which may be correlated with communication, sensation and cognition, causing activity
limitation. It persists throughout the life span. The possibility of occurrence is at the time of
birth i.e. prenatal, perinatal and post natal. CP is found in 2-3 children per 1000 births. The
level of severity, parts of body affected and the symptoms differ for each child. At present,
there is no cure for CP, however many supportive treatments such as rehabilitation therapies,
medications and surgery may help alleviate symptoms. As these standard treatments do not
address the pathophysiology of the disorder, there is a need for new treatment strategies.
Recently, stem cell therapy is being explored extensively as a potential treatment strategy for
CP. Stem cells are the immature cells of an organism that are capable of differentiating into
more cells of same type or different. These cells carry out the repair process either by directly
Medical Research as promising results of stem cell therapy was observed in a 2.2-year-old
female child diagnosed with CP. During 8th week of gestation, the mother suffered from
chicken pox and was on medications. The child was born at full term through caesarean
section and cried immediately after birth and had a normal birth weight. There was a history
of meconium aspiration and breathing difficulty at birth for which she was in the neonatal
intensive care for 9 days. A two-dimensional echocardiogram was done which revealed
patent ductus arteriosus. After 2 months, a repeat two-dimensional echocardiogram echo
revealed ductal closure. At 9 months of age, parents noticed developmental delay and on
consultation with paediatrician she was diagnosed as a case of Cerebral Palsy (CP). Magnetic
resonance imaging (MRI) of the brain was done which revealed bilateral subcortical and deep
white matter abnormalities.
In India, NeuroGen Brain & Spine Institute is a well-known stem cell therapy centre for
cerebral palsy treatment. Dr. Alok Sharma, a well-known neurosurgeon performs stem cell
therapy. When the patient was brought to NeuroGen hospital, a thorough examination was
done by a team of experts and Dr. Alok Sharma. On examination, Cognition was affected as
she could not understand and concentrate. She failed to respond to her name or make eye
contact. Babinski sign was positive with brisk deep tendon reflexes in the lower limbs, while
deep tendon reflexes in the upper limbs were normal. Muscle tone in the plantar flexors and
knee flexors bilaterally were increased. She could not sit from supine position and standing
balance was poor. She was dependent for ambulation, transfers and bladder bowel hygiene.
She was fed semisolid food as biting and chewing was affected. Speech was limited to 2-3
words. On Functional Independence Measure for Children (WeeFIM), she scored 34. She
was at level III on the Gross Motor Function Classification System-Expanded & Revised
(GMCS-E&R), On Gross Motor Function Measure-88 (GMFM-88) she scored 36.36%.
Prior to stem cell therapy, Brain positron emission tomography–computed tomography (PET-
CT) scan was performed. It revealed hypometabolism in bilateral cerebellar hemispheres,
bilateral thalami, hippocampi and amygdala. Rest of the brain parenchyma revealed preserved. Magnetic resonance imaging brain revealed diffuse paucity of the bilateral
cerebral white matter and mild dilatation of the lateral ventricles. Magnetic resonance
imaging-diffusion tensor imaging with fiber tracking revealed mild diffuse attenuation of the
bilateral cerebral fiber tracts.
After the assessment was done the patient was administered with stem cells by
Dr Alok
Sharma. Following stem cell therapy, the patient underwent a multidisciplinary personalized
neurorehabilitation program which included physiotherapy, occupational therapy, speech
therapy, psychological therapy, special education and nutritional advice. A personalized
home program was given to continue rehabilitation regime at home. After 9 months, to
enhance the functional improvements seen after the first stem cell therapy, the patient
underwent second cell therapy.
Post stem cell therapy, no side effects were reported. The child could crawl and walk
independently with the help of walker. She could independently transfer from the bed to the
floor as spasticity was reduced. She could perform reach out in all positions. Eating food
items such as a biscuit was possible as biting and chewing had also improved. Cognitive
improvements were observed. Her understanding and command following had improved. She
made more eye contact with her parents, and started responding to her name. She could now
indicate that she was hungry by crying, making it easier for her parents to understand.
Awareness of the surroundings and social interaction had improved. Before stem cell therapy,
she would pass urine and stool in the diaper, but now she would get down from the bed to the
floor, indicating to the mother her urge to pass urine/stool and after second cell therapy she
would pass urine/stool in potty chair only. On WeeFIM, scores improved from 34 to 38. On
GMFCSE&R, she improved from level III to level II. GMFM score improved from 36.36%
to 38.62%.
Comparative PET CT performed 9 months post stem cell therapy showed improved
metabolism in bilateral cerebellum, bilateral thalami and medial temporal cortex including
hippocampus and amygdale. In this study, PET CT was used to monitor the changes in the
metabolic activity of the brain after stem cell therapy as shown in the figure below.
Comparative PETCT scan after cell therapy.Top row (A) represents PET CT scan before stem cell
therapy. Bottom row (B) represents a 9-month follow-up PET CT scan after stem cell therapy. Post
transplantation shows significant improvement in uptake corresponding to medial temporal cortex
(MT), cerebellum (C) and thalamus (T).
This study has revealed that Stem cell therapy along with neurorehabilitation is safe and
effective treatment strategy for children suffering form cerebral palsy. This treatment
promotes acquisition of developmental milestones in kids with Cerebral Palsy.
