The scientists detailed the process of constructing the neuroprosthetic that allowed the first Parkinson’s patient to be treated, allowing him to walk comfortably, confidently, and without falling, in an article published in Nature Medicine.
Disabling walking difficulties affect around 90% of people with severe Parkinson’s disease. The treatments that are currently available for these walking abnormalities are frequently ineffective. Marc, 62, has had Parkinson’s disease for nearly three decades. Dopamine, followed by deep brain stimulation in 2004, alleviated his tremors and stiffness. He recently experienced severe walking difficulties that were unresponsive to dopamine or brain stimulation. “I could hardly walk any longer without falling several times a day.” In some cases, such as approaching an elevator, I’d trample on the spot, as if I were frozen there.”
Spinal cord stimulation using electricity
“The idea of developing a neuroprosthetic that electrically stimulates the spinal cord to harmonise the procedure and correct locomotor disorders in patients with Parkinson’s is the result of several years of research on the treatment of paralysis due to spinal-cord injuries,” says Grégoire Courtine, professor of neuroscience at EPFL, CHUV, and UNIL. Unlike traditional Parkinson’s treatments, which target brain regions directly affected by the loss of dopamine-producing neurons, this neuroprosthetic targets the spinal area responsible for activating leg muscles while walking, which appears to be unaffected by Parkinson’s disease.
“It is impressive to see how, in the same way that we have done with paraplegic patients, we can correct walking disorders caused by Parkinson’s disease by electrically stimulating the spinal cord in a targeted manner,” says Jocelyne Bloch, neurosurgeon and professor at Lausanne University Hospital (CHUV), UNIL, and EPFL, and co-director of the.NeuroRestore center with Grégoire Courtine.
The implantation of this neuroprosthetic in a patient would not have been feasible without the assistance of Dr. Erwan Bezard, a neuroscientist at Inserm, CNRS affiliate, and University of Bordeaux professor who has dedicated his career to understanding neurodegenerative illnesses. His expertise in Parkinson’s disease preclinical models was critical to producing the technological and conceptual advancements required for clinical use in humans.
“I’m not even afraid of the stairs anymore”
The team of scientists and surgeons was ready two years ago, and the first patient was operated on at Lausanne University Hospital (CHUV). Marc, from Bordeaux, was fitted with this novel neuroprosthetic after a precision neurosurgery procedure that included an electrode field put against the spinal cord, which governs walking, and an electrical impulse generator implanted beneath the skin of his abdomen. Marc’s walking condition has quickly improved because to specific programming of spinal-cord stimulations that react in real time to his motions. He can now walk practically normally after several weeks of rehabilitation with the neuroprosthetic. He currently wears his neuroprosthetic for approximately 8 hours per day, only turning it off when he sits for an extended amount of time or when he sleeps: “I turn on the stimulation in the morning and turn it off in the evening.” This enables me to walk more comfortably and steadily. I’m not even terrified of the stairs any longer. Every Sunday, I walk roughly 6 kilometers to the lake. It’s amazing.”
The Problem of Large-Scale Use
This neuroprosthetic opens up new possibilities for treating walking disorders, which affect many people with Parkinson’s disease; however, at this stage, the treatment concept has only been demonstrated in one person, with an implant that still needs to be optimized for large-scale use. Grégoire Courtine and Jocelyne Bloch are creating a commercial version of the neuroprosthetic in collaboration with ONWARD Medical, which will have all of the necessary functionalities for optimal everyday use. “Our ambition is to provide general access to this innovative technology to improve the quality of life of Parkinson’s patients significantly, all over the world,” they go on to say.
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