Friday, May 23, 2014

Johnny Cash & Deep Brain Stimulation (DBS) for OCD

Washington Post


How a brain treatment for OCD turned a man into a Johnny Cash fanatic

Here’s a title you can’t help but read, even though it’s in a highly technical scholarly journal: “A case of musical preference for Johnny Cash following deep brain stimulation of the nucleus accumbens.”
Johnny Cash in 1977. (AP)
Johnny Cash in 1977. (AP)

It’s published in the May issue of Frontiers of Behavioral Neuroscience.

And it’s one of the more unusual tales recently from the field of neuroscience, already famous for stories so fantastic that not even the authors can fully explain them, which is the case here.

Here’s what happened: A patient identified only as “Mr. B,” age 59, was referred to doctors at a hospital in the Netherlands for treatment of obsessive-compulsive disorder (OCD) from which he had suffered for 46 years.

He had made little or no progress with conventional treatment. So, in 2006, he was treated with deep brain stimulation (DBS), better known for making life easier for patients with Parkinson’s disease, but also used for OCD.

According to the authors, Mariska Mantione and Martijn Figee of the University of Amsterdam’s psychiatry department and Damiaan Denys of the Netherlands Institute for Neuroscience, electrodes were implanted in his brain targeting the nucleus accumbens, which plays a role in pleasure as well as fear.

Within six weeks, Mr. B felt better, reporting that “he felt very confident, calm and assertive.” He also started to call himself “‘Mr. B. II,’” a “new and improved version of himself.”
But something else happened. Mr. B had had only a modest interest in music — mostly in Dutch songs, the Beatles and the Rolling Stones. His tastes had always been “very fixed,” the authors reported, with his preferences staying “the same throughout decades.”

Then about a year after DBS surgery, Mr. B was listening to the radio one day when he heard Johnny Cash singing “Ring of Fire.”
Love is a burning thing. And it makes a fiery ring.
Bound by wild desire. I fell into a ring of fire.
I fell into a burning ring of fire, I went down, down, down as the flames went higher
And it burns, burns, burns. The ring of fire, the ring of fire.
Gradually he began listening to more Johnny Cash. His favorites? “Folsom Prison Blues” and “Sunday Morning Coming Down.”

He said the songs, with their fast tempos, moved him and made him feel better.

Before long, however, Mr. B would only listen to Johnny Cash — “simply and solely” to Johnny Cash, the authors reported. Nothing else. No more Dutch songs, Beatles or Rolling Stones. He went out and bought all of Johnny Cash’s CDs and DVDs.

From that moment on, it was all Johnny Cash.

The authors write:
When listening to his favorite [Johnny Cash] songs he walks back and forth through the room and feels like he finds himself in a movie in which he plays the hero’s part. He reports that there is a Johnny Cash song for every emotion and every situation, feeling happy or feeling sad and although Mr. B. played almost simply and solely Johnny Cash songs for the following years, the music never starts to annoy him.
It gets more interesting still.

When the implanted electrical stimulators run down or accidentally go out, so does Mr. B’s interest in Johnny Cash. The Man in Black is ignored, and Mr. B’s “old favorites are played just once again, just as it was for the past 40 years.

But when the electrical stimulators’ batteries are replenished, it’s back to Johnny Cash, with the Rolling Stones, Beatles and Dutch songs “banned.”

What’s the explanation? The nucleus accumbens ”plays a fundamental role in the rewarding properties of music,” the researchers note, and Mr. B’s experience reinforces that understanding.
But why Johnny Cash? Why Johnny Cash and only Johnny Cash?

Was Mr. B perhaps just obsessing over Johnny Cash? Was this just another manifestation of his OCD?

No, the researchers say. “The patient does not feel obsessed with Johnny Cash, nor compelled to listen and his behavior does not result in reduction of anxiety or tension.” Perhaps, they speculate, the Johnny Cash songs match his “‘new’ confident self.”

They really don’t know, they concede. “More research is needed” to figure it out.

Perhaps the patient came as close as anyone to figuring it out. Mr. B told the researchers:

“‘It seems as if Johnny Cash goes together with DBS.’”

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