Thursday, March 21st, 2013
By RICK NAUERT PHD Senior News Editor
Reviewed by John M. Grohol, Psy.D. on March 13, 2013
Those with schizophrenia are often functionally limited by mental or cognitive impairments.
Memory, attention, IQ, and verbal and motor skills are often disrupted, and these deficits tend to compromise the ability to perform normal day-to-day activities.
Scientists have been exploring a variety of strategies to reduce these impairments, including “exercising the brain” with specially designed computer games and medications that might improve the function of brain circuits.
In a new study, Mera Barr, Ph.D., and her colleagues at University of Toronto provide evidence that stimulating the brain using repetitive transcranial magnetic stimulation (rTMS) may be an effective strategy to improve cognitive function.
“In a randomized controlled trial, we evaluated whether rTMS can improve working memory in schizophrenia,” said Barr and senior author Zafiris Daskalakis, M.D.
“Our results showed that rTMS resulted in a significant improvement in working memory performance relative to baseline.”
Transcranial magnetic stimulation is a non-invasive procedure that uses magnetic fields to stimulate nerve cells. It does not require sedation or anesthesia and so patients remain awake, reclined in a chair, while treatment is administered through coils placed near the forehead.
In 2008, rTMS was FDA-approved to treat depression for individuals who don’t respond to pharmacotherapy.
The study is presented in the journal Biological Psychiatry.
“TMS can have lasting effects on brain circuit function because this approach not only changes the activity of the circuit that is being stimulated, but it also may change the plasticity of that circuit, i.e., the capacity of the circuit to remodel itself functionally and structurally to support cognitive functions,” said Dr. John Krystal, editor of the journal.
Experts say that previous studies have shown that rTMS improves working memory in healthy individuals, and a recent open-label trial showed promising findings for verbal memory in schizophrenia patients.
These findings informed the current study to determine if high frequency rTMS could improve memory in individuals with schizophrenia.
Researchers recruited medicated schizophrenia patients who completed a working memory task before and after 4 weeks of treatment.
Research methodology involved a double-blind study, where neither the patients nor the researchers knew who was receiving real rTMS or a sham treatment that was designed to entirely mimic the procedure without actually delivering brain stimulation.
Investigators discovered TMS not only improved working memory in patients after 4 weeks, but the improvement was to a level comparable to healthy subjects.
These findings suggest that rTMS may be a novel, efficacious, and safe treatment for working memory deficits in schizophrenia.
While the current findings are preliminary, researchers hope additional investigations will replicate the findings and provide an approved treatment for cognitive impairments in schizophrenia.
The authors concluded: “Working memory is an important predictor of functional outcome. Developing novel treatments aimed at improving these deficits may ultimately translate into meaningful changes in the lives of patients suffering from this debilitating disorder.”
Tags: Anxiety, dementia, depression, major depression, memories, memory, neuropsychiatry, neurotransmitters, psychiatrist, psychiatry, therapy, tms, transcranial magnetic stimulation
Posted in Article | No Comments »
Thursday, March 21st, 2013
Harborough Mail- Published on 04/03/2010 16:48
A handheld device could ‘zap away’ headaches according to several newspapers. They say that the device, which delivers a magnetic pulse to the back of the head, could be an alternative to drug treatments for sufferers.
The news is based on a well-conducted randomised controlled trial and has found promising results when using a ‘single-pulse transcranial magnetic stimulation’ device to treat people who frequently suffer from migraine with visual distortions (aura). Within two hours of the onset of symptoms more people were pain-free when using the handheld device than those who had used an identical dummy device.
Although the study has reliable results, there are some points to consider when putting these findings into context. Importantly, the results will need to be verified in larger trials that directly compare the technology to other active treatments for migraine, principally medication. Therefore, the news reports are premature in announcing this treatment as an ‘alternative’ to pain medications. Further issues of optimal use, effectiveness and safety also need to be explored when further researching this promising technology.
Where did the story come from?
This research was conducted by Dr Richard Lipton and colleagues from Einstein College of Medicine, New York and other institutions across the US. The study was funded by Neuralieve, the medical technology company that makes the prototype device being tested. The study was published in the peer-reviewed medical journal The Lancet.
What kind of research was this?
This was a phase 2 randomised, ‘sham’-controlled trial testing the use of a prototype ‘single-pulse transcranial magnetic stimulation’ (sTMS) device using magnetic fields to treat certain types of migraine. The study was termed a ‘sham trial’ as it compared a real device against an identical mock device that actually performed no function.
A randomised controlled trial is the best way of examining the safety and efficacy of a treatment. However, results of this trial will need follow-up in larger phase 3 trials that compare sTMS use to other active treatments for migraine (eg replace the sham sTMS device with suitable drugs) and in larger groups of people.
News coverage has generally reflected the findings of this well-conducted trial, although most reports have jumped too far ahead in hailing this as a new treatment for migraine ‘at the press of a button’. The current stage of this research, plus the fact that it hasn’t been compared to any active treatment, mean that questions still remain over its safety and efficacy.
What did the research involve?
This research was carried out at 18 different locations across the US and studied people who experienced migraines accompanied by aura – visual distortions that precede the pain of migraines. Aura symptoms usually last less than an hour and can include visual disturbances (such as flashing/flickering spots of lights, zigzag lines or even temporary blindness), numbness, tingling sensations and slurred speech.
All eligible adults met diagnostic criteria of having at least 30% of their migraines accompanied by aura. Their migraines also had to occur at least once a month and to be associated with moderate or severe headache in 90% of those attacks. People were excluded if their migraine was suspected to be caused by, or associated with, overuse of painkillers, use of other medications, or underlying disease or trauma.
Before the treatment phase began, the recruited participants were trained in the use of an electronic headache diary, which they used for one month to verify that they had a suitable diagnosis of migraine for the trial. Sixty-six people dropped out in this phase, after which the remaining 201 individuals were randomly allocated by computer to either sham stimulation (99 people) or sTMS (102 people). Training was given in the use of the devices before the trail.
The sTMS machine tested was a handheld device that could be positioned against bone at the base of the skull. It delivers two magnetic pulses, 30 seconds apart, when the ‘treat’ button is pressed. The ‘sham’ stimulator device was identical to the real device, even buzzing and vibrating in the same manner. Neither researchers nor participants knew which device each person was using.
Participants were instructed to treat up to three attacks over a three-month period at the onset of aura. The main outcome was being pain-free within two hours of the attack, and with secondary outcomes being no difference between the sTMS device and sham device in terms of reports of symptoms of nausea, oversensitivity to light, and oversensitivity to sound within two hours of the attack. All participants were allowed to use their usual migraine medication throughout the trial.
What were the basic results?
The researchers excluded the results on 37 people who did not treat a single migraine attack during the trial. This left 164 patients (82 sTMS and 82 sham). Significantly more people treated with sTMS were pain-free within two hours (39% v 22%; 17% difference, 95% CI 3 to 31%).
At 24 and 48 hours after using the device, sustained pain-free response rates were also better in the treatment group.
There were also no differences between the sTMS and sham groups in rates of associated nausea, sensitivity to light, or sensitivity to sound. No device-related serious adverse effects were observed.
How did the researchers interpret the results?
The researchers conclude that early treatment of migraine with aura using sTMS resulted in increased freedom from pain at two hours compared with sham stimulation, and sustained absence of pain at 24 and 48 hours. They say that sTMS this could be a promising new treatment for migraine with aura.
This well-conducted, double-blind, randomised controlled trial has found promising results when using single-pulse transcranial magnetic stimulation (sTMS) to treat people who frequently suffer from migraine with visual aura. Within two hours of the onset of symptoms, more people were pain-free when using the handheld device than those who had used an identical ‘sham’ device.
Although the study has reliable results, there are a couple of things to consider when putting these findings into context:
This was a phase 2 trial, which has so far compared sTMS only with no treatment in a relatively small number of people (164 completed the study). Results will need follow-up in larger phase 3 trials that compare sTMS to other active treatments for migraine (eg actual drugs rather than sham sTMS) and in larger groups of people.
People in this trial were allowed to use medications to treat their migraine as normal, so at this stage it is difficult to extract the extent of the effect that sTMS alone is having, for example how people would feel if they used sTMS as their sole treatment for migraine. Therefore, the news reports are premature in announcing this treatment as an ‘alternative to pain medications’.
Although no significant adverse effects of this device were observed, a greater number of people who had used this device for much longer than three months (the period of this study) would need to be observed in order to see whether there were any longer-term adverse effects or health risks of sTMS.
As the researchers say, they have not yet explored the possible range of sTMS doses that could be given, or the optimum timing of treatment (at what stage in the headache, for example). The device at the current time would only be suitable for people who experience migraine with visual aura.
Overall, the findings of this study are promising, and further trials are awaited.
Tuesday, February 5th, 2013
Will Parker- Researchers are reporting a successful phase IIa clinical trial of GLYX-13, a first-of-its-kind ketamine-like antidepressant that takes effect within 24 hours and delivers double the antidepressant effect of traditional selective serotonin re-uptake inhibitor (SSRI) treatments. Details of the clinical development of GLYX-13 appear in the current issue of the journal Neuropsychopharmacology and the trial results were presented last Thursday at the 51st Annual Meeting of the American College of Neuropsychopharmacology.
GLYX-13 was developed by a team led by Joseph Moskal, research professor of biomedical engineering at Northwestern University. Moskal said the drug was novel because it targets the brain receptors responsible for learning and memory – a very different approach from SSRI antidepressants. The researchers speculate it also could be helpful in treating other neurological conditions, including schizophrenia, bipolar disorder, anxiety and Alzheimer’s disease.
GLYX-13 works by modulating the N-methyl-D-aspartate (NMDA) receptor in the brain, as do other NMDA receptor antagonists such as ketamine, but GLYX-13 does not have their serious and limiting side effects, such as hallucinations and schizophrenia-like effects. NMDA receptors play a key role in regulating synaptic plasticity – the quality of the connection between neurons – and thus are important in regulating learning and memory functions.
In trials administered at 12 sites across the country, a single dose of GLYX-13 resulted in significant reductions in depression symptoms among subjects who had shown little improvement with previous drugs. The positive effects of GLYX-13 were evident within 24 hours and lasted an average of seven days. The effect size, a measure of the magnitude of the drug’s antidepressant efficacy, at both these times after a single dose was nearly double the effect size seen with most other antidepressant drugs after four to six weeks of repeated dosing. Side effects of GLYX-13 were mild to moderate and were consistent with those observed in subjects receiving a placebo.
GLYX-13 is administered intravenously but Moskal is working on an oral version. The drug is currently undergoing a phase IIb clinical trial at 20 sites across the United States. This trial is evaluating repeated doses of the drug.
Tags: antidepressants, depression, ketamine, major depression, neuropsychiatry, neurotransmitters, psychiatrist, psychiatry, therapy, tms, transcranial magnetic stimulation
Posted in Article | No Comments »
Thursday, January 17th, 2013
Kristine Crane(Gainsville Sun)- Elizabeth Bate used to go to bed at night praying she wouldn’t wake up in the morning.
Bate has suffered from depression since 1974, the year her daughter was born, which threw Bate into postpartum depression.
“She cried, and I would cry. She got colic, and I had colic of the brain,” Bate said.
For the past three decades, Bate, now 62, has been what she calls “a functional depressive.” She took medications — as many as four at a time — that kept her suicidal thoughts at bay but did little else.
Sometimes to distract herself from her depressive thoughts, she stayed in bed all day, reading or watching “crap TV,” she said, without remembering anything about the shows or books.
“I would see my grandkids and feel sad because I didn’t feel joy,” Bate said.
But in May, Bate began to reclaim her life with a treatment called TMS, which stands for transcranial magnetic stimulation. Electric pulses to the brain reactivate what Bate’s doctor, psychiatrist Michael Johnson, calls the brain’s “emotional circuitry,” which connects such functions as thoughts, mood and appetite.
“When you trigger one part of it, the current flows through the whole circuit,” Johnson said. In other words, TMS normalizes the neurotransmitters such as serotonin and dopamine, which affect everything as diverse as mood, memory and sex drive. In depressed patients, the malfunctioning circuitry allows negative emotions to take over.
The FDA approved TMS in 2008 for patients who already had at least one medication fail. Patients who don’t want to deal with the side effects of antidepressants also are opting for TMS.
“Medications can affect the entire body. You can have side effects such as nausea, vomiting weight loss, weight gain, sexual side effects,” said Dr. Richard Holbert, a psychiatrist and professor at the University of Florida and Shands. TMS instead is “very focused treatment,” Holbert continued, careful to distinguish it from electroconvulsive therapy (ECT), in which “you’re actually put to sleep and made to have a seizure so the entire brain is affected.”
Bate tried ECT but said she suffered memory loss, a common side effect. She also can attest to the negative side effects of antidepressants, which gave her night and day sweats and made her gain weight.
“Gaining 32 pounds in one year will definitely add to your depression,” she said.
TMS sessions last about 45 minutes and are typically done Monday through Friday for a maximum of six weeks. “People come in on their lunch breaks,” Johnson said.
“We’ve treated a number of doctors, nurses, and attorneys, and it’s nice for them,” Holbert added.
Most patients’ depression goes into remission after the six-week treatment, research has shown, with some requiring repeated sessions. Afterward, patients can receive maintenance therapy in the form of therapy sessions.
For Bate, she says the treatment was worth the cost.
“It gave me my life back,” said Bate, correcting herself. “It gave me my life.”
A former physical education instructor who stopped working out during her depression, Bate said she now walks every morning and does Qigong, a Chinese exercise using meditation, four nights a week. She said she loves spending time with her grandchildren and wakes up in the morning happy to be alive.
“She’s basically had complete recovery,” Johnson said, adding that TMS “is not just another me-too drug.” Studies suggest the effects might last longer than other depression treatments and essentially put patients into remission. Sometimes they repeat TMS once a month to prevent relapse, or more often, they start therapy.
Holbert said that depression “is the most disabling condition in the world, much more than heart disease. It’s imperative that we get patients into remission.”
Thursday, August 9th, 2012
Time.com) — Why do some people find it impossible to get rid of old newspapers and junk mail, and end up hoarding them instead?
New research suggests that hoarders have unique patterns of brain activity when faced with making decisions about their possessions, compared with healthy people. And despite the fact that hoarding has traditionally been seen as a symptom or subtype of obsessive compulsive disorder (OCD), brain activity in those who cannot de-clutter is also distinct from that of people with typical OCD, the study shows.
“Many things are unique and distinct about hoarding,” says Dr. Eric Hollander, director of the autism and obsessive compulsive spectrum disorder program at Montefiore/Albert Einstein School of Medicine in New York, who was not associated with the new research.
He notes that the new study adds to the evidence that hoarding should be recognized as a specific syndrome that falls not under the standard definition of OCD — only about 18% of people with hoarding symptoms meet the full criteria for OCD as it is currently defined — but within a spectrum of related conditions.
“[This] is a very interesting and important study,” he says.
Indeed, a separate diagnosis of hoarding disorder has been proposed for inclusion in the upcoming revision of psychiatry’s diagnostic manual, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).
Time.com: Real-world hoarders and obsessive-compulsives
For the new research, published in the Archives of General Psychiatry, David Tolin of the Institute of Living in Hartford, Connecticut, recruited 107 people for brain scans using functional magnetic resonance imaging (fMRI). Forty-three people had hoarding disorder, 31 people had OCD and 33 participants were normal controls.
The participants were asked to bring a sample of their own junk mail or newspapers to the lab and were assured that researchers wouldn’t throw out anything they wanted to keep. The participants were also told that while they were having their brain activity imaged, they would be asked to decide whether to keep or shred these papers.
Inside the scanner, the participants were shown images of either their own stuff — preceded by a slide identifying it as “Yours” — or images of junk mail and newspapers from the lab, labeled “Ours.” For each item, they had to decide whether or not to submit it to the shredder.
Not surprisingly, people with hoarding disorder chose to keep more of their own items than did those with OCD or those without a diagnosis. When they were faced with tossing or keeping their own items, the hoarders’ brain responses also differed from that of the other participants: they showed excessive activation in the anterior cingulate cortex, a brain region involved with decision-making, particularly in situations involving conflicting information or uncertainty.
Activity was also elevated in the insula, a region that monitors one’s emotional and physical state (it’s also involved in disgust, shame and other strong negative emotions). Together, these regions help assign relative levels of importance or significance to objects.
“Hoarders have great difficulty making decisions, especially around the value of their possessions,” says Michael Jenike, an OCD expert and professor of psychiatry at Harvard, who was not associated with the research. “This study is very interesting as it demonstrates that brain regions associated with monitoring for errors under conditions of uncertainty are activated when hoarding patients are deciding whether or not to throw out personal items.”
In other words, hoarders assign too much value to their possessions, making it difficult or impossible to decide to get rid of them.
Consequently, the study found that people with hoarding disorder took much longer to make decisions about discarding their possessions and felt more sadness and anxiety about these choices than did the other participants.
“One of the characteristics of hoarding is that people feel this sense of discomfort if they feel like they may be giving away something that they could use in future,” says Hollander, explaining that patients often become greatly distressed or even angry if they are pushed to give up apparently useless or excess possessions.
Interestingly, however, when people with hoarding disorder made similar decisions about discarding junk mail that didn’t belong to them, they again showed unusual levels of activity in the anterior cingulate cortex and insula — but in this case, their brain activity was much lower than normal.
The paper’s authors note that the reduced activity is a “pattern reminiscent of that seen in patients with autism,” who are often disengaged from others and who, like hoarders, have rigid routines as well as obsessive behavior.
The authors suggest that this lack of brain activity could be linked with the “diminished motivation and poor insight frequently observed” in patients who hoard; that is, it may be what allows them to live amidst overwhelming clutter and piles of junk, but fail to clear it out or even be bothered by it.
Meanwhile, the hyperactivity in these regions may make them overly anxious about and attached to their own possessions, rendering them too overwhelmed to decide to change.
Hollander compares it to a “check engine” light that keeps flashing on the dash for no reason. A healthy person might be able to disregard the alarm as irrelevant, but the hoarder becomes obsessively focused on it.
“One problem with hoarding, and with OCD, is that when that alarm goes off, it becomes more and more important and the brain pays more and more attention to these signals.” says Hollander. “The [person's] specific concern becomes more and more salient and other routines and activities become less salient, and that’s what’s associated with functional consequences. Their lives get smaller and smaller.”
So, it’s not that hoarders are slobs or obsessive collectors. Rather, it’s that they have problems making the kinds of decisions about their stuff that others would consider reasonable.
Hollander notes also that the new findings could have important implications for the treatment of hoarding. A new type of transcranial magnetic stimulation (TMS), for example — a therapy that uses non-invasive electrical stimulation of the brain to treat depression — may work for people with hoarding disorder.
Wednesday, February 29th, 2012
When it comes to depression, one of five adults at some point in their life will experience it.
“I didn’t want to live. I could see no the point in living. Everything was pointless,” said Martha Rhodes.
Even as a teen, Martha Rhodes could remember having thoughts of suicide. Her depression cost her career and nearly her life.”I overdosed because I couldn’t go on, I just couldn’t go on,” said Rhodes.
Neither therapy nor medication was helpful, she was considered treatment resistant. Her last hope was an alternative treatment called NeuroStar TMS, Transcranial Magnetic Stimulation, where through a coil, highly focused magnetetic stimulation is applied to areas of the brain thought to control mood.
Dr. Randy Pardell, a Psychiatrist said, “We utilize an MRI strength magnet to gently and persistently stimulate the areas of the brain that are under performing and under functioning.” The pulse is delivered for four seconds, with a 26 second break, the cycle lasts forty minutes.
“We see on spec scans or pet scans, these are scans that are able to look at brain functioning, that it awakens those areas of the brain,” said Dr. Pardell.
Rhodes said, “The only side effect is the intense tapping, and it’s intense, like a neogie.”
There’s no prep work for treatment and no after effects, unlike some antidepressant medication. Most patients have one treatment five days a week, for 4 to 5 weeks. Martha began to see results after her 18th session.
“I thought something was missing and I couldn’t put my finger on it and then I realized, it’s the awful feeling, the dread, that disgusting emotional nausea is gone,” said Rhodes.
The treatment is relatively new but there are other things they are treating, such as pain management, anxiety and headaches.
Some critics worry that the magnetic pulse is dangerous.
“The amount of stimulation you get from our machine in the total treatment is less than one MRI,” said Dr. Pardell.
Martha is medication free and most importantly, depression free.
“I feel saved and I feel survived form a dark and dangerous place,” said Rhodes.
Wednesday, January 18th, 2012
This finding supports a warning issued by the FDA during 2006 that alerted women that those taking SSRIs wer six times more likely to deliver babies with PPHN.
PPHN is high blood pressure in the arteries of the lungs. It causes the right ventricle of the heart- which must pump blood through the lungs to pick up oxygen- to work harder, too hard. This can ultimately cause weakening of the heart and heart failure.
Pulmonary hypertension affects about 1 in 1,000 newborns, but more than double that number of newborns of mothers taking antidepressants in the second half of their pregnancies seem to be affected. And an increased risk-though lower- appears to be present in those babies born to mothers who take antidepressants in the first half of their pregnancies.
Antidepressants of one kind or another have been implicated in- but not proven to be absolutely responsible for- increasing the risk of low birth weight, premaurity, and low blood sugar.
So, women should stop antidepressants when they learn they are pregnant, right? Not exactly. There are reasons to stop and theire are reasons to continue.
So, my advice is this:
1) If you are a woman considering pregnancy, try to stop or not to start antidepressants- as long as your symptoms are relatively mild. If you require treatment for depression, try psychotherapy or Transcranial Magnetic Stimulation (TMS), which treats depression with magnetic pulses delivered to the head and which has no known contraindications in pregnancy. But, if you have serious symptoms of depression, use SSRIs, with the advice and under the care of your physician.
2) If you find out you are pregnant while you are already taking anti-depressants, talk to your doctor about very slowly stopping them, but only if you can do so safely, without severe symptoms of depression returning.
3) Never stop antidepressants all of a sudden. This can cause serious symptoms that affect you and your unborn child.
4) Do not stop antidepressants during pregnancy if you have been suicidal while depressed in the past and antidepressants have been necessary to ward off thoughts of harming yourself.
As a final note, while many obstetricians and many primary care doctors are comfortable treating depression, I believe it is best to be seen by a psychiatrist if you are taking antidepressants and want to have a baby.
Tags: antidepressants, depression, major depression, mothers, neuropsychiatry, paxil, pregnancy, pregnant, prozac, psychiatrist, psychiatry, SSRI, SSRIs, therapy, tms, transcranial magnetic stimulation, Zoloft
Posted in Article | No Comments »
Wednesday, December 7th, 2011
San Diego News-Transcranial magnetic stimulation (TMS) does not require anti-depressants, and patients only need to relax in a chair while magnetic pulses are sent to key neurons in the brain.
Sonja Tanner, who is currently using TMS to treat her depression, has battled it for 25 years. “It’s been the battle of my life,” Tanner said.
Tanner has been on and off medication, but she recently turned to the Botkiss Center for TMS Therapy in Del Mar. She receives treatment by sitting in a chair, five days a week for 40 minutes, while pulses stimulate the parts of her brain that controls mood.
In about three weeks, she said she saw dramatic changes. “My focus was better, my memory was better, my anxiety was better,” Tanner said.
Dr. Philip Botkiss understands why some who have never heard of this may be skeptical. “Anything that’s new and different is going to be scrutinized in the psychiatric community and even by patients,” Botkiss said.
Tanner admitted she did not believe it would work either.
“I was the biggest skeptic, I really was … I have 25 years of non-effective treatment,” Tanner said.
The treatment has been approved by the FDA, and the American Psychiatric Association recently included TMS in its depression treatment guidelines. ”It’s still relatively new so I think the challenge will be to find where it fits in our entire set of tools,” said Dr. Catherine Moore, a longtime psychiatrist and past president of the San Diego Psychiatric Society.
”TMS has been a lifesaver for me,” Tanner said.
Tags: antidepressants, Anxiety, depression, major depression, neuropsychiatry, neurotransmitters, psychiatrist, psychiatry, psychology, therapy, tms, transcranial magnetic stimulation
Posted in Article | No Comments »
Tuesday, November 29th, 2011
EuroNews (Nov. 21, 2011)- Katherine Damazer was at school doing exams when she became anorexic. Previously on holiday with her family in Tibet she caught a virus, became very ill and lost a lot of weight.
At first she enjoyed being thin, then dieting took over her life.
“I used to feel faint all the time and every morning I woke up and blacked out for a while every time I got out of bed, and I used to be freezing, constantly freezing and shivering and having funny heart palpitations and having this constant feeling like your stomach was eating itself. You’re just so hungry and it kind of becomes enjoyable and satisfying because you know you’re doing a really good job at having an eating disorder,” she laughs.
But it is no laughing matter. Anorexia nervosa is a complex condition.
A London-based team is investigating whether repetitive transcranial magnetic stimulation could help sufferers. They are targeting the part of the brain that is implicated in the experience of craving.
“We found that one session of Trans Cranial Magnetic Stimulation as we deliver it may reduce cravings in people with bulimia nervosa, food cravings. In people with anorexia nervosa we found that reduces their sense of fullness and fatness when they’re exposed to foods and it also reduces their anxiety,” says Consultant Psychiatrist at King’s College, London, Frederique Van den Eynde.
Professor of Eating Disorders Ulrike Schmidt says anorexia takes an enormous toll on the body.
“They have, typically, after a period of time, lots of physical disabilities, the bones crumble, osteoporosis develops, people have problems with all their internal organs,” she says.
Around a million people in the UK suffer from eating disorders and experts do not really know what causes them. Up to 20 per cent of sufferers will die from their illness, so any new potential therapy has to be good news for patients and their families.
Thursday, November 3rd, 2011
Dr. Yoon-Hee Cha, with UCLA’s Department of Neurology, answers the most commonly asked questions about Mal de Debarquement Syndrome:
What is Mal de Debarquement Syndrome?
Mal de debarquement syndrome is a term used to describe the persistent sensation of motion that people feel after they have been passively moved for a long time. It can happen with all kinds of travel but is most common after sea and air travel. It is a disorder of adulthood, with the average age of a first episode being about age 40, with women affected much more frequently than men, by at least a 3 to 1 ratio.
How can you treat it?
There is no cure for the disorder but benzodiazepines and antidepressants that raise serotonin tone can help manage symptoms in some people. For those people for whom medications don’t help and who have persistent symptoms, we are investigating neuromodulation tools like transcranial magnetic stimulation to see whether we can change the connectivity between different brain regions that may be driving the symptoms.
Can anything be done to prevent MdDS?
Overall, persistent MdDS lasting over a month is uncommon, but there are many people who are prone to experiencing recurrent episodes of MdDS. Some of the common factors include sleep deprivation and stress during travel. So, I advise my patients to plan their trips so that they are not sleep deprived when traveling. In some people who tend to get MdDS very frequently, I have them take a small dose of valium during travel.
What kind of research are you doing?
A few years ago, I did a clinical study involving about 100 patients. Now we have about 300 people in our database. It was clear that there were no structural brain or inner ear abnormalities in these patients. And, why should they? All they did was to step off of a boat or plane and developed their symptoms. So, I decided that we needed to study this disorder with functional neuroimaging like PET and functional MRI to see changes in glucose metabolism, functional connectivity, and really fine volume changes. And, it was clear that many if not most people with MdDS were not responding to medication. Which is why I decided that we needed to use external neuromodulation to treat these patients.
What is neuromodulation?
Many disorders do not respond well to medication or other more traditional therapies. So, a growing body of researchers are trying induce brain activity changes externally. The most common form of neuromodulation practiced is transcranial magnetic stimulation, or TMS. TMS is one form of neuromodulation in which a changing magnetic field placed over the head is used to induce either an inhibitory or excitatory physiological change in the brain. The effects obtained depend on the frequency, intensity, and location of the stimulation. Other forms are transcranial direct current stimulation, or stimulating peripheral nerves as a window into altering brainstem activity.
We did a pilot study using 4 different TMS conditions and there was one condition that was associated with very significant reduction in symptoms in some of the participants. So, we are testing longer exposure to TMS to see whether can induce a longer duration of symptom relief.