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