Cain Josh A, Spivak Norman M, Coetzee John P, Crone Julia S, Johnson Micah A, Lutkenhoff Evan S, Real Courtney, Buitrago-Blanco Manuel, Vespa Paul M, Schnakers Caroline, Monti Martin M
Department of Psychology, University of California Los Angeles, Los Angeles, CA 90095, USA.
Brain Injury Research Center (BIRC), Department of Neurosurgery, University of California Los Angeles, Los Angeles, CA 90095, USA.
Brain Sci. 2022 Mar 23;12(4):428. doi: 10.3390/brainsci12040428.
The promotion of recovery in patients who have entered a disorder of consciousness (DOC; e.g., coma or vegetative states) following severe brain injury remains an enduring medical challenge despite an ever-growing scientific understanding of these conditions. Indeed, recent work has consistently implicated altered cortical modulation by deep brain structures (e.g., the thalamus and the basal ganglia) following brain damage in the arising of, and recovery from, DOCs. The (re)emergence of low-intensity focused ultrasound (LIFU) neuromodulation may provide a means to selectively modulate the activity of deep brain structures noninvasively for the study and treatment of DOCs. This technique is unique in its combination of relatively high spatial precision and noninvasive implementation. Given the consistent implication of the thalamus in DOCs and prior results inducing behavioral recovery through invasive thalamic stimulation, here we applied ultrasound to the central thalamus in 11 acute DOC patients, measured behavioral responsiveness before and after sonication, and applied functional MRI during sonication. With respect to behavioral responsiveness, we observed significant recovery in the week following thalamic LIFU compared with baseline. With respect to functional imaging, we found decreased BOLD signals in the frontal cortex and basal ganglia during LIFU compared with baseline. In addition, we also found a relationship between altered connectivity of the sonicated thalamus and the degree of recovery observed post-LIFU.
尽管对意识障碍（DOC，如昏迷或植物状态）患者在严重脑损伤后恢复的促进作用的科学理解不断增加，但这仍然是一个持久的医学挑战。事实上，最近的研究一致表明，脑损伤后深部脑结构（如丘脑和基底神经节）对皮质调节的改变与DOC的发生和恢复有关。低强度聚焦超声（LIFU）神经调节技术的（重新）出现，可能为选择性地无创调节深部脑结构的活动以研究和治疗DOC提供一种手段。该技术在相对较高的空间精度和无创实施方面具有独特性。鉴于丘脑在DOC中的持续作用以及先前通过侵入性丘脑刺激诱导行为恢复的结果，我们在此对11例急性DOC患者的中央丘脑应用超声，在超声处理前后测量行为反应性，并在超声处理期间进行功能磁共振成像。关于行为反应性，我们观察到与基线相比，丘脑LIFU后一周有显著恢复。关于功能成像，我们发现与基线相比，LIFU期间额叶皮质和基底神经节的血氧水平依赖（BOLD）信号降低。此外，我们还发现超声处理的丘脑连接性改变与LIFU后观察到的恢复程度之间存在关联。
