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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by SLS on January 25, 2011, at 23:59:58
Another idea comes to fruition.
http://www.nerve.com/news/current-events/woman-cured-of-clinical-depression-by-revolutionary-surgery
It took them long enough. DBS works, in part, by flooding a pathologically overactive circuit with exogenous electric currents that disrupt their function by reducing the propogation of action potentials (nerve firings). One region of the brain that has demonstrated overactivity in depression is the subgenual cingulate Brodman's Area 25. To brag just a little, I would like to say that I came up with this same idea a few years ago when it seemed like common sense to investigate stereotactic tissue ablation in the overactive areas of the brain responsible for depression. It was the breakthrough work of Helen S. Mayberg, M.D and others who first identified these overactive brain regions. I just figured that a precise application of tissue ablation in these areas would serve to provide the same therapeutic benefits as DBS.
- Scott
Posted by Bob on January 26, 2011, at 1:26:41
In reply to A better DBS?, posted by SLS on January 25, 2011, at 23:59:58
> Another idea comes to fruition.
>
> http://www.nerve.com/news/current-events/woman-cured-of-clinical-depression-by-revolutionary-surgery
>
> It took them long enough. DBS works, in part, by flooding a pathologically overactive circuit with exogenous electric currents that disrupt their function by reducing the propogation of action potentials (nerve firings). One region of the brain that has demonstrated overactivity in depression is the subgenual cingulate Brodman's Area 25. To brag just a little, I would like to say that I came up with this same idea a few years ago when it seemed like common sense to investigate stereotactic tissue ablation in the overactive areas of the brain responsible for depression. It was the breakthrough work of Helen S. Mayberg, M.D and others who first identified these overactive brain regions. I just figured that a precise application of tissue ablation in these areas would serve to provide the same therapeutic benefits as DBS.
>
>
> - Scott
>
The problem with the DBS trials is that it seems from the research that somewhere between 40 and 60 percent of people respond to varying degrees and then there's the 40 to 60 percent that don't. Nobody knows why of course.There is also some controversy as to what the electrodes are actually doing, as the research indicates that it almost certainly is not mimicking the ablation caused by a surgical lesion. There are indications that the electrical stimulation is making certain tracts/pathways in the brain hyperactive. There also may be a dual near and far-field simultaneous effect involving inhibition at close proximity to the electrode and an excitatory effect at greater distances.
Then there's the question of the optimal target - anterior cingulate, nucleus accumbens, caudate nucleus, ventral anterior capsule, lateral habenula, etc. The anterior cingulotomy looks to in the dorsal region of the anterior cingulate and reverts back to ablation techniques, but with more advanced and accurate methods. This is an extremely interesting case as the trial at University of Bristol involved 4 electrodes stimulating two different areas... and only after that the woman received and additional anterior cingulotomy. Amazing. I wonder sometimes if the more accurate ablation techniques may be better in the future than the DBS stimulation.
Bob
Posted by SLS on January 26, 2011, at 3:41:36
In reply to Re: A better DBS? » SLS, posted by Bob on January 26, 2011, at 1:26:41
Hi Bob.
Thank for the reply. I guess I was hoping that things were simpler than they first appeared. I was hoping that an ablation technique would produce the same results as DBS.
> The problem with the DBS trials is that it seems from the research that somewhere between 40 and 60 percent of people respond to varying degrees and then there's the 40 to 60 percent that don't. Nobody knows why of course.
> There is also some controversy as to what the electrodes are actually doing, as the research indicates that it almost certainly is not mimicking the ablation caused by a surgical lesion. There are indications that the electrical stimulation is making certain tracts/pathways in the brain hyperactive. There also may be a dual near and far-field simultaneous effect involving inhibition at close proximity to the electrode and an excitatory effect at greater distances.
>
> Then there's the question of the optimal target - anterior cingulate, nucleus accumbens, caudate nucleus, ventral anterior capsule, lateral habenula, etc. The anterior cingulotomy looks to in the dorsal region of the anterior cingulate and reverts back to ablation techniques, but with more advanced and accurate methods. This is an extremely interesting case as the trial at University of Bristol involved 4 electrodes stimulating two different areas... and only after that the woman received and additional anterior cingulotomy. Amazing. I wonder sometimes if the more accurate ablation techniques may be better in the future than the DBS stimulation.Nice info.
- Scott
Posted by jhj on January 27, 2011, at 4:12:35
In reply to Re: A better DBS?, posted by SLS on January 26, 2011, at 3:41:36
How does it compare with frontal lobotomy? Is it in anyway better than frontal lobotomy?Thanks
Posted by SLS on January 27, 2011, at 4:55:58
In reply to Re: A better DBS?, posted by jhj on January 27, 2011, at 4:12:35
>
> How does it compare with frontal lobotomy? Is it in anyway better than frontal lobotomy?The ablation (burning away of tissue) of anterior cingulate is a much more precise at targeting an area of the brain that helps regulate mood. A frontal lobotomy is a crude attempt at pacifying behaviorally activated psychosis. The tissue removed during this procedure often results in a deficit of affect and cognitive impairments. The regions of the brain that are chosen to interrupt for these two procedures are completely different.
I suppose they could find the exact location of the tissue to ablate using the same type of electrodes used in DBS as a probe. When they find the spot that elicits the greatest change in mood (which is instantaneous), that area would be ablated.
- Scott
Posted by rovers95 on January 30, 2011, at 11:59:53
In reply to Re: A better DBS? » jhj, posted by SLS on January 27, 2011, at 4:55:58
> >
> > How does it compare with frontal lobotomy? Is it in anyway better than frontal lobotomy?
>
> The ablation (burning away of tissue) of anterior cingulate is a much more precise at targeting an area of the brain that helps regulate mood. A frontal lobotomy is a crude attempt at pacifying behaviorally activated psychosis. The tissue removed during this procedure often results in a deficit of affect and cognitive impairments. The regions of the brain that are chosen to interrupt for these two procedures are completely different.
>
> I suppose they could find the exact location of the tissue to ablate using the same type of electrodes used in DBS as a probe. When they find the spot that elicits the greatest change in mood (which is instantaneous), that area would be ablated.
>
>
> - ScottThanks for this, it gives me great hope....how long do you think it is before this treatment becomes a medically licensed treatment?
Rover
Posted by SLS on January 30, 2011, at 13:14:23
In reply to Re: A better DBS...how far is this away? » SLS, posted by rovers95 on January 30, 2011, at 11:59:53
> > >
> > > How does it compare with frontal lobotomy? Is it in anyway better than frontal lobotomy?
> >
> > The ablation (burning away of tissue) of anterior cingulate is a much more precise at targeting an area of the brain that helps regulate mood. A frontal lobotomy is a crude attempt at pacifying behaviorally activated psychosis. The tissue removed during this procedure often results in a deficit of affect and cognitive impairments. The regions of the brain that are chosen to interrupt for these two procedures are completely different.
> >
> > I suppose they could find the exact location of the tissue to ablate using the same type of electrodes used in DBS as a probe. When they find the spot that elicits the greatest change in mood (which is instantaneous), that area would be ablated.
> >
> >
> > - Scott
>
> Thanks for this, it gives me great hope....how long do you think it is before this treatment becomes a medically licensed treatment?
>
> Rover
The FDA is an enigma. It would be difficult to predict how soon a device and procedure such as this would be approved. Drugs can take a decade of work. Devices probably take less time.In other words, I can't answer your question.
:-(
- Scott
Posted by EERR11CC on February 15, 2011, at 22:43:20
In reply to Re: A better DBS? » SLS, posted by Bob on January 26, 2011, at 1:26:41
I had DBS surgery at Toronto Western Hospital, Helen Mayberg held my hand when I had a panic attack as they screwed the stereotactic frame onto my skull. This was about about 5 years ago. The procedure got rid of the really bad "pain" of depression, that pain that escapes description, but cripples and ends lives. I was able to go back to work and function in society again. The procedure did not get rid of depression however, it just very noticeably made it less "painful".
Posted by EERR11CC on February 15, 2011, at 22:43:28
In reply to Re: A better DBS? » SLS, posted by Bob on January 26, 2011, at 1:26:41
I had DBS surgery at Toronto Western Hospital, Helen Mayberg held my hand when I had a panic attack as they screwed the stereotactic frame onto my skull. This was about about 5 years ago. The procedure got rid of the really bad "pain" of depression, that pain that escapes description, but cripples and ends lives. I was able to go back to work and function in society again. The procedure did not get rid of depression however, it just very noticeably made it less "painful".
This is the end of the thread.
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