request good review article (ECT)

F. Frank LeFever flefever at ix.netcom.com
Wed Nov 18 22:57:04 EST 1998


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.

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!

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.

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.


- - - - - - -(snip) - - - - - - - - - - - - - - - - --



>> Far from being analoguous to pummeling (with implications
>> of physical abuse and pain), it is nowadays undertaken with muscle
>> relaxants (to avoid injury during seizure) and sedatives (to
minimize
>> anxiety).

To address his "cattle-prod" fantasy directly: cattle-prods are used to
cause pain, and thereby alter behavior--inhibiting the punished
behavior, eliciting behavior to avoid pain, etc.  ECT is administered
in such a way as to avoid pain and anxiety.

The goal is not to punish or frighten or distract the patient, but to
alter brain physiology.  Modified procedures are under study (e.g.
brief pulses rather than long trains, e.g. magnetic stimulation
targeted to specific brain areas) to do this more precisely and with
fewer undesirable side effects.


- - - - - - -(snip) - - - - - - - - - - - - -



>"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?


>> still less, "punishment" as those
>> who ignorantly think of it as a "cattle-prod" procedure applied to
the
>> head might assert.
>
>It's hardly distinguishable from a "cattle-prod to the head"... and
just
>about as "effective" :-)
>

(v. my counter argument above.  Please note kkollins has read no
efficacy studies or has misunderstood any that he has read, judging by
this assertion)




>> I can only hope your unfounded
>
>The above is Libel... all my work is thoroughly-Verified (Frankly,
Frank,
>so far, it seems you're far-"better" at Libel than you are at
>Neuroscience.)
>


Apparently his knowledge of the law is at the same level as his
knowledge of neuroscience.


I'll repeat:

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.
>



>I will =Gladly= give them the Understanding that can Lift them Up out
of
>their Sorrow... if Neuroscience ever desides to stop Withholding the
>Understanding from them.
>

What is he waiting for--invitation from the Nobel community?  Who is
withholding--kkollins? Neurooscience??

The reast of this pathetic exchange follows.

F. Frank LeFever, Ph.D.
New York Neuropsychology Group






>> Your lack of intellectual honesty and humility is especially immoral
in
>> these life and death matters. (Yes, life and death; ever hear of
>> depressed patients committing suicide?)
>
>Get thee before a mirror.
>
>> Your putting "depression" in quotes suggests you do not take it
>> seriously as a medical condition--"everybody feels bad sometimes;
why
>> don't they just pull themselves together? get a hobby or something
to
>> distract thenmselves".  Is that your level of understanding? That is
>> disgusting.
>
>I'll tell you what's disgusting, Mr. Frank, Ignorance "in
high-places". K.
>P. Collins
>




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