request good review article (ECT)

kkollins at pop3.concentric.net kkollins at pop3.concentric.net
Thu Nov 19 22:39:04 EST 1998


I stand on what I posted. K. P. Collins

John wrote:

> >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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