Placeholder Image

Subtitles section Play video

  • One of the things I want to establish right from the start

  • is that not all neurosurgeons wear cowboy boots.

  • I just wanted you to know that.

  • So I am indeed a neurosurgeon,

  • and I follow a long tradition of neurosurgery,

  • and what I'm going to tell you about today

  • is adjusting the dials in the circuits in the brain,

  • being able to go anywhere in the brain

  • and turning areas of the brain up or down

  • to help our patients.

  • So as I said, neurosurgery comes from a long tradition.

  • It's been around for about 7,000 years.

  • In Mesoamerica, there used to be neurosurgery,

  • and there were these neurosurgeons that used to treat patients.

  • And they were trying to -- they knew that the brain was involved

  • in neurological and psychiatric disease.

  • They didn't know exactly what they were doing.

  • Not much has changed, by the way. (Laughter)

  • But they thought that,

  • if you had a neurologic or psychiatric disease,

  • it must be because you are possessed

  • by an evil spirit.

  • So if you are possessed by an evil spirit

  • causing neurologic or psychiatric problems,

  • then the way to treat this is, of course,

  • to make a hole in your skull and let the evil spirit escape.

  • So this was the thinking back then,

  • and these individuals made these holes.

  • Sometimes the patients were a little bit reluctant

  • to go through this because, you can tell that

  • the holes are made partially and then, I think,

  • there was some trepanation, and then they left very quickly

  • and it was only a partial hole,

  • and we know they survived these procedures.

  • But this was common.

  • There were some sites where one percent

  • of all the skulls have these holes, and so you can see

  • that neurologic and psychiatric disease is quite common,

  • and it was also quite common about 7,000 years ago.

  • Now, in the course of time,

  • we've come to realize that

  • different parts of the brain do different things.

  • So there are areas of the brain that are dedicated

  • to controlling your movement or your vision

  • or your memory or your appetite, and so on.

  • And when things work well, then the nervous system

  • works well, and everything functions.

  • But once in a while, things don't go so well,

  • and there's trouble in these circuits,

  • and there are some rogue neurons that are misfiring

  • and causing trouble, or sometimes they're underactive

  • and they're not quite working as they should.

  • Now, the manifestation of this

  • depends on where in the brain these neurons are.

  • So when these neurons are in the motor circuit,

  • you get dysfunction in the movement system,

  • and you get things like Parkinson's disease.

  • When the malfunction is in a circuit that regulates your mood,

  • you get things like depression,

  • and when it is in a circuit that controls your memory and cognitive function,

  • then you get things like Alzheimer's disease.

  • So what we've been able to do is to pinpoint

  • where these disturbances are in the brain,

  • and we've been able to intervene within these circuits

  • in the brain to either turn them up or turn them down.

  • So this is very much like choosing the correct station

  • on the radio dial.

  • Once you choose the right station, whether it be jazz or opera,

  • in our case whether it be movement or mood,

  • we can put the dial there,

  • and then we can use a second button to adjust the volume,

  • to turn it up or turn it down.

  • So what I'm going to tell you about

  • is using the circuitry of the brain to implant electrodes

  • and turning areas of the brain up and down

  • to see if we can help our patients.

  • And this is accomplished using this kind of device,

  • and this is called deep brain stimulation.

  • So what we're doing is placing these electrodes throughout the brain.

  • Again, we are making holes in the skull about the size of a dime,

  • putting an electrode in, and then this electrode

  • is completely underneath the skin

  • down to a pacemaker in the chest,

  • and with a remote control very much like a television remote control,

  • we can adjust how much electricity we deliver

  • to these areas of the brain.

  • We can turn it up or down, on or off.

  • Now, about a hundred thousand patients in the world

  • have received deep brain stimulation,

  • and I'm going to show you some examples

  • of using deep brain stimulation to treat disorders of movement,

  • disorders of mood and disorders of cognition.

  • So this looks something like this when it's in the brain.

  • You see the electrode going through the skull into the brain

  • and resting there, and we can place this really anywhere in the brain.

  • I tell my friends that no neuron is safe

  • from a neurosurgeon, because we can really reach

  • just about anywhere in the brain quite safely now.

  • Now the first example I'm going to show you is a patient

  • with Parkinson's disease,

  • and this lady has Parkinson's disease,

  • and she has these electrodes in her brain,

  • and I'm going to show you what she's like

  • when the electrodes are turned off and she has her Parkinson's symptoms,

  • and then we're going to turn it on.

  • So this looks something like this.

  • The electrodes are turned off now, and you can see that she has tremor.

  • (Video) Man: Okay. Woman: I can't. Man: Can you try to touch my finger?

  • (Video) Man: That's a little better. Woman: That side is better.

  • We're now going to turn it on.

  • It's on. Just turned it on.

  • And this works like that, instantly.

  • And the difference between shaking in this way and not --

  • (Applause)

  • The difference between shaking in this way and not is related to the misbehavior

  • of 25,000 neurons in her subthalamic nucleus.

  • So we now know how to find these troublemakers

  • and tell them, "Gentlemen, that's enough.

  • We want you to stop doing that."

  • And we do that with electricity.

  • So we use electricity to dictate how they fire,

  • and we try to block their misbehavior using electricity.

  • So in this case, we are suppressing the activity of abnormal neurons.

  • We started using this technique in other problems,

  • and I'm going to tell you about a fascinating problem

  • that we encountered, a case of dystonia.

  • So dystonia is a disorder affecting children.

  • It's a genetic disorder, and it involves a twisting motion,

  • and these children get progressively more and more twisting

  • until they can't breathe, until they get sores,

  • urinary infections, and then they die.

  • So back in 1997, I was asked to see this young boy,

  • perfectly normal. He has this genetic form of dystonia.

  • There are eight children in the family.

  • Five of them have dystonia.

  • So here he is.

  • This boy is nine years old, perfectly normal until the age six,

  • and then he started twisting his body, first the right foot,

  • then the left foot, then the right arm, then the left arm,

  • then the trunk, and then by the time he arrived,

  • within the course of one or two years of the disease onset,

  • he could no longer walk, he could no longer stand.

  • He was crippled, and indeed the natural progression

  • as this gets worse is for them to become progressively twisted,

  • progressively disabled, and many of these children do not survive.

  • So he is one of five kids.

  • The only way he could get around was crawling on his belly like this.

  • He did not respond to any drugs.

  • We did not know what to do with this boy.

  • We did not know what operation to do,

  • where to go in the brain,

  • but on the basis of our results in Parkinson's disease,

  • we reasoned, why don't we try to suppress

  • the same area in the brain that we suppressed

  • in Parkinson's disease, and let's see what happens?

  • So here he was. We operated on him

  • hoping that he would get better. We did not know.

  • So here he is now, back in Israel where he lives,

  • three months after the procedure, and here he is.

  • (Applause)

  • On the basis of this result, this is now a procedure

  • that's done throughout the world,

  • and there have been hundreds of children

  • that have been helped with this kind of surgery.

  • This boy is now in university

  • and leads quite a normal life.

  • This has been one of the most satisfying cases

  • that I have ever done in my entire career,

  • to restore movement and walking to this kind of child.

  • (Applause)

  • We realized that perhaps we could use this technology

  • not only in circuits that control your movement

  • but also circuits that control other things,

  • and the next thing that we took on

  • was circuits that control your mood.

  • And we decided to take on depression,

  • and the reason we took on depression is because it's so prevalent,

  • and as you know, there are many treatments for depression,

  • with medication and psychotherapy,

  • even electroconvulsive therapy,

  • but there are millions of people,

  • and there are still 10 or 20 percent of patients with depression

  • that do not respond, and it is these patients that we want to help.

  • And let's see if we can use this technique

  • to help these patients with depression.

  • So the first thing we did was, we compared,

  • what's different in the brain of someone with depression

  • and someone who is normal,

  • and what we did was PET scans to look at the blood flow of the brain,

  • and what we noticed is that in patients with depression

  • compared to normals,

  • areas of the brain are shut down,

  • and those are the areas in blue.

  • So here you really have the blues,

  • and the areas in blue are areas that are involved

  • in motivation, in drive and decision-making,

  • and indeed, if you're severely depressed as these patients were,

  • those are impaired. You lack motivation and drive.

  • The other thing we discovered

  • was an area that was overactive, area 25,

  • seen there in red,

  • and area 25 is the sadness center of the brain.

  • If I make any of you sad, for example, I make you remember

  • the last time you saw your parent before they died

  • or a friend before they died,

  • this area of the brain lights up.

  • It is the sadness center of the brain.

  • And so patients with depression have hyperactivity.

  • The area of the brain for sadness is on red hot.

  • The thermostat is set at 100 degrees,

  • and the other areas of the brain, involved in drive and motivation, are shut down.

  • So we wondered, can we place electrodes in this area of sadness

  • and see if we can turn down the thermostat,

  • can we turn down the activity,

  • and what will be the consequence of that?

  • So we went ahead and implanted electrodes in patients with depression.

  • This is work done with my colleague Helen Mayberg from Emory.

  • And we placed electrodes in area 25,

  • and in the top scan you see before the operation,

  • area 25, the sadness area is red hot,

  • and the frontal lobes are shut down in blue,

  • and then, after three months of continuous stimulation,

  • 24 hours a day, or six months of continuous stimulation,

  • we have a complete reversal of this.

  • We're able to drive down area 25,

  • down to a more normal level,

  • and we're able to turn back online

  • the frontal lobes of the brain,

  • and indeed we're seeing very striking results

  • in these patients with severe depression.

  • So now we are in clinical trials, and are in Phase III clinical trials,

  • and this may become a new procedure,

  • if it's safe and we find that it's effective,

  • to treat patients with severe depression.

  • I've shown you that we can use deep brain stimulation

  • to treat the motor system

  • in cases of Parkinson's disease and dystonia.

  • I've shown you that we can use it to treat a mood circuit

  • in cases of depression.

  • Can we use deep brain stimulation to make you smarter?

  • (Laughter)

  • Anybody interested in that?

  • (Applause)

  • Of course we can, right?

  • So what we've decided to do is

  • we're going to try to turbocharge

  • the memory circuits in the brain.

  • We're going to place electrodes within the circuits

  • that regulate your memory and cognitive function

  • to see if we can turn up their activity.

  • Now we're not going to do this in normal people.

  • We're going to do this