STROKE - CEREBRAL VASCULAR ACCIDENTS

In France, the number of new cases a year is currently estimated at 130 000, in other words, STROKE occurs every 4 minutes.
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DISEASE DESCRIPTION

SYMPTOMS

STROKE is a condition which occurs very suddenly, and causes motor deficits (limb movement), loss of sensitivity or language disorders.

CAUSES

There are two types of strokes : in most cases (85 %) it is an infarction – a blocked artery in the brain ; and the rest of the time (15 %) it is a hematoma due to rupture of a vessel in the brain. In both cases an area of the brain is deprived of irrigation and the tissue dies ( focal lesion) losing its neurological functions and leading to the symptoms observed.

PREVALENCE

In most of the 15 million STROKES occurring each year globally, about 25% of them are fatal and more than 30% leave severe after-effects with permanent disability, making its victims dependent, directly impacting their family and relatives.

In France, the number of new cases a year is currently estimated at 130 000, in other words, STROKE occurs every 4 minutes. Even if all strokes do not have the same severity, they are the 1st cause of motor disabilities acquired in adults, 2nd cause of dementia and 3rd cause of mortality. Because of a lack of specialised care in less-developed countries, the risk of disability is 10 times higher in the least-developed countries.

ICM RESPONSES

ICM researchers are trying to understand the brain plasticity neurological process set up at the brain level in response to stroke and work more specifically on post-stroke recovery. It is possible through Trans-Cranial Magnetic Stimulation therapeutics (Charlotte Rosso’s work in Stéphane Lehéricy and Marie Vidailhet’s team), and through patient rehabilitation with therapeutic games – serious games such as “Voracy Fish” (work of the Brain e-NOVATION LabCom, joint lab common to the ICM and the GENIOUS group). These approaches improve patients’ everyday life and ease the after-effects.

TRANS-CRANIAL MAGNETIC STIMULATION THERAPEUTICS

Charlotte Rosso, neurologist specialised in STROKE, working both in the Pitié-Salpêtrière hospital, in the department devoted to this pathology (Pr Yves Samson) and in Pr Marie Vidailhet and Dr. Stéphane Lehéricy’s team on movement control within the ICM, explains her research :

After stroke and the onset of a focal lesion, even if the underlying nerve tissue dies, there is a chance of recovery through brain plasticity implementation. The team I am working with at the ICM is interested in this brain plasticity. Thanks to magnetic resonance neuroimaging techniques (MRI) in static (observation of lesions) or dynamic (follow up of the activation of different brain areas during a movement), we are studying in what proportion different brain plasticity processes are implemented in each patient : we may find management of the lost function by surrounding tissues, participation in movement control by secondary areas involved in programming a movement or support by contralateral areas (healthy hemisphere, non-affected by stroke) since we have 2 cerebral hemispheres. For example, when an individual suffering from stroke shakes hand (as long as he still can) an area of his brain, different from a healthy person’s one, will activate.

We want to help patients recovering from stroke by determining which areas of the brain could be made stronger through Trans-Cranial Magnetic Stimulation therapeutics, (TCMS), a medical technology currently used for diagnosis and tested at the ICM in terms of treatment. This is a non-invasive brain stimulation using a coil placed next to the patient’s skull, which will try to make an area more excitable so that it supports a function.

These new innovative technologies will be of greatest hope in the forthcoming years. We hope that treatments are adapted to each patient in his individuality and the specificity of the stroke he was victim of, by focusing on a specific area rather than another one, through TCMS.”

POST-STROKE PATIENTS REHABILITATION THROUGH THERAPEUTIC GAMES – “VORACY FISH”

Marie-Laure Welter, hospital neurologist practitioner, coordinator of the Brain e-NOVATION LabCom at the ICM, responsible for the deep brain stimulation activity within the Neurology Department and co-director of the “Power/Balance/Posture/Movement/TMS and neuronavigation in man” platform at the ICM, tells us about it:

With a desire to set up a partnership between the ICM and the GENIOUS group, a company manufacturing video games, the Brain e-NOVATION joint lab aims at creating “serious games” – therapeutic games – aiming at re-educating and rehabilitating patients suffering from neurological or psychiatric diseases. The “Voracy Fish” therapeutic game has been created for patients suffering from stroke, to enable them to rehabilitate their upper limbs.

These therapeutic video games aim at being played at home or in institutional settings (with a practitioner or at hospital). The patient can play alone, with a relative, or networking with other patients. Remote practice of this game is monitored through a technology platform allowing to collect different parameters of the patient’s motor behaviour, and their analysis by therapists and so propose an adjustment of the video game according to each patient and his progression.

The concept of a “video game therapy” aims at both overcoming the difficulties encountered by patients in more conventional rehabilitations and resolving their possible lack of motivation facing the repetitive aspect and the difficulty of downtown access to a therapist. The benefit of this type of innovative treatment intended to be playful, is to be able to combine different components of human behaviour : motor skills with body movements, cognition with the challenges and objectives of success on different levels of the game, while combining the motivational and emotional aspect with the playfulness of the device.

Brain e-NOVATION’s idea is to incorporate these games – which are complementary to rehabilitation with practitioners (therapists, or physical therapists) – in clinical trials to evaluate and demonstrate the effectiveness and the benefit of this type of treatment and tools, either for stroke with Voracy Fish or for other kinds of pathologies.