U. gets early access to medical brain device

By
Tuesday, March 17, 2009

As the patient sat listening to music on her iPod, an electronic device protruding from her head delivered a series of clicks into her skull, vibrating the skin around her forehead.

“It feels like a woodpecker knocking on your head,” the patient said, who asked to remain anonymous.

The patient was being treated with the Transcranial Magnetic Stimulation therapy device, a new method designed to treat bipolar depression, said Linda Carpenter, associate professor in the Bio-Med department of psychiatry and human behavior.

Carpenter, who is chief of the Mood Disorders program, said the device was first used to treat patients on Jan. 15 at Butler Hospital in Providence, where many Brown medical students perform their residencies and which serves as the University’s “flagship” psychiatric hospital.

TMS therapy uses an appliance to send “short pulses of magnetic energy to stimulate nerve cells in the brain,” according to the Neurostar Web site.

The system targets a specific region of the brain that controls mood – the left prefrontal cortex­ – by inducing electrical charges to flow and stimulate brain cells.

The system is one of only “eight to ten” in operation around the country, Carpenter said, adding that it is seen as a revolutionary breakthrough in the treatment of bipolar depression.

“It’s a huge step forward for many patients that aren’t getting better with existing treatments,” she said.

Carpenter explained that due to Brown’s reputation for brain stimulation research, Butler Hospital was able to quickly acquire a TMS device from the company and get it running promptly.

“Based on our track record (the company) knew we had expertise and knew how to identify patients for this sort of treatment, and clearly we had an interest in making it available to the Rhode Island community as quickly as possible,” she said.

Before the device was approved by the Federal Drug Administration in Oct. 2008, treating depression involved only a limited number of options such talk therapy, anti-depressant medication and electroconvulsive therapy, otherwise known as “shock therapy,” Carpenter said. Of the 20 million people in the United States with serious depression, only one-third got better after taking anti-depressant medications.

Even with the introduction of the new TMS device, electroconvulsive therapy is considered by psychiatrists “the most effective treatment for depression” and is still recommended to people with serious cases, she said.

Each of the existing treatments, except for talk therapy, comes with considerable risks ­- most notably, loss of memory and the monetary cost of shock therapy.

But the TMS therapy machine has not yet shown any negative side effects as patients are able to remain fully conscious during the process, experience no confusion afterwards and don’t generate expensive medical bills, Carpenter said.

When patients start treatment they come to the hospital for an hour a day, five days a week, for a little over a month.

So far there have been six patients that have gone through TMS therapy at Butler Hospital. All but one have shown some level of improvement in treating their symptoms of depression, Carpenter said, adding that so far two patients have had total remission of their depression while one patient noticed a 20 percent decrease in depression symptoms.

“It’s been really fun to see patients get better with this because these are people that are not getting better with medications,” she said. “Many of them had done ECT in the past for their depression, some had had hospitalizations.”

So far the device has been implemented in a limited number of hospitals. There were roughly 20 hospitals involved in the clinical trials, Carpenter said, adding that each hospital still has its machine.

The slow pace of implementation is due to the time needed to train staff in machine operation, as well as typical hospital procedure for implementing new programs, Carpenter said, adding that she is the only doctor who currently performs the treatments at Butler Hospital even though three others have been trained.

“What’s really cool about this is that we’re probably at the beginning of an era where we can give better treatments for psychiatric disorders.” Carpenter said. “It’s a whole different way to get at the organ that you’re trying to treat.”