Pacemaker-like device logs brain activity round the clock and helps medical teams fine-tune therapy without needing to physically be with their patients, but “It will be like being with them all the time.”
Building on decades-old technology known as deep brain stimulation (DBS), which can help control the shakes and muscle tightness tied to brain disorders such as Parkinson’s, the device puts a new high-tech tool in physicians’ tool kits: the ability to capture brain activity of DBS patients such as Luke around the clock.
“We can actually stream live from his brain,” said Krembil neurologist Dr. Alfonso Fasano.
As Fasano fiddles with the laptop, his patient’s sturdy frame is still, with the electrode stimulation keeping his symptoms at bay.
A team from the Krembil Brain Institute in Toronto, including neurologist Dr. Alfonso Fasano, left, and neurosurgeon Dr. Suneil Kalia were involved in a Canadian first: Providing patients with a new device that can capture their brain activity around the clock. (Lauren Pelley/CBC)
WATCH – Live manipulation of brain stimulation:
Controlling symptoms in real time
With a couple of clicks, Fasano tweaks the level of stimulation from the electrode in the right hemisphere of Luke’s brain, and he quickly starts shaking — his left foot is tapping up and down involuntarily. With another tweak, his foot is back firmly on the ground.
The short-term hope, according to Fasano and his colleague, neurosurgeon Dr. Suneil Kalia, is that patients will be able keep a digital diary of their symptoms, which physicians can match up to the ongoing log of their brain activity.
“Physicians can later look at that brain diary to see when symptoms were severe or better and fine-tune their therapy,” Kalia said.
In Luke’s case, Fasano hopes he’ll eventually be able to adjust the settings on the device from the comfort of his own home, in consultation with his medical team by phone, from thousands of kilometres away.
“We can record for days, months, the different signals in the brain,” Fasano said. “This will be, like never before, a window into their activities.”
The personalized treatments that follow could help alleviate symptoms for years on end, according to Fasano and Kalia.
Approved by Health Canada in October, the Percept PC deep brain stimulation system was developed by Medtronic, a Dublin-based medical technology company.
Working alongside surgically implanted brain electrodes, the small, pacemaker-like device is placed under the skin of a patient’s chest, which sends electrical signals through thin wires to a targeted area of the brain and offers real-time recording.
Patients with brain disorders such as epilepsy and Parkinson’s tend to see symptom improvements once their DBS electrode implants are turned on. With the chest and brain implants working in tandem, physicians can now see exactly what’s happening inside their patients’ brains when that switch is flipped.
Automatic adjustments may one day be possible
Previously, medical teams could only track those signals during brain surgery, according to Kalia.
“What this new device allows is whether it’s the first day after surgery or even five years after the surgery, we can interrogate the device,” he said.
Through ongoing research, Fasano says, the technology may lead to “adaptive stimulation” in the longer term, where the device adjusts the level of stimulation automatically.
It’s a bit like a smart home thermostat. At first, those high-tech temperature controls require a homeowner to adjust the settings manually. Too cold in the morning? Crank up the heat. Too hot by the afternoon? Turn it back down.
Over time, as the technology learns someone’s patterns and preferences, the thermostat can start making those adjustments on its own — regulating the temperature and keeping people inside the house comfortable automatically.
Kalia said that’s a lot like how the implants could one day regulate — or even predict and ward off — symptoms, including seizures and tremors. The first three Canadians underwent surgery to install their new smart technology this fall, and there are more to come.
‘Like being with them all the time’
Though wary at first of having the procedure, Luke said he jumped at the chance to try the new device in November. His Parkinson’s symptoms have worsened over the last six years.
“Your muscles tighten up, everything shakes, you shuffle more than walk, you’re prone to falls,” he said. “It really changes your life, big time.”
Speaking to CBC News outside his downtown Toronto hotel, he said the day before his medical team at Krembil turned on the electrode, he was barely able to walk. Now, much of his shaking and unsteadiness has subsided.
Driving a car, spending more time outdoors, and carving wooden animal figurines are all pastimes Luke plans to pursue back home in Wawa.
It’s not a cure, to be clear. But it offers Luke, who’s a 10-hour drive from the Krembil specialists, a way to manage his disease’s progression with fewer trips to Toronto and log a treasure trove of data for his medical team at the same time.
Fasano says that’s a welcome change from the small glimpses of someone’s life physicians typically get when patients like Luke visit, which can’t possibly capture their day-to-day symptoms and flare-ups.
“It will be like being with them all the time,” he said.