For 15 years, a Toronto woman endured severe depression, without getting relief from medication or other treatments.
With no end to this chronic condition in sight, she agreed to enroll in a clinical study of a new treatment known as deep brain stimulation (DBS), which delivers electrical stimulation to targeted areas in the brain and blocks abnormal nerve signals.
Within 10 months, the debilitating symptoms of depression became more manageable. One year later, the woman was well, says Dr. Anthony Levitt, chief of the Hurvitz Brain Sciences Program.
One of a number of treatments that fall under the term neuromodulation, DBS is an example of the high-tech procedures that will become available within the Hurvitz Brain Sciences Program at Sunnybrook.
Neuromodulation is the process of altering the brain's circuitry by directly intervening inside the brain. Electrical, ultrasound or magnetic energy is used to change the brain's circuitry or disrupt pathways.
The field of neuromodulation is rapidly evolving, and Sunnybrook has been leading the charge. As part of the goal to deliver care that's tailored to the patient, Sunnybrook will house a Centre for Neuromodulation (CFN).
"Rather than a one-size-fits-all solution, we will provide individualized care," says Dr. Nir Lipsman, a neurosurgeon and scientist at Sunnybrook. "Our ability to offer the full range of neuromodulation strategies all in one place will make this program unique on a global scale."
Discoveries from neuromodulation techniques are opening up new treatment possibilities for people with conditions such as depression, obsessive compulsive disorder, schizophrenia and anorexia nervosa. "It's a whole new way of looking at mental health treatment," says Dr. Levitt, one of the lead physicians in charge of establishing the CFN.
Dr. Anthony Levitt, chief of the Hurvitz Brain Sciences Program. Photograph by Doug Nicholson
"For the last 40 years, we've talked about mental illness as being a "chemical imbalance." That understanding has helped, but our treatments remain
50 to 60 per cent effective and relapse is unfortunately still too frequent," he says. There is
renewed hope that understanding mental illnesses as brain circuitry disorders will provide a quantum leap forward in treatment: if mental illnesses are circuitry disorders, then once the malfunctioning circuits are found, they can be adjusted.
Cutting-edge and minimally invasive techniques, such as DBS and high intensity-focused ultrasound (HIFU), will be used at the CFN to modulate dysfunctional circuits for conditions as varied as dementia, stroke, depression and anxiety.
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The rising prevalence of neuropsychiatric disorders is driving the urgency to find new treatments for these conditions. The number of Canadians with dementia is expected to double from 747,000 in 2011 to 1.4 million by 2031, while major depression has already become the number one cause of chronic illness and lost productivity worldwide.
Neuromodulation, one response to the coming crush, has become one of the fastest-
growing areas in neuroscience and a new frontier for treatment of brain disorders.
Existing techniques, such as more invasive surgical procedures or electroconvulsive treatment (ECT), also adjust circuitry but lack precision and have side effects that are unacceptable to many patients. The use of HIFU, meanwhile, can much more precisely direct energy to the appropriate location in the brain and can modulate pathways that are not working as they should be, while leaving normally functioning circuits intact.
Already, protocols for the use of neuromodulation are being developed. "Our goal is to work on techniques to reach as many patients as possible," says Dr. Lipsman.
"If we can change the abnormal pathways in the brain that are leading to these mental illnesses, it is entirely possible that we might be able to offer not just treatment, but a cure for some patients," he says.
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