Over the microscope

Dr Elsa Fouragnan explores the potential for ultrasound to create a significant shift in mental health treatments

Photograph of Dr Elsa Fouragnan with patient

Imagine your brain was like an octopus. It has the elements trying to control what you need to do and when. But then there are eight tentacles, each working independently and trying to pull you in every direction.

“I once asked someone to explain what it was like to have obsessive compulsive disorder,” says Professor Elsa Fouragnan , Associate Professor in Neuroscience. “That was the analogy they gave. They know what they want to do, but then there’s all these other factors getting in the way.”

Appreciating the challenges faced by people with mental health conditions is critical to Elsa’s research. Her primary focus is on trying to understand how the brain works, and in turn how specific functions might go awry. That has resulted in studies exploring afflictions affecting millions of people all over the world – anxiety, depression, addiction, and much more.

But the personal experiences of each individual are just as important. These help Elsa and her team build a picture of how mental health conditions work. How they chip away at a person’s mind, and have knockon effects on their bodies. How they can impact friendships and families.

“People are talking a lot more about mental health conditions these days,” Elsa says. “But what if there was a way to use non-invasive technology to help people affected by them? I have seen the effects of addiction at very close quarters. Trying to prevent other people from having to go through anything like that is something that drives me.”

In Elsa’s research lab, there are certainly no octopuses in sight.

A patient sits in a chair while researchers apply a thin layer of gel to their skin. A small ultrasound device is then run over the coated area, sending sound waves to specific parts of the brain, while a screen projects the person’s brain and where the ultrasound focus is. It is the kind of scenario commonly found in hospitals and health centres across the UK, except that ultrasound has not been used in this way before.

Most people might associate ultrasound and pregnancy. But the objective here – in a room within the University’s Brain Research & Imaging Centre (BRIC) – is not to check the health of a baby. It is to momentarily alter specific parts of the brain, areas associated with the mental health conditions mentioned previously.

It is around a decade since Elsa first realised such techniques might be possible. While part of a related research project at the University of Oxford, she observed that low frequency ultrasound could stimulate changes within individual parts of the brain. Many scientists spend their whole lives on the quest for that ‘Eureka!’ moment – Elsa’s had come.

“I can remember the buzz of excitement around the room,” Elsa says. “We were looking at results of ultrasonic neuromodulation, and there was a moment of realisation that something we thought was possible was actually happening. It’s a feeling I won’t forget in a hurry.”

The reason for Elsa’s tireless work in this field, however, is not simply the desire for another scientific breakthrough. It is a quest to deliver genuine transformative change.

At the moment, being treated for depression and addiction usually results in medication. But that impacts the whole brain – both the areas being targeted and everywhere else besides. For many people, it causes side effects that only add to their list of problems.

Transcranial ultrasonic stimulation (TUS) offers a potential solution. A non-invasive, non-harmful way of stimulating neural activity within very precise parts of the brain. The research carried out by Elsa and her team at 50�Ȼ� in recent years has shown it works. They have also outlined the circumstances in which it can be applied, and written protocols now being used all over the world.

Now though, comes a different kind of challenge. So far, the TUS process has been trialled on people without diagnosed mental health conditions. Elsa and her team are this year shifting their focus to the people she believes the technology has the most potential to benefit.

It has taken a lot of effort to get to this point, but now, we hope to get people coming into the lab with addictions, depression or OCD.

It is the next phase in the development of our story. I am both excited, and a little nervous, to see how it goes.

While there may be no cephalopods in her lab or office, the story of the octopus is never far from Elsa’s thoughts. As well as working at the cutting edge of neuroscience technologies, she is an accomplished artist.

If she is trying to get her head around a complex issue, her solution is often to draw it. It was a method advocated by Santiago Ramón y Cajal, a Nobel laureate often referred to as the father of modern neuroscience.

“The brain is hugely complex,” says Elsa, who has long been an admirer of his work.

“There are things that happen within it that can, for the majority of people, be difficult to comprehend. Cajal used his drawing to bring the brain to life. A century later, it is giving me insights into some of the mysteries it might hold.”

Sketch by Dr Elsa Fouragnan