tag:blogger.com,1999:blog-7091385072379923372024-03-20T05:21:04.312-04:00The Brain DetectivesMaria Schamis Turnerhttp://www.blogger.com/profile/08162242147675671584noreply@blogger.comBlogger16125tag:blogger.com,1999:blog-709138507237992337.post-70990462723704188752011-06-02T18:05:00.001-04:002011-06-02T18:07:07.642-04:00Saying Goodbye to Dr David Colman<a href="http://www.montrealgazette.com/health/Visionary+leader+neuroscience/4878315/story.html">http://www.montrealgazette.com/health/Visionary+leader+neuroscience/4878315/story.html</a>Maria Schamis Turnerhttp://www.blogger.com/profile/08162242147675671584noreply@blogger.com0tag:blogger.com,1999:blog-709138507237992337.post-45786037511171662822011-04-24T14:26:00.002-04:002011-04-24T14:29:27.684-04:00At McGillI will be speaking at the Science Career Panel at McGill University on Tuesday April 26th. <br /><br />Science Careers Outside Academia<br />April 26, 12:00 - 1:30<br /><br />If you think that a graduate degree in science means a future only in academia, come discover what scientists are doing in the private and public sectors and how they partner with academics. A collection of seasoned professionals will discuss how they capitalized on their graduate training in the Sciences, brainstorm about your career options and answer any questions you may have about the industry at large.<br /><br />PANELISTS:<br />Maria Schamis Turner, Freelance Science Writer<br />Janine Lepage, Senior Consultant, Le Groupe JBL<br />Bill O'Neil, Associate Director, Business Development, BioMedCom<br />Anne-Marie Alarco, Director of Research Development, Génome Québec<br /><br />For more information: http://bit.ly/hTWcmYMaria Schamis Turnerhttp://www.blogger.com/profile/08162242147675671584noreply@blogger.com0tag:blogger.com,1999:blog-709138507237992337.post-75490100550213800442011-03-14T15:34:00.004-04:002011-03-14T20:30:29.018-04:00People behaving badly: An interview with Alain Dagher about addiction, obesity, and making bad decisions<a href="http://www.mni.mcgill.ca/neuro_team/mbic/alain_dagher/" target="_blank"><span style="font-weight:bold;">Alain Dagher</span></a> is a neurologist who specializes in movement disorders and functional brain imaging. He became interested in dopamine through his work in Parkinson’s, and began to study things like addiction and other dopamine-related problems. <br /><br /><span style="font-style:italic;">You do research in the field of addiction and obesity. What are you looking at specifically in this field?</span><br /><br />We’re basically trying to understand addictive phenomena, where an individual loses control of their behaviour. It has something to do with how we make decisions or fail to make decisions. We’re interested in understanding what brain regions are implicated in addiction and what they do specifically. What dysfunction leads to drug craving or the inability to resist smoking when you’re trying to quit? With respect to appetite, the basic idea is that brain regions involved in controlling of appetite are the same regions involved in addiction. That’s why addictive drugs are addictive, because they act on those structures. <br /><br /><span style="font-style:italic;">The dopamine reward centre?</span><br /><br />Dopamine plays a big role in it – it’s the main determinant of reward learning and motivation to obtain rewards. We’re doing a lot of research trying to measure vulnerability to addiction, why some people become addicted and others don’t. It’s partly genetic, partly environmental, and part of our research is aimed at looking for those things in the brain that predict that vulnerability. <br /><br /><span style="font-style:italic;">What kind of studies are you doing?</span><br /><br />We often do studies in healthy subjects to try and see decision making related to rewards and/or reward learning, that is, how you learn that something is rewarding, what parts of the brain are involved in that learning process, and how dopamine affects that process. That is one kind of research. <br /><br />We’re looking also at the role of hunger signals, signals from the gut and from the rest of the body that act on the brain to change appetite. The reason you are hungry before lunch, for example, is that a bunch of hormones in the blood change their levels. The satiety hormone levels go down, and the hunger hormones, there is only one hunger hormone called ghrelin, it goes up. These hormones, which are secreted by the gut and by fat cells, and by the liver and pancreas, all act on the brain to make you desire food and make you willing to expend energy in order to obtain that food. And this is very interesting because we think that these hormones play a role in obesity – at the very least they play a role in the inability to lose weight. When you go on a diet you decrease caloric intake and the first thing that happens is you get hungrier. That, in part, is because of these hormonal signals that detect the reduction in caloric intake and tell the brain: “Hey something is going wrong, you’ve got to eat more.” Obviously this is of great interest in the treatment of obesity and diabetes, which is now the number one cause of disease in the Western world. <br /><br /><span style="font-style:italic;">When we make a decision to eat a donut even though we’ve had a full meal - do these hormones play a role in that?</span><br /><br />That’s what we’re trying to study. We’re trying to understand how ghrelin acts on the brain, how it’s involved in hunger, in making foods more rewarding, and in how we learn about food. One aspect of obesity in children is that being exposed to high calorie food, especially very sweet soft drinks, seems to create a process of conditioning, just like Pavlovian conditioning, where the reward value of the sweet food becomes higher and higher. Once that’s happened, it’s there for life, so we’re trying to study that process of conditioning to foods. <br /><br />There’s also an interaction between these hunger hormones and stress, a complex interaction. Stress can enhance the activity of hunger hormones, and vice-versa, some of the hunger hormones can actually cause stress, at least I think they can. So, stress is also a major factor in weight gain and obesity. <br /><br />We’re also looking at this from a standpoint of what’s called “neuroeconomics.” It’s clear that a major cause of the increase in obesity in the last 30 years is cheap food. The cost of food has gone way down, especially the cost of calories. When food is cheaper people eat more. There’s also a lot of evidence that obesity is becoming a disease of the poor. In this generation there’s a very weak association between socioeconomic status and body mass, but in children there’s a very strong association. In the next 20 to 30 years obesity is going to become a disease of the poor in the Western world, much like cigarette smoking. Even in the developing world, they’re going from famine to obesity in one generation. China, for example, is leading the world in the increased incidence of diabetes. Studying neuroeconomics, that is bringing in financial decision-making aspects to the research, we think is potentially very helpful. <br /><br /><span style="font-style:italic;">We weren’t programmed to deal with abundance.</span> <br /><br />Well, presumably not. Abundance is something that we detect, but normally abundance is followed by winter, that is by lack of food. When food is abundant you eat more, when it is scarce, you save your energy. Now we’re in a situation where it’s always abundant. <br /><br /><span style="font-style:italic;">How do you factor in neuroeconomics? </span><br /><br />You can look at it in a simple way: how do hunger hormones change your willingness to pay money for food? In animals what that means is if an animal is very hungry, it may be willing to work harder for food. It may be willing to take more risks, to spend more time in the open, to risk being at the mercy of predators for example. Or, if you are a predator, you may be more willing to go and attack a large animal at risk to yourself. Not surprisingly, people are willing to pay more for food when they are hungry than when they are full. The brain systems that are involved with changing your degree of motivation to eat are also implicated in your degree of motivation to pay for food. By bringing in these neuroeconomic approaches, you can formally study these things using paradigms that have been used by economists for 40 – 50 years. <br /><br />Obesity is also related to other aspects of decision-making; there’s some evidence that people who are overweight are more likely to be impulsive, that is, to make rapid decisions without due consideration of the consequences. They’re also more likely show what’s called “delayed discounting,” that is, they discount the value of future rewards. For example, if you offer someone $100 now, or $120 a month from now, they’ll take the $100 now, because the $120 is discounted, it’s worth less when it’s in the future. This delayed discounting goes along with impulsivity and the desire to have the immediate reward. It’s measured by financial paradigms but it’s actually associated with obesity. It’s a small association, but it’s there. <br /><br /><span style="font-style:italic;">How does this understanding translate into treating problems like obesity? </span><br /><br />If you understand how peptide hormones in the gut, or stress, or various patterns of decision-making can impact obesity, you can develop therapeutic approaches. For example, you might conclude that you shouldn’t go to the supermarket when you’re hungry—people know that already. You would also conclude that maybe you shouldn’t skip meals because if you skip meals your appetite hormones will be greater and you’ll eat more at the next meal, for example. That’s at the individual level. You might also use that research to develop drugs to reduce appetite or to test potential drugs. At the societal level, you could also [use the research] to make policy recommendations. You may not need the neuroscience to say that we should not subsidize unhealthy food, but the neuroscience helps to promote that idea and maybe to inform what kinds of policies we should be taking to reduce obesity in the general population. So there are two different approaches, the treatment of the individual person and the treatment of society, both of which I think will benefit from the neuroscience.<br /><br />There’s no weight loss clinic in Quebec that’s funded by the government. It’s the thing that costs healthcare systems the most, and nothing’s done about it. Now, the success rate of weight loss programs is extremely low. Weight Watchers has the highest success rate and it’s about 1%. <br /><br /><span style="font-style:italic;">What about drug treatments?</span> <br /><br />As for drugs for weight loss, the situation is not so good right now. There was one drug called rimonabant that was very effective but it caused mood side effects, it caused depression. It was taken off the market, and that has scared all the drug companies I think. The problem, of course, is if the drug acts on the reward system it risks having serious side effects. If you suppress the function of the reward system chances are you will cause depression or mood problems in most people. So one of the problems is to find a drug treatment that will not cause these side effects. Although if someone has diabetes and obesity, it’s going to kill them, so it’s worth risking depression, especially if you follow the patient and you monitor their mood. If they have problems you take them off the medication.<br /><br />There’s a drug called bupropion that helps for quitting smoking but is also useful for weight loss. I think there’s a company that has a phase-3 trial with a bupropion plus something else. Again, it will have side effects but it might be acceptable to risk the side effects when you have obesity and diabetes.<br /><br />Currently the only treatment for obesity that works is bariatric surgery, which is obviously reserved for very overweight people, morbidly obese people. <br /><br /><span style="font-style:italic;">How does the surgery work? Does it affect ghrelin levels?</span><br /><br />We don’t know. Some of the surgeries do appear to reduce ghrelin levels. Basically all of these surgeries restrict the stomach in some way, either by restricting the size, or removing part of the stomach. They have multiple effects and it is still not known how they work. Some effects clearly have to do with decreased food intake; you eat less because you feel full sooner. But there are other effects, for example, on the first day after the surgery, diabetes is cured. That can’t be due to weight loss, of course. It’s quite puzzling. <br /><br /><span style="font-style:italic;">In terms of understanding impulsivity, what is considered normal?</span><br /><br />There’s not necessarily a “normal,” but you can develop laboratory tests of impulsivity (there are several) and come up with average patterns of behaviour. You can decide that something is normal if it falls one or two standard deviations away from the average pattern, that’s the usual way we define normality in biology. A lot of the associations are weak, but there’s a very strong association between attention deficit disorder and obesity, for example. Attention deficit is a proto-type disease of impulsivity. It’s an inability to focus attention correctly, so things that grab your attention are hard to resist. It’s not attention deficit so much as an inability to properly regulate attention, and so people with ADHD tend to be very impulsive and have a much higher rate of obesity than people who don’t have ADHD. They also have a higher rate of addiction. And there are other diseases that predispose to obesity: depression, anxiety disorders, schizophrenia, almost any mental health disorder predisposes to obesity. <br /><br /><span style="font-style:italic;">Why is that?</span><br /><br />We don’t know. That’s one of the things we are studying. The study of the brain’s role in obesity is extremely new. <br /><br /><span style="font-style:italic;">In terms of addictions, are you also looking at people who are addicted to gambling, drugs, etc?</span><br /><br />I’ve done a couple of studies on gambling. And also a lot of studies on cigarette smoking, That’s the main drug that I have studied. <br /><br /><span style="font-style:italic;">As an ex-smoker, it seems to me that the addiction never really goes away. I’ve quit, but I don’t feel as if I have unlearned the addiction, more as if I overruled it somehow.</span> <br /><br />That’s because the learning process has been hard wired. That’s what an addiction is, an aberrant learning process, where you learn to value the drug. We know that it involves the same brain areas that are involved in the control of eating. So just like eating is an extremely important behaviour, when a drug comes into that system, it sort of subverts the system into making your brain think that smoking is crucial to your survival. That’s one way to think about it. And some people can’t overrule it, and that relates back to this impulsivity issue. The more impulsive you are, the more likely it is that you can’t resist those urges. <br /><br /><span style="font-style:italic;">Researchers in Robert Zatorre’s lab have shown that music can affect the dopamine system. Does this mean that we can become addicted to music?</span><br /><br />No one has ever described music addiction, as far as I know. Usually an addictive behaviour has to be harmful, it’s very hard to see how listening to music could be harmful. I don’t know of any cases of people who listen to music at the expense of social activities—that’s one way behavioural addictions are defined. You don’t talk to your spouse or you don’t have friends because you spend all your time on the Internet, say. I’ve never heard of anything like this for music. <br /><br />Behavioural addictions are difficult – the problem is that you spend too much time doing one thing and less time doing other things that you should be doing. That may not be enough, I think, to call something an addiction. For example, if a child would rather play video games than do their homework, you would not really call that an addiction, that would be silly.<br /><br /><span style="font-style:italic;">Why is it that one thing that triggers the dopamine system might go into overdrive and another thing, like music, doesn’t?</span><br /><br />The dopamine system is somewhat self-regulated but drugs act directly on the brain cells that release dopamine, and so they bypass any regulatory system. That’s always been the theory of why drugs can be addictive. Why gambling is addictive, I think is really not clear, although it’s clear that it is. In fact it’s probably one of the worse addictions you can have. It’s extremely damaging. <br /><br />[This interview has been edited for clarity.]Maria Schamis Turnerhttp://www.blogger.com/profile/08162242147675671584noreply@blogger.com0tag:blogger.com,1999:blog-709138507237992337.post-22331478188583376052011-03-01T19:06:00.003-05:002011-03-01T19:11:40.251-05:00A short story by neurologist Liam Durcan<span style="font-weight:bold;">At First it Feels Like Hunger</span><br /><br />Elaine’s brother Dennis arrives with his girlfriend that Friday evening, the headlights of the car tunneling through a crystal-cold night and stopping near the house at a little past ten. Elaine and her mother have stayed up to meet them, as it’s the first time he’s brought Sarah home. Sarah. Elaine loved the name from the moment Dennis told them about her. In the days leading up to their arrival it was all she could think about; she repeated the name over and over to herself and imagined a woman of intelligence and beauty, a figure sitting alone in a garden, aristocratic features heightened in the evening light.<br /><br />Elaine presses her head to the window to get a closer look at the car that now sits quiet and dark in the drive, the whole scene obscured by her breath that pulses on the pane in front of her. She wipes the window clean with the heel of her hand and is able to make out a light coming on in the car as a door is opened. The motion of her hand on the window produces a delicate honk that causes her mother to look up from the kitchen table.<br /><br />Read the rest of the story on <a href="http://carte-blanche.org/at-first-it-feels-like-hunger-fiction/" target=_blank>carte blanche</a>.Maria Schamis Turnerhttp://www.blogger.com/profile/08162242147675671584noreply@blogger.com0tag:blogger.com,1999:blog-709138507237992337.post-16129231531479124882011-01-27T19:03:00.009-05:002011-01-27T19:23:32.886-05:00On Narrative and Neurology: A conversation with Liam DurcanLiam Durcan is the Neurologist-in-Chief at the Montreal Neurological Hospital and Clinical Director of Neurology at the McGill University Health Centre. He is also the author of the novel <span style="font-style:italic;"><a href="http://www.thebukowskiagency.com/Garcia's%20Heart.htm" target="_blank">Garcia’s Heart</a></span> and a book of short stories, <span style="font-style:italic;"><a href="http://www.vehiculepress.com/titles/388.html" target="_blank">A Short Journey by Car</a></span>. <br /><br />I asked Durcan about the relationship between narrative and neurology. Here is part of the wide-ranging conversation that followed. <br /><br /><span style="font-weight:bold;">Liam Durcan</span> - I guess I approach it in a few different ways. As a neurologist I am interested in the generation of narrative, that is, in the neurobiological mechanisms—the language areas plus the emotional part of the brain plus the frontal lobes—that together generate some sort of sequential order out of things. I find that just fascinating in terms of narratives and disordered narratives that we see in neurology. For example, you can have perfect language function and good recall but if your frontal lobes aren’t working, it is sometimes quite difficult to be able to relay history in an organized way. You see that in some patients with frontal temporal lobe dementia. <br /><br />Also, as a physician the way into any problem is through narrative. You realize fairly early on that you are in the process of translation: translation of the patient’s experience into their history. There can be multiple parallel histories and then you translate that into the history for the medical record, history that you will base investigations, diagnosis, and prognosis on. I think you gain either an explicit or implicit reverence for narrative. Some people have said that it’s on the wane, that we are relying more on technology. There’s a joke that the only question you really have to ask people now is “Do you have any metal in your body?” because you need to ask that before you get into an MR. I can understand that but it’s not just about having the tools but appropriately using them. Not only is narrative important to become an effective clinician in terms of getting the right diagnosis and applying medical technology properly, but I also think it’s probably a key step in the development of empathy. <br /><br /><span style="font-style:italic;">MST - It strikes me that narrative is probably still more important in neurology than it is perhaps in other medical fields. </span><br /><br />Yes, simply because the complaints can be so complicated or protean or vague. Psychiatry relies on narrative even more but we rely on it a great deal. That being said, it’s always interesting, especially in a hospital, to understand how the narrative can be split. One of the things you’ll notice if you see a patient waiting for a test and they’re away from their ward, is that they cannot help but look in their chart. And that’s because they understand that their narrative and the narrative about them are not necessarily the same. And they want to know all the discrepancies. And they have the right to know. I always feel like asking, “Were you surprised? Shocked? Disappointed?” <br /><br /><a href="http://www.narrativemedicine.org/about/people.html" target="_blank">Rita Charon</a> at Columbia has done pilot projects where she’s had patients keep their own chart, a parallel chart, to see what the major differences were. Sometimes I’ll come out of a patient’s room with the team, and I’ll think, “that went well,” and then I realize through conversations with the nurses, or with the family, that the patient understood nothing. Or misinterpreted or felt that the explanations were brief, or too complicated, or lacked any sort of emotional content. You see all these discrepancies. I think that’s true of any form of communication but when health issues are involved it’s heightened. Especially when there are neurological issues and the ability to understand what’s going on might be impaired somewhat. <br /><br /><span style="font-style:italic;">Is there anything that you do to try and help the patient construct the narrative about their illness? </span><br /><br />You ask them what they think is going on. You can be frank. One of the questions I tend to ask most at the bedside, or in the office is: “What are you most afraid of?” Is it a disease that you have read about on the Internet? Is it independent of disease but the fear that you might need a wheelchair and that would mean you’d have to move out of your house? Is it your relationship with your spouse or how you’ll be seen in the eyes of your children? Do we need to get the children in and speak about it? Sometimes when I’m seeing patients for the first time, and they’ve had sort of a long course, I’ll ask, “What do you understand about what’s going on?” It gives you insight into their level of understanding. Sometimes patients won’t play every card, but it gives you some insight into their ability to understand the narrative that has been constructed around them, and the differences between that and the narrative they’ve constructed for themselves. <br /><br /><span style="font-style:italic;">What’s the longest you’ll see or follow a patient for? </span><br /><br />Usually a consultation is 45 minutes. I’d like to take longer but with things like waiting lists, doctors calling you to see cases… Typically we’ll talk about things in a preliminary way. Sometimes patients do need rapid referral. For example, if the patient has a bad disc in his back, and it’s been there for six months and it’s not getting any better, you might have to refer him to a surgeon. We had a patient in this office once who was telling me (and he was very descriptive about things), he said, “I’ve got this terrible chest pain.” I was with a resident, and I wanted to show the resident that when the patient says certain things, you just have take him at face value. So I walked him across the street to the emergency room. I didn’t actually think he had anything wrong with his heart, but it turned out he was having a heart attack. <br /><br />Other times, you don’t know what’s going on. You need to find out what the patient’s concerns are, you express your own concerns, and propose some tests to try and understand them. In our system you wait a bit longer for some tests, things like imaging, so you try and give the patient some reassurance that if there is any change, that you’ll see them again. We’ve forgotten the value of the follow up appointment. Visits to the doctor are too often like visits to the accountant, they’re sort of yearly reckonings. But sometimes there are issues that come up and being able to see the patient allays your own fears. And I often find just talking to the patient on the phone can allay their fears. <br /><br />In terms of follow up, it depends. Some patients I’ll see every two months, others need to be seen every couple of years, depending on the disease process and on the patient’s level of anxiety. I’ll see patients who don’t have a neurological diagnosis but they feel that their muscles are jumping and they are sure they have Lou Gehrig’s disease. You try and reassure them but you know that they have this tremendous anxiety. What you say is “I’ll see you every few months and reassure you,” and as the disease doesn’t progress you try and reinforce that. Most patients after two or three visits don’t need to be seen anymore. If you see them once and say, “It isn’t Lou Gehrig’s bye bye,” they’re just going to see doctor after doctor. I think the value of the follow up is extremely important. Also they trust you if they see you a few times. And sometimes what you thought was not neurologic turns out to be neurologic, so I think it’s a tremendous benefit. <br /><br /><span style="font-style:italic;">Is that because some of the manifestations can vary so greatly? </span><br /><br />Some illnesses are variable by definition. For example, myasthenia gravis can be bad at certain times of the day. Or sometimes the symptoms that the patient feels might be quite pronounced, but you just can’t see objective evidence of it and it might take two to three months to declare itself. It’s the old saying, sometimes you only know you’re in the pumpkin patch in the fall. <br /><br /><span style="font-style:italic;">Personal accounts of illness that I’ve read seem to focus a lot on identity. Patients are reconstructing their personal narratives to accommodate for their illness. </span><br /><br />Absolutely. When we talk about narrative, every person carries three or four. There’s the autobiography, the grand history of yourself, then there’s that moment-to-moment narrative that we’re all judging ourselves upon, and then there’s the narratives that are constructed about you. I find that interesting. <br /><br /><span style="font-style:italic;">As a physician do you feel that it’s part of your job to help the patient readjust his narrative?</span><br /><br />I think you have to be careful, because you can readjust it in a way that just suits yourself. In other words, if I need to get you out of the office because I’m behind and have a full waiting room, I have to ask myself “Am I doing things for those reasons?” You always have to be vigilant about what you’re doing in terms of changing the narrative. Also, the narrative has meaning for more than just the patient. They don’t teach you this in medical school, but there are third parties who are very interested in the patient’s narratives. If you’re filling out Régie des rentes forms or insurance forms for somebody, you have the legal responsibility to be truthful, but sometimes those two narratives come into conflict. I’ve inherited patients who have been given diagnoses have been revised, and I am sure I have given diagnoses that in five to ten years might be revised. That can have a really major impact, not just on the person’s finances, but also on the person’s identity. If you’ve been told you’re not going to get better, you will often attain a sort of sick role, you’ll say I can’t do certain things, I shouldn’t expect to do certain things, and you’ll curtail certain thoughts about what you’re going to do in the next five years. It’s really important to consider that the narrative is not just what’s come before but also the projected narrative into the future. We don’t talk a lot about prognosis but people are constructing their own narratives years in advance as. <br /><br /><span style="font-style:italic;">Why don’t you talk a lot about prognosis? </span><br /><br />Well, I think that we’re not as good at talking about it as we are about diagnosis. If you look at medical charts, the diagnosis has to be mentioned, it’s a medical necessity, but not the prognosis. I’m on the wards right now, and I like to talk about prognosis with people, but I’m sure I’ve probably not had as explicit a discussion as I should have with most patients. What’s the risk of this person having another stroke and was it explained to him? What’s the risk of this person’s multiple sclerosis getting worse in the next five years? I mean, there is an element of uncertainty, and we don’t like to expose ourselves to uncertainty. And sometimes patients aren’t prepared for that, especially when they are in a hospital bed. But in all cases prognosis should be discussed. <br /><br /><span style="font-style:italic;">What kind of people do you think go into neurology? Is there a personality type?</span><br /> <br />In medical school they talk about the different personality types that are drawn toward different specialties, e.g., the surgeon is a decisive person. They use to describe neurologists as being bridge players that were interested in sophisticated systems and arcane information—I always found that offensive. It was a way of saying that you were interested in things that have really no applicability to patients’ lives. I think that was insulting to the neurologists of fifty years ago, who were really palliative care physicians. These weren’t cold diagnosticians who walked away; they were people who looked after people. <br /><br />I don’t know that there’s any clear type. I think you have to have curiosity, but then I think curiosity is important for any sort of endeavor. When we bring people into our program to train them, at the end of medical school, one of the questions we ask is, “How do you feel about most of your patients not getting better? Are you able to deal with that?” That can be tough. We do have people when they see patients getting worse and worse that will view that as some sort of repudiation of their efforts, as some sort of ego destroying event. But I think if you take a larger view of medicine, most of what we do is palliative, aside from treating a few infections and taking out the rare inflamed appendix. We’re moving curves, we’re delaying events, and we’re trying to prevent things. And I think once you understand that, you have a deeper understanding of medicine, the pursuit of neurology doesn’t seem full of despair. <br /><br /><span style="font-style:italic;">When did you start writing? </span><br /> <br />I’ve written since my teenage years and then I put it away for medical school. I finished my residency when I was 28 years old. I was a qualified neurologist but I felt grossly unprepared in some larger sense to look after people. I felt like I needed more of a liberal arts education at that point in my life. And I think that I probably began writing for that reason, to try and address some of that. I think part of it was also emulation—I love reading and I love well-written prose, it gives me a tremendous amount of pleasure. <br /><br /><span style="font-style:italic;">How do you find the time to write? </span><br /><br />It was easier before. I would get up at four in the morning and write for an hour and a half. After the second child, it was a bit more difficult. Thomas, our youngest, was born in 2008, and there was just less and less time. Also, I have just taken on a few more administrative duties in the last couple of months that have made any sort of pretence at writing more difficult. I used to think that having a limited amount of time to write was conducive to writing and I still do. I deal better when I have constraints than when I have absolute freedom. If I had a week off, I don’t think I would write, but if I had 30 minutes a day, then I would. I remember commuting and writing on the suburban commuter trains. I found that really concentrated my writing. And I found that the individual plot issues or story issues that I was concerned about would seem to have been addressed in the time when I wasn’t thinking about it and I was interested in that. It seemed to work for me. I published a fair bit in a few years. When I wrote a book, I think I had been thinking about it for a long time, because it didn’t take that long to work the book into shape. It was almost a bit embarrassing—it just seemed to happen fairly naturally. <br /><br /><span style="font-style:italic;">Why did you choose to make the main character of </span>Garcia’s Heart<span style="font-style:italic;"> a neuroscientist?</span><br /><br />When I started writing, I thought there is no way I want to write medical narratives. I thought if I write, I just want to be a writer, I don’t want to be labeled as the doctor/writer. I wanted people to read the book and be refreshed that it wasn’t a narrative in a hospital. The one lament I had about the book is that I couldn’t make it work any other way. I really hesitated at every step. The story didn’t start with a person interested in neuroscience, it started out as a short story about a person who works in a Dépanneur, for someone who used to be a doctor. (It was originally set in the 1980’s, with a Vietnamese doctor.) As it got bigger and bigger, I realized that he would have to identify with him in a professional way, so he had to be a doctor too. Then as I was writing, I was thinking about theories of moral responsibility and who can best understand these ideas on an intellectual level and yet be baffled on an emotional level, and I ended making the character essentially a neuroscientist. I didn’t want to write it that way, but I couldn’t see any way out of it. So I ended up writing a narrative about a disaffected doctor who wasn’t practicing medicine. That was the saving grace.<br /><br /><span style="font-style:italic;">But it’s interesting, especially for those of us who aren’t neuroscientists. One of the things that struck me was the way Patrick sees things, how he sees the world through the lens of neuroscience. Is that partly how you see things?</span> <br /><br /> Well, no. I think that’s the bias that we have in medicine and in neurology. We’re necessarily materialistic and reductionist. We deal with understanding function through dysfunction, which pushes us in that direction. That being said, I wanted the character to have very sophisticated technical and material understanding and yet be completely baffled emotionally. I mean he was not only baffled, he was miserable at his inability to figure things out. I wanted to make that point, that things have to be understood not just at an intellectual level but also at an intuitive level. <br /><br /><span style="font-style:italic;">He comes across as a stereotypical scientist – he knows a lot about the world but doesn’t know why his relationships failed.</span><br /><br />Or how to think about this person. I think that’s perhaps that’s how I felt when I finished my training, and I was trained by very humane people and in a curriculum that I don’t think meant to produce a person who felt the way I did. But I just felt that I was missing something. By the end Patrick comes towards that understanding, and I think he’s more satisfied in certain ways. Not to say that I think I have achieved that—I think it’s always a process, a continuing process. <br /><br /><span style="font-style:italic;">We know more about the brain than we used to and there is starting to be a cultural resonance of what’s happening in neuroscience and medicine…</span><br /><br />I think there have been huge cultural changes in terms of the acceptance of neuroscience or the understanding that the principles of neuroscience and neurobiology can be very interesting and can, not replace, but complement things like psychology. I also view neuroscience as being at that point that genetics was 15 years ago, when they said, “This is going to explain everything.” We do the genome: we’ve got the answer. That simply hasn’t been… it’s just more complicated than that. That hasn’t lessened the importance of genetics it’s just that we have a more nuanced and sophisticated understanding of it. And I think you’re seeing the same thing now in neuroscience. We’re going through a phase of “neurocracy” and the skeptical backlash against it, which I think is healthy. There’s been a great deal of wariness about how to apply what we know about neuroscience to our concepts of law or public policy, and I think people are beginning to understand that it can’t define things but it can complement our understanding. <br /><br />[<span style="font-style:italic;">This interview has been condensed and edited for clarity.</span>]Maria Schamis Turnerhttp://www.blogger.com/profile/08162242147675671584noreply@blogger.com1tag:blogger.com,1999:blog-709138507237992337.post-28588777809881450432011-01-05T19:50:00.001-05:002011-01-05T19:54:39.528-05:00A Neuro ChristmasDr Ken Hastings doesn’t look much like Santa Claus, but he shares a few of his more important traits: he has a beard, he is jolly, and he brings joy to others at Christmas. He is, in fact, much slimmer than Santa and he has a very different day job. Hastings works as a <a href="http://www.mni.mcgill.ca/neuro_team/neuromuscular/kenneth_hastings/" target="_blank">researcher</a> in the neuromuscular research unit at the Neuro. Hastings’ passion, next to understanding the molecular biology of muscle cells, is music. “I’m an amateur musician,” says Hastings. “I don’t have any training, but I just love music.” His love of music led the researcher to join the Neuro Cosgrove Choir (named after its founder, Dr Bert Cosgrove) some 25 years ago. “I still remember the first practice I had,” says Hastings. “The choir director said: ‘We’ll sing, “Deck the Halls,” and you’ll be a tenor.’ When it came time to sing, I sang the melody that everybody knows. He said: ‘No, no, no, no! Each voice has a different part. You have to learn your part.’ That’s how I learned about harmonizing.”<br /><br />Hastings learned how to harmonize so well that 12 years ago he took over as choir director. Every Christmas he gathers together a group of fellow researchers, technicians, students, doctors, neuro-psychologists, and pathologists to practice a small repertoire of carols that they perform at the Neuro’s Reitman lunch (an annual Christmas lunch for the whole staff, given by the Reitman family) and on the wards at the Royal Victoria Hospital and the Neuro. <br /><br />This past year’s iteration of the Choir got together on a Monday evening before the holidays to share some food and a glass of wine before making their way around the wards. The mood was cheerful with a slight touch of pre-performance jitters. There were those, like Janet Arts, who had been singing with the choir since 1975, one year after it was founded, and who had only missed one year of caroling in over 30 years, and others who were singing with the choir for the first time. There were no obvious correlations between occupation and participation, except for the two students from the music and neurosciences lab, and an unexplained strong showing from the transcranial magnetic stimulation lab at the Royal Vic. <br /><br />After the food and a little bit of singing to warm everybody up, Hastings gathered his guitar, a green Santa hat, and his carolers and went to find some patients to sing for. Outside the Intensive Care Unit at the Neuro, he reminded the group that they needed to keep the volume down for the ICU patients. Once inside, he gathered the choir behind him in the hallway, just outside a patient’s room. Wedged in next to shelves of supplies, the group looked expectantly towards their leader. Hastings sounded a note, nodded, and they broke into a hushed version of “Silent Night.” In the quiet of the ward, the song filled the hallway. A face peeked around a pulled bedside curtain. The nurses listened but continued to go about their business. It was only when Rosalind Sham, a second-year neuroscience student at McGill, started to sing a solo of “Have Yourself a Merry Little Christmas,” that all activity seemed to stop. Something in her voice lent a sacred tone to the song. As the singers made their way around the ward, several had tears in their eyes. <br /><br />A couple of floors down, rousing versions of “The Virgin Mary Had a Baby Boy” and a Hanukkah song had the nurses dancing. “How do I join the choir?” one asked. In the epilepsy ward, patients and visitors applauded. “They sing well,” said someone, approvingly. On yet another ward, a young woman pulled out her phone and filmed a short video of the singers. “Will we be on youtube?” one of the carolers asked. “It depends how good you are!” joked the videographer. As the evening came to an end, Hastings thanked the Choir. “It was a very good year,” he said.Maria Schamis Turnerhttp://www.blogger.com/profile/08162242147675671584noreply@blogger.com1tag:blogger.com,1999:blog-709138507237992337.post-57666664258217452572010-12-24T10:39:00.005-05:002010-12-24T10:48:56.215-05:00Review: The Mind's Eye, by Oliver SacksFor those of us whose vision is relatively unimpaired, the world appears a coherent place. We see words on a page or the face of a loved one sitting across the table from us and can easily recognize both as what they are. This is enabled by complex visual circuitry in the brain, which is divided into discrete areas, each responsible for “seeing” different things. There are groups of neurons that specialize in faces, others in words, and yet others that are responsible for detecting movement. The brain then combines these different pieces together (just how is not fully understood) to form a coherent whole.<br /><br /><br />Read more on the <i>National Post </i><a href="http://arts.nationalpost.com/2010/12/24/book-review-the-minds-eye-by-oliver-sacks/#ixzz192nZlkUs" target="_blank">website</a>Maria Schamis Turnerhttp://www.blogger.com/profile/08162242147675671584noreply@blogger.com0tag:blogger.com,1999:blog-709138507237992337.post-75858835290679650892010-12-13T17:05:00.001-05:002010-12-13T17:07:55.818-05:00Alzheimer's disease and deep brain stimulationJust published on dana.org, my article on deep brain stimulation for Alzheimer's disease:<br /><span class="Apple-style-span" style="font-size: 12px; color: rgb(50, 50, 50); line-height: 18px; "><h1 style="margin-top: 10px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-size: 18px; "><a href="http://dana.org/news/features/detail.aspx?id=29578">Alzheimer’s Disease a New Target for Deep Brain Stimulation</a></h1></span>Maria Schamis Turnerhttp://www.blogger.com/profile/08162242147675671584noreply@blogger.com0tag:blogger.com,1999:blog-709138507237992337.post-49112529504835062792010-12-09T08:40:00.004-05:002010-12-09T20:17:29.077-05:00Notes from a surgeryThe day starts with morning traffic. Although he is running a few minutes late, neurosurgeon Dr Rolando Del Maestro does not seem fazed. He stops to pick up his surgical garb—it’s all automatic now, like a vending machine: swipe the card, open the drawer, and take out a fresh set of scrubs—then he heads into the operating room. It’s a little after 8 am.<br /><br />Besides Del Maestro, there are at least 10 other people in the OR, not including the patient. These include a neuronavigation technician, a surgical resident or two, scrub nurses, circulating nurses, a nursing resident, and the anaesthesiologist. Everyone has a critical role to play or, because this is a teaching hospital, is there to learn. There are two surgeons working today, Del Maestro and research fellow Dr Alessandro Perin.<br /><br />The nurses are responsible for getting the room ready for the surgery. “It’s like preparing supper,” explains Elizabeth Coté, the head nurse. “We prepare the whole environment, and all the equipment, to make sure nothing inadvertent happens. Then we invite the doctor to sit down to the meal.”<br /><br />The room is cool. The temperature is kept intentionally low, both to keep bacteria proliferation down and to prevent the surgical team from getting too hot in their scrubs. You don’t want to be dripping with sweat during a surgery.<br /><br /><div style="text-align: center;">*</div><br />Today’s patient is anxious. An anxious patient means general anaesthetic because it is safer and easier for everyone if he is asleep. Someone of a different temperament could be awake for this same procedure. Sedated, but awake. Being awake during surgery has advantages. The surgeon can get direct feedback during the operation, testing the patient’s cognitive and motor functions as the surgery progresses. But if the patient is too uncomfortable with the idea, like today’s patient, it’s not worth it.<br /><br />The patient has already gone through pre-op with the residents. Now it’s time to get ready for the surgery. Before he goes under, the patient wants to know if they will be removing the tumour from his brain with a saw. The team explains that a saw is used only to open the skull, the tumour itself will be removed with a Cavitron ultrasonic aspirator. The Cavitron breaks the tumour into fragments using high frequency sound waves. The fragments are then vacuumed up by a suction tube.<br /><br /><br />Del Maestro, Perin, and the residents review the patient’s MRI scans and discuss the surgical plan. The MRI scans show a large tumour – the reason for today’s surgery. The doctors suspect a glioblastoma, the most common of the primary brain tumours. These are tumours that initiate in the brain, that have not metastasized there from elsewhere in the body. Unlike other types of cancers, the risk factors for these types of tumours are unknown.<br /><br />The tumour is located at the junction of the parietal, occipital, and temporal lobes of the right-hand side of the brain. That it is in the right hemisphere of the brain is good news for the patient. He is right-handed which means his speech functions are controlled by the dominant left hemisphere and won’t be affected by the surgery. Also, the tumour is close to the surface of the brain, which makes access a little easier. It is also close to one of the most important veins in the brain, which the surgeons must be very careful not to damage.<br /><br />The MRI scans provide a map of the brain, allowing the surgeon to plot a trajectory through the brain to the tumour. But they do not tell the whole story. The surgeons also need the bone data, that is, the exact positioning of the skull over the brain so they know the best way to enter. They get this information through a probe attached to a machine known as a neuronavigation system. They run the probe over the patient’s head and it sends information about the skull to the neuronav, which then matches it with the MRI images.<br /><br />Despite all of this technology, there is still room for error. The brain is held in place by the skull, and once the skull has been opened, the brain can shift. And swelling, in reaction to the tumour, can put pressure on the brain and cause it to herniate through the opening, which in turn could lead to major impairments.<br /><br />The surgical team is well aware of all of the potential complications and dangers of the procedure they are about to perform, but they look relaxed. For them, this is just part of the job.<br /><br /><div style="text-align: center;">*</div><br />Once the patient is asleep he has to be properly positioned on the operating table. This involves not only positioning the head to give the surgeons access to the tumour site, but also making sure that the patient will not suffer bed sores or injury from being in an awkward position. This kind of surgery usually takes from four to six hours but if there is major bleeding or any other complications during the procedure, it can take up to twelve.<br /><br />The surgical team then gets to work. The patient is draped in surgical sheets until the only part of him showing is the piece of his head where the surgeon will enter the brain. The patient’s head is shaved very carefully just around where the incision will go. It has been shown that shaving a greater area increases risk of infection.<br /><br />Opening the skull takes time. Although there are automatic instruments available, Del Maestro prefers to do things by hand. “I do many operations on patients who are awake,” he says. “Automatic instruments really shake the skull.” First, he drills holes into the skull with a hand-operated drill. Once the holes are drilled, a Gigli saw—a long wire with a blade and two handles—is used to cut through the skull between the holes. The section of skull is then removed while the rest of the operation is performed.<br /><br />It takes over an hour to get through the skull and the dura, the layer that lies between the brain and the skull, and expose the tumour. It will take hours more to remove the tumour. The surgeons look through a microscope as they work, so they can better see what they are doing. Del Maestro and Perin take turns sitting on a stool as they aspirate, suction, and mop up the blood with surgical patties, swabs designed to absorb fluids and protect the surrounding normal brain tissue. At the end of the day, a nurse will count all of the used patties removed from the patient to make sure that nothing has been left inside.<br /><br />During the operation, a sample of the tumour is sent to the pathology lab to confirm the diagnosis. Dr Perin takes the residents to see the pathologist while Del Maestro stays behind and continues the surgery. The diagnosis is confirmed as a very malignant glioblastoma multiforme.<br /><br />It’s going on 4:30 pm by the time the surgical team is ready to close the surgery and replace the skull flap, approximately another hour and a half of work. For many in the OR, this will mean a 12-hour workday, having started their shifts at the hospital at six that morning. Del Maestro has not left the room during the whole procedure. Not to pee, not to eat. “You get used to it,” he says. This is a discipline that requires physical stamina. (According to a resident, at a similar surgery the previous week the entire surgical team had been on call the night before, which meant they hadn’t had much sleep.)<br /><br />The surgery has gone well. If everything goes smoothly with recovery, the patient will go home within three days. This does not mean the end of his medical treatment. He will most likely undergo chemotherapy and radiation following his recovery from surgery.<br /><br />As for the surgical team, in a couple of days they will start all over again: another patient, another operation.Maria Schamis Turnerhttp://www.blogger.com/profile/08162242147675671584noreply@blogger.com1tag:blogger.com,1999:blog-709138507237992337.post-68042643469150795482010-11-25T12:24:00.004-05:002010-11-25T12:30:24.146-05:00Write your lifeI will be giving a writing workshop for people with neurological conditions in January.<br /><br />Dates: Tuesday January 4th, Tuesday January 11th, & Tuesday January 18th <br />Time: 3 – 5:00 pm (time to be confirmed) <br />Location: At the Neuro (exact location to be confirmed)<br /><br /><br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiCzjBnTYsw-KNI33n2xe_UrprQaJMb-XA35KuwumFx9FsFz-rr85Ym2B_ut81AhYOAHsp2iqiW5VP_HDVrFHpMy8l0s8uI7F9flk0ZYBZ6MuoZQYhGjfVYIZSKtt3VqxBE-K7dm5Y3p1Vm/s1600/Writing+Poster-1-Rev.jpg"><img style="float:left; margin:0 10px 10px 0;cursor:pointer; cursor:hand;width: 207px; height: 320px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiCzjBnTYsw-KNI33n2xe_UrprQaJMb-XA35KuwumFx9FsFz-rr85Ym2B_ut81AhYOAHsp2iqiW5VP_HDVrFHpMy8l0s8uI7F9flk0ZYBZ6MuoZQYhGjfVYIZSKtt3VqxBE-K7dm5Y3p1Vm/s320/Writing+Poster-1-Rev.jpg" border="0" alt=""id="BLOGGER_PHOTO_ID_5543540187528025058" /></a>Maria Schamis Turnerhttp://www.blogger.com/profile/08162242147675671584noreply@blogger.com0tag:blogger.com,1999:blog-709138507237992337.post-35634820633736910562010-11-25T12:14:00.003-05:002010-11-25T12:22:46.582-05:00Coming soon...A day in surgery with Dr Rolando Del Maestro, a conversation about narrative and neurology with Dr Liam Durcan, and more!<br /><br />(Apologies for the hiatus in posting - I was out of town.)Maria Schamis Turnerhttp://www.blogger.com/profile/08162242147675671584noreply@blogger.com0tag:blogger.com,1999:blog-709138507237992337.post-8518829978573946382010-11-08T12:59:00.010-05:002010-11-09T10:06:23.669-05:00An interview with Brenda MilnerAt the beginning of this year I had the opportunity to conduct a long interview with Brenda Milner. Not everything that we talked about made it into the final piece. Here is one of my favourite snippets that got cut. <br /><br />“But I will read, I’ll read anything. I’ll read advertisements—I’m a glutton for reading. I don’t have television, I listen to the radio or I read. Words are the thing that please me the most.”<br /><br />Here is the rest of that interview as it appeared on <a href="http://www.dana.org" target="_blank">Dana.org</a>.<br /><br /><span id="ctl00_cColumn_NewsArticle1_lblDetail"><p><i><a href="http://www.mni.mcgill.ca/neuro_team/cognitive_neuro/brenda_milner/" target="_blank">Brenda Milner</a>,</i><i> </i><i>a neuropsychologist at the Montreal Neurological Institute (MNI), is widely recognized for her studies on memory with the patient known as H.M. [see story, <a href="http://www.dana.org/news/features/detail.aspx?id=25322" target="_blank">“Tracing Permanent Memories”</a>] Milner, 91, won the International Balzan Prize in cognitive neurosciences last year and is an active member of the research community at the Institute. She is currently overseeing the planning stages of a research project tracing the connectivity between the two hemispheres of the brain.</i></p><h3>Q: What led you to study psychology?</h3><p><b>Milner:</b> It was just luck, really. Psychology as a career subject was non-existent in pre-war England. I went to Cambridge to do mathematics. I thought mathematics was just pure reasoning and I could reason as well as anyone else, but in higher mathematics you have to have special skills, perceptual skills. When I got to Cambridge I realized that mathematics wasn’t going to work out for me.</p><p>I had a chance to change fields at the end of the first year, and I thought, ‘I’ll do philosophy!’ And then people from my college said, ‘Brenda, don’t you have to earn a living?’ (I was as poor as a church mouse then, I was on scholarships.) They said, ‘No one ever learned a living doing philosophy, so forget that!’ And now comes the real bit of luck. In England, in Cambridge pre-World War II, experimental psychology was grouped with philosophy and ethics, under the “moral sciences.” Since I had mentioned philosophy, they suggested psychology because [as a psychologist] you could always get a job as a factory inspector.</p><p>Then I discovered I was good at it. I was a good observer and I enjoyed working with people in the lab. But it was luck, you see. I didn’t even know what psychology was!</p><h3>How did you become interested in memory?</h3><p>I wasn’t particularly interested in working on memory when I first came to the MNI, in June 1950, I was interested in problem solving and perception. I was working with Dr. Penfield’s temporal-lobe patients—patients who had had unilateral removals from the <a href="http://en.wikipedia.org/wiki/Temporal_lobe" target="_blank">temporal lobe</a> in the left hemisphere or the right hemisphere—and it was my job to try and find out something about them. I was looking for visual effects from temporal lobe lesions.</p><p>My work was being guided by what I could learn from experiments in animals and I knew about the effect of bilateral temporal removals in the monkey. But then the patients with lesions on the left came to me and complained about their memories. Remember, these patients were young, their average age was in the twenties, so they should have had reasonably good memories. They complained that they couldn’t remember things, and it was always things that were verbal—things that they read or things that they heard. They weren’t forgetting their lives or people’s faces or anything nonverbal. Then I found the corresponding thing for the right hemisphere, that is, inverse problems with memory, problems with remembering faces, places, and tunes etc. So I thought, I am going to have to study memory.</p><h3>What was it like when you started working with <a title="Patient H.M." href="http://en.wikipedia.org/wiki/HM_(patient)" target="_blank">Patient H.M.</a> in 1955?</h3><p>I gave him standard intelligence tests and memory tests, the sorts of things I had done with Dr. Penfield’s patients, and I would talk to him, distract him and give him numbers to remember and so on. H.M. (Henry Molaison) could pay attention and had no problem with immediate memory, but as soon as he was distracted, he would forget what had happened before. So you could make this general prediction [about H.M.] that he’s going to forget everything, but no psychologist is happy with this sort of statement—you can’t test a null hypothesis. The challenge was: with practice, with repetition, could he learn something?</p><p>I went to the McGill psychology department and borrowed learning tasks to give him. I took down a maze task, which I was sure he wouldn’t learn, and he didn’t. It was a nice control test, because he showed absolutely no progress over three days. Then I gave him the mirror drawing task. H.M. did 30 trials over three days and at the end of the last trial, his performance was absolutely perfect. I can still remember him looking at what he had drawn, saying: “This is strange. I thought this would be difficult, but it looks as though I’ve done it rather well.” I was very excited because it showed that he could have this excellent performance without any awareness that the reason he was doing so well was that he had had the chance to practice the task over three days.</p><p>When I saw that H.M. had this beautiful learning of something he had no memory of having acquired, I then speculated that this task, which involved motor learning, depended on a different system in the brain. His surgeon had damaged his medial temporal system, but this was a kind of learning that was unaffected by this operation, so therefore it must involve other structures.</p><h3>H.M. didn’t remember who you were from one visit to the next. Was that difficult for you?</h3><p>I didn’t find it awkward to work with him; he was always very pleasant and cooperative. H.M. knew he had had the surgery, because he could remember discussions leading up to it, and he had always had this wish to be helpful to medicine. He wanted to help.</p><p>You have to remember the reason why he had the surgery. He had had these terrible seizures. Not all epilepsy is dreadful by any means, but this was. He was on the maximum doses of whatever medication was available in those days and in spite of that he would have these major convulsions plus lots and lots of little attacks. It took him ages to finish high school because of this, and then the only job he got was in a factory. And he was having trouble keeping that because he would be falling so often. So this was a terrible life.</p><p>I used to say, when I lectured about H.M., that although the surgery controlled his seizures it was at an unacceptable cost. <a href="http://www.dana.org/news/author.aspx?id=13940" target="_blank">Sue Corkin</a>, a fellow researcher and former student of mine who also studied H.M., challenged me on that a year or so ago. She said, have you thought about what would have happened to Henry if he hadn’t had that surgery? He would have been in a back ward in some psychiatric hospital, he would have deteriorated, and he probably would have died long ago. Instead he lived to be 82, and in his own way enjoyed what he was doing. And I think in this case that she’s right.</p><h3>What do you think about the <a href="http://www.dana.org/news/braininthenews/detail.aspx?id=24130" target="_blank">recent process creating digital images of H.M.’s brain</a>?</h3><p>It makes for good scholarship—it’s important to have excellent neuropathology on a patient of interest, in terms of the case history, that’s perfect—but I don’t think it’s going to teach us anything new about memory. That’s my personal view.</p><p>The important thing was the first MRI that was done. It showed that Dr. Scoville had done exactly what he said he was going to do. It was a beautifully symmetric removal. It wasn’t more in one hemisphere than the other, and it took the entorhinal cortex, the anterior hippocampus, and the amygdala, but it spared the posterior hippocampal gyrus. The important thing was that it did not damage the neocortex, so we knew we were really studying the effects of a bilateral medial temporal-lobe lesion. [The Dana Foundation funded part of the <a href="http://thebrainobservatory.ucsd.edu/hmblog/" target="_blank">project to create the H.M. brain scans</a>.]</p><h3>Memory is a hot topic these days, both scientifically and culturally. Why do you think it has become so popular?</h3><p>There is a great deal of interest in the different types of memory and how they relate to different systems in the brain. People are living much longer now than when I was a student in 1936. They are not succumbing to diseases that used to carry them off, and so they are getting Alzheimer’s or other sorts of dementia that are affecting their memories. And we all have memory problems not related to age. We are leading busy lives, trying to handle different mental activities. This is one of the things that make people anxious about their memory, but it’s just that they’ve got crowded minds. There is a lot of interference, and I think interference is a huge factor in whether we remember or forget.<b> </b>At the same time, neuroscience has made big advances in understanding memory. The fact that people can now genuinely look to neuroscientists for advice and help, well, it keeps a duet going between the public and the scientist in a profitable way.</p><p>It’s also spilled over into in popular culture, in the cinema and other art forms that get communicated to the public, so that helps to make it a hot topic. Once you start studying memory you are really studying so many different dimensions. We are our memories. Of course we aren’t <i>only</i> our memories, because you can have memory problems and still show the same personality to others that they’ve come to expect from you. Are you an extrovert or introvert? There are all these different personality variables that are not a consequence of your memory, that are genetic. But this is another dimension.</p><h3>You are 91 and seem to have a pretty good memory. What’s your secret?</h3><p>I wish I could take credit for it but it’s just my genes, I think. My mother worked until 88 and lived to be 95, and she was always very mentally and physically active. I have always walked everywhere myself, I never drove, never had a car. There are many things that can go wrong with our brains as we get older, but by keeping active we can help put that moment off.</p><h3>The field of neuroscience has really grown over the course of your career. Is it mostly technology that is behind this?</h3><p>A lot of it is technology. I don’t think the interest in the brain and behavior is new, but people had the sense not to ask questions that were impossible to answer. You don’t ask how to get to the moon without the technology. Now with these developing techniques, you can indulge your curiosity more and more. The curiosity was always there, of course.</p><p>The field is attractive to people and there are so many bright young scientists that I think there will be an explosion of knowledge soon. It would be very exciting to be young in this field today.</p><p>I was starting out in what was really a brand new field, though I didn’t know that was what I was doing. I would never have been brave enough if I had thought of it that way! But in a way I was one of a few pioneers, there were some in Western Europe and a few in North America, who started something.</p><p>That’s what makes it exciting to talk about the history—I’ve lived not just through the history of my own life, but also of the life of my field. Neuroscience has grown incredibly over the past 50 to 60 years. It’s a flourishing industry.</p><h3>Do you have any predictions about what the future has in store for neuroscience?</h3><p>People who were guessing where things were going fifty years ago probably guessed wrong—it is difficult to guess. Some serendipitous discovery could potentiate a whole line of research that we can’t even imagine at this moment. What would interest me would be to get a better idea of the actual neural networks that correspond to some of these learning processes. In terms of understanding the networks of cells, we are nowhere near there. That would be nice, that would be really nice.</p><p><i>[</i><i>This interview has been condensed and edited for clarity.]</i></p></span>Maria Schamis Turnerhttp://www.blogger.com/profile/08162242147675671584noreply@blogger.com1tag:blogger.com,1999:blog-709138507237992337.post-31331386253104148302010-11-03T18:27:00.005-04:002010-11-03T18:40:48.133-04:00Homicidal somnambulismIt is the stuff of nightmares. A man in his early twenties falls asleep while watching Saturday Night Live on television. The next thing he knows, he’s staring into his horrified mother-in-law’s face. His memory is patchy after that. He’s in his car, a knife in his hand, and then he’s at the police station, telling the police that he thinks he might have hurt someone. He had. Twenty-three year old Kenneth Parks had murdered his mother-in-law and rendered his father-in-law unconscious. Parks went to trial but was eventually acquitted. According to the defense, and the assessment of psychiatric and neurological experts, Parks had committed the murder in his sleep. He did not remember doing so and had not intended to attack or kill his in-laws.<br /><br />The case report, published in the journal<span style="font-style:italic;"> Sleep </span>in 1994, reads like a film script. There are details. The night before the murder, Ken had slept badly. Saturday morning he played rugby with friends and received a mild blow to his right temple. That evening’s episode of Saturday Night Live was hosted by Dennis Hopper. A scene from the movie Blue Velvet was shown. (If anyone could drive you to homicide in your sleep, Hopper’s character in Blue Velvet would be a likely candidate.)<br /><br />In many ways, Parks was the perfect suspect. He had started gambling, betting on horses, and heavy losses drove him to steal money from work. He took money from the family savings and forged his wife’s signature. His theft at work was eventually uncovered and he was fired from his job; he and his wife put the house up for sale to cover his debts. It would not have been so surprising then, to find out that he had tried to murder his in-laws in a desperate attempt to access money or to prevent them from finding out what he had done. (Parks was apparently very close to his in-laws.) Instead, a medical assessment of Parks and his family showed a history of sleep disorders. Parks had wet the bed until he was 11 – 12 years of age; he was a chronic sleep talker; he slept very deeply and did not remember his dreams; and had a history of sleepwalking. The conclusion was that Parks had committed these acts of violence in his sleep and therefore he was not responsible. He had a keen sense of remorse for what he had done and was reported to be in a “deep state of emotional despair” after the crime.<br /><br />I heard this story for the first time at a lecture (at the MNI) on parasomnias, or sleep-related disorders, given by Dr Antonio Zadra, a researcher and clinical psychologist at the Centre du Sommeil at l’hôpital du Sacré Coeur. It is, apparently, not the only case of homicidal somnambulism. (see “<a href="http://www.slate.com/id/2236557" target="_blank">Rough Night?</a>”) According to Zadra, sleepwalking is not considered a “disease of the mind” which means that to plead somnambulism as a defense for murder is not the same as pleading insanity. Parks was acquitted, not committed to a mental institution. (He did receive psychotherapy after the trial and took sleeping pills.)<br /><br />Zadra and his colleagues at the sleep centre are looking for an objective protocol to confirm the diagnosis of parasomnias, including sleepwalking, since much of the diagnosis rests upon anecdotal evidence, often from the sleepwalker’s family. Although episodes are seen in the sleep lab – Zadra showed video footage of people moving and talking in their sleep, including one man who thought he had dropped his baby and was searching for it in his bed – they happen less frequently in laboratory conditions than at home. He and his colleagues have found that sleep deprivation in conjunction with “forced arousals” (disrupting people’s sleep in the lab), increases the frequency of episodes. This allows researchers to further study what is happening in the brain when these episodes occur, and confirm that a person is indeed suffering from a sleep disorder.<br /><br />Most episodes of somnambulism are relatively harmless, but as Parks’ story demonstrates, for some it is a matter of life and death.<br /><br />For a funnier (although still somewhat disturbing) story of someone suffering from a sleep disorder, check out <a href="http://castroller.com/podcasts/TheMothPodcast/926620-Mike%20Birbiglia%20Sleepwalk%20with%20Me" target="_blank">this story by Mike Birbiglia</a> on the Moth podcast.Maria Schamis Turnerhttp://www.blogger.com/profile/08162242147675671584noreply@blogger.com2tag:blogger.com,1999:blog-709138507237992337.post-40374155206303186992010-10-28T09:51:00.012-04:002010-11-03T15:48:16.671-04:00On music and pleasureThe people who slowly filtered into room W201 for an afternoon seminar on music and the brain couldn’t help but notice the noise of construction that intermittently interrupted conversation. For some, the sound of power tools would be enough to drive them away, but the group of cognitive neuroscientists who had gathered seemed to take it in stride. “Maybe we’re part of a social experiment,” a few of them offered. The talk of possible experiments continued as the seminar was moved to a quieter and smaller room. Do people ask more questions in a small room than in a large room? (The consensus hypothesis seemed to be that the intimacy of a small room would make people feel more comfortable about asking questions.) The real experiments under discussion, however, had nothing to do with room size but were all about how and why people experience pleasure when they listen to music.<br /><br />As Valorie Salimpoor, a PhD student working with <a href="http://www.zlab.mcgill.ca/home.html" target="_blank">Dr Robert Zatorre,</a> explained, why we listen to music at all is a mystery. What is it about a sequence of tones that brings us pleasure? It is not like other “pleasure-producing stimuli.” It has no biological value (like food, for example), it comes with no tangible rewards, and, despite the existence of self-professed music junkies, listening to music is not known to be addictive. So what does listening to music do to us?<br /><br />Salimpoor set out to test the idea that listening to music gives us pleasure by affecting our emotions. The problem with studying emotional response is that emotions are subjective. Salimpoor needed an objective measurement of pleasure in order to study the effects of music so she looked at changes in people’s autonomic nervous systems, such as changes in body temperature and heart rate, while they were listening to music that they enjoyed. Volunteers for the study were chosen if they experienced pleasurable chills in response to a piece of instrumental music. Not everyone is lucky enough to get chills when they listen to music, but those who do associate them with feeling intense pleasure brought on by the music. And chills have the benefit of being accompanied by typical changes in physiological arousal.<br /><br />The music used in the study was self-selected by the study participants and Salimpoor played examples, ranging from house to classical. “Who gets pleasure from this?” she asked her audience. People raised their hands according to their preferences. To a casual observer, there seemed to be a high correlation between the style of music that gave pleasure and the age of the listener.<br /><br />In the experiment, those who found a piece of music pleasurable had signs of emotional arousal as measured by the changes in the autonomic nervous system. In a further study, Salimpoor and her colleagues also found that music activates the <a href="http://thebrain.mcgill.ca/flash/a/a_03/a_03_cr/a_03_cr_que/a_03_cr_que.html" target="_blank">dopamine reward circuit</a>, which is involved in the brain’s response to other things that give us pleasure, and is also implicated in addictive behaviour.<br /><br />Composers, though they may not have needed the results to prove that music gives pleasure, were quick to look for practical applications. Several contacted Salimpoor to ask what kind of music gave people chills. Although the musical styles ranged greatly from person to person in the study, a few pieces of music, and a few composers, showed up more than once. And, said Salimpoor, at least once piece of music, Barber’s Adagio for Strings, appeared to transcend musical styles, showing up both in its original form, and in various remixes.<br /><br />Seminar over, Salimpoor was peppered with questions, confirming, or at least supporting, the small-room hypothesis.<br /><br /><span style="font-style:italic;">Further reading</span><br /><a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0007487#s4" target="_blank">The Rewarding Aspects of Music Listening Are Related to Degree of Emotional Arousal</a>Maria Schamis Turnerhttp://www.blogger.com/profile/08162242147675671584noreply@blogger.com1tag:blogger.com,1999:blog-709138507237992337.post-11752797601228375212010-10-27T17:17:00.002-04:002010-11-01T17:41:10.789-04:00Watching the detectivesThis fall I became the writer-in-residence at the Montreal Neurological Institute. The position is new and something of an experiment. This blog is a record of that experiment.<br /><br />The idea to spend some time observing neuroscientists at work started with a lecture given by Brenda Milner for the 75th anniversary of the MNI in 2009. Milner presented an overview of her research of the now famous patient HM. I was fascinated both by the story of HM and Milner’s discoveries about memory, and by Milner herself. At 92, she is still active in the world of research (she appears to have more energy than I usually do at less than half her age) and she’s a good storyteller. I was curious to know more about her.<br /><br />I had the opportunity to <a href="http://www.dana.org/news/features/detail.aspx?id=26086" target="_blank">interview Milner</a> for the online news and features service of the Dana Foundation, but, as with many freelance assignments, I felt that I had only touched the surface (through no fault of the Dana Foundation, I should add.) Many of the science articles I write follow a formula (Martin Robbins hit all too close to the mark in <i><a href="http://www.guardian.co.uk/science/the-lay-scientist/2010/sep/24/1?CMP=twt_gu" target="_blank">The Guardian</a></i>) and leave little room for what physicist and writer Jeremy Bernstein calls “the human side of science.” Who are the people who spend their lives working at science? We hear about writers, artists, actors, and others engaged in creative pursuits, but little is written about scientists.<br /><br />Wilder Penfield, who founded the MNI in 1934, once said, “The problem of neurology is to understand man himself.” (This quote is etched into the façade of the building that houses the MNI.) It seems an interesting problem, therefore, to try and understand the neurologist.<br /><br /><b>Disclosure</b><br />I am not receiving any funding from the MNI for this residency. I work occasionally as a freelance writer for the Faculty of Medicine at McGill University (which is affiliated with the MNI), but the work is completely unrelated to this project.Maria Schamis Turnerhttp://www.blogger.com/profile/08162242147675671584noreply@blogger.com0tag:blogger.com,1999:blog-709138507237992337.post-13454302833065949822010-10-27T13:34:00.006-04:002010-10-30T17:24:08.714-04:00About meMaria Schamis Turner is a Montreal-based writer and editor who is attempting to reconcile her divergent interests in science and literature. She has been writing about topics in neuroscience since 2008 and is currently the writer-in-residence at the <a href="http://www.mni.mcgill.ca/" target="_blank">Montreal Neurological Institute</a>.<br /><br />She is also the editor of the online literary magazine <a href="http://www.carte-blanche.org/" target="_blank">carte blanche</a>. She can be reached at turnmaria [at] gmail [dot] com.Maria Schamis Turnerhttp://www.blogger.com/profile/08162242147675671584noreply@blogger.com3