tag:blogger.com,1999:blog-21605329.post6860003910902884221..comments2024-03-22T00:30:09.536-07:00Comments on The Neurocritic: NAcc Localization for DBSThe Neurocritichttp://www.blogger.com/profile/08010555869208208621noreply@blogger.comBlogger6125tag:blogger.com,1999:blog-21605329.post-26004265070298932692007-05-25T11:34:00.000-07:002007-05-25T11:34:00.000-07:00Anonymous Julian writes:Unfortunately, experimenta...Anonymous Julian writes:<BR/><I><BR/>Unfortunately, experimental procedures can tend to get adopted before 'science' (even a lose definition) gets a look in. Remember lobotomies anyone?<BR/></I><BR/><BR/>Well, what about them? One of the most interesting and disturbing aspects about the lobotomy/leucotomy story is that the clinical data for <B>some</B> uses of lobotomy were really solid. The abuses of lobotomy have, of course, pretty much taken the treatment off the table, which also almost happened with ECT. But the fascinating thing about all of these techniques, which can have absolutely dazzing clinical effectiveness in some cases, is that the reason for the improvements are really not clear at all. <BR/><BR/>ECT and DBS are only used as treatments of last resort for depression. This currently makes some sense, (no pun intended) yet if we knew who would or would not respond to these or other treatments, the gain in human happiness would be immense. It is understandable why you might not want to start off with ECT, but there is no question that there are individuals who are actually dying (by suicide) who might have been vastly helped and might still be with us...if only we knew enough about how any of this worked. <BR/><BR/>So I guess I am more of a basic science guy at heart, but I have my reasons. And, for that matter, so does Karl Pribram, who, to this day, insists there are many situations where a lobotomy of an appopriate scale and placement would be vastly preferable to pharmacological (and, for depression, ECT) treatments. That sounds outlandish, but Karl Pribram is a man whose background and intellect are still completely amazing, and he can cite literature to back up his opinions.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-21605329.post-17566638034840986952007-05-24T23:59:00.000-07:002007-05-24T23:59:00.000-07:00Despite promising results, I just don't find this ...Despite promising results, I just don't find this sort of thing 'science'. I'm glad at least to see the authors are cautious about espousing the virtues of this 'treatment'. Without a theory.. where are we? <BR/>Unfortunately, experimental procedures can tend to get adopted before 'science' (even a lose definition) gets a look in. Remember lobotomies anyone? I really hope some sense in practiced before this becomes mainstream.<BR/>That is my concern.<BR/><BR/>I feel MORE so about ECT and also have grave concerns about the use of EMS. Until we know how these are effecting the brain (which means understanding a lot more about the electrical and magnetic: functional role, mechanisms, sensitivity and relationships, within the brain) we're not really better than ... well, people who gave hysterectomies to depressed (or artistic) women in the 1800's. Shooting in the dark. Not good news. That's really what this is doing.<BR/><BR/>Once again, thank you for keeping up this excellent blog. <BR/><BR/>JulianAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-21605329.post-13094606667836070992007-05-24T14:04:00.000-07:002007-05-24T14:04:00.000-07:00SAC - Do you know where the "best" active contacts...<I>SAC - Do you know where the "best" active contacts were located? The globus pallidus interna is another (albeit less popular) target region (Uc & Follett, 2007) that's larger than the subthalamic nucleus.</I><BR/><BR/>I would have to check some notes on the talk that are, alas, not very handy these days. This was a presentation done by members of the WashU group. As I remember it, the contact was physically outside the STN in a white matter tract a couple of millimeters away. Now, you could tell a reasonable story about the current affecting the nearby structure, but this would have to be shown, I think.<BR/><BR/>In response to Johan, I'm not saying we shouldn't be pragmatic about the therapy, but I'm a bit uneasy about basing inferences about functional neuroanatomy on the results from this technique, at least at the moment.<BR/><BR/>In response to the other anonymous person, if your coprolalia is accompanied by motor tics or even premonitory urges underlying motor tics, then you might consider seeking treatment. Risperidone, clonodine, and sertraline all (perhaps amazingly) have been shown to have positive value in some people with Tourette Syndrome. But if you're just being a jerk, I would definitely seek a blog with a larger audience and meaner commenters.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-21605329.post-79099853879929972572007-05-23T10:34:00.000-07:002007-05-23T10:34:00.000-07:00Thanks for stopping by, Johan and sane anonymous c...Thanks for stopping by, Johan and sane anonymous commenter. SAC - Do you know where the "best" active contacts were located? The globus pallidus interna is another (albeit less popular) target region <A HREF="http://www.thieme-connect.com/DOI/DOI?10.1055/s-2007-971175" REL="nofollow">(Uc & Follett, 2007)</A> that's larger than the subthalamic nucleus.The Neurocritichttps://www.blogger.com/profile/08010555869208208621noreply@blogger.comtag:blogger.com,1999:blog-21605329.post-17774567458750029972007-05-22T13:18:00.000-07:002007-05-22T13:18:00.000-07:00Hey, it's not like we know how ECT works, and that...Hey, it's not like we know how ECT works, and that's the most effective therapy known at present. Let's be pragmatic.<BR/><BR/>Besides, if enough people get these implanted there will be some pretty nifty opportunities for single-cell recording studies in humans. Everybody wins!Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-21605329.post-24234412570003983442007-05-21T16:42:00.000-07:002007-05-21T16:42:00.000-07:00So this kind of work is definitely interesting and...So this kind of work is definitely interesting and potentially very important. I think that people should know, however, that the reason why DBS works is still somewhat mysterious. There are at least anecdotal cases for movement disorders, for example, where substantial (even almost miraculous) clinical relief was obtained when the targeted brain region was the subthalamaic nucleus but where the "best" active contacts (many of these electrodes have multiple contactes) are outside the targeted structure.<BR/><BR/>Go figure...Anonymousnoreply@blogger.com