Sascha Rasquin and Teresa Schuhmann Sascha Rasquin and Teresa Schuhmann Loraine Bodewes

Non-invasive brain stimulation: miracle or hype?

In Mind
Written by  Hans van Vinkeveen Thursday, 15 October 2015 14:30

The clinical potential of non-invasive brain stimulation seems to be almost unlimited. But with few applications having been thoroughly tested, the expectations are too high. Research is now set to begin on the effects of brain stimulation on cognitive rehabilitation after a stroke. The study is a unique collaboration between Teresa Schuhmann of Maastricht University (UM) and Sascha Rasquin from the Adalante-Zorggroep rehabilitation centre. “The interaction between fundamental research and clinical treatment is a win-win situation.”

 

Non-invasive brain stimulation is booming. Initially a research technique used to evaluate the functionality of different brain regions, it is now being used more and more often to treat psychiatric patients. The principle itself is not new. A coil on the head generates a brief magnetic pulse, which produces electric currents in the brain that stimulate neurons to fire. This in turn causes neighbouring cells to respond, both in other areas of the brain and elsewhere in the body.

“We use electric pulses to either activate or inhibit the activity of a specific brain region”, explains Schuhmann, a researcher at the Faculty of Psychology and Neuroscience. “The goal might be, for example, to improve the communication between brain regions.” She is enthusiastic about the technique: “It’s a fantastic method that has taught us a lot about the brains of healthy people. It has great clinical potential.”

Unprofessional use
Meanwhile, the number of clinics and clinicians offering the technique as a treatment is on the rise. Non-invasive brain stimulation, it seems, is being hailed as a miracle treatment for a wide range of psychological and neurological disorders, from strokes and obsessive-compulsive disorder to obesity and depression. “But many of these clinical applications are unfounded. The effect has only been shown in cases of severe depression and neuropathic pain”, Schuhmann warns. “In the absence of fundamental research, you have to be careful with treatment methods. It’s unethical as well. We receive an incredible number of emails for help from patients we have to disappoint.”

The popularity of non-invasive brain stimulation is leading to unprofessional use. “It’s a safe technique, but you’ve got to know what you’re doing. You can’t just put a coil on someone’s head. We usually take a brain scan first, so that we know exactly which areas to stimulate. Also, the magnetic field can’t be too strong or too weak.” For these reasons, a foundation will soon be established to raise awareness of the difference between sensible application of brain stimulation and quackery.

Forgotten side of the body
That said, non-invasive brain stimulation is developing rapidly. Schuhmann is now collaborating with Rasquin, a neuropsychologist at Adalante-Zorggroep, to investigate whether brain stimulation can be used to treat neglect, a disorder that occurs after a stroke. Patients with neglect ignore one side of the world: they eat only half of what’s on their plate, or shave only half of their face. “It’s essentially an attention problem, which makes rehabilitation extra difficult”, says Rasquin. “The patient is unaware of one side of their body, but also of the problem itself.” Around one in five of stroke survivors suffer from neglect.

As Rasquin explains, neglect involves an imbalance between the healthy and the damaged areas of the brain. Brain stimulation is used to inhibit the healthy area in hopes of activating the damaged area. This is done by having patients perform tasks that engage the neglected side, directly after real brain stimulations and after placebo treatments. Rasquin: “The key question is, do patients with neglect respond positively to the real brain stimulation?”

Unique collaboration
Both researchers see the interaction between fundamental research and clinical treatment as a win-win situation. Schuhmann: “We neuroscientists investigate whether models based on healthy people work for patients as well. Conversely, the clinical examination of damaged brains provides us with new knowledge. We keep going back and forth like that.” And yet, this type of collaboration is still rare in Limburg – which surprises Schuhmann, considering its number of hospitals and rehabilitation centres. Within UM, however, collaboration is just getting started. There are plans to investigate the effects of brain stimulation on depression, and Schuhmann’s department together with the Department of Clinical Psychological Science will explore whether the technique can be used to treat obesity and eating disorders.

More efficient rehabilitation
The brain is an immense network of neurons kept in balance by a cacophony of electric signals and chemicals. This complexity, the researchers warn, calls for humility. “We still know very little about the brain”, says Rasquin. “You often hear people saying that after a stroke, this or that area of the brain is damaged. Which is true in some cases, but not in many others.”

“And with fundamental research you often don’t know what results you’ll get”, Schuhmann adds. Ultimately, the researchers hope to show that patients benefit from receiving brain stimulation before starting on rehabilitation exercises. “Rehabilitation will be much more effective once the brain is more balanced and attention to the forgotten side of the body has been restored.” And who knows – they might even discover a new treatment for neglect. “Of course we’d love to make headlines with that kind of discovery,” says Rasquin, “but that’s not the way it works. It’s always three steps forward, two steps back.”

 

Teresa Schuhmann (1979) is assistant professor at the Department of Cognitive Neuroscience at UM’s Faculty of Psychology and Neuroscience. Her research focuses on the combined use of transcranial magnetic stimulation (TMS) and functional magnetic resonance imaging (fMRI) in the fields of applied and social neuroscience. She is also interested in a translational approach in which non-invasive brain stimulation (NIBS) techniques are applied in a clinical setting to treat neuropsychiatric and neurological patients.

Sascha Rasquin (1976) obtained her PhD at UM. She combines the roles of scientist and psychologist, having worked since 2008 for both the UM Department of Rehabilitation Medicine and the Adelante-Zorggroep rehabilitation centre. As a psychologist, she is engaged in diagnostics, cognitive rehabilitation and treatment of the psychological consequences of brain injury. As a scientist, she is responsible for coordinating scientific activities in the field of trauma, implementing new research projects and presenting results.

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