Breaking the code in analysing trauma

The Brain Behaviour Initiative (BBI), one of UCT's first two signature themes, has received a shot in the arm with the acquisition of landmark technology, which could help unlock the mysteries in understanding the mind and its disturbances.

The device, the repetitive transcranial magnetic stimulation machine (rTMS), transmits electro-magnetic pulses into the brain - so-called transcranial magnetic stimulation (TMS). This technique has temporary effects on very specific pathways in the brain, or neurocircuits.

The machine has various applications, and may be particularly relevant to understanding the role that specific brain pathways can play in trauma and resilience.

Professor Dan Stein, head of psychiatry, says: "One of the focuses of the BBI is on understanding the neurocircuitry that underlies resilience and vulnerability after psychological trauma. TMS can potentially contribute to this work."

It is not generally known that neuropsychiatric disorders are the second largest contributor to South Africa's burden of disease, after HIV/AIDS. Trauma and its subsequent effects on the brain may play an important role in contributing to many of these conditions.

Associate professor in the UCT/MRC Research Unit for Exercise Science and Sports Medicine, Alan St Clair Gibson explains: "Trauma has the effect of putting specific kinds of memory into the brain. The repetitive transcranial magnetic stimulation machine is an interesting device because it can apply pulsations into the brain and perhaps repress those memories. But it can also perhaps knock them out entirely, and then we can see how this affects the brain afterwards."

Indeed, there is growing evidence that repetitive application of electro-magnetic fields or pulses into the brain is a new treatment for depression, potentially replacing older interventions like electroconvulsive therapy. Stein emphasises, however, that the current machine is not easily used for treatment purposes. Nevertheless, having the device will help create capacity in this area, and so lay the foundations for the future purchase of a machine that is dedicated to therapy.

The rTMS machine is on loan from Dr Thomas Schlaepfer of the Department of Psychiatry, University Hospital in Bonn, Germany, to the UCT Brain Behaviour Initiative, an inter-disciplinary research collaboration between academics involved in brain-based work that focuses on trauma.

The university-wide initiative encompasses several disciplines, including psychiatry, psychology, genetics, molecular and cell biology, engineering and human biology. There is also close collaboration with other institutions, such as the University of Stellenbosch, in these areas.

The rTMS machine is of particular interest to the UCT/MRC Research Unit of Exercise Science and Sports Medicine, where St Clair Gibson is based, and the UCT/MRC Medical Imaging Research unit lead by Professor Kit Vaughan.

The rTMS, a first in South Africa, will be used initially in studies of healthy volunteers. Input into these protocols will be obtained from Schlaepfer and from visiting professor in neuropsychology at the Utrecht Medical Centre, Jack van Honk.

The key to understanding brain behaviour is yet to be found, but the rTMS device could be an important step up in our understanding of the working patterns of the brain-mind, shedding some light on the origins of trauma-related psychiatric disorders, as well as of resilience in healthy people.