Monday, January 14, 2013

Finding Their Muse...In A Pill

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Medications typically prescribed for the treatment of Parkinson’s disease are eliciting an unexpected side effect in many Parkinson’s patients, but the risk to the patient, it seems, is minimal. Some doctors, like Rivka Inzelberg at Tel Aviv University’s Sackler Faculty of Medicine, have begun to embrace the strange new phenomenon for its therapeutic potential.

Parkinson’s disease is a neurodegenerative disease in which neurons in the area of the brain that regulates movement are destroyed. As the disease progresses, even the simplest movements are hard to initiate and even harder to continue. Fine motor control is challenging, making activities like eating and writing difficult. After beginning a course of treatment for the disease, however, many Parkinson’s patients seem to be finding their muse. Parkinson’s experts are reporting that their patients are suddenly drawing, sculpting, painting, writing, and more.

Inzelberg first noticed the phenomenon around the holidays, when patients would bring small gifts, often chocolates and other small tokens, to the clinic where she worked to show their appreciation. Over time, Inzelberg noticed an emerging trend- instead of the usual holiday gifts, a surprising number of patients brought in artwork they had created themselves.

Inzelberg realized this most likely wasn’t a coincidence and began to seek out the ‘common thread’ among all of the newly inspired artists, combing through case studies from around the world and her own patients’ histories. It seemed that this wasn’t the first time this had happened, and that the same phenomenon had caught the eye of doctors and researchers treating Parkinson’s patients worldwide. What all of these patients had in common, she found, was that they were all being treated with drugs that increase dopamine activity in the brain.

Dopamine is a neurotransmitter, one of the small molecules which travel in the space between neurons to relay messages from one nerve cell to the next. Dopamine is particularly important in the part of the brain which regulates movement. When nerve cells in this area are destroyed, it can cause a loss of muscle function as dying neurons impede neural ‘communication’ in this area.

Some of the medications prescribed for the treatment of Parkinson’s disease attempt to make up for this deficit by supplying a drug which can be converted into dopamine in the brain, or by supplying a drug which activated the receptors that normally ‘receive’ the message from dopamine, even when the message itself is absent. The Parkinson’s patients were all being prescribed one of the two types of drugs described above.

Inzelberg speculates that dopamine’s alternate activity in the brain’s ‘reward system’ pathway is behind the observed creative bursts in Parkinson’s patients. Our brain’s built-in reward system is responsible for the feeling of satisfaction and pleasure we get after we accomplish something. Rewarding activities are reinforced by the burst of dopamine which accompanies them, which can be a powerful motivator.

Therapies which affect dopamine pathways in the brain sometimes result in a loss of impulse control, in extreme cases leading to addiction or obsessive behavior. It has been suggested that this lowering of inhibitions may push artistically inclined patients to free their latent creativity, and that lowered inhibitions and increased arousal may facilitate the creative process.

The link between dopamine and creativity has not been fleshed out, but misregulation of dopamine levels in the brain has been linked to several diseases, including schizophrenia. Inzelberg cites Vincent van Gogh as an example: it is believed that rising levels of dopamine in van Gogh’s brain resulted in his psychotic episodes, and that much of his creativity was drawn from those episodes.

‘Increased creativity’ may be the most beneficial side effect of these medications, as it has added therapeutic potential. Inzelberg believes that when Parkinson’s patients begin pursuing artistic endeavors it has a positive effect on them both psychologically and physiologically. Many patients report being happier when they are being creative, and sometimes their motor symptoms show improvement, especially when actively engaged in drawing, painting, sculpting, or other artistic endeavors which require fine motor control.

Does this mean that it is only a matter of time before these drugs are touted as “creative pills”? Let’s hope it doesn’t get that far. Still, it is fascinating to see the effect something as physical as brain chemistry can have on something as transcendental as art and creativity.

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