Monday, February 20, 2006
Functional neurosurgery and deep brain stimulation
), "functional neurosurgery" is making a comeback. Medical device companies have adapted cardiac pacing technology to build "deep brain stimulators," which can cure maladies, alter mood and induce responses. In addition to great results in the treatment of Parkinson's disease, surgeons around the world are using DBS and other forms of direct neurostimulation to treat depression, migraines, sexual disfunction, obesity, stroke, and other more arcane pathologies. US News has a very accessible overview here.How does neurostimulation work? Basically, the surgeon implants a tiny battery-powered stimulator, usually under the pectoral muscle. The stimulator sends a pulse down a wire lead, the business end of which is precisely positioned to hit a "target," meaning a specific point the brain known to control a particular function.
Neurostim, as it is called, has enormous potential for good, but it will disrupt the established order along the way. We will see a series of turf battles develop. Surgical treatments will, for some patients under some circumstances, displace medical or psychiatric treatments, so some neurologists and psychiatrists will lose patients. Others will team up with neurosurgeons to provide these treatments in unified practices. Certain medical device companies may prosper at the expense of drug companies -- if we can cure depression with stimulation, perhaps we can wean depressed people from a lifetime of selective serotonin reuptake inhibitors.
As usual, medical knowledge is to some degree outpacing (yes, I am a punster) the full development of ethical principles. For example, some surgeons allow some patients to manipulate the stimulator's pulse within specified parameters. In at least one case I've heard about, one of the stimulator's leads was unintentionally close to a pleasure center. The patient could elevate his mood by dialing up his stimulator. I asked the neurosurgeon who told me about this whether he would deliberately implant a lead to achieve this result, and he thought that it would be unethical. I'm not sure I know why, given our huge consumption of anti-depressants, but he seemed quite taken aback when I suggested that DBS as a mood elevator might become popular in jurisdictions with different ethics rules. Once the surgical techniques proliferate widely, as they inevitably will, one can imagine a big business in, say, Hong Kong implanting stimulators for fun and profit.
Think I'm nuts? Check out this patent application, including Claims 5, 25, and particularly 31 and 35. Claim 31 requires the use of a "controller," and claim 35 involves stimulation "wherein the first phase includes sexual arousal and the second phase includes sexual orgasm." Medtronic is going after Pfizer's ED business, it seems, the difference being that it may be possible for neurostim patients to trigger their own orgasms.
It is certainly a brave new world.
11 Comments:
By 
, at
Mon Feb 20, 01:28:00 PM:
I've actually been present in a research capacity in a couple of stim transplant procedures for the purpose of treating Parkinson's disease. The results of these operations are often mixed though. Even though the application is more focused it is often very difficult to find the right loci and a great deal of patient cooperation is required.
I find it hard to believe that anyone would want to go through this without some very strong compelling reason.
By 
TigerHawk, at
Mon Feb 20, 01:49:00 PM:
That sounds right to me with the current technology and surgical experience. The question is, what happens as the surgery becomes more routine.
By Pyrthroes, at
Mon Feb 20, 02:44:00 PM:
Years ago, there were reports of laboratory test-subjects (rats and monkeys) hooked to reward-stimulus circuits, who literally starved to death in ever-expanding quests for neuro-orgasms. A mechanical, not a psychological or physiological response-- but what's the difference? They were still dead.
When "gin", named after its origin in Geneva, Switzerland, first "hit the shelves" in early 18th Century European cities, whole districts degenerated to the "Gin Lanes" horrifically memorialized by Hogarth and others as London street scenes. Analagous to crack-cocaine, the scourge eventually bred itself out of the population, meaning that like a parasite it killed without issue all those overly susceptible to its appeals.
As "progress" in neuro-stimuli marches on, we may well experience similar effects. But the obsessive-neurotics that blast themselves to pieces by this means, meantime congregating in updated equivalents of Gin Lanes, must eventually self-extinguish. Survivors, by definition those less prone to such abuse, will publish Hogarthian memoirs and go on from there... where sinks of neuro-stim remain, medico-commissars will eventually step in as they did in Canton when Maoist armies first arrived.
Within days the opium dens, plus opium denizens, had disappeared. The retreating British Governor asked his counterpart, "How did you manage that? We've been trying for 150 years." Mao's exemplar simply smiled at him and said, "We killed them."
So there it is. As neuro-stim takes hold, whole cohorts will likely deliquesce. In a Darwinian death-spiral, they will render themselves "unfit". Blaming others, grasping for "entitlements" compensating their inane proclivities, they will nonetheless dispose their own fates, unlamented. Another blip on the screen of societal awareness... and don't think any doofus regulators will have a thing to say. Except ex post facto, they never do. Certain traits are too ingrown, habits too ineradicable, for any mere Agency to combat. British colonialists and Maoist commissars both had it right-- either sequester self-inflicted victims in their "dens", or kill 'em.
Researchers in these areas might have a care for consequences. But why stop now? We're having so much fun!
By Lanky_Bastard, at
Mon Feb 20, 03:05:00 PM:
Sounds a bit like electroshock-lite. Although it seems barbaric on the surface, electroshock is a common procedure for treating depression.
It is a particularly popular option among the Amish, who recognize that depressed people need treatment and approve of the cost effectiveness of shock (cheap relative to daily pills ad infinitum, and evidently highly effective).
Pythroes: it's a treatment for sick people. I think we'll be spared "Darwinian death-spirals".
By Charlottesvillain, at
Mon Feb 20, 05:02:00 PM:
I don't know... I could pop into a neuro-bar about now.
By , at
Mon Feb 20, 09:03:00 PM:
In SciFi, the idea for wiring your brain for pleasure and other has been around for years as 'cyberpunk'. Wikipedia has a decription of that too. http://en.wikipedia.org/wiki/Cyberpunk The real world is just starting to catch up. Oh, yeah, the ramifications are probably not going to be entirely pleasant.
By , at
Tue Feb 21, 01:04:00 PM:
My fiancee has something similar. She has a Vagus Nerve Stimulator implanted above her left breastbone. Every five minutes, she gets an electrical charge to her Vagus nervce, sending electricity into her brain to treat her epilepsy.
Results so far have been mixed. It's a definite improvement over her previous condition, but it hasn't cured her. She's still on large amounts of medication, but the medication is staying effective vs her previous trend of needed larger doses every 8 months.
You can read more about it at the company's web site: www.cyberonics.com
By , at
Tue Feb 21, 02:37:00 PM:
Yuurrgh. Sounds like one of Larry Niven's Wireheads .
By Cassandra, at
Tue Feb 21, 06:44:00 PM:
I have a relative who had such severe Parkinson's symptoms he was really all but dead. This has all but cured him. It is literally a miracle.
Nothing, in the past 20-odd years I've watched this man suffer with this debilitating disease, has helped him the way this treatment has. The effects were immediate and dramatic.
Quite simply, it gave him back his life.
By , at
Fri Sep 01, 05:37:00 PM:
I personally have Deep Brain Stimulators implanted bilaterally for Essential Tremor and am very happy to answer questions from anyone about it. No matter what your point of view is of how we got here, I can only say that it has changed my life.
Email matthewnsea@aol.com
if questions.
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