Archive for October, 2016

[WEB SITE] Researchers Reveal New Possible Cause of Epilepsy – Neuroscience News

A team of researchers from Sanford-Burnham and SUNY Downstate Medical Center has found that deficiencies in hyaluronan, also known as hyaluronic acid or HA, can lead to spontaneous epileptic seizures. HA is a polysaccharide molecule widely distributed throughout connective, epithelial, and neural tissues, including the brain’s extracellular space (ECS). Their findings, published on April 30 in The Journal of Neuroscience, equip scientists with key information that may lead to new therapeutic approaches to epilepsy.

The multicenter study used mice to provide the first evidence of a physiological role for HA in the maintenance of brain ECS volume. It also suggests a potential role in human epilepsy for HA and genes that are involved in hyaluraonan synthesis and degradation.

While epilepsy is one of the most common neurological disorders—affecting approximately 1 percent of the population worldwide—it is one of the least understood. It is characterized by recurrent spontaneous seizures caused by the abnormal firing of neurons. Although epilepsy treatment is available and effective for about 70 percent of cases, a substantial number of patients could benefit from a new therapeutic approach.

Epilepsy is a brain disorder that causes seizures that disturb brain activity. Credit Sanford-Burnham Medical Research Institute.

“Hyaluronan is widely known as a key structural component of cartilage and important for maintaining healthy cartilage. Curiously, it has been recognized that the adult brain also contains a lot of hyaluronan, but little is known about what hyaluronan does in the brain,” said Yu Yamaguchi, M.D., Ph.D., professor in our Human Genetics Program.

“This is the first study that demonstrates the important role of this unique molecule for normal functioning of the brain, and that its deficiency may be a cause of epileptic disorders. A better understanding of how hyaluronan regulates brain function could lead to new treatment approaches for epilepsy,” Yamaguchi added.

The extracellular matrix of the brain has a unique molecular composition. Earlier studies focused on the role of matrix molecules in cell adhesion and axon pathfinding during neural development. In recent years, increasing attention has been focused on the roles of these molecules in the regulation of physiological functions in the adult brain.

In this study, the investigators examined the role of HA using mutant mice deficient in each of the three hyaluronan synthase genes (Has1, Has2, Has3).

“We showed that Has-mutant mice develop spontaneous epileptic seizures, indicating that HA is functionally involved in the regulation of neuronal excitability. Our study revealed that deficiency of HA results in a reduction in the volume of the brain’s ECS, leading to spontaneous epileptiform activity in hippocampal CA1 pyramidal neurons,” said Sabina Hrabetova, M.D., Ph.D., associate professor in the Department of Cell Biology at SUNY.

“We believe that this study not only addresses one of the longstanding questions concerning the in-vivo role of matrix molecules in the brain, but also has broad appeal to epilepsy research in general,” said Katherine Perkins, Ph.D., associate professor in the Department of Physiology and Pharmacology at SUNY.

“More specifically, it should stimulate researchers in the epilepsy field because our study reveals a novel, non-synaptic mechanism of epileptogenesis. The fact that our research can lead to new anti-epileptic therapies based on the preservation of hyaluronan adds further significance for the broader biomedical community and the public,” the authors added.

NOTES ABOUT THIS EPILEPSY RESEARCH

Contact: Susan Gammon, Ph.D. – Sanford-Burnham Medical Research Institute
Source: Sanford-Burnham Medical Research Institute press release
Image Source: The image is adapted from the Sanford-Burnham Medical Research Institute press release
Original Research: Abstract for “Hyaluronan Deficiency Due to Has3 Knock-Out Causes Altered Neuronal Activity and Seizures via Reduction in Brain Extracellular Space” by Amaia M. Arranz, Katherine L. Perkins, Fumitoshi Irie, David P. Lewis, Jan Hrabe, Fanrong Xiao, Naoki Itano, Koji Kimata, Sabina Hrabetova, and Yu Yamaguchi in Journal of Neuroscience. Published online April 30 2014 doi:10.1523/JNEUROSCI.3458-13.2014

Source: Researchers Reveal New Possible Cause of Epilepsy – Neuroscience News

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[WEB SITE] Scientists Take Big Step Toward Being Able To Repair Brain Injuries – Huffington Post

SOFIA GRADE
Embryonic neurons (shown in red) transplanted into the adult mouse brain connect with host neurons (shown in black), rebuilding neural circuits previously lost due to an injury.

Scientists have long been working toward a day when a traumatic injury or stroke doesn’t cause brain cells to be permanently lost.

Executing this extremely difficult task would involve figuring out how to transplant new neurons into brain tissue. But neurons form precise connections with each other, and are guided by physiological signals that are active during early brain development ― meaning that you can’t sow a fistful of new neurons into mature brain tissue and expect them to grow the way they should.

But scientists are making progress.

Embryonic neurons transplanted into the damaged brain of mice formed proper connections with their neighbors and restored function, researchers wrote in a study published Wednesday in the journal Nature.

By the fourth week, the transplanted young cells became the type of cells normally seen in that area of the brain. They were functional and responded to visual signals from the eyes. Moreover, the cells didn’t develop aberrant connections, something that could lead to epileptic seizures.

“What we did there is proof of concept,” said neuroscientist Magdalena Götz of Ludwig-Maximilians University and the Institute of Stem Cell Research at the Helmholtz Center in Munich, Germany.

“We took the best type of neurons, chosen at a specific time, and then we put them in the lesioned brain,” she said. “That was to find out how well can it work.”

The finding is an important step forward for someday repairing brain injury by using replacement neurons, other researchers said. Still, there are many challenges left.

“I’m excited about this study,” said Sunil Gandhi of University of California, Irvine, who wasn’t involved with the research. “This is evidence that the brain can accept the addition of new neurons, which normally doesn’t happen. That’s very exciting for its potential for cell-based repair for brain.”

SOFIA GRADE
Transplanted cells formed long-range connections with thalamic cells (shown in black).

But with complicated human biology comes complicated questions. What if the new cells become cancerous? What if the trauma of brain surgery causes more harm than the good a transplant might bring?

“In the case of stroke, there are therapeutic avenues that involve behavioral rehabilitation that can help to some degree,” Gandhi said. “It is true that the options are limited and frustrating. But the alternative is that we may end up going too fast and have unwanted harmful side effects.”

Neuroscientist Zhiping Pang, of Rutgers Robert Wood Johnson Medical School, agreed.

“This is absolutely an interesting and exciting paper,” he said. “Nevertheless, translating this to human stroke patients, safety will be a concern. A lot more work needs to be done, like the current study, before we can realize this exciting cell-replacement strategy in restoring proper brain functions of a stroke patient.”

The new study is promising, Götz said, but acknowledged that things are a lot messier outside the lab. Injuries to the brain are not clean-cut. They can occur in various sites, involve different types of neurons, and are accompanied by inflammation and other meddling signals. But Götz is hopeful that these problems can be solved.

“We are doing this now in more realistic models, in models of traumatic and ischemic brain injury and all I can say is that it looks pretty good,” she said.

Another challenge is to account for glial cells in the brain, which form scar tissue when an injury happens. That’s why Götz and her team are exploring the potential for turning these glial cells into new neurons that can replace the lost ones.

That approach could also solve the problem of supply, as using cells from fetuses is not a practical option for human patients.

Some forms of neuron transplantation have been done before. People with Parkinson’s disease suffer from a death of dopamine-producing cells deep in the brain, and it’s possible to transplant into their brains new neurons that secrete dopamine and help with certain symptoms. These neurons, however, don’t need to become a part of the existing circuitry. They don’t even need to be human cells ― the first transplant of this kind was done using brain cells from pigs.

Other groups have turned to induced pluripotent stem cells, or adults cells ― from a patient’s skin, for example ― that can be reprogrammed to an embryonic state and then directed to grow into a desired type of neuron.

“What’s going to be important now is to demonstrate that neurons that are grown from pluripotent stem cells can be coaxed to wiring up into the brain,” Gandhi said.

Source: Scientists Take Big Step Toward Being Able To Repair Brain Injuries | Huffington Post

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[WEB SITE] 5 steps to speed recovery from concussions and traumatic brain injury

Concussions and traumatic brain injury, or TBIs, affect over a million Americans every year. The vast majority are relatively mild, not requiring hospitalization. However, even in these mild concussions, over 75% will develop chronic pain, problems with memory and attention, irritability, and other neurocognitive issues that interfere with school, work, and family life. When people are discharged from the emergency room after a TBI, they usually receive little guidance on what they can do to speed their recovery and greatly reduce the risk of long-term problems with pain or chronic mental health issues that can become severe.

I am a clinical professor of medicine and work with a team in a traumatic brain injury clinic that treats patients with mild to severe injuries. I also do clinical research on diet and lifestyle interventions to improve neurocognitive (thinking) ability and mood of people with traumatic brain injury and multiple sclerosis.

Science has demonstrated that the axons, or wiring, between brain cells are damaged in a concussion: The more severe the concussion, the greater the damage. In addition, brain injury leads to inflammation in the brain, which further slows down the healing process.

We used to think that the adult brain lacked the ability to repair itself, but now we know the opposite is true: the adult brain is capable of building new synapses (connections) between brain cells and even growing more brain cells given the right environment. We have also observed that stem cells, which orchestrate these changes, are present even in the adult brain, and can begin the repair process.

Your brain needs the right tools to repair itself. Here are the top 5 things you can do to speed recovery following a concussion or traumatic brain injury.

1) Strength train at least 4 times a week. Exercise, particularly strength training, stimulates the production of nerve growth factors that encourage stem cell activity and help build more synapses between brain cells.

2) Stop the sugar and artificial sweeteners. Sugar increases insulin levels in the brain. Higher insulin levels are associated with more rapid loss of synapses and accelerated shrinkage of the brain and spinal cord. Artificial sweeteners are excitotoxins, which induce excessive production of glutamate in the brain, again leading to accelerated shrinkage.

3) Replace flour-based food (bread, pasta, rice, cereal) with vegetables. Get your carbohydrates from eating 6 to 9 cups of vegetables each day, which will dramatically increase your intake of vitamins and antioxidants. Eating more vegetables and berries has been shown to improve cognition and mood markedly.

4) Increase omega-3 fatty acid intake. Omega-3 fatty acids reduce the severity of injury and speed recovery. Eat more wild fish and grass-fed meat; you may also take a fish oil supplement.

5) Eat sufficient protein every day. The brain uses amino acids from protein to make neurotransmitters. For most, eating 6 to 12 ounces of protein (depending on your size and gender) will provide sufficient protein. If you are vegetarian, pay attention to protein intake and also take vitamin B12–many vegetarians are B12 deficient, which can also lead to cognitive and mood problems.

This is not theoretical. I have seen it over and over in my traumatic brain injury clinics: when my patients drop the sugar and white flour and instead eat six to nine cups of vegetables a day, their thinking ability improves, mood improves, pain diminishes, fatigue fades and they are steadily happier. They begin thriving again. In short, when people adopt a diet and lifestyle designed specifically for optimal function of their brain cells, their brain and overall health steadily improves. If you want to learn more about the dietary programs that we use in our clinics, visit www.terrywahls.com and pick up my book, The Wahls Protocol: A Radical New Way to Treat All Chronic Autoimmune Conditions Using Paleo Principles, which details the protocols we use in our clinics and in our clinical trials to restore health and vitality.

Source: 5 steps to speed recovery from concussions and traumatic brain injury

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[WEB SITE] Traumatic Brain Injury Resource Guide – Neurobehavioral Rehabilitation

Neurobehavioral Rehabilitation

Changes in personality and behavior are familiar consequences of traumatic brain injury (TBI) and often represent a significant barrier to effective rehabilitation and a successful outcome. In the acute stages of recovery from TBI, it is common for a person to exhibit a variety of behavioral complications which are considered by many to be a normal phase of recovery. When these behaviors continue beyond the acute recovery phase, however, and form on-going negative patterns of interaction with others, very specialized treatment is required. These behaviors can be disturbing to families and staff, disruptive to therapy, jeopardize patient safety and negatively impact a patient’s community re-entry and future quality of life.

 

Applied Behavior Analysis

Applied behavior analysis can be a powerful methodology for teaching people more positive ways of interacting with their environment and those around them. Centre for Neuro Skills provides a staff of Board Certified Behavior Analysts and over thirty-five years of experience in successfully treating patients with the most severe behavioral complications following their brain injury. Our behavior analysts complete in-depth assessments and detailed treatment plans to reduce challenging behaviors and increase positive behaviors. Staff members at both our clinic and residential locations are trained in behavior skills, crisis prevention, implementation of behavioral programming and regularly meet with behavior analysts to discuss the effectiveness of treatment plans.

 

Neurobehavioral Rehabilitation Program

Centre for Neuro Skills treats a variety of challenging and severe behaviors including:

  • Physical Aggression
  • Verbal Aggression
  • Self-Injurious Behavior
  • Lack of Initiation
  • Inappropriate Social Behavior
  • Noncompliance
  • Sexual Disinhibition
  • Property Destruction
  • Escape and Elopement

 

Our Neurobehavioral Rehabilitation Program is based on fundamentals of behavior analysis, such as precisely identifying a patient’s challenging behaviors, any environmental and internal factors that might be contributing to the occurrence of the behaviors and responses to the behaviors that make it more likely to continue. Neurobehavioral treatment is most effective when it is integrated with a comprehensive brain injury rehabilitation program. Centre for Neuro Skills provides coordinated medical and behavioral programming so as to maximize learning and reduce reliance upon medication, however, some patients are optimized by a combination of the two. Neurobehavioral treatment provides a “meta-structure” within which the various therapeutic disciplines of brain injury rehabilitation are carried out. The goal is to reduce those behaviors that limit independence and increase positive behaviors that empower a person and enhance opportunities for community, social, and family interaction.

 

Neuro Behavior Program Emphasizes Community Re-Integration: Read more

Case Study: Overcoming Behavioral Struggles, a Woman Embraces Life Again: Read more

TBI and Behavior Articles: Read abstracts

 

CNS Behavior Publications

The use of noncontingent reinforcement and contingent restraint to reduce physical aggression and self-injurious behaviour in a traumatically brain injured adult, Persel, C.S. and Persel, C.H. (1997), Brain Injury, 11(10), 751-60. Read abstract

Persel, C.S., & Persel, C.H. (2010). The Use of Applied Behavior Analysis in Traumatic Brain Injury Rehabilitation. In M.J. Ashley (Editor), Traumatic Brain Injury: Rehabilitation, Treatment and Case Management. Third Edition. Boca-Raton, FL: CRC Press Inc. Read more

 

Neurobehavioral Treatment of Severe Behavior After Traumatic Brain Injury

Source: Traumatic Brain Injury Resource Guide – Neurobehavioral Rehabilitation

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[WEB SITE] What is Cortical Priming?

The brain consists of two hemispheres each responsible for controlling the opposite side of the body. Normally, each hemisphere inhibits the opposite side to avoid mirror movements (both sides performing same movement simultaneously).

After a stroke, the two hemispheres experience an unbalancing of both sides with the unaffected hemisphere receiving more signals than the affected hemisphere. This imbalance leads to increased excitability and decreased inhibition to the healthy side. 

Priming is a technique used to enhance the brain’s ability to re-balance the two hemispheres following a stroke. Priming interventions include invasive and non-invasive techniques and can be administered prior to or during recovery. 

Stimulate Recovery. 

Sensory electrical stimulation using the SaeboStim Micro is an example of a safe, non-invasive technique used to improve cortical excitability of the affected side of the brain. By priming the brain with the SaeboStim Micro, prior to or during functional training, cortical plasticity and rebalancing of the hemispheres may lead to better functional outcomes.

Source: What is Cortical Priming?

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[WEB SITE] Reinventing Our Family – Drawing the Line – Brainline.org

To live in the brain injury world is to accept that much of the landscape here is gray. You don’t have to be here long to realize that the answers to most of your questions are, “I don’t know” or “Wait and see.” There are no authorities who can tell you with certainty how long recovery will take or what it will look like a number of years down the road. There are no clear rules for rebuilding and sustaining relationships with a brain injury survivor. There are no rules period.

In the same conversation, I was told TC would likely survive his injury. I was also told he could change in a number of unknown ways. “He might be aggressive or inappropriate or have a different personality,” one doctor warned me.

At the time I accepted this answer without hesitation. He’ll survive? I thought. Yay! TC’s immediate survival was as much as I could process in that moment.

But the doctor’s ambiguous warning proved true. My husband was changed. His personality was different. In the months that followed, he displayed moments of aggression, depression, and other uncharacteristic behaviors – none of which I felt fully prepared for when they emerged.

In the meantime, this is how much of the world saw me: a loving, deeply committed wife, fulfilling the vows she espoused on her wedding day. One stranger went so far as to commend me for being a “good Christian wife.” I sat in puzzlement at her words. This is NOT how I saw myself.

At times, I wanted to run. I had daydreams about getting in the car and starting over as a bartender in Florida somewhere near the beach. With a son to consider, this was never a serious plan, but on really bad days I often kept it in my back pocket as a reminder that escape was always an option.

As the days went on, however, I continued to stick it out. And little by little, the husband who used to love, respect, and take care of me began to return, and TC 2.0, the post-TBI stranger I saw him as, began to feel a little less like a stranger to me.

On this day, in the moment, I’m deeply grateful I stuck it out because time proved to be a powerful healer in my marriage. But this is not true for every caregiver relationship. Sometimes, time does not change or heal enough of the hard things to make a relationship sustainable. Sometimes, a personality shift in a survivor leads to critical safety issues such as abuse, neglect, or self-harm. Sometimes the trauma of TBI can cause troubling personality changes in the caregiver. And sometimes it’s necessary for a good Christian woman to love herself first, and to step away.

These are gut-wrenching decisions to make. I know that not only from my own experience, but from the network of caregivers I communicate with everyday on social media and in personal conversations. When to stay? When to go? When to get professional help? These are some of the hardest questions we will face in our post-TBIlives.

I don’t have the definitive answers, of course, but I do believe the journey to wisdom begins with boundaries: clear, transparent lines we draw around ourselves and our relationships to help us define what is OK and what is NOTOK in our lives.

Admittedly, I’m terrible at boundary setting. Confrontation of any kind is not my favorite thing, so finding my voice and declaring, “This does not work for me,” is something I don’t have a lot of experience with. But I’m learning. And as a mother, I don’t have the option of pushing this task aside. I have to decide what my limits are and where to draw those lines so that I can ensure my children’s wellbeing and safety.

The best time to have these conversations, of course, is before someone gets sick – when two people can sit in loving solidarity and decide, with clear heads, on a course of action. A family member’s recent diagnosis of Alzheimer’s has served as a reminder to do just this. Now that TC and I have entered our new normal, it’s time to sit down and think ahead. If he should backslide, develop dementia, or exhibit other potential personality changes, we must choose our reaction now. The same is true for my own health. The best time to establish these boundaries – to decide when too much really is too much – is before we are pulled back into the abyss of crisis.

Knowing our boundaries and firmly establishing them in caregiving relationships is the closest to black and white we can hope to get, and by no means is it easy work. Even on those worst days, when I struggled to find likeability in my partner and when I wanted an opportunity for a new life, I was still bogged down with suffocating guilt. I felt selfish and unloving when I wasn’t able to just take it on the chin and suck it up. This is what good caregivers do, I told myself. They just take it. But here’s the truth: “good” caregivers come in all shapes and forms. They do not act in one prescribed way, and while they have the patience to stick out some of the bad days, they also have the self-respect and love to demand good days in between.

Whether you are in the role of caregiver or survivor, draw those lines now – for yourself, and for others. Inform the people you love about what you need to be loved back, and don’t shy away from planning ahead.

Source: Drawing the Line

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[WEB SITE] Neurorehabilitation & brain research group

 

The Neurorehabilitation and Brain Research Group is a multidisciplinary team focused on assessing and promoting the recovery of brain function after an injury and on examining the underlying mechanisms of different brain processes. The group involves researchers from i3B Institute and Labpsitec, and maintains close collaborations with other national and international entities

Areas

Source: Neurorehabilitation & brain research group

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[BLOG] Neuro Landscape – A brain injury blog by Dr. Mark J. Ashley, CEO, Centre for Neuro Skills

ABOUT

Dr. Mark J. Ashley is founder and president/CEO of Centre for Neuro Skills (CNS), which operates postacute brain injury rehabilitation programs at facilities in Bakersfield, Dallas, Los Angeles, and San Francisco. Dr. Ashley founded CNS in 1980. He serves on the Board of Directors of the Brain Injury Association of America (BIAA) as the emeritus chair. He also serves on the Board of Directors of the Brain Injury Association of California and is the current chair. Dr. Ashley worked to establish BIAA’s Brain Injury Business Practices College and the Business and Professional Council.

Dr. Ashley is the immediate past chair of the Corporate Advisory Committee of the American Academy for Certification of Brain Injury Specialists. He serves as the vice chairman of the Access to Treatment Committee of the Business and Professional Council, and the Federal Legislative Advisory Committee for BIAA. He is an adjunct professor at the Rehabilitation Institute of the College of Education at Southern Illinois University, and served on the California Traumatic Brain Injury Advisory Council.

He is a member of the Advisory Committee for the Department of Rehabilitation Sciences, Cyprus University of Technology, and a member of the Advisory Board for the Applied Neuroscience and Neurobehavioral Research Center, University of Cyprus. He participated in preparation of Traumatic Brain Injury Medical Treatment Guidelines for the State of Colorado Department of Labor and Employment and serves on several grant review committees.

Dr. Ashley founded the Centre for Neuro Skills Clinical Research and Education Foundation (CREF), a non-profit research organization. His work has been published in numerous professional and research publications and he has written three books, “Working with Behavior Disorders: Strategies for Traumatic Brain Injury Rehabilitation” and “Traumatic Brain Injury Rehabilitation,” including this publication’s third edition.

Dr. Ashley received his Masters Degree in speech pathology and a Doctorate of Science from Southern Illinois University. The university named him Distinguished Alumni of the Year in 1995. He is an Adjunct Professor for the university’s Department of Communication Disorders and Sciences in the College of Education, specializing in brain injury and cognitive deficits. Dr. Ashley is a licensed Speech/Language Pathologist in California and Texas and is a Certified Case Manager.

He belongs to many professional associations, including the American Speech, Language, and Hearing Association, the American Congress of Rehabilitation Medicine, the American Society of Neurorehabilitation, the American Academy for the Advancement of the Science, the National Neurotrauma Society, the National Association for Independent Living, the International Association of Rehabilitation Professionals, the National Rehabilitation Association, the National Rehabilitation Administration Association, the California Speech and Hearing Association, and the Texas Speech and Hearing Association.

Source: About – Neuro Landscape

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[Abstract] Constraining movement reveals motor capability in chronic stroke: An initial study

Abstract

Objective: To determine if persons with chronic stroke and decreased hip and knee flexion during swing can walk with improved swing-phase kinematics when the task demands constrained gait to the sagittal plane.

Design: A one-day, within-subject design comparing gait kinematics under two conditions: Unconstrained treadmill walking and a constrained condition in which the treadmill walking space is reduced to limit limb advancement to occur in the sagittal plane.

Setting: Outpatient physical therapy clinic.

Subjects: Eight individuals (mean age, 64.1 ±9.3, 2 F) with mild-moderate paresis were enrolled.

Main measures: Spatiotemporal gait characteristics and swing-phase hip and knee range of motion during unconstrained and constrained treadmill walking were compared using paired t-test and Cohen’s d (d) to determine effect size.

Results: There was a significant, moderate-to-large effect of the constraint on hip flexion (p < 0.001, d = –1.1) during initial swing, and hip (p < 0.05, d = –0.8) and knee (p < 0.001, d = –1.1) flexion during midswing. There was a moderate effect of constraint on terminal swing knee flexion (p = 0.238, d = –0.6). Immediate and significant changes in step width (p < 0.05, d = 0.9) and paretic step length (p < 0.05, d = –0.5) were noted in the constrained condition compared with unconstrained.

Conclusion: Constraining the treadmill walking path altered the gait patterns among the study’s participants. The immediate change during constrained walking suggests that patients with chronic stroke may have underlying movement capability that they do not preferentially utilize.

Source: Constraining movement reveals motor capability in chronic stroke: An initial study

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[WEB SITE] UCLA researchers use noninvasive ultrasound technique to jump-start the brain of coma patient

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.

Source: University of California – Los Angeles

Source: UCLA researchers use noninvasive ultrasound technique to jump-start the brain of coma patient

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