Deans' stroke musings: Focused Ultrasound With Blood Brain Barrier Opening Shows Benefits in Early Alzheimer’s Disease

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Wednesday, September 1, 2021

Focused Ultrasound With Blood Brain Barrier Opening Shows Benefits in Early Alzheimer’s Disease

Until much more research is done I can't see insurance paying for MRI use for this. And you would need early detection of Alzheimers.

Focused Ultrasound With Blood Brain Barrier Opening Shows Benefits in Early Alzheimer’s Disease

By Nancy Melville

VIRTUAL -- August 26, 2021 -- A magnetic-resonance (MR)-guided low-intensity focused ultrasound technique of opening the blood brain barrier shows efficacy in the potential treatment of early Alzheimer’s disease by removing amyloid-beta plaque and slowing cognitive decline, according to a small study presented at the Virtual 2021 American Association of Neurological Surgeons (AANS).

“Focused ultrasound mediated blood brain barrier opening is feasible, reversible, and safe in multiple large brain regions among persons with Alzheimer’s disease,” said Ali R. Rezai, MD, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, West Virginia.

The procedure involves no incision or skull opening and a focal delivery of ultrasound energy, with live MR thermometry allowing for MR-targeted evaluation. A low-intensity focused ultrasound approach of temporarily opening the blood brain barrier for targeted therapeutics, still investigational, is being explored for applications including Alzheimer’s disease, Parkinson’s disease, and other applications.

“The ability to open the blood brain barrier on demand and allow antibodies and larger molecules or other chemotherapy agents in the brain opens up a tremendous opportunity for neurosurgeons,” explained Dr. Rezai.

For the current phase 2 trial, patients with mild Alzheimer’s disease with amyloid on positron emission tomography (PET) underwent the MRI-guided low intensity focused ultrasound technique (ExAblate Neuro) with concomitant intravenous microbubble (Definity) administration in 3 separate sessions, each 2 weeks apart, targeting the hippocampus, frontal lobes, and parietal lobes, with up to 30 cc of treatment volume.

The patients had a mean age of 64.1 years. Of the 15 patients treated for a total of 45 treatments, all had successful immediate opening of the blood brain barrier, observed with parenchymal intravenous gadolinium contrast enhancement, and subsequent closure within 24 to 48 hours.

There were no imaging adverse effects and no permanent clinical adverse effects. The treatments were all well tolerated and no neurological adverse events have been reported.

With more than 1 year of follow-up, 8 patients showed reductions in cognitive decline compared with a matched longitudinal Alzheimer’s Disease Neuroimaging Initiative (ADNI) cohort subset of 46 subjects, with a mean relative change score after 1 year of 2.2 versus 3.8, respectively.

However, Dr. Rezai noted that the limited sample size prevents a meaningful interpretation of the differences.

Furthermore, 8 of the patients showed a reduction in brain amyloid after 1 year in the regions of the brain treated with the focused ultrasound compared with the ADNI group, with a mean relative change score of 4.6 versus 5.6, respectively.

“The focused ultrasound group shows less cognitive decline than the corresponding age and sex-matched ADNI cohort subset,” said Dr. Rezai. “There was no meaningful cognitive or behavioural worsening with focused ultrasound as compared with the ADNI comparator group.”

Further evaluation of changes in beta-amyloid on the Centiloid Scale with PET quantification among 10 patients showed an average beta-amyloid reduction of 26% in the treated regions. One patient showed no significant increase or decrease in beta-amyloid.

Dr. Rezai noted that the study is ongoing and more participants will be needed with a longer follow-up.

Funding for this study was provided by Insightec.

[Presentation title: Focused Ultrasound Mediated Blood Brain Barrier (BBB) Opening of the Hippocampus, Frontal and Parietal Lobes in Mild Alzheimer’s Disease: Long-Term Safety and Clinical Outcome of a Multicenter Phase II Clinical Trial]