This decade has seen fascinating developments in the field of Neurology. New drugs, new interventional procedures, new investigations, cutting edge research and newer & faster machines have transformed the field entirely. What was once considered as more of a palliative treatment field with no hopes for cure, has been changed to an ever-expanding medical field which is advancing at breathtaking speed. Older diseases in Neurology like Stroke have newer treatments now and there are newer diseases like ‘Antibody Mediated Autoimmune Diseases’ being discovered almost every few days! What has made a vast difference in the ever-expanding field of Neurology is none other than advances in technology.
Advances in Neurological Diagnostics
Advanced imaging methodologies in CT and MRI have revolutionised the neurological treatments, especially in the field of acute stroke. There is increasing analysis to support a physiology-based approach designed on advanced imaging, instead of merely a time-based determination of whether or not or not a patient with acute stroke would profit from reperfusion. Advanced imaging such as CT-Perfusion and MR DWI-FLAIR can be used to establish the age of the lesion and determine the extent of the brain tissue that is salvageable. If Physicians could identify those patients with wake-up strokes that are candidates for intervention, there may be opportunity to treat more people, reducing long term disability and healthcare expenditures.
MRI is a powerful imaging technique that produces detailed, high quality, and high-resolution images of the brain’s anatomical structure without radiation using magnetic field. Within the field of MRI, two new imaging techniques are proving particularly valuable: Functional MRI and Diffusion Tensor Imaging (DTI). Functional MRI can observe brain structures and scan the brain while patients perform cognitive tasks, such as solving math problems or responding to stimuli such as sounds or flashing lights. It visualises neural activity in the brain and spinal cord and is a popular imaging technology for neuroscience research. Functional MRI can determine the specific location in the brain where a certain function, such as speech or memory, occurs, which varies slightly for each patient. Knowing where these functional areas are located is critical in planning surgery or other treatments for diseases such as Epilepsy.
Since its introduction, MRI technology has been constantly advancing, producing sharper, clearer images in less time. The most powerful MRI scanners offer ultra-high magnetic fields of 7T which can visualise the brain in unprecedented detail through enhanced contrast mechanisms, such as Blood Oxygen Level-Dependent (BOLD) and flow-dependent contrast. At 7T, MRI increases lesion visibility and more accurately characterises brain abnormalities. For example, it can help delineate the brain area where epileptic seizures originate, visualise brain tumor pathology, measure metabolic markers in tumor tissue, identify neuron loss in the hippocampus in Alzheimer’s disease, and detail the pathologic features of multiple sclerosis.
Other advances in MRI technology are improving brain scan speed, ease, and accuracy:
- 3D volume scans offer thin-slice, SNR-rich studies with exquisite detail to help visualise small and subtle lesions
- 3D Arterial Spin Labeling (ASL) delivers quantitative perfusion assessment to reliably rule out focal or global perfusion defects and evaluate tumor, stroke and other cerebrovascular diseases
- Automated brain exams help reduce workload and improve consistency
- Real time acquisition, processing, and display of functional results enables a single technician to manage all aspects of BOLD MRI studies acquired with synchronised stimuli.
Also, Susceptibility-Weighted Imaging (SWI) can detect substances with different susceptibilities, such as deoxygenated blood, better than conventional MRI techniques. In future, AI will play an increasingly important role in neuroimaging. Artificial neural networks may reduce perceptual and interpretive errors through computer analysis of images augmented by artificial intelligence.
Advances in neurological therapeutics
With the breakneck speed of advances in neurological diagnostics, therapeutic advances in every subspecialty of neurology are also on the horizon. Increased sophistication and technological advances have paved a new path for treatment of acute and chronic neurological diseases. In addition to drugs a whole new field of devices in neurology has been opened up.
Neurological devices include CSF management devices, interventional neurology devices, neurosurgical devices and neurostimulation devices. CSF shunts and CSF drainage devices like Ommaya reservoir have been used since long for management of hydrocephalus and increased intracranial tension. Advent of programmable shunts has refined these neurosurgical procedures giving better results.
Advances in the field of interventional neurology have been mind boggling. Various devices used in neurointerventional procedures include embolisation coils, balloon occlusion devices and flow diverters used in treatment of cerebral aneurysms and arteriovenous malformations, various types of stents and microcatheters used in treatment of arterial stenosis as well as clot retrievers and neurothrombectomy devices used in treatment of acute ischemic stroke. The ischemic strokes segment is poised to be the fastest growing segment with very significant reduction in morbidity due to acute stroke.
Neurostimulation therapies embody invasive and noninvasive approaches that involve the applying of electrical stimulation to drive neural operate inside a circuit. Recent advances in neurotechnologies and neuroimaging, in conjunction with associate degree enlarged understanding of neurocircuitry, are factors contributive to the speedy rise within the use of neurostimulation therapies to treat associate degree increasingly wide range of neurologic and psychiatric disorders. Established neurostimulation methods include Deep Brain Stimulation (DBS), Motor Cortex Stimulation (MCS), Responsive Neuro Stimulation (RNS), Spinal cord Stimulation (SCS), and Vagus Nerve Stimulation (VNS). All these implantable neurostimulation systems include 3 primary components: stimulating electrode(s), an Internalised Pulse Generator (IPG) that serves as a battery pack, and electrode extender(s) to subcutaneously connect the electrode(s) to the pulse generator. Responsive neurostimulation therapies to treat medically uncontrollable encephalopathy continuing to evolve as advances in neurotechnologies have enabled an additional complete understanding of the pathological brain electronic equipment. Neurostimulatory approach is the only effective treatment option for several refractory neurologic disorders and is rapidly expanding to other clinical application domains.
Advances in NeuroRehabilation
There is a plethora of neurorehabilitation devices available at present. Erigo system for bed ridden patients, Lokomat robot for lower limb training, Armeo power, Armeo spring and Amadeo for upper limb training are the major ones being used especially in hemiplegia and paraplegia patients. Also, functional electrical stimulation devices, advanced orthotics, virtual reality-based rehabilitation devices, telerehabilitation devices, various gait analysis machines, body weight supported treadmill training, EMG biofeedback devices and mirror therapy are being increasingly used in neurorehabilitation. Trascranial magnetic stimulation field is also increasingly expanding for therapeutic as well as rehabilitation purposes.
A Brain–Computer Interface (BCI) could be a direct communication pathway between an increased or wired brain and an external device. BCI differs from neuromodulation therein it permits for two-way data flow. BCI has applications in disorders of impaired consciousness and aiding motor as well as sensory recovery in paralysed patients.
Technological advances in various fields of neurology have been quite mind-boggling. Translating these advances to better patient care in a cost-effective way would be quite challenging. But these advances would definitely change the way various neurological disorders are diagnosed and treated in future.