The Manhattan Adult ADD Support Group
We Have Offered Support & Information To Adults In NYC
And The Surrounding Communities With ADD/ADHD Since 1992
We Are Not "Lazy, Crazy, Or Stupid"
 
Past Presentations:
Every month, we invite a prominent Dr., Clinician or Professional to speak to our group about their practice, and their contribution to helping people in the ADD/ADHD Community.
 
Deep Brain Stimulation:
A NEW PSYCHIATRIC TREATMENT?

 
who:      Ron Alterman, MD, neurosurgeon;
                    associate professor of neurosurgery,
                         Mount Sinai School of Medicine;
                    director of Functional and Restorative Neurosurgery,
                          Mount Sinai Hospital
 
  why:      In 2007, attempts to treat ADD -- or, more formally, AD/HD:
               Attention-deficit/Hyperactivity Disorder -- are marked by good
               intentions, dedication, and hard work. And -- all too often --
               frustration.
 
               While some who seek help are helped, others -- for the most
               part -- are not. Some, while moved in the right direction, aren't
               taken far enough. For others, the therapeutic effects are more
               potent; but are then defeated by side effects. Still others do
               well for a time, only to watch their gains recede as a tolerance
               develops to this or that medication.
 
               Compounding this is a dearth of up-and-coming therapies. A
               line of research that might translate to an effective treatment --
               within the lifetimes of those who attend this Support Group --
               is hard to spot. And the clock is ticking.
 
               In AD/HD, a key tool has been pharmacology. Which, in
               terms of efficacy, seems to have an upper limit set by the
               diffuse impact of whatever molecule is selected. Genetic
               research is now popular, but -- while this might aid in drug
               selection -- a direct payoff could be decades away. The
               same may be true of stem cell use.
 
               Coincident with this has been the appearance, within
               psychiatry, of a surgical technique known as deep-brain
               stimulation. In DBS -- a procedure not without risk, and
               not for the faint of heart, but sometimes used when other
               options fail -- an implanted electrical device sends a
               symptom-suppressing pulse to a selected brain target.
               DBS -- often compared to a cardiac pacemaker* -- is
               approved for use in three neurological ailments: essential
               tremor, Parkinson's Disease, and primary generalized
               dystonia.
 
               It's also being tried for epilepsy, chronic pain, high blood
               pressure, low blood pressure, headache, multiple sclerosis,
               or states involving minimal consciousness. As well as:
 
               -- Obsessive-Compulsive Disorder (OCD) in which
               repetitive, fear-provoking thoughts (obsessions) create
               the need for time-consuming -- and often pointless --
               behaviors (compulsions). DBS has reduced both -- to
               one or another degree. While at least one patient has
               done well, the overall numbers are not as good as they
               might be. (Though perhaps they look better for another
               syndrome: Generalized Anxiety Disorder.) Meanwhile,
               a search is underway for a new stimulation target.
                  
               -- Depression, a state of ongoing -- and sometimes
               crippling -- sadness or despair. With DBS, at least
               three potential treatment avenues have emerged;
               each seems to ease a different aspect of the disorder.
               Another breakthrough: the use of imaging to select a
               target.
                               
               -- Tourette Syndrome (TS) consists of sudden, repetitive,
               involuntary movements or sounds. In selected patients,
               DBS has eased this type of motor "tic" [videos available
               in two formats] or vocal tic [click VIDEO]. While not every
               story has been a happy one, and a preferred electrode site
               has yet to emerge, the issue is being pursued.**
 
               These last three will form our topic for September 20.
               Our speaker will be neurosurgeon Ron Alterman, who
               earned a medical degree at New York's Albert Einstein
               College of Medicine. After stints on the faculties of
               three medical schools, Dr. Alterman now teaches at
               Mount Sinai. There, he supervises the program which
               includes DBS.
 
               Dr. Alterman's concerns include cancer treatment,
               aneuryism detection, and image-guided surgery. He
               trained in DBS in the mid-1990s, and has published
               about it since 1999; in particular, he's known as an
               expert on its use for dystonia. Dr. Alterman has also
               considered psychiatric applications, and is part of a
               DBS-for-depression clinical trial. This will be his first
               appearance before the Support Group.
 
               * And sometimes confused with one of the following:
               vagus nerve stimulation; dural ("cortical") stimulation;
               transcranial magnetic stimulation; transcranial direct
               current stimulation; or electroconvulsive therapy.
 
               ** Many who have TS also have some version of AD/HD.
               Through the back door of a TS comorbidity, we now have a
               case study of DBS versus AD/HD-like symptoms. Reported:
               a drop in hyperactivity; a rise in attentiveness; improvements
               in verbal reasoning, psychomotor speed, mental flexibility,
               and visual perception; a decline in memory capability; and --
               for whatever reason -- a 15-point jump in tested IQ.
 

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