Joyce, my spouse was one of the earliest study subjects for VNS Therapy for Depression (December 13, 1999). I am her long time support person and health care advocate/activist of 5 decades. The intent of the blog is not to promote any therapy, product or treatment but to continue sharing our experiences and knowledge as it relates to VNS. I endorse patient education in collaboration with a caring, knowledgeable and licensed health care professional while also encouraging hope and persistence.
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Putting a brake on depression with deep brain stimulation
A pioneering treatment (DBS) is bringing hope to the many sufferers - like Bruce Ross - whose disorder is resistant to drugs and other common therapies
Rewired: the new treatment, known as DBS, involves either stimulating or inhibiting neural activity
Bruce Ross was depressed for nearly 40 years. “I’d had it since early high school,” he says. “But this was the Seventies, and depression wasn’t really talked about, so I didn’t know what it was.” Mr Ross, a gentle-voiced 53-year-old Canadian credit union executive, battled alone against his unknown enemy for two decades. He even tried moving home, 1,200 miles from Nova Scotia, to Chatham, Ontario, to shake off his mystery ailment. Nothing helped: “I found that my problems followed me wherever I went.”
In the late Nineties, a doctor finally diagnosed clinical depression. Anti-depressants did not shift it, although he tried more than a dozen types; neither did psychotherapy, nor electroconvulsive therapy (ECT). By this time, he was married with a young daughter. “My psychiatrist said I was the most treatment-resistant patient he’d ever seen,” he says, “although I’m not sure that’s a badge of honour.” At one stage, Ross found himself on the fifth floor of a multi-storey car park, wondering whether it was time to end it all. “I don’t think I’d have ever gone through with it, but there were definitely times I thought about it.”
Two years ago, Mr Ross learnt about a pioneering approach to treatment-resistant depression being trialled at the University of Toronto. Called deep brain stimulation (DBS), it involves inserting tiny electrodes, attached to a battery implanted below the collarbone, to target areas deep inside the brain. The electrodes act, loosely speaking, as a brain pacemaker, transmitting high frequency, continuous electrical impulses that, depending on where they are placed, can either inhibit or stimulate neural activity. Desperate for some relief, Mr Ross agreed to take part. “I wasn’t at all nervous,” he says. “By that stage, I was pretty desperate. I just wanted it done.”
DBS is already used for intractable Parkinson’s disease and also chronic pain. For intractable depression, the research is still at an early stage – but according to Prof Andres Lozano, the Toronto neurosurgeon who operated on Mr Ross, studies show it can improve symptoms in 60 per cent of such cases.
About 10 to 20 per cent of depressed patients are resistant to conventional treatments, he points out. “These patients are severely disabled,” he says, “and at significant suicide risk.”
Like all brain surgery, the operation is carried out while the patient is conscious, so that surgeons can be sure no brain damage is being inflicted. It involves drilling a half-inch hole in the skull and placing the electrodes in the target area. A battery is fitted just below the skin in a separate operation, with the lead connecting it to the electrodes running up the side of the neck to the head.
Prof Helen Mayberg, a neurologist at Emory University in Atlanta, Georgia, is one of the leading researchers in the field and carried out the first DBS on a patient with depression in 2005. In Parkinson’s, she says, researchers had identified the right target area: a motion circuit associated with structures called basal ganglia was found to be hyperactive, causing the typical symptoms of the disease, such as tremor. Blocking certain areas on this circuit with an electrical impulse was found to dampen down the circuit, and mitigate symptoms.
“We took the principle of the Parkinson’s treatment and applied it to depression,” says Prof Mayberg. Years of medical imaging, she says, have shown several parts of the brain that are involved in mood disorders. “We hypothesised that a brain region called Area 25, which is part of the cingulate region, was the problem.” Researchers experimented by using electricity to “turn down” activity in this area. “Same process as in Parkinson’s but a different spot.”
“Area 25 is connected to areas related to sleep, motivation, reward and pleasure,” adds Prof Lozano. “Think of your car. You have an accelerator but you also have a brake. Similarly, the brain has 'excitatory’ and 'inhibitory’ circuits. In depression, the sadness circuits are stuck on full throttle. We’re stimulating the inhibitory circuit, stepping on the brake.”
And stepping on the brake seems to work. Far more research is needed, but the small studies that have been published – including the trial Mr Ross took part in, published recently in the Journal of Neurosurgery – “have built up a fairly substantial body of evidence” in its favour, according to Prof Mayberg. Of the 21 patients that took part, nearly two thirds had a 40 per cent or more reduction in symptoms at 12 months.
“With treatment of Area 25, if you get better, you stay better,” says Prof Mayberg. And when it works, it’s dramatic, “like flipping a switch”, according to Prof Lozano. The “million-dollar question”, he says, is why some patients do not get better. “One possibility is that they have a different disease, that we call it depression but the basis of it is different. Another is that the brain wiring is different, that we’re not hitting the appropriate spot.”
In the UK, researchers led by Dr Andrea Malizia, a psychiatrist at the University of Bristol, are looking at whether treating brain regions other than Area 25 might work for these non-responsive patients. “It’s far too early to say,” he says, warning that the research is still unpublished, “but what we’ve found suggests that some people don’t respond to stimulation in one area and do respond to stimulation in another.”
So far, the procedure has been carried out in just a few hundred patients with depression, but researchers hope it will become more widely used. “The costs of depression to an individual, to a family, to society, are considerable. No one wants unnecessary brain surgery, but if the procedure is shown to be safe, then it should be an option,” says Prof Mayberg.
There are, of course, risks – including the possibility of the current spreading to neighbouring regions of the brain, causing side effects such as mania or panic – as have been seen in Parkinson’s patients. “If you make a hole in someone’s skull, there are risks,” says Prof Mayberg. Dr Malizia also notes that DBS may be similar to some other treatments for depression, in which people become more motivated and energetic, but are still extremely depressed, making them a higher suicide risk.
Nevertheless, DBS represents a “paradigm shift” in thinking about depression and brain disorders, says Prof Mayberg. “We used to think of depression as a weakness of character, and thank God we got rid of that,” she says. “Then we started thinking of it as a chemical imbalance. But your brain is not a bowl of soup, add salt and stir. It’s a wiring network of billions of neurons organised into units, choreographed, communicating with each other with exquisite precision. Now, we’re thinking in those terms.” DBS for other conditions, such as obsessive-compulsive disorder and epilepsy, is also being investigated.
Two years in, Bruce Ross is delighted with the result. “Before the surgery, I’d have described my life as a four out of 10,” he says. “Since then, I’d say I’m a seven. I don’t think I’ll ever be a nine or a 10, but is anybody? I sleep better, my appetite’s better. I feel more relaxed, I’m more motivated at work. Would I recommend it to others? Absolutely.”
We have been following the advances in deep brain stimulation (DBS) pretty closely here at ET. Just the other week, we explained the motivations behind treatments for Parkinson’s disease with DBS electrodes placed in the subthalamic nucleus, and hinted at a couple of ways that they might be improved. Perhaps the biggest advance in DBS systems since they were first developed has just been reported by a group of researchers working in the Movement Disorders Group at Oxford University. By recording activity with what is essentially a brain-computer interface (BCI), the researchers were able to close the stimulation loop with direct feedback from the subthalamic nucleus. The ability to incorporate meaningful data from the implant user’s brain into the moment-to-moment control of the stimulation puts the one-size-fits-all DBS system on the fast track to obsolescence — and ushers in the new era of personalized implants.
Once activated, most DBS systems generate continuous pulses, typically at a frequency above 100Hz. Always-on stimulation fatigues not only the batteries, but more importantly the brain itself. The symptoms of Parkinson’s disease fluctuate continuously and any form of smart control needs to be fast to be effective. Previous research has demonstrated that the spike output of motor neurons in the cortex of a monkey could be used as feedback to provide better results than continuous stimulation. Directly implementing these results in humans calls for a bit more caution though — blunt exploratory implantation of multiple brain areas comes at a price. The Oxford group, led by Peter Brown, realized that the stimulation electrodes themselves can be used to record local field potentials. These signals are not the signatures of single cells, but can be thought of instead as more diffuse summary reports of larger groups of cells.
In order to use these averaged potentials for control, some criteria is needed to pass judgement on their desirability. Studies in Parkinson’s patients have consistently shown that subthalamic nucleus activity in the beta frequency band (3-30Hz) correlates with motor impairment. Brown’s group was able to build a control system that was able to filter and capture activity in this band, and then use it to control the stimulation current. The device was tested in eight patients and provided significant improvements over both continuous and random stimulation conditions.
This proof-of-principle demonstration provides a tantalizing glimpse of what lies ahead. For now, the control hardware is a bulky external system, although work on miniaturizing its footprint to fit inside the skull is ongoing. Once that happens, we have the essentials of two closely-related kinds of devices that are also under development in several labs. One is a device to police undesirable activity, like for example, seizures. In fact an important study in this area just appeared in the journal Neurosurgery. The other, more intriguing use is for what is commonly referred to as a “memory implant.”
DBS electrodes, reaching down into a human’s brain
There is really no substantial, convincing, evidence yet that memory implants are practical. The main problem is that we don’t know how to interpret what little brain activity we can manage to record. What I suspect we will find going forward is that, rather than attempting to build memory implants from scratch that access high-level areas of the brain (like the hippocampus), they will instead directly evolve from the on-board learning algorithms, and storage, that are built into motor control implants like those described here.
The pace of advance of these kinds of implants will be driven to a large degree by the pace at which they are made open. Interoperability between components is essential, as well as keeping the user in the loop to provide direct input to device designers. A huge boost in this area was just provided by Medtronic, the leading implant manufacturer, when it finally caved to overwhelming user demand for access to critical data generated by their implants. The irony of users having better feedback from an inexpensive Fitbit than from their $30,000 implant was not lost on vocal advocate, user, and TED Talk giver, Hugo Campos. Others were quick to jump on Medtronic CEO, Omar Ischrak when he tweeted how much he enjoyed access to his Runtastic data, yet at the same time denying feedback to users of his own products.
Opening implant data to users is harmless enough, although giving them unbridled control over critical parameters certainly has its risks. The larger community has already realized what the medical community has been slow to accept — the benefits of providing users with control over their implants far outweighs these risks, and that fact can no longer be ignored. Increasingly, we interact with our external environment through our personal electronic devices — that same power, and ease of interaction, for our inner space will be sought, demanded, and granted.
Responsive brain stimulation could improve life for Parkinson's sufferers
The new system cancels out Parkinson’s-related brainwaves only when needed.
(Medical Xpress)—Researchers in Oxford have demonstrated a significant improvement in the treatment of advanced Parkinson's disease with deep brain stimulation.
Deep brain stimulation involves permanently inserting electrodes into the brain to deliver electrical impulses that cancel out the brain signals causing symptoms of Parkinson's.
The new 'adaptive' system, successfully trialled by a Oxford University team based at the John Radcliffe Hospital, only delivers electrical stimulation when it detects the brainwaves responsible for causing the symptoms.
This is a significant refinement – present systems deliver continuous electrical stimulation to the brain.
The personalised system, which actively detects and responds to a patient's brainwaves using a brain-computer interface, proved more effective than conventional stimulation. By using less than half the power of existing systems, it could also reduce the need for repeat operations to replace batteries.
Deep brain stimulation (DBS) is used to treat the difficulties in moving and involuntary shaking experienced by those living with advanced Parkinson's disease, although it is not suitable for all patients.
Professor Peter Brown of the Nuffield Department of Surgical Sciences at the University of Oxford and consultant neurologist at Oxford's John Radcliffe Hospital, led the study. He said: 'Parkinson's symptoms fluctuate on a moment by moment basis and the brain signal activity causing symptoms is not continuous, it comes in bursts. By only delivering stimulation when these bursts are detected, you increase the effectiveness and reduce the amount of electrical stimulation delivered to the brain, reducing power consumption.
'DBS treatment is used by Parkinson sufferers for many years. We believe reducing the amount of electrical stimulation will lower the risk of side effects, although further research is needed on this aspect.' Potential side effects of deep brain stimulation can include speech and cognitive deterioration.
His team's proof of concept study is published in the journal Annals of Neurology. The research was supported by the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (a collaboration between Oxford University Hospitals NHS Trust and Oxford University), the Medical Research Council and The Wellcome Trust.
Professor Brown said a major advantage of adaptive DBS was the potential to significantly extend battery life.
He added: 'At present patients need an operation every three or four years to replace the battery. These are elderly patients who are operated on under general anaesthetic. By extending battery life we can reduce the need for these operations.'
The adaptive system was trialled with eight patients. The trial was for 10 minute periods and compared to the effect of no stimulation, constant stimulation and randomised intermittent stimulation.
Professor Brown said: 'We have believed for some time that this adaptive system could work, but this study has now proved the concept. Our conclusions were backed by independent assessment from experts at University College London.
'However, this was a small-scale proof of concept study. We now need to trial the system for longer periods. For anything longer than a few hours we will need to overcome technological hurdles in terms of miniaturising the system.
'The ultimate goal is a closed loop system small enough to be implanted in the body, similar to conventional DBS systems.'
Benefits of Asleep Deep Brain Stimulation (DBS) Lead Placement With ClearPoint Neuro Intervention System Indicated in Study of Pediatric Primary Dystonia Patients
IRVINE, CA--(Marketwired - Jul 15, 2013) - MRI Interventions, Inc. (OTCQB: MRIC) today announced the presentation of data and results indicating the benefits of its ClearPoint® Neuro Intervention System as a platform for iMRI-guided deep brain stimulation (DBS) lead placement in pediatric patients. A research team led by Dr. Philip Starr (neurosurgeon) and Dr. Jill Ostrem (neurologist) from the University of California, San Francisco (UCSF) presented an abstract at the 2013 International Congress of Parkinson's Disease and Movement Disorders in Sydney, Australia outlining data collected from the treatment and post-operative follow up of six children with pediatric primary dystonia who underwent iMRI-guided DBS procedures with the ClearPoint system. Leslie Markun, MSc, lead author on the abstract, showed that iMRI-guided DBS surgery, which allows patients to sleep through the procedure, is a technically simple and accurate option for a patient population that traditionally exhibits a low tolerance for conventional awake DBS surgery. The UCSF team plans to submit its findings for publication in a peer-reviewed journal.
Highlights of the presentation included:
Only a single brain penetration was used for placement of the DBS leads;
The average accuracy of the lead placement was under one millimeter;
The average surgical time for lead placement was just over three hours;
At 12 months follow up, the patients' movement scores improved an average of 88% on the Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS);
Clinical outcomes were comparable to the best reported outcomes that have been achieved using traditional methods.
"The data from this study suggest that 'asleep DBS' can be performed extremely accurately when guided by ClearPoint," said Philip A. Starr, MD, PhD, at UCSF, who collaborated with MRI Interventions in developing the iMRI procedure, but holds no intellectual property rights to it. "The clinical outcomes indicate that this is an excellent surgical method in children, and on a MRI system providing high resolution imaging, the procedure is straightforward to perform."
Deep brain stimulation surgery for children has long presented a challenge to stereotactic neurosurgeons because the procedure traditionally has required patients to remain awake and provide feedback to help confirm accurate placement of the DBS leads. Children often have not been considered good candidates for DBS surgery due to this requirement.
IMRI-guided surgery with the ClearPoint system opens up the possibility of DBS as a treatment option for these children by allowing patients to undergo an "asleep DBS" procedure. Using the ClearPoint system, a surgeon can see, in real time, the inside of a patient's brain and the location of surgical tools and devices, which can eliminate the need for a patient's conscious feedback. The ClearPoint system easily integrates with a hospital's existing MRI scanner, which is ideal for real-time imaging throughout surgery because it provides high-quality visualization of the soft tissue of the brain and does not expose patients to ionizing radiation, unlike other imaging methods such as computed tomography (CT) and X-ray. In addition to DBS lead placement, the ClearPoint system can be used as a delivery platform for neurological therapies and interventions such as focal laser ablation, brain biopsy, and drug delivery.
The UCSF study included six patients, aged 7 to 15, with primary dystonia. Patients were candidates for surgery if they had marked disability and other medical therapy was ineffective. Patients received bilateral globus pallidus or subthalamic nucleus DBS. Funding for the study was provided by Medtronic, Inc. and MRI Interventions, as well as a grant from the NIH.
About MRI Interventions, Inc. Founded in 1998, MRI Interventions (OTCQB: MRIC) is a publicly traded company creating innovative platforms for performing the next generation of minimally-invasive surgical procedures in the brain and heart. Utilizing a hospital's existing MRI suite, the company's FDA-cleared and CE-marked ClearPoint® system is designed to enable a range of minimally-invasive procedures in the brain. MRI Interventions has a co-development and co-distribution agreement with Brainlab, a leader in software-driven medical technology, relating to the ClearPoint system. In partnership with Siemens Healthcare, MRI Interventions is developing the ClearTrace® system to enable MRI-guided catheter ablations to treat cardiac arrhythmias, including atrial fibrillation. Building on the imaging power of MRI, the company's interventional platforms strive to improve patient care while reducing procedure costs and times. MRI Interventions is also working with Boston Scientific Corporation to incorporate its MRI-safety technologies into Boston Scientific's implantable leads for cardiac and neurological applications. For more information, please visit www.MRIInterventions.com.
About the ClearPoint® Neuro Intervention System The ClearPoint system is designed to allow real-time, direct visualization during neurosurgery by utilizing the powerful imaging capabilities of MRI. The ClearPoint system is intended to be used as an integral part of procedures, such as biopsies and catheter and electrode insertions, which have traditionally been performed using stereotactic methods.
Forward-Looking Statements Certain matters in this press release may constitute forward-looking statements within the meaning of Section 27A of the Securities Act of 1933 and Section 21E of the Securities Exchange Act of 1934. Forward-looking statements by their nature address matters that, to different degrees, are uncertain and involve risk. Uncertainties and risks may cause MRI Interventions' actual results and the timing of events to differ materially from those expressed in or implied by MRI Interventions' forward-looking statements. Particular uncertainties and risks include, among others: demand and market acceptance of our products; our ability to successfully expand our sales and clinical support capabilities; availability of third party reimbursement; the sufficiency of our cash resources to maintain planned commercialization efforts and research and development programs; future actions of the FDA or any other regulatory body that could impact product development, manufacturing or sale; our ability to protect and enforce our intellectual property rights; our dependence on collaboration partners; the impact of competitive products and pricing; and the impact of the commercial and credit environment on us and our customers and suppliers. More detailed information on these and additional factors that could affect MRI Interventions' actual results are described in MRI Interventions' filings with the Securities and Exchange Commission, including, without limitation, MRI Interventions' Quarterly Report on Form 10-Q filed with the Securities and Exchange Commission on May 10, 2013. Except as required by law, MRI Interventions undertakes no obligation to publicly update or revise any forward-looking statements contained in this press release to reflect any change in MRI Interventions' expectations or any change in events, conditions or circumstances on which any such statements are based.
UC Disclaimer The information stated above was prepared by MRI Interventions and reflects solely the opinion of the corporation. Nothing in this statement shall be construed to imply any support of endorsement of MRI Interventions, or any of its products, by the Regents of the University of California, its officers, agents and employees.
Contact Information
Contact Information: MRI Interventions, Inc. David Carlson CFO 901-522-9300
Study Finds Factors That May Cause Fluctuations In Deep Brain Stimulation Levels Over Time
July 11, 2013
Deep brain stimulation therapy blocks or modulates electrical signals in the brain to improve symptoms in patients suffering from movement disorders such as Parkinson’s disease, essential tremor and dystonia, but a new study suggests that several factors may cause electrical current to vary over time.
Led by Michele Tagliati, MD, director of Cedars-Sinai Medical Center’s Movement Disorders Program, the study identified variables that affect impedance – resistance in circuits that affect intensity and wavelength of electrical current. Doctors who specialize in programming DBS devices fine-tune voltage, frequency and other parameters for each patient; deviations from these settings may have the potential to alter patient outcomes.
“Deep brain stimulation devices are currently designed to deliver constant, steady voltage, and we believe consistency and reliability are critical in providing therapeutic stimulation. But we found that we cannot take impedance stability for granted over the long term,” said Tagliati, the senior author of a journal article that reveals the study’s findings.
“Doctors with experience in DBS management can easily make adjustments to compensate for these fluctuations, and future devices may do so automatically,” he added. “Although our study was not designed to link changes in impedance and voltage with clinical outcomes, we believe it is important for patients to have regular, ongoing clinic visits to be sure they receive a steady level of stimulation to prevent the emergence of side effects or the re-emergence of symptoms.”
Findings of the study – one of the largest of its kind and possibly the first to follow patients for up to five years – were published online ahead of print in Brain Stimulation. Researchers collected 2,851 impedance measurements in 94 patients over a period of six months to five years, evaluating fluctuations in individual patients and in individual electrodes. They looked at a variety of factors, including how long a patient had undergone treatment, the position of the implanted electrode, the side of the brain where the electrode was implanted, and even placement and function of contact positions along electrodes.
Medications usually are the first line of treatment for movement disorders, but if drugs fail to provide adequate relief or side effects are excessive, neurologists and neurosurgeons may supplement them with deep brain stimulation. Electrical leads are implanted in the brain, and an electrical pulse generator is placed near the collarbone. The device is then programmed with a remote, hand-held controller.
Deep brain stimulation (DBS) has proven to be a remarkable success for the treatment of many movement disorders. The dramatic video below shows what happens to Andrew “Cyber-AJ” Johnson just seconds after he turns off his Medtronic DBS unit. AJ has Parkinson’s disease and his otherwise debilitating tremors are completely eliminated once the stimulators placed in the subthalamic nucleus (STN) of his brain kick in. The obvious question that neurohackers and transhumanists are asking, though, is: What’s so special about the subthalamic nucleus?
Researchers initially hit upon the STN as a site for stimulation when studying monkeys with artificially induced movement disorders. It was known that the drug, MPTP, caused damage to the substantia nigra, the major dopamine-producing part of the brain. The STN is actually right next door to the substantia nigra, and by virtue of its interconnectedness to the motor areas of the brain was a logical site to explore. The other thing going for the STN was that the excitatory output cells there seemed to be spontaneously active — pacemakers, as some would have it. Neurons there were reliably hammering out spikes at 80 or 90 hertz, even when the monkeys seemed to be doing nothing at all.
The larger story however, is that there is nothing particularly special about stimulating in the STN for gross tremor relief. Both lesions, which eliminate STN activity, and stimulation, which presumably increases it, seem to have similar effects. Furthermore, putting the electrodes instead in any number of surrounding brain nuclei, or passing fiber tracts, seems to have similar beneficial effects.
What’s the take-home message from this for DIY neurohacking?
As we noted in one of our articles on transcranial magnetic stimulation, when there is something seriously wrong with your brain, the stimulation need not be so precise to have a beneficial effect. For example, if your response to someone extending their hand to greet you is to hemiballastically flap both arms in what best be described as a futile attempt to get airborne, any side effects of powerful STN stimulation may be tolerable. For recreational DBS, or its prescriptionless proxy, tDCS (transcranial direct current stimulation), a slightly more informed position may be desirable.
With brain stimulation, the readily observable motor effects, and the more subtle internal emotional correlates that may accompanying it, are not always easy to extricate from one another. In 1999, two middle-aged men with Tourette’s syndrome had their thalamic nuclei implanted with stimulators to curb their motor tics. Their devices were similar, one had a Medtronic 7425 pulse generator, and the other the 7428. For whatever reason, researchers ended up doing some penile plethysmography on these guys — strain gauges and all. Apparently one bloke was having man problems and had to turn off his device to complete his conjugal relations, while the other chap apparently had just the opposite problem, a little too much excitement.
Long story short, extrapolating stimulation effects from one brain to another is not always reliable. Medtronic, which currently monopolizes the DBS market, does provide for some customizability of the stimulation programs used, and the choice of electrode sites to be used. However, it remains to be seen how much power the end user will have in selecting the settings. Most devices have a current mode, and a voltage mode, and in addition to adjustable stimulation amplitude, common parameters which can be set include, pulse width, pulse width limits, rate, electrode polarity, ramp-up, and brain hemisphere chosen. That is actually a fair bit of control. We can only hope companies do not seek to patent specific programs or stimulation sequences — as that perhaps would be the height of brain stimulation absurdity. (See: Do you own your genes, or can Big Pharma patent them?)
One major problem with the existing protocol for DBS of the subthalamic nucleus is that the electrodes are destructively plunged into position from the top of the brain (pictured above). There are better ways to access this area of the brain from the bottom if a little more imagination is used. Other parts of the brain might even be accessible transsphenoidally, or through the nose, as is often used to access the pituitary region in surgery. We are not advocating DBS of the pituitary in attempt to release extra growth hormone for aspiring hoopsters, just noting that paying a little attention to cranial anatomy may be useful. For example, there are various natural sinuses close to the brain which may prove to be valuable real estate as communications relays, or other electronics depots.
In particular, the frontal sinus and the ethmoidal sinus seem to be regular structures from individual to individual, and may ultimately be co-opted into service, provided hardware does interfere with their natural function. In a fashion-aware society, a premium may for some time be put on the appearance of normalcy, and therefore using every cubic centimeter of natural space may be preferable to having the odd, bulbous, protrusion on the scalp.
Together, Butler Hospital and Rhode Island Hospital are participating in The ADvance Study, a clinical trial investigating the use of deep brain stimulation (DBS) as a treatment for patients with Alzheimer's disease. The collaborative study between the two hospitals is part of a multisite clinical trial investigating the safety and efficacy of DBS in slowing the loss of memory and cognition in patients with Alzheimer's disease, a disease which currently afflicts more than 5 million people in the US and for which there is no cure.
A device currently used to treat other brain-related conditions, DBS is often described as a 'pacemaker for the brain,' as it uses an implanted device to electronically stimulate the brain. In the ADvance Study, a pacemaker-like device is implanted beneath the skin in the patient's chest to deliver electrical pulses directly to the fornix- a part of the brain that plays a central role in memory. DBS is currently FDA approved to treat Parkinson's disease, Tourette's syndrome and resistant Obsessive Compulsive Disorder.
"Alzheimer's researchers from around the world, including those at Butler and Rhode Island Hospital, are committed to developing safe and effective treatments for Alzheimer's disease," said Stephen Salloway, MD, principal investigator for the study and director of the Memory and Aging Program at Butler Hospital. "DBS has helped transform the treatment of Parkinson's disease and we hope that stimulation of memory circuits can have a similar benefit in treating Alzheimer's disease." Salloway notes that the approach in this study differs from medications and vaccines that are being investigated for Alzheimer's disease. DBS uses a device that has already been safety-checked and FDA approved for treating other conditions and has been shown to be safe in early studies with Alzheimer's patients.
This clinical trial stems from a preliminary DBS study in six patients with Alzheimer's disease in Canada. That study found that patients with mild forms of the disease showed sustained increases in glucose metabolism, an indicator of neuronal activity, over a 13-month period. Most patients with Alzheimer's disease show decreases in glucose metabolism over the same time period.
In the double-blind clinical trial being conducted at Butler and Rhode Island Hospital, all participants will have the device implanted. Half of the participants will have the device activated in the first year, and all participants will receive active stimulation in the second year of the study. Following an initial evaluation at Butler, participants will have the device implanted at Rhode Island Hospital under the direction of Garth Rees Cosgrove, MD, chief of neurosurgery at Rhode Island Hospital, Chairman of the Department of Neurosurgery at Warren Alpert Medical School of Brown University, and Director of the Norman Prince Neuroscience Institute at Rhode Island Hospital.
"The results of the preliminary trial are very encouraging," said Dr. Cosgrove. "We have seen tremendous success in using deep brain stimulation on many of our patients with other neurological illnesses such as Parkinson's disease, and it has truly been a life-changing treatment. If we can achieve a similar response with our Alzheimer's patients then we will have the opportunity to improve millions of lives."
After the device is implanted, participants will visit Butler to have the device programmed by Victoria Chang, MD, a neurologist with expertise in DBS programming. Researchers at Butler will monitor safety outcomes and changes in memory, cognition and daily functioning with brain scans performed at Rhode Island Hospital. "This study is an example of a true collaborative effort between our two hospitals and health care systems to make progress against a devastating illness," said Dr. Salloway.
New technique for deep brain stimulation surgery proves accurate and safe
June 5th, 2013 in Neuroscience
The surgeon who more than two decades ago pioneered deep brain stimulation surgery in the United States to treat people with Parkinson's disease and other movement disorders has now developed a new way to perform the surgery—which allows for more accurate placement of the brain electrodes and likely is safer for patients.
The success and safety of the new surgical technique could have broad implications for deep brain stimulation, or DBS, surgery into the future, as it may increasingly be used to help with a wide range of medical issues beyond Parkinson's disease and familial tremors.
The new surgery also offers another distinct advantage: patients are asleep during the surgery, rather than being awake under local anesthesia to help surgeons determine placement of the electrodes as happens with the traditional DBS surgery.
A study detailing the new surgical technique is being published in the June 2013 edition of the Journal of Neurosurgery, and has been published online at the journal's website.
"I think this will be how DBS surgery will be done in most cases going forward," said Kim Burchiel, M.D., F.A.C.S., chair of neurological surgery at Oregon Health & Science University and the lead author of the Journal of Neurosurgery article. "This surgery allows for extremely accurate placement of the electrodes and it's safer. Plus patients don't need to be awake during this surgery—which will mean many more patients who can be helped by this surgery will now be willing to consider it."
DBS surgery was first developed in France in 1987. Burchiel was the first surgeon in North America to perform the surgery, as part of a Food and Drug Administration-approved clinical trial in 1991.
The FDA approved the surgery for "essential tremor" in 1997 and for tremors associated with Parkinson's disease in 2002. The surgery has been performed tens of thousands of times over the last decade or so in the United States, most often for familial tremor and Parkinson's disease. Burchiel and his team at OHSU have performed the surgery more than 750 times.
The surgery involves implanting very thin wire electrodes in the brain, connected to something like a pacemaker implanted in the chest. The system then stimulates the brain to often significantly reduce the tremors.
For most of the last two decades, the DBS patient was required to be awake during surgery, to allow surgeons to determine through monitoring the patient's symptoms and getting other conscious patient feedback whether the electrodes were placed in the right spots in the brain.
But the traditional form of the surgery had drawbacks. Many patients who might have benefitted weren't willing to undergo the sometimes 4 to 6 hour surgery while awake. There also is a small chance of hemorrhaging in the brain as the surgeon places or moves the electrodes to the right spot in the brain.
The new technique uses advances in brain imaging in recent years to place the electrodes more safely, and more accurately, than in traditional DBS surgery. The surgical team uses CT scanning during the surgery itself, along with an MRI of the patient's brain before the surgery, to precisely place the electrodes in the brain, while better ensuring no hemorrhaging or complications from the insertion of the electrode.
The Journal of Neurosurgery article reported on 60 patients who had the surgery at OHSU over an 18-month period beginning in early 2011.
"What our results say is that it's safe, that we had no hemorrhaging or complications at all—and the accuracy of the electrode placement is the best ever reported," Burchiel said.
Burchiel and his team have done another 140 or so surgeries with the new procedure since enrollment in the study ended. OHSU was the first center to pioneer the new DBS procedure, but other surgical teams across the U.S. are learning the technique at OHSU, and bringing it back to their own centers.
The positive results with the new DBS technique could have ramifications as medical researchers nationwide continue to explore possible new uses for DBS surgery. DBS surgery has shown promising results in clinical trials with some Alzheimer's patients, with some forms of depression and even with obesity.
If the early promising results for these conditions are confirmed, the number of people who might be candidates for DBS surgery could expand greatly, Burchiel said.
The length of the new surgery for the 60 patients involved in the study was slightly longer than traditional DBS surgery. But as Burchiel and his team have developed the new surgical technique, the new DBS surgeries are usually much shorter, often taking half the time of the more traditional approach. Given that, and that the electrodes are placed more accurately and the surgery is cheaper to perform, the new DBS surgery likely will be the technique most surgeons will use in coming years, Burchiel said.
DBS surgery often helps significantly reduce tremors in patients with familial tremor and tremors and other symptoms in Parkinson's disease. A parallel study is ongoing at OHSU to assess how symptoms of the patients have improved since their DBS surgery using this new method.
Provided by Oregon Health & Science University
"New technique for deep brain stimulation surgery proves accurate and safe." June 5th, 2013.
Now, as other companies advance me-too deep
brain stimulation devices in the U.S. and bring them to market in other
countries (read: St.
Jude Medical and Boston
Scientific), there’s a market opportunity for technology that can make the
newer devices different and better.
NDI has spun off a new portfolio company, Deep Brain Innovations, to do
just that. CEO Thrope said NDI has been working with Warren Grill, a professor
of biomedical engineering at Duke University, over the past several years to
identify needs of clinicians that weren’t being met by existing DBS technology.
Thrope said they saw two big opportunities: making the devices more efficient,
so that their batteries would last longer, and improving their performance.
DBS devices comprises electrodes, leads and a pulse generator that are
implanted in patients. They deliver electrical pulses to targeted areas of the
brain to block electrical nerve signals that generate PD symptoms like tremor,
stiffness, slowed movement and walking problems. Clinicians program a “dose” of
therapy by selecting the amplitude of stimulation delivered, the duration of the
pulse and the frequency of stimulation.
Grill – also the company’s chief scientific officer – has developed a fourth
dimension, enabling clinicians to control what he calls the temporal pattern of
stimulation, or the pattern of time between the pulses. Using computer models
and engineering methods, he design patterns of stimulation,like Morse code, that
maintain the device’s efficacy while making it more efficient. Deep Brain
Innovations, then, thinks it can use that technique to improve the longevity of
implanted DBS devices and reduce replacement-related risks and costs.
Over the last few years, the team has done a series of clinical studies with
thought leaders at Duke
University, Emory University and Wake Forest Baptist Medical Center that
have demonstrated effectiveness of the technique, Thrope said. Now, Deep Brain
Innovations is looking to secure a commercial partner with which it can run a
final clinical trial, complete the regulatory process and bring the device to
market within the next 24 months.
“Now what you can do is modify (a device’s) pattern through software, whether
that’s with technology already on the market or a company that’s bringing a new
product into the marketplace,” Thrope said. “We should be able to accelerate the
process of delivering this particular new therapy into the marketplace in a much
more efficient manner that if you were coming up with a totally new
therapy.”
Formed in 2012, Deep Brain Innovations is the latest spinoff of NDI, which
invests in and develops neurostimulation technologies in large markets where
there’s at least one validated product but where needs still exist. The global
market for neurostimulation devices is expected to grow rapidly, reaching
$6.8 billion within three years.
Drug treatments are often ineffective in these disorders. But what if there was a way to simply switch off a devastating tremor, or boost a fading memory?
Recent advances using Deep Brain Stimulation (DBS) in selective brain regions have provided therapeutic benefits and have allowed those affected by these neurological disorders freedom from their symptoms, in absence of an existing cure.
A pacemaker for the brain
Artificial cardiac pacemakers are typically associated with controlling and resynchronising heartbeats by electrical stimulation of the heart muscle. Schematic of deep brain stimulation. stutteringmedia
Click to enlarge
In a similar manner, DBS sends electrical impulses to specific parts of the brain that control discrete functions. This stimulation evokes control over the neural activity within these regions.
Prior to switching on the electrical stimulation, electrodes are surgically implanted within precise brain regions to control a specific function.
The neurosurgery is conducted under local anaesthetic to maintain consciousness in the patient. This ensures that the electrode does not damage critical brain regions.
The brain itself has no pain receptors so does not require anaesthetic.
Following recovery from surgery the electrodes are activated and the current calibrated by a neurologist to determine the optimal stimulation parameters.
The patient can then control whether the electrodes are on or off by a remote battery-powered device.
Deep Brain Stimulation surgery.
Turning off tremors
Perhaps the most documented success of DBS is in the control of tremors and motor coordination in Parkinson’s disease.
This is caused by the degeneration of neurons in an area of the brain called the substantia nigra. These neurons secrete the neurotransmitter dopamine. Basal ganglia circuits, including substantia nigra. Wikimedia Commons
Click to enlarge
Deterioration of these neurons reduces the amount of dopamine available to be released in a brain area involved in movement, the basal ganglia.
Drug therapy for Parkinson’s disease involves the use of levodopa (L-DOPA), a form of dopamine that can cross the blood brain barrier and then be synthesised into dopamine.
The administration of L-DOPA temporarily reduces the motor symptoms by increasing dopamine concentrations in the brain. However, side effects of this treatment include nausea and disordered movement.
DBS has been shown to provide relief from the motoric symptoms of Parkinson’s disease and essential tremors.
For the treatment of Parkinson’s disease electrodes are implanted into regions of the basal ganglia – the subthalamic nucleus or globus pallidus, to restore control of movement.
These are regions innervated by the deteriorating substantia nigra, therefore the DBS boosts stimulation to these areas.
Patients can then switch on the electrodes, stimulating these brain regions to enhance control of movement and diminish tremors.
Restoring fading memories
Recently, DBS has been used to diminish memory deficits associated with Alzheimer’s disease, a progressive and terminal form of dementia. British author Terry Pratchett has been diagnosed with Alzheimer’s Disease. Bolt of Blue
The pathologies associated with Alzheimer’s disease involve the formation of amyloid plaques and neurofibrillary tangles within the brain leading to dysfunction and death of neurons.
Brain regions primarily affected include the temporal lobes, containing important memory structures including the hippocampus.
Recent clinical trials with DBS involve the implantation of electrodes within the fornix – a structure connecting the left and right hippocampi together.
By stimulating neural activity within the hippocampi via the fornix, memory deficits associated with Alzheimer’s disease can be improved, enhancing the daily functioning of patients and slowing the progression of cognitive decline.
Deactivating addiction
Another use of DBS is in the treatment of substance abuse and drug addiction. Substance-related addictions constitute the most frequently occurring psychiatric disease category and patients are prone to relapse following rehabilitative treatment.
Understanding of the reward systems affected in addiction has created a range of treatment options that directly target dysregulated brain circuits in order to normalise functionality.
One of the key reward regions in the brain is the nucleus accumbens and this has been used as a DBS target to control addiction.
Translational animal research has indicated that stimulation of the nucleus accumbens decreases drug seeking in models of addiction. Clinical studies have shown improved abstinence in both heroin addicts and alcoholics. Diagram of a rat self-administering morphine. Wikimedia Commons
Click to enlarge
Studies have extended the use of DBS to potentially restore control of maladaptive eating behaviours such as compulsive binge eating.
In a recent study, binge eating of a high fat food in mice was decreased by DBS of the nucleus accumbens. This is the first study demonstrating that DBS can control maladaptive eating behaviours and may be a potential therapeutic tool in obesity.
Despite its therapeutic use for more than a decade, the neural mechanism of DBS is still not yet fully understood.
The remedial effect is proposed to involve modulation of the dopamine system – and this seems particularly relevant in the context of Parkinson’s disease and addiction.
DBS potentially has effects on the functional activity of other interconnected brain systems. While it can provide therapeutic relief from symptoms of neurological diseases, it does not treat the underlying pathology.
But it provides both effective and rapid intervention from the effects of debilitating illnesses, restoring activity in deteriorating brain regions and aids understanding of the brain circuits involved in these disorders.
Provided by Joseph Helpern's laboratory at MUSCAn image of tractography, a technique that tracks the movement of water molecules in the brain to create a 3-D map of its highly complex network of axons. By tracking these pathways, MUSC researchers are studying brain disorders including ADHD and Alzheimer's disease. The colors represent the direction water molecules are moving.
We now know that many disorders are physiological, not psychological
Posted: Sunday, April 14, 2013 12:01 a.m. UPDATED: Sunday, April 14, 2013 9:42 a.m.
Text size: AAA
Exhaustion weighs her down until she gets out of bed. Trudging to the shower and going down the grocery store aisles feel like a long slog through dark molasses.
By the numbers
Who are the mentally ill? They are our neighbors, friends, family — and us. Put five people in a room and one has suffered from a mental illness in the past year. One in five adults (46 million Americans) experiences mental illness each year. One in 17 suffers serious mental illness such as schizophrenia, major depression or bipolar disorder.One in 10 children lives with a serious mental or emotional disorder. The rate of mental illness is more than twice as high among those aged 18 to 25 (29.9 percent) than among those 50 and older. Less than one-third of adults and half of children with a diagnosable mental disorder receives mental health care in a given year. Half of all lifetime cases of mental illness begins by age 14, three-quarters by 24. More than 50 percent of students 14 and older with a mental disorder drop out of high school — the highest dropout rate of any disability group. 24 percent of state prisoners and 21 percent of local jail prisoners have a recent history of mental illness. 70 percent of children in juvenile justice systems have at least one mental disorder. The annual economic, indirect cost of mental illness in the U.S. is about $79 billion, mostly in lost productivity. Adults living with serious mental illness die 25 years earlier than other Americans, largely due to treatable medical conditions. An estimated 8.7 million American adults had serious thoughts of suicide in the past year. Of them, 2.5 million made suicide plans, and 1.1 million attempted suicide.
Sources: Substance Abuse and Mental Health Services Administration, National Alliance on Mental Illness, National Institute of Health, U.S. Department of Health and Human Services, National Center for Mental Health and Juvenile Justice
The heaviness caused by major depression has come and gone throughout Lisa Livingston Baker's life. And when her husband died in 2008, she could not even lift her body from her bed.
Major mental illnesses
Mental illness refers to a wide range of disorders that affect mood, thinking and behavior. More common ones include: Attention-deficit/hyperactivity disorder: Characterized by inattention, hyperactivity and impulsivity. Strong scientific evidence indicates ADHD is a biologically based disorder. Research also suggests a strong genetic basis. Bipolar disorder (formerly known as “manic-depressive disorder”): A major mood disorder in which a person experiences episodes of depression and mania (extreme irritability or euphoria). Likely caused by an imbalance of neurotransmitters or hormones. Trauma and major loss may play roles.Major depression (known as clinical depression): A combination of depressed mood, poor concentration, insomnia, fatigue, appetite disturbances, excessive guilt and suicidal thoughts. Depression is twice as common in women for reasons not fully understood. Likely caused by biological differences in the brain along with trauma or major loss. Post-traumatic stress disorder: Severe or repeated exposure to trauma can affect the brain in a way that makes a person feel like the event is happening again and again. Can induce anxiety, sleeplessness, anger or substance abuse. PTSD can affect everyone from survivors of sexual trauma and natural disasters to emergency and rescue personnel and military veterans. Generalized anxiety disorder: A severe, chronic, exaggerated worrying about everyday events. Likely caused by genetics, brain chemistry and environmental stresses. Obsessive-compulsive disorder: Obsessions are intrusive, irrational thoughts or impulses that repeatedly well up in a person's mind. Compulsions are repetitive rituals such as handwashing, counting, checking, hoarding or arranging. Evidence suggests that OCD is caused by a chemical imbalance in the brain. People whose brains are injured also can develop OCD. Panic disorder: Feelings of terror that strike suddenly and repeatedly with no warning. Symptoms include sweating, chest pain and irregular heartbeats. More common in women. Brain abnormalities, family history, major life stress and abuse of drugs and alcohol may play roles. Schizophrenia: A group of severe brain disorders in which people interpret reality abnormally. May result in hallucinations, delusions and disordered thinking and behavior. Likely caused by differences in the brain, genetic vulnerability and environmental factors that occur during a person's development. Personality disorders Borderline personality disorder: Characterized by unstable moods, interpersonal relationships, self-image and behavior. Antisocial personality disorder: A person's thinking and relating to others are abnormal and destructive, such as disregard for right and wrong, lying and behaving violently. Narcissistic personality disorder: Characterized by an inflated sense of self-importance and a deep need for admiration. Personality disorders are thought to be caused by genetic and environmental factors. Sources: National Alliance on Mental Illness, Mayo Clinic, WebMD
She blamed herself.
First in a series
The mentally ill are under pressure and scrutiny like never before. Mental health budgets have been slashed. State inpatient beds are at historic lows. Emergency rooms and jails are the new front lines of care. In the wake of mass shootings — and would-be school shooters such as Alice Boland — some want registration of the severely ill. But there is promise for change. State funding may increase. Research is showing these illnesses are based in flawed physiology, not character flaws. And many who suffer are challenging the stereotypes that affect them. The Post and Courier is examining these issues in a series of stories over the next few months. We start with the stigma and its undercurrent of shame.
The master's-educated teacher struggled to raise her three girls as she took medications and entered therapy. Books and tapes about coping amassed beneath her bed.
“I've done it all,” the Summerville mom sighed. “And how many more Lisas are out there?”
Millions. One in four adults experiences mental illness in a given year. One in 17 suffers serious mental illness such as schizophrenia, major depression or bipolar disorder, according to the U.S. Department of Health and Human Services.
And at perhaps no other time have they received more public attention than today.
Megachurch Pastor Rick Warren's son committed suicide a week ago after a long battle with major depression.
Lawmakers are debating mental health care funding, gun control and registries of the mentally ill. And last week, 9th Circuit Solicitor Scarlett Wilson voiced doubt that the state can fully rehabilitate the violent mentally ill.
What does all this attention mean for the average person with a mental illness, suffering amid a public that stigmatizes them?
Baker can't count how often she's heard:
Buck up. Get over it. Just cheer up!
“People make you feel bad about yourself — and you make you feel bad about yourself,” Baker said. “I'm not a bad person. I'm not lazy or weak. I'm a good person. I'm trying.”
She recently joined a clinical trial at the Medical University of South Carolina that administers a brain stimulation treatment based on researchers' improving knowledge of the brain as a highly complex electro-chemical organ, one that can malfunction just like any body part.
After receiving most of her treatments, Baker can laugh again. She even tackled her taxes.
And it's not just the relief. The boost proves to her that the depression is caused not by personal failure, as stigma insinuates, but rather by malfunctioning brain circuitry.
It's proof that the illness isn't her fault.
Biology trumps
Dr. Mark George trained in psychiatry and neurology. He doesn't see a distinction between the two.
Both deal with disorders caused by dysfunctional brain circuitry. So why are neurological disorders — Parkinson's disease, for instance — viewed without the stigma that clouds others like depression and bipolar disorder?
“Stigma is really hard for me to deal with. I've trained across these disciplines, and to me it's all the same,” said George, director of MUSC's Center for Advanced Imaging Research and its Brain Stimulation Laboratory.
Stigma stems from historical misunderstandings, such as when people thought the mentally ill were inherently weak-minded or evil, or when George's medical school professors taught that the brain was a fixed organ, incapable of changing and repairing itself.
Not true.
Modern imaging technology is allowing researchers to track the brain's activity and to examine its wiring, structures and tissue micro-architecture to see exactly what is going on inside a living, thinking organ.
It has revolutionized knowledge of psychiatric disorders.
“The brain is really the last frontier in medicine,” George said.
What is now clear to researchers is that malfunctioning brain circuitry, and its interplay with genetics, trauma and environmental stress, plays a major role in many illnesses, including depression, anxiety and addictions. A new mantra rising among medical professionals calls mental illnesses “brain disorders.”
“We have these powerful imaging tools so we can see all of these things,” George said. “This new understanding should make people wake up to stigma.”
For instance, when imaging showed differences in the brains of people with attention deficit hyperactivity disorder, it indicated that the problem wasn't bad parenting or a lack of discipline. It was based in physiology.
“That was huge. Imaging can add that legitimacy,” said Joseph A. Helpern, professor and vice chairman for research in radiology and endowed chair in brain imaging at MUSC.
Today, MUSC psychiatry is the largest research department in its College of Medicine, and is especially known for research of addictions and imaging techniques. And just this month President Barack Obama announced his BRAIN (Brain Research through Advancing Innovative Neurotechnologies) Initiative to map the brain's activity in unprecedented detail.
So much research promises better understanding of this final frontier, and new treatments for when its circuits malfunction.
“In mental illness and addiction, the brain is different,” said Rhonda Faughender, clinical director for adult services at Palmetto Behavioral Health System. “But we can retrain our brains.”
Which means there is hope for people like Baker.
Biology of change
Baker sits in a small room in the Institute of Psychiatry lying on what resembles a dentist's chair.
Dr. Baron Short, clinical director of MUSC's Brain Stimulation Services, positions a plastic block containing an electromagnetic coil onto the upper left area of Baker's forehead. She wears neon yellow earplugs to block out the rapid and fairly loud tapping of electrical pulses that penetrate her scalp and skull.
Brain tissue lacks pain receptors, so she can't feel where the pulses penetrate into her prefrontal cortex, the upper front area of the brain.
Coils pulse for four seconds, then quiet for 20. The sensation on her skin is irritating but not painful, Baker said, like getting snapped by a rubber band.
Transcranial Magnetic Stimulation, recently approved by the FDA for the treatment of depression, aims to rouse the prefrontal cortex. It is considered the brain's CEO, responsible for abstract thinking and regulating behavior and emotions, and it tends to be underactive in people with depression.
This underactivity, in turn, appears to affect the brain's limbic system, a primitive area often called the “feeling and reacting brain” that is important in memory formation. This area tends to be overly active in people with depression.
“We're helping the brain re-regulate itself,” Short explained.
Brain stimulation may hold promise in treating other illnesses, including addiction, which imaging indicates is another form of brain disorder. This also could change societal views of addiction — after all, when it comes to stigma, few disorders carry more shame than drug addiction, George said.
Yet it appears that some people are predisposed to addiction due to overly active brain regions that control craving and desire, while impulse-control areas are not as active. Researchers are testing ways to correct this circuitry just as they are with depression and other illnesses.
On Monday, George and a team of researchers will publish a study in the journal Biological Psychiatry that showed high-frequency TMS significantly reduced nicotine craving even in heavy smokers.
“People still think it's about bad behavior and not an illness,” George said. “But it's not you. It is a part of the brain that needs to exercise differently.”
Surviving stigma
Today, when someone is released from a psychiatric hospital, there are no sympathy cards in the mail, no meals provided by friends, no flowers or well-wishers eager to visit.
Often, there is only the suffocating silence of fear and rejection.
“We as a people don't look at mental illness as an illness. If we just pull up our bootstraps and go, we can go. And it's so untrue. It's an illness just like heart disease or cancer,” said Wanda Brockmeyer, emergency services director for Roper St. Francis Healthcare.
When Baker turned 50 recently, she cried.
“This isn't where I wanted to be,” she said. Then she reminded herself: I'm not a loser.
She wonders if others see her that way.
“Imagine if you said to a person, 'If you had only been stronger, you wouldn't have gotten cancer,'” Baker said.
She agreed to share her story here to challenge the stigma, to remind people that those with mental illness are parents, children, neighbors. And that their illnesses aren't their fault.
Reach Jennifer Hawes at 937-5563, follow her on Twitter at @JenBerryHawes or subscribe to her at facebook.com/jennifer.b.hawes.
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