Cerebral Palsy

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Cerebral palsy refers to a group of diseases involving problems with hearing, seeing, movements, learning and thinking that occur due to abnormalities related to the development of the brain.

 


TREATMENT LIST
Clinics providing Cerebral palsy treatment:$ 15600.00

Causes
Cerebral palsy occurs because of abnormalities or due to any trauma to the brain. Most commonly, it occurs during the growth of the fetus in the womb. However, it can also happen during the first 2 years after birth, while the baby’s brain is still developing.
In some patients with cerebral palsy, a part of the brain is damaged because of reduced amount of oxygen (hypoxia) in the area. The exact cause for the same is not known.

Birth asphyxia (reduced level of oxygen during birth) and trauma are the uncommon causes of this disease.
Premature babies have a higher risk of suffering from cerebral palsy. This condition also occurs during early infancy due to the conditions mentioned beneath:

  • Head injuries
  • Bleeding in the brain
  • Infections in the brain, such as encephalitis, herpes simplex and meningitis
  • History of mother having rubella infection during pregnancy
  • Severe jaundice

Different types of Cerebral Palsy are:

  • The most common type of this condition is Spastic cerebral palsy
  • Dyskinetic cerebral palsy, also called athetoid cerebral palsy, causes abnormal movements such as twisting and jerking.
  • Hypotonic cerebral palsy results in floppy muscles, more at rest, and higher range of motion of the joints.
  • Ataxic cerebral palsy leads to unsteady gait, tremors, loss of coordination and other abnormal movements.
  • Mixed cerebral palsy causes a combination of any of the above symptoms.

Symptoms

Damage to the cerebrum, the largest part of the brain, results in the loss of normal functions of the nerves in different parts. Most children with this problem develop increased muscle tone or spasticity.

Spasticity usually affects:

  • Left or right side of the body (spastic hemiplegia)
  • One leg or arm
  • Both the legs (spastic diplegia)
  • Both the arms and the legs (spastic quadriplegia)

The symptoms usually start manifesting before the age of 2 years. In severe cases, they start appearing at 3 months of age.

Symptoms include:

  • Abnormal sensations
  • Abnormal movements
  • Decreased intelligence
  • Abnormal muscle tone
  • Difficulty in feeding the infant
  • Increased drooling
  • Hearing problems
  • Irregular breathing
  • Reduced range of motion
  • Learning disabilities
  • Pain
  • Peg teeth
  • Complete or partial loss of movements (paralysis)
  • Seizures
  • Problems in swallowing (at all ages)
  • Difficult Speech (dysarthria)
  • Vision problems
  • Incontinence of urine
  • Vomiting and constipation

Tests and exams

A doctor’s examination often reveals:

  • Abnormal gait and a tendency to hold the arms close towards the sides of the body as if tucked in
  • Scissor like movements of the legs
  • Walking on the toes
  • Slow and abnormal writhing movements, which worsen when in stress and disappear during sleep
  • Delayed motor skills development, including reaching, rolling, crawling, sitting and walking
  • Infant reflexes including startling and sucking continue even after the age at which they should ideally disappear
  • Muscle contractions
  • Joint contractures
  • Spasticity of the muscles (lack of ability to stretch)
  • Muscle weakness
  • Muscle tremors

The following tests can be performed:

  • CT scan of the head
  • Hearing screen
  • Blood tests
  • Electroencephalogram (EEG)
  • Vision testing
MRI of the head

DETAILS

Management
Cerebral palsy cannot be cured. The aim of the therapy should be to help the patient be as independent as possible.
Cerebral palsy treatment

The treatment involves a team approach of:

  • A primary care physician
  • Nurses
  • A social worker
  • Occupational, speech and physical therapists
  • Other specialists

Treatment is aimed at reducing patient’s symptoms and at preventing complications.

Eligibility criteria:

Eligible Age for Study: 4 Years and above
Genders: Both
Healthy Volunteers: Accepted

INCLUSION CRITERIA:

This study includes children and adults suffering from cerebral palsy and patients having dystonia as well as able-bodied children above 6 years of age. The patients must meet the following criteria:

  • The patient must be diagnosed with cerebral palsy or dystonia.
  • He or she should have the ability to follow the instructions for successful completion of the testing.
  • The patient must be willing and motivated to do the tasks.
  • The patient should be above 4 years of age.
  • The patient should stop taking medications that affect the spasticity, a minimum of 48 hours before the first investigation. But, if the effect of any anti-spasticity drug is longstanding and stable, it can be maintained during the entire study.

EXCLUSION CRITERIA:

  • Lack of ability of the person to carry out instructions for accomplishing the tasks.
  • Any structural deformity at the level of knee joints.
  • If patients are not able to fulfill all the conditions or the tasks, they can still be enrolled for completing a part of the study.

Basic overview: some basic principles must be followed before initiating Regenerative Tissue Therapy (cells) infusion (in case of frozen Regenerative Tissue Therapy (cells)).
The frozen Regenerative Tissue Therapy (cells) are first thawed in a warm water bath at 37o C by constant agitation.
Precautions must be taken to avoid the exposure of the Regenerative Tissue Therapy (cells) to bright light while thawing.
The Regenerative Tissue Therapy (cells) should then be collected in a syringe with the help of a wide bore needle (No. 18) to prevent any damage to the fragile Regenerative Tissue Therapy (cells). The syringe should be covered with a tape in order to prevent exposure to light.
A 23 gauge needle should be used for the infusion. The infusion should be given slowly over a period of 3 to 5 minutes in dim light.
Keep a check for immediate transfusion reaction.

Dosage and route of infusion of Regenerative Tissue Therapy (cells):

The dose of Regenerative Tissue Therapy (cells) can vary between 30 and 100 million Regenerative Tissue Therapy (cells) to generate positive results. However, a dose as low as 1 million can also be sufficient to generate the desired results.
An intravenous route is recommended for the administration of Regenerative Tissue Therapy (cells) in most cases. However, we also advocate intra-arterial, intramuscular, subcutaneous, sub-dural, sub-arachnoid, intrathecal and intraocular administration in some special cases and some specific disease. Direct on-site administration of the Regenerative Tissue Therapy (cells) at the site of injury can be done using special interventional techniques or by direct on-site implantation or injection.
The decision about the exact dosage and the mode of infusion is best taken on a case to case basis after thorough deliberation of the complete medical history of the patient and depending on the cause and the extent of the illness.

Allogenic Umbilical Cord Derived Regenerative Tissue Therapy (cells)

Each infused dose of umbilical Regenerative Tissue Therapy (cells) must be preceded by GM-CSF therapy one day before the infusion in a dosage of 5 µ-gram per kg body wt in adults and 2.5 µ-gram per kg body wt in pediatric patients.

Mode of administration for GM-CSF therapy:
As a subcutaneous injection under the skin
As an intravenous infusion into the vein

How It Works

General points to understand for Regenerative Tissue Therapy (cells) obtained from cord blood or umbilical cord lining
CD 34+ cells mentioned for the purpose of discussion here are the cells akin to hematopoetic cells carrying CD 34+ markers, which are procured from cord blood following isolation by using different cell sorting techniques and magnetic bead.

Mesenchymal Regenerative Tissue Therapy (cells) mentioned for the purpose of discussion here are the cells akin to total nucleated cells, which are derived from the cord lining and are obtained after exhaustive processing.
Recommended dosage of Regenerative Tissue Therapy (cells)

32-80 million Mesenchymal Regenerative Tissue Therapy (cells) + 10 to 40 to million CD 34 + cells over 1 year of duration.
Duration: approximately 8-20 million MSCs + 2.5 to 10 million CD 34+ cells over 3 month of duration (simultaneously with GCSF one day before the Regenerative Tissue Therapy (cells)).

A total dose of 100 to 200 million Regenerative Tissue Therapy (cells) for generating adequately favorable results.

Route of administration of Regenerative Tissue Therapy (cells)
Intravenous

Treatment Details

Side Effects of GM-CSF

Points to remember regarding the side effects of GM-CSF

  • Most of the people do not develop all the side effects listed below.
  • Side effects are usually reversible and go away once the treatment is complete.
  • Side effects are predictable as far as their onset and duration are concerned.
  • There are numerous options to minimize and prevent these side effects.
  • There is no relation between the occurrence of these adverse effects and the effectiveness of the therapy.

Commonly seen side effects of GM-CSF therapy:

    • Once the first dose of GM-CSF is administered, a patient may experience reduced blood pressure, flushing, fast heart rate, lightheadedness or dizziness. This is called the first-dose effect. It does not occur with future doses.
    • Loose motions
    • Localized reactions at the site of injection such as swelling, tenderness and redness
    • Weakness

Less common side effects

    • Mild flu-like symptoms such as fever, generalized body pains, headache and fatigue
    • Swelling in arms and legs

Possible adverse effects caused by Regenerative Tissue Therapy (cells)

  • Fever
  • Headache
  • Rash

Quality Check

The cells should be tested to meet the quality standards proposed by the GMP and GLP:

HIV I AND II by PCR and ELIZA

HCV by PCR and ELIZA

HbsAG by PCR and ELIZA

Endotoxin content

Bacterial contamination

CMV

OR

Allogenic / Autologous therapy by using Regenerative Tissue Therapy (cells) obtained from placenta, amniotic fluid and / or amniotic sac

Diverse forms of progenitor cell populations such as mesenchymal, trophoblastic, hematopoietic and possibly many more primitive Regenerative Tissue Therapy (cells) can be obtained from the placenta and the amniotic fluid. At least some of these amniotic and placental cells have a common origin, the inner cell mass of the morula. Most forms of progenitor cells obtained from these 2 sources share common characteristics. The placenta and the amniotic fluid also contain numerous progenitor cell types from the developing embryo such as muscle, bone and fat.

Placenta and Amniotic sac (amniotic membranes):

Once the harvesting of blood cells derived from the umbilical cord (UCB), the placenta blood (UPB) and the placenta tissue (UPT) is carried out simultaneously for their content of nucleated cells, CD34 (hematopoietic stem progenitor marker) positive cells, it showed that the nuclear cell obtained from UPB and UPT was almost 3-4 times than those derived only from the umbilical cord blood. The cells that were obtained from UPB (Placental Blood) and UPT (Placental tissue) had a better survival ability than the cells obtained from UCB when tested under long-term cell culture conditions. These cells, when stored in the liquid nitrogen, did not show any significant loss of total nucleated cell count and CD34 (+) cells. The results also proved that the UPT and UPB had more suppressor lymphocytes, an important feature that helps in the prevention of graft-versus-host disease. These implications suggest the importance of placental tissue and blood collection and their simultaneous processing with the umbilical cord blood for Regenerative Tissue Therapy (cells) transplantation.

Amniotic fluid

Regenerative Tissue Therapy (cells) obtained from amniotic fluid can be used to differentiate into muscular tissues, adipose tissues, cartilage, nerve, bone, blood vessels, etc.

These cells are known to provide a valuable solution for organ, cell and tissue repair.

The Regenerative Tissue Therapy (cells) that are sourced from amniotic fluid are referred to as Amniotic Fluid Derived Regenerative Tissue Therapy (cells) or AFS cells. They denote the intermediate stage between the embryonic Regenerative Tissue Therapy (cells) and the adult Regenerative Tissue Therapy (cells). These cells have the ability of self-renewal, which can be termed a characteristic defining property of Regenerative Tissue Therapy (cells). These cells can be utilized for producing a broad range of cells, which can be highly valuable for the therapy.

AFS cells are found in plenty in amniotic fluids and can be obtained by using a procedure called amniocentesis, which is usually carried out to examine cells for prenatal diagnosis of genetic disorders. Childbirth is also a valuable source of amniotic fluid. The chances of a perfect match are higher in this case due to its primitive nature.

AFS cells offer several advantages as given below:

1) They can be obtained easily by performing amniocentesis.

2) These cells multiply and double in every 36 hours. So, they can be easily grown in large amounts so as to generate large quantities of Regenerative Tissue Therapy (cells).

3)’Feeders’ and ‘Factors’ are not required for guiding them to the targeted cell line.

4) They are not known to cause tumors. That is why they are given a higher preference over the embryonic Regenerative Tissue Therapy (cells).

5) Specialized cells, which are generated from AFS cells, comprise of all 3 forms of cells existing in the developing embryo such as ectoderm, mesoderm and endoderm. Therefore, these cells have the ability to differentiate into any cell type, organ and tissue of the body.

6) Just like the embryonic Regenerative Tissue Therapy (cells), these cells can be used to generate any type of adult cell.

The project director usually advocates the use of Regenerative Tissue Therapy (cells) that are obtained from amniotic sac, placenta and / or amniotic fluid. These Regenerative Tissue Therapy (cells) are processed and isolated carefully. Then, they are cultured in a clean room as per the GLP and GMP standards. They can also be used for allogenic as well as autologous use, just like the Regenerative Tissue Therapy (cells) that are isolated from cord tissue and cord blood, at times, with simultaneous hyperbaric oxygen and / or chelation therapy following administration of GM-CSF. The selection of the Regenerative Tissue Therapy (cells) to be used and their dose, their route and mode of administration, accompanying therapies etc. differ on a case to case basis.

Route of administration of Regenerative Tissue Therapy (cells)

Intravenous

Possible side effects caused by amniotic Regenerative Tissue Therapy (cells)

  • Fever
  • Headache
  • Rash on the skin

Quality Check

The cells should be tested to meet the quality standards proposed by the GMP and GLP as given below:

HIV I AND II by PCR and ELIZA

HCV by PCR and ELIZA

HbsAG by PCR and ELIZA

Bacterial contamination

Endotoxin content

CMV

Or

Autologous Bone Marrow derived Regenerative Tissue Therapy (cells)

  • 150-200 ml of bone marrow should be collected in a blood bag under aseptic precautions in an OT under general anesthesia.
  • Then, Regenerative Tissue Therapy (cells) should be processed and isolated, keeping in mind the standards recommended by GMP and GLP.
  • The final volume of 5 -10 ml should be infused intravenously within 6-8 hours of its collection.

Regenerative Tissue Therapy (cells): Route of administration

Intravenous

Or

Autologous Regenerative Tissue Therapy (cells) derived from adipose tissue

  • About 150-200 ml of adipose tissue is obtained in a blood bag by performing a procedure called liposuction. The procedure should be performed by a plastic surgeon in an OT, after giving general anesthesia.
  • Regenerative Tissue Therapy (cells) should then be processed and isolated following the standards recommended by GLP and GMP.
  • The final volume of 5 -10 ml should then be administered via intravenous route within 6-8 hours of the collection.
  • As the Regenerative Tissue Therapy (cells) cannot be checked for possible contamination, we advise providing an antibiotic cover before the infusion.

Mode of administration: Intravenous.

Or

Autologous Regenerative Tissue Therapy (cells) derived from Peripheral Blood

  • The Regenerative Tissue Therapy (cells) are first obtained by performing a procedure known as apheresis.
  • The procedure should be performed in an ambient environment using a cell separator (Kobe Spectra or Hemonitics) that is programmed to provide the desired dose of Regenerative Tissue Therapy (cells) (about 200-250 ml) from the peripheral blood stream in a blood bag designed for the purpose.
  • An infusion with GM-CSF (in a dosage of 5 microgram per kg weight in adult person and 2.5 microgram per kg weight in a child) before initiating the procedure helps to ensure maximum mobilization of the Regenerative Tissue Therapy (cells) from the bone marrow.

Mode of administration: Intravenous.

Or

Autologous Regenerative Tissue Therapy (cells) isolated from the skin, the teeth, the small intestine, the cornea, the liver etc.

  • The Regenerative Tissue Therapy (cells) should be procured from one of these organs with the help of sophisticated techniques, which are performed in an OT after administering general anesthesia.
  • Regenerative Tissue Therapy (cells) are then processed and isolated as per the standards of GLP and GMP.
  • The final volume of 5-10 ml is then administered intravenously within 6-8 hours of the collection.
  • Since the Regenerative Tissue Therapy (cells) can not be tested for any contamination, an antibiotic cover prior to the infusion is highly recommended.

Mode of administration: Intravenous.

Points for evaluation

Functions Complete Failure to Execute

Incomplete(Doubtful)

Complete

Turning from the Abdomen to the Back

Retention of Head

Crawling on Abdomen

Taking toys by hand

Standing

Sitting

Walking

Understanding addressed speech

Tracking toys by eyes

Speaking

Recommended Self and Home Care:

Getting healthy food and nutrition

Ensuring safe home environment

Performing exercises advised by healthcare providers

Practicing good bowel care habits by using stool softeners or laxatives and by increasing intake of fluids and fibers

Protecting the joints from injuries

Admitting the child in a regular school is advised, unless lack of mental development or any physical disability makes this impossible. Special schooling and education may also help.

Most adults are able to live in the community, sometimes independently and sometimes with help from others. The patient may need to be placed in an institution in some severe cases.

The following aids help patients with learning and communication:

Hearing aids

Glasses

Walking aids

Muscle and bone braces

Wheelchairs

Occupational therapy, physical therapy, orthopedic treatment and other therapies may also be needed.

Medications may include:

Anticonvulsants for preventing and reducing the frequency of convulsions

Botulinum toxin to manage drooling and spasticity

Muscle relaxants (baclofen) to minimize tremors and spasticity

Surgery may also be needed in some patients for:

Controlling gastroesophageal reflux

Cutting some nerves arising from the spinal cord so as to reduce pain and spasticity

Placing feeding tubes

Releasing joint contractures

Burnout and stress are quite common among parents and caregivers of patients with cerebral palsy. Frequent monitoring for the same is needed.

Support Groups

Check cerebral palsy resources to know about the organizations that provide support and additional information about the problem.

Outlook (Prognosis)

Cerebral palsy is a chronic disorder that persists for the entire life of the patient. Long-term care is often required. However, it does not affect the expected length of life of the patient. The extent of physical disability varies.

Possible Complications of Cerebral Palsy

Bowel obstruction

Bone thinning

Hip dislocation

Arthritis of the hip joint

Repeated trauma due to falls

Pneumonia due to choking

Joint contractures

Poor nutrition

Reduced intellectual abilities (occasional)

Reduced communication skills (occasional)

Scoliosis

Social stigma

Convulsions (in about 50% of patients)

When to see a Medical Professional

Patients or their caregivers should call a healthcare expert if they notice the symptoms of cerebral palsy, especially when they know that an injury had occurred during early infancy or birth.

Prevention

Proper prenatal care often helps to reduce the possibility of some rare causes that lead to cerebral palsy. However, in spite of dramatic improvements in healthcare in the past 15 years, there is no improvement in the rate of occurrence of this illness. In most patients, the injury causing the disease is not preventable.

Pregnant women with some medical disorders should be followed in a high-risk prenatal clinic.

Alternative Names

Paralysis – spastic; Spastic paralysis

FAQs

What are the Benefits of Regenerative Tissue Therapy Therapy?
Regenerative tissue therapy, also known as Stem Cell Therapy,helps in the repair,healing and regeneration of damaged or injured tissues. It regeneratestissues that are injured due to meniscal tears, rotator cuff tears, ligament tears, tennis elbow and degenerative diseases such as arthritis and osteoarthritis. It reduces pain caused due to injury and improves performance. The treatment is performed in theoffice, under local anesthesia. This eliminates any risks associated with anesthesiaor surgery.
How do I know Whether this Therapy is Good for Me?
For this, you should consult your doctor if you suffer from any degenerative diseaseor have any type of joint pain. Regenerative Tissue Therapyallows the patient’s body to use it’s own cells for healingand repairing damaged tissue.
Are there any Ethical Issues involved with Adult Cells?
Not at all. Adult Regenerative tissue cells are not embryosand donot have the potential to develop into a human being. They reside within the bone marrow as well as the fatlayers,and exist in large quantities.
Does the Therapy Involve any Side Effects?
Regenerative Tissue therapy is an extremely safe procedure. Following a complete medical evaluation, our specialists determine whether you are theright candidate for this treatmentor not. A few patients might experience some pain and soreness during the post-operative period. Since fat and autologous blood is used, there are minimal chances of an allergic reaction.
What’s the Difference between Cells from Bone Marrowand Fat?
Both bone marrow and adipose cells belong to a type of adult cell calledMesenchymal Cells. Bone marrow derived cells are collected from the hipboneand adipose cells are collected through a mini liposuction procedure. The bone marrow cells possess a superior ability to repair as well as differentiate into ligaments, bone and cartilage.Adipose cellson the other hand have regenerative properties to produce new blood vessels, a process which is important for the delivery of nutrients and oxygen to the tissues.
How do I know Whether the Cells are injected in the Right Place?
We know that the success of any treatment depends upon a reliable delivery system. We put to use a simple injection in and out method, in order to deliver the cells. Also, our injections are all done under X-Ray (fluoroscopy) to visualize the site of injury as well as provide effective and accurate treatment.
What is PRP and why is it used along with Regenerative Tissue Therapy?
PRP is blood plasma which containsa high autologous concentration of cells known as platelets. These cells release growth factors as well as other proteins which promote healing of wounds in bone and soft tissues. When PRPis injected, the high concentration of platelets delivers a powerful dose of growth factors that helps to accelerate and enhance the repair and healingof tissues. In addition, these growth factors attract regenerative cells to the injury site. While injecting PRP, more than 1injection is recommended in order to maximize results.
How is PRP Derived?
PRP is obtained using a safe and simple blood draw. For collection, special collection tubes are used and approximately 16 cc of blood is obtained. The collected blood is centrifuged using special equipment until the PRP is obtained. Following this process,PRP is ready to be injected or mixed along with fat for aesthetic enhancement.
Is there any Special Procedure to prepare for when undergoing PRP or Regenerative Tissue Therapy?
Prior to treatment, patients are encouragedto undergo a simple detox in order to prepare the body to be better conditioned for receiving the regenerative cells. Patients mustcease smoking and alcohol consumption at least 1 week before the procedure. An IV Vitamin Therapyis recommendedto clean the system oftoxinsand simultaneously infuse vitamins as well as minerals in the bloodstream. The vitamins are required by some cells to perform important functions. Possessing a good balance of such vitamins will improve the effectsof the treatment.
When can I Resume Work and Routine Activities?
The treatment is ambulatory. Generally, patients are sore during the first couple of days after the injection. They can resume work after 2 to 3 days, depending upon the site of treatment as well as the levelof physical activity required from patientsat their respective jobs.
Is the treatment approved by the FDA?
There is no clear protocol to treat any disease using adult cells in the U.S. With advancements in science and more research, the laws and regulations in the field of regenerative medicine have been changing quite rapidly. Even though the therapyis not regulated by the FDA, we ensue that we follow the standard regulations for patients’safety as well as safe laboratory practices.

PRECAUTION

Consulting

  • Before doing any treatment please consult your doctor to confirm if the treatment is the right one for you
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