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  1. Deep brain stimulation may ease opioid addiction when other treatments fail

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    Doctors at West Virginia University’s Rockefeller Neuroscience Institute are testing the experimental procedure on patients for whom other treatments didn’t work.

     

    As James Fisher awaited experimental brain surgery he underwent recently, he wondered whether it will be the treatment that finally helps him get his addiction under control.

    The tiny electrodes surgeons implanted in the reward center of his brain are designed to carry electrical stimulation that could, in theory, help drown out the constant craving he feels for benzodiazepines, his drug of choice.

    Fisher, 36, who lives in West Virginia, is the third patient enrolled in a clinical trial being conducted at West Virginia University’s Rockefeller Neuroscience Institute. To be included in the study, which uses a technique called deep brain stimulation, patients must have gone through numerous rehabilitation efforts that didn’t work and suffered multiple overdoses.

    At first, Fisher, who had been using drugs since high school, easily found doctors willing to write prescriptions for his social anxiety. When that stopped working, he began buying from friends and eventually started stealing from strangers to get the money to pay for drugs. Initially it was just “benzos,” but later he moved on to prescription opioids and then heroin.

    After four nearly fatal overdoses, he had jumped at the chance to participate in the trial.

    “I don’t want to die,” Fisher told NBC News before the surgery. “I don’t want to live that miserable life of being sober and still wanting something and not being able to get it.”

    As part of an NBC News series, “One Nation Overdosed,” “Nightly News with Lester Holt” was given access to West Virginia University’s experimental trial as surgeons implanted wires in Fisher’s brain to treat his severe opioid use disorder.

    Image: X Ray
    In the West Virginia University addiction trial, tiny electrodes are implanted in a part of the brain that evolved to reward behaviors such as seeking food and sex. W. Virginia University

    Deep brain stimulation (DBS) has been used successfully for decades to treat symptoms of Parkinson’s disease. Doctors at the Rockefeller Neuroscience Institute developed the technique for worst-case drug addiction on the theory that targeting one of the brain’s reward centers — the nucleus accumbens — with tiny sparks of electricity could quiet powerful cravings, allowing the brain regions involved in judgment and decision-making to be heard, said principal investigator Dr. Ali Rezai, executive chair of the institute in Morgantown.

    Drugs such as benzodiazepines and opioids hijack the reward system and once users are exposed, they need more and more of the substances to get the rush of the feel-good neurotransmitter dopamine.

    “Our hypothesis was that by using the DBS in this part of the brain, we would essentially be normalizing the dopamine levels,” Rezai said. “In addiction, the rewards part of the brain releases dopamine when the drug is taken and people feel good. And then they want more next time to get to the same feeling.”

    For Parkinson’s patients, electrodes are implanted in the parts of the brain involved in movement. In the addiction trial, the electrodes are implanted in a different part of the brain, an area that evolved to reward behaviors that keep the species going, such as seeking food and sex. Dopamine is released when those goals are accomplished, as well as at times when people are experiencing natural beauty, such as a particularly colorful sunset or an emotive piece of music.

    When the surgery to implant the electrodes is complete, doctors switch on the deep brain stimulation device. For Fisher, the results were immediate and startling. The depression, anxiety and irritability are gone, replaced by a feeling of calm and comfort, like “a warm blanket.”

    “It’s like night and day,” he said.

    Fisher’s surgery was at the end of July. After four weeks, he told NBC News he feels “fantastic” with no craving to use drugs.

    Two months later, he is still sober.

    “I’m willing to do what it takes to get my brain back to normal,” Fisher said. “I hope that I can get back to that period before I started using benzos. Just being naturally happy — enjoying music again, enjoying food again, enjoying seeing a smile on somebody’s face.”

    Image: James Fisher
    “I’m willing to do what it takes to get my brain back to normal,” James Fisher said before the experimental treatment for his opioid addiction. NBC News

    The initial phase of the trial, which began with the first patient in 2019, is designed to test the safety of the treatment and will eventually include four people with severe substance use disorders. A second phase with 10 patients will test how well it works in keeping people off drugs.

    The need for additional treatments for opioid addiction is urgent. In 2020, during the pandemic, drug overdose deaths spiked to record levels of more than 93,000, according to data from the Centers for Disease Control and Prevention. Synthetic opioids, including fentanyl, were responsible for 60 percent of the deaths.

    According to the Substance Abuse and Mental Health Services Administration, there were 18.9 million people ages 12 or older in 2019 with a substance use disorder and 16.3 million misusing prescription drugs.

    Based on the experience of Gerod Buckhalter, the first patient to have the surgery at the institute, Fisher’s chances of long-lasting sobriety are good.

    Buckhalter, 35, became addicted to prescription opioids after a shoulder injury when he was 15. Despite numerous stints in rehab and scary overdoses, he wasn’t able to shake his addiction. He immediately signed on when he was offered a chance to be the first patient in the trial.

    Once the electrodes were implanted, the researchers turned on the device. The effect was dramatic.

    “I didn’t find joy in living,” Buckhalter recalled. “When they turned it on, of course, I didn’t know what was going to happen in the future, but at that time I knew if I could continue to feel the way that I was feeling right then, that I would be OK.”

    He says he hasn’t used even once in two years. He still goes to therapy and takes Suboxone, a compound medication designed to help with opioid addiction. But staying away from opioids is a lot easier after the surgery.

    Buckhalter’s recovery from the 2019 brain stimulation procedure was first chronicled by The Washington Post in June.

    Experts caution that the results are preliminary and not a guaranteed cure. Of the three initial patients, one relapsed and is no longer in the trial. Even if the institute’s trial shows that it can help some people with untreatable substance use disorders, broader use is still years away.

    “There is a lot of research where there have been positive findings initially and then they don’t prove to be that reproducible,” said Dr. W. Jeffrey Elias, a professor of neurological surgery at the University of Virginia Brain Institute. Even so, he says the concept and early findings are exciting.

    “We are understanding more and more about the brain circuitry, especially with reward and addiction issues, and so we have very precise tools to target the brain,” he said.

    Dr. Ausaf Bari, an assistant professor and director of functional and restorative neurosurgery at the UCLA David Geffen School of Medicine, compares the device to a pacemaker for the heart.

    “One of the things people are trying to use DBS for is to specifically change the brain circuits involved in craving and relapse,” he said. “Just like a pacemaker treats abnormal rhythms of the heart, we can use DBS to fix abnormal rhythms in the brain.”

    In future studies, researchers may have to individualize the exact spots they use DBS to target, Bari said. Sparking different parts of the brain may yield different responses. Until researchers and patients try it, they won’t know how to get the most effective response, he said.

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    Original Article: By Kate Snow, Linda Carroll and Lauren Dunn / From NBC News

  2. Marcellus/Utica Poised for Growth as Another Big Shale Play Slows Down

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    An expected drop over the next couple of years in the country’s hot crude oil and natural gas play, the Permian Basin in Texas and New Mexico, will end up benefitting the Marcellus and Utica in the future, according to a natural gas executive.

    What has happened in the Permian has so far had a big impact here in Pennsylvania and the rest of Appalachia, which is the largest gas field in the country but doesn’t have the same output in crude oil. The mostly oil play has been booming over the last few years, and it has been throwing off natural gas and natural gas liquids in such quantities that it’s almost giving away natural gas and liquids. For natural gas producers in the Marcellus and Utica Shale, who are trying to make money off the gas produced here, the Permian associated gas has been dropping prices as well as competing for capital.

    But some projections show the Permian’s rapid growth may be declining — and the Energy Information Administration reported earlier in 2019 that year-over-year production growth has slowed from a peak in 2018. The Marcellus and Utica, for instance, continue to grow production. John Powell, SVP of marketing, supply and logistics for Crestwood Equity Partners LP, told the Marcellus Utica Midstream Conference on Thursday morning in downtown Pittsburgh, said that poses an opportunity after 2024 in Appalachia to provide for the natural gas liquids like ethane, propane and butane.

    “That gas is going to come from the Marcellus and Utica area,” said Powell. Crestwood Equity (NYSE: CEQP), a master limited partnership for midstream operations that has assets in the region, believes there’s pretty much enough pipeline capacity, with small exceptions, in the Marcellus and the Utica to handle the liquids that would need to be transported. But, Powell said, there might need to be more fractionation capacity – processing plants like MarkWest and Blue Racer Midstream — that processes natural gas into liquids.

    Despite a somewhat downbeat tone to the first day of the conference due to the immediate and near future term for natural gas producers and the midstream companies that take the gas from the field to market, Thursday’s sessions were more positive about the outlook. Presenters talked about challenges, including regulatory and activist. But they also said that the Marcellus and Utica midstream industry is likely to see growth with the use of ethane, a natural gas byproduct, as the raw feedstock for the Shell petrochemical plant in Beaver County as well as one proposed in Belmont County, Ohio, and potential other petrochemical plants that will spring up. And there’s also a potential to export more natural gas liquids to the rest of the world for future development. But the fast production growth has meant that there’s a lot of product that doesn’t have anywhere to go yet, said Jeff Pinter, EVP of NGL Liquids, a division of midstream provider NGL Energy Partners LP (NYSE: NGL).

    “The future is very bright. There’s a lot of demand coming … but we’re a little early on supply,” Pinter said.

    The main market for export in the future will be Asia, Pinter said. But those plants haven’t been built yet.

    And, said Wally Kandel, SVP of Solvay Specialty Polymers USA as well as a founding member of Shale Crescent USA, there are lots of opportunities to use the natural gas liquids here, either as polyethylene and polypropylene plants or in downstream manufacturing facilities.

     

    Article By Paul J. Gough, Pittsburgh Business Times

  3. First Look: West Virginia University’s Rockefeller Neuroscience Institute

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    Walking through the new WVU Rockefeller Neuroscience Institute’s Innovation Center, you get the feeling you’re trodding into the future of the treatment of brain disorders and the scientific methods to improve human performance.

    One device, with only a handful in the world like it, delivers focused ultrasound from 1,000 different ultrasound emitters in a single helmet that is placed on the head. It has already been used by WVU Medicine doctors to successfully open the blood-brain barrier to allow for better treatment of people with Alzheimer’s disease. Another system has the patient puts on a multicolored cap with emitters and a handheld wand delivers transcranial magnetic stimulation to treat addiction and Alzheimer’s. And around the innovation center, there’s technology from souped-up gaming systems and virtual reality to a cryogenic chamber to speed workout recovery and a system that maps the nervous system, from head to toe.

    And that’s just scratching RNI’s surface.

    When the Rockefeller family and WVU Medicine envisioned the WVU Rockefeller Neuroscience Institute, they sought a center that would draw leading experts in the fields of brain science and human performance as well as a place where cutting-edge treatments could be developed and deployed. That’s coming to fruition in the WVU Rockefeller Neuroscience Institute, which opened officially earlier this year and has been breaking ground in the field. The finishing touches are being put on the Innovation Center, on the WVU Health System campus in Morgantown, West Virginia, where researchers are working and where patients will be welcomed for the latest advances.

    It’s a partnership between former U.S. Sen. John D. Rockefeller IV and his family along with WVU Medicine and West Virginia University to bring together care, research and teaching centered in Morgantown but spreading all the way through WVU Medicine’s footprint. It’s led by Dr. Ali R. Rezai, a world-renowned neurosurgeon who has developed innovations to treat paralysis, Parkinson’s disease, Alzheimer’s disease and other afflictions.

    And it’s that innovative spirit – and approach from many different specialities, as well as government and industry collaborations – that Rezai is bringing to bear at RNI.

    We’re always looking at rapid applications of new technology, and being one of the first in the world to do it,” Rezai said. “That’s one of our missions: Quickly deploy technology for patients.

    RNI and WVU Medicine have been in growth mode, part of a lot of building projects on the Morgantown campus. There are now 145 faculty, 73 residents and postdoctoral fellows and more than 700 clinic, research and administrative staff in four departments: neuroscience, neurology, neurosurgery and behavioral medicine and psychiatry. And there are several current and future RNI facilities. Beyond the Innovation Center, there’s also a neuro ambulatory and education center that is being built atop the nearby physician’s office center, the Erma Byrd Biomedical Research Center and a behavioral center at Chestnut Ridge. Then there’s also a brain and spine hospital that will be built in the parking lot behind the hospital.

     

     

    Article By Paul J. Gough, Pittsburgh Business Times