Spinal Cord Injuries : Treatments

by Food and Drug Administration (FDA)

(Page 3 of 3)

Treatments Under Study

Another drug under study is GM-1 ganglioside. Fred H. Geisler, M.D., Ph.D., a neurosurgeon at the Chicago Neurosurgical Center, headed a team at the University of Maryland Shock Trauma Center in Baltimore that studied 34 people with paralyzing spinal cord injuries in a placebo- controlled, double-blind, randomized study.

The study results were reported in the June 27, 1991, New England Journal of Medicine. Within three days of injury, 16 of Geisler's patients began daily injections of GM-1 for 18 to 32 days, while the rest received placebo injections. Patients given GM-1 had improved recovery of motor functions in the arms, and later in the legs. About half of the improvement occurred at the two-month mark. Most of the improvements happened within four months of patients' receiving GM-1 injections, but some improvements continued for up to one year after GM-1 treatment.

Researchers theorize that GM-1 ganglioside, naturally present in cell membranes of the spinal cord and brain, helps protect against additional nerve cell death after spinal cord injury and also stimulates nerve-fiber growth and repair. "We saw some major improvements. ... In many cases, people were walking where they could not ambulate at all before," Geisler says. He is now heading a new study of this investigational drug, following 166 patients given GM-1 at 22 medical centers in North America. Geisler says the goal is to enroll 720 patients.

Neural grafting, or transplantation of tissue into the brain and spinal cord, is still highly experimental. Possible sources of grafting material include genetically engineered cells, human fetal tissue, and other tissues from a patient's own body. Neural grafts are being tested in animal models of brain and spinal cord injury to find out if they can induce growth or replace damaged areas.

Other Improvements

Other factors besides drug advances and technology are improving the outlook for people with spinal cord injuries. Car accidents by far remain the number one cause of spinal cord injuries (47.7 percent), followed by falls, gunshot wounds, and recreational sports, particularly diving accidents. Spinal cord injury happens mostly to young people, and mostly to males (82 percent).

MCV's McKinley says improvements in on-site emergency medical management, with better-trained technicians skilled in stabilizing the spine to prevent further injury, means doctors are seeing more patients with "non-complete" injuries, or injuries where some function and motor sensation is preserved.

"We are also doing a better job of educating people in how to protect against spinal cord injury, such as wearing seat belts, buying cars with air bags, and not diving into shallow water," he says.

In rehabilitation, the emphasis remains on regaining as much functional ability as possible.

"Chronic patients and rehabilitation are the real challenge. Research is exciting and potentially part of the future, but it still has a long way to go," McKinley says, pointing out that helping patients through the adjustment period after injury remains challenging. "They need to know how to self- catheterize, how to detect bladder infections," he says. "Are the doors at home wide enough for a wheelchair? Do they need a ramp?"

McKinley says the first thing newly injured patients ask about is their ability to walk, but questions about sexuality are not far behind.

"Paralysis can affect the ability to have an erection. ... But with adaptations, sexual relations are very possible. So I tell patients yes, it's possible, but different. Loving and caring and other means of sexual gratification take on new priority for injured patients," he explains.

Hope and patience may be the most important factors regarding the future treatment of spinal cord-injured people. Hope comes from optimism about recent advances in treatment, but research complexity and funding issues make patience necessary as well.

"For at least the last decade, research papers have shown that spinal cord injuries can be improved, or that the amount of injury can be decreased," Geisler says. "My hope is that lab findings will be able to move to the clinical area." Marc Miller, like many people with spinal cord injuries, is both optimistic and philosophical about the treatment advances.

"I think in the next 10 years they will find treatments that reduce the impact of spinal cord injuries. But I think it's important for people to remember that we're just normal folks who can't walk," he says. "I have a better grasp of who I am now; being in a wheelchair gives you a different perspective. I'm not disabled, I just can't walk. I play wheelchair basketball, I want to learn to water ski and to snow ski. ... I just want to do all I can do now."

About the Author

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