A Stroke and Brain Injury Breakthrough

*Transcript generated by YouTube

Good evening and welcome to ’60 Minutes.’

Every ten minutes in Australia, somebody suffers a stroke.

It’s our second biggest killer

and has left nearly half a million survivors

living with crippling disability.

But despite the dramatic medical advances in other fields,

there is only so much that can be done for a stroke patient.

Which makes the work of one clinic, in America,

so tantalizing.

Its results have to be seen to be believed.

The therapy is controversial and heavily criticized,

but the patients say it’s truly miraculous.

Can you please count from one to ten?

Every minute of Linda’s daily life is

a frustrating struggle.

[Attempting to say ‘one’]

One.

[Attempting to say ‘two’]

Two.

She suffered a stroke three years ago, which left this teacher

barely able to walk or talk.

Four.

Five.

Doctors have told her this is how she’ll be forever.

That’s why Linda’s traveled to this Florida clinic:

to try a controversial new stroke treatment.

Well, I can understand why you would-

The speech makes it very frustrating.

It’s her last shot.

One injection of a drug called, ‘etanercept’

[near] her spinal cord at the back of the neck.

What’s different?

Oh!

A brief few minutes pass to let the drug flow to her brain.

It’s clear, clear!

Clear?

Okay.

Not even Linda, nor the doctors here, expect what happens next.

Okay, did it look cloudy?

Uh huh!

Okay, now it’s clear?

Uh huh!

Oh, oh, oh my!

It was a bull’s-eye hit on the pathology

that was interfering with her brain function.

You’re doing fine. You’re doing super fine.

Using etanercept in this way,

on stroke patients, is groundbreaking.

It’s so crisp!

One.

Two.

The conventional and approved use of etanercept

is for the treatment of severe arthritis.

Can you bring it up?

Doctor Ed Tobinick has [over] 700 stroke patients who have

received this treatment at his Florida clinic.

Little stick.

An anti-inflammatory, it attacks or
blocks the buildup in the brain of a

molecule called ‘TNF,’ or ‘tumor necrosis factor.’

In stroke, what happens is, there’s

an inflammatory response.

A chronic, inflammatory response that is caused by the stroke.

Etanercept works by neutralizing that chemical, TNF,

thereby improving the ability of brain areas to communicate with each other.

Hi, Charlie, nice to see you.

I’m going to give you a few words to repeat one at a time.

We featured Dr. Tobinick on ’60 minutes’ in 2011.

Can you tell me who is the U.S. President?

No.

When he used the same drug, injected the same way,

on Alzheimer’s patients.

Who is the President of the United States?

Obama.

Yes.

Doctor Tobinick now claims

his unorthodox treatment can aid stroke
recovery.

Okay, you’ll feel a little stick, just for a second.

We see improvements in cognition.

We see improvements in motor function.

We see improvements in spasticity.

We see improvements in pain.

It’s those improvements that 52 year-old, Linda,

and husband, Benny, have been searching for.

How would you describe your wife

before this happened?

Oh, very outgoing, people person.

Loved to chat with people and visit,

you know.

Help people, also.

[Attempting to recite the alphabet]

Linda collapsed while

teaching in her classroom in late 2010.

It was a massive stroke following an epileptic seizure.

She lost virtually all speech, and
Linda’s left side fell limp and numb.

Touch your nose.

Traditional stroke therapy could only do so much,

and after six months in rehabilitation,

Linda was sent home.

This must have been heartbreaking
watching your wife become this person.

When she first came home, she couldn’t even do stairs.

It was a struggle to do bathing; couldn’t prepare meals.

She had a difficult, very difficult time.

She always was very independent, and it was hard.

So, to see her become the
complete opposite of that

must have been terrible for you.

Well, there’s a like a shock almost, you know.

We thought, you know, ‘She’s going to get better,

progressively better,’ and as time goes on,
yeah a little bit, a little bit,

but not really what I thought, as time went on.

So, I was like, ‘Well, maybe this is the way it’s going to be,

and we need to learn how to deal with this.’

Well, she’d get frustrated.

Linda’s twin daughters, Christy and Casey, struggled to accept

there was not much more that could be done for Linda.

It was hard. My mother was a teacher.

That’s who she was, and I think it’s hard

to watch your mother not know who she is
anymore,

because that’s –

She was a mom, and she was a teacher.

Then, when that’s gone –

She’s really a different person.

Yet, she’s trying to find her place.

Okay, now do you want to take this by hand or put it in the bag?

No, I’ll take it on board.

Like Linda, Antoinette, from Brisbane,

knows the pain and suffering of stroke.

Are you alright there, baby?

Yeah, I’m fine.

With husband, Carlo,

she’s making the long journey to America

for an appointment with Dr. Tobinick.

For twelve years, she’s lived with

paralysis and constant pain,

and she’s been searching for any

treatment that may help.

Now, she’s willing to try the etanercept perispinal injection.

What are you hoping it’ll do for you?

We have talked of that a lot.

We’d be happy between five and ten
percent improvement.

For me, if I could get rid of some of
this tightness in my arm,

that would make a huge difference,

because it’s not just – sort of makes things difficult,

but it’s also quite painful. Having the stretches is very painful.

So, it’s not a pleasant thing,

and it’s a very hard condition to treat with anything else.

So, if you could get a very slight
improvement, in the least –

I’d be very, very happy, yeah.

Turn your head to the left.

The etanercept injection will not

reverse paralysis in stroke patients, like Antoinette.

Can you squeeze?

Dr. Tobinick believes it can
decrease severe muscle spasticity

and ease post-stroke pain.

Go ahead.

One of the most crippling effects of stroke,

for which there’s little treatment.

No?

The shoulder pain, is that something you have every day?

Yeah, just about every day. Yeah.

But if I try to move your wrist up,

is that uncomfortable?

Yes, it is.

Just a little motion is uncomfortable, okay.

It’s really tight.

Antoinette is also somewhat of a guinea pig.

She’ll be the clinic’s first stroke
patient to undergo a sophisticated 3D

brain scan following the injection.

All done.

To see how blood flow and activity are

affected or improved by the drug.

Coming up: Antoinette’s amazing results.

That’s quite spectacular.

And the incredible moment:

Hi!

Hello there!

Linda wakes up.

Woohoo!

It – It worked!

That’s next on ’60 Minutes.’

[Clock ticking]

Welcome back to ’60 Minutes’ and

the extraordinary new stroke therapy transforming lives.

When Linda suffered a stroke three years ago,

she lost her speech and struggled to walk.
Like so many stroke victims,

rehabilitation could only do so much.

But then she heard about a controversial

injection that was reducing the effects of stroke.

It isn’t fully tested, and is

viewed cynically by many neurologists,

but that hasn’t stopped Linda.

The results are something to see.

What’s different?

Ah!

It’s only been a brief few minutes since Linda

received that injection of etanercept

at the base of her brain.

It’s clear, clear!

Clear?

She’s being tipped upside down to allow

the medicine to flow into her brain.

Oh my!

Remember, this is stroke-affected Linda just before the injection.

[Attempting to say ‘one’]

One.

[Attempting to say ‘two’]

Two.

Oh, oh, oh, my!

Moments after the shot, she sits up.

The change in Linda is something to behold.

It – It’s gone!

Hi!

Hello there!

[Laughing]

Woohoo!

It – It worked!

I’m – I’m me!

Yeah!

Oh!

In – In here, is clear.

Hi!

It’s me!

It’s truly a miracle.

It happens all so quickly, and it’s [snap] done!

[Laughing] Oh, my word!

Before you know it,

it’s all over with, and then boom! [snap]

I can talk! I can walk!

We felt it was likely that she would improve.

To improve almost back to normal was just

spectacular and wonderful

and gratifying

and very, very moving to watch.

Hi!

How would you describe yourself before

and then after the injection?

It’s just truly amazing.

The change is absolutely miraculous.

It’s amazing.

Every day, there seems to be something that’s like,

‘Oh!

Oh, I can do that now!’

It’s amazing.

[Music & Flowing Water]

Back at home with her family,

Linda is full of life.

[Chatting]

It’s Maine Maple Sunday on Sunday!

[Reading] Elizabeth Brown entered the world skinny, nearsighted, and shy.

It’s hard to believe that this simple joy of reading to her grandchildren

was impossible just eight weeks before.

Um…

[Attempting to say ‘cluster’]

Mhm.

[Attempting to say ‘mistake’]

I described it, like,

if you think of your mind as, like, a window

and the window is always dirty.

It’s got this film, filthy film, on it,

and no matter how hard you scrub, it will not go away.

That was my mind, and I, literally,

would see words,

and then, if you could get the words

in an order that would make some sense,

then, to try to get those words to, actually, come out of your mouth correctly…

That didn’t work well either.

Sissy got on the phone; she goes,

“Mammy, you sound funny!”

For Linda’s twin daughters, Christy and Casey,

they have, quite simply, got their mom back.

[Laughing]

Can you talk to Mammy?

Can you talk to Mammy?

It’s amazing and humbling, and

something that you can’t describe.

When your mother leaves, and

she can’t pick up your newborn son,

and then she comes home, and she can.

Talk to mammy! Hi!

Now, she changes diapers,

[Laughing]

and babysits, you know.

Here you go, Mom.

Do you believe what’s happened to your mom is a miracle?

Yes.

Yep.

Absolutely.

[Laughing]

It just is mind-blowing, and there’s no words

besides that it’s an amazing miracle

that so many people should be able to experience.

Linda’s, almost total, post-stroke recovery

is just astounding.

Can you measure the extent of your recovery?

I didn’t think I’d be completely me.

I really didn’t think it would be as

profound as it actually turned out to be.

But I thought, you know,

‘If I can just have my speech back, because I want to be

able to think and speak, correctly,

and if I can’t have the physical part back,

that’s okay. I can deal with that.’

But to get it all back, it’s – it’s truly a miracle.

But this drug treatment has critics

who don’t think it’s so miraculous.

Well, I believe anyone who offers etanercept for post-stroke plasticity,

in the current state of the evidence,

is a snake-oil salesman.

The blockage is right here.

Neurology professor, Doctor Jeffrey Saver

is the director of the acclaimed stroke unit

at the University of California.

He says Dr. Tobinick’s work

hasn’t been subjected to independent clinical trials.

In medicine, the way to prove a treatment works

is the placebo-controlled trial,

because we know that the placebo response,

the tendency of the body to respond to

hope, is remarkable, and the

only way to tell that a particular

treatment is better than chance,

is to compare that treatment to a placebo,

and that is not occurred with this therapy.

So, I would say, you know, ‘The only proven

effect of this treatment and post-stroke disability,

is to separate patients from their money.’

Okay, you’ll feel a little stick, just for a second.

The injection can cost patients [with or] without

health insurance [over] $6,000,
(Fee determined during a consultation)

and the American Academy of Neurology

has written a draft warning about etanercept injections

for stroke patients.

They’ve concluded that, ‘because of the

potential for serious adverse outcomes,

and high cost,

clinicians should not offer etanercept to

post-stroke disability patients,

unless treatment is part of a research study.’

Yes.

Does that put an end to what you’re doing?

Well,

I think that – that ‘conclusion’ is still a draft.

‘Draft conclusion,’

and

we don’t feel that that is scientifically accurate

or

a proper conclusion.

Is it possible, though, that Dr. Tobinick is onto something here?

It’s always possible that something might work.

Pigs might fly;

the Sun might not come up;

and it’s also the case that we,

in traditional neurology, are wide open

to treatments that seem to come out of left field.

We have no reason not to jump for joy.

But you’re not jumping for joy.

Unfortunately, I’m not jumping for joy,

because the evidence is not there.

Still uncomfortable if we touch it?

Yeah.

Dr. Tobinick acknowledges his treatment won’t work for everyone.

It’s only another few minutes.

He says, ‘one in five will show no significant response.’

Cube, cluster, mistake, machine…

Out of the hundreds of his patients who have shown improvement,

…learning, ladder

many, like Linda, are quick to answer the critics.

I – I remember how to read!

I – I don’t get it, because have they viewed

any of the people who have agreed to be taped

when they’ve received the treatment?

Have they read anything?

Have they talked to any of us?

Because I invite them to.

I would tell them to take a look at me.

How much more proof do you need?

They think, ‘It seems too good to be true,

sounds too good to be true,’ but

if you just look, there’s no denying it.

There’s no doubt Linda’s recovery is remarkable,

but

will it last?

The short answer is, ‘Nobody knows.’

There are no guarantees and

no long term research yet.

Should the effects begin to wear off,

patients, like Linda, say

they’re more than happy to return to Dr. Tobinick

for another shot.

We don’t know if the effect will be permanent,

because we only have several years of experience .

I think it’s reasonable to think that it could be long-lasting,

based on what we’ve seen with other patients.

Dr. Tobinick is pushing ahead with his own science

and evidence to back his work.

Like mapping the brain to see where the etanercept flows,

and how, or why, it seems to improve brain function.

Antoinette, from Brisbane, is his

first patient to undergo the test.

When there is a red area, like we see, that

indicates a more than three and a half times standard deviations

improvement in blood flow in that area.

That’s quite spectacular.

Before the etanercept treatment,

Antoinette’s brain looked like this.

One day later, there are six red spots on the scan.

They indicate new activity in the brain.

Blood flow appears to have returned to areas

previously affected by her stroke.

I think that what we’re seeing

represents a transformation from

what’s called, ‘stunned brain,’

where the brain cells are actually, essentially

hibernating; they’re not able to communicate.

To a state where the brain cells,

and that in these areas, have woken up.

Later, Antoinette says she can feel

what the scan shows.

Do you have less pain now than you did before?

Yes, definitely.

Importantly for her, more flexibility in her paralyzed side

and significantly less pain.

Look at that!

Any pain?

No!

(Before) 162 degrees with the pain of six (out of ten),

Now, we’re at 170 (degrees) with a pain of zero (out of ten).

That’s amazing!

Really it’s amazing, you know.

It’s like in a couple of days,

to have increased by that much,

without having to do a whole lot of physical exercise

to get there, it’s just incredible.

Any pain? From zero to ten?

About a one.

What exactly has changed or improved?

Well, that pain is a big one.

Increased mobility, and the fact that my arm is so much looser.

It’s fantastic.

Some people are cynical of this treatment.

Yeah.

For you, is it – is it real?

It’s not just a placebo effect?

Absolutely real, yeah.

After your stroke, you must have felt as if you are housebound.

Yes, it was difficult to get out and about,

unless somebody was willing to take me,

but now, I can go-

For Linda, the days of pain and disability and isolation are over.

I avoided a lot of places, many people.

Simple things, like, just going to the

supermarket became too hard.

Totally avoided it. I could be looking at the

section of cheese, for example,

and say I needed, you know,

provolone cheese, or whatever,

I could be looking and look and look and look,

and it would take several minutes to locate what it was I needed,

and decide, “Okay, that’s the right one.”

Got your list?

Yes.

Now, Linda can take an easy walk

down the supermarket aisle again.

So, tell me the difference now-

Oh!

-standing on this spot.

I want provolone cheese.

Yeah.

That is as easy as that now.

Oh, yeah.

It’s not a problem.

Keeping up with Linda is the new challenge.

So now, I have to try and keep up with you,

because you’re off. Right? Okay.

You know, that’s what Benny says! [Laughing]

He says, “It’s back to old times!”

He’s gotta keep up with me.

All right, I’ll follow you.

Okay.

You’ve got the list.

It’s like someone’s reached into your brain,

and flicked the ‘on switch.’

It’s quite incredible.

It’s like life’s back,

and I’m ready!

Like you say, that light, all that fog’s gone.

You can think, you can talk,

and all that numbness, that ting-

your, your mobility, you’ve got everything. It’s all back.

So, you’ve got all this time to make up for,

and, so, I’m not letting any dust settle.

[Clock ticking]

We’ll be keeping a close eye on Linda’s and Antoinette’s progress.

You can also see more by going to “Extra Minutes”

on our app for iPhone or iPad.

[Clock ticking]