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Deep Brain Stimulation for Therapeutics: What is the prognosis?
- 1. Deep Brain Stimulation: What is the Prognosis? Katina Michael, Ph.D. (UOW), MTransCrimPrev (UOW), BIT (UTS) @katinamichael #uberveillance #risk #harm #socialimplications #unintendedconsequences
- 3. Deep Brain Stimulation Deep Brain Stimulation: Sheila Cook has electrodes inserted in her head to help with her severe depression
- 5. Jose Delgado Experiment 1960s https://www.youtube.com/watch?v=23pXqY3X6c8
- 6. Jose Delgado Experiment 1960s https://www.youtube.com/watch?v=23pXqY3X6c8
- 8. Anatomical Variability of the Cerebral Cortex Schizophrenia Atlas Team: Narr & Thompson et al. A 3D map of variability is shown (above), on an average surface Representation of the cortex derived from a schizophrenia (left) and normal control population (right). Individual variations in brain structure, in frontal association areas (red colors), are greater in schizophrenia. http://users.loni.usc.edu/~thompson/disease_atlases.html
- 16. rTMS (Transcranial Magnetic Stimulation) • Electromagnetic induction using an insulated coil placed over the scalp • Focused on an area of the brain thought to play a role in mood regulation • Coil generates brief magnetic pulses, which pass easily and painlessly through the skull and into the brain http://www.hopkinsmedicine.org/psychiatry/specialty_areas/brain_stimulation/tms/
- 19. Vagus Nerve Stimulation (VNS) • Stimulation of the nerve responsible for relaying messages between the brain and certain parts of the body • Does not require brain surgery • Patient magnet offers additional seizure control • Holding the magnet over the generator when you feel a seizure coming on (or during a seizure), the seizure may be stopped or shortened in duration or intensity. http://us.livanova.cyberonics.com/vns-therapy/how-vns-therapy-works
- 21. “Buyer Beware” Important Safety Information • DBS can have serious if not fatal complications including coma, bleeding inside the brain, seizures and infection. • Once implanted the system may become infected, parts may wear through the skin, and the lead, and/or extension connector may move. • The device could suddenly stop because of mechanical or electrical problems. • Any of these situations may require additional surgery or cause symptoms to return. * But these are plain vanilla issues of surgical implantation that are true for ANY implant.
- 22. Unintended Consequences • Psychotic symptoms • Auditory hallucinations • Modifications in sleep patterns • Uncontrolled and accidental stimulation of other parts of body function • Hypersexuality • Hypomania • Changes to heart and pulse rates
- 23. Humanitarian Device or Ultimate ESD • One patient, as a result of a particular procedure in a DBS pilot study described a sensation of “feeling hot, flushed, fearful, and panicky.” • He could feel palpitations in his chest, and when asked indicated he had an impending sense of doom. • The feelings were coincident and continuous with the stimulator “on” setting and they rapidly dissipated when switched off. S. NA, et al., "Panic and fear induced by deep brain stimulation," J. Neurol. Neurosurg Psychiatry, vol. 77, pp. 410–12, 2006. J. Fins, et al., "Misuse of the FDA's humanitarian device exemption in deep brain stimulation for obsessive-compulsive disorder," Health Aff. (Millwood ), vol. 30, pp. 302–311, 2011.
- 24. DBS Therapy Off Off Medication DBS Therapy On Off Medication e this page has been amended to drive home a point about reverse engineering a perfectly normal person. It is a scenario ONLY.
- 25. Transformers – Episode 11 “The Ultimate Doom” (1984)
Editor's Notes
- 1
- http://www.telegraph.co.uk/news/health/news/8279868/What-is-deep-brain-stimulation.html
- Till 1min 20sec
- http://americanhealthimaging.com/~ahi/wp-content/uploads/2014/12/equipment-banner.jpg Magnetic Resonance of the Brain (MRI) Services Provided We provide comprehensive Neurological and Neurosurgical care under one practice. Neurological Consultations: Diagnosis and treatment of common neurological diseases: Alzheimer's, Dementia, Strokes, Multiple Sclerosis, Brain Tumors, Peripheral Neuropathies, Myasthenia, Epilepsy, Parkinson's, Neck and Back pain, Headaches, Botox for headaches and spasticity. Neurosurgical Consultations: Diagnosis and treatment of common neurosurgical disorders: BrainTumors, Pituitary tumors, Schwanomas, Surgical treatment of Spinal Disorders (Lower back and neck), Carpal Tunnel, Deep Brain Stimulator (DBS), Spinal Cord Implants. Pediatric Neurology Consultations: Diagnosis and treatment of childhood neurology, epilepsy http://www.neuroassociates.us/services-provided.html
- http://www.schizophrenia.com/images/COS_map.jpg
- http://www.meddeviceonline.com/doc/ibm-aims-to-make-brain-implant-to-predict-stop-seizures-0001
- A Bergonic chair, a device "for giving general electric treatment for psychological effect, in psycho-neurotic cases", according to original photo description. World War I era.
- UNILATERAL PLACEMENT, BILATERAL PLACEMENT There are primarily two types of electrode placements used for the delivery of ECT. Differences between these two techniques include the area of the brain stimulated, timing of response and potential side effects. Right Unilateral Placement To generate a seizure with a right unilateral treatment, one electrode is placed on the crown of the head and the other on the right temple. Those receiving the right unilateral treatments may respond somewhat more slowly than those who receive bilateral treatments. This difference is usually no greater than 1 to 2 treatments. Right unilateral treatment is typically associated with less memory side effects. Patients who do not respond to right unilateral treatments may require a switch to bilateral placement. Bilateral Placement Bilateral ECT treatment involves placing the electrodes on both temples. This treatment may be associated with more acute memory side effects than right unilateral treatments. Bilateral ECT is indicated for severe mental illnesses including depression with psychosis, manic episodes of bipolar disorder, psychosis related to schizophrenia and catatonia.
- Why are we still using electroconvulsive therapy? By Jim ReedBBC NewsnightThe use of electricity to treat mental illness started out as an experiment in the 1930s Continue reading the main storyRelated Stories ECT 'turns down brain connection' The idea of treating a psychiatric illness by passing a jolt of electricity through the brain was one of the most controversial in 20th Century medicine. So why are we still using a procedure described by its critics as barbaric and ineffective? Sixty-four-year-old John Wattie says his breakdown in the late 1990s was triggered by the collapse of his marriage and stress at work. "We had a nice house and a nice lifestyle, but it was all just crumbling away. My depression was starting to overwhelm me. I lost control, I became violent," he explains. John likens the feeling to being in a hole, a hole he could not get out of despite courses of pills and talking therapies. But now, he says, all of that has changed thanks to what is one of the least understood treatments in psychiatry - electroconvulsive therapy (ECT). "Before ECT I was the walking dead. I had no interest in life, I just wanted to disappear. After ECT I felt like there was a way out of it. I felt dramatically better." The use of electricity to treat mental illness started out as an experiment. In the 1930s psychiatrists noticed some heavily distressed patients would suddenly improve after an epileptic fit. Jump media player Media player help Out of media player. Press enter to return or tab to continue. John Wattie on why he feels he needs ECT to keep severe depression at bay Passing a strong electric current through the brain could trigger a similar seizure and - they hoped - a similar response. By the 1960s it was being widely used to treat a variety of conditions, notably severe depression. But as the old mental asylums closed down and aggressive physical interventions like lobotomies fell out of favour, so too did electroshock treatment, as ECT was previously known. The infamous ECT scene in One Flew Over the Cuckoo's Nest cemented the idea in the public's mind of a brutal treatment, although by the time the film was released in 1975 it was very rarely given without a general anaesthetic. Perhaps more significantly, new anti-depressant drugs introduced in the 1970-80s gave doctors new ways to treat long-term mental illness. But for a group of the most severely depressed patients, ECT has remained one of the last options on the table when other therapies have failed. Annually in the UK around 4,000 patients, of which John is one, still undergo ECT. "It's not intuitive that causing seizures can be good for depression but it's long been determined that ECT is effective," says Professor Ian Reid at the University of Aberdeen, who heads up the team treating John. ECT procedure (Warning: Some may find images upsetting)Continue reading the main storyA mouth guard is put between patient's teeth to prevent damage during shock and convulsions, and electrodes are applied to the temples. The electric shock is administered for about four seconds. Immediately afterwards the patient convulses for up to 60 seconds. On average patients convulse for 20 seconds. Continue reading the main story 3/4 In the 75 years since ECT was first used scientists have argued about why and how it might work. The latest theories build on the idea of hyperconnectivity. This new concept in psychiatry suggests parts of the brain can start to transmit signals in a dysfunctional way, overloading the system and leading to conditions from depression to autism. Jump media player Media player help Out of media player. Press enter to return or tab to continue. Helen Crane on how she forgot major events including her mother's death after ECT Prof Reid and his colleagues used MRI scanners to map the brains of nine patients before and after treatment. In an academic paper in 2012 they claimed ECT can "turn down" overactive connections as they start to build, effectively resetting the brain's wiring. "For the first time we can point to something that ECT does in the brain that makes sense in the context of what we think is wrong in people who are depressed," Prof Reid says. "The change that we see in the brain connections after ECT reflects the change that we see in the symptom profile of patients who generally see a big improvement." But passing electricity through the most complex organ in the body is not without risk. Many doctors think the side-effects of ECT can be so serious they outweigh any possible benefits. Helen Crane was given two rounds of ECT in the late 1990s. She now blames the second course for wiping years of her memory, from trips abroad to dramatic family events. "After ECT, I had this instinct that something was wrong with my mother. I said to my husband 'What's happened to my mother?' And then he had to tell me that she'd died nearly two years earlier," she says. "It was devastating going through bereavement again. How on Earth could I have forgotten something so important and fundamental? Getting words wrong is frustrating, but to have lost really basic stuff in your life is awful." Continue reading the main story“Start Quote I'm convinced that in 10 or 15 years we will have put ECT in same rubbish bin of historical treatments as lobotomies and surprise baths that have been discarded over time” Dr John ReadUniversity of Liverpool Critics of ECT claim around a third of patients will notice some sort of permanent change from memory loss to problems with speech and basic skills like addition. "What happens is a little like recharging a car battery," says the psychologist Dr John Read from the University of Liverpool, one of the most vocal critics of ECT. "It's not difficult to get artificial changes in the brain, you could do it with cocaine, but it doesn't last and three or four weeks later the person is either back at the same level of depression or many studies show worse levels of depression." Opponents say that ECT patients can enter into an addictive cycle of repeated treatment and that any improvement beyond the very short term is likely to be little more than an extreme form of the placebo effect, with patients benefitting psychologically from the extra care and medical attention associated with ECT. "It's not in any way addressing the cause of their depression. It's systematically and gradually wiping out their memory and cognitive function," says Dr John Read. "I'm convinced that in 10 or 15 years we will have put ECT in same rubbish bin of historical treatments as lobotomies and surprise baths that have been discarded over time." Continue reading the main storyECT in the UK Women are twice as likely to be given ECT as men, reflecting the general pattern of serious depression in society Around a third of patients are too ill to give their consent Across the UK as a whole it is thought around 4,000 people a year are given ECT Scottish hospitals alone still treat 370 people a year, according to the latest figures. But Prof Reid says when weighing up the risks and benefits of the treatment "it is important to realise that the people who are treated with ECT are suffering from an illness that could kill them". "Depression is associated with a measurable mortality. It can be lethal. Untreated patients can die." The team in Aberdeen now hope their research will allow drug companies to develop new treatments that mimic some of the effects of electroconvulsive therapy. "One of the exciting things about being able to identify a change in the brain related to a psychiatric disorder is that it might make it easier to diagnose that condition over time," Prof Reid says. "No one would be happier than me if we could reproduce the changes that ECT has on the brain in a less invasive and safer way for patients."
- Transcranial Magnetic Stimulation (TMS) Service http://www.hopkinsmedicine.org/psychiatry/specialty_areas/brain_stimulation/tms/ TMS is a non-invasive method of brain stimulation that relies on electromagnetic induction using an insulated coil placed over the scalp, focused on an area of the brain thought to play a role in mood regulation. The coil generates brief magnetic pulses, which pass easily and painlessly through the skull and into the brain. The pulses generated are of the same type and strength as those generated by magnetic resonance imaging (MRI) machines. When these pulses are administered in rapid succession, it is referred to as “repetitive TMS “ or “rTMS”, which can produce longer lasting changes in brain activity. rTMS has been shown to be a safe and well-tolerated procedure that can be an effective treatment for patients with depression who have not benefitted from antidepressant medications or cannot tolerate antidepressant medications due to side-effects. We offer rTMS at Johns Hopkins using the only TMS device approved by the FDA for the treatment of major depression. However, rTMS therapy is not appropriate for all patients. Before scheduling you for treatment, you must first be evaluated by one of our TMS psychiatrists to determine if rTMS would be safe and appropriate for you.
- Lobotomies of the 1930s-1950s… Ice picks through http://www.delanceyplace.com/view-archives.php?p=2768
- https://www.tga.gov.au/alert/medtronic-neurostimulators-used-deep-brain-stimulation-therapy
- The Transformers (1984) Ultimate Doom - Part 1 “The Hypnochip”