Summary:
Researchers at the UCLA Department of Neurology have developed an individualized method of delivering non-invasive electrical stimulation to treat acute human ischemic stroke. Background: Stroke is a leading cause of mortality and morbidity across the world. Over 80% of strokes are ischemic due to blockage of blood vessels, causing a low blood flow state (ischemia). Treatments for acute ischemic stroke are limited to mechanical opening of the blood vessels via Endovascular Thrombectomy (EVT) or via intravenous lytic medications that can lyse the blood clot, opening the occluded vessel. However, the preponderance of patients are not EVT and lytic candidates, and even in patients who do receive them, outcomes remain suboptimal, with only 20-25% achieving a disability-free outcome. Therefore, there is a tremendous unmet need for developing more therapies for acute ischemic stroke patients.
Transcranial direct current stimulation (tDCS) is a non-invasive neuromodulatory technique that applies a weak electrical current to the brain via scalp electrodes. Preclinical studies testing tDCS in acute ischemic stroke models have shown that cathodal direct electrical current carries a strong neuroprotective effect, salvaging the ischemic brain tissue at risk of infarction, also known as penumbra, via its anti-excitatory effects. Furthermore, in a pilot first-in-human proof of concept study published in the journal JAMA Network Open, UCLA researchers developed an individualized method of Cathodal tDCS delivery only to the penumbral brain tissue using high-definition electrodes in patients suffering from acute ischemic stroke. They showed that cathodal direct current enhances blood flow in the ischemic region and salvages penumbra. They also observed a very high recanalization rate (occluded blood vessel opening) in the treated individuals, likely due to enhancement of blood flow. Therefore, given the available preclinical evidence and the promising UCLA researchers' work in humans, individualized delivery of Cathodal tDCS is a novel non-invasive acute ischemic stroke treatment strategy that can improve outcomes of acute stroke patients.
Innovation: Researchers at the UCLA Department of Neurology developed a non-invasive individualized method of delivering cathodal direct current stimulation to the ischemic brain tissue to treat acute ischemic stroke patients. The device includes a helmet embedded with several electrodes operable in combination and in an arrangement to deliver the electrical current to each individual's ischemic brain tissue using hemodynamic and perfusion imaging data. The device delivers a current between the plurality of electrodes when in contact with the patient's scalp. Acute ischemic stroke patients are then treated non-invasively and rapidly via neuroprotection, blood flow enhancement, and by promoting recanalization of the occluded vessels. The treatment can be applied in emergency rooms, hospital beds, and even en route to the hospital in ambulances. Furthermore, the device is the first-in-human individualized method to treat acute ischemic stroke.
Potential Applications: • Individualized treatment of acute ischemic stroke • Non-invasive bedside treatment of acute ischemic stroke
Advantages: • Promising benefits to treat acute ischemic stroke patients non-invasively • Incorporating patients' imaging data to deliver an individualized treatment to each patient's penumbral tissue • Bedside delivery of the treatment in a rapid, feasible manner
Patent: Transcranial electrical stimulation in stroke early after onset
Publications: High-definition Cathodal Direct Current Stimulation for Treatment of Acute Ischemic Stroke Mersedeh Bahr-Hosseini; Kambiz Nael; Gozde Unal; et al. Neurology. JAMA Netw Open. 2023;6(6):e2319231. doi:10.1001/jamanetworkopen.2023.19231
Neurovascular-modulation: A review of primary vascular responses to transcranial electrical stimulation as a mechanism of action Mersedeh Bahr-Hosseini; Marom Bikson; Brain Stimulation, Volume 14, Issue 4, July–August 2021, Pages 837-847
Transcranial Electrical Stimulation in Stroke EaRly After onset Clinical Trial (TESSERACT), Bahr-Hosseini, Mersedeh et al. Brain Stimulation: Basic, Translational, and Clinical Research in Neuromodulation, Volume 16, Issue 1, 236 Reference: UCLA Case No. 2020-787
Lead Inventor: Mersedeh Bahr Hosseini