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Completed

NCT Number: NCT04921683

The Use of LIFUP in Chronic Disorders of Consciousness

When patients survive a severe brain injury but fail to fully recover, they often enter a Disorder of Consciousness (DoC) --that is, a set of related conditions of decreased awareness and arousal including the Vegetative State (VS) and the Minimally Conscious State (MCS). When these conditions become chronic, there are no approved treatments to help bolster any further recovery. In prior work, we have shown the clinical feasibility and potential of Low Intensity Focused Ultrasound Pulsation (LIFUP) as a remarkably safe form of non-invasive brain stimulation in these conditions.

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Key information

About this study

In the present study, we propose taking the "next step" to assess whether LIFUP can affect objective and validated markers of DoC patient impairment (in the direction of lesser impairment). Specifically, patients will be admitted at Casa Colina Hospital for a 10-day (in-patient) protocol, and two follow-up sessions, conducted remotely (e.g., over the phone) at 7 and 30-days post-discharge. The full length of the study is 40 days from admission. Over the admission period, patients will undergo multiple measurements of validated biomarkers, including behavioral testing, brain metabolism (using Positron Emission Tomography), and electroencephalography, before and after one session of LIFUP to thalamus.

Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

  • Diagnosis of VS or MCS based on the CRS-R .
  • Chronic status:
  • 3 months post-injury for non-traumatic etiologies
  • 12 months post-injury for traumatic etiology
  • 18 years of age or older.
  • If on a psychotropic medication regimen, that regimen will be stable for at least 4 weeks prior to entry to the study and the patient will be willing to remain on a stable regimen during the protocol.

Exclusion criteria

  • History of neurological disorder (other than the brain injury).
  • Unsuitability to undergo Magnetic Resonance (MR) assessment (e.g., non-MR compatible implants).
  • Unsuitability to undergo LIFUP neuromodulation (e.g., presence of non-bone implant or absence of bone under the expected positioning of the device by the left temporal bone window).
  • Manifest continuous spontaneous movement (which would prevent imaging)
  • Participation in another concurrent clinical trial.
  • Having undergone PET, CT, or other exam involving the use of ionizing radiation in the 12 months prior to the date of scheduled admission to Casa Colina.
  • Dependence on ventilator.

Treatment and study plan

BX Pulsar 1002 (LIFUP) Low intensity Focused Ultrasound Pulsation

Device

Administration of LIFUP will be performed at the bedside using frameless stereotaxy. Specifically, the LIFUP transducer will be fit to the patient's head employing adjustable straps, and will be positioned over the patient's left temporal bone, over the "temporal window" in order to minimize bone absorption and refraction. Accurate aiming will be ensured employing the BrainSight neuronavigation device, customized for tracking our LIFUP transducer (total ~10 min). Once satisfactory aiming is achieved, the LIFUP exposure will be initiated employing the settings described previously (which meet the FDA safety limits: ISPPA <= 190W/cm2, ISPTA <= 0.72W/cm2). Accurate aiming will be monitored in real-time throughout exposure using the Brain Sight Neuronavigation interface.

Primary outcomes

  1. Coma Recovery Scale-Revised

    Time frame: Coma recovery scale-revised is completed at enrollment and twice a day on Day 1-10, except for Day 4. Maximum score is 23 with a minimum of 0. Higher scores mean better outcome.

    Change in maximum total and subscale scores.

  2. Electroencephalography

    Time frame: The EEG will be conducted at Day 3, 4, 7 and 10 of the study.

    Change in fast to slow frequency power spectrum density and in P3b amplitude.

  3. Positron Emission Tomography

    Time frame: This will be conducted on Day 4.

    Assess change in local standard uptake value (SUV) and global SUV.

  4. Polysomnography

    Time frame: This will be conducted Day 1-10 of the study.

    Change in nightly average density of sleep-spindles and sleep structure.

Sponsors and collaborators

Lead sponsor

Casa Colina Hospital and Centers for Healthcare

Other

Collaborators

  • Tiny Blue Dot Foundation
  • University of California, Los Angeles

Registry information

Official study title

Biomarkers of Thalamic LIFUP in Chronic Disorders of Consciousness

Important dates

Study start
2021
Primary completion
2023
Study completion
2023
First posted
Jun 10, 2021
Registry last updated
May 6, 2023

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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