Julia
- Spinal Cord Injury (SCI),
- T6, T7, Complete
Stem Cells, Epidural Stimulation
- Name:Julia
- Age at Time of Treatment:Under 18
- Sex:Female
- Nationality:Dutch
- Treatment Location:Thailand
- Diagnosis on Admission:Spinal Cord Injury (SCI)
- Injury Level:T6, T7, Complete
- Time Since Injury:Less than 1 year
- ASIA Before Treatment:A
- ASIA After Treatment:C
- Treatment Received:Stem Cells, Epidural Stimulation
- Date of Admission:11/02/2024
- Date of Discharge:16/03/2024
Patient Overview
Julia’s story began with a life-altering car accident in July last year, which resulted in a T6-T7 complete spinal cord injury. Despite this recent challenge, there is no slowing down for Julia. As a fitness enthusiast, a devoted mother to two wonderful children, and a supportive wife, her life is a testament to her unwavering strength and determination.
Patient Condition on Admission
Julia sustained a traumatic spinal cord injury at the T6-T7 level as a result of an accident in July 2023, which rendered her paralyzed. She had a complete spinal cord injury with a complete loss of motor and sensory functions below the level of injury. She also experienced a complete loss of bowel and bladder function. Additionally, she suffered from moderate spasticity and severe neuropathic pain. Julia completed a rehabilitation program at St.Maartenskliniek Nijmegen in Holland 3 months before receiving treatment at Verita Neuro. Also, she used to take anti-spasmodic medication.
Treatment Received
After extensive medical evaluation, the medical and surgery team proceeded with the implantation of spinal cord stimulation at the lumbar spinal cord level. Following the operation, Julia rested for 2 days. Then, she started the mapping program. In the following week, Julia received mesenchymal stem cell treatment in the form of one intravenous and two lumbar puncture injections. The total treatment duration was 35 days.
| Treatment received | Implantation site | Number of devices | Duration of stay |
|---|---|---|---|
| Epidural Stimulation | Lumbar spinal cord | 1 | 35 days |
Stem Cells Treatment Summary
| Stem cells treatment | Total number of stem cells | Delivery method |
|---|---|---|
| Mesenchymal Stem Cells (MSCs) | 60 million cells | Intravenous injection (IV injection) |
| Mesenchymal Stem Cells (MSCs) | 70 million cells | Lumbar puncture injection (LP injection) |
| Mesenchymal Stem Cells (MSCs) | 70 million cells | Lumbar puncture injection (LP injection) |
| Total number of stem cells | 200 million cells |
Device Mapping and Therapy
| Post-surgical care | Total sessions | Sessions per week | Time (Hr.) per session |
|---|---|---|---|
| Mapping | 90 | 20 | 1 |
| Physical therapy | 26 | 5 | 1 |
| Total sessions of rehabilitation | 116 |
Muscle Power Improvement Post-Surgery
Lower Body
| Muscle improvement | Before ES surgery | At discharge (35 days after ES surgery) |
|---|---|---|
| Hip flexors | 0 | 4 |
| Hip extensors | 0 | 2 |
| Hip abductors | 0 | 2 |
| Hip adductors | 0 | 2 |
| Knee extensors | 0 | 4 |
| Knee flexors | 0 | 4 |
| Ankle dorsiflexors | 0 | 3 |
| Ankle Plantarflexors | 0 | 2 |
| Long toe extensors | 0 | 2 |
Muscle power improvement was assessed according to the Manual Muscle Testing (MMT) protocol on the patient’s discharge date, with the stimulator on. 0 indicates total paralysis, 1 indicates visible contraction, 2 indicates active movement, full range of motion (ROM) with gravity eliminated, 3 indicates active movement, full ROM against gravity, 4 indicates active movement, full ROM against gravity and moderate resistance in a muscle-specific position, and 5 (normal) indicates active movement, full ROM against gravity, and moderate resistance in a muscle-specific position expected from an unimpaired person.
Functional Improvement Post-Surgery
Motor Function
| Abilities & Symptoms | Before ES surgery | At discharge (35 days after ES Surgery) |
|---|---|---|
| Standing with support | Not possible | Possible |
| Stepping with support (for more than 10 meters) | Not possible | Possible |
| Standing balance | Absent * | Fair * |
| Sitting balance | Poor * | Good * |
| Motor coordination (while stepping) | Poor * | Good * |
| Sit to stand (in a walker) | Maximum assistance | Moderate assistance |
| Ability to transfer | Maximum assistance | Minimum assistance |
| Ability to use abdominal muscles during bowel program | Not possible | No change |
| Stamina & Fatigue | Poor * | Endurance increased |
| Spasticity | Moderate | Decreased |
Sensory Function
| Abilities & Symptoms | Before ES surgery | At discharge (35 days after ES Surgery) |
|---|---|---|
| Neuropathic pain | Severe | Significantly decreased |
| Temperature sensations | No sensation (below the level of injury) | Slightly improved |
| Proprioception | Absent | Present |
| Bladder sensation | Absent | No change |
| Bowel sensation | Absent | No change |
Autonomic Function
| Abilities & Symptoms | Before ES surgery | At discharge (35 days after ES Surgery) |
|---|---|---|
| Sweating ability | No | Improved (on legs while stepping) |
| Temperature regulation | Poor * | Improved |
| Blood Pressure Regulation | Stable | Stable |
Motor Funtions
90%
Sensory Funtions
60%
Autonomic Function
100%
Overall
82%
Improvements are monitored in 18 targeted areas: 9 Motor areas, 5 Sensory areas and 3 autonomic 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. No improvement, the existence of pain or spasms, or an inability to perform a measured function is reported as negative. *According to the Functional Balance Grades, ‘Absent’ indicates that the patient is unable to perform a particular activity or function. ‘Poor’ indicates that the patient requires support and moderate to maximal assistance for a particular activity or function. ‘Fair’ indicates that the patient is able to perform a particular activity or function with minimal assistance. ‘Good’ indicates that the patient is able to perform a particular activity or function and can accept moderate challenge. ‘Normal’ indicates that the patient can perform a particular activity or function without any support.
Results Intrepretation
Motor Function
Julia reported significant improvements among all motor areas. After the treatment she was able to stand and walk with the help of a standing frame. She also had better sitting balance, standing balance and postural stability.
Sensory Function
Julia reported improved proprioception and she was able to feel her lower limbs again for the first time since her injury. She also reported mild improvements in the temperature sensation below the level of injury.
Autonomic Function
Julia was able to sweat and reported better body temperature regulation after the treatment.
Sitting
Significant improvements were reported in her sitting balance and trunk stability while in the sitting position.
Standing
She was able to stand in the standing frame, which was not possible before.
Case Summary
Julia underwent Epidural spinal cord Stimulation surgery at the lumbar spinal cord site and regenerative medicine treatment with mesenchymal stem cells. Her total stay was 35 days. In the first week, she had extensive check-ups, MRI scans, and surgery without complications or side effects.
Two days post surgery, Julia began the mapping program and intensive rehabilitation. She regained volitional muscle function for the first time since her injury. Gradual improvements in motor functions were seen in the second week, along with standing and walking training throughout her 35 days of treatment.
Following the Epidural Stimulation surgery, Julia had 90 mapping sessions and 26 physical therapy sessions. She received 200 million mesenchymal stem cells through 3 injections (1 intravenous and 2 lumbar puncture) with no side effects.
Julia’s motor function improved gradually, enabling her to stand and walk. Her balance, coordination, muscle mass, strength, and overall quality of life all showed remarkable improvement, while spasticity and neuropathic pain levels decreased.