Neural degenerative conditions are complex and multiple sclerosis (MS) is no different. The prevalence is high. According to a study published in the journal Neurology, multiple sclerosis (MS) is the most common progressive neurologic disease of young adults worldwide. There are nearly 1 million people living with MS in the United States and an estimated 2.5 million worldwide.
Multiple sclerosis is a progressive immune disease attacking the central nervous system, including the brain, spinal cord, and optic nerve. The disease impacts the myelin sheath that protects nerve fibers. Once any part is damaged, then nerve impulses are disrupted when traveling to and from the brain or along the spinal cord. This results in a variety of symptoms of the disease.
Symptoms of MS include extreme fatigue, impaired vision, problems with balance and walking, numbness or pain, bladder and bowel symptoms, tremors, problems with memory or concentration, mood swings, or slurred speech.
The symptoms can be unpredictable and may change on a daily basis or become permanent. Symptoms are not uniform among people living with the disease. MS can be difficult to diagnose; however MRI (magnetic resonance imaging) is the best tool to detect the disease in the human nervous system. A new on-line service, BrainKey, offers tools for people to track the MRIs of their brains and puts more information into the hands of those living with the condition.
There are four different categories of the disease.
- Relapsing-Remitting (RRMS) is the type in which the person experiences episodes of worsening neurological function that is followed by partial or complete recovery. This is the most common type.
- Primary-Progressive (PPMS) is categorized by a slow progression of worsening neurological function. The progression rate varies and may include temporary plateaus.
- Secondary-Progressive (SPMS)is a combination of the prior to categories in which the person initially experiences a relapse-remit episodes followed by a steady progression of the disease.
- Clinically Isolated Syndrome (CIS) This is the first experience or symptomatic episode of MS that lasts at least 24 hours. The symptoms are caused by inflammation and demyelination of the central nervous system. In the case, early treatment may delay the onset of MS but this is still in early studies. Those with CIS still show lesions in on an MRI.
Rarely is MS fatal to people living with the disease. Rather, the most common causes of death are due to secondary health conditions such as chronic urinary tract infections, infections from bed sores or difficulty swallowing or breathing. Most people with MS learn to cope with the symptoms of the disease. There has been recent research and development of medications, medical devices and exercise protocols to help people living with MS better manage the life changing symptoms.
There are several neurotechnology devices commercially available to aid in the combat against secondary conditions. Locomotion therapy is the art and science of robotic rehabilitation systems. Several neurotech vendors offer these devices for both upper and lower extremity exercise/therapy such as Hocoma, Tyromotion, Barrett, Movendo and more. The devices are typically not designed for home use but can be accessed through rehabilitation facilities or a local neuro-gym or activity-based therapy program. The use of functional electrical stimulation for exercise is also an option for people living with MS. In the case where the peripheral nerves will respond to electrical stimulation, exercise is possible with leg cycling or arm cycling from companies such as Restorative Therapies, Myolyn, Motorika, or RECK-Motomed. Robotic exoskeletons are also an alternative for both upper and lower extremity mobility. Rewalk Robotics, the Israeli manufacturer of robotic exoskeletons, announced a collaboration with Harvard University’s Wyss Institute for Biologically Inspired Engineering for the licensing and development of concepts and designs of lightweight “soft suit” exoskeleton system technologies for lower limb disabilities.
Wearables are all the rage for the general population, but they can provide true function for people living with MS in particular. A wearable arm brace or knee brace may provide some additional function away from using the typical mobility aid such as a wheelchair, walker or cane. Drop foot stimulation systems have been available for some time and offer an alternative to the standard orthosis. Neurotech vendors such as Bioness, Walkaide and OFS are all available in various parts of the world. As with any device, it is important to have a trained professional provide a proper fitting and programming. More so for those living with degenerative diseases such as MS, it is important to also have periodic re-programming due to bodily changes.
There are also devices available for urinary incontinence, breathing, spasticity and more. The use of these devices and therapies are as diverse as the MS population.
There has also been significant research and development of neurotechnology devices for MS. Here are a few recently highlights.
- Helius Medical Technologies announced in 2016 the results of a case series of individuals with advanced symptoms of multiple sclerosis treated with the company’s PoNS therapy. The study was performed at TCNL, University of Wisconsin, Madison and the data was presented at the 2016, Annual Meeting of the Consortium of Multiple Sclerosis Centers. Six people with advanced MS were enrolled in a six-month pilot study. They were trained in PoNS therapy, which combines use of the device with physical training in balance, gait, movement, and postural stability. Results demonstrated improvements in physical, cognitive, and quality of life parameters. The training regimen also resulted in significant real life improvements such as re-adopting a walker for community mobility, decreased fatigue, increased independence with daily activities, overcoming physical obstacles at home, and increased community access.
- According to a 2017 study published in Neuromodulation: Technology at the Neural Interface, people with multiple sclerosis had better problem solving ability and response time after training with transcranial direct current stimulation. Led by researchers at NYU Langone’s Multiple Sclerosis Comprehensive Care Center, the study reports that participants with MS who used tDCS while playing the cognitive training computer games designed to improve information processing abilities showed significantly greater gains in cognitive measures than those who played the computer games alone. Importantly, the participants completed the cognitive training and tDCS while at home. By enabling people to be treated without repeat visits to the clinic, which can be a major challenge for people with MS as their disease progresses, the approach may improve quality of life for this patient population, according to the study’s authors. The lead researcher Leigh Charvet, associate professor of neurology at NYU stated, “Many MS medications are aimed at preventing disease flares but those drugs do not help with daily symptom management, especially cognitive problems. We hope tDCS will fill this crucial gap and help improve quality of life for people with MS.”
- Researchers from the Netherlands Institute for Neuroscience used a new technique to show how electrical impulses are traveling with high speed in the brain. It appears that myelin, the sheath around neurons, creates a coaxial cable producing multiple waves of electrical potentials traveling in a more complicated manner than was envisioned earlier. These findings allow us to create better theories and tools to understand demyelinating diseases, including the most common neurological disorder, multiple sclerosis. The 2020 paper was published in Cell. Neuronal communication happens by means of exchanging electrical impulses traveling at velocities of up to 360 km/h. “This research opens new avenues to understand the hardware of the brain in terms of how they compute with rapid signal transfer,” said Maarten Kole, a professor at NIN. Together with researchers of the Max-Planck Institute of Experimental Medicine in Göttingen, Germany, the researchers used electron microscopy to measure the distance between the nerve cell membrane and the insulating sheath, which turned out to be 12 nanometers. Furthermore, the NIN team used a new technique to make electricity visible and took advantage of a supercomputer to calculate the specific properties of myelin sheaths. “All the findings together showed that instead of being an insulating sheath, myelin creates an additional layer like coaxial cables producing multiple waves of electrical potentials travelling in a more complicated manner than was envisioned earlier,” Kole said. These findings open new avenues to understand the hardware of how brains are computing with rapid signal transfer.
These are just a few examples of the recent efforts to development neurotechnologies to better diagnose and improve the quality of life for those living with MS. Just as there are varied degrees of MS, there are varied technologies for treatment. Neurotech Network offers free resources and a directory of devices specifically for multiple sclerosis. Check out our page here.
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