Stop the rock, stop the rockYou'll probably be stuck with that tune for a few minutes, but with any luck it'll go away eventually. However, for the 63-year old Italian man reported on in a new paper by Cosentino et al., the melodic misery never stopped.
Stop the rock, stop the rock
Stop the rock, can't stop the rock
You can't stop the rock, stop the rock
Stop the rock, can't stop the rock
You can't stop the rock, can't stop the rock. etc.- Apollo 440, "Stop the Rock"
The patient had suffered from partial hearing loss for 20 years, probably as a result of his work as a stonemason, which involved a lot of loud noise. His real problems started, however, when he suffered a car accident which cause damage to his right temporal pole. This caused
continuous musical hallucinations in the form of popular songs by Renato Carosone ... the songs were the ones he often used to listen to when he was younger. The volume of the musical hallucinations was initially low, and then became progressively louder; it was perceived in the middle of head and changed in severity over the course of the day. The intensity of the hallucinations evaluated through an arbitrary scale ranging from 0 (no hallucinations) to 10 (unbearable hallucinations) varied from 5 to 8 during the day.The spectral songs didn't directly interfere with his life, but they were extremely annoying. He reported no other symptoms, his hearing was no worse than it had been before the accident, all neuropsychological tests were normal, and he had no history of any neurological or psychiatric problems.
Doctors tried to control the harmonic hallucinations with a range of anti-epileptic drugs, but they didn't work. A PET scan showed reduced brain activity in the area which was damaged, but increased activity in the posterior temporal lobe. Maybe this was to blame for the problems.
So Cosentino et al. decided to use repetitive transcranial magnetic stimulation (rTMS) to suppress activity in the offending part of the brain. rTMS uses strong magnetic fields to stimulate the brain; through some unknown neurobiological process, it can, in the long term, lead to reduced activity.rTMS was given 5 days per week for 2 weeks. After the first week, the patient reported that the music had got a lot quieter and after another week, it was gone. A few months later it started again, but far quieter than before and only occasionally. The patient was offered more treatment but he said it wouldn't be worth it, because the hallucinations were no longer annoying. A second PET scan showed normalization of the activity...maybe (see the picture above; A=before B=after.)
There was no placebo condition, so it's hard to know whether this was a true effect of the magnetic stimulation, but the fact that a number of drugs hadn't worked suggests that it wasn't merely a placebo effect. So it turns out that you can Stop the Rock. Or at least, you can Stop the Canzone Napoletana of Renato Carosone. Whether the Rock is harder to Stop is a topic for future research.
Cosentino, G., Giglia, G., Palermo, A., Panetta, M., Lo Baido, R., Brighina, F., & Fierro, B. (2010). A case of post-traumatic complex auditory hallucinosis treated with rTMS Neurocase, 16 (3), 267-272 DOI: 10.1080/13554790903456191
9 comments:
Just to note, the fact that drugs didnt work and yet rTMS did, doesnt really prove it wasn't a placebo effect.
Consider a conditioned model of placebo: each time a drug fails to work, the other ones become less credible. Therefore, he probably had very much reduced expectancies relating to the drugs, but the rTMS was a new phenomenon, which the doctor was probably enthusiatic about and which he or she communicated to the patient.
It doesnt really matter to the patient, but placebo effects are slippery things, and its wise to be very careful with them.
But the important question still remains, have you heard about the bird?
Everybody knows that the bird is the word!
(buh-buh-buh bird bird bird, the bird's the word...)
Disgruntled PhD: Right. And this is especially a problem with TMS which has the allure of being ultra-high-tech, expensive, and being guided by the PET scan. I can see how that would be a powerful placebo, and we know that expectation can cause musical hallucinations... so no we can't rule it out.
Any remedy against this one?
More to the general theme of this blog, I have never seen any mention of Phenibut, Rhodiola rosea, Sulbutiamine, Mucuna Pruriens, Picamilon, Choline bitartrate(etc...), do you even know these or are you stuck to "products of the pharm industry"?
Can this technique help me to forget my ex-wife and her maniacal rages?
Maybe. Only a randomized controlled trial can determine whether rTMS is an effective treatment for Post-Marriage Maniacal Rage Memory Syndrome (PMMRMS)
"Right and this is especially a problem with TMS which has the allure of being ultra high-tech, expensive..."
Quick question for you Neuroskeptic, are there any studies that have demonstrated that the more expensive or high-tech the placebo the greater the placebo effect?
I'm not sure about expensive or high-tech, but there are studies showing that injections are better placebos than pills etc. In general anything that makes a placebo more believable will make it more effective, almost by definition.
Phenibut is effective both
as a sleep aid and for anxiety reduction in my opinion
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