The ‘brain-pacers’

An American news correspondent, Bob Woodruff of ABC TV, suffered a brain injury in 2006 from a roadside bomb while covering the Iraq war. The injury was so severe that part of his skull was removed and he was kept in an induced medical coma for about a month. Many believed that he would never walk again. However, after more than a year of intensive treatment that included relearning of speech, he was able to eventually return to work as a reporter and produced a documentary about injuries in American soldiers and the lack of care of the US government.

Woodruff’s recovery is a great example of how an adult with an injured brain can come back to a productive life which, only a few decades ago, was not believed to be possible.

Every morning when you wake up, you are physically a different person. Yes, you are a new creature when examined under an electronic microscope. One obvious change is your hair. It grows every day, and this is the reason men and women have it trimmed regularly. The covering of our body, the skin, also changes regularly in its outermost cells called the epidermis.

You cannot see it but the fastest changing cells in our body are the brain cells, the neurons. Literally every new experience we see, feel, hear, taste, and think about brings about immediate changes in the brain cells’ configuration.

Before the 1990s, biologists believed that all of our brain cells had been completed shortly after birth, that from then on no more neurons would be added, and that millions die every day. But in the 1990s, scientists surprised the field of neurobiology by announcing a dramatic new idea: that a mature mammalian brain can make new cells in the olfactory bulb and hippocampus, and that it does not stop until old age. This concept is called neurogenesis.

During this time, too, the idea that the brain is hardwired was shattered. Instead, cognitive researchers also introduced the idea of the brain being plastic and changing its pathways as the need arises. When a part of the brain is damaged by a stroke or loss of blood supply, new pathways are created and bypass the injured area. And the good news is that when learning new skills, ideas, words, and languages, the brain network rearranges itself. This is known as neuroplasticity.

Aside from these novel ideas about the brain, scientists also found that our actions, thoughts, feelings, and environment can change our genes by expressing or suppressing traits as well as risks of certain diseases ranging from cancer to schizophrenia. This is known as epigenetics.

The triple plays of neurogenesis, neuroplasticity and epigenetics are opening an entire new way of studying the brain and its effect on learning. Researchers are now looking into the effects of the environment, like child abuse, neglect and bullying on the growing brain. And on the opposite positive side are the effects of self-help programs, religious experiences, positive personal transformation, and psychotherapy. These new findings about the brain can explain why cognitive behavioral therapy and psychotherapy are helping many people with mental illness.

Scientists are now working on new ways of helping those with brain injury. One such technique for those who suffered a stroke is binding the good arm and leaving the affected arm free to move. With this new treatment, the brain is forced to make new pathways that will help the weakened arm. Another but more invasive procedure is implanting brain stimulators to help depression, tremors, seizures, and paralysis. These brain implants can help with brain-machine interfaces and thought-driven prosthetics.

One example of how a brain implant works was shown in the 1970s when neuroscientist Jose Delgados inserted a radio-equipped electrode deep into the brain of a bull. He allowed the bull to lunge toward a matador and when he flicked a handheld switch that sent a jolt of electricity into the electrode in the bull’s brain, the animal stopped in its tracks.

In the 1980s electroshock and lobotomy went out of favor, and in the 1990s brain-stimulation studies became controversial especially concerning ethical issues and funding. Research favored the use of psychopharmacology.

With the advances in magnetic resonance imaging and safer technology, hundreds of people have had electrical brain stimulation for the treatment of severe pain not controlled by medication, and a number for the relief of severe depression, phantom limb pain, cluster headache, Tourette’s syndrome, and obsessive compulsive disorders.

Worldwide there are more than 40,000 people who have electrodes installed in their brain to treat epilepsy, Parkinson’s disease, and other movement-related disorders. These patients can flip a switch to stop their tremors and convulsions. Thousands more afflicted with dystonia, a disabling movement disorder that limits them to wheelchairs, can now walk and lead better lives with these “brain-pacers” which they can control.

In the coming years this technology, including transcranial magnetic stimulation, which has been approved in the United States for the treatment of depression, will reach Metro Manila hospitals.

Welcome to the brave new world of brain-pacers.

Dr. Leonardo L. Leonidas (nonieleonidas68 @gmail.com) retired in 2008 as assistant clinical professor in pediatrics from Boston’s Tufts University School of Medicine, where he was recognized with a Distinguished Career Teaching Award in 2009. He is a 1968 graduate of the University of the Philippines College of Medicine and now spends some of his time in the province of Aklan.