Patrick Freund @ Wings for Life Scientific Meeting
Patrick Freund @ Wings for Life Scientific Meeting  

Predicting recovery – Importance for trials

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Spinal cord injuries can have very variable effects. On top of this, contrary to a common idea, patients often recover some functions naturally. The extent and nature of this recovery is hard to predict, which makes clinical trials extremely complex.

Prediction is key
The following concept is very important: Clinical trial are made to test if a medication can help recover functions. If we cannot tell what a person will recover naturally, how can we know the effect of a medication? In this case, prediction is the key to understanding the effect of a therapy.
This is exactly what the scientists headed by Dr Patrick Freund did. In a collaboration between the Spinal Cord Injury Center of the University of Zurich (UZH) and the Balgrist University Hospital, scientists established that assessing patients at six months could help predict the future recovery.

Tissue health six months after injury
Using a special imaging tool (magnetic resonance), scientists could correlate the tissue degradation observed six months after the injury to the functional recovery seen after two years. Spinal cord injury creates tissue damage. In this particular case, they assessed the amount of tissue loss, myelin loss (the isolation envelope of the nerve fibers) and iron accumulation (sign of oxidative stress and chronic inflammation). Smaller tissue degradation at six months could predict a good functional recovery at two years. On the contrary, greater tissue degradation could predict worse functional recovery.

What is next?
Dr Patrick Freund and his colleagues were able to create a tool that could be very useful in all future clinical trials. It will then be possible to determine the effects of rehabilitation and treatments that aim at boosting functional recovery after a spinal cord injury.

This study was published in the journal Neurology and was supported by Wings for Life.

Source: “Progressive neurodegeneration following spinal cord injury: Implications for clinical trials”. Ziegler G, Grabher P, Thompson A, Altmann D, Hupp M, Ashburner J, Friston K, Weiskopf N, Curt A, Freund P. Neurology, March 2018.