Study indicates this method could be a new approach to treating a variety of severe mental illnesses
From:
University of Minnesota Medical School
November 1, 2021 -- In a pilot human
study, researchers from the University of Minnesota Medical School and
Massachusetts General Hospital show it is possible to improve specific human
brain functions related to self-control and mental flexibility by merging
artificial intelligence with targeted electrical brain stimulation.
Alik Widge, MD, PhD, an assistant
professor of psychiatry and member of the Medical Discovery Team on Addiction
at the U of M Medical School, is the senior author of the research published
in Nature Biomedical Engineering. The findings come from a human
study conducted at Massachusetts General Hospital in Boston among 12 patients
undergoing brain surgery for epilepsy -- a procedure that places hundreds of
tiny electrodes throughout the brain to record its activity and identify where
seizures originate.
In this study, Widge collaborated with
Massachusetts General Hospital's Sydney Cash, MD, PhD, an expert in epilepsy
research; and Darin Dougherty, MD, an expert in clinical brain stimulation.
Together, they identified a brain region -- the internal capsule -- that
improved patients' mental function when stimulated with small amounts of
electrical energy. That part of the brain is responsible for cognitive control
-- the process of shifting from one thought pattern or behavior to another,
which is impaired in most mental illnesses.
"An example might include a person
with depression who just can't get out of a 'stuck' negative thought. Because
it is so central to mental illness, finding a way to improve it could be a
powerful new way to treat those illnesses," Widge said.
The team developed algorithms, so that
after stimulation, they could track patients' cognitive control abilities, both
from their actions and directly from their brain activity. The controller method
provided boosts of stimulation whenever the patients were doing worse on a
laboratory test of cognitive control.
"This system can read brain
activity, 'decode' from that when a patient is having difficulty, and apply a
small burst of electrical stimulation to the brain to boost them past that
difficulty," Widge said. "The analogy I often use is an electric
bike. When someone's pedaling but having difficulty, the bike senses it and
augments it. We've made the equivalent of that for human mental function."
The study is the first to show that:
- A
specific human mental function linked to mental illness can be reliably
enhanced using precisely targeted electrical stimulation;
- There
are specific sub-parts of the internal capsule brain structure that are
particularly effective for cognitive enhancement; and
- A
closed-loop algorithm used as a controller was twice as effective than
stimulating at random times.
Some of the patients had significant
anxiety in addition to their epilepsy. When given the cognitive-enhancing
stimulation, they reported that their anxiety got better, because they were
more able to shift their thoughts away from their distress and focus on what
they wanted. Widge says that this suggests this method could be used to treat
patients with severe and medication-resistant anxiety, depression or other
disorders.
"This could be a totally new
approach in treating mental illness. Instead of trying to suppress symptoms, we
could give patients a tool that lets them take control of their own
minds," Widge said. "We could put them back in the driver's seat and
let them feel a new sense of agency."
The research team is now preparing for
clinical trials. Because the target for improving cognitive control is already
approved by the Food and Drug Administration for deep brain stimulation, Widge
says this research can be done with existing tools and devices -- once a trial
is formally approved -- and the translation of this care to current medical
practice could be rapid.
"The wonderful thing about these
findings is that we are now in a position to conduct clinical trials to further
demonstrate effectiveness and then hopefully move to helping
treatment-resistant patients who are in desperate need for additional
interventions to treat their illnesses," Dougherty said.
This work was supported by grants from
the Defense Advanced Research Projects Agency (DARPA) under Cooperative
Agreement Number W911NF-14-2-0045 issued by the Army Research Organization
(ARO) contracting office in support of DARPA's SUBNETS Program, the National
Institutes of Health, Ellison Foundation, Tiny Blue Dot Foundation, MGH
Executive Council on Research, OneMind Institute and the MnDRIVE and Medical
Discovery Team on Addiction initiatives at the University of Minnesota Medical
School.
https://www.sciencedaily.com/releases/2021/11/211101141757.htm
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