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Brain-O-Matic
Can a jolt from a nine-volt battery make you smarter? Happier? Medical researchers revive a discarded technology and set the stage for the brain pod
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Stuart Gromley sits hunched over a desk in his bedroom, groping along the skin of his forehead, trying to figure out where to glue the electrodes. The wires lead to a Radio Shack Electronics Learning Lab, a toy covered with knobs, switches, and meters. Even though hes working with a kiddie lab, Gromley, a 39-year-old network administrator in San Francisco, cant afford to make mistakes: hes about to send the current from a nine-volt battery into his own brain. Gromleys homemade contraption is modeled on the devices used in some of the top research centers around the world. Called transcranial direct current stimulation (tDCS), the technology works on the principle that even the weak electrical signals generated by a small battery can penetrate the skull and affect hot-button areas on the outer surface of the brain. In the past few years, scholarly research papers have touted tDCS as a non-invasive and safe way to rejigger our thoughts and feelings, and possibly to treat a variety of mental disorders. Most provocatively, researchers at the National Institute of Health have shown that running a small jolt of electricity through the forehead can enhance the verbal abilities of healthy people. That is, tDCS might do more than just alleviate symptoms of disease. It might help make its users a little bit smarter.

Say electricity and brain in the same sentence, and most of us flash on certain scenes from One Flew Over the Cuckoos Nest. But tDCS has little in common with shock therapy. The amount of current that a nine-volt battery can produce is tiny, and most of it gets blocked by the skull anyway; what little current does go into brain tissue tends to stay close to the electrodes. By placing these electrodes on the forehead or the side of the head, researchers can pinpoint specific regions of the brain that theyd like to amp up or damp down. Gromley is one among a small clique of hobbyists who have been discussing the tDCS machine on the Web. Like ham-radio operators of the brain, they share advice with their fellow tinkerers. I accidentally found a way to make GREY FLASHES IN MY VISION using a 9v battery. Dont you try it, says one hacker in an on-line forum. Heres how not to do it, he adds, and then provides instructions. Gromley has been suffering from bouts of depression since he was a teenager; antidepressant medication has only made him feel worse. Now he finds himself sitting before a Radio Shack kit, with sponge electrodes he bought on e-Bay affixed to his head one on the temple area and one on the brow. When he flips on a switch, current runs from the battery through a resistor and then into wires and into his prefrontal cortex. He leans back in his chair with his eyes closed, wondering if he feels anything. Thats when he sees the flash what he describes as a horizontal lightning bolt that seems to arc from one side of his forehead to the other. No, that didnt happen, he thinks, and tries to calm himself. Then, a few minutes later, he shifts in his seat, the wires jiggling, and he sees lightning again. Gromley yanks off the electrodes and begins searching on Google, using keywords like tDCS and flash until he finds a study that reassures him: those spots of light were harmless. So Gromley returns to his experiment. Flash, flash, flash. He rearranges the electrodes several times before he finds the sweet spot. Do you remember the first time you drank coffee? It was like, Oh my god, if Id known how good this was, Id be drinking coffee all the time. Needless to say, the researchers I talked with cautioned against trying this sort of thing at home, although they had a grudging respect for anyone with the pluck to do it. In the past, a lot of scientific discoveries were made by amateurs who experimented on themselves, notes Peter Bulow, a psychiatrist at Columbia University. He says that a recent safety study found that tDCS causes no damage to brain tissue, but cautioned that any cutting-edge treatment comes with unknown risks. Bulow himself has just submitted a proposal to study the effects of tDCS on 20 depressed patients, and teams of researchers are experimenting with battery-powered electrodes at the National Institute of Health (NIH), the Harvard Center for Noninvasive Brain Stimulation, and at the University of Gttingen in Germany, among other centers. Theyre exploring tDCS as a treatment for depression, chronic pain, addiction to cigarettes, and Parkinsons disease, as well as motor disorders caused by stroke and neurodegenerative diseases. Some believe that if tDCS continues to pan out, a consumer version of the machine might someday appear on the market available with a prescription from a doctor. Asked whether the tDCS machine might look like an iPod if it ever hit the market, one NIH researcher smiles. The brain-pod! he jokes. It should play music, receive calls, and . . . shoot like a gun. Then he grows serious. It could be very simple and wearable. Yet its very simplicity could be its undoing. The cost of parts electrodes, a battery, a resistor can be had for as low as $10. How would a medical-supplies company make money off of a gizmo so rudimentary that it sounds like a seventh-grade science-fair project? I, Science Experiment It is October 2006, and a group of researchers are gathered around a conference table at the Harvard Center for Noninvasive Brain Stimulation at Beth Israel Deaconess Medical Center. Felipe Fregni, an instructor in Neurology at Harvard Medical School, is delivering an introductory lecture on what might be called Brain Zapping 101. His hair slicked to the side in the manner of a 1920s tycoon, Fregni is wielding a remote control, flashing images onto a white board. About 25 scientists from Thailand, Brazil, Bolivia, Israel, and Germany, among other countries crowd the room. The graphs Fregni projects on the wall create a frisson of excitement. The audience ooh and aahs. They lift digital cameras and snap photos. You can feel it the buzz this technology is beginning to generate among the clique of researchers enchanted by both brains and gadgets. At the end of his lecture, Fregni announces that he will demonstrate tDCS. Does anyone in the audience want to try it out? Silence.

The scientists gaze around, waiting for someone else to volunteer. And then the room erupts into laughter at the collective reluctance to be wired up. Before I quite realize what Im doing, I hear myself say, Ill do it. My hand shoots up in the air, seemingly of its own accord. My heart seems to beat everywhere, my hands, my feet, my face. Why hasnt anyone else any of the experts volunteered? Now, I am teetering toward the front of the room. Shirley Fecteau, another Harvard researcher, guides me to a chair. She and Fregni place the sponge-covered electrodes on the top of my head, in the two spots where I might grow bunny ears if I were a character in a fairy tale. This position, which targets the prefrontal cortex, is used to treat depressed patients. Someone wraps an Ace bandage around my head so tightly that I begin to feel headachy. I have lots of hair, so the bandage begins to slide upward. Someone pushes it back in place and I can feel fingers on my scalp, checking the position of the electrodes. Clearly, the Ace bandage alone wont do the job. Fecteau finds a giant elastic band and stretches it vertically around my head so it cuts into my cheeks. For the rest of the experiment, it squashes my windpipe, like an especially tight birthday-party-hat strap. Fregni shows the control box to the audience, a black brick with a meter and a few knobs on its face. The wire from that box dangles along my arm and up beyond the line of my vision to my head. Thats when it hits me: they really are going to send electricity through my skull. Fregni turns the switch. The sponge on the left side of my scalp begins to prickle, the way poison ivy will after you scratch it. The elastic band makes me gasp for breath. The Ace bandage strangles my forehead. The room flashes as members of the audience take photos, and I try not to think about how I must look with all the elastic pinching my face and my hair sticking every which way. Rather than enjoying an elevated mood, I feel mortified sitting here on display in mental-patient drag. Fregni keeps me hooked up for only five minutes, long enough to demonstrate the equipment but not long enough to have much clinical effect. Then he frees me. I shuffle back to my chair, still trying to smooth my wet hair back into place. And now, as if by delayed reaction, euphoria overwhelms me. I feel all fluttery, as if Id just stepped off a roller coaster. Maybe the electrodes gave me the high. Or maybe I was just elated to leave the stage. Its hard to say. In the midst of my intoxication, a thought comes to me: Ive touched my own b rain. Before this moment, I had always thought of my brain as imperious and remote, like a queen who issued commands from a red-velvet room high up in a tower. Worry ceaselessly! my brain might decree, and I would have no choice but to obey. But now, I have tried to turn the tables. History of technology I feel for the 30-year-old woman who, in 1962, regularly shuffled around Summersdale Hospital, in England, with a battery pinned to her dress and two silver electrodes, wrapped in gauze, winking above her brow like a second set of eyes. Shed spent half her life in mental asylums: when she was a girl, her father had shot himself, and afterward shed become convinced that other people could see a mark upon her. Nothing had lifted her malaise, not even shock treatment. When she arrived at Summersdale Hospital, she muttered Get rid of me in response to questions. According to the scientific papers that reported on the study, researchers J.W.T Redfearn and O.C.J. Lippold kept her brow area bathed in electricity for as many as 11 hours a day, three treatments a week. The patient began to sleep soundly, no longer tormented by nightmares; she ate well; she prettied herself up; she found a boyfriend. She became, the researchers said, a different person. That year, she was just one of several dozen people wandering the halls of Summersdale with electrodes plastered to their foreheads and batteries on their lapels like boutonnieres. In an earlier study, Lippold and Redfearn had found that they could change the personalities of their subjects with electrical stimulation: positively charged electrodes on the forehead caused people to giggle and chat. Under the influence of negatively charged electrodes, people shut down, became silent and apathetic. Some of the patients had so enjoyed the positive electrodes that they asked for the battery treatment again. And so Lippold and Redfearn launched a new study; this time they would expose people many of them severely depressed to long sessions of electrical stimulation. The patients were allowed to go home with electrodes glued to their heads, the battery still buzzing. Almost half of them experienced miraculous recoveries. A shell-shocked World War II veteran compared the effects to a shot of whiskey I feel quite all right, he crowed, after hed been stimulated. In the decade that followed, other researchers tried to replicate these effects. They produced inconsistent results. Nowadays its clear why: researchers applied currents that were too small and glued electrodes to the wrong parts of the scalp. They used some parameters of stimulation that we know now are not effective. They didnt have the information that we have now, according to Fregni. Because the battery-powered electrodes seemed to be unreliable, the medical community lost interest in brain polarization.

Then, in the 1980s, researchers found a much more powerful way to stimulate isolated buttons of the brain. Called repetitive transcranial magnetic stimulation (rTMS), the technique uses electromagnetic radiation which can easily pass through the skull to create localized electrical fields near the surface of the brain. The effects of rTMS are dramatic and reproducible. Place the machines wand on one part of the scalp and the patient will lose her ability to talk; move the wand to another spot and her leg will jerk. In essence, rTMS is a souped-up version of the old battery-and-electrodes treatment. But it also comes with greater risks: it can trigger seizures, an arm that wont stop shaking, or a patient who slumps over in his chair. However, such side effects are rare, and rTMS has proven to be a powerful tool for mapping the brain and modulating brain activity; in the 1990s, researchers began using it (along with other new technologies) to draw blueprints of neural function. This new knowledge, in turn, meant that the battery treatment became relevant again because now scientists could design a more effective tDCS machine. MORE POWER TO YOU: Researchers wire the author for a round of tDCS. covered them with sponges in order to allow more current to pass through the skull. They also created new protocols for placement of the electrodes. Just a few years ago, these design changes began to pay off in studies that showed promising results: the new, In the late 1990s, a team at the University of Gttingen enlarged the electrodes and improved battery treatment could quicken the tongue and the hand. It could make people smarter and faster, if only by a small margin. When German researchers trained the positive electrode on the motor cortex, their human subjects became significantly faster at learning to hit a keyboard in response to a visual cue. Meanwhile, NIH researchers found that people with their heads hooked up to batteries performed better on verbal tests. There is the promise, then, that portable machines could juice up particular spots in the brain. But would a brain-pod make you smarter than an ordinary cup of coffee? Thats still unclear. Ride em Ronco Picture your brain as a forest in the summer, all dry timber and secret layers of leaves. One stray match and fire will flare through it, consuming every tree. This is the metaphor that Yousef Mohammad uses to describe a migraine headache: a stray spark sets off a flame, and soon a whole area of the brain is burning. We now believe the migraine starts with some kind of neuronal hyperexcitability and that this small flare-up of neurons kicks off a chain reaction, says Mohammad, a neurologist at the Ohio State University Medical Center. He thinks he has found a way to halt the migraine before it rages out of control: a machine the size of a Kleenex box, with handles. It has already proved itself in a study of 43 patients. Now Mohammad is preparing to test the machine on 200 migraine sufferers; if it continues to show a significant ability to alleviate pain and nausea, it could hit the market within two years. The machine delivers two pulses of TMS to the back of the head. Because the pulses are discrete, rather than repetitive, there is no danger of triggering a seizure. These pulses, Mohammad says, work like a firebreak in a forest, creating a barrier to stop the conflagration. But of course, in this case its not fire but electricity thats out of control. Were treating electricity with electricity, rather than treating electricity with medications, according to Mohammad. The same principle of interrupting errant nerve signals before they cause a firestorm could be used to treat chronic pain and depression with battery-powered electrodes. For instance, someone with chronic pain could use a tDCS machine to zap his or her motor cortex regularly over a period of weeks. The electric current would help to control signals near the surface of her brain, which in turn would help to quiet the thalamus. In a patient with chronic pain, the thalamus shrieks its message ouch! ouch! ouch! like a car alarm that doesnt know how to shut itself off. This year, researchers at the Harvard Center for Noninvasive Brain Stimulation, working with colleagues in Brazil and Germany, published results of a preliminary experiment that showed tDCS could in fact provide relief for people with spinal cord injuries. In addition, Harvard researchers, along with their colleagues, also released the results of a preliminary study on depression: daily sessions of tDCS led to statistically significant boosts of mood in people diagnosed with major depression. Fregni, the Harvard researcher who was lead author on both studies, says tDCS would offer one huge advantage when compared with drug treatments. Drugs can potentially expose the entire brain and body to chemical changes, while tDCS would affect only one neighborhood of the brain. There are large advantages because you are targeting a problem, he said. Of course, tDCS still has yet to prove itself in a large study. How, I ask him, would such a low-tech machine ever make it to the market? Who would pay the exorbitant bill required to secure

FDA approval for the pocket-size brain zapper, especially when anyone can rip off the design? Its a big concern, the future of this technique, Fregni agrees, sighing. Big Pharma, he notes, already has a tried-and-true method for generating profits: a company can change one molecule of an existing drug, make up a new name for it, splash advertisements on TV, and resell it at a much higher price In a market like that its hard to compete, he says. Fregni notes that the machine has a greater chance of catching on outside the United States. In Germany, for instance, two companies Schneider Electronic and Eldith already sell tDCS machines for use in labs. These gizmos cost a bafflingly large amount of money: the equivalent of thousands of US dollars. Apparently, it pays to sell machines to researchers. But what about ordinary people? Fregni believes that tDCS might be particularly suited to the needs of developing nations, where those who suffer from depression have little access to meds. Last year, he and some of his colleagues wrote a letter to the British Journal of Psychiatry suggesting that tDCS machines which could cost under $100 and be rigged up in local factories might be a good fit for poor countries. Indeed, a group in Brazil is now developing such a low-cost machine. Perminder S. Sachdev, a neuropsychologist at the University of New South Wales, fired back a rebuttal in the same journal: Depressed patients in the developing world should be dissuaded from unplugging their car batteries and clamping them on their foreheads. But a few months later, the outraged Sachdev had apparently become a convert. He contacted Fregni asking for more information about tDCS it seemed that he, too, wanted to study tDCS as a treatment for depression. Eric Wassermann, chief of brain stimulation in the Office of the Clinical Director at NIHs National Institute of Neurological Disorders and Stroke, believes that if we are ever to have a brain-pod in the United States, it would likely be tested and developed by the military first. But he doesnt rule out the chance that a private company would bankroll tDCS if it continues to perform in the lab. It is unlikely that any [company] would do this unless they were guaranteed a market share, and the only way they could be guaranteed a market share would be if they had a patent on some important part of the process. I think we know so little about it at this point that there may be patent-able parts. However, Wassermann is not eager to put this device into the hands of consumers; hes concerned about the ethical problems it poses. I would not be in favor of this being an iPod. Not yet. Not until the issues of safety and fairness have been resolved. A while ago, someone suggested to Wassermann that he take some tDCS machines to a nearby university and wire up half the students in a classroom before they took a test. Would the battery-powered kids do better? I thought the ethics of that sort of application were questionable, because you dont want to advantage people who can afford something that others cant, Wassermann says. Of course, these machines could be as cheap as clock radios or coffee makers. So arguing about the ethics of brain-pods might be an exercise in futility; if tDCS turns out to produce strong effects, the machines will pop up everywhere, whether we like it or not. Its an interesting phenomenon, if this were an effective treatment, to have it get completely loose, Wassermann says. Im not excited enough about [tDCS] as a panacea or a great social evil at this point to be very worried. But if it were very potent, it will be all over the place. The Chinese would flood the market with gizmos. This could get completely out of control. It could be like blogging. Everybody could be a brain manipulator.

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