As brain surgeons test new procedures and drugs to treat conditions ranging from psychiatric disorders to brain cancer, accuracy is becoming an ever-greater issue.
In treating the brain, the state of the art today starts with images from a magnetic resonance (MR) scanner, usually made a few days before surgery. Then, in the operating room, multiple cameras track instruments as they are inserted through a hole in the skull, creating images that can be superimposed on the original MR scans.
But there is no guarantee that the brain will not shift slightly during the surgery and throw off the best efforts at exact guidance.
For 20 years, neurosurgeons have discussed a radical way to achieve real-time accuracy in placement: performing surgery with the brain inside an MR machine, says Walter Block, professor of biomedical engineering at the University of Wisconsin-Madison. “When you open the brain for surgery, the tissue can shift slightly, and that will throw off predictions made in advance.”
To bring the full promise of MR into the operating room, Block has formed a company called InseRT MRI to develop software that allows surgeons to observe the brain in real time on an MR machine during surgery.
Such a system would have a number of applications, he says. Drugs for brain cancer can be delivered over as long as 54 hours. “It would be valuable to see where the drug is going during the first few hours,” Block says. “Drugs move at different rates through gray and white matter, and this ability to recalibrate the treatment plan, based on actual data on where the drug is moving, would allow you to alter the location of the catheter or the flow rate of the medication.”
To get that accuracy advantage, Block does not envision forcing surgeons to learn a new operating environment. “Surgeons have operating room tools and work stations that are familiar to them,” he says. “We are creating a set of tools that make the MR space a comfortable place for the surgeon.”
UW-Madison neurosurgeon Azam Ahmed plans to use the system through test procedures on animal brains and cadavers, Block says. “We are working with Dr. Ahmed to design the workflow so it’s intuitive to him. We are not going to piggyback on top of a large scanner market designed for largely diagnostic purposes, kludging it to make it work for interventional applications.”
The goal is not to develop software that could be spliced into MR manufacturers’ systems, he says, “since every time they alter their software, we would have to change ours.” Instead, Block is borrowing tactics from the smartphone industry. “People write apps that use various phone resources — GPS, the screen, the orientation system. We look at the MR scanner as a set of resources that we can control. An app writer does not have to go to Samsung or Apple and say, ‘We have this idea.’”
Block says his software will interact with the MR machine through a software “portal” being developed by another firm.
One obvious market is the pharmaceutical industry. “Any drug trial in the brain will cost hundreds of millions of dollars,” he says, “and we often see trials being repeated after post-mortem analysis raises questions about the accuracy of drug placement.”
Targeted surgery could also help remove bits of brain tissue to treat severe epilepsy. Marvel Medtech in Cross Plains, Wisconsin, is developing a system that would employ InseRT MRI’s guidance to biopsy breast tumors. The technology also raises the potential for localized psychiatric drug therapy, Block says.
In the brain, the MR-guidance system is already accurate to less than a millimeter, Block says. While conventional stereotactic systems can approach that accuracy “in the best case,” the error can rise to 1.5 or 2 millimeters — a vast distance in an organ as delicate as the human brain, in which damage to healthy tissue must be minimized.
Block says InseRT MRI’s competitive advantage resides in his long experience in medical imaging. “Our value is (faster) time to market. We have come up with ways to circumvent the significant hurdles that now limit image-guided therapy, and we believe we can do this faster than anybody else.”
Scientists Create a 3-D Model That Mimics Brain Function
For the first time, bioengineers have produced a kind of rudimentary “brain in a dish.” The 3-D model could eventually lead to new ways of studying disease, injury, and treatment.
The research, led by David Kaplan, the chairman of the bioengineering department at Tufts University, and published Monday in the journal PNAS, is the latest example of biomedical engineering being used to make realistic models of organs such as the heart, lungs and liver.
Brain models have been mostly two-dimensional or made with a three-dimensional gel, said Rosemarie Hunziker, program director of tissue engineering and biomaterial at the National Institute of Biomedical Imaging and Bioengineering, which funded Dr. Kaplan’s research.
Whereas in the first stage of recovery survivors deal with social adversity mainly by retreating to a protected environment, in the third stage survivors may wish to take the initiative in confronting others. It is at this point that survivors are ready to reveal their secrets, to challenge the indifference or censure of bystanders, and to accuse those who have abused them.
Survivors who grew up in abusive families have often cooperated for years with a family rule of silence. In preserving the family secret, they carry the weight of a burden that does not belong to them. At this point in their recovery, survivors may choose to declare to their families that the rule of silence has been irrevocably broken. In so doing, they renounce the burden of shame, guilt, and responsibility, and place this burden on the perpetrator, where it properly belongs.
Family confrontations or disclosures can be highly empowering when they are properly timed and well planned. They should not be undertaken until the survivor feels ready to speak the truth as she knows it, without need for confirmation and without fear of consequences. The power of the disclosure rests in the act of telling the truth; how the family responds is immaterial. While validation from the family can be gratifying when it occurs, a disclosure session may be successful even if the family responds with unyielding denial or fury. In this circumstance the survivor has the opportunity to observe the family’s behavior and to enlarge her understanding of the pressures she faced as a child."
Woah woah woah, I am not a pedophile apologist. The point of the article is that young people who have never before touched a child but are sexually attracted to children and don’t WANT to be—don’t WANT to hurt children—are unable to seek treatment because it’s such a horrible thing to admit. The more we shame this behavior (and it is 100% justifiable that we shame this behavior, please don’t misread me here), the less of a chance we have of rehabilitating someone with these thoughts, and the greater a chance we have of these thoughts becoming behaviors.
I’m sincerely sorry I offended you and that you were a victim of such an awful crime. Rereading what I added on to that reblog, I realize that I do come across as forgiving of the behavior; I have a horrible tendency to write fast and not articulate myself well when reblogging, so again, I am very very very sorry about that to anyone I horrified! It’s not at all what I intended to say.
Intense article, totally worth the read. Warning- it is intense and does include a graphic depiction of child pornography.
I think I just mentioned something about this.
I’m about a third of the way through the article. It is really good. The comments are annoying, though. Why do I bother clicking.
This review is freely available :-)
the concept is good butttttt binge eating is not a component of anorexia…?
As a follow up to Shirley’s post on eating hyper-palatable foods during eating disorder treatment , I asked Liz–SEDs’ resident expert on animal behaviour, particularly in relation to binge eating and drug addiction–to look at some of the studies that Julie O’Toole mentioned as evidence for Kartini Clinic’s guidelines of avoiding hyper-palatable foods for the first year of eating disorder recovery.
The same gene family that may have helped the human brain become larger and more complex than in any other animal also is linked to the severity of autism,
Many recent imaging studies have shown that in children with autism, different parts of the brain do not connect with each other in typical ways. Initially, most researchers thought that the autistic brain has fewer connections between key regions. The most recent studies, however, point to an opposite conclusion: The brains of people with autism exhibit overconnectivity.
To date, almost all studies of autism in children have used a single imaging technique to explore connectivity. None has been able to capture a robust picture of the brain abnormalities associated with autism—until now.
Two new grants from the National Institute of Mental Health (NIMH) will allow San Diego State University Psychology Professor Ralph-Axel Müller to combine three imaging techniques and harness the best of each one in his study of autism.
Techniques in tandem
Although the term “brain imaging” gets thrown around a lot when describing the latest advances in neuroscience and psychology, there are dozens of different brain imaging techniques. Each gives scientists a different view of the inner workings of the brain, and each comes with its own strengths and limitations.
For example, the frequently cited technique of fMRI, or functional magnetic resonance imaging, measures blood flow in different areas of the brain at specific snapshots in time, based on the knowledge that increased blood flow indicates increased activity of nerve cells in that area of the brain. The technique is powerful, but has limitations when it comes to detecting dynamic changes in brain activity that occur very fast, within milliseconds.
EEG (electroencephalography), a much older technique, is actually better at detecting such dynamic changes, although it cannot pinpoint exactly where in the brain the activity occurs. A powerful and more recent technique is MEG, or magnetoencephalography, which can detect dynamic changes in brain activity that happen within a few milliseconds.
Müller looks for disorganized patterns of brain activity that could be responsible for some of the telltale characteristics of autism spectrum disorder, such as inattention to social cues and repetitive and obsessive behaviors. For example, last year, Müller and his colleagues discovered that in children with autism, connectivity was impaired between the cerebral cortex and the thalamus, a deep brain structure that is important for sensorimotor functions and attention.
With $4.2 million in new funding from NIH, Müller—together with collaborators Ksenija Marinkovic at SDSU and Thomas Liu at the University of California, San Diego—will apply fMRI, EEG, and MEG to study both autistic and non-autistic, or typically-developing, children and adolescents during a variety of tests, including language tests designed to tease out activity in various parts of the brain.
Defining the differences
One component of the project will concern the visual system. Previous research has shown that people with autism rely on their visual cortex more than typically- developing people during thought processes, for example, when making a semantic distinction, such as deciding whether a truck is a vehicle. Using the one-two punch of fMRI and MEG together, Müller and his team will be able to determine the dynamic processes in how brain regions work together to come up with a response, and how these processes differ in autism.
The study will also examine brain function during its resting state in order to identify abnormalities in brain network organization. The combined use of EEG and MEG, together with fMRI techniques that reveal brain anatomy, will produce a much more complete picture of abnormal brain organization in autism.
Ultimately, Müller and his colleagues hope to identify biomarkers in the brain that can reliably indicate whether the participant falls on the autism spectrum.
“Autism is a brain-based disorder, but its diagnosis is still based entirely on behavioral observation,” Müller said. “This is inadequate. We need to find brain biomarkers for autism.”
Another goal of the researchers is to find brain biomarkers that can distinguish different subtypes of autism. It is generally suspected that the term “autism” actually covers several different disorders, each of which may be caused by different genetic and environmental risk factors. Eventually, brain biomarkers might be tied to genetic data, giving scientists a better understanding of the origins of autism, as well as new leads for treatment.
“For decades, research teams studying autism have specialized in one or another scientific technique, often without understanding well what other techniques can reveal. Our study combining several of the major imaging techniques will be one step toward a more comprehensive account of how the autistic brain differs from the typically developing one – and what may be done about it,” Müller said.
BFRB Awareness Week is coming, and we’ve got a lot planned! Here’s the first release of what we’re doing, and we need your participation for it!