Hacker Newsnew | past | comments | ask | show | jobs | submitlogin
Neurosurgeon pioneers Alzheimer's, addiction treatments using ultrasound [video] (youtube.com)
217 points by gardenfelder on Feb 29, 2024 | hide | past | favorite | 92 comments


my father had a similar focused ultrasound treatment for tremors. he went from spilling everything that he tried to carry to rock solid with his right hand. it was a life-changing event for him, and now he is impatient for the treatment for his left hand.

he was even able to go back to his woodworking hobby, that he thought he'd never be able to do again.

they did multiple MRI's to make sure they could hit the exact location, and they appear to have done so.


We had somehow missed this treatment for essential tremor, and thanks to this video expect a family member will be visiting a neurologist or surgeon soon to discuss, for the same reasons you describe. Now available in Australia apparently.


A friend’s mother had this treatment last year (in either Hobart or Melbourne, unsure) and the difference is remarkable. I’ll find out the details. Email me (me @ myHNusername dot com) and I’ll pass them on.


Great that it worked out for him and your family. These kinds of technological advancements gives hope to many people.


I saw this on 60 Minutes I'm amazed this isn't worldwide front page news. Especially just for treating addiction alone. Basically sit in a machine get your head buzzed by ultrasound. All better.


Careful, that was literally the exact same selling point of Electroconvulsive therapy 80 years ago.


So...there's a distinction:

Electroshock therapy for behavioral modification in schools: bad

Modern Electroconvulsive therapy under anesthesia: actually effective and arguably lifesaving for severe clinical depression.


> Electroshock therapy for behavioral modification in schools: bad

Is that just violent punishment / torture by another name?


Yes, that's why it was banned in Massachusetts, if I recall, there were state schools/institutions that were using it way back when.


Shocking!


In Massachusetts? Not sure I'd use that word. Look up the Fernald Institute.


Lack of human experiments and anesthesia


If you've got a better treatment for a case of severe depression that's resisted all other attempts at therapy and medication, we're all ears.

If not, I suggest we leave it up to the patients and their doctors to determine whether or not ECT is improving their lives, or not.


SAINT protocol tCMS from Magnus Medical https://www.magnusmed.com/

Not available to everyone yet.


ECT therapy is AWESOME. It can treat depression and mood disorders, and it can help with severe epilepsy.

It was falsely maligned in the "One Flew Over the Cuckoo's Nest", because it can _look_ upsetting. However, even when it was done without anesthesia, it caused amnesia so patients didn't remember the procedure itself.


I have someone in my family history that underwent electroshock therapy, and by all accounts was only traumatized and destabilized further by the ordeal. YMMV, I guess.


I remember reading the comparison, that all modern psychiatric treatments can be thought of as banging a misbehaving car engine with a hammer.

Sometimes it helps, if the hammer is hitting just the right place. Often it does nothing, letting the underlying disease to progress. And in distressingly many cases, it can harm patients.

This absolutely applies to the ECT.


So because the patient cannot recall the traumatic events, they're not thought to be experiencing that trauma, or taking lasting effect from it?


Yep.

That's also how dissociative sedation works. You don't remember being sedated, and you are not (psychologically) traumatized by medical procedures happening during it. I had it several times for minor oral surgeries, and it's great.

And the modern ECT is also done under deep sedation.


How long after the event do you think it makes sense for this erasure to happen? Like, let's say that you are going to experience something absolutely traumatic but you know next week you won't remember it... is that also ok?


Yes? You are basically describing every surgery.


Not really though. Surgery typically uses anaesthesia that makes you not experience it in the first place, which is different than forgetting the trauma.

I don't think the human memory is well understood enough to say for sure whether consciously forgetting something means that there aren't still effects of your body having experienced the trauma in the first place. The mind, it would seem, goes deeper than conscious recollection, and perhaps beyond the brain.

Plenty of children abused before they can remember it still have exhibited signs of harm from the trauma.


Yes, those are taken far too lightly as well.


I'm reminded of this particularly beautiful TED Talk... https://www.ted.com/talks/sherwin_nuland_how_electroshock_th...


Low citation on the original paper, none of the paper that cite Rezai's paper have citations.


Also I think the big originators of FUS thalamotomy/pallidotomy were Bob Gross from Emory and Jeff something something at UVA


it happens to diplomats in Cuba all the time!


ok you made me laugh


I didn't watch the video, but I assume it is not just ultrasound, but a very focused beam / beams of ultrasound in combination with MRI to hit just the right spot.


ultrasound is used to temporarily open the blood brain barrier so that drugs can target plaque buildups


That's quite a different mechanism.


More of a dystopian nightmare. Rather than seeing an individual having agency to make decisions and face consequences … we may be moving to a model of a human as nothing more than a fancy automaton. Ohh so Mr Jim is showing addictive traits and not performing task X well. No problem let’s sap his brain and get him fixed up.

Super excited for any breakthroughs with Dementia … but fixing addiction, obesity… or even paranoid wrong think with ultrasounds is scary and perhaps harks back to the era of lobotomies.


Have you ever considered that nothing is wrong with you because nothing is wrong with you, and not that nothing is wrong with you because you are some stoic or heroic figure who managed to simply resist temptation?

I've been drunk plenty of times. I've also not consumed enough alcohol to be in a drunken state in almost 8 years despite having a collection of bourbon worth thousands. A good friend of mine, who drank no more than I did for a long while, could not stop. He kept going until he wrecked his liver and died from organ failure.

I didn't have the strength to overcome alcoholism. I was simply never an alcoholic. He was.


Indeed, I am not better than chain smokers, I just happen to be wired differently that it does not have a grip on me. It’s not like something I deserve.

Chocolate on the other hand…


It seems you could do this with any technological/medical advancement - how is this any different from semaglutide for obesity or wellbutrin for addiction? It's just a different lever to pull.

Harkening back to lobotomies is a false dichotomy, the environment in which research is done today wouldn't even allow for an outcome like that.


I disagree. It's a fair concern.

They are literally shaking small parts of the brain until they act differently. It's not as extreme as a lobotomy but its lobotomy adjacent and a little scary.

Sure, unlike a lobotomy it probably just jostling areas of the brain and not damaging entire sections with an icepick, but it's still fair to accept that some people (like myself) feel automatic body horror and fear at the idea of parts of my brain being damaged.


If my life were ruined and I was dying from alcoholism or drug addiction I get the feeling I probably wouldn't be thinking about this in a philosophical way. Societal impacts or potential abuses would be the least of my concerns.


How about this scenario: In 20 years, this treatment is standard, but there's a catch: it's bundled with a wider behavioral modification treatment protocol, whereby they first reduce the cravings for drugs and alcohol, then they start showing you anti-establishment imagery, and zap the parts of your brain that respond to it.

In fact the second treatment is also standard issue for all those who are diagnosed with oppositionism, a growing mental health disorder characterized by symptoms such as distrusting government authorities and forbes 500 companies. Treatments show a 90% reduction of symptoms and improving quality of life, for example they no longer clash with authorities or make hate statements as defined by the patriot act II of 2028.

Obviously an exaggeration, but there is a real concern. The line is blurry and will be crossed if we let it happen. Taking intravenous drugs for 20 years does some serious damage. It's nice if we develop a treatment for it, but it also shifts the focus away from prevention. People shouldn't be reaching that point, and wouldn't if we were acting on it.


It's not really a blurry line. "They" could require you to take antipsychotic pills when you renew your driver license. "They" could chemically castrate you when you register to vote and select the wrong party affiliation. But they can't, because in the US patients can refuse treatment.

Panicking about new treatments because "they" might someday bundle them with other treatments isn't particularly effective, because you can just decline the treatments you don't want. The days of no-oversight asshole doctors drilling holes in people for being weird are conscripted to the past. If patient rights to refuse treatment are destroyed, then sure, freak out all you want.

Meanwhile, research is not a zero-sum game. Treatments and prevention can be, and are, worked on in parallel, often by people with wildly different research backgrounds. Specifically, the resources and personnel involved are not fungible. Discouraging field A because you'd rather have someone work on field B doesn't necessarily mean anyone will work on field B, it just guarantees you don't make progress in field A.


Especially if the alternative is cold turkey, or a good old DT... All my heartfelt deep thanks to everyone who keeps digging for solutions, workarounds... anything that might help there.


No, that's fair, my stance very much was from the viewpoint of a generically healthy mind and not from the viewpoint of a damaged mind.

If I were in that position I might seriously consider the value of having 99% of me make it to the other side of this misery in exchange for the 1% of my brain that is ruining my life.


> They are literally shaking small parts of the brain until they act differently.

No, from what other comments have said, they are using ultrasound to open the blood/brain barrier so that drugs can enter the affected area. They aren't indiscriminately shaking the patient's brain and hoping for the best.


My issue is more with framing it as a lobotomy analogue when in reality the similarity ends at them both being brain procedures. My read is that this is more akin to something like rehabilitation in that previously damaged tissue is being worked on to improve function.

With regards to the body horror thing, that is legitimate and there is the possibility that we look back on this in 20 years like we do with lobotomy. I personally think it's unlikely considering the differences in how research is regulated compared to the past.

In general I think we need to reframe how we look at medical treatments. Changing the brain is literally the point - it's dysfunctional. Whether that be through physical manipulation like this or via pharmacology, something HAS to change functionally or there will be no difference. Until the point that we have nano robots carrying out bodily processes for us it's on our brain and body to adapt to whatever environmental stress it's exposed to, for better (exercising improving health for example) and for worse(trauma causing increased likelihood of addiction etc). This treatment is no different from anything else, all that matters is the positive or negative reaction.


Something tells me you are wholly unaware of the damage that addiction and obesity can inflict not just on the person afflicted, but on their family, community, and society as a whole. The benefits/costs equation is so massively lopsided here that you'd be cruel to advocate that people endure years of avoidable torment to satisfy your faulty notion of free will / agency. I can't think of anything more agency-promoting than ridding someone of their addictions.


What line would you draw between the technology existing and being useful to society and people's fundamental and inalienable right to refuse ever having it used on them?

Following their original thread, how would you feel if the government decided that this could be used for criminal correction, or if a company made going through a quick brain cleanse a part of the hiring process, or a college part of it's onboarding, or the military a part of boot camp?

Do we clean every spot to flawless similarity or just clean the bad thoughts?

If the latter, who gets to decide what the bad thoughts are?


Your argument is akin to being against needles because the government might use them to perform lethal injections.

I don't know if you've ever known any addicts, but they aren't exactly happy about being addicted. Give them a treatment that works and is affordable and most of them will be just happy to get some targeted head buzzing to treat their symptoms.


There is a similarity but I don't think it's quite 1:1. Both of your reference points are an order of magnitude weaker or stronger than mine.

As I've said in other responses, my viewpoint is coming from the viewpoint of a generally healthy mind and not wanting that to be taken from me.

If I become someone with an unhealthy mind my viewpoint could change.


Hysterical scaremongering which masquerades as lucid, rational thought doesn't go very far here.


Once again, an order of magnitude more than the reality. My response was not by any but the thinnest stretched imagination "hysterical scaremongering"


Your real problem is with the state, not with technology.


Wrong again. It's trusting my brain to other people.


There needs to be a better way at delivering drugs to the brain.

The BBB is essential for the brain from cytokines. An imbalance of immune system function inside the brain can cause havoc long term.

I read regarding the BLB (barrier for the Cochlear). A compromised BLB is thought to be the cause for many hearing ailments such as Tinnitus and hearing loss. An experiment was done where blood was injected directly into the cochlear fluids and this resulted in extreme hearing loss in mice.

A drug delivery method in a controlled fashion is what has been needed yesterday.


So the following things are basically happening or exist right now:

- we can map the brain structure using fMRI

- we can change the structure (or parts of it) using ultrasound

- we can (or soon will be) able to read thought patterns via LLMs analyzing brain waves

To me, that sounds like we are not far off from being able to take an iterative approach to live brain modification.

Both scary and fascinating at the same time.


- we can use magnetic pulses to temporarily alter the conciousness of part of the brain, create the feeling of a "presence of God" etc. Note: I am not say there is or isn't a god(s). Just that this is how some people interpret the experience.

The LLM thing sounds a bit off though. I think whatever article you read on this may have misinterpreted it.


That's called transcranial therapy and what I've heard is that it usually just improves your mood temporarily, which is supposed to help you deal with depression and/or addiction.


> - we can map the brain structure using fMRI

fMRI has poor spatial (about 1mm) and temporal (about 1s) resolution.


1mm is so massive, and 1 second is a massive timeframe, in relation to the mechanisms at play. There are so many papers (and retractions at massive scale) around attribution to fMRIs.

Maybe it is because it would be a dream to see into the brain that the mainstream media keeps bringing this stuff up?


Better magnets can improve MRI resolution eventually


> we can (or soon will be) able to read thought patterns via LLMs analyzing brain waves

source ?

who says that the brain waves we can measure hold information like that in a useful level of granularity ?

you can have something that distinguishes "angry" from "happy" etc, sure, but thought patterns ?


Here are a couple papers related to this topic, but the primary focus has been on showing that LLM embeddings correlate with neural activity better than alternatives. But given one has neural recordings, one could train a model to take them as input and output what was heard. How well that would work, I think, is an open question.

https://www.biorxiv.org/content/10.1101/2023.06.27.546708v1 https://www.biorxiv.org/content/10.1101/2022.07.11.499562v3


Wouldn't the model need to be trained on some valid data before being used to guess/approximate output from input?


yeah. yet people believe AI can do new things without training.


It's actually a pretty big field in neurophysiology along several levels, and not just w/ LLMs, ppl are trying to throw more basic EE DSP at it. Most analyses can do simple things - i.e. differntiator/discriminator type things, but who's to say if recording technology gets better, more complicated thought patterns can't be interpreted

LFP - "macro recordings" from larger electrical contacts like EEG, DBS leads, ECoG, i.e. waves from large areas of the brain

single unit - smaller electrodes thought to capture recordings from 1 or a few neurons. There's actually a ton of stuff looking at differential responses of single unit brain waves against a lot of different psychological stimuli.

NEURIPS had a couple of presentations on LLMs interpreting stuff from fMRI - maybe not "brain waves" technically speaking but it may be approaching "thought patterns".


There have been PD trials with aDBS for the past 5-10 years iirc.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10357172/


could look great in the short run but go very, very sideways (ultrasound could fragments plaques, possibly below size detection limit, but then nucleate the formation of even more plaques if your'e not fixing the underlying problem):

https://www.sciencedirect.com/science/article/abs/pii/S00222...


Correct me if I am wrong. there are already treatments discovered for removing plaques, but it turned out that plaques aren't the real cause of cognitive decline. That's what I read before.


That's not exactly correct. Amyloid plaque is a hallmark of Alzheimer's and is still believed to be the primary cause of cognitive decline.

However, that doesn't mean removing the plaques will replace cognitive abilities.

If you think of neurons like plumbing, the plaques clog up the tubes, and the neural connections are no longer firing. Removing the plaques doesn't mean a whole doesn't exist in the tube, it just means you've unclogged it, meaning the contents can now spill out.

This isn't to say that amyloid plaques are the only marker in age related cognitive decline.

My suspicion (and I do some work in the field) is that many different diseases are being lumped into a single thing that we don't completely understand. There is a lot more which will be learned in the next decade.


My understanding is it’s still the primary hypothesis as the cause, but this hypothesis is not conclusive and is still being actively debated for multiple reasons.

There was a research scandal a while back that called into question some amount of data. And there’s the fact that many attempts at attacking the plaques have not been able to show any significant improvement to patients.


You're right, primary hypothesis is better way to state this.

You're also mostly correct that attacking the plaques have not shown significant improvement.

But that only shows that the damage done to the brain is irreversible - if in fact the plaques are the cause/related. It does not show that preventing the plaques/damage is the key.


Yes, but this is a surgeon. Surgeon like to cut/burn things. This is a new form of lesion therapy, but at its heart, it's...lesion therapy


Great to see Dr. Rezai getting his due. One of the pioneers of neuromodulation; he's been involved in deep brain stimulation since the early days.


I’ve seen two papers on stimulation and entrainment of brain waves. Is there any place that has a huge pile of resources on that? Everything from introductory to cutting-edge papers?


"neuromodulation" mostly means deep brain stimulation since it's by far the most effective and clinically - if you pubmed stuff, there's reams of reams of papers (probably written by someone else than Ali Rezai...). That being said, anything re above neurophysiology is mostly still handwaving, bc honestly, we still don't know exactly how it works.


"Brain washing" with focused ultrasound is a thing.

UEF’s new JPND projects explore focused ultrasound and multimodal interventions to fight dementia https://www.uef.fi/en/article/uefs-new-jpnd-projects-explore...

>Focused ultrasound (FUS) is a non-invasive, ground-breaking brain stimulation technique suggested for the treatment of Alzheimer’s disease. FUS promotes transient opening of the blood-brain barrier and enhances the microglial-mediated clearance of beta-amyloid typically accumulating in the brain in Alzheimer’s disease. However, the molecular mechanisms underlying these beneficial effects are poorly known, which limits the full translation of FUS into the therapeutic arena.

>The REBALANCE project coordinated by Professor Tarja Malm at the A. I. Virtanen Institute for Molecular Sciences aims to discover the key cellular targets and molecular mechanisms underlying FUS-induced brain cleaning and therapeutic efficacy in Alzheimer’s disease. The project partners have previously demonstrated therapeutic efficacy for FUS stimulation alone and combined with microbubbles.

>We hypothesise that FUS, through the activation of mechanosensitive Piezo1 channels, enhances beta-amyloid clearance by microglial cells and facilitates the removal of waste from the brain into the blood stream. This occurs through the improvement of glymphatic flow together with transient increase in the blood-brain barrier permeability. Moreover, increased blood-brain barrier permeability enables drug delivery into the brain, further boosting beta-amyloid clearance,”


I was waiting for the part where they'd brainwash you using this technique and realized it's wash in the more literal sense of getting rid of accumulated bad stuff rather than changing your thoughts or some sort of amnesia inducing procedure.


"We're brainwashing you." "WHAT??" "No, I mean we're literally washing your brain."


....in short, it's a lesion.


I suspect unreported (and drastic) side effects in some cases, particularly when the layout of the patient's brain doesn't perfectly align with the operator's expectations.


This will depend on how accurate the machine is. I assume that not only are there restraints to keep the head in the right place, but that the machine targets the beams based on where the head actually is rather than where it expects it to be. I also imagine that ultrasound is also being used to precisely locate the brain or even the targeted section.

For the Alzheimers treatments, it seems the damage (if it can be called that?) is subtle enough that it only lasts 24-48 hours, and shouldn't have side effects if that is true (the drugs themselves will of course have side effects). For other treatments, it is essentially pinpoint surgery, so has all the same risks, but less so because pinpoint. I can certainly imagine that destroying a few neurons to treat essential tremor could have drastic side effects.


Maybe can be used on healthy subjects to prevent Alz


I'm pretty sure the BBB is there for a reason, unavoidably there will be some side effects.


No, this removes plaques, and having plaques means you already have Alzheimers. This just slows or stops progression. Thankfully we seem to be developing ways to test for Alzheimers, so we should be able to catch it before any symptoms, and treatments to hold it in stasis. Reversing the damage is a whole different problem.


it s just amazing to see the amyloid plaque removal


I wonder if deep loud bass music in clubs leverage something similar inadvertently.


that's infrasound, not ultrasound


it's also not the sound that is doing the healing here. the sound waves are used to create an opening in the blood-brain barrier so that the drugs which do the actual healing can get where they need to go.

i suspect a nightclub that plays music which opens the blood-brain barrier would lead to some peculiar outcomes


Could this be used for removing calcified plaques or even soft plaques in hearts?


That seems a great idea, and could even be perfected with animal testing before getting near a human. I have no idea if the engineering is good enough yet to precisely hit a rapidly moving target.


Ultrasound is routinely used to break kidney stones. With more precision like this, why not? I don't know if there would be risks though.


Kidney stones flow down a one way river, I'd be worried about a large plaque dislodging and causing an embolism


Havana syndrome?


Video not available in my region. I'm in Canada, come on.




Consider applying for YC's Fall 2025 batch! Applications are open till Aug 4

Guidelines | FAQ | Lists | API | Security | Legal | Apply to YC | Contact

Search: