“Getting doctors and engineers to ‘speak each other’s language’ is a time-consuming process”

Good co-operation between medical specialists and engineers could allow us to tackle a great many neurological disorders, according to Wouter Serdijn, the coordinator of the NeuroTech pillar of the Delft Health Initiative. An example is deafness, which – strictly speaking – we might regard as a thing of the past. “As I move around the Neuroscience department in Rotterdam, my head simply bursts with ideas.”

“There’s quite a lot of low-hanging fruit in the interface between technology and medicine,” says Wouter Serdijn, coordinator of the NeuroTech pillar in Delft as well as professor in the Neuroscience department at Erasmus University Rotterdam.

“A case in point is the improvement we have achieved for people who have lost bladder and sphincter muscle control, for example paraplegics. We have developed a better technique that allows people in this situation to drive the contraction and relaxation of the muscles themselves. The requisite technology wasn’t even really complicated!”

“To me, this was a real eye-opener. Before, my thought at seeing someone in a wheelchair was always that the fact that they couldn’t walk was the major problem. Actually, though, the major problem is the loss of dignity that these people may suffer to the fact that they have no control over their sphincter muscles.” This is a good illustration of how NeuroTech, too, is about more than just technology.

Much broader

“At NeuroTech, we work with disorders that involve the nervous system in some or other way,” continues Serdijn. “This could be the loss of hearing or eyesight, but also behavioural disorders, dementia, Parkinson’s disease, epilepsy or migraine. It certainly doesn’t only concern brain disorders, though. We actually focus on all the places where, aided by technology, you can exert influence on the nervous system. This is a much broader field of application than people tend to think. For example, certain cardiac arrhythmias can be tackled by influencing nerves. And a disease like irritable bowel syndrome can be treated by stimulation of what is known as the visceral nervous system.”

“In NeuroTech, we focus on three things. The first is the technology that neuroscience needs; the second the technology required for neurodiagnosis (such as imaging technology) and neuromonitoring, and the third component is treatment and rehabilitation. These three are equally important. Neuroscience certainly must not be underestimated; there is still so much that we do not know regarding how the brain works. The scientists researching this need technology too.”

Faster

A current example of research is the use of ultrasound. “This is a relatively new way of engaging interaction with the brain, the classical method of doing this being MRI. MRI machines are relatively expensive, though, and they’re slow. In a programme under the auspices of the Dutch Research Council (NWO), we are currently busy making images of the brain, but very quickly. This allows us, in a manner of speaking, to see how brain activity moves around, which could give us a better understanding of how the brain works.”

“As a matter of interest, ultrasound can be used to ‘seduce’ neural pathways to be more or less active, which can then be used in treatments. This has the major advantage that it can be done non-invasively with ultrasound.”

“Rehabilitation is obviously an important focus of attention for us too. Frans van der Helm’s group at the Faculty of ME has been active in this field for years. All kinds of technology are being developed to help people rehabilitate better and more quickly.”

Electroceuticals

One important field of research within NeuroTech could be defined as electroceuticals (as opposed to pharmaceuticals). Somewhat more simply put: electronic medicines versus pills. “The oldest example of an electroceutical is the pacemaker. At a certain point, this technology – in other words, administering directed electrical pulses – was applied to the brain as well, and this has proved successful in the treatment of Parkinson’s disease.”

“Along the way, more and more applications get added. Another very successful example of an electroceutical is the cochlear implant, which allows deaf people to engage in spoken communication again. Deafness can now be relegated to history! Implants to improve eyesight should also soon become reality. We are working with the Netherlands Institute for Neuroscience. They are trying to have an implant ready for market within five years, which when implanted in the back of your head will return your sensory experience of images.”

“The major challenge is to make this technology patient-specific, in other words to adapt it to the patient’s exact requirements. The beauty of it all is that, in principle, this is much easier to do with electroceuticals than with pills, since pills are not very specific. In general, the price we pay for making pills more specific is an increase in side effects. The settings of an electroceutical can be altered and it can be adapted to your requirements from one moment to the next. What’s more, you can measure exactly what you need. Basically, an electroceutical can itself adapt the therapy it delivers to what the patient needs. This is what is known as a closed-loop system.”

Technical

Notwithstanding these excellent steps in the right direction, NeuroTech still has enough technical challenges to tackle, Serdijn maintains. “If a cardiologist cannot see anything on an ECG, the patient is sometimes sent home with a Holter monitor, so that longer-term monitoring can be done at home. |This is not common practice in neuroscience yet, but you actually do want to be able to monitor someone with neurological problems for a longer period, and you want to do this in a less invasive manner. This step is technically difficult since monitoring the brain is more complicated than monitoring the heart, for example. We would also prefer to monitor the entire brain and not only one specific spot.”

“Interpreting what has been measured is enormously important. What do these signals actually mean? One problem we are currently grappling with is encountered in people with locked-in syndrome. These people benefit enormously from a brain-machine interface, but we have to be able to detect what the patient’s intended action actually is.”

“After all, miniaturising and reduced energy consumption is an important technical issue with implants. Ultimately, we will be moving away from titanium cases to flexible and more body-like materials.”

Patient journey

“Aside from the technical challenges, we try to do the research at NeuroTech from a certain point of view, and that’s what our colleagues in OncoTech and CardioTech also do, incidentally. An important aspect of this is always keeping in mind the entire patient journey. This means closer attention to symptom prevention, a development evident in the entire health domain. This probably is the only way to contain costs at all.”

“In terms of research, the new set-up of the Delft Health Initiative focuses on developing an inclusive network in which experienced people share their networks with younger professionals. The latter might be very good in their own discipline but often still haven’t found the people with whom to further develop their technology. In other words, we try very hard to look for further opportunities for co-operation.”

Coincidence

“Coincidence often yields the most beautiful results,” says Serdijn, with reference to his own research career. “In a certain sense, it is pure coincidence that I ended up in this specific field of expertise. I have been with TU Delft all along, first as a doctoral candidate, then as a post-doc and ultimately as professor. I specialised in energy-efficient microelectronics; you need these for places that are difficult to get to for maintenance purposes. The human body must be the ultimate as far as hard to get to for maintenance purposes is concerned, so I have worked on pacemakers, hearing aids and neurostimulators. That is how I ended up here. What is special is that these are all areas in which you need others. We absolutely need to work with the medical professionals.”

“In this cooperation between medical and technical professionals, there are three types. There’s the engineer who says: here’s the technology; just use it. There’s the doctor who says to the engineer: you must have further technology lying around that I could use to do fine things with. And you have the doctor, or engineer, who asks him/herself: what could you conceivably do with this? How good is it, and could it still be improved? This last category of professional is the one you need. Sincere interest in each other’s field of expertise is necessary.”

“What the engineer must get to understand is what it is that the doctor really needs. And this takes time; you need to leave your comfort zone to find out. Both parties come from extremely worthwhile disciplines, but it takes time to learn each other’s language.”

“However the case might be, I find the current collaborations, such as Medical Delta and the convergence process with Erasmus University Rotterdam, fantastic. It is really good for engineers and medical professionals to get together and that Delft and Rotterdam are implementing this in the Randstad area together with Leiden. As I move around the Neuroscience department in Rotterdam, my head simply bursts with ideas. I think we are going to do unique things yet!”