They're already helping
people like Chelsey Loeb. The 26-year-old can't feel the responsive
neurostimulator (RNS System for short) firing electrical pulses into her
brain. It's about the size of an iPod Nano and is constantly monitoring
electrical activity from under her skull, looking for signs of a
seizure so it can send out a targeted pulse to cut one off before it
begins.
Designed by Silicon
Valley-based NeuroPace, the RNS System is on the frontier of this new
technology. But there are hopes that devices implanted under the skin
could one day do things like automatically regulate glucose levels in
diabetics or tell someone when their knee is about to give out.
Right now, smart
implants are giving hope to epilepsy patients like Loeb. Across the
nation, 128 of them have been installed since the FDA approved the
device in 2013. Clinical trials showed a 38 percent drop in the average
number of seizures per month. So far, it's working for Loeb.
Trying to beat epilepsy
She
first noticed the seizures in the summer, when she was only 15 years
old. It wasn't immediately clear what was happening to her.
"It almost felt like I was dreaming, like I was having a dream in the middle of the day," Loeb told NBC News.
With school looming, she
finally told her parents about the strange sensations she was having.
The doctor told her she suffered from intractable epilepsy. At first, it
got better with medication. The seizures stopped for a year and a half,
and she was able to do things that typical 18-year-olds do, like drive a
car and go off to college.
Then they came back — at
first about every month, then every day. Worse, they were getting more
severe. Sometimes, she would wake up after wandering around for several
minutes with no memory of what had happened.
She had to stop driving.
In her classroom in Paterson, New Jersey, she needed an assistant, who
would look after her whenever she would "get the aura," a feeling that a
seizure was about to hit.
Finally, she decided
she'd had enough. Loeb learned that she was a candidate for a relatively
new procedure at New York University Langone Medical Center.
Over the course of two
surgeries in November, they removed part of her left temporal lobe. It
had been scarred, possibly since birth. Removing the entire lobe could
have ended the seizures — but it also would have destroyed her
short-term memory.
Instead, doctors
supplemented the excision with the RNS System. Researchers aren't
completely sure why it works, because nobody fully understands how the
brain functions.
The latter was used as a
"reset" button on the entire brain, said Werner Doyle, the NYU
neurosurgeon who operated on Loeb. The RNS System allows for more
targeted treatment.
"You're not rebooting
the whole brain," he told NBC News. "It's like when you are on your
laptop computer, and there is one application that gets stuck. What you
do is quit that application and reboot it."
After only eight days in
the hospital, she was at her parents' home with a device roughly the
size of a curved iPod nano connected to her brain. Everyday, she passes a
wand-like device over her head, which uploads her brain activity to the
cloud. That lets doctors study it and make adjustments when she comes
into the hospital.
"It's like a big
puzzle," she said. "They are trying to figure out how to make it work
with my brain, because my brain is unlike any other."
Smarter medical devices
Researchers think
similar devices could help patients battle obsessive-compulsive disorder
(OCD), Parkinson's disease and even depression. Sensortech Corporation
announced a Bluetooth-enabled knee replacement in 2013
that gives doctors data in real-time, helping reduce the duration of
surgery.
The company thinks the technology could one day be used to give
wireless updates on wear and tear for the life of an artificial joint.
At Boston Children's
Hospital, bioroboticist Pierre Dupont is working on a way to use
machines to treat esophageal atresia. Babies born with this condition
can't eat because their mouths don't connect to their stomachs.
Treating it now requires
frequent X-rays and repeatedly sedating infants as sutures that stick
outside of the baby's back are tightened to guide the growing parts of
the esophagus together.
Dupont is testing a
device that could detect how the esophagus is growing and use its motor
to adjust accordingly, vastly reducing the risk and hospital time
involved in fixing the condition. (So far, it has only been tried in
pigs).
His team is also
researching smart devices that could regulate blood flow from the heart
for kids with congenital heart defects. None of these are available on
the market right now. Doctors in the future, however, might find smart
devices that can adjust to their surroundings especially useful when
treating children.
"That's a big challenge," Dupont told NBC News. "You need something that accommodates growth."
DARPA, the research arm
of the U.S. Department of Defense, is also looking into smart implants.
In August 2014, it announced the Electrical Prescriptions (ElectRx) program,
which encourages the development of "ultraminiaturized devices" the
size of nerve fibers that would "continually assess conditions and
provide stimulus patterns tailored to help maintain healthy organ
function."
DARPA
Researchers are also starting to think about how multiple smart devices might work together. The EU-funded WISERBAN
is a project aimed at creating a 'wireless body-area network' (WBAN)
that would let smart implants communicate wirelessly with each other and
the outside world without draining their limited power resources.
Battery life is a major
issue when it comes to these devices. The tiny battery in the RNS System
only lasts three to four years — after which, the whole device needs to
be replaced with surgery. Smart implants also need to be small in order
to fit next to organs inside of the human body.
At least researchers
know how the heart and esophagus work. The brain is still a mystery.
Creating devices that target the right areas of the brain when
scientists aren't even sure how the brain works is a serious challenge.
"We're like the Wright
brothers at the stage where they were first trying to build an
airplane," said Tim Denison, director of Medtronic's neuromodulation
division. "Before they could do it, they had to build a wind tunnel to
understand the principles of flight."
For epilepsy patients
like Loeb, the benefits could be more immediate. It's too early to tell
if the RNS System has solved her problem. Doctors had to spend time
monitoring and adjusting the device.
But over the last month, she has only had one seizure, a huge improvement over the daily seizures she was having before.
Now, she is eager to be
more independent. She wants to take the train, work and meet new people
without the nagging fear of a seizure in waiting in the wings.
"I feel a little more like myself," she said. "I don't have to worry every day about when the next one is coming."
