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)

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.’”

The Limits of Neuroplasticity: Brain-injured War Veterans

WSJ

GERMANTOWN, Md.— Pete Bunce walked into a room at a U.S. military hospital in Germany in March 2004, and stared hard at the unconscious young Marine on the bed. His head, gouged by shrapnel from an insurgent bomb in Iraq, was grotesquely swollen. His face was distorted and his right eye was near blind.

Mr. Bunce spoke his first thought: "This is not my son."

 

      Former Marine Justin Bunce, who got a brain injury serving in Iraq, works with Niemah Bowins, a life-skills trainer. Jonathan Hanson for The Wall Street Journal

 

The Bunce family and their doctors have spent the decade since trying to restore Justin Bunce to the man they knew, with limited success.

Cpl. Bunce remains intelligent and funny. But his brain no longer sends the messages that allow him to walk smoothly, or to warn him when his behavior might offend or frighten people. "I can't dream anymore," he said. "I would even be happy with nightmares, but I don't even have those."

The wars in Afghanistan and Iraq have left a generation of brain-injured veterans who, like Cpl. Bunce, may get better, but never well.

 

Between Jan. 1, 2001, and Sept. 30, 2013, more than 265,000 U.S. troops suffered traumatic brain injuries, according to the Defense and Veterans Brain Injury Center. Most were mild concussions. Some 26,250 troops, however, suffered penetrating head wounds or brain injuries classified as moderate or severe, which caused unconsciousness from 30 minutes to more than a day. 

 

...

Cpl. Bunce is one of 119 brain-injured veterans that the VA has placed in privately run group homes around the U.S., immersing them in therapies for movement, memory and speech, while gently exposing them to civilian life.

Recent advances in battlefield medicine keep alive troops with head wounds that might have killed them in World War II, Korea or Vietnam. But science hasn't kept pace in its ability to cure.

Soldiers who lose arms or legs can, in many cases, learn to use prosthetic limbs. Those with serious brain injuries will likely always need someone by their side.

 

 

...

 

Cpl. Bunce and five other veterans share the split-level ranch on 5 acres on a bucolic lane. There is a soldier who, after two tours in Iraq, shot himself in the head; he rolls his wheelchair onto the front porch of the group home to smoke. Another housemate, a 57-year-old Virginia National Guardsman, whose brain was damaged by too many close calls with incoming mortars in Iraq, wonders if he will work again as a long-haul trucker. A helicopter pilot, confined to a wheelchair after a crash in Afghanistan, is relearning to talk.

The house is set up to resemble more home than hospital. But it has 24-hour attendants, community activities, in-house therapies and access to VA medical care. The vets socialize and can cook their own meals, if they are inclined. Each resident has a trainer to teach such ordinary life skills as shopping and going to the movies.

The group-home program is a five-year pilot that finishes on Sept. 30 unless Congress extends it. The program has some powerful friends on Capitol Hill. But if Congress doesn't act, it is unclear where Cpl. Bunce and the others will live next. VA officials expect to start drawing contingency plans for the veterans next month.

 

 

Cpl. Bunce, at right, with fellow Marines in Iraq before his injury. Bunce Family

 

...

 

At times, Cpl. Bunce seems to adapt well. His group-home trainer, Katie Gorman, takes him to a facility where he helps train companion dogs for other disabled veterans. He enjoys the company of elderly veterans at a nursing home. He gets a kick telling grade-school jokes to anyone who will listen: "What do you call a grizzly bear with no teeth? A gummy bear."

But the brain injury has left him with personality quirks the group-home staff and his doctors struggle to address. He speaks profanely and uses sexual innuendo when it isn't welcome. He can't seem to read facial expressions that would tell him he is making people uncomfortable when he touches them or holds them for too long.

He often makes threats—apparently empty ones—against people who annoy him. During one recent session with his neuropsychologist, Mark Sementilli, Cpl. Bunce complained angrily about a doctor who, he said, refused to prescribe sufficient painkillers.

"He better pray I never find out where he lives," Cpl. Bunce said.

"What would happen?" Dr. Sementilli asked.

"Back of a milk carton," Cpl. Bunce replied.

 

He tells stories that sound made-up: punching out a lieutenant colonel or jabbing a brain specialist in the throat.

 

Cpl. Bunce "generally has the ability to control behaviors," Dr. Sementilli said. "I've seen him show amazing compassion toward children, vets and pets, of course. On the other side, I've seen hostile vulgarities."

During an outing to an Italian restaurant last week, Cpl. Bunce stuffed crème brûlée into his immobile left hand, saving it to eat later. He filled his pockets with Sweet'N Low packets and stuffed a bag of Doritos in his sleeve. He eats so much candy and takes so little care of his teeth that on Tuesday a dentist had to pull many of them out.

 

One day last week, a physical therapist, Michelle Wilson, sat next to Cpl. Bunce and tried to gently pry open his left hand.

 

He stroked Ms. Wilson's gloved hand as she worked. "You're going to be my wife," he told her. She brushed off the suggestion. He cooperated briefly then stopped to take a few drags of nicotine on an electronic cigarette.

 

"I know it's not what you want," Ms. Wilson said. "You want it to work like your right hand." 

 

He shot back a vulgarity, and threatened, with no apparent malice, to get a hookah and stick it in her eye. During a break he picked up her shoe, held it to his face and inhaled deeply.

 

...

 

His family believes he has made progress at the group home. They also recognize the limits to his recovery.

 

His mother sees signs of depression in her son, and, despite his optimistic talk, believes he now realizes that life has only so much in store for him.

 

"They won't ever be well," Ms. Bunce said of her son and others with serious brain injuries. "It has taken me 10 years to be able to say that and not cry."

 

 

 

 

 

Using Music to Elicit Autobiographical Memories in Brain Injured Patients

Science Daily

After a serious head injury (wear a helmet, kids!) some patients can have difficulty recalling even autobiographical memories. In many rehab facilities, therapists use an Autobiographical Memory Interview to help patients recall their past. It includes questions like, "Who were some of your friends when you were in grade school?" The study that follows played hit songs from the patients' pasts and then asked them if those songs brought back any memories.

Baird and Samson played extracts from 'Billboard Hot 100' number-one songs in random order to five patients. The songs, taken from the whole of the patient's lifespan from age five, were also played to five control subjects with no brain injury. All were asked to record how familiar they were with a given song, whether they liked it, and what memories it invoked.

Doctors Baird and Samson found that the frequency of recorded MEAMs was similar for patients (38%-71%) and controls (48%-71%). Only one of the four ABI ["acquired brain injury"] patients recorded no MEAMs. In fact, the highest number of MEAMs in the whole group was recorded by one of the ABI patients. In all those studied, the majority of MEAMs were of a person, people or a life period and were typically positive. Songs that evoked a memory were noted as more familiar and more liked than those that did not.

As a potential tool for helping patients regain their memories, Baird and Samson conclude that: "Music was more efficient at evoking autobiographical memories than verbal prompts of the Autobiographical Memory Interview (AMI) across each life period, with a higher percentage of MEAMs for each life period compared with AMI scores."

Notice that the study included only FOUR patients with brain injury, and for ONE of them, the music technique didn't work at all. Just goes to show that even in scientific publishing, if you've got a hot hook, you don't need much else.

It interesting to think about what music was playing on the car radio when you were 5, 10, 15, and 20 years old, and what impact those songs might still have on you today. Perhaps not coincidentally, one of the songs I have posted to this blog, as well as the one that I had been planning to post on Saturday, were hits when I was between 4 and 5 years old.

Here's the link to the Billboard Hot 100 archive, in case you want to play this game.