Restorative therapy using autologous bone marrow derived mononuclear cells infusion intra-arterially in patients with cerebral palsy: An open label feasibility study

Cerebral Palsy is a common and devastating neurological disorder, with no medical treatment apart from physiotherapy regimes to alleviate the functional disability. Regenerative medicine using stem cells has gained momentum in recent years as a possible strategy to repair the injured brain. Present study was undertaken in a open label series to evaluate the safety, feasibility and observe for any benefi cial effects of intra-arterial infusion of autologous bone marrow derived mononuclear cells in patients with cerebral palsy with moderate disability. Functional improvement was assessed using the motor power and spasticity scales, dystonia and abnormal movements scale and the activities of daily living scales by modifi ed Barthel Index and modifi ed Rankin Scores. Serial structural imaging with MRI and functional imaging with FDG-PET scans were done. Of the 30 patients injected with an average of 10-30 million cells into each carotid artery, improvements were observed in all clinical scales, and predominantly in the disability scores. No adverse events were noted on a 12 months follow up.

Treatment of writer's cramps with botulinum toxim

Treatment of writer's cramp is quite disappointing. Botulinum toxin A [BTX] is emerging as the first line of treatment of writer's cramp. We evaluate the effect of BTX in 12 patients of writer's cramp. Patients and Method: Twelve patients of writer's cramp [11 men, one woman], with mean age of 33.92 years and mean duration of symptoms for 3.3 years, received 17 treatment sessions of BTX. Each patient was evaluated before and 3 and 12 weeks after BTX therapy on a rating scale for speed of writing, ease of writing, abnormal posture and pain. Each patient also gave a global subjective assessment 12 weeks after BTX therapy. Result: Follow-up was available in 13 treatment sessions. Significant improvement occurred in speed of writing [p=0.0025], ease of writing [p=0.0025], abnormal posture [p=0.0039] and pain [p=0.0092]. An improvement of 50% or more was observed after nine BTX therapy sessions whereas less than 50% improvement was observed after four treatment sessions. All patients developed mild asymptomatic weakness in limb muscles. Only three patients complained of any weakness. The mean onset of improvement was 8.79 days and duration of effect 8.0 weeks. BTX is an effective treatment of writer's cramp. Improvement of patient's hand writing is not a good indicator of patients satisfaction and relief of symptom. EMG guided BTX injection should be restricted for deep muscles. Frequent repeated infections of BTX should be avoided