Novel personalized treatment strategy for patients with chronic stroke with severe upper-extremity impairment : The first patient of the AVANCER trial

Article Article scientifique Rapport de cas Novel personalized treatment strategy for patients with chronic stroke with severe upper-extremity impairment : The first patient of the AVANCER trial eng 2023-07-11 2023-09-08 author Bigoni Claudia Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), Ecole Polytechnique Fédérale de Lausanne (EPFL), 1202 Geneva, Switzerland; Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), Ecole Polytechnique Fédérale de Lausanne Valais (EPFL Valais), Clinique Romande de Réadaptation, 1951 Sion, Switzerland. author Beanato Elena Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), Ecole Polytechnique Fédérale de Lausanne (EPFL), 1202 Geneva, Switzerland; Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), Ecole Polytechnique Fédérale de Lausanne Valais (EPFL Valais), Clinique Romande de Réadaptation, 1951 Sion, Switzerland. author Harquel Sylvain Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), Ecole Polytechnique Fédérale de Lausanne (EPFL), 1202 Geneva, Switzerland; Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), Ecole Polytechnique Fédérale de Lausanne Valais (EPFL Valais), Clinique Romande de Réadaptation, 1951 Sion, Switzerland. author Hervé Julie Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), Ecole Polytechnique Fédérale de Lausanne (EPFL), 1202 Geneva, Switzerland; Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), Ecole Polytechnique Fédérale de Lausanne Valais (EPFL Valais), Clinique Romande de Réadaptation, 1951 Sion, Switzerland. author Oflar Meltem Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), Ecole Polytechnique Fédérale de Lausanne (EPFL), 1202 Geneva, Switzerland; Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), Ecole Polytechnique Fédérale de Lausanne Valais (EPFL Valais), Clinique Romande de Réadaptation, 1951 Sion, Switzerland. author Crema Andréa Clinical Neuroscience, University of Geneva Medical School, 1202 Geneva, Switzerland; Bertarelli Foundation Chair in Translational Neuroengineering, Neuro-X Institute (INX) and Institute of Bioengineering, School of Engineering, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland. 919264 author Espinosa Arnau Wyss Center for Bio and Neuroengineering, Chemin des Mines 9, 1202 Geneva, Switzerland. author Evangelista Giorgia G Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), Ecole Polytechnique Fédérale de Lausanne (EPFL), 1202 Geneva, Switzerland; Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), Ecole Polytechnique Fédérale de Lausanne Valais (EPFL Valais), Clinique Romande de Réadaptation, 1951 Sion, Switzerland. author Koch Philipp Department of Neurology, University Hospital Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany; Center of Brain, Behavior and Metabolism (CBBM), University of Lübeck, Ratzeburger Allee 160, 23562 Lübeck, Germany. author Bonvin Christophe Division of Neurology, Wallis Hospital, Sion, Switzerland. author Turlan Jean-Luc Department of Neurological Rehabilitation, Clinique Romande de Réadaptation SUVA, 1951 Sion, Switzerland. author Guggisberg Adrian 0000-0001-7178-7793 Universitäre Neurorehabilitation, Universitätsklinik für Neurologie, Inselspital, University Hospital Berne, Bern, Switzerland. 707883 Département des neurosciences cliniques (OTONO) author Morishita Takuya Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), Ecole Polytechnique Fédérale de Lausanne (EPFL), 1202 Geneva, Switzerland; Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), Ecole Polytechnique Fédérale de Lausanne Valais (EPFL Valais), Clinique Romande de Réadaptation, 1951 Sion, Switzerland. author Wessel Maximilian J Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), Ecole Polytechnique Fédérale de Lausanne (EPFL), 1202 Geneva, Switzerland; Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), Ecole Polytechnique Fédérale de Lausanne Valais (EPFL Valais), Clinique Romande de Réadaptation, 1951 Sion, Switzerland. author Zandvliet Sarah B Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), Ecole Polytechnique Fédérale de Lausanne (EPFL), 1202 Geneva, Switzerland; Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), Ecole Polytechnique Fédérale de Lausanne Valais (EPFL Valais), Clinique Romande de Réadaptation, 1951 Sion, Switzerland; Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, the Netherlands. author Hummel Friedhelm Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), Ecole Polytechnique Fédérale de Lausanne (EPFL), 1202 Geneva, Switzerland; Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), Ecole Polytechnique Fédérale de Lausanne Valais (EPFL Valais), Clinique Romande de Réadaptation, 1951 Sion, Switzerland; Clinical Neuroscience, University of Geneva Medical School, 1202 Geneva, Switzerland. Electronic address: friedhelm.hummel@epfl.ch. 868060 Département des neurosciences cliniques (OTONO) 591-599.e3 10.1016/j.medj.2023.06.006 37437575 2666-6340 https://www.sciencedirect.com/science/article/pii/S2666634023001939 Background: Around 25% of patients who have had a stroke suffer from severe upper-limb impairment and lack effective rehabilitation strategies. The AVANCER proof-of-concept clinical trial (NCT04448483) tackles this issue through an intensive and personalized-dosage cumulative intervention that combines multiple non-invasive neurotechnologies. Methods: The therapy consists of two sequential interventions, lasting until the patient shows no further motor improvement, for a minimum of 11 sessions each. The first phase involves a brain-computer interface governing an exoskeleton and multi-channel functional electrical stimulation enabling full upper-limb movements. The second phase adds anodal transcranial direct current stimulation of the motor cortex of the lesioned hemisphere. Clinical, electrophysiological, and neuroimaging examinations are performed before, between, and after the two interventions (T0, T1, and T2). This case report presents the results from the first patient of the study. Findings: The primary outcome (i.e., 4-point improvement in the Fugl-Meyer assessment of the upper extremity) was met in the first patient, with an increase from 6 to 11 points between T0 and T2. This improvement was paralleled by changes in motor-network structure and function. Resting-state and transcranial magnetic stimulation-evoked electroencephalography revealed brain functional changes, and magnetic resonance imaging (MRI) measures detected structural and task-related functional changes. Conclusions: These first results are promising, pointing to feasibility, safety, and potential efficacy of this personalized approach acting synergistically on the nervous and musculoskeletal systems. Integrating multi-modal data may provide valuable insights into underlying mechanisms driving the improvements and providing predictive information regarding treatment response and outcomes. Translation to patients Brain stimulation Brain-computer interface Neurorehabilitation Personalized therapy Stroke Humans Transcranial Direct Current Stimulation / methods Stroke Rehabilitation / methods Precision Medicine Treatment Outcome Stroke / therapy Upper Extremity Dewey 616.8 Swiss National Science Foundation Novel, individualized Brain Stimulation, network-based approaches to improve Cognition in healthy seniors and patients with MCI (NiBS-iCog) 197899 CH Projects 61 Département des neurosciences cliniques 226 false 567 Neuroréhabilitation et neuromodulation 910 Med 4 9 aca18211-54e1-4047-a11d-3ca9daee3444 Article (Published version) Restricted 1-s2.0-S2666634023001939-main.pdf 2594922 application/pdf f06f587b28f06c6a869c88f9f2201507e0ed1d2038eca557ebbdc38f10aefdcd e772aee4-4010-43b9-8183-74618e5c6d97 Supplemental data Restricted ScienceDirect_files_17Jun2024_07-45.zip 4061623 application/zip 30db20e45340ef050d188df568fab4b95f91c086d8991732a777f994e177cb3e Vignette Public 1-s2.0-S2666634023001939-fx1.jpg 190675 image/png restrictedAccess Faculté de médecine / Section de médecine clinique / Département des neurosciences cliniques

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Novel personalized treatment strategy for patients with chronic stroke with severe upper-extremity impairment : The first patient of the AVANCER trial	Med			2023	96	0

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