The latest news and information about what's going on with SCI science and research. Brought to you by Sam Maddox, author of the Christopher & Dana Reeve Foundation Paralysis Resource Guide.

Darek Rides A Trike; More Stab Wounds Wanted.

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Darek Fidyka is in the news again. Your remember him. Polish fireman, got stabbed and completely paralyzed, got better after cells from his olfactory bulb were injected into his spinal cord. Big news 18 months ago; lots of chatter about what a major breakthrough it was.

Well, here’s to Darek, who continues to get better. A video was posted last week showing how well he can pedal a trike. He told BBC news, "I can tell that sensation is coming back and I am getting stronger. A year ago I would not have been able to ride a tricycle. Now I can feel each muscle and each press of the foot on the pedals.”
 
Quite impressive. Darek has become sort of famous in western Poland, and especially popular with Polish women, maybe because of the public discussion of his restored sexual function; he has reportedly fended off numerous marriage proposals.
 
The team that did Darek’s treatment announced a global search for two more candidates to get the cell transplant Darek got. They have to search all over because it’s exceedingly rare to find spinal cord injuries due to knife transection. The type of wound limits the pool of patients, and limits the interpretation of the results too – gluing together the edges of a cut spinal cord may work but most injuries are not at all like that – they are more like a bruise than a slice.
 
At an rate, neurosurgeon Pawel Tabakow wants to hear from you if you have three years to spare and fit the rest of the criteria, this taken from his Walk Again Project.
  • traumatic severance of the spinal cord, e.g. due to injury caused by a sharp object
  • confirmation of the severance of the spinal cord in magnetic resonance imaging (MRI)
  • total absence of all types of sensation and voluntary muscle mobility in areas provided for by the spinal cord below the point of damage (damage level ASIA A, Frankel A – in the event of uncertainty, the patient should seek the opinion of a local neurologist/neurosurgeon regarding the damage severity level)
  • age from 16 to 65 years
  • patient undergoing constant physiotherapy
  • high motivation and willingness to cooperate, no mental disturbance
Darek was the center of a long feature article in January in the New Yorker.  It’s a must-read if you follow spinal cord injury research. From reporter D.T. Max:
Fidyka’s medical team was not stinting in its self-congratulations. The results of the operation, Raisman said in a 2014 BBC documentary, were “more impressive than a man walking on the moon.”
 
Here’s a sample from Max, with an eagle eye for detail. Max flew to Poland, met Darek at a rehab called Akson in Wroclaw. Previously, Darek had been languishing in a state of depression and hopelessness.
The man I met at Akson was no longer demoralized. Fidyka shook my hand with exaggerated vigor, like a salesman. He wore a T-shirt and sweatpants, and his blue eyes twinkled. When I asked him why he was always chewing gum, he joked that he’d been told to exercise all his muscles. His custom-built red wheelchair has a seat-back cushion with an image of a stallion rearing from a wheelchair; as he rolled himself up and down the halls of Akson, his jaws working fervently, you felt that the same image was in his head. The other patients in the facility seemed beaten down by the irreversibility of their situation, but Fidyka projected an intense, if trammelled, physicality.
 
Max provides a lot of backstory. Raisman, generally considered a first rate scientist, gave up a huge lab at The National Institute for Medical Research in Mill Hill to take a position at University College London.
Raisman, who is seventy-six, is querulous by nature, a determined outsider. When I visited him in London, at the Institute of Neurology, in Queen Square, I found that he worked at a makeshift desk in a corridor, as if he were a graduate student. “I have no office,” he boasted.
 
Here’s what happened in surgery:
.... In April, 2012, Tabakow, with his medical team, opened up Fidyka’s skull and removed part of his olfactory bulb. The human sense of smell is not very acute, so the olfactory bulb is relatively small—about the size of a sunflower seed. (A goat’s is larger.) Tabakow and his associates next sliced the extracted tissue into two-millimetre sections, isolated the olfactory ensheathing cells, and then gave them almost two weeks to subdivide, in order to have enough cells—half a million—for the operation. Then he opened Fidyka’s spine around the T9 vertebra and made almost a hundred microinjections to situate the cells above and below the wound. He placed more of the cells onto a strip of nerve tissue that he’d extracted from Fidyka’s lower leg and inserted in his spine, in order to help span the gap in his cord. Tabakow closed the incision, and within a few weeks his patient was beginning his real rehabilitation.
 
It’s not part of our spinal cord research angle, but it’s fun to add a little drama. I'm paraphrasing Daniel Max and a news report in the London Daily Mail here: It was a former friend and fellow fireman, Jaroslaw, who attacked Darek. He was the ex-spouse of woman Darek had recently moved in with, only the assailant, who had just gotten out of jail for attacking the female node of this triangle, thought that Darek had begun the affair before Justyna had divorced Jaroslaw. Darek insisted he waited to make his move in until the marriage was over. Jaroslaw wasn’t buying it; he stabbed Darek 18 times, then went to the woods and hung himself. Darek had his spinal cord sliced almost all the way through.
 
OK. I hope they quickly find a couple of more patients with knife wounds. Maybe they will show some improvement, as Darek has. I predict it will be difficult to prove it was the olfactory cells and not the nerve graft or even the heavy duty PT that did the trick. Certainly one of the major confounding factors in moving this work forward is how the olfactory bulb cells are harvested. Darek consented to have his skull opened to access the bulbs. It's hard to imagine that’s going to be the standard of care. Raisman and Tabakow have been experimenting with cadavers to get at the olfactory bulb by way of an eyebrow incision (also known as
keyhole supraorbital craniotomy), which is somewhat less gnarly. Future wise, both suggest this treatment can be applied to people with more normal contusion injuries, once they work out a few more details.

Said Tabakow: "If we can bridge the gap between two spinal cord stumps then there will be no doubt that our technique works and this will be historic - if we succeed we will have found a cure for paralysis. Then we will be able to help other patients with the most common type of injury, caused by a crush or compression."


 
Posted by Sam Maddox on Mar 7, 2016 1:46 AM America/New_York

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