A photo of Martin Monti.

Scientists jump-start two people’s brains after coma

A photo of Martin Monti.

Monti said two patients exhibited “behaviors [that] are diagnostic markers of emergence from a disorder of consciousness.” (Photo Credit: Ivy Reynolds)

In 2016, a team led by UCLA’s Martin Monti reported that a 25-year-old man recovering from a coma had made remarkable progress following a treatment to jump-start his brain using ultrasound.

Wired U.K. called the news one of the best things that happened in 2016. At the time, Monti acknowledged that although he was encouraged by the outcome, it was possible the scientists had gotten a little lucky.

Now, Monti and colleagues report that two more patients with severe brain injuries — both had been in what scientists call a long-term “minimally conscious state” — have made impressive progress thanks to the same technique. The results are published online in the journal Brain Stimulation.

“I consider this new result much more significant because these chronic patients were much less likely to recover spontaneously than the acute patient we treated in 2016 — and any recovery typically occurs slowly over several months and more typically years, not over days and weeks, as we show,” said Monti, a UCLA professor of psychology and neurosurgery and co-senior author of the new paper. “It’s very unlikely that our findings are simply due to spontaneous recovery.”

The paper notes that, of three people who received the treatment, one — a 58-year-old man who had been in a car accident five-and-a-half years prior to treatment and was minimally conscious — did not benefit. However, the other two did.

One is a 56-year-old man who had suffered a stroke and had been in a minimally conscious state, unable to communicate, for more than 14 months. After the first of two treatments, he demonstrated, for the first time, the ability to consistently respond to two distinct commands — the ability to drop or grasp a ball, and the ability to look toward separate photographs of two of his relatives when their names were mentioned.

He also could nod or shake his head to indicate “yes” or “no” when asked questions such as “Is X your name?” and “Is Y your wife’s name?”

Small but significant improvement

In the days following the second treatment, he also demonstrated, for the first time since the stroke, the ability to use a pen on paper and to raise a bottle to his mouth, as well as to communicate and answer questions.

“Importantly,” Monti said, “these behaviors are diagnostic markers of emergence from a disorder of consciousness.”

The other patient who improved is a 50-year-old woman who had been in even less of a conscious state for more than two-and-a-half years following cardiac arrest. In the days after the first treatment, she was able, for the first time in years, according to her family, to recognize a pencil, a comb and other objects.

Both patients showed the ability to understand speech.

“What is remarkable is that both exhibited meaningful responses within just a few days of the intervention,” Monti said. “This is what we hoped for, but it is stunning to see it with your own eyes. Seeing two of our three patients who had been in a chronic condition improve very significantly within days of the treatment is an extremely promising result.”

The changes the researchers saw are small, but Monti said even the smallest form of communication means a way to reconnect. One powerful moment during the study was when the wife of the 56-year-old man showed him photos and asked whether he recognized who he saw.

“She said to us, ‘This is the first conversation I had with him since the accident,’” Monti said. “For these patients, the smallest step can be very meaningful — for them and their families. To them it means the world.”

Using acoustic energy

Scientists used a small device to aim ultrasound at the thalamus in the brain.

The scientists used a technique called low-intensity focused ultrasound, which uses sonic stimulation to excite the neurons in the thalamus, an egg-shaped structure that serves as the brain’s central hub for processing. After a coma, thalamus function is typically weakened, Monti said.

An image of a small device to aim ultrasound at the thalamus in the brain

Scientists used a small device to aim ultrasound at the thalamus in the brain. (Photo Credit: Martin Monti/UCLA)

Doctors use a device about the size of a saucer creates a small sphere of acoustic energy they can aim at different brain regions to excite brain tissue. The researchers placed the device by the side of each patient’s head and activated it 10 times for 30 seconds each in a 10-minute period. Each patient underwent two sessions, one week apart.

Monti hopes to eventually translate the technology into an inexpensive, portable device so the treatment could be delivered not only at state-of-the-art medical centers, but also at patients’ homes, to help “wake up” patients from a minimally conscious or vegetative state.

The treatment appears to be well tolerated; the researchers saw no changes to the patients’ blood pressure, heart rate or blood oxygen levels, and no other adverse events. Monti said the device is safe because it emits only a small amount of energy, less than a conventional Doppler ultrasound.

While the scientists are excited by the results, they emphasize that the technique is still experimental and likely will not be available to the public for at least a few years. For now, there is little that can be done to help patients recover from a severe brain injury that results in either a chronic vegetative state or a minimally conscious state, Monti said.

Monti said his team is planning additional studies to learn exactly how thalamic ultrasound modifies brain function; he hopes to start those clinical trials once the researchers and patients are assured of being safe from COVID-19.

The study’s lead author is Josh Cain, a UCLA graduate student in psychology, and a co-senior author is Caroline Schnakers, a former UCLA researcher who is now assistant director of research at Casa Colina Hospital and Centers for Healthcare in Pomona, California. The work was funded by the Tiny Blue Dot Foundation and the Dana Foundation.

This article, written by Stuart Wolpert, originally appeared in the UCLA Newsroom.

Million Dollar Hoods is already influencing policing in Los Angeles

Students, staff and faculty members of Million Dollar Hoods. Less than five years old, the effort has nevertheless helped shape Los Angeles and California law enforcement policy in several areas. (Photo Credit: Leroy Hamilton)

In less than five years, Million Dollar Hoods has already begun to influence criminal justice and policing in Los Angeles.

The program, launched in 2016, produced research on cannabis enforcement that shaped the development of the city’s Social Equity Program, which addresses the impact of disparate enforcement of cannabis prohibition. Its research on the money bail system, the first to document the scale of money bail in a large U.S. city, was instrumental to the passage of California legislation ending money bail for misdemeanor and nonviolent felony cases.

Its report on the Los Angeles School Police Department helped persuade the Los Angeles Unified School District to stop arresting children 14 and younger. And its analyses of Los Angeles Police Department arrests of homeless people unmasked the fact that arrests are outpacing the growth of the city’s homeless population — revealing an escalating focus on policing homeless persons.

Million Dollar Hoods is a big-data research initiative based at UCLA that uses Los Angeles police and jail records to monitor how much authorities are spending to lock up residents, neighborhood by neighborhood. In some communities, that figure is more than $1 million per year.

And not every neighborhood is affected equally by Los Angeles’ massive jail system. Data from arrest records shows that Los Angeles’ jail budget, nearly $1 billion per year, is largely devoted to incarcerating people from just a few neighborhoods.

Million Dollar Hoods researchers have researched and written dozens of “rapid response reports” in response to concerns from community members. Each report is made available on the program’s website.

Million Dollar Hoods researchers have also interviewed nearly 200 Los Angeles residents, under the guidance of Terry Allen, the lead researcher and director of the oral history project and a recent doctoral graduate of the UCLA School of Education and Information Studies. The oral histories tell stories of individual experiences of dealing with police and being arrested or incarcerated, as well as the impact of incarceration on families.

Its research team is led by Kelly Lytle Hernández, a UCLA professor of history and urban planning, and includes UCLA students, staff and faculty. Every project also benefits from the involvement of community organizations; Youth Justice Coalition, Los Angeles Community Action Network, Dignity and Power Now!, and JusticeLA are among those that have contributed to recent projects.

The project has attracted a passionate collective of undergraduate researchers, said Marques Vestal, faculty advisor for Million Dollar Hoods.

“There are lines out the door to get involved with this project,” said Vestal, a UCLA postdoctoral fellow and leader on the Million Dollar Hoods team who will joins the faculty of UCLA’s department of urban planning in July 2021. “Million Dollar Hoods gives students the chance to work with big data in ways that have a reparative impact on their communities.”

Next up: Thanks to a portion of a $3.65 million grant from the Andrew W. Mellon Foundation, Million Dollar Hoods will expand its capacity to produce oral histories — including training students to conduct interviews — and digitize more records and work with members of the community to document their experiences with and perspectives on mass incarceration.

This article, written by Jessica Wolf, originally appeared in the UCLA Newsroom.