datarancher

EDIT: The poster replaced their previous expert declaration with one raising entirely different arguments about brain damage. I haven't read the new one yet....

I'm a neuroscientist who develops brain stimulation techniques (and am totally uninvolved in this case). I took a look at the "expert" declaration, and it seems....dicey.

They are not showing any direct evidence of injury to a patient--there's no MRI, CT, or autopsy showing a lesion where there wasn't one before.

Instead, the principal claim in paragraph 28 is that ECT leads to increased expression of a few proteins that are sometimes linked to injury. They make a particularly big deal about changes in the amount of brain-derived neurotrophic factor (BDNF). There's some data suggesting that BDNF levels in the cerebrospinal fluid do increase after injury, but they can also be increased by things like exercise, and we normally think of those as good changes that improve neurogenesis, memory, recovery from disease, etc. However, it matters where you measure: serum (i.e., in the blood) levels seem to anti-correlated with levels in cerebrospinal fluid, and it's unclear what is going on in the actual neural tissue, which is presumably what matters. In short, the relationship between BDNF (and the other proteins they mention) and injury/function is crazy complicated and this "expert" doesn't really do it justice.

Furthermore, there's some weird mind-body dualism in there. Memory loss is an incredibly well-known side effect of ECT, and prospective patients were almost certainly warned about it; this had to part of the FDA approval process. The report makes a lot of hay out of the fact that these physical changes were seen in the hippocampus, an area associated with memory. OBVIOUSLY! It's not particularly surprising that a change in brain function is associated with physical changes in the brain. Maybe that should be made more explicit in case Rene Descartes wants ECT, but it's hardly gross malpractice.

Finally, I want to point out that the "expert" witness appears to be an internal medicine specialist, not a neuroscientist, neurologist, or any other sort of brain-related specialization. While I'm sure she's not a dummy, her credentials don't suggest that she has more than a cursory understanding of this stuff.

I looked at the "expert" data and was also...unimpressed.

Furthermore....

• There are some pretty substantial differences between the rodent hippocampus and the human/primate one. A mouse hippocampus is literally a few millimeters below the skull. It's more like 30mm in monkeys, and even more in humans. The organization and cell composition appear to be a bit different too.

• The mouse brain is also a lot smaller and smoother, which would expose the mouse hippocampus to a stronger electric field. The human brain has all kinds of wrinkles, and these serve to shunt electricity around in weird ways.

• The hippocampus appears to have some (albeit slow) neurogenesis, so it's not clear how long these effects would last.

In summary, that 10% number is not a particularly firm one.

(Disclaimer: I have wasted the last month/year working on the first two things for other studies, and these seemed like as good an opportunity as any to vent about the dangers of extrapolating from mouse data).

I don't want to throw too much shade at someone I've never met, but I will admit to a certain skepticism when I saw that her professional interests include "medical accountability."

Edit: So....the OP, Connor Karen, swapped the expert declaration with something else entirely, which is kind of an obnoxious thing to do.

That seems way more profitable than my business plan of a) drink eggnog and b) rant to strangers about the "expert" is not that expert. Damn my scruples!