9. Regular checkup and replacement

This process is quick. It involves "interrogating" or analyzing the pump using the handheld programmer, for example, N-Vision Programmer. We have to check whether the pump is working correctly and looking for any trauma at the pump site. If the patient has an MRI appointment, we must stop the pump before examination, then the pump is checked within 2 h after MRI to make sure the pump rotor has restarted itself after an expected stall because of the magnetic effect on the rotor.

Replacement is needed usually after 5–7 years. It is replaced with surgery. Unless there is a problem with the catheter system, the catheter will not require replacement, and the section near the pump will be simply reconnected to the new pump.

### 10. Conclusions

ITB is a good method for managing spastic cerebral palsy, especially in patients with some potentially useful extremities. Performing ITB requires a well-trained multidisciplinary team that can deal with patient education, pump refills and dose adjustments.

However, it is expensive and associated with some complications; yet, it is one of the best therapeutic options available for patients with spasticity.

## Author details

Moneer K. Faraj

Address all correspondence to: drmkfaraj@uob.edu.iq

College of Medicine, University of Baghdad, Iraq

#### References

system, including the catheter and cerebrospinal fluid (CSF). It requires removal of the entire

Leak may appear due to insertion of Tuohy needle with a catheter. The incidence is from 5 to 15% in patients with CP (most of whom are children), in contrast to the 3% leak rate reported in adults. The difference explained by malnutrition of chronically disabled children, thinner tissue masses, the smaller body size and the presence of higher CSF pressures associated with

This process is quick. It involves "interrogating" or analyzing the pump using the handheld programmer, for example, N-Vision Programmer. We have to check whether the pump is working correctly and looking for any trauma at the pump site. If the patient has an MRI appointment, we must stop the pump before examination, then the pump is checked within 2 h after MRI to make sure the pump rotor has restarted itself after an expected stall because of

Replacement is needed usually after 5–7 years. It is replaced with surgery. Unless there is a problem with the catheter system, the catheter will not require replacement, and the section

ITB is a good method for managing spastic cerebral palsy, especially in patients with some potentially useful extremities. Performing ITB requires a well-trained multidisciplinary team

However, it is expensive and associated with some complications; yet, it is one of the best

pump with postoperative parenteral antibiotics for 3 weeks [19].

8.4. CSF leaks

occult hydrocephalus [20].

120 Cerebral Palsy - Clinical and Therapeutic Aspects

the magnetic effect on the rotor.

10. Conclusions

Author details

Moneer K. Faraj

9. Regular checkup and replacement

near the pump will be simply reconnected to the new pump.

therapeutic options available for patients with spasticity.

Address all correspondence to: drmkfaraj@uob.edu.iq

College of Medicine, University of Baghdad, Iraq

that can deal with patient education, pump refills and dose adjustments.


[15] Coffey RJ, Edgar TS, Francisco GE. Abrupt withdrawal from intrathecal baclofen: Recognition and management of a potentially life-threatening syndrome. Archives of Physical Medicine and Rehabilitation. 2002;83:735-741

**Chapter 8**

**Provisional chapter**

**Plasma Growth Factors in Cerebral Palsy**

**Plasma Growth Factors in Cerebral Palsy**

DOI: 10.5772/intechopen.80369

The use of plasma growth factors is opening a new field of clinical application in medicine, developing a new discipline called regenerative medicine. In many fields such as traumatology, dental implantology or anesthesia, the use of this biotechnology is improving the quality of life of patients, through techniques that are not invasive but with extraordinary functional results. A discipline where this type of procedure opens an interesting field of application is undoubtedly neurology, especially those processes of ischemic or hypoanoxic origin such as cerebral palsy, where recent studies point to an improvement of cognitive abilities in patients, together with specific neurorehabilitation therapies. **Keywords:** cerebral palsy, growth factors, neuronal plasticity, intravenous infusion

The use of plasma rich in growth factors in various fields of medicine especially orthopedics, dentistry, and general surgery has experienced an extraordinary development given the enormous capacity for regeneration, differentiation and chemotaxis that produce so-called growth factors, modulating angiogenesis, and cellular plasticity of injured tissues. Among them the best known are: insulin-like growth factor (IGF-1), transforming growth factor A or B (TGF-A B), vasculo-endothelial growth factor (VEGF), and platelet-derived growth factor (PDGF) [1, 2].

Through complex biochemical regulatory feedback-type mechanism that involves numerous cytokines, the injured cell f has specific receptors for these proteins which have shown great power to intervene in apoptotic and antiapoptotic mechanisms that regulate both their own life cycle and as cell differentiation. Also recent studies have objectified the possibility

> © 2016 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

© 2018 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use,

distribution, and reproduction in any medium, provided the original work is properly cited.

Jesús Alcaraz Rubio and Juana María Sánchez López

Additional information is available at the end of the chapter

Additional information is available at the end of the chapter

http://dx.doi.org/10.5772/intechopen.80369

and Juana María Sánchez López

Jesús Alcaraz Rubio

**Abstract**

**1. Introduction**


#### **Plasma Growth Factors in Cerebral Palsy Plasma Growth Factors in Cerebral Palsy**

Jesús Alcaraz Rubio and Juana María Sánchez López Jesús Alcaraz Rubio and Juana María Sánchez López

Additional information is available at the end of the chapter Additional information is available at the end of the chapter

http://dx.doi.org/10.5772/intechopen.80369

#### **Abstract**

[15] Coffey RJ, Edgar TS, Francisco GE. Abrupt withdrawal from intrathecal baclofen: Recognition and management of a potentially life-threatening syndrome. Archives of Physical

[16] Zuckerbraun NS, Ferson SS, Albright AL. Intrathecal baclofen withdrawal: Emergent

[17] Gooch JL, Overg WA, Grams B. Complications of intrathecal baclofen pumps in children.

[18] Motta F, Stignani C, Antonello CE. Effect of intrathecal baclofen on dystonia in children with cerebral palsy and the use of functional scales. Journal of Pediatric Orthopedics. 2008;

[19] Motta F, Buonaguro V, Stignani C. The use of intrathecal baclofen pump implants in children and adolescents: Safety and complications in 200 consecutive cases. Journal of

[20] Albright AL, Gilmartin R, Swift D. Long-term intrathecal baclofen therapy for severe

[21] Walker RH, Danish FO, Swope DM. Intrathecal baclofen for dystonia: Benefits and complications during six years of experience. Movement Disorders. 2001;15:1242-1274

[22] Woon K, Segaye MT, Vioeberghs MH. The role of Intrathecal baclofen in the management of primary and secondary dystonia in children. British Journal of Neurosurgery. 2007;21:

spasticity of cerebral origin. Journal of Neurosurgery. 2003;98:291-295

recognition and management. Pediatric Emergency Care. 2004;20:759-564

Medicine and Rehabilitation. 2002;83:735-741

Pediatric Neurosurgery. 2003;39:1-6

122 Cerebral Palsy - Clinical and Therapeutic Aspects

Neurosurgery. 2007;107:32-35

28:213-217

355-358

The use of plasma growth factors is opening a new field of clinical application in medicine, developing a new discipline called regenerative medicine. In many fields such as traumatology, dental implantology or anesthesia, the use of this biotechnology is improving the quality of life of patients, through techniques that are not invasive but with extraordinary functional results. A discipline where this type of procedure opens an interesting field of application is undoubtedly neurology, especially those processes of ischemic or hypoanoxic origin such as cerebral palsy, where recent studies point to an improvement of cognitive abilities in patients, together with specific neurorehabilitation therapies.

DOI: 10.5772/intechopen.80369

**Keywords:** cerebral palsy, growth factors, neuronal plasticity, intravenous infusion

#### **1. Introduction**

The use of plasma rich in growth factors in various fields of medicine especially orthopedics, dentistry, and general surgery has experienced an extraordinary development given the enormous capacity for regeneration, differentiation and chemotaxis that produce so-called growth factors, modulating angiogenesis, and cellular plasticity of injured tissues. Among them the best known are: insulin-like growth factor (IGF-1), transforming growth factor A or B (TGF-A B), vasculo-endothelial growth factor (VEGF), and platelet-derived growth factor (PDGF) [1, 2].

Through complex biochemical regulatory feedback-type mechanism that involves numerous cytokines, the injured cell f has specific receptors for these proteins which have shown great power to intervene in apoptotic and antiapoptotic mechanisms that regulate both their own life cycle and as cell differentiation. Also recent studies have objectified the possibility

© 2016 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. © 2018 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

of improve levels of certain plasma growth factors depending on the platelet or mononuclear predominance of the product finally obtained [3, 4].

**2. Plasma growth factor functions**

promoting blood vessel air permeability.

**Content Feature**

Macrophage inflammatory protein 1-alpha

Platelet-derived growth factor (PDGF) Transforming growth factor b (TGF-B) Epidermal or epithelial growth factor

Vasculo-endothelial growth factor (VEGF) Insulin-like growth factor-1 (IGF-1) Hepatocyte growth factor (HGF)

Brain-derived neurotrophic factor (BDNF)

**Chemokines, cytokines**

Platelet factor 4 B-tromboglobina RANTES\*

Interleukin 1 and 8

**Adhesive proteins** 1 and 2 thrombosin Fibrinogen Fibronectin

**Growth**

(EDGF)

angiogenesis and extracellular matrix synthesis (**Table 1**).

collagen [5, 7].

cellularity.

*PDGF* (*platelet-derived growth factor origin*): promotes angiogenesis via macrophages by a mechanism of chemotaxis, having a significant mitogenic activity on neurons, microglia cells, making both proliferation and remyelination and facilitates the formation of type 1

Plasma Growth Factors in Cerebral Palsy http://dx.doi.org/10.5772/intechopen.80369 125

*FGF* (*fibroblast growth factor*): enables the proliferation and differentiation of neural stem cells.

*IGF-1* (*insulin-like growth factor 1*): it induces a potent mitotic effect on neural progenitor stem

*VEGF* (*vasculo-endothelial growth factor*): enables chemotaxis and differentiation neural cells

*Ectodermal growth factor* (*EGF*): great proapoptotical capacity, chemotaxis on neural and glial cells.

*BDNF* (*brain-derived neurotrophic factor*): produces proliferation, differentiation and neuronal chemotaxis on microglial and oligodendrocitarial cellularity and remyelination thereof.

*HGF* (*hepatocyte growth factor*): induces cell proliferation and differentiation, chemotaxis,

Regulation of inflammation, chemotaxis

Cell interactions and coagulation

extracellular matrix synthesis

Cell proliferation and differentiation, chemotaxis, angiogenesis,

*TGF-beta* (*transforming growth factor-beta*): induces differentiation of neural stem cells.

An emerging medical field of application is undoubtedly neurology, especially those processes of anoxic or hypoxic ischemic origin, including cerebral palsy. The immunomodulatory and proangiogenic effect that plasma growth factors have on neurogenesis opens up a surprising range of treatment possibilities together with neurorehabilitation with the aim of improving functional capacity in these patient with the aim of improving functional capacity in these patients, especially in the cognitive area: language, memory, ability to perform complex tasks, etc., using a technique that is minimally invasive, easy to reproduce and with a very low economic cost [4–6] (**Figure 1**).

**Figure 1.** Effects of growth factors in neural tissue.
