The experience in the use of stem and progenitor cells in patients with persistent vegetative state
A persistent vegetative state (PVS) is a disorder of consciousness in which patients with severe brain damage are in a state of partial arousal. The vegetative state is a chronic or long-term condition. Patients in a vegetative state are unable to regain awareness. In the vegetative state patients can open their eyelids occasionally and demonstrate sleep-wake cycles, but completely lack cognitive function. After a year, the chances that a PVS patient will regain consciousness are very low and those who do recover consciousness experience significant disability. Rehabilitation can contribute to recovery, but many patients never progress to the point of being able to take care of themselves.
Currently no treatment for vegetative state exists that would satisfy the efficacy criteria of evidence-based medicine.
Our experience of using the cells therapy for PVS comprises a rather small group, of which 33% had the apallic syndrome or the akinetic mutism following clinical death, 27% were after the severe hypoxia (13.5% after self-hanging and 13.5% after drowning), 33%patients with various degrees of impaired consciousness resulting from the post-traumatic diffusive axonal lesion, and 7% following the subdural intracerebral hemorrhage.
In the therapy of 40% we used the fetal material isolated from the cerebral vesicle of a fetus in 9-12 weeks of gestation. In other 60% we applied the autologous material obtained through the stimulation of bone marrow precursor cells in the patient. In all cases we used the intrathecal (through a spinal tap) or intraventricular injection of hematopoietic stem cells (HSCs) and hematopoietic precursor cells (HPCs). After the treatment 73% patients repaired consciousness so that they were able to establish verbal contact as well as to follow instructions. 13.5% patients with hypoxia after drowning were unable to restore consciousness as the long-lasting hypoxia is the least responsive to restoration.
One patient with significant improvement following the severe intracerebral hemorrhage has died from acute lung thromboembolism during rehabilitation. The cases of the cerebral post-traumatic injury of the diffusive axonal type appeared to be the most responsive and positive to the HSCs and HPCs therapy. The longest period spent in PVS by our patients was 18 months after the event, while the least was 6 months. It is obvious that the earlier the stem cell therapy begins the better are the chances to regain impaired consciousness.