Ramblings of an old Doc

 

Many folks have asked for “medical stuff” (enough computer viruses how about human ones?) so, this is about some gadgetry which has caused an earthquake in the treatment of depression.

Many folks have episodes of Depression through their lives, tied to events or not. In most, they resolve without the need for intervention. In many though, medications (thank G-d for them) are needed (and they work well for most, Mr. Cruise). They aren’t uniformly successful, and can cause problems (occasionally severe). They often need change, and for those in whom they failed, or caused other problems only behavioral therapy or ECT (electro-convulsive shock) remained as possibilities.

Now there’s something new: DBS (Deep Brain Stimulation). This form of therapy was initially found for movement disorders (Parkinson’s disease, and the like), and experimentally for anti-pain treatment.

In this form of treatment, electrodes are placed by a Neurosurgical team in problem areas. These devices work very similarly to heart pace makers: There’s a battery and miniprocessor (externally programmable) and electrodes (single or double) on wires placed beyond the problem area of electrical blockage. Some of these devices also function as defibrillators.

So, what does it look like?

Just like that.

Where does it go? In Brodmann Area 25 which is a sort of “conduit” of fibers going from the frontal lobe to the limbic area (regular and in 3D from the Wikipedia):

 

 

Graphically:

 

And in real life:

 

So, the patient is mildly sedated during the procedure and as electrodes are stimulated, describes his/her feelings. Various electrodes along the wire are stimulated until a helpful one is found. The generator is then programmed and placed under the skin (just like a pacemaker) and wires run under the skin to a connection point (in the xray, the four horizontal bars).

So…. As requested… some medical stuff.

Sources:

https://en.wikipedia.org/wiki/Brodmann_area_25

http://www.mentalhelp.net/poc/view_doc.php?type=doc&id=12999&cn=5

http://psychcentral.com/blog/archives/2006/10/11/area-25-may-help-the-severely-depressed/http://www.medicalnewstoday.com/releases/106460.php

http://www.empowher.com/depression/content/depression-and-brodmann-area-25

http://psychcentral.com/news/2008/06/27/new-study-of-dbs-for-depression/2518.html


Comments (Page 2)
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on Jul 08, 2012

So, the patient is mildly sedated during the procedure and as electrodes are stimulated, describes his/her feelings. Various electrodes along the wire are stimulated until a helpful one is found. The generator is then programmed and placed under the skin

Sounds disturbing, it doesn't fix an actual problem but uses direct manipulation of emotions to mask symptoms.

It is calibrated to force "positive" emotional states via direct brain cell stimulation with gross electrical signals (neurons transmit on a cell to cell basis), in effect faking electrical impulses from other parts of the brain to fake emotions.

I also cannot see it being effective since the brain is constantly re-calibrating and such repeated stimulation will cause the area to lose sensitivity until the new baseline requires this stimulation.

Also, electromagnetic radiation such as microwave turns into electricity when it hits metal. Shielding against that can only be achieved via a Faraday cage and grounding. This will ground into the brain of the patient which is bad. And what if the electrodes move? (very bad!)

on Jul 08, 2012

TheCatsMeowMix
Dr. JBHL...

I forgot to mention... a person with the Vagus Nerve Stimulator cannot go through metal detectors... be around strong magnetic fields or have an MRI. The VNS can be controlled through a magnet to turn it on if a person feels a seizure is coming on if the VNS is not currently going through its cycle. They can turn it off by taping the magnet to their chests too if they have to for any reason. Is this device also controlled by a magnet?

Yes it is programmed (like pacemakers) with a unit employing magnets.

taltamir
Sounds disturbing, it doesn't fix an actual problem but uses direct manipulation of emotions to mask symptoms.

It is calibrated to force "positive" emotional states via direct brain cell stimulation with gross electrical signals (neurons transmit on a cell to cell basis), in effect faking electrical impulses from other parts of the brain to fake emotions.

I also cannot see it being effective since the brain is constantly re-calibrating and such repeated stimulation will cause the area to lose sensitivity until the new baseline requires this stimulation.

Also, electromagnetic radiation such as microwave turns in electricity when it hits metal. Shielding against that can only be achieved via a Faraday cage and grounding. This will ground into the brain of the patient which is bad. And what if the electrodes move? (very bad!)

1. It changes the brain chemistry using electricity - just like the brain (and any tissue which maintains a potential difference does).

2. It does not "force" anything. Depression "forces" problems. The patient isn't turned into a grinning idiot.

3. About EMR? If strong enough, it will cook anyone with or without a medical device.

 

on Jul 08, 2012

There is a HUGE amount of research driving this sort of invention that has NEVER been seen before.

The research focus for the past few years on Alzheimer's, Parkinsons, Creutzfeldt–Jakob's Disease, ADD/AAHD as well as depression studies, endocrinology and even the fields of artificial intelligence, neural sciences and cybernetics have synergistically started to dovetail together and are providing huge amounts of very precise data on how the brain and nervous system work.

It is the first time we have ever had the technological tools to actually map and experiment real-time with the brains multifaceted processes--electromagnetic, hormonal, etc.--while it is working.

This isn't like the days when we used tap hammers to drive metal rods into people's brains to see if it might help.  We can now watch in real time the molecular, chemical and physical changes happening in the brain as we interact with it.  The understanding of the brain is greater than it has ever been in history and this may be one of those watershed moments where whole new realms of treatment and cure become available.

Depression is one of the biggest issues because it affects everyone in the world and there are so many areas affected by it and causal to it that a lot of information and research is needed.  If you have ever known anyone "chemically lobotomized" as the means of managing their symptoms, you'd understand why any sort of experiment that might give hope is worth it to a lot of people.

They recently just lab demonstrated a machine that allowed to computer wired couples to ask and answer each other's questions without saying a word and in future plan to do trials with comatose and brain dead patients to see if they are capable of "yes-no" conversations.

I have a friend who was just prescribed Abilify and for her it works wonders--she said the "cloud is gone" and she feels perfectly normal...yet the adverse effects for people who don't respond well to the drug are frightening.  We need a lot more alternatives.

on Jul 08, 2012

Precisely, Sinperium. 

on Jul 08, 2012

One thing's for sure, medical science is advancing into areas long thought way past science fiction. 

Personally, I am taking drugs manufactured on a molecular level. We have video and audio signals that can be sent directly into the brain (hearing impaired, blind, etc). With the increased mapping of the brain, the above is becoming not only possible, but approaches the mundane.

The future is amazing. And a little frightening. And it's nearly here, too.

On another note, this is one area I'd personally move into veeeery carefully. I'd be curious to know what the long term effects of sending impulses directly into the brain this way would be; would it affect emotional or mental development in any way? Would the lack of an internal cause/effect link cause 'confusion' in the development of responses? (This is very much in layman's terms.). 

 

 

on Jul 08, 2012

I read in some article a few months ago, they're trying this (DBS) for PTSD.  The patient still remembers the traumatic event, but they remember it as if they were watching it in a movie to an actor (detached) rather than actually reliving the traumatic event over again themselves.  This is fantastic news.

on Jul 08, 2012

I read in some article a few months ago, they're trying this (DBS) for PTSD.  The patient still remembers the traumatic event, but they remember it as if they were watching it in a movie to an actor (detached) rather than actually reliving the traumatic event over again themselves.  This is fantastic news.

That would seem to be the behavioral method as well, Karen... using video game simulation loosely, then more and more closely to reproduce the original event and by doing so 'desensitize' (much like allergy shots) the person to the original trauma.

Khardis
I'd be curious to know what the long term effects of sending impulses directly into the brain this way would be; would it affect emotional or mental development in any way? Would the lack of an internal cause/effect link cause 'confusion' in the development of responses?

For long range results, we'll just have to wait. Lack of an 'internal link'? I'm afraid I don't understand what you're trying to convey there.

on Jul 08, 2012

DrJBHL
Micowaves are dangerous only if unshielded... i.e. cooking with an open door (which can't be done, anyway).

Why can't that be done? Maybe not in a perfectly functional modern microwave, but it's certainly possible and I've seen one that insisted on staying on if you opened the door.

on Jul 08, 2012

Only 'problem' is that some of the world's most 'creative' minds have been depressed and/or suicidal, etc.  'Kill' the 'disease' and bang goes their creative artistry.

Simple test....see if you can list ALL of the British comedians who WEREN'T cronically depressed and/or suicidal....

 

Then there's all those musicians that have taken themselves 'out' with illicit and/or prescription drugs.....

on Jul 08, 2012

LightStar
Would this help people diagnosed as bi-polar Doc? I have a couple of friends who could use it is it does.

 

Was my question too. At least they are admitting that depression exists.

 

on Jul 08, 2012

Only 'problem' is that some of the world's most 'creative' minds have been depressed and/or suicidal, etc. 'Kill' the 'disease' and bang goes their creative artistry.

I think that is what Aldous Huxley was saying in "Brave New World."  I remember reading that book and thinking "This is no dystopia!  This is a wonderful society" but then I got to the part where art and poetry and music were obliterated because there was no need for them, because everyone being happy and productive, and there was no muse, no stimulus to be creative for.

on Jul 08, 2012

Vampothika
i find with my bipolar... when im depressed, andy takes me outside for a stroll around our town... works wonders..

plus i hate being stuck indoors 24/7 its not healthy for anyone...

 

I take so many darn drugs I have to work to be depressed - or just not take the drugs. Drugs keep me mellow but unwilling to go or do anything in the real world unless chased out. No drugs and I'm manic, depressed, and subject to paranoia and panic attacks. I would give anything to be off the drugs. Being up 24 hours a day leads to a lot of computer productivity, but on the other hand the depression could be a killer and so could the extreme anger coupled with the knowledge of how to really hurt people. So, I'm stuck with drugs. Having a gadget stuck in my head would be far less side effects than the long term effects of the chemicals.  Because of my health, I can see both sides all to well.

 

on Jul 08, 2012

Only 'problem' is that some of the world's most 'creative' minds have been depressed and/or suicidal, etc.  'Kill' the 'disease' and bang goes their creative artistry.

Simple test....see if you can list ALL of the British comedians who WEREN'T cronically depressed and/or suicidal....

 

Then there's all those musicians that have taken themselves 'out' with illicit and/or prescription drugs.....

That really isn't a proven fact... no one has demonstrated a loss of creativity or humor by easing depression... of course, on the other hand, how many have committed suicide, and was laughing at a joke really worth that price?

LizMarr
I can see both sides all to well.

Lizmarr, that is a different problem. Sorry, but the DBS won't fix that.

On the other hand, you have five fingers.    

[see? no DBS and you smiled - I hope].

on Jul 08, 2012

DrJBHL
On the other hand, you have five fingers.

  (insert Worf gif here) 

on Jul 08, 2012

I know it won't fix that. It was an argument about why a gadget would be better than all the other stuff someone with a mental illness goes through. Where I used to work I would say half of the people we admitted were off of their meds. They got to feeling well and kinda forgot to take them for a while. This was long term depression to schizophrenia and all steps in between. Once they were there for a bit and back on their meds they were another person altogether. Sometimes in as short as three days they were going back home (with a firm scolding by doctors and nurses alike about taking drugs) Reminding me to take my drugs is one of the things my service dog is trained for.

Such a device even if it is only one condition that it helps at this time, would take strain like this off of the medical system. Not to mention what joy it would be to not worry about taking drugs and their cost (one of mine is $600 per month and I have no insurance, the company that makes it gives it to me)

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