Spinal implants help treat paralysis but aren’t ready for primetime

David Mzee's left leg protrudes from the trampoline and paralyzed since he broke his neck in 2010. So when he woke up last night in the middle of the night, he realized he was moving his left foot. Believe it. "I did not know if it was real," he says. He kept shaking his toes and shook it again. "I was awake for an hour after that and was looking to see if it keeps moving."

Keep moving. Mzee's toe wobble was the result of several months of physical training and device delivering pulses of electrical stimulation to Mzee's spinal cord. Now studying at the Swiss Federal Institute of Technology in Lausanne, Switzerland, he can walk crutches with another man with partial paresthesia, Gert-Jan Oskam . The third participant, Sebastian Tobler, initiated a study of extreme cases of lower extremity paralysis and published a study Nature [19659003] on Wednesday.

Stepping to all participants is still slow and difficult. They continue to ride in wheelchairs (and compete for wheelchair rugby in Mzee). Surprisingly, however, Mzee and Oskam turned the stimulator off . Keep your crutches and move joints that could not move before. For example, like Mzee's left toe. It shows that with electrical stimulation and training, the spinal cord can control the paralyzed muscles for years after injury.

The work led by Grégoire Courtine, EPFL Associate Professor, is the third small study in just one month to show similar results. And I wonder if it is time for the spinal cord stimulation device to move beyond the lab to the clinic. Reggie Edgerton, professor of integrated biology and physiology at the University of California, Los Angeles, says, "If you go too fast, you can make a mistake and return everything. Edgerton cautiously warned many people in the medical community about the urgency that "they are waiting and waiting." [19659007] According to the World Health Organization (WHO) every year, hundreds of thousands of traumatic injuries In the United States, 1.3 million people suffer from spinal cord injuries.For those who live with such injuries, these studies can bring a tremendous benefit, such as greater independence, better blood pressure control, and improved physical strength, if once the paralyzed muscles can move a little It will provide hope that you can. And there is currently no actual treatment 0.19459005 not even something that can actually be used except for experimental studies that claim to provide long-term benefits, "says Jeff Marquis after the accident mountain biking lower body completely paralyzed.

Like Mzee, Marquis received spinal cord transplantation as part of a study. Implantation and training at the University of Louisville, Kentucky helped the Marquis and other paraplegic patients (Kelly Thomas) walk with those who walk. "I did not get out of bed unless I had someone to help me with it," he says, "I do not even think about what I am doing now." "

Thomas made a lot of progress in the walking process – all of the go-karts – but other power benefits have also had a profound effect for her." Before they had this implant, they could not shrink all of their torso muscles. Now you need to cough or clean your throat, "she says." It comforts my mind. "According to a second paper published last month, a Mayo Clinic study with a complete under-paralyzed

The performance is not perfect. Some of the participants in the Louisiana study were two other participants who were not as dramatic as Thomas and Marquis, and the others in the Mayo clinic Nevertheless, three studies conducted at three different centers showed a positive result using a somewhat different approach: the Courtine team in Switzerland used the technique Mactronic, a device for improving brain function,


  Kelly Thomas and Jeff Marquis participated in a similar study at the University of Louisville.

Kelly Thomas and Jeff Marquis studied at the University of Louisville
University of Louisville

"We scientifically came up with that shit," he said. "The way we stimulate the spinal cord depends on the precision of the Swiss watch. When we stimulate, we give stimuli. "The theory is that this stimulated stimulus is similar to that of the brain, and the precise timing is consistent with that of the study participants. Phase – Helps reconnect the injured nervous system "In the central nervous system plasticity is related to time. When neurons are fired together they form a new link.

Now the theory is supported by studies of animal models, but in Louisville and the Mayo Clinic, Both methods have helped to move parts of the body that could not have been done before, but despite both success, both methods are offered to a wider range of patients.

The first step is technological improvement: "Obviously we have reached the limits of what we can do as an academic investigator," he says. To continue, I sprayed a new company called GTX medical. The Swiss Federal Institute of Technology (EPFL)


1541252113 504 spinal implants help treat paralysis but arent ready for primetime

David Mzee
Photo: EPFL

The goal is to continue optimizing the electrode array and nerve stimulator and voice activated user interface. "It's incredible "You can not just use Siri," says Courtine. "For example, imagine someone next to you can turn your stimulus on or off."

But investment in R & D and clinical trials are not cheap, which is one reason why Courtine's startups do not face a crowd of competitors. Invest more than $ 100 million in large-scale, long-term clinical trials to show that the device is safe and effective. "NAMSA's strategic scientist Donald Palme said," It takes an average of eight to ten years from absolute beginnings to approval. "This is very difficult, and this is a major barrier, and most companies have the potential to benefit."

Clinical trials on spinal cord injury populations can be difficult. "All the injuries are different, the injuries are different, it will work on some, and it will not work for others," Palme says. He suspects that the big names of electrical stimuli such as Medtronic, Boston Scientific, and Abbott are closely following these academic studies. But Medtronic, the company with the most close ties to technology, says little about future plans. "We learned a lot about the types of products that really need this indication and the clinical pathways to bringing this treatment to market," said Sara Thatcher, spokesperson for the company. "

" "

Even if the implant has a large clinical trial, there is another group that needs to buy technology. Mzee, Thomas, and Marquis agree, and using it requires a serious commitment. " It's not a magic pill that can walk you," says Mzee. "You must train hard."

In addition to physical labor, a cycle of hopes and disappointments It's worth it, Mzee is worth it. Once you have better control of the left paralyzed limb, you can sleep upside down on the bed. "But people are sometimes emotional roller coasters and training can be very difficult "Mzee says," and we still do not know the long-term effects, good or bad. "

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