The Brainsgate Device - Guidance System

The Brainsgate device is an electrode that is implanted in a patient's palate which when stimulated, triggers the sphenopalatine ganglion to dilate the surface blood vessels of the Brain (Pial circulation). The principle promises novel approach to treatment of acute stroke, vascular Dementia, Vasospasm in Subarachnoid Hemorrhage and even augment Oncologic treatment of Brain tumors by increasing delivery of Chemotherapeutic drugs to tumor bed.

Until recently, the implantation was done through direct visualization of the patients palate by the implanter. There is a chance that the electrode can be in the wrong place thereby making it ineffective (no harm to the patient). With the new guidance system, it is easier to implant the electrode.

During a recent family trip to Israel, my son and I visited the Brainsgate Facility to get ourselves acquainted with the new guidance system and pictured is Karl Echiverri easily deploying the electrode into the Sphenopalatine fossa using the Guidance System Monitor. Once the electrode is implanted, by means of an external device utilizing bluetooth technology, the electrode is triggered to stimulate the Sphenopalatine Ganglion that then causes dilatation of the Pial Collateral Vessels, increasing delivery of blood in the surface of the Brain. This can then bypass areas of blockages such as in the situation of an acute Stroke. In cases of Tumors, it increases flow that assures delivery of drugs to tumor bed. In vascular dementia, it can potentially help by increasing microcirculation. See related Blog

Dr Henry Echiverri is a Stroke Neurologist who is certified to perform this procedure under the study protocol IMPACT-24 at Central DuPage Hospital, in Winfield, Illinois, one of the 6 Centers in the United States who are participating in the study of this device. It is currently being tested in other Stroke Centers worldwide. He is also on staff at EDWARD HOSPITAL in Naperville, IL and GOOD SAMARITAN HOSPITAL in Downers Grove, IL. Visit the Brainsgate site for more details.

Stroke Treatments - do not malign tPA. One day, it can save your own brain

I was called by ER regarding a very functional lady in her late 60s who suddenly developed difficulty speaking and promptly worsens to include paralysis on the left arm and leg. By the time I saw her, the paralysis and slurred speech worsened to an NIHSS of 12. It was 2 hours since her stroke onset. The patient's daughters were presented treatment options literature that instilled fear of bleeding if a certain drug is infused (tPA). They wanted a catheter put into the arteries and the clot causing the stroke "pulled out". I quickly point out that the FDA approved treatment is still IV tPA. In fact, the treatment window has been expanded up to 4.5 hours from the time stroke onset. I have seen the MERCI and even the PENUMBRA devices used since I took the job as co-Medical Director of Central DuPage Hospital Stroke and Neurovascular Program 5 years ago. These are wonderful and clever devices and more often than not, helps re-canalize an occluded vessel. However, like tPA, if blocked arteries are opened up, reestablishing flow into vessels that are rendered "leaky" due to lack of oxygen, also increases the risk of bleeding. Finally, threading those catheters into tortuous vessels can be a technological challenge that I have seen great expectations vanish into thin air, as the interventionalist struggles to pass its tip through kinked or tortuous vessels. This particular patient's daughters reluctantly accept my order to proceed with the IV tPA but as a compromise, I gave partial loading, leaving some amount available for the Interventionalist to use intra-arterially in case he needed to go in later. The patient improves 100% and the MRI does not show any trace of minor stroke.