Category Archives: pacemakers

Living better with electroceuticals

Beter worden met ‘electroceutica’by Harry Baggen, in Elektor Magazine, 30 maart 2016, 15:03

Electroceuticals can help combat a wide variety of medical conditions, such as tinnitus (ringing ears) and epilepsy. Electroceuticals comprise the smart, localized and targeted application of therapeutic electrical stimuli to the body. The technological challenge is to make electroceutical devices smarter and smaller.

According to Wouter Serdijn, Professor of Bio-Electronics at TU Delft in the Netherlands, electroceuticals could develop into a new and significant form of medicine, complementing existing pharmaceuticals. The targeted application of electrical stimuli can alleviate many medical conditions and is not limited to brain therapy. The main advantage of electroceuticals over pharmaceuticals is that the effect is localized. Drug act on the entire body, which can easily lead to adverse effects.

Existing electroceutical devices are still fairly bulky, with relatively large batteries and wires. There is also a high degree of trial and error in treatment methods. The aim is to develop a flexible brain implant on a polymer substrate that can serve as a general platform for various electroceutical devices.

Besser heilen mit „Electroceutica“

Electroceutica können helfen, verschiedene Erkrankungen wie Tinitus (Ohrpfeifen) oder Epilepsie zu lindern. Electroceutica bedeuten die intelligente, lokale und gezielte Verabreichung heilender elektrischer Impulse in den Körper. Die technische Herausforderung ist, die dafür erforderlichen Geräte kleiner und intelligenter zu machen.

Nach Wouter Serdijn, Professor für Bio-Elektronik an der niederländischen Technischen Universität Delft, können Electroceutica zu einem neuen bedeutenden medizinischen Mittel statt oder als Zusatz zur bestehenden Pharmazeutik werden. Die gezielte Anwendung elektrischer Impulse kann bei vielen Erkrankungen helfen, nicht nur bei solchen des Gehirns. Der große Vorteil der elektrischen Methode gegenüber der pharmazeutischen ist, dass sie lokal begrenzt sind: Pillen wirken auf den ganzen Körper ein und haben deswegen oft gravierende Nebenwirkungen.

Zurzeit ist die Verabreichung elektrischer Impulse an den Körper noch recht grobschlächtig mit relativ großen Batterien und Kabeln. Zudem funktioniert diese Methode noch in einem hohen Maß nach dem „Trial-and-error“-Prinzip. Das Ziel ist es, ein flexibles Hirnimplantat auf einem Polymersubstrat zu entwickeln, das zur allgemeinen Grundlage diverser Implantattypen werden kann.

Beter worden met ‘electroceutica’

Electroceutica kunnen helpen om allerlei aandoeningen zoals tinnitus (oorsuizen) en epilepsie te bestrijden. Electroceutica betreft het slim, lokaal en gericht toedienen van helende elektrische pulsen aan het lichaam. De technische uitdaging is het slimmer en kleiner maken van de benodigde apparatuur.

Volgens prof. Wouter Serdijn, hoogleraar bio-elektronica aan de TU Delft, kunnen ‘electroceutica’ uitgroeien tot een nieuw en belangrijk type medicijn, naast en als aanvulling op de al bestaande farmaceutica. Het gericht geven van elektrische pulsen kan bij veel aandoeningen helpen, en is niet alleen toepasbaar in de hersenen. Het grote voordeel van de elektrische methode boven farmaceutica is dat het effect lokaal is. Pillen werken in op het hele lichaam en veroorzaken derhalve snel bijwerkingen.

Op dit moment is het toedienen van elektrische pulsen aan het lichaam nog vrij grofstoffelijk, met bijvoorbeeld relatief grote batterijen en draden. Ook heeft de methode nog een vrij hoge graad van trial and error. Het streven is om een flexibel hersenimplantaat te ontwikkelen op een polymeer-substraat dat dan kan dienen als algemeen platform voor diverse typen implantaten.

Elektroceutica: elektronische medicijnimplantaten voor in je hoofd

Epilepsie, tinnitus en alcoholverslaving zijn misschien verschillend, de behandeling kan erg op elkaar lijken. En wel met elektrische medicijnen die je in je hoofd geïmplanteerd krijgt.

Hoogleraar bio-elektronica Wouter Serdijn houdt morgen zijn intree-rede over electroceutica aan de TU Delft. Het woord stamt af van het Engelse ‘electroceuticals’, de elektronische tegenhanger van de ‘pharmaceuticals’, medicijnen dus. Maar dan met een batterijtje erin die de patiënt als implantaat krijgt, meestal in de hersenen.

“Een bekende ziekte is Parkinson. Dan ontstaan tremoren. Die kun je onderdrukken met kleine, elektrische pulsjes. In de arm kun je het ook behandelen, maar dan behandel je de oorzaak niet, zegt Serdijn. “Vaak gaan tremoren gepaard met de aansturing van heel veel verschillende spieren. Dan zou je iemand moeten behangen met elektronica om de plaats waarop het zich openbaart de symptomen te onderdrukken.”

In de toekomst hoopt Serdijn de implantaten kleiner, draadloos en slimmer te maken: “Dat ze echt luisteren naar wat de patiënt nodig heeft”, legt Serdijn uit.

Klik hier voor de link naar het item op BNR Nieuwsradio: http://www.bnr.nl/?service=player&type=archief&fragment=20160330065325240

Slimme stroomstootjes als medicijn

Kleine, draadloze en intelligente implantaten die werken als elektronisch medicijn, dat is de droom van Wouter Serdijn. Serdijn hield deze week aan de TU Delft zijn intreerede als hoogleraar bio-electronica. Hij noemt zulke implantaten ‘electroceuticals’, als tegenhanger van de ‘farmaceuticals’, ofwel pilletjes. Het idee is eenvoudig: waar pilletjes de biochemische activiteit van lichaamscellen veranderen, veranderen electroceuticals de elektrische activiteit.

De moleculen uit een pilletje komen via de bloedbaan in het hele lichaam terecht. De effecten treden niet direct op, zijn niet lokaal en ook niet meteen omkeerbaar. Bovendien hebben pilletjes vaak ongewenste bijeffecten. Maar eeuwenlang was er geen andere mogelijkheid.

Micro-electronica heeft hier verandering in gebracht. Zo kunnen sinds een jaar of tien patiënten met ernstige Parkinson of depressie behandeld worden met een hersenimplantaat dat lokaal in de hersenen elektrische pulsjes genereert. ‘Deze implantaten hebben echter flink wat nadelen’, vertelt Serdijn een dag voor zijn oratie. ‘Ze zijn groot en hebben ook nog eens een grote batterij nodig, typisch iets van zes bij vier bij één centimeter. De batterij wordt nu nog in de borstkas aangebracht. Via draadjes loopt de stroom naar het implantaat in de hersenen. Die draadjes zitten eigenlijk in de weg. Een ander nadeel is dat het implantaat zelf dom is. Arts en de patiënt moeten samen de beste instelling zien te ontdekken. Maar dat is vaak moeilijk en subjectief.’

Chips met een luisterend oor

Serdijn ontwikkelt microchips voor implantaten die niet alleen klein en draadloos zijn, maar ook intelligent: ‘Onze chips zijn slechts twee bij twee millimeter groot, vooral doordat we de pulsgenerator veel kleiner hebben kunnen maken. Ze verbruiken veel minder stroom en daardoor volstaat een kleinere batterij. Bovendien is de batterij oplaadbaar. Ik stel me voor dat deze in de toekomst draadloos wordt opgeladen door een spoel in een intelligent kussen, terwijl de patiënt ligt te slapen.’

Nieuw is dat de chip lokaal luistert naar de therapeutische behoefte en daarop zijn gegenereerde pulsen afstemt. Serdijn geeft het voorbeeld van de behandeling van oorsuizen: ‘Bij sommige patiënten onderdrukken elektrische pulsen de klachten. Nu gebeurt die behandeling nog subjectief. De patiënt moet zelf aangeven wat hij hoort en of er verlichting is opgetreden. Een slim implantaat meet het signaal op de gehoorschors, genereert elektrische pulsjes en meet tegelijkertijd hoe goed het effect is. Idealiter werkt het implantaat alleen op de momenten dat het nodig is en in de hoeveelheid die nodig is. Het implantaat denkt als het ware mee. Electroceuticals houden automatisch rekening met het feit dat ieder mens anders is en dat de toestand van een persoon in de tijd verandert.’

Fijnregelen met schokjes

Behandeling met slimme stroomstootjes hebben de eerste positieve resultaten opgeleverd in de behandeling van epilepsie bij muizen. Serdijn werkt ook samen met de Belgische hoogleraar neurowetenschappen Dirk de Ridder in de behandeling van alcoholverslaving. De implantaten hoeven ook niet beperkt te blijven tot de hersenen, zegt Serdijn. ‘Elk weefsel dat gevoelig is voor elektriciteit, dus ook spieren en organen, kun je met electroceuticals beïnvloeden. Een paar jaar geleden is bijvoorbeeld aangetoond dat elektrische stimulatie ook een aandoening als reuma kan onderdrukken.’

Serdijn ziet electroceutica niet als vervangers van de klassieke farmaceutica, maar als aanvulling. ‘Electroceutica zijn vooral geschikt voor aandoeningen die hun oorsprong op een specifieke plek vinden. Met farmaceutica kun je als het ware de biochemische basiswaarde van het lichaam veranderen en daarna kun je heel lokaal met electroceutica de boel fijnregelen.’

Op dit moment zit het onderzoek naar electroceutica nog in de fase van dierproeven. ‘Voordat hier goedgekeurde behandelingen voor mensen uit komen, zijn we jaren verder’, besluit Serdijn.

Bennie Mols vertelde ook over dit onderwerp in het radioprogramma De Ochtend: Stroomstootjes in plaats van pillen

Can heart beats really power cardiac pacemakers?

Baron von Munchausen

Today, I received a link (http://tweakers.net/nieuws/85353/hartslag-kan-pacemaker-van-stroom-voorzien.html) from Marijn, honorary member of the Biomedical Electronics Group, in which it is mentioned that researchers have found a way to harvest enough energy from a piezo-electric transducer so that a cardiac pacemaker can be powered from the heart itself. This would render the bulky batteries in the pacemakers unnecessary and the pacemaker thus does not have to be replaced after a couple of years because of a depleted battery.

I have two concerns about this. First, there is a kind of “Baron-von-Munchausen” effect. Baron von Munchausen was an 18th-century German nobleman, who, according to Rudolf Erich Raspe’s story The Surprising Adventures of Baron Munchausen, pulls himself out of a swamp by his hair (specifically, his pigtail). Now, let’s suppose that a pacemaker, equipped with a piezo-electric energy harvester to power the pacemaker, for no particular reason, fails to operate and the heart stops its precious beating, what will then power up the pacemaker again to make the beat again? Scary thought, isn’t it?

Second concern is of another nature. Pacemakers are usually replaced, not because the battery has depleted, but simply because a next generation pacemaker can provide a better therapy to the patient. As a side note, uncomfortable but true, current pacemakers (and thus also the batteries included therein) on average live longer than their owners. Hopefully this latter aspect will change for the better soon.

Wouter

Mission Possible

In order to present the Biomedical Electronics Group of Delft University of Technology to a couple of companies, it made sense to reveal our mission statement. So here it goes…

The mission of the Biomedical Electronics Group of Delft University of Technology is "to provide the technology for the successful monitoring, diagnosis and treatment of cortical, neural, cardiac and muscular disorders by means of electricity." In order to reach this goal we investigate and design circuits and systems for electrical stimulation, ExG readout, signal specific analog signal processing, power management/conversion, energy harvesting and wireless communication, to be applied in future wearable and implantable medical devices, such as hearing instruments, cardiac pacemakers, cochlear implants and neurostimulators.

So how about that? Reactions are welcome via this blog.

Wouter

Wilson Greatbatch, co-inventor of the pacemaker, has died at the age of 92

Wilson Greatbatch

Tuesday 27th of September, the co-inventor of the pacemaker, Wilson Greatbatch, died at the respectable age of 92 years. With the invention of the pacemaker as first implantable medical device, he created the basis of modern implantable medical devices used today. He is also founder of the Greatbatch company which put a lot of effort into the improvement of battery lifetime for implants. I believe that for many of the modern engineers he has been a great and inspiring person.

Cees-Jeroen

Be gentle to the heart, otherwise you’ll lose it

Researchers at the Max Planck Institute and Cornell University have come up with a low-energy pulse sequence to
restart hearts and make implants last longer is what we can read in IEEE Spectrum today. Other advantages of using a train (a burst) of pulses instead of using a single (tonic) pulse are that defibrillation becomes less painful to the patient and is less likely to evoke fibrillation elsewhere in the heart. The new therapy still has to be tested on patients, though. 

From this, it is only a small step towards realizing that other types of tissue should be stimulated with burst-like or even more exotic yet gentle pulses, too. In the Biomedical Electronics Group of Delft University of Technology, we’re working on interfacing with the brain in a more natural manner. Stay tuned…

Wouter

Smaller can be better

After the 2011 edition of ELCA Music Festival, I was dragged (by some mysterious power) deep into the idea that came to my mind around three years ago. At that time, I was trying to simultaneously linearize and reduce a transconductance of a Gm cell (VI converter circuit) for very low frequency biomedical filtering. The linearization and transconductance reduction were successful but the success came prices that I needed to pay:

  1. circuit complexity which is really unfriendly to weak inversion CMOS.
  2. more current consumption which was not surprising. It was very well in line with the circuit complexity. 
  3. more noise contribution (this was also a good friend with circuit complexity).

When I looked into the dynamic range of my design, it was not improved that much from that of an ordinary differential pair circuit (even so the paper was published [1] :). Then I got an idea that ‘instead of inventing a sophisticated linearization technique to obtain larger dynamic range, trying to use as less as possible noisy circuit elements and forget about linearization are more reasonable for biomedical signal processing which requires a good deal of power reduction’. The idea was left there since then for two reasons: I had other jobs to do and the idea seemed too sloppy.

Let me tell you more about the mysterious power. Several times we did rehearsals before the ELCA festival. I was in charge of acoustic guitar and harmonica for the song called ‘The end of the world’ http://www.youtube.com/watch?v=KmnKCE99sYE. Playing two instruments at the same time made me tired and it did not make a good harmony as expected. So I stopped playing the guitar and exercised only the harmonica (of course combined with the piano from Wouter, the electric guitar of Mark and Wannaya’s voice (I could not find this song on our Youtube channel — don’t know why). The song turned out better than before and this reminded me of that sloppy idea!!!

I did an investigation and found that there are strong evidences supporting my idea founded in low-pass filter design [2] [3]… It works!!! Large dynamic range was achieved as well as a very good figure of merit. Although the above filters were dedicated to communication systems rather than for low frequency biomedical signals, the underlying concept of the filter should be applicable for biomedical signal as well. Only a bit more effort was needed to work it out.

Good news!!! Recently, with the help from Senad, who has become 22 years old today — the same as me :). Happy Birthday!!!— my sloppy idea was realized. A 6th-order ECG low-pass filter with a large dynamic range of 59dB and extremely low power consumption of 0.45nW has been designed. We plan to submit this work to BioCAS2011. Hopefully, the reviewers will like it, too.

More good news!!! The application is not limited to low-pass filters only. I’m developing this idea further to apply it for a cochlear channel band-pass filter. What I can say now from the circuit simulations is that the filter provides the best figure of merit compared to state of the art designs. The secret is that all terminals of a single MOSFET device are being used, one pole and one zero are achieved by only two transistors sharing the same bias current.

Next time, I will tell you more about this. Stay tuned if you are interested!!!

Healthy Haring is coming. I heard from Marijn that this year, since the weather is warm, the fish is growing bigger. See you in the Pub this coming Thursday for Harings and Beers 😀

June

[1] C. Sawigun, D. Pal and A. Demosthenous, “A wide linear range transconductor subthreshold transconductor for sub-Hz filtering,” Proc. IEEE ISCAS, pp.1567-1570, 2010

[2] D. Python, A. S. Porret and C. Enz, “A 1V 5th-order Bessel filter dedicated to digital standard proceses,” Proc. IEEE CICC, pp. 505-508, 1999

[3] S. D’Amico, M. Conta and A. Baschirotto, “A 4.1mW 10MHz fourth-order source-follower-based continuous-time filter with 79-dB DR,” IEEE J. Solid-State Circuits, pp. 2713-2719, Dec. 2006

Thoughts over an exam…

Besides many research related posts on this weblog, there is another important aspect in universities: education. Currently the spring examinations take place. It is time to see if our efforts in introducing the students into the exciting world of transistors were good enough. Today I was supervising a retake of a first year BSc-course. In order not to get too bored, I printed out a bunch of papers to read through…

Despite the reading material, I was preparing for a long morning. But nothing could be further from the truth! While the students were sweating and battling their way through the exam, I picked up a paper about the history of electrical stimulation [1]. It was discussing about the very first steps of electricity for medical applications. As it turns out, soon after the development of the first electrical devices in the second half of the 18th century (such as static electricity machines, the Leyden jar or later the volta-cell), these devices were put in use for medical research very soon. Just like myself today, people were fascinated by how our body responds to electricity.

It is incredible to read what achievements were made with the extremely limited equipment that was available. Even more incredible were the experiments that were carried out: the effect of electricity on the human body was demonstrated using the decaptivated heads of executed criminals! Furthermore the functionality of pacemakers was demontrated by over-anesthesthetized animals until cardiac arrest occured, to subsequently reanimate them using electrical stimulation. Remarkably the method was also applied to a human subject, but without success…

Besides experiments, the inguinity of researchers to build machines is very remarkable. Without the availability of vacuum tubes (let alone transistors), it is hard to make pulses with accurate duration in the order to hundred milliseconds (which are required for stimulation). Various mechanical systems are described, of which the most remarkable one is a system in which a gun is fired to cut two wires placed at a certain distance from each other. Only during the time the bullet is travelling from the first wire to the second, the system is injecting electrical energy into the tissue. Imagine how being a researcher was like in those days: shooting rifles the whole day! Quite a difference from running circuit simulations like we do today!

For more interesting stories I can highly recommend to read this paper. Or save it for when you have to supervise an exam. For now: time to check the exam!

Marijn

[1] Geddes, L.A., "The first stimulators-reviewing the history of electrical stimulation and the devices crucial to its development", Engineering in Medicine and Biology Magazine, IEEE , vol.13, no.4, pp.532-542, Aug/Sep 1994

Can the upcoming solar storm turn your pacemaker into a killer inside you?

It has been predicted that today (Febr. 17, 2011) one of the largest solar storms in years will reach the earth and may interfere with sensitive electronic equipment, such as GPS receivers in cars and PDAs. Also air traffic and power grids may suffer from this kind of interference.

 Solar Storm 

Solar storms, also called geomagnetic storms, are caused by solar coronal mass ejections and modify the electromagnetic fields in the ionosphere, magnetosphere and heliosphere. They usually last only one or two days and can cause auroras further away from the poles than usually. According to Wikipedia, "On March 13, 1989 a severe geomagnetic storm caused the collapse of the Hydro-Québec power grid in a matter of seconds as equipment protection relays tripped in a cascading sequence of events. Six million people were left without power for nine hours, with significant economic loss."

So how dangerous are these solar storms for life-supporting devices like pacemakers and neurostimulators? In order to answer this question, we need to understand the physical and electrical effects of solar storms. Solar storms induce fluctuations in the Earth’s magnetic field. These fluctuations, in turn, can induce currents in large electrically conducting structures, such as power grids and metal pipelines, leading to damaged transformers and corrosion. Solar storms also influence the electrical currents in the magnetosphere and the ionosphere and thereby affect wireless communication that propagates through them.

So my conclusion: as long as you do not use your shortwave radio or CB set to control your implantable device remotely and you do not power it from the mains, you’re safe. Ain’t that a relief?

Wouter