2023-12-20 15:25:04
In 2015, there were more than 167,000 people suffering from Parkinson’s disease in France, and this number is expected to double by 2030. This neurodegenerative disease causes the progressive death of dopamine neurons in our brain, but this molecule is a neurotransmitter involved in voluntary movements and cognition, among others. This results in disabling motor disorders, such as a disturbance in balance, posture and the ability to walk. More than ten years after their first diagnosis, 70% of patients present one of the most serious symptoms of this disease: kinetic blocking, which results in a sudden inability to initiate or continue walking and which is accompanied by a feeling of feet stuck to the ground. These symptoms greatly increase the risk of falls, reduce the mobility and independence of patients, leading to higher hospitalization rates. There are treatments consisting of administering dopamine to counteract the symptoms, but their beneficial effect on gait and balance disorders diminishes as the disease progresses. In a recent study, the NeuroRestore team led by Jocelyne Bloch and Grégoire Courtine, in Switzerland, and their colleagues at the University of Bordeaux demonstrate how to effectively overcome kinetic blocking using a neuroprosthesis.
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Rhythm to walk again
For this work, the researchers relied on an approach that they had already used to restore the ability to walk in people who had suffered a spinal cord injury: epidural electrical stimulation. Their strategy consists of surgically implanting a device in the lumbar spine, the function of which is to electrically stimulate, using electrodes, the entry points of the sensory nerves into the spinal cord. The researchers first tested the device in non-human primates: they studied the natural pattern of electrical activation in the spinal cord in healthy specimens, before reproducing them, using the device, in model specimens of Parkinson’s disease. They then observed significant improvements in walking and balance; their speed of locomotion returned to a normal level and the kinetics of their movements approached those of healthy animals. Better yet: even on an obstacle course, sick primates fell less often
This man has suffered from Parkinson’s disease for almost thirty years. As the pathology progressed, walking became difficult. In particular, he was doing kinetic blocking, his feet did not come off the ground. Following an operation to install a neuroprosthesis and a rehabilitation period of a few weeks, he regained almost fluid walking.
© CHUV/Gilles Weber/Chateau de Chillon-Montreux Veytaux
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When the brain controls an implant to walk again
The process was then tested in a single human patient aged 62, who had suffered from Parkinson’s disease for around thirty years. The neuroprosthesis, combined with treatments that the patient was already receiving (dopamine injections and deep brain stimulation) with hitherto limited results, proved to be just as effective in reducing the symptoms, and even kinetic suppression almost disappeared. This epidural electrical stimulation approach therefore opens a promising new therapeutic avenue to make the lives of people affected by Parkinson’s disease easier. It still remains to be tested on a larger group of people to verify its long-term effectiveness.
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