An experimental treatment could have “jump-started” the brains of two patients who had been in a minimally conscious state for months after a coma, according to a new study.
Both patients had brain damage and had shown only limited signs of consciousness for over a year. But after receiving the treatment – which involved an ultrasound to “excite” cells in a region of the brain called the thalamus – patients showed sudden improvement in their condition, according to the study published Jan. 15 in the journal. Brain stimulation. For example, after treatment, a patient may move their head to indicate “yes” or “no” in response to certain questions.
Such rapid recovery is unusual in patients with a prolonged state of minimal consciousness – meaning the person is awake but showing only small signs of consciousness. In these patients, “recovery usually occurs slowly over several months and more typically years,” says Martin Monti, study co-lead author, professor of psychology and neurosurgery at the University of California, Los Angeles. said in a press release. But both of these patients showed significant progress within days to weeks, he said.
Previous studies have shown that stimulation of the thalamus with surgically implanted electrodes can lead to similar improvements, but this method is invasive and does not work in all patients, said Dr Neel Singhal, assistant professor of neurology at the University of California, San Francisco who did not participate in the study. Singhal called the new research “revolutionary” because the method is “non-invasive and has the potential to be applied to a much wider set of patients than deep brain stimulation.”
However, the new findings are very preliminary and the ultrasound method does not appear to help all patients. There were a total of three patients in the new study; of the two patients who received it, one showed initial improvement but then regressed, and a third patient showed no benefit.
Related: 10 things you didn’t know about the brain
Sudden improvement
For the study, doctors used a saucer-shaped device to direct ultrasound pulses to specific areas of the brain. In this case, the researchers targeted the thalamus, a structure deep in the brain that acts as a hub to relay sensory information to other parts of the brain. They targeted this region because its performance is usually weakened after a coma, the researchers said.
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The three patients in the study underwent two 10-minute sessions with the device, one week apart.
One of the patients was a 56-year-old man who had been in a minimally conscious state for 14 months after having stroke. After the ultrasound treatment, the man was shown to be able to constantly respond to commands such as dropping a bullet or looking at pictures of loved ones when he heard their names. He could also nod his head for “yes” and shake his head to say “no” when asked about himself. And for the first time since his stroke, he could use pen and paper and put a bottle in his mouth. However, the man regressed to his minimal state of consciousness after a few months.
The second patient was a 50-year-old woman who had been in a state of minimal consciousness for 2.5 years after cardiac arrest. Previously she had not shown any response when given an order, but after treatment she always responded to commands by moving her head or fingers. She was also able to recognize objects, including a pencil and a comb, for the first time in years. The woman maintained her improvements over the six-month follow-up period, they said.
The third patient, a 58-year-old man who had been in a minimal state of consciousness for 5.5 years following a car accident, showed no benefit from treatment.
Revolutionary discoveries
In 2016, this same group of researchers used ultrasound treatment on a 25-year-old man who had been in minimal consciousness for just a few weeks. In this case, the treatment also seemed to inflame his brain – he soon became full conscience and understanding the language.
But at that point, the researchers warned that their discovery may have been a coincidence – in other words, the man may have spontaneously recovered by the time the researchers began treatment. In the new report, it is “highly unlikely” that both patients recovered spontaneously, given the length of time they were in a minimal state of consciousness, Monti said.
As to why the third patient in the new study did not respond to treatment, researchers believe the person’s thalamus may have been damaged or disconnected from other areas of the brain. In this subset of patients, this method may not help.
“Just to give an example, if someone had a ‘totally disconnected’ thalamus, we could stimulate it as much as we want, and that wouldn’t help rekindle the complex web of brain networks required for complex cognitive function (and behavior), ”Monti told 45Seconds.fr in an email.
Even though the changes seen in the study are minimal, they can mean a lot to patients and their families. “For our patients, even just being able to communicate with their loved one – however restricted it may be … can mean regaining the ability to be part of their social environment, the lives of their loved ones and to regain some degree of personal autonomy. Said Monti.
The researchers said they were looking to determine whether the dose and frequency of ultrasound exposure could affect the level and duration of the benefit. “With further adjustments to the pacing protocol, patient selection and device, this may bring tangible benefits to patients with severe brain damage,” who currently lack any definitively effective treatment to improve neurological recovery, Singhal told 45Seconds.fr.
The authors stressed that ultrasound treatment is experimental and will likely not be available to the public for several years.
Originally posted on 45Seconds.fr.
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