Regularly, there are exciting research leads that have a meaningful impact on the prevention of developmental brain damage or on the improvement in the quality of life of persons with disabilities due to cerebral palsy and other developmental brain damage. These include: searching for causes and their prevention; protecting the threatened brain of the newborn; and improving interventions to minimize impairments and the consequences of disability. The term "cure", meaning healing of the damaged brain area, has not been addressed since we knew that damaged areas could not be "healed". Once brain cells were gone, they were gone forever and there was no way to replace them -- or so we thought!

Comment: Conventional wisdom has told us over the years that there was no way of replacing the damaged nerve cells that had been lost in the brain. There have been attempts to "develop or open up" other brain pathways to replace the damaged ones, but these "other pathways" have been hard to influence or evaluate effectively. At best, if new pathways were established, they appear to function at minimal levels, providing very limited improvements in performance.

For Parkinson's disease, fetal brain cells and animal cells have been implanted in the human brain. These cells produce a chemical that the brain needs to control movement (L-Dopa). The brain cell connections are still there, so the implant provides the missing but needed chemical messenger. There has been some success using this implant technique for this specific type of chemical replacement therapy. Although there is a distant relationship to cerebral palsy, Parkinson's disease is different enough that the ability to implant L-Dopa producing cells has had no impact on cerebral palsy.

In the recent past, a series of findings have reopened the issue of repair of damage to the brain. Scientists discovered banks of uncommitted, embryonic-like neural cells (neural stem cells) in specialized areas of the adult animal nervous system important to the sense of smell. Smell is a very important sensory skill in animals and critical to getting food, recognition of the environment and sexual behavior. As "smell neurones" are lost, these neuronal stem cells replace them. Recently, similar banks of stem cells have been found in the sensory nervous system of adult humans. As infections and trauma destroy sensory cells in the human smell system, they are regularly replaced -- as in animals.

The above is very interesting, but what has it to do with repairing brain injury: developmental, traumatic or vascular?

There are very recent reports that neural stem cells have also been found in one area of the depths of the adult human brain. Thus, the presence of these cells is not a unique phenomenon found only in that part of the human nervous system associated with smell. If they are present in two areas of the human central nervous system, are they present in other areas?

In any case, what are they doing in the depths of the brain? Are they non-functional cells left behind during brain development? Are they actively replacing damaged cells? If so, under what stimulus? Under what control?

Another important piece of information is that neural stem cells are uncommitted as to structure and function. Available evidence indicates that when stem cells mature, they take on characteristics controlled by the local environment. Since all cells have the complete genetic code, something locally activates the genes that influence the maturing stem cell to take on the characteristics of the local environment. What is that stimulus?

Let us assume we have the answers to the above. If there are neural stem cells in an area of the brain that has been injured, can they be activated to replace cells that have been destroyed? If there aren't neural stem cells in that area, can neural stem cells from other areas be captured, grown in tissue culture and then placed in the area of injury? Will they take on the lost function? Is this approach technically feasible? What are the dangers in this approach?

As you can see, there are many questions that need answers. However, the finding that these uncommitted stem cells exist offers a ray of hope that brain cells in damaged areas may be able to be replaced and function restored.

How? When? We don't know! However, a light has been seen at the end of a long tunnel. We can begin to consider the concept of "cure". The Foundation will keep you informed as we learn more.

P.S.: Since the writing of the above, a report was released on July 1, 1998, that nerve cells grown in tissue culture have been implanted in the brain of a person who has had a stroke; there is no report yet on the effect of the implant on lost function. However, in prior animal experiments, there was a return of some function to animals that had a stroke caused by a experimental procedure. In many respects, cerebral palsy can be considered to be "stroke in infancy"; thus this recent report may have important implications to our area of interest, developmental brain damage.