Can Devices Solve Disorders of the Central Nervous System?

“Nervous system disorders are a large and growing challenge. Pills will not save us,” said Warren Grill. “There is a tremendous opportunity for biomedical engineering to begin solving some of these problems.”
Grill, who is Addy Professor of Biomedical Engineering, made these comments while moderating a panel on neural engineering as part of the 40th anniversary celebration of the biomedical department at Duke. Grill defined neural engineering as “the application of biomedical engineering to analyze, diagnose, and treat disorders of the nervous system.”
The growth in disorders of the nervous system is due in large part to an aging population, Grill said: “We’re living to be old enough that our brains are getting sick.”

Some pharmaceutical companies have gotten out of the business of trying to develop drugs for central nervous system disorders, due to the lengthy and expensive regulatory process, so there is an opportunity for biomedical devices to fill the void.
Panelist Ananth Natarajan said he sees a trend toward “devices over drugs.” He said, “Devices can have a better safety and efficacy profile over drugs.” Natarajan earned a BSE in biomedical engineering at Duke at age 18, and went on to earn a MSE and a MD. He’s affiliated with three universities and is co-founder of Infinite Biomedical Technologies.
Natarajan also said, “It’s important to consider clinical needs and let that drive where we are going.” This was a theme echoed by the other panelists—all Duke engineering alums who are at the forefront of designing and using medical devices to treat neurological diseases and symptoms.
“Engineers must understand the clinical context of the problem they are called to address,” said John Chae, who is also a physician and engineer. “Go beyond engineering—what will it do for our patients with respect to the quality of their life?”
Chae spoke from personal experience as a physician when he said that nervous system disorders such as chronic pain can be extremely challenging to treat. To solve such problems, he said, will require “an interdisciplinary convergence of knowledge” to bring together science and engineering with the needs of patients and physicians.
Beth Winkelstein recommended that Duke students be given structured opportunities to interact with clinicians. At the University of Pennsylvania, where she is an associate professor of engineering, she studies the mechanisms of spine and neck injury and the relationship of such injury to the development of chronic pain. She’s interested in designing tools to help predict, prevent, diagnose and treat pain that’s produced by injury to the spinal cord. Winkelstein began her spine studies in the lab of Barry Meyers when she was a graduate student at Duke. She was drawn to studying spinal cord injuries because “[I] could see how it would help people.”
Panelist Scott Greenwald’s primary focus is to help clinicians choose the best therapies and maintain the best treatment programs for disorders such as depression, migraine, and Parkinson’s. He’s using EEG technology to identify optimal brain states for various conditions and to create quantifiable benchmarks to gauge treatment success. Greenwald earned a BSE in biomedical engineering at Duke, a PhD from MIT, and is now vice president for advanced research at Covidien in Norwood, Massachusetts.
Adam Cates, senior principal research scientist at CVRx, is working on a device to lower blood pressure. Controlling high blood pressure is a well known strategy to reduce the risk of heart disease and death, he said, but for 10-20 percentof hypertensive patients, drugs are not effective. At CVRx, Cates is testing an implantable device that produces electrical pulses that stimulate the autonomic nervous system to lower blood pressure. In trials with humans, the device does lower blood pressure, but that’s not all—it also lowers heart rate, decreases arterial stiffness, improves heart function and structure, and improves renal arteries and preserving renal function, among other benefits. 
“Neuroengineering may provide greater benefit than the intended purpose because neural pathways are so pervasive,” Cates said. “It may provide an opportunity to treat multiple diseases.”
Everyone on the panel expressed excitement about the future of this relatively young and growing field. Natarajan said, “Billions of individuals are entering the world as health care consumers,” he said. “It’s a good opportunity for the field of biomedical engineering.”
Natarajan left the students and engineers in the audience with this advice: “Neurotechnology is moving far too fast to develop a long-range plan. It’s important to be highly opportunistic. Focus on fundamentals: critical thinking skills and a culture of innovation.”

By Mary-Russell Roberson

For the entire series of stories about the 40th anniversy of BME at Pratt, please visit the latest edition of Duke Engineering News.