Telemedicine used in MS neuromodulation study at NYU Langone, with positive results (US)

MS patients in a small NYU Langone Medical Center-led pilot of neuromodulation and cognitive training using telemedicine supervision experienced significant improvement in complex attention and reaction time. Non-invasive transcranial direct current brain stimulation (tDCS) was added to a previously tested cognitive training program for MS patients. Telemedicine (real-time video) was used to deliver the training, monitor patients in the program and provide follow-up support.

The study control was a cognitive training (CT)-only group. According to the abstract, “after ten sessions, the tDCS group (n = 25) compared to the CT only group (n = 20) had significantly greater improvement in complex attention (p = 0.01) and response variability (p = 0.01) composites. The groups did not differ in measures of basic attention (p = 0.95) or standard cognitive measures (p = 0.99).” These results corresponded to the stimulation area in the dorsolateral prefrontal cortex, according to the lead researcher Leigh Charvet, PhD.

The current used in the tDCS unit helps neurons fire more readily, versus making them fire. The tDCS unit used was likely provided by NYC-based Soterix Medical, a developer of neuromodulation systems used in clinical trials. One of the study authors, Abhishek Datta, PhD, is their CTO.

The research is also promising in helping to deliver therapy to MS patients at home, reducing the travel need on both sides, and to develop analytics to optimize medication. In future, the researchers hope to expand the study group to Parkinson’s disease patients. MedCityNews, Neuromodulation (the official journal of the International Neuromodulation Society; abstract only, full study requires additional access)

Writing an ‘Electrical Prescription’ for biosensing ‘neural dust’

How can sensors better communicate with and regulate the central nervous system (CNS)? DARPA (Defense Advanced Research Projects Agency), which is part of the US Department of Defense, is on the case with research on miniaturized electronics suitable for chronic use for biosensing and neuromodulation of peripheral nerves in the Electrical Prescriptions (ElectRx) program.  A DARPA-funded ElectRx research team led by the University of California, Berkeley’s Department of Electrical Engineering and Computer Sciences has developed what they term ‘neural dust’–a millimeter-scale wireless device small enough to be implanted in individual nerves, using ultrasound for power coupling and communication. In vivo test results on rodents have been published in the peer-reviewed neuroscience journal Neuron. A nice return to Armed With Science, which has been bereft of device or robotics news for months.

TBI neuromodulation therapy in phase 3 trials with US Army

Helius Medical Technologies and the US Army Medical Research and Materiel Command (USAMRMC) jointly announced the phase 3 trial of Helius’ mPoNS (Portable Neuromodulation Stimulator), a non-invasive brain stimulation device for the treatment of balance disorder in patients with mild-to-moderate traumatic brain injury. This commercializes the research of USAMRMC and University of Wisconsin-Madison we covered two years ago [TTA 28 Feb 13] in using electrical stimulation of the cranial nerves located in the tongue. The phase 3 study will be at three sites for seven months: the Montreal Neurofeedback Center, the Oregon Health & Science University Center for Regenerative Medicine, and the Orlando Regional Medical Center. The mPoNS is also being researched in Canada for treatment of gait and balance in multiple sclerosis. Press release

The Future of Medicine – Technology & the Role of the Doctor in 2025 – a brief summary

The following is a brief summary of a joint Royal Society of Medicine/Institute of Engineering & Technology event held at the Academy of Medical Sciences on 6th May. The event was organised, extremely professionally, by the IET events team. The last ticket was sold half an hour before the start, so it was a genuine sell-out.

The speakers for the event were jointly chosen by this editor and by Prof Bill Nailon, who leads the Radiotherapy Physics, Image Analysis and Cancer Informatics Group at the Department of Oncology Physics, Edinburgh and is also a practising radiological consultant. As more of those invited by Prof Nailon were available than those invited by this editor, the day naturally ended up with a strong focus on advances in the many aspects of radiology as applied to imaging & treating cancer, as a surrogate for the wider examination of how medicine is changing.

The event began with a talk by Prof Ian Kunkler, Consultant Clinical Oncologist & Professor in Clinical Oncology at the Edinburgh Cancer research Centre. Prof Kunkler began by evidencing his statement that radiotherapy delivers a 50% reduction in breast cancer reappearance, compared with surgery alone. He stressed the importance of careful targeting of tumours with radiotherapy – not an easy task, especially if the patient is unavoidably moving (eg breathing) – Cyberknife enables much more precise targeting of tumours as it compensates for such movement. Apparently studies have shown that 55% of cancer patients will require radiotherapy at some point in their illness.

This was followed by Prof Joachim Gross, Chair of Systems Neuroscience, Acting Director of the Centre for Cognitive Neuroimaging & Wellcome Trust Senior Investigator, University of Glasgow, talking about magnetoencephalopathy (MEG), which enables excellent spatial & temporal resolution of the brain. However it currently uses superconducting magnets that in turn require liquid helium, so is very expensive to run. He then showed an atomic magnetometer which apparently is developing fast and will be a much cheaper alternative to MEG – he expects people will be able to wear sensors embedded in a cap soon. He then went on to show truly excellent graphics on decoding brain signals with incredible precision; he explained that the 2025 challenge is understanding how the different brain areas interact. Finally he described neurostimulation, using an alternating magnetic field with the same frequency as brain waves to change behaviour; whence the emergence of neuromodulation as a new therapy. Both exciting, and just a little scary.

Dr David Clifton, Lecturer, Dept of Engineering Science & Computational Informatics Group, University of Oxford, followed with a talk on real-time patient monitoring. He began by explaining the challenges that clinicians face with this wall of patient data coming towards them: only “big data in healthcare” enables all the data generated by patients to be analysed to identify the early warning signals that are so important to minimise death and maximise recovery. (more…)