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Deep Brain Stimulation, amazing new report


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Well after all that buildup I sure hope you're registered with the NYTimes. as this is way long and I'm too tired to excerpt.

Basically it's about an "area 25" in the brain (isn't that in New Mexico or something?) and accessing it in complex probe with implant,  shows great promise in really intractable depression

(strange and terrifying case history given - deep intractible depression hit happy, well adjusted housewife overnight!)

Title of the article is "A Depression Switch?"

It's got a limited audience for now (for one, 40K and what insurance co would touch it?  Blue Cross thinks C reactive protein testing is "experimental" and that's recommended by the AMA and the American Heart Association! )

However at the least a great deal of useful reerach info seems to be  forthcoming about brain function and depression. 

http://www.nytimes.com/2006/04/02/magazine...agewanted=print

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They used to think the same about the labotomy way back when. 

Happy housewife overnight after an icepick in the eye were sent home, dumb as a doorknob with big smiles, if they lived.

Interesting? Yes.  Terrifying?  Absolutely.

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Yes, but in this case, the housewife has not experiences a miracle cure, just a relief otherise not attainable. She ws awake guiding placement of the (removeable) electrode the whole time - how they identified the area in her. 

If you can accesss the article, you will see the difference.  Also - as important - it opens up a whole new area of research into the neurophsiology of depression.  That it's not just neurotransmitters.  At least, in some.  (In her case,  it does seem as if I switch were thrown)

  I said neurophysiology but I should have  said neuroanatomy - a huge difference in understanding the human body -  here human brain.

Exploring the different areas of brain anatomy (and wiring ) as they pertain to behavior - normal and abnormal  - is vastly neglected.  I suspect it is key for many - beneath what may be the substrate of chemistry and even gene expressions.  And brain damage in such critical areas can as we already know, dramatically change pretty much any aspect of behavior and function.  Look at what hypothalamic damage can cause (like uncontrollable eating) ! And look what they've only recently discovered about viral causes of diabetes Type I!  NOBODY would have thought a virus could cause specific endocrine damage like that.

 

I suspect that's what damaged Area 25 in the happy houewife!  No prodrome, nothing! That BTW is why her dramatic case was chosen for journalistic purposes - it was so clearly NOT psychological in origin.  Such damage may well underly the cause of intractable TRD depression for many (in which case, meds are strictly bandaids - and not very good ones)

This is true of such focus areas as weight control, emotional lability, explosiveness/flatness, sleep disorders, sexual responsiness etc.

Most unfortunately, owing to the limits of ethical  experimentation on humans, everything we know about complex emotional/cognitive function is pretty much limited to accidental findings from traumatic injuries (and their effects), brain tumor results - especially at excision and what may be discovered when other brain surgery is performed (as for epilepsy, stroke control, and other unrelated problems).

Probing can uncover almost unbelieveable facts about brain function. Jees, what would we have done without all the findings from the tragic injury of poor old Phineas Gage (the railroad construction worker whose brain was accidentally impaled right in the frontal cortex - and whose skull is still preserved for study)?

In another lifetime, I would definitely be a neurosciences researcher - if i could handle dealing with all those poor decorticate cats, that is...

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Here are some hopefully more accessible links all about her research with neurologist Helen Mayberg.

I recommend especially you read the Medcape interview with Dr. Mayberg, if you're interested in the scientific angle, and/or the statistical rigors applied.  (It's a 4000 wd article but you can skip around).

Note this does NOT seem to be the same study the  NYtimes referenced (will go check). Ooh,  this IS sounding appealing to me as it's precisely these symptoms I most need to alleviate (and I DO need to clean the garage!)  - not adding something, but subtracting. That is, if you can call subtracting "emptiness" or a "void" substracting.  I don't need to feel cheery, and uppered. THese symptoms  sound like what are called in schizophrenia, "negative symptoms" .

Hey, you people with sz, I'll bet stimulation of the temporary regions and prefrontal cortex WOULD treat negative symptoms and cognitive deficits which seem auite clearly localized.  All PET scans even in prodrome, show

hypoactivity" of the prefrontal cortex.

Wonder how long and how I could get Brit citizenship if they're serious about it being treated by the Public Health Service. ;)   And JFTR this is a perfect example of why we need far-reaching medical care reform in this country.  The cost to insurance cos her of covering this treatment, would be prohibitive, but the savings to society could easily make it worthwhile, by eliminating a major cause of - very expensive - disability in both depression and sz.

Here:

http://www.guardian.co.uk/science/story/0,,1743846,00.html

Depression breakthrough

'When we turn the current on, the patients report the emptiness suddenly disappears'

By inserting electrodes into the brain while the patient is conscious (so that the surgeon knows if they have hit the right spot), Dr Mayberg found remarkable results. When she published her work, she said: "In the operating room, when we first turn the current on and get into the right location, the patients report that the heaviness or emptiness suddenly disappears. If they had a sense of a black cloud, they report it physically lifting."

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OK, I get it,  THe NY Times article is about Mayberg's trials in Toronto where she moved from Johns Hopkins. The Guadian article is about clinical trials TO COME in the UK.

This is all a pretty big deal - though not strictly speaking new.  These studies have been going on for about ten years.  The weight of the results in depression especially with the Toronto trials, is now extremely striking though. Started out BTW as an investigational approach to treatina Parkinsonism:

Note from NYTimes article (also about 5000 wds.)

Several researchers were working on this. But Mayberg, and, separately, Dr. Wayne Drevets, then at Washington University and now at the N.I.M.H., increasingly homed in on Area 25, which seemed crucial in both its behavior and its position in this network. They found that Area 25 was smaller in most depressed patients; that it lighted up in every form of depression and also in nondepressed people who intentionally pondered sad things; that it dimmed when depression was successfully treated; and that it was heavily wired to brain areas modulating fear, learning, memory, sleep, libido, motivation, reward and other functions that went fritzy in the depressed.
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  • 2 weeks later...

I approached my pdoc about DBS and she referred me to a nuero who does VGS but is part of a DBS study!!!

I had the appointment today.......he has ordered a bunch of tests (MRI, EEG, sleep study, etc.) and said that we would get these test results and then discuss it.........

I have already had brain surgery due to another issue...no problem, so I would volunteer for ay DBS study in a heartbeat!!!!! 

Now if I can keep this suicidal depression at bay long enough to get any results..... ;) I have dealt with Major Depression for so long that I am not sure what this really good feeling is...........ah yes....it's HOPE:))))!

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I approached my pdoc about DBS and she referred me to a nuero who does VGS but is part of a DBS study!!!

I had the appointment today.......he has ordered a bunch of tests (MRI, EEG, sleep study, etc.) and said that we would get these test results and then discuss it.........

I have already had brain surgery due to another issue...no problem, so I would volunteer for ay DBS study in a heartbeat!!!!! 

Now if I can keep this suicidal depression at bay long enough to get any results..... ;) I have dealt with Major Depression for so long that I am not sure what this really good feeling is...........ah yes....it's HOPE:))))!

<{POST_SNAPBACK}>

Where are you located Zelda? Are they doing studies in the US? Oh, wait, Ill bet you're in Canada.  They are doing the BEST MI  research there,  McGill especially. 

I wish you lots and lots of luck with it.  Are they really willing and will they pay for it?  I'm starting to  think I'd go for it too. The thing is, my life events  are so sad I can't think throwing a switch is going to make me feel like carrying on.  Almost seems like the wrong thing to do, as if I OUGHT to feel pain. 

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I live in Ohio......but I had read an article in the winter 2005 edition of The Cleveland Clinic Magazine (where I had my earlier brain surgery).

I didn't pay much attention to it until I read the NYtimes article and then decided to approach my pdoc.

I am not sure I will qualify for anything at this point, but I would do  ANYTHING at this point, and have tried almost everything. 

I really do not think I can go on much longer......I HATE this illness.....and consequently myself:(.

Present meds:

Effexor xr 600 mgs

provigil 200 mgs

levoxyl 150 mgs

remeron 7.5 mgs

clozaril 200 mgs

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Have you looked into the rTMS trials?

It's actually already be approved in Canada as a treatment for depression, but it's still in trials in the US. It's supposed to be an alternative to ECT, effectiveness without the side effects.

I was evaluated for a trial about a year and a half ago. I didn't qualify because -- get this -- I was too depressed!

Then I went back on Parnate and the world started coming properly into focus and I am better than I thought I would ever manage.

Fiona

(official Parnate cheerleader)

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  • 1 year later...

DBS was written up in Oct. 2007 issue of Popular Science. That mag has plenty crackpot nonsense but does also have brief, real reporting.

Dr. Ali R Rezai implanted the programable power sources in the chest and implanted electrodes in her head. She was a severely depressed patient that opted for and was admitted for the trials. It was conducted at Cleveland Clinic's surgery center.

Emory University and the University of Toronto are in trials as well.

Apparently there have been 40,000 of similar procedures performed for treatment of Parkinson's sufferers.

No instructions for DIY types in the article. Pity that-have drawer's full of junk electronics and what not.

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  • 11 months later...

hi all,

my doc mentioned this to me at my last session. a brief newspaper write up on it is here: http://thetyee.ca/News/2006/10/26/DBS/. it is two years old, but far be it from me to be on time for anything.

my doc is affiliated with the university in some way, but i don't know if that means he could bump me up in the line. i don't know what the cost would be, if any. i could bring my own wire of course.

i'll have to find out more.

grouse.

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No instructions for DIY types in the article. Pity that-have drawer's full of junk electronics and what not.

I did some research into the waveforms (signal shapes), magnetic intensities and durations. It's not that hard to build a circuit to duplicate them. The thing is the energy levels are HUGE and I don't want to mess with voltages and currents that high. The lethal potential is too high when you are putting the device onto someones head. Also the cost factor goes way up because all the components are so specialized for high energy applications.

a.m.

p.s. If you look at the huge electro-magnetic specifications for this device, which yeilds questionable results, it should cause anyone afraid of their laptops killing them to shut the fuck up and go hide in their conspiracy closet.

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Just adding a bit, I believe that DBS is much more common for use in Parkinson's disease, though I'm not sure it's Area 25 they're stimulating, and I don't think it's an FDA approved treatment (or even under jurisdiction of the FDA, which I believe VNS is).

Probably will work well for some people with resistant depression, though as with any med, you run the risk of instead making the problem much, much worse (this is compounded by the physical trauma the head and brain incur during the implantation procedure/s.

I wonder what the field/voltage/current differences are between this stuff and ECT (I assume that every unit of of raw power would count more in DBS since the electrodes are placed much closer together and within the person's tissues themselves, but it's been 5 years since I was forced to take physics E&M and basically I'm not going to try and mathematically integrate cross-sections of the thalamus to figure out this crap for myself.

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  • 3 years later...

An article on DBS was published in the Wall Street Journal, Jan. 17 2012, page D1 - "Wiring the Brain, Literally, to Treat Stubborn Disorders".

Some excerpts:

". . .

Neurologists asked her questions and issued commands as they pinpointed the exact spot in her brain for electrical stimulation. At one point, "I suddenly felt hopeful and optimistic about the future," recalls Ms. Battiloro, who had battled severe depression for more than a decade. That's when the doctors knew they had found Brodmann 25, an area deep in the cerebral cortex associated with negative mood.. . .

Within two months, Ms. Battiloro says, her depression had lifted considerably. Now, nearly four years later, it hasn't returned. "My friends and family are amazed," say Ms. Battiloro, 41, of Boynton Beach, Fla. "I'm a new and improved Lisa." . . .

Ms. Battiloro was one of 17 patients in a study published this month in the Archives of General Psychiatry. After two years of DBS, 92% reported significant relief from their major depression or bipolar disorder and more than half were in remission, with no manic side effects. "We are seeing dramatic effects in the small numbers of subjects, and they are not just getting well, they are getting well without side effects and without relapsing," says neurologist Helen Mayberg, who led the study at Emory University in Atlanta.. . ."

This appears to be a follow-up report to ongoing research in this area; you'll note the references to Dr. Mayberg at Emory, and the targeting of Brodmann Area 25. A prior report appeared in 2008.

The clinical trial identifier at clinicaltrials.gov is NCT00367003; it is currently recruiting patients.

Here is a review article published in 2010 of all of the DBS studies published at that time - "Results: The results of DBS in MDD have been presented in 2 case reports and 3 studies of 47 patients operated upon in 5 different target areas. Positive effects have been presented in all studies and side effects have been minor. DBS in the nucleus accumbens resulted in a mean reduction of Hamilton depression rating scale (HDRS) of 36% after 1 year and 30% of the 10 patients achieved remission. DBS in the internal capsule/ventral striatum resulted in a reduction of 44% after 1 year, and at the last evaluation after in mean 2 years, 40% of the 15 patients were in remission. The 20 patients with subcallosal cingulated gyrus DBS had a reduction of HDRS of 52% after 1 year, and 35% were within 1 point from remission or in remission."

DBS is also be studied for treatment resistant OCD - clinicaltrials.gov identifier NCT00640133 and NCT01135745 . Also for Bipolar Disorder - NCT01476527 .

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