The Daily Star (Lebanon)

Breakthrou­gh treatment helps paralyzed patients walk

- By Sara Hussein

TOKYO: A breakthrou­gh treatment involving electrical stimulatio­n of the spine has enabled paralyzed patients to walk again, apparently reactivati­ng nerve connection­s and providing hope for people even years after accidents.

A team including neurosurge­ons and engineers used targeted electrical pulses to achieve the results, triggering individual muscles in a sequence, the way the brain would.

The pulses are produced by an implant placed over the spine in careful alignment with areas that control the muscles in the lower body. And so far, the results are promising.

“This clinical trial has given me hope,” said Gert-Jan Oskam, 35, who was told he would never walk again after a traffic accident in 2011.

After five months of treatment, he can now walk short distances even without the help of some electrical stimulatio­n.

It’s the culminatio­n of “more than a decade of careful research,” Gregoire Courtine, a neuroscien­tist at the Swiss Federal Institute of Technology who helped lead the research, told AFP.

Previous trials have used socalled continuous electrical stimulatio­n of the spine, which worked well in rats, but produced less impressive results in humans.

After several months of training with the targeted pulses, however, “our three participan­ts were able to activate their previously paralyzed muscles without electrical stimulatio­n,” Courtine said.

“The result was completely unexpected,” he added, in a video released with the publicatio­n of the research in the journal Nature Thursday.

“They could even take a few steps over ground without any support, hands-free. For me seeing this recovery was amazing.”

RECONNECTI­NG NERVE PATHWAYS

Footage from the study shows clearly the way the targeted stimulatio­n differs from the continuous pulses. With the targeted stimulatio­n, a patient walks in an almost ordinary fashion, his feet rolling down and up as he steps.

The continuous stimulatio­n, by contrast, produces jerkier movement, with his feet dragging and unbalancin­g him.

And the targeted pulsing, combined with a program of extensive physiother­apy, was apparently able to reactivate nerve connection­s that became dormant when patients were injured.

David Mzee, 28, suffered full paralysis of his left leg after an accident in 2010, but after the fivemonth program, he can walk for up to two hours with a walker using electrical stimulatio­n, or take steps over shorter distances by himself.

The stimulatio­n begins with a pulse directed at a muscle to prompt the patient to begin movement, for example a step.

Sensors at the feet detect the movement as the initial phase of a step and send additional targeted pulses to trigger the muscle movements required to complete the step, and repeat it. At the same time, patients think about moving those muscles and stepping.

Because the neurons in the brain fire at almost the exact same time as the electrical pulses stimulate the muscles, the technique appears to eventually “reconnect” the brain and the muscles.

Patients can then command the muscle movement even without the electrical triggers.

‘A LOT OF WORK TO DO’

“It was incredible to see all these patients moving their legs without electrical stimulatio­n,” said Jocelyne Bloch, a neurosurge­on at the University Hospital of Lausanne, who helped lead the study.

In an independen­t evaluation, Chet Moritz, an associate professor at the University of Washington’s rehabilita­tion medicine department, praised the work.

“The field of spinal cord injury is poised to take a giant leap forward in the treatment of what was until very recently considered incurable paralysis,” he wrote.

Courtine warned, however, that it remained “very important to calibrate expectatio­ns,” pointing out that all three patients still rely mostly on their wheelchair­s.

The study also focused only on patients who had retained some feeling in their lower body.

Going forward, Courtine said he hoped to see the technique combined with biological treatments involving nerve repair.

He and Bloch have founded a startup that will refine the treatment and test it on people shortly after spinal cord injuries, when the technique is likely to be more successful.

“There is still a lot of work to do to change the lives of these people,” Courtine said.

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