Rewiring the brain

A local study on non-invasive brain stimulation is giving new hope to stroke patients, writes Syida Lizta Amirul Ihsan

FOR Tan Chee Heng, 60, suffering a stroke two years ago was a wake-up call to take her health seriously. “We are negligent on so many things,” she says.

Since then, she has been going for therapy regularly at University Malaya Medical Centre’s rehabilitation unit.

The always upbeat Tan is much happier now than when she was first stricken by stroke. She suffered some loss of motor function on her left arm but her condition has since improved.

“Now I can grip and move my arms”, she says, as she squeezes her fingers as hard as she could.

These days, she has another reason to be excited. Tan is one of 10 patients recruited by rehabilitation physician Assoc Prof Dr Lydia Abdul Latif and her team for their research on neuromodulation, a new way to maximise brain recovery after a stroke.

Neuromodulation has been the buzzword in medical rehabilitation for a few years and it has now reached our shores.

This new technique of “rewiring the brain” gives hope to stroke patients, both old and new cases, who, for the longest time, had to rely only on conventional therapy.

POWERED UP

The new method uses trans-cranial direct current stimulation where electrodes deliver very low voltage electricity— about one-tenth of what you get from listening to your iPod— through the scalp, to the target area of the brain.

“The most common weakness among stroke patients is the loss of function on one side of the body, so we ‘zap’ the targeted brain area to stimulate the brain, which may result in better functioning on that weak side,” says Dr Lydia.

“What this process does is deliver the current so a patient’s therapy which follows this procedure is more effective.

“With stroke, a part of the brain is damaged. What doctors know is that cells in the surrounding area can take over the job of the injured cells.

“So, if the movement area is affected, the surrounding cells can learn to do the job.

“We are hoping that brain stimulation can enhance and accelerate the process.”

Dr Lydia completed her fellowship in neuromodulation in Harvard University recently where the team tested 16 patients (eight on TDCS and eight on sham or placebo).

“The research found that the brain cells tested with electricity treatment improved much faster.”  

Research results for neuromodulation have been published in medical journals such as Lancet.

FINAL AIM

As a specialist in medical rehabilitation, Dr Lydia, a petite, soft-spoken mother of one who knows her patients and even their family members, wants this to result in better motor function for her patients.

“We want to see changes in the brain towards neurocovery,” she says. “More important than the brain map, we want this to translate into better function for the patients to carry out simple daily tasks.”

Dr Lydia is among the few local experts who specialise in neuromodulation and she hopes to analyse the results of the 10 patients by June.

“Non-invasive brain stimulation is not limited to movement recovery. It may also help with speech and memory,” she says.

She says she recruits chronic stroke patients who have suffered stroke for more than six months because “within six months, there are still recovery processes happening in the brain”.

Currently, UMMC is the only local hospital with this facility.

The TDCS machine costs between RM2,012 and RM12,074. and improvements are being rapidly made to the technology.

Although this treatment is still in research stage, Dr Lydia and her team have high hopes that this will revolutionise the way stroke patients are treated.

LIFE AFTER STROKE

Stroke used to be a dead end for patients and along with it, the challenging journey for carers. Dr Lydia hopes the novel method can “expand the current thinking and the ability to try new modality to treat stroke patients”.

Dr Lydia doesn’t believe in passive treatment for her patients. Research has shown that, for example, when a patient has reduced function on one arm, he or she compensates by using the other arm more, resulting in the rapid deterioration of the weak arm.

“The more you train, the more you recover. If you pamper stroke patients, you are only doing them more damage. They have to use their muscles or lose them,” she says.

She realises that while some stroke patients follow up with rehabilitation years after stroke, others prefer to stay at home and eventually adapt to the reduced bodily functions.

“But if these patients come for therapy, their functions can improve at a faster rate.

“Carers must play their role, too. If the patient’s function deteriorates, then it adds stress to the carers. But if the patient’s condition improves, the quality of life and the relationship also improve,” she says.

Meantime, she is hoping that neuromodulation can pave the way for patients like Tan to carry out their daily routine without too much help from others.

“If that happens, God willing, I will be ever grateful and happy,” she says.

IS STROKE PREVENTABLE?

Rehabilitation physician Dr Lydia Abdul Latif  says it’s not possible but we can minimise the risk factors. “There are non-modifiable and modifiable factors. Non-modifiable factors like ageing, family history or abnormal congenital defects, we cannot do anything about.”

Modifiable factors are hypertension, diabetes and high cholesterol. “If the patient’s medical conditions are well-controlled, the risk of stroke is also reduced.”

And then there’s stress, which seems to affect everyone, particularly if we need to juggle and balance everything, at all times. “Stress is heterogenous. What is stressful to one is not to another. Most importantly, everyone must find ways to de-stress,” says Dr Lydia.

Dr Lydia says that when she feels overwhelmed, she bakes and cooks. “It doesn’t matter if the food turns out well or not, but the process is therapeutic.”

Otherwise, it’s a game of tennis with her husband or meeting family and friends. “You have to find something that calms you. You have to find your centre, and that is different for everyone,” she says.

Signs of stroke

• Sudden numbness or weakness of face, arm or leg, especially on one side of the body.
• Sudden confusion, trouble speaking or understanding.
• Sudden trouble seeing in one or both eyes.
• Sudden trouble walking, dizziness, loss of balance or co-ordination.
• Sudden severe headache with no known cause.

Source: Adapted from National Institute of Neurological Disease and Stroke, US

 

Stroke patient So Ah Kow diligently undergoing therapy at UMMC. Therapy allows stroke patients to improve their condition at a faster rate

 

Dr Lydia Abdul Latif

A stroke occurs when a blood vessel that carries oxygen and nutrients to the brain is either blocked by a clot or bursts

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