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Neurological Disorders Channel
Reported January 9, 2012

Brain Scans for PTSD -- In Depth Doctor's Interview

Brian Engdahl, Ph.D., Associate Professor on Psychology at the VA Medical Center in Minneapolis, talks about a study Involving a new technology to help study PTSD in War Veterans or other mental problems in patients

Tell me a little bit about what PTSD is and why it is so difficult to live with it.

Dr. Engdahl: PTSD is a set of long lasting reactions or symptoms that come after exposure to life threatening events to yourself or to others who are close to you. It has four parts: 1) permanent painful memories, 2) understandable maneuvers that people use to avoid being reminded of these very painful experiences, 3) withdrawing from the world, and numbing of emotions (a sort of depression), and a loss of connection to other people, and 4) over arousal or hyper arousal: the startle, the anger, the sleep problems; in general being more nervous.

Does somebody have to have all of those?

Dr. Engdahl: You need one of the following related to the trauma: unwanted memories, nightmares, flashbacks, or to be distressed or aroused when reminded. Three of the following: avoiding thoughts or feelings, avoiding reminders, memory gaps related to the trauma, a loss of interest for formerly enjoyable activities, alienation from others, emotional numbing, or a loss of hope for the future. Two of the following: sleep problems, irritability, concentration problems, hyper alertness, or a startle reaction.

These are things they are telling you this is what’s happening to me and then you make the diagnosis. There are no tests or blood tests or things like that like in a lot of other illnesses?

Dr. Engdahl: Correct, we rely totally on what people tell us as we ask the questions about certain problem areas. We relied only on self-report, until now. We feel that today we have the first medical or biological marker of a mental disorder, PTSD.

Tell me what this technology is, how does this work, what’s the name of it?

Dr. Engdahl: Magnetoencephalography or MEG for short. It’s not actually a type of brain scan that uses radiation or magnetic fields, it is a technology that takes a reading of brain activity. You can think about it as a very sophisticated EEG (electroencephalogram) where electrical leads are placed on the scalp. In MEG, your head is placed in what looks like an old beauty parlor hair dryer. The room is shielded from the earth’s magnetism so that the sensors in the scanner can read the activity from the surface of your brain.

How does it read the activity on your brain?

Dr.Engdahl: There are two hundred forty eight sensors that are cooled to almost absolute zero to be very sensitive. They come close to your head but don’t touch it and they take the readings of the activity.

How long is the reading process?

Dr. Engdahl: The scanning session is one minute, with readings taken a thousand times per second.

For the people that go in how is it for them, do they say it’s relatively easy?

Dr. Engdahl: I think almost without exception people find it easy and the most we ask them to do in this study is close their eyes for a time and open their eyes for a time and focus on a spot.

Is it pretty simple as far as medical test go?

Dr. Engdahl: Very safe, no risks, and easy, unless you have problems lying still for a few minutes.

What are you seeing in the activity of patients with PTSD?

Dr. Engdahl: By analyzing the interconnections among parts of the brain’s surface, we see patterns of miscommunication that define a PTSD "stamp". This stamp is seen even in people with other problems, such depression or concussion.

Is it always in one area of the brain?

Dr. Engdahl: There are several affected areas, but the most prominent one is in the right temporal/parietal area, just ahead of your right ear.

What is that part of the brain responsible for?

Dr. Engdahl: No one is certain, but it fits with theories about memory and PTSD. Traumatic memory can be out of control and not well-consolidated. It may be reflected in the miscommunication patterns that we see. Our findings also mesh with brain surgery done 40 years ago by Penfield. He stimulated this part of the brain and many of his patients experienced vivid memories of past life events.

When you see this pattern of activity is it hyperactivity are just a different activity than a person without PTSD?

Dr. Engdahl: We are not seeing activity, as much as patterns of connections, patterns of miscommunication among brain regions. Our brains are constantly rewiring themselves. In PTSD, new connections have been formed that we do not see in people free from PTSD.

That is the theory that the way the brain the brain has kind of rewired its self leads them to these nightmares, the inability to cope with these memories.

Dr. Engdahl: Yes. This fits our observations of people who have recovered to some degree from PTSD; they still show this pattern, but at a lower intensity. This may reflect what our patients tell us: such painful memories remain with you all of your life.

This is not just for veterans who have been in wars, this is for other issues, right?

Dr. Engdahl: Yes, we are beginning to study non-veterans. Also, many of the veterans in our current study have PTSD related to trauma from their childhood or post-service trauma. So we’re not just talking about war trauma.

What did the results show from your study?

Dr. Engdahl: That we are able to accurately classify people with PTSD ninety-five to one hundred percent of the time. That there is a brain pattern or "stamp" that is so distinctive that it allows us to identify PTSD.

Why is that so important to have this kind of test or image to diagnose PTSD?

Dr. Engdahl: Well, it appears to be one of the first, if not the first biological marker of a mental disorder (further work to confirm this is in progress). I think it’s very important that a scan can show physical evidence of a mental disorder; our subjects have found that to be a relief: "You can actually see from my brain scan that I have PTSD? It’s not something that I’m making up or exaggerating." In a very meaningful way, it’s real because we can see it. That can reduce some of the guilt or the shame. We think this helps de-stigmatize mental illness.

How surprised where you to find this, when you first started seeing these patterns?

Dr. Engdahl: Dr. Georgopoulos has done previous work looking at other groups (people with depression, multiple sclerosis and other disorders) and had promising results. The work with the PTSD was surprising for its even higher classification accuracy; it was so clear, it was just startling.

How does this benefit patients, what’s the potential with this?

Dr. Engdahl: Many think we’ll use this for diagnosis. I don’t think that that would be the first use of this sort of approach. More likely, it will serve as a marker of the disorder and should be helpful in improving treatment research; you can see what works and doesn’t work. Right now we have the self-report as the only way to determine if people are getting benefits from their treatment. Also, I think it gives us ways to learn more about what’s actually wrong. With a clearer view of what is wrong, we are in a better position to propose new treatments.

What is the next step for this research?

Dr. Engdahl: We are currently looking at veterans with mixtures of depression and PTSD. We will be looking at veterans who have Gulf War illness from the 1991 Gulf War and eventually we’ll be looking at veterans from the current wars who have combinations of mild brain injury and PTSD because that’s been so common and so difficult to figure out.

What is it like to live with this, what is it like for people?

Dr. Engdahl: After such experiences, life can be difficult, especially with sleep, with anger, with drinking too much, or with being very riled up. And settling down to study in school, to hold down a job, or to start a family can be a huge challenge after a war. Eventually folks are able to settle down, find their way, get a job and start a family. But they are still nervous, they’re still grieving over some of their losses, and the nightmares can continue. The permanent painful memories are still there even after many years. Often we hear folks say that there isn’t a day that goes by that that they don’t think about their traumatic experiences, but they can lead satisfying lives in spite of this.

END OF INTERVIEW

This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors; always consult your physician on medical matters.

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If you would like more information, please contact:
Brian Engdahl, PhD
VA Medical Center, Minneapolis
(612)467-3033

To read the full report, Brain Scans for PTSD, click here.

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