Medical Tech: 1) A Pacemaker For The Brain Helped A Woman With Crippling Depression. It May Soon Offer Hope To Others,2) Brain Wave-Powered Tech Allows Canadian Kids ‘Trapped In Their Own Bodies’ To Play
COULD EVENTUALLY HELP MILLIONS WITH DEPRESSION THAT RESISTS OTHER TREATMENTS
Courtesy of Barrie360.com and Canadian PressPublished: Feb 21st, 2024
Laura Ungar, The Associated Press
Emily Hollenbeck lived with a deep, recurring depression she likened to a black hole, where gravity felt so strong and her limbs so heavy she could barely move. She knew the illness could kill her. Both of her parents had taken their lives.
She was willing to try something extreme: Having electrodes implanted in her brain as part of an experimental therapy.
Researchers say the treatment —- called deep brain stimulation, or DBS — could eventually help many of the nearly 3 million Americans like her with depression that resists other treatments. It’s approved for conditions such as Parkinson’s disease and epilepsy, and many doctors and patients hope it will become more widely available for depression soon.
The treatment gives patients targeted electrical impulses, much like a pacemaker for the brain. A growing body of recent research is promising, with more underway — although two large studies that showed no advantage to using DBS for depression temporarily halted progress, and some scientists continue to raise concerns.
Meanwhile, the Food and Drug Administration has agreed to speed up its review of Abbott Laboratories’ request to use its DBS devices for treatment-resistant depression.
“At first I was blown away because the concept of it seems so intense. Like, it’s brain surgery. You have wires embedded in your brain,” said Hollenbeck, who is part of ongoing research at Mount Sinai West. “But I also felt like at that point I tried everything, and I was desperate for an answer.”
“NOTHING ELSE WAS WORKING”
Hollenbeck suffered from depression symptoms as a child growing up in poverty and occasional homelessness. But her first major bout happened in college, after her father’s suicide in 2009. Another hit during a Teach for America stint, leaving her almost immobilized and worried she’d lose her classroom job and sink into poverty again. She landed in the hospital.
“I ended up having sort of an on-and-off pattern,” she said. After responding to medication for a while, she’d relapse.
She managed to earn a doctorate in psychology, even after losing her mom in her last year of grad school. But the black hole always returned to pull her in. At times, she said, she thought about ending her life.
She said she’d exhausted all options, including electroconvulsive therapy, when a doctor told her about DBS three years ago.
“Nothing else was working,” she said.
She became one of only a few hundred treated with DBS for depression.
Hollenbeck had the brain surgery while sedated but awake. Dr. Brian Kopell, who directs Mount Sinai’s Center for Neuromodulation, placed thin metal electrodes in a region of her brain called the subcallosal cingulate cortex, which regulates emotional behavior and is involved in feelings of sadness.
The electrodes are connected by an internal wire to a device placed under the skin in her chest, which controls the amount of electrical stimulation and delivers constant low-voltage pulses. Hollenbeck calls it “continuous Prozac.”
Doctors say the stimulation helps because electricity speaks the brain’s language. Neurons communicate using electrical and chemical signals.
In normal brains, Kopell said, electrical activity reverberates unimpeded in all areas, in a sort of dance. In depression, the dancers get stuck within the brain’s emotional circuitry. DBS seems to “unstick the circuit,” he said, allowing the brain to do what it normally would.
Hollenbeck said the effect was almost immediate.
“The first day after surgery, she started feeling a lifting of that negative mood, of the heaviness,” said her psychiatrist, Dr. Martijn Figee. “I remember her telling me that she was able to enjoy Vietnamese takeout for the first time in years and really taste the food. She started to decorate her home, which had been completely empty since she moved to New York.”
For Hollenbeck, the most profound change was finding pleasure in music again.
“When I was depressed, I couldn’t listen to music. It sounded and felt like I was listening to radio static,” she said. “Then on a sunny day in the summer, I was walking down the street listening to a song. I just felt this buoyancy, this, ‘Oh, I want to walk more, I want to go and do things!’ And I realized I’m getting better.”
She only wishes the therapy had been there for her parents.
THE TREATMENT’S HISTORY
The road to this treatment stretches back two decades, when neurologist Dr. Helen Mayberg led promising early research.
But setbacks followed. Large studies launched more than a dozen years ago showed no significant difference in response rates for treated and untreated groups. Dr. Katherine Scangos, a psychiatrist at the University of California, San Francisco, also researching DBS and depression, cited a couple of reasons: The treatment wasn’t personalized, and researchers looked at outcomes over a matter of weeks.
Some later research showed depression patients had stable, long-term relief from DBS when observed over years. Overall, across different brain targets, DBS for depression is associated with average response rates of 60%, one 2022 study said.
Treatments being tested by various teams are much more tailored to individuals today. Mount Sinai’s team is one of the most prominent researching DBS for depression in the U.S. There, a neuroimaging expert uses brain images to locate the exact spot for Kopell to place electrodes.
“We have a template, a blueprint of exactly where we’re going to go,” said Mayberg, a pioneer in DBS research and founding director of The Nash Family Center for Advanced Circuit Therapeutics at Mount Sinai. “Everybody’s brain is a little different, just like people’s eyes are a little further apart or a nose is a little bigger or smaller.”
Other research teams also tailor treatment to patients, although their methods are slightly different. Scangos and her colleagues are studying various targets in the brain and delivering stimulation only when needed for severe symptoms. She said the best therapy may end up being a combination of approaches.
As teams keep working, Abbott is launching a big clinical trial this year, ahead of a potential FDA decision.
“The field is advancing quite quickly,” Scangos said. “I’m hoping we will have approval within a short time.”
But some doctors are skeptical, pointing to potential complications such as bleeding, stroke or infection after surgery.
Dr. Stanley Caroff, an emeritus professor of psychiatry at the University of Pennsylvania, said scientists still don’t know the exact pathways or mechanisms in the brain that produce depression, which is why it’s hard to pick a site to stimulate. It’s also tough to select the right patients for DBS, he said, and approved, successful treatments for depression are available.
“I believe from a psychiatric point of view, the science is not there,” he said of DBS for depression.
MOVING FORWARD
Hollenbeck acknowledges DBS hasn’t been a cure-all; she still takes medicines for depression and needs ongoing care.
She recently visited Mayberg in her office and discussed recovery. “It’s not about being happy all the time,” the doctor told her. “It’s about making progress.”
That’s what researchers are studying now — how to track progress.
Recent research by Mayberg and others in the journal Nature showed it’s possible to provide a “readout” of how someone is doing at any given time. Analyzing the brain activity of DBS patients, researchers found a unique pattern that reflects the recovery process. This gives them an objective way to observe how people get better and distinguish between impending depression and typical mood fluctuations.
Scientists are confirming those findings using newer DBS devices in a group of patients that includes Hollenbeck.
She and other participants do their part largely at home. She gives researchers regular brain recordings by logging onto a tablet, putting a remote above the pacemaker-like device in her chest and sending the data. She answers questions that pop up about how she feels. Then she records a video that will be analyzed for things such as facial expression and speech.
Occasionally, she goes into Mount Sinai’s “Q-Lab,” an immersive environment where scientists do quantitative research collecting all sorts of data, including how she moves in a virtual forest or makes circles in the air with her arms. Like many other patients, she moves her arms faster now that she’s doing better.
Data from recordings and visits are combined with other information, such as life events, to chart how she’s doing. This helps guide doctors’ decisions, such as whether to increase her dose of electricity – which they did once.
On a recent morning, Hollenbeck moved her collar and brushed her hair aside to reveal scars on her chest and head from her DBS surgery. To her, they’re signs of how far she’s come.
She makes her way around the city, taking walks in the park and going to libraries, which were a refuge in childhood. She no longer worries that normal life challenges will trigger a crushing depression.
“The stress is pretty extreme at times, but I’m able to see and remember, even on a bodily level, that I’m going to be OK,” she said.
“If I hadn’t had DBS, I’m pretty sure I would not be alive today.”
2) Brain Wave-Powered Tech Allows Canadian Kids ‘Trapped In Their Own Bodies’ To Play
Courtesy of Barrie360.com and Canadian PressPublished: Feb 20th, 2024
By Nicole Ireland in Toronto
Eight-year-old Giselle Alnaser wants the Elmo stuffed toy sitting on a stool across the room, and she’s going to use her brain waves to get it.
As her mother encourages her with calls of, “Let’s go, let’s go, let’s go!” Giselle concentrates asthe platform beneath her wheelchair appears to roll by itself toward Elmo. She smiles when she reaches the stool and an occupational therapist hands her the toy.
Giselle was diagnosed with a CAMK2b gene mutation when she was a toddler. It affects her brain’s ability to communicate with her muscles — meaning she can’t walk or move her arms much — and she’s not able to speak.
The Brain Computer Interface program at Holland Bloorview Kids Rehabilitation Hospital in Toronto develops technology that allows Giselle and dozens of other physically disabled children to use their minds to move and play.
“(These are) children who are not able to move themselves in space, (who) don’t have reliable movement and don’t have verbal communication or have difficulty with verbal communication. So really their only way of interacting with the environment is through their thoughts,” said Susannah Van Damme, an occupational therapist and team lead for the hospital’s clinical BCI program.
The brain computer interface works like an on-off switch triggered by electrical patterns in the brain. While wearing a headset with EEG electrodes, the child is asked to think about something specific that will serve as a “command” thought. The child is then asked to relax and put their mind in a quiet, passive state, which serves as the “stop” thought.
The electrodes transmit those electrical signals to a computer, where they are saved. The computer is trained through artificial intelligence to recognize those specific brain patterns when it sees them again and start or stop whatever device it’s connected to — such as Giselle’s rolling wheelchair platform.
“As long as an individual can generate activity in the brain you can kind of flick the switch and control the activity,” said Tom Chau, senior scientist and head of Holland Bloorview’s Paediatric Rehabilitation Intelligent Systems Multidisciplinary lab.
Giselle generates a “command” thought bythinking about moving fast in her wheelchair, or focusing on the phrase “go, go, go.”
But any thought will do. The key is for the child to concentrate on it while the computer records the electrical brain pattern it creates.
Then when the child wants to make something happen, they think the same thought again, generating the same brain pattern that the computer now recognizes.
“(When a child) sends that “go” signal, the computer interprets that just as a command to start, to activate whatever it is that it’s attached to,” Van Damme said.
For another activity, the team attaches the computer to a bubble maker. The same command thoughts that allow Giselle to move her wheelchair now allow her to make bubbles appear.
In agame of “freeze,” the computer is programmed to play music when she thinks her command thought. As the Barney dance song plays, Giselle turns the music on and off as her mom and hospital staff dance around her. When she stops the music to make them freeze in position, Giselle smiles with delight.
“Someone who has not been able to turn on their favourite music or play a video game because of a physical disability, they can use their brain power to do that,” Van Damme said.
Giselle’s parents, Samah Darwish and Naser Alnaser, said watching their daughter use BCI technology has been “amazing.”
“Like any parent, you want some independence for the kids to do their own things … to move, to play, to learn and everything,” said Alnaser.
“To be herself. To be a kid.”
Although BCI research has occurredin various parts of the world for decades, a Canadian network comprised of Holland Bloorview, Alberta Children’s Hospital in Calgary and Glenrose Rehabilitation Hospital in Edmonton has taken the lead in recent years in bringing the technology to children and youth with disabilities.
“One thing that we noticed as a group of clinicians who see children and their families was that although those BCI technologies are rapidly advancing, the pediatric population were really neglected,” said Dr. John Andersen, a University of Alberta associate professor of pediatrics who leads the BCI program at Glenrose.
“We wanted to see how we can make this accessible to children and learn from them and their families to kind of co-develop how this emerging technology can be accessible in its current form and how we can develop the technology and expertise around it in the future,” said Andersen, noting that Chau at Holland Bloorview has been the trailblazer for the group.
Although the on-off switch activities help children and youth with neuromotor disabilities gain more control in their lives, the researchers say developing BCI technology to help non-verbal children communicate is the next major step — and a priority requested by their parents.
“We’ve been doing research in communication for, you know, two decades now. But we’re finally getting it to the point where you’re going to be able to translate it,” said Chau.
The hope is that in the near future, children will be able to use BCI to convey wants and needs using their minds, he said.
“(That would) really unlock huge potential for kids who’ve been basically trapped in their own bodies,” Chau said.
“They have so much that they want to express. And there’s just never been the means.”
Patricia is the Business Mentor and owner of Grow Vantage and a Past President of the Barrie Chamber of Commerce. She applies over 30 years of business experience (from start-up to corporate) to mentor entrepreneurs. Since 2011, she has held over 6,500 coaching and training sessions in-person and online. Through Ask For Directions Training, her entrepreneurial training program (and parent company Grow Vantage), and as a business coach, she works with start-ups who are new (or who have lost traction) to design, launch and grow their businesses. Along with 20 other expert instructors she teaches strategies in marketing, sales, communications, and finance, as well as practical techniques to increase productivity, and manage their businesses. In other words, everything entrepreneurs need to learn to grow and run their businesses successfully, and avoid the costly mistakes they can't even see coming - that lead to delays in growth and getting stuck.