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Novel Brain Stimulation Strategies – Obesity, Pain, AddictionsMark S. George, MDDistinguished Professor of Psychiatry, Neurology and Radiology, Medical University of South Carolina
02/05/15 RiverMend Health, LLC 2
Acknowledgments - – Foundations - NARSAD, Stanley, Dana, Hope– NIMH, NINDS, NIDA, NIAAA, NASA, DARPA, DOD, VA– Industry grants (last 20 yrs) – Brainsway, Cadwell, Cortex, Cyberonics,
Dantec, Darpharma, Electrocore, Glaxo Smith Kline, Jazz, MagStim, MECTA, Medtronic, Neostim, Neosync, Neuronetics, Neotonus, St. Jude Medical.
Disclosures - – No equity in any device or pharma company– 2 combinational patents pending– Speakers fees from industry (none in past 3 years)– Past Paid Consultant - GSK, Cyberonics, NeuroPace, Jazz– Unpaid Consultant – Brainsway, Neuronetics, Neostim, Neosync– Paid Consultant – Puretech Ventures– Editor-in-Chief, Brain Stimulation, Elsevier
02/05/15 RiverMend Health, LLC 3
Electricity is the Currency of the BrainElectricity is the Currency of the Brain
All of synaptic pharmacology simply serves to All of synaptic pharmacology simply serves to transmit electrical signals to the next neurontransmit electrical signals to the next neuron
The Brain is an The Brain is an ElectroElectrochemical chemical OrganOrgan
US FDA Approved ECT - Electroconvulsive Therapy
– FEAST rTMS - repeated Transcranial
Magnetic Stimulation– Neuronetics, Magstim, Brainsway,
Neuralieve, Neostim, Neosync DBS - Deep Brain Stimulation -
PD– RST - Responsive Stimulation
Therapy– Epidural Cortical Stimulation
VNS - Vagus Nerve Stimulation – Epilepsy and Depression
Not FDA Approved MST - Magnetic Seizure
Therapy tDCS - transcranial Direct
Current Stimulation TENS - transcutaneous
Electrical Nerve Stimulation– Cranial Electrical Stimulation
(CES) Alpha-stim
EPI-fMRI - echoplanar fMRI Transcranial pulsed ultrasound
02/05/15 RiverMend Health, LLC 4
Craving is certainly modifiable with cortical TMS– Lab induced craving, knockout– Small clinical trials
Smoking Brainsway has unpublished pilot study,
ongoing FDA RCT
Unclear if tDCS has enough power to be clinically useful
DBS may work, no large studies underway or planned
VNS can modulate, likely too costly
02/05/15 RiverMend Health, LLC 6
Gyral morphology differs radically, even in identical twins
Functional location varies even more, especially for complicated tasks.
50%
RestSmoking
CuesNeutral
Cues Rest
A) B)
Group AverageCraving minus neutral
Individual PeaksCraving minus neutral
What is the right task, imaging modality, for each application or disease?
• Acute Lab pain is certainly modifiable with cortical TMS• Opiate dependent, blocked with morphine• Numerous studies have found post-op TMS able to reduce post
surgical opiate use• Some evidence of effectiveness in chronic pain, fibromyalgia
• tDCS also works, perhaps 2-3 times smaller effect size. • DBS of thalamus may work, cortical stim works, • VNS can also modulate