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]]> http://www.brainandspinalcord.org/blog/2009/07/09/spinal-cord-injury-and-brain-injury-crisis-in-care/feed/ http://www.brainandspinalcord.org/blog/2009/07/09/spinal-cord-injury-and-brain-injury-crisis-in-care/ http://feedproxy.google.com/~r/Brainandspinalcord/~3/74EXxLEYOno/ http://www.brainandspinalcord.org/blog/2009/07/07/can-seizures-caused-by-brain-injuries-be-prevented/#comments Tue, 07 Jul 2009 16:17:25 +0000 Kaya http://www.brainandspinalcord.org/blog/?p=988 ScienceDaily reports new findings that may explain why acquired epilepsy is sometimes a result of a traumatic brain injury..

The study’s lead author, CU-Boulder’s psychology and neuroscience Professor Daniel Barth, believes that this new information can be used to prevent acquired epilepsy (also called adult epilepsy). The researchers found that the seizures are possible linked to the chemicals the brain releases when it attempts to heal a damaged area after a head injury.

Up until now, the most prevalent theory has attributed seizures to “electrical storms” in the brain, caused by “excessive or synchronous neuronal activity in the brain” – overactive neurons. Barth’s research may change this notion, instead pointing to micro-glial cells as the culprits.
“When there has been serious damage to the brain, such as a head injury or infection, the immune system is activated and tries to counteract the damage and repair it,” Barth said. “These glial cells migrate to the damaged area and release chemicals called cytokines that, unfortunately, also profoundly increase the excitability of the neurons that they are near.
“In our new study, we showed for the first time that glial cells moving in and secreting these cytokines cause the neurons in the area to become excitable enough to cause seizures.”
The theory is that temporarily switching off the brain’s immune system soon after a traumatic brain injury is incurred will prevent the development of acquired epilepsy.

“After a traumatic brain injury, there is often a period of several months where nothing seems to be happening,” Barth said. “And then suddenly the person may start having seizures, which often develop into chronic epilepsy.”

The CU research team believes that the initial seizures are caused by the brain’s immune response to the injury and that they are then cemented through actual structural changes to the brain. There are drugs that can be used to suppress this glial cell response, hopefully preventing the changes that lead to epilepsy.

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Brain and spinal cord injuries are two common results of automobile accidents.  A large number of lawsuits have been filed against General Motors by persons suffering from brain and spinal cord injuries sustained in accidents involving defective GM vehicles or parts, and many of those cases are currently pending.  On June 1, 2009, GM filed for protection from creditors in the Bankruptcy Court for the Southern District of New York, resulting in all pending lawsuits being stayed until the bankruptcy is finalized.  The case was assigned to Judge Robert E. Gerber who is holding hearings on GM’s proposed reorganization at the time of this post.

One of the issues Judge Gerber is expected to rule on this week is whether persons injured by defective GM products will retain their rights to sue or continue lawsuits pending against GM.  There are three categories of injured people whose rights will be affected by the Court’s rulings.  The first are people who had filed lawsuits against GM and received judgments prior to the bankruptcy, but had not yet been paid.  These people are considered unsecured creditors of GM.  The second category are those who were injured by GM products and filed lawsuits that were not resolved before the bankruptcy, so their claims are pending subject to the stay.  The final group, are those who will be injured in the future by GM products sold before bankruptcy.   Under pressure from consumer groups and Attorney’s General from more than ten states, , GM agreed in negotiations leading up to this week’s hearings to allow people injured by GM products in the future to retain their rights to sue.  GM has not, however, capitulated on recognizing pending claims and judgments.

An example of the types of claims that would be extinguished if the court approves GM’s proposed plan is the claims of four year old Alyssa Perrino.  Alyssa was a healthy, intelligent  little girl who sustained catastrophic brain injuries requiring removal of a large portion of her skull when a weak seat in the GM vehicle in which she was riding failed rearward and struck her head.  At the time of the accident, Alyssa was properly strapped into her car seat in the rear of the vehicle.  Prior to the accident, Alyssa spoke three languages, but as a result of her brain injuries, she is now only able to speak ten to fifteen words.  Her mobility is severely limited.  Alyssa was lucky to survive the accident, but her life and the life of the Perrino family has been forever changed.  While the Perrino family’s lawsuit against GM was resolved prior to GM’s bankruptcy, it is typical of cases in which defective vehicles caused irreversible brain and spinal cord injuries.

The bankruptcy plan proposed by GM would transfer automotive brands Chevrolet, Cadillac, Buick and GMC to a new company called Vehicle Acquisition Holdings LLC (Newco).  Under the plan, the United States Government would own 60 percent of Newco, the Canadian government would get 12.5 percent, the United Auto Workers Union, 17.5 percent and unsecured creditors, 10 percent.  Existing GM shareholders are not expected to receive any interest in Newco.  Technically, People whose lawsuits the bankruptcy court does not extinguish will proceed against Newco.  Those lawsuits that do not survive the bankruptcy can continue against the “old GM”, but the old GM is not expected to have assets to pay claims even it the lawsuits were successful.

While the proposed reorganization plan submitted by General Motors, would extinguish claims for injuries like Alyssa Perrino’s if they were pending at the time the bankruptcy was filed, ironically,  GM has agreed that the new owner of GM would assume GM’s liability for warranty claims.   Thus, approval of the plan would lead to the illogical result that if a GM part fails under warranty, the new GM would be liable for the repair, but if the same part killed or injured a person prior to the bankruptcy, the new GM would have no liability at all.

On June 19, 2009, the deadline for filing objections to the proposed GM sale, consumer groups, unions and creditors filed objections to the GM bailout.  Philadelphia attorney Barry Bessler is represented a number of consumer groups in the Chrysler bankruptcy and is representing them in the GM proceedings, as well.  During the Chrysler proceedings, Chrysler successfully washed its hands of all past and future product liability claims involving Chrysler products sold prior to the bankruptcy.  Bressler had argued that the GM case is distinguishable from the Chrysler case in terms of the proper way to treat product liability claimants.  Bressler was quoted in Law.Com as saying “[i]n GM, there is no third-party buyer. Hopefully, that means there’s a stronger case [for successor liability].”  Attorneys for people with pending asbestos products liability lawsuits against GM, have filed objections to the proposed plan, as well.

In addition to consumer groups, attorneys general from at least eleven states filed objections to the “no successor liability” provisions of the bankruptcy plan proposed by GM.  Attorneys general from Connecticut, Kentucky, Maryland, Minnesota, Missouri, Nebraska, North Dakota, Montana, Ohio, West Virginia and Vermont filed objections arguing that GM’s plan to extinguish liabilities for injuries cased by safety defects would take key legal rights away from victims.  Attorney General Richard Blumenthal of Connecticut referred to GM’s proposal as “very unfair and unwise “.   In an interview, Blumenthal stated “[s]o much is at stake. We have fought repeatedly for repair or recall of vehicles and parts that are defective so that people can be spared injury, and there are far-reaching ramifications of failing to apply accountability to the New GM.”

Attorneys general from a number of states also filed objections to GM’s proposed plan due to the impact it would have on GM dealers in their states.  In his statement regarding Montana’s objections to the GM proposal, Montana’s Attorney General Steve Bullock said that GM is attempting to circumvent state laws designed to protect auto dealers. According to Bullock, GM has insisted that current GM dealers sign new dealership agreements that force these dealers to waive state laws that were enacted to protect them.  Bullock further stated that, if his state lost dealerships, some consumers in rural areas would have to drive hundreds of miles just to get their cars or trucks serviced.

In addition to objections on behalf of consumers and dealers, objections to the GM restructuring were also filed by various bondholders who argued that they were treated unfairly vis a vis other creditors.  Finally, the Steelworkers Union filed objections on behalf of retired steelworkers and engineers who said the plan would leave GM without funds to pay health benefits to union-represented retirees and their families. In their objections, the Steelworkers and Engineers said that “GM has been not only unfair, but cruel” in its treatment of the steelworkers and engineers, and that GM was attempting to renege on a deal to create a health care trust for current workers and to protect the health and life insurance benefits of retirees.

A multi-day hearing on GM’s proposed sale began June 30, 2009 .   At the time this article was posted, proceedings were ongoing and Judge Gerber had not ruled on the objections of injured consumers.  Persons interested in following the proceedings in near real time can do so at http://dealbook.blogs.nytimes.com.

The outcome of the negotiations and court proceedings will affect many people who stand to lose jobs, benefits or investments, but none will be more profoundly affected than persons who have suffered catastrophic injuries such as brain and spinal cord injuries caused by defective GM products. With many millions of GM vehicles on U.S. roads, it is impossible to estimate the number of people who will be injured, and lack the resources to obtain essential medical and other services.   Given that many of these people will become medical wards of the States, U.S. taxpayers will continue bailing out and GM and Chrysler long after the astounding infusion of public funds during the current bankruptcy proceedings has been forgotten.

In today’s press release, XenoPort’s chief medical officer David A. Stamler said that “currently available medications for treating spasticity are often limited by their short duration of action and significant central nervous system side effects. The efficacy and tolerability of AP that were observed in this trial was encouraging, and we believe that AP offers the potential to address important medical needs for SCI patients.”

XenoPort is a biopharmaceutical company that is focused on the development of products that use the body’s “natural transport mechanisms” to improve existing drugs.

XP19986 showed no compelling negative side effects and demonstrated “significant improvements” in comparison with a placebo. It’s “designed to engage natural nutrient transport mechanisms found on intestinal cell membranes, thereby gaining efficient entrance into the bloodstream”, and XenoPort states that it could allow for just one or two needed doses in their future medial trials.

Muscle spasticity can cause many different conditions from an inability to walk to difficulty speaking due to stiffened muscles. If this drug withstands further trials, it may be able to benefit those who are suffering from spasticity caused by a spinal cord injury.

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One example they provide is of Timothy Whalen’s recent death from unknown causes. According to ABC, officials are investigating the possible link between his death and a traumatic brain injury that he sustained eight years ago.

The article goes on to say that “in fact, research shows that those who suffer from the most severe brain injuries are statistically more likely to die early — from a variety of causes”.

ABC quotes Dr. Steven Flanagan, director of The Rusk Institute of Rehabilitation Medicine at the New York University Langone Medical Center in New York City as saying “there are a couple of lines of evidence to suggest that after a particularly acute brain injury that you have shorter life expectancy, even if you survive the acute injury phase”.

There are a handful of studies that seem to validate this view, but it’s difficult to create a direct correlation between a traumatic brain injury and a death years later. With Whalen’s autopsy still in the future, the jury is still out on this one.

A recent WCTV.tv interview discusses a new study for restoring bladder control in patients with spinal cord injuries.

The Xiao procedure, named for Professor Xiao, a urologist, splices a functioning nerve from the patient’s leg to the non-functioning one that is supposed to control bowel and bladder function.

The resulting “reflex arc” allows an injured patient to regain control of the elimination process.

According to the WCTV.tv interview, Professor Xiao was able to restore up to 80% functionality in his Chinese patients.

If current and future studies find similar results without any prohibitive side effects, this procedure has the potential to greatly increase the quality of life for those with spinal cord injuries.

A clinical trial to evaluate this procedure is currently being conducted at the All Children’s Hospital.

Bangalore’s BGS Global Hospital claims to have successfully used transplanted bone marrow stem cells to reactivate brain cells.

Madhumalika, 27, suffered a “diffuse axonal brain injury” after a “road accident” on December 14, 2008. Due to the severity of her head trauma, Madhumalika was in a coma for more than three months and had been given a 20 percent chance of survival. Diffuse axonal injuries are one of the most common types of traumatic brain injuries (TBI). They tend to affect a larger portion of the brain, and are one of the leading causes of death in those with a TBI.

“The patient was suffering from altered sensorium, severe cognitive dysfunction and lack of movement in limbs. Following the surgery, she has now regained full consciousness, memory, communication abilities and purposive movements in limbs,” N K Venkataramana, Chief neurosurgeon of BGS Hospitals, told reporters.

According to Venkataramana, this was the first procedure of its kind in India and only the second in the world. China made the first attempt, but if they showed similar results, they have stayed pretty quiet about it. (There are studies, such as this one and this one performed on rats, showing different types of brain injuries improving with stem cell transplants.)

A month after transplanting more than four million stem cells into the patient’s brain, Madhumalika regained her ability to talk, move her limbs, and recognize her family and friends.

Dramatic results? We think so! However, as with any new procedures, it’s smart to watch for further tests and examples of its effectiveness. There is very little data available at this point, and until more extensive research is provided, we curbing our excitement.

Venkataramana says that Madhumalika’s recovery has proven that brain injuries are curable, “Since 2004, there has been a pressing need to help the rising number of people who were disabled following road accidents. Stem cell therapy was one of the means to face the situation,” he said. He also notes that there are plans for a pilot study in the future.

We will be keeping our eyes open for more developments – the potential for a “brain injury cure”, while sounding almost too good to be true, is worth watching.

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If you are in the Denver, Colorado area next week, be sure to check out the 3^rd annual National Brain Injury Employment Conference on June 17^th and 18^th at the Red lion Hotel Denver Southeast.

The conference will last two days and feature speakers discussing topics that will help people with brain injuries obtain work-related resources. There are a multitude of factors that influence someone’s ability to find a job, continue a career, and do it successfully even without an injury, but those whose lives have been irrevocably changed from a brain injury face challenges that aren’t often addressed.

This even will be an opportunity for networking, exchanging ideas, and learning from experts in related recovery and workforce integration fields. A list of presenter biographies can be found here.

To register, call Call 1-800-733-5466.

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The Sarah Jane Brain Foundation deserves some serious kudos for this one. It’s been the driving force behind the creation of the National Pediatric Acquired Brain Injury Plan (PABI Plan). The PABI Plan, unveiled today in Washington, is being called “the largest collaborative effort in the history of medicine”.

The History of PABI and Sarah Jane

Patrick Donohue of New York founded the Sarah Jane Brain Foundation (SJBP) in 2007 after his infant daughter sustained traumatic brain injury (TBI) when she was shaken violently by a nurse. Today she is unable to talk, crawl, or sit up.

The Sarah Jane Brain Project’s mission is “to create a model system for children suffering from all Pediatric Acquired Brain Injuries (PABI)”. Its leading efforts to expand research, develop protocols, and build awareness of PABI. To this end, in January 2009, the SJBP brought together more than 60 of the top pediatric neurologists in the country to draft the PABI Plan, the first of its kind.

The PABI Plan calls for the development of a “seamless, standardized, evidence-based, national system of care universally accessible for all children/young adults and their families regardless of where they live in the country”.

Fifty-two institutions have been selected through an open application process – one from each state plus the District of Columbia and Puerto Rico – to become the State Lead Centers. Selected by a committee of seven prominent brain scientists and rehabilitation experts, these State Lead Centers will be responsible for developing the master plan of acute care for children and young adults with brain injuries for their respective states.

Why is PABI Important?

According to the SJBP, more than a million children are hospitalized every year in the U.S. because of an acquired brain injury, with 17,000 suffering permanent disability and 5,000 dying from their injuries.

To paint a clearer picture - the World Health Organization reported that twice as many children suffered a brain injury than received stitches in 2008. In addition, the Centers for Disease Control and Prevention have estimated the financial burden of pediatric brain injury to cost more than $12 billion per year.

The SJBP website states that most brains aren’t fully developed until the age of 25, making many of the U.S.’s Iraq and Afghanistan veterans victims of Pediatric Traumatic Brain Injuries (PTBI). PABI includes more than just traumatic brain injury cases; it encompasses injuries caused by everything from brain tumors to substance abuse.

PABI calls for spending $125 million per year on work to ensure that U.S. children with brain injuries are provided needed care - from medical treatment to developmental therapies.

How can you help?

This plan will depend on the amount of federal stimulus funds and other funding it receives, and you can help by making a donation on the SJBP website, www.thebrainproject.org.

Entest BioMedical, Inc., formed in April 2009, is a subsidiary of bio-Matrix Scientific Group, Inc. Bio-Matrix is an interesting company. They provide stem cell storage for future use using cryogenics (the resurrection scene from Demolition Man is flashing through my head) as well as “stem cell related” services.

Entest focuses on research and development of ” autologous adipose-derived” for traumatic brain and spinal cord injuries.

“Our new Web site demonstrates Entest BioMedical’s mission and key scientific personnel who are dedicated to discovering and developing new procedures, treatments and medical devices that improve the quality of life - leading research and technology that serve the present and help shape the future,” said David Koos, Ph.D., DBA, Chairman and CEO in a recent press release for Entest.

How do they propose to help traumatic brain and spinal cord injuries?

Entest intends to use adipose-derived (read “fat derived”) stem cells (ASCs) that are taken from the fat that is vacuumed out during the liposuction process. It’s not clear who the patients are that will be donating their fat or from what specific lipo procedure the ASCs will come from. Whatever the source, Entest should be able to avoid the anti-stem cell furor with this approach.

According to the Entest website fat tissue is “the most abundant and accessible source of adult stem cells”. Considering that more than 800,000 liposuction procedures are performed every year, the decision to utilize this resource doesn’t come as a surprise!

These adult stem cells can “differentiate into neural cells” meaning that they are able to divide and change into the more complex neural cell type. These neural cells have a healing effect on the restricted blood supply, inflammation, and damaged neurons often caused by a traumatic brain injury (TBI) or spinal cord injury (SCI).

What have they discovered so far?

Entest states that “there is no effective therapeutic approach to reverse the initial brain damage caused by trauma because …cells have limited ability for self-repair…”. At this time, they have just begun the to develop their ASC-based therapy and won’t know how effective it is until the research is fully underway.

What are they doing now?

Entest submitted a Project Summary Reportto the U.S. Army Medical Research and Materiel Command (USAMRMC) in May 2009. They hope to receive some funding for their research as combat-related SCIs and TBIs continue to rise due to prevalence of explosives (roadside bombs especially) in Iraq and Afghanistan.

Let’s hope that Entest’s efforts will pay off! Safer, more effective approaches are needed, and needed now.

Adipose image from here.