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Thursday, March 28, 2013

MSU Professor on Lies and the Human Brain

MSU Professor on Lies and the Human Brain

Julian Keenan of Montclair State University’s Biology and Psychology departments talks about research and how parts of the brain can be turned off to prevent lying.

Whether you are young or old, everyone tells lies in one way or another on a daily basis.
Of course, there are all sorts of different lies — white lies, exaggerations, delusions, deceptions — and some are worse than others. But regardless of the what kind of lie it is, the same parts of the brain are used in manufacturing the fabrication.

As April Fool’s Day approaches, Montclair Patch decided to talk with professor Julian Keenan of Montclair State University’s Biology and Psychology departments about the science of lies.

A portion of the conversation is below.

What kind of research have you done on the topic of lying?
Keenan: We are looking at what areas of the brain are involved in deception, and the lying we are most interested in is the lying people do to themselves or what goes on in your brain when you are telling yourself that you are better than you are, smarter than you are, funnier than you are.

So you can see specific parts of the brain becoming active when someone is telling a lie?
Keenan: Yes, but unfortunately the brain works like that for a lot of different things. So at Montclair State, we use a machine called transcranial magnetic stimulation, or TMS, which is able to block certain types of the brain from functioning for a brief amount of time — a fraction of a second.
So we ask people questions and ask them to lie. If we are focusing on the right part of the brain using TMS, they won’t be able to lie.

How then do you turn those parts of the brain off?
Keenan: This is the part where people really become interested.

The TMS machine is placed up against the skull and you can target a part of the brain as small as 1 centimeter by 1 centimeter. It turns off parts of the brain by creating a magnetic field and makes all the cells in that small area of the brain work at once. When all the cells work at once, they don’t work at all, which creates a virtual lesion.

The uses for TMS seem ideal for interrogations and intelligence gathering, no?
Keenan: I could care less about that stuff, but yes, some people are using TMS for interrogation purposes.

Is the technology being used widely by law enforcement? 
Keenan: It is being used widely. The problem is that it is not reliable enough, and not immiscible in court.

What else have you found in your research about lying?
Keenan: People love to tell themselves lies. We found what people throughout time have found: People lie to themselves all the time. The brain is not very concerned with reality; the brain is concerned about making you feel better.

Is it natural for us to lie then?
Keenan: Absolutely. Lying is healthy and a sign of high intelligence.

Kids are lying by the age of 2. And while 2-year-olds are horrible liars, kids usually begin lying well enough to get away with it by the age of 5.

Is lying tied to self-esteem then?  
Keenan: Yes. The more we lie to ourselves, the better we feel.

People with clinical depression are more based in reality than people without depression, because they see the world as it really is by lying to themselves less.

http://maplewood.patch.com/articles/msu-professor-on-lies-and-the-human-brain

MRI-guided brain surgery easier on Parkinson’s patients



             

MRI-guided brain surgery easier on Parkinson’s patients

Published March 25, 2013
 
Clear-Point.jpg
 
For patients with advanced Parkinson’s disease, getting deep brain stimulation, a sort of “pacemaker” for the brain, can dramatically reduce their debilitating symptoms, including tremors, rigidity, stiffness, slowed movement and walking problems.

Since 2002, more than 70,000 patients have undergone deep brain stimulation (DBS) surgery to treat their symptoms.

Yet, the brain surgery is about eight hours long and difficult for patients, who have to be awake through some of the operation. Not only that, but Parkinson’s patients have to go off their medications before the surgery, often causing them much pain and discomfort.

“The thought of being awake and having brain surgery is stressful for patients,” said Dr. Hooman Azmi, director of the division of movement disorders at Hackensack University Medical Center in New Jersey. “I’ve had patients who are just so worried about it that they don’t want the surgery or there are patients that just never go to surgeons because of these fears."

Over the last two years, brain surgeons have begun using a new computer-driven surgical system to reduce these drawbacks of the surgery and to improve the accuracy of the procedure. The new system, called ClearPoint, uses magnetic resonance imaging (MRI) during the surgery (it’s done in the MRI suite, not the OR) to precisely pinpoint the target for the pacemaker in real time.

Traditionally, the surgery is done through a small burr hole and is based on images taken before surgery and “stereotactic” techniques, which provide a 3-D coordinate system and brain mapping to help hit the target as precisely as possible. A “lead” or thin, insulated wire is implanted in the brain and the tip of the wire is within the targeted area, which is about the size of a pea (the battery pack is typically implanted under the skin near the collarbone).

“The benefits of the surgery depend on how accurately we place it, and the side effects depend on our accuracy as well,” Azmi said.

Because the brain can shift ever so slightly, surgeons need the patient’s feedback from the electrical activity of the brain to be sure they’ve hit their target—that’s why patients need to be woken up during the surgery. The operation can take eight hours because it requires extensive brain mapping and waking the patient out of their anesthesia. The reason patients have to go off their medications is because the drugs mask the symptoms. Surgeons need patients to experience the symptoms in order to tell if the DBS wire is accurately positioned to reduce them.

With ClearPoint, the surgeon uses MRI images taken during surgery to visualize the brain and see the precise target during the surgery. Because of this precision, there’s no need to wake the patient during surgery and patients can stay on their medications because the surgeon no longer needs to “test” whether they’ve hit their target.   The procedure takes about half the time.

“Surgery is safer because it’s shorter; the patient is more comfortable, (and) we can see the wires going in," Azmi said.  "If there’s any bleeding we could see it."

The system, which is being used in 18 medical centers in the U.S., can also be used to treat other movement disorders treated by DBS such as essential tremors and dystonia, which causes muscle contractions.

http://www.foxnews.com/health/2013/03/25/mri-guided-brain-surgery-easier-on-parkinsons-patients/

Tuesday, March 26, 2013

Noninvasive, Hand-held Device Promising for Migraine

Noninvasive, Hand-held Device Promising for Migraine

Caroline Cassels

Mar 26, 2013
                                                                                               
San Diego, California — Noninvasive vagus nerve stimulation (nVNS) using a portable, hand-held device may offer an effective, well tolerated, and safe treatment for acute migraine, preliminary research suggests.

A small, open-label pilot study conducted by investigators at the University of Southern California San Francisco (UCSF) showed nVNS reduced pain and increased pain-free status in a group of migraine patients with, and without, aura.

According to principal investigator Peter Goadsby, MB, BS, although the findings are preliminary, they offer the hope of an effective treatment without many of the adverse effects associated with current migraine treatments, which include triptans, ergotamine, antiepileptics, and antidepressants.
In addition, he noted, over the past 5 to 7 years there has been a trend toward developing neuromodulation treatments with implantable devices. He added that if it proves effective, this hand-held, portable, and noninvasive modality would be a step up.

"The nice thing about external devices is if they don't work [the patient] can give them back and you don't have to do anything complex. One of the problems we have with internal devices at the moment is that they are expensive to do, they're relatively invasive and things can go wrong — not big things, but still.

"If you give me a device that can help 20% of my patients then will be a happy man, particularly if I don't do any harm to any of them," Dr. Goadsby told delegates here at the American Academy of Neurology (AAN) 65th Annual Meeting.

Results
Dr. Goadsby, who is director of UCSF's Headache Center, said the move to develop noninvasive neuromodulation approaches came from a number of clinical observations, the seminal one being the case of a young man who was treated with a VNS implant for intractable epilepsy.
The treatment failed to control his seizures, but clinicians noted that he became migraine free. The report was published in 2002 in Cephalagia.

For the pilot study the investigators recruited 30 patients — 25 females and 5 males — with a median age of 39 who had episodic migraine with and without aura.

Patients were asked to treat 3 attacks over the 6-week study period. The treatment consisted two 90-second doses at 15-minute intervals delivered to the right cervical branch of the vagus nerve. Patients were asked to self-treat once pain became moderate severe or after 20 minutes of mild pain.

Essentially, said Dr. Goadsby, the device was placed on the right side of the neck, and a thumbwheel allowed patients to turn the electrical stimulator up or down.

Three of the study participants experienced no attacks, so the final analysis was based on 27 patients and 84 treated attacks.

Data for the first attack among patients with moderate and severe pain showed that 4 of 19 patients (21%) were pain free at 2 hours and 8 of 19 (42%) had pain relief that decreased to nil or mild at 2 hours.

Results for those with mild pain at first attack showed 5 of 8 (63%) were pain free at 2 hours.
When researchers examined the effect of the device on all migraine attacks, they found that 12 of 55 (22%) patients with moderate to severe migraine and 10 of 26 (38%) with mild migraine were pain free at 2 hours.

Mild, Infrequent Adverse Effects
Adverse events were infrequent and mild and included neck twitching (n = 3), raspy voice (n = 1), and neck redness (n = 1).

Dr. Goadsby noted that the sensation patients experience from the device is not pleasant but also not unpleasant.

These findings, he said, warrant further investigation in randomized, placebo-controlled trials and added that a sham device is being developed.

Future studies of the device will examine whether there are treatment differences between the right and left sides of the neck, as well as the treatment durability.

Noninvasive neuromodulation, said Dr. Goadsby, has much to offer migraineurs.

"If we can develop noninvasive treatments for even a small group of patients that would be a helluva step forward," he said.

Warrants Further Study
Commenting on the study for Medscape Medical News, Tobias Kurth, MD, director of research, Institut national de la santé et de la recherche médicale (INSERM), University of Bordeaux, Talence, France, and associate epidemiologist, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, agreed that the data are "convincing enough to warrant further study."

"If this turns out to be an effective treatment it would add to the treatment options for migraine with a device that is almost free of side effects," said Dr. Kurth.

He noted that about 30% of migraineurs do not respond to therapy and so novel treatment approaches are urgently needed.

Dr. Kurth added that although invasive neurostimulation for severe migraine has demonstrated some benefit, he remains unconvinced that it is a good treatment option for even in this severely affected population.

On the basis of the data at this point, he said, in his opinion it should be considered a "last resort" treatment in severely affected patients for whom nothing else has worked.

On the other hand, by eliminating the need for surgery and its related risks and adverse effects, nVNS may have potential as a viable treatment option for at least a proportion of patients with migraine, he added.

"It will not be for everybody for sure but even if it works for a small fraction of patients for whom no other medication seems to work this would be a huge success," said Dr. Kurth.

Dr. Goadsby reports he has received $2000 in direct compensation related to the presentation from the device manufacturer. Funding from the study came from multiple sources, most prominently from the Sandler Family Trust and the Department of Defense. Dr. Goadsby also reports the device manufacturer had no role in the study's data collection or analysis. Dr. Kurth has disclosed no relevant financial relationships.
                    
American Academy of Neurology (AAN) 65th Annual Meeting. Abstract S40.004. Presented March 20, 2013.
 

http://www.medscape.com/viewarticle/781443

Monday, March 25, 2013

Cyberonics Says Former Employee Dismisses Suit

  • February 4, 2013, 12:01 p.m. ET

  • Cyberonics Says Former Employee Dismisses Suit

     
    By Anna Prior 
    
     
     
    Cyberonics Inc. (CYBX) said a former employee voluntarily dismissed without prejudice a lawsuit he filed against the medical-device maker in a Massachusetts federal court.

    The employee, former sales representative Andrew Hagerty, had previously filed a wrongful termination suit against the company in which he raised questions about the legality of Cyberonics sales and marketing practices.

    The lawsuit had raised "the potential for this case broadening to something larger" like a qui tam, or "whistleblower" suit, Jefferies analyst Raj Denhoy said in a note to clients.

    Shares of the medical-device maker recently rose 8.4% to $48.08.

    While the employee's "motivation for dismissal of the wrongful termination suit is unknown, the move nonetheless removes a major overhang" on Cyberonics' stock, Mr. Denhoy said as he reiterated a buy rating on the stock.

    In January, a short-seller's report discussed the lawsuit in its criticism of Cyberonics, sending shares tumbling on heavy volume.

    The company responded to those allegations, declining to comment on the suit and disputing the short-seller's criticism of the company's implantable device used to treat epilepsy and depression.
    On Monday, Cyberonics said that under the terms of Mr. Hagerty's employment, his claims are subject to binding arbitration and Mr. Hagerty has the right to re-file the lawsuit or to purse a resolution through binding arbitration.
    
    Write to Anna Prior at anna.prior@dowjones.com 

    http://online.wsj.com/article/BT-CO-20130204-708197.html

    Study Participants Experienced Improvement in Pain and Well-Being that Persisted Through One Year

    PR Newswire: news distribution, targeting and monitoring 2013
     
    NeuroStar TMS Therapy, a Non-Drug Depression Treatment, Demonstrates Statistically Significant Benefits on Patient-Reported Pain Outcomes  

    Study Participants Experienced Improvement in Pain and Well-Being that Persisted Through One Year

                                 
    SAN DIEGO, March 19, 2013 /PRNewswire/ -- New data released today at the annual meeting of the American Academy of Neurology show that transcranial magnetic stimulation (TMS) administered using the NeuroStar TMS Therapy System® significantly reduced pain-related symptoms in patients with Major Depressive Disorder (MDD), with improvement sustained through one year.  Pain-related symptoms are present in more than 75 percent of patients living with depression, indicating a need to offer patients effective treatment options.
     
    "A majority of people living with depression experience pain-related symptoms, which often interfere with patients' quality of life and may result in greater treatment costs," said Dr. Mark George , M.D., Director of the Brain Stimulation Laboratory at the Medical University of South Carolina. "The data in this preliminary study indicate that TMS may serve as a promising, effective, non-drug option to relieve symptoms of moderate to extreme pain in patients with MDD without the systemic side effects of oral medications."  
     
    In this subset analysis of a Neuronetics-sponsored multisite, naturalistic, observational study involving 42 TMS clinical practice sites based in the United States, 307 outpatients with a primary diagnosis of MDD were treated with NeuroStar TMS Therapy and received an average of 28 TMS sessions during acute treatment.  Investigators evaluated improvement in pain measures using two quality of life instruments, the EuroQol Questionnaire (EQ-5D) and the Short Form 36-Item Questionnaire (SF-36).
     
    At baseline, 47.1 percent of patients indicated moderate pain and discomfort while 11.7 percent of patients indicated extreme pain and discomfort, which decreased significantly by the end of acute treatment to 41.4 percent and 6.6 percent of patients, respectively. The improvement in the percent of patients reporting extreme pain and discomfort was sustained through 12 months of follow-up, demonstrating durability in the most extreme pain cases.
     
    The percentage of patients reporting general pain-related problems significantly reduced from 58.8 percent at baseline to 48 percent at the end of acute treatment, as measured by the EQ-5D. In addition, the SF-36 bodily pain scores improved significantly following acute NeuroStar TMS Therapy from 44.5 to 48.1, which persisted through 12 months. There was a significant correlation between the improvement of the SF-36 bodily pain scores and the improvement of depressive symptomatology, as measured by the Patient Health Questionnaire (PHQ-9).
     
    About NeuroStar TMS Therapy®
    Neuronetics' NeuroStar TMS Therapy System was cleared by the FDA in October 2008 for the treatment of Major Depressive Disorder (MDD).  NeuroStar TMS Therapy is indicated for the treatment of MDD in adult patients who have failed to achieve satisfactory improvement from one prior antidepressant medication at or above the minimal effective dose and duration in the current episode. NeuroStar TMS Therapy is a non-systemic (does not circulate in the bloodstream throughout the body) and non-invasive (does not involve surgery) form of neuromodulation.  It stimulates nerve cells in an area of the brain that has been linked to depression by delivering highly-focused MRI-strength magnetic field pulses. The treatment is available by prescription and typically administered daily for 4-6 weeks.  For full safety and prescribing information, visit www.NeuroStar.com.
     
    About Depression
    Depression is a serious illness that affects about 20 million Americans annually.  People with depression may experience a range of physically and emotionally debilitating symptoms, including anxiousness, sadness, irritability, fatigue, changes in sleep patterns, loss of interest in previously enjoyable activities and digestive problems.  It is estimated that about four million patients do not benefit from standard treatments for depression, even after repeated treatment attempts. 
     
    About the StudyThis study was designed to assess patient-reported pain outcomes following Transcranial Magnetic Stimulation (TMS) treatment for major depression disorder (MDD) in clinical practice. Three hundred and seven depressed patients were part of a prospective, multi-site, observational clinical trial studying the utilization and outcomes of the NeuroStar TMS Therapy system in naturalistic clinical practice. Patients who received benefit from acute TMS treatment (N= 257) consented to long-term follow up over 12 months, and were evaluable for statistical analysis. The objectives of the study were to assess the change in depressive symptomatology and functional capacities across the duration of the study. Data for the pain domains in the Short Form 36-Item Questionnaire (SF-36) and the EuroQol Questionnaire (EQ-5D) were collected at baseline, end of acute treatment (EOA), 3-, 6-, 9-, and 12-months follow-up, in order to evaluate the effect of NeuroStar TMS therapy on pain in patients with MDD.
     
    About Neuronetics, Inc.Neuronetics, Inc., is a privately-held medical device company focused on developing non-invasive therapies for psychiatric and neurological disorders using MRI-strength magnetic field pulses.  Based in Malvern, PA, Neuronetics is the leader in the development of TMS Therapy, a non-invasive form of neuromodulation.  For more information, please visit www.neuronetics.com.
    NeuroStar®, NeuroStar TMS Therapy® and TMS Therapy® are registered trademarks of
    Neuronetics, Inc.

    SOURCE Neuronetics, Inc.

    http://www.prnewswire.com/news-releases/neurostar-tms-therapy-a-non-drug-depression-treatment-demonstrates-statistically-significant-benefits-on-patient-reported-pain-outcomes-198969741.html

    Research and Markets Announces The Release of 'Neuromodulation Market - Forecasts to 2017'

     
    PR Newswire  
     
     
     
     

     
     

    Research and Markets Announces The Release of 'Neuromodulation Market - Forecasts to 2017'

    DUBLIN, March 25, 2013 /PRNewswire/ --
     
    Research and Markets (http://www.researchandmarkets.com/research/t8zp6f/neuromodulation) has announced the addition of the "Neuromodulation Market - [Spinal Cord Stimulation (SCS), Vagus Nerve Stimulation (VNS), Gastric Electrical Stimulation (GES), Deep Brain Stimulation (DBS), Sacral Nerve Stimulation (SNS), & Transcranial Magnetic Stimulation (TMS)] - Forecasts to 2017" report to their offering.
     
    Neuromodulation devices have emerged as one of the fastest growing segments of the medical device market due to high demand for minimally invasive and non-invasive treatment. With advancements in technology, neuromodulation is expected to become a promising therapeutic area and high growth industry in the next decade, as it offers symptomatic relief mainly from chronic pain, incontinence, heart failure, headache, depression, epilepsy, etc. The neuromodulation devices market includes deep brain stimulation, spinal cord stimulation, vagus nerve stimulation, sacral nerve stimulation and others external stimulation devices such as transcranial magnetic stimulation, and transcutaneous electrical nerve stimulation (TENS).
     
    The neuromodulation technique acts directly upon nerves or the target area where the activity of nerves is altered due to biological responses produced by electrical stimulation or drug infusion. These devices include small electrodes that are attached to the brain, the spinal cord, or peripheral nerves. These precisely placed leads are connected by means of an extension cable to a pulse generator to generate electrical stimulation. Neuromodulation can have applications in any area of the body and can treat several diseases like chronic pain, epilepsy, psychiatric disorder, movement disorder, cardiovascular disorder, genitourinary and colorectal disorder, stroke and brain injury, and gastric disorder.
     
    The main drivers for the neuromodulation market are the rising population of aged people and age-related diseases like Alzheimer's, epilepsy, spinal cord injury, and Parkinson's disease. According to the International Neuromodulation Society, about 40 million to 50 million patients worldwide suffer from epilepsy, and 1.5 million people currently (2012) suffer from Parkinson disease in the U.S. The large pool of patients that suffer from depression, stroke, anxiety disorders, lower back pain, urinary incontinence, and tremor offers the neuromodulation industry opportunities to grow in the next five years. The market for treatment of tinnitus, in particular, represents an emerging application of neuromodulation. According to the American Tinnitus Association, about 50 million people currently (2012) suffer from this disease in the U.S.
     
    Key Topics Covered:
    1 INTRODUCTION
    2 EXECUTIVE SUMMARY
    3 MARKET OVERVIEW
    4 GLOBAL NEUROMODULATION MARKET (INTERNAL & EXTERNAL)
    5 GEOGRAPHIC ANALYSIS
    6 COMPETITIVE LANDSCAPE
    7 COMPANY PROFILES (Overview, Financials, Products & Services, Strategy, & Developments)*
    Companies Mentioned
    - Anm Adaptive Neuromodulation Gmbh
    - Biocontrol Medical, Ltd.
    - Boston Scientific Corporation
    - Cerbomed Gmbh
    - Cyberonics, Inc.
    - Endostim, Inc.
    - Enteromedics, Inc.
    - The Magstim Company Limited
    - Medtronic, Inc.
    - Neuronetics, Inc.
    - Neuropace, Inc.
    - Neurosigma, Inc.
    - Nevro Corporation
    - Rs Medical
    - Spinal Modulation, Inc.
    - St. Jude Medical
    - Synapse Biomedical, Inc.
    - Uroplasty, Inc.
    - Zynex, Inc.
     
    Research and Markets

    Laura Wood , Senior Manager
    press@researchandmarkets.com
    U.S. Fax: +1-646-607-1907
    Fax (outside U.S.): +353-1-481-1716
    Sector: Medical Devices

    SOURCE Research and Markets

     
     
    Links referenced within this article

    http://www.researchandmarkets.com/research/t8zp6f/neuromodulationhttp://www.researchandmarkets.com/research/t8zp6f/neuromodulation
    http://photos.prnewswire.com/prnh/20130307/600769http://photos.prnewswire.com/prnh/20130307/600769
    http://www.researchandmarkets.com/research/t8zp6f/neuromodulationhttp://www.researchandmarkets.com/research/t8zp6f/neuromodulation
    press@researchandmarkets.comhttp://www.prnewswire.com/news-releases/mailto:press@researchandmarkets.com

    Thursday, March 21, 2013

    Non-invasive vagus nerve stimulation for the treatment of acute asthma exacerbations--results from an initial case series.

    2013 Mar 19;6(1):7. [Epub ahead of print]

    Non-invasive vagus nerve stimulation for the treatment of acute asthma exacerbations--results from an initial case series.

    Abstract

    A prospective multicentre clinical study was initiated to evaluate the safety and potential clinical benefit of non-invasive vagus nerve stimulation (nVNS) for the treatment of bronchoconstriction exacerbations in asthmatics. Due to slow enrolment and design changes of the device, the study was prematurely terminated after enrolment of four eligible patients. Three of the four patients were considered treatment successes based on improvement in FEV1, improvement in VAS dyspnoea scoring, and the absence of device-related adverse events. ClinicalTrials.gov Identifier NCT01385306.
    PMID:
    23510361
    [PubMed - as supplied by publisher]
    http://www.ncbi.nlm.nih.gov/pubmed/23510361