0:00:00.401,0:00:02.717 One of the things I want to establish right from the start 0:00:02.717,0:00:05.747 is that not all neurosurgeons wear cowboy boots. 0:00:05.747,0:00:07.926 I just wanted you to know that. 0:00:07.926,0:00:10.335 So I am indeed a neurosurgeon, 0:00:10.335,0:00:14.262 and I follow a long tradition of neurosurgery, 0:00:14.262,0:00:15.855 and what I'm going to tell you about today 0:00:15.855,0:00:18.173 is adjusting the dials in the circuits in the brain, 0:00:18.173,0:00:20.128 being able to go anywhere in the brain 0:00:20.128,0:00:22.547 and turning areas of the brain up or down 0:00:22.547,0:00:24.759 to help our patients. 0:00:24.759,0:00:27.709 So as I said, neurosurgery comes from a long tradition. 0:00:27.709,0:00:31.261 It's been around for about 7,000 years. 0:00:31.261,0:00:34.986 In Mesoamerica, there used to be neurosurgery, 0:00:34.986,0:00:38.754 and there were these neurosurgeons that used to treat patients. 0:00:38.754,0:00:42.665 And they were trying to -- they knew that the brain was involved 0:00:42.680,0:00:45.032 in neurological and psychiatric disease. 0:00:45.032,0:00:47.193 They didn't know exactly what they were doing. 0:00:47.193,0:00:50.007 Not much has changed, by the way. (Laughter) 0:00:50.007,0:00:51.880 But they thought that, 0:00:51.880,0:00:53.883 if you had a neurologic or psychiatric disease, 0:00:53.883,0:00:56.474 it must be because you are possessed 0:00:56.474,0:00:58.826 by an evil spirit. 0:00:58.826,0:01:00.795 So if you are possessed by an evil spirit 0:01:00.795,0:01:03.615 causing neurologic or psychiatric problems, 0:01:03.615,0:01:05.636 then the way to treat this is, of course, 0:01:05.636,0:01:11.319 to make a hole in your skull and let the evil spirit escape. 0:01:11.319,0:01:12.697 So this was the thinking back then, 0:01:12.697,0:01:16.841 and these individuals made these holes. 0:01:16.841,0:01:19.824 Sometimes the patients were a little bit reluctant 0:01:19.824,0:01:22.239 to go through this because, you can tell that 0:01:22.239,0:01:24.690 the holes are made partially and then, I think, 0:01:24.690,0:01:26.705 there was some trepanation, and then they left very quickly 0:01:26.705,0:01:28.606 and it was only a partial hole, 0:01:28.606,0:01:30.922 and we know they survived these procedures. 0:01:30.922,0:01:32.130 But this was common. 0:01:32.130,0:01:33.396 There were some sites where one percent 0:01:33.396,0:01:36.121 of all the skulls have these holes, and so you can see 0:01:36.121,0:01:39.315 that neurologic and psychiatric disease is quite common, 0:01:39.315,0:01:43.748 and it was also quite common about 7,000 years ago. 0:01:43.748,0:01:45.901 Now, in the course of time, 0:01:45.901,0:01:48.121 we've come to realize that 0:01:48.121,0:01:50.379 different parts of the brain do different things. 0:01:50.379,0:01:51.566 So there are areas of the brain that are dedicated 0:01:51.566,0:01:54.259 to controlling your movement or your vision 0:01:54.259,0:01:57.208 or your memory or your appetite, and so on. 0:01:57.208,0:01:59.942 And when things work well, then the nervous system 0:01:59.942,0:02:01.611 works well, and everything functions. 0:02:01.611,0:02:03.858 But once in a while, things don't go so well, 0:02:03.858,0:02:06.400 and there's trouble in these circuits, 0:02:06.400,0:02:09.104 and there are some rogue neurons that are misfiring 0:02:09.104,0:02:12.283 and causing trouble, or sometimes they're underactive 0:02:12.283,0:02:14.827 and they're not quite working as they should. 0:02:14.827,0:02:16.964 Now, the manifestation of this 0:02:16.964,0:02:19.448 depends on where in the brain these neurons are. 0:02:19.448,0:02:21.870 So when these neurons are in the motor circuit, 0:02:21.870,0:02:24.282 you get dysfunction in the movement system, 0:02:24.282,0:02:26.448 and you get things like Parkinson's disease. 0:02:26.448,0:02:29.744 When the malfunction is in a circuit that regulates your mood, 0:02:29.744,0:02:32.028 you get things like depression, 0:02:32.028,0:02:35.852 and when it is in a circuit that controls your memory and cognitive function, 0:02:35.852,0:02:38.373 then you get things like Alzheimer's disease. 0:02:38.373,0:02:41.096 So what we've been able to do is to pinpoint 0:02:41.096,0:02:43.403 where these disturbances are in the brain, 0:02:43.403,0:02:46.440 and we've been able to intervene within these circuits 0:02:46.440,0:02:50.096 in the brain to either turn them up or turn them down. 0:02:50.096,0:02:52.380 So this is very much like choosing the correct station 0:02:52.380,0:02:54.355 on the radio dial. 0:02:54.355,0:02:57.004 Once you choose the right station, whether it be jazz or opera, 0:02:57.004,0:02:59.337 in our case whether it be movement or mood, 0:02:59.337,0:03:01.303 we can put the dial there, 0:03:01.303,0:03:04.074 and then we can use a second button to adjust the volume, 0:03:04.074,0:03:06.083 to turn it up or turn it down. 0:03:06.083,0:03:07.311 So what I'm going to tell you about 0:03:07.311,0:03:11.369 is using the circuitry of the brain to implant electrodes 0:03:11.369,0:03:13.837 and turning areas of the brain up and down 0:03:13.837,0:03:15.541 to see if we can help our patients. 0:03:15.541,0:03:17.874 And this is accomplished using this kind of device, 0:03:17.874,0:03:20.335 and this is called deep brain stimulation. 0:03:20.335,0:03:23.406 So what we're doing is placing these electrodes throughout the brain. 0:03:23.406,0:03:27.355 Again, we are making holes in the skull about the size of a dime, 0:03:27.355,0:03:29.506 putting an electrode in, and then this electrode 0:03:29.506,0:03:31.734 is completely underneath the skin 0:03:31.734,0:03:33.824 down to a pacemaker in the chest, 0:03:33.824,0:03:38.352 and with a remote control very much like a television remote control, 0:03:38.352,0:03:41.331 we can adjust how much electricity we deliver 0:03:41.331,0:03:43.399 to these areas of the brain. 0:03:43.399,0:03:46.290 We can turn it up or down, on or off. 0:03:46.290,0:03:48.945 Now, about a hundred thousand patients in the world 0:03:48.945,0:03:50.821 have received deep brain stimulation, 0:03:50.821,0:03:51.975 and I'm going to show you some examples 0:03:51.975,0:03:54.686 of using deep brain stimulation to treat disorders of movement, 0:03:54.686,0:03:59.200 disorders of mood and disorders of cognition. 0:03:59.200,0:04:01.939 So this looks something like this when it's in the brain. 0:04:01.939,0:04:04.174 You see the electrode going through the skull into the brain 0:04:04.174,0:04:07.357 and resting there, and we can place this really anywhere in the brain. 0:04:07.357,0:04:09.817 I tell my friends that no neuron is safe 0:04:09.817,0:04:11.999 from a neurosurgeon, because we can really reach 0:04:11.999,0:04:14.565 just about anywhere in the brain quite safely now. 0:04:14.565,0:04:17.085 Now the first example I'm going to show you is a patient 0:04:17.085,0:04:18.795 with Parkinson's disease, 0:04:18.795,0:04:20.782 and this lady has Parkinson's disease, 0:04:20.782,0:04:23.092 and she has these electrodes in her brain, 0:04:23.092,0:04:24.374 and I'm going to show you what she's like 0:04:24.374,0:04:27.881 when the electrodes are turned off and she has her Parkinson's symptoms, 0:04:27.881,0:04:30.214 and then we're going to turn it on. 0:04:30.214,0:04:32.909 So this looks something like this. 0:04:32.909,0:04:37.414 The electrodes are turned off now, and you can see that she has tremor. 0:04:37.420,0:04:41.139 (Video) Man: Okay. Woman: I can't. Man: Can you try to touch my finger? 0:04:41.139,0:04:44.764 (Video) Man: That's a little better. Woman: That side is better. 0:04:44.764,0:04:48.556 We're now going to turn it on. 0:04:48.556,0:04:52.994 It's on. Just turned it on. 0:04:54.561,0:04:57.824 And this works like that, instantly. 0:04:57.824,0:05:00.806 And the difference between shaking in this way and not -- 0:05:00.806,0:05:05.407 (Applause) 0:05:05.407,0:05:09.512 The difference between shaking in this way and not is related to the misbehavior 0:05:09.512,0:05:13.485 of 25,000 neurons in her subthalamic nucleus. 0:05:13.485,0:05:16.061 So we now know how to find these troublemakers 0:05:16.061,0:05:17.452 and tell them, "Gentlemen, that's enough. 0:05:17.452,0:05:18.786 We want you to stop doing that." 0:05:18.786,0:05:20.008 And we do that with electricity. 0:05:20.008,0:05:23.422 So we use electricity to dictate how they fire, 0:05:23.422,0:05:26.884 and we try to block their misbehavior using electricity. 0:05:26.884,0:05:30.328 So in this case, we are suppressing the activity of abnormal neurons. 0:05:30.328,0:05:32.890 We started using this technique in other problems, 0:05:32.890,0:05:34.292 and I'm going to tell you about a fascinating problem 0:05:34.292,0:05:37.460 that we encountered, a case of dystonia. 0:05:37.460,0:05:39.965 So dystonia is a disorder affecting children. 0:05:39.965,0:05:43.027 It's a genetic disorder, and it involves a twisting motion, 0:05:43.027,0:05:45.851 and these children get progressively more and more twisting 0:05:45.851,0:05:47.842 until they can't breathe, until they get sores, 0:05:47.842,0:05:49.873 urinary infections, and then they die. 0:05:49.873,0:05:53.246 So back in 1997, I was asked to see this young boy, 0:05:53.246,0:05:56.202 perfectly normal. He has this genetic form of dystonia. 0:05:56.202,0:05:58.421 There are eight children in the family. 0:05:58.421,0:06:01.780 Five of them have dystonia. 0:06:01.780,0:06:03.965 So here he is. 0:06:03.965,0:06:08.151 This boy is nine years old, perfectly normal until the age six, 0:06:08.151,0:06:12.546 and then he started twisting his body, first the right foot, 0:06:12.546,0:06:15.966 then the left foot, then the right arm, then the left arm, 0:06:15.966,0:06:19.213 then the trunk, and then by the time he arrived, 0:06:19.213,0:06:22.153 within the course of one or two years of the disease onset, 0:06:22.153,0:06:24.473 he could no longer walk, he could no longer stand. 0:06:24.473,0:06:27.171 He was crippled, and indeed the natural progression 0:06:27.171,0:06:30.726 as this gets worse is for them to become progressively twisted, 0:06:30.726,0:06:36.416 progressively disabled, and many of these children do not survive. 0:06:36.416,0:06:38.444 So he is one of five kids. 0:06:38.444,0:06:42.538 The only way he could get around was crawling on his belly like this. 0:06:42.538,0:06:44.494 He did not respond to any drugs. 0:06:44.494,0:06:46.434 We did not know what to do with this boy. 0:06:46.434,0:06:48.550 We did not know what operation to do, 0:06:48.550,0:06:50.744 where to go in the brain, 0:06:50.744,0:06:53.517 but on the basis of our results in Parkinson's disease, 0:06:53.517,0:06:55.522 we reasoned, why don't we try to suppress 0:06:55.522,0:06:58.619 the same area in the brain that we suppressed 0:06:58.619,0:07:02.274 in Parkinson's disease, and let's see what happens? 0:07:02.274,0:07:04.061 So here he was. We operated on him 0:07:04.061,0:07:07.935 hoping that he would get better. We did not know. 0:07:07.935,0:07:12.062 So here he is now, back in Israel where he lives, 0:07:12.062,0:07:16.115 three months after the procedure, and here he is. 0:07:16.115,0:07:21.065 (Applause) 0:07:24.669,0:07:27.290 On the basis of this result, this is now a procedure 0:07:27.290,0:07:28.538 that's done throughout the world, 0:07:28.538,0:07:29.833 and there have been hundreds of children 0:07:29.833,0:07:34.040 that have been helped with this kind of surgery. 0:07:34.040,0:07:36.157 This boy is now in university 0:07:36.157,0:07:38.193 and leads quite a normal life. 0:07:38.193,0:07:40.561 This has been one of the most satisfying cases 0:07:40.561,0:07:42.540 that I have ever done in my entire career, 0:07:42.540,0:07:45.917 to restore movement and walking to this kind of child. 0:07:45.917,0:07:52.172 (Applause) 0:07:52.172,0:07:55.041 We realized that perhaps we could use this technology 0:07:55.041,0:07:57.213 not only in circuits that control your movement 0:07:57.213,0:07:59.165 but also circuits that control other things, 0:07:59.165,0:08:00.312 and the next thing that we took on 0:08:00.312,0:08:03.305 was circuits that control your mood. 0:08:03.305,0:08:05.381 And we decided to take on depression, 0:08:05.381,0:08:07.640 and the reason we took on depression is because it's so prevalent, 0:08:07.640,0:08:10.184 and as you know, there are many treatments for depression, 0:08:10.184,0:08:12.221 with medication and psychotherapy, 0:08:12.221,0:08:14.283 even electroconvulsive therapy, 0:08:14.283,0:08:15.617 but there are millions of people, 0:08:15.617,0:08:18.409 and there are still 10 or 20 percent of patients with depression 0:08:18.409,0:08:21.661 that do not respond, and it is these patients that we want to help. 0:08:21.661,0:08:23.764 And let's see if we can use this technique 0:08:23.764,0:08:26.003 to help these patients with depression. 0:08:26.003,0:08:27.853 So the first thing we did was, we compared, 0:08:27.853,0:08:29.677 what's different in the brain of someone with depression 0:08:29.677,0:08:31.345 and someone who is normal, 0:08:31.345,0:08:34.805 and what we did was PET scans to look at the blood flow of the brain, 0:08:34.805,0:08:37.174 and what we noticed is that in patients with depression 0:08:37.174,0:08:39.219 compared to normals, 0:08:39.219,0:08:40.717 areas of the brain are shut down, 0:08:40.717,0:08:41.982 and those are the areas in blue. 0:08:41.982,0:08:43.602 So here you really have the blues, 0:08:43.602,0:08:47.175 and the areas in blue are areas that are involved 0:08:47.175,0:08:49.831 in motivation, in drive and decision-making, 0:08:49.831,0:08:52.326 and indeed, if you're severely depressed as these patients were, 0:08:52.326,0:08:55.018 those are impaired. You lack motivation and drive. 0:08:55.018,0:08:56.897 The other thing we discovered 0:08:56.897,0:08:59.386 was an area that was overactive, area 25, 0:08:59.386,0:09:00.974 seen there in red, 0:09:00.974,0:09:03.631 and area 25 is the sadness center of the brain. 0:09:03.631,0:09:06.504 If I make any of you sad, for example, I make you remember 0:09:06.504,0:09:08.791 the last time you saw your parent before they died 0:09:08.791,0:09:10.424 or a friend before they died, 0:09:10.424,0:09:11.630 this area of the brain lights up. 0:09:11.630,0:09:13.353 It is the sadness center of the brain. 0:09:13.353,0:09:16.565 And so patients with depression have hyperactivity. 0:09:16.565,0:09:18.743 The area of the brain for sadness is on red hot. 0:09:18.743,0:09:21.400 The thermostat is set at 100 degrees, 0:09:21.400,0:09:24.528 and the other areas of the brain, involved in drive and motivation, are shut down. 0:09:24.528,0:09:27.525 So we wondered, can we place electrodes in this area of sadness 0:09:27.525,0:09:29.954 and see if we can turn down the thermostat, 0:09:29.954,0:09:31.667 can we turn down the activity, 0:09:31.667,0:09:33.789 and what will be the consequence of that? 0:09:33.789,0:09:36.916 So we went ahead and implanted electrodes in patients with depression. 0:09:36.916,0:09:39.403 This is work done with my colleague Helen Mayberg from Emory. 0:09:39.403,0:09:41.337 And we placed electrodes in area 25, 0:09:41.337,0:09:43.622 and in the top scan you see before the operation, 0:09:43.622,0:09:45.908 area 25, the sadness area is red hot, 0:09:45.908,0:09:48.302 and the frontal lobes are shut down in blue, 0:09:48.302,0:09:50.710 and then, after three months of continuous stimulation, 0:09:50.710,0:09:53.725 24 hours a day, or six months of continuous stimulation, 0:09:53.725,0:09:55.499 we have a complete reversal of this. 0:09:55.499,0:09:58.338 We're able to drive down area 25, 0:09:58.338,0:10:00.290 down to a more normal level, 0:10:00.290,0:10:02.326 and we're able to turn back online 0:10:02.326,0:10:03.634 the frontal lobes of the brain, 0:10:03.634,0:10:05.503 and indeed we're seeing very striking results 0:10:05.503,0:10:08.250 in these patients with severe depression. 0:10:08.250,0:10:11.152 So now we are in clinical trials, and are in Phase III clinical trials, 0:10:11.152,0:10:13.695 and this may become a new procedure, 0:10:13.695,0:10:15.878 if it's safe and we find that it's effective, 0:10:15.878,0:10:19.552 to treat patients with severe depression. 0:10:19.567,0:10:22.527 I've shown you that we can use deep brain stimulation 0:10:22.527,0:10:24.614 to treat the motor system 0:10:24.614,0:10:27.060 in cases of Parkinson's disease and dystonia. 0:10:27.060,0:10:29.445 I've shown you that we can use it to treat a mood circuit 0:10:29.445,0:10:31.095 in cases of depression. 0:10:31.095,0:10:35.640 Can we use deep brain stimulation to make you smarter? 0:10:35.640,0:10:37.736 (Laughter) 0:10:37.736,0:10:40.302 Anybody interested in that? 0:10:40.302,0:10:42.602 (Applause) 0:10:42.602,0:10:45.590 Of course we can, right? 0:10:45.590,0:10:47.804 So what we've decided to do is 0:10:47.804,0:10:50.225 we're going to try to turbocharge 0:10:50.225,0:10:52.430 the memory circuits in the brain. 0:10:52.430,0:10:55.166 We're going to place electrodes within the circuits 0:10:55.166,0:10:57.842 that regulate your memory and cognitive function 0:10:57.842,0:11:01.112 to see if we can turn up their activity. 0:11:01.112,0:11:03.050 Now we're not going to do this in normal people. 0:11:03.050,0:11:06.702 We're going to do this in people that have cognitive deficits, 0:11:06.702,0:11:10.161 and we've chosen to treat patients with Alzheimer's disease 0:11:10.161,0:11:12.268 who have cognitive and memory deficits. 0:11:12.268,0:11:14.207 As you know, this is the main symptom 0:11:14.207,0:11:16.630 of early onset Alzheimer's disease. 0:11:16.630,0:11:18.824 So we've placed electrodes within this circuit 0:11:18.824,0:11:20.819 in an area of the brain called the fornix, 0:11:20.819,0:11:23.597 which is the highway in and out of this memory circuit, 0:11:23.597,0:11:27.025 with the idea to see if we can turn on this memory circuit, 0:11:27.025,0:11:30.274 and whether that can, in turn, help these patients 0:11:30.274,0:11:32.583 with Alzheimer's disease. 0:11:32.583,0:11:34.901 Now it turns out that in Alzheimer's disease, 0:11:34.901,0:11:38.973 there's a huge deficit in glucose utilization in the brain. 0:11:38.973,0:11:42.391 The brain is a bit of a hog when it comes to using glucose. 0:11:42.391,0:11:44.151 It uses 20 percent of all your -- 0:11:44.151,0:11:45.666 even though it only weighs two percent -- 0:11:45.666,0:11:48.811 it uses 10 times more glucose than it should based on its weight. 0:11:48.811,0:11:51.394 Twenty percent of all the glucose in your body is used by the brain, 0:11:51.394,0:11:53.824 and as you go from being normal 0:11:53.824,0:11:56.017 to having mild cognitive impairment, 0:11:56.017,0:11:58.472 which is a precursor for Alzheimer's, all the way to Alzheimer's disease, 0:11:58.472,0:12:01.161 then there are areas of the brain that stop using glucose. 0:12:01.161,0:12:03.456 They shut down. They turn off. 0:12:03.456,0:12:05.738 And indeed, what we see is that these areas in red 0:12:05.738,0:12:07.505 around the outside ribbon of the brain 0:12:07.505,0:12:09.781 are progressively getting more and more blue 0:12:09.781,0:12:12.953 until they shut down completely. 0:12:12.953,0:12:15.312 This is analogous to having a power failure 0:12:15.312,0:12:17.855 in an area of the brain, a regional power failure. 0:12:17.855,0:12:20.252 So the lights are out in parts of the brain 0:12:20.252,0:12:22.850 in patients with Alzheimer's disease, 0:12:22.850,0:12:25.259 and the question is, are the lights out forever, 0:12:25.259,0:12:28.120 or can we turn the lights back on? 0:12:28.120,0:12:31.356 Can we get those areas of the brain to use glucose once again? 0:12:31.356,0:12:33.906 So this is what we did. We implanted electrodes in the fornix 0:12:33.906,0:12:36.519 of patients with Alzheimer's disease, we turned it on, 0:12:36.519,0:12:40.030 and we looked at what happens to glucose use in the brain. 0:12:40.030,0:12:43.292 And indeed, at the top, you'll see before the surgery, 0:12:43.292,0:12:46.656 the areas in blue are the areas that use less glucose than normal, 0:12:46.656,0:12:48.864 predominantly the parietal and temporal lobes. 0:12:48.864,0:12:50.574 These areas of the brain are shut down. 0:12:50.574,0:12:53.249 The lights are out in these areas of the brain. 0:12:53.249,0:12:56.203 We then put in the DBS electrodes and we wait for a month 0:12:56.203,0:12:57.594 or a year, and the areas in red 0:12:57.594,0:13:00.901 represent the areas where we increase glucose utilization. 0:13:00.901,0:13:03.021 And indeed, we are able to get these areas of the brain 0:13:03.021,0:13:06.535 that were not using glucose to use glucose once again. 0:13:06.535,0:13:08.887 So the message here is that, in Alzheimer's disease, 0:13:08.887,0:13:11.216 the lights are out, but there is someone home, 0:13:11.216,0:13:13.365 and we're able to turn the power back on 0:13:13.365,0:13:15.671 to these areas of the brain, and as we do so, 0:13:15.671,0:13:18.607 we expect that their functions will return. 0:13:18.607,0:13:20.734 So this is now in clinical trials. 0:13:20.734,0:13:22.635 We are going to operate on 50 patients 0:13:22.635,0:13:24.613 with early Alzheimer's disease 0:13:24.613,0:13:26.670 to see whether this is safe and effective, 0:13:26.670,0:13:29.649 whether we can improve their neurologic function. 0:13:29.649,0:13:37.129 (Applause) 0:13:37.129,0:13:40.077 So the message I want to leave you with today is that, 0:13:40.077,0:13:42.681 indeed, there are several circuits in the brain 0:13:42.681,0:13:46.607 that are malfunctioning across various disease states, 0:13:46.607,0:13:48.815 whether we're talking about Parkinson's disease, 0:13:48.815,0:13:51.897 depression, schizophrenia, Alzheimer's. 0:13:51.897,0:13:54.927 We are now learning to understand what are the circuits, 0:13:54.927,0:13:57.129 what are the areas of the brain that are responsible for 0:13:57.129,0:13:59.649 the clinical signs and the symptoms of those diseases. 0:13:59.649,0:14:01.955 We can now reach those circuits. 0:14:01.955,0:14:04.587 We can introduce electrodes within those circuits. 0:14:04.587,0:14:07.569 We can graduate the activity of those circuits. 0:14:07.569,0:14:10.821 We can turn them down if they are overactive, 0:14:10.821,0:14:13.778 if they're causing trouble, trouble that is felt throughout the brain, 0:14:13.778,0:14:16.359 or we can turn them up if they are underperforming, 0:14:16.359,0:14:18.752 and in so doing, we think that we may be able to help 0:14:18.752,0:14:21.092 the overall function of the brain. 0:14:21.092,0:14:23.646 The implications of this, of course, is that we may be able 0:14:23.646,0:14:25.956 to modify the symptoms of the disease, 0:14:25.956,0:14:27.865 but I haven't told you but there's also some evidence 0:14:27.865,0:14:32.028 that we might be able to help the repair of damaged areas of the brain using electricity, 0:14:32.028,0:14:34.480 and this is something for the future, to see if, indeed, 0:14:34.480,0:14:36.719 we not only change the activity but also 0:14:36.719,0:14:38.733 some of the reparative functions of the brain 0:14:38.733,0:14:40.288 can be harvested. 0:14:40.288,0:14:43.335 So I envision that we're going to see a great expansion 0:14:43.335,0:14:45.787 of indications of this technique. 0:14:45.787,0:14:48.566 We're going to see electrodes being placed for many disorders of the brain. 0:14:48.566,0:14:51.525 One of the most exciting things about this is that, indeed, 0:14:51.525,0:14:53.372 it involves multidisciplinary work. 0:14:53.372,0:14:56.174 It involves the work of engineers, of imaging scientists, 0:14:56.174,0:14:58.376 of basic scientists, of neurologists, 0:14:58.376,0:15:01.128 psychiatrists, neurosurgeons, and certainly at the interface 0:15:01.128,0:15:04.069 of these multiple disciplines that there's the excitement. 0:15:04.069,0:15:06.826 And I think that we will see that 0:15:06.826,0:15:10.262 we will be able to chase more of these evil spirits 0:15:10.262,0:15:12.158 out from the brain as time goes on, 0:15:12.158,0:15:14.060 and the consequence of that, of course, will be 0:15:14.060,0:15:16.332 that we will be able to help many more patients. 0:15:16.332,0:15:17.582 Thank you very much.