Tuesday, May 29, 2007

NY Times Book Review on Neuroplasticity

The New York Times has a review on a book published recently by Norman Doidge that reports on the revolution/evolution of the science surrounding neuroplasticity.
The credo of this revolution is neuroplasticity — the discovery that the human brain is as malleable as a lump of wet clay not only in infancy, as scientists have long known, but well into hoary old age......
Dr. Doidge, a Canadian psychiatrist and award-winning science writer, recounts the accomplishments of the “neuroplasticians,” as he calls the neuroscientists involved in these new studies, with breathless reverence. Their work is indeed mind-bending, miracle-making, reality-busting stuff, with implications, as Dr. Doidge notes, not only for individual patients with neurologic disease but for all human beings, not to mention human culture, human learning and human history.

This should be some interesting reading. I will get some thoughts on this books into the blog as soon as I get my hands on a copy and get through it.
If you have read the book I would like to hear what you have to say.

Monday, May 21, 2007

Wired Article on TMS

Interesting blog entry from Wired on the handheld TMS unit by Neuralieve. I know relatively little about the actual power of this unit and I have to admit that I am little skeptical of the ability to accurately focus and the ability to penetrate with such a small unit. A little more reading is in order.....Anyone out there with an opinion on this technology???

Wired Article on TMS

Neuralieve Website

Saturday, May 19, 2007

tDCS for major depression

Nice study done by Fregni et al. looking at treating depression with transcranial direct current stimulation (tDCS) for 20 min/day for five days. The patients, n=10, were divided into a control group getting sham treatment and a treatment group. All subjects were evaluated with the Hamilton and Beck Depression Inventories prior to and after treatment (or sham treatment). The treatment group HAM and BDI scores improved approximately 60% and 65%, respectively. The sham group improved 10% and 25%, respectively.
As the authors state, "The importance of this study lies in the fact that this treatment is inexpensive, easy to administer, non-invasive and painless."
They go on to say that the effects of tDCS are most likely related to neuronal depolarization and prolonged enhancement of the excitability of the left dorsolateral prefrontal cortex. This stimulation may re-equilibriate the balance of excitation/inhibition in that area of the brain.
As the basic science is accumulating, and the CNS imaging techniques improve, it seems like resetting this excitation/inhibition balance is one of the keys to neuromodulation whether it is with tDCS, TMS, pharmacology or psychological approaches.

Treatment of major depression with transcranial direct current stimulation.

Wednesday, May 16, 2007

Mayo Clinic article on TMS for the public

Here is a link to a post from mayoclinic.com about TMS and how it works. I am curious about who the authors are for this article, I posted about the article that first introduced me to TMS and that article came out of the Mayo Clinic.

Newsweek Article on TMS

Here is a link to an article that appeared in Newsweek on TMS. It seems to give a fair evaluation of some of the pros and the cons of TMS. Nice that they identified Dr. Pascual-Leone in the article considering the breadth and depth of research that he has done.
Newsweek article

Slow-Frequency rTMS and Fibromyalgia Pain

This was the first article I read that introduced me to the concept of transcranial magnetic stimulation. I had just seen a patient the day before in a Rheumatology clinic I was visiting and had a long chat with the Rheumatologist I was working with about the etiology of Fibromyalgia and what sorts of treatments were available. Needless to say, he was fairly pessimistic about what was possible. I ran across this article in Rehab in Review, it piqued my interest and I pulled the article.
Some thoughts about the article: an n of four is always concerning, so it needs to be considered a limited case series. But if you examine the response of the patients to repetitive transcranial stimulation (rTMS), it was pretty amazing. A baseline pain of 8.2(ranging from 7-9.5 on a scale of 0-10) that was dropped to 1.5 (0-3.5) is not only statistically significant, but if you consider the functional ramifications it is amazing. These subjects received rTMS five days per week for four weeks, one of the patients received sham rTMS prior to the four weeks and one got an additional twelve treatments because she (they were all women) had remission of depressive symptoms. All had been diagnosed by board certified Rheumatologists and all had been evaluated by Psychiatrists.
The results showed one patient had resolution of depression and two of the four had resolution of their pain. Pain was improved, defined as not increasing more than 1.5 points on the 0-10 scale, for 15-27 weeks.
This was a real eye-opener for me even when taken with a large grain of salt. Just something to think about.
PubMed Citation

Saturday, May 12, 2007

Welcome to the Neuromodulation Blog! Neuromod

This blog is dedicated to exploring the many different methods of neuromodulation and their potential therapeutic uses. Examining the possibilities and the rapidly accumulating basic science has become a passion of mine and I would like to create a blog where scientific articles can be explored and commented upon by the basic science, medical and lay-person communities.
I will start to post links to articles that have caught my attention and link to them in PubMed. Please feel free to post comments and provide links.
Some of the areas I will explore are transcranial magnetic stimulation (TMS), transcranial direct current stimulation (tDCS) and percutaneous nerve stimulation (PNS-an acupuncture technique).
This is not the sole scope of this blog, just a starting point.