When Neurotech Isn’t Right

Neurotechnology devices have proven to be a viable choice in treating and diagnosing a large number of neurological diseases and disorders. But not every neurotech device is right for every patient in every situation and it’s worthwhile for vendors to have a good understanding of when their products are not the best choice.

Two recent studies point out some of the issues facing neurotech vendors when alternative treatment options coexist with neurotech solutions. In an article in Archives of Neurology, a team of researchers from Cedars Sinai Medical Center in Los Angeles and Mount Sinai Medical Center in New York reported that about half the patients currently referred for DBS treatment for Parkinson’s disease are not appropriate candidates for the therapy. Although the article points out the percentage of inappropriate referrals has declined compared to a similar study conducted in 2004, physicians still often refer patients for DBS therapy before other treatment options have been exhausted or because they have unrealistically high expectations for it, according to Michele Tagliati, director of the Movement Disorders Program at Cedars-Sinai’s Department of Neurology and senior author of the paper.

In another study published in the New England Journal of Medicine, a team of researchers from Washington University School of Medicine in St. Louis reported that BIS monitoring for intraoperative awareness performed no better than a lower-cost method based on measuring exhaled anesthetics. The BIS monitor, developed by Aspect Medical (now part of Covidien) measures a surgical patient’s EEG activity and computes a “bispectral index” that helps clinicians determine how deeply a patient is anesthetized. Aspect Medical strenuously objected to a 2008 study from the same team that found similar results.

In the new, multi-center trial, investigators found that 19 of 2,861 high-risk surgical patients in the BIS monitor group experienced either definite or possible intraoperative awareness. Among those randomized to the exhaled anesthetic technique, only eight of the 2,852 had intraoperative awareness. The authors pointed out that other monitoring techniques based on EEG measurements might avoid a problem with the BIS monitor, which runs EEG readings through a proprietary algorithm that takes some time to process. Faster processing of EEG values might be useful in producing a better real-time measurement of how deeply a patient is anesthetized.

It will clearly benefit neurotech vendors to be aware of other treatment and diagnostic modalities and the precise situations in which the neurotech approach is most cost-effective. If not, we can be fairly certain that others will do that job for us.

James Cavuoto
Editor and Publisher