Join 3,556 readers in helping fund MetaFilter (Hide)


we know a lot, but not everything
May 22, 2014 4:04 AM   Subscribe

Inside the Science of an Amazing New Surgery Called Deep Brain Stimulation
posted by Potomac Avenue (40 comments total) 20 users marked this as a favorite

 
Some NSFWish brain surgery pics inside
posted by Potomac Avenue at 4:04 AM on May 22 [1 favorite]


I shot the images for the piece. It's no exaggeration to say it was one of the most amazing things I've ever witnessed. The patient walked in with tremors and walked out without them. I actually had a conversation with him while the doctors were fishing a wire around in his head. Total science fiction.
posted by photoslob at 4:33 AM on May 22 [68 favorites]


So if one has a relative with, let's say, Parkinson's, how do average people get their hands on this? So to speak.
posted by A Terrible Llama at 4:34 AM on May 22


Deep Brain Stimulation (DBS) has recently been credited with creating a Johnny Cash fan:
Previously Mr B had been quite fond of the Rolling Stones, but he wasn’t really a big music lover. However a half year after DBS surgery, Mr. B. stated that he was turning into a Johnny Cash fan ... His appreciation for the Man in Black soon progressed from liking into devotion.

Mr. B. reported that he felt good following treatment with DBS and that the songs of Johnny Cash made him feel even better. From this moment on, Mr. B. kept listening simply and solely to Johnny Cash and bought all his CD’s and DVD’s…

However, this remarkable Cash-omania apparently vanished on occasions when the DBS stimulation turned off: His former musical taste reoccurred immediately when stimulation was interrupted due to battery depletion, suggesting a direct causal link between musical preference and stimulation of the accumbens.
posted by airing nerdy laundry at 4:37 AM on May 22 [21 favorites]


If this improves people's musical taste I vote Obama makes it a mandatory surgery at birth.
posted by Potomac Avenue at 4:40 AM on May 22 [1 favorite]


Great pics photoslob!
posted by Potomac Avenue at 4:50 AM on May 22


One day, this procedure or some other method will remove the idiot part from idiot/savant for those who can afford it.

While that sounds wonderful, not sure I like the implications of what the first people wealthy enough to afford will be able to do before the treatment "trickles down."

Stil, extremely cool and looks like it's going to help a lot of people before our new Mentat overlords spoil the party.
posted by digitalprimate at 5:04 AM on May 22


Metafilter: suggesting a direct causal link between musical preference and stimulation of the accumbens.
posted by Devonian at 5:05 AM on May 22 [3 favorites]


The music thing is awesome because Johnny Cash is awesome, but the fact that you can change something as idiosyncratic as an individual's music preference through science is simultaneously cool and terrifying.
posted by Bulgaroktonos at 5:10 AM on May 22 [7 favorites]


I think it's a timing issue.Maybe we prefer certain rhythms and stuff over others and this changes our internal timing?
posted by I-baLL at 5:41 AM on May 22 [1 favorite]


So if one has a relative with, let's say, Parkinson's, how do average people get their hands on this? So to speak.

This article claims that in the US it's covered by insurance. Warren Grill works with the Movement Disorders Center Wake Forest.
posted by Comrade_robot at 5:41 AM on May 22


In grad school I did a rotation in a neuroscience lab. We had giant racks full of carefully set up gear for doing electrophysiology on living slices of rat brain (gory details here). Two scientists worked with me, Victor and Xiao. Victor did not like Xiao. One day Xiao's equipment was messed up, so Victor reluctantly let Xiao use his, with certain caveats that Xiao tried to skirt around. Victor saw him and yelled out across the lab in his pronounced eastern European accent "DON'T TOUCH MY STIMULATOR!"
posted by exogenous at 5:49 AM on May 22 [3 favorites]


This sounds almost exactly like the technology of the novel Amped, which unfortunately was pretty lackluster. Still, the thought that this works and could lead to improving the lives of many people with neurological disorders is awesome.
posted by Mr.Encyclopedia at 5:57 AM on May 22


I was just the other day reading jscalzi's novella Unlocked: An Oral History of Haden’s Syndrome, in which inserting tiny filaments into peoples' brains is a thing that cures them, sort of, of a thing. I love science (non)fiction.
posted by rtha at 5:58 AM on May 22


simultaneously cool and terrifying.

Exactly. If I get Parkinson's, sign me up, but it would be a pretty high price to pay for my health if the treatment also turned me into a Morris dancer.
posted by pracowity at 5:58 AM on May 22 [5 favorites]


The hell you say! Some of my best friends are Morris dancers!
posted by rtha at 6:05 AM on May 22 [2 favorites]


Foote ponders that idea as the subject of cosmetic surgery comes up. Sixty years ago, plastic surgery, a technically challenging specialty with one of the longest training regimens in medicine, was centered on the treatment of facial trauma and disfigurement. Today, ordinary people think nothing about undergoing multiple cosmetic procedures to make themselves more attractive, and surgeons are happy to perform them.

“That’s actually a really good analogy,” Foote says. “I hadn’t thought of it that way. If you’re not dysfunctional, should you be able to get functional surgery? And I think DBS is going to be a similar battleground.” He hesitates a moment, then finishes the thought. “And we will ultimately cave in. Just like we did with cosmetic surgery.” This is a revelation for him, and not a good one. “I hadn’t really gone that far in my head, but now that I think about the whole cosmetic surgery thing... yeah... goddamn.”
posted by gaspode at 6:29 AM on May 22 [9 favorites]


That's fascinating. As with transcranial stimulation, I find it astonishing that such a crude intervention -- a steady, unmodulated trickle of current in roughly the right volume of the brain -- can have such reproducible and useful effects. Given the density and complexity of the connections within the brain, it's really bizarre to me that this works any better than just e.g. flinging a hammer at a misfiring engine.
...Okun and Foote “tickle” a region near her nucleus accumbens, a part of the brain associated with pleasure, reward, motivation and other complex phenomena.

“Describe what you’re feeling right now,” Okun says. With an ecstatic smile on her face, in a voice giddy with joy, the woman replies, “I feel happy.”
I find the ethics of this fascinating. The argument they make about plastic surgery is very compelling; it seems inevitable to me that as the technology matures they'll be offer to offer a growing suite of enhancements at ever-decreasing risk, and that this will gradually become normalised. A little button that gives you a jolt of joy (or mirth, or tranquillity, or reverence, or lust...) would be pretty much the ultimate recreational "drug". If the data from TMS are real, it may be possible to enhance your learning ability (if you're rich), provide spiritual experiences on demand (if you're rich), etc. All of which is great, unless it ends up in a Gattaca-style situation where the wealthy are able to buy upgrades that will make them more capable, ensuring that the poor will never be able to catch up.

I know that makes me sound like a paranoiac who's read too much sci-fi (which is at least half right), and there are definitely counter-arguments to be made, e.g. that the invention of glasses didn't create a permanent underclass of people with blurry vision. But with the ability to influence or boost personality traits on the horizon, along with in utero or heritable gene therapy to make lasting, targeted changes to someone's genetic makeup, I think we really are on the cusp of a big change in what it's possible for a motivated (and rich) person to change about themselves and their offspring. Not now, but within a generation or two. And I think that's a conversation that needs to happen well in advance.
posted by metaBugs at 6:33 AM on May 22 [2 favorites]


Some of my best friends are Morris dancers!

They should check with their insurance companies. They may be eligible for Deep Brain Stimulation.

... toodle toodle toodle, jingle jingle jingle, clack clack clack, ...
posted by pracowity at 6:44 AM on May 22 [3 favorites]


A little button that gives you a jolt of joy (or mirth, or tranquillity, or reverence, or lust...) would be pretty much the ultimate recreational "drug".

My schedule for today lists a six-hour self-accusatory depression
posted by Bulgaroktonos at 6:47 AM on May 22 [6 favorites]


I shot a short iPhone video where you can hear the frequency and see the audio waves.
posted by photoslob at 6:52 AM on May 22 [8 favorites]


The most futuristic medical treatment ever imagined is now a reality.
Now watch this drive.
posted by weapons-grade pandemonium at 6:56 AM on May 22 [1 favorite]


"DBS isn’t an option for everyone. It offers hope to selected patients who, despite expert medical management, remain disabled by their symptoms. While it usually works, it is hardly a panacea. It’s brain surgery, after all, arguably the most invasive of all invasive procedures. And besides the usual surgery risks ..."
Like those "contact your physician if you experience erections lasting more than four hours" warnings, this paragraph, tucked snugly in an otherwise exciting story, is very, very key.

About ten years ago now, my father chose DBS. Like the story says, he was awake during the procedure, right up to the moment when the surgeon accidentally sliced a capillary and induced a major stroke. God, that was a mess. Fortunately, he only spent about three months as a vegetable before the end.
posted by octobersurprise at 6:57 AM on May 22 [10 favorites]


I shot a short iPhone video where you can hear the frequency and see the audio waves.

Holy. Moly.
posted by Potomac Avenue at 7:08 AM on May 22


So if one has a relative with, let's say, Parkinson's, how do average people get their hands on this? So to speak.

By speaking to your doctor? I'm a little confused about the gosh-wow sci-fi element of this. My stepfather suffered from Parkinsons and had two of these operations, for either hemisphere of the brain, a couple years apart back in the early 90s. (He passed away in 2001.)

The first time he had electrodes implanted in the left side of his brain with wiring that ran under his skin to a battery pack implanted around his shoulder blade so it could be recharged with a magnetic loop thingie held against the skin. Supposedly the electrodes detected tremor activity in his brain and flooded the area with a storm of impulses that just damped them out. As described, he had to be awake during the surgery so they could get feedback from him about just where they were in the brain.

It actually worked pretty well to control tremor in the right side of his body, and so a couple years later they went in again and put another one in the right side of his brain for his left side.

It was certainly advanced, but we were hardly the sort of people with the social or financial means to get our hands on pre-approval bleeding edge science stuff. So I'm sure they've gotten better at it in the meantime, more precise in it's applications, for example. But this was going on - for very average patients - a good 20 years ago.
posted by Naberius at 7:14 AM on May 22 [3 favorites]


it's really bizarre to me that this works any better than just e.g. flinging a hammer at a misfiring engine.

It's just about that rudimentary, yes.

Full disclosure - my wife worked on the research in Non-Human Primates that helped demonstrate the efficacy of this treatment. She would train the monkeys to do some tasks, then they would be dosed with MPTP to give them MPTP induced parkinsons and then re-evaluate them. Then, they would have the surgery done and be again evaluated.

Then they would be euthanized and their brains studied.

Hundreds, if not thousands, of animals went through this before it ever got tried on a human. And as Octobersurprise points out, even when it works.... It doesn't last forever and has tremendous side effects. All those animals died to increase our knowledge and capability by tiny, incremental amounts.

Not to be debbie downer. The joy of a person who can touch their finger to their nose for the first time in a decade aint nothing. And the knowledge gained is useful in all sorts of other contexts. Still, my wife would sometimes come home from a necropsy of one of her animals and have to spend the evening eating ice cream and grieving. These advances rarely come for free.
posted by Pogo_Fuzzybutt at 7:14 AM on May 22 [19 favorites]


There's a video they showed in my intro psych class in undergrad recorded in, I think, the 1960s of a woman with an electrode implant in her accumbens. I believe this is the one. She was given a controller with a button she could press to turn the juice on.

Takeaway quote: "I think it's somewhat of sexy button."

It's pretty great that wireheading is about to take off.
posted by logicpunk at 7:17 AM on May 22


Also, the first time I heard of this idea was in the '70s. It didn't end well.

and jesus christ, did people have no idea how to make a movie trailer in the '70s?
posted by Naberius at 7:58 AM on May 22


My grandmother had terrible tremors when I was a kid, and underwent DBS surgery about twelve years ago, only two years before she died. I remember how mind-blowing it was to see the stimulation in action. Her hands would shake so bad that she was unable to write her name or put her glasses on, but then she would swipe a little magnet over the device implanted in her collarbone and they would disappear completely (for a few weeks, I think). The difference was so profound that it looked like she faked it.
posted by lollymccatburglar at 8:11 AM on May 22 [1 favorite]


For anyone who is interested in actually seeing the difference, here is a video(wimp.com) of a man who had the procedure done, and demonstrates difference between having his implant on and off.
posted by I Havent Killed Anybody Since 1984 at 9:04 AM on May 22 [6 favorites]


A high school friend of mine has a teenage son with one of the worst cases of Tourette's Syndrome in the country. Earlier this year doctors put him into a coma when all other efforts to control his tics failed. He is sometimes unable to walk, or even move. Caring for him is so intensive that both my friend and her husband have quit their jobs to care for him. Last year, they lost their house.

He's going to be undergoing this surgery later this year. There is much hope that it will finally bring relief.

This 30-minute video about a camp for kids with Tourrette's is excellent and features my friend's family.
posted by not that girl at 9:32 AM on May 22 [1 favorite]


This image shows a spiral Mr Haning drew prior to the surgery and the spiral he drew during the procedure.

btw, Mr Haning was having the procedure done for the second time. As Pogo mentioned, it doesn't last forever. What I found strange was that the doctors removed the existing leeds and then implanted new ones into a slightly different part of his brain. I don't think the story mentions that.
posted by photoslob at 9:39 AM on May 22 [5 favorites]


Bulgaroktonos: The music thing is awesome because Johnny Cash is awesome, but the fact that you can change something as idiosyncratic as an individual's music preference through science is simultaneously cool and terrifying.

Well, science is cleaner than the Phineas Gage treatment, and more likely to be reversible if things go awry.
posted by filthy light thief at 9:50 AM on May 22 [1 favorite]


photoslob: As Pogo mentioned, it doesn't last forever. What I found strange was that the doctors removed the existing leeds and then implanted new ones into a slightly different part of his brain. I don't think the story mentions that.

Fascinating - it seems that this is just addressing the symptom, not the root cause, if the brain re-wires itself to recreate the problematic symptom.
posted by filthy light thief at 9:59 AM on May 22


A little button that gives you a jolt of joy (or mirth, or tranquillity, or reverence, or lust...) would be pretty much the ultimate recreational "drug".

This is a major and terrifying plot point in Stephen Donaldson's Gap Cycle if you are interested in space opera and despair.
posted by elizardbits at 10:50 AM on May 22 [1 favorite]


Every time I read about something like this I start to mutter "please work for bipolar depression" like a lunatic. My depression is pervasive and almost untreatable. Sooner or later we're going to have to go to the source.
posted by Biblio at 11:39 AM on May 22 [2 favorites]


All my love and hopes, Biblio. Stick around - sooner or later, we ARE going to break through on these issues, and come out of the Dark Ages.
posted by IAmBroom at 1:13 PM on May 22 [1 favorite]


Previously Mr B had been quite fond of the Rolling Stones, but he wasn’t really a big music lover. However a half year after DBS surgery, Mr. B. stated that he was turning into a Johnny Cash fan ... His appreciation for the Man in Black soon progressed from liking into devotion.

Mr. B. reported that he felt good following treatment with DBS and that the songs of Johnny Cash made him feel even better. From this moment on, Mr. B. kept listening simply and solely to Johnny Cash and bought all his CD’s and DVD’s…

However, this remarkable Cash-omania apparently vanished on occasions when the DBS stimulation turned off: His former musical taste reoccurred immediately when stimulation was interrupted due to battery depletion, suggesting a direct causal link between musical preference and stimulation of the accumbens.
Thank you for this amazing quote and for digging up that fascinating link, airing nerdy laundry, because it shines a light on Parkinson's and DBS from a direction wholly unexpected by me, and which makes them look extremely weird.

It's worth quoting a little more of one section, perhaps:
His appreciation for the Man in Black soon progressed from liking into devotion. Mr. B kept Cash on his mind both day and night
Mr. B. reported that he felt good following treatment with DBS and that the songs of Johnny Cash made him feel even better. From this moment on, Mr. B. kept listening simply and solely to Johnny Cash and bought all his CD’s and DVD’s… From the first time Mr. B. heard a Johnny Cash song, [all other music] has been banned.
And worth noting at this point that Mr. B was being treated for OCD rather than Parkinson's, and that the target of stimulation was the nucleus accumbens rather than the substantia nigra, which deteriorates during the course of Parkinson's, though both are part of the basal ganglia and are also connected to each other.

The weirdness comes in with the fact that Johnny Cash was diagnosed with Parkinson's in 1997, and that in my opinion, you can hear the distinctive Parkinsonian quaver in his singing years and years earlier-- in fact, I was startled to read about the diagnosis because I'd assumed he'd had it for years and just kept it to himself. His father Ray died of complications related to Parkinson's in the early 80s.

That Mr. B was obsessed with Johnny Cash's quavery voice only when "tremor circuits" in(?) his nucleus accumbens were being inhibited by the DBS seems to suggest that tremor signal is somehow important to wider brain function-- it's tempting to say it provides a bass-line-- and that the absence of tremor signals can be at least partially compensated for by injecting them via music.

And just to add one more complicating factor, obsessive-compulsive personality disorder (OCPD) appears to be very common among people with Parkinson's:
Results
100 PD patients (57 men; mean age 59.0±10.2 years) and 100 healthy subjects (52 men; mean age 58.1±11.4 years) were enrolled in the study. The most common personality disorder was the obsessive-compulsive personality disorder diagnosed in 40 PD patients and in 10 controls subjects ... followed by the depressive personality disorder recorded in 14 PD patients and 4 control subjects (p-value 0.02). Obsessive-compulsive personality disorder was also found in 8 out of 16 de novo PD patients with a short disease duration.

Conclusion
PD patients presented a high frequency of obsessive-compulsive personality disorder that does not seem to be related with both disease duration and dopaminergic therapy.
posted by jamjam at 1:22 PM on May 22 [3 favorites]


Sometimes the hole isn't enough, because the demons don't want to come out. So you gotta stick a wire in there and give them a little shock.
posted by rifflesby at 4:30 AM on May 23 [1 favorite]


Can the Nervous System Be Hacked?
posted by homunculus at 10:34 AM on May 24 [1 favorite]


« Older Starting up fan localization projects feels much l...  |  The Back to the Future theme, ... Newer »


This thread has been archived and is closed to new comments