[Script Info]
Title: 
[Events]
Format: Layer, Start, End, Style, Name, MarginL, MarginR, MarginV, Effect, Text
Dialogue: 0,0:00:00.40,0:00:02.72,Default,,0000,0000,0000,,One of the things I want to establish right from the start
Dialogue: 0,0:00:02.72,0:00:05.75,Default,,0000,0000,0000,,is that not all neurosurgeons wear cowboy boots.
Dialogue: 0,0:00:05.75,0:00:07.93,Default,,0000,0000,0000,,I just wanted you to know that.
Dialogue: 0,0:00:07.93,0:00:10.34,Default,,0000,0000,0000,,So I am indeed a neurosurgeon,
Dialogue: 0,0:00:10.34,0:00:14.26,Default,,0000,0000,0000,,and I follow a long tradition of neurosurgery,
Dialogue: 0,0:00:14.26,0:00:15.86,Default,,0000,0000,0000,,and what I'm going to tell you about today
Dialogue: 0,0:00:15.86,0:00:18.17,Default,,0000,0000,0000,,is adjusting the dials in the circuits in the brain,
Dialogue: 0,0:00:18.17,0:00:20.13,Default,,0000,0000,0000,,being able to go anywhere in the brain
Dialogue: 0,0:00:20.13,0:00:22.55,Default,,0000,0000,0000,,and turning areas of the brain up or down
Dialogue: 0,0:00:22.55,0:00:24.76,Default,,0000,0000,0000,,to help our patients.
Dialogue: 0,0:00:24.76,0:00:27.71,Default,,0000,0000,0000,,So as I said, neurosurgery comes from a long tradition.
Dialogue: 0,0:00:27.71,0:00:31.26,Default,,0000,0000,0000,,It's been around for about 7,000 years.
Dialogue: 0,0:00:31.26,0:00:34.99,Default,,0000,0000,0000,,In Mesoamerica, there used to be neurosurgery,
Dialogue: 0,0:00:34.99,0:00:38.75,Default,,0000,0000,0000,,and there were these neurosurgeons that used to treat patients.
Dialogue: 0,0:00:38.75,0:00:42.66,Default,,0000,0000,0000,,And they were trying to -- they knew that the brain was involved
Dialogue: 0,0:00:42.68,0:00:45.03,Default,,0000,0000,0000,,in neurological and psychiatric disease.
Dialogue: 0,0:00:45.03,0:00:47.19,Default,,0000,0000,0000,,They didn't know exactly what they were doing.
Dialogue: 0,0:00:47.19,0:00:50.01,Default,,0000,0000,0000,,Not much has changed, by the way. (Laughter)
Dialogue: 0,0:00:50.01,0:00:51.88,Default,,0000,0000,0000,,But they thought that,
Dialogue: 0,0:00:51.88,0:00:53.88,Default,,0000,0000,0000,,if you had a neurologic or psychiatric disease,
Dialogue: 0,0:00:53.88,0:00:56.47,Default,,0000,0000,0000,,it must be because you are possessed
Dialogue: 0,0:00:56.47,0:00:58.83,Default,,0000,0000,0000,,by an evil spirit.
Dialogue: 0,0:00:58.83,0:01:00.80,Default,,0000,0000,0000,,So if you are possessed by an evil spirit
Dialogue: 0,0:01:00.80,0:01:03.62,Default,,0000,0000,0000,,causing neurologic or psychiatric problems,
Dialogue: 0,0:01:03.62,0:01:05.64,Default,,0000,0000,0000,,then the way to treat this is, of course,
Dialogue: 0,0:01:05.64,0:01:11.32,Default,,0000,0000,0000,,to make a hole in your skull and let the evil spirit escape.
Dialogue: 0,0:01:11.32,0:01:12.70,Default,,0000,0000,0000,,So this was the thinking back then,
Dialogue: 0,0:01:12.70,0:01:16.84,Default,,0000,0000,0000,,and these individuals made these holes.
Dialogue: 0,0:01:16.84,0:01:19.82,Default,,0000,0000,0000,,Sometimes the patients were a little bit reluctant
Dialogue: 0,0:01:19.82,0:01:22.24,Default,,0000,0000,0000,,to go through this because, you can tell that
Dialogue: 0,0:01:22.24,0:01:24.69,Default,,0000,0000,0000,,the holes are made partially and then, I think,
Dialogue: 0,0:01:24.69,0:01:26.70,Default,,0000,0000,0000,,there was some trepanation, and then they left very quickly
Dialogue: 0,0:01:26.70,0:01:28.61,Default,,0000,0000,0000,,and it was only a partial hole,
Dialogue: 0,0:01:28.61,0:01:30.92,Default,,0000,0000,0000,,and we know they survived these procedures.
Dialogue: 0,0:01:30.92,0:01:32.13,Default,,0000,0000,0000,,But this was common.
Dialogue: 0,0:01:32.13,0:01:33.40,Default,,0000,0000,0000,,There were some sites where one percent
Dialogue: 0,0:01:33.40,0:01:36.12,Default,,0000,0000,0000,,of all the skulls have these holes, and so you can see
Dialogue: 0,0:01:36.12,0:01:39.32,Default,,0000,0000,0000,,that neurologic and psychiatric disease is quite common,
Dialogue: 0,0:01:39.32,0:01:43.75,Default,,0000,0000,0000,,and it was also quite common about 7,000 years ago.
Dialogue: 0,0:01:43.75,0:01:45.90,Default,,0000,0000,0000,,Now, in the course of time,
Dialogue: 0,0:01:45.90,0:01:48.12,Default,,0000,0000,0000,,we've come to realize that
Dialogue: 0,0:01:48.12,0:01:50.38,Default,,0000,0000,0000,,different parts of the brain do different things.
Dialogue: 0,0:01:50.38,0:01:51.57,Default,,0000,0000,0000,,So there are areas of the brain that are dedicated
Dialogue: 0,0:01:51.57,0:01:54.26,Default,,0000,0000,0000,,to controlling your movement or your vision
Dialogue: 0,0:01:54.26,0:01:57.21,Default,,0000,0000,0000,,or your memory or your appetite, and so on.
Dialogue: 0,0:01:57.21,0:01:59.94,Default,,0000,0000,0000,,And when things work well, then the nervous system
Dialogue: 0,0:01:59.94,0:02:01.61,Default,,0000,0000,0000,,works well, and everything functions.
Dialogue: 0,0:02:01.61,0:02:03.86,Default,,0000,0000,0000,,But once in a while, things don't go so well,
Dialogue: 0,0:02:03.86,0:02:06.40,Default,,0000,0000,0000,,and there's trouble in these circuits,
Dialogue: 0,0:02:06.40,0:02:09.10,Default,,0000,0000,0000,,and there are some rogue neurons that are misfiring
Dialogue: 0,0:02:09.10,0:02:12.28,Default,,0000,0000,0000,,and causing trouble, or sometimes they're underactive
Dialogue: 0,0:02:12.28,0:02:14.83,Default,,0000,0000,0000,,and they're not quite working as they should.
Dialogue: 0,0:02:14.83,0:02:16.96,Default,,0000,0000,0000,,Now, the manifestation of this
Dialogue: 0,0:02:16.96,0:02:19.45,Default,,0000,0000,0000,,depends on where in the brain these neurons are.
Dialogue: 0,0:02:19.45,0:02:21.87,Default,,0000,0000,0000,,So when these neurons are in the motor circuit,
Dialogue: 0,0:02:21.87,0:02:24.28,Default,,0000,0000,0000,,you get dysfunction in the movement system,
Dialogue: 0,0:02:24.28,0:02:26.45,Default,,0000,0000,0000,,and you get things like Parkinson's disease.
Dialogue: 0,0:02:26.45,0:02:29.74,Default,,0000,0000,0000,,When the malfunction is in a circuit that regulates your mood,
Dialogue: 0,0:02:29.74,0:02:32.03,Default,,0000,0000,0000,,you get things like depression,
Dialogue: 0,0:02:32.03,0:02:35.85,Default,,0000,0000,0000,,and when it is in a circuit that controls your memory and cognitive function,
Dialogue: 0,0:02:35.85,0:02:38.37,Default,,0000,0000,0000,,then you get things like Alzheimer's disease.
Dialogue: 0,0:02:38.37,0:02:41.10,Default,,0000,0000,0000,,So what we've been able to do is to pinpoint
Dialogue: 0,0:02:41.10,0:02:43.40,Default,,0000,0000,0000,,where these disturbances are in the brain,
Dialogue: 0,0:02:43.40,0:02:46.44,Default,,0000,0000,0000,,and we've been able to intervene within these circuits
Dialogue: 0,0:02:46.44,0:02:50.10,Default,,0000,0000,0000,,in the brain to either turn them up or turn them down.
Dialogue: 0,0:02:50.10,0:02:52.38,Default,,0000,0000,0000,,So this is very much like choosing the correct station
Dialogue: 0,0:02:52.38,0:02:54.36,Default,,0000,0000,0000,,on the radio dial.
Dialogue: 0,0:02:54.36,0:02:57.00,Default,,0000,0000,0000,,Once you choose the right station, whether it be jazz or opera,
Dialogue: 0,0:02:57.00,0:02:59.34,Default,,0000,0000,0000,,in our case whether it be movement or mood,
Dialogue: 0,0:02:59.34,0:03:01.30,Default,,0000,0000,0000,,we can put the dial there,
Dialogue: 0,0:03:01.30,0:03:04.07,Default,,0000,0000,0000,,and then we can use a second button to adjust the volume,
Dialogue: 0,0:03:04.07,0:03:06.08,Default,,0000,0000,0000,,to turn it up or turn it down.
Dialogue: 0,0:03:06.08,0:03:07.31,Default,,0000,0000,0000,,So what I'm going to tell you about
Dialogue: 0,0:03:07.31,0:03:11.37,Default,,0000,0000,0000,,is using the circuitry of the brain to implant electrodes
Dialogue: 0,0:03:11.37,0:03:13.84,Default,,0000,0000,0000,,and turning areas of the brain up and down
Dialogue: 0,0:03:13.84,0:03:15.54,Default,,0000,0000,0000,,to see if we can help our patients.
Dialogue: 0,0:03:15.54,0:03:17.87,Default,,0000,0000,0000,,And this is accomplished using this kind of device,
Dialogue: 0,0:03:17.87,0:03:20.34,Default,,0000,0000,0000,,and this is called deep brain stimulation.
Dialogue: 0,0:03:20.34,0:03:23.41,Default,,0000,0000,0000,,So what we're doing is placing these electrodes throughout the brain.
Dialogue: 0,0:03:23.41,0:03:27.36,Default,,0000,0000,0000,,Again, we are making holes in the skull about the size of a dime,
Dialogue: 0,0:03:27.36,0:03:29.51,Default,,0000,0000,0000,,putting an electrode in, and then this electrode
Dialogue: 0,0:03:29.51,0:03:31.73,Default,,0000,0000,0000,,is completely underneath the skin
Dialogue: 0,0:03:31.73,0:03:33.82,Default,,0000,0000,0000,,down to a pacemaker in the chest,
Dialogue: 0,0:03:33.82,0:03:38.35,Default,,0000,0000,0000,,and with a remote control very much like a television remote control,
Dialogue: 0,0:03:38.35,0:03:41.33,Default,,0000,0000,0000,,we can adjust how much electricity we deliver
Dialogue: 0,0:03:41.33,0:03:43.40,Default,,0000,0000,0000,,to these areas of the brain.
Dialogue: 0,0:03:43.40,0:03:46.29,Default,,0000,0000,0000,,We can turn it up or down, on or off.
Dialogue: 0,0:03:46.29,0:03:48.94,Default,,0000,0000,0000,,Now, about a hundred thousand patients in the world
Dialogue: 0,0:03:48.94,0:03:50.82,Default,,0000,0000,0000,,have received deep brain stimulation,
Dialogue: 0,0:03:50.82,0:03:51.98,Default,,0000,0000,0000,,and I'm going to show you some examples
Dialogue: 0,0:03:51.98,0:03:54.69,Default,,0000,0000,0000,,of using deep brain stimulation to treat disorders of movement,
Dialogue: 0,0:03:54.69,0:03:59.20,Default,,0000,0000,0000,,disorders of mood and disorders of cognition.
Dialogue: 0,0:03:59.20,0:04:01.94,Default,,0000,0000,0000,,So this looks something like this when it's in the brain.
Dialogue: 0,0:04:01.94,0:04:04.17,Default,,0000,0000,0000,,You see the electrode going through the skull into the brain
Dialogue: 0,0:04:04.17,0:04:07.36,Default,,0000,0000,0000,,and resting there, and we can place this really anywhere in the brain.
Dialogue: 0,0:04:07.36,0:04:09.82,Default,,0000,0000,0000,,I tell my friends that no neuron is safe
Dialogue: 0,0:04:09.82,0:04:11.100,Default,,0000,0000,0000,,from a neurosurgeon, because we can really reach
Dialogue: 0,0:04:11.100,0:04:14.56,Default,,0000,0000,0000,,just about anywhere in the brain quite safely now.
Dialogue: 0,0:04:14.56,0:04:17.08,Default,,0000,0000,0000,,Now the first example I'm going to show you is a patient
Dialogue: 0,0:04:17.08,0:04:18.80,Default,,0000,0000,0000,,with Parkinson's disease,
Dialogue: 0,0:04:18.80,0:04:20.78,Default,,0000,0000,0000,,and this lady has Parkinson's disease,
Dialogue: 0,0:04:20.78,0:04:23.09,Default,,0000,0000,0000,,and she has these electrodes in her brain,
Dialogue: 0,0:04:23.09,0:04:24.37,Default,,0000,0000,0000,,and I'm going to show you what she's like
Dialogue: 0,0:04:24.37,0:04:27.88,Default,,0000,0000,0000,,when the electrodes are turned off and she has her Parkinson's symptoms,
Dialogue: 0,0:04:27.88,0:04:30.21,Default,,0000,0000,0000,,and then we're going to turn it on.
Dialogue: 0,0:04:30.21,0:04:32.91,Default,,0000,0000,0000,,So this looks something like this.
Dialogue: 0,0:04:32.91,0:04:37.41,Default,,0000,0000,0000,,The electrodes are turned off now, and you can see that she has tremor.
Dialogue: 0,0:04:37.42,0:04:41.14,Default,,0000,0000,0000,,(Video) Man: Okay. Woman: I can't. Man: Can you try to touch my finger?
Dialogue: 0,0:04:41.14,0:04:44.76,Default,,0000,0000,0000,,(Video) Man: That's a little better. Woman: That side is better.
Dialogue: 0,0:04:44.76,0:04:48.56,Default,,0000,0000,0000,,We're now going to turn it on.
Dialogue: 0,0:04:48.56,0:04:52.99,Default,,0000,0000,0000,,It's on. Just turned it on.
Dialogue: 0,0:04:54.56,0:04:57.82,Default,,0000,0000,0000,,And this works like that, instantly.
Dialogue: 0,0:04:57.82,0:05:00.81,Default,,0000,0000,0000,,And the difference between shaking in this way and not --
Dialogue: 0,0:05:00.81,0:05:05.41,Default,,0000,0000,0000,,(Applause)
Dialogue: 0,0:05:05.41,0:05:09.51,Default,,0000,0000,0000,,The difference between shaking in this way and not is related to the misbehavior
Dialogue: 0,0:05:09.51,0:05:13.48,Default,,0000,0000,0000,,of 25,000 neurons in her subthalamic nucleus.
Dialogue: 0,0:05:13.48,0:05:16.06,Default,,0000,0000,0000,,So we now know how to find these troublemakers
Dialogue: 0,0:05:16.06,0:05:17.45,Default,,0000,0000,0000,,and tell them, "Gentlemen, that's enough.
Dialogue: 0,0:05:17.45,0:05:18.79,Default,,0000,0000,0000,,We want you to stop doing that."
Dialogue: 0,0:05:18.79,0:05:20.01,Default,,0000,0000,0000,,And we do that with electricity.
Dialogue: 0,0:05:20.01,0:05:23.42,Default,,0000,0000,0000,,So we use electricity to dictate how they fire,
Dialogue: 0,0:05:23.42,0:05:26.88,Default,,0000,0000,0000,,and we try to block their misbehavior using electricity.
Dialogue: 0,0:05:26.88,0:05:30.33,Default,,0000,0000,0000,,So in this case, we are suppressing the activity of abnormal neurons.
Dialogue: 0,0:05:30.33,0:05:32.89,Default,,0000,0000,0000,,We started using this technique in other problems,
Dialogue: 0,0:05:32.89,0:05:34.29,Default,,0000,0000,0000,,and I'm going to tell you about a fascinating problem
Dialogue: 0,0:05:34.29,0:05:37.46,Default,,0000,0000,0000,,that we encountered, a case of dystonia.
Dialogue: 0,0:05:37.46,0:05:39.96,Default,,0000,0000,0000,,So dystonia is a disorder affecting children.
Dialogue: 0,0:05:39.96,0:05:43.03,Default,,0000,0000,0000,,It's a genetic disorder, and it involves a twisting motion,
Dialogue: 0,0:05:43.03,0:05:45.85,Default,,0000,0000,0000,,and these children get progressively more and more twisting
Dialogue: 0,0:05:45.85,0:05:47.84,Default,,0000,0000,0000,,until they can't breathe, until they get sores,
Dialogue: 0,0:05:47.84,0:05:49.87,Default,,0000,0000,0000,,urinary infections, and then they die.
Dialogue: 0,0:05:49.87,0:05:53.25,Default,,0000,0000,0000,,So back in 1997, I was asked to see this young boy,
Dialogue: 0,0:05:53.25,0:05:56.20,Default,,0000,0000,0000,,perfectly normal. He has this genetic form of dystonia.
Dialogue: 0,0:05:56.20,0:05:58.42,Default,,0000,0000,0000,,There are eight children in the family.
Dialogue: 0,0:05:58.42,0:06:01.78,Default,,0000,0000,0000,,Five of them have dystonia.
Dialogue: 0,0:06:01.78,0:06:03.96,Default,,0000,0000,0000,,So here he is.
Dialogue: 0,0:06:03.96,0:06:08.15,Default,,0000,0000,0000,,This boy is nine years old, perfectly normal until the age six,
Dialogue: 0,0:06:08.15,0:06:12.55,Default,,0000,0000,0000,,and then he started twisting his body, first the right foot,
Dialogue: 0,0:06:12.55,0:06:15.97,Default,,0000,0000,0000,,then the left foot, then the right arm, then the left arm,
Dialogue: 0,0:06:15.97,0:06:19.21,Default,,0000,0000,0000,,then the trunk, and then by the time he arrived,
Dialogue: 0,0:06:19.21,0:06:22.15,Default,,0000,0000,0000,,within the course of one or two years of the disease onset,
Dialogue: 0,0:06:22.15,0:06:24.47,Default,,0000,0000,0000,,he could no longer walk, he could no longer stand.
Dialogue: 0,0:06:24.47,0:06:27.17,Default,,0000,0000,0000,,He was crippled, and indeed the natural progression
Dialogue: 0,0:06:27.17,0:06:30.73,Default,,0000,0000,0000,,as this gets worse is for them to become progressively twisted,
Dialogue: 0,0:06:30.73,0:06:36.42,Default,,0000,0000,0000,,progressively disabled, and many of these children do not survive.
Dialogue: 0,0:06:36.42,0:06:38.44,Default,,0000,0000,0000,,So he is one of five kids.
Dialogue: 0,0:06:38.44,0:06:42.54,Default,,0000,0000,0000,,The only way he could get around was crawling on his belly like this.
Dialogue: 0,0:06:42.54,0:06:44.49,Default,,0000,0000,0000,,He did not respond to any drugs.
Dialogue: 0,0:06:44.49,0:06:46.43,Default,,0000,0000,0000,,We did not know what to do with this boy.
Dialogue: 0,0:06:46.43,0:06:48.55,Default,,0000,0000,0000,,We did not know what operation to do,
Dialogue: 0,0:06:48.55,0:06:50.74,Default,,0000,0000,0000,,where to go in the brain,
Dialogue: 0,0:06:50.74,0:06:53.52,Default,,0000,0000,0000,,but on the basis of our results in Parkinson's disease,
Dialogue: 0,0:06:53.52,0:06:55.52,Default,,0000,0000,0000,,we reasoned, why don't we try to suppress
Dialogue: 0,0:06:55.52,0:06:58.62,Default,,0000,0000,0000,,the same area in the brain that we suppressed
Dialogue: 0,0:06:58.62,0:07:02.27,Default,,0000,0000,0000,,in Parkinson's disease, and let's see what happens?
Dialogue: 0,0:07:02.27,0:07:04.06,Default,,0000,0000,0000,,So here he was. We operated on him
Dialogue: 0,0:07:04.06,0:07:07.94,Default,,0000,0000,0000,,hoping that he would get better. We did not know.
Dialogue: 0,0:07:07.94,0:07:12.06,Default,,0000,0000,0000,,So here he is now, back in Israel where he lives,
Dialogue: 0,0:07:12.06,0:07:16.12,Default,,0000,0000,0000,,three months after the procedure, and here he is.
Dialogue: 0,0:07:16.12,0:07:21.06,Default,,0000,0000,0000,,(Applause)
Dialogue: 0,0:07:24.67,0:07:27.29,Default,,0000,0000,0000,,On the basis of this result, this is now a procedure
Dialogue: 0,0:07:27.29,0:07:28.54,Default,,0000,0000,0000,,that's done throughout the world,
Dialogue: 0,0:07:28.54,0:07:29.83,Default,,0000,0000,0000,,and there have been hundreds of children
Dialogue: 0,0:07:29.83,0:07:34.04,Default,,0000,0000,0000,,that have been helped with this kind of surgery.
Dialogue: 0,0:07:34.04,0:07:36.16,Default,,0000,0000,0000,,This boy is now in university
Dialogue: 0,0:07:36.16,0:07:38.19,Default,,0000,0000,0000,,and leads quite a normal life.
Dialogue: 0,0:07:38.19,0:07:40.56,Default,,0000,0000,0000,,This has been one of the most satisfying cases
Dialogue: 0,0:07:40.56,0:07:42.54,Default,,0000,0000,0000,,that I have ever done in my entire career,
Dialogue: 0,0:07:42.54,0:07:45.92,Default,,0000,0000,0000,,to restore movement and walking to this kind of child.
Dialogue: 0,0:07:45.92,0:07:52.17,Default,,0000,0000,0000,,(Applause)
Dialogue: 0,0:07:52.17,0:07:55.04,Default,,0000,0000,0000,,We realized that perhaps we could use this technology
Dialogue: 0,0:07:55.04,0:07:57.21,Default,,0000,0000,0000,,not only in circuits that control your movement
Dialogue: 0,0:07:57.21,0:07:59.16,Default,,0000,0000,0000,,but also circuits that control other things,
Dialogue: 0,0:07:59.16,0:08:00.31,Default,,0000,0000,0000,,and the next thing that we took on
Dialogue: 0,0:08:00.31,0:08:03.30,Default,,0000,0000,0000,,was circuits that control your mood.
Dialogue: 0,0:08:03.30,0:08:05.38,Default,,0000,0000,0000,,And we decided to take on depression,
Dialogue: 0,0:08:05.38,0:08:07.64,Default,,0000,0000,0000,,and the reason we took on depression is because it's so prevalent,
Dialogue: 0,0:08:07.64,0:08:10.18,Default,,0000,0000,0000,,and as you know, there are many treatments for depression,
Dialogue: 0,0:08:10.18,0:08:12.22,Default,,0000,0000,0000,,with medication and psychotherapy,
Dialogue: 0,0:08:12.22,0:08:14.28,Default,,0000,0000,0000,,even electroconvulsive therapy,
Dialogue: 0,0:08:14.28,0:08:15.62,Default,,0000,0000,0000,,but there are millions of people,
Dialogue: 0,0:08:15.62,0:08:18.41,Default,,0000,0000,0000,,and there are still 10 or 20 percent of patients with depression
Dialogue: 0,0:08:18.41,0:08:21.66,Default,,0000,0000,0000,,that do not respond, and it is these patients that we want to help.
Dialogue: 0,0:08:21.66,0:08:23.76,Default,,0000,0000,0000,,And let's see if we can use this technique
Dialogue: 0,0:08:23.76,0:08:26.00,Default,,0000,0000,0000,,to help these patients with depression.
Dialogue: 0,0:08:26.00,0:08:27.85,Default,,0000,0000,0000,,So the first thing we did was, we compared,
Dialogue: 0,0:08:27.85,0:08:29.68,Default,,0000,0000,0000,,what's different in the brain of someone with depression
Dialogue: 0,0:08:29.68,0:08:31.34,Default,,0000,0000,0000,,and someone who is normal,
Dialogue: 0,0:08:31.34,0:08:34.80,Default,,0000,0000,0000,,and what we did was PET scans to look at the blood flow of the brain,
Dialogue: 0,0:08:34.80,0:08:37.17,Default,,0000,0000,0000,,and what we noticed is that in patients with depression
Dialogue: 0,0:08:37.17,0:08:39.22,Default,,0000,0000,0000,,compared to normals,
Dialogue: 0,0:08:39.22,0:08:40.72,Default,,0000,0000,0000,,areas of the brain are shut down,
Dialogue: 0,0:08:40.72,0:08:41.98,Default,,0000,0000,0000,,and those are the areas in blue.
Dialogue: 0,0:08:41.98,0:08:43.60,Default,,0000,0000,0000,,So here you really have the blues,
Dialogue: 0,0:08:43.60,0:08:47.18,Default,,0000,0000,0000,,and the areas in blue are areas that are involved
Dialogue: 0,0:08:47.18,0:08:49.83,Default,,0000,0000,0000,,in motivation, in drive and decision-making,
Dialogue: 0,0:08:49.83,0:08:52.33,Default,,0000,0000,0000,,and indeed, if you're severely depressed as these patients were,
Dialogue: 0,0:08:52.33,0:08:55.02,Default,,0000,0000,0000,,those are impaired. You lack motivation and drive.
Dialogue: 0,0:08:55.02,0:08:56.90,Default,,0000,0000,0000,,The other thing we discovered
Dialogue: 0,0:08:56.90,0:08:59.39,Default,,0000,0000,0000,,was an area that was overactive, area 25,
Dialogue: 0,0:08:59.39,0:09:00.97,Default,,0000,0000,0000,,seen there in red,
Dialogue: 0,0:09:00.97,0:09:03.63,Default,,0000,0000,0000,,and area 25 is the sadness center of the brain.
Dialogue: 0,0:09:03.63,0:09:06.50,Default,,0000,0000,0000,,If I make any of you sad, for example, I make you remember
Dialogue: 0,0:09:06.50,0:09:08.79,Default,,0000,0000,0000,,the last time you saw your parent before they died
Dialogue: 0,0:09:08.79,0:09:10.42,Default,,0000,0000,0000,,or a friend before they died,
Dialogue: 0,0:09:10.42,0:09:11.63,Default,,0000,0000,0000,,this area of the brain lights up.
Dialogue: 0,0:09:11.63,0:09:13.35,Default,,0000,0000,0000,,It is the sadness center of the brain.
Dialogue: 0,0:09:13.35,0:09:16.56,Default,,0000,0000,0000,,And so patients with depression have hyperactivity.
Dialogue: 0,0:09:16.56,0:09:18.74,Default,,0000,0000,0000,,The area of the brain for sadness is on red hot.
Dialogue: 0,0:09:18.74,0:09:21.40,Default,,0000,0000,0000,,The thermostat is set at 100 degrees,
Dialogue: 0,0:09:21.40,0:09:24.53,Default,,0000,0000,0000,,and the other areas of the brain, involved in drive and motivation, are shut down.
Dialogue: 0,0:09:24.53,0:09:27.52,Default,,0000,0000,0000,,So we wondered, can we place electrodes in this area of sadness
Dialogue: 0,0:09:27.52,0:09:29.95,Default,,0000,0000,0000,,and see if we can turn down the thermostat,
Dialogue: 0,0:09:29.95,0:09:31.67,Default,,0000,0000,0000,,can we turn down the activity,
Dialogue: 0,0:09:31.67,0:09:33.79,Default,,0000,0000,0000,,and what will be the consequence of that?
Dialogue: 0,0:09:33.79,0:09:36.92,Default,,0000,0000,0000,,So we went ahead and implanted electrodes in patients with depression.
Dialogue: 0,0:09:36.92,0:09:39.40,Default,,0000,0000,0000,,This is work done with my colleague Helen Mayberg from Emory.
Dialogue: 0,0:09:39.40,0:09:41.34,Default,,0000,0000,0000,,And we placed electrodes in area 25,
Dialogue: 0,0:09:41.34,0:09:43.62,Default,,0000,0000,0000,,and in the top scan you see before the operation,
Dialogue: 0,0:09:43.62,0:09:45.91,Default,,0000,0000,0000,,area 25, the sadness area is red hot,
Dialogue: 0,0:09:45.91,0:09:48.30,Default,,0000,0000,0000,,and the frontal lobes are shut down in blue,
Dialogue: 0,0:09:48.30,0:09:50.71,Default,,0000,0000,0000,,and then, after three months of continuous stimulation,
Dialogue: 0,0:09:50.71,0:09:53.72,Default,,0000,0000,0000,,24 hours a day, or six months of continuous stimulation,
Dialogue: 0,0:09:53.72,0:09:55.50,Default,,0000,0000,0000,,we have a complete reversal of this.
Dialogue: 0,0:09:55.50,0:09:58.34,Default,,0000,0000,0000,,We're able to drive down area 25,
Dialogue: 0,0:09:58.34,0:10:00.29,Default,,0000,0000,0000,,down to a more normal level,
Dialogue: 0,0:10:00.29,0:10:02.33,Default,,0000,0000,0000,,and we're able to turn back online
Dialogue: 0,0:10:02.33,0:10:03.63,Default,,0000,0000,0000,,the frontal lobes of the brain,
Dialogue: 0,0:10:03.63,0:10:05.50,Default,,0000,0000,0000,,and indeed we're seeing very striking results
Dialogue: 0,0:10:05.50,0:10:08.25,Default,,0000,0000,0000,,in these patients with severe depression.
Dialogue: 0,0:10:08.25,0:10:11.15,Default,,0000,0000,0000,,So now we are in clinical trials, and are in Phase III clinical trials,
Dialogue: 0,0:10:11.15,0:10:13.70,Default,,0000,0000,0000,,and this may become a new procedure,
Dialogue: 0,0:10:13.70,0:10:15.88,Default,,0000,0000,0000,,if it's safe and we find that it's effective,
Dialogue: 0,0:10:15.88,0:10:19.55,Default,,0000,0000,0000,,to treat patients with severe depression.
Dialogue: 0,0:10:19.57,0:10:22.53,Default,,0000,0000,0000,,I've shown you that we can use deep brain stimulation
Dialogue: 0,0:10:22.53,0:10:24.61,Default,,0000,0000,0000,,to treat the motor system
Dialogue: 0,0:10:24.61,0:10:27.06,Default,,0000,0000,0000,,in cases of Parkinson's disease and dystonia.
Dialogue: 0,0:10:27.06,0:10:29.44,Default,,0000,0000,0000,,I've shown you that we can use it to treat a mood circuit
Dialogue: 0,0:10:29.44,0:10:31.10,Default,,0000,0000,0000,,in cases of depression.
Dialogue: 0,0:10:31.10,0:10:35.64,Default,,0000,0000,0000,,Can we use deep brain stimulation to make you smarter?
Dialogue: 0,0:10:35.64,0:10:37.74,Default,,0000,0000,0000,,(Laughter)
Dialogue: 0,0:10:37.74,0:10:40.30,Default,,0000,0000,0000,,Anybody interested in that?
Dialogue: 0,0:10:40.30,0:10:42.60,Default,,0000,0000,0000,,(Applause)
Dialogue: 0,0:10:42.60,0:10:45.59,Default,,0000,0000,0000,,Of course we can, right?
Dialogue: 0,0:10:45.59,0:10:47.80,Default,,0000,0000,0000,,So what we've decided to do is
Dialogue: 0,0:10:47.80,0:10:50.22,Default,,0000,0000,0000,,we're going to try to turbocharge
Dialogue: 0,0:10:50.22,0:10:52.43,Default,,0000,0000,0000,,the memory circuits in the brain.
Dialogue: 0,0:10:52.43,0:10:55.17,Default,,0000,0000,0000,,We're going to place electrodes within the circuits
Dialogue: 0,0:10:55.17,0:10:57.84,Default,,0000,0000,0000,,that regulate your memory and cognitive function
Dialogue: 0,0:10:57.84,0:11:01.11,Default,,0000,0000,0000,,to see if we can turn up their activity.
Dialogue: 0,0:11:01.11,0:11:03.05,Default,,0000,0000,0000,,Now we're not going to do this in normal people.
Dialogue: 0,0:11:03.05,0:11:06.70,Default,,0000,0000,0000,,We're going to do this in people that have cognitive deficits,
Dialogue: 0,0:11:06.70,0:11:10.16,Default,,0000,0000,0000,,and we've chosen to treat patients with Alzheimer's disease
Dialogue: 0,0:11:10.16,0:11:12.27,Default,,0000,0000,0000,,who have cognitive and memory deficits.
Dialogue: 0,0:11:12.27,0:11:14.21,Default,,0000,0000,0000,,As you know, this is the main symptom
Dialogue: 0,0:11:14.21,0:11:16.63,Default,,0000,0000,0000,,of early onset Alzheimer's disease.
Dialogue: 0,0:11:16.63,0:11:18.82,Default,,0000,0000,0000,,So we've placed electrodes within this circuit
Dialogue: 0,0:11:18.82,0:11:20.82,Default,,0000,0000,0000,,in an area of the brain called the fornix,
Dialogue: 0,0:11:20.82,0:11:23.60,Default,,0000,0000,0000,,which is the highway in and out of this memory circuit,
Dialogue: 0,0:11:23.60,0:11:27.02,Default,,0000,0000,0000,,with the idea to see if we can turn on this memory circuit,
Dialogue: 0,0:11:27.02,0:11:30.27,Default,,0000,0000,0000,,and whether that can, in turn, help these patients
Dialogue: 0,0:11:30.27,0:11:32.58,Default,,0000,0000,0000,,with Alzheimer's disease.
Dialogue: 0,0:11:32.58,0:11:34.90,Default,,0000,0000,0000,,Now it turns out that in Alzheimer's disease,
Dialogue: 0,0:11:34.90,0:11:38.97,Default,,0000,0000,0000,,there's a huge deficit in glucose utilization in the brain.
Dialogue: 0,0:11:38.97,0:11:42.39,Default,,0000,0000,0000,,The brain is a bit of a hog when it comes to using glucose.
Dialogue: 0,0:11:42.39,0:11:44.15,Default,,0000,0000,0000,,It uses 20 percent of all your --
Dialogue: 0,0:11:44.15,0:11:45.67,Default,,0000,0000,0000,,even though it only weighs two percent --
Dialogue: 0,0:11:45.67,0:11:48.81,Default,,0000,0000,0000,,it uses 10 times more glucose than it should based on its weight.
Dialogue: 0,0:11:48.81,0:11:51.39,Default,,0000,0000,0000,,Twenty percent of all the glucose in your body is used by the brain,
Dialogue: 0,0:11:51.39,0:11:53.82,Default,,0000,0000,0000,,and as you go from being normal
Dialogue: 0,0:11:53.82,0:11:56.02,Default,,0000,0000,0000,,to having mild cognitive impairment,
Dialogue: 0,0:11:56.02,0:11:58.47,Default,,0000,0000,0000,,which is a precursor for Alzheimer's, all the way to Alzheimer's disease,
Dialogue: 0,0:11:58.47,0:12:01.16,Default,,0000,0000,0000,,then there are areas of the brain that stop using glucose.
Dialogue: 0,0:12:01.16,0:12:03.46,Default,,0000,0000,0000,,They shut down. They turn off.
Dialogue: 0,0:12:03.46,0:12:05.74,Default,,0000,0000,0000,,And indeed, what we see is that these areas in red
Dialogue: 0,0:12:05.74,0:12:07.50,Default,,0000,0000,0000,,around the outside ribbon of the brain
Dialogue: 0,0:12:07.50,0:12:09.78,Default,,0000,0000,0000,,are progressively getting more and more blue
Dialogue: 0,0:12:09.78,0:12:12.95,Default,,0000,0000,0000,,until they shut down completely.
Dialogue: 0,0:12:12.95,0:12:15.31,Default,,0000,0000,0000,,This is analogous to having a power failure
Dialogue: 0,0:12:15.31,0:12:17.86,Default,,0000,0000,0000,,in an area of the brain, a regional power failure.
Dialogue: 0,0:12:17.86,0:12:20.25,Default,,0000,0000,0000,,So the lights are out in parts of the brain
Dialogue: 0,0:12:20.25,0:12:22.85,Default,,0000,0000,0000,,in patients with Alzheimer's disease,
Dialogue: 0,0:12:22.85,0:12:25.26,Default,,0000,0000,0000,,and the question is, are the lights out forever,
Dialogue: 0,0:12:25.26,0:12:28.12,Default,,0000,0000,0000,,or can we turn the lights back on?
Dialogue: 0,0:12:28.12,0:12:31.36,Default,,0000,0000,0000,,Can we get those areas of the brain to use glucose once again?
Dialogue: 0,0:12:31.36,0:12:33.91,Default,,0000,0000,0000,,So this is what we did. We implanted electrodes in the fornix
Dialogue: 0,0:12:33.91,0:12:36.52,Default,,0000,0000,0000,,of patients with Alzheimer's disease, we turned it on,
Dialogue: 0,0:12:36.52,0:12:40.03,Default,,0000,0000,0000,,and we looked at what happens to glucose use in the brain.
Dialogue: 0,0:12:40.03,0:12:43.29,Default,,0000,0000,0000,,And indeed, at the top, you'll see before the surgery,
Dialogue: 0,0:12:43.29,0:12:46.66,Default,,0000,0000,0000,,the areas in blue are the areas that use less glucose than normal,
Dialogue: 0,0:12:46.66,0:12:48.86,Default,,0000,0000,0000,,predominantly the parietal and temporal lobes.
Dialogue: 0,0:12:48.86,0:12:50.57,Default,,0000,0000,0000,,These areas of the brain are shut down.
Dialogue: 0,0:12:50.57,0:12:53.25,Default,,0000,0000,0000,,The lights are out in these areas of the brain.
Dialogue: 0,0:12:53.25,0:12:56.20,Default,,0000,0000,0000,,We then put in the DBS electrodes and we wait for a month
Dialogue: 0,0:12:56.20,0:12:57.59,Default,,0000,0000,0000,,or a year, and the areas in red
Dialogue: 0,0:12:57.59,0:13:00.90,Default,,0000,0000,0000,,represent the areas where we increase glucose utilization.
Dialogue: 0,0:13:00.90,0:13:03.02,Default,,0000,0000,0000,,And indeed, we are able to get these areas of the brain
Dialogue: 0,0:13:03.02,0:13:06.54,Default,,0000,0000,0000,,that were not using glucose to use glucose once again.
Dialogue: 0,0:13:06.54,0:13:08.89,Default,,0000,0000,0000,,So the message here is that, in Alzheimer's disease,
Dialogue: 0,0:13:08.89,0:13:11.22,Default,,0000,0000,0000,,the lights are out, but there is someone home,
Dialogue: 0,0:13:11.22,0:13:13.36,Default,,0000,0000,0000,,and we're able to turn the power back on
Dialogue: 0,0:13:13.36,0:13:15.67,Default,,0000,0000,0000,,to these areas of the brain, and as we do so,
Dialogue: 0,0:13:15.67,0:13:18.61,Default,,0000,0000,0000,,we expect that their functions will return.
Dialogue: 0,0:13:18.61,0:13:20.73,Default,,0000,0000,0000,,So this is now in clinical trials.
Dialogue: 0,0:13:20.73,0:13:22.64,Default,,0000,0000,0000,,We are going to operate on 50 patients
Dialogue: 0,0:13:22.64,0:13:24.61,Default,,0000,0000,0000,,with early Alzheimer's disease
Dialogue: 0,0:13:24.61,0:13:26.67,Default,,0000,0000,0000,,to see whether this is safe and effective,
Dialogue: 0,0:13:26.67,0:13:29.65,Default,,0000,0000,0000,,whether we can improve their neurologic function.
Dialogue: 0,0:13:29.65,0:13:37.13,Default,,0000,0000,0000,,(Applause)
Dialogue: 0,0:13:37.13,0:13:40.08,Default,,0000,0000,0000,,So the message I want to leave you with today is that,
Dialogue: 0,0:13:40.08,0:13:42.68,Default,,0000,0000,0000,,indeed, there are several circuits in the brain
Dialogue: 0,0:13:42.68,0:13:46.61,Default,,0000,0000,0000,,that are malfunctioning across various disease states,
Dialogue: 0,0:13:46.61,0:13:48.82,Default,,0000,0000,0000,,whether we're talking about Parkinson's disease,
Dialogue: 0,0:13:48.82,0:13:51.90,Default,,0000,0000,0000,,depression, schizophrenia, Alzheimer's.
Dialogue: 0,0:13:51.90,0:13:54.93,Default,,0000,0000,0000,,We are now learning to understand what are the circuits,
Dialogue: 0,0:13:54.93,0:13:57.13,Default,,0000,0000,0000,,what are the areas of the brain that are responsible for
Dialogue: 0,0:13:57.13,0:13:59.65,Default,,0000,0000,0000,,the clinical signs and the symptoms of those diseases.
Dialogue: 0,0:13:59.65,0:14:01.96,Default,,0000,0000,0000,,We can now reach those circuits.
Dialogue: 0,0:14:01.96,0:14:04.59,Default,,0000,0000,0000,,We can introduce electrodes within those circuits.
Dialogue: 0,0:14:04.59,0:14:07.57,Default,,0000,0000,0000,,We can graduate the activity of those circuits.
Dialogue: 0,0:14:07.57,0:14:10.82,Default,,0000,0000,0000,,We can turn them down if they are overactive,
Dialogue: 0,0:14:10.82,0:14:13.78,Default,,0000,0000,0000,,if they're causing trouble, trouble that is felt throughout the brain,
Dialogue: 0,0:14:13.78,0:14:16.36,Default,,0000,0000,0000,,or we can turn them up if they are underperforming,
Dialogue: 0,0:14:16.36,0:14:18.75,Default,,0000,0000,0000,,and in so doing, we think that we may be able to help
Dialogue: 0,0:14:18.75,0:14:21.09,Default,,0000,0000,0000,,the overall function of the brain.
Dialogue: 0,0:14:21.09,0:14:23.65,Default,,0000,0000,0000,,The implications of this, of course, is that we may be able
Dialogue: 0,0:14:23.65,0:14:25.96,Default,,0000,0000,0000,,to modify the symptoms of the disease,
Dialogue: 0,0:14:25.96,0:14:27.86,Default,,0000,0000,0000,,but I haven't told you but there's also some evidence
Dialogue: 0,0:14:27.86,0:14:32.03,Default,,0000,0000,0000,,that we might be able to help the repair of damaged areas of the brain using electricity,
Dialogue: 0,0:14:32.03,0:14:34.48,Default,,0000,0000,0000,,and this is something for the future, to see if, indeed,
Dialogue: 0,0:14:34.48,0:14:36.72,Default,,0000,0000,0000,,we not only change the activity but also
Dialogue: 0,0:14:36.72,0:14:38.73,Default,,0000,0000,0000,,some of the reparative functions of the brain
Dialogue: 0,0:14:38.73,0:14:40.29,Default,,0000,0000,0000,,can be harvested.
Dialogue: 0,0:14:40.29,0:14:43.34,Default,,0000,0000,0000,,So I envision that we're going to see a great expansion
Dialogue: 0,0:14:43.34,0:14:45.79,Default,,0000,0000,0000,,of indications of this technique.
Dialogue: 0,0:14:45.79,0:14:48.57,Default,,0000,0000,0000,,We're going to see electrodes being placed for many disorders of the brain.
Dialogue: 0,0:14:48.57,0:14:51.52,Default,,0000,0000,0000,,One of the most exciting things about this is that, indeed,
Dialogue: 0,0:14:51.52,0:14:53.37,Default,,0000,0000,0000,,it involves multidisciplinary work.
Dialogue: 0,0:14:53.37,0:14:56.17,Default,,0000,0000,0000,,It involves the work of engineers, of imaging scientists,
Dialogue: 0,0:14:56.17,0:14:58.38,Default,,0000,0000,0000,,of basic scientists, of neurologists,
Dialogue: 0,0:14:58.38,0:15:01.13,Default,,0000,0000,0000,,psychiatrists, neurosurgeons, and certainly at the interface
Dialogue: 0,0:15:01.13,0:15:04.07,Default,,0000,0000,0000,,of these multiple disciplines that there's the excitement.
Dialogue: 0,0:15:04.07,0:15:06.83,Default,,0000,0000,0000,,And I think that we will see that
Dialogue: 0,0:15:06.83,0:15:10.26,Default,,0000,0000,0000,,we will be able to chase more of these evil spirits
Dialogue: 0,0:15:10.26,0:15:12.16,Default,,0000,0000,0000,,out from the brain as time goes on,
Dialogue: 0,0:15:12.16,0:15:14.06,Default,,0000,0000,0000,,and the consequence of that, of course, will be
Dialogue: 0,0:15:14.06,0:15:16.33,Default,,0000,0000,0000,,that we will be able to help many more patients.
Dialogue: 0,0:15:16.33,0:15:17.58,Default,,0000,0000,0000,,Thank you very much.