Tag: Brain

Deep Brain Stimulation

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Deep Brain Stimulation

When I hear about electromagnetic brain stimulation, I immediately think of the old-style electro-convulsive therapy (ECT) portrayed in movies, like Jack Nicholson’s character in One Flew Over the Cuckoo’s Nest [1]. In the film, Nicholson’s character (as well as many others) are sent to the presumably painful “Shock Therapy”, where they essentially have a battery connected to their head to “reset” them.

However, this is far from an accurate (or fair) representation of what is available today. In modern times, we have two major modalities available: electroconvulsive therapy (ECT) and transcranial magnetic stimulation (TMS).

The first, ECT, is much different than what is portrayed in the movies [2]. The ECT that is available today (and the style that has been employed since the late 1950s) is much more civilized than is portrayed [2]. In particularly difficult to treat depression and anxiety disorder, ECT is often adopted to address and ultimately treat these persistent symptoms [3]. ECT works by inducing small, controlled seizures that offer some therapeutic benefit [3]. In these scenarios, the patient is always given muscle relaxers, so that the patient does not harm themselves during the convulsions that are induced. Overall, it is a much more scientific and civilized process than what is commonly imagined.

A bit more recent development in cerebral stimulation therapies is Transcranial Magnetic Stimulation (TMS). TMS grew out of the work that had already been established with ECT, and simply built upon it to create a second option that was (ideally) less invasive and intimidating to the patient [4]. TMS was originally developed to be used as a diagnostic tool—and eventually some therapeutic uses became apparent [4]. It wasn’t until 2008 that TMS finally became approved by the US Food and Drug Administration [4].

TMS is a technique in which an electromagnetic wand is passed over the cranium, or simply just near the head [6]. The coil is simply metal that is attached to an electric generator which delivers electrical pulses—ultimately delivering electromagnetic pulses intended to interact with natural electromagnetic brain wave outputs [6]. TMS is able to directly target specific regions of the brain in order to address certain neurological issues. In this way, they are able to address major issues without causing damage to other non-necessary brain regions. The technique ultimately helps to “reset” the person, much like in ECT [3].

In two major studies by University of Pennsylvania and Mayo Clinic, TMS was able to help individuals with memory [3]. In one of these studies, the patients were read a list of words while they were receiving TMS directed toward the lateral temporal cortex region of their brain [7]. The patients who were receiving TMS stimulation to this region of their brain as they were being read the list of words were able to remember the words significantly better than those who did not [7]. That is because the lateral temporal cortex is responsible for language understanding [7]. It was further confirmed by another study by UPenn which showed that when this cortex was not stimulated at the exact right time, the significant increase in memory was not present [8].

An interesting study found that ECT is slightly more effective that TMS on some psychiatric disorders, including major depression that was resistant to other methods of treatment [5]. In addition, ECT addressed the symptoms of anxiety while TMS did not [5]. Although ECT was more effective, patients still said they would have preferred TMS should both treatments be covered by their insurance [5].  This was shown to be related to the feelings of stigma and fear associated with ECT [3]. For example, films such as One Flew Over the Cuckoo’s Nest [1] paint a terrifying and animalistic picture of brain stimulation. People seemed to much prefer something that would offer even a fraction of the relief in order to avoid the fear of a perceived tortuous scenario [3].

Overall, it is clear that brain stimulation deserves a little more attention from both the general public and the behavioral health community. It is clear with several different research studies that brain stimulation, whether it come in the form of ECT or TMS can be greatly effective for a range of psychological and neurological disorder that have few other treatment options. However, TMS seems to provide a workaround to a major barrier that ECT has: negative stigma. Since the development of TMS is relatively new compared to ECT, it hasn’t had the same ability to be impacted by popular media.  Instead, it seems to offer similar benefits to patients who are in need of this more radical level of treatment. It also serves as a stepping stone into ECT—should it ever become necessary.

References

  1. Zaentz, S., & Douglas, M. (Producers), & Forman, M. (Director). (1975). One Flew Over the Cuckoo’s Nest  [Motion picture]. United States: United Artists
  2. Estridge, B. (2011). Jack Nicholson did for shock therapy what Jaws did for sharks: An expert argues that ECT has been stigmatised. Retrieved from http://www.dailymail.co.uk/health/article-2012924/Jack-Nicholson-did-shock-therapy-Jaws-did-sharks.html
  3. Payne, N. A., & Prudic, J. (2009). Electroconvulsive therapy Part I: a perspective on the evolution and current practice of ECT. Journal of psychiatric practice, 15(5), 346.
  4. Horvath, JC; Perez, JM; Forrow, L; Fregni, F; Pascual-Leone, A (March 2011). “Transcranial magnetic stimulation: a historical evaluation and future prognosis of therapeutically relevant ethical concerns”. Journal of Medical Ethics. 37(3): 137–43. doi:1136/jme.2010.039966.
  5. Rapposelli, D. (2016). TMS Versus ECT: That Is the Question | Psychiatric Times. Retrieved from http://www.psychiatrictimes.com/major-depressive-disorder/tms-versus-ect-question
  6. Lopez-Ibor, J. J., López-Ibor, M. I., & Pastrana, J. I. (2008). Transcranial magnetic stimulation. Current Opinion in Psychiatry, 21(6), 640-644.
  7. Kucewicz, M. T., Berry, B. M., Miller, L. R., Khadjevand, F., Ezzyat, Y., Stein, J. M., … & Gorniak, R. (2018). Evidence for verbal memory enhancement with electrical brain stimulation in the lateral temporal cortex. Brain.
  8. Kucewicz, M. T., Berry, B. M., Miller, L. R., Khadjevand, F., Ezzyat, Y., Stein, J. M., … & Gorniak, R. (2018). Evidence for verbal memory enhancement with electrical brain stimulation in the lateral temporal cortex. Brain.