Combining Cognitive Drug Therapy with Brain Device Therapy

The CNS Summit, held in Boca Raton this year, is a forward looking conference on the state of drug development for a wide range of brain disorders. The past few years have not been kind to CNS drug companies, with several notable failures in clinical trials for drugs to cure, or at least slow down the progression of Alzheimer’s Disease. The CNS Summit brings together drug developers, government agencies, and research labs in an effort to collaborate more efficiently.

One of the topics I found most interesting is the emerging idea of combining CNS drug therapy with “brain device” therapy, in order to produce more positive, patient-specific health outcomes.

Several companies and labs presented a range of applications:

    Transcranial Magnetic Stimulation (TMS): using a powerful external magnet to target specific regions of the human cortex. TMS can penetrate 2-3 centimeters into brain tissue, which is quite a lot. The magnetic coil acts on groups of neurons by initiating or changing electrical current. The FDA has approved TMS therapy for major depression — Neuronetics is one company that provides a packaged TMS system. There are probably also some interesting off label uses of TMS that are being tried out as well.

    Consumer ready EEG devices: the days of wearing uncomfortable skull caps with dozens of plugs and wires to record brain waves are giving way to personal, wearable EEG sensors that transmit user EEG data by wireless link. NeuroVigil’s iBrain device is used for at-home sleep monitoring, which is useful for conditions such as epilepsy and chronic sleep disorders.

    Computerized Cognitive Training & Rehabilitation: while the media debate continues to rage about the merits of first-person shooter video games, there are several companies that have staked out areas of expertise using software-based games for cognitive remediation and rehabilitation — Cogmed is a software tool used for ADHD remediation, for example. Dr. Michael Merzenich, an expert in cognitive training, launched the Brain Plasticity Institute to develop new software-based games and exercises that can be used to treat cognitive deficits apparent with Alzheimer’s and other forms of dementia. Dr. Adam Gazzaley, Director of the Neuroscience Imaging Center at UCSF, is working with the Brain Plasticity Institute on this effort.

Using computerized cognitive training games in parallel with traditional CNS drug therapy is a new and promising approach. With 70+ Million baby boomers beginning the march into their 60s and beyond, some kind of broad-based, easily accessible therapeutic option to help maintain cognitive health will become increasingly important. The shift away from the sole reliance on a pill, to a more nuanced approach that combines brain devices with drugs will be an interesting change to watch in health care.