Assistant professor of neurology, Thomas Jefferson University

Mijail Serruya, MD, PhD

"The device part doesn’t have to solve everything. We have neurologists, neurosurgeons, and occupational therapists. The question is, ‘how can we make a device that leverages this?’”

Earlier this year, researchers at the Vickie and Jack Farber Institute for Neuroscience at Thomas Jefferson University initiated a clinical trial, dubbed Cortimo (NCT03913286), using microelectrodes in the brain and a robotically powered brace to test a method that could hopefully restore movement in parts of the body impaired by stroke. Led by Mijail Serruya, MD, PhD, the study is centered around a single patient who will be worked on daily.

Serruya and his colleagues will train the patient to take control of the brain-implant to drive movement of the robotic brace fitted for his weaker arm, as well as how to overcome his abnormal muscle tone. Unlike prior studies that have examined brain-computer interface, these electrodes will be placed in an area adjacent to the stroke.

Serruya, assistant professor of neurology at 

, claims that we need more knowledge before expanding this type of method to more common cases of stroke. In an interview with 

he explained the steps in progressing brain electrodes and the importance of remaining transparent with the stroke community and the FDA.

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The assistant professor of neurology at Thomas Jefferson University discussed the potential and feasibility of brain implants in patients with stroke.  

Future Research Using Brian Implants in Stroke: Mijail Serruya, MD, PhD

"The idea is that if you can show that there’s a possibility that there’s signals in there and that there can be learning, maybe that will be enough energy for people to revisit it and say, ‘oh well, maybe poststroke care beyond just those 2 months can still do something,’ and that there’s something worth rescuing and keeping awake.”

Emergency stroke treatment can vary depending on whether a patient is having an ischemic stroke or a stroke that involves bleeding into the brain (hemorrhagic). The process of treating stroke is time sensitive and is often done by using emergency intravenous medication such as alteplase or endovascular procedures, which have been studied frequently. An area that some clinicians note could use some improvement, however, is the poststroke phase of care.

Mijail Serruya, MD, PhD, claims that clinicians have a greater academic knowledge of locating lesions and identifying areas of the brain stroke may have an impact, though a limited one in terms of actually mitigating these impacts outside of the traditional physical therapy. Serruya, an assistant professor of neurology at Thomas Jefferson University, is leading a project using brain implants connected to a robotic arm brace on a poststroke patient to see if they can overcome abnormal movement and restore abilities.

If successful, the trial could potentially open up more treatment options for this patient population. In this interview, Serruya discusses the levels of poststroke disability and the inconsistencies that occur with the available treatment options. He stresses that increasing the research opportunities may lend itself to an overall greater treatment of the disease as well as more leeway from insurance companies on the restrictions for physical therapy and other specialist options.

The assistant professor of neurology at Thomas Jefferson University discussed areas of poststroke care that need improvement including a more streamlined process. 

The Need to Improve Poststroke Care: Mijail Serruya, MD, PhD

"We were recording what the brain did and worked around that. The next step is to see if we can combine these. Can we both record from the brain and get signals out? Maybe we can modulate the brain and have motor learning.”

Researchers at Thomas Jefferson University recently initiated the Cortimo trial (NCT03913286), which will test a method of recovery using a brain implant and robotic brace in a single patient with long-term disability following a stroke. In the past, other clinical trials of brain-computer interface (BCI), focused on patients with much more rare and devastating forms of brainstem stroke or spinal cord injury that causes paralysis from the neck down.

Unlike prior BCI studies, which implant and record from electrodes in relatively health brains, the researchers have implanted electrodes in an area adjacent to the stroke. Lead investigator Mijail Serruya, MD, PhD, assistant professor of neurology, and colleagues will also be forced to regularly adjust and refine the artificial intelligence algorithms in order to interpret the patient’s intention to move with better fidelity.

Serruya claims that the severity of the stroke in this patient-specific trial sets itself apart from previous studies. He sat down with 

to discuss a few of the ongoing and completed studies using brain electrodes and how they differ from Cortimo.

Can brain implants improve mobility after stroke? News release. Thomas Jefferson University. February 1, 2021. Accessed February 22, 2021. 

https://www.prnewswire.com/news-releases/can-brain-implants-improve-mobility-after-stroke-301218999.html

The assistant professor of neurology at Thomas Jefferson University gave background on what other studies have observed brain implants for poststroke patients and how they differ from his work.

Comparing Poststroke Trials of Brian Implants: Mijail Serruya, MD, PhD

"In every single patient to my knowledge that’s been implanted, we have always figured out what the brain is saying. There have been advances in making sense of those signals as well as showing that you can record from different brain regions.”

Fifteen years ago, Mijail Serruya, MD, PhD, was part of a team of researchers that implanted the first human with a brain electrode. Serruya, an assistant professor at Thomas Jefferson University, will now lead a recently initiated clinical trial that will use microelectrodes in the brain and a robotically powered brace to test a method that could 1 day restore movement in parts of the body impaired by stroke.

Although there are options such as endovascular therapy (EVT) to treat stroke, they require rapid response and intervention after the start of a stroke, and not all patients are eligible. Patients with stroke have varying degrees of severity, some causing more permanent damage and loss of certain motor function. Rehab therapies, when available, can restore some function, but improvements can plateau over time.

The idea of using differing modalities to help patients recover from stroke has become an increasingly growing area of research over the past decade. In this interview, Serruya describes how the landscape for these modalities and the knowledge researchers have on using brain implants has grown since he first started 15 years ago.

The assistant professor of neurology at Thomas Jefferson University provided perspective on how researchers have gained a better understanding of using modalities in poststroke patients.

Growing Knowledge of Brain Implants for Poststroke Patients: Mijail Serruya, MD, PhD

"Typically, the way it works is that it records residual signals. Even if someone has difficulty moving their limb, they often have the ability to make tiny little ENG signals.”

Researchers at Thomas Jefferson University recently initiated a clinical trial using a brain implant and robotic brace to test a method that could possibly offer hundreds of thousands of patients with stroke with long-term disability a new option for better mobility. The Cortimo trial (NCT03913286), led by Mijail Serruya, MD, PhD, represents the first patient implanted with electrodes who can walk and lives semi-independently.

Serruya has been working with this patient for the past 3 months to train his control of the brain-implant in order to drive movement of the robotic brace that was fitted for his impaired arm. While there are varying degrees of poststroke disability, the aim of the brain implantation is to assist the more common degrees of poststroke, straying away from the more severe cases that can lead to nearly total paralyzation or other serious complications.

Serruya, an assistant professor of neurology, sat down with 

to discuss the mechanism of the brain implant procedure, and the advantages it brings.

The assistant professor of neurology at Thomas Jefferson University discussed the details using a brain implant and robotic brace in a newly initiated clinical trial.

Mijail Serruya, MD, PhD

Articles

Future Research Using Brian Implants in Stroke: Mijail Serruya, MD, PhD

The Need to Improve Poststroke Care: Mijail Serruya, MD, PhD

Comparing Poststroke Trials of Brian Implants: Mijail Serruya, MD, PhD

Growing Knowledge of Brain Implants for Poststroke Patients: Mijail Serruya, MD, PhD

Improving Poststroke Mobility With Brain Implants: Mijail Serruya, MD, PhD

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