Sourasky Medical Center researchers bump heads with the brain

What are the causes of mental illness? Are mental illnesses caused not only by psychological and environmental factors but also biological ones? Talma Hendler, a professor of psychiatry and neuroscience at Tel Aviv University and the founding director of the Sagol Brain Institute in Tel Aviv, thinks so. She and a team of researchers and students are working on a multidisciplinary platform to address mental health problems, including attention deficit disorder, autism, emotion dysregulation, maladaptive stress and anxiety, trauma and depression through brain regulation training of neurofeedback. Further, she is using advanced brain imaging techniques, including functional magnetic resonance imaging (fMRI), Diffusion Tensor imaging (DTI) intracranial and scalp electroencephalography (EEG) and magnetic encephalography (MEG) to study processing in the healthy and diseased human brain, which she hopes will “bring psychiatry back to medicine,” where she feels it belongs. Hendler says that advanced brain imaging and other artificial intelligence and neuroscience techniques have provided a wealth of new information about the human brain and its neural networks, which can be used to diagnose and treat mental health disorders. For that, she has been working to find objective brain markers and characteristics of the behavior dynamics of an individual brain that is experiencing a mental disorder. “Instead of a person saying, 'I am depressed,' I want to get to the stage where we can, in addition, look at his brain and tell whether he is really clinically depressed and, if so, how and in what way,” Hendler explained. She said psychiatrists should not only be talking to and looking at patients to determine their state. Rather, psychiatrists should be able to combine subjective with objective factors, which will lead to better characterization and classification of patients, and ultimately better results. “We treat the heart and the gastrointestinal track as the organs they are,” Hendler said. “We should be treating the brain as an organ when treating a patient with a mental disorder, but we largely disregard it. I would like to change the 'neural blindness' about diagnosis and treatment of mental disorders.” She continued, “There is always a latest fad – eat this way, read this. We must move away from all these eclectic approaches to a system that is evidence- based, like other areas of medicine. For example, Hendler believes in the power of brain computer interface approaches, like neurofeedback, whereby patients learn to control brain function using real-time signals from their own brain as rewarding feedback. In patients, such internal-regulation techniques can be used to mark and modulate the brain networks of a given mental disorder, thus restoring function, alleviating symptoms and promoting resilience. “A psychiatrist should be able to test the patient's brain, body and their interactions with one another, and to see if he will respond to certain stimuli to help alter his brain or the way he mentally experiences and relates to the world,” she explained. “It will be at least another 10 years until this is an integrated treatment technique,” she said, “but the goal is to have enough technological advancement and neurological understanding to bring this to the clinic. The end goal is to have personalized brain treatment based on an individual's brain network functioning, being able to calculate one's mental state based on the brain and through this calculation coming up with a specific treatment plan. “This sounds trivial, but it is anything but trivial and it has yet to be accomplished,” she said. “I believe this work could be the hook for ending a lot of mental suffering.” Science fiction or fact? Similarly, Zvi Ram, the director of Tel Aviv Sourasky Medical Center's neurosurgery division, is trying to alleviate suffering. He is working on how to assess high-cognitive brain functioning before, after and during brain surgery so that he can help preserve it. “It used to be that a patient could just wake up walking and talking and the surgery was considered a success,” Ram told The Jerusalem Post Magazine. “But now we understand that there are other characteristics – characteristics that define a person's integrity and personality – that also need to be preserved.” Ram explained that the brain accomplishes many of its more complex tasks via a series of neuronal network interactions and when they undergo changes it can result in different brain function, affecting everything from language to musicality to creativity. His team has designed a series of examinations using advanced brain imaging and other techniques – including tests that are done during surgery while the patient is awake – to ensure the surgery is not harming the patient's functioning. He cited examples where a mistake during surgery could alter a person's life. “For a judge, decision-making processes are critical,” he explained. “What if we could identify where these processes are in the brain and map that area of the brain and then preserve the functioning? If not, he may not be able to continue working. Or how about a musician? If he were to lose his harmonic recognition, it would be the difference between losing his career or continuing life as usual.” He said his team is working to get to a place where they can screen patients before surgery, including asking the patients about the strengths that are critical to preserve, and then be able to try to focus on these areas during surgery. “It will be a patient-tailored approach,” Ram said. He said they are in the process of identifying the correct tools to carry out what is still a dream. But he said he envisions the work being complete within a few years. Then, the same process could later be applied to patients who are suffering from brain disorders – including manic depression, obsessive compulsive disorder or eating disorders – in that they could then identify the networks that are causing the symptoms and try to manipulate them via stimulation, inhibition or even surgery. Similarly, if they could determine what neuronal networks are responsible for memory, “everyone wants better memory. Maybe we could enhance memory in a non-invasive way.” He continued, “It is partly science fiction, but it will become science fact soon, I am pretty sure.” This article was written in cooperation with Sourasky Medical Center

Sourasky Medical Center researchers bump heads with the brain

‘There is always a latest fad – eat this way, read this. We must move away from all these eclectic approaches to a system that is evidence-based’ says Prof. Talma Hendler.

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