Mark George, M.D.

Neural Engineering Meets Clinical Neuropsychiatry – Recent Successes, Some Failures, and a Peak into the Near Future

Approximately 30 years ago, when I began my career, we could  finally begin to view  the  living   human  brain  without  sacrificing  people.  CT, then PET, then MRI  allowed  us  to  see  and  understand  the  brain,  much  like  the  rest  of  medicine  had  long  been  able  to  view  other  less  interesting  organs  like  the  heart  or  liver.   Adventurous scientists quickly quickly started using these brain  maps  enabled  by  the  brain  imaging  revolution  to  guide  tools  to  stimulate  the  brain.  The fields of brain stimulation and neural engineering were born. Both invasive and non-invasive brain stimulation methods are  now  rapidly proliferating, with the technological advances far outstripping our clinical knowledge of where to apply them and in which diseases.

In this talk, I will outline the  main  brain  stimulation  methods  in  place  and  a few that are on  the  drawing  board. I will talk largely about lessons learned in getting FDA approval for transcranial magnetic stimulation (TMS) for treating depression, and vagus nerve stimulation for treating epilepsy, depression and now other disorders. The rapid  growth  of  brain  stimulation  startup  companies  in  some  ways  resembles  the  California  Gold  Rush.  I will use several examples  to  make  the  case  that  whether  a  technique  makes  it  to  FDA  approval  and  general  clinical  use  depends  on  many  factors, only some of which are scientific. The future is bright for neural engineering and brain stimulation.

Biography

Mark George pictureAs an undergraduate student in philosophy at Davidson College in Davidson, NC, Dr. George first began studying the relationship between mind and brain, or brain/behavior relationships.  He has continued this interest throughout his career with a focus on using brain imaging and brain stimulation to understand depression and devise new treatments.

He received his medical degree from the Medical University of South Carolina in Charleston in 1985, where he continued with dual residencies in both neurology and psychiatry. He is board certified in both areas. Following his residency training he worked for one year (1990-91) as a Visiting Research Fellow in the Raymond Way Neuropsychiatry Research Group at the Institute of Neurology, Queen Square, London, England. He then moved to Washington, DC, working with Dr. Robert Post in the Biological Psychiatry Branch of the Intramural National Institute of Mental Health (NIMH).  During his 4 years at NIMH he was one of the first to use functional imaging (particularly oxygen PET) and discovered that specific brain regions change activity during normal emotions. He then started using imaging to understand brain changes that occur in depression and mania, a quest that he and many others are still pursuing. This imaging work directly led to his pioneering use of a non-invasive brain stimulation method, transcranial magnetic stimulation (TMS), as a probe of neuronal circuits regulating mood, and to clinical trials using TMS as an antidepressant. In 1993 while at the NIMH, he discovered that daily prefrontal rTMS over several weeks could treat depression and ever since he has worked to grow the science of TMS, both in terms of how it works in the brain, and in critically evaluating its therapeutic applications, especially in the area of treating depression. In June 1998 at MUSC, he also helped pioneer another new treatment for resistant depression, vagus nerve stimulation (VNS). This was FDA approved in 2006. He and his group have used MRI imaging to understand VNS brain effects.

He is a world expert in brain stimulation, and depression, and is the editor-in-chief of a new journal he launched with Elsevier in 2008 called, Brain Stimulation: Basic, Translation and Clinical Research in Neuromodulation. He has been continuously funded by NIH and other funding agencies since his fellowships. He has received both a NARSAD Young Investigator and Independent Investigator Award to pursue TMS research in depression. He has received numerous international awards including the NARSAD Klerman Award (2000), NARSAD Falcone Award (2008) and the Lifetime Achievement Award (2007) given by the World Federation of Societies of Biological Psychiatry (WFSBP). In 2009 US News and World Report named him one of 14 ‘medical pioneers who are not holding back’. He is on several editorial review boards and NIH study sections, has published over 400 scientific articles or book chapters, and has written or edited 6 books.