Brain me up, Scotty!

24. June 2011

It has a bit of "Star Trek" about it: patients with memory problems go into the "tube" – after that, the brain works again. Medical researchers at the UKE recommend this non-invasive method in order to re-establish neural plasticity in older patients.

Technology is already in use across Germany, its only that the fields of their applications are some distance away from those published by researchers in the journal “Frontiers in Ageing Neuroscience”. Thus, what the team under Hamburg researcher Neurologist Friedhelm Hummel has now published in a review article could, during times of an ageing society, become increasingly important – and provide physicians with a new field of activity. Its true to say that improvements in the neuro-plasticity of the elderly brain using non-invasive brain stimulation (NIBS) seem to have been possible for some time, its only that until this point few doctors in everyday practice took any notice.

Use of high tech in a big way

In fact, the procedure, in which the use of electrical or magnetic impulses stimulates certain brain areas, is nothing new. At the Clinic of Neurology of the University Hospital Schleswig Holstein in Kiel for example, several laboratories are engaged in transcranial brain stimulation. The stimulation of brain areas takes place “through the intact skull,” explain the doctors, and “the methods used are painless and can be used on healthy subjects as well as on patients with neurological diseases”.

In actuality, for the activation of grey cells in the brain at times a whole legion of technologies is used. Sometimes it is transcranial magnetic stimulation (TMS), other times transcranial direct current stimulation (tDCS). And if that alone does not bring the success that was hoped, the neurologist uses transcranial brain stimulation procedure “in combination with functional imaging and (for instance) laser-evoked potentials”. But why?

From a biochemical perspective, the matter so far seems clear: Primarily TMS is able to modulate the activity of the nervous system. “The specific and controlled modulation of cortical excitability via repetitive TMS (rTMS) or tDCS also offers therapeutic options, for instance in the treatment of people with epilepsy, headache syndromes, or in rehabilitation after a stroke”, the Kiel-based medical researcher describes as the potential of the methods. In fact, the list of applications is very promising. Whether pharmacoresistant epilepsy or migraine prophylaxis, devices using electric fields are, just as with chronic pain, ever more often the agent of choice. Even ENT doctors use the stimulation of brain regions, since it seems to bring relief to tinnitus patients.

The power is on – now go and hit the piano

Beautiful as this list of achievements may be, it gets even better, Hummel attests. Transcranial direct current stimulation seems to be one of the most effective methods to use. In a laboratory study, elderly patients had to with one hand – like pianists – learn a particular finger sequence. Without rTMS, the subjects had significant problems memorising the correct sequence. The electrical stimulus, in contrast, resulted in a significant improvement in performance, as reported by Hummel and his team. The stimulation seems – so assume the scientists, in any case – to re-activate those areas of the brain which, due to age, only lay idle. The motor cortex proves to have a particular affinity to stimulation. Which processes are playing out in the somatomotor cortex has not yet been clarified.

This exciting field of medicine is still in its infancy, say the neurologists, and give their colleagues another advantage of brain stimulation with older patients to take away with them. Unlike pills which act against mental decline for example, stimuli involve virtually no serious side effects. There is only one drawback: in the first few seconds of stimulus therapy, some subjects have felt a burning sensation. Yet it disappears as quickly as it comes, the elderly subjects recall.

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When my time comes and I am old, can I reserve a day of “brain stimulation” ?

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