Graeme Clark Oration presentation
Professor Timothy Denison
Unversity of Oxford
Towards an Electronic Prescription? The opportunities and challenges for interfacing electrical and biological circuits for the treatment of disease.
When treating diseases of the nervous system, doctors have generally relied on drug discoveries. But uncovering new pharmaceutical treatments can be a risky and lengthy process, and diseases of the central nervous system have proven especially challenging. With the significant personal and societal costs incurred by these disorders, there is an imperative to explore alternative approaches to treatment.
Bioelectronics is the concept of interfacing directly with the body's own nervous system to monitor physiological signals and, as needed, modulate the electrical activity within the nervous system to alleviate symptoms of diseases. The first generation of bioelectronic systems are now treating a number of disorders, with perhaps the most familiar being cardiac pacemakers that aim to maintain a healthy heart rhythm. Pacing systems are deployed in hundreds of thousands of patients today, and reinforce the potential for bioelectronic medicine to restore health.
Expanding bioelectronics to neurological disorders like epilepsy, chronic pain and dementia is an exciting but challenging opportunity. Despite the clinical success in treating symptoms of diseases like Parkinson's, existing bioelectronic systems have several attributes that currently limit their adoption. For example, currently a skilled neurosurgeon is required to place the implant, and the device's output is relatively inflexible in contrast to the rapidly changing and reactive activity of the nervous system. Resolving these issues requires the complementary pursuit of technological innovation and scientific discovery.
For technology, the microelectronics-enabled flexibility of bioelectronic systems creates opportunities for both research and medical device design. Digital technology is adaptable for addressing various diseases, as well as for fine-tuning to patient-specific needs. In the future, sensor- and algorithm-enabled systems might rapidly respond to physiological fluctuations within the body, allowing the possibility of building restorative prosthetics that serve as a surrogate nervous system. In addition, the algorithms used to operate the bioelectronics can “evolve” with our scientific understanding of the nervous system. But to fully realize this potential, we first need a better understanding of how the nervous system functions and responds to therapeutic interventions.
To this end, bioelectronic platforms are also being used as a unique window into the brain. This window allows access for gathering data on how the nervous system functions, and then goes awry due to disease. Clinician-researchers can then characterize the response of the nervous system to drugs and stimulation to better understand how more “neurotypical” function might be restored.
The flexibility of bioelectronics allows for a breadth of therapies to be explored with these scientific toolkits. High-impact, problematic clinical needs are currently being explored in human volunteers, including postural instability in Parkinson's disease, seizure prediction and prevention in epilepsy, and emotional and sensory processing in chronic pain and depression. The breadth of these studies reflects the diversity of challenges created by neurological disorders, but also the hope that bioelectronic systems can help address them.