Will Rosellini

As busy as I have been, I’m glad my COO made me attend the Future of Medicine conference at the Singularity Institute…while it is good to remain very focused as a sensory and motor neurorehabilitation company, sometimes it is good to zoom outand pay attention to larger trends.   I thought I would post some notes from the conference speakers:

Ray Kurzweil gave his standard talk (beamed into a 3D hologram of himself) and then showed a set of graphs talking to the rate of change for IT related technologies.  His thesis assumes that given enough activity in a research space loosely defined as information technology, the rate of change will be exponential, as opposed to linear.  Check out his charts here:

http://www.singularity.com/charts/page82.html

He believes that biology has become an information technology…of course I share this view and built some projected neuroenhancement devices for the video game Deus Ex: Human Revolution.

We spent most of the morning on personal genomics, which remain far behind in their promise to revolutionize healthcare.  I did the MS in Computational Biology based on this hype, but agree with the sentiment that there is alot more work to be done to make personal genome sequencing actionable.  To date, the best advice we can give is exercise, don’t be fat, don’t smoke, keep stress low and don’t do drugs/drink.   Most genome maps would conclude the with the same treatment plan…I do think there will be some short term wins in this space as it relates to focused genomic mapping for drug dosing…of special note, I think the Warfarin dosing studies based on genomic analysis shows promise…not clear who will pay for the test though.

We spent the afternoon discussing aspects of EMR’s and mobile health…cardiologists are the farthest along in this space, but readily admit that more information isn’t necessarily helping them in making treatment decisions…this is also to say, we don’t know what to do with 24/7 data…since everything we do now is based on the office consult…this area will continue to develop as gamification (integrating games into a routine health check or patient lifestyles integration (EKG covers for iphones/seatbelts with defibrillators etc…)

Day 2 should be more interesting…however, after day 1 I still believe that neurostimulation will be the biggest “surprise” in the next 10 years…we will see if I change my tune after today.

An Overview of the history of Northstar Neuroscience, Inc.

 Northstar Neuroscience Inc. was an American company that was centered on the development and marketing of various neuromodulation therapies targeted to improve the quality of life of individuals suffering from a wide group of neurological disorders. The company was founded in 1999 and was initially named Vertis Neuroscience, Inc. which had been changed to Northstar Neuroscience, Inc. in 2003.

Renova – ST

Renova-ST was the company’s primary product which was a cerebral cortex neurostimulation system that was used to deliver targeted stimulatory current to the cerebral cortex. Since early 2000, the company had been conducting a group of clinical trials that examined the safety and efficacy of Renova-ST in the management of various neurological disorders such as stroke, tinnitus, stroke induced aphasia and major depression.

The Renova-ST consisted of a neurostimulator device, cortical stimulation electrodes and a special programming system.

-         Neurostimulator: which is an electrical stimulating device that is usually implanted under the skin of the upper chest area.

-         Cortical stimulation electrodes: which are leads connected to the neurostimulator device. They are placed over the cerebral cortex to deliver stimulating electric current to the target area of the cortex.

-         Programming system: which is a form of a portable computer that permits communication with the implanted neurostimulating device. It allows the physician to modify the parameters of cortical stimulation.

The Everest Trial

Northstar Neuroscience conducted a major clinical trial, which was known as the Everest trial, which examined the efficacy of the Renova neurostimulation system in association with special rehabilitation therapies in recovery of arm functions in upper limb hemiparesis caused by stroke. Unfortunately, as of January 2008, Northstar Neuroscience announced that the Everest trial had failed to meet its predefined main end point.

The trial’s end point was a form of a composite that was utilized to assess the gains in the functions of hand and arm after 4 weeks of completion of rehabilitation therapy as measured by the Upper Extremity Fugl-Meyer test (UEFM). The assessment also included the patients’ ability to perform normal daily activities via the Arm Motor Ability test (AMAT).

The winding down of Northstar Neuroscience, Inc.

In January 2008, John Bowers, the CEO of Northstar Neuroscience, Inc., announced that the Everest trial failed to support positive effects of cortical neurostimulation therapy on the recovery of motor stroke which was proven in past studies.  However, there has been much debate into the causes of the failure…subsequent analysis of the data has shown that if the surgical implant was done with imaging (business types cut this cost out of the pivotal study), then the results were extraordinary…by the time this was shown, the investors had taken nearly $90M dollars out of the company, wound it down and sold the IP to Advanced Neuromodulation–St. Jude.   St. Jude has not done anything in this space and recently reported a large layoff in their deep brain stimulation unit.

I met another soldier (a high school friend, SEAL) who experiences tinnitus.   The other guys at the table were surprised that he had never mentioned it before…I thought I might post briefly on some basics, just in case you want to send this explanation to your friends/family.

Tinnitus is a perception of feeling an annoying sound in the ears or the head. The term tinnitus is derived from tinnire, a Latin word which means to ring. Typically, a person falsely perceives a sound when there is no actual sound in the external environment i.e. the perception of sound is irrelevant to any external stimuli.

More than 10% of the entire population suffer from tinnitus at a point or another during their lives. On the other hand, approximately 85% of individuals suffering from chronic ear problems complain of tinnitus. The problem can affect children as well as adults; however, the incidence of tinnitus rises with age.

Occasionally, tinnitus is experienced after exposure to a loud noise as a gunshot or amplified sounds as in a music concert. Although this form of tinnitus is somehow annoying, it usually lasts only for a few hours.

What are the causes of tinnitus?

It is worth emphasizing that tinnitus is a mere symptom not a clinical disorder; hence, searching for an underlying cause is mandatory, especially when it has been present for a long period. This is of pivotal importance because tinnitus is sometimes accompanied by sensorineural hearing loss. Special forms of tinnitus such as fluctuating tinnitus, tinnitus with vertigo, pulsatile tinnitus or unilateral tinnitus must be thoroughly investigated.

Tinnitus is categorized into 2 groups:

-         Objective tinnitus: is audible to everyone including the complaining individual.

-         Subjective tinnitus: is only audible to the affected individual.

Objective tinnitus:

Objective tinnitus is rather uncommon. The sound originates in the ear, head or neck because of a vascular or a muscular cause. Muscular tinnitus associates multiple degenerative disorders of the head and neck such as amyotrophic lateral sclerosis which is a neuromuscular disorder that occasionally affects the muscles of the ear leading to myoclonus or a form of repetitive flutter of the tensor tympani and/or stapedius muscles. This leads to an audible and observable flutter originating from the ear.

Palatal myoclonus is another uncommon cause of muscular induced tinnitus. It is the result of rhythmic discharge originating in the inferior olivary nucleus in patients suffering from brainstem lesions. The disorder is usually secondary to trauma, stroke, multiple sclerosis or encephalitis.

Carotid artery aberrances are relatively common causes of objective tinnitus. Furthermore, senile ectatic changes of the carotid artery can lead to tortousity of the blood routes through the neck and ear yielding turbulent flow that can be auscultated.

The jugular vein and jugular bulb can yield a form of tinnitus that is associated with a venous hum. It is often described as a low pitch sound or vibration rather than a ringing sound.

Subjective tinnitus:

Clinically speaking, subjective tinnitus is sound perception which is unrelated to auditory stimuli. Subjective tinnitus is the result of the brain’s response to deprivation of sensory input from the auditory effector organs. Therefore, subjective tinnitus can be associated with any form of conductive or sensorineural hearing loss. These include chronic ottitis media, otosclerosis, congenital sensorineural hearing loss…etc.