Portugal is the first in the world to implant neurostimulator with long-term monitoring in epileptic patients
10th August 2020
A new neurostimulator, approved for human use in Europe in January this year, which simultaneously allows the generation of stimuli and the reading of the brain signal in the deep areas of the brain, was implanted in a patient with epilepsy, at the end of June, at the University Hospital Center of São João (UHCSJ). This is the first time in the world that this neurostimulator model is implanted and used in the long-term continuous monitoring (1 week) of an epileptic patient to study new approaches to adaptive stimulation therapy in this neurological disease.
Deep brain stimulation (DBS) in epilepsy has been used for some years in some situations, but it has been done in a “blind” way. In other words, “we know that a large part of the cases (about 60%) benefit in some way from DBS, but that only a small part (about 15%) ceases to have epileptic seizures with this therapy and we don't know why. In fact, there is no understanding of the mode of action of stimulation in patients' neuronal circuits and, therefore, much research is needed, which can be carried out, for example, through this new neurostimulation technology launched earlier this year by Medtronic at Europe (the device will only now be launched in the USA, as it was only approved by the FDA at the end of June)”, explains João Paulo Cunha, coordinator of the Biomedical Engineering Research Centre at the Institute for Systems and Computer Engineering, Technology and Science ( INESC TEC).
The medical community has thus sought evidence that it is possible to extend and improve the use of this technique by basing stimulation on information that can be read in the brain, while therapy is administered.
It was what was recently tested in Porto, with an epileptic patient, the first in the world to be implanted with this new neurostimulator from the American manufacturer and to be monitored continuously in a specialized inpatient unit for several days. “For the first time, with this neurostimulator, we were able to measure changes in electrical signals in the deep areas of the brain and on the surface (using conventional electroencephalography), and measure the movements induced by epileptic events in 3D (using 3D video-EEG technology, developed by INESC TEC) as we programmed different levels of brain stimulation. We also tried to find out what type of electrical activity measured by this new neurostimulator can help us better detect, or even predict, the occurrence of epileptic seizures ”, says João Paulo Cunha, also Associate Professor with Aggregation at the Faculty of Engineering at the University of Porto (FEUP). “With this new neurostimulator we can leave this “blind” paradigm and move on to new approaches to "adaptive" or "reactive" stimulation, which could make the difference in the quality of life of patients", concludes João Paulo Cunha.
"This system was implanted in a patient with chronic and disabling epilepsy, resistant to treatment with anti-epileptic drugs. The individual has independent epileptic foci in both brain hemispheres, meaning the he is not a good candidate for resective surgery (i.e., removal of a damaged portion of the brain). For this type of patient, neurostimulation is the best chance to improve the control of epilepsy. We hope that this new generation of neurostimulators can actually be more effective than the current ones, since we will be able to modulate the electrical parameters of stimulation in a quite individualised way. Concerning CHUSJ and the Reference Centre for Refractory Epilepsy, we are proud to be the first national centre (and one of the first worldwide) to use this system for the benefit of our patients, as well as the first in the world to implement it in a context of long-term 3D EEG video monitoring. This way, we are improving the patients’ future therapeutic possibilities, through a scientific partnership with INESC TEC”, mentioned Ricardo Rêgo, coordinator of the Epilepsy Monitoring Unit of the Neurology Service of CHUSJ and the Reference Centre for Refractory Epilepsy
A multidisciplinary team - including doctors at the Neurophysiology and Neurosurgery services of CHUSJ and INESC TEC engineers - will further explore the data obtained during a week of monitoring throughout the upcoming months, in order to study all the components: stimulation, deep brain signals, brain surface signals (EEG) and 3D movements of the patient.
The CHUSJ services plan to implant more neurostimulators in other patients, and there are strong collaborative efforts in this field, with the University Hospital of Tampere in Finland, and the University Hospital of Munich, in Bavaria - which will increase the number of cases and advance the discovery of new adaptive stimulation therapies in epilepsy.
Porto - September 10, 2020
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