One of the most important areas of health also happens to be the least advanced, with neurology trailing behind most other fields – though that is set to change.
“If you can keep your head when all about you are losing theirs and blaming it on you …”
Rudyard Kipling’s If deals with attitudes, rather than medical concerns, but, as far as opening lines go, this a good one.
And it’s the ‘keeping of the head’ that is most concerning in a growing area of medicine: neurology.
We’re surrounded by a plethora of devices of varying medical importance, with the likes of Apple Watches and FitBits visible on a growing number of wrists throughout the world.
As we continue to monitor steps, heart rate or, in some cases, blood levels, more and more data is emerging, allowing for better, more informed medical decisions.
However, neurology lags far behind almost any other field of medicine, with the few companies truly focused on brain health treatments fighting a tough battle to get therapies to market.
What are we fixing?
The problem, surprisingly, is that we don’t know what we need treatments for. Research is slow and arduous.
For example, in the broad, confusing world of concussion, studies of the human brain often require subjects to be deceased, donating their organs to science. This is as slow a testing environment as you can have in health.
Oncology has millions of patients around the world, providing endless data, endless information and, therefore, endless ways to measure ‘good’ and ‘bad’.
Osteology, dentistry and haematology are the same.
In neurology, though, there are few clearly defined barriers, few ‘gold standards’ to overcome, despite the obvious problem with neurological disorders.
That’s according to Leo Petrossian, CEO of Neural Analytics, a California-based medtech company developing diagnostic tools for brain health.
“I believe that brain health is the largest undressed area in all of healthcare. It’s not just me that believes this, it’s supported by the numbers,” he told Siliconrepublic.com.
One, two, three
The numbers Petrossian refers to are basic living tallies. We are living longer than before, sure, but is the added decade onto our lives of genuine quality?
Not according to Petrossian, who sees the example of 10 added years onto a lifespan, with eight years of dementia, as a sign that something isn’t quite right.
“The brain is now the bottleneck,” he said, in the wake of massive strides being made throughout almost every other major area of health and medicine.
“Advantages in the rest of healthcare shed light on the inadequacies of brain health.”
Neural Analytics has been prominent in the news in recent months, with its Lucid System – a monitor of brain health – securing $10m in funding this year alone. The company’s device works similar to an ultrasound, with recent testing showing a 95pc success rate when assessing early strokes.
However, the device is armed to do a whole lot more, if only we knew what to look for. The problem is that many diseases have yet to be truly diagnosed.
Capable of more
“We make a device that can do 10 things, we have absolute confidence it can do 10 things. But, to commercialise it, we see [the illnesses in which] the FDA has a clear bar or hurdle for us to jump. They tell us and we go jump it.”
These hurdles are rare, so Neural Analytics can only truthfully, and clinically, diagnose a handful of issues that it claims it has the capability for.
Brain health is worth around $760bn annually in the US, which is close to 5pc of the country’s GDP. So, the Lucid System is aimed at the ‘lion’s share’ of what can be achieved: dementia, Alzheimer’s and strokes.
For everything else? If you can’t define it, you can’t fix it.
“More and more people are becoming aware of this problem, and that conditions of the brain are poorly managed today,” said Petrossian, who shared with me one of the most telling phrases I have ever heard in the whole of health.
Neurologists, such as Petrossian’s wife, have one phrase: “Diagnose, adios!” Find the problem, then walk away as there’s nothing to be done.
However, that is gradually starting to change.
Earlier this year, Elon Musk revealed his new company, Neuralink, which plans to develop ‘neural lace’ technology.
It will use this lace to allow people to communicate directly with machines without going through a physical interface. By implanting electrodes into the brain, the lace could theoretically let people upload or download their thoughts to or from a computer, as well as improve general cognitive function.
This sounds very sci-fi, but it’s on the back of a growing mound of research into how the brain works. It is research such as this that will help companies such as Neural Analytics to target greater areas of the market.
It is not the first company to look at this technology, though.
Paralysed no more
One year ago, Battelle teamed up with researchers at Ohio State University Wexner Medical Center to develop a device called NeuroLife, which helped a quadriplegic man to regain hand function through a novel approach to neuroscience and technology.
The patient was paralysed after he injured his spine in a bad accident in 2010. NeuroLife acted as a middleman between his brain and his hand, bypassing his spinal chord and delivering signals to allow the man to perform functions such as swipe credit cards or play Guitar Hero.
Since then, Battelle has been refining an elaborate piece of equipment into what will soon become a small, transportable medtech creation.
“We’re bypassing damaged spinal chord at the level of the chest,” said Herbert Bresler, interdisciplinary innovation team leader at Battelle. “The subject has use of his shoulders and a bit of his bicep, but no control of the hand or wrist or fingers.”
Bresler explains that the machine works like a motorway. If you want to get from point A to point B, there could be a bridge in the middle. He and his team provide a detour for the brain signals, with the device’s sensor-laden make-up essentially “bypassing the bridge”.
What was previously paralysed is now functioning.
Battelle’s algorithms are continually being worked on, meaning smaller and smaller equipment is needed to sync the patient’s brain with their hand.
A cap on the head, wire connections attached to the skin and an incredibly technologically advanced glove, with the addition of some immense scientific expertise, and bingo! Regained movement.
“In the past year, we’ve increased the number of motions that can be decoded,” said Bresler, with this a key element to building a function for quadriplegics to regain sufficient movement.
Time after time
But Battelle’s creation is far from market, with the data collection a slow and difficult process.
Each session involving Battelle, medical professionals and a patient takes up to one hour to calibrate. Training tasks are then undertaken with the patient, followed by free time in which they try to replicate what they have just learned.
This can take an awful lot of time, meaning the improvements – while vast – are only really edging along.
“It’s very labour-intensive, very painstaking and very tedious to get through these,” said Bresler, but he and his team are clearly onto something big.
Given how non-invasive the process, when it is refined to a high enough degree, dramatic improvements in health will no doubt follow.
‘A typical neurologist has a stethoscope, a reflex hammer and a tuning fork’
– LEO PETROSSIAN
The lack of invasion appeals to many studies, though the brain obviously makes this a difficult ideal to stick to.
Take aneurysms, for example. In 2017, the success rate of treatments is still mediocre, and the likelihood of you getting a brain aneurysm is about one in 50.
These are not odds that society should have to deal with, especially if treatments are unreliable.
Essentially, there are two ways to treat brain aneurysms. One process is opening up the skull and performing a craniotomy. Here, surgeons separate the brain tissue and manually put a platinum clip in place to stop the problem.
This is about as invasive a surgery as you can get. It’s time-consuming, very expensive and, in general, far from ideal. In the EU, healthcare has moved away from this, instead looking to install medical devices, solutions or treatments via catheters.
Another option is platinum coils. A typical aneurysm has a narrow neck and a wide body and, to treat this, you need to fill the bulk of the wide body. Platinum coils are the general way to do this, with the coil filling some, but not all, of the expanded space. However, sometimes aneurysms are different shapes, rendering the coils less and less effective. Luckily, some researchers are developing a fix.
Well, gel-o there
Dr Owen Clarkin, a member of DCU’s School of Mechanical and Manufacturing Engineering, is the brains behind Enduragel.
Injected through a catheter, the hydrogel – made primarily of water, with a seaweed-derived polymer and microparticles making up the final components – can be fed up small tubes towards where the aneurysms occur.
“Due to the risks associated with open surgery, the majority of treatments these days involve placing fine platinum coils into the aneurysm to inhibit blood from entering the aneurysm and causing further expansion,” explained Clarkin.
“Traditional approaches rely on blood clotting to fill the extra space,” he said. “This works to a degree but blood clots are liable to degradation or reabsorption etc.
“What tends to happen in 50pc of cases is you get regrowth of the aneurysm or it continues to grow. So, in that case, there’s extra space around the coils and you continue to get the problem.
“So we’re trying to fill that space better.”
Once injected into the affected area, Enduragel hardens, closing the aneurysm. This prevents any blood getting through, as well as continued expansion. It fills the space entirely. No coil, no concern.
Clarkin and his team hope that this new technology will improve the clinical outcomes of patients with cerebral aneurysms, and allow doctors to treat the untreatable.
Society should hope that this new technology will be commercial soon.
Already prepared for scale, Clarkin’s next move is to produce Enduragel in a good manufacturing practice environment.
Neurology: Time for a change
As this is health, paperwork, studies and regulation must be taken into account. As it’s to do with the brain, perhaps even greater care is required.
But, given the general struggle to advance the industry in general, any neurological research – or devices to help treat common, almost standard, diseases and concerns – should be welcomed.
“A typical neurologist has a stethoscope, a reflex hammer and a tuning fork,” said Petrossian.
“People are now coming to observe and understand the state of the situation; how bad and inadequate the technologies are for diagnosis and therapeutics.”
That needs to change, but change it will.