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CyborgRx: How Smart Implants Could Change Medicine

RNS System

NeuroPace

The cyborgs are coming ... and that's a good thing. A new breed of smart devices designed to be implanted in the brain, heart and other body parts could be used to treat everything from epilepsy to Parkinson's disease.

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.

Chelsey Loeb
Chelsey Loeb, 26, with Werner Doyle, her neurosurgeon at NYU Langone’s Comprehensive Epilepsy Center. Chelsey Loeb

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.

Smart Brain Implant Helps Fight Seizures 0:30

Back in the 1930s and 1940s, doctors would perform lobotomies and electroshock therapy, blunt measures meant to treat a wide array of conditions nobody really understood.

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."

ElectRX
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."

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That could change if programs like the $300 million BRAIN Initiative announced by the White House in 2013 can accomplish its goal of showing how "individual cells and complex neural circuits interact in both time and space." Treating something like Parkinson's disease with a smart implant is still probably far in the future.

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."