Date: 11/24/2008
By LAURAN NEERGAARD
AP Medical Writer
WASHINGTON (AP) _ Just in time for the holidays, some medical advice most people will like: Take a nap.
Interrupting sleep seriously disrupts memory-making, compelling new research suggests. But on the flip side, taking a nap may boost a sophisticated kind of memory that helps us see the big picture and get creative.
“Not only do we need to remember to sleep, but most certainly we sleep to remember,” is how Dr. William Fishbein, a cognitive neuroscientist at the City University of New York, put it at a meeting of the Society for Neuroscience last week.
Good sleep is a casualty of our 24/7 world. Surveys suggest few adults attain the recommended seven to eight hours a night.
Way too little clearly is dangerous: Sleep deprivation causes not just car crashes but all sorts of other accidents. Over time, a chronic lack of sleep can erode the body in ways that leave us more vulnerable to heart disease, diabetes and other illnesses.
But perhaps more common than insomnia is fragmented sleep — the easy awakening that comes with aging, or, worse, the sleep apnea that afflicts millions, who quit breathing for 30 seconds or so over and over throughout the night.
Indeed, scientists increasingly are focusing less on sleep duration and more on the quality of sleep, what’s called sleep intensity, in studying how sleep helps the brain process memories so they stick. Particularly important is “slow-wave sleep,” a period of very deep sleep that comes earlier than better-known REM sleep, or dreaming time.
Fishbein suspected a more active role for the slow-wave sleep that can emerge even in a power nap. Maybe our brains keep working during that time to solve problems and come up with new ideas. So he and graduate student Hiuyan Lau devised a simple test: documenting relational memory, where the brain puts together separately learned facts in new ways.
First, they taught 20 English-speaking college students lists of Chinese words spelled with two characters — such as sister, mother, maid. Then half the students took a nap, being monitored to be sure they didn’t move from slow-wave sleep into the REM stage.
Upon awakening, they took a multiple-choice test of Chinese words they’d never seen before. The nappers did much better at automatically learning that the first of the two-pair characters in the words they’d memorized earlier always meant the same thing — female, for example. So they also were more likely than non-nappers to choose that a new word containing that character meant “princess” and not “ape.”
“The nap group has essentially teased out what’s going on,” Fishbein concludes.
These students took a 90-minute nap, quite a luxury for most adults. But even a 12-minute nap can boost some forms of memory, adds Dr. Robert Stickgold of Harvard Medical School.
Conversely, Wisconsin researchers briefly interrupted nighttime slow-wave sleep by playing a beep — just loudly enough to disturb sleep but not awaken — and found those people couldn’t remember a task they’d learned the day before as well as people whose slow-wave sleep wasn’t disrupted.
That brings us back to fragmented sleep, whether from aging or apnea. It can suppress the birth of new brain cells in the hippocampus, where memory-making begins — enough to hinder learning weeks after sleep returns to normal, warns Dr. Dennis McGinty of the University of California, Los Angeles.
To prove a lasting effect, McGinty mimicked human sleep apnea in rats. He hooked them to brain monitors and made them sleep on a treadmill. Whenever the monitors detected 30 seconds of sleep, the treadmill briefly switched on. After 12 days of this sleep disturbance, McGinty let the rats sleep peacefully for as long as they wanted for the next two weeks.
The catch-up sleep didn’t help: Rested rats used room cues to quickly learn the escape hole in a maze. Those with fragmented sleep two weeks earlier couldn’t, only randomly stumbling upon the escape.
None of the new work is enough, yet, to pinpoint the minimum sleep needed for optimal memory. What’s needed may vary considerably from person to person.
“A short sleeper may have a very efficient deep sleep even if they sleep only four hours,” notes Dr. Chiara Cirellia of the University of Wisconsin, Madison.
But altogether, the findings do suggest some practical advice: Get apnea treated. Avoid what Harvard’s Stickgold calls “sleep bulimia,” super-late nights followed by sleep-in weekends. And don’t feel guilty for napping.
___
EDITOR’S NOTE — Lauran Neergaard covers health and medical issues for The Associated Press in Washington.
Copyright 2008 The Associated Press.
Attorney Gordon Johnson
Chair Traumatic Brain Injury Litigation Group, American Association of Justice
g@gordonjohnson.com :: 800-992-9447 :: Attorney Gordon S. Johnson, Jr.
http://subtlebraininjury.com :: http://brainanatomyguide.com :: http://car-accident-rain.com :: http://tbilaw.com
http://waiting.com :: http://vestibulardisorder.com :: http://youtube.com/profile?user=braininjuryattorney
US family opposes end to care for brain-dead boy
Date: 11/8/2008
By DAVID B. CARUSO
Associated Press Writer
NEW YORK (AP) _ A U.S. hospital has asked a judge for permission to stop treating a brain-dead 12-year-old cancer patient, even though his ultra-religious New York parents want to keep him on life support.
Motl Brody of Brooklyn was pronounced dead this week after a half-year fight against a brain tumor, and doctors at Children’s National Medical Center in Washington say the seventh-grader’s brain has ceased functioning entirely.
But for the past few days, a machine has continued to inflate and deflate his lungs. As of late Friday afternoon, his heart was still beating with the help of a cocktail of intravenous drugs and adrenaline.
That heartbeat has prompted Motl’s parents, who are Orthodox Jews, to refuse the hospital’s request to remove all artificial life support.
Under some interpretations of Jewish religious law, including the one accepted by the family’s Hasidic sect, death occurs only when the heart and lungs stop functioning.
That means Motl “is alive, and his family has a religious obligation to secure all necessary and appropriate medical treatment to keep him alive,” the family’s attorney wrote in a court filing this week.
The family has asked the hospital to leave the breathing machine on and keep administering drugs until the boy’s heart and lungs no longer respond.
Disagreements between families and medical providers over when to end care for terminally ill patients are common, experts say, but this case wound up in court with unusual speed.
Unlike Terri Schiavo or Karen Ann Quinlan, who became the subjects of right-to-die battles when they suffered brain damage and became unconscious, Motl’s condition has deteriorated beyond a persistent vegetative state, his physicians say. His brain has died entirely, according to an affidavit filed by one of his doctors.
His eyes are fixed and dilated. His body neither moves nor responds to stimulation. His brain stem shows no electrical function, and his brain tissue has begun to decompose.
“This is death at its simplest,” the hospital’s lawyers wrote in a court filing.
The hospital said it would help the family move what it called the boy’s “earthly remains” to another medical facility, but has found none willing to accept a brain-dead child.
The dispute wound up in court Sunday, when the family asked a federal judge to block the hospital from doing any further tests for brain activity.
The hospital responded by asking a District of Columbia Superior Court judge for permission to discontinue treatment.
Jeffrey I. Zuckerman, the attorney for Motl’s parents, says they have been “utterly shattered” by the hospital’s actions.
He stressed that the family’s demand for continued life support was based on their obligations under religious law, not an unrealistic hope that their boy will recover.
“You can always hope for a miracle, but if you are asking if they are in denial about their child’s medical condition, no, they are not,” Zuckerman said.
A hearing was scheduled for Monday, but Children’s National Medical Center said it would ask for a postponement until Wednesday.
“We respect the family’s beliefs, and have tried since the patient’s arrival in June to work closely with them in a spirit of mutual respect,” the hospital said in a written statement.
It added, however, that attempts to discuss end-of-life issues with the family had been complicated.
Motl’s mother and father, Eluzer and Miriam Brody, haven’t been to the hospital since July. The medical center says its requests to speak directly with them have been rebuffed, and in recent days, hospital employees “have been inundated with harassing and threatening calls” regarding the case.
A substantial delay in resolving the disagreement may render it moot. The hospital suggested in legal filings that the boy’s remaining body functions will cease within weeks, if not days.
Dr. Edward Reichman, an associate professor of medicine at Albert Einstein Medical College in New York, said the question of how to accommodate religious beliefs regarding brain death comes up occasionally in New York, where there is a large population of Orthodox Jews.
While there is intense debate over whether to accept brain death as the spiritual end of life, hospitals usually find a way to work through it, he said.
“More often than not, the medical team … will accept the wishes of the family, especially if cardiac death is anticipated in a short window of time,” he said.
Arthur Caplan, a professor of bioethics at the University of Pennsylvania, said physicians aren’t obligated to provide care that can’t possibly be medically helpful.
“Doctors are well within their rights to say, ‘We are stopping,’” he said. “I don’t think medicine can become subservient to religious, spiritual or mystical hopes and beliefs concerning how to manage death.”
Copyright 2008 The Associated Press.
Attorney Gordon Johnson
Chair Traumatic Brain Injury Litigation Group, American Association of Justice
g@gordonjohnson.com :: 800-992-9447 :: Attorney Gordon S. Johnson, Jr.
http://subtlebraininjury.com :: http://brainanatomyguide.com :: http://car-accident-rain.com :: http://tbilaw.com
http://waiting.com :: http://vestibulardisorder.com :: http://youtube.com/profile?user=braininjuryattorney
By DAVID B. CARUSO
Associated Press Writer
NEW YORK (AP) _ A U.S. hospital has asked a judge for permission to stop treating a brain-dead 12-year-old cancer patient, even though his ultra-religious New York parents want to keep him on life support.
Motl Brody of Brooklyn was pronounced dead this week after a half-year fight against a brain tumor, and doctors at Children’s National Medical Center in Washington say the seventh-grader’s brain has ceased functioning entirely.
But for the past few days, a machine has continued to inflate and deflate his lungs. As of late Friday afternoon, his heart was still beating with the help of a cocktail of intravenous drugs and adrenaline.
That heartbeat has prompted Motl’s parents, who are Orthodox Jews, to refuse the hospital’s request to remove all artificial life support.
Under some interpretations of Jewish religious law, including the one accepted by the family’s Hasidic sect, death occurs only when the heart and lungs stop functioning.
That means Motl “is alive, and his family has a religious obligation to secure all necessary and appropriate medical treatment to keep him alive,” the family’s attorney wrote in a court filing this week.
The family has asked the hospital to leave the breathing machine on and keep administering drugs until the boy’s heart and lungs no longer respond.
Disagreements between families and medical providers over when to end care for terminally ill patients are common, experts say, but this case wound up in court with unusual speed.
Unlike Terri Schiavo or Karen Ann Quinlan, who became the subjects of right-to-die battles when they suffered brain damage and became unconscious, Motl’s condition has deteriorated beyond a persistent vegetative state, his physicians say. His brain has died entirely, according to an affidavit filed by one of his doctors.
His eyes are fixed and dilated. His body neither moves nor responds to stimulation. His brain stem shows no electrical function, and his brain tissue has begun to decompose.
“This is death at its simplest,” the hospital’s lawyers wrote in a court filing.
The hospital said it would help the family move what it called the boy’s “earthly remains” to another medical facility, but has found none willing to accept a brain-dead child.
The dispute wound up in court Sunday, when the family asked a federal judge to block the hospital from doing any further tests for brain activity.
The hospital responded by asking a District of Columbia Superior Court judge for permission to discontinue treatment.
Jeffrey I. Zuckerman, the attorney for Motl’s parents, says they have been “utterly shattered” by the hospital’s actions.
He stressed that the family’s demand for continued life support was based on their obligations under religious law, not an unrealistic hope that their boy will recover.
“You can always hope for a miracle, but if you are asking if they are in denial about their child’s medical condition, no, they are not,” Zuckerman said.
A hearing was scheduled for Monday, but Children’s National Medical Center said it would ask for a postponement until Wednesday.
“We respect the family’s beliefs, and have tried since the patient’s arrival in June to work closely with them in a spirit of mutual respect,” the hospital said in a written statement.
It added, however, that attempts to discuss end-of-life issues with the family had been complicated.
Motl’s mother and father, Eluzer and Miriam Brody, haven’t been to the hospital since July. The medical center says its requests to speak directly with them have been rebuffed, and in recent days, hospital employees “have been inundated with harassing and threatening calls” regarding the case.
A substantial delay in resolving the disagreement may render it moot. The hospital suggested in legal filings that the boy’s remaining body functions will cease within weeks, if not days.
Dr. Edward Reichman, an associate professor of medicine at Albert Einstein Medical College in New York, said the question of how to accommodate religious beliefs regarding brain death comes up occasionally in New York, where there is a large population of Orthodox Jews.
While there is intense debate over whether to accept brain death as the spiritual end of life, hospitals usually find a way to work through it, he said.
“More often than not, the medical team … will accept the wishes of the family, especially if cardiac death is anticipated in a short window of time,” he said.
Arthur Caplan, a professor of bioethics at the University of Pennsylvania, said physicians aren’t obligated to provide care that can’t possibly be medically helpful.
“Doctors are well within their rights to say, ‘We are stopping,’” he said. “I don’t think medicine can become subservient to religious, spiritual or mystical hopes and beliefs concerning how to manage death.”
Copyright 2008 The Associated Press.
Attorney Gordon Johnson
Chair Traumatic Brain Injury Litigation Group, American Association of Justice
g@gordonjohnson.com :: 800-992-9447 :: Attorney Gordon S. Johnson, Jr.
http://subtlebraininjury.com :: http://brainanatomyguide.com :: http://car-accident-rain.com :: http://tbilaw.com
http://waiting.com :: http://vestibulardisorder.com :: http://youtube.com/profile?user=braininjuryattorney
CA surgeon to stand trial in organ donation case
Date: 11/2/2008 5:28 PM
By GREG RISLING
Associated Press Writer
LOS ANGELES (AP) — Ruben Navarro loved horror movies. He watched the “Nightmare on Elm Street” and “Friday the 13th” series with his mother, Rosa, and liked to visit Knott’s Berry Farm when it was transformed every October to “Knott’s Scary Farm.”
Since his death 2½ years ago, Rosa Navarro says she has been living a real-life nightmare without her only child. Ruben Navarro, who had multiple medical problems, died in a San Luis Obispo hospital following a heart attack, and then was taken off a ventilator and prepared for organ donation.
The circumstances surrounding that death will be center stage as opening statements are scheduled to begin Monday in the trial of Dr. Hootan Roozrokh, a San Francisco transplant surgeon who is accused of hastening Navarro’s death so his organs could be harvested.
“He was my world,” Rosa Navarro told The Associated Press on Thursday. “It’s been very, very hard for me. He didn’t die with respect and integrity.”
Roozrokh, 34, faces one count of felony dependent adult abuse. Two other felony counts were dismissed by San Luis Obispo County Superior Court Judge Martin J. Tangeman in March.
If convicted, he could face four years in prison.
Defense lawyer M. Gerald Schwartzbach has said Roozrokh did nothing wrong, saying he did not endanger Navarro’s health or life. Schwartzbach did not respond to an e-mail message for further comment.
The case against Roozrokh is believed to be the first such criminal action brought against a transplant doctor in the U.S.
Navarro, 25, died in February 2006 at Sierra Vista Regional Medical Center in San Luis Obispo. He had a debilitating neurological disease and was in a coma after suffering the heart attack.
His kidneys and liver were never harvested because he didn’t die within a time frame when those organs would have been considered viable.
The hospital has said it had Rosa Navarro’s permission to remove her son from life support, but she disputes that.
Statements to police by nurses present in the operating room indicated Roozrokh improperly ordered excessive doses of morphine and a sedative for Navarro. State law says transplant surgeons must wait until a potential donor is dead before participating in procedures.
But Tangeman said in his ruling dismissing the other two charges that there was no evidence Roozrokh administered or ordered a combination of morphine and the sedative. The judge also noted that doctors and nurses present when Navarro died gave conflicting accounts of what happened.
Roozrokh, a surgeon at Kaiser Permanente’s now-closed kidney transplant program, was working at the time on behalf of a group that procures and distributes organs.
The case is being watched closely by physicians and others in the medical field, said Arthur Caplan, a professor of medical ethics at the University of Pennsylvania who worries that a conviction could hurt prospects for expanding organ donation.
“It’s a trust issue,” Caplan said. “It’s such a moral taboo to give the appearance of hastening a death through organ donation. Were he to be found guilty, it would be a thunderclap heard through the organ procurement field.”
Navarro, who weighed about 80 pounds, was born with a neurological disorder known as adrenoleukodystrophy and also had cerebral palsy. He lived in a home for mentally and physically challenged adults in the year before his death.
The hospital and its parent company settled a lawsuit last year filed by Rosa Navarro for $250,000. Under terms of the settlement, the hospital acknowledged no wrongdoing.
Copyright 2008 The Associated Press.
Attorney Gordon Johnson
Chair Traumatic Brain Injury Litigation Group, American Association of Justice
g@gordonjohnson.com :: 800-992-9447 :: Attorney Gordon S. Johnson, Jr.
http://subtlebraininjury.com :: http://brainanatomyguide.com :: http://car-accident-rain.com :: http://tbilaw.com
http://waiting.com :: http://vestibulardisorder.com :: http://youtube.com/profile?user=braininjuryattorney
By GREG RISLING
Associated Press Writer
LOS ANGELES (AP) — Ruben Navarro loved horror movies. He watched the “Nightmare on Elm Street” and “Friday the 13th” series with his mother, Rosa, and liked to visit Knott’s Berry Farm when it was transformed every October to “Knott’s Scary Farm.”
Since his death 2½ years ago, Rosa Navarro says she has been living a real-life nightmare without her only child. Ruben Navarro, who had multiple medical problems, died in a San Luis Obispo hospital following a heart attack, and then was taken off a ventilator and prepared for organ donation.
The circumstances surrounding that death will be center stage as opening statements are scheduled to begin Monday in the trial of Dr. Hootan Roozrokh, a San Francisco transplant surgeon who is accused of hastening Navarro’s death so his organs could be harvested.
“He was my world,” Rosa Navarro told The Associated Press on Thursday. “It’s been very, very hard for me. He didn’t die with respect and integrity.”
Roozrokh, 34, faces one count of felony dependent adult abuse. Two other felony counts were dismissed by San Luis Obispo County Superior Court Judge Martin J. Tangeman in March.
If convicted, he could face four years in prison.
Defense lawyer M. Gerald Schwartzbach has said Roozrokh did nothing wrong, saying he did not endanger Navarro’s health or life. Schwartzbach did not respond to an e-mail message for further comment.
The case against Roozrokh is believed to be the first such criminal action brought against a transplant doctor in the U.S.
Navarro, 25, died in February 2006 at Sierra Vista Regional Medical Center in San Luis Obispo. He had a debilitating neurological disease and was in a coma after suffering the heart attack.
His kidneys and liver were never harvested because he didn’t die within a time frame when those organs would have been considered viable.
The hospital has said it had Rosa Navarro’s permission to remove her son from life support, but she disputes that.
Statements to police by nurses present in the operating room indicated Roozrokh improperly ordered excessive doses of morphine and a sedative for Navarro. State law says transplant surgeons must wait until a potential donor is dead before participating in procedures.
But Tangeman said in his ruling dismissing the other two charges that there was no evidence Roozrokh administered or ordered a combination of morphine and the sedative. The judge also noted that doctors and nurses present when Navarro died gave conflicting accounts of what happened.
Roozrokh, a surgeon at Kaiser Permanente’s now-closed kidney transplant program, was working at the time on behalf of a group that procures and distributes organs.
The case is being watched closely by physicians and others in the medical field, said Arthur Caplan, a professor of medical ethics at the University of Pennsylvania who worries that a conviction could hurt prospects for expanding organ donation.
“It’s a trust issue,” Caplan said. “It’s such a moral taboo to give the appearance of hastening a death through organ donation. Were he to be found guilty, it would be a thunderclap heard through the organ procurement field.”
Navarro, who weighed about 80 pounds, was born with a neurological disorder known as adrenoleukodystrophy and also had cerebral palsy. He lived in a home for mentally and physically challenged adults in the year before his death.
The hospital and its parent company settled a lawsuit last year filed by Rosa Navarro for $250,000. Under terms of the settlement, the hospital acknowledged no wrongdoing.
Copyright 2008 The Associated Press.
Attorney Gordon Johnson
Chair Traumatic Brain Injury Litigation Group, American Association of Justice
g@gordonjohnson.com :: 800-992-9447 :: Attorney Gordon S. Johnson, Jr.
http://subtlebraininjury.com :: http://brainanatomyguide.com :: http://car-accident-rain.com :: http://tbilaw.com
http://waiting.com :: http://vestibulardisorder.com :: http://youtube.com/profile?user=braininjuryattorney
Magnet device aims to treat depression patients
Date: 10/20/2008 5:05 PM
By LAURAN NEERGAARD
AP Medical Writer
WASHINGTON (AP) _ The government has approved the first noninvasive brain stimulator to treat depression — a device that beams magnetic pulses through the skull.
If it sounds like science-fiction, well, those woodpecker-like pulses trigger small electrical charges that spark brain cells to fire. Yet it doesn’t cause the risks of surgically implanted electrodes or the treatment of last resort, shock therapy.
Called transcranial magnetic stimulation or TMS, this gentler approach isn’t for everyone. The Food and Drug Administration approved Neuronetics Inc.’s NeuroStar therapy specifically for patients who had no relief from their first antidepressant, offering them a different option than trying pill after pill.
“We’re opening up a whole new area of medicine,” says Dr. Mark George of the Medical University of South Carolina in Charleston, who helped pioneer use of TMS in depression. “There’s a whole field now that’s moving forward of noninvasive electrical stimulation of the brain.”
While there’s a big need for innovative approaches — at least one in five depression patients is treatment-resistant — the question is just how much benefit TMS offers.
The FDA cleared the prescription-only NeuroStar based on data that found patients did modestly better when treated with TMS than when they unknowingly received a sham treatment that mimicked the magnet. It was a study fraught with statistical questions that concerned the agency’s own scientific advisers.
For a more clear answer, the National Institutes of Health has an independent study under way now that tracks 260 patients and may have initial results as early as next year.
Quantifying the benefit is key, considering the price tag. TMS is expected to cost $6,000 to $10,000, depending on how many treatments a patient needs, says Dr. Philip Janicak of Rush University Medical Center in Chicago, who helped lead the NeuroStar study. That’s far more expensive than medication yet thousands of dollars cheaper than invasive depression devices.
Neuroscientists have been using TMS for years as a research tool in brain studies. Zap a powerful magnet over a certain spot on the head — where motion is controlled — and someone’s arm can suddenly, involuntarily, lash out. Beyond the “wow” factor, magnetized pulses were triggering brain activity.
The question was how to harness that activity in a way that might improve disease. TMS also is being studied in stroke rehabilitation and other brain disorders.
“Nobody thought this would work; it was a crazy idea. I had to do it at 6 in the morning before the real scientists came in,” South Carolina’s George laughs as he recalls work he began in 1993.
But, “the brain is an electrical organ,” George adds, explaining the rationale. “Electricity is the currency of the brain. It’s how the brain does what it does.”
For depression, psychiatrists aim the magnet at the left front of the head, the prefrontal cortex. Since everyone’s brain is different, they first zap the top of the head to find a patient’s motor-control region, and then carefully move 5 centimeters forward. Then, the NeuroStar beams about 3,000 pulses a minute during a 40-minute treatment, done about five times a week for up to six weeks.
The theory: Stimulating brain cells in the prefrontal cortex triggers a chain reaction that also stimulates deeper brain regions involved with mood.
TMS did prove to be very safe: Patients in the NeuroStar study suffered no seizures or memory problems like shock therapy can cause, or other reactions throughout the body. The chief complaint from the sessions was headaches.
The FDA cleared the device after focusing just on a subset of the patients initially enrolled — 164 who had failed one antidepressant during their current bout of depression, not those who were more severely treatment-resistant.
What’s a modest benefit? About 24 percent who got TMS scored significantly better on standard depression measures after six weeks, compared with 12 percent who got the sham, says Janicak. That’s about as well as patients respond to a single antidepressant, he says.
Some reported remarkable improvement.
“One day it was like a light switch went off,” says Steve Newman, 60, of Washington, D.C., who enrolled in the NeuroStar study at the University of Pennsylvania in 2005.
Newman had suffered repeated bouts of depression since he was a teenager, and drug after drug barely blunted it. He was considering shock therapy when he heard about TMS.
After two weeks of treatment, Newman was wondering if he was getting the sham — when suddenly, he started feeling lots better, and doctors spotted a corresponding major improvement in his depression measurements.
“I was awake. I was there,” says Newman who said he still gets what he calls a “maintenance dose” of TMS about once a month.
___
EDITOR’s NOTE — Lauran Neergaard covers health and medical issues for The Associated Press in Washington.
Copyright 2008 The Associated Press.
Attorney Gordon Johnson
Chair Traumatic Brain Injury Litigation Group, American Association of Justice
g@gordonjohnson.com :: 800-992-9447 :: Attorney Gordon S. Johnson, Jr.
http://subtlebraininjury.com :: http://brainanatomyguide.com :: http://car-accident-rain.com :: http://tbilaw.com
http://waiting.com :: http://vestibulardisorder.com :: http://youtube.com/profile?user=braininjuryattorney
By LAURAN NEERGAARD
AP Medical Writer
WASHINGTON (AP) _ The government has approved the first noninvasive brain stimulator to treat depression — a device that beams magnetic pulses through the skull.
If it sounds like science-fiction, well, those woodpecker-like pulses trigger small electrical charges that spark brain cells to fire. Yet it doesn’t cause the risks of surgically implanted electrodes or the treatment of last resort, shock therapy.
Called transcranial magnetic stimulation or TMS, this gentler approach isn’t for everyone. The Food and Drug Administration approved Neuronetics Inc.’s NeuroStar therapy specifically for patients who had no relief from their first antidepressant, offering them a different option than trying pill after pill.
“We’re opening up a whole new area of medicine,” says Dr. Mark George of the Medical University of South Carolina in Charleston, who helped pioneer use of TMS in depression. “There’s a whole field now that’s moving forward of noninvasive electrical stimulation of the brain.”
While there’s a big need for innovative approaches — at least one in five depression patients is treatment-resistant — the question is just how much benefit TMS offers.
The FDA cleared the prescription-only NeuroStar based on data that found patients did modestly better when treated with TMS than when they unknowingly received a sham treatment that mimicked the magnet. It was a study fraught with statistical questions that concerned the agency’s own scientific advisers.
For a more clear answer, the National Institutes of Health has an independent study under way now that tracks 260 patients and may have initial results as early as next year.
Quantifying the benefit is key, considering the price tag. TMS is expected to cost $6,000 to $10,000, depending on how many treatments a patient needs, says Dr. Philip Janicak of Rush University Medical Center in Chicago, who helped lead the NeuroStar study. That’s far more expensive than medication yet thousands of dollars cheaper than invasive depression devices.
Neuroscientists have been using TMS for years as a research tool in brain studies. Zap a powerful magnet over a certain spot on the head — where motion is controlled — and someone’s arm can suddenly, involuntarily, lash out. Beyond the “wow” factor, magnetized pulses were triggering brain activity.
The question was how to harness that activity in a way that might improve disease. TMS also is being studied in stroke rehabilitation and other brain disorders.
“Nobody thought this would work; it was a crazy idea. I had to do it at 6 in the morning before the real scientists came in,” South Carolina’s George laughs as he recalls work he began in 1993.
But, “the brain is an electrical organ,” George adds, explaining the rationale. “Electricity is the currency of the brain. It’s how the brain does what it does.”
For depression, psychiatrists aim the magnet at the left front of the head, the prefrontal cortex. Since everyone’s brain is different, they first zap the top of the head to find a patient’s motor-control region, and then carefully move 5 centimeters forward. Then, the NeuroStar beams about 3,000 pulses a minute during a 40-minute treatment, done about five times a week for up to six weeks.
The theory: Stimulating brain cells in the prefrontal cortex triggers a chain reaction that also stimulates deeper brain regions involved with mood.
TMS did prove to be very safe: Patients in the NeuroStar study suffered no seizures or memory problems like shock therapy can cause, or other reactions throughout the body. The chief complaint from the sessions was headaches.
The FDA cleared the device after focusing just on a subset of the patients initially enrolled — 164 who had failed one antidepressant during their current bout of depression, not those who were more severely treatment-resistant.
What’s a modest benefit? About 24 percent who got TMS scored significantly better on standard depression measures after six weeks, compared with 12 percent who got the sham, says Janicak. That’s about as well as patients respond to a single antidepressant, he says.
Some reported remarkable improvement.
“One day it was like a light switch went off,” says Steve Newman, 60, of Washington, D.C., who enrolled in the NeuroStar study at the University of Pennsylvania in 2005.
Newman had suffered repeated bouts of depression since he was a teenager, and drug after drug barely blunted it. He was considering shock therapy when he heard about TMS.
After two weeks of treatment, Newman was wondering if he was getting the sham — when suddenly, he started feeling lots better, and doctors spotted a corresponding major improvement in his depression measurements.
“I was awake. I was there,” says Newman who said he still gets what he calls a “maintenance dose” of TMS about once a month.
___
EDITOR’s NOTE — Lauran Neergaard covers health and medical issues for The Associated Press in Washington.
Copyright 2008 The Associated Press.
Attorney Gordon Johnson
Chair Traumatic Brain Injury Litigation Group, American Association of Justice
g@gordonjohnson.com :: 800-992-9447 :: Attorney Gordon S. Johnson, Jr.
http://subtlebraininjury.com :: http://brainanatomyguide.com :: http://car-accident-rain.com :: http://tbilaw.com
http://waiting.com :: http://vestibulardisorder.com :: http://youtube.com/profile?user=braininjuryattorney