Scientists successfully use ultrasound equipment to awaken patients with traumatic brain injury from coma

Scientists successfully use ultrasound equipment to awaken patients with traumatic brain injury from coma

September 06, 2016 Source: Medical Device Innovation Network

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Last week, doctors and neuroscientists from the University of California, Los Angeles (UCLA) successfully used ultrasound equipment to wake a 25-year-old brain trauma patient from a coma. If the technology can be further tested and researched on a large scale, then there will be opportunities to help those with brain damage known as "vegetatives."
 

Left, three-dimensional reconstruction of the patient's head wearing ultrasound equipment. Right, the cross section of the device, the patient's brain and the thalamus as a target (red).

 
The experimental equipment used by UCLA is about the same size as a cup holder, focusing the ultrasound on the thalamus and applying a stimulus to this area. The thalamus is a key information flow center in the brain that helps the body regulate consciousness and sleep.

 
The use of electrical stimulation to restore the consciousness of patients with brain damage is considered a "good idea." This research idea can be traced back to 2007. Scientists have implanted electrodes in the brain of patients, providing stimulation to the thalamus, trying to awaken patients with coma, and they have succeeded in using this method to have a micro-consciousness. The 38-year-old man awakened from a six-year long “sleep” and restored part of his brain function. In 2007, Nicholas Schiff, the head of the study, was from Weill Cornell Medical School. He was a pioneer in the use of brain stimulation to rebuild consciousness, which he considered to be a "very likely" research direction.

 
Nine years later, Martin M. Monti, a psychology and neuroscientist from UCLA, led the study that began with our article. He, like his predecessor, Schiff, has been working on cognitive and conscious areas. The difference is this time. The experimental equipment is not an invasive electrode. The study, published in Brain Stimulation, said that we have discovered a new way to start brain circuit reconstruction services.

 
This "restarted" brain belongs to a lucky young man whose name is Bradley Crehan.

 
In February last year, the newly graduated Crehan was knocked down by a passing car when he came out of a Santa Monica bar. He was diagnosed with severe brain damage by the hospital. Later, he said, "I may have drunk too much at the time. So far I have no memory of the accident and the weeks that followed."

 
Crehan cut off some of the skull to relieve stress, and then was placed in a medical coma, allowing his brain to heal itself. About a week later, the doctor tried to wake him up from a coma, but did not succeed. After another week of coma, Crehan was out of a coma, but he seemed to be unresponsive to the outside world: he could do some spontaneous little movements, and his eyes could open and close during sleep and waking hours, but showed no ability to understand and communicate.

 
His father, Michael Crehan, said, "He is recovering, but no one knows how far he can recover. Doctors tell us that we have 5-6 months in the hospital, maybe there is hope."

 
Bradley Crehan, who just woke up from a coma, had no memory. "My brain completely lost its function," he said. "I can feel a dent in my brain. I want to know where I am. I have no fear. Feeling, just sleepy."

 
The experimental treatment included a 5-minute ultrasound pulse for the thalamus, and the doctor accurately manipulated the ultrasound by magnetic resonance imaging (MRI). After a day of treatment, Crehan can already recognize the object and try to use the spoon, or blink according to the instructions. Monti said that after three days, Crehan can understand the problem and express "Yes" and "No" through the posture. .

 
Crehan's recovery is fast and smooth. After 4 months, he was discharged from the hospital, which was faster than everyone expected.

 
"When I left, the nurse said to me, 'Wow, can you leave the hospital?'", Crehan said.

 
Now, Crehan is actively carrying out treatment and fitness, and at the same time doing various kinds of intensive memory training, applying for work, so as to start a new life at an early date.

 
This is really a happy ending, but Monti cautions that the reason for Crehan's recovery is not clear.
 

 
“We may be very fortunate to have chosen the time when he started self-healing to start the treatment process,” Monti said. “It’s also possible that he will recover anyway, and our stimulation has no effect.”

 
In fact, humans have long lacked research and understanding of consciousness. Therefore, doctors' research on brain damage is often frustrated by unexpected things. A seriously injured patient may suddenly wake up, while others It may be in the vegetative state for several years or even longer. Others are in a state of micro-consciousness, they can be awake, maybe they can laugh, cry, or even give a "Yes" or "No" response, but they can't take care of themselves.

 
A more complicated problem is that the judgment of a person's soberness is a challenge in itself, because the state of this consciousness may be very short-lived.

 

Monti's 2010 study showed that patients who seemed to be good were actually in a state of vegetative and micro-consciousness, and experts were still arguing about the sobriety of such patients.

 
A more radical treatment regimen like implanting electrodes into the patient's brain is difficult to conduct. The patients studied are also crucial, preferably those patients who have only a micro-conscious or vegetative state for many years, and who have little hope of self-recovery. But Crehan was involved in the treatment on the 19th day after his injury, so it seems difficult to determine whether the brain stimulation can really help the recovery of consciousness.

 
Schiff, of Cornell University, said in a study published last month that they tried invasive treatment for a patient who was only slightly conscious for 21 years, although not able to observe a significant improvement in behavior, but The patient's brain was detected to respond to the stimulus. But this is just a study rather than a formal clinical trial.

 
According to incomplete statistics, in the United States, more than 100,000 patients are in a micro-conscious dilemma, and their families often choose to give up their lives and donate their organs.

 
Despite the difficulties, Schiff and Monti still hope to help these patients with brain damage get out of the coma and restart their brains.
 

 
Therapeutic ultrasound equipment was developed by Dr. Alexander Bystritsky of UCLA. His original intention was to treat nervous and other brain diseases such as epilepsy, Alzheimer's disease and Parkinson's disease. It can also be used as a research tool for detection. Healthy brain work. Dr. Bystritsky founded Brainsonix to further develop the device and bring it to market. According to Monti, this non-invasive portable device can provide low-cost treatment for patients with brain damage.

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