Monday, May 12, 2008

A visit to the TMS lab, and some questions answered

I’ve started getting quite a few questions about the TMS work I’m participating in at Alvaro Pascual-Leone’s lab in Boston http://www.tmslab.org/ I’m going to answer a few of them here. Feel free to ask your own questions in the comments. I’ll try to answer, and I’ll run any technical or medical questions past Alvaro, Shirley, and the other doctors to make sure I have the facts straight.

What is TMS?

As we think, our brains generate small electrical signals. These signals pass through our nerves to work our muscles, and the pass within our brains to create our thoughts and memories. All our nerves work on electricity – nerves in our eyes, ears, and even our nose generate electrical signals that our brain interprets and processes.

TMS uses the principle of electromagnetic induction to add its own signal to the signals running along our neural pathways. TMS is very precise, so we can aim it at fairly specific paths. For example, we can use TMS to stimulate one finger in the hand. By applying TMS pulses to the part of the brain that controls it, we can make the finger twitch.

These pulses can augment the function of a brain area, or they can inhibit it. So you might say they allow us to “speed up” or “slow down” small parts of the brain. The TMS equipment we’re using in this work focuses on a bit less than 1% of the brain mass.

So how could it help people with autism?

Shirley and Alvaro developed a theory that some parts of the autistic mind are over-active, and those overactive parts sort of overwhelm the other parts. By “slowing down” the over-active areas they hoped to bring about an improvement in overall function.

In this first study, several areas were targeted over four sessions.

So far, my results look very, very promising. Really exciting stuff. We also have positive initial results from a few others in the study. But it’s too soon to say more – we need to analyze the data and run more experiments.

Now, if I may, I’d like to show you what it looks like. Meet Shirley Fecteau, PhD, the leader of this particular study. She’s an instructor at Harvard Medical School and a part of Dr. Pascual-Leone’s team at Beth Israel Deaconess Medical Center.




Shirley is French-Canadian. One of the things I've noticed is that people have come from all over the world to work in these Harvard programs. They really do get the best and the brightest from all over.

In this image you can see me getting TMS to the right front of my brain.





She's holding the coil against the side of my head. The black headband has some targets on it that allow two computer cameras on the wall to track my head so she can keep the coil in the right spot. You’ll notice I have a blank expression. That’s because the TMS induces an almost meditative state in me. The picture you see is not a setup, it’s real TMS.


This next shot shows a bit more of the setup. You can see the cameras on the wall, looking down at the chair. Those cameras feed the computer below, which tells Shirley where to hold the TMS coil. Fellow Aspergian Michael Wilcox is in the chair, and he's going to write about his TMS experience on his own site, which is http://www.mfw.us/ The fellow with the camera is filming is for a Canadian Television documentary based upon Dr. Norman Doidge's book The Brain That Changes Itself. Dr. Doidge and the crew came to see us 2 weeks ago and I took the chance to shoot a bunch of photos.






In this photo, you can see the brain map and the targets for stimulation.





The upper right view has some small colored dots . . . those are the target areas. The pair of cameras on the wall match points on my face with the MRI images to show them where to place the TMS coil.

The crosshairs on the left show the coil (the black) dot with the target area being the X

This shot shows the actual TMS machine:




Here's a better view of the TMS coil, on my son Cubby's head:




The hose coming out of the coil is an air line, to pass air through the coil to cool it. The coil is a figure 8 of wire in the blue plastic casing.


And a few more questions before I go . . .


Does TMS damage or kill brain cells?

In my previous post, I described some pretty dramatic effects from TMS. Someone on the http://www.ageofautism.com/ site asked if those vivid images were produced by "millions of neurons dying off."

TMS does not injure or kill brain cells. In this study, we are using what's called functional MRI imagery to watch brain activity before, after, and even during TMS. We can see areas become less active, or more active, and we see them return to their pre-TMS states. We can say with certainty that TMS is not killing brain cells.

We are able to watch the areas of the brain that we stimulate change and evolve.


In addition, Alvaro and other neuroscientists have observed the effects of TMS during open-brain surgical procedures in patients. TMS alters the signals passed through the neurons. It does not burn them out.


Is TMS like ECT, electro convulsive or shock treatment?

Not really. It's only similar in that they are both electrical processes. To use an analogy, TMS is like touching your fingers across the terminals of a AA battery. ECT is like throwing a cable over a high-tension electric powerline. Needless to say, both are electrical experiences but their effect on the person is drastically differrent.


TMS is a low-energy and highly focused procedure that's aimed at less than 1% of the brain mass. It's painless and in fact induces something of a tranquil state while it's being done. For me, TMS has produced a lasting elevation of mood and made me somewhat calmer overall.


ECT, on the other hand, is a very violent, high energy jolt to the whole brain. It induces seizures and it's so painful that people must be under general anesthesia. As you can see, none of that happens with TMS.


I'm aware that any tool that reaches into the brain and alters the way we think is scary. I guess it's not as scary for me because I have a good understanding of the electronic principles, and I'm seeing it unfold firsthand. And it's also exciting. The results I am seeing are truly like science fiction come to life.

30 comments:

Polly Kahl said...

Keep up the good work and keep us posted John. This reminds me somewhat of the neurofeedback work therapists have been doing with ADD clients with great success in the past fifteen years, only it's a more passive process. It's very exciting to see how this is all evolving. Congrats (and thanks) again for being a part of it.

Chumplet said...

That was fascinating. I wonder if it helps with epilepsy.

Thanks for visiting my blog. Always makes me feel good!

momof3feistykids said...

Might TMS have the potential to help people with severe mental illnesses, such as schizophrenia or severe anxiety and depression?

Kim Stagliano said...

John, Shirley is gorgeous! I think you'd sacrifice brain cells to spend time with her - although I'm glad your brain is intact...

Must. Learn. More! Love this. THanks for sharing it with us.

Check out what Dr. Healy (Former head of NIH) said on Imus today. I managed to live transcribe some of it on Age of Autism. Should have gone to Katie Gibbs school instead of BC! I don't type fast enough.

K

John Elder Robison said...

A few of you have asked about TMS and other conditions . . . TMS is used to treat depression right now. It's covered by insurance in Canada and some European countries.

You can get TMS right now at BIDMC in Boston, but it's not covered by insurance yet.

TMS is also used to aid stroke recovery. Applications in epileptic s and others are being explored right now.

John Elder Robison said...

Kim, I'm glad you approve of Shirley. I like to think I come out of my encounters with her with all brain cells intact, though.

Katie Alender said...

Fascinating! I can't wait to read more.

The Muse said...

How I wish that this treatment had been available for my Mom for depression 5 years ago. As you know my Mom had ECT as a last resort for her depression. This procedure should be outlawed for elderly people. Their neural pathways are much too fragile and inflexible to be "shocked" into reorganization. ECT destroyed my Mother's memory and her spirit. I think that magnetic stimulation is much different than ECT because it is targeted and much less violent. Although I believe that psychologists were on the right track with this concept of brain stimulation and changing neural pathways in the brain. ECT is supposed to induce a grand mal seizure of the brain which causes a temporary amnesia in the patient. In a sense people "forget" that they are depressed and become disoriented. The problem is that in older patients those neural connections sometimes never return and they suffer permanent memory loss and dementia. My Mom does not remember certain periods of time. It is tragic. She does not remember all of the 90's which includes my wedding, the birth of my son and all of the grandchildren. Those memories are somewhere locked in her brain hidden and inaccessible...

Polly Kahl said...

That is really heartbreaking, Muse. My mother almost went thru ECT during one of her mental hospital stays but my father was able to stop it at the last minute. Very scary stuff. Sad too.

Kanani said...

I didn't read the article, but it does look like you're going in for some insane beauty treatment. Do let me know if there's any improvement, okay? ;0)

Look, I've not forgotten about the interview I did with you. I'm waiting to have it coincide with the paperback release in June.

Wasn't that right? A new release? Was it here? Or maybe I'm confusing you with Patricia?
xx
Kanani

John Elder Robison said...

Kanani, the paperback release was going to be June but they moved it back to Sept 9th. I guess it's a matter of bookstore display space, school timing, etc.

And if you think TMS is an effective beauty treatment . . . you got me mixed up with someone else in those photos!

Jill Elaine Hughes said...

Very cool stuff, John. Fascinating. Do keep us informed. My mom had ECT in the 80s, and it totally messed her up. I'm glad to see that an effective alternative to ECT is emerging.

Regarding your previous post, it seems to me you have a rare condition called "synesthesia" (i.e., the ability to "see" music). This is considered by many to be an extraordinary gift, almost like ESP. Congrats on getting it back.

I am going to meet your brother this Thursday when he makes an appearance in Chicago's north suburbs. I'm really looking forward to it.

The Muse said...

Polly,

Thanks for your kind words. ECT is such a risky crapshoot. I tried to stop the treatments and begged my father to stop them; but the doctor convinced my father that she needed at least 12 of them to receive any benefit. At one point my Mom could not remember how to spell her own name! She has aged 15 years in the last five and is very, very frail now.

I am so thankful for this TMS research that John is participating in because I sincerely believe that the most obvious benefit has been his elevation of mood. I am so hopeful about this study. I suspect that TMS will someday routinely be used to treat people that have OCD, phobias, anxiety, and depression.

Strange Behaviour said...

TMS holds a. Tremendous amount of hope for my family. Several times I have considered ECT for myself. I'm still youg-ish at 36 I have reasoned. A few years ago I suffered a breakdown. I battle the terrible beast that is Major Depressive Disorder. As I understand it, depression and autism/aspergers are similar as brain function is concerned. I too have experienced hypersensitivity to light, sound, touch, smell and taste. Consequently I have a unique understanding of my children's experiences. This has been the only benefit from all of this. Autism has complicated their lives to say the least, but I feel I have caused irreperable damage to their development. This is why I would consider TMS for myself first and then, perhaps them.

Kanani said...

Ah, John. You're gorgeous.
Hey, btw... I liked your financial recap about your advance. Very clear. I'm sure there are other expenses as well, and I think we'd love you to write about this for The Writerly Pause or I could just phone you.
xx
Yer crazy beauty fanatic, Kanani

ChrisEldin said...

Yes, the doc is pretty!!

John, this is fascinating beyond words. I feel like you're sharing with us the start of a major breakthrough in medicine. I'm so glad you feel it's a positive experience, and that you're reaping benefit from it. TMS has the potential for so many more applications.

Thank you for sharing your journey with us!!!!

I remember a few years ago I was doing as much reading as possible about people who stutter (both of my children stutter). And a doctor in Israel hypothesized about the role of dopamine in the brain. The way he explained it, I felt totally convinced. Now others are catching up to his research. People who stutter seem to have too much dopamine; people with Parkinsons disease don't have enough dopamine. This is a tangent, I know. But studies about the brain are so interesting to me.

Theresa said...
This comment has been removed by the author.
Theresa said...

Mr. Robison, are the results your son Cubby and those of other participants similar to your own?


Can TMS help my son NOT throw away his schoolwork he didn't finish on time or doesn't want or know how to do??? :)

John Elder Robison said...

Theresa, Cubby and several others in the study had similarly striking results. We did not all see the same things but the results are consistent and dramatic.

I do not know the specific answer with respect TMS's ability to affect your son's behavior.

The larger issue is that TMS is still in the research labs. We've got to verify results on grownups, then extend the study into kids, and then begin the longer process of government approval.

I can say from experience that it's science fiction made real, but we've got a lot to learn before deploying it as a tested and validated therapy for the public.

Michelle O'Neil said...

This is so interesting John. Will you ask them the implications of this treatment for chronic anxiety? Will they be able to just tweak the anxiety part of the brain...make it not fire so strongly over every little bump in the road?

(Yes, the doctor is cute, but so are you and Cubby).

Woof!

Mom to Max said...

wow...that is really something. i wonder if it could help with multiple sclerosis which i have.

PLANET3RRY said...

History Channel or National Geographic had a show on Savants and they used magnets to activate and deactivate parts of the brain. It was pretty cool. I'd love to get a chance to do something like this.

Michael said...

I attended a consultation with Dean Mooney, a Psychologist in Vermont who specializes in working with people with non-verbal learning disorders. He subscribes to a theory (if I understood it correctly!)that in Asperger's there's a problem in the white matter and corpus callosum in the right hemisphere of the brain, which results in communication problems between the right and left hemispheres. An example he gives of the effect of this communication problem is that his patients often report that they regularly hear an inner voice talking to them which, he believes, is in fact the right brain communicating with the left brain however it can. Neurotypical young children often experience this phenomenon (sometimes referring to thier "imaginary friend"), but usually grow out of it as their brains develop, by age 5.

I wonder--if there's any validity to that theory--if TMS is in some way improving communication between the two hemisheres of your brain?

Drama Mama said...

John, this is the perfect marriage for you - autism and technology.

Fascinating stuff. I"m so glad that you're enjoying.

I want a coil!

Linda said...

As the mother of an 11 year old Aspergian, this is really encouraging to me. Maybe some day it will be available to others. Thanks for participating in the study and please keep us posted.

susan hardman said...

I get so much from your postings
your book and the CD of the book.
Our son Sam, 38,learned he had
Aspberger's about five years ago.
He is learning, just as you have,
about himself and how to negociate
this world, it's messy and hopeful
as at the same time. We were talking the other day about your
book and he said, " I want to know
how JEB met his second wife and what happened to his first one." I
said he should go on your blog. He
said you didn't really tell about
that in your book. He is thinking
about this as he is the recently
divorced father of three young
children, one with Aspberger's and
he is wanting to be in another relationship and doesn't really
know how to do it. And so it goes... Your recent experience with
TMS is very exciting and hopeful.

Do you have any dates to be in The
Twin Cities of Minneapolis/St. Paul?
We would love to see you here. How
would I go about making that happen?

Thanks for connecting so well with
us out here. Susan Hardman

Susan said...

Great news about TMS. My husband
has done something like this for
his Parkinsonism. This is hopeful
for our son Sam, 38, who is in the
Aspberger's club. Sam wants to know more about what caused the
breakup of your first marriage and
how you met your second wife. He
says you didn't explain much in the
book. As recently divorced Aspie
with three children he is trying to
figure out how to be in a new relationship and struggling alot.
I've encouraged him to get on line
and ask you himself. Thanks for
being so out there with your story
It helps us all. Susan Hardman
The mom

Susan said...

Great news about TMS. My husband
has done something like this for
his Parkinsonism. This is hopeful
for our son Sam, 38, who is in the
Aspberger's club. Sam wants to know more about what caused the
breakup of your first marriage and
how you met your second wife. He
says you didn't explain much in the
book. As recently divorced Aspie
with three children he is trying to
figure out how to be in a new relationship and struggling alot.
I've encouraged him to get on line
and ask you himself. Thanks for
being so out there with your story
It helps us all. Susan Hardman
The mom

susan hardman said...

Great stuff! Keep the news about
TMS coming. We are learning much
from you and our son Sam, 38, is
walking through this Aspberger's
journey with you. He wants to know
more about your marriages as he
says your book didn't go into much
detail. He is trying to connect
with someone after a divorce and
finding it hard. Thus the question. Thanks so much for your
being out there and helping all of
us Aspies and families. Susan Hardman

susan hardman said...

Great stuff! Keep the news about
TMS coming. We are learning much
from you and our son Sam, 38, is
walking through this Aspberger's
journey with you. He wants to know
more about your marriages as he
says your book didn't go into much
detail. He is trying to connect
with someone after a divorce and
finding it hard. Thus the question. Thanks so much for your
being out there and helping all of
us Aspies and families. Susan Hardman