Abstract W P129: Armamentarium Of Neurorestorative Therapies: A Clinico-Functional Paradigm For Stroke Recovery
Background: The limited time window of neuroprotectants has enabled restorative therapies to be aggressively used in research to repair a disabling stroke. Cell based, electrotherapeutics and growth factor based therapeutics help in axonal remodeling, neuronal plasticity inducing cortical reorganization. The present paper studied the efficacy of cell transplantation, motor learning regimes (CIMT, rTMS and virtual reality) on clinical scores and functional imaging.
Methods: Patients with stroke between 3 to 18 months of index event, MRC grade of wrist (mass flexion/ extension) at least = 2, NIHSS of between 4 and 15 were recruited and assessed at baseline, 3 and 6 months using MRC scale, ashworth tone, fugl meyer and barthel index along with functional imaging. Twenty patients were transplanted with 50 million autologous stem cells intravenously followed by virtual reality therapy for 8 weeks with respective controls. Fifteen patients are currently administered CIMT + r TMS and CIMT alone for 2 weeks. rTMS is applied over DLPFC (dorso lateral prefrontal cortex) region of the lesioned stroke hemisphere using an intensity of 120% RMT of the non-stroke hemisphere. MEP (Motor Evoked Potential) in paretic flexor muscle is recorded with each session lasting for 45min.
Results: No cell related adverse reactions were observed. Barthel index was statistically significant amongst the two groups (p=0.04).Increased laterality index with a high voxel counts of BA 4, 6 and a high corticospinal fiber number was observed at follow up in stem cell group. An increase of 17.1% in FL ratio and 28% in the FN ratio was found between baseline and one year follow up (95%CI-12.3-3.4, p=0.06) in all stem cell patients as compared to the controls. In ongoing patients, baseline FM score (mean of 34.2/66) increased to 47.8 (follow up) with a percentage gain of 34.2 % after the CIMT+ rTMS session and baseline mean MEP 72% with 8%gain as compared to CIMT alone. No significant difference was observed in MRC (p=0.67) and ashworth scale (p=0.98) between the two groups.
Conclusion: Above mentioned neurorestorative therapies aid in recovery through re building of neuronal circuits (cell therapy) and principles of learning. Proof of concept intervention strategies need to be developed in future trials.
Author Disclosures: A. Bhasin: None. M. Srivastava: None. M. Srivastava: None. R. Bhatia: None.
- © 2015 by American Heart Association, Inc.