Megan & her remote-controlled mind
As Prism initiates the second phase of its rollout across American OR’s, I think I’m going to do a short series describing case studies of some of the technology that’s made its way into the purview of ClearPoint Neuro.
Today I’ll start with deep brain stimulation (DBS) or neuro stim for short.
I met Meg on Twitter by complete accident (hear her story here)— I wasn’t looking for her. But I did learn that she received a DBS implant for OCD a number of years ago.
She suffered from severe, treatment resistant OCD which started as a kid and continued into adulthood. It literally immobilized her. Stuck to her room, as an adult Meg was fully convinced that if she ever left her room, she’d bring a terrible calamity upon others. So, she largely stayed to her room and eventually became severely depressed. As her fortunes turned, she met Brian. They met, fell in love, and Brian probably saved her life. But Meg was still deeply ill and without adequate treatment, she turned to an experimental procedure to treat OCD using DBS. Her implant took place in 2013, just 4 years after the FDA initially granted DBS for OCD humanitarian device exemption.
As of 2021, 230 patients had undergone >= 36 months of follow-up across 29 studies. Making Meg’s surgery quite rare. What follows in my eyes is the physical evidence free will of choice is largely an illusion surrounding the autonomy that we perceive when healthy. It’s better to listen (hear her story here), but the audio/transcript recordings from testing Meg’s device settings are hollowing.
ALIK WIDGE: While you were talking, I slowly ramped it up again. Anything different now?
MEGAN: A little bit.
WIDGE: Yeah? What's - what's happening?
MEGAN: Slightly more aware.
WIDGE: OK.
MEGAN: Like, I really - it's not, like, in the past, where it was, like, oh, I feel good. But it's, like, a different feeling.
WIDGE: A general just sharpening or it's like everything got, like, turned up a little bit.
MEGAN: Yeah.
WIDGE: Yeah, that's - OK, people say that. Let's try going up one more step.
WIDGE: Anything different there?
MEGAN: Yeah.
WIDGE: We should dial this one back a little bit. Now, if you notice me turning it down, then maybe I'll change my mind on that.
MEGAN: (Crying, unintelligible).
WIDGE: Did you just feel it?
MEGAN: (Crying) I don't feel very good at all right now.
WIDGE: Oh, so something just changed. That's why - because in the process of reconfiguring it, it just temporarily went off. So, you really noticed that. Give me one second.
This may seem weird, but a small little regular AC pulse is enough to immediately affect her mood.
SPIEGEL: During the surgery, they tested the electricity some. But they hadn't left it on. They couldn't until she was fully healed. And she wasn't scheduled for activation until several months later. That was when she traveled to Boston so the doctors at Mass General could finally flip her switch and figure out the best level of electricity to give her.
She didn't think it was going to be a big deal. So, she went by herself, and there wasn't much hubbub during the actual level setting. She just sat in a chair as the doctor dialed her electricity up and down. He started out really low. But when he got to 3 volts, Megan began to really respond.
MEGAN: It was a feeling of euphoria - like, not just an emotional sensation of, I feel so unburdened, but just a physical sensation, like, after, like, a really great massage and maybe a shot of bourbon, you know? Like, it was like a massage, a shot of bourbon and someone telling you that you won a million bucks all wrapped in this one moment. And I was like, oh - it felt great. And remember I felt - I smelled - I had a - I smelled something that the only way I can describe it is chalk and chocolate mixed together.
SPIEGEL: Megan could barely contain her excitement.
MEGAN: Oh my gosh, leave it here because this is heaven.
While I don’t know the exact site of implant was taken place, I can take a guess and very briefly describe the theory in a layman’s words.
The hint is in the word neuromodulation. It’s the stimulator impacting or modulating the activity of these ‘aberrant patterns’ found within very specific areas the brain implicated with OCD, changing a patient’s mood and behavior. As time has gone on, imaging has grown to become an increasingly crucial step in planning these procedures, and for the newly created and cleared SAINT TMS protocol, it appears as if imaging (which is ultimately impacting accuracy of non-invasive neuro stimulation) is vital to achieving a clinically successful outcome.
Here’s another example of the situation I’m describing:
There are examples like this littered across the world for conditions you’ve probably never heard of that are similarly miraculous. In the autism spectrum disorder, there’s a condition called ‘serious injurious behavior,’ it resembles OCD in that these patients almost obsessively attempt to hurt themselves against their own will. It’s a heartbreaking thing to watch, as usually what you’ll see is a kid outfitted with a pair of oven mitts and a helmet provided by parents, relentlessly trying to brain or bite themselves. Here’s a video— viewer discretion is advised.
Here’s a story about a DBS case that successfully treated SIB in ASD.