Recently a new movie got released in India by the name of “Guzaarish”. In this the lead actor is paralyzed down the waist (paraplegic). The movie is believed to be a remake of the 2006 Hollywood film ‘The Prestige’, which was directed by the ‘The Dark Knight’ director Christopher Nolan.
Paraplegia can occur secondary to many spinal cord diseases, which include trauma (most common), tumors, hemorrhage, genetic (familial spastic paraplegia), etc. Patients with some amount of preserved lower limb function are called paraparetic. One of the common accompaniments of loss of power in the lower limbs is spasticity or tightness of lower limbs. This can range from minor to very severe tightness. At its worst it can lead to spasm and pain. In female patients the severe tightness can come in the way of maintenance of proper hygiene. There can be associated involvement/dysfunction of bladder and bowel adding to the misery of these patients.
Presently, very little can be done in the form of direct treatment to improve the clinical conditions of these patients. Significant interest is seen in the field of engineering and robotics that use various algorithms from hand held control to nerve stimulated messages that can be delivered to regain some function in the damaged legs. However, apart from sporadic breakthroughs (e.g. Rex Robot) innovations that can significantly improve function have yet to come.
LET ME PUT A STRONG REMARK HERE CAUTIONING ONE AND EVERYONE THINKING ABOUT EXPLORING THE USE OF STEM CELLS TO IMPROVE THEIR CONDITION. IT IS A COMPLETE SHAM AND LACKS ANY CONCRETE MEDICAL PROOF THAT THEY ARE EFFECTIVE IN ANY WAY.
In this situation, the present day treatment aims at reducing the spasticity. The main therapy for this is oral Lioresal tablets. However, above a certain dose it causes marked drowsiness and other side effects. An alternative to this treatment is the use of intrathecal baclofen pump. This is a drug delivery system that is implanted over the spinal cord to delivery baclofen directly to the target tissue. (Fig. 1.) This highly sophisticated pump reduces the requirement of baclofen by 1/300 times. The therapy can be programmed to deliver 1ml. of volume over 24 hours. It can further be programmed to increase or decrease the dose based on different requirements during the day. The therapy can be tailored to each individual patients requirement. This reduces the spasticity, spasm and pain associated with it. We have had several patients who after implantation of the pump have regained their mobility (though wheel chair bound) and self esteem. For more information visit http://www.neurologicalsurgery.in/