Most patients who have had a spinal cord injury suffer from disabling chronic hypotension and dangerous hypertension tips. If research has long focused on their mobility recovery, their inability to regulate their blood pressure has been relegated to the background. In a series of discoveries published simultaneously in “Nature” and “Nature Medicine”, neuroscientists from Switzerland, the Netherlands and Canada have a revolutionary neurotechnological solution to help them.
“I have found my life,” said Julie, participant in the clinical study. Since her medullary lesion, she suffered from dizziness and persistent fatigue that prevented her from leading an active life. “I can now return to university and finish my doctorate.” Daniel, another participant, moves in a wheelchair from a ski accident. Thanks to this new implant, he was able to resume this winter alpine skiing seated with more confidence and stability.
Exhaustion and loss of knowledge
These testimonies reflect this little -known reality affecting people living with a spinal cord injury: more than 70% of them, according to a survey of 1479 people in the study, live with chronic hypotension, leaving them exhausted, cognitively slowed down and subjects to loss of knowledge.
This deregulation is due to the interruption of projections between the brainstem and the spinal cord, preventing the body from modulating the vascular tone and the heart rate according to the needs of everyday life. Chronic hypotension is very disabling; To this must be added that this deregulation can cause potentially fatal tension peaks.
In an exceptional double publication in “Nature” and “Nature Medicine”, two major studies carried out by Grégoire Courtine (professor of neuroscience at EPFL and director of the Neuro-X Institute), Jocelyne Bloch (neurosurgeon at the CHUV and professor at the University of Lausanne) and Aaron Phillips (University of Calgary) describe the development of a targeted therapy Restore the regulation of blood pressure in these patients. In collaboration with the EPFL ONWARD MEDICAL spin-off, the team has shown that an implanted neurostimulation system made it possible to effectively restore the stability of blood pressure.
Implant like a pacemaker
“In the study we have published in” Nature “, we were first able to identify the entire neuronal architecture of the spinal cord responsible for the uncontrolled and potentially fatal elevation of blood pressure, called autonomous dysreflexia. We have shown that stimulating the spinal cord can interfere with this circuit to regulate the pressure in a safe and precise manner. This interaction focuses on a region that we have named hemodynamic hotspotexplains Grégoire Courtine, director of .Nenestore with Jocelyne Bloch. In “Nature Medicine”, we used this discovery to design an implantable system capable of targeting this hotspot by electrical stimulation and thus prevent chronic hypotension. “
Over the past decade, a series of patents on this technology has been deposited by Swiss and Canadian teams as they advance their discoveries and development work. Developed by Onward Medical, this system called ARC-IM includes a new generation electrodes network, specially designed to marry the target area. These electrodes are connected to a dedicated pulse generator (similar to a pacemaker) which delivers electrical stimulation adjusted to the individual patient needs. Result: a compact and adaptable system, capable of stabilizing blood pressure by targeted neuromodulation.
Therapy against hypotension has been tested on 14 patients in four clinical studies in Switzerland, the Netherlands and Canada, with independent medical teams. “International deployment shows that surgery and therapy are safe and effective, regardless of local medical protocols. This is a key step towards the wide diffusion of this technology, ”says Jocelyne Bloch.
Pressure restored in a few minutes
The results are clear: once activated, the system restores blood pressure at a functional level in a few minutes. “Based on our experience with this new treatment, the beneficiaries report a decrease in cerebral fog, more energy, a stronger voice, and attenuation of the drops in postprandial tension. In addition, after its establishment at the Radboud University Medical Center, in the Netherlands, by the neurosurgeon Erkan Kurt, this system is relatively simple to use in their domestic environment, “said Ilse Van Nes, who successfully deployed the system at the Sint Maartenskliniekliniekliniek Rehabilitation Center in Nimègue, in the Netherlands.
“Its impact goes beyond the only framework of physical health: by stabilizing blood pressure, this therapy improves cognitive clarity, energy level, mood and autonomy, essential aspects of daily life often altered after a spinal cord injury,” adds Jocelyne Bloch.
Towards large -scale tests
“The objective is now to go towards an enlarged clinical adoption,” concludes Grégoire Courtine. Onward Medical recently received an “exemption” relating to an experimental device from the US Food and Drug Administration (FDA) to launch a pivotal test on this therapy, which should involve around 20 cutting-edge research centers in neuroréAdaptation and neurosurgery in the United States, Canada and Europe.
This multicenter study will be crucial to demonstrate the safety and efficiency of the system on a large scale. In the event of success, it will pave the way for regulatory authorization and reimbursement by insurance, making this therapy accessible to the whole community of people with spinal lesions. ”
