Posts tagged TMS

New imaging techniques are mapping the locations of our aesthetic response

In Michelangelo’s Expulsion from Paradise, a fresco panel on the ceiling of the Sistine Chapel, the fallen-from-grace Adam wards off a sword-wielding angel, his eyes averted from the blade and his wrist bent back defensively. It is a gesture both wretched and beautiful. But what is it that triggers the viewer’s aesthetic response—the sense that we’re right there with him, fending off blows?

Recently, neuroscientists and an art historian asked ten subjects to examine the wrist detail from the painting, and—using a technique called trans­cranial magnetic stimulation (TMS)—monitored what happened in their brains. The researchers found that the image excited areas in the primary motor cortex that controlled the observers’ own wrists.

“Just the sight of the raised wrist causes an activation of the muscle,” reports David Freedberg, the Columbia University art history professor involved in the study. This connection explains why, for instance, viewers of Degas’ ballerinas sometimes report that they experience the sensation of dancing—the brain mirrors actions depicted on the canvas.

Freedberg’s study is part of the new but growing field of neuroaesthetics, which explores how the brain processes a work of art. The discipline emerged 12 years ago with publication of British neuroscientist Semir Zeki’s book, Inner Vision: An Exploration of Art and the Brain. Today, related studies depend on increasingly sophisticated brain-imaging techniques, including TMS and functional magnetic resonance imaging (fMRI), which maps blood flow and oxygenation in the brain. Scientists might monitor an observer’s reaction to a classical sculpture, then warp the sculpture’s body proportions and observe how the viewer’s response changes. Or they might probe what occurs when the brain contemplates a Chinese landscape painting versus an image of a simple, repetitive task.

Ulrich Kirk, a neuroscientist at the Virginia Tech Carilion Research Institute, is also interested in artworks’ contexts. Would a viewer respond the same way to a masterpiece enshrined in the Louvre if he beheld the same work displayed in a less exalted setting, such as a garage sale? In one experiment, Kirk showed subjects a series ofimages—some, he explained, were fine artwork; others were created by Photoshop. In reality, none were Photoshop-generated; Kirk found that different areas of viewers’ brains fired up when he declared an image to be “art.”

Kirk also hopes one day to plumb the brains of artists themselves. “You might be able to image creativity as it happens, by putting known artists in the fMRI,” he says.

Others, neuroscientists included, worry that neuroscience offers a reductionist perspective. Vilayanur Ramachandran, a neuroscientist at the University of California at San Diego, says that neuro­aesthetics undoubtedly “enriches our understanding of human aesthetic experience.” However, he adds, “We have barely scratched the sur­face…the quintessence of art, and of genius, still eludes us—and may elude us forever.”

(Source: smithsonianmag.com)

ScienceDaily (July 26, 2012) — In one of the first studies to look at transcranial magnetic stimulation (TMS) in real-world clinical practice settings, researchers at Butler Hospital, along with colleagues across the U.S., confirmed that TMS is an effective treatment for patients with depression who are unable to find symptom relief through antidepressant medications. The study findings are published online in the June 11, 2012 edition of Depression and Anxiety in the Wiley Online Library.

(Credit: Butler Hospital)

Previous analysis of the efficacy of TMS has been provided through more than 30 published trials, yielding generally consistent results supporting the use of TMS to treat depression when medications aren’t sufficient. “Those previous studies were key in laying the groundwork for the FDA to approve the first device for delivery of TMS as a treatment for depression in 2008,” said Linda Carpenter, MD, lead author of the report and chief of the Mood Disorders Program and the Neuromodulation Clinic at Butler Hospital. “Naturalistic studies like ours, which provide scrutiny of real-life patient outcomes when TMS therapy is given in actual clinical practice settings, are the next step in further understanding the effectiveness of TMS. They are also important for informing healthcare policy, particularly in an era when difficult decisions must be made about allocation of scarce resources.”

Carpenter explains that naturalistic studies differ from controlled clinical trials because they permit the inclusion of subjects with a wider range of symptomatology and comorbidity, whereas controlled clinical trials typically have more rigid criteria for inclusion. “As a multisite study collecting naturalistic outcomes from patients in clinics in various regions in the U.S., we were also able to capture effects that might arise from introducing a novel psychiatric treatment modality like TMS in non-research settings,” said Carpenter. In all, the study confirms how well TMS works in diverse settings where TMS is administered to a real-life population of patients with depression that have not found relief through many other available treatments.

The published report summarized data collected from 42 clinical TMS practice sites in the US, and included outcomes from 307 patients with Major Depressive Disorder (MDD) who had persistent symptoms despite the use of antidepressant medication. Change during TMS was assessed using both clinicians’ ratings of overall depression severity and scores on patient self-report depression scales, which require the patient to rate the severity of each symptom on the same standardized scale at the end of each 2-week period. Rates for “response” and “remission” to TMS were calculated based on the same cut-off scores and conventions used for other clinical trials of antidepressant treatments. Fifty-eight percent positive response rate to TMS and 37 percent remission rate were observed.

"The patient outcomes we found in this study demonstrated a response rate similar to controlled clinical trial populations," said Dr. Carpenter, explaining that this new data validates TMS efficacy in treating depression for those who have failed to benefit from antidepressant medications. "Continued research and confirmation of the effectiveness of TMS is important for understanding its place in everyday psychiatric care and to support advocacy for insurance coverage of the treatment." Thanks in part to the advocacy efforts of Dr. Carpenter, TMS was recently approved for coverage by Medicare in New England, and it is also now covered by BCBSRI. "Next steps for TMS research involve enhancing our understanding of how to maintain positive response to TMS over time after the course of therapy ends and learning how to customize the treatment for patients using newer technologies, so TMS can help even more patients."

Source: Science Daily