A man with Alzheimer's disease was given 100 doses for a cutting-edge treatment that directs about 1,000 beams of ultrasound energy to a target the size of a pencil tip in his brain, despite knowing there is no cure for the disease. He wore a million dollar helmet.
Dan Miller, 61, said he had nothing to lose when he signed up for the experimental procedure pioneered by neurosurgeon Dr. Ali Rezai. He has been using ultrasound for 70 years to help doctors better observe organs and fetal development. Rezai is currently being tested as a treatment tool for people with the following conditions: Alzheimer's disease and those struggling with drug addiction.
“There are no miracle cures here,” Rezai says. “We are taking calculated risks to advance medicine and push the frontiers.”
Can ultrasound help Alzheimer's patients?
Miller was one of three patients in Rezai's clinical trial at the Rockefeller Neuroscience Institute in Morgantown, West Virginia. Rezai allowed 60 Minutes to witness his innovative attempt to use ultrasound to slow cognitive decline in Alzheimer's patients.
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Scans of Miller's brain revealed red spots indicating a buildup of beta-amyloid protein. Beta-amyloid protein is a type of “brain plaque” that is thought to play a key role in Alzheimer's disease patients by blocking communication between brain cells. A few hours before the experimental procedure, trial patients will receive IV treatment of aducanumab, a drug used to reduce plaque.
aducanumab Rezai said the antibodies, given once or twice a month over 1 to 2 hours for more than 18 months, work slowly with the usual method of administration. It takes this long because the drug has difficulty crossing the so-called blood-brain barrier.
In July, the Food and Drug Administration also granted traditional approval to an Alzheimer's disease drug. lecanemabknown by the brand name Leqembi. fast approval Published in January 2023.
Rezai uses focused ultrasound to open the blood-brain barrier. Patients in his trial wore special helmets and lay on an MRI table. Once inside, you will be given an intravenous solution containing microscopic bubbles. When hit by ultrasound energy, the bubbles vibrate and break open the blood-brain barrier, allowing therapeutic agents to temporarily enter the brain quickly.
“In this way, we can deliver the therapeutic payload precisely to the required area with high penetration,” the neurosurgeon said. “But we have to be careful because we want to be safe. We don't want to give away too much and we don't want to open the blood-brain barrier too much.”
Rezai says that if the barrier opens too much, it can cause bleeding and swelling in the brain.
Rezai's trial patients were awake during the surgery but did not feel anything. They each received treatment once a month for six months.
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Rezai's team says so far there has been no change in the three patients' ability to live their daily lives since the ultrasound treatment ended in July. Brain scans of patients also showed a clear reduction in beta-amyloid protein. Beta amyloid plaques targeted with ultrasound were reduced by more than 50% than areas targeted with injections alone.
After showing that focused ultrasound can remove beta-amyloid plaques faster, Rezai received permission from the Food and Drug Administration to use ultrasound to restore function in brain cells lost in Alzheimer's disease.
“We don't know if the damage to the brain will ever recover because the underlying cause, Alzheimer's disease, is still progressing,” Rezai said. “So we're doing other research using ultrasound to see if we can reverse that by first removing the plaque and then applying different doses of ultrasound to stimulate the brains of Alzheimer's patients even more.” I'll see if I can do it.”
But Rezai isn't just focused on helping people with Alzheimer's disease. He and his team are also targeting drug addiction, a disease that affects about 21 million Americans. Rezai also uses ultrasound to treat addiction.
Treating addiction with brain implants
Before arriving at the concept of using ultrasound to treat addiction, Rezai thought that technology used to treat Parkinson's disease could be applied to treat people with severe drug dependence. started. In cases of Parkinson's disease, brain implants are used to stop tremors. Rezai considered using similar implants in parts of the brain that control behavior regulation, anxiety, and craving as a way to target addiction.
”“Certain parts of the brain malfunction electrically and chemically in relation to addiction,” he says.
The National Institute on Drug Abuse agreed to support his research, and in 2019 the Food and Drug Administration gave Rezai the green light to do the research.
Jerrod Buckhalter has agreed to become the first addict in the United States to receive implant surgery. He became addicted to painkillers after his shoulder injury and has been dealing with addiction for over 15 years. Buckhalter was unable to stay clean for more than four days at a time, he said. He doesn't remember how many times he overdosed.
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“There were nights I didn't know where to sleep. My family didn't want me around anymore,” Buckhalter said. “I just did so much to hurt them that it was too much for them to handle.”
He met Rezai four years ago. Neurosurgeons performed a seven-hour operation, but it was so new that it didn't have a name yet. Mr. Rezai cut a nickel-sized hole in Mr. Buckhalter's skull and inserted a thin wire with four electrodes deep into it. Buckhalter remained awake during the surgery.
Once in place, the wire was connected to a device placed under the collarbone. The electrical pulses sent to the brain are intended to suppress cravings. Dr. Buckhalter said there was no pain after the surgery. The system is calibrated remotely using a tablet computer as needed.
As soon as I turned on the system after surgery, there was a change.
“I felt better,” Buckhalter said. “I felt the same way I felt before I took the drug, just a little bit better.” “And at that point I knew I had a legitimate chance to succeed.”
A total of four patients with severe drug addiction underwent implant surgery. One had a mild relapse, another dropped out of the trial completely, and two, including Buckhalter, have not taken drugs since surgery.
How ultrasound therapy helps drug addicts
Opening a human skull is always risky. Rezai thought he could treat more patients faster by leveraging ultrasound technology, which he was already using to treat other brain diseases.
“We don't cut the skin. We don't open the skull,” he said. “I see, brain surgery can be performed without cutting the skin.”
In the new trial, he and his team treat addiction by directing hundreds of ultrasound beams to precise points in the brain.
“So the area we're treating is the reward center of the brain, the nucleus accumbens, which is right below this dark area,” Rezai said. “Then we send ultrasound waves to specific parts of the brain and, on a table, observe how desire and anxiety rapidly change in response to the ultrasound waves.”
The entire procedure will take an hour, Rezai said.
Last February, Rezai used focused ultrasound to treat Dave Martin, who was surrounded by friends and family who had used drugs his entire life. Martin started using drugs at age 7, he said, and continued for 37 years. A lot has changed for him since the ultrasound treatment.
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“The day of my surgery was the best day of my life,” Martin said.
Dr. Rezai's team said Martin admitted to taking a painkiller pill at a party in December. Still, 10 of the 15 patients in the ultrasound clinical trial remain completely drug-free.
What will happen next with Rezai's ultrasound treatment?
Dr. Rezai is trying the same treatment on 45 more addicts and is already planning to expand the use of ultrasound to help people with other brain disorders, such as post-traumatic stress disorder and obesity. thinking.
He is determined to learn more and replicate his findings.
“There's always risk, but you can't move forward or discover anything without risk,” Rezai says. “But we have to move forward and take risks, because people with addiction and Alzheimer's are not going away. It's already happening, so why wait 10, 20 years?” Do we need to? Act now.”
