Abstract

Introduction: Positron Emission Tomography (PET) imaging provides exquisite sensitivity information regarding changes in brain metabolism after traumatic brain injury (TBI). TBI is major cause of morbidity and mortality resulting in permanent neurobiological damage and lifelong deficits. Cell transplantation in combination with neurorehabilitation has a potential to cease the degeneration and replace the damaged neurons, which current standard intervention may not tackle.
Methods: Herein, we present a case of a 7-year-old female who suffered from TBI 15 months before she underwent first cell transplantation. She underwent two cell transplantations at an interval of 4 months with intrathecal autologous bone marrow derived mononuclear cells.
Results: Over the span of 9 months, improvements in posture, balance, bed mobility, voluntary control of the upper extremity, overhead activities, cognition, speech, understanding and attention was observed. Percutaneous endoscopic gastrostomy (PEG) tube was removed as her swallowing capacity improved. The Functional independence measure (FIM) score improved from 22 to 35 and Disability rating scale (DRS) improved from 15 to 12. There was an improvement in the Glasgow coma scale from 8 to 15. A repeat PET CT scan of the brain at 4 months’ post first cellular transplantation revealed improved metabolism in the cerebellum, cingulate regions, vermis and parietal gyrus. These changes corresponded to the clinical improvements seen in the patient. No adverse events related to the procedure was observed.
Conclusion: Cell transplantation is a safe and efficacious treatment for chronic TBI. However, we recommend future controlled clinical trials with objective imaging like PET CT to further establish cell transplantation as a therapeutic modality in severe chronic TBI.

Key words: Traumatic brain injury, autologous bone marrow mononuclear cells, cell transplantation, stem cells, PET CT, neurorehabilitation