Case Study

Patient A,

Male, American

Patient Overview

Age at time of treatment: 18 – 25
Injury Level: C7
Treatment Received: Stem Cells, Epidural Stimulation
Location of Treatment: Thailand
Time between injury and treatment: —
Date of Surgery: 02/09/2018
Date of Discharge: 05/10/2018

Condition on Admission

Patient sustained a C7 fracture-dislocation on November 2, 2016. He experienced subsequent spinal cord myelomalacia (softening of the spinal cord) and has minimal motor or sensory function below the injury level. He has neurogenic bowel and bladder. Patient does not suffer severe spasticity but does suffer moderate to severe neuropathic pain, particularly in the upper extremities. This is managed by high doses of Gabapentin (600 mg, 4 times a day). Patient is able to move his upper limbs and is independent in his daily activities.

Previous Therapies & Treatments

Prior to coming to Verita Neuro, patient received stem cell treatment in 2017, as well as physical and occupational therapy.

Verita Neuro Treatment Received

After a spinal MRI scan and comprehensive blood work, patient underwent laminectomy and implantation of the epidural stimulation device. The device is the ‘Medtronic Restore Advance 16-electrode MRI Compatible Device’. The surgery was completed without significant adverse effects and the surgical wound healed normally. No serious complications were reported during the hospital stay. Patient also received 100 million Amniotic Fluid Stem Cells (hAFSC) through a combination of IV injection and lumbar puncture injection. Device Mapping and physical therapy were carried out after surgery for 35 days, and the patient was discharged.

Results

Motor Functions
Sensory Functions
Autonomic Functions

Patient is able to stand with support at a parallel bar when the spinal stimulator is switched on. He is able to lock his left knee better than right knee. He has good upper trunk control, but limited lower trunk control. Patient is able to lock his hips which allows him to stand. While standing, patient applies more weight to his right leg than left leg. Patient is able to take steps with the walking frame, no hoist required, and is able to lift both feet when taking steps. He is able to lock his left knee consistently, but right knee only sometimes. Patient has very good coordination between left and right foot when taking steps. When taking short steps, patient does not require assistance in foot placement, but does when taking longer steps.

Patient’s gross motor skills have improved significantly when Epidural Stimulation device is switched on, including ankle, hip and knee flexion, and knee extension (kicking out). Patient has good static sitting balance and no support is needed. However, during dynamic sitting, balance is poor due to weak lower trunk muscles. Static standing balance is good at the parallel bar.

Patient experienced no improvement in sensory function.

Spasms and spasticity are lessened when epidural stimulation device is switched on.
There was no noticeable change in bladder and bowel functions. Patient is still taking the same dose of Gabapentin (600 mg, 4 times a day), therefore no change was visible in neuropathic pain. After 35 days, patient was discharged and will continue his physiotherapy back home.

Improvements are monitored in 15 targeted areas: 11 Motor areas and 4 Sensory areas. However, the number of targeted areas may vary depending on patient’s condition prior to admission. If patient does not experience symptoms in certain Motor/Sensory functions, or is not impaired in a speciﬁc targeted area prior to surgery, it is excluded from the report (Not Applicable). If there is progress in any given area — either mild, moderate, or signiﬁcant — it is measured and reported as positive (“Yes”). No improvement, the existence of pain or spasms, or an inability to perform a measured function is reported as “No”.

Results Interpretation

In this patient, fine motor skills were normal, therefore 14 areas instead of 15 were targeted. Motor function improved in 10 out of 10 targeted areas when the Epidural Stimulation device was switched on. There was no change in neuropathic pain. Patient has not noticed any changes in Sensory Function areas, and more feedback will be collected after 3 months to note any improvements made by regenerative medicine treatment. Overall, improvements were recorded in 10 out of 14 targeted Motor and Sensory Function areas.

Three Month Follow Up

Three months after discharge, the patient completes 15 hours of therapy per week with local physio.

Motor Functions
Sensory Functions
Autonomic Functions

Patient has not experienced much change in motor function since discharge. Patient has noticed moderate improvement during stepping exercises. Patient is able to lift both feet up very well while taking steps, however, still requires assistance in foot placement. He is able to lock his left knee, but not his right knee, and his coordination is improved in both legs. When standing with support, he is able to lock his hips well.

Patient has not noticed much change but has not experienced any increase in spasms, spasticity, or neuropathic pain. In fact, he has noticed minor improvements in spasms when the epidural stimulation device is switched on. Patient’s neuropathic pain has also remained stable and he is still taking Gabapentin (600 mg, 4 times a day).

No visible changes were seen in muscle mass or stamina. However, the patient noticed the strengthening of core muscles in the abdominal area, which does help the patient with emptying his bowel faster.

Overall, the patient is very satisfied with his outcomes after the Epidural Stimulation surgery. He will continue his physical therapy and another follow-up call will be made in three months time.

Six-Month Follow Up

Six months after discharge, the patient completes 15 to 20 hours of physical therapy per week. The patient has returned to Verita Neuro for more mapping sessions and for regenerative medicine treatment, seven months after his initial visit. He received 100 million Amniotic Fluid Stem Cells (hAFSCs) through two lumbar puncture injections and one IV injection.

Motor Functions
Sensory Functions
Autonomic Functions

Patient’s gross motor functions have improved moderately, all programs on his device are still working. The patient is able to flex his ankle, hip, and knees, as well as perform knee extensions – both kicking and pushing out. Patient’s dynamic standing balance has improved moderately as well. The patient has noticed an increase in muscle mass in legs since the epidural stimulation device was implanted.

The patient has noticed significant improvements during standing and stepping exercises. The patient is still able to stand up straight, has good static standing balance, and improved trunk control. Patient is still able to lock his hips and bears weight equally on both legs. However, patient is still not able to lock his knees completely and requires assistance in keeping his knees locked.

During stepping exercises, the patient is still able to lift his feet and set them down by himself without any assistance. Significant improvement was noticed in the patient’s foot coordination while taking steps. Patient is able to lock his left knee the majority of the time, however, requires assistance in locking his right knee. Patient also reports improvement in strength and stamina, his core muscles have become stronger.

The patient has reported mild improvement in his neuropathic pain. Patient is now taking 300mg of Gabapentin per dose instead of 600mg.

Patient noticed an increase of spasm and spasticity after receiving stem cells this time. Patient reports that he is not able to switch on the overnight program on the epidural stimulation device due to the sensation of the electrical current, which does not allow him to sleep. When the stimulator is on, the patient does not experience spasms, but sometimes does when it is off. Patient has not noticed any improvement in bowel functions and sweating ability, however mild improvement is noticed in his bladder functions. Patient has also regained his sexual functions. Patient has noticed an increase in sensation when his bladder is full and before he has to go to the bathroom.