2023-11-11 19:50:41
Neurotechnologies open new perspectives in the field of the interface between the brain and something external to it, allowing it to carry out some of its functions. It has been demonstrated that it is possible, in strictly selected cases, to restore the ability to walk to people who had lost it. And new potential applications are emerging in the field of various pathologies affecting the nervous system.
This is a very advanced frontier research sector, which requires significant investments and which should not be confused with proclamations and false promises for commercial purposes. This was discussed at Tempo della Salute in a meeting attended by Professor Gianvito Martino, scientific director of the Irccs San Raffaele in Milan, and Professor Pietro Mortini, head of the Neurosurgery and Stereotactic Radiosurgery Unit in the same institute, head of the team that performed an operation thanks to which a woman who had not walked for five years due to paralysis of the lower limbs was able to recover her motor functions through the implantation of a spinal cord neurostimulator. The young woman, 32 years old, victim of a sports accident which caused a spinal cord injury, is now able to maintain an upright position and walk with the aid of a walker.
As Professor Martino recalled, the history of the brain starts from Egyptian times and reaches the present day: We understand that the brain exists thanks to a papyrus which summarizes a series of accidents involving workers employed in the construction of the pyramids who caused injuries when falling to the head. The brain of an adult weighs 1.5 kilograms, has 90 billion neurons, 100 billion synaptic connections, 2 million kilometers of wiring. And it is precisely this concept of wiring that is at the basis of the new therapeutic perspectives of cutting-edge neurotechnologies. In spinal cord injuries, the brain can no longer transmit or receive information from the rest of the body. But innovative technology is making it possible to reconstruct these circuits artificially.
The San Raffaele program
At San Raffaele there is a program underway to operate on 10 quadriplegic patients with spinal cord injuries as a result of sports or road accidents – explained Professor Mortini – 7 have been carried out worldwide so far and two of these at San Raffaele .
The first, last May. Professor Mortini showed a video shot by the patient two days ago, walking in the mountains. The second operation was carried out on 16 September and involved a patient who fell on a motorbike. The day after the surgery, the man walked with a walker. And on September 18th he was walking on crutches in the corridors of the University.
On November 22nd we will operate on a third patient. The program involves an intervention every three months because then there is a complex rehabilitation program, added Mortini.
The future and worries
The future? Science has already taken a further step forward with brain-machine interfaces – said Professor Martino -. The idea was: why, instead of inventing stimuli, don’t we go and get the original ones? So we take these stimuli and transmit them directly to the spine and so they use physiological stimuli. Electrodes could even be implanted in the brain and through these implanted or surface chips, the brain could control a whole series of functions.
Now, science has arrived at connections via wi-fi. Experimentally, even between multiple brains. For this reason, as Professor Martino underlined, it is important to create rules. We must now establish what the rules are – reiterated Professor Mortini -. We don’t know everything about how the central nervous system works. A conference was convened in London a few days ago to regulate artificial intelligence. We need to establish what the rules of neurotechnology are and that it becomes an element of international law. Because we see some small danger on the horizon. We will need to take information from the brain: in the US this could happen within the next 12 months and in Europe in the rest of the 24.
Previous
The objective was achieved thanks to the collaboration with a group of engineers from the Biorobotics Institute of La Scuola Superiore Sant’Anna in Pisa, which is directed by Professor Silvestro Micera. After the operation, the patient began a complex rehabilitation process. The latter are the same, to be clear, who collaborated with the group of the Polytechnic of Lausanne (EPFL), led by Professor Grgoire Courtine, in the experimentation with which at the end of 2021 three paralyzed people were able to walk, swim and cycle again thanks to electrodes implanted in the spinal cord.
How does it work
The implanted device consists of two parts: a biocompatible support for 32 electrodes which is inserted into the epidural space of the spinal column and a pulse generator (a sort of pacemaker) similar to those used in patients with cardiac arrhythmias, inserted under the skin at hip level. The impulses are delivered to the spinal cord from where they pass to the nerves and muscles. The pacemaker was then programmed to ensure coordinated activation of all the muscles necessary for walking.
Control of the stimulator functions is possible thanks to a series of options that can be chosen by the patient based on the locomotor needs of daily life. This is a first step within an advanced research program to develop innovative therapies that make use of an interface between electronic devices and the central nervous system to overcome functional deficiencies.
Quality of life after surgery
So far, the path described from a technical point of view. But what happens to a patient who undergoes a similar procedure? What is his quality of life? As said – replies the head of Neurosurgery at San Raffaele -, patients must first face a particular rehabilitation program in successive stages: walking on a flat surface, then climbing the stairs and so on. And the stimulators are “set” precisely for this purpose. So there is a dependence, so to speak, on external software, which for now is becoming more and more elaborate and more and more sophisticated. Even the miniaturized device. The quality of life, therefore, is certainly better than before: let’s not forget that. in our case, a 32 year old person who has been in a wheelchair for five years can now walk.
Psychological assistance and diet
It is therefore a long and delicate journey, which requires a multidisciplinary approach. In addition to neurosurgeons, engineers and rehabilitators, professionals who deal with psychological and nutritional aspects are also involved. Sometimes patients need to be assisted from this point of view too. We have equipped ourselves and offer them the support they may need, adds Professor Mortini.
Future developments
What will happen now? Professor Piero Mortini explains: We are conducting an advanced clinical research protocol, coordinated by my collaborator, Doctor Luigi Albano, at the end of which this intervention could enter current clinical practice, offering a therapeutic solution to patients with spinal cord injuries. In Italy, the protocols for testing do not yet allow neurostimulation to be carried out for cervical injuries (like the one suffered by Oskam, ed.) – explains Professor Mortini -. Hospital ethics committees authorize the procedure only for the “lowest” lesions. The implanted device is similar to the one used in the stimulation therapy in case of chronic pain. Furthermore, we have the possibility of programming it in such a way as to obtain brilliant results: after four weeks the patient walks, with the help of a walker.
November 11, 2023 (modified November 11, 2023 | 6:02 pm)
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