By David Kattenburg for CBC News - February 4, 2016
Studies could help people suffering from panic attacks, psychosis and obsessive-compulsive disorder.
"It's like sort of boxes opening up, and your brain just launches these things without you actually trying to stimulate them." That was how then-senator, and retired general, Romeo Dallaire described the flashbacks that bubble up in his head.
Dallaire made the comments in a 2013 interview with the CBC's Sunday Edition, 20 years after the Rwandan genocide he tried to stop. He's far from alone in dealing with those type of unwelcome flashbacks. An estimated 10 per cent of Canadians struggle with depression, flashbacks and panic attacks as a result of post-traumatic stress disorder, or PTSD, according to the Canadian Mental Health Association.
About 14,000 Canadian veterans also suffer from PTSD, including Dallaire. And the retired general's description aptly sums up how brain circuits work.
It also fits with recent brain research on post-traumatic stress disorder, or PTSD. Dr. Apostolos Georgopoulos is the director of the Brain Science Centre at the Minneapolis VA Medical Centre, a large veterans' hospital in Minnesota. Researchers there say they've pinpointed the neural circuits that drive PTSD flashbacks and panic attacks.
"Your brain is a dynamic network," said Georgopoulos, describing how healthy brains form neural networks, and then wipe the slate clean and start all over. "So when you have, let's say, a visual stimulus come in to your eyes, then the visual network that receives that information becomes temporarily locked. That individual system lasts for a few seconds. And then very quickly, [the network] becomes again ready to absorb new information."
That's how nine of out of 10 people process their experiences, be they mundane or horrific. One out of 10, however, don't wipe the slate clean. Dreadful sights and sounds resonate in their heads.
Georgopoulos' lab can spot PTSD sufferers by magnetically scanning their brains, a procedure called magnetoencephalography.
"The healthy people had the ability to maintain the flexibility of their networks at various trauma strength exposures," said Georgopolous. Those with PTSD, though, have what he calls "inflexibility" in their neural networks. "Their networks were locked in and could not be modulated," he said.
Based on a one-minute scan, Georgopolous' team can spot inflexible PTSD circuits with 95 per cent accuracy. If they do detect PTSD, drugs can be prescribed as a treatment. A variety of behavioural therapies aimed at getting stubborn brain circuits to unlock can also help.
"You can sort of re-package that all together and put that memory aside," said Dr. Lisa James, a clinical psychologist at the Brain Science Center. "So it allows for their brain to de-correlate and become more flexible, so that that memory isn't just constantly there, popping up."
PTSD flashbacks are hard to shake. The more we learn about how neural circuits recycle or get stuck, the better treatment will be. And the dividends could be huge. The locked circuits in PTSD are located in the brain's temporal lobe, just above the right ear. The stubborn thoughts associated with neuroticism, psychosis and obsessive-compulsive disorder originate elsewhere in the brain, and can also be picked up in magnetic scans. Solving the PTSD riddle may help solve these as well.
"LPS for Vets" is an annual golf fundraising event that started a decade ago by LPS and friends to raise funds and awareness for local organizations dedicated to improving the lives of our Veterans. On Saturday June 11, 2016 Logistics Planning Services conducted its 14th Annual Charity Golf Classic at White Eagle Golf Club in Hudson, WI to benefit our military veterans and specifically to benefit the Minneapolis VA Brain Sciences Center in its Post-Traumatic Stress Disorder (PTSD) research.
Funds raised by this event are pledged to the breakthrough research being conducted by Dr. Georgopoulos (VA Clinic) and Dr. Engdahl (University of MN) in their work to help soldiers and all victims of PTSD.
More information: http://lpsforvets.com/about-the-event/.
Todd Wilson, KSTP - Dec 10 2015
Brian Zimmermann joined the Army soon after quitting college. School just wasn't his thing.
"You don't think you'll have to fight when going into the Army," he said.
He was deployed for seven months during the first gulf war.
"We were attached to the seventh corps, and the seventh corps is who breached the berms from Saudi Arabia into Iraq," he said. "And we pushed across the country and made it all the way to the highway of death."
Zimmermann said he finished out his duty at a base in Kansas. Even before he came back from Iraq he knew something was wrong with him. Ever since that time, he said he has suffered from anxiety and feeling as if his skin is on fire.
"I have joint pain all the time, it doesn't go away. Sometimes it gets worse, it feels like your joints are exploding from the inside," he said.
According to the Department of Veterans Affairs, there are roughly 200,000 vets affected by Gulf War Illness. Ten thousand of those vets live here in Minnesota.
Dr. Brian Engdahl of the BSC talks with Todd Wilson/KSTP about a recently discovered test for GWI.Dr. Brian Engdahl at the Brain Sciences Center at the V.A. says, researchers have been testing Gulf War Illness since 1991. What they're doing now is brand new.
"So we said, lets get right down to it, lets look at your genes," Engdahl said.
For his study 82 vets were recruited who were interviewed and donated blood.
What they found was groundbreaking. Engdahl and his fellow researchers could determine from person to person by taking blood they could figure out who would suffer from Gulf War Illness with a high degree of accuracy.
How high is the accuracy? About 90 percent.
Engdahl said the breakthrough allows them to help people avoid these illnesses in the future by predicting patterns.
Zimmermann said he's thankful for findings.
"Someone needs to get it out there that 200,000 men and women are in pain," Zimmermann said.
Minnesota Military Radio Hour, August 23, 2015
A discussion of POW's, PTSD and coping mechanisms with Dr. Brian Engdahl from the Minneapolis VA.
by Carmen Peota - Minnesota Medicine - August 2015
When Lisa M. James, PhD, arrived at the Brain Sciences Center at the Minneapolis Veterans Affairs Medical Center in 2010, the young scientist was very much aware that researchers there had just shown that magnetoencephalography (MEG) could be used to diagnose post-traumatic stress disorder (PTSD). In a 2010 article published in the Journal of Neural Engineering, they reported being able to distinguish, with better than 90 percent accuracy, between brain scans of people who did and did not have PTSD.
James was interested in building on that work, most of which had been done using male veterans as subjects. But she had a fresh question: What about female veterans?
James knew women had higher rates of PTSD than men (the rate is estimated at 20 percent for women compared with 8 percent overall) and experienced different types of trauma. "Whereas combat exposure might be more common in male veterans, things like sexual trauma are more common in female veterans," she explains. And there was some evidence that women might have a different neural signature of PTSD than men. Most important, women were participating in the military in unprecedented numbers and hadn't been studied much. It seemed to her that an intentional focus on female veterans was warranted.
James designed a research project, applied for and got a VA grant, and last August began a three-year study that will eventually include 200 female veterans in this region. She has two main goals: defining the neural signature of PTSD for women and finding a genetic basis for why some women might be more resilient than others. Specifically, she's looking at a gene called apolipoprotein E, which she's found to be associated with PTSD symptom severity.
James and her team are asking female vets about their military experience, trauma history and mental health status; drawing blood for genetic tests; and having the women spend about five minutes lying on a table while recording their brain activity using MEG. She hopes the work will have clinical applications. "Our goal is that we'd have this neural signature for PTSD in women that we can then use to potentially diagnose women vets and track treatment outcomes," she explains.
Although James says it's too early to talk about findings, this research has already attracted the attention of the American Association of Medical Colleges, which is highlighting projects aimed at rectifying a health or health care inequity related to mental health (see "Snapshot"). "We're recognizing that there are women vets," she says, "and they merit study as well as men."
AAMCtoday - 2015 Health Equity Research Snapshot - May 4, 2015
Researchers use brain imaging to identify biological indicators of PTSD in women and genetic tests to understand why some women will develop PTSD while others won't.
WNBC - News 4 New York - May 2, 2014
Doctor Brian Engdahl talks about the reality of PTSD and how those suffering from the disorder can get effective help.
Health Sciences, UMN - November 11, 2013
Brian Engdahl, Ph.D., a professor of neuroscience, cognitive science, and psychology at the Brain Sciences Center at the University of Minnesota and psychologist and clinician investigator at the Minneapolis VA Medical Center, has been appointed the Anderson Chair in Post-Traumatic Stress Disorder (PTSD) Research at the University of Minnesota Medical School.
The Anderson Chair helps understand and heal the psychological scars that often haunt veterans as they return home from service. The $2 million gift honors the late William Lewis Anderson, a combat medic who died trying to save a wounded soldier on the battlefield in World War II.
Engdahl has served veterans for more than 30 years at the Brain Sciences Center and Minneapolis VA Medical Center and is working on numerous research initiatives to assess and treat veterans with serious disabilities, including PTSD.
"It's an honor to be named the Anderson Chair in PTSD Research," said Engdahl. "We hope to continue the great work done at the University of Minnesota and VA Medical Center to help those who served our country but now are afflicted with PTSD and other life altering disabilities."
With Apostolos Georgopoulos, M.D., Ph.D., and his colleagues at the Brain Sciences Center, Engdahl has recently helped discover that a special kind of brain scan can identify, with 95 percent accuracy, veterans with PTSD. Because this appears to be the first objective marker of a mental disorder, the findings should help develop better kinds of PTSD treatment, encourage more people who suffer from it to seek help, and reduce the stigma associated with PTSD and other mental disorders.
"The University of Minnesota has strong programs in brain science and on the provision of care for those with brain injury," said Aaron Friedman, M.D., vice president for health sciences and dean of the Medical School. "The awarding of this Chair to Professor Engdahl reflects his enormous contribution in understanding and treating brain injury."
by Deane M. Morrison - UMNnews - Health+Medicine - August 27, 2013
When a disaster strikes, groups of people spontaneously form and start talking all at once.And your brain does the same thing in response to personal trauma. Groups of neurons in the cerebral cortex start firing at the same time, "talking" to each other, and get locked into a correlated pattern of activity. Previous work by University of Minnesota researchers identified a particular pattern so strongly associated with post-traumatic stress disorder (PTSD) that they can clearly tell who has PTSD. Now, a new study shows that in people with PTSD, these patterns persist, just as do the intrusive, incapacitating memories or re-experiencing of the events, emotional numbing, and hyperarousal that define the disorder.
But, they found, in people who have not developed PTSD despite exposure to trauma, the patterns lack staying power. In them, "these patterns loosen and dissipate over weeks, months, or days," says lead researcher Lisa James, an assistant professor in the U's Department of Psychiatry and a researcher in the Brain Sciences Center at the Minneapolis VA Medical Center, where the study took place. "This wipes the slate clean."
"Our work means that in resilient people the brain can actively adapt to traumatic experiences in a way that those with PTSD cannot. The better we understand the brain mechanisms associated with PTSD, the sooner we can apply that knowledge to evaluating treatment efficacy."
Co-author Apostolos Georgopoulos likens the situation in a trauma-exposed brain to an infection.
The advantage of MEG is its ability to detect brain activity on a scale of milliseconds. The researchers placed an apparatus resembling a helmet over the heads of the subjects, who were asked to fixate on a stationary dot with their eyes for 60 seconds. The helmet contained 248 sensors, each of which detected the magnetic fields generated in a population comprising tens of thousands of cortical cells. Together, the sensors scanned the magnetic activity over the whole cortex.
'It's like having a disease, where you make antibodies," says Georgopoulos, a Regents Professor of neuroscience and director of the Brain Sciences Center. "If you can't make antibodies, you don't adapt to the virus. Similarly, if you don't de-correlate your brain networks, you're still sick."
Short-term tracking of the PTSD-linked patterns in people exposed to trauma could potentially identify those who are resilient vs. those who need treatment. Pattern tracking could also be used to monitor progress during PTSD treatments or to validate a simpler test for resilience, such as genetic or personality traits, the researchers say.
The work is published online in the journal JAMA Psychiatry.
The researchers studied 86 veterans with PTSD and 113 veterans who were resilient to trauma. A questionnaire revealed the extent of their exposure to trauma; those with trauma exposure but no PTSD were, by definition, resilient controls.
The team used a noninvasive technique called magnetoencephalography (MEG; see sidebar)) to study the magnetic fields generated in neurons of the right temporal lobe cortex as they received messages during neuronal "talk." Neurons receiving messages experience movements of ions across their outer membranes; these movements generate the magnetic fields.
The MEG measured the strength of correlated patterns of activity in cell populations—i.e., simultaneous generation of magnetic fields—characteristic of PTSD. They discovered:
Most people are resilient to some events, so the question becomes: Why isn't everybody?
"About 60 to 90 percent of people will experience a potentially traumatic event in their lifetime, like a car accident or the sudden death of a loved one, but they are resilient. They don't develop symptoms of a psychiatric disorder," says James.
"Only seven percent of people in the general population and about 20 percent of veterans develop PTSD. Most come back [from service] without PTSD—what enables them to do that?"
To answer that question, the researchers are turning their attention to a search for genetic markers of resilience. If certain genes or, perhaps, personality traits, are found to be associated with resilience, that could allow researchers to predict one's degree of resilience before trauma hits.
"PTSD sufferers have options that include medications, talk therapy, and interventions to treat nightmares," James says. "We're interested in what happens in the brain as individuals with PTSD respond to treatment."
by Jessica Mador · MPRnews · February 20, 2013
New research from the Minneapolis VA Medical Center has identified brain patterns that appear to be markers of resilience to trauma. The findings could suggest why some people exposed to trauma develop post-traumatic stress disorder, or PTSD, while many others do not.
Researchers say the findings, published online Wednesday in the journal JAMA Psychiatry, point to a central mechanism showing how the brain can recover from traumatic events.
In the study, scientists compared the brains of nearly 200 veterans who had experienced trauma, using magnetoencephalography (MEG). The machine detects the magnetic fields produced when groups of brain cells communicate.
The MEG scans of PTSD-affected brains showed distinctive clusters of neurons locked into interactions with other clusters.
"We believe these neuron networks were stuck in the trauma-encoding phase," said lead author Lisa James, a research psychologist at the Brain Sciences Center and an assistant psychiatry professor at the University of Minnesota. "The trauma had a hold on them. They weren't available to encode new information."
She compared the phenomenon to a "phone network where every line is busy."
By contrast, James said, non-PTSD volunteers showed no such patterns.
Their neural networks were flexible, adaptable and available. They were free to link up with other neuron groups as needed to react to new incoming experiences.
"People really are resilient," James said, "and we've been able to demonstrate exactly what is going on in the brain that helps facilitate healthy functioning following trauma exposure."
The study's co-author, Brian Engdahl, a psychologist at the Minneapolis VA and an associate psychology professor at the University of Minnesota, said PTSD-affected brains look very different from normal brains, which process trauma and move on to other tasks.
"Those who have continued to experience disorders such as PTSD have not yet adapted their brain function to accommodate the trauma," Engdahl said, "and we are actively investigating the best treatment routes to produce those changes."
Engdahl used the analogy of a handshake to describe how healthy neural networks respond to traumas: "When a trauma comes in, everyone [populations of neurons within the brain] is shaking hands tightly. The neurons are very tied up with processing this experience. Over time, the handshake weakens. It gets less intense. The network eventually gets released and is free to respond to other events."
In normal brains, he said, the traumatic memory eventually gets consolidated and deposited in other brain regions. The memory remains housed in the brain, but it's not pathological. It does not impair function.
The brain area where the researchers saw the sharpest difference between the two groups of study volunteers was the right superior temporal gyrus.
Part of this region in the brain helps with auditory processing, but the researchers say the area they were probing was a deeper part of the superior temporal gyrus, the role of which is not clearly known.
"It's no man's land," said senior author Dr. Apostolos Georgopoulos, director of the Brain Sciences Center at the Minneapolis VA and Regents Professor in the University of Minnesota Medical School's Department of Neuroscience.
He pointed out, though, that some studies have linked the region to the re-experiencing of past events, which clearly plays a role in PTSD.
"Our patients with PTSD tell us that the intrusive memories have a life of their own," Georgopoulos said. "They pop into their minds when they don't want them. And that's what we're seeing on the brain scans."
The new study complements research published by the group in 2010 in which it first described distinctive PTSD brain patterns, as detected by the MEG.
"This new paper helps explain why we found what we found in those earlier studies," Georgopoulos said. "Based on this work, we hope to develop reliable biomarkers for PTSD and for emotional resilience."
The study was partly supported by a grant from the Department of Veterans Affairs.
By Ellen Burkhardt - Minnesota Monthly - June 2012
How one machine and two Minnesota researchers are forever changing the stigma surrounding Post-Traumatic Stress Disorder
Apostolos Georgopoulos looks like a brain scientist. Animated, friendly, and crowned with a mane of flyaway gray hair, he shakes my hand and ushers me into his office. He immediately offers to make me coffee, then, in the next breath, insists I sit in the throne situated next to the window—a gift he received for being a Regents professor of neuroscience at the University of Minnesota. "Isn't it something?" he says enthusiastically. "I don't even know how they got it in here!"
I don't catch everything he says, and not just because he talks fast: his thick accent (Georgopoulos was born and raised in Patras, Greece) has caught me by surprise. I look to Dr. Brian Engdahl, the Watson to Georgopoulos's Sherlock, for help, and find instead an amused smile.
The two men form an unlikely team: Georgopoulos, the mustachioed, 100-miles-a-minute director of the Brain Sciences Center; and Engdahl, the soft-spoken, dry-humored counseling psychologist. The two met in 1991 when Georgopoulos came to the Minneapolis Veterans Affairs Medical Center, but it wasn't until 2010 that they rocked the world of neuroscience: that's when they published a study in the Journal of Neural Engineering demonstrating that they could prove, with 97 percent accuracy, that Post-Traumatic Stress Disorder isn't a phantom disease, but a physically traceable condition in victims' brains.
The machine that could forever change the face of PTSD doesn't look like much. Tucked away in a vault of a room that looks more like a walk-in freezer than a groundbreaking research chamber, the contraption resembles a beauty-salon hair dryer—albeit a gigantic one. But this brain-scanning machine, technically known as the Magnetoencephalography (MEG), is much more than its unassuming exterior advertises: it is, as Georgopoulos and Engdahl discovered, an essential tool for unlocking the mystery of PTSD.
Developed in 1968 by a physicist at the University of Illinois, MEG is most commonly used to study such neurological disorders as epilepsy and Alzheimer's. It's an expensive and rare machine (approximately 60 MEGs exist worldwide; only a handful are as high-quality as the one at the Minneapolis VA), but it's also the most accurate and safest brain scanner in existence. Where an MRI scan can be skewed if a patient so much as wiggles or has any metal in their body, the MEG is a passive scanner that is not inhibited by such restrictions.
Here's how it works: the subject lies with his or her head inside the helmet portion of the MEG and, for one minute, focuses on a dot. During that minute, 248 hypersensitive sensors detect and record the tiny voltages that occur on the surface of the brain when neurons communicate with each other. The resulting magnetic field provides a snapshot of what a brain affected by PTSD looks like.
The Minneapolis VA received its MEG through a congressional appropriation in the late 1990s. It was installed in 2001, and has since played a critical role in Engdahl and Georgopoulos's research. In the last four years alone, they've scanned more than 700 brains, "more than all the MEG scanners in the world combined," Engdahl says. Those scans have led to unprecedented insight into many mental illnesses, each identified by its own unique marker.
In 2007, Georgopoulos and Engdahl applied for funding to see if MEG could be used to detect PTSD. Dr. Robert A. Petzel, then the network director of the Veterans Affairs Midwest Health Care Network, now the Under Secretary for Health in the U.S. Department of Veterans Affairs, approved the idea, making way for the groundbreaking research. At the time (and currently), doctors rely on a 17-point questionnaire to diagnose PTSD. But that process has a lot of "gray area," as Georgopoulos puts it, due to its dependence on patients' honesty in disclosing their symptoms. The researchers hoped to find a more definitive way to locate the disorder.
But no one could have predicted how drastically the study would deepen researchers' understanding of PTSD; how it would change the way everyone—scientists, soldiers, victims, society—perceived it. Or how incredibly capable the MEG would be in giving the disorder a face: something Georgopoulos and Engdahl call the "PTSD stamp."
By January 1, 2009, Georgopoulos and Engdahl had gathered 74 veterans diagnosed with varying degrees of PTSD, plus hundreds of control subjects. They scanned each subject, then compared the results, searching for a biomarker that would identify those affected by the disorder. They didn't have to look hard.
"We saw clear abnormal network activity in the brain's right-temporal cortex on the scans of PTSD victims," Georgopoulos says. "That pattern of hyperactivity is very specific to PTSD, and goes along with observations from neurosurgeons who say that region is tied to experiential memories."
The stamp is so distinct, in fact, that Georgopoulos and Engdahl were able to spot it in all but two of the 74 victims' scans. With an image to validate it, PTSD went from being a largely unrecognized condition (it wasn't considered a diagnosable disorder by the American Psychiatric Association until 1980) to being a very real problem in need of a solution.
"Before we had the scan, victims felt like they had to hide their symptoms or ignore them, for fear of being perceived as weak," Georgopoulos says. "Now, we have an extremely objective way to show and measure PTSD."
"All my patients who see the scans say, 'I knew it. I know what I went through, and I know how it changed my brain,'" adds Engdahl. "And now you can see it."
One such patient was Robert Michelsen. Michelsen is a World War II veteran who spent 95 days as a prisoner of war in Tokyo in 1946. He enlisted when he was just 17 years old, and served for two-and-a-half years as a gunner on a B-29 in the Pacific before getting shot down. Of the 11 men on his plane, he was one of eight who survived and were taken into custody.
"We were fortunate to be shot down over Tokyo," he tells me matter-of-factly from across the table in a conference room at the VA. At 86, he's a sharp-looking man, with black-rimmed glasses, crisply ironed khaki pants, and white hair that's neatly parted to one side. "If you were shot down anywhere else, one man would be sent to Tokyo for interrogation, the rest would be eliminated. That I survived was just a matter of luck."
But that miracle came with a price tag. For Michelsen, it meant years of guilt, nightmares, and a deep fear of dying alone—none of which he shared with anyone once he got home. And if it hadn't been for two men 55 years later, he might have kept his story to himself forever.
One of those men was Don Patton, a retired U.S. Army colonel and author on military history. In 1999, Patton introduced Michelsen to the "Wednesday club," a group of Pacific POWs who met once a month to eat lunch and swap stories at the Robbinsdale American Legion. There, Michelsen met the other man who changed his mind about keeping quiet: Irving Silverlieb. "He was a superb person," Michelsen says. "He brought me to the POW group [led by Dr. Engdahl] here at the VA, and I've been here ever since."
Encouraged by the other veterans' willingness to share, Michelsen began to unload the many memories that had been haunting him for so long. He even agreed to get scanned in the MEG. Seeing the scan converted him from being "quite the skeptic" into a believer, he says. "This is just the tip of the iceberg."
But even with such seemingly irrefutable evidence, not everyone puts PTSD on par with war's more "traditional" injuries.
The U.S. Department of Defense still refuses to add PTSD to the list of injuries that merit a Purple Heart medal. And many soldiers still think that if they disclose their mental struggles, they won't be deployed again—or that they'll be judged by their peers and commanding officers, says staff sergeant Chad McNiesh, a medic in the Minnesota Army National Guard.
"I see a lot of my guys struggling with it, but they don't want to be stuck at a desk job or perceived as weak," he says. "So they don't say anything."
What they don't realize, he adds, is that this fear is largely unwarranted.
McNiesh has been deployed three times in the past eight years. After returning home from his second deployment, he began experiencing extreme bouts of anger and paranoia, often triggered by everyday situations. He sought help and was diagnosed with mild PTSD. After a series of counseling sessions and medications, his symptoms subsided enough that he was also allowed to return overseas.
"There's still a stigma attached to PTSD, but there shouldn't be," he says. "It's bound to happen when you're constantly exposed to those circumstances. There's no shame in admitting that."
Armed with their MEG scans and encouraged by veterans' increasing willingness to participate in their studies, Engdahl and Georgopoulos are already looking ahead to their next project—one that could center around yet another way to spot the PTSD stamp in victims' brains.
On a recent sunny afternoon, I got a call from Dr. Engdahl. "Apostolos just called me from California," he said, a buzz of excitement in his voice. "He said that they've been comparing functional MRI scans with MEG scans, and have been able to spot PTSD in both!"
He went on to explain the significance of the discovery: "If we can figure out what the PTSD stamp looks like in functional MRI scans, we won't be limited to using only the MEG to identify the disorder in patients. Almost every hospital has an MRI machine—patients could be scanned and treated anywhere!"
And that, coupled with a recent influx of research money from Washington, D.C., is big news. "These are the silver linings in the dark cloud of war," says Engdahl. "The future is pretty bright."
Ellen Burkhardt is the assistant editor of Minnesota Monthly.
University of Minnesota /Facebook - November 20, 2010
U of M researcher Brian Engdahl talks about new research that could help diagnose and treat post-traumatic stress disorder (PTSD), which often affects veterans.
By Mark Thompson - Time - Monday, Jan. 25, 2010
For all the attention focused on posttraumatic stress disorder (PTSD) in recent years, doctors have never had a clear-cut way to be certain a patient has it. But Minnesota scientists now believe they have found a long-sought PTSD fingerprint that confirms the disorder by measuring electromagnetic fields in the brain. The finding, detailed in the latest issue of the Journal of Neural Engineering, could help the 300,000 cases of PTSD that are anticipated among the 2 million U.S. troops who have gone to war in Afghanistan and Iraq.
"This shows that PTSD is a brain disease," says Dr. Apostolos Georgopoulos, who led the research along with Brian Engdahl and a team from the Brain Sciences Center at the Minneapolis VA Medical Center and University of Minnesota. "There have been questions that this is a made-up disorder and isn't a true brain disease, but it is." Just as importantly, he says, the magnetic-imaging biomarker shows changes over time in a brain's electrical activity, allowing mental-health workers to chart the effectiveness of various therapies. "It will be a tremendous tool in monitoring treatment," he says, "because these abnormal communication patterns will be normalized as the treatment works."
Up until now, more conventional diagnostic tools, including computed tomography, magnetic-resonance imaging and X-rays have not been able to detect evidence of PTSD because their snapshots of brain activity occur too slowly. The new diagnostic procedure uses magnetoencephalography (MEG), a way of monitoring the flow of electrical signals along the brain's neural pathways from cell to cell. By using a helmet with 248 noninvasive sensors arrayed around the head, scientists can map patterns of electrical activity inside the skull and detect abnormalities. The Minnesota researchers used MEG to assess 74 U.S. veterans believed to be suffering from PTSD, along with 250 subjects not thought to be suffering from the condition. Distinctive brain patterns indicating PTSD were found in 72 — or 97.3% — of the 74 people diagnosed with PTSD through the traditional interview process; false positives turned up in 31 of the 250 subjects (12.4%) without PTSD. (All the subjects were given "a simple fixation task ... to engage the brain in a stable condition.")
Still, outside experts aren't rushing to declare the challenge of diagnosing PTSD solved. Dr. Sally Satel, a psychiatrist affiliated with the American Enterprise Institute who has studied PTSD, says she's skeptical that there's "a fixed neural signature" for the condition. But she adds that the study "is a first step toward a more thorough analysis that may or may not prove useful in diagnosing, treating and predicting outcomes."
While usually associated with combat, PTSD has been linked to many psychologically traumatic events. It generates severe anxiety along with flashbacks, nightmares and anger, and is generally treated with therapy and medication. As the U.S. military has become better at treating the physical wounds of its troops, the mental ailments are looming larger. For years, the Pentagon has been seeking better ways to diagnose PTSD, which has remained a largely subjective process involving mental-health workers conducting structured interviews with patients suffering PTSD-like symptoms. The PTSD research builds on earlier work that showed MEG could be used to detect Alzheimer's and multiple sclerosis in infected brains. "These communication patterns are very different from disease to disease," Georgopoulos says. "So the different diseases create disturbances in the communication that can be used as a fingerprint, a signature, for the disease." He likens the MEG test for PTSD to the blood-glucose monitoring tests regularly done by diabetics to keep their disease under control. Such testing, he adds, could be done by PTSD patients to monitor their progress. "The test is totally safe — there are no magnets, no isotopes — you can do it as frequently as you want," Georgopoulos says, adding that it also doesn't require dredging up the traumatic events that generate PTSD. "The whole thing takes literally a minute." It will be a lot longer, however, and require several follow-up studies, if the use of MEG to track PTSD is to become widespread.
by Maura Lerner - StarTribune - Jan. 20, 2010
There's never been a simple test to diagnose post-traumatic stress, but a group of Minnesota scientists say they've found a high-tech way to identify people who have the disorder -- by studying their brain signals. The discovery could have huge implications for the way PTSD is diagnosed and treated in the future, says Dr. Apostolos Georgopoulos, who led the research as director of the Brain Sciences Center at the Minneapolis VA Medical Center.
PTSD is thought to afflict tens of thousands of combat veterans, but it can be hard to diagnose. It's a collection of psychological symptoms that can, in some cases, be caused by other conditions, such as head injuries or depression. That's one reason that exact numbers are hard to pin down; the VA estimates that anywhere from 11 to 20 percent of returning veterans from Afghanistan and Iraq have PTSD. But in a study released Wednesday, Dr. Georgopoulos and his research team found what they call the first "biological marker" for PTSD: A distinctive pattern of brain signals that can be detected with a $2 million device called MEG (magnetoencephalography).
"The brain patterns are very different," said Georgopoulos, who has been studying brains for 30 years. In men and women with PTSD, he said, the machine found a cluster of abnormal brain signals in an area of the brain involved in memory. Exactly why is still a mystery, but he speculates that it may interfere with the ability to suppress bad memories, one of the hallmarks of post-traumatic stress.
Georgopoulos, who is also a neurology professor at the University of Minnesota, is one of a growing band of scientists using brain imaging, such as MEG and PET scans, to study psychiatric disorders. "That's a big area in psychiatry," said Dr. Monte Buchsbaum, a leading brain researcher and psychiatrist at the University of California at San Diego. "Mental illness is a devastating brain disease, and we now have better technology to look at the brain in action." Three years ago, Georgopoulos led a small study of patients with Alzheimer's, schizophrenia and several other brain disorders and found that each group had a distinctive pattern of brain signals when examined with the MEG device, which measures moment to moment changes in the brain's electrical activity.
For the latest study, he and his team recruited several hundred veterans from Minnesota and Wisconsin, spanning every war since World War II. Among them were 74 men and women who had been diagnosed with PTSD. One was Gary K. Lore of Minnetonka. Lore, 62, served two tours of duty in Vietnam in the 1960s. The experience left him with "horrendous nightmares," flashbacks, sleeplessness and other classic symptoms of post-traumatic stress, he said. Yet it took more than two decades to get a diagnosis. "I just thought I was another crazy Vietnam vet," he said. It wasn't until the Gulf War in 1991, when he watched the horrific images on TV, that Lore realized he needed help. Since then, he's been treated successfully with therapy and medications, he said, and gets checkups at the Minneapolis VA. Lore went to the VA hospital's Brain Sciences Center, and allowed researchers to scan his brain. He fixed his eyes on a spot for 60 seconds at a time while the MEG device, which looks like a science-fiction helmet, measured the tiny magnetic fields emitted by the electrical signals in his brain. The result was a sort of footprint of the brain's activity at any given moment.
By studying the images of all the volunteers, the scientists were able identify the patients with PTSD 97 percent of the time, said Georgopoulos. Even among patients who had recovered, the pattern was still visible, though less intense. Georgopoulos said the technique could also help treatment, by allowing doctors to monitor how well the brain responds to different therapies.
Andrea Northwood, a Minneapolis psychologist who treats patients with PTSD at the Center for Victims of Torture, said she would welcome a device that could make her job easier. "With these kind of complex behavioral conditions, we need as many tools as possible," she said. Georgopoulos notes that the device itself is harmless, emits no radiation, and can be safely used even "in newborns." Yet it may be some time before the brain scans are widely available. The MEG devices are costly and rare, and mainly used in research. But that could change, Georgopoulos said, if the device proves to be as useful as it appears.
For Lore, the veteran, it was "a relief" to learn the results of his brain scan. "It wasn't just because I couldn't think straight or whatever; there were real changes in the brain," he said. Georgopoulos says his discovery does not mean the damage from PTSD is permanent. "I'm optimistic that this is a reversible condition," he said.
The study appears in the Jan. 20 online issue of the Journal of Neural Engineering.