Benefits of Autologous Bone Marrow Mononuclear Cell Transplantation in Chronic Ischemic Pontine Infarct

Abstract

Introduction: Ischemic stroke is brain injury due to hypoperfusion leading to sudden neurological symptoms. Despite advances in medicine, prognosis is still grim especially with chronic residual neurodeficits. Autologous bone marrow mononuclear cells (BMMNCs) transplantation is safe and has shown positive outcomes in previous studies of ischemic stroke. Our aim was to study the effect of autologous BMMNCs transplantation in chronic ischemic stroke. Intervention and Results: We treated a case of pontine ischemic infarct three years later, with BMMNCs transplantation followed by standard rehabilitation. Seven months after transplantation he showed significant improvement in spasticity, motor function and voluntary control of upper and lower extremity, static and dynamic sitting and standing balance. Improvement was noted in the scales like Modified Ashworth scale (mAS), Motor Assessment scale (MAS), Disabilities of Shoulder, arm and hand questionnaire (DASH), Modified Rankin Scale (MRS), Berg Balance Scale (BBS) and Brunnstrom Voluntary Control Grading (BVCG). Functional Independence Measure score increased from 59 to 81. BMMNCs exert paracrine effects, neoangiogenesis and trophic effect which facilitate various reparative and regenerative processes in the penumbral area. Conclusion: In this case, the clinical changes exhibited by BMMNCs transplantation even at a chronic stage in stroke substantiate their therapeutic potential. Although a single case report, these findings provide foundation for further research. Larger randomized controlled trials are warranted to study the safety and efficacy.