments/paralysis. People who suffer a minor stroke may have only slight impairments/problems, such as a weak arm or leg. A massive stroke, however, can cause a person to lose the ability to read, write, or speak. It also can cause paralysis. Fortunately, with rehabilitation therapy (physiotherapy, occupational therapy, speech therapy), about 25% of victims recover with slight impairments and an additional 10% recover almost completely.
What kind of treatment is available for stroke patients?
The type of treatment provided depends on the type and severity of the stroke. If the victim has suffered an ischemic stroke, immediate therapies may include medications to dissolve the clot, surgery, and/or interventional neurosurgery, such as stenting and so on. If the victim has suffered a hemorrhagic stroke, immediate therapies may include medications and/or surgery. REMEMBER: The sooner the victim receives treatment, the better his or her chances are of survival and recovery.
What kind of rehabilitation is available for stroke victims?
Rehabilitation is a very important aspect of stroke care. NeuroGen Brain and Spine Institute offer patients the most comprehensive and holistic stroke rehabilitation in Mumbai and India. Our rehabilitation program includes speech therapy, physical therapy, and occupational therapy, with experienced staff that specialize in helping stroke and patients with neurological disorders regain their independence.
How does stem cell therapy help in stroke, especially in comparison with regular rehabilitation?
Stem cell therapy helps repair the damage to the brain and stimulates the parts of brain, which are functioning less (after the brain stroke). It works complimentary to the rehabilitation. Stem cell therapy along with a comprehensive rehabilitation program helps in accelerating the process of recovery. Stem cell is not a substitute for rehabilitation; it works hand in hand with the exercises. At NeuroGen Brain and Spine Institute, the best of neurorehabilitation is combined with the newest technology of stem cell therapy, which makes treatment for stroke patients more effective.
How does stem cell therapy work?
The biological task of stem cells is to repair and regenerate damaged cells. Stem cell therapy exploits this function by administering these cells in high concentrations directly in and around the damaged tissue, where they advance its self-healing and repair.
Are there ethical concerns surrounding adult stem cell research and therapy?
Bone marrow transplantation has been used successfully for genetic disorders of blood, such as sickle cell anemia, thalassemia, as well as cancers such as leukemia. Since our therapy uses these very cell, which are harvested from the patient's own body (autologous cells), there are no major ethical concerns. Ethical concerns are primarily on the use of embryonic stem cells (which we do not use).
Is the treatment painful?
The therapy is done under local anesthesia and a mild sedation. There is no significant pain or discomfort during or after the procedure.
Does the treatment have any side effects?
Stem cell therapy is minimally invasive and reasonably safe. None of our patients have shown any neurological deterioration so far in connection with the stem cell therapy itself. Some side effects, such as headache (spinal headache) lasting 3-4 days which is generally self limiting, neck/back pain, vomiting, some mild rash or pain at the site of bone marrow aspiration/stem cell injection may occur. However, like any other medical or surgical treatment unexpected complications are always a possibility. These complications may be related to the medicines given, the stem cell procedure, the anesthesia, and the rehabilitation or to any of the preexisting medical or neurological conditions.
How long will it take me to know that I have benefitted from the treatment?
Maximal improvements are seen around 3-6 months after the treatment. However, in many patients there are slow progressive improvements that continue for several months/years later. Most patients do show some immediate improvements also i.e. before the discharge, in some of their symptoms.
Is the transplantation of the stem cells done once or more than once?
The decision to do the therapy a second time is taken after seeing the progress/improvements after the first therapy. If the patients show some encouraging improvement, then the entire medical and rehabilitation team reviews the case and a second treatment may be recommended. This may be done anytime between 3-6 months of the first therapy.
Can other treatments be taken at the same time?
We will review what other medications the patient is already on. In most cases we do not discontinue any already going on treatment. However this is decided on a case-by-case basis. Blood thinners like aspirin, clopidrogel, warfarin, etc. needs to be stopped. Please inform us about any medications you are taking beforehand.
How much improvement will the patient have?
This is difficult to predict, since this a new therapy. It depends on multiple factors such as age of patient, type of illness, duration of illness and extent of rehabilitation taken after the treatment. At NeuroGen Brain and Spine Institute, we have treated over 30 patients of with stem cell therapy along with rehabilitation. All these patients had attained a plateau stage with respect to symptomatic and functional improvements. The symptoms they presented with included upper limb activity/hand functions, lower limb activity, trunk activity, balance, higher mental functions/speech, ambulation and Activities of Daily Living.
Our data is regularly published in various medical and scientific journals (available for reading on our website). You are strongly advised to study these before proceeding with treatment.
Case Report 1
Stroke or paralysis is a lifestyle disease. The burden of these lifestyle diseases is increasing day by day. There are many risk factors and contributing factors for these diseases but it is impossible to pin point a single cause. Owing to all these factors such diseases occur at a relatively younger age. Our patient Mr. Chandru D suffered from stroke only at the age of 19 years. Seven years after suffering the stroke for the first time, he visited NeuroGen. When he came to us, he mainly complained of difficulty in walking, imbalance while walking, abnormal walking pattern, weakness in his left hand, difficulty in using his left upper limb, difficulty in climbing stairs. He used to find it difficult to transfer himself at lower or higher level place. He was experiencing mild depression. When we examined him further, he also had abnormal muscle tone in left upper limb muscles. His movement control was also greatly affected.
At NeuroGen, Chandru underwent Stem Cell Therapy along with a customized rehabilitation program. The aim of the rehabilitation program was to develop disassociation and gait training, therapies to increase the strength of the affected areas without fatigue and to increase overall stamina of the patient. He was given exercises that would help him improve his balance, walking, stair climbing, speech, posture and his grip. These exercises carried out in a systematic pattern with sufficient rest intervals to the patient. Together, the aim of the rehabilitation program was to improve his overall quality of life. Mr. Chandru found new hope with NeuroGen's Stem Cell Therapy. He was motivated and positive for himself after going back. Physiotherapy, Occupational Therapy and rehabilitation taught at NeuroGen were continued at home.
He came to us after three months for a review. The abnormal muscle tone had reduced. Upper limb overhead activity had improved, shoulder range increased, effort reduced. Upper limb fine motor activity had also improved. He could stand for a longer period of time with a more erect posture. His walking speed had increased, with a much-reduced effort. Balance in standing and walking had improved. He could ascend and descend stairs faster. His left upper limb and ankle movement control was slightly better. He could do upper body dressing faster and with lesser effort. He was very focused and underwent rehabilitation diligently.
Case Report 2
Lakshmi Mohan, a 54 year old female suffered a stroke and had paralyzed her right side of the body. In August 2016 she visited NeuroGen to take treatment for the same. When she came to us, she was completely dependent for all activities of day-to-day living. When we examined her she showed some abnormalities of tone in the muscles. Her speech was unclear. Her movement control was affected. She had profound weakness in the muscles of her right side. She was walking for a step with 2 peoples' assistance.
With the impairment caused by stroke she had pinned a lot of hope in stem cell therapy. She continued vigorous therapy post stem cell therapy. When we saw her three months later, she was a whole new individual. Her walking ability had significantly improved. She could walk independently with a cane. Her balance in standing and walking had improved greatly. Her movements of shoulder and elbow were more controlled and faster than before. Her stamina had improved. The tone abnormalities of the muscles had reduced. Her speech had become clearer. Her urine control had improved. Six months after stem cell therapy her improvements was consistent. Furthermore, her walking pattern had improved with an increased shoulder control. The abnormal tone had almost normalized. Balance was better. She started climbing stairs with minimal assistance. She completely stopped wetting her pants accidentally. She was very minimally dependent for her day-to-day activities. She was very eager to be independent again. She was very driven and motivated and complied with rehabilitation. Looking at the results from the first stem cell therapy she decided to do it again. 7 months after the first stem cell therapy she underwent stem cell therapy once again.