Non-invasive brain stimulation interventions in Disorders of Consciousness


   School of Psychology

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  Dr D Fernández-Espejo, Dr Sang-Hoon Yeo  No more applications being accepted  Competition Funded PhD Project (Students Worldwide)

About the Project

Informal enquiries should be directed to Dr Davinia Fernández-Espejo [Email Address Removed]

Research link https://www.daviniafernandezespejo.com/

Centre for Human Brain Health https://www.birmingham.ac.uk/research/centre-for-human-brain-health/index.aspx

Person specification:

Applicants should have a strong background in cognitive neuroscience and / or psychology, or biomedical sciences, and ideally a background in neuroimaging and / or brain stimulation, as well as strong computational/coding skills or enthusiasm to learn this. They should have a commitment to research in brain injury and rehabilitation and hold or realistically expect to obtain at least an Upper Second Class Honours Degree in a relevant subject. 

Project details:

Prolonged disorders of consciousness (DOC), caused by the most severe brain injuries, lead to catastrophic disability and complex care needs. While DOC patients are considered to be entirely unconscious, some are in fact conscious but simply unable to show it because they also have damage to the parts of their brain that control movement. Consequently, many patients survive for years ‘trapped’ in their unresponsive bodies. Research by Fernández-Espejo has identified specific thalamo-cortical processes that accompany the recovery of consciousness and function after severe brain injury. This project will use cutting-edge non-invasive brain stimulation and neuroimaging methods (including focused ultrasound stimulation -FUS- and magnetic resonance imaging -MRI-) to develop an intervention that can help repair these thalamo-cortical processes. FUS is uniquely placed to address the limitations of other neurostimulation tools in being able to target deep-brain structures such as the thalamus directly, with high spatial precision, and non-invasively, making it a perfect candidate for therapeutic interventions in DOC. There is already proof-of-concept data supporting the safety of FUS in acute DOC, but to-date, no effective and mechanistically informed therapies have been developed.

 Project Aims:

-      To establish whether thalamic FUS can modulate thalamo-cortical dynamics relevant for awareness and behavioural responsiveness in DOC.

-      To identify MRI-based markers that predict whether an individual will likely respond to FUS.

-      To translate our proposed intervention to clinical settings.

To this end, we will conduct a series of well-controlled studies in healthy volunteers first, before translating our methods to DOC patients themselves. We will stimulate specific thalamic nuclei whose local damage and reduced cortical projections are at the root of the lack of awareness and external responsiveness in DOC. In a recently completed MRC project, Fernández-Espejo has already established a methodological framework to use cutting-edge multi-modal MRI imaging to characterise the effects of NIBS in neural processes known to be key to the recovery of DOC. Building upon this work, we will use advanced modelling methods to characterise online and delayed effects of FUS on thalamo-cortical coupling. We will test different theoretically motivated target regions, dosage levels, and potential benefits of pairing FUS with practice. Finally, we will use state-of-the-art structural MRI analyses (i.e., diffusion tensor tractography, and cortical thickness) to identify markers that predict individual differences in responsiveness to the stimulation.

If successful, our intervention will have a profound impact on patients’ quality of life and level of recovery by allowing them to interact with their external world for the first time since their injury.

To apply:

Please click on the institutional website which will direct you to the MRC AIM website which contains full information and the application forms.

Please ensure your application is submitted by midday (GMT) Friday 12 January 2024. Late applications will not be considered.

Biological Sciences (4) Medicine (26) Psychology (31)

Funding Notes

This is a fully funded studentship provided by the Medical Research Council.
If you are successful, you will receive a stipend (currently £18,622 per year for 2023/24) and a tuition fee waiver for 4 years.
Successful candidates will also receive an allowance for a laptop, a travel and conference allowance and an allowance for laboratory/PhD running costs.

References


Aloi D, Jalali R, Tilsley P, Mial RC, Fernández-Espejo D. tDCS modulates effective connectivity during motor command following; a potential therapeutic target for disorders of consciousness. NeuroImage. 247, 118781 (2022).
Aloi D, Jalali R, Calzolari S, Lafanechere M, Miall RC, Fernández-Espejo D. NeuroImage 274,120145 (2023).
Cain, J. A. et al. Ultrasonic Deep Brain Neuromodulation in Acute Disorders of Consciousness: A Proof-of-Concept. Brain Sci. 12, 428 (2022).
Monti, M. M., Schnakers, C., Korb, A. S., Bystritsky, A. & Vespa, P. M. Non-Invasive Ultrasonic Thalamic Stimulation in Disorders of Consciousness after Severe Brain Injury: A First-in-Man Report. Brain Stimulat. 9, 940–941 (2016).
Park TY, Jeong JH, Chung YA, Yeo SH, Kim H. Application of subject-specific helmets for the study of human visuomotor behavior using transcranial focused ultrasound: a pilot study. Comput Methods Programs Biomed. 226:107127 (2022).
Royal College of Physicians. Prolonged disorders of consciousness: National clinical guidelines. (2013).

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