Background: Cerebral palsy (CP) is a non-progressive disorder. The global incidence of neonatal CP is 1-5 per 1000 live births where 45% of children with CP have a comorbid intellectual disability (ID). This affects the quality of life and reduces life expectancy of affected individuals. Methods and findings:With an aim to study the efficacy and safety of autologous bone marrow mononuclear cells (BMMNCs) transplantation in CP with ID, we administered a 17-year-old boy with BMMNCs along with neurorehabilitation. On follow up after 6 months, clinical improvements were recorded in speech, fine motor skills, ambulation, oromotor skills, social awareness, cognitive skills, memory and attention. Comparative Positron Emission Tomography-Computer Tomography scan of brain before and six months after cell transplantation revealed improved metabolism in the anterior cingulate cortex, left caudate head, thalamus, medial temporal cortex, cerebellum. Intelligent Quotient improved from 21 to 29. Social age according to the Vineland Social Maturity Scale was increased by 1 year. Functional Independence Measure and Gross Motor Functional Measure increased from 22 to 26 and 74.65 to 76 respectively. On Gross Motor Functional Classification System, he improved from IV to III. Conclusion:These changes suggest that BMMNCs transplantation along with neurorehabilitation was effective for this child suffering from CP with ID.
On the Indian Scale for Assessment of Autism (ISAA), his score was 98, while his Childhood Autism Rating Scale (CARS) and Functional Independence Measure (WeeFIM) scores were 28.5 (ASD) and 80, respectively. MRI of the brain and EEG were normal. PET CT scan of the brain revealed hypometabolism in the bilateral cerebellar hemispheres and hypermetabolism in frontal, parietal and temporal lobes. AbstractAutism is a complex neurodevelopmental disorder defined by a triad of deficits including impaired social interaction, communication and behaviour. With greater understanding of mechanism of action of cellular therapy it is now possible to address the pathology of autism. Here is a case of a six and a half year old boy with autism who was administered autologous bone marrow mononuclear cells (BMMNCs) intrathecally followed by an intensive rehabilitation program. On follow up at 3months and 7months post intervention, he showed significant symptomatic improvements with no major side effects. At the end of 7months, ISAA score improved from 98 to 81. The Wee FIM showed improvement 80 to 89.1. CARS score reduced from 28.5 (mild to moderate autism) to 23.5 (mild autism). PET CT scan of the brain performed pre intervention and seven months post showed a balancing effect in the metabolism of affected areas. It also showed reduction in hypermetabolism of the frontal, parietal and temporal lobe bilaterally and increase in metabolism of the previously hypometabolic bilateral cerebelli. The changes observed on the PET CT scan of the brain correlated with clinical improvements. We hypothesize that cellular therapy holds great potential as a treatment modality for autism in combination with standard rehabilitation therapy. Randomized controlled trials are warranted to study their long term effects in treating autism.
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