Patient narrates:
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.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 realized 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 recognized 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 paralyzed down my left side, had no power in my left arm, and my speech was slurred.
The doctors said the fall was stroke and so much time had elapsed — about 24 hours between me having it and getting to hospital — there was little they could do.
Spending three days in hospital, slowly I started to realize just how much my life would have to change.
I spent 13 weeks in a rehabilitation center 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.
Unexpectedly 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. When I was apprehensive of the of injecting stem cells directly into brain, he reassured me, and I underwent the procedure.
Over the next few weeks I started physiotherapy and finally began to feel a change.
I had no control over my left arm and it would sometimes shake uncontrollably, whereas now I can lift it over the chest. My speech has also become clearer although my walk 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.
Strokes can be 1. Ischemic: Where blood supply to any area in the brain is stopped due to a clot. Happens in 85% of the cases.
Hemorrhagic: Where a weakened blood vessel supplying the brain ruptures.
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.
Ischemic strokes can be treated with medication to dissolve the blood clot and restore blood supply to the affected areas, if recognized and treated early.
But these drugs must be given within four hours of a stroke occurring in orderto be effective as brain tissue doesn’t survive very long without a blood supply.
Patients are left with irreversible disability as there are no treatments to help brain cells grow again.
These patients are offered physiotherapy and rehabilitation, which can be of limited effectiveness.
Recently, 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 of their 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.
Procedure:
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 anesthesia, a neurosurgeon drills a small hole about 1cm wide in the skull.
Brain scan is used to locate the damage and guide the injection, aiming to place the stem cells in an intact area of brain close to where the stroke damage has occurred. Injecting directly into the affected area renders them useless as there are no tissues to hold on and they also get washed away by fluid 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.
Assuming that a chemical signal from damaged tissue directs these stem cells. 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 discharged the next day.
Studies:
- 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 centers 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.
WHAT ARE THE RISKS ASSOCIATED WITH STEMCELL THERAPY FOR STROKE?
- A small chance of infection.
- As with any brain surgery, bleeding in the brain is a possibility.
- Seizures are occasionally seen after injections to the brain (estimated in around 2 per cent of cases).
- There have not been any side-effects related to the injected cells so far but long-term follow-up has only been done in a few people.
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