Restoration of locomotion in posttraumatic paraplegics: the multidisciplinary approach and unexpected plasticity of single neurons--facts and fantasy.
In Europe there are about 300,000 paraplegics and in every country approximately 1000 new cases per year. Treatment requires a multidisciplinary approach with scientific cooperation targeted to exchange personal knowledge and expertise. At present a completely disrupted spinal cord cannot heal for recovery of motor and/or sensory functioning, although some promising treatment modalities in laboratory animal experiments have been reported. No interventional stem cell procedure so far has shown evidence to restore impaired functioning in human paraplegics. However, functional electrical stimulation (FES) via an implanted neuroprosthesis (SUAW concept) and central nervous system-peripheral nervous system (CNS-PNS) connection have successfully been used for alternative compensatory strategies for voluntary locomotion. This report is to analyse the authors' experience from two European projects in paraplegic. Factors will be identified that might have caused the one or other pitfall since so far both surgical reconstructive procedures have not been adopted by rehabilitation physicians and/or restorative (neuro-)surgeons despite the promising functional results we have achieved. Unexpected plasticity of single neurons following CNS-PNS by-pass procedures is discussed. Future interventions, for example the present phase 1 prospective multiple centre study on the side effects, effectiveness, and reliability of intrathecal treatment of anti-Nogo-A antibodies, are presented and the Chinese stem cell implantation is critically reviewed.
von Wild
K R H
KR
Medical Faculty of the Westphälische Wilhelms-University Münster, Münster, Germany. kvw@neurosci.de
Brunelli
G
G
D002490:Central Nervous System / Q000166:cytology / Q000502:physiology; D004558:Electric Stimulation / Q000379:methods; D049673:History, 20th Century; D049674:History, 21st Century; D006801:Humans; D033183:Interdisciplinary Communication; D020407:Internet; D008124:Locomotion / Q000502:physiology*; D009473:Neuronal Plasticity / Q000502:physiology*; D009474:Neurons / Q000502:physiology*; D010264:Paraplegia / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology* / Q000628:therapy*