Subarachnoid placement of stem cells in neurological disorders.
BACKGROUND
"Medically untreatable neurological disorders" is an area where stem cell (SC) therapy has generated hope in the last decade. Among various routes for SC infusion, subarachnoid placement via the lumbar route is particularly challenging because of technical difficulties in this group of patients. We carried out a prospective, single-center, clinical study to analyze the technical difficulties and short- and long-term effects of SC infusion in various neurological conditions.


METHODS
One hundred eighty patients underwent subarachnoid placement of SCs between December 2005 and October 2007. Technical difficulties in the form of localization of subarachnoid space, number of attempts, and postprocedural complications were evaluated. Functional evaluation was done with Hauser Ambulation Index by the SC transplant team on a regular basis. The Institutional Review Board approved of informed consent forms and study protocol.


RESULTS
Of 180 patients, we encountered technical difficulties in 52 (29%) in the form of general anesthesia supplementation and difficulty localizing the lumbar space. In 102 (56.6%) patients, side effects were observed (headache, low-grade fever, and meningism), which resolved with symptomatic treatment within 24 hours. On long-term follow-up, functional indices improved in 57 (31.67%) patients, including 54 patients with traumatic paraplegia/quadriplegia, two with cerebral palsy, and one with viral encephalitis.


CONCLUSIONS
Subarachnoid placement of SCs is safe with no long term adverse effects.
Department of Anesthesiology and Critical Care, Dr H.L. Trivedi Institute of Transplantation Sciences (ITS)-G.R. Doshi and K.M. Mehta Institute of Kidney Diseases and Research Centre (IKDRC), Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat, India.
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Mehta
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Feroz
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Thakkar
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Vanikar
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Shah
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Trivedi
D001927:Brain Diseases / Q000601:surgery; D006801:Humans; D016472:Motor Neuron Disease / Q000601:surgery; D012449:Safety; D013119:Spinal Cord Injuries / Q000601:surgery*; D033581:Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods*; D013346:Subarachnoid Space / Q000601:surgery*