Pioneering brain surgery to treat Tourette’s

February 9, 2011February 9, 2011

Brain structures implicated in Tourette syndrome

The BBC UK health website carries a story this week of a Devon man with Tourette’s syndrome who is to undergo a pioneering form of brain surgery.

Mike Sullivan, 32, who was diagnosed with the condition at the age of 12, has elected to undergo deep brain stimulation to help reduce his involuntary tics.

Tourette syndrome is an inherited neuropsychiatric disorder which begins in childhood. It is characterised by multiple physical (motor) tics and at least one vocal (phonic) tic

Mr Sullivan has tried a number of different medications. None has relieved his symptoms but many have given him serious and unpleasant side effects.

For deep brain stimulation a local anaesthetic is used and electrodes are put into the brain through the skull.

These are linked to a pacemaker-type battery in the patient’s chest then electrical impulses are sent to the brain to block the damaging signals.

A common perception of Tourette’s is that it is a bizarre condition, most often marked by the involuntary exclamation of obscene words, but actually this symptom is present in only a small minority of people with Tourette’s.^[1] Between 1 and 10 children per 1,000 have Tourette’s;^[2] as many as 10 per 1,000 people may have tic disorders,^[3] with the more common tics of eye blinking, coughing, throat clearing, sniffing, and facial movements. The severity of the tics decreases for most children as they pass through adolescence, and extreme Tourette’s in adulthood is a rarity.

The exact cause of Tourette’s is unknown, but it is well established that both genetic and environmental factors are involved.^[4] Gender appears to have a role in the expression of the genetic vulnerability: males are more likely than females to express tics.^[5]

Tourette syndrome is a spectrum disorder—its severity ranges over a spectrum from mild to severe. The majority of cases are mild and require no treatment.

However Mr Sullivan said he has to work hard to suppress the almost continual tics while working with the public at Exeter Register Office. He describes this experience as exhausting and mentally draining. He says he is aware of the risks involved in undergoing brain surgery, but if it led to any improvement in his condition it would be worth it.

“Whilst I’m scared and it’s not something I’d choose to do, it’s more than worth the risk,” he said. “If it improves me even by 5% or 10%, it will make such a massive difference to my quality of life.”

Doctors at the National Hospital for Neurology and Neurosurgery in London are trialling the use of deep brain stimulation to treat not only Tourette’s Syndrome, but Obsessive Compulsive Disorder, which many Tourette’s patients including Mr Sullivan also suffer from.

Only a few procedures have so far been carried out worldwide, but Mr Sullivan has been recommended for treatment by Dr Tim Harrower, a consultant neurologist at the Royal Devon and Exeter Hospital.

Tourette Support Ireland hopes to develop a countrywide network to support adults with the condition at its annual general meeting at 11am on Saturday, February 19th, in the Ashling Hotel, Dublin. Dr Tara Murphy, clinical psychologist at Great Ormond Street Hospital, will offer advice on behaviour therapies for the condition, and there will be a music workshop for young people. Tel: 087-2982356 or e-mail support@tsireland.ie. Advance registration on tsireland.ie.

^Notes

^{[1] Schapiro NA. “Dude, you don’t have Tourette’s:” Tourette’s syndrome, beyond the tics. Pediatr Nurs. 2002 May–Jun;28}

^[2] Lombroso PJ, Scahill L. “Tourette syndrome and obsessive–compulsive disorder”. Brain Dev. 2008 Apr;30(4):231–7. doi:10.1016/j.braindev.2007.09.001 PMID 17937978

.^[3] Tourette Syndrome Fact Sheet. National Institute of Neurological Disorders and Stroke/National Institutes of Health (NINDS/NIH), February 14, 2007. Retrieved on May 14, 2007

^{[4]Walkup JT, Mink JW, Hollenback PJ, (eds). Advances in Neurology, Vol. 99, Tourette Syndrome. Lippincott, Williams & Wilkins, Philadelphia, PA, 2006, p. xv. ISBN 0-7817-9970-8}

^[5]Black, KJ. Tourette Syndrome and Other Tic Disorders.eMedicine (March 30, 2007). Retrieved on August 10, 2009.

Six ways to apply neuroscience to learning

February 7, 2011

If you have been following my series of posts last week on neuroeducation, you will have seen how learning actually changes the shape of the brain, allowing specific areas in the brain to grow or change.

Neuroeducation is moving closer to the classroom as researchers understand how young minds develop and learn.

An interesting recent finding is that children from troubled family situations show abnormally high blood levels of cortical – a stress hormone – which drops dramatically while in preschool. This finding suggests that placing children from troubled families as early as possible in a safer environment – such as preschool – is a good idea not just from an educational- but also a mental health point of view.

Six ways to apply neuroscience to learning

Connect emotionally with the child – a safe environment promotes learning while fear kills learning. This is first on the list because it is the most important.
Create an enriched physical learning environment – employ as many of the five senses – seeing, hearing, touching, tasting and smelling – in your teaching.
Teach on how to apply knowledge – not just impart knowledge for knowledge sake – thus, learning to tie a shoelace can also be used to wrap a gift for mom.
Teach for mastery – break down the information into manageable units and create tests for students to take on each of the units. Leave no child behind.
Design curricula based on big-picture concepts – change your style and approach as situations change.
Evaluate learning outcomes periodically – you need to know quickly what’s working – and what’s not.

Image Credit: Superstock

Weekly Round-Up

February 4, 2011February 4, 2011

Why do we love to learn about the brain?

In today’s weekly round-up..how patients with signs of dementia may improve their brain health with exercise, how brain cooling could aid stroke recovery, how brain scans can predict the likely success of giving up smoking, and finally why learning about the brain can become addictive.

According to researchers, just 40 minutes of moderate exercise in pensioners physically grows the brain and helps people enhance their brain power. It was found that regular exercise programs work on people already showing signs of dementia and loss of brain function. Meanwhile, McGill’s Dr Véronique Bohbot, believes that spatial strategies can reduce risk of dementia.

Cooling the brain of patients who have suffered a stroke could dramatically improve their recovery, according to research at the Centre for Clinical Brain Sciences at the University of Edinburgh.

Were you one of the many who made a New Year’s Resolution to give up smoking? Brain scans showing neural reactions to pro-health messages can predict if you’ll keep that resolution to quit smoking more accurately than you yourself can. That’s according to a new study forthcoming in Health Psychology.

Finally, in the Psychology Today blog, Dr David Rock asks the question “why is it so engaging, almost addictive, to learn about how your brain functions” and concludes that it is “because it makes life feel richer, and enables us to achieve our intentions”.

What better way to end this week’s round-up! May the learning continue…

Dyslexia rules KO

February 2, 2011February 3, 2011

Image Source: Corbis

In my previous neuroeducation post, I briefly outlined the latest scientific research which shows that learning actually changes the shape of the brain, allowing specific areas in the brain to grow or change and how most importantly this brain growth can be accelerated to improve learning and memory using certain approaches to teaching.

Neuroeducation also encompasses the study of common conditions such as brain injury, dyslexia, hyperactivity attention deficit disorder, learning disability, malnutrition, stuttering and indeed depression and anxiety disorder.

Today let’s take a look at one of these conditions in more detail.

Dyslexia rules KO

Research has shown that children with dyslexia suffer from two specific problems: trouble analyzing and processing sound (phonology) and difficulties with rapid naming of objects.

Early intervention particularly with phonological therapies – before the child gets into trouble in school – appears to prevent dyslexia. The old idea was that dyslexia was somehow a hole in brain – a mental deficit – is not the case. These children appear to be just on the low end of an ability to learn to read instead of having some problem in their brains in much the same way as those children who find difficulty learning a musical instrument.

The problem for dyslexic children is that unlike learning a musical instrument, learning to read is regarded by society as an essential skill – thus putting these kids on the back foot. The good news is that early detection and treatment for dyslexia is available and better and more effective treatments are being developed as we speak.

Dalai Lama to visit University of Limerick

February 1, 2011

The University of Limerick is to host a public address by His Holiness, the Dalai Lama on Thursday, 14th April 2011. The event is being organised in conjunction with the charity ‘Children in Crossfire’ established by Richard Moore, a long-time friend of the Dalai Lama, and two non profit organisations, Spunout.ie and Afri.

The University of Limerick address will be the final engagement for the Dalai Lama who will be in Ireland for just two days in April as a guest of Richard Moore and ‘Children in Crossfire’. The charity was established in 1996 by Richard Moore from Derry, who in 1972, aged 10 was blinded by a rubber bullet and has since become a leading international advocate for the rights of children suffering from the injustice of poverty.

Richard was awarded the Harry McKillop Irish Spirit Award for his humanitarian activities. ‘Children in Crossfire’ envisages the creation of a safe environment where all children can realise their rights, develop to the fullest and reach their potential. By improving early childhood care for development, the charity, of which the Dalai Lama is Patron, strives to empower young children and their communities to build a better future.

Civic and community leaders will be invited to hear His Holiness speak on the theme of ‘The Power of Forgiveness’ and the event will include ritual chant and music performances by students and faculty of the Irish World Academy at UL as well as performances by the Irish Chamber Orchestra. Limerick primary and secondary school children involved in the ‘Music as an Instrument of Social Change” programme will also perform. This programme aims to bring music into the culture of schools, particularly those in the Regeneration areas.

The event, which will take place from 9:30am to11:30am, is open to members of the public. Tickets for this event will be on sale at a cost of €25 and are subject to booking fees and online charges. All proceeds from the event will support a Dalai Lama initiative to be established at UL. Tickets will shortly be available for purchase. Those interested in purchasing tickets can register their interest by accessing www.ul.ie/dalailama

How learning changes the shape of your brain

January 31, 2011February 7, 2011

Neuroeducation – the brain science of learning – is an interdisciplinary field that combines neuroscience, psychology, education theory and practice, and machine learning algorithms to create improved teaching methods and curricula.

The latest scientific research shows that learning actually changes the shape of the brain, allowing specific areas in the brain to grow or change and – most importantly – this brain growth can be accelerated to improve learning and memory using certain approaches to teaching. This new discipline is moving closer to the classroom as researchers understand how young minds develop and learn.

Why I practice what I preach

As a neuroscientist and teacher I have a keen interest in this area and I have tried to apply the latest findings to my own teaching in the classroom over the past 30 years. I had the honour of being invited to speak at an International Conference on Engaging Pedagogy (ICEP) * in NUI Maynooth last Friday 28^th January. This is an annual event that brings together researchers and practitioners in the field of third-level teaching in order to discuss means and methods of improving student engagement. In my talk I discussed how recent findings from neuroscience – the scientific study of the brain – impacts on education and I commented on the fast pace of research in this area over the past five years. You can view my abstract and those of the other presenters here.

My talk has prompted me to explore in more detail the nature of neuroeducation and how it can lead to improved teaching and learning. This week on the Inside the Brain blog I will be exploring how certain approaches to teaching act to improve brain function, learning and memory.

* Click here for ICEP proceedings

Image Credit – Dreamstime

Weekly Round-Up

January 28, 2011

Does sleep help you learn? (Image: Big Stock)

In today’s weekly round-up..how memories take better hold during sleep, nature vs nurture, fake it til you make it, the nature of heroism, the pathology of Alzheimer’s, the neuroscience of fear and loathing, and more.

It appears from the latest research that the best way to hold onto a newly learned poem, card trick or algebra equation may be to take a quick nap, for the brain is better during sleep than during wakefulness at resisting attempts to scramble or corrupt a recent memory. The study, published in Nature Neuroscience, provides new insights into the complex process by which we store and retrieve deliberately acquired information.

Athena Stalk in Your Brain and The Power of Rehearsing Your Future explains that the advice to “fake it til you make it” is backed up by some of the latest findings on the brain.

Interesting article from Jonah Lehrer in the Wall Street Journal on the perennial nature vs nurture debate. And in a similar vein, is there a gene for heroism or is it down to social or economic factors? Can neuroscience explain the nature of heroism?

The Neuroscience of Fear and Loathing is an interesting look at this universal emotion.

Findings from a new study from the University of Haifa shows that people diagnosed as psychopathic have difficulty showing empathy, just like patients who have suffered frontal head injury.

Article in this week’s New York Times on a new brain scan technology to detect Alzheimer’s pathology in the brain.

How Perception Reveals Brain Differences explores the ways in which brains differ from one another and the ways in which we owners perceive the world accordingly.

Set your Brain to Meditate: Part 3

January 27, 2011

This is the third part in this series on mindfulness and today we will be taking a look at our mental images and preconceived ideas, more on mindlessness, the power of imagination and the role of intuition in our lives.

Ms. Havisham in Dickens’s Great Expectations

We need to be careful not to hold on to outmoded opinions and attitudes – false frozen mental images – best exemplified in Ms. Havisham in Dickens’s Great Expectations – who continued to wear her wedding dress in which she was abandoned many years before and which hung in torn and faded threads over her aged body.

Even a child can fall into this trap – for instance by regarding all old men as grumpy after just one experience with a grumpy old man and this impression may even be carried into adulthood. In not bothering to change this perception in later life – a person can be locked into a false perception in later life that is likely to be reflected in their own experience – they will turn into an old grump too! – and this of course applies to other aspects of life.

Context is everything

Mindlessness results when people accept information without taking the context into account. However in mindfulness context is everything! In fact, psychologists argue that all pain is context dependent. Getting a bruise out on the football pitch will matter much less to us than if we sustain one at home.

The power of imagination

Imagination is the key to perceiving things differently. The Birdman of Alcatraz stuck in his prison cell for over 40 years managed to make his life a rich one by taking care of injured birds. The message is simple – you can put up with anything as long as it is within a positive context – and with a personal vision everything can be put into perspective. In the famous words of Nitzche “If you have a WHY you can put up with almost any HOW”.

It’s not what you do – it’s the way that you do it!

Another key characteristic of mindfulness is a focus on process before outcome – doing rather than achieving. We look at a text book and assume that the author must be a genius …but this is a faulty comparison. With rare exceptions most successes in life are the result of years of work that can be broken down into stages. Before you face any task no matter how daunting – ask not ‘can I do it? – But – HOW can I do it?’ This type of approach sharpens your judgment and leads to increased self confidence.

Intuition is effortless and it works!

Sometimes it’s good to drop old habits and expectations and try something that may go against reason. Intuition is an important path to mindfulness. It may surprise you to know that the best scientists are intuitive – many spending years methodically validating what appeared to them in a flash of intuitive truth.

Intuition is achieved by escaping the heavy single minded striving of everyday life. It is believed to occur on those rare occasions when both hemispheres of the brain – the logical left side and the holistic right side – have a brief uninterrupted conversation. Intuition gives valuable information about our survival and success – ignore it at your cost.

The mindful person will go with what works even if it doesn’t make sense!

In summary, the beauty of mindfulness is that it is not work. It leads to greater control of your own thinking and can create a sense of quiet excitement about what is possible.

Try it and see for yourself!

Set Your Brain To Meditate

Part 1

Part 2

Set your Brain to Meditate: Part 2

January 25, 2011January 28, 2011

Image: Photostock

The Buddhist understanding holds that meditation is a mindful state that leads to ‘right action’. When combined with mindfulness it has the same effect not just for the health of the individual but also for greater society.

Our tendency to look at the negatives, to put outcomes ahead of actually doing things and by making faulty comparisons with others can leave us like feeling like robots at the mercy of daily events. In essence mindfulness is about preserving our individuality – through openness to the new, reclassifying the meaning of our knowledge and experience and by an ability to see our daily actions in a bigger consciously chosen perspective.

When good categories turn bad

Rather than always look at things afresh and anew – we create categories – and let things ‘fall into them’. We do this for the sake of convenience. These categorisations can be small such as defining a flower as a rose, a person as a boss – or a wider categorization – such as a religion or a political system. These categories help to give us psychological certainty and save us from the effort of constantly challenging our own beliefs. In this way we define animals as ‘livestock’ or ‘pets’ so that we can feel OK eating one and loving the other.

Shhhh….there’s a secret to being a genius

Mindlessness is when we accept these categories without really thinking about them. In contrast, mindfulness is about questioning old categories and creating new ones. In fact ‘genius’ has been described as perceiving things afresh, in a non habitual way.

Let me leave you with a quote from Marcel Proust’s great novel In Search of Lost Time Past to illustrate what I mean and check back in later this week for Part 3 of this meditation series.

We commonly live with a self reduced to its bare minimum; most of our faculties lie dormant, relying on habit; and habit knows how to manage without them.

Read the first part of this series here

Set Your Brain to Meditate

January 22, 2011January 28, 2011

Ms Ursula Bates, keynote speaker, UL Research Forum and Professor Billy O'Connor

I was delighted to host the Fourth Annual University of Limerick Medical School Research Forum last Wednesday, 19 January, where over twenty researchers from the University of Limerick and local teaching hospitals made presentations on topics ranging from pharmaceuticals, biomedical devices, medical technology, community health, gastrointestinal and vascular surgery, psychiatry and communications.

A leading clinical psychologist and Director of Psychosocial and Bereavement Services at Blackrock Hospice, Dublin, Ms Ursula Bates, delivered the keynote address “Mindfulness Based Interventions in Oncology and Palliative Care and Bereavement-Research Advances”.

Ursula’s talk has prompted me to explore in more detail the nature of mindfulness and how its practice can lead to improved brain function and mental health.

Let’s start by taking a look at the latest scientific research which has shown that the practice of meditation actually changes the shape of the brain, allowing specific areas in the brain to grow or change. This finding has established a new field of contemplative neuroscience – the brain science of meditation – and helps to explain how meditation acts to improve brain function and mental health.

Mindfulness and mindlessness

Have you ever written a cheque in January with the previous years date? …for most of us the answer is probably yes. Scientists now know that these small mistakes are actually the tip of a mindlessness iceberg! Mindfulness harnesses one of the great themes in all self help literature – the need to be free of unconsciously accepted habits and norms.

Five qualities of a mindful person