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 1)
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on Jul 08, 2012

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

on Jul 08, 2012

I'm not aware of its use in bipolarity, Tom... if it were only to stop Depression but not hypomania, might not be good... 

One thing for sure: We're only at the beginning - "walking along the seashore, pausing to pick up a pretty shell here and there, while the whole ocean lies before us."

on Jul 08, 2012

Interesting stuff.

on Jul 08, 2012

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...

on Jul 08, 2012

Correct... exercise is a very good addition for many reasons, not just how it helps depression. Good addition to the post, Vamps - thanks.

on Jul 08, 2012

I wouldn't trust DBS any more than I do pacemakers.  Obviously they can be necessary, but enough of em screw up to make you worry.

Mind you it sounds like a great idea, just a tiny bit dangerous.

on Jul 08, 2012

Yeah. Suicide's much better.

Note: Only if drugs and all other dangerous treatments fail.

 

 

on Jul 08, 2012

Dr. JBHL....

It looks very much like the VNS... The Vagus Nerve Stimulator... used for Epilepsy. Think of it as a pacemaker for the brain. It sends electrical signals every so often through the left Vagus Nerve to the brain to try an prevent seizure activity. I will be having surgery soon to replace it since it's battery life just went out of service.

I also have MS. Anti Depressants are being taken to help control the temper that can come with Epilepsy. Can this device interfere with the Vagus Nerve Stimulator?

on Jul 08, 2012

DrJBHL
Yeah. Suicide's much better.

Note: Only if drugs and all other dangerous treatments fail.

What other dangerous treatments?  Beating em with a stick?  

 

Anyway, I'd personally love to have something like this though I'm not suicidal.  Just not sure I couldn't find a better way.

on Jul 08, 2012

These electronic implants may be a great advance in technology but I have to ask, quite seriously;

If microwaves in public locations can have bad effects on pacemakers, enough so to require warnings, how safe are implanted devices in the brain?

on Jul 08, 2012

Micowaves are dangerous only if unshielded... i.e. cooking with an open door (which can't be done, anyway). In the public, there is no real danger at ll. Just don't stand in front of a jet or radar set when it's on, or in a strong magnetic field (like an MRI).

As I wrote. This IS NOT a "first line" option. Meds, behavioral therapy are. If they fail? I'd rather have the implant than ECT, any day.

Why is it pacemakers are safe, but these devices which act in the same way are not?

on Jul 08, 2012

TheCatsMeowMix
Dr. JBHL....

It looks very much like the VNS... The Vagus Nerve Stimulator... used for Epilepsy. Think of it as a pacemaker for the brain. It sends electrical signals every so often through the left Vagus Nerve to the brain to try an prevent seizure activity. I will be having surgery soon to replace it since it's battery life just went out of service.

I also have MS. Anti Depressants are being taken to help control the temper that can come with Epilepsy. Can this device interfere with the Vagus Nerve Stimulator?

From the OP...

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.

I don't believe they would interfere with each other, TCMM - theoretically... quite distant from each other and the stimuli are very small in output. I don't know of any article about that possibility. BTW... only the "generator/battery" will be changed, not the wires. They'll be left in place.

on Jul 08, 2012

I get depressed on occasion ,  and so my heart really goes out to those who suffer this.

 

What helps me is actually what Vamps mentioned-  getting outside.    I'm lucky to live near some park areas, and even in our suburbs, there are a few trees-  just getting out into the sunlight with some greenery and birds around really uplifts me.

During the Winter months, I need to use those SADD sunlamps-- which do make a difference as well.   It gets dark here, in the Northeastern regions of the US.   

What also helps me during my depression times is making sure I get enough essential oils--  especially Oil of Evening Primrose which I found effective in stabilizing my PMS bouts.       Essential Oils are also great for those suffering Bipolar--    which  my aunt - a very intelligent woman - suffers, so I also feel deeply for anyone going through that as well.

 

on Jul 08, 2012

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?

on Jul 08, 2012

read chricton's book called terminal man?

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