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Novel Brain Stimulation Strategies –
Obesity, Pain, Addictions
Mark S. George, MD
Distinguished Professor of Psychiatry, Neurology
and Radiology, Medical University of South Carolina
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
02/05/15 RiverMend Health, LLC 3
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
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
02/05/15 RiverMend Health, LLC 4
02/05/15 RiverMend Health, LLC 5George MS. Sci Am. 2003;289:66-73.
 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 Brainsway has unpublished pilot study,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
02/05/15 RiverMend Health, LLC 6
 Gyral morphology differs radically, even in
identical twins
 Functional location varies even more,
especially for complicated tasks.
50
%
Rest
Smoking
Cues
Neutral
Cues Rest
Novel Brain Stimulation Strategies – Obesity, Pain, Addictions
A) B)
Group Average
Craving minus neutral
Individual Peaks
Craving minus neutral
What is the right task, imaging modality, for each application or disease?
• 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
• VNS, particularly of gastric fibers, can reduce eating
• Pigs, dogs, one small human trial
• No real work with TMS or tDCS
• DBS of hypothalamus

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Novel Brain Stimulation Strategies – Obesity, Pain, Addictions

  • 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
  • 3. 02/05/15 RiverMend Health, LLC 3 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 02/05/15 RiverMend Health, LLC 4
  • 5. 02/05/15 RiverMend Health, LLC 5George MS. Sci Am. 2003;289:66-73.
  • 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 02/05/15 RiverMend Health, LLC 6
  • 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