The «brain Holter» can constantly monitor brain activity in daily life and improve diagnosis and treatment. An Italian device implanted under the skin anticipates the arrival of the crisis
Taking advantage of the proximity between the auditory canal of the inner ear and the brain, researchers from La Jolla University in San Diego directed by Ernesto De la Paz and Yuchen Xu have published a study based on particulars in Nature Biomedical Engineering earphones similar to those of wireless Bluetooth headphones on cell phones constantly monitor brain activity like a sort of wearable electroencephalogram which sends the data collected via the web to the doctor who can remotely monitor the progress of the patient’s neurological disease.
These headphones can be worn anywhere, overcoming the age-old problem of monitoring patients outside the clinical setting when it is necessary to monitor brain activity in diseases such as
where the so-called RL data, i.e. Real Life, are almost always missing, daily life. The patient recorded on the EEG in the hospital does well, but then goes home and has a crisis whose characteristics were previously impossible to know when it occurred and which are instead important for adapting the therapy.
Half of the crises are not reported to the doctor
It is estimated that almost half of the crises are not reported to the doctor, in particular nocturnal ones or focal ones with alteration of consciousness that the patient does not remember or is not fully aware of, especially if he lives alone. Not to mention the diagnostic improvement in cases where crises are confused with those
while a contextual recording can demonstrate that it is not a case of an uncontrollable sleep attack due to narcolepsy, but that the patient fell to the floor due to an epileptic fit that needs to be treated in a completely different way.
Preventing sudden death in epilepsy
For the same reason, this tool could also help in cases of SUDEP, acronym for Sudden Unexpected Death in Epilepsy, sudden and unexpected death in epilepsy, a very rare percentage of deaths that occur in these patients and the cause of which is still unknown. In these cases, other recent implantable devices used rather than for diagnostic purposes could also work with the aim of stopping crises in the bud with electrical micropulses sent promptly to the cerebral epileptogenic focus.
How the device works: electrochemical sensors that evaluate lactic acid
The particular USA earphones do not record the electrical activity of the brain directly like normal electroencephalographs, but are able to deduce it thanks to electrochemical sensors who evaluate the variations in lactic acid of sweat from the auricle. The sweat concentration of this substance is in fact a faithful mirror of brain activity and increases significantly when the epileptic attack occurs. «However, this increase also occurs, for example, in the case of excessive physical effort – comments the professor Angelo Labate of the University of Messina and SIN National Coordinator for Epilepsy in the Italian Society of Neurology – and therefore, even if the method provides a real-time analysis of conditions that change dynamically such as brain activity, its specificity does not appear to be equal to that of a normal electroencephalogram and further studies will be needed to verify its real usefulness, especially in the so-called subtle seizures with focal onset which are moreover the most frequent and the least obvious to any observers or even to the patient himself”.
Not just epilepsy
According to American researchers, however, these earphones would be a sort of Cerebral Holter similar to the cardiac one used for decades to monitor the heart’s activity 24 hours a day and could highlight in Real Life the dynamic and synergistic interactions that occur in the brain not only for lactate, but also for other brain and body biomarkers by identifying early and monitoring a long term too neurodegenerative diseases such as Alzheimer’s you hate Parkinson
The Italian device
The Italian response to US earphones was presented at the latest SIN congress just concluded in Naples by a group of researchers from Modena, Naples and Trieste directed by Nicola Specchio of the Bambin Gesù of Rome who, with the aegis of the Next Generation EU, have developed a slightly more invasive method, but certainly error-proof because it is designed for the particular genetic form of epilepsy known by the acronym DEE, acronym for developmental epileptic encephalopathy, i.e. developmental epileptic encephalopathy always burdened by the problem of remaining too often underdiagnosed with consequent problems of correct treatment. Before the age of 16 it affects approximately one in 300 children (over 3 million in Italy) and its monitoring over time is essential for an early definition of the origins of the disorder, a correct prognosis and rapid multidisciplinary management. «In fact, there are various forms – explains Professor Labate – but in all of them epileptic seizures are associated to a variable extent with intellectual disability, motor and mental disorders which require monitoring over time for a personalized diagnostic-assistance path depending on the predominant DEE component in every single patient.”
The study conducted by Italian researchers and called EMIRE (EEG Monitoring In Rare Epilepsies) uses a microscopic electroencephalograph implanted subcutaneously behind the ear (sqEEG) which continues to record brain activity for 3-6 months: i data is instantly sent via web to the hospital where a particular algorithm identifies the suspected arrival of a possible seizure and at the same time outlines a profile of epileptic periodicity indicating particular moments of the day or week in which the patient is at greater risk of seizure.
In this way, any triggering factors are identified and the response to ongoing treatments is also assessed. Both patients and their caregivers declared themselves satisfied with this electronic surveillance which relieves them from the stigma of illness and from the anxiety of the attack which loses its characteristics of unpredictability: the word epilepsy in fact derives from the Greek epilambanein which means to be seized surprise.
If the first results of the EMIRE study are confirmed by broader telehealth evaluations, the researchers hope to further develop the method to make the treatment of this patient population increasingly effective in the perspective of precision neurology which was one of the main themes of the the last SIN congress in Naples.
November 3, 2023 (changed November 3, 2023 | 08:25)
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