UCLA Scientists "Jump-start" the Brain of a Coma Patient with New Device

Would any part of this be useful for locked in stroke patients? Or for the damaged neurons in the penumbra? We'll never know.
http://bigthink.com/paul-ratner/scientists-use-ultrasound-to-jump-start-a-coma-patients-brain

A new ultrasound treatment by UCLA scientists was used to restart brain activity in a 25-year-old man recovering from a coma. Before the treatment, the man showed few signs of consciousness and understanding speech, able to perform very limited movements. Three days after the treatment, the man could fully understand language, communicated by nodding his head and even fist-bumped one of the doctors.
“The changes were remarkable,” said Martin Monti, the study’s lead author and a UCLA associate professor of psychology and neurosurgery.
He elaborated on the technique which used a sonic stimulation device to excite neurons in the thalamus, the brain’s central processing hub. It is the area with a typically diminished performance in post-coma patients.

“It’s almost as if we were jump-starting the neurons back into function,” Monti said. “Until now, the only way to achieve this was a risky surgical procedure known as deep brain stimulation, in which electrodes are implanted directly inside the thalamus. Our approach directly targets the thalamus but is noninvasive.”

The device used is the size of a coffee cup saucer. According to the UCLA press release, it “creates a small sphere of acoustic energy that can be aimed at different regions of the brain to excite brain tissue”.

The researchers targeted the thalamus with low-intensity focused ultrasound pulsation. Credit: Monti/UCLA.
Both the device and the technique, called low-intensity focused ultrasound pulsation, was developed by another UCLA professor Alexander Bystritsky. He is the co-author of the study and founder of Brainsonix, a company that made the device.
The small amount of energy emitted by the device is safe for the patient.
Can this technique be used to help other patients recovering from comas? The researchers are taking a wait and see approach. More studies need to be done to see if they can get consistent results. UCLA researchers will be testing the procedure on several more people in the fall.

“It is possible that we were just very lucky and happened to have stimulated the patient just as he was spontaneously recovering,” cautioned Monti.

Monti hopes that if the technology pans out, their research will lead to the creation of low-cost portable devices that can “wake up” the brain of vegetative or minimally conscious patients.

Scientists use ultrasound to jump-start a man's brain after coma

We'll never know if this might be useful for locked in syndrome because we have NO stroke leader to talk to or any stroke strategy to update.
https://www.sciencedaily.com/releases/2016/08/160824135049.htm

A 25-year-old man recovering from a coma has made remarkable progress following a treatment at UCLA to jump-start his brain using ultrasound. The technique uses sonic stimulation to excite the neurons in the thalamus, an egg-shaped structure that serves as the brain's central hub for processing information.

"It's almost as if we were jump-starting the neurons back into function," said Martin Monti, the study's lead author and a UCLA associate professor of psychology and neurosurgery. "Until now, the only way to achieve this was a risky surgical procedure known as deep brain stimulation, in which electrodes are implanted directly inside the thalamus," he said. "Our approach directly targets the thalamus but is noninvasive."
Monti said the researchers expected the positive result, but he cautioned that the procedure requires further study on additional patients before they determine whether it could be used consistently to help other people recovering from comas.
"It is possible that we were just very lucky and happened to have stimulated the patient just as he was spontaneously recovering," Monti said.
A report on the treatment is published in the journal Brain Stimulation. This is the first time the approach has been used to treat severe brain injury.
The technique, called low-intensity focused ultrasound pulsation, was pioneered by Alexander Bystritsky, a UCLA professor of psychiatry and biobehavioral sciences in the Semel Institute for Neuroscience and Human Behavior and a co-author of the study. Bystritsky is also a founder of Brainsonix, a Sherman Oaks, California-based company that provided the device the researchers used in the study.
That device, about the size of a coffee cup saucer, creates a small sphere of acoustic energy that can be aimed at different regions of the brain to excite brain tissue. For the new study, researchers placed it by the side of the man's head and activated it 10 times for 30 seconds each, in a 10-minute period.
Monti said the device is safe because it emits only a small amount of energy—less than a conventional Doppler ultrasound.
Before the procedure began, the man showed only minimal signs of being conscious and of understanding speech—for example, he could perform small, limited movements when asked. By the day after the treatment, his responses had improved measurably. Three days later, the patient had regained full consciousness and full language comprehension, and he could reliably communicate by nodding his head "yes" or shaking his head "no." He even made a fist-bump gesture to say goodbye to one of his doctors.
"The changes were remarkable," Monti said.
The technique targets the thalamus because, in people whose mental function is deeply impaired after a coma, thalamus performance is typically diminished. And medications that are commonly prescribed to people who are coming out of a coma target the thalamus only indirectly.
Under the direction of Paul Vespa, a UCLA professor of neurology and neurosurgery at the David Geffen School of Medicine at UCLA, the researchers plan to test the procedure on several more people beginning this fall at the Ronald Reagan UCLA Medical Center. Those tests will be conducted in partnership with the UCLA Brain Injury Research Center and funded in part by the Dana Foundation and the Tiny Blue Dot Foundation.
If the technology helps other people recovering from coma, Monti said, it could eventually be used to build a portable device—perhaps incorporated into a helmet—as a low-cost way to help "wake up" patients, perhaps even those who are in a vegetative or minimally conscious state. Currently, there is almost no effective treatment for such patients, he said.

Explore further: Tests conducted on Israel's Ariel Sharon reveal significant brain activity

Provided by: University of California, Los Angeles

PET Scans Predict Coma Outcome

Would this help in identifying locked in syndrome?
From Science Based Medicine

PET Scans Predict Coma Outcome

A new study shows that 42 really is the answer to life, the universe, and everything. OK, not really, but it does show that 42% of healthy brain activity is the minimum threshold for consciousness.
Disorders of consciousness, also referred to as coma when severe enough, can be a difficult situation to assess sufficiently to make reliable predictions about outcome. Part of the problem is that once someone is not able to maintain consciousness, we lose much of the neurological exam, and therefore it becomes more difficult to assess brain function other than to say that they are not conscious.

Types of coma

Two types of coma in particular are of interest: the persistent vegetative state, also called unresponsive wakefulness syndrome (UWS), and the minimally conscious state (MCS). Both are severe impairments of consciousness. In UWS, by definition, the patient may have sleep-wake cycles, open their eye, have roving eye movements, and grimace, but they do not have any interaction with their environment. They do not respond to voice, look at faces, or move in response to stimuli.
MCS is similar, except that patients give minimal signs of consciousness. They may attend to a face, or move in response to stimuli, but cannot communicate or participate in their care. There is a continuum, of course, from the MCS to a fully conscious state.
Sometimes it can be difficult to distinguish MCS from UWS. In a previous study, 41% of patients who were diagnosed as being in a UWS by standard neurological exam were actually in a MCS when a more thorough neurological exam was conducted.
Later research found that using fMRI scans (which measure blood flow) or quantitative EEGs (which measure electrical activity) were even more sensitive at distinguishing MCS from UWS. However, a 2014 study showed that a PET scan, which measures tissue metabolism, was even better at predicting who had signs of consciousness and also who might recover function a year later.
Of note, this research tends to show that patients who have impaired consciousness due to diffuse anoxic ischemic damage (lack of blood flow to the brain) had poor function and poor prognosis. They tended to really be UWS and not recover. Meanwhile, patients in a coma due to trauma were more variable. Some had more function and more potential to recover. This makes sense as trauma patients may look worse due to focal damage but still have some hidden brain function, while anoxic ischemic patients have damaged their entire brain.

The new PET study

With this background comes the new study, which includes many of the same researchers as the studies I mention above. They looked at PET scanning, because that showed the most potential in previous research, and also looked at trauma patients, because they also showed the most potential in previous research. They examined 131 head trauma patients using [¹⁸F]-fluorodeoxyglucose (FDG) PET scanning, and then followed them for a year as they recovered. They found several interesting things.
First, by quantifying overall brain metabolic activity they found that the minimal activity necessary to produce a conscious state was 42% of normal activity (determined by examining healthy controls). Simply put, the brain has to be able to produce a certain minimal amount of activity in order for conscious wakefulness to emerge.
Further, there does not seem to be any part of the brain that was essential for consciousness. There is no “seat of consciousness.” Consciousness is a whole-brain phenomenon, and all parts of the brain contribute their bit to consciousness. This fits with the current science of consciousness, which has failed to find any one piece of the brain that generates consciousness.
Local differences in brain function, however, did predict the return of specific functions. In other words, the activity in the visual cortex predicted the return of vision, while activity in the language cortex predicted the return of language. Therefore, the PET scanning was able to demonstrate not only overall brain activity, but the significance of activity in specific parts of the brain. This helps confirm the lack of a specific part of the brain needed for consciousness, because this study should have been able to show it.
All of this is interesting, but the clinical goal is to determine if such technology can predict overall patient outcome. This study delivered there as well:

Overall, the cerebral metabolic rate accounted for the current level, or imminent return, of awareness in 94% of the patient population, suggesting a global energetic threshold effect, associated with the reemergence of consciousness after brain injury.

PET scan activity specifically predicted the outcome (recovery to consciousness) in 88% of subjects.

Utility

Predicting who is likely to recover from head trauma to the point that they are conscious and able to have some quality of life is extremely useful to family members tasked with making decisions about care.
Patients who are likely to recover based on this type of PET data might benefit from more aggressive care, while patients who have little or no potential to recover can be treated to maximize comfort.
It may seem like it is asking a lot of a diagnostic test to determine the overall care of a patient, but right now those decisions are still being made, just with greater uncertainty as we generally base such decisions on clinical assessment and anatomical imaging. PET scanning, according to this study which also builds upon previous studies, adds another piece of information that can help us make better assessments and predictions.
The fact that this study was able to quantify PET metabolism and consciousness is also extremely helpful. Knowing that there is a threshold, 42%, that is necessary for consciousness is especially useful.
Clearly more research will be necessary to confirm these results and add more details. I would like to see a similar study in patients suffering from other causes of coma, such as diffuse anoxia. The more information we have about PET scanning results and long term outcomes the better.
Families caring for loved-ones in a coma are in a very difficult position. They don’t want to give up if there is hope, but they also don’t want to condemn their loved-one to an existence they may not have wanted if there is no hope. Uncertainty is agonizing, and anything that can reduce uncertainty is extremely useful.

Brain Scans May Help Predict Recovery From Coma

Would this be helpful in diagnosing locked-in patients before your doctor tells you it is hopeless to recover? You are going to have to hope your doctor and hospital have a correct protocol for this even though they have no protocols for any other stroke rehabilitation items. Good luck with that.
http://dgnews.docguide.com/brain-scans-may-help-predict-recovery-coma?
Brain scans of people in a coma may help predict who will regain consciousness, according to a study published in the November 11, 2015, online issue of the journal Neurology.
The study looked at connections between areas of the brain that play a role in regulating consciousness. For the study, 27 people in a coma with severe brain injuries were compared with 14 healthy people of the same age. All of the participants had functional magnetic resonance imaging (fMRI) scans taken of their brains.
For those in a coma, the scans were conducted after any sedative drugs were out of their systems. Three months after their injuries, 4 of the people with coma had recovered consciousness. The others remained in a minimally conscious state or a vegetative state at 3 months.
All of the comatose people had significant disruption in the connections between brain areas and the posterior cingulate cortex. These changes were the same whether the brain injury was due to trauma or to lack of oxygen, such as from cardiac arrest.
The researchers found that the coordination of activity between the posterior cingulate cortex and the medial prefrontal cortex was significantly different between those who went on to recover from the coma and those who remained in a minimally conscious state or a vegetative state. The coordination between the 2 brain areas was the same for the healthy participants and those who regained consciousness.
Stein Silva, MD, French National Research Institute, INSERM U825, Toulouse, France, said that more research is needed before these results can be used to guide decisions about people in comas.
“We need to do more studies with larger numbers of patients to substantiate these results, but the findings are promising,” said Dr. Silva. “We could be able to predict better who is more likely to recover from a coma and eventually develop innovative networks-based personalised treatments for people with brain injuries.”
SOURCE: American Academy of Neurology

The man with the missing brain

This sounds like the recovery that Pedro Bach-y-Rita made.
http://www.telegraph.co.uk/culture/books/11039266/The-man-with-the-missing-brain.html

Has your doctor contacted them to save the protocols for their severely damaged survivors?