Tuesday, May 7, 2013

Brain Mapping

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Last month, President Obama committed $100 million in the next fiscal year to map the human brain the way we have mapped the human genome. Once private funds are included, and government funding over the next fifteen years it's considered about a $10 billion project. It's called the BRAIN Initiative, and its goal is to better treat brain injuries and diseases, from PTSD and concussions in war vets to Parkinson's and Alzheimer's. One goal is an effective treatment for Alzheimer's by 2025. By comparison, the Human Genome Project (HGP) cost about $3.8 billion, and took a little less than its 15-year estimate (about 12-1/2 years).

Even before it was completed,results of the HGP were used to test for and treat medical conditions with a genetic component, and the same is true for the BRAIN initiative.

I went to a talk last week by Dr. Steve Rasmussen, a professor in the Brown Medical School who has made strong inroads in the treatment of obsessive-compulsive disorder, co-author of the most commonly used scale for monitoring symptoms, the Yale-Brown Obsessive Compulsive Scale (Y-BOCS). But some people have multiple work lifelines, and for the past decade or so he's been concentrating on where in the brain OCD lives, and trying to find ways to disrupt the brain functioning in those areas to break OCD cycles, using either a gamma knife or a lesion. It's wicked expensive but at times highly effective.

I knew Steve in another lifetime, when I worked in the Bradley Research  Center  with a great team led by Ron Seifer that studied how mental illness is transmitted through generations, focusing upon mood and anxiety disorders since their development in children is likely a complex combination of factors between genetics and family environment. We observed kids, interviewed parents, videotaped and coded unstructured family dinners, and assessed family functioning. If we did the work now, we'd likely study their brains because Brown is deeply involved already in the Brain Mapping quest.

This project is going to be quite complicated, as you can imagine. One neuron can connect to as many as one million other neurons, and understanding those pathways and connections is complicated by the fact that we can't see a working brain easily, nor clearly see how it works. We rely on activity bursts visible on an fMRI or PET scan, and our knowledge of which parts of the brain typically do what. In high school I was taught there were 6 main parts, in college about 50, and now we know of more than 100 but there are as many neurons in one human brain as there are stars in the Milky Way--more--and mapping their pathways difficult. Scientists are beginning to use fluorescent genes inserted into a live, clarified mouse brain, as announced in Nature this week. Cool, but just a start. Finding solutions for degenerative neurological conditions like Parkinson's, ALS and Alzheimer's are still years away, tragic for those already in their grips. Hope for those of us with such tragedies in our futures.

There will be many announcements along the way, and if you're interested in following along, the best books I have found for understanding the brain and its pathways are both by Rita Carter. The Human Brain book is mostly pictures, and explains the structure and functions of the brain. Mapping the Mind is mostly essays, and explains the connections and the flow of information throughout the brain and body. Both are fascinating.

Especially to me, of course, living with a mild traumatic brain injury. I was seen twice last month by a team of clinicians at the UConn Speech and Hearing Clinic, who  ran me through a few hours of grueling tests and diagnosed an aquired auditory processing disorder, which is the most problematic of my postconcussive symptoms, in my estimation, because it affects my ability to function in the world.  I have a combination of acute sensitivitiy to sound (along with the other senses) and difficulty interpreting what is being said around me. There is a treatment recommended, pioneered at UConn, Dichotic Interaural Intensity Difference Training (DIID), which is quite hideous but often effective after 2-6 months of hard work.

You'll be hearing more about this from me, I guarantee.

This is how my problem plays out as of now (for reference in the future, when we see how much better I am):

When I am anywhere noisy, like my dinner table last night for my stepfather Fred's birthday, I hear odd words, and a lot of nonverbal sound--the laughs, the shrieks--but not full sentences. It's miles beyond nails-on-a-chalkboard irritating. I get headaches and then migraines quickly. I often think if they were speaking another language I'd be in similar straits. Last night, perhaps due to my facial expressions, or perhaps due to my intermittent requests that they all stop talking, my lovely stepdad initiated a "pass the candle" protocol, which was awesome. Only one person spoke at a time. I still couldn't pick it all up, because some of it was silly and nonsensical, and some of it slurred or mumbled, but I could participate. I stopped being irritated by the lot of them and vice versa. It felt good, until I got tired and threw them all out anyway with minimal grace but I was a wreck. It was a school night. They understood.

If you have someone in your family who is hearing impaired in any way, I suggest this for you too. They will love you for it.

But even in quiet, it's hard to listen to anyone discuss something new. Even my husband. Most of what he says is familiar and expected. We talk about the kids, money, funny stories, all stuff I know. After work he tells me familiar tales. These typically involve rude customers at his retail job, staff call-outs, conflicts between co-workers, hassles with the supply chain, and the messiness of his store. I can understand what he's saying quickly, because there's an overlap with what he said the day before, only half the words change. But if he's telling me something new, I don't understand what he's saying. At all. I have to hear it two or three times before I get it, a couple more times to remember it and even then I miss the subtleties because after the second time, he's talking in big-bold-black-and-white and not bothering to fill in the colors. It's annoying to us both. Actually everyone, because I ask people to repeat themselves all the time. Ironic, since I can hear a click on the dishwasher three rooms away from a dead sleep.

So, I'll try the DIID, which is considered a form of cognitive therapy rehabilitation. It involves strengthening the langauge processing in my right hemisphere, since testing showed the connectivity between what is heard on the right side, and the language processing centers in the left, is muddled, likely by sheering within the corpus callosum during my reverberation head injuries.

And it's good to get some answers. They're slow-coming for those with concussive symptoms that
persist for months and years. The book that is most helpful with the general post-concussive process is Mild Traumatic Brain Injury: The Guidebook, by Mary Lou Acimovic. She really knows her stuff. Lots of books will give a first-person account, as I do, in chunks and pieces, but she puts it all together, especially for adults.

For when you otherwise think you're going crazy, though soon enough there will be a brain scan for that and we'll have to live with the fact that we're all normal, in our own ways.

Love, Lisa

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