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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by Kingfish on April 5, 2001, at 17:37:17
This might be better on the Social Board - I'm not certain. It does touch med issues too.
On 60 Minutes II the other evening, there was a report re: ECT, and its rise from being shocking to suddenly acceptable.
Anyway, to try to keep my personal opinion out of this, the following is from the transcript:
"All that's known is that a short jolt of electricity triggers a seizure that lasts less than a minute. This seizure - not the electricity - apparently changes the brain's chemistry in a way that lifts depression."
I didn't know this was what happened during shock treatment.
This, combined with the successful recent use of anti-seizure meds for BP, makes me wonder if there is a connection between the two. Could the mood swings be caused by minute seizures?
Has anyone found such a thing in their research or come to a similar conclusion?
Just curious.
Thanks!
- K.
Posted by SLS on April 5, 2001, at 20:54:30
In reply to Bipolar Dis. Seizures - Is there a connection?, posted by Kingfish on April 5, 2001, at 17:37:17
> "All that's known is that a short jolt of electricity triggers a seizure that lasts less than a minute. This seizure - not the electricity - apparently changes the brain's chemistry in a way that lifts depression."
>
> I didn't know this was what happened during shock treatment.
>
> This, combined with the successful recent use of anti-seizure meds for BP, makes me wonder if there is a connection between the two. Could the mood swings be caused by minute seizures?
>
> Has anyone found such a thing in their research or come to a similar conclusion?
:-)Your intellectual connection is very much like a well accepted theory known as "kindling". Congratulations!
- Scott
Posted by Kingfish on April 5, 2001, at 22:16:32
In reply to Re: Bipolar Dis. Seizures - Is there a connection? » Kingfish, posted by SLS on April 5, 2001, at 20:54:30
> Please tell me more. I have certainly heard of "kindling" but am quite new to all of this, and that's about as far as my knowledge goes. Any direction would be appreciated. :)
Posted by kate9999 on April 6, 2001, at 1:30:04
In reply to Re: Bipolar Dis. Seizures - Is there a connection?, posted by Kingfish on April 5, 2001, at 22:16:32
Actually I don't think kindling or sensitization are what you're talking about. That model just means (very roughly) that the more episodes you have, the more likely you are to have them in the future.
The idea is that early in the course, episodes (of either bipolar or epilepsy) need an external trigger to happen (say an emotional stressor in bipolar). As time goes by triggers can be smaller and smaller (called "sensitization"). At a certain point no external trigger at all is needed - and episodes happen spontaneously(called "kindling").
Because both sensitization and kindling seem to happen in both bp and epilepsy, some people think they're related disorders.
But that says nothing about whether bipolar is actually caused by small seizures. In fact, if it is, you'd think ECT would be the last thing you'd want to give in bp - if anything you'd think inducing seizures would worsen the course of the illness. Although, I dunno- has anyone ever tracked that?
There's also speculation that the reason anticonvulsants work is that they interfere with either sensitization or kindling processes in the brain. So that gives a little explanation why they might work in both bipolar and epilepsy without requiring that seizures or mood swings *themselves* be related.
But, that still doesn't explain at all why a seizure should relieve a depression or a mania.
Total speculation I've heard before, but which makes the most sense to me - is that in both mania and depression the brain is caught up in some sort of vicious neurochemical cycle that perpetuates itself. By inducing a seizure you're somehow interrupting it, like rebooting a computer. Or throwing a bump into an oscillating system.
> > Please tell me more. I have certainly heard of "kindling" but am quite new to all of this, and that's about as far as my knowledge goes. Any direction would be appreciated. :)
Posted by phillybob on April 6, 2001, at 17:49:46
In reply to Re: Bipolar Dis. Seizures - Is there a connection?, posted by kate9999 on April 6, 2001, at 1:30:04
Here's a link to an article on the neuro-cybernetic prosthesis (a pacemaker type device, I believe) which has been approved and used for epilepsy, but since those who've used it experienced improvement in mood, it has been tried successfully for depression (read it in a magazine, but haven't looked online further than what's attached).
The version used for depression was this nerve-zapping device going off every 5 minutes with a 30 second shock (which caused voice alteration but easy to get used to; also, shortness of breath so it can be turned off during exercise).
"Vagus Nerve Stimulator
The first procedure done in Tallahassee for the implantation of the Vagus Nerve Stimulator was performed January 22, 1999 at Tallahassee Memorial Hospital by local physicians - Dr. Mark Cuffe, Dr. Christopher Rumana and Dr. Ricardo Ayala. Since then many additional patients have benefited from this procedure being done locally. The Neuro Cybernetic Prosthesis System (Vagus Nerve Stimulator) was developed by Cyberonics after 15 years of research and clinical studies. The Vagus Nerve Stimulator was approved by the U. S. Food and Drug Administration (FDA) on July 16, 1997 for use as an add-on therapy in reducing the frequency of seizures in adults and adolescents over 12 years of age who have partial onset seizures which are refractory to antiepileptic medications. The role of the neurologist in treating patients who have this implanted device is to program and monitor the device that controls the electrical stimulations of the Vagus Nerve along with managing the antiepileptic medications. The surgeon plays a more technical role in the care of these patients, he is responsible for the placement of the electrode and stimulator and for the follow-up surgical care.
Currently under investigation at several university centers is the use of the Vagus Nerve Stimulator in the treatment of depression. During prior clinical trials for epilepsy treatment, the investigators had noticed that patient’s with seizures who also suffered from clinical depression showed an improvement in their depression. This beneficial “side-effect” has been well documented and the results from current clinical trials are encouraging. Within the next couple of years, the vagus nerve stimulator may prove to be an additional, effective therapy for patients with clinical depression." ( http://www.tnc-neurosurgery.com/neurosurgery/vagus.htm )
Posted by SLS on April 10, 2001, at 11:32:16
In reply to Re: Bipolar Dis. Seizures - Is there a connection?, posted by kate9999 on April 6, 2001, at 1:30:04
Dear Kate9999,
Nice post. It helped me better understand the difference between sensitization and kindling. Thanks.Although it wasn’t an exacting explanation, I thought Kingfish’s association was astute.
- Scott
> Actually I don't think kindling or sensitization are what you're talking about. That model just means (very roughly) that the more episodes you have, the more likely you are to have them in the future.
>
> The idea is that early in the course, episodes (of either bipolar or epilepsy) need an external trigger to happen (say an emotional stressor in bipolar). As time goes by triggers can be smaller and smaller (called "sensitization"). At a certain point no external trigger at all is needed - and episodes happen spontaneously(called "kindling").
>
> Because both sensitization and kindling seem to happen in both bp and epilepsy, some people think they're related disorders.
>
> But that says nothing about whether bipolar is actually caused by small seizures. In fact, if it is, you'd think ECT would be the last thing you'd want to give in bp - if anything you'd think inducing seizures would worsen the course of the illness. Although, I dunno- has anyone ever tracked that?
>
> There's also speculation that the reason anticonvulsants work is that they interfere with either sensitization or kindling processes in the brain. So that gives a little explanation why they might work in both bipolar and epilepsy without requiring that seizures or mood swings *themselves* be related.
>
> But, that still doesn't explain at all why a seizure should relieve a depression or a mania.
>
> Total speculation I've heard before, but which makes the most sense to me - is that in both mania and depression the brain is caught up in some sort of vicious neurochemical cycle that perpetuates itself. By inducing a seizure you're somehow interrupting it, like rebooting a computer. Or throwing a bump into an oscillating system.
>
>
>
>
> > > Please tell me more. I have certainly heard of "kindling" but am quite new to all of this, and that's about as far as my knowledge goes. Any direction would be appreciated. :)
Posted by Noa on April 10, 2001, at 16:55:05
In reply to Re: Bipolar Dis. Seizures - Is there a connection? » kate9999, posted by SLS on April 10, 2001, at 11:32:16
Wasn't the vagus nerve stimulator found to be more effective for the depression in epilepsy patients than for the siezures?
Posted by sweetmarie on April 11, 2001, at 15:10:11
In reply to Vagus Nerve Stimulator, posted by phillybob on April 6, 2001, at 17:49:46
> Here's a link to an article on the neuro-cybernetic prosthesis (a pacemaker type device, I believe) which has been approved and used for epilepsy, but since those who've used it experienced improvement in mood, it has been tried successfully for depression (read it in a magazine, but haven't looked online further than what's attached).
>
> The version used for depression was this nerve-zapping device going off every 5 minutes with a 30 second shock (which caused voice alteration but easy to get used to; also, shortness of breath so it can be turned off during exercise).
>
> "Vagus Nerve Stimulator
>
> The first procedure done in Tallahassee for the implantation of the Vagus Nerve Stimulator was performed January 22, 1999 at Tallahassee Memorial Hospital by local physicians - Dr. Mark Cuffe, Dr. Christopher Rumana and Dr. Ricardo Ayala. Since then many additional patients have benefited from this procedure being done locally. The Neuro Cybernetic Prosthesis System (Vagus Nerve Stimulator) was developed by Cyberonics after 15 years of research and clinical studies. The Vagus Nerve Stimulator was approved by the U. S. Food and Drug Administration (FDA) on July 16, 1997 for use as an add-on therapy in reducing the frequency of seizures in adults and adolescents over 12 years of age who have partial onset seizures which are refractory to antiepileptic medications. The role of the neurologist in treating patients who have this implanted device is to program and monitor the device that controls the electrical stimulations of the Vagus Nerve along with managing the antiepileptic medications. The surgeon plays a more technical role in the care of these patients, he is responsible for the placement of the electrode and stimulator and for the follow-up surgical care.
> Currently under investigation at several university centers is the use of the Vagus Nerve Stimulator in the treatment of depression. During prior clinical trials for epilepsy treatment, the investigators had noticed that patient’s with seizures who also suffered from clinical depression showed an improvement in their depression. This beneficial “side-effect” has been well documented and the results from current clinical trials are encouraging. Within the next couple of years, the vagus nerve stimulator may prove to be an additional, effective therapy for patients with clinical depression." ( http://www.tnc-neurosurgery.com/neurosurgery/vagus.htm )Anyone,
I just saw a programme on telly about the vagus nerve stimulator. Having read previous postings on this subject, I`ve gathered that it`s a little contraversial.
Does anyone know of vagus nerve stimulator on trial, or even in usage here in the UK?
If anyone using this message board comes from England, could they report back if they know anything.
Ta,
Anna.
Posted by PhoenixGirl on April 11, 2001, at 16:33:42
In reply to Re: Vagus Nerve Stimulator, posted by sweetmarie on April 11, 2001, at 15:10:11
Emory University in Atlanta, GA, where I live, is doing that study. I almost was going to participate in it, but I wouldn't suggest anyone do that, because damage to the vagus nerve can cause PERMANENT stomach problems and hoarse voice, among other things. It's very invasive, and could have awful problems that they will only discover when YOU develop them!
Posted by sweetmarie on April 12, 2001, at 10:38:36
In reply to I'd be wary because...., posted by PhoenixGirl on April 11, 2001, at 16:33:42
> Emory University in Atlanta, GA, where I live, is doing that study. I almost was going to participate in it, but I wouldn't suggest anyone do that, because damage to the vagus nerve can cause PERMANENT stomach problems and hoarse voice, among other things. It's very invasive, and could have awful problems that they will only discover when YOU develop them!
Thanks.
The woman shown on this programme I was refering to lived in Texas. She mentioned having a hoarse voice, but nothing about stomach problems.
What she did say was that she responded to anti-depressants since having this thing fitted, whereas she previously hadn`t. Having said that, I have always maintained (despite the odds) that there is a medication (or group of medications) that can be found for everyone. I must say that I`m really losing grip on this, having been failed by SO many meds, but it`s a view that I`ve been assured of by various different professionals.
On a more practical level, I was wondering whether the principle of the Vagus Nerve Stimulator was similar to ECT. If so, then I might as well forget it anyway, as I`ve had a course of 20 ECT sessions, with no result in lifting my mood, and the total erasure of my memory of the previous year.
Thanks,
Anna.
Posted by phillybob on April 13, 2001, at 23:33:58
In reply to Re: I'd be wary because.... » PhoenixGirl, posted by sweetmarie on April 12, 2001, at 10:38:36
Implantable Device Approved in Canada for Treatment of Depression
--------------------------------------------------------------------------------WASHINGTON (Reuters Health) Apr 11 - Cyberonics Inc. said Wednesday that it has received approval in Canada to market its NeuroCybernetic Prosthesis, an implantable device for the treatment of depression and bipolar disorder.
The system, similar to a cardiac pacemaker, is implanted beneath the collarbone and continuously delivers intermittent electrical pulses to the vagus nerve. The US Food and Drug Administration approved the device in July 1997 as adjunct therapy for patients over the age of 12 with refractory partial onset seizures.
Health Canada approved the device to treat "chronic or recurrent depression in patients that are in a treatment resistant or treatment intolerant major depressive episode," Cyberonics said in a news release. The Canadian approval mirrors the device's recent CE Mark approval, the company noted.
Both clearances were based on a study in which 1-year follow-up data from 30 patients showed that 46% experienced at least 50% improvement in their depressive symptoms, while 29% reported no remaining symptoms.
The follow-up findings also demonstrated that 91% of subjects who had responded to treatment by the end of the study maintained their response over 1 year, while 18% of patients who were unresponsive at the close of the study had begun to respond to therapy at 1 year.
Separately on Wednesday, Cyberonics issued a statement responding to a warning letter it received in March from the FDA, in which the agency charged the company with delaying for approximately 3 years reports on certain adverse events, including deaths, in patients with epilepsy implanted with the device. The company noted a number of procedural and staff changes it had made to improve its reporting system.
This is the end of the thread.
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