It is generally understood that comatose patients cannot be aroused from their unconscious state. Doctors and family can only watch powerlessly until patients eventually wake up by themselves, become vegetative or die. This may take weeks, months or even years. But a new study published in the latest issue of Brain Stimulation revealed how a 25-year-old man had an incredible awakening shortly after being subjected to a revolutionary treatment through ultrasonic stimulation.
He was the first comatose patient in the world to be treated with low-intensity focused ultrasound pulsation (alternatively, non-invasive ultrasonic thalamic stimulation), which uses low-intensity acoustic pulses to stimulate neurons and bring about a wide range of cognitive outcomes; in this case, the recovery of a comatose patient.
Procedure
A small saucer-sized device that generates small, localized epicenters of acoustic energy was placed next to the patient’s head and activated for 30 seconds ten times over a 10-minute period. The sound waves were directed to the thalamus – area of the brain responsible for the regulation of consciousness, sleep and wakefulness.
Clinical progression
Before the procedure, the patient had been in a minimally conscious state for three weeks, displaying very elusive signs of consciousness and speech comprehension. He would, for example, make very slight and limited movements if encouraged by doctors. Three days after treatment, the man regained full consciousness and had full understanding of language. He was able to communicate by shaking his head with signs of ‘yes’ or ‘no’ and to wave ‘goodbye’ to the doctors. One week after the treatment, the patient attempted to walk.
A non-invasive alternative to deep brain stimulation
The only other way to potentially achieve such a recovery from coma is a very risky and invasive surgical procedure known as deep brain stimulation, where electrodes are implanted directly into the thalamus. Many known risks are associated with this procedure. Ultrasonic stimulation, on the other hand, can be applied in a localized manner and is harmless to brain tissue owing to the low-intensity of the stimulus.
Furthermore, according to Martin Monti, professor of psychology and neurosurgery at UCLA (University of California, Los Angeles) involved in the project, ultrasound also prevents the so-called consciousness disorders such as the vegetative state or minimally conscious state, which can cause severe brain damage.
Even when there are no such disorders, full recovery from coma can take a very long time. Therefore, the new treatment was received enthusiastically by researchers.
Revolution ahead?
The new procedure is potentially revolutionary, but professor Monti highlights that further research is needed to empirically validate the new non-invasive procedure; mainly because the possibility that the patient simply had a spontaneous recovery after the procedure cannot be excluded.
Consequently, researchers plan to use the new procedure on at least 10 other patients to consolidate their current findings. If this non-invasive technique proves to be successful in more patients, it may revolutionize the prognostic profile of comatose patients by dramatically speeding up full recoveries and enabling significant cost savings in the care and treatment of these patients.
