Functional improvement in multiple system atrophy of the cerebellar type

History

The patient had been under the care of neurologists in Belgium for a long time with a gradually progressive cerebellar syndrome.

As the disease advanced, the disturbance of balance and coordination became the most pronounced feature, walking deteriorated and dysarthria appeared. The medical records gave a diagnosis of multiple system atrophy of the cerebellar type – MSA-C. There had been a marked loss of independent walking, which had persisted for more than a year.

The patient continued to work actively at supportive treatment: he attended physiotherapy, swam and worked with a speech therapist. Despite rehabilitation, his mobility remained substantially limited: he could cover only short distances with a walking frame and needed help in everyday life.

A distinctive feature of this case was that our programme was carried out in cooperation with the patient's own neurologist, who continued to see him throughout. This preserved full neurological care and meant that changes in his condition could be judged not only from what the patient and his family reported, but within his ongoing medical follow-up.

Neurological findings

The clinical picture corresponded to predominant involvement of the cerebellar systems.

The examination described:

• dysarthria
• altered quality and clarity of speech
• impaired balance
• incoordination on finger-to-nose testing
• bilateral dysdiadochokinesia
• nystagmus
• impaired control of precise movements of the arms

The incoordination also affected everyday activity considerably. The patient found it difficult to carry out tasks requiring precise use of the hands: shaving himself, cutting up food, putting on socks and shoes.

Brain MRI showed atrophic changes mainly in the infratentorial structures. Compared with the previous scan, no substantial further progression of atrophy had been recorded at the time of the last assessment.

At the time of the consultation

At the first consultation the patient's main complaints were:

• marked dysarthria
• incoordination
• impaired balance
• severely restricted walking – about 10–20 metres
• occasional episodes of dysphagia
• impaired fine motor control and precision of hand movement

Speech, walking and coordination mattered most to him, because those were what limited his independence in daily life the most.

The aim was not to act on a single symptom but to build a comprehensive programme directed at preserving the functional reserve of the nervous system and improving the functions already impaired.

The programme

After reviewing the history, the neurological status and the investigation results, a personalised combined programme of regenerative and immunoregulatory therapy was drawn up for the patient.

At the first stage peripheral venous blood was collected to obtain his own regulatory T lymphocytes, which were then cultured and prepared as autologous cell therapy.

The programme that followed included several complementary directions:

• therapy with mesenchymal stromal cells of placental origin
• use of the patient's own autologous regulatory T cells
• a combination of systemic and neurally targeted delivery of the cell product
• exosome therapy
• intranasal neuroregenerative support

The exact doses, sequence and parameters of the procedures were selected individually and formed part of an internal personalised protocol.

Throughout, the patient remained under the care of his own neurologist, and the programme was carried out in collaboration with his primary medical team.

Course after treatment

At follow-up the patient and those close to him noted positive changes across several functionally important areas 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.

Speech

One of the most noticeable results was improved speech.

His speech became clearer and easier to understand, and holding a conversation became easier for him. This matters particularly given that dysarthria had been one of the pronounced features of the disease.

Coordination

The patient and those around him also noted that the incoordination became less marked.

Control of movement improved, and movements became more precise and easier to direct.

Swallowing

Before the programme, episodes of impaired swallowing occurred from time to time.

After treatment the patient and his family reported that the episodes of dysphagia stopped.

Fine motor control

A slight improvement in fine motor control and in the precision of hand movement was also noted.

The change was less pronounced than in speech and coordination, but the patient noted progress in this area too.