Omental therapy for primary progressive aphasia with tau negative histopathology: 3 year study.

OBJECTIVE: Omentum transposition surgery (OT) applied to various neurodegenerative disorders has produced clinically significant improvement, which may be due to omentally-derived factors. To evaluate the clinical effect of left hemisphere OT in a primary progressive aphasia (PPA) patient, 3 year follow-up data were analysed. METHODS: Left hemisphere OT was performed on a 68-year-old male with PPA, characterized by moderate dementia and severe expressive aphasia with relatively preserved comprehension, object recognition and visual-spatial abilities. He was longitudinally assessed with cognitive, functional, behavioral and brain HMPAO SPECT measures pre-OT, at baseline and every 3-6 months for 34 months. RESULTS: All measures improved above baseline for >20 months and persisted at or above baseline for 34 months. Cortical activity increased by a maximum of 21% underneath transposed omentum and in synaptically connected areas, and persisted in >50% of the cortex for at least 12 months. Subjectively, family members observed improved verbal and non-verbal communication. CONCLUSION: OT produced a sustained, beneficial treatment effect in PPA and warrants further clinical and basic research to identify explanatory factors.

Omentum transposition surgery for patients with Alzheimer's disease: a case series.

OBJECTIVE: To examine effect of omentum transposition surgery (OT) in Alzheimer's disease (AD). METHODS: Within-subjects design, also known as repeated-measures design, was used. OT was performed on six biopsy-confirmed AD patients (three to the left and right hemispheres each). Follow-up was conducted over 16-50 months. Outcome measures included the sum of the sub-scores of the clinical dementia rating scale (CDRSS), dementia severity rating scale (DSRS), mini-mental status exam (MMSE) and neuropsychiatric inventory (NPI), all normalized to 0-1.0. Outcomes were compared to baseline values and to expected decline with and without cholinesterase inhibitors therapy (ChEI). RESULTS: Compared to baseline and to expected decline with ChEI, CDRSS scores were 22 and 39% less impaired at means of 14 and 25 months post-OT, and DSRS scores were 12 and 22% less impaired at means of 14 and 19 months post-OT (p<0.0001). Compared to baseline and expected course with and without ChEI, the MMSE scores of the left hemisphere OT patients were not significantly different for 11, 17 and 22 months respectively (p>0.49), while those of the right hemisphere OT patients more rapidly declined. The two patients with significant pre-operative behavioral problems markedly improved; NPI severity scores decreased by 23 (16%) and 78 (54%) points and were sustained for 22 and 42 months. DISCUSSION: OT yielded cognitive, functional or behavioral improvement for up to 3.5 years in these AD patients. Compared to randomized ChEI clinical trials, OT was 34 times more likely to produce clinically significant improvement. Basic research to identify the mechanisms underlying the therapeutic effect of omentum is warranted.

NeuroSPECT demonstrates increased cortical function in alzheimer’s disease patients for at least two years after omental transposition neurosurgery

Se ha comunicado mejoría clínica después del implante quirúrgico de Omento (delantal de los epiplones) en el cerebro en varias condiciones neurológicas que incluyen Infarto cerebral, Encefalitis, Transecciones de la médula espinal y enfermedad de Alzheimer's. La explicación fisiopatológica de estas mejorías no es conocida pero puede relacionarse con la presencia de Células Madres y factores de crecimiento en el Omento que tendrían efectos sobre la angiogénesis, neurogénesis y sobrevida neuronal. El presente trabajo describe los cambios en la actividad cerebral en dos pacientes con diagnóstico de Enfermedad de Alzheimer's confirmado por biopsia, cuya evolución clínica había entrado a una fase de rápida progresión antes del trasplante de Omento. Los pacientes fueron evaluados psicométricamente mediante la escala de clínica de severidad demencial , desde el punto de vista cognitivo el MMSE examination y Neurospect sequencial con HMPAO medido durante 22 y 42 meses respectivamente. La severidad de la demencia mejoró durante dos o más años, mientras la actividad cortical en áreas bajo, adyacente y contralateral al Omento implantado aumentó en una o dos desviaciones standard sobre los niveles pre-operativos del paciente (el máximo aumento fue un 21 por ciento, cuatro desviaciones standard). En el paciente con menor severidad de demencia se observó a los 22 meses post-trasplante que el cingulado posterior demostraba un aumento de perfusión de 20 por ciento comparado con el nivel pre-operativo. Esto es notable si consideramos que el Omento no tenía un contacto directo con la corteza cingulada posterior que se ve envuelta en las fases iniciales de la Enfermedad de Alzheimer's (Braak y Braak etapas 3-4). Estos hallazgos justifican investigación respecto de los mecanismos por los cuales el Omento puede mejorar la actividad cerebral cortical y las funciones clínicas durante dos o más años en la enfermedad de Alzheimer's.