There
is a common misconception amongst the general populace that we only use 10% of
our brains and the other 90% is a complete mystery. I am here today to assure
you that the only mystery is where this myth could have originated because it
is just that. A myth. If there’s one thing nature has taught us over our
century or so of study in the world of evolution, it’s that nature doesn’t
waste energy, (it isn’t human after all), in fact, it conserves it to such a
degree its mind blowing.
Take
for instance certain species of subterranean mammals like the naked mole rat.
While they aren’t completely blind, nature didn’t see fit to give them the same
set of photoreceptors as us. Why? Because they didn’t need it. They needed energy for other things, so evolution phased
sight out.
Now
don’t get me wrong, I’m not saying the human brain is slowly phasing out the
human race, but to think there are parts we don’t use is just absurd.
But
if you worded that statement a little differently to say we only understand about 10% of the brain, I
might be able to rally behind you. And so wouldn’t many other scholars in the
world of neuroscience. The scary truth is we really don’t know that much about it. We know what part stimulates breathing,
motor function, and emotion. We even know with pinpoint accuracy where and how
the pituitary gland influences our growth. But consciousness? Ha! Good luck
with that.
While
it’s true consciousness and how it works is a mystery unto itself and there are
pieces of the brain we can tell are active but don’t know why, it’s not true
that only a fraction of it is in use. In fact, just getting up, walking to the
fridge, opening the door, and cracking a cold beer open to take a sip causes so
many neurons to fire that under the right kind of imaging your brain would like
an explosion at a power plant. So why am I telling you all this?
Well
because in a world today dominated by Cancer research and a fast paced consumer
entertainment market, disorders of the brain sometimes get swept to the
wayside. Until those disorders of the brain begin to affect us on a large
scale. A large scale like the one we have seen trending in the past decade.
It’s
not that these diseases weren’t around before (most of them anyway) it was our
way of dealing with them.
With
advances in scanning techniques, treatment for once thought manageable yet
un-curable diseases were being discovered. Perhaps amongst the most amazing of
these advances in the realm of Neurosurgery was DBS, otherwise known as “Deep
Brain Stimulation.”
Today
we’re going to talk about this incredible surgery and its origins. We’ll also
talk about some of the original techniques used to perform this “cutting-edge”
(no pun intended) surgery in its infancy. We’ll also talk about the wealth of
diseases it can currently cure, the ones they’re aiming it at, and the nano-technology
that is going to take them there.
The Enemy
While
any disease is the enemy of doctor’s worldwide, Parkinson’s is the Loki to the
Neurosurgeon’s Avenger’s. As you can see in the graphic above there are a wide
range of areas afflicted by Parkinson’s disease. What’s worse are the areas affected
themselves. Because of the combination of misfiring neurons in the variety of
locations the spastic micro-seizures accompanied with Parkinson’s disease
(among many other disorders) can occur.
There
are four symptoms related to motor function that are essential to PD. The first
of which is the tremor. While it isn’t necessarily present at onset, this is
one of the hallmarks of the disease, involuntarily spasms of the muscles.
Bradykinesia, which is slowness of movement, comes next. The final two are
rigidity of the muscles which can present in uniform ways or a cogwheel formation
(a ratchet-like jerking of the extremity being analyzed as demonstrated in the
video here), and then
the final sign is postural instability. Postural instability is linked to falls
amongst those affected by the disease.
On
top of all that, there are neuropsychiatric symptoms linked to this disorder as
well. Some are a result of the medications meant to control the symptoms, but
some are thought to be resultant of the disease itself. Disorders such as
insomnia, loss of appetite, depression, paresthesia (numbness or tingling in
the extremities), these can all be warning signs of the onset. Why does this
happen?
The
short answer is Dopamine. Dopamine works like a messenger in the brain. It’s a
neurotransmitter with a variety of tasks but whatever it’s delegated to do, at
its core the primary function of Dopamine is to deliver a message. If abnormal
levels of dopamine are produced or if production stops in certain areas catastrophic
events begin to take place within the brain.
While
scientists understand it’s the dopamine producing neurons to blame, when they
die off, for the associated motor disabilities, they still don’t understand why the dopamine producing centers are
dying. Mitochondrial dysfunction, oxidative stress, even environmental factors
such as exposure to certain pesticides can be linked to Parkinson’s disease,
but how the cells making dopamine are systematically destroyed is still a
mystery.
What
they do understand completely are the
parts PD, and other diseases like it, are attacking. That’s why in recent years
it’s been announced that DBS may be able to treat a variety of psychiatric
disorders as well ranging from OCD and depression, to the more severe cases of
schizophrenia and psychosis. OCD has been effectively treated in some instances
already, giving physician’s the confidence to feel like this isn’t just a claim
to get more grant money, this is real science.
Armed
with this information and a fortress of cutting edge technology, doctors are
now finally ready to suit up for that final confrontation with Lex Luthor. Like
Superman, they may not understand Parkinson’s intentions, but they have a plan
to put him behind bars.
DBS: Like An
Architect For Your Brain
The
brain is divided into two hemispheres, the right side and the left side. The
left side is the logic center (i.e. math, science, reasoning.) while the right
side is the creative cluster (poetry, arts, dance, etc.). But when the neural
pathways in either side of the brain begin to deteriorate, as I mentioned
before, bad things happen.
That’s
where Deep Brain Stimulation (or DBS) comes into play. The way the brain works is
extremely complicated and in order to explain it accurately and in full detail
it would encompass the entirety of this article. So for the purposes of what we’re
talking about today we’ll grossly oversimplify it and just say billions of tiny
electrical pulsations are what make the brain do what it does. If you want the
full scoop on how your three-pound thought box functions you can read what the
guys at How Stuff Works cooked up by clicking here.
In
the case of Parkinson’s disease where neurons are dying off, electrical impulses
are having difficulty sending communications to other areas of the brain. When
this happens the Axon’s that work like cable wires to carry the information don’t
know what to say to the Dendrites, the ones who receive and interpret the
information. When this happens the body begins to behave in a peculiar manner.
Think
of it in terms of your television. The cable company acts like a cell body,
gathering all the T.V. shows and arranging them in a digestible format for
everyday viewers. The T.V. shows signal is then transmitted down the cable line
which in the case of the brain would be the Axon. Its final destination is your
cable box which would be the Dendrite, which then interprets that information
into a picture for your T.V. or in the case of a Neuron, a command to lift your
arm.
When
Parkinson’s attacks, the cable company shuts down. There are no signals coming
in or out down the wire to reach to your cable box. Because of this the
television only displays static and eventually your interest dies out. Think of
the Neuron like your interest in waiting for the cable company to fix the T.V.
Without a signal it just dies.
The
cause of this neuron death is widely unknown but research continues every day.
What we do know is how to manipulate the electrical signals that are no longer
transmitting. If the neurons function like a cable company to a T.V. then DBS
is the Consumer’s Energy to get the lights turned back on. Let’s take a brief
look at the history of psychosurgery to put in perspective just how far this truly remarkable science
has come.
C’mon…It’s Not Like
It’s Brain Surgery…
Psychology
and the neurosciences are still in their infancy as far as medical fields go.
Neurosurgery is even younger than that. Part of it stems from the limitations
of technological advances, but the other part of it is the simple fact that we
just didn’t understand the brain. We knew it was essential in diagnosing
disorders like schizophrenia and various dyskinesia’s (involuntary muscle
movement) associated with disorders like Parkinson’s and Palsy but we had no
idea how.
Enter
Dr. Gottlieb Burckhardt. In 1888 he performed six brain surgeries. But his
instruments were crude and his methods, while good intentioned, were
horrifyingly misguided. What ended up happening is two patients showed no
change, two patients became catatonic mutes, another one died, but ONE GOT
BETTER!!! He tried to publish his findings with a 50% success rate but instead
received nothing but haughty laughter and hostility from his peers.
Then
in 1910 another doctor in Russia took up the scalpel to three mentally ill
patients. He attempted to redo Dr. Burckhardt’s earlier gamble with
neurosurgery but collided with the same wall his predecessor had. The surgeries
failed and in 1912 a scathing article was published demonizing Gottlieb’s
original work quoting, “We have quoted
this data to show not only how groundless but also how dangerous these
operations were. We are unable to explain how their author, holder of a degree
in medicine, could bring himself to carry them out...”
But
yet he failed to mention that just two years prior he attempted to do the same
thing…
Nonetheless,
the Russian physician, Dr. Ludvig Puusepp changed his tune to the sound of
retraction sharp in the 1930’s. As medical technology had advanced, as well as
an understanding of the human mind, psychosurgery was becoming a viable option.
In 1937, apparently forgetting he’d ever laughed Dr. Burckhardt off the world
stage, he returned to the surgical theatre to help lead a new era of doctors in
this unique field of study.
That’s
when Portuguese neurologist (and inventor of the term psychosurgery) António
Egas Moniz decided it was time for him to “cut in”. (hee hee). See while Dr.
Burckhardt and Dr. Puusepp were trying to dig a trench around the cortex and
sever the connections they thought were creating the problem, Moniz was taking
a whole different approach. He determined that the only way to cure these
patients was to remove the frontal lobe, thus giving birth to the lobotomy or
as it was called then, leucotomy.
Now…to
say the medical community found the lobotomy to be controversial and crazy to
consider a viable treatment option is like saying that, “The Hebrew population
in 1930’s Poland had mixed feelings about Hitler.” In short, it’s an
understatement.
The
problem didn’t stem from the method itself; in fact, lobotomies were performed
to the ends of mixed results for quite some time. The problem lied in the fact
that the patient receiving the operation didn’t really have a say in the
matter. In those days, once you were institutionalized, you were officially at
the mercy of your captors. In this case, the doctors.
By
the 1950’s antipsychotic medications were becoming available and the lobotomy
(thankfully) began seeing a steady decline. It wouldn’t return the livelihood
of the some 20,000+ people that had been forced to undergo the surgery, but at
least it would prevent anyone else from having to go through the barbarism of
it again.
But
this raised a new problem. If we can’t cut the bad wires to stop it, and if we
can’t remove the fried circuit entirely then what do we do? Ablate the hell out
of it course! In the 1940s till the late 80s, Neurosurgeons decided that if
removing the parts of the brain that caused these ill effects wasn’t going to
work, then maybe slicing and burning them would.
While
lesioning (making precise incisions in targeted areas of the brain so as to
achieve a desired effect within the patient) may not have been the best thing for patients, by 1987 it had
paved the way for a new form of therapy. Deep brain stimulation. This
technology would revolutionize the way we viewed the brain, the techniques used
to assess, diagnose, and treat psychiatric disorders, and for the first time, it
would seem to provide doctors with a means to fight back.
The
enemy…the disease, was no longer invincible.
Hey! That Hertz!
These last few decades have been great ones
for science. We’ve seen advances in medicine, climatology, genetics research;
in fact, we’ve made such strides in these areas we’ve had to create all new niche areas of study to just be able
to properly encompass and give attention to it all. But as scientific disciplines
get bigger, it seems the method of delivery gets smaller.
Before
Benabid and Pollak in 1987 discovered that targeted electro-currents to the
brain could re-fire the damaged neurons thereby alleviating tremor symptoms,
our answer was to hack & slash our way through. These two men decided another;
more delicate answer was needed to the burning questions of the brain. So what
was their solution? Shock the crap out of it.
As
we mentioned before the only form of dealing with movement disorders until this
time was lesioning and that was dangerous and irreversible. Dr. Benabid wanted
to find another method; one that could be undone should unforeseeable
consequences take place. What he discovered was the effect of high frequency on
the brain.
It
wasn’t the first time electricity had been used in direct contact with the
brain. In fact, using electrical pulses to render areas of the brain useless
was a popular tactic used by doctors for lesioning already. But by changing the
output of the current, it was possible to, in a sense; turn the non-working
parts of the brain back on without causing permanent damage. However it was
unfeasible for a patient to walk around with an open skull and a cattle prod
just to keep from falling prey to the tremors of PD. They needed a constant
delivery mechanism, one that could be installed through surgery, monitored and
taken out should problems arise, and be altered as new technology became
available. To say this seemed daunting is to say the Pyramids are big. It doesn’t
encompass the scope of it even close to accurately.
Early
DBS surgery was terrifying to the patient. First and foremost, it’s brain surgery. The thought of someone
chiseling inside my brain with scalpels and drills doesn’t remotely appeal to
me. To make matters worse the surgery took around 4 to 6 hours to complete. Now
that doesn’t sound so bad until you find out that you have to stay awake the
whole time.
In
order for doctors to monitor the patient and make sure the leads were doing
more good than harm, the patient would have to remain conscious in order to
answer questions. In a video of a New York City police officer who underwent
this surgery, Mike not only remains conscious, but when asked questions by the
doctor, he responds in Russian. When the doctor calls attention to this, Mike
jokingly states, “Well you must be doing something
right I’m learning Russian!” (I absolutely adore this guy, its brain surgery so
parts of the video are a little graphic but his courage is definitely worth the
watch! Check out his story hereon YouTube.)
But
even though Mike was willing to take the risk to make a change, the thought of
being awake while doctor’s installed a car battery in your brain was terrifying
to most. First they have to drill a hole in the skull cap. Wire leads are run
along the back of the skull and down into the chest cavity. A screw is fixed in
the skull in order to hold the leads in place. And that’s just the reader’s
digest version of the first surgery.
The
second surgery involved a battery pack, like a pacemaker, being installed in
the chest to hook the leads to. Luckily this second surgery was one doctor’s
were used to and the patient could be anesthetized for this one. But trying to
convince patients on undergoing the first one was a tough sell. Because of this
the process, while not exactly ignored, wasn’t highly recommended by physicians
because medication was able to manage the disease in the early stages. DBS wasn’t
readily recommended until the later stages of the disorder.
However
thanks to an ever progressing world of technology, DBS fears may fall to the
wayside and become a thing of the past. Patients no longer have to be awake
during the surgery (which is a huge plus) thanks to new forms of imaging and
scanning, and because of nanotechnology and robotics, the big problems doctor’s
faced in the past are becoming much smaller as we move into the future.
The Shocking Future
of SWCNTs
SWCNT’s
(Single-Walled Carbon Nanotubes) and MWCNTs (Multi-Walled Carbon Nanotubes), are
rather unique little inventions. Depending on the way you arrange the molecules
in them, the structure can be used for a variety of tasks. For instance, a
certain arrangement yields a structure stronger than steel but is six times
lighter. This would be extremely useful for devices such as body armor for the
military or lighter vehicles for the daily commuter. But for the purposes of
this article we’re going to talk about SWCNT’s being used a different way, as
microprocessors.
While
much research is needed on Carbon Nanotubes still, one thing is abundantly
clear. They have electrically conductive properties, and what’s more, they have
actually been found to repair the damaged links between neurons in the brain.
To put it in perspective let’s recycle our original analogy with the cable
company.
With
early DBS treatments, metal conductors and wire leads were required and had to
be attached to a battery pack. This whole process is long, drawn out, and while
strides have been made to accommodate those afflicted, having these bulky
artificial parts inserted into your body can over time wear on a person. So if
we make the pacemaker the cable company, the wires the Axons, and the brain the
T.V. screen, SWCNT’s are the electrical tape used to make a patch.
Instead
of using the complex procedure of leads and battery packs, Carbon Nanotubes are
capable of natural conduction if the atoms are arranged in the right formation.
Because of this they are able to slip into the areas that have burned out and
respark the connections in order to send signals to the rest of the body once
more. The surgery is as minimally invasive as one can imagine given the
miniscule size of the Nanotubes. However, there are issues with it. For example…
“There are three fundamental obstacles to
developing reliable neuroprosthetics: 1) stable interfacing of
electromechanical devices with neural tissue, 2) understanding how to stimulate
the neural tissue, and 3) understanding what signals to record from the neurons
in order for the device to make an automatic and appropriate decision to
stimulate. The new carbon nanotube-based interface technology discovered
together with state of the art simulations of brain-machine interfaces is the
key to developing all types of neuroprosthetics -- sight, sound, smell, motion,
vetoing epileptic attacks, spinal bypasses, as well as repairing and even
enhancing cognitive functions.” – Read more here.
While
these are all still in the testing phase it’s impossible to deny that the
future of this technology is promising. Only time will tell if Carbon Nanotubes
will be able to deliver on the theories scientists have proposed for them. One
thing is certain though, if disease itself is capable of feeling fear, it
should. And the weapon to fear is Nanotechnology.
-
Ryan
Sanders
I hope you enjoyed this article on
Deep Brain Stimulation. If so please share it around on Facebook and Twitter.
If you would like to know more about DBS, SWCNT’s, or anything else discussed
in this article, feel free to follow any of the links below. As always, happy
learning!
No comments:
Post a Comment