Mark S. George, MD.-
Member, RiverMend Health Scientific Advisory Board for Eating Disorders & Obesity
Distinguished Professor of Psychiatry, Neurology and Radiology, Medical, University of South Carolina
Dr. George addresses the RiverMend Health Scientific Advisory Board on different brain stimulation techniques and how they can be use in treatment of addictions, pain and obesity.
To watch lecture visit : http://vimeo.com/112420864
For more information visit: http://www.rivermendhealth.com/scientific-advisory-board-addiction.html
1. Novel Brain Stimulation Strategies –
Obesity, Pain, Addictions
Mark S. George, MD
Distinguished Professor of Psychiatry, Neurology
and Radiology, Medical University of South Carolina
2. 02/05/15 RiverMend Health, LLC 2
Acknowledgments -
– Foundations - NARSAD, Stanley, Dana, Hope
– NIMH, NINDS, NIDA, NIAAA, NASA, DARPA, DOD,VA
– Industry grants (last 20 yrs) – Brainsway, Cadwell, Cortex, Cyberonics,
Dantec, Darpharma, Electrocore, Glaxo Smith Kline, Jazz, MagStim, MECTA,
Medtronic, Neostim, Neosync, Neuronetics, Neotonus, St. Jude Medical.
Disclosures -
– No equity in any device or pharma company
– 2 combinational patents pending
– Speakers fees from industry (none in past 3 years)
– Past Paid Consultant - GSK, Cyberonics, NeuroPace, Jazz
– Unpaid Consultant – Brainsway, Neuronetics, Neostim, Neosync
– Paid Consultant – PuretechVentures
– Editor-in-Chief, Brain Stimulation, Elsevier
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Electricity is the Currency of the BrainElectricity is the Currency of the Brain
All of synaptic pharmacology simply serves toAll of synaptic pharmacology simply serves to
transmit electrical signals to the next neurontransmit electrical signals to the next neuron
The Brain is anThe Brain is an ElectroElectrochemicalchemical
OrganOrgan
4. US FDA Approved
ECT - Electroconvulsive Therapy
– FEAST
rTMS - repeated Transcranial
Magnetic Stimulation
– Neuronetics, Magstim, Brainsway,
Neuralieve, Neostim, Neosync
DBS - Deep Brain Stimulation -
PD
– RST - Responsive Stimulation
Therapy
– Epidural Cortical Stimulation
VNS - Vagus Nerve Stimulation –
Epilepsy and Depression
Not FDA Approved
MST - Magnetic Seizure
Therapy
tDCS - transcranial Direct
Current Stimulation
TENS - transcutaneous
Electrical Nerve Stimulation
– Cranial Electrical Stimulation
(CES) Alpha-stim
EPI-fMRI - echoplanar fMRI
Transcranial pulsed ultrasound
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6. Craving is certainly modifiable
with cortical TMS
– Lab induced craving, knockout
– Small clinical trials
Smoking
Brainsway has unpublished pilot study,
ongoing FDA RCT
Unclear if tDCS has enough power
to be clinically useful
DBS may work, no large studies
underway or planned
VNS can modulate, likely too
costly
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7. Gyral morphology differs radically, even in
identical twins
Functional location varies even more,
especially for complicated tasks.
50
%
Rest
Smoking
Cues
Neutral
Cues Rest
9. A) B)
Group Average
Craving minus neutral
Individual Peaks
Craving minus neutral
What is the right task, imaging modality, for each application or disease?
10. • Acute Lab pain is certainly modifiable with cortical TMS
• Opiate dependent, blocked with morphine
• Numerous studies have found post-op TMS able to reduce post
surgical opiate use
• Some evidence of effectiveness in chronic pain, fibromyalgia
• tDCS also works, perhaps 2-3 times smaller effect size.
• DBS of thalamus may work, cortical stim works,
• VNS can also modulate
11. • VNS, particularly of gastric fibers, can reduce eating
• Pigs, dogs, one small human trial
• No real work with TMS or tDCS
• DBS of hypothalamus