RESUMEN
BACKGROUND: The last two decades have come up with some important progresses in the genetic, immune, histochemical and bio (nano)-technological domains, that have provided new insight into cellular/molecular mechanisms, occurring in the central nervous system (CNS)--including in spinal cord-injuries. METHODS: In previous works, emerging from our theoretical and practical endeavors in the field, we have thoroughly described the principal intimate propensity and the pathophysiological processes--representing intrinsic limitations for self-recovery after SCI, and, at the same time, subtle targets for neuroprotection/recovery--and reviewed the main related worldwide-published reports. The aim of this paper is to emphasize the connections between such main aspects and some feasible integrative solutions, including the ones for clinical practice. RESULTS: Consequently, we stress upon some therapeutic suggestions regarding this subject matter by systematizing the most up to date and efficient ones--obviously, within major limits, according to the very low capacities of CNS/ spinal cord (SC) to post-injury self preserve and recover. Moreover, we also talk about accessible drugs, respectively those being already in clinical use (but at present, mainly used to treat other conditions, including the neurological ones) and hence, with relatively well known, determined effects and/or respectively, restrictions. DISCUSSIONS: The recent advances in the knowledge on the basic components of the afore mentioned CNS/ SC propensity for self destroying and inefficient endogenous repair mechanisms in the actual new context, will hopefully be, from now on, more effectively correlated with revolutionary--mostly still experimental--treatments, especially by using stem cells within tissue engineering, including, if needed, more advanced/courageous approaches, based on somatic cell nuclear transfer (SCNT). CONCLUSIONS: This paper contains the scientific motivated highlighting of some already available drugs, "neuroprotective" (and not only) properties too, which enable practitioners with (although not yet capable to cure--but anyway) more efficient therapeutic means, to approach the extremely difficult and still painfully disappointing domain, of spinal cord injury (SCI).
Asunto(s)
Traumatismos de la Médula Espinal/fisiopatología , Traumatismos de la Médula Espinal/terapia , Apoptosis , Caspasas/fisiología , Humanos , Medicina Integrativa , Modelos Neurológicos , Fármacos Neuroprotectores/uso terapéutico , Estrés Oxidativo , Recuperación de la Función , Transducción de Señal , Traumatismos de la Médula Espinal/patologíaRESUMEN
BACKGROUND: Discovery of neurotrophic factors--emblematic: the nerve growth factor (NGF)--resulted in better approaching central nervous system (CNS) lesions. Recently, another crucial property has been unveiled: their rather unique pleiotropic effect. Cerebrolysin is a peptide mixture that penetrates the blood-brain barrier in significant amounts and mimics the effects of NGF. METHODS: Comparative analysis: Cerebrolysin treated (10 ml x 2/day, i.v. x 3 weeks) vs. non-treated, in patients (all received aside, a rather equivalent complementary, pharmacological and physical, therapy). Two lots of patients, admitted in our Physical & Rehabilitation (neural-muscular) Medical-PR(n-m)M-Clinic Division, during 2007-2009: 69 treated with Cerebrolysin (22 F, 47 M; Average: 59.333; Mean of age: 61.0 Years old; Standard deviation 16.583) and 70 controls (41 F, 29 M; A: 70.014; M.o.a.: 70.5 Y.o.; S.d.: 6.270) were studied. The total number of assessed items was 13: most contributive in relation with the score of Functional Independence Measure at discharge (d FIM), were: admission (a FIM), number of physical therapy days (PT), number of hospitalization days (H), age (A) and--relatively--days until the first knee functional extension (KE). Concomitantly, the main/key, focused on neuro-motor rehabilitative outcomes, functional/analytical parameters, have been assessed regarding the speed in achieving their functional recovery. RESULTS: Concerning d FIM, there have not been objectified significant differences between the two lots (p=0.2453) but regarding key, focused on neuro-motor rehabilitative outcomes, functional/analytical parameters: KE (p=0.0007) and days until the first time recovery of the ability to walk between parallel bars (WPB--p=0.0000)--highly significant differences in favor of Cerebrolysin lot resulted. CONCLUSION: Cerebrolysin administration, as neurorehabilitative outcomes, proved to hasten, statistically significant, especially the recovery of some critical, for standing and walking, parameters. Thus encouraged, we have now initiated a comprehensive national, 5 year retrospective, multi-centre--based on unitary data acquisition frame and mathematical apparatus--study, to evaluate the results of the treatment with Cerebrolysin in traumatic brain injuries (TBI).