IUBio

request good review article (ECT)

John go at away.com
Thu Nov 19 09:32:31 EST 1998



>In article <7304ug$h5d at sjx-ixn3.ix.netcom.com>, flefever at ix.netcom.com(F.
>Frank LeFever) wrote:
>
>> It is obvious that this fellow is off on a trip of his own, so there
>> would be little point in replying to him; however, there is the danger
>> that someone not sophisticated enough to discount his comments might be
>> led to reject a treatment that could be life-saving.
>>
>> See comments below:
>>
>>
>> In <3650E7E9.57FC5323 at pop3.concentric.net> kkollins at pop3.concentric.net
>> writes:
>> >
>> >"Good"-Grief, Frank, you "embarrass" me :-)
>> >
>> >F. Frank LeFever wrote:
>> >
>> >> Again, kkollins pontificates from his position of authority based on
>> no
>> >> more than popular fiction (e.g. One Flew Over the Cuckoo's Nest).
>> Is
>> >> your response a joke or are you really ignorant of the practice of
>> >> unilateral ECT?
>> >
>> >Without Physically-separating the hemispheres, there's nothing
>> "unilateral"
>> >that occurs in the nervous system... yes, one can try to "steer" such,
>> but
>> >what do you think the cortical targets of the commisural fibers do?
>> >..."opt-out?
>>
>> First, a general observation: we have often seen (in this newsgroup)
>> people who know a little bit about something (often scattered and
>> poorly-undertood terms and facts) assume that others know even less,
>> adolescent "big insights" proclaimed naively (to others who had and
>> worked through such "insights" long ago) as if it were a private
>> revelation, etc., etc.


A good observation. As an individual with rather eclectic interests I have
frequently noticed that when I first look into an area of interest I start
seeing things here and there. I take down a few notes, draw some hopefully
promises speculations therefrom, test and find them good and so feel quite
good about myself until one day (usually months later) I read where someone
has considered the idea and have thoroughly thrashed it out (sometimes
right, sometimes wrong). It takes a while but eventually you realise:

If something makes so much sense to you that you cannot understand why
others have not thought of it before one of three possiblities exist:

 someone has, you just haven't read enough.
 someone has, and they know why its a stupid idea.
 no-one has, see a psychiatrist.

I use this formula as a standard epistemological heuristic, I only wish more
would adopt it.

>> In this particular case, kkollins assumes that someone who has been
>> studying brain function for several decades, has done research at the
>> physiological/anatomical level as well as at the cognitive/behavioral
>> level as a (doctoral level) clinical and experimental neuropsychologist
>> has not done even as much reading as he has about interhemispheric
>> relations.  Naive, arrogant, presumptious!


Consider the number of self help books kicking around relying on popular
neuroscience. I think its part of being human, most people are fascinated by
the grey stuff upstairs and many, myself included, wish to sound
knowledgeable about such stuff. Unfortunately I am just confused about it
all these days, but of course when speaking to others I throw out airs of
authority ... .

>> Besides a pretty good general professional knowledge of not oonly the
>> corpus callosum but also the anterior commissure, posterior commissure,
>> and hippocampal commissure (to say nothing of indirect influences via
>> the diencephalon), there are several more "personal" experiences to
>> keep me alert to interhemispheric relationships.
>>
>> For ex., about 35 years ago, in preparation for research with a recent
>> post-doc from Sperry's lab (a "classmate" of Gazzaniga's), I was
>> practicing corpus callosum section and unilateral hippocampal excisions
>>  in (dead) cat heads--project fell through when NYU delayed too long in
>> buying cages for LIVE cats.
>>
>> For ex., about 18-20 years ago, one of my patients with MS, a
>> right-hander, switched to the left hand to do the Block Design (WAIS).
>> Having seen demonstrations of the superiority of left-hand Block Design
>> performances  by split-brain patients (compared to right-hand), I had
>> the sudden insight that inasmuch as the corpus callosum is the largest
>> myelinated stucture in the brain, MS patients may have a partial
>> disconnection syndrome--unfortunately, did not write this up, but
>> others have indeed demontrated that this is true.
>>
>> For ex., sometime in the past 20-30 years, a former student of mine
>> (Stanley Glick) found that the CC was impoortant in neurotransmitter
>> balance across the hemispheres--after it was cut, prior DA asymmetries
>> increased and ACh asymmetries developed.


This sounds interesting, where can I read about it?

>> About 15 years ago, using a computer-driven visual display I built
>> (LEDs in a plexiglass dome) I was able to replicate Brend Milner's
>> finding of a slight latency difference between ipsilateral and
>> contralateral reaction times in a patient with callosal agenesis (about
>> the same order of magnitude as she found, if I recall correctly).
>>
>> More recently (5-6 yrs?), a former colleague, Robert Sloviter,
>> described long inhibitory fibers from each hippocampus to the other (I
>> heard it from the horse's mouth).
>>
>> ACCOORDINGLY, you may be sure I did not forget callosal transmission
>> when I wrote about unilateral vs. bilateral ECT.  The difference
>> between kkollins inferences and mine lies in the fact that I know
>> something about ECT and he apparently does not.
>>
>> There have been and coontinue to be many studies comparing unilateral
>> and bilateral ECT.  Hormonal responses, clinical outcomes, cognitive
>> effects have been compared (unilateral vs. bilateral).
>>
>> Yes, of course seizure propagation from right to left cortex is to be
>> expected, but the latest EEG evidence I know of shows concordance
>> mainly in the froontal lobes (which is the preferred target for
>> neurophysiological changes, inasmuch as functional imaging studies show
>> them to be most important), but much less between posterior areas.
>> Indeed, it has been suggested that the decreased cognitive side-effects
>> (transient and mild, n.b.) with unilateral ECT is due to the
>> procedure's eliciting less seizure activity in left temporal (and
>> occipital) areas.


Talking of the cc, can you direct me to a good text dealing with theories
regarding just what is happening here? I sometimes wonder if the cc is
overlooked to some extent yet this massive bundle must provide important
clues. Is it true that across the visual cortex the numbe of cc connections
increases from primary to tertiary visual structures? If so, can you
speculate on what this may indicate?

Kkollins complaint about ECT may have some historical validity but I
understand the procedure has been refined over the years and proving to be
much more effective. The situation reminds me of the lobotomy hassles
decades ago. While there were some grievances to be addressed here, from
what I can gather the whole ruckus grew more out bad public reporting than
the predominant medical practice at the time.

>> >"Depression" is an engineered-in, fully-functional mechanism upon
>> which
>> >Survival depends.
>> >
>>
>> So is activation of the HPA axis by various stressors; but unregulated
>> activation can be harmful to the individual.  Perhaps kkollins has in
>> mind "Survival of the Fittest" (as crudely construed by those who don't
>> really understand Darwin)? Racial improvement via individual suicide?


Oh go read Dawkins, the trouble people go to in trying explain suicide in an
evolutionary perspective.
 >> I can only hope that his unfounded
>> >> but confident assertions do not
>> >> discourage someone from taking advantage of a therapy which DOES
>> work
>> >> for many depressives who still suffer and do not respond well to any
>> >> medication.

That's what we amateurs hate about you experts. How can we sound clever with
people like you around Frank? Your comments re the use of this treatment is
exact, the ECT therapy is utilised when other measures have failed, and as
someone who suffers occasionally from severe depression I can assure you
evolution has nothing to do with it. My bet is that the frontal lobes, one
if not the last areas to undergo expansion during our evolution, have not
been sufficiently fine tuned by the evolutionary process and so things will
tend to go awry on occasions. Many psychiatric conditions seem to relate to
frontal lobe dysfunction.


kkollins should take a leaf out of my book. If he wants to run wild
speculations around he should become a Rugrat, as I was not so long ago. It
can be a useful game, but only if you remember it is a game.

Finally, many people on ngs like myself learn a good deal through well
informed ng posters. This is the only place I can discuss these things as
none of my friends or associates are interested in this stuff.

The Astonishing Hypothesis: The Scientific Search for the Soul, Crick,
Francis

251
"At times I even persuade myself that I can glimpse some of the answers, but
this is a common delusion experienced by anyone who dwells too long on a
single problem."


Too curious for my own good,


John
johnhkm at logicworld.com.au





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