Tens of thousands of people each year are left paralysed to some degree by a stroke. Billy Elder, 63, from Renfrew, Glasgow, is one of the first people to receive a new stem cell treatment to restore movement, as he tells OONA MASHTA . .
THE PATIENT
One day in August last year I was reaching for food in the fridge, when I suddenly fell unconscious. I don’t know how long I was out for and I thought I had just tripped over.
Afterwards I felt a bit dizzy so I went for a lie down until my wife Catherine came home about an hour or two later.
I told her I fell and didn’t feel very well, but neither of us were particularly worried as all I had to show for my dizzy spell was a small scratch on my elbow. I had no idea that the fall was a stroke.
The next morning I made myself a cup of coffee, but when I tried to take a sip, it spilt as I couldn’t co-ordinate my hand to my mouth properly.
Catherine realised something wasn’t right so rang our daughter, Sonja, who took me to A&E. I swiftly deteriorated and by the time I got there an hour later, the left side of my mouth drooped and I couldn’t use my left arm. I wasn’t too concerned, but I wasn’t thinking clearly.
The doctors recognised instantly that I was having a stroke, and I was rushed in for a brain scan.
This showed that a blood clot was blocking blood flow to my brain and as a result various areas were permanently damaged, including the areas that govern movement and speech.
I was virtually paralysed down my left side, had no power in my left arm, and my speech was slurred.
I spent three days in hospital resting and slowly I started to realise just how much my life would have to change.
I spent 13 weeks in a rehabilitation centre having intense speech therapy and physiotherapy, but I just couldn’t regain any movement in my left arm or leg and my speech was still slurred. Things I’d taken for granted such as walking were now beyond me.
Back home I could no longer work and I had to rely on Catherine for most things — and had pretty much given up on ever regaining movement in my left side.
Then out of the blue in June, my neurologist rang to ask if I’d like to take part in a new trial for stem-cell therapy that would be the first ever treatment for damage caused by a stroke, I was immediately keen.
He explained that the treatment involved an injection of stem cells from a tissue bank and these would help regenerate the damaged brain areas and could restore movement. I was slightly worried about the idea of a needle going straight into my brain, but the doctors reassured me it was safe.
I went in for the two-hour surgery under general anaesthetic in September. Unsurprisingly, I don’t remember much about it, but I was well enough to go home the next day. Over the next few weeks I started physiotherapy and finally began to feel a change.
Before, I’d had no control over my left arm — it just dangled by my side with my fist clenched and it would sometimes shake uncontrollably — but now I can lift it above my chest. My friends have told me my speech is clearer, too. But my walking is still unsteady.
Before the treatment I had felt self-conscious, but the stem-cell therapy has given me a lifeline and I’m hopeful that I’ll get even better with more physio.
THE SPECIALIST
Professor Keith Muir is a consultant neurologist at the Queen Elizabeth University Hospital in Glasgow.
Every year more than 150,000 people in the UK have a stroke and half of these are left with some kind of disability because blood supply to key areas is blocked.
Around 85 per cent of cases are ischaemic strokes, where the blood supply is stopped due to a clot. The others are known as haemorrhagic, where a weakened blood vessel supplying the brain bursts.
If the supply of blood is restricted or stopped, brain cells begin to die, resulting in permanent brain damage and disability as nerve cells don’t regrow.
Often if caught early, ischaemic strokes can be treated with medication to dissolve the blood clot and restore blood supply to the affected areas.
But these drugs have to be given within four hours of a stroke occurring in order to be effective as brain tissue doesn’t survive very long without a blood supply.
But now scientists from Glasgow University and Reneuron, a biotechnology company based in Wales, are testing whether stem cells injected into the brain of patients after a stroke can stimulate regeneration of brain cells and blood vessels in order to restore some function.
These stem cells, called CTX, are derived from a brain tissue sample donated to a tissue bank in the U.S. and transported to the hospital.
Animal studies suggest that they can stimulate some of the brain’s natural repair systems and so recover some lost function.
Before the operation a ‘dose’ of around 20 million stem cells is unfrozen in the hospital pharmacy and drawn up into a syringe.
Under general anaesthetic a neurosurgeon drills a small hole about 1cm wide in the skull.
The cells can’t be injected into the damaged area since there’s no tissue there for them to hold on, and they would be washed away by the fluid circulating in the brain. However, animal studies show that when they are injected into nearby healthy brain tissue, the stem cells move to the site of damage.
We think that a chemical signal comes from damaged tissue that tells the cells to move there. As the cells move into the injured areas they are thought to release chemicals which stimulate the growth of nerve cells and new blood vessels.
We slowly inject a dose of 20 million CTX stem cells into the brain, which can take up to two hours, as the syringe is only gradually pushed down so that the cells drip into the brain precisely.
After the procedure, the hole in the skull is filled with a bone substitute material, similar to Polyfilla, and the scalp stitched.
Patients are usually ready to leave the hospital the next day.
A safety study published in the Lancet in June involving 11 stroke patients suggested there were no side-effects related to the cells over a two-year follow up.
Our current study at eight NHS centres has finished recruiting 21 patients, and so far results suggest significant improvement in patients’ disability scores.
We are awaiting full results from this study before we plan larger trials in more patients.