Evolutionary Medicine: A Look at Brain Treatments
Back in 6500 B.C., our ancestors drilled holes in the skull to release the evil spirits they believed caused seizures, headaches and mental illness. Thanks to a greater understanding of how the brain works, modern medicine has made quantum leaps in medical technology and treatments since the Stone Age. Here are a few examples of this amazing evolution.
Flashback: In ancient India, physicians used seeds from the Mucuna, a pod-bearing plant, to treat a disease that caused uncontrollable shaking, stooped posture and stiffness of motion, then known as Kampavata.
Flashforward: In the 1950s, researchers found that dopamine reduction in the brain causes what is now called Parkinson’s disease. This led to the development of l-dopa, or levodopa, a drug that converts into dopamine.
Today researchers work toward promoting dopamine production by developing drugs that strengthen and protect cells. Doctors now perform a less invasive surgery called deep brain stimulation (DBS). Performed at Rush by neurosurgeon Roy Bakay, MD, and neurologist Leo Verhagen, MD, PhD, DBS shuts down overactive brain circuits using electrodes.
The Mucuna plant has been found to be a source of l-dopa and is used by some people as an alternative to conventional treatments for Parkinson’s disease.
Flashback: In ancient times, epilepsy was thought to be the result of possession by demons or evil spirits, a curse from the gods or even a witch’s spell. People with epilepsy in most cultures were stigmatized or even locked away.
Flashforward: Doctors realized that epileptic seizures are caused by abnormal electrical activity in the brain, which led to the development of potassium bromide, the first effective drug for epilepsy, in the mid-19th century. Today there are 15 U.S. Food and Drug Administration (FDA)-approved epilepsy drugs. And thanks to improvements in imaging such as the revolutionary imaging technique SISCOM — available at only a handful of hospitals including Rush — doctors can now more accurately pinpoint a seizure’s origin. This has enabled the creation of targeted treatments — including electrical stimulators and implantable pacemakers — for people whose epilepsy can’t be controlled with medications.
Flashback: Identified by Hippocrates as early as 1599, a stroke was still considered by doctors to be treatable only after the fact as late as the mid-1990s.
Flashforward: In 1996 the FDA approved tissue plasminogen activator (TPA), which can dissolve the blood clots that cause bleeding in the brain. Now there’s a way to stop an ischemic stroke as it’s happening — assuming it’s diagnosed quickly.
Aided by the development of 3-D imaging, neurologists and neurosurgeons started using catheters to treat stroke-causing aneurysms, malformed blood vessels and clots nonsurgically. Doctors at Rush, including endovascular neurosurgeons Demetrius Lopes, MD, and Michael Chen, MD, tested and refined rapidly evolving endovascular technology, including Wingspan, the first stent specifically designed for blocked blood vessels in the brain; the Penumbra Stroke System, which restores blood flow in the brain to limit damage caused by stroke; and Onyx, a state-of-the-art glue used to seal aneurysms.
Flashback: Intrigued by the ancient practice of using herbs to spur convulsions, doctors in 1932 used electricity to create a similar effect in patients with major depression, leading to the development of electroconvulsive therapy (ECT).
Flashforward: A greater understanding of chemical imbalances in the brain and the origins of depression led to the advent of antidepressants in the 1960s. “Talk therapy” also had a place in treatment along with medication and ECT.
In the 1990s, however, researchers discovered that magnetic stimulation of the brain makes people feel better. In 2008, a study co-authored by Philip Janicak, MD, a psychiatrist at Rush, reported that using electrically generated magnetic pulses — transcranial magnetic stimulation (TMS) — is an effective treatment for depression in patients for whom medication does not work. Noninvasive, TMS excites neurons in the brain with magnetic pulses to the scalp. Unlike ECT, TMS does not trigger epileptic seizures or adversely affect memory.
Head and Neck Tumors
Flashback: Although the first head and neck “polyp” was removed in 1860 with the aid of a crude laryngoscope, most head and neck tumors in the late 1880s went untreated — an often fatal approach — because of the high risk of surgical complications.
Flashforward: In the late 1990s, doctors began offering in-office biopsies so patients could avoid a trip to the operating room. Guided by a high-definition GPS mapping system and using specially designed endoscopes, head and neck surgeons and neurosurgeons can now remove many small brain tumors through the mouth or nose.
Targeted radiation therapy, developed in the late 1990s, seeks out any microscopic cells left behind after tumor removal, making minimally invasive procedures a good option for more patients. In 2005, Guy Petruzzelli, MD, PhD, director of the Coleman Foundation Head and Neck Cancer Center at Rush, was the first in the Midwest to remove a malignant brain tumor at the base of the skull through the nose.
For more information on Parkinson’s Disease
To learn more about surgical solutions for Parkinson’s disease, join us for a free class on Dec. 2. See Upcoming Events to register online or, for more details, call (888) 352-RUSH.
Neurological Care at Rush
The neuroscience program at Rush University Medical Center in Chicago, Illinois, is considered among the nation’s best. From using deep brain stimulation to eliminate the tremors of Parkinson’s and other movement disorders to applying minimally invasive approaches to treating the spine and brain, experts at Rush are helping to revolutionize care for patients at Rush and around the world.
At Rush, our team is on the leading edge of advances in medicine, whether it’s a new minimally invasive technique or a novel drug. Because Rush is an academic medical center, our patients benefit from all of the latest innovations, including some that are unavailable anywhere else in the world.
For more information about care for neurological conditions visit the Neurological Care home page.
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