Deep brain stimulation - success!

Professor Helen Mayberg describes the incredible transformation in some patients following deep brain stimulation to treat depression.

So it’s really interesting because as a non-surgeon, we’ve all read about Penfield and the whole notion of what it’s like as you probe the brain in order to cut out an area that as you would stimulate, you can evoke some very, very interesting memories or other events. He was often operating in the temporal lobe where memories are thought to be stored or at least can be brought up. What we found, and much to our great interest when we first started, because we didn’t know what we were going to have happen; this is not an area of the brain that has been operated on for anything like this ever. So when this area of the brain is damaged (it could be from an aneurism), it’s just not an area anyone knows a whole lot about to be stimulating. But as you enter into this area, you don’t actually get any of these evoked memories, but when we actually turned the contacts on we were amazed by the fact, and I remember very distinctly the first patient; not the first contact we tested which she had no response to at any voltage, but we got to the second contact and got up to a moderate amount of current, and she all of a sudden said, “Did you just do something? I have this intense sense of calm or relief.” And then she kind of had this very kind of puzzled expression on her face and she says, “It’s just so hard to describe”, and I said well what’s it like? I had this immediate thought that oh this is like Penfield; she’s having some memory thing, and she says, “It’s just so hard to describe; it’s like that first day of spring when the crocus just pop up through the snow;” and I’m going, “Wait a minute, are you seeing crocus?” And she says no, and she kind of throws her hand out, and you have to imagine that someone is in this frame, and they are lying on a hospital bed, and everyone is sitting in the room and everybody comes to total attention. And she’s a sweet woman, and she just kind of throws her hand out and says “No, no,” like ‘you idiot, I’m not talking about seeing flowers, I don’t know what she’s talking about’. She says, “I’m trying to think of something that evokes this kind of emotional state, this kind of calm and satisfaction.” It turned out that this woman was a gardener. We lived in Toronto. It was as if she realized that first day when you walk outside in spring and see the flowers, it’s a sense of renewal, it’s the start of spring. It was the most amazing and poetic statement. She was groping, quite frankly, for something that was like the feeling she had, even though the feeling itself was very ethereal and very hard to explain. That was one of the most amazing things, although other patients would get a change in state; you could see it on their face before they recognized it. It was as if, when patients are this ill there is a pain-ness to their face. If they walk past you on the street you think ‘Boy this person must have had a bad day’, they look like that all the time, and when we would get to the right contact, we’ve gotten to where you can watch their facial expression and you can actually just see it relax. Or you’ll have a patient say ‘did you turn the lights up’; there’s like a lifting, there’s so many interesting phenomena that, it’s not mapping it in the same way that Penfield did where you can evoke a reproducible memory of an event or a time, but you can see that we are actually in the emotional control system that is sort of hijacked. As it’s released it’s a real state of calm, relief, lifting; one patient said “You know, when you are depressed, you are so turned inward, it doesn’t matter what anybody outside you says, you cannot pay attention to them. And whatever you just did, I can take attention away from myself and attend to you”. So again, we are in this fundamental area of the brain that when it is dysfunctional, it hijacks you. Your emotions hijack anything else that you can possibly do, and there is something about this small amount of current, in this very specific place that allows the system to just re-equilibrate. It isn’t about becoming happy or becoming engaged in an exaggerated way, it’s just allowing your brain to be back in your own control. And figuring that out is the coolest part of science that anybody can hope to participate in.

deep brain stimulation, depression, treatemnt, rehabilitation, penfield, temporal lobe, helen, mayberg

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