A BBC story about a man with SCI who can walk again after receiving a new therapy has been in the news over the past couple of days.
The story reports that Darek Fidyka, a 40-year-old Polish man who sustained a spinal cord injury during a stabbing, had olfactory bulb cells from his nasal cavity transplanted into his spinal cord, and two years following this treatment (and extensive rehabilitation), he is able to walk with a walker. There is a lot of excitement in the media about this new treatment, conducted in Poland and pioneered by British researcher and physician Dr. Geoffrey Raisman.
While this research is very interesting, ICORD Director Dr. Wolfram Tetzlaff has some concerns.
“This is a study with one patient only, so I believe it is premature to draw conclusions. It’s important to do a large-scale clinical trial with blinded assessors before we can know for sure whether the transplantation surgery will be a viable treatment for SCI,” said Dr. Tetzlaff, who was asked for comments by several news outlets on October 21st. “This patient presented as having a complete SCI, but he had a 2mm “bridge” of spared tissue at the site of injury. These bridges can be non-functional when compressed by scarring. It’s possible that the surgery done to remove the scar tissue before transplanting the olfactory cells (known as “untethering“) might have decompressed the bridge, allowing it to function again.”
“In addition this patient received extensive physiotherapy (5 hours daily/5 days a week) for 8 months before and 21 months after his surgery. He showed modest but significant motor recovery by 11 months after surgery, and this rehabilitation regimen likely contributed to the recovery seen by the patient. For these reasons alone, it is impossible to conclude presently whether these cells and bridges had an effect. The MRI performed 19 months post-treatment showed no new nerve fibres in the lesion site, suggesting this was not a regeneration effect,” Dr. Tetzlaff continued.
“We hear similar anecdotal reports from our colleagues in China, who are fortunate to have the resources to provide 6 hours of rehab/6 days a week (with the help of family members living in or near the hospitals). What this indicates is that some functionally complete patients would likely benefits from more extensive and longer rehabilitation than is presently offered. We do know that apart from initial stabilization surgery, rehabilitation is currently the only effective treatment for SCI, although there are therapies currently available to improve the quality of life of people living with SCI. Sadly, this media hype makes other people living with SCI wonder if they should try to get this new treatment right away. I really feel that it’s important for people to remember that any risky intervention like this, involving two separate surgeries, needs validation in a clinical trial,” he said.
“What it should leave us with is the hope that indeed improvements are possible, even in cases deemed ‘complete,'” said Dr. Tetzlaff. “I feel strongly that with more funding, incremental steps towards more effective treatments will happen.”
Find out more:
See the CTV news report
See the CBC News report
Read SCI-BC’s blog post on this topic.
Read this important document about the risks and potential benefits of participating in clinical trials.
Read the scientific paper in Cell Transplantation. Note: this link may require academic library access. For assistance, please visit the Community Resource Centre in the atrium of the Blusson Spinal Cord Centre.