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By Linda Carroll
(Reuters Health) – A preliminary study suggests that a new skin sensor could help prevent life-threatening attacks for millions of people with hydrocephalus, a disease that causes fluid build-up in the brain.
When the disorder is diagnosed, a tube, called a shunt, is inserted surgically to drain the excess fluid. The problem is that shunts often obstruct or develop wrinkles, and that liquid accumulates.
The failure rate for 10-year shunts is 98%, said the study's lead author, Siddharth Krishnan, Ph.D. candidate at the McCormick School of Engineering at Northwestern University. "When they fail, there is no way to diagnose it quickly. The symptoms are nonspecific: headache and nausea.
Currently, the only way to diagnose shunt failure is to perform a brain scan and sometimes even surgery.
The risks of missing a shunt failure are enormous. "This can lead to coma, convulsions and possibly death," said Krishnan. "And the uncertainty that accompanies it can wreak havoc in the lives of families because they know that the next headache could be catastrophic."
In the small pilot study of five patients, researchers determined that the new wireless band-aid sensor could detect the difference between a functioning shunt and a non-functioning shunt, according to the report published in Science Translational Medicine.
In other words, this could warn patients and doctors if the headache is a sign that the shunt that drains excess fluid from the brain has failed.
If the results are proven by a larger trial, the device could revolutionize the management of hydrocephalus, which could save the US health care system millions of dollars, said lead author Siddharth Krishnan, Ph.D. candidate at the McCormick School of Engineering at Northwestern University.
About one million Americans have hydrocephalus and one in every 1,000 babies is born with this disease, according to the Hydrocephalus Association. It is often a complication of premature birth. In adults, some cases of hydrocephalus are related to traumatic brain injury or other neurological conditions, said Krishnan.
"Most of us produce about 12 ounces of cerebrospinal fluid a day," Krishnan explained. "In a healthy person, it is drained (or absorbed) about as fast as it is produced. In people with hydrocephalus, the brain does not absorb the product well, which produces too much. "
As the fluid accumulates, pressure increases on other parts of the brain.
The new device developed by Krishnan and his colleagues has a tiny heater in the center and a sensor at each end. It is placed on the skin above where the shunt is located just below the surface. When the tiny heating element raises the temperature of a small area of skin by a few degrees, it also heats the fluid inside the shunt at that location. If the shunt works, the sensors at both ends will detect the heat of the heated fluid as it goes down the shunt.
Krishnan and his colleagues plan a much larger study – involving 100 patients – in the hope that the first results will be replicated.
The researchers made "a step forward in a long journey," said Dr. Shenandoah Robinson, a professor in the pediatric neurosurgery division of Johns Hopkins Medicine. "Not everything is important. It would be nice to have easier ways to diagnose a shunt dysfunction. "
Robinson can imagine problems that may interfere with the device in some patients: obesity, for example. Nevertheless, she said, "it is possible that this may be useful for a small fraction of patients. I think we will have to have validation studies to get a better idea of the utility.
SOURCE: http://bit.ly/2zywA42 Translational Medicine Science, online 31 October 2018.
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