Paraplegics walk again one day after receiving an electronic implant

In a ground breaking operation in Lausanne, Switzerland, three paraplegics fitted with an electronic implant walk again one day later. The three left paraplegic after motorcycle accidents have managed to stand and to take their first steps.
The surgical intervention undertaken by neuroscientist Grégoire Courtine , from the Federal Polytechnic School of Lausanne (Switzerland), and the neurosurgeon Jocelyne Bloch , implanted 16 electrodes directly onto the spinal cord of the patient. All three participants had lost all ability to move in their lower limbs and trunk due to complete spinal severing.
Michel Rocatti, one of the three patients said: “One day after I started practicing I saw that my legs were moving again; It was a very intense emotion.”
The four-hour operation involves implanting electrodes that emit synchronized electrical pulses that mimic the signals that circulate along the spinal cord, linking the brain with the lower limbs. In turn, the electrodes are connected to a computer with an artificial intelligence system that reproduces the impulses necessary to walk, ride a special bicycle or row a canoe (in the case of a patient without mobility in the lower chest) according to details published in Nature Medicine .
Courtine’s team has spent years trying to restore mobility to people who were paraplegic due to accidents, with her system first tested in 2014 on mice that had previously had their marrow removed. Two years later she replicated the experiment with monkeys and in autumn 2018, the Swiss team presented the innovations with David Mzee, a young man who became a paraplegic at the age of 20. Thanks to this type of epidural stimulation and with the help of a walker, Mzee was able to walk again.
Courtine said: “Until now, all implants of this type reused electrodes originally designed to treat pain. For the first time, designing a specific technology for this new use allows us to better synchronise stimulation with the moment of movement, imitating the real signals sent by the brain when walking, for example.”
With each set produced specifically for each individual patient, it has been possible to stimulate not only the nerves that move the legs, but also the muscles of the abdomen and lower back. The participants were able to return to their feet immediately after the operation and took their first steps, initially suspended in a harness.
Fine-tuning the movements took time to train, but finally, after about four or five months, Rocatti, for example, was able to walk down the street and go out for a drink at a bar, walking with a walker from which he can control the intensity and rate of electrical impulses. “When I use the device I feel better, I feel stronger and the pain associated with the wheelchair disappears”, explained the patient.

Electronic implants mean injuries are no longer irreversible

Two US teams working with continuous electrical stimulation have also allowed patients to walk, confirming the growing view that some spinal cord injuries are irreversible.
The Swiss team has already treated nine people in what is currently an experimental intervention, but Courtine and team hope to start the first clinical trials with more patients in 2023, in part through Onward Medical , the company she has created with Bloch for the future commercialisation of this technology. The trials will still take a few years of work. “We’re going as fast as we can,” says the neuroscientist.
“These new results are spectacular,” says Filipe Barroso, a researcher in the neurorehabilitation group at the Cajal Institute (CSIC), in Madrid. He indicates that the most outstanding thing is that these are patients with a complete spinal cord injury, compared to the previous ones in 2018, who did preserve some residual function. “Furthermore, the results appear in one day, which is explained by the optimal placement of the electrodes”, he highlights.
Barroso works with less invasive stimulation systems that can be placed on the skin or even inside the muscles. In the latter case, his team demonstrated last summer that electrodes achieve a “spectacular” reduction in tremors in patients with nervous system disorders.
Diego Serrano, a researcher at the University of Castilla-La Mancha, visited Courtine and Bloch’s laboratory in 2018. “It is clear that they are fine-tuning their technique to achieve the most natural movement possible,” he highlights. “The electrodes are now implanted with millimetre precision, in fact, placing it one or two millimetres higher or lower has enormous results,” highlights the expert, who sees “complicated” expanding the scope of this technology to a greater number of patients. “It’s difficult because each spinal cord injury is very specific, practically unique, so you need to develop a specific treatment for each one,” he adds.
Every day there are new medical advances that provide new hope for patients, medical implants being one of those areas. But up until now electronic implants have had limited results and the many paraplegics around the world will be watching this one closely in the hope that they too can walk again one day.

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