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Skip to content Home / Medicina / Ultrasuoni terapeutici per “risvegliare” un cervello in coma Partiamo con ordine: cosa sono gli ultrasuoni? Gli ultrasuoni sono onde acustiche con una frequenza che convenzionalmente è fissata intorno ai 20 kHz, per differenziarle dalle onde invece acustiche, percepibili quindi dall’orecchio umano. In particolare nell’ambito medico la frequenza utilizzata varia dai 20 kHz ai 2 MHz. Come tutte le onde, anche quelle ultrasoniche (US) sono soggette ai fenomeni di rifrazione, riflessione e diffrazione, oltre ad essere definite mediante i soliti parametri: lunghezza d’onda, frequenza, velocità di propagazione, intensità ( dB) e attenuazione, la quale dipende dall’impedenza acustica del materiale attraversato dalle onde.
In ambito medico, le US vengono impiegate sostanzialmente in due campi ben distinti: nella realizzazione di immagini con finalità diagnostica e nella terapia. L’esame più comunemente conosciuto è l’ecografia, in particolare nel reparto di ostetricia, ma viene sfruttato anche per diagnosi in campo cardiaco.
Restart di un cervello per superare il coma
Quanto seguirà è successo in America, nell’University of California di Los Angeles (UCLA), dove un team di ricercatori ha sperimentato, per la prima volta e con successo, un modo per far “ripartire” un cervello appena uscito dal coma. Il paziente in questione è un ragazzo di 25 anni, sottoposto ad una serie di impulsi ad ultrasuoni, chiaramente sotto il monitoraggio costante del personale ospedaliero.
“È stato come riaccendere di colpo i neuroni, e riportarli in funzione”
racconta Martin Monti , ricercatore della Ucla e coordinatore dell’esperimento
Martin Monti, Professore presso la University of California Los Angeles (UCLA) nei dipartimenti di Psicologia e Neurochirurgia. newsroom.ucla.edu “Fino ad oggi esisteva un unico modo per farlo, ma si tratta di un’operazione chirurgica impegnativa, che prevede di impiantare degli elettrodi direttamente all’interno del talamo. Il nostro approccio, al contrario, è completamente non invasivo”.
Lo studio, pubblicato sul Bain Stimulation , si è basato su una tecnica chiamata Low-Intensity Focused Ultrasound Pulsation , inventata dagli stessi ricercatori della UCLA; i vantaggi che offre sono innumerevoli, primo tra tutti la non invasività e l’assoluta mancanza di rischio, seguito poi dalla possibilità di modulazione. In precedenza, questa stessa tecnica fu applicata anche per ridurre crisi epilettiche in pazienti affetti da epilessia.
La procedura ha previsto l’uso di una sorta di disco, puntato direttamente sul talamo del paziente appena uscito dal coma, in grado di creare un fascio di ultrasuoni ben mirati. Il trattamento, in particolare, è stato effettuato per 10 volte, ognuna per 30 secondi per un periodo totale di 10 minuti, con risultati eccezionali: infatti, dopo un solo giorno di trattamento si sono verificati segnali di miglioramento e a soli tre giorni dalla terapia il paziente era tornato ad avere una normale condizione di coscienza e di comprensione linguistica. Poteva muovere la testa correttamente per dire “si” o “no” e ha persino sferrato un pugno ad uno dei medici.
Stimolazione diretta del talamo tramite la Low-Intensity Focused Ultrasound Pulsation (Ultrasuoni a bassa intensità) thescienceexplorer.com Nonostante i risultati estremamente soddisfacenti, i ricercatori placano gli animi, asserendo che sono necessari ulteriori studi per confermare l’effettiva validità della terapia.
“E’ possibile essere incappati in un caso molto fortunato, con un paziente sottoposto a stimolazione proprio nello stesso istante in cui lui stesso si stava riprendendo spontaneamente”
spiega Monti, il quale chiarisce che l’intera terapia potrebbe dare nuove speranze di recupero per coloro che sono intrappolati nelle profondità di coma.
Se lo studio avrà successo, sarà dunque possibile creare un dispositivo simile ad un casco, accessibile a tutti, da poter utilizzare comodamente a casa, senza recarsi costantemente in ospedale.
Gli stessi ricercatori della UCLA hanno inoltre avviato uno spin-off per poter riprodurre il dispositivo appena descritto.
LOW-INTENSITY FOCUSED ULTRASOUND PULSATION (LIFUP)
La tecnologia della neuromodulazione ( ovvero un insieme di modificazioni della trasmissione degli impulsi nervosi indotte a scopo terapeutico, sia a livello del sistema nervoso centrale che periferico, mediante stimolazione elettrica o somministrazione di farmaci) offre un vantaggio notevole rispetto al trattamento farmacologico, in quanto la sua influenza sui circuiti neuronali è più diretto e focalizzato. Queste caratteristiche la rendono attraente sia per i neuroscienziati che per i clinici, in quanto può essere utilizzato per diagnosticare malfunzionamenti e modificare i meccanismi biologici neurologici e psichiatrici.
Ma quali sono i vantaggi della LIFUP nella neuromodulazione e nella stimolazione cerebrale? Attualmente sono sul mercato diversi tipi di tecniche di neuromodulazione invasive chirurgiche: la stimolazione del nervo vago (VNS), la stimolazione cerebrale profonda (DBS ), impiantato di stimolazione elettrocorticale (IES) e la stimolazione epidurale corticale (ECS). Inoltre, esistono anche diverse tecnologie di neuromodulazione minimamente invasive, come la TMS, la stimolazione a elettroterapia craniale (CES), la stimolazione transcranica a corrente continua (tDCS) e la stimolazione del nervo trigemino (TNS).
Come si può evincere da questo elenco, le tecniche di neuromodulazione e stimolazione cerebrale sono molteplici. Gli US possono penetrare il cranio e possono essere utilizzati per ablazioni, sfruttandone le proprietà termiche ( HIFU , High Intensity Focused Ultrasound). Sono inoltre onde acustiche, non magnetiche, quindi possono essere utilizzate con successo simultaneamente e facilmente al fMRI (functional Magnetic Resonance Imaging), per la mappatura ad alta risoluzione del cervello. L’utilizzo congiunto delle due le tecniche, cioè l’ablazione con HIFU, guidata da risonanza magnetica funzionale, è stato utilizzato sperimentalmente per sradicare tumori cerebrali.
LIUFP utilizzata simultaneamente alla rtfMRI immagini. https://www.researchgate.net Permangono comunque diverse questioni ancora aperte, prima che l’uso di LIFUP negli esseri umani a fini diagnostici e terapeutici possa diventare una realtà. -In primo luogo, gli ultrasuoni hanno effetti reversibili sulla conduttività neuronale: qual è la natura degli effetti? -In secondo luogo, può la LIFUP produrre effetti sul tessuto cerebrale visibili tramite fMRI? -In terzo luogo, quali parametri (come ad esempio, intensità, frequenza e durata di ultrasuoni scoppia e la lunghezza dell’intervallo dell’impulso) dovrebbero essere utilizzati sia per la stimolazione o inibizione del tessuto neuronale? -In quarto luogo, è possibile che la LIFUP penetri il cranio in modo analogo alla HIFU?
Le risposte a tutte queste domande sono state affrontate di recente e tuttora sono oggetti di studio.
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