Lynn Milam says that a nervous stimulating implant has considerably improved his rheumatoid arthritis, allowing him, he and her husband, Donald, to find the life of which they once appreciated.
Lynn Milam
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Lynn Milam
For more than four years, the life of Lynn Milam was linked by the pain that radiated from his swollen joints.
“My children couldn’t hug me,” she said. “I couldn’t hold my husband’s hand.”
Milam could not go up the stairs either to raise his teenage son. She spent most days on the sofa.
The reason was rheumatoid arthritis, which occurs when the immune system begins to attack the lining of the joints.
Milam has tried everything: physiotherapy, acupuncture, steroids and even the latest immune drugs. Nothing worked.
This changed in October 2023, when a surgeon established an experimental device in the neck of Milam. For a minute every morning, he delivers impulses of electricity to his vagus nerve, which connects the brain to internal organs.
This device, when attached to the vagus nerve, can considerably reduce symptoms in patients with some of the most serious cases of rheumatoid arthritis.
Medical configuration
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Medical configuration
“Three weeks later, my elbow pain had completely disappeared,” she said. “Then my hands did not hurt me anymore, swelling began to disappear.”
Finally, all the symptoms of rheumatoid arthritis had disappeared. Milam, 60, says that she and her husband found the life they appreciated before becoming sick.
“It’s like a rebirth,” she said.
And now the device will be available for many other people like Milam.
In July, Food and Drug Administration approved the device, manufactured by SetPoint Medical, for people with rheumatoid arthritis whose symptoms are not properly controlled by medication.
On August 22, Northwell Health surgeons in New York implemented the first device approved in a patient.
Milam says that the stimulator has restored its ability to mount the stairs, cooking and traveling.
Lynn Milam
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Lynn Milam
FDA approval could be a turning point for the treatment not only of rheumatoid arthritis, but other autoimmune diseases, including multiple sclerosis and inflammatory intestine disease.
“This treatment uses the mechanism of the body of inflammation management,” said Dr. John Tesser, a rheumatologist in Phoenix who supervised the study that led to the approval of the device.
By stimulating the vagus nerve, the device sends a signal to the hypothalamus, a brain area that regulates bodily functions and interacts with the immune system. This brain area responds by returning signals in the vagus nerve to the spleen.
Signals allow certain spleen cells to slow down protein production called cytokines, which regulate inflammation, including inflammation in the joints. Cytokines play an important role in the fight against infection, but can also trigger damage to healthy tissues, including the lining of the joints.
The device rarely produces the type of spectacular recovery that Lynn Milam has known. But the Pivot clinical trial revealed that patients who had not responded even to the most powerful drugs have often experienced significant improvement.
“Thirty-five percent of patients made it in this very difficult group to treat,” said Tessss. It was significantly more than in a comparison group whose stimulators had not yet been activated.
The entire process is initiated by an implant “the size of a Lima bean”, explains Dr. Peter Konrad, president of neurosurgery at the Rockefeller Neuroscience Institute of West Virginia University. “Everything is built on a small chip, then it is contained in a small silicon jacket.”
Ambulatory surgery to implant the device is simple for any surgeon who has implanted vagus nerve stimulators often used to control epilepsy, explains Konrad.
“I underwent dental surgery that was more a process than this surgery,” said Milam.
After surgery, however, there was a hitch.
Because the device is so close to the vocal cords, Milam’s voice was temporarily limited to a murmur. A second procedure fixed this but left his voice slightly lower than it was.
Milam says that she will accept this for a treatment that did what drugs could not.
The stimulator has restored its ability to mount the stairs, cooking and traveling, she says.
Her husband, Donald Milam, says that it also allows the couple to do things together.
“Walking dogs, holding hands – just simple things,” he said. “And hugs.”
