Star Trek Medicine: Selectively Rewiring Brain Circuitry to Treat Depression

Source:  The Economist

On Star Trek, futuristic doctors wave small devices over the heads of
both humans and aliens, diagnose their problems through evaluating 
changes in brain activity or chemistry, and then treat behavior 
problems by selectively stimulating relevant brain circuits.  

Another example of how fiction often predicts reality.  Good job to Gene Roddenberry and the writers of Star Trek, though I have to admit I don't know if the fictional tricorder pictured above directly influenced these researchers.  The odds that these men and women watched Star Trek while growing up are pretty high.  And the tricorder has been a staple since the earliest days of the original ABC Television series in the 1960's.  

It must be quite an experience for a writer to see something they imagined become reality.  Now if some researcher somewhere could come up with a working transporter.

Here's the story: 


While the day a physician can wave a small, hand-held "tricorder" over a patient and evaluate what ails them is a long way off, transcranial magnetic stimulation (TMS) does treat symptoms of depression in humans by placing a relatively small device on a person's scalp and stimulating brain circuits.

journal.frontiersin.org
Schematic of the default mode network (DMN), salience
network (SN) and central executive network (CEN)
However, relatively little is known about how, exactly, TMS produces these beneficial effects.  Some studies have suggested that TMS may modulate atypical interactions between two large-scale neuronal networks, the fronto-parietal central executive network (CEN) and the medial prefrontal-medial parietal default mode network (DMN). These two functional networks play important roles in emotion regulation and cognition.

Liston, an Assistant Professor at Weill Cornell Medical College, further details their findings, "We found that connectivity within the DMN and between nodes of the DMN and CEN was elevated in depressed individuals compared to healthy volunteers at baseline and normalized after TMS.

Additionally, individuals with greater baseline connectivity with subgenual anterior cingulate cortex -- an important target for other antidepressant modalities -- were more likely to respond to TMS."
These findings indicate that TMS may act, in part, by selectively regulating network-level connectivity.

Suggested reading
Dr. John Krystal, Editor of Biological Psychiatry, comments, "We are a long way from Star Trek, but even the current ability to link brain stimulation treatments for depression to the activity of particular brain circuits strikes me as incredible progress."

Dubin, also an Assistant Professor at Weill Cornell Medical College, adds, "Our findings may inform future efforts to develop personalized strategies for treating depression with TMS based on the connectivity of an individual's default mode network. Further, they may help triage to TMS only those patients most likely to respond."



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Story Source: Materials provided by Elsevier.  Conor Liston, Ashley C. Chen, Benjamin D. Zebley, Andrew T. Drysdale, Rebecca Gordon, Bruce Leuchter, Henning U. Voss, B.J. Casey, Amit Etkin, and Marc J. Dubin. Default Mode Network Mechanisms of Transcranial Magnetic Stimulation in Depression. Biological Psychiatry, October 1, 2014

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