A woman suffering from a neurodegenerative disease and bedridden for more than a year was able to walk once more thanks to an epidural electrostimulation technique developed by a team from CHUV and EPFL. The patient systematically lost consciousness in the raised position.
Jocelyne Bloch, neurosurgeon at the CHUV and professor at the University of Lausanne, and Grégoire Courtine, professor of neurosciences at the Federal Polytechnic School of Lausanne (EPFL), are already well known for having made paraplegics walk once more.
With their teams from the NeuroRestore research center, they have now looked into the case of a 48-year-old patient suffering from MSA-P (Multiple Systems Atrophy of the Parkinson type). This neurodegenerative disease affects, among other things, the sympathetic nervous system.
Bedridden for more than a year and a half because of these disorders, she might not walk more than five meters without losing consciousness. The disease causes the loss of sympathetic neurons specialized in pressure regulation.
The resulting disorders are manifested in particular by a sudden drop in blood pressure in the raised position, going as far as syncope. They increase the risk of falls, decrease the ability to stand and walk, and ultimately lead to a reduction in life expectancy.
walking rehabilitation
By implanting electrodes and an electrical stimulation generator – a device generally used in the treatment of chronic pain – directly on the spinal cord, the two researchers were able to observe an improvement in the regulation of blood pressure. An acceleration sensor determines whether the patient is sitting or standing and, if so, activates electrical stimulation.
This technology enabled the patient to remain conscious much longer in the raised position, and to undertake walking rehabilitation. She was able to regain some autonomy in everyday life and cover a distance of 250 meters with a walker. For Jocelyne Bloch, this breakthrough opens up important clinical perspectives in the management of degenerative diseases.
“We knew the applications of this therapy in people who suffered from an injury due to spinal cord trauma. Thanks to this discovery, we can now also treat people whose deficits come from neurodegeneration. This is the first time that we have managed to improve the pressure regulation mechanisms of people with MSA”, explains the researcher in a press release from the CHUV and EPFL.
Risks and benefits
The therapy allowed the patient to stop taking her blood pressure medication, Bloch told Keystone-ATS. With stimulation, not everything is perfect, but the pressure is much better regulated. The patient lives at home, supported by her husband and nursing staff.
Neuroscientist Grégoire Courtine notes for his part that this technology was not specially designed for this type of application. “The future is to develop a technology targeted at orthostatic hypotension that might be used by all people suffering from these disorders around the world,” he says.
It is important to weigh the risks of surgery and the expected benefits over the long term, according to the authors, who now intend to test their method on more patients and carry out larger clinical trials. This case study is published in the New England Journal of Medicine.
This article has been published automatically. Source: ats
