Brain Injury
by Drs. Like Wu, Xiaojuan Wang, Bo Cheng,Susan Chu, Baolei Xu and Fang Peng
Wu Medical Center, Bejing, China
The morbidity and severity of brain trauma are both on the top of the list in many kinds of nervous system diseases. According to the American Association of Trauma statistics, there are about 500,000 people admitted to a hospital suffering from craniocerebral trauma every year, 75000-90000 of them die, and most of patients are healthy young people who were left with a permanent disability.
Definition
Sequelae of traumatic brain injury (sTBI) is a group of long-standing motor nerve dysfunctions and imbalance of the autonomic nervous system function or mental symptoms which are caused by nervous necrosis, loss or/and disorder after convalescence. Symptoms include: paralysis, sensory attention disorder, headache, irritability, neuroticism, concentration, memory barriers, obstacles, insomnia, dizziness etc. There are no new focuses and progressing abnormalities that could be found in the neurologic check and in the neuro-radiological examinations. If this group of symptoms persist and have not improved after 3 months then they become the sTBI.
Type
All of the below can cause sequelae; basal skull fracture, brain contusion, intracranial hematoma, subdural or epidural hematoma, an injury of the cranial nerve, carotid cavernous fistula, pneumocephalus emphysema and rhinorrhea, concussion of the brain and so on.
Pathological changes of brain trauma
Besides brain contusion, extradural, subdural, subarachnoid and intracerebral hemorrhage, most of the brain trauma may cause tissue edema and vasogenic edema and have an infarction zone as well. This is a result in vasospasm which is caused by subarachnoid hemorrhage around the basal vascular. Above pathological changes are the source of the neural cell apoptosis and necrosis and the loss of the nerve cells are basic of persistent disability.
Symptoms of sequelae of traumatic brain injury
Symptoms of Persistent disability: movement disorders (paralysis), sensory disorder, aphasia, balance disorder, ataxia, epilepsy, dementia and so on. Classification: awake patients; soon restored patients (headache and dizziness after mild head trauma); delayed syncope after head trauma; sleepiness; headache and trance; dementia; temporary traumatic paraplegia, blindness and migraine; traumatic permanent paralysis, delayed paralysis; persistent coma; post-traumatic epilepsy and psychiatric disorders, post-traumatic extrapyramidal and cerebellar disease; Boxing - drunk encephalopathy (boxer dementia), post-traumatic hydrocephalus; cognitive and psychiatric disorder after trauma etc; all of above may cause persistent symptoms.
Treatment
Many factors affect treatment of the sTBI. It is generally thought that the longer time dysfunction persists and/or the age older the possibility of recovery becomes smaller. Only the correct treatment can ease the patients' suffering. The newest definition of disease recovered from WHO is:"The most fundamental way to treat sTBI is to repair the cells, improve the cell metabolism, and activate the cell function."
Our research found that the neural stem cell implantation that treats sTBI have good treatment outcome, and the stem cells can start the repair process again (brain tissue repair time window was closed in sequela period), increased the number of effective neural cells, improved movement sensation, spiritual intelligence of patients, improved life quality and prevented delayed neural degeneration.
Following medical development, people realize that the cells are the foundation and guarantee of life; healthy cells are the foundation of a healthy body. "Stem cells implantation" is a hot topic for the medical area, "The new discovery of stem cell research" is Top 1 in the "The world achievements of Science TOP 10, 1999". As far as we know, besides good treatment outcomes in leukemia, diabetes and in tumors, stem cell implantation gradually attracts people's attention in brain areas which can treat sTBI and sequelae of stroke.
The neural stem cell implantation that treats sTBI has a good outcome because the neurons and glial cells, which differentiate from stem cells, can secrete many kinds of neurotrophic factors to improve microenvironment of brain and start sequential expression of regeneration genes, damaged axonal re-growth again. Meanwhile, they produce a variety of extracellular matrix; fill the cavity left from the brain injury, provide support for the regeneration of axons; supplement the neurons and glial cells which are lost after injury. Then the remaining demyelination nerve fibers and newborn nerve fibers form a new medullary sheath; maintaining a completeness of nerve fibers function. Then they assist in a rehabilitation training to promote the growth and repair of stem sells which were implanted into the body, which significantly reduce sequelae and improve sequelae symptoms, improving the life quality of the patients.
Stem cell implantation into the body via IV or lumbar puncture to avoid patient undergoing the craniotomy operation, and reduce the occurrence of complications, shorten the patient's hospitalization, then reduces the hospitalization expense. Neural stem cell implantation treatment is a kind of safety, economic, effective treatment for sTBI. Stem cell is an undifferentiated immature cell which shows weak cell surface antigen expression, patient's own immune system has low recognition ability for this kind of immature cell, they can not determine stem cells' properties, and this is why stem cells implantation can avoid organ transplant immune rejection and allergic reaction, to ensure implantation is safe for patients.
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