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Brain Stimulation

by Barry Waldman

Born on St. Patrick’s Day, Mark George, M.D., peppers his conversation with references to his good fortune.

With a career marked by accomplishment and international recognition, George summited the field of medical science with two Food and Drug Administration-approved depression treatments to his credit, 47,000 published citations and a slew of awards, including the American Psychiatry Association’s 2023 Award for Research in Psychiatry. He is currently a Distinguished Professor of Psychiatry, Radiology and Neurosciences at MUSC as well as the founder of the Center for Biomedical Imaging (CBI)

Despite starting out as a philosophy major in college and wanting to be a journalist, lawyer or foreign service officer, George says he surprised himself. “My life has been decidedly nonlinear,” he said. 

In 1995, George and his team at the NIH began work with TMS for depression, and shortly after returning to MUSC he did early work pioneering the use of vagus nerve stimulation (VNS) to manage treatment-resistant epilepsy and depression. 

After receiving FDA approval for VNS treatment in 2005, George and others continued work with a minimally invasive option for patients. And by 2008, he had received FDA approval for transcranial magnetic stimulation (TMS) to treat those with major depressive disorder, or MDD, without surgery. 

Magnetic StimulationMark George, M.D., performs transcranial magnetic stimulation on a patient. TMS uses magnetic fields to stimulate nerve cells in the brain that can reduce symptoms of depression. Credit: Brennan Wesley

In vagus nerve stimulation (VNS), a wire is threaded from an implantable device in the chest into the left vagus nerve to send targeted electrical signals to the brainstem. These signals often reduce seizures in individuals with epilepsy who do not respond to medication. VNS has been found to reduce the intensity of epileptic seizures and their frequency by 20%-50%. Because the vagus nerve also helps regulate emotions, stimulation appears to ease depression symptoms and improve mood, particularly for individuals who don’t respond well to medicines or therapy. 

Transcranial magnetic stimulation (TMS) is less invasive, employing magnetic fields to stimulate nerve cells in the brain that can reduce symptoms of depression. These were exciting developments for psychiatry and for George himself. 

After preliminary results from the first double-blind study with TMS clearly demonstrated its efficacy, he carried the printout in his lab coat and showed it to everyone he saw. 

There appear to be common threads connecting VNS and TMS. “TMS is coming in from the top, tickling the cortex and interacting with the limbic areas. Vagus is coming up from the neck. They’re opposite approaches, and some of the interesting research we’re doing today involves the question, ‘what if we do both?’” he said. 

He was surprised by their quick adoption and commercial success. “These therapies require high-tech gizmos, and it’s easier to go to the doctor and take a prescription,” he said. 

It’s a bit of cosmic irony that someone with such an active mind earned his international fame in brain stimulation. But even before the current international buzz around brain stimulation, George was bubbling with activity through over 400 scientific articles and book chapters written or edited and launching a medical journal on brain stimulation. 

After initially working in Haiti in medical school to help those with fewer resources, George returned to Charleston and MUSC to focus on what he considers the last frontier in medicine: the brain. He got immediately hooked on the then-new technology of diagnostic brain imaging and has been interested ever since. 

George is quick to credit his success to collaborations with mentors and colleagues open to new ideas and appreciates the importance of sharing ideas too. He also takes great pleasure in those he was fortunate enough to mentor. 

But demonstrating Thomas Edison’s dictum that invention is 2% inspiration and 98% perspiration, George often found himself at odds with the psychiatric establishment. 

“This takes patience,” he said. “My ideas were so heretical that I was kicked out of a meeting of the society that does electro-convulsive therapy. While that society has come around, the APA (American Psychiatric Association) has still never fully embraced the concept of electro-convulsive therapy.” 

Which makes the most recent award so sweet. George has been recognized for his contributions to science in the past – including in 2009 by U.S. News and World Report, which named him one of 14 “medical pioneers who are not holding back” – but the APA’s 2023 Award for Research in Psychiatry is vindication of his persistence in the face of opposition from his own profession. 

“The award officially says from the highest levels that, yes, this is important work, and it is changing lives for the better,” he said. “The APA also created a caucus on brain stimulation, so we’re changing psychiatry.” 

The award also demonstrates to George the value of the vanishing physician-scientist. The health care system today pressures physicians to choose between patients and research, but George advocates for more people who do both. He sees how his science benefits from daily patient interactions and how his patients benefit from the research he is doing. While most will want to choose one track or another, there must still be a place for the dual practitioner. 

While he credits his colleagues and good luck for much of his success, George believes every advance comes back to patients, both those who benefit and those who participate in the research. 

“Not a thing I’ve done in my career would have been possible if not for the patients who volunteered in critical research,” he said. “They’re the ones who allowed us to ask these questions.”

Progressnotes Spring 2023

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