What is Traumatic Brain Injury?
Traumatic Brain Injury is one of the most common causes of death and disability worldwide. It occurs when a bump, blow, jolt, or other head injury causes damage to the brain. The severity of injury varies from mild to severe depending on the cause of injury. It can lead to neurological damage, and may be associated with chronic headaches, seizures, cognitive dysfunction, sleep disorders, memory deficits, along with behavioral problems and depression which greatly impacts the daily functioning of the patient.
Causes of Traumatic Brain Injury are very diverse. It most commonly results from falls, vehicle accidents, sports accidents and gunshot wound.
Traumatic Brain Injury can have wide-ranging physical and psychological effects. Some signs or symptoms may appear immediately after the traumatic event, while others may appear days or weeks later. Individuals suffering from mild traumatic injury may show loss of consciousness, headache, nausea or vomiting, fatigue and loss of balance. They may also exhibit sensory and cognitive issues such as blurred vision, ringing in the ears, a bad taste in the mouth, changes in the ability to smell, memory loss, concentration problems and mood swings. Moderate to severe traumatic brain injuries can include any of the signs and symptoms of mild injury, as well as the following symptoms that may appear within the first hours to days after a Traumatic Brain Injury:
- Convulsions and seizures
- Dilation of one or both pupils
- Weakness and numbness in the toes and fingers
- Loss of coordination
- Lack of movements of limbs
- Agitation, combativeness or other unusual behaviour
- Changes in speech clarity and comprehension
- Difficulty in swallowing and breathing
- Abnormal posturing of limbs
- Tightness in limbs
Emergency care focusses on stabilizing the patient and ensuring that the patient gets adequate oxygen and blood supply, maintains blood pressure and any further secondary injury is prevented. Surgery may also be required to remove blood clots and repair skull fractures. Medications are also used to treat the symptoms of associated with Traumatic Brain Injury. Rehabilitation including physiotherapy, occupational therapy, speech and language therapy, psychological intervention may be required either for a short duration or throughout the life depending on severity of injury. These treatment strategies may help in efficient management of the symptoms post injury and recover lost functions.
Despite advances in the medical field with respect to treatment of traumatic brain injury, a significant number of patients are left with neurological deficits for which there is no treatment so far. Stem cell therapy has evolved as a potential treatment which addresses the neurological damage in traumatic brain injury when administered in combination with other conventional treatments. It helps in restoring lost functions by neuroregenerative and neuroprotective mechanisms. Stem cell therapy involves transplantation of stem cells which migrate to the damaged brain areas and carry out the repair process directly or indirectly. These cells on transplantation, multiply, differentiate and directly replace the dead or damaged brain cells. They also indirectly carry out repair and restoration via paracrine mechanisms. They release various cytokines and growth factors which stimulate the endogenous cells and stop further damage of brain cells. They promote angiogenesis (development of new blood vessels) which help in increased supply of blood and oxygen to the brain and initiate sprouting of new axons. These mechanisms together re-establish the neuronal networks and help in formation of new communication networks which further lead to restoration of lost functions in Traumatic Brain Injury.
At NeuroGen BSI, we have treated over 70 cases of Traumatic Brain Injury with intrathecal transplantation of autologous bone marrow mononuclear cells combined with neurorehabilitation. Overall improvement was observed in 94% of these patients.
Significant Improvements were seen in higher mental functions, posture, upper limb activity, lower limb activity, trunk control, sitting balance, standing balance, coordination, oromotor skills, ambulation and Activities of Daily Living (ADLs). The progress of these patients was also measured on various scales such as Functional Independence Measure (FIM), Disability rating Scale (DRS), SF-8 questionnaire which showed improved scores after stem cell therapy.
PET CT scan brain was also used to monitor the effect of stem cell therapy at cellular level. Improvement in brain metabolism was recorded on comparing the PET CT scans performed before and after stem cell therapy. The improvements in clinical symptoms correlated with the areas showing improved metabolic functions on the PET CT scan.
Pre-stem cell therapy PET-CT scans showing blue areas which are areas of reduced metabolism or damage.
Post stem cell therapy PET-CT scan showing reduction in blue areas which have been replaced by green areas indicating improvement in metabolism/function
What is a Traumatic Brain Injury (TBI)?
Traumatic brain injury (TBI) occurs when a sudden trauma, often a blow or jolt to the head, causes damage to the brain. The severity of TBI can range from mild (a concussion) to severe (coma).
Is TBI recoverable completely?
The recovery in TBI depends on the degree of injury/damage to the brain. In addition, parts of the brain injured may also play as a deciding factor in prognosis of the patients.
Does it have long-term effect?
Long-term neurological sequelae or deficits are possible. They may range from severe (patient remaining in coma), to paralysis of hands and/or legs, speech impairment, swallowing issues and memory or cognitive issues. Loss of major sensory functions such as vision or hearing may also occur.
Would my life be normal?
There are some patients, who recover completely. However, some of them suffer long term problems. The severity of problems can be reduced by proper management including rehabilitation (physiotherapy, occupational therapy, speech therapy, cognitive therapy, etc.) along with stem cell therapy. These can help improve quality of life and take the patient a step towards functional independence.
What are the possible long term complications seen?
A) In a comatose patient: complications that any bed-ridden patient will have are possible, such as bedsores, deep vein thrombosis, chest infections, etc.
B) Deformities/contractures, due to disuse of limbs are possible, if rehabilitation is not done regularly
C) Myositis ossificans: Calcium and bone deposits in the joints are a common problem in TBI, which restricts joint movements and ambulation. Deep massages, hence, should be avoided.
D) Fits/seizures: Some patients, who have suffered a TBI also have potential of seizures. Hence, are generally started on antiepileptic.
What is the role of stem cell therapy in a patient with TBI?
Stem cell therapy along with rehabilitation helps in recovery of neurological deficits. It also helps in improving other problems, which are not improved by rehabilitation alone.
Our experience suggests that, aggression reduces, memory improves, and Speech improves along with other motor/physical functions.
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 promote 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 anaemia, thalassemia, as well as cancers such as leukaemia. 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).
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 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 anaesthesia, and the rehabilitation or to any of the pre-existing 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 case is reviewed by the entire medical and rehabilitation team 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.
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. It is important to note that at NeuroGen we give no assurances or guarantees of any definitive improvements or results. However our past clinical results demonstrate that 94.22% of patients showed overall improvement. Improvements were seen in higher mental functions, posture, trunk activity, upper limb activity, lower limb activity, coordination, oromotor function, ambulation, and Activities of Daily Living.
Our data is regularly analysed and published in various medical and scientific journals (available for reading on our website). You are strongly advised to study these before proceeding with treatment.
7 year old gets a Rebirth with Stem Cell Therapy
Miss ABC, a 7 year old female child and a case of Quadriparesis due to Traumatic Brain Injury met with a road accident in the year 2015 while crossing the street. She was immediately hospitalized as she was unconscious and for 3 months she was on ventilator as she had difficulty to breath on her own. In the hospital slowly and gradually, she regained consciousness and could identify her parents.
After discharge from the hospital, she was completely bed ridden and completely dependent on her parents. They tried various treatment options like homeopathy, occupational therapy and natural acupuncture but nothing worked. She was started on rehabilitation in terms of physiotherapy and occupation therapy post which there was mild improvement in her condition. She had 3 episodes of seizures post the accident and was started on anti-epileptics.
When she was hospitalized after the accident there was another patient with a brain disorder who suggested them about NeuroGen Brain & Spine Institute. After trying other methods they decided to approach NeuroGen and know more about Stem Cell Therapy.
On examination following points were noted :
- She could not speak or express herself but she used to smile back when she was hungry.
- Improper tone and posture
- Sitting and standing balance was poor.
- She was completely dependent for bed mobility, transfers and ADLs
- Her both right and left side movements were affected but movements of left body parts were more affected than right side due to which she could not perform rolling, turning, kneeling.
- She could not independently stand, sit or walk and had poor trunk control.
- There was abnormal movement of toes of both legs
- There was grade 2 tightness in calf muscles, thigh muscles and hip muscles - this tightness restricts movement of these body parts
- She was on Peg tube as she had problem in swallowing
At NeuroGen, she underwent stem cell therapy along with the Neuro rehabilitation program. The aim of the rehabilitation program was to develop trunk control, normalize tone, increase the strength of the affected areas without fatigue and increase overall stamina of the patient. She was given exercises that would help her improve her balance, walking, stair climbing, cognition, poster, 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 her overall quality of life. Parents found new hope with NeuroGen's Stem Cell Therapy. They were motivated and positive for their child after going back. Physiotherapy and rehabilitation taught at NeuroGen were continued after going home.
After 4 months of Stem Cell Therapy at NeuroGen following improvements were seen:
- She has now started swallowing her food, earlier she was fed through the peg tube.
- She can now sit for 10 to 15 minutes with back support, earlier she was completely bed ridden.
- Now she can make sounds for communication
- Cognition has improved
- She has started communicating non-verbally by pointing at objects
- Voluntary control of upper body has improved
- She can now say Amma and Papa
- She attempts to stand with the support of her father
- Overall tightness of the body has reduced
- Her voluntary control of left hand has improved, earlier it was poor.