Consensus of Clinical Neurorestorative Progress in Patients with Complete Chronic Spinal Cord Injury

Abstract

Currently, there is a lack of effective therapeutic methods to restore neurological function for chronic complete spinal cord injury (SCI) by conventional treatment. Neurorestorative strategies with positive preclinical results have been translated to the clinic, and some patients have gotten benefits and their quality of life has improved. These strategies include cell therapy, neurostimulation or neuromodulation, neuroprosthesis, neurotization or nerve bridging, and neurorehabilitation. The aim of this consensus by 31 experts from 20 countries is to show the objective evidence of clinical neurorestoration for chronic complete SCI by the mentioned neurorestorative strategies. Complete chronic SCI patients are no longer told, "nothing can be done." The clinical translation of more effective preclinical neurorestorative strategies should be encouraged as fast as possible in order to benefit patients with incurable CNS diseases. This manuscript is published as part of the International Association of Neurorestoratology (IANR) special issue of Cell Transplantation.

New Aspects of Graft-induced Central Plasticity and Neuroregeneration at T 10 in a Rat Model†

“…Spinal cord plasticity can evolve regenerative mechanisms that are normally suppressed by multiple extrinsic and intrinsic factors but can be activated by injury to stimulate neural growth and proliferation [20,21]. The additional beneficial effects of olfactory stem cell transplantation in animal experiments and human SCI, although still limited, have been reported [5][6][7][26][27][28][29]78,85].…”

“…An advantage is its ability to penetrate the blood-spinal cord barrier. We hypothesized that the acute treatment with CERE resulted in a) cell protection in the region of surgical spinal cord injury by the grafting procedure, b) neuroregeneration, and c) neuro-recovery within both the cord and graft, according to promising reports and evidence from brain and spinal cord lesions [18,19,22,23,28,31,[86][87][88][89][90][91][92][93][94].…”

“…Until now, traumatic paraplegia by severance of the spinal cord (SC) remains an irreversible condition. Basically, current clinical treatment strategies are targeted to promote axon regeneration and outgrowth beyond the scar formation following SC avulsion [1][2][3][4][5][8][9][10][11][12][13][14][15][16][17][18][20][21][24][25][26][27][28][29][30][31][72][73][74][75][76][77][78][79][80][81][82][83][84][85] Previous experimental and clinical studies together with GB have aroused some hope that paraplegic patients might achieve some selective voluntary muscle reinnervation after grafting the first motor neuron to skeletal hip muscles [10,11,25,72,73].…”

“…This study was focused on evaluating different aspects of graft-induced central plasticity with regard to neuroregeneration, neuroprotection, cell death, scarring, and positive effects of CERE by pharmacological neuromodulation on functional recovery [18,19,28,29].…”

A brief introduction to the thematic series of neurorestoration in neurotrauma

“…The common causes of neurotrauma are road traffic accidents, falls and violence. Even current neurorestorative strategies, including cell therapy, neuromodulation and neurorestorative surgery, can restore patients with neurotrauma to some degree of neurological functions; [1][2][3][4][5][6] there exists an urgent demand to find more effective methods for neurotrauma to better restore damaged or lost neurological functions and/or structures. The objective of this thematic series is to report the latest advances in neurotrauma to motivate clinicians and scientists to know more and find more effectively neurorestorative methods for neurotrauma.…”