For 3,000 years, doctors have believed that spinal cord injuries were incurable. But over the past decade or so, researchers have made enormouse strides, and many think a successful therapy will be rolled out in just a few years.
One of the leading scientists in this field is Dr. Wise Young, head of the neuroscience center at Rutgers University in New Jersey. Dr. Young is optimistic about the chances for a cure. We talked to him about the latest research, and the frustrating nature of spinal cord injury. Here's what he had to say.
Even With A Cure, Recovery Will Take A Long Time
Dr. Young: Human recovery takes a long time. Regeneration takes a long time. Axons have to grow long, long distances to get back to their original target. In the case of Christopher Reeve, in order for the nerves to reach the motor neurons that enervate his legs, the axons have to grow from the top of his spine all the way to the bottom of his spine.
"It's like cutting your arm off. The part that's cut off from your body dies. Axons that have been cut off from the cell body die.They have to grow all the way back. Sometimes they have to grow as much as 600, 700 millimeters. An axon grows at the rate of your hair, which is no faster than one millimeter a day. Basically, 600 millimeters would take nearly two years, and that's if it's growing with its foot to the pedal -- the axon growing as fast as it can go, straight down to its target."
A Possible Breakthrough: 4-aminopyridine (4-AP)
Dr. Young: "64% of those who are paralyzed are so called incomplete spinal cord injuries. In other words, they have some connection across the injury site. They're partially paralyzed. It's also very likely that people who are so-called 'completes' also have some connection. In those cases, axons across the site have lost the myelin, the sheath that covers the nerve. 4AP increases the exciteability of the axons that are demyelinated. Recent studies suggest that 30% of people with spinal cord injury can be helped by it. But when you stop 4AP the improvement goes away."
What 4-AP Can Do
Dr. Young: "The results are varied. Some people have had spectacular results. There was one man who says he not only was able to walk for the first time, but he consummated his marriage for the first time, when he was on 4AP. He was the most spectacular. There are lots of patients who claim that it improves their sensation. It sharpens sensation, makes it more sensitive. In a number of people it got rid of their pain. About 30% of patients with spinal cord injuries showed some improvement."
Charlie Hince, who was paralyzed from the shoulders down in a swiming accident, holds out hope for a cure. (CBS)
Excitement Over 4-AP's Potential
Dr. Young: "It is not approved by the FDA. But word has leaked out that 4AP may work, and many people are actually taking it. There are pharmacies that actually dispense it. It's estimated that maybe 9000 people in the United States are taking it."
How Can Doctors Prescribe A Drug Not Approved By The FDA?
Dr. Young: "The FDA does not regulate what a physician can prescribe. The FDA's responsibility is to ensure that treatments are safe when they're sold by a company. Secondly they make sure that no company can makes false claims for a drug. However, this does not prevent doctors from prescribing anything. A doctor can prescribe apples for a cold. A doctor can prescribe beef testicles if he thinks it will make your axons grow. The doctor is of course liable if you die from that, but the doctor is perfectly free to ask a pharmacy to dispense it. Pharmacies are then covered if the prescription is given from a doctor."
Another Possible Cure
Dr. Young: "We're working on a molecule called L1, which is present in peripheral nerves. When we apply it to animals it appears to regenerate the spinal cord. This molecule is present during development, but it is absent from the adult spinal cord. We believe that this molecule is the natural antagonist to the inhibitors [that keep the spinal cord from regenerating]."
An Even More Amazing Possibility
Dr. Young: "For a long time people have known that the olfactory nerve can regenerate. It's one of the only nerves in the central nervous system that seems to be able to partially regenerate. People have speculated that olfactory cells help with the regeneration [of the spinal cord]. They took these cells from the nose and implanted them into the spinal cord. The cells migrated very rapidly, forming a scaffolding, and axons loved them. They grow on them. [Researchers] reported functional regeneration in the spinal cords of rats. This needs to be confirmed, but this is potentially another therapy."
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written by David Kohn