Stabilisation and functional improvement in a progressive cerebellar syndrome

History

The first symptoms appeared at around 2020. The patient began to notice increased fatigue and weakness in his legs, particularly after physical exertion.

His balance began to deteriorate at almost the same time. The motor limitations gradually grew to the point where he lost the ability to run, and later came to need additional support when walking.

Dizziness, progressive unsteadiness on walking and dysarthria joined the disturbance of balance thereafter. Urinary difficulty also appeared, with trouble emptying the bladder completely.

Neurological examination found impairment of gait, of postural stability and of performance on coordination testing.

MRI showed atrophic changes in the cerebellum and pons, including reduced volume of the brainstem structures and changes in the cerebellar peduncles.

The clinical picture was considered to be possible MSA-C, though the specialists noted that the relatively slow course over several years was not entirely typical of classical multiple system atrophy.

Before treatment

At the time he came to us the patient's main problems were:

• moving about mainly with support
• markedly impaired balance
• unsteadiness and instability on walking
• dizziness
• weakness of the legs
• marked incoordination
• episodes of orthostatic hypotension accompanied by falls
• dysarthria

The main aim of treatment was to stabilise a progressive disease, preserve the patient's independent mobility and improve as far as possible the functions that directly determine the safety and quality of his walking.

The programme

A personalised autologous programme of cell, immunoregulatory and neuroregenerative therapy was drawn up for the patient.

At the preparatory stage peripheral venous blood and bone marrow were collected for the subsequent production and preparation of his own cell components for the programme.

The protocol that followed included:

• autologous therapy with mesenchymal stromal cells
• use of his own regulatory T cells
• systemic and neurally targeted cell components
• use of neurally induced mesenchymal cells
• concentrated exosome therapy

The exact doses, the sequence of procedures and the technical parameters formed part of an individual internal protocol.

Course after treatment

After the programme the patient noted positive change across several of the most significant neurological impairments at once.

Disease stabilisation

One of the main results was that the previous clinical progression of the disease stopped.

The patient no longer noticed the steady deterioration he had seen before treatment. Over the follow-up period his condition became considerably more stable.

Coordination and balance

Marked positive change appeared in cerebellar function.

The patient noted less incoordination, better control of movement and greater steadiness when moving about.

Walking became more confident, and the unsteadiness and instability lessened.

Dizziness

The dizziness also decreased considerably; before treatment it had been one of the constant factors making balance and safe movement worse.

Orthostatic hypotension

Positive changes were noted in autonomic function as well.

Partial compensation of the orthostatic hypotension occurred: episodes of deterioration on standing up became less marked and tolerance of the upright position improved.

Speech

There was a slight positive change in the dysarthria too.

Speech became somewhat clearer and better controlled, although the change here was less pronounced than the improvement in coordination and balance.