This book begins with a synopsis of experimental work underlying degeneration and recovery in the nervous system, which is then discussed in the context of strategies to repair the central nervous system (CNS) and peripheral nervous system (PNS). The major part of the book is given over to the approach involving the use of transplanted tissues to replace and restore disrupted neural networks. This experimental work has formed the basis for the emerging clinical trials employing neural grafts for diseases such as Parkinson's and Huntington's, which are discussed in detail. The book then goes on to discuss newer cellular strategies involving the manipulation of neural cells both in culture and genetically, an approach that may ultimately be employed in the clinical situation. Neural Repair, Transplantation and Rehabilitation is unique in bridging the gap from experimental studies to clinical trials, whilst also providing the non-specialist with a background in rehabilitation strategies as well as basic neuroscience. It is recommended for all those involved in the management of patients with degenerative and traumatic injuries to the nervous system.
Transplants of cells and tissues to the central nervous system of adult mammals can, under appropriate conditions, survive, integrate, and function. In particular, the grafted cells can sustain functional recovery in animal models of a range of neurodegenerative conditions including genetic and idiopathic neurodegenerative diseases of adulthood and aging, ischemic stroke, and brain and spinal cord trauma. In a restricted subset of such conditions, cell transplantation has progressed to application in humans in early-stage clinical trials. At the present stage of play, there is clear evidence of clinical efficacy of fetal cell transplants in Parkinson disease (notwithstanding a range of technical difficulties still to be fully resolved), and preliminary claims of promising outcomes in several other severe neurodegenerative conditions, including Huntington disease and stroke. Moreover, the experimental literature is increasingly suggesting that the experience and training of the graft recipient materially affects the functional outcome. For example, environmental enrichment, behavioral activity, and specific training can enhance the recovery process to maximize functional recovery. There are even circumstances where the grafted cells have been demonstrated to restore the neural substrate for new learning. Consequently, it is not sufficient to replace lost cells anatomically; rather, for the grafts to be effective, they need to be integrated functionally into the host circuitry, and the host animal requires training and rehabilitation to maximize function of the reconstructed graft−host circuitry. Such observations require reconsideration of the design of the next generation of clinical trials and subsequent service delivery, to include physiotherapists, cognitive therapists, and rehabilitation experts as core members of the transplant team, along with the neurologists and neurosurgeons that have conventionally led the field.
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