Case Analysis for Chronic inflammatory demyelinating polyradiculoneuropathy, (CIDP)
By: Like Wu, Xiaojuan Wang, Shuangshuang Liu, Xiang Wang, Bo Cheng, Susan Chu
Wu Medical Center, Beijing China
The patient is 30-year-old male. He was presented with both lower limbs’ weakness and has difficult in walking and going up and down stairs for the past 4 years without any apparent cause. The disease progressed gradually. He can barely raise his upper limbs. When he is in recumbent position, it is difficult for him to sit up or stand. He needs someone to help him when he walks. He easily gets tired; he can’t go up the stairs. He has no heritable basis. He had cerebrospinal fluid examination, electrophysiology examination and NMR at the local hospital and was diagnosed with chronic inflammatory demyelinating polyradiculoneuropathy, (CIDP). He had gamma globulin for 5 days and took prednisone for 4 years, but his condition was not better. He wanted a better life so he came to Wu Medical Center. General examination: his vital signs were normal, his heart, lung and other organs were normal. Nervous system examination: his speech and spirit was good, his cranial nerves were normal. His neck was soft; he could turn around, his neck was powerful. The muscle power of shrugging shoulders was at level 5-, the muscle power of upper limbs was at level 4-. The interosseus muscles power was at level 3, the extensor and flexor muscle power was at level 4. The muscle power of lower limbs was at level 3 in external rotatory position. He couldn’t do the dorsiflexion and planter flexion. The skin temperature of both shanks was lower than normal. The muscle tension of four limbs was normal, the tendon reflex was decreased. He didn’t have abdominal reflexes. The pathological sign of four limbs was negative. The distal ends of four limbs had little depth feeling. Both side finger to nose test, finger to finger test and rapid rotation test were normal. He couldn’t do the heel-knee-tibia test. He had bad balance control. The meningeal irritation sign was negative. He was diagnosed as CIDP.
Treatment target: Replace the degenerative and damaged nerve cells and myelin sheath with normal stem cells to repair the nerves, regulate the abnormal immune system with the normal mesenchymal stem cells (MSCs), improve the internal environment, fix the abnormal nerve and regenerate new and normal cells, and also to improve equilibrium function and motor function.
Treatment procedure and results:
We gave the patient 4 times neural stem cells (NSCs) and 4 times mesenchymal stem cells (MSCs) implantation treatment for 3 weeks. The stem cells were activated in the patient’s body to repair the nerve damage. Together with nourishment of the neurons, improvement of circulation and regulating the immune, daily rehabilitation training was incorporated. During the treatment, the patient was happy, had a regular eating and sleeping pattern. With our doctor’s help, he was able to complete the treatment. After the treatment, the patient had significant improvement.
His weakness was better, the muscle power of shrugging shoulders was at level 5, the muscle power of both upper limbs was at level 5-, the interosseus muscles power was at level 4+, and the muscle power of lower limbs was at level 4. He could do the dorsiflexion and planter flexion. The skin temperature of both shanks was normal. The distal ends of four limbs had depth feeling. Both of his lower limbs could do heel-knee-tibia test. His examinations were normal before he was discharged and he had no untoward reaction.
CIDP is a kind of autoimmunity kinesthetic peripheral neuropathy. The main pathological changes is proximal end of peripheral nerve has demyelination. The symptom: gradual onset, without prodromal, in the beginning. It progresses as soon as AIDP, but 4 months later, the chronic symptom will be more obvious. The progressive stage is from months to years, average is 3 months. It doesn’t get better in 6 months, the normal course of disease include 3 phases: progress in steps, stable progress and relapse-relief. The normal treatment methods are: intravenous injection of gamma globulin, using glucocorticoid, plasmapheresis, immunologic suppression and immunological regulation.
But these methods can’t relieve the patient’s disease in a long period; the patients need a kind of more directional, specific and efficacious treatment method. The Wu Stem Cell Medical Center (WSCMC) uses stem cells transplantation to treat many cases of CIPD, which has resulted in a clear recovery for many patients. This medical center found that neural stem cells can be effective in repairing damages in the nerve myelin sheath and axon, and mesenchymal stem cells can be effective for immune regulation, reducing immune system attacks, and preventing recurrence of the disease. Combining these two kinds of stem cells provides a more effective treatment for CIDP patients.
The stem cells have the ability to proliferate and multi-directional differentiation. The cells can move to the injured region, and differentiate into neuron, Schwann cell and relational tissue. All of these can fix the damaged myelin sheath and neurite. Our center has found that when the stem cells are fixing the Peripheral nerve myelin sheath, it can locate through damaged fragments of nerve myelin sheath; these fragments release multiple cell factors and inflammatory factor around the nerve neurite. All of these are useful to help the stem cells we injected locate and differentiate into Schwann cell. It's worth noting that during our research, the myelin sheath that differentiate from stem cells will come off in a short time after it finishes the fix, but the myelin sheath that is initiated by the stem cells will grow up and fix the neurofibra. That is one of the treatment mechanisms of CIDP. The stem cells can secrete many kinds of neurotrophic factor to progress the nerve and myelin sheath growing. And the injected stem cells can fix the damaged part of cells and the myelin sheath.
It's worth noting that the clinical results of stem cells treatment in CIDP is related to clinical technique of therapeutic centre, because all of the stem cells’ injection, location, growth and expressive function are related to the prolific clinical treatment experience. The patient can only get better with individual treatment plan, that includes the affected time, affected part, affected age and the degree of nerve injury.