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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 19 of 19. This is the beginning of the thread.
Posted by Phillipa on October 1, 2006, at 22:41:49
60 minutes had a segement on DBS. They say trials in the US probably within a year. They showed two women they were awake during the proceedure. When the wires were in the right spot colors were brighter and they felt better. Although they said it was not perfect. Their lives shown at home showed two smiling women. One was working again. Love Phillipa
Posted by Jost on October 1, 2006, at 23:30:46
In reply to Anyone See 60minutes tonight DBS on, posted by Phillipa on October 1, 2006, at 22:41:49
Posted by WeeWilly on October 1, 2006, at 23:45:20
In reply to Anyone See 60minutes tonight DBS on, posted by Phillipa on October 1, 2006, at 22:41:49
Hi,
I saw an online video of that program. I find this DBS procedure to be rather crude. They remove the patients skull caps to access the brain regions they target. The ladies gave a history of their disorder and what hit me was I have struggled for many more years than they had and have tried 10 or 20 times as many treatments as they expressed. I certainly understand the desperation that our disorders cause, but I sure hope not many people are put through this misguided treatment. We are on the verge of remarkable breakthroughs in the understanding of the molecular biology of mood disorders and appropriate treatments will soon follow.
Posted by SLS on October 2, 2006, at 5:52:50
In reply to Re: DBS? what is it? (nm) » Phillipa, posted by Jost on October 1, 2006, at 23:30:46
DBS = deep brain stimulation
You can Google it.
It is a treatment idea that was stolen from Parkinsons.
There is a structure in the brain that is overactive in depression. It is known as Brodman's area 25 in the subgenual cingulate of the limbic-cortical system. It was hypothesised that signaling here could be disrupted by sending electical pulses through two electrodes, and that this might be therapeutic for depression.
A small hole is drilled in the skull and two wires routed through the brain while the patient is awake. Using MRI as a visual aid, these wires are tarteted to Brodman's area 25. The stimulator is turned on and a determination is made whether there is any therapeutic effect based upon what the patient reports. An immediate effect is expected if the wires are positioned optimally. Patients often report objects in the operating room looking more colorful and that there is slight lifting of mood or that they feel somehow "lighter". A stimulator device is implanted in the chest and is capable of being adjusted.
This thing will get a higher percentage of people well than VNS.
US clinical trial:http://www.clinicaltrials.gov/ct/show/NCT00367003?order=1
- Scott
Posted by Squiggles on October 2, 2006, at 8:13:09
In reply to Re: DBS? what is it? » Jost, posted by SLS on October 2, 2006, at 5:52:50
The treatment sounds a bit like
acupuncture. I would be more worried
about the possibility of infection,
than any real harm (or permament good)
coming from it.Squiggles
Posted by Jost on October 2, 2006, at 11:13:34
In reply to Re: DBS? what is it? » Jost, posted by SLS on October 2, 2006, at 5:52:50
Thanks a lot Scott. I'll have to follow this up. There are various brain stimulation ideas around, but I've never looked into it much.
Thanks also for the reference.
Jost
Posted by SLS on October 2, 2006, at 13:11:04
In reply to Re: DBS? what is it? » SLS, posted by Jost on October 2, 2006, at 11:13:34
> Thanks a lot Scott. I'll have to follow this up. There are various brain stimulation ideas around, but I've never looked into it much.
There are only a dozen or so people who the procedure has been tried on.
- Scott
Posted by Jost on October 3, 2006, at 0:11:18
In reply to Re: DBS? what is it?, posted by SLS on October 2, 2006, at 13:11:04
Yeah, The clincal study at Emory was hoping to enlist 20 people-- don't know how many they have yet, but that's not a lot.
Jost
Posted by Bob on October 3, 2006, at 1:44:06
In reply to Re: DBS? what is it? » Jost, posted by SLS on October 2, 2006, at 5:52:50
> DBS = deep brain stimulation
>
> You can Google it.
>
> It is a treatment idea that was stolen from Parkinsons.
>
> There is a structure in the brain that is overactive in depression. It is known as Brodman's area 25 in the subgenual cingulate of the limbic-cortical system. It was hypothesised that signaling here could be disrupted by sending electical pulses through two electrodes, and that this might be therapeutic for depression.
>
> A small hole is drilled in the skull and two wires routed through the brain while the patient is awake. Using MRI as a visual aid, these wires are tarteted to Brodman's area 25. The stimulator is turned on and a determination is made whether there is any therapeutic effect based upon what the patient reports. An immediate effect is expected if the wires are positioned optimally. Patients often report objects in the operating room looking more colorful and that there is slight lifting of mood or that they feel somehow "lighter". A stimulator device is implanted in the chest and is capable of being adjusted.
>
> This thing will get a higher percentage of people well than VNS.
>
>
> US clinical trial:
>
> http://www.clinicaltrials.gov/ct/show/NCT00367003?order=1
>
>
> - Scott
So, is all the equipment, i.e. wires, stimulators and whatever completely implanted inside the skull and body, or is there a wire permanently penetrating the skull? In other words, is there a permanent whole in the person's skull?
Posted by Bob on October 3, 2006, at 1:45:28
In reply to Re: DBS? what is it? » Jost, posted by SLS on October 2, 2006, at 5:52:50
http://www.clinicaltrials.gov/ct/show/NCT00367003?order=1
>
>
> - Scott
That clinical trial mentions following people for 5 years. Sounds like this thing won't be an available treatment for many years to come, even if it does become somewhat effective.
Posted by monserrat on October 3, 2006, at 3:08:13
In reply to Re: DBS? what is it? » SLS, posted by Bob on October 3, 2006, at 1:44:06
The holes are very small and so will heal. But the wires are run underneath the scalp to the collarbone area where they are connected to a pace maker type device.
Posted by Bob on October 3, 2006, at 11:48:03
In reply to Re: DBS? what is it?, posted by monserrat on October 3, 2006, at 3:08:13
> The holes are very small and so will heal. But the wires are run underneath the scalp to the collarbone area where they are connected to a pace maker type device.
So there is actually a wire(s) permanantly protruding through the skull but they are extremely small and under the scalp.
Posted by bipolarspectrum on October 3, 2006, at 18:54:45
In reply to Re: DBS? what is it? » monserrat, posted by Bob on October 3, 2006, at 11:48:03
Hi,
I almost had DBS done in Toronto by the originators of the procedure... its basically the exact same procedure which has been done in 10000+ parkinson patients.. they make two burr holes in the skull... insert wires to a specific area of the brain, run the wires back out the skull under the skin to a paccemaker in the chest and close up the burrholes.. the procedure itself is very benign, the only worry is infection and thats usually treated effectively by IV antibiotics..i know someone who had it done and they said the procedure is excruciatingly painful, he vomited.. but then he said it saved his life and he went from planning his suicide to fully functioning... he had tried every antidepressant.... so i dont think u should fear it, but i do think it should be saved for the extremely ill of which all else has failed..
also, new research has shown that it seems to work best in melancholic depressives...
If anyone is considering it, talk to ur the docs involved, u have nothign to lose... im sure they will only select those that have the best chance of having success...
bps
Posted by Bob on October 3, 2006, at 20:52:19
In reply to Re: DBS? what is it?, posted by bipolarspectrum on October 3, 2006, at 18:54:45
> i know someone who had it done and they said the procedure is excruciatingly painful, he vomited.. but then he said it saved his life and he went from planning his suicide to fully functioning...> bps
Geez... that's kinda scary.
Posted by SLS on October 3, 2006, at 21:37:44
In reply to Re: DBS? what is it?, posted by bipolarspectrum on October 3, 2006, at 18:54:45
> also, new research has shown that it seems to work best in melancholic depressives...
That makes sense base upon the brain structure being manipulated. It is involved in the generation of feelings of sadness.
That totally sucks for me, though. I don't have that type of depression.
I still haven't decided where my depression originates, but it comes down to hypoactivity in DLPFC, I believe. Although, hyperactivity in subgenual cingulate produces that too. I don't know if something like this treatment, where disruption of an area of hyperactivity seems to be the mechanism of action, would be be helpful for such a condition of hypoactivity. I really don't know how DBS works for Parkinsons. I guess it really doesn't matter. If no one has started working with stimulating another area of the brain by now, we won't see anything like it in my neighborhood for many years.
- Scott
Posted by bipolarspectrum on October 4, 2006, at 0:05:19
In reply to Re: DBS? what is it?, posted by SLS on October 3, 2006, at 21:37:44
SLS,
Have you considered T4?? I personally vouch that it has psychotropic activities... I'm not claiming that it will cure you but I definately think its worth a shot.. it could be a powerful augmenting agent... also, have u tried folic acid? zinc? High dose Vit C? these have all sent me manic, which inclines me to believe they have antidepressant qualities.. i would especially recommend the folic acid and Vit C as there is literature supporting its use... anywayz, just some ideas, let me know what u think...
bps
Posted by SLS on October 4, 2006, at 0:44:21
In reply to SLS, posted by bipolarspectrum on October 4, 2006, at 0:05:19
> SLS,
> Have you considered T4?? I personally vouch that it has psychotropic activities... I'm not claiming that it will cure you but I definately think its worth a shot.. it could be a powerful augmenting agent...Good idea.
I may revisit T4. I tried it once in combination with Parnate + desipramine + amphetamine. I felt a mild improvement. Because it was insufficient, I discontinued it, but perhaps it would be more helpful now since I am taking different medication. Also, my TSH is greater than 5.0.
> also, have u tried folic acid? zinc? High dose Vit C?
Yup. Yup. Yup.
> these have all sent me manic,
Man, you sure are sensitive. What does magnesium or taurine do for you?
One doctor that I saw not too long ago had a treatment-resistent rapid-cycling bipolar patient who responded to Keppra monotherapy.
- Scott
Epilepsy Behav. 2004 Dec;5(6):1017-20. RelatedMonotherapy treatment of bipolar disorder with levetiracetam.
Kaufman KR.
Department of Psychiatry, UMDNJ-Robert Wood Johnson Medical School, 125 Paterson Street, Suite 2200, New Brunswick, NJ 08901, USA. kaufmakr@umdnj.edu
Bipolar patients with early-onset, comorbid substance abuse, rapid cycling, and mixed episodes are difficult to treat and frequently require rational polypharmacy. When polypharmacy is unsuccessful, the clinician must consider the off-label use of newer psychotropics. Levetiracetam is a novel anticonvulsant with antikindling, inhibitory, and neuroprotective properties that is effective in an animal model of mania. This case report describes a patient with treatment-resistant rapid cycling bipolar disorder who failed 15 psychotropics, individually or in various combinations (maximum of 6), but ultimately responded to levetiracetam monotherapy and remained without bipolar features during 1 year of maintenance treatment, excluding 1 week during which the patient was medicine noncompliant. Further, methylphenidate used to treat comorbid attention deficit disorder did not precipitate manic features. Levetiracetam should be further studied for its potential use in the treatment of bipolar disorders.
Publication Types:
* Case Reports
PMID: 15582854 [PubMed - indexed for MEDLINE]
Posted by bipolarspectrum on October 4, 2006, at 1:38:08
In reply to Re: SLS » bipolarspectrum, posted by SLS on October 4, 2006, at 0:44:21
SLS,
Yeah, I tried keppra.. it also sent me up and up... I'm currently going back to basics and tryin lexapro with lithium, both low dose... hopefully the lithium will curb any hypomania and they'll both combine together to battle the depression... one last idea i had for you us alpha-gammic acid.. i forget exactly whats its called, but its a fatty acid... not the omega-3s, but another one.. i found it very calming and depression alleviating.... also, this may sound stupid, but have u tried em power plus?
bps
ps. magnesium and taurine both send me up and away.. taurine is interesting in that i think a major study regarding it is being published soon, apparently it may work well...
Posted by Phillipa on October 4, 2006, at 19:47:53
In reply to Re: SLS, posted by bipolarspectrum on October 4, 2006, at 1:38:08
Lar told me to take taurine for anxiety? Love Phillipa
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