Robison - Switched On A Memoir of Brain Change and Emotional Awakening

I N Switched On, John Robison has written a remarkable, engaging, and moving story that reminds me of why I first became a physician. In my practice, I try never to lose sight of this admonition attributed to Hippocrates, the Ancient Greek physician who was arguably the father of modern medicine: If you have to choose between learning about the disease that a patient has, or about the patient who has a disease, choose always the latter. As a cognitive and behavioral neurologist, my mission is to help patients affected by various neurological and psychiatric conditions, including autism, epilepsy, stroke, Parkinsons disease, or drug-resistant depression. Modern medicine places immense importance on decision-making based on the most up-to-date science, and on accumulating specialized knowledge of disease, but the truth remains that clinical medical practice, at its core, should be about helping a persona specific individualget better. John Robisons story brings me back to this truth. It echoes through my head every morning when I walk through the doors of the Berenson-Allen Center for Noninvasive Brain Stimulation at Beth Israel Deaconess Medical Center, which I run and where much of the action in this book takes place.

The concept of brain plasticity refers to the ongoing capacity of the brain and the nervous system to change itself. Everything that we do, think, feel, and experience changes our brain. A stroke or a traumatic brain injury can affect brain plasticity, and plasticity may also be associated with such developmental disorders as autism. Increased brain plasticity may also potentially endow a person with unanticipated new abilities, as John appears to have experienced in this book. TMS, or transcranial magnetic stimulation, the intervention that John undergoes, provides a unique opportunity for us to learn about the mechanisms of plasticity, and to identify alterations in the brains networks that may be responsible for a patients problematic symptoms, and also for recovery.

Over the past three decades, TMS has become a valuable tool in psychiatry and neurology, and this book comes at a time when interest in brain stimulation in general, and in TMS in particular, is growing. In the United States, the FDA has cleared several devices to deliver TMS for the treatment of medication-resistant depression, migraine, and presurgical brain mapping, and international approval extends to treatment of developmental disorders, pain, stroke recovery, epilepsy, and dementia. Nearly one thousand TMS clinics exist in the United States, where patients who have seen little or no response to drug treatments and other more traditional interventions are being helped. However, knowledge of TMS and its potential remains limited in the medical community and among the general public, and many patients who could benefit from it are not being offered access. This is something that I hope will change in the near future, as stories like Johns come to light. At the same time, more research into the effects of TMS on the brain are needed to improve its therapeutic potential and minimize its risks.