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Format: 04/25/2014
Format: 04/25/2014


Los Angeles Times: Deep-brain stimulation being tested with brain injury, Alzheimer's, obesity and more

Tuesday, June 2nd, 2009

By Andreas von Bubnoff

Deep brain stimulation for depression and epilepsy is already being tested in large clinical trials, but it has only been tested in a few patients for other conditions such as traumatic brain injury, Alzheimer's disease, obesity, anorexia and addiction.

Brain injury: Dr. Nicholas D. Schiff at Weill Cornell Medical College in New York was part of a team that used deep brain stimulation to help a man who was in a minimally conscious state after a traumatic brain injury.

The man had been hit on the side of the head, which caused bleeding and swelling of the brain. He was initially in a coma, then in a vegetative state for about 12 weeks and then in a minimally conscious state for six years.

His eyes were closed much of the time, he could not swallow, and he had to be fed by a tube in his stomach, Schiff says. On rare occasions, he could move his thumb to trigger a communication device. He did utter words on rare occasions but could not give verbal responses in formal testing.

The man received deep brain stimulation in the central thalamus, an area in the middle of the skull that controls arousal, sleep and wakefulness. After treatment, he could chew and swallow, communicate in short sentences and use his hands or limbs to demonstrate the functional use of objects.

This is the first case, Schiff says, where deep brain stimulation has clearly been shown to improve people with traumatic brain injury. To prove that deep brain stimulation was the reason for the man's improvement, the six-month study had one-month-long phases where the device was turned on or off and his condition was observed to get better or worse.

He also was at the "higher end" of a minimally conscious state, in that he could follow commands. Schiff says that in other cases, such as Terri Schiavo, the 41-year-old brain-damaged woman who became the centerpiece of a national right-to-die battle, deep brain stimulation didn't work because the brain damage was just too great.

Schiff says the team has Food and Drug Administration approval to treat 12 patients.

Obesity: Dr. Andres Lozano, professor of neurosurgery at the University of Toronto and president of the World Society for Stereotactic and Functional Neurosurgery, used deep brain stimulation to treat obesity in a 420-pound man.

The patient lost about 25 pounds but later regained the weight. One possible reason? He turned off the device at night to snack.

That's why patients in the first deep brain stimulation-obesity experiments in the U.S. don't have the option to turn off their devices, says Dr. Donald M. Whiting of the Allegheny General Hospital in Pittsburgh, who is conducting the U.S. obesity trials with colleague Dr. Michael Oh.

So far, only two patients have been treated, chosen because they failed numerous diets as well as gastric bypass surgery.

Carol Poe from Morgantown, W.Va., joined the trial in February and says that nine weeks after the device was turned on she had lost 11.5 pounds.

But it's too soon to say if the therapy worked, Whiting says, because the initial effects could be due to a placebo effect from the surgery -- the patient knew you did something and thus expects a change that may not last.

Whiting has FDA approval to treat just three patients for now. He says he stimulates -- and thereby theoretically down-regulates -- the lateral hypothalamus, a brain area that acts as the feeding center of the brain. Animals with damage in this area simply stop eating.

To read more, visit the Los Angeles Times web site.


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