1 00:00:00,401 --> 00:00:02,717 One of the things I want to establish right from the start 2 00:00:02,717 --> 00:00:05,747 is that not all neurosurgeons wear cowboy boots. 3 00:00:05,747 --> 00:00:07,926 I just wanted you to know that. 4 00:00:07,926 --> 00:00:10,335 So I am indeed a neurosurgeon, 5 00:00:10,335 --> 00:00:14,262 and I follow a long tradition of neurosurgery, 6 00:00:14,262 --> 00:00:15,855 and what I'm going to tell you about today 7 00:00:15,855 --> 00:00:18,173 is adjusting the dials in the circuits in the brain, 8 00:00:18,173 --> 00:00:20,128 being able to go anywhere in the brain 9 00:00:20,128 --> 00:00:22,547 and turning areas of the brain up or down 10 00:00:22,547 --> 00:00:24,759 to help our patients. 11 00:00:24,759 --> 00:00:27,709 So as I said, neurosurgery comes from a long tradition. 12 00:00:27,709 --> 00:00:31,261 It's been around for about 7,000 years. 13 00:00:31,261 --> 00:00:34,986 In Mesoamerica, there used to be neurosurgery, 14 00:00:34,986 --> 00:00:38,754 and there were these neurosurgeons that used to treat patients. 15 00:00:38,754 --> 00:00:42,665 And they were trying to -- they knew that the brain was involved 16 00:00:42,680 --> 00:00:45,032 in neurological and psychiatric disease. 17 00:00:45,032 --> 00:00:47,193 They didn't know exactly what they were doing. 18 00:00:47,193 --> 00:00:50,007 Not much has changed, by the way. (Laughter) 19 00:00:50,007 --> 00:00:51,880 But they thought that, 20 00:00:51,880 --> 00:00:53,883 if you had a neurologic or psychiatric disease, 21 00:00:53,883 --> 00:00:56,474 it must be because you are possessed 22 00:00:56,474 --> 00:00:58,826 by an evil spirit. 23 00:00:58,826 --> 00:01:00,795 So if you are possessed by an evil spirit 24 00:01:00,795 --> 00:01:03,615 causing neurologic or psychiatric problems, 25 00:01:03,615 --> 00:01:05,636 then the way to treat this is, of course, 26 00:01:05,636 --> 00:01:11,319 to make a hole in your skull and let the evil spirit escape. 27 00:01:11,319 --> 00:01:12,697 So this was the thinking back then, 28 00:01:12,697 --> 00:01:16,841 and these individuals made these holes. 29 00:01:16,841 --> 00:01:19,824 Sometimes the patients were a little bit reluctant 30 00:01:19,824 --> 00:01:22,239 to go through this because, you can tell that 31 00:01:22,239 --> 00:01:24,690 the holes are made partially and then, I think, 32 00:01:24,690 --> 00:01:26,705 there was some trepanation, and then they left very quickly 33 00:01:26,705 --> 00:01:28,606 and it was only a partial hole, 34 00:01:28,606 --> 00:01:30,922 and we know they survived these procedures. 35 00:01:30,922 --> 00:01:32,130 But this was common. 36 00:01:32,130 --> 00:01:33,396 There were some sites where one percent 37 00:01:33,396 --> 00:01:36,121 of all the skulls have these holes, and so you can see 38 00:01:36,121 --> 00:01:39,315 that neurologic and psychiatric disease is quite common, 39 00:01:39,315 --> 00:01:43,748 and it was also quite common about 7,000 years ago. 40 00:01:43,748 --> 00:01:45,901 Now, in the course of time, 41 00:01:45,901 --> 00:01:48,121 we've come to realize that 42 00:01:48,121 --> 00:01:50,379 different parts of the brain do different things. 43 00:01:50,379 --> 00:01:51,566 So there are areas of the brain that are dedicated 44 00:01:51,566 --> 00:01:54,259 to controlling your movement or your vision 45 00:01:54,259 --> 00:01:57,208 or your memory or your appetite, and so on. 46 00:01:57,208 --> 00:01:59,942 And when things work well, then the nervous system 47 00:01:59,942 --> 00:02:01,611 works well, and everything functions. 48 00:02:01,611 --> 00:02:03,858 But once in a while, things don't go so well, 49 00:02:03,858 --> 00:02:06,400 and there's trouble in these circuits, 50 00:02:06,400 --> 00:02:09,104 and there are some rogue neurons that are misfiring 51 00:02:09,104 --> 00:02:12,283 and causing trouble, or sometimes they're underactive 52 00:02:12,283 --> 00:02:14,827 and they're not quite working as they should. 53 00:02:14,827 --> 00:02:16,964 Now, the manifestation of this 54 00:02:16,964 --> 00:02:19,448 depends on where in the brain these neurons are. 55 00:02:19,448 --> 00:02:21,870 So when these neurons are in the motor circuit, 56 00:02:21,870 --> 00:02:24,282 you get dysfunction in the movement system, 57 00:02:24,282 --> 00:02:26,448 and you get things like Parkinson's disease. 58 00:02:26,448 --> 00:02:29,744 When the malfunction is in a circuit that regulates your mood, 59 00:02:29,744 --> 00:02:32,028 you get things like depression, 60 00:02:32,028 --> 00:02:35,852 and when it is in a circuit that controls your memory and cognitive function, 61 00:02:35,852 --> 00:02:38,373 then you get things like Alzheimer's disease. 62 00:02:38,373 --> 00:02:41,096 So what we've been able to do is to pinpoint 63 00:02:41,096 --> 00:02:43,403 where these disturbances are in the brain, 64 00:02:43,403 --> 00:02:46,440 and we've been able to intervene within these circuits 65 00:02:46,440 --> 00:02:50,096 in the brain to either turn them up or turn them down. 66 00:02:50,096 --> 00:02:52,380 So this is very much like choosing the correct station 67 00:02:52,380 --> 00:02:54,355 on the radio dial. 68 00:02:54,355 --> 00:02:57,004 Once you choose the right station, whether it be jazz or opera, 69 00:02:57,004 --> 00:02:59,337 in our case whether it be movement or mood, 70 00:02:59,337 --> 00:03:01,303 we can put the dial there, 71 00:03:01,303 --> 00:03:04,074 and then we can use a second button to adjust the volume, 72 00:03:04,074 --> 00:03:06,083 to turn it up or turn it down. 73 00:03:06,083 --> 00:03:07,311 So what I'm going to tell you about 74 00:03:07,311 --> 00:03:11,369 is using the circuitry of the brain to implant electrodes 75 00:03:11,369 --> 00:03:13,837 and turning areas of the brain up and down 76 00:03:13,837 --> 00:03:15,541 to see if we can help our patients. 77 00:03:15,541 --> 00:03:17,874 And this is accomplished using this kind of device, 78 00:03:17,874 --> 00:03:20,335 and this is called deep brain stimulation. 79 00:03:20,335 --> 00:03:23,406 So what we're doing is placing these electrodes throughout the brain. 80 00:03:23,406 --> 00:03:27,355 Again, we are making holes in the skull about the size of a dime, 81 00:03:27,355 --> 00:03:29,506 putting an electrode in, and then this electrode 82 00:03:29,506 --> 00:03:31,734 is completely underneath the skin 83 00:03:31,734 --> 00:03:33,824 down to a pacemaker in the chest, 84 00:03:33,824 --> 00:03:38,352 and with a remote control very much like a television remote control, 85 00:03:38,352 --> 00:03:41,331 we can adjust how much electricity we deliver 86 00:03:41,331 --> 00:03:43,399 to these areas of the brain. 87 00:03:43,399 --> 00:03:46,290 We can turn it up or down, on or off. 88 00:03:46,290 --> 00:03:48,945 Now, about a hundred thousand patients in the world 89 00:03:48,945 --> 00:03:50,821 have received deep brain stimulation, 90 00:03:50,821 --> 00:03:51,975 and I'm going to show you some examples 91 00:03:51,975 --> 00:03:54,686 of using deep brain stimulation to treat disorders of movement, 92 00:03:54,686 --> 00:03:59,200 disorders of mood and disorders of cognition. 93 00:03:59,200 --> 00:04:01,939 So this looks something like this when it's in the brain. 94 00:04:01,939 --> 00:04:04,174 You see the electrode going through the skull into the brain 95 00:04:04,174 --> 00:04:07,357 and resting there, and we can place this really anywhere in the brain. 96 00:04:07,357 --> 00:04:09,817 I tell my friends that no neuron is safe 97 00:04:09,817 --> 00:04:11,999 from a neurosurgeon, because we can really reach 98 00:04:11,999 --> 00:04:14,565 just about anywhere in the brain quite safely now. 99 00:04:14,565 --> 00:04:17,085 Now the first example I'm going to show you is a patient 100 00:04:17,085 --> 00:04:18,795 with Parkinson's disease, 101 00:04:18,795 --> 00:04:20,782 and this lady has Parkinson's disease, 102 00:04:20,782 --> 00:04:23,092 and she has these electrodes in her brain, 103 00:04:23,092 --> 00:04:24,374 and I'm going to show you what she's like 104 00:04:24,374 --> 00:04:27,881 when the electrodes are turned off and she has her Parkinson's symptoms, 105 00:04:27,881 --> 00:04:30,214 and then we're going to turn it on. 106 00:04:30,214 --> 00:04:32,909 So this looks something like this. 107 00:04:32,909 --> 00:04:37,414 The electrodes are turned off now, and you can see that she has tremor. 108 00:04:37,420 --> 00:04:41,139 (Video) Man: Okay. Woman: I can't. Man: Can you try to touch my finger? 109 00:04:41,139 --> 00:04:44,764 (Video) Man: That's a little better. Woman: That side is better. 110 00:04:44,764 --> 00:04:48,556 We're now going to turn it on. 111 00:04:48,556 --> 00:04:52,994 It's on. Just turned it on. 112 00:04:54,561 --> 00:04:57,824 And this works like that, instantly. 113 00:04:57,824 --> 00:05:00,806 And the difference between shaking in this way and not -- 114 00:05:00,806 --> 00:05:05,407 (Applause) 115 00:05:05,407 --> 00:05:09,512 The difference between shaking in this way and not is related to the misbehavior 116 00:05:09,512 --> 00:05:13,485 of 25,000 neurons in her subthalamic nucleus. 117 00:05:13,485 --> 00:05:16,061 So we now know how to find these troublemakers 118 00:05:16,061 --> 00:05:17,452 and tell them, "Gentlemen, that's enough. 119 00:05:17,452 --> 00:05:18,786 We want you to stop doing that." 120 00:05:18,786 --> 00:05:20,008 And we do that with electricity. 121 00:05:20,008 --> 00:05:23,422 So we use electricity to dictate how they fire, 122 00:05:23,422 --> 00:05:26,884 and we try to block their misbehavior using electricity. 123 00:05:26,884 --> 00:05:30,328 So in this case, we are suppressing the activity of abnormal neurons. 124 00:05:30,328 --> 00:05:32,890 We started using this technique in other problems, 125 00:05:32,890 --> 00:05:34,292 and I'm going to tell you about a fascinating problem 126 00:05:34,292 --> 00:05:37,460 that we encountered, a case of dystonia. 127 00:05:37,460 --> 00:05:39,965 So dystonia is a disorder affecting children. 128 00:05:39,965 --> 00:05:43,027 It's a genetic disorder, and it involves a twisting motion, 129 00:05:43,027 --> 00:05:45,851 and these children get progressively more and more twisting 130 00:05:45,851 --> 00:05:47,842 until they can't breathe, until they get sores, 131 00:05:47,842 --> 00:05:49,873 urinary infections, and then they die. 132 00:05:49,873 --> 00:05:53,246 So back in 1997, I was asked to see this young boy, 133 00:05:53,246 --> 00:05:56,202 perfectly normal. He has this genetic form of dystonia. 134 00:05:56,202 --> 00:05:58,421 There are eight children in the family. 135 00:05:58,421 --> 00:06:01,780 Five of them have dystonia. 136 00:06:01,780 --> 00:06:03,965 So here he is. 137 00:06:03,965 --> 00:06:08,151 This boy is nine years old, perfectly normal until the age six, 138 00:06:08,151 --> 00:06:12,546 and then he started twisting his body, first the right foot, 139 00:06:12,546 --> 00:06:15,966 then the left foot, then the right arm, then the left arm, 140 00:06:15,966 --> 00:06:19,213 then the trunk, and then by the time he arrived, 141 00:06:19,213 --> 00:06:22,153 within the course of one or two years of the disease onset, 142 00:06:22,153 --> 00:06:24,473 he could no longer walk, he could no longer stand. 143 00:06:24,473 --> 00:06:27,171 He was crippled, and indeed the natural progression 144 00:06:27,171 --> 00:06:30,726 as this gets worse is for them to become progressively twisted, 145 00:06:30,726 --> 00:06:36,416 progressively disabled, and many of these children do not survive. 146 00:06:36,416 --> 00:06:38,444 So he is one of five kids. 147 00:06:38,444 --> 00:06:42,538 The only way he could get around was crawling on his belly like this. 148 00:06:42,538 --> 00:06:44,494 He did not respond to any drugs. 149 00:06:44,494 --> 00:06:46,434 We did not know what to do with this boy. 150 00:06:46,434 --> 00:06:48,550 We did not know what operation to do, 151 00:06:48,550 --> 00:06:50,744 where to go in the brain, 152 00:06:50,744 --> 00:06:53,517 but on the basis of our results in Parkinson's disease, 153 00:06:53,517 --> 00:06:55,522 we reasoned, why don't we try to suppress 154 00:06:55,522 --> 00:06:58,619 the same area in the brain that we suppressed 155 00:06:58,619 --> 00:07:02,274 in Parkinson's disease, and let's see what happens? 156 00:07:02,274 --> 00:07:04,061 So here he was. We operated on him 157 00:07:04,061 --> 00:07:07,935 hoping that he would get better. We did not know. 158 00:07:07,935 --> 00:07:12,062 So here he is now, back in Israel where he lives, 159 00:07:12,062 --> 00:07:16,115 three months after the procedure, and here he is. 160 00:07:16,115 --> 00:07:21,065 (Applause) 161 00:07:24,669 --> 00:07:27,290 On the basis of this result, this is now a procedure 162 00:07:27,290 --> 00:07:28,538 that's done throughout the world, 163 00:07:28,538 --> 00:07:29,833 and there have been hundreds of children 164 00:07:29,833 --> 00:07:34,040 that have been helped with this kind of surgery. 165 00:07:34,040 --> 00:07:36,157 This boy is now in university 166 00:07:36,157 --> 00:07:38,193 and leads quite a normal life. 167 00:07:38,193 --> 00:07:40,561 This has been one of the most satisfying cases 168 00:07:40,561 --> 00:07:42,540 that I have ever done in my entire career, 169 00:07:42,540 --> 00:07:45,917 to restore movement and walking to this kind of child. 170 00:07:45,917 --> 00:07:52,172 (Applause) 171 00:07:52,172 --> 00:07:55,041 We realized that perhaps we could use this technology 172 00:07:55,041 --> 00:07:57,213 not only in circuits that control your movement 173 00:07:57,213 --> 00:07:59,165 but also circuits that control other things, 174 00:07:59,165 --> 00:08:00,312 and the next thing that we took on 175 00:08:00,312 --> 00:08:03,305 was circuits that control your mood. 176 00:08:03,305 --> 00:08:05,381 And we decided to take on depression, 177 00:08:05,381 --> 00:08:07,640 and the reason we took on depression is because it's so prevalent, 178 00:08:07,640 --> 00:08:10,184 and as you know, there are many treatments for depression, 179 00:08:10,184 --> 00:08:12,221 with medication and psychotherapy, 180 00:08:12,221 --> 00:08:14,283 even electroconvulsive therapy, 181 00:08:14,283 --> 00:08:15,617 but there are millions of people, 182 00:08:15,617 --> 00:08:18,409 and there are still 10 or 20 percent of patients with depression 183 00:08:18,409 --> 00:08:21,661 that do not respond, and it is these patients that we want to help. 184 00:08:21,661 --> 00:08:23,764 And let's see if we can use this technique 185 00:08:23,764 --> 00:08:26,003 to help these patients with depression. 186 00:08:26,003 --> 00:08:27,853 So the first thing we did was, we compared, 187 00:08:27,853 --> 00:08:29,677 what's different in the brain of someone with depression 188 00:08:29,677 --> 00:08:31,345 and someone who is normal, 189 00:08:31,345 --> 00:08:34,805 and what we did was PET scans to look at the blood flow of the brain, 190 00:08:34,805 --> 00:08:37,174 and what we noticed is that in patients with depression 191 00:08:37,174 --> 00:08:39,219 compared to normals, 192 00:08:39,219 --> 00:08:40,717 areas of the brain are shut down, 193 00:08:40,717 --> 00:08:41,982 and those are the areas in blue. 194 00:08:41,982 --> 00:08:43,602 So here you really have the blues, 195 00:08:43,602 --> 00:08:47,175 and the areas in blue are areas that are involved 196 00:08:47,175 --> 00:08:49,831 in motivation, in drive and decision-making, 197 00:08:49,831 --> 00:08:52,326 and indeed, if you're severely depressed as these patients were, 198 00:08:52,326 --> 00:08:55,018 those are impaired. You lack motivation and drive. 199 00:08:55,018 --> 00:08:56,897 The other thing we discovered 200 00:08:56,897 --> 00:08:59,386 was an area that was overactive, area 25, 201 00:08:59,386 --> 00:09:00,974 seen there in red, 202 00:09:00,974 --> 00:09:03,631 and area 25 is the sadness center of the brain. 203 00:09:03,631 --> 00:09:06,504 If I make any of you sad, for example, I make you remember 204 00:09:06,504 --> 00:09:08,791 the last time you saw your parent before they died 205 00:09:08,791 --> 00:09:10,424 or a friend before they died, 206 00:09:10,424 --> 00:09:11,630 this area of the brain lights up. 207 00:09:11,630 --> 00:09:13,353 It is the sadness center of the brain. 208 00:09:13,353 --> 00:09:16,565 And so patients with depression have hyperactivity. 209 00:09:16,565 --> 00:09:18,743 The area of the brain for sadness is on red hot. 210 00:09:18,743 --> 00:09:21,400 The thermostat is set at 100 degrees, 211 00:09:21,400 --> 00:09:24,528 and the other areas of the brain, involved in drive and motivation, are shut down. 212 00:09:24,528 --> 00:09:27,525 So we wondered, can we place electrodes in this area of sadness 213 00:09:27,525 --> 00:09:29,954 and see if we can turn down the thermostat, 214 00:09:29,954 --> 00:09:31,667 can we turn down the activity, 215 00:09:31,667 --> 00:09:33,789 and what will be the consequence of that? 216 00:09:33,789 --> 00:09:36,916 So we went ahead and implanted electrodes in patients with depression. 217 00:09:36,916 --> 00:09:39,403 This is work done with my colleague Helen Mayberg from Emory. 218 00:09:39,403 --> 00:09:41,337 And we placed electrodes in area 25, 219 00:09:41,337 --> 00:09:43,622 and in the top scan you see before the operation, 220 00:09:43,622 --> 00:09:45,908 area 25, the sadness area is red hot, 221 00:09:45,908 --> 00:09:48,302 and the frontal lobes are shut down in blue, 222 00:09:48,302 --> 00:09:50,710 and then, after three months of continuous stimulation, 223 00:09:50,710 --> 00:09:53,725 24 hours a day, or six months of continuous stimulation, 224 00:09:53,725 --> 00:09:55,499 we have a complete reversal of this. 225 00:09:55,499 --> 00:09:58,338 We're able to drive down area 25, 226 00:09:58,338 --> 00:10:00,290 down to a more normal level, 227 00:10:00,290 --> 00:10:02,326 and we're able to turn back online 228 00:10:02,326 --> 00:10:03,634 the frontal lobes of the brain, 229 00:10:03,634 --> 00:10:05,503 and indeed we're seeing very striking results 230 00:10:05,503 --> 00:10:08,250 in these patients with severe depression. 231 00:10:08,250 --> 00:10:11,152 So now we are in clinical trials, and are in Phase III clinical trials, 232 00:10:11,152 --> 00:10:13,695 and this may become a new procedure, 233 00:10:13,695 --> 00:10:15,878 if it's safe and we find that it's effective, 234 00:10:15,878 --> 00:10:19,552 to treat patients with severe depression. 235 00:10:19,567 --> 00:10:22,527 I've shown you that we can use deep brain stimulation 236 00:10:22,527 --> 00:10:24,614 to treat the motor system 237 00:10:24,614 --> 00:10:27,060 in cases of Parkinson's disease and dystonia. 238 00:10:27,060 --> 00:10:29,445 I've shown you that we can use it to treat a mood circuit 239 00:10:29,445 --> 00:10:31,095 in cases of depression. 240 00:10:31,095 --> 00:10:35,640 Can we use deep brain stimulation to make you smarter? 241 00:10:35,640 --> 00:10:37,736 (Laughter) 242 00:10:37,736 --> 00:10:40,302 Anybody interested in that? 243 00:10:40,302 --> 00:10:42,602 (Applause) 244 00:10:42,602 --> 00:10:45,590 Of course we can, right? 245 00:10:45,590 --> 00:10:47,804 So what we've decided to do is 246 00:10:47,804 --> 00:10:50,225 we're going to try to turbocharge 247 00:10:50,225 --> 00:10:52,430 the memory circuits in the brain. 248 00:10:52,430 --> 00:10:55,166 We're going to place electrodes within the circuits 249 00:10:55,166 --> 00:10:57,842 that regulate your memory and cognitive function 250 00:10:57,842 --> 00:11:01,112 to see if we can turn up their activity. 251 00:11:01,112 --> 00:11:03,050 Now we're not going to do this in normal people. 252 00:11:03,050 --> 00:11:06,702 We're going to do this in people that have cognitive deficits, 253 00:11:06,702 --> 00:11:10,161 and we've chosen to treat patients with Alzheimer's disease 254 00:11:10,161 --> 00:11:12,268 who have cognitive and memory deficits. 255 00:11:12,268 --> 00:11:14,207 As you know, this is the main symptom 256 00:11:14,207 --> 00:11:16,630 of early onset Alzheimer's disease. 257 00:11:16,630 --> 00:11:18,824 So we've placed electrodes within this circuit 258 00:11:18,824 --> 00:11:20,819 in an area of the brain called the fornix, 259 00:11:20,819 --> 00:11:23,597 which is the highway in and out of this memory circuit, 260 00:11:23,597 --> 00:11:27,025 with the idea to see if we can turn on this memory circuit, 261 00:11:27,025 --> 00:11:30,274 and whether that can, in turn, help these patients 262 00:11:30,274 --> 00:11:32,583 with Alzheimer's disease. 263 00:11:32,583 --> 00:11:34,901 Now it turns out that in Alzheimer's disease, 264 00:11:34,901 --> 00:11:38,973 there's a huge deficit in glucose utilization in the brain. 265 00:11:38,973 --> 00:11:42,391 The brain is a bit of a hog when it comes to using glucose. 266 00:11:42,391 --> 00:11:44,151 It uses 20 percent of all your -- 267 00:11:44,151 --> 00:11:45,666 even though it only weighs two percent -- 268 00:11:45,666 --> 00:11:48,811 it uses 10 times more glucose than it should based on its weight. 269 00:11:48,811 --> 00:11:51,394 Twenty percent of all the glucose in your body is used by the brain, 270 00:11:51,394 --> 00:11:53,824 and as you go from being normal 271 00:11:53,824 --> 00:11:56,017 to having mild cognitive impairment, 272 00:11:56,017 --> 00:11:58,472 which is a precursor for Alzheimer's, all the way to Alzheimer's disease, 273 00:11:58,472 --> 00:12:01,161 then there are areas of the brain that stop using glucose. 274 00:12:01,161 --> 00:12:03,456 They shut down. They turn off. 275 00:12:03,456 --> 00:12:05,738 And indeed, what we see is that these areas in red 276 00:12:05,738 --> 00:12:07,505 around the outside ribbon of the brain 277 00:12:07,505 --> 00:12:09,781 are progressively getting more and more blue 278 00:12:09,781 --> 00:12:12,953 until they shut down completely. 279 00:12:12,953 --> 00:12:15,312 This is analogous to having a power failure 280 00:12:15,312 --> 00:12:17,855 in an area of the brain, a regional power failure. 281 00:12:17,855 --> 00:12:20,252 So the lights are out in parts of the brain 282 00:12:20,252 --> 00:12:22,850 in patients with Alzheimer's disease, 283 00:12:22,850 --> 00:12:25,259 and the question is, are the lights out forever, 284 00:12:25,259 --> 00:12:28,120 or can we turn the lights back on? 285 00:12:28,120 --> 00:12:31,356 Can we get those areas of the brain to use glucose once again? 286 00:12:31,356 --> 00:12:33,906 So this is what we did. We implanted electrodes in the fornix 287 00:12:33,906 --> 00:12:36,519 of patients with Alzheimer's disease, we turned it on, 288 00:12:36,519 --> 00:12:40,030 and we looked at what happens to glucose use in the brain. 289 00:12:40,030 --> 00:12:43,292 And indeed, at the top, you'll see before the surgery, 290 00:12:43,292 --> 00:12:46,656 the areas in blue are the areas that use less glucose than normal, 291 00:12:46,656 --> 00:12:48,864 predominantly the parietal and temporal lobes. 292 00:12:48,864 --> 00:12:50,574 These areas of the brain are shut down. 293 00:12:50,574 --> 00:12:53,249 The lights are out in these areas of the brain. 294 00:12:53,249 --> 00:12:56,203 We then put in the DBS electrodes and we wait for a month 295 00:12:56,203 --> 00:12:57,594 or a year, and the areas in red 296 00:12:57,594 --> 00:13:00,901 represent the areas where we increase glucose utilization. 297 00:13:00,901 --> 00:13:03,021 And indeed, we are able to get these areas of the brain 298 00:13:03,021 --> 00:13:06,535 that were not using glucose to use glucose once again. 299 00:13:06,535 --> 00:13:08,887 So the message here is that, in Alzheimer's disease, 300 00:13:08,887 --> 00:13:11,216 the lights are out, but there is someone home, 301 00:13:11,216 --> 00:13:13,365 and we're able to turn the power back on 302 00:13:13,365 --> 00:13:15,671 to these areas of the brain, and as we do so, 303 00:13:15,671 --> 00:13:18,607 we expect that their functions will return. 304 00:13:18,607 --> 00:13:20,734 So this is now in clinical trials. 305 00:13:20,734 --> 00:13:22,635 We are going to operate on 50 patients 306 00:13:22,635 --> 00:13:24,613 with early Alzheimer's disease 307 00:13:24,613 --> 00:13:26,670 to see whether this is safe and effective, 308 00:13:26,670 --> 00:13:29,649 whether we can improve their neurologic function. 309 00:13:29,649 --> 00:13:37,129 (Applause) 310 00:13:37,129 --> 00:13:40,077 So the message I want to leave you with today is that, 311 00:13:40,077 --> 00:13:42,681 indeed, there are several circuits in the brain 312 00:13:42,681 --> 00:13:46,607 that are malfunctioning across various disease states, 313 00:13:46,607 --> 00:13:48,815 whether we're talking about Parkinson's disease, 314 00:13:48,815 --> 00:13:51,897 depression, schizophrenia, Alzheimer's. 315 00:13:51,897 --> 00:13:54,927 We are now learning to understand what are the circuits, 316 00:13:54,927 --> 00:13:57,129 what are the areas of the brain that are responsible for 317 00:13:57,129 --> 00:13:59,649 the clinical signs and the symptoms of those diseases. 318 00:13:59,649 --> 00:14:01,955 We can now reach those circuits. 319 00:14:01,955 --> 00:14:04,587 We can introduce electrodes within those circuits. 320 00:14:04,587 --> 00:14:07,569 We can graduate the activity of those circuits. 321 00:14:07,569 --> 00:14:10,821 We can turn them down if they are overactive, 322 00:14:10,821 --> 00:14:13,778 if they're causing trouble, trouble that is felt throughout the brain, 323 00:14:13,778 --> 00:14:16,359 or we can turn them up if they are underperforming, 324 00:14:16,359 --> 00:14:18,752 and in so doing, we think that we may be able to help 325 00:14:18,752 --> 00:14:21,092 the overall function of the brain. 326 00:14:21,092 --> 00:14:23,646 The implications of this, of course, is that we may be able 327 00:14:23,646 --> 00:14:25,956 to modify the symptoms of the disease, 328 00:14:25,956 --> 00:14:27,865 but I haven't told you but there's also some evidence 329 00:14:27,865 --> 00:14:32,028 that we might be able to help the repair of damaged areas of the brain using electricity, 330 00:14:32,028 --> 00:14:34,480 and this is something for the future, to see if, indeed, 331 00:14:34,480 --> 00:14:36,719 we not only change the activity but also 332 00:14:36,719 --> 00:14:38,733 some of the reparative functions of the brain 333 00:14:38,733 --> 00:14:40,288 can be harvested. 334 00:14:40,288 --> 00:14:43,335 So I envision that we're going to see a great expansion 335 00:14:43,335 --> 00:14:45,787 of indications of this technique. 336 00:14:45,787 --> 00:14:48,566 We're going to see electrodes being placed for many disorders of the brain. 337 00:14:48,566 --> 00:14:51,525 One of the most exciting things about this is that, indeed, 338 00:14:51,525 --> 00:14:53,372 it involves multidisciplinary work. 339 00:14:53,372 --> 00:14:56,174 It involves the work of engineers, of imaging scientists, 340 00:14:56,174 --> 00:14:58,376 of basic scientists, of neurologists, 341 00:14:58,376 --> 00:15:01,128 psychiatrists, neurosurgeons, and certainly at the interface 342 00:15:01,128 --> 00:15:04,069 of these multiple disciplines that there's the excitement. 343 00:15:04,069 --> 00:15:06,826 And I think that we will see that 344 00:15:06,826 --> 00:15:10,262 we will be able to chase more of these evil spirits 345 00:15:10,262 --> 00:15:12,158 out from the brain as time goes on, 346 00:15:12,158 --> 00:15:14,060 and the consequence of that, of course, will be 347 00:15:14,060 --> 00:15:16,332 that we will be able to help many more patients. 348 00:15:16,332 --> 00:15:17,582 Thank you very much.