Wednesday, February 25, 2009

Cool-Cap treatment fosters hope for infants

"Oxygen-deprived newborns now stand a fighting chance against permanent brain damage through innovative technological advances involving controlled-temperature treatment. 
The Bristol-Myers Squibb Children’s Hospital at Robert Wood Johnson University Hospital offers a new treatment involving the Olympic Cool-Cap System, which combines a continuous flow of cooling water connected to the cap and an infant’s head, according to a press release. 
“This therapy offers hope for a situation and condition that we previously did not have anything to nto before,” said Dr. Daniel Hirsch, an attending neonatologist in the Neonatal Intensive Care Unit at The Bristol-Myers Squibb Children’s Hospital.
While the cap is connected, the infant has a body temperature three to four degrees below normal, according to the release.
The hospital’s informational fact sheet said that infants who qualify for the treatment are full-term newborns affected by prenatal asphyxia and diagnosed with acute hypoxic-ischemic encephalopathy
HIE is a condition in which the infant’s brain does not receive enough oxygen, and it occurs about two to three times per every thousand births, according to the fact sheet. Infants who suffer from this condition endure such long-term damage as cerebral palsy, delayed development, seizures and even death.
We know that the babies suffering moderate to severe brain injury due to lack of oxygen will do better, not only in the short term but in the long term as well, which has been seen through large group trials,” said Hirsch, an assistant professor of pediatrics at the RWJUH of the University of Medicine and Dentistry of New Jersey.
Babies up to one and a half years old who received the treatement were developing better than those who did not receive the treatment, he said. 
“There are follow up studies in the trial to measure the benefits and effectiveness to persist to even six or seven years in life,” Hirsch said.
A stand-alone unit carefully regulates and monitors the water temperature and the infant’s scalp, abdominal wall and rectal temperatures to about 34 to 35 degrees Celsius, Hirsch said. 
“We will get the brain cool enough to slow down the biochemical reactions that have started secondary due to lack of oxygen to the brain,” Hirsch said.
Applying the Cool-Cap treatment within the first six hours of birth for 72 hours impedes the destructive secondary biochemical reactions in the brain due to HIE, according to the fact sheet.
The cool water circulates through a cap similar to a bathing cap, Hirsch said. A middle layer assures that there is good contact between this cap and the infant, and the final, third cap insulates the infant’s scalp from the surrounding environment.
A large clinical trial showed that the Olympic Cool-Cap System is safe and has prevented or reduced the degree of an infant’s brain injury, which is also supported through findings in animal testing, according to the hospital’s fact sheet.
The Bristol-Myers Squibb Children’s Hospital is a top-rated children’s hospital in the United States and is the first hospital in New Jersey to offer the Cool-Cap treatment, according to the press release. 
“It is another way in which our hospital can continue to stay on the side of cutting edge technology and offer the kids of New Jersey the best of care, opposed to having all these babies to be sent out of state to New York or Pennsylvania,” Hirsch said.
Hirsch expects that other New Jersey hospitals will follow in the footsteps of Bristol-Myers Squibb Children’s Hospital and offer the valuable treatment within the next few months to one or two years.
Hirsch said the hospital staff have all been carefully trained and prepared to use the Olympic Cool-Cap System, and currently the hospital offers the revolutionary treatment to any infant who qualifies."

Tuesday, February 17, 2009

HBOT for veterans with TBI

The video found here is from a Louisiana TV news station interview with Dr. Paul Harch regarding the small ongoing study currently in progress looking into the effects of HBOT on veterans with TBI. Hopefully larger studies focused on HBOT and brain injury will take place. In my opinion, if HBOT can measurably help people with brain injury recover some lost function, it's worth putting time, energy and resources into further research.

Saturday, February 14, 2009

Improvement in cerebral palsy cognition by oxygen therapy

A while back I signed up to receive Google Alerts for topics of interest, like "hyperbarics and cerebral palsy" and "alternative therapies for cerebral palsy".  If I find something relevant I try to write about it here.

Our son did 40 sessions of HBOT when he was 12 months old.  It's hard to quantify the results we witnessed, but needless to say we saw positive physical and cognitive changes with HBOT.  We're getting ready for another 40 sessions is a few weeks, coupled with intensive pediatric therapy.

Study from 
The Indian Journal of Occupational Therapy

"Adjunctive hyperbaric oxygen therapy significantly improves cognition for children with cerebral palsy, compared with standard therapy alone, according to an open, ongoing, observational study.

All participants significantly improved their physical, speech, and motor

Capabilities after 6 months, compared with baseline. Interim results for 84 children whose parents chose hyperbaric oxygen therapy (HBOT) and 20 children in a non-HBOT group were presented at a symposium on hyperbaric oxygen therapy.

Changes in cognition were distinctive.
“Children receiving HBOT showed statistically significant improvements in cognitive-only parameters. This is interesting and what is driving us to go on with this treatment,” said Dr. Arun Mukherjee of Majeedia Hospital, New Delhi, India.

Researchers used a modified 49-item Gross Motor Function Measure to monitor clinical progress at 2-month intervals. In an attempt to assess the effects of hyperbaric oxygenation, researchers focused on 26 cognitive-only items, which are less dependent on therapist input. “This is the closest measure we can get to brain repair,” said Dr. Mukherjee, who is also director of the UDAAN Project for Cerebral Palsy at the Foundation for Spastic and Mentally Handicapped Persons in New Delhi. UDAAN is a Hindi word for flight (of freedom).

Hyperbaric therapy consisted of 100% oxygen delivered at 1.5 atmospheres. Not included in this interim analysis is a recently added third group of patients who receive a low pressure HBOT option (ambient air delivered at 1.3 atmospheres).

Dr. Mukherjee and his associates launched the UDAAN HBOT-Based Multimode Long-Term Observational Study in 2001 to assess the benefits, if any, of adjunctive therapy for children with cerebral palsy. They tried nerve block with Botox and phenol, computer-assisted biofeedback, and pulsed magnetic field therapy. “We were not impressed with their cost-to-benefit ratio as per Indian prices. Hence, we have dropped them.”

Standard therapy consists of special education, occupational therapy, speech therapy and physiotherapy totaling 2 hours daily.
After 5 months of HBOT, clinicians administer 60 sessions of electro acupuncture using transcutaneous electrical nerve stimulation (TENS) specifically designed for cerebral palsy. This therapy reduces pain and discomfort of intensive exercises and helps the brain recognize pathways revived by HBOT, Dr. Mukherjee said at the symposium sponsored by the Ocean Hyperbaric Neurology Center in Fort Lauderdale, Fla. “This alerts the brain that these circuits are now working,” he said.

Short-term treatment has limited other pediatric studies of hyperbaric oxygen for cerebral palsy, Dr. Mukherjee said. In the current investigation, it took 6 months before cognitive differences between groups reached statistical significance. He said this suggests the need for a long-term commitment to hyperbaric therapy for cerebral palsy."

Monday, February 2, 2009

by David Prentice, PhD, William L. Saunders, JD, Jan Ledochowski, and Lukas Lucenic

Brain Injury
New nerve cells, produced naturally by adult neural stem cells present in the brain, appear to be essential for learning and memory. The old idea that brain cells are not renewed was debunked in the 1990's, when researchers showed that the adult brain continues to make new neurons, a process termed
"neurogenesis," throughout life. Now, researchers at Kyoto University in Japan have shown in mice that new brain cells are necessary for learning and for memory. The new research, published in Nature Neuroscience, indicates that neural stem cells in the adult brain continue to produce new brain cells that are important for memory and learning.

The new study supports work published earlier this year showing that
new brain cells can affect learning and memory. Last year, research showed that transplanting adult neural stem cells into brain-injured mice could restore some memory. In March 2008, another study showed that injecting human umbilical cord blood stem cells into the brains of aging animals boosted neurogenesis. Another recent study also suggested that stimulating specific molecules in the brain could reactivate adult neural stem cells. Exercise has also been shown to stimulate neurogenesis in the brain.[5]

An Auckland twin who was brain-damaged at birth has become the first New Zealander to undergo experimental treatment in the United States using her own umbilical cord blood. Three months ago, Maia Friedlander, 4, was locked in her own world. Despite six hours of therapy a day for three years, Maia-who was born six weeks premature-struggled to talk, walk properly, or even chew her food without choking. Her twin sister, Ariel, achieved all her developmental milestones about six months early, but Maia did not learn to crawl until she was three. Her father, Daniel, said: "Our lives revolved around her therapy regime but we could not see much improvement."

The breakthrough came in February, when they met American mother Mary Schneider, whose son, Ryan, was the first to undergo cord blood transfusion for his brain injury at Duke University , North Carolina . Five years later, he is developmentally normal. More than 50 other children with brain injuries have been treated through Duke's reinfusion program. In August, Maia and her mother, Jillian, traveled to the U.S., where she received a two-hour infusion of her own cord blood stored by her parents at birth. Within days her concentration and coordination improved. Maia now goes to kindergarten five days a week. "She's like a different child-talking, hugging us, playing . . . She's had a second chance at life and we can now have the family life we'd always dreamed of."

Doctors have used a revolutionary stem cell treatment to restore the power of speech for a stroke victim. Walter Bast also regained the use of his right arm after the operation to place a "teabag" of drug-producing adult stem cells in his brain. Speaking a week after the operation-the first of its kind in the world-he said: "I feel like a lucky guy." If further trials confirm the value of the treatment, it could be on the market in as little as five years, providing fresh hope for the 45,000 Britons each year who suffer a hemorrhagic stroke caused by the bursting of a blood vessel in the brain. Currently, the only treatment option is surgery, which has a variable success rate. Half will die within a month and just one in 20 patients will recover to the extent of Mr. Bast, a 49-year-old mechanic. British experts described the operation as "very promising."

The CellBeads treatment is the brainchild of scientists at the British medical technology firm Biocompatibles International, based in Farnham, Surrey , U.K. At its center is a teabag-like sachet filled with tiny capsules, each containing approximately a million stem cells. The stem cells, taken from bone marrow, have been genetically engineered to produce a drug that protects brain cells from dying. This allows the cells to rejuvenate and repair the damage done by the stroke. The stem cells are encapsulated in beads to hide them from the immune system and ensure they are not rejected by the body.

Cerebral Palsy
When Chloe Levine was 9-months-old, her parents noticed she could not hold her bottle with her right hand. That was not her only developmental setback. Chloe, of Pinetop , Arizona , was unable to raise both hands above her head and could not crawl. At 12 months, a CAT scan showed a portion of the left side of Chloe's brain had not developed and contained fluid. Chloe's parents, Ryan and Jenny Levine, took her to a neurologist who diagnosed the toddler with right-side hemiplegic cerebral palsy. "The cerebral palsy had only affected the right side of her body," Jenny Levine said. "The neurologist told us we were looking at 17-18 years of therapy." That was when the Levines heard about an experimental procedure at Duke University in North Carolina , where children with cerebral palsy were infused with their own cord blood stem cells in an effort to heal and repair damaged brain tissue.

The Levines remembered they had banked Chole's cord blood when she was born. "It was a miracle," Dr. Manny Alvarez said on FOX & Friends. "I congratulate you for banking her cord blood. Stem cells are a new field of medicine and they certainly can rejuvenate the tissue." Two months ago, Chloe, 2, received an infusion of her own stem cells and her progress is remarkable, said her father, Ryan. "Her therapist said she's made a 50 percent recovery," he said. "She can walk, run, and do sign language with her right hand."

Spinal Cord Injury
The Australian team at the National Centre for Adult Stem Cell Research, Griffith University , continues to produce exciting results. The latest report published in the journal Brain gives the results of a 3-year clinical trial, using olfactory ensheathing cells (specialized adult cells that surround nerves) from the patients' own noses, transplanted into the damaged spinal cord. The initial one year follow-up has shown no adverse effects from the transplant.

This was a highly controlled trial, with matched control and transplant patients, followed for 3 years. Patients were chosen who might be considered "chronic"-at least 2 years after their spinal cord injury-to control for any spontaneous recovery. The trial was designed to show the safety of the transplant. The transplant was safe by all measures, and one transplanted patient showed improvement over 3 segments in light touch and pin-prick sensitivity. The cells were shown to be quite safe, to take well in the patients, and to safely improve function.