Статьи и материалы.
Embryonic neural cells transplantation therapy
for vegetative and minimal conscious states.
Tsymbaliuk V.I., Latyshev D.Yu., Pichkur L.D.
Institute of Neurosurgery n. acad. A. Romodanov AMS of Ukraine.
32 Manuilskiy str., Kiev, 04050, Ukraine.
Sixty-four patients (38 men, 26 women 1-38 years, mean 7,7) with vegetative state (persistent /permanent) and minimal conscious state (mobile/unmobile) after traumatic brain injury (TBI) – 21 cases and after atraumatic brain damage (ABD) – 43 cases. It was treated by embryonic neural cells transplantation (ENCT) therapy and followed up at 1 to 10 years. The study was approveal by the local Ethics Committee in accordance with the Helsinki Declaration of 2000. We are diagnosed on establishment criteria of Multy-Society Task Force on PVS (1994) and Aspen Consensus Conference (1999) persistent vegetative state (PVS) in 10 cases, permanent or chronic vegetative state (ChVS) in 8 cases and minimal conscious state (MCS) in 46 cases (mobile – 26, unmobile - 20). The clinical condition before and long-term after surgical treatment defined by Rappaport Disability Rating Scale (RDRS) and Rancho Los Amigos levels cognitive function (RCFS). There neural graft (NG) is native fragment human embryonic tissue 1-2 mm3 and native or cryoconserved suspension neural cells, 7-9 weeks gestation, 36,7±11,5x106 cells in 1 ml suspension. The NG introduced intrathecal (8 cases), intraparenchymatously (46 cases) and intrathecal with intraparenchymatously (10 cases). The intraparenchymatously ENCT include: transplantation NG in to the central or precentral cortex and stereotactic introduce NG in to the deep structures (VL thalami and caput nucleus caudate). There were no complication in the pre- and postoperative periods. The “Good” long-term result on RDRS (decrease on 6 to 10 scores) defined in 50% cases, “Minimal Change” (decrease on 3 to 5 scores) – in 34,5% cases. The “Poor” result on RDRS (include 3 died patients after 1,5; 2 and 9 years after surgery) complete 15,5% cases. The “Good” reintegration cognitive function on RCFS (increase 4-6 levels) defined in 12,5% patients, “Minimal Change” (increase 2-3 levels) – in 62,5% patients and “Poor” result – in 25% cases.
Therefore, ENCT effective restorative procedure for PVS patients, more decreased disability and moderate reintegrated cognitive function in long-term period after surgery. We are defined the best result in patient with atraumatic brain damage and patients with mobile MCS.