2009 – Page 28 – Mind Hacks

Mad pride of place

Newsweek has a good article on the ‘Mad Pride’ movement in the US, a British import where those diagnosed with mental illness reject the medical view of their experiences and decide to live with ‘extreme mental states’ both good and bad.

It makes a good complement to last year’s New York Times article on ‘mad pride’ although this focuses on the impressive The Icarus Project, a group of activists who campaign for mental health reform and work to support those who decide to forego psychiatric treatment.

After all, aren’t we all more odd than we are normal? And aren’t so many of us one bad experience away from a mental-health diagnosis that could potentially limit us? Aren’t “normal” minds now struggling with questions of competence, consistency or sincerity? Icarus is likewise asking why we are so keen to correct every little deficit‚Äîit argues that we instead need to embrace the range of human existence.

While some critics might view Icaristas as irresponsible, their skepticism about drugs isn’t entirely unfounded. Lately, a number of antipsychotic drugs have been found to cause some troubling side effects.

There are, of course, questions as to whether mad pride and Icarus have gone too far. While to his knowledge no members have gravely harmed themselves (or others), Hall acknowledges that not everyone can handle the Icarus approach. “People can go too fast and get too excited about not using medication, and we warn people against throwing their meds away, being too ambitious and doing it alone,” he says.

Link to Newsweek article ‘Listening to Madness’.

Help, I’m a prisoner in a brain fiction factory

The Sunday Times has one of the most gullible neuroscience articles I’ve read in a very long time. While most mainstream press articles are happy to make a hash of one study at a time, this manages to misinterpret virtually every headline-grabbing neuroscience experiment from the last couple of years.

The article claims that neuroscience is much more advanced than we realise and sets out to demonstrate this by over-interpreting recent discoveries, padding the article with false information, and using fallacies to discuss the implications.

It’s full of howlers:

Then, in the 1980s, a range of new technologies began to emerge, including positron emission tomography (Pet) computerised axial tomography (Cat) and, perhaps the best known, functional magnetic resonance imaging (fMRI).

PET was invented in the late 1960s / early 1970s, CAT was invented at virtually the same time, and fMRI was invented in the 1990s.

In a simplistic example, a scientist might show a picture of a scantily-clad woman to a man, and then see the parts of the brain associated with sex and lust lighting up as they consumed more oxygen. Meanwhile, the areas linked to reasoning and morality might go dark as they rapidly shut down.

I’m not sure whether “simplistic example” is a malapropism, a Freudian slip, or a grim admission of the the nonsense to come. Not only is the description of the technique completely misleading (all functional scans are comparisons between different situations, not just a measure of one reaction) but the example is completely bizarre.

The piece then goes on to suggest that neuromarketing gives a better idea how to market products (not one example to date), that brain scanning is a form of advanced lie detection (so advanced it doesn’t work very well) and that studies on the neuroscience of criminal behaviour (like writing crap brain articles) “suggest it could be wrong to hold such people responsible for their actions” (you wish).

I can’t face going through the rest of the examples because I keep weeping over my computer, but look out for the ‘this complex human attribute = this one brain area’ drivel, a profound confusion where brain activation is used to justify a behavioural or psychological conclusion, and the invention of the term “brainjacking” which is reported as if it’s already used.

I also noted that one of the quotes has just been lifted from other news reports.

Perhaps its only redeeming feature is that it could be a useful teaching aid if you’re giving a class on how neuroscience gets misrepresented in the media because it has at least virtually every type of slip-up in one handy place.

Link to ropey Sunday Times article.

Art and mental illness at the birth of modern psychiatry

If you’re in London before the end of June, make sure you drop into the Wellcome Collection museum which has two fantastic free exhibitions on the art and history of mental illness. If you can’t make it, the exhibition website is excellent and has video and images from the shows.

The first exhibition, Madness and Modernity, explores mental illness and the visual arts in Vienna in 1900, then the epicentre of the medical world.

Modern psychiatry was beginning to emerge and the ‘mad doctors’ employed some of Europe’s most pioneering architects to create asylums that were intended to be therapeutic by their very design.

For example, this poster is for one of the newly developed asylums of the time, as well as being beautiful in itself. The image to the right is the somewhat more intimidating ‘Tower of Fools’.

Also the use of art as a tool to document and disseminate ideas about mental illness became popular, as did an interest in the ‘art of the insane’.

There’s a video on the site which is a wonderful summary of the exhibition as well as being a great standalone discussion of how art and psychiatry influenced each other in the heady culture of 1900s Vienna.

The other exhibition is a series of diary paintings made by artist Bobby Baker from 1997-2008, as she charted her experience of mental illness and treatment. They’re only really done justice when seen as larger pictures, and the online gallery will give you a feel for their impact and humour.

A couple of things you can’t get online are the free events that accompany the exhibitions, which sadly seem all booked up, and the bookshop, which has a special section where they’ve collected (curated?) a great collection of books on almost everything to do with madness, the mind, art and history.

If you’re just visiting the website, you may need to do a bit of clicking around to see the best of the online material, but it’s well worth the visit. Watch the video if nothing else.

Link to Wellcome Collection Art and Mental Illness website.

Full Disclosure: I’m an occasional grant reviewer for the Wellcome Arts scheme, but I’m not associated with this exhibition in any way.

Tell me about your mother superior

I found this fascinating aside in a 1969 article on ‘Psychiatric Illness in the Clergy’ about a group of monks who underwent psychoanalysis, causing two thirds of them to realise they were “called to married life”.

The Pope immediately banned psychoanalysis from the priesthood as a result:

[Bovet] suggests that many clergy would benefit from psychotherapy during their training. This was attempted in Mexico when in 1961 a group of 60 Benedictine monks underwent group and individual psychoanalysis. However, of the original 60 monks taking part in this experiment, only 20 are still monks ; and of the 40 who have left the monastery it is reported that “there are some who realized that they were really called to married life” (Lemercier, 1965).

The Papal Court answered this “threat” the following decree: “You will not maintain in public or in private psychoanalytical theory or practice, under threat of suspension as a priest, and you are rigorously forbidden under threat of destitution to suggest to candidates for the monastery that they should undergo psychoanalysis” (Singleton, 1967).

This would not be the last time psychotherapists cause stirrings in the faithful.

The book Lesbian Nuns, Breaking Silence contains a chapter by the former Sister Mary Benjamin of the Immaculate Heart of Mary convent in California.

Psychotherapists Carl Rogers and William Coulson arranged for the nuns to take part in encounter group, essentially a form of fashionable 60s group psychotherapy aimed at well people rather than patients for ‘personal growth’.

The effect was disastrous for the convent, with hundreds of the nuns defaulting on their vows, and several, including Sister Mary Benjamin, discovering repressed lesbian desires.

The convent eventually collapsed and was closed in 1970.

There’s a brief online article that also recounts this story and I was intrigued to see a footnote at the end:

Having abandoned his once lucrative career, Dr. William Coulson now lectures to Catholic and Protestant groups on the dangers of psychotherapy, with a particular emphasis upon the “encounter group” dynamic.

There’s a whole novel right there in that footnote.

Link to summary of ‘Psychiatric Illness in the Clergy’.
Link to online article about Dr William Coulson.

Between a rock and a kind face

Newsweek has an article on human good and evil that trots out the usual Milgram-fuelled moral pondering before morphing into a fascinating piece on the psychology of compassion.

The most interesting part is where it discusses which psychological traits predict compassionate behaviour:

A specific cluster of emotional traits seem to go along with compassion. People who are emotionally secure, who view life’s problems as manageable and who feel safe and protected tend to show the greatest empathy for strangers and to act altruistically and compassionately.

In contrast, people who are anxious about their own worth and competence, who avoid close relationships or are clingy in those they have tend to be less altruistic and less generous, psychologists Philip Shaver of the University of California, Davis, and Mario Mikulincer of Bar-Ilan University in Israel have found in a series of experiments. Such people are less likely to care for the elderly, for instance, or to donate blood.

The Newsweek article labels these characteristics ’emotional traits’ but the researchers are actually using the psychological concept of attachment – an approach to relationships and human interaction style that can be seen throughout the lifespan.

The same research team has completed studies showing that increasing people’s perceived security increases altruistic behaviour.

Link to Newsweek on ‘Adventures In Good And Evil’.

2009-05-01 Spike activity

Quick links from the past week in mind and brain news:

Wired has a great piece on illusionist Teller and how stage magic could help cognitive science.

Some fascinating research on the use of video to give insight to brain injured patients unaware of their own paralysis is covered by BPS Research Digest.

The Journal of Neurology, Neurosurgery, and Psychiatry has a case report on restless legs syndrome affecting a phantom limb.

The curious link between the urban environment and schizophrenia is explored by Frontier Psychiatrist.

Channel N finds a video lecture on mental illness and creativity by Kay Redfield Jamison.

Funny or offensive? Probably both. The Onion has a satirical news report on World’s Oldest Neurosurgeon Turns 100.

BoingBoing finds an usual vintage comic book series entitled ‘The Strange World of your Dreams‘.

In 2001, all illicit drugs were decriminalised for personal use in Portugal. Time magazine investigates what happened, it turns out drug use has fallen.

The New York Times has an extended article on the meeting of Zen Buddhism and Freudian psychoanalysis.

A wonderful neurophilosophical quote from Melville’s Moby Dick is captured by Brain Hammer.

Cognition and Culture reviews new book ‘The Art Instinct’.

Do ‘brain training‘ games really work? asks ScAim. The answer, a bit.

PsyBlog has an excellent post on the psychology of consumption.

The media creates concept of media psychologists, encourages them to be unethical, then acts amazed when they are, says Dr Petra.

Wired talks to psychologist Craig Haney about the mental impact of solitary confinement.

Important new research on the genetics of autism spectrum is covered by Not Exactly Rocket Science.

BBC News reports on musician Prince discussing his childhood epilepsy and how he revealed it in a coded message on The Love Symbol Album.

Lithium levels in drinking water linked to fewer suicides

Higher levels of naturally occurring lithium in the water supply are associated with fewer suicides in the local population, reports a study just published in The British Journal of Psychiatry.

Lithium is one of the fundamental elements, but is also used by psychiatrists as one the most effective drug treatment for mood disorders, in the form of lithium carbonate and lithium citrate, where it is also known to reduce the risk of suicide.

This new study suggests that even trace amounts might have an influence on the whole population level, and this is not the first time this link has been made.

A 1990 study found higher levels of lithium in drinking water were linked to fewer incidences of crimes, suicides, and arrests related to drug addictions.

This leads to the intriguing question of whether lithium should be added to the water supply as a public health measure.

The idea of adding psychoactive substances to the water supply sounds creepy, but some might argue that if we add fluoride simply to prevent tooth decay, boosting lithium concentrations to the high end of naturally occurring levels to reduce deaths could be justified.

Philosophers and conspiracy theorists start your engines.

Link to BJP lithium study.
Link to DOI entry for same.

Extreme altitude climbs and the Sherpa brain

It’s now well known that high altitude mountain climbing damages the brain and causes a marked reduction in mental functioning.

I naively assumed this was true for everyone but I just found an intriguing 1996 study that compared brain function of lowland mountain climbers and Nepalese Sherpas after ascent to high altitude, which found that the Sherpas suffer few of these neurological problems.

Are Himalayan Sherpas better protected against brain damage associated with extreme altitude climbs?

Garrido E, Segura R, Capdevila A, Pujol J, Javierre C, Ventura JL.

Clin Sci (Lond). 1996 Jan;90(1):81-5.

1. The potential risk of brain damage when low-landers attempt to climb the highest summits is a well-known fact. However, very little is known about what occurs to Himalayan natives, perfectly adapted to high altitude, when performing the same type of activity.

2. Taking into account their long-life climbing experience at extreme altitudes, we examined seven of the most recognized Sherpas with the aim of performing a comprehensive neurological evaluation based on medical history, physical examination and magnetic resonance brain imaging. We compared them with one group of 21 lowland elite climbers who had ascended to altitudes of over 8000 m, and another control group of 21 healthy individuals who had never been exposed to high altitude.

3. While all of the lowland climbers presented psychoneurological symptoms during or after the expeditions, and 13 of them (61%) showed magnetic resonance abnormalities (signs of mild cortical atrophy and/or periventricular high-intensity signal areas in the white matter), only one Sherpa (14%) showed similar changes in the scans, presenting neurological symptoms at extreme altitude. The neurological examination was normal in all three groups, and no neuroimaging abnormalities were detected in the control group.

4. The significant differences, in both clinical and neuroimaging terms, suggest that Sherpa highlanders have better brain protection when exposed to extreme altitude. Although the key to protection against cerebral hypoxia cannot be established, it is possible that an increase in the usually short period of acclimatization could minimize brain damage in those low-landers who attempt the highest summits without supplementary oxygen.

Link to study of neurology of lowland climbers and Sherpas.

NeuroPod oscilates 100 year-old autistic robots

The latest edition of Nature’s excellent neuroscience podcast NeuroPod has just the wires and discusses using light to control the brain, a quite remarkable breakthrough in the genetics of autism, emotional robots and neurologist Rita Levi-Montalcini, the first Nobel prizewinner to turn 100.

The highlight is probably the section about Rita Levi-Montalcini who jointly won the Nobel prize for her discovery of nerve growth factor, a protein that is known to be key in neuroplasticity.

Although actually, it’s one of the most interesting and varied NeuroPod’s I’ve heard in a while, which is saying something for a programme which is usually on top form. Enjoy.

Link to NeuroPod page with streaming and download.
mp3 of April edition.

Blast from the past

New Scientist covers the debate on the causes of the non-specific emotional and cognitive symptoms that are appearing at an alarming rate in US soldiers who have been caught up in blasts while on service.

The controversy centres on whether the symptoms of ‘post concussional syndrome’ (which can include depression, irritability, concentration difficulties, headaches and reduced memory function) are caused by damage to the brain or from shock waves of the explosion, or are largely triggered by an emotional reaction to the stress of war.

It’s an interesting debate, not least because it’s almost 100 years since almost exactly the same debate raged over shell shock.

This is from an excellent article by medical historian Edgar Jones and colleagues who discuss the similarities between the ‘shell shock’ debates, and the current controversy:

Frederick Mott, then Britain‚Äôs leading neuropathologist, who was recruited by the War Office to discover the etiology of the disorder, argued that in extreme cases shell shock could be fatal if intense commotion affected “the delicate colloidal structures of the living tissues of the brain and spinal cord,” arresting “the functions of the vital centers in the medulla”. It was also speculated that the disorder resulted from damage to the CNS from carbon monoxide released by the partial detonation of a shell or mortar. In other words, shell shock was formulated as an organic problem even though the pathology remained unclear.

However, research conducted in 1915 and 1916 by Myers, consultant psychologist to the British Expeditionary Force, led to a new hypothesis. Based on his own observations, an increasing appreciation of the stress of trench warfare, and the finding that many shell-shocked soldiers had been nowhere near an explosion but had identical symptoms to those who had, Myers suggested a psychological explanation. For these cases, the term “emotional,” rather than “commotional,” shock was proposed. The psychological explanation gained ground over the neurological in part because it offered the British Army an opportunity to return shell-shocked soldiers to active duty.

As mentioned by the NewSci two big studies have recently found strikingly similar results: many soldier who have the symptoms of ‘post concussional syndrome’ were never actually in an explosion.

Extreme stress and trauma, of whatever type, seems to predict the likelihood of someone having the symptoms better than actually being caught up in an explosion.

The more things change, the more they stay the same.

Link to NewSci ‘Brain shock: The new Gulf War syndrome’.
Link to ‘Shell Shock and Mild Traumatic Brain Injury: A Historical Review’.

Voodoo II: this time it isn’t personal

More analysis problems with brain scanning research have come to light in a new study just released in Nature Neuroscience and expertly covered by the BPS Research Digest. It demonstrates that the common practice of using the same data set to identify an area of interest and then home in on this area to test further ideas can lead to misleading results.

This usually occurs when brain activation is compared between two conditions where participants are doing different tasks. A whole brain analysis looks for statistically significant differences at every point in the brain.

It’s very complete, but because of the large amount of data, but the data also contains a large amount of noise, so it’s hard to find areas which you can confidently say are more active in one condition than the other.

An alternative approach is to only look at activation in one area of the brain, perhaps an area where it is most likely to occur based on what we already know about how the brain works. This is called region of interest analysis (often done with the wonderfully named ‘MarsBaR‘ tool) and because the data set is much smaller, it is more likely to find a reliable difference.

However, some studies do a whole brain analysis to find likely areas, and then home in using region of analysis tools to examine them ‘more closely’. This ‘magnifying glass’ metaphor seems intuitive, but because your using the same data set to create and test hypothesis, it can be problematic.

It’s like shooting arrows randomly into a wall and then drawing a target around ones which landed together. Someone looking at wall afterwards might think the archer was a good shot, but this impression is caused by the after-the-event painting of the target, and the same problem could affect these brain imaging studies.

After the recent furore over the ‘voodoo correlations’ study, this new study is markedly more measured in its language and doesn’t list individual offenders.

Indeed, the ‘Voodoo Correlations in Social Neuroscience’ paper was actually retitled on publication to ‘Puzzlingly high correlations in fMRI studies of emotion, personality, and social cognition’, presumably to avoid stirring the pot any further.

However, this new study takes a similar tack, demonstrating through several careful simulations that ‘double dipping’ a data set is likely to distort the results just due to statistical problems.

From the BPS Research Digest:

Nikolaus Kriegeskorte and colleagues analysed all the fMRI studies published in Nature, Science, Nature Neuroscience, Neuron and Journal of Neuroscience, in 2008, and found that 42 per cent of these 134 papers were guilty of performing at least one non-independent selective analysis – what Kriegeskorte’s team dub “double dipping”.

This is the procedure, also condemned by the Voodoo paper, in which researchers first perform an all-over analysis to find a brain region(s) that responds to the condition of interest, before going on to test their hypothesis on data collected in just that brain region. The cardinal sin is that the same data are used in both stages.

A similarly flawed approach can be seen in brain imaging studies that claim to be able to discern a presented stimulus from patterns of activity recorded in a given brain area. These are the kind of studies that lead to “mind reading” headlines in the popular press. In this case, the alleged statistical crime is to use the same data for the training phase of pattern extraction and the subsequent hypothesis testing phase.

Link to BPS Research Digest on the fMRI analysis problems.
Link to PubMed entry for study.

Stylish psychotherapy magazine launches

Contemporary Psychotherapy is a new magazine dedicated to the practice of psychological treatment of all types and the current debates in this sometimes hotly contested field.

The first issue contains articles on the future of psychotherapy, CBT in North America, how psychiatrists deal with somatic or psychogenic symptoms and the challenges in conducting psychotherapy with asylum seekers, to name but a few.

It makes a good complement to the US-based Psychotherapy Networker magazine, it’s stylishly put together, you can download it for free as a PDF file, and long may it continue as it’s off to a brilliant start.

Link to Contemporary Psychotherapy with PDF download.

Encephalon 68, 69 and my memory is like a sieve

The 69th edition of the Encephalon psychology and neuroscience carnival has just appeared on Brain Stimulant and… dear God, I just realise I missed the 68th edition on the excellent Ouroboros as well, so here are both for your reading pleasure.

A couple of my favourites include a fantastic post on Neuroanthropology post entitled “Who you callin‚Äô a ‚Äòneuroconstructivist‚Äô punk?!” (actually, I added the punk, but you get the idea), and a Neurocritic article on a curious neurological condition where people lose the ability to correctly point at a named body part.

I always say there’s plenty more, but this time there’s a whole load more where that came from, thanks to my slightly faulty memory.

Link to Encephalon 68.
Link to Encephalon 69.

A Trance of Pleasure

A 2003 study in Epilepsy and Behavior has some descriptions of the ecstatic seizures experienced by some patients with epilepsy.

They include intense erotic and spiritual experiences, feelings of become close to and blending with other people, and some sensations that couldn’t be fully captured in words.

I’ve put some of the descriptions below because they sound absolutely wonderful:

Patient 1
The first seizure occurred during a concert when he was a teenager. He remembers perceiving short moments of an indefinable feeling. Such episodes recurred and a few months later evolved into a GTC [generalized tonic‚Äìclonic seizure]. He characterizes these sensations as ‚Äúa trance of pleasure.‚Äù ‚ÄúIt is like an emotional wave striking me again and again. I feel compelled to obey a sort of phenomenon. These sensations are outside the spectrum of what I ever have experienced outside a seizure.‚Äù He also describes cold shivering, increased muscle tension, and a delicious taste, and he swallows repeatedly. He enjoys the sensations and is absorbed in them in a way that he can barely hear when spoken to. When in a particular, relaxed mood, he can sometimes induce seizures by ‚Äúopening up mentally‚Äù and contracting muscles. He denies any religious aspects of the symptoms. ‚ÄúIt‚Äôs the phenomenon, the feeling, the fit taking control.‚Äù It lasts a few minutes and afterward he is tired with difficulties expressing himself for about 1 hour.

Patient 6
This man has a multifaceted symptomatology and a tendency to interpret bodily sensations as supernatural phenomena. Nevertheless, from the beginning of his forties, he experienced distinct, stereotypical attacks with a ‚Äúchange of concept of the surrounding world.‚Äù He reports an ‚Äúoscillating erotic sensation, like twinkling polar light‚Äù in his pelvic region and down the inside of his thighs. This is described as different from sexual excitement, more like ‚Äúan erogenous charge of the skin.‚Äù He may also have a clairvoyant feeling of a ‚Äútelepathic contact with a divine power.‚Äù These sensations are of short duration and may be accompanied by faintness and followed by drowsiness. With carbamazepine treatment, the frequency of these attacks has been considerably reduced.

Patient 11
The attacks started in his first school year. The experiences are beyond what can be described in words. ‚ÄúI can sense the colours red and orange without seeing them. The feeling has an erotic aspect. It starts in the stomach and spreads upwards. It is pleasant, but not similar to ordinary joy. It is like an explosion.‚Äù In the close presence of another person, he can feel a sort of peculiar unification. An intense d√©j√† vu sensation, a queer taste, and ‚Äúgooseflesh‚Äù are also components of the seizures. As a child he was surprised that his friends denied having similar feelings, and he learned to keep them to himself. Sometimes these attacks evolved into CPSs with reduced consciousness and complex automatisms and afterward he had transient difficulties speaking. Before the diagnosis of epilepsy was made in his late teens, he was referred to a psychiatrist. A right-sided temporal lobe calcification was diagnosed by computed tomography at about 30 years, but he refused surgery. At 42, an expansion in the same region was found by MRI, and he was operated for an anaplastic oligodendroglioma. He was seizure-free for 6 years until recurrence of the tumor.

One of the striking things about epilepsy is how different each person’s experience of having a seizure can be.

While it is stereotypically assumed to be a negative experience, some aspects can be remarkably beautiful.

The Russian author Dostoyevsky famously said of his epilepsy “I would experience such joy as would be inconceivable in ordinary life – such joy that no one else could have any notion of. I would feel the most complete harmony in myself and in the whole world and this feeling was so strong and sweet that for a few seconds of such bliss I would give ten or more years of my life, even my whole life perhaps.”

There are several more case descriptions in the article, all of which have some aspect which touch at least the edge of ecstasy, if not the very heart of the experience.

Link to article.
Link to PubMed entry for same.

Beautiful butterfly brain

This is a beautiful butterfly brain greetings card, created by graphic designer TweeK. I’d never would have imagined that an MRI scan and butterflies would go together so effortlessly, and the effect is quite stunning.

You can buy copies of the card online, so you can impress the hardest-to-impress of your brain-inclined friends, or you can just visit the page to see it in more detail.

I can’t stop looking at it.

Fantastic.

Link to TweeK’s butterfly brain greetings card.

Dodging the border agency of the brain

I just noticed that neurotechnology analyst Zack Lynch has a forthcoming article in Epilepsy and Behavior on the latest developments in the commercial brain science field. Avid neuroscience fans may be familiar with most of it but the section on new technologies to cross the blood-brain barrier was eye-opening.

The blood-brain barrier (BBB) is a sieve-like border crossing that allows only certain molecules to pass from the blood into the brain.

It’s remarkably restrictive and many molecules are just too big to get past, meaning that many drugs that could affect the brain are virtually useless, simply because they can’t cross the border.

This has led neuroscientists to think of ways of smuggling, tunnelling and sneaking this these molecules past the barrier, and Lynch’s article lists some of the latest technologies which aim to jump the fence.

‚Ä¢ Implantable devices: Implantable pumps bypass the blood‚Äìbrain barrier (BBB) and deliver highly accurate amounts of drugs to specific sites in the brain or spinal cord.

‚Ä¢ Expression systems: A French company is circumventing the BBB using encapsulated cell technology (ECT), a polymer implant containing cells that provide continuous, long-term release of the therapeutic protein to the brain or eye.

‚Ä¢ Receptor-mediated transport: Receptors that transport nutrients to the brain from the blood can be tricked into transporting therapeutic chemicals, peptides, and proteins across the BBB. Insulin, transferrin, and lipoproteins, for example, cross the BBB by facilitated transport, and can be combined with therapeutic proteins or other molecules to promote access to the brain.

‚Ä¢ Cell-penetrating peptides: During the past decade, several arginine-rich peptides have been described, such as SynB vectors, which allow for intracellular delivery and BBB transport. The mechanism for this transport is unknown. A Swiss company is using cell-penetrating peptides to develop treatments for stroke and myocardial infarction.

‚Ä¢ Focused ultrasound: Some research shows that focused ultrasound can temporarily open the BBB in a targeted area for a window of time. A seed stage company is working to commercialize this technology and improve it for use in humans.

‚Ä¢ Nanoparticle formulations: Nanoparticle formulations refer to therapeutics encapsulated in nanoscale particles that can pass the BBB. Although there is great interest in using nanotechnology to improve neuropharmaceutical delivery to the brain, it will take some time to overcome challenges of this platform, including the need for intravenous delivery, manufacturing, and clearance by the liver.