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Showing posts with label transcranial direct current stimulation. Show all posts
Showing posts with label transcranial direct current stimulation. Show all posts

Thursday, March 13, 2014

TMS Relieves Symptoms in Teens With Resistant Depression

Medscape Medical News from the:

This coverage is not sanctioned by, nor a part of, the European Psychiatric Association.

Medscape Medical News > Conference News

TMS Relieves Symptoms in Teens With Resistant Depression

Daniel M. Keller, PhD

March 10, 2014

MUNICH — Repetitive transcranial magnetic stimulation (rTMS) may help relieve symptoms in teens with treatment-resistant depression, new research suggests. Researchers also found that among responders, rTMS also raised levels of the neurotransmitter glutamate in the dorsolateral left prefrontal cortex (DLPFC).

rTMS is a noninvasive intervention that uses a pulsating magnetic field applied to the scalp to induce electric currents in brain cortical neurons and thus modulate cortical excitability. Few studies have been performed on the effects of rTMS in children.

While at the University of Calgary in Alberta, Canada, Sarah Pradhan, a medical student at the Royal College of Surgeons in Dublin, Ireland, conducted a study on the effects of rTMS in the treatment of major depressive disorder in children.

Speaking here at the 22nd European Congress of Psychiatry (EPA), she said her study involved 11 patients aged 15 to 21 years (4 females, 7 males) who were resistant to previous therapies, such as selective serotonin reuptake inhibitors (SSRIs).

Study patients received rTMS at the same time each weekday for 3 weeks. They were assessed clinically at baseline and weekly during treatment, using Hamilton Depression Rating Scale (HAM-D) scores to assess depressive symptoms. Magnetic resonance spectroscopy was used to measure neurochemicals, and magnetic resonance imaging was performed.

Seven patients responded to the rTMS treatments.

There was a 62% decrease in HAM-D scores, from 25.43 to 9.57, and another 30% decrease in Children's Depression Rating Scale scores, from 74.43 to 52.14 [P = .002]," Pradhan reported. The investigators also found a 78% decrease in Hamilton Anxiety Rating Scale scores, from 23.86 ± 9.65 to 5.29 ± 3.55 (P = .001).

Table. Effect of rTMS on Depression Scores and Left DLPFC Glutamate Levels

image

Few Adverse Events

Treatment responders "had a greater than 50% decrease in Hamilton depression scores, and they had a lower pretreatment glutamate concentration," which rose in the left DLPFC with treatment, Pradhan said. "They also had clinical alleviation of depressive symptoms and anxiety symptoms."

Nonresponders had a higher baseline glutamate concentration, which decreased after treatment.

"They had comorbid social phobia," which has been linked to higher baseline glutamate levels [and] "which we think may be predictive of poor treatment response," said Pradhan.

Adverse effects were minimal. Some patients complained of scalp discomfort during the treatments. Some also had mild posttreatment headaches.

Pradhan concluded that rTMS shows promise as a safe and effective therapy for adolescent major depressive disorder. But the study was small and the technology still very experimental, so further work is needed to validate it for this indication.

But with 350 million people worldwide suffering from major depression and many resistant to current therapies, "it is important to have some other type of intervention for these people so they don't give up and so there are always alternate therapies available," she said.

Logical Connection

Session chair Anastasiya Nestsiarovich, MD, of the Republican Research and Practice Center of Mental Health in Minsk, Belarus, who was not involved in the study, called the work "high quality" with "big biological theoretical significance."

"Of course, it's doing something biologic related to glutamate metabolic [pathways]," Dr. Nestsiarovich said. "We all know that this system of glutamate is extremely important in the developing of depression, so this is logical that it is connected."

The benefits and risks for any treatment have to be weighed. In the case of rTMS in this study, the adverse effects were fairly benign.

"Any instrument, I think, has its own adverse effects, but still, it's very good that we have a choice.... We can use medications, which also have a lot of adverse effects.... Perhaps the use [of rTMS] is much more than the damage," she said.

Sarah Pradhan and Dr. Nestsiarovich report no relevant financial relationships. There was no commercial funding for the study.

22nd European Congress of Psychiatry (EPA). Session FC02. Presented March 2, 2014.

http://www.medscape.com/viewarticle/821704?src=rss

 

1 comment

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Dr. james fugedy

Dr. james fugedy|  Anesthesiology
2 days ago

Transcranial direct current stimulation (tDCS) provides similar effects to TMS, using a tiny amount of electricity from a stimulator powered by a 9 volt battery instead of magnetic induction coils. Effective for treatment-resistant depression, bipolar disorder and schizophrenia.  tDCS is safer, easier to do, without side-effects and a fraction of the cost of TMS.

http://www.medscape.com/viewarticle/821704?src=rss

Monday, July 8, 2013

Inside the incredible mind of a savant

Inside the incredible mind of a savant

Date
July 8, 2013
 
Melissa Davey
Melissa Davey
Health Reporter
Orlando Serrell.

Orlando Serrell.

When a baseball smashed into the side of Orlando Serrell's head as he made a frantic dash to first base, the then 10-year-old fell to the ground and stayed there, for several minutes.

Once he slipped out of his daze, he climbed to his feet and, with a splitting headache, continued to play the game. He did not tell his parents about the accident, so did not receive medical treatment, despite a headache that would persist for months.

Serrell had become what the scientific and medical worlds refer to as an acquired savant: someone who is perfectly ordinary until an injury to the brain, after which they possess a remarkable ability.

Serrell, from the US, was an ordinary child before he received that blow to the head on a Virginia baseball field in 1979. But one year later, when the headaches had cleared, it dawned on Serrell that he had been left with an uncanny side effect, one that has stayed with him. He could perform complex calendrical calculations in his head with dizzying speed and complete accuracy. The number of days between two dates, the number of times January 6 has fallen on a Saturday - Serrell could answer questions such as these in his head, and in an instant.

Professor Allan Snyder, Director Centre for the Mind.

Professor Allan Snyder, Director Centre for the Mind. Photo: Steve Baccon

Since the accident, he remembers things in minute detail - the outfit a friend wore on a certain day years ago, the number plate of each car that has crossed his path, his every meal.

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Serrell had become what the scientific and medical worlds refer to as an acquired savant: someone who is perfectly ordinary until an injury to the brain, after which they possess a remarkable ability, such as a photographic memory, a talent for a musical instrument despite no prior training, a sudden propensity for complex mathematical equations, the ability to sculpt or draw scale replicas of objects they've only glimpsed. Brain damage, usually to the left hemisphere, unlocks something in their brains as the right hemisphere compensates for the injury. The result is, very rarely, great skill, unfathomable to the ordinary person.

Not all savants acquire their skill - some are born with these abilities and are known as ''classical savants''. They usually fall somewhere on the autism spectrum and their skills tend to appear in early childhood. Classical savants may have great difficulty carrying out seemingly ordinary tasks such as social interaction or tying shoelaces, but despite this, possess remarkable talent in a specific area.

But what if these skills could be unlocked in ordinary people without having to inflict damage to the brain? Founder of the Centre for the Mind at the University of Sydney, Dr Allan Snyder, a neuropsychologist, is working to unlock extraordinary potential in ordinary minds. It is an area he has been investigating since the early 1990s.

''I had a radical idea that these skills must be latent within everyone,'' Snyder says. ''It's just that unlike savants, we don't have access to them.

''I thought maybe I could release it myself by decreasing the influence of the left brain hemisphere and enhancing the right.''

Savants are exceedingly rare, and Snyder says he is unaware of any acquired savants living in Australia. While estimates vary, it is thought about 10 per cent of the autistic population possess savant abilities, compared with less than 1 per cent of the rest of the population. Male savants outnumber females by about 6:1. Savants have a range of abilities. Some can speak dozens of languages, learning them at a rapid pace. Others are exceptional painters, sculptors and drawers. Many have memory skills that allow them to memorise telephone books. Their skills seem so remarkable because they would take years to learn, or seem impossible, for an ordinary person.

''I was inspired by the fact that music, art, mathematics and even memory are taken by many to be an exceptional ability in humans requiring laborious hours of study and training,'' Snyder says.

''And yet here, we have a group of people without a bigger or better brain than we do, just a different one, able to do these things.''

Snyder's first attempts to bring out the latent savant skills in his subjects were ''not so successful''. He and his researchers used magnetic pulses on participants' brains to temporarily make the area underneath the pulses less inhibited; in other words, simulating a lesion or damage.

''That was our first experiment,'' Snyder says. ''The results were good, but not brilliant. They were constant, but not enormous, people didn't suddenly show any enormous savant skills.''

Then, he turned to transcranial direct-current stimulation, where non-invasive and weak electrical currents are applied to the brain. It is considered safe, and is used as a treatment for conditions such as migraines and depression. Using this method, Snyder can make the networks of neurons near the surface of the brain less likely to fire. An electrode is placed on each side of the heads, over the anterior temporal lobes just above the ears.

A weak electric current then passes between the electrodes. The dose given, Snyder says, changes the behaviour of the underlying neurons in participants for about an hour. His experiments have shown during that 60-minute window that people are able to solve arithmetic problems that would ordinarily stump them.

During one experiment, 33 participants were asked to solve the notoriously difficult nine-dots problem, the goal being to connect all nine dots in a square formation using four straight lines, without lifting pen from paper. In the laboratory, Dr Snyder says, about 5 per cent of participants manage to solve it, even with hints and added time. In his experiment group, no participant could solve it. After receiving the stimulation, however, 14 of them cracked it. Snyder and his researchers calculated that the probability they had gone on to solve it by chance was less than one in a billion. The results were published in the journal Neuroscience Letters last year.

''We go through a rigorous scientific protocol to separate placebo affects from real affects,'' Snyder says. ''I'm really very confident there's no way this ability could be due to any other affects other than the stimulation.''

What had stopped participants from solving the problem initially was that people have rigid mindsets, researchers suspect, which make them less receptive and even resistant to novel interpretations and ideas. In a piece he wrote for Scientific American last November, Snyder describes prior learning and experience as shaping the way we see the world and allowing for mental short cuts. While these mental filters mean our minds are more conceptual, the savant mind, Snyder says, is more literal, their mental filters less powerful. As an example, he describes a savant who, when asked about the ending of a book, recited the last page word for word.

''We look at the world through filters, through our mindsets, which are carefully evolved to be able to manoeuvre rapidly in our world,'' Snyder says.

''We see the forest, not the trees. Savants see the trees, not the forest. It's why savants do very badly in tests where you ask them things like, 'What does it mean by the grass is always greener on the other side?' They want to interpret it literally.''

Genius is a word that gets used a lot when describing savants. To acquire an injury one day and be able to play the piano, or draw scale replicas of buildings seen only once the next is, in fact, extraordinary. But Snyder wonders if the word genius is quite right to describe these skills.

''Our brains are deliberately designed not to have access to peculiar skills, which in some instances are advantageous but mostly are bizarre,'' he says.

''The classical image of a savant, to me, is a person who has an ability to mimic things extraordinarily quickly and with detail. But a memory for licence plates, or knowing what dates a Saturday falls on - what kind of memory is that? It is a memory without meaning.

''We have the same memory power as savants do, their brains aren't bigger or better than ours. It's just more of our memory is devoted to conceptual detail, and more of theirs is devoted to literal details.''

So what would be the point of bringing these latent skills out in ordinary people, and finding a way of doing so that doesn't injure, but merely suppresses, neurons in the left hemisphere of the brain? Snyder refers to the nine-dots problem again. It was only when participants had their pre-existing prejudices dampened that they were able to solve the difficult task by coming at it in a different way. Imagine the seemingly impossible problems that could be solved and the different ways of seeing the world there could be, Snyder says, if we could break down these prejudices in everyone. Even just temporarily.

''Opening the doors of perception to be able to look at the world without prejudice, just for a moment, would be of enormous value,'' Snyder says. ''This technology we have, and the interaction between technology and the mind - if this could be perfected, then perhaps problems like nine dots are just the tip of the iceberg.''

The uniqueness of savants is what makes them so fascinating, and Snyder hopes that someday anyone will have access to the kind of technology he is experimenting with.

But if savant-like skills become something that could be induced in anyone, would it be unfair? Would it take the intrigue away from skills once seen as unique and unfathomable?

On this point, Snyder is focused firmly on the greater good. ''If I gave you a pill to increase intellectual ability, would you think it was cheating if you got a Nobel prize for curing cancer as a result of taking that pill?''

Beautiful minds

Alonzo Clemons

Colorado, US

A brain injury when he was a child left Clemons with an IQ of between 40 and 50. But he was also left with the ability to sculp animals out of clay to incredible detail and at great speed, only needing to see an animal briefly to create a replica. He has shown his work at galleries and some have sold for tens of thousands of dollars.

Daniel Tammet

London, England

Tammet (below) is unique in that he is a high-functioning savant. While many autistic savants lack the ability to describe how they think, Tammet has documented the workings of his mind through a series of books, including the autobiographical Born on a Blue Day. He can learn a language in one week and performs calculations to 100 decimal places in his head.

Leslie Lemke

Wisconsin, US

Lemke was born with brain damage and glaucoma, which left him blind. He was 15 before he learnt to walk. But at the age of 16, his adoptive mother found him playing Tchaikovsky's Piano Concerto No.1 after he had heard the piece once on television. Lemke can play all musical styles and is considered a musical prodigy, able to play a song after hearing it once, as well as composing his own pieces.

Gilles Trehin

Nice, France

Trehin is an autistic savant who has created hundreds of maps and drawings of an imaginary French city, which he calls Urville. He has devoted his life to documenting Urville through maps and drawings of the city, which he says has a population of 12 million and is the capital of a large island province. He has published books devoted to it.

http://www.dailylife.com.au/lifestyle/inside-the-incredible-mind-of-a-savant-20130709-2pmzg.html

Tuesday, July 2, 2013

Deep brain stimulation: The bleeding edge of neurohacking and transhumanism

Deep brain stimulation: The bleeding edge of neurohacking and transhumanism

Deep-brain-stimulation

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.

Subthalamic

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.

DBS Electrode

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.

SinusIn 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.

http://www.extremetech.com/extreme/160203-deep-brain-stimulation-the-bleeding-edge-of-neurohacking-and-transhumanism

Thursday, May 16, 2013


Electrical Stimulation Might Improve The Brain's Capacity For Math  


Alice G. Walton










Alice G. Walton, Contributor
I cover health, medicine, psychology and neuroscience.
 
5/16/2013 @ 1:47PM |5,189 views        

English: Phillippine stock market board
(Photo credit: Wikipedia)
 
For people who aren’t so good at math, a mild form of brain stimulation may improve your proficiency. The relatively new form of electrical stimulation is apparently gentler than previously tested methods, so you don’t feel as much like your head is being zapped. And a new study, carried out by a team at the University of Oxford, has implications not only for math, but possibly for “stimulating” other types of cognitive skills. Since math ability relies on fairly high-level cognition, the authors suggest that applying it to lower-level ones will be, well, a no-brainer in the end.

In previous research, Oxford’s Roi Cohen Kadosh and colleagues had found that a form of brain stimulation called transcranial direct current stimulation (TDCS), which places electrodes on the skull, helped people learn and remember a novel set of numbers. This form was effective at improving certain math skills, but not always pleasant for the subject, and came with some adverse effects.


But the new study uses a different form of stimulation, known as transcranial random noise stimulation (TRNS), which applies randomly fluctuating currents (within certain parameters) to the head. According to Cohen Kadosh, the nice part is you don’t feel any of its brain stimulating action. In the study, he and colleagues focused on an area of the brain called the left dorsolateral prefrontal cortex (DLPFC), which has been strongly implicated in our ability to play with numbers in our heads.
 

As they were undergoing the stimulation, 25 Oxford students complete numbers tasks involving bizarre calculations: for example, 4 # 12 = 17. They did these for five days, and improved over time. The control group received sham stimulation while learning the new math. At the end of the training period, the participants who’d received TRNS were significantly faster at doing the calculations than the control group – and these changes seemed to persist over time.

“With just five days of cognitive training and noninvasive, painless brain stimulation, we were able to bring about long-lasting improvements in cognitive and brain functions,” says Cohen Kadosh. When students were called back to the lab six months later, they TRNS group was still 28% faster at solving the problems.

So what exactly is the TRNS doing to the brain to account for these improvements? The authors were interested in illustrating just this, so they tracked various measures of brain metabolism in the TRNS group and the controls. What they found was fascinating: blood flow in the area was actually reduced in the TRNS group, but oxygen consumption was not. This suggests that brain cells were working more efficiently, firing more with more synchronization, which could be the main effect of TRNS. If electric “noise” is reduced, the authors explain, it would mean that less blood flow is required for the same amount of brain activity.

The results of this study might be far reaching. In addition to the 5-7% of the population who suffers from dyscalculia (the numbers form of dyslexia), about 20% of school-age children have significant problems in math. This technique might help them gain better skills. It might also be applied, in different ways, to the great number of people who have various cognitive problems due to neurodevelopmental disorders or neurodegenerative diseases.

“Maths is a highly complex cognitive faculty that is based on a myriad of different abilities,” Cohen Kadosh says. “If we can enhance mathematics, therefore, there is a good chance that we will be able to enhance simpler cognitive functions.”

While TRNS hasn’t been associated with any adverse effects, TDCS, mentioned earlier, has recently been linked to certain adverse neurological effects, by Cohen Kadosh and his team themselves.

Future research will have to assess whether any costs come along with TRNS, as well as how long the beneficial effects really last.

It’s exciting, if a little troublesome, to think about the applications that might exist with this type of stimulation. If you’re preparing for a test or about to do your tax refund, will you be able to go to your local stimulation center for a little pre-event zap? Will mild brain stimulation be the new Adderall? Hopefully it will be reserved for people with documented math disabilities or brain disorders, but time will tell what the applications may be.

Wednesday, May 15, 2013

'Good Vibrations:' Brain Ultrasound Improves Mood


'Good Vibrations:' Brain Ultrasound Improves Mood



May 15, 2013 — Non-invasive brain stimulation techniques aimed at mental and neurological conditions include transcranial magnetic stimulation (TMS) for depression, and transcranial direct current (electrical) stimulation (tDCS), shown to improve memory. Transcranial ultrasound stimulation (TUS) has also shown promise.
Ultrasound consists of mechanical vibrations, like sound, but with frequencies far greater than the upper limit of human hearing, around 20 thousand to 20 million cycles per second (20 kilohertz to 20 megahertz). Ultrasound vibrations penetrate bodily tissue including bone, and are widely used to image anatomical structures via echo effects, e.g. visualizing unborn babies in mothers' wombs, and organs, blood vessels, nerves and other structures in medical procedures. Virtually every part of the body, including the brain, has been safely imaged with low to moderate intensity ultrasound.

High intensity, focused ultrasound can damage tissue by heating and cavitation, and has been used to ablate tumors and other lesions. 'Sub-thermal' ultrasound can safely stimulate neural tissue. In 2002 a UCLA group led by Alexander Bystritsky noticed beneficial side effects in psychiatric patients whose brains were imaged by TUS. A team led by Virginia Tech's W. Jamie Tyler has shown TUS-induced behavioral and electrophysiological changes in animals. A Harvard group led by S-S Yoo has used focused ultrasound aimed at mouse motor cortex to wag the mouse's tail. But clinical trials of TUS aimed at human mental states have been lacking.

Now, in an article in the journal Brain Stimulation, a group from the Departments of Anesthesiology and Radiology at the University of Arizona Medical Center in Tucson, Arizona has investigated TUS for modulating mental states in a pilot study in human volunteers suffering from chronic pain. A clinical ultrasound imaging device (General Electric LOGIQe) was used, with the ultrasound probe applied at the scalp overlying the brain's temporal and frontal cortex (visible on the imaging screen). In random order, each subject received two 15 second exposures: sham/placebo, and 8 megahertz ultrasound (undetectable to subjects). Following exposure, subjects reported (by visual analog scales) significant improvement in mood both 10 minutes and 40 minutes after TUS, but not after sham/placebo. In a followup study (led by University of Arizona psychologists Jay Sanguineti and John JB Allen) preliminary results suggest 2 megahertz TUS (which traverses skull more readily) may be more effective in mood enhancement than 8 megahertz TUS.

The mechanism by which TUS can affect mental states is unknown (as is the mechanism by which the brain produces mental states). Tyler proposed TUS acts by vibrational stretching of neuronal membranes and/or extracellular matrix, but two recent papers from the group of Anirban Bandyopadhyay at National Institute of Material Sciences (NIMS) in Tsukuba, Japan (Sahu et al. [2013] Appl. Phys. Letts. 102, 123701; Sahu et al [2013] Biosensors and Bioelectronics 47:141) have suggested another possibility. The NIMS group used nanotechnology to study conductive properties of individual microtubules, protein polymers of tubulin (the brain's most prevalent protein). Major components of the neuronal cytoskeleton, microtubules grow and extend neurons, form and regulate synapses, are disrupted in Alzheimer's disease, and theoretically linked to information processing, memory encoding and mental states. Bandyopadhyay's NIMS group found that microtubules have remarkable electronic conductive properties when excited at certain specific resonant frequencies, e.g. in the low megahertz, precisely the range of TUS.

Dr. Stuart Hameroff, lead author on the new TUS study, said: "This suggests TUS may stimulate natural megahertz resonances in brain microtubules, enhancing not only mood and conscious mental states, but perhaps also microtubule functions in synaptic plasticity, nerve growth and repair. We plan further studies of TUS on traumatic brain injury, Alzheimer's disease and post-traumatic stress disorders. 'Tuning the tubules' may help a variety of mental states and cognitive disorders."

http://www.sciencedaily.com/releases/2013/05/130515094825.htm

Wednesday, April 17, 2013

'Pacemakers for brain' offer new treatment options for depression at N.J. center


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'Pacemakers for brain' offer new treatment options for depression at N.J. center
April 17, 2013
By Maiken Scott @maikenscott

A new University of Medicine and Dentistry of New Jersey center in Cherry Hill offers a slew of cutting-edge options for people with depression and anxiety who have not responded to medications, or can't tolerate the side effects.

At the Center for Mood Disorders and Neuromodulation Therapies, psychiatrist John O'Reardon reclined on a comfy chair to test a transcranial magnetic stimulation machine. When a patient is in the chair, a wand hovers close to their head and delivers weak electric currents to jolt specific regions of the brain into action.

The center specializes in different forms of brain stimulation techniques, which director O'Reardon likens to advances in another medical field.

"This is the same as cardiology ... cardiology had medications, but they didn't have pacemakers or stents," explained O'Reardon. "Once they had devices for the heart, they advanced greatly. These are devices for the brain -- they are pacemakers for the brain."

Different types of brain stimulation, under study since the mid-'90s, have shown strong results in treating those with severe depression, anxiety, and obsessive compulsive disorder. TMS, which as been approved by the Food and Drug Adminstration, is covered by Medicare and some insurance companies.

These treatments have a major advantage compared with medications; they have no side effects.
"The brain is like a large soup the medications go into, and they go everywhere and they give you side effects," O'Reardon said. "Here, we are targeting just 1 centimeter on the cortex."

In addition to offering a variety of brain stimulation treatments, the center also will conduct research studies.

O'Reardon is currently testing the effectiveness of an at-home device for TMS called Synchronized TMS. A patient comes in for an EEG; the levels on the device are set accordingly; then the patient takes it home and comes back for monitoring, he explained. O'Reardon says that trial will be complete in three months.

The center also offers a treatment called transcranial direct current stimulation or tDCS, which has shown promising results in several research studies.

Going forward, O'Reardon said, these new approaches will become more widely available to people suffering from mental illness. "The hope is to have a suite of devices, and that everybody can get better," he said.

The center at 2250 Chapel Ave. West, Cherry Hill, will host an open house Friday from 11 a.m. to 1 p.m.

http://www.newsworks.org/index.php/health-science/item/53672-new-treatment-center-offers-cutting-edge-options-for-people-affected-by-depression?Itemid=3

Friday, December 14, 2012

[Will electroconvulsive therapy disappear in the near future?].

2012;114(10):1208-15.

[Will electroconvulsive therapy disappear in the near future?].

[Article in Japanese]

Source

Department of Neuropsychiatry, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi.

Abstract

Electroconvulsive therapy (ECT) has been widely used, with some modification of its methods, for the treatment of refractory mental disorders. In Japan, brief-pulse ECT was approved in 2002 under conditions that well-trained psychiatrists should administer ECT and that modified ECT is mandatory. However, unmodified ECT is still often performed in Japan. We have to improve safety of ECT further. Major indications for ECT are depression and catatonia. Mechanisms of ECT are still unknown, but the neurogenesis hypothesis is promising. Furthermore, several brain stimulation techniques without seizure induction, such as transcranial magnetic stimulation, vagus nerve stimulation, deep brain stimulation and transcranial direct current stimulation, have been introduced for the treatment of refractory mental disorders. Ethical criteria must be determined for further research and treatment with these techniques.
PMID:
23234202
[PubMed - in process]

http://www.ncbi.nlm.nih.gov/pubmed/23234202

Tuesday, October 30, 2012

Electric brain stimulation gains ground


Electric brain stimulation gains ground

NEUROLOGY Electric stimulation under study to treat brain trauma from stroke to Parkinson's and even dementia

Victoria Colliver

Published 5:15 p.m., Tuesday, October 30, 2012
 
Dr. Emily Kappenman (left) prepares psychologist Michael Callaghan for transcranial direct current stimulation. Photo: Sarah Rice, Special To The Chronicle / SF
Dr. Emily Kappenman (left) prepares psychologist Michael Callaghan for transcranial direct current stimulation. Photo: Sarah Rice, Special To The Chronicle / SF


Dr. Marom Bikson, who developed the transcranial direct current stimulation device, demonstrates the product at the Highland Hospital workshop. Photo: Sarah Rice, Special To The Chronicle / SF
Dr. Marom Bikson, who developed the transcranial direct current stimulation device, demonstrates the product at the Highland Hospital workshop. Photo: Sarah Rice, Special To The Chronicle / SF

 
Internist Kim Wood from Joplin, Mo., watches Marom Bikson demonstrate how to use the device. Photo: Sarah Rice, Special To The Chronicle / SF
Internist Kim Wood from Joplin, Mo., watches Marom Bikson demonstrate how to use the device. Photo: Sarah Rice, Special To The Chronicle / SF

Applying a current of electricity through the brain conjures up the kind of nightmare-inducing seizures immortalized in the 1975 film adaption of Ken Kesey's "One Flew Over the Cuckoo's Nest."
But a kinder, gentler, almost imperceptible form of electric brain stimulation - an experimental approach known as transcranial direct current stimulation - is gaining traction as a promising therapy for brain injuries due to stroke or other traumas, depression, dementia, attention-deficit disorder and other conditions.
Transcranial direct current stimulation, or tDCS, bears little in common with electroshock therapy or invasive forms of deep brain stimulation, which involve drilling holes in the head and implanting electrodes.
The level of the current used is tiny - typically between 1 and 2 milliamps, or less than one-one-hundredth of a single electrical watt. At most, the current causes a tingling or slight itching, if it's felt at all.
Even the technique's staunchest defenders acknowledge that the idea of treating a broad range of disorders with something you can hardly feel and that has few, if any, side effects sounds more like snake oil than science.
"How could this do anything? It seems so small. We're talking about a few volts," said Marom Bikson, associate professor of biomedical engineering at City University of New York who co-founded Soterix Medical Inc., a company that holds patents to Bikson's transcranial direct current stimulation devices.
Jolt to the brain
But Bikson said studies have shown a few volts of current can change the rate at which a brain cell fires in a way that is believed to improve brain plasticity, or its ability to change and learn new things.
"It's not some magical, unknown hocus-pocus," he said.
The concept is fairly simple: After dampened electrodes are strapped to a patient's scalp, a device charged by a 9-volt battery - the kind used in transistor radios - delivers a small current to change the activity in targeted regions of the brain.
The current, which is typically delivered for 10 to 30 minutes over multiple sessions, is thought to be able to excite or inhibit the brain's neurons in the stimulated area.
A positive current could help people with depression, stroke or other brain traumas, while a negative current may be helpful for such conditions as epilepsy or language recovery. Both currents can be used at the same time, and the effects of the stimulation are thought to continue or even increase, even after the device has been turned off.
Transcranial direct current stimulation has been used in a small number of hospitals - mostly on the East Coast - since about 2000 but has not been approved by the U.S. Food and Drug Administration. Soterix and other manufacturers plan to seek FDA approval for the devices once enough research has been done.
Earlier this month, Bikson was part of a research team that demonstrated the technique for doctors, therapists and other health experts during a one-day workshop at Alameda County Medical Center's Highland Hospital in Oakland.
Getting the word out
Dr. Lance Stone, medical director of rehabilitation and restoration at the county's Fairmont Hospital in San Leandro, was introduced to the technique earlier this year and invited the researchers to give his colleagues and other specialists the opportunity to learn more about it.
Stone is interested in the device's use in the emerging field of neurorehabilitation, which teaches or retrains patients with nervous system injuries such as stroke, Parkinson's disease or other brain trauma.
"There seems to be countless potential applications (of the technique) for acquired neurological disorders, but the main ones seem to be primarily pain, motor recovery and depression," said Stone, who plans to apply for a research grant to study the device.
The concept of using electrical stimulation for health purposes dates back thousands of years to the Greeks, whose medical practitioners were said to use electric eels in water to reduce symptoms of arthritis and other types of pain.
Modern usage of electroconvulsive therapy, formerly known as electroshock therapy, has been controversial, dating back to its early use in the 1940s and '50s in psychiatric hospitals. While it has been making a bit of a lower-voltage comeback in patients with severe depression, the method is generally considered a last resort because of the risk of memory loss and other side effects.
Trials and studies
Transcranial direct current stimulation has been around for decades, but the technique earned interest in the 1990s and early 2000s after some European physicians published promising results of the work. Currently it's the subject of numerous ongoing clinical trials and studies in this country.
In 2010, a team of Oxford University scientists published a small study that showed tDCS improved math skills in the majority of participants.
That same year, researchers at Beth Israel Deaconess Medical Center in Boston published findings that showed that the motor skills of stroke patients treated with the device, along with physical and occupational therapy, improved threefold compared with those who received a placebo form of stimulation and the same amount of physical and occupational therapy.
But some health experts warned that the technique's safety and effectiveness are unknown and that larger, controlled human clinical trials are needed.
"Whenever you do something - whether it's swallowing a drug or applying current - there may be a downside," said Dr. Sidney Wolfe, director of Public Citizen's Health Research Group, a consumer and health advocacy lobbying organization.
Sounds promising
Wolfe said the device sounds promising and is the subject of a myriad of clinical trials but shouldn't be approved until the larger, controlled studies are conducted. "The variety of medical problems for which they are trying this is enormous, and in most of the studies the number of patients is so small it's not statistically significant," he said.
Dr. Dylan Edwards, director of the Non-Invasive Brain Stimulation and Human Motor Control Laboratory at Burke Medical Research Institute in White Plains, N.Y., agreed that further research is needed to answer many of the unknown questions. His institute received a $3.5 million grant from the National Institutes of Health to study the device's effectiveness in stroke patients.
"The brain is an electrical organ," said Edwards. "What we're trying to do is develop methods that interfere with brain activity in a targeted way and positively influence it."
Edwards said several companies in the United States and around the world are already making transcranial direct current stimulation devices and he expects more.
Part of the appeal of the device is that it is relatively low cost - retailing for about $800. In addition, it's portable, so it can be used in many different settings.
Using on patients
Some doctors and researchers who attended the recent workshop had no experience using the device, while others had already tried it on a few patients. The device, which is considered investigational by the U.S. Food and Drug Administration, can be used either as part of a clinical trial or by a medical doctor for specific cases.
UC Berkeley psychologist Ludovica Labruna has experimented with using the device for language acquisition - to see if subjects could learn languages more quickly after receiving tDCS sessions. But she said her results have been somewhat disappointing, and she's not sure if she's using the device correctly.
"TDCS looks so simple, but it's really not so simple to apply because there are so many variables," Labruna said. "You really need to be trained."
Similar concerns drew Emily Kappenman to the workshop.
Kappenman, a postdoctoral researcher at UC Davis' Center for the Mind and Brain, said she's interested in the device's potential for working with patients with anxiety. She said she's tried it to see whether it helps people become less distracted and anxious by moving their attention away from certain emotions.
"It's hard to tell if it's working yet or if we're using optimal levels," she said. "It's hard to know what's best."
Brain stimulation
Brain stimulation uses magnetic or electrical energy to improve brain function. Here are some of the techniques in use or being studied:
Electroconvulsive therapy (ECT): With ECT, an electric current passes briefly through the scalp to the brain, inducing a seizure. It's generally considered only for those with severe depression or other serious mental illnesses who do not respond to other treatments.
Transcranial magnetic stimulation (TMS): TMS uses wrapped coil wires to generate electric current throughout the scalp and can induce involuntary movements. Although it has a few potentially serious side effects, including seizures, the treatment received federal approval for patients with severe depression in 2008.
Transcranial direct current stimulation (tDCS): Weaker still than TMS, tDCS has not been approved, but researchers are studying its use to help patients with strokes and other brain injuries. It has also been considered for use in healthy subjects, with researchers testing everything from memory enhancement to improved golf swing.
Source: Chronicle research
Victoria Colliver is a San Francisco Chronicle staff writer. E-mail: vcolliver@sfchronicle.com
 

Sunday, June 3, 2012

Treatment-resistant depression: therapeutic trends, challenges, and future directions.

Patient Prefer Adherence. 2012;6:369-88. Epub 2012 May 1.

Treatment-resistant depression: therapeutic trends, challenges, and future directions.

Source

Medical College, King Saud Bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia.

Abstract

BACKGROUND:

Patients with major depression respond to antidepressant treatment, but 10%-30% of them do not improve or show a partial response coupled with functional impairment, poor quality of life, suicide ideation and attempts, self-injurious behavior, and a high relapse rate. The aim of this paper is to review the therapeutic options for treating resistant major depressive disorder, as well as evaluating further therapeutic options.

METHODS:

In addition to Google Scholar and Quertle searches, a PubMed search using key words was conducted, and relevant articles published in English peer-reviewed journals (1990-2011) were retrieved. Only those papers that directly addressed treatment options for treatment-resistant depression were retained for extensive review.

RESULTS:

Treatment-resistant depression, a complex clinical problem caused by multiple risk factors, is targeted by integrated therapeutic strategies, which include optimization of medications, a combination of antidepressants, switching of antidepressants, and augmentation with non-antidepressants, psychosocial and cultural therapies, and somatic therapies including electroconvulsive therapy, repetitive transcranial magnetic stimulation, magnetic seizure therapy, deep brain stimulation, transcranial direct current stimulation, and vagus nerve stimulation. As a corollary, more than a third of patients with treatment-resistant depression tend to achieve remission and the rest continue to suffer from residual symptoms. The latter group of patients needs further study to identify the most effective therapeutic modalities. Newer biomarker-based antidepressants and other drugs, together with non-drug strategies, are on the horizon to address further the multiple complex issues of treatment-resistant depression.

CONCLUSION:

Treatment-resistant depression continues to challenge mental health care providers, and further relevant research involving newer drugs is warranted to improve the quality of life of patients with the disorder.
PMID:
22654508
[PubMed - in process]
http://www.ncbi.nlm.nih.gov/pubmed/22654508

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