Physician, Heal Thyself

"It's restored me to life. I was on a path where I was not going to live much longer."
"I never felt drunk and don't think I appeared drunk. That was part of the problem. I could consume a lot without falling down. I didn't get angry and throw things and that kind of stuff."
"Your whole head shakes with the drilling, and it's noisy. But it only lasts a short time [deep brain stimulation]."
Dr.Frank Plummer, microbiologist, 'high-functioning alcoholic'

Left: Frank Plummer. Photo: Kevin Van Paassen, Sunnybrook Health Sciences Centre. Right: An X-ray of Gerod Buckhalter’s brain, where scientists have placed a deep brain stimulation device. Credit: West Virginia University Rockefeller Neuroscience Institute

"I'm not sure if it [DBS: deep brain stimulation] will ever be in widespread use. It's for patients who are treatment-resistant and who are able to undergo surgery."
"It's still an invasive procedure."
"The idea is that if we can stimulate this part of the brain, disrupt the activity in the [brain’s reward] circuit and essentially reset it, we may have a good chance of having an influence and impact on some of these behaviours” involved in alcohol-use disorder."
"It’s among the most stigmatized illnesses there are." 
"We view it as no different from Parkinson’s disease or Huntington’s disease or tremor, or any of these motor-circuit conditions. … These are circuit-based disorders of the brain."
Dr.Nir Lipsman, Sunnybrook Research Institute of Health Sciences, Toronto

Dr. Nir Lipsman (left) In December 2018, researchers at Sunnybrook were the first in North America to begin a clinical trial investigating the use of deep brain stimulation (DBS) for the treatment of alcohol use disorder (AUD).

DBS, explains Dr. Lipsman, acts as a "pacemaker for the brain". It administers small electric shocks to the nucleus accumbens every few seconds. Its purpose is to kick-start the "reward centre" of the brain. According to Dr. Lipsman, a person's brain chemistry can be rewired after years of drug or alcohol addiction, to the point that neuron signals fail to zap through the brain as they normally would. A kind of faulty wiring in the area of the brain responsible for pleasure and reward.

Healthy, normal types of pleasure stimuli, from dancing, listening to music, laughing with friends, or playing with your children no longer provides the same "reward" as such activities in a fully normal and pleasurable life once did. The lack of which is what drives addicts to rely on drugs or alcohol for their rewards.

Frank Plummer, 67, was one of six patients who volunteered and whose personal cases fit the models required to take part in a six-patient study on the potential efficacy of deep brain stimulation to treat alcoholism. DBS is a neurosurgical procedure where electrodes are drilled into the brain directly to "re-wire" that indispensable organ's signal circuits.

Various mental illnesses and drug addiction had been treated previously with DBS. The procedure was in common usage for neurodegenerative disorders such as Parkinson's. This was the first study with alcoholics. And Dr.Plummer is seen as the first person in the world to successfully undergo the treatment.

The use of DBS appears as a last-choice effort to help people when every other form of treatment seen as conventional fails to help. Dr. Plummer, formerly the scientific director of Canada's National Microbiology Laboratory, had tried one-on-one therapy and Alcoholics Anonymous, but nothing seemed to work for him. In the 1980s and 1980s, he was living in Kenya, lending himself and his medical-research expertise in the effort to stem the AIDS outbreak.

Several of his colleagues died from AIDS and when severe stresses began to take their emotional toll  he turned to alcohol for comfort. The result was that he began drinking at least four tumblers of whisky each evening to control his nerves and the depression he was under. From there he graduated to full-blown alcoholism. It took until 2012 -- 12 years following his return to Canada -- when he was diagnosed with cirrhosis and end-stage liver disease, to realize he was an alcoholic.

A successful liver transplant followed in 2014, and he began to slip back into drinking whisky again, when he heard of the DBS trial at Sunnybrook Research Institute, and he signed up to become one of six patients in the proposed study. After experiencing the surgery involved, he described feeling nothing as doctors first made an incision across his skull and then drilled two holes into his brain, each "the size of a 25-cent Canadian piece".

Jo Kennelly places a device beside Frank Plummer’s shoulder that turns his deep brain stimulation on and off on Dec 10 2019.  Fred Lum

This neurosurgical procedure where electrodes are drilled directly into the brain represented a world-first experiment. Dr.Plummer recalls the operation as "pretty innocuous". Awake for the duration, but feeling nothing, as a result of the local anaesthetic that had been administered, where his head was placed into a metal halo to ensure he was kept immobile during the procedure. Now, he no longer feels the need for alcohol and has weaned himself from his whisky habit.

Researchers looking for a clearer idea of whether the benefits of DBS are real, and not merely a placebo effect, plan to test DBS in a larger study to compare results of alcoholic patients receiving the procedure, with a control group receiving "dud" electrodes, not emitting any electric signals. The procedure is fairly costly; each implant between $15,00 and $25,000, with an additional $15,000 to $20,000 for the battery, requiring replacement every three to four years.

"By directly targeting dysfunctional ‘wiring’ in the brain, the hope is to influence these circuits to a healthier state. "
"In Frank’s case, we saw significant improvements in mood and alcohol consumption. The nucleus accumbens is not only an addiction-related area of the brain but also involved in mood, anxiety and depression."
"Helping to relieve symptoms may have helped play a role in his progress."
Dr. Benjamin Davidson, study co-investigator, surgical resident, Sunnybrook

Postscript: "Plummer, 67, was in Kenya, where he was a keynote speaker at the annual meeting of the University of Nairobi's collaborative centre for research and training in HIV/AIDS/STIs."

"Dr. Larry Gelmon, who helped set up that meeting, said Plummer collapsed and was taken to hospital in Nairobi, where he was pronounced dead on arrival."
"No confirmed cause of death has yet been released."
CBC announcement, February 5, 2020