The Week That Wasn't: DBS, Algorithms, Trichomegaly

Liz Neporent

Disclosures

May 17, 2019

Welcome to The Week That Wasn't. Here are three trending medical stories our news team didn't cover this week — and why.

Fighting Addiction With DBS

Deep brain stimulation, or DBS, has shown promise for neurologic disorders such as Parkinson's, epilepsy, and dystonia. Now, in a clinical trial in China, researchers are using the neurostimulation technique in an attempt to cure methamphetamine addiction.

In this study, a surgical implant sent small electric shocks through a patient's brain to switch off the areas associated with addiction. The intervention worked, according to news reports. The patient's drug dependence seemed to instantly disappear, a result the patient himself described as "magical." After years of long-term meth use, he claims he has been completely drug free for 6 months.

Because only one patient has been treated so far, we didn't think this research merited a full news story. Outcomes from similar investigations have been mixed, and several have been halted over safety concerns. It's worth noting that globally, there are eight registered DBS clinical trials for substance abuse, including six in China and one small US trial for opioid use disorder, which was recently given a greenlight by the FDA.

Playlist Technology Helps Predict CV Outcomes

Netflix and Spotify use sophisticated algorithms to recommend movies and build playlists. An experimental app borrows this approach to help diagnose serious cardiovascular (CV) events.

When a machine learning tool called the LogitBoost used 85 health and medical variables to calculate the CV event risk of 950 patients during a 6-year period, it retroactively predicted outcomes with 90% accuracy.

Doctors use risk scores to make treatment decisions all the time, but they sometimes struggle to correctly anticipate the future health of individual patients. Through repetition and adjustment, machine learning can exploit large amounts of data and identify complex patterns that may not be evident to humans, said Luis Eduardo Juarez-Orozco, MD, PhD, the study's lead author, who is a research fellow at Finland's Turku University Hospital.

The study was presented earlier this week at the International Conference on Nuclear Cardiology and Cardiac CT in Lisbon, Portugal. Although the advance could lead to effective, personalized treatment, we didn't give this more attention because it's still early days for the technology.

Surprising Side Effect for Cancer Drug

We don't typically cover case reports because they usually offer limited clinical insight, but one from BMJ Case Reports, which highlighted a patient whose eyelashes grew more than an inch during treatment for stage IV metastatic colorectal cancer, caught our attention.

Trichomegaly

The woman was given the epidermal growth factor receptor inhibitor cetuximab (Erbitux, ImClone). One side effect of the drug is skin and hair toxicities that occur a few months into treatment, including trichomegaly, which is associated with curling, lengthening, and pigmentation of the eyelashes. This might seem like something to envy; eyelash extensions cost $100 or more. But according to the woman, the condition is painful. It can also lead to eyelid infections and corneal ulcerations.

Cetuximab works by binding and inhibiting epidermal growth factor receptors, which can be expressed in some normal tissues as well as tumors. Skin toxicity with this agent is not uncommon, occurring in up to 80% of cases.

Her clinicians recommended that she trim and clean her eyelashes every 2 to 4 weeks with the help of a beautician. After doing so, "the patient reported a marked improvement in her quality of life," the authors note. The outcome of her cancer treatment was not reported.

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