Clinical trial uses innovative spinal cord device for Parkinson's patient mobility advance
"Previously, walking through a store would have been nearly impossible for me due to the freezing of gait that often occurred in those settings. Now, that doesn't happen anymore, and I no longer suffer from freezing. I live close to Bordeaux, France, and recently shared this news during a news conference. Translated from French, I said in English:
In a recent study, I received an experimental spinal cord neuroprosthesis to improve walking disorders in people with Parkinson's disease. This device has helped me regain my stride step by step.
Dr. Eduardo Moraud, one of the study's authors and a researcher at Lausanne University Hospital in Switzerland, explained during the news conference how the neuroprosthesis operates by electrically stimulating specific areas of the spinal cord associated with walking. Moraud noted the difficulties associated with addressing gait and balance issues in Parkinson's patients due to the variability of symptoms:
"Improving walking problems in Parkinson's disease is extremely difficult. These issues can be diverse and change from patient to patient. They can affect the way one walks but also balance, symmetry, and posture."
This new method targets and addresses these problems on an individual basis for each patient using real-time electrical stimulation. It also complements existing treatments like deep brain stimulation or medications to increase dopamine levels.
Parkinson's is a degenerative brain condition that causes brain cells to deteriorate. Symptoms related to walking arise when the basal ganglia area of the brain, which controls movement, becomes impaired or dies. These nerve cells typically produce dopamine, but when they die or become impaired, the lack of dopamine often affects a person's ability to move, walk, or maintain balance. Nearly all people with this disease (90%) experience locomotor deficits. While there is currently no cure for Parkinson's, some therapies, such as deep brain stimulation or dopamine-increasing medications, can help alleviate symptoms.
Diagnosed with Parkinson's at age 36, Gauthier, a father of two, experienced severe walking disorders that didn't respond to his existing treatments. These issues included his body stiffening and falling around four times daily, forcing him to stop working as an architect.
When invited to test the experimental spinal cord neuroprosthesis, Gauthier initially turned down the opportunity due to the time commitment, but changed his mind and decided to participate. The neuroprosthesis´s development involved visualization and mapping of the hotspots in the lower spinal cord that would require electrical stimulation to alleviate gait impairments and balance issues in Parkinson's patients. These researchers targeted six hotspots related to walking.
Gauthier underwent surgery at Lausanne University Hospital approximately two years ago to implant an array of electrodes near his lower spinal cord, serving as a guide to reach the six hotspots identified. A neural stimulator placed under the skin in his abdomen was linked to the electrodes, allowing for the application of electrical stimulation to the spinal cord. Bloch, a neurosurgeon and study author, described the surgical process as follows:
"The connection between the electrode and the stimulator is under the skin, and we control the device using a remote control."
After months of rehabilitation, Gauthier regained the ability to walk independently with the implant. He can also opt to wear wearable sensors on his legs for additional stimulation. Sensor data can be used to synchronize epidural electrical stimulation with movements and reinforce them.
The researchers reported that the neuroprosthesis, based on epidural electrical stimulation, helps "promote larger steps, improve balance, and reduce freezing of gait." Gauthier uses the device for about eight hours daily, activating the stimulator in the morning and shutting it off during long periods of sitting or sleeping. Despite being a non-cure, this intervention gives Gauthier "a bit of quality of life."
"With this spinal cord stimulation, we may still have to manage progressively worsening symptoms," Bloch added. "However, we can still provide him with some relief from the therapy.″"
'A Sign of Progress'
"For decades, physicians and scientists have sought to develop a solution for the walking and balance problems that often accompany Parkinson's complexities. Gauthier's successful treatment is a significant step forward, suggesting that neuroprosthetic devices could be an option for individuals with Parkinson's."
"This neuroprosthesis, employing epidural electrical stimulation, has the potential to revolutionize the treatment of walking disorders in Parkinson's disease. With further study, these devices may become widely available and provide patients with a non-surgical, effective means of improving their mobility."
However, future research will be necessary to assess the efficacy, long-term impact, and potential side effects of this therapy. Despite the encouraging results, the neuroprosthesis remains a prosthetic implant, not a cure for Parkinson's disease.
In an email, Dr. Svjetlana Miocinovic, a neurologist specializing in Parkinson's disease and associate professor at Emory University School of Medicine, described the proof-of-concept study as "exciting" and "impressive." While not involved in the new research, she expressed enthusiasm for the potential of better treatments for gait and balance impairment in PD.
"It will be important to demonstrate that the gait benefit observed in this study is specifically due to spinal stimulation," Miocinovic stated. "Comparisons with sham stimulation are crucial. Additionally, it must be shown that patients can achieve this benefit, and the technology can be deployed in clinical practice."
David Dexter, director of research at Parkinson's UK, shared a similar sentiment. He emphasized the need for testing this technology in more individuals with Parkinson's disease, including those who haven't received deep brain stimulation as a therapy. So far, this experimental therapy has only been tested on a single individual with Parkinson's who already had deep brain stimulation.
"We need to see it be tested in many more people with the condition, including those without DBS, in clinical trials to further explore the potential benefits and side effects/risks of this innovative new therapy," Dexter mentioned in a written statement distributed by the UK-based Science Media Centre.
Dexter, who was not involved in the new study, added, "This is quite an invasive procedure but could be a game-changing technology to help restore movement in people with advanced Parkinson's where the drugs are no longer working well. This research is still at a very early stage and requires much more development and testing before it can be made available to people with Parkinson's. However, this is a significant and exciting step forward, and we hope to see this research progress quickly."
Moraud acknowledged that another patient has already initiated the therapy, and the researchers plan to conduct clinical tests next year for six more patients with Parkinson's disease. The work is being funded by a $1 million donation from the Michael J. Fox Foundation. In collaboration with the Netherlands-based medical technology company ONWARD Medical, Bloch and Grégoire Courtine, an author of the study and professor of neuroscience at the Lausanne University Hospital, are working on developing a commercial version of the neuroprosthesis.
Courtine expressed a desire for a larger scale clinical trial after the initial phase to validate the therapy during the news briefing. He noted that this ongoing research would take "at least five years of development and tests."
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In the same study, Gauthier also mentioned experiencing improved balance and symmetry as a result of using the neuroprosthesis.
During the news conference, Moraud highlighted the potential application of neuroprosthetic devices to address gait and balance issues in a diverse range of Parkinson's patients.
Source: edition.cnn.com
