Adam Gazzaley and Parneet Pal, Chief Science Officer of Wisdom Labs, discuss the challenges of the modern world for our ancient brains, how to become aware of, and overcome, the interference of distraction and multitasking, and the new era of digital medicine. Conversation includes: The critical elements of what it means to be human, ethical design of technology, the cascading effect of cognitive challenges, and harnessing neuroplasticity through experience to develop stronger brains…
Akili, the business end of Gazzaley’s research aims to build ‘experiential treatments’, delivered through video games, “…as medicine–as prescribable, reimbursable medicine, right up there with pharmaceuticals”. The patent is not for a video game, the patent is for a game engine… Akili now has a dozen studies going on across multiple clinical conditions. From Post Traumatic Stress Disorder to Traumatic Brain Injury to anxiety to Autism, depression, early Alzheimer’s Disease, Parkinson’s Disease, Multiple Sclerosis… The study which has garnered the most attention was the completion of our Phase 3 trial for Pediatric ADHD… What was shown was that we were able to significantly, with a reasonable effect size, improve attention ability in children with ADHD. Now advancing an application to the FDA for their class 2 medical device for the treatment of inattention in children with ADHD.
If we’re successful, it will be the first non-drug treatment for ADHD. The first prescribable video game, and the first of a new category of medicine that we think of as digital medicine, to treat a host of different conditions of the mind.
We’ve met Adam Gazzaley elsewhere on the blog, but probably because he and Rob Reid have a friendship spanning years, this is a very friendly and thorough discussion of all Adam is up to. Reid has a new book (fiction, sci-fi) called After On, and Gazzaley was called on to provide insights into a few of the book’s key concepts related to consciousness and neuroscience.
There has been a lot of talk in the literature lately about tACS as it applies to cognitive enhancement and this is explored in the conversation. If I got this right… there is a distinct pattern of ‘Midline Frontal Theta’ frequency, at around 6Hz (as measured by EEG) associated with ‘focus’ (as measured by fMRI) in the Pre Frontal Cortex. This begs the question as to whether focus could be generated by using tACS to ‘entrain’ the PFC (as in… induce 6Hz Theta in the PFC using tACS). Again I will remind the reader that I am not a scientist!
Gazzaley also brings us up to speed on the clinical trial for FDA clearance of EVO, his video game/therapeutic that Akili has developed for kids with ADHD.
The episode is embedded here, but swing over to https://after-on.com/episodes/002 to read the show notes and to learn more about Rob Reid. He has a number of fascinating interviews with other guests in his podcast and brings a lot to the table himself considering a long career both as a technologist, investor and author.
Mike Weisend – Treating the Brain from the Outside We met Michael Weisend back in podcast #4 (March 2013!) and have been following along ever since. In this interview Mike discusses what he’s been up to at Rio Grande Neurosciences. What caught my ear especially were the discussion around ‘closed-loop TES’, where EEG information informs when and where to stimulate with TES. Also, his discussion of personalized disposable bio-degradeable electrodes was interesting. Mike closes the interview with an invitation to anyone knowing how to engineer an ‘EEG amplifier’ that would allow for the separation of EEG data and active TES stimulation, to contact him. (mike.weisend [theAtSign] riograndeneurosciences.com). Kudos to Richard Jacobs for an interesting interview.
Can a little electrical stimulation help people learn quicker? And how would technology that does this be used? And why would you want to use this over medicines?
Professor Roi Cohen Kadosh describes a phenomena that they’ve noticed where giving people a little electrical stimulation to the scalp appears to help people learn things quicker; and rather than using this to make super-geniuses, could this be used to help people with learning difficulties? Roi discusses how it might work, and discussed the moral and ethical implications of such a technology. From Oxford Sparks.
Fascinating stories of people with Aspergers who discover feelings and empathy as participants in TMS (Transcranial Magnetic Stimulation) studies. Begs the question, what if, as the effects of TMS fade, tDCS could be used to ‘top up’ their emotional awareness?
Frame of Reference From NPR’s amazing ‘Invisibilia’.
We all carry an invisible frame of reference in our heads that filters our experience. Alix and Hanna talk to a woman who gets a glimpse of what she’s been missing – and then loses it.
Anna Wexler is a Ph.D. candidate in the HASTS Program (History, Anthropology, Science, Technology, and Society) at MIT. Her dissertation focuses on the ethical, social and regulatory implications of consumer non-invasive brain stimulation. She is currently a 2015-2016 visiting scholar at the Center for Neuroscience and Society at the University of Pennsylvania. In 2007, Anna graduated from MIT with two Bachelors’ of Science degrees, one in Brain and Cognitive Science and the other in Humanities and Science with a focus in Writing.
[Did you just pop back for the Caputron promo code? It’s ‘diytdcs’ without the quotes.]
Robin Azzam is the founder of Caputron. While pursuing a Masters in medical engineering at New York City College, Robin realized there was a need in the research community for a place to source brain stimulation supplies. Shortly after leaving a position in product development at Soterix Medical, Robin and a few friends set up Caputron with the intention of becoming a ‘one stop shop’ for all things related to brain stimulation. His time at Soterix, working alongside Marom Bikson, led to the sort of relationships that allowed Caputron to become a distributor for high-end products like Soterix HD-tDCS and Neurosoft’s TMS devices. But Caputron also began to carry a large selection of electrodes, cables, straps and stimulation-related accessories. Caputron is now developing their own products, and hope to have their own research-grade home DC current device on the market by the end of the year. They recently began selling their mindGear device which I will cover in detail in the near future.
What DIYtDCS readers will likely find most exciting is Caputron’s ActivaDose II Starter Kit. This is the FDA cleared iontopheresis device widely used ‘off label’ for tDCS. It is the device used by two of my previous podcast guests, Dr. Jim Fugedy (for treating depression) and, (at the time) Michael Weisend for research. But Caputron has customized the included accessory package making it tDCS-friendly right out of the box.
In the three years I’ve been running the blog I’ve not previously felt comfortable recommending any specific tDCS device (mostly due to my own ignorance of electronics). I’ve either had doubts about the device itself or not had confidence in the vendor’s customer support. But based on my own experience with the ActivaDose products, the fact that it’s an ‘FDA cleared’ device, and also that it’s coming from Robin and his team, I feel, finally, that we have a product/vendor you could recommend your Mother to. (Assuming she does her homework!)
To that extent, I asked for, and Robin agreed to, a discount on all Caputron products for DIYtDCS readers. Simply plug the promo code ‘diytdcs’ (without quotation marks) into the Voucher window at checkout for a generous discount.
Here’s our interview. Your feedback is welcomed!
Note: The ActivaDose II has a max output of 4.0 mA which, as you know if you’ve done your homework, is twice as much as is typically used in tDCS research.
Excellent! A full hour with Dr. Wesiend. Haven’t listened yet but guaranteed to be the latest info in our understanding of tDCS. We met Dr. Weisend earlier in podcast #4,
Recently, transcranial direct current stimulation (tDCS) or the non-invasive targeting of weak direct current (DC) to specific brain regions has received media attention. Among the scientific research community, tDCS has been a subject of great interest owing to its usage ease, relative inexpensiveness, and encouraging research results on a range of functions. Studies have seen tDCS accelerate learning, reduce symptoms of dementia, and improve attention in those with Attention Deficit Disorder (ADD). Understandably, a coinciding rise in the DIY community has also prompted an increase in consumer devices available for home use in hopes of mimicking tDCS’s potential neuroenhancement abilities.
Lynne Malcolm: Colleen Loo says that this transcranial direct current stimulation treatment is best used for people with clinical depression who haven’t responded to other treatments. There are very few, if any, side-effects and some participants have even noticed benefits beyond changing their moods.
Colleen Loo: Yes, and this was very exciting. So when we did our first depression trial we were measuring things like memory and thinking…you know, it was just to be safe, to check these things. And one of the things we measured was we asked people to do a test which really showed you how quickly the brain was working. And as people went through the trial they were saying things like, ‘Gee, I don’t know what kind of stimulation I’m having, but it’s almost like my brain clears and I can concentrate and think so much more clearly after the stimulation.’
So we were very excited when we got the end of the study and we formally analysed the results of the formal test, that it showed exactly what people were saying to us, that after the act of stimulation the actual thinking speed was faster, and that has led our team to develop a whole parallel line of research of using TDCS to improve memory and thinking. So our main line of research is in treating depression, but I also have a very promising young researcher who is a clinical neuropsychologist, Dr Donel Martin, who is heading a whole program of research into using this to improve memory and thinking. For example, in people who are older and who are just starting to notice some changes in their memory and thinking.
Jesse interviews Nathan Whitmore, creator of the open-source project OpenBrainStim, an affordable alternative to commercial transcranial Direct Current Stimulation (tDCS) devices. Nathan tells us how the project got started, how the “DIY-tCDS” community has grown, and how you can experiment from the comfort of your own home.
In the last couple years, tDCS has been all over the news. Researchers claim that juicing the brain with just 2 milliamps (think 9-volt battery) can help with everything from learning languages, to quitting smoking, to overcoming depression. We bring Michael Weisend, neuroscientist at Wright State Research Institute, into the studio to tell us how it works (Bonus: you get to hear Jad get his brain zapped). Peter Reiner and Nick Fitz of the University of British Columbia help us think through the consequences of a world where anyone with 20 dollars and access to Radioshack can make their own brain zapper. And finally, Sally tells us about the unexpected after-effects of a day of super-charged sniper training and makes us wonder about world where you can order up a state of mind.
Michael Weisend PHD. is a principal investigator at The Mind Research Network, MRN.org, and assistant professor of Translational Neuroscience at the University of New Mexico, Albuquerque. Dr. Weisend and his team pioneered a method for determining optimal brain regions for tDCS stimulation using fMRI. Much of Dr. Weisend’s work is focused on cognitive enhancement in healthy subjects for the purpose of reducing the amount of time it takes to master a skill. He shared a full hour of his time and a wealth of tDCS-related information. Download the interviewhere (zipped mp3). Subscribe in iTunes. (Firefox users- there’s an issue with the html5 audio player. In the meantime you can download the episode or open the page in another browser).
Marom Bikson is CEO of Soterix Medical and Associate Professor at City College of New York in the Department of Biomedical Engineering. Marom is a distinguished tDCS scientist and prominent in the development of HD-tDCS. Download the interviewhere (zipped mp3). (Firefox users- there is an audio player here, but it’s displaying intermittently. Trying to track down the issue. In the meantime you can download the episode or open the page in another browser).
(We got a good forty minutes of interview in before the Skype gremlins caught up with us. I had to cobble an ending together.)
Perhaps depression studies are closest to FDA qualification for tDCS?
(Prediction is very hard, especially about the future – Yogi Berra.)
A device (NorDoc Smartstim) that can go to 4mA is being used in a smoking cessation trial? (Trial info indicates 2mA current dose.)
FDA tDCS approval would be device-specific at first. But would open the door to ‘me too’ mechanism, FDA 510(k)
HD tDCS can have multiple cathodes and or multiple anodes. An array of 4 small anodes splitting 2mA, for example (.5 mA each electrode), can function as an anodal ‘virtual pad’. Assumes cathode somewhere else on the body).
Image By Richard McKinley USAF
Tolerability is how tolerable in terms of side effects a medication is.
A Theory of tDCS (“Gross oversimplification”) As positive current flows into the cortex it passes neurons.
Because of the nature of neurons, this positive current depolarizes somas (cell’s body), increasing excitability, thereby increasing the functionality & plasticity of that region (hypothesis… “We really don’t know.”). Under the cathode, somas (cells) are being hyper-polarized – excitabilty decreases.
A synapse is a structure that permits a neuron (or nerve cell) to pass an electrical or chemical signal to another cell. Pyramidal neuron
Titration, also known as titrimetry, is a common laboratory method of quantitative chemical analysis that is used to determine the unknown concentration of an identified analyte.
TES Transcranial Electric Stimulation
“transcranial electrical stimulation” Merton and Morton 1980
“Priming the network in conjunction with applying tDCS makes a lot of sense, as a way to make the tDCS to do what you want.” (Co-priming – The idea that one would initiate an activity first, and THEN add tDCS.)
[Apologies for audio quality. It won’t happen again.]
Dr. Jim Fugedy runs the Brain Stimulation Clinic, in Atlanta, GA, and has been treating patients using tDCS since 2007. Download the interviewhere (zipped mp3).
Dr. Jim Fugedy
The Brain Stimulation Clinic in Atlanta is the destination for memory and learning enhancement and treatment-resistant patients who suffer from chronic pain, fibromyalgia, migraine headaches, CRPS, depression and tinnitus. Transcranial direct current stimulation (tDCS) therapy is provided in a pleasant, relaxing environment. Instruction, training and supervision for home use is also available for select patients.
Jim is an anesthesiologist.
The study Jim refers to regarding Felipe Fregni & fibromyalgia: A randomized, sham-controlled, proof of principle study of transcranial direct current stimulation for the treatment of pain in fibromyalgia (full pdf)
tDCS for treatment of fibromyalgia is not certified – it’s ‘off label’
Device is certified, but not for tDCS = no insurance code, can’t be billed to insurance
20 minute treatment for 5 days.
For fibromyalgia – reduces pain, improves issues – fatigue, compromised mental function
(ActivaDose ii Update 3/16 now available as complete tDCS kit through Caputron Medical, use voucher code ‘diytdcs’ for generous discount.)
Most benefit… chronic depression, treatment protocol based on Colleen Loo, Black Dog Institute 6 weeks, follow up maintenance. Up to 8 weeks of treatment + 1-2 treatments follow up maintenance. Daily 20 minute sessions
Can be treated at the clinic for 1-2 weeks. Or home treatment package.
“To treat depression, I place the anode over the left dlpfc (left dorsolateral prefrontal cortex) and the cathode over the contralateral supraorbital area. I have tried positioning the cathode over the contralateral dlpfc and extracephalically (opposite shoulder or upper arm), but the contralateral supraorbital locations provides the most robust effect.” (Correspondence)
Pain montage 2mA, anode M1 & cathode contralateral supra-orbital area
For chronic pain, the M1 is the most used area and that’s almost always my first choice. But you can use the cathode over the somatosensory (S1) cortex, to down-regulate the patient’s perception of pain.
And you can also stimulate the Dorsalateral prefrontal cortex which is involved in the emotional component of pain.
Looking at stimulating right dorsalateral prefrontal cortex to attenuate anxiety.
… it may be a location
for the non-pharmaceutical treatment for ADD.
Office visit $150.
Home use treatment package $2400 includes in-office evaluation and training, ActivaDose ii device, electrodes, and unlimited follow-up via visit, phone, skype…
Only side effect Jim has seen is skin burn (but easily avoided with sponge electrodes).
(Patient with skin burns who’d been treated by a doctor using electroencephalogram (EEG) electrodes.)
Tinnitus responds well, though temporarily, to tDCS
Anode, right dorsalateral prefrontal cortex, cortex opposite supra-orbital Harvard one day course on how to treat with tDCS. Taught 3-4 times a year.
Contrast with approved Electromagnetic treatment for depression (I think he’s referring to TMS transcranial magnetic stimulation here) A 6 week 30 treatment protocol costs between $10-15,000. Affects last about 6 months. And even though it’s certified, it’s not covered by insurance.
…”in the 12 years that it’s been used there have been no side effects reported other than skin (irritations).
“You know we hear stories about Canadians having to wait for surgery. But in the United States, if you don’t have the money and you don’t have insurance, you don’t have to worry about waiting, you won’t get the surgery.”
You can reach Jim at: doctorfugedy [theAtSignHere] transcranialbrainstimulation.com