Advanced MRI scans may help treat essential tremors and Parkinson's disease

Researchers at UT Southwestern Medical Center have recently developed MRI techniques used to more precisely target a small area in the brain linked to Parkinson's disease and essential tremor. This may lead to better outcomes without surgery and with less risk of negative effects of treatment of tremors and Parkinson's disease.

The study have been published in the journal Brain.

The research describes recently refined MRI methods designed to allow neuroradiologists to zero in on a pea-sized region in the brain's thalamus involved in movement. Using the images, doctors then can use high-intensity focused ultrasound (HIFU) to ablate, or burn away, problem tissue, says Bhavya R. Shah, M.D., first author of the study and an assistant professor of radiology and neurological surgery at UT Southwestern's Peter O'Donnell Jr. Brain Institute.

"The benefit for patients is that we will be better able to target the brain structures that we want," Shah says. "And because we're not hitting the wrong target, we'll have fewer adverse effects." The procedures are already Food and Drug Administration-approved for use in patients, and UTSW plans to begin employing them to treat patients when its Neuro High Intensity Focused Ultrasound Program opens this fall.

Adverse effects from imprecise targeting include problems walking or slurring words. While such effects are usually temporary, they can be permanent in 15 to 20 percent of cases, says Dr. Shah.

According to the National Institutes of Health, essential tremor affects up to 10 million Americans and Parkinson's disease impacts more than 1 million. Both are neurologic diseases thought to have genetic links. The first line of treatment for the involuntary trembling or shaking seen with these diseases is medication. However, approximately 30 percent of patients do not respond well to drugs, according to the study.

In the late 1990s, neurosurgeons began using a procedure called deep brain stimulation, opening the skull to permanently implant metal electrodes that could then be stimulated via a battery pack.

About a decade ago, a new MRI-guided procedure emerged that uses high-intensity ultrasound waves to heat and eliminate a small section of the thalamus linked to the disorders. MRI-guided HIFU is currently approved for treatment of essential tremor and tremors seen in Parkinson's disease patients. The outpatient procedure does not require opening the skull, and the patient is awake while it is performed, says Dr. Shah. "No cuts. No anesthesia. No implanted devices."

A challenge in both procedures has been locating the precise area inside the brain's thalamus to treat - the pea-sized ventral intermediate nucleus, says Dr. Shah.

Traditionally, doctors have relied on either landmarks or maps of the brain drawn from cadavers to help them pinpoint the correct location. However, every brain is different, Dr. Shah says, and tiny errors can lead to damage in surrounding tissue, or to missing portions of the correct target.

Three newly refined MRI techniques are better at delineating the target tissue, according to the study.

The most widely studied and perhaps most promising imaging method is called diffusion tractography, says Dr. Shah. It creates precise brain images by taking into account the natural water movement within tissues.

The other methods described are quantitative susceptibility mapping - which creates contrast in the image by detecting distortions in the magnetic field caused by substances such as iron or blood - and fast gray matter acquisition TI inversion recovery - which operates much like a photo negative, turning the brain's white matter dark and its gray matter white in order to provide greater detail in the gray matter.

Dr. Shah and his team plan to participate in a multicenter clinical trial with collaborators at the Mayo Clinic in Rochester, Minnesota, testing the diffusion tractography method in patients.

 

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Advanced MRI scans may help treat essential tremors and Parkinson's disease

Researchers at UT Southwestern Medical Center have recently developed MRI techniques used to more precisely target a small area in the brain linked to Parkinson's disease and essential tremor. This may lead to better outcomes without surgery and with less risk of negative effects of treatment of tremors and Parkinson's disease. The study have been published in the journal Brain. The research describes recently refined MRI methods designed to allow neuroradiologists to zero in on a pea-sized region in the brain's thalamus involved in movement. Using the images, doctors then can use high-intensity focused ultrasound (HIFU) to ablate, or burn away, problem tissue, says Bhavya R. Shah, M.D., first author of the study and an assistant professor of radiology and neurological surgery at UT Southwestern's Peter O'Donnell Jr. Brain Institute. "The benefit for patients is that we will be better able to target the brain structures that we want," Shah says. "And because we're not hitting the wrong target, we'll have fewer adverse effects." The procedures are already Food and Drug Administration-approved for use in patients, and UTSW plans to begin employing them to treat patients when its Neuro High Intensity Focused Ultrasound Program opens this fall. Adverse effects from imprecise targeting include problems walking or slurring words. While such effects are usually temporary, they can be permanent in 15 to 20 percent of cases, says Dr. Shah. According to the National Institutes of Health, essential tremor affects up to 10 million Americans and Parkinson's disease impacts more than 1 million. Both are neurologic diseases thought to have genetic links. The first line of treatment for the involuntary trembling or shaking seen with these diseases is medication. However, approximately 30 percent of patients do not respond well to drugs, according to the study. In the late 1990s, neurosurgeons began using a procedure called deep brain stimulation, opening the skull to permanently implant metal electrodes that could then be stimulated via a battery pack. About a decade ago, a new MRI-guided procedure emerged that uses high-intensity ultrasound waves to heat and eliminate a small section of the thalamus linked to the disorders. MRI-guided HIFU is currently approved for treatment of essential tremor and tremors seen in Parkinson's disease patients. The outpatient procedure does not require opening the skull, and the patient is awake while it is performed, says Dr. Shah. "No cuts. No anesthesia. No implanted devices." A challenge in both procedures has been locating the precise area inside the brain's thalamus to treat - the pea-sized ventral intermediate nucleus, says Dr. Shah. Traditionally, doctors have relied on either landmarks or maps of the brain drawn from cadavers to help them pinpoint the correct location. However, every brain is different, Dr. Shah says, and tiny errors can lead to damage in surrounding tissue, or to missing portions of the correct target. Three newly refined MRI techniques are better at delineating the target tissue, according to the study. The most widely studied and perhaps most promising imaging method is called diffusion tractography, says Dr. Shah. It creates precise brain images by taking into account the natural water movement within tissues. The other methods described are quantitative susceptibility mapping - which creates contrast in the image by detecting distortions in the magnetic field caused by substances such as iron or blood - and fast gray matter acquisition TI inversion recovery - which operates much like a photo negative, turning the brain's white matter dark and its gray matter white in order to provide greater detail in the gray matter. Dr. Shah and his team plan to participate in a multicenter clinical trial with collaborators at the Mayo Clinic in Rochester, Minnesota, testing the diffusion tractography method in patients. This is only for your information, kindly take the advice of your doctor for medicines, exercises and so on.      https://gscrochetdesigns.blogspot.com. one can see my crochet creations   https://gseasyrecipes.blogspot.com. feel free to view for easy, simple and healthy recipes     https://kneereplacement-stickclub.blogspot.com. for info on knee replacement

DRD2 May Protect Brain Regions from Alcohol-Induced Brain Damage

Brain scans of two strains of mice imbibing significant quantities of alcohol reveal serious shrinkage in some brain regions — but only in mice lacking a particular type of receptor for dopamine, the brain’s “reward” chemical. The study, conducted at the U.S. Department of Energy’s Brookhaven National Laboratory and published in the May 2012 issue of Alcoholism: Clinical and Experimental Research, now online, provides new evidence that these dopamine receptors, known as DRD2, may play a protective role against alcohol-induced brain damage.

“This study clearly demonstrates the interplay of genetic and environmental factors in determining the damaging effects of alcohol on the brain, and builds upon our previous findings suggesting a protective role of dopamine D2 receptors against alcohol’s addictive effects,” said study author Foteini Delis, a neuroanatomist with the Behavioral Neuropharmacology and Neuroimaging Lab at Brookhaven, which is funded through the National Institute on Alcohol Abuse and Alcoholism (NIAAA). Coauthor and Brookhaven/NIAA neuroscientist Peter Thanos stated that, “These studies should help us better understand the role of genetic variability in alcoholism and alcohol-induced brain damage in people, and point the way to more effective prevention and treatment strategies.”

The current study specifically explored how alcohol consumption affects brain volume — overall and region-by-region — in normal mice and a strain of mice that lack the gene for dopamine D2 receptors. Half of each group drank plain water while the other half drank a 20 percent ethanol solution for six months. Then scientists performed magnetic resonance imaging (MRI) scans on all the mice and compared the scans of those drinking alcohol with those from the water drinkers in each group.

The scans showed that chronic alcohol drinking induced significant overall brain atrophy and specific shrinkage of the cerebral cortex and thalamus in the mice that lacked dopamine D2 receptors, but not in mice with normal receptor levels. Mice in both groups drank the same amount of alcohol.
“This pattern of brain damage mimics a unique aspect of brain pathology observed in human alcoholics, so this research extends the validity of using these mice as a model for studying human alcoholism,” Thanos said.

In humans, these brain regions are critically important for processing speech, sensory information, and motor signals, and for forming long-term memories. So this research helps explain why alcohol damage can be so widespread and detrimental.

“The fact that only mice that lacked dopamine D2 receptors experienced brain damage in this study suggests that DRD2 may be protective against brain atrophy from chronic alcohol exposure,” Thanos said. “Conversely, the findings imply that lower-than-normal levels of DRD2 may make individuals more vulnerable to the damaging effects of alcohol.”

That would in effect deal people with low DRD2 levels a double whammy of alcohol vulnerability: Previous studies conducted by Thanos and collaborators suggest that individuals with low DRD2 levels may be more susceptible to alcohol’s addictive effects.

“The increased addictive liability and the potentially devastating increased susceptibility to alcohol toxicity resulting from low DRD2 levels make it clear that the dopamine system is an important target for further research in the search for better understanding and treatment of alcoholism,” Thanos said.




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Doctors Restore Consciousness in Man Who Spent 15 Years in a Vegetative State

For the first time, doctors have used a type of nerve stimulation device to restore consciousness in a patient who spent 15 years in a vegetative state due to brain injury.

The man showed significant improvements in movement and attention after just one month, and this exciting case study could become a starting point for new treatments for patients with similar injuries.

Unlike a coma, in which a person is asleep and unresponsive, a patient in a vegetative state is awake, but shows no signs of awareness or cognitive function, even though they can have basic reflexes like blinking when startled.

Sometimes people can transition from a complete vegetative state to what's known as a minimally conscious state (MCS), in which patients have at least a tiny bit of awareness of their surroundings.

But when a person has been in a vegetative state for more than 12 months after a traumatic brain injury, they are deemed to be in that state permanently and are highly unlikely to ever recover.

The patient in question was a 35-year-old man who suffered a traumatic brain injury in a car accident and had been in a vegetative state ever since, for 15 years.

The team used a medical implant that stimulates the vagus nerve, one of the most important nerves linking the head to the rest of the body. Shaped like flat, round batteries, vagus nerve stimulators (VNS) are sometimes called "pacemakers for the brain" and are used in treating epileptic seizures.

It wasn't just a random guess that this device might help a patient in a vegetative state - doctors worked from a hypothesis based on previous research that showed improvements in patients with MCS when they got stimulation to the thalamus, a brain centre involved in coordinating sensory signals.

The vagus nerve serves as a direct link to the thalamus (among other brain areas), and vagus nerve stimulation has previously shown to increase metabolism in that part of the brain, so the team wanted to test what would happen if they used a VNS implant in a vegetative state patient.

The doctors measured the patient's behaviour in response to stimulus, and recorded an electroencephalogram (EEG) and PET scans of his brain before implanting the stimulator, and then again afterwards.

Then they gradually increased the intensity of the stimulation. After just one month - once the electric current in the device reached 1 milliampere, the patient started showing consistent improvements  "in general arousal, sustained attention, body motility and visual pursuit."

For the first time in 15 years, he showed consistent, measurable signs of consciousness. And that's huge - according to the doctors, their patient transitioned from a vegetative to a minimally conscious state.

"The man began responding to simple orders that had been impossible before. For example, he could follow an object with his eyes and turn his head upon request," the team reports in a press statement.

"His mother reported an improved ability to stay awake when listening to his therapist reading a book."

And it wasn't just behavioural improvements, either - both EEG findings and a PET scan confirmed there was consistent, sustained activity in parts of the brain that are deemed to be markers of consciousness.

As the team writes in their report, their unique findings directly contradict the general assumption that spending 12 months or longer in a vegetative state makes the condition irreversible.

"Brain plasticity and brain repair are still possible even when hope seems to have vanished," says lead researcher.

But we have to remember that one exciting case study doesn't make for a new treatment just yet. It's really early days, as we only have data for one patient so far, but we must admit the results sound promising.

The team is now planning to use this case study as a starting point for a larger trial investigating how VNS might be used as a therapy for such patients.

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