Andres Lozano: Parkinson’s, depression and the switch that might turn them off

Translator: Joseph Geni
Reviewer: Morton Bast One of the things I want to establish right from the start is that not all neurosurgeons wear cowboy boots. I just wanted you to know that. So I am indeed a neurosurgeon, and I follow a long tradition of neurosurgery, and what I’m going to tell you about today is adjusting the dials in the circuits in the brain, being able to go anywhere in the brain and turning areas of the brain up or down to help our patients. So as I said, neurosurgery comes from a long tradition. It’s been around for about 7,000 years. In Mesoamerica, there used to be neurosurgery, and there were these neurosurgeons that used to treat patients. And they were trying to — they knew that the brain was involved in neurological and psychiatric disease. They didn’t know exactly what they were doing. Not much has changed, by the way. (Laughter) But they thought that, if you had a neurologic or psychiatric disease, it must be because you are possessed by an evil spirit. So if you are possessed by an evil spirit causing neurologic or psychiatric problems, then the way to treat this is, of course, to make a hole in your skull and let the evil spirit escape. So this was the thinking back then, and these individuals made these holes. Sometimes the patients were a little bit reluctant to go through this because, you can tell that the holes are made partially and then, I think, there was some trepanation, and then they left very quickly and it was only a partial hole, and we know they survived these procedures. But this was common. There were some sites where one percent of all the skulls have these holes, and so you can see that neurologic and psychiatric disease is quite common, and it was also quite common about 7,000 years ago. Now, in the course of time, we’ve come to realize that different parts of the brain do different things. So there are areas of the brain that are dedicated to controlling your movement or your vision or your memory or your appetite, and so on. And when things work well, then the nervous system works well, and everything functions. But once in a while, things don’t go so well, and there’s trouble in these circuits, and there are some rogue neurons that are misfiring and causing trouble, or sometimes they’re underactive and they’re not quite working as they should. Now, the manifestation of this depends on where in the brain these neurons are. So when these neurons are in the motor circuit, you get dysfunction in the movement system, and you get things like Parkinson’s disease. When the malfunction is in a circuit that regulates your mood, you get things like depression, and when it is in a circuit that controls your memory and cognitive function, then you get things like Alzheimer’s disease. So what we’ve been able to do is to pinpoint where these disturbances are in the brain, and we’ve been able to intervene within these circuits in the brain to either turn them up or turn them down. So this is very much like choosing the correct station on the radio dial. Once you choose the right station, whether it be jazz or opera, in our case whether it be movement or mood, we can put the dial there, and then we can use a second button to adjust the volume, to turn it up or turn it down. So what I’m going to tell you about is using the circuitry of the brain to implant electrodes and turning areas of the brain up and down to see if we can help our patients. And this is accomplished using this kind of device, and this is called deep brain stimulation. So what we’re doing is placing these electrodes throughout the brain. Again, we are making holes in the skull about the size of a dime, putting an electrode in, and then this electrode is completely underneath the skin down to a pacemaker in the chest, and with a remote control very much like a television remote control, we can adjust how much electricity we deliver to these areas of the brain. We can turn it up or down, on or off. Now, about a hundred thousand patients in the world have received deep brain stimulation, and I’m going to show you some examples of using deep brain stimulation to treat disorders of movement, disorders of mood and disorders of cognition. So this looks something like this when it’s in the brain. You see the electrode going through the skull into the brain and resting there, and we can place this really anywhere in the brain. I tell my friends that no neuron is safe from a neurosurgeon, because we can really reach just about anywhere in the brain quite safely now. Now the first example I’m going to show you is a patient with Parkinson’s disease, and this lady has Parkinson’s disease, and she has these electrodes in her brain, and I’m going to show you what she’s like when the electrodes are turned off and she has her Parkinson’s symptoms, and then we’re going to turn it on. So this looks something like this. The electrodes are turned off now, and you can see that she has tremor. (Video) Man: Okay. Woman: I can’t. Man: Can you try to touch my finger? (Video) Man: That’s a little better. Woman: That side is better. We’re now going to turn it on. It’s on. Just turned it on. And this works like that, instantly. And the difference between shaking in this way and not — (Applause) The difference between shaking in this way and not is related to the misbehavior of 25,000 neurons in her subthalamic nucleus. So we now know how to find these troublemakers and tell them, “Gentlemen, that’s enough. We want you to stop doing that.” And we do that with electricity. So we use electricity to dictate how they fire, and we try to block their misbehavior using electricity. So in this case, we are suppressing the activity of abnormal neurons. We started using this technique in other problems, and I’m going to tell you about a fascinating problem that we encountered, a case of dystonia. So dystonia is a disorder affecting children. It’s a genetic disorder, and it involves a twisting motion, and these children get progressively more and more twisting until they can’t breathe, until they get sores, urinary infections, and then they die. So back in 1997, I was asked to see this young boy, perfectly normal. He has this genetic form of dystonia. There are eight children in the family. Five of them have dystonia. So here he is. This boy is nine years old, perfectly normal until the age six, and then he started twisting his body, first the right foot, then the left foot, then the right arm, then the left arm, then the trunk, and then by the time he arrived, within the course of one or two years of the disease onset, he could no longer walk, he could no longer stand. He was crippled, and indeed the natural progression as this gets worse is for them to become progressively twisted, progressively disabled, and many of these children do not survive. So he is one of five kids. The only way he could get around was crawling on his belly like this. He did not respond to any drugs. We did not know what to do with this boy. We did not know what operation to do, where to go in the brain, but on the basis of our results in Parkinson’s disease, we reasoned, why don’t we try to suppress the same area in the brain that we suppressed in Parkinson’s disease, and let’s see what happens? So here he was. We operated on him hoping that he would get better. We did not know. So here he is now, back in Israel where he lives, three months after the procedure, and here he is. (Applause) On the basis of this result, this is now a procedure that’s done throughout the world, and there have been hundreds of children that have been helped with this kind of surgery. This boy is now in university and leads quite a normal life. This has been one of the most satisfying cases that I have ever done in my entire career, to restore movement and walking to this kind of child. (Applause) We realized that perhaps we could use this technology not only in circuits that control your movement but also circuits that control other things, and the next thing that we took on was circuits that control your mood. And we decided to take on depression, and the reason we took on depression is because it’s so prevalent, and as you know, there are many treatments for depression, with medication and psychotherapy, even electroconvulsive therapy, but there are millions of people, and there are still 10 or 20 percent of patients with depression that do not respond, and it is these patients that we want to help. And let’s see if we can use this technique to help these patients with depression. So the first thing we did was, we compared, what’s different in the brain of someone with depression and someone who is normal, and what we did was PET scans to look at the blood flow of the brain, and what we noticed is that in patients with depression compared to normals, areas of the brain are shut down, and those are the areas in blue. So here you really have the blues, and the areas in blue are areas that are involved in motivation, in drive and decision-making, and indeed, if you’re severely depressed as these patients were, those are impaired. You lack motivation and drive. The other thing we discovered was an area that was overactive, area 25, seen there in red, and area 25 is the sadness center of the brain. If I make any of you sad, for example, I make you remember the last time you saw your parent before they died or a friend before they died, this area of the brain lights up. It is the sadness center of the brain. And so patients with depression have hyperactivity. The area of the brain for sadness is on red hot. The thermostat is set at 100 degrees, and the other areas of the brain, involved in drive and motivation, are shut down. So we wondered, can we place electrodes in this area of sadness and see if we can turn down the thermostat, can we turn down the activity, and what will be the consequence of that? So we went ahead and implanted electrodes in patients with depression. This is work done with my colleague Helen Mayberg from Emory. And we placed electrodes in area 25, and in the top scan you see before the operation, area 25, the sadness area is red hot, and the frontal lobes are shut down in blue, and then, after three months of continuous stimulation, 24 hours a day, or six months of continuous stimulation, we have a complete reversal of this. We’re able to drive down area 25, down to a more normal level, and we’re able to turn back online the frontal lobes of the brain, and indeed we’re seeing very striking results in these patients with severe depression. So now we are in clinical trials, and are in Phase III clinical trials, and this may become a new procedure, if it’s safe and we find that it’s effective, to treat patients with severe depression. I’ve shown you that we can use deep brain stimulation to treat the motor system in cases of Parkinson’s disease and dystonia. I’ve shown you that we can use it to treat a mood circuit in cases of depression. Can we use deep brain stimulation to make you smarter? (Laughter) Anybody interested in that? (Applause) Of course we can, right? So what we’ve decided to do is we’re going to try to turbocharge the memory circuits in the brain. We’re going to place electrodes within the circuits that regulate your memory and cognitive function to see if we can turn up their activity. Now we’re not going to do this in normal people. We’re going to do this in people that have cognitive deficits, and we’ve chosen to treat patients with Alzheimer’s disease who have cognitive and memory deficits. As you know, this is the main symptom of early onset Alzheimer’s disease. So we’ve placed electrodes within this circuit in an area of the brain called the fornix, which is the highway in and out of this memory circuit, with the idea to see if we can turn on this memory circuit, and whether that can, in turn, help these patients with Alzheimer’s disease. Now it turns out that in Alzheimer’s disease, there’s a huge deficit in glucose utilization in the brain. The brain is a bit of a hog when it comes to using glucose. It uses 20 percent of all your — even though it only weighs two percent — it uses 10 times more glucose than it should based on its weight. Twenty percent of all the glucose in your body is used by the brain, and as you go from being normal to having mild cognitive impairment, which is a precursor for Alzheimer’s, all the way to Alzheimer’s disease, then there are areas of the brain that stop using glucose. They shut down. They turn off. And indeed, what we see is that these areas in red around the outside ribbon of the brain are progressively getting more and more blue until they shut down completely. This is analogous to having a power failure in an area of the brain, a regional power failure. So the lights are out in parts of the brain in patients with Alzheimer’s disease, and the question is, are the lights out forever, or can we turn the lights back on? Can we get those areas of the brain to use glucose once again? So this is what we did. We implanted electrodes in the fornix of patients with Alzheimer’s disease, we turned it on, and we looked at what happens to glucose use in the brain. And indeed, at the top, you’ll see before the surgery, the areas in blue are the areas that use less glucose than normal, predominantly the parietal and temporal lobes. These areas of the brain are shut down. The lights are out in these areas of the brain. We then put in the DBS electrodes and we wait for a month or a year, and the areas in red represent the areas where we increase glucose utilization. And indeed, we are able to get these areas of the brain that were not using glucose to use glucose once again. So the message here is that, in Alzheimer’s disease, the lights are out, but there is someone home, and we’re able to turn the power back on to these areas of the brain, and as we do so, we expect that their functions will return. So this is now in clinical trials. We are going to operate on 50 patients with early Alzheimer’s disease to see whether this is safe and effective, whether we can improve their neurologic function. (Applause) So the message I want to leave you with today is that, indeed, there are several circuits in the brain that are malfunctioning across various disease states, whether we’re talking about Parkinson’s disease, depression, schizophrenia, Alzheimer’s. We are now learning to understand what are the circuits, what are the areas of the brain that are responsible for the clinical signs and the symptoms of those diseases. We can now reach those circuits. We can introduce electrodes within those circuits. We can graduate the activity of those circuits. We can turn them down if they are overactive, if they’re causing trouble, trouble that is felt throughout the brain, or we can turn them up if they are underperforming, and in so doing, we think that we may be able to help the overall function of the brain. The implications of this, of course, is that we may be able to modify the symptoms of the disease, but I haven’t told you but there’s also some evidence that we might be able to help the repair of damaged areas of the brain using electricity, and this is something for the future, to see if, indeed, we not only change the activity but also some of the reparative functions of the brain can be harvested. So I envision that we’re going to see a great expansion of indications of this technique. We’re going to see electrodes being placed for many disorders of the brain. One of the most exciting things about this is that, indeed, it involves multidisciplinary work. It involves the work of engineers, of imaging scientists, of basic scientists, of neurologists, psychiatrists, neurosurgeons, and certainly at the interface of these multiple disciplines that there’s the excitement. And I think that we will see that we will be able to chase more of these evil spirits out from the brain as time goes on, and the consequence of that, of course, will be that we will be able to help many more patients. Thank you very much.

100 thoughts on “Andres Lozano: Parkinson’s, depression and the switch that might turn them off

  1. I feel for you, Citygal. I hope you find some answers. Relief will be sweet when you get it. So nice that you've been clean for so long.

  2. You sound like a candidate for surgery, since you tried everything else, right? (You didn't mention shock, if they still do that.) I'm really eager for you to look into this. You can feel good again. You did before.

  3. awoo , I really feel good for the Israeli boy , but also I feel sad for Millions Palestinian boys whom been taken away from their land because the Israel's occupation. 🙁

  4. The only person you are a slave to is yourself. Paranoia is a very real condition. We evolved to always see danger all around us, so the power of suggestion often driven by scary looking conspiracy videos etc. can make a person CONVINCED that they are a slave. Unless you live in a handful of countries (like North Korea), I promise you, you are more free than you could have been at any time in history. Slavery really exists still in some parts of the world, the term should not be used so loosely!

  5. Implants are nothing new. They have been used to help with depression, epilepsy and so on as an alternative to fairly toxic drugs. Hell, new pacemakers for the heart have bluetooth etc. built in, so they can get new firmware wirelessly, and can even communicate with your doctor over the Internet if something goes wrong. Bio-technology will make these kinds of things much more prevalent in the future.

  6. maybe this work for extreem cases but i wouldn`t want this in my brain, you have to think what`s the long term effect of this in your brain it`s kinda perfected electroshock therrapy that is not used anymore because they find out that kills your brain.

  7. I decided that I wanted to know EXACTLY what all recovered anxiety and panic attacks sufferers had done to eliminate their conditions. ANXIETYANDDEPRESSIONTREATMENT.JUPLO.COM

  8. The minds of soldiers are already controlled in some way. New technologies have always had their negative sides but it hasn't stopped us from getting into a better world.

  9. please take this in and really listen to what I have to say: psychiatry is false, it is pseudoscience. it has taken a position in society as something real because your oppressive slavemasters want you to take drugs so that your mind becomes more accepting to their crazed commandments. deep brain stimulation is a direct attack and will inevitably morph your personality. all serial killers, gang members and plain lunatics were created by the illuminati to incapacitate you with fear at all times.

  10. This actually sounds a LOT more like surgical intervention, than life long drug treatments for profit, to me.

  11. LMFAO!!!!!! Good one. 🙂 Poe's Law at work if we take it seriously, I hope. 🙂

    Corrupt people are corrupt. Try to reign in the Crazy and realize that not ALL people are corrupt. It's often the very top layer that is most in question, in organizations, in my experience. All "scientists", millions and millions of people, are not "in on it". Not "out to get you". Paranoia might also be curable through this method? 🙂 🙂

  12. taking a look at history is a great way to theorize the future. societies with more governmental control tend to be destroyed in the most devastating ways imaginable. the model of direct ownership of your taxpayers/citizens as observed in modern day north-korea is horrible for the people and even for the state, partial ownership of the livestock.. oops, I mean PEOPLE, has less government-created problems (like the "democracies" of today) and societies with no rulers tend to strive.

  13. the absence of corruption is a truly rare thing, and the corrupt will spread into what has not yet been infected by one way or another. if there is an incorruptible person, he will be ostracized or even destroyed and the corrupt majority will reign supreme. individuals are weak, and as they are being wooed by the devil one by one, the majority will identify with the immoral. individual politicians or small groups of rulers will inevitably receive unethical offerings, and they will accept them.

  14. Re Alzheimer's: isn't it so that the brain shrinks and eventually dies off? I once saw a comparison between a 'healthy' (i.e. normal) brain and a brain affected by Alzheimer's disease. The 'Alzheimer's brain' was about half the size of the other. The brain cells had died off. So I don't really understand how they can make brain tissue work when it has been damaged like that. Can anyone explain this to me?

  15. I agree with bomotor on this. maybe you should look into getting some of this treatment, on that part of your brain that thinks…oh yeh, that's all of it. They did say that the boy was perfectly normal until the age of six. So tell me…how the hell did you come to the conclusion that they knew their kids had this disease when they conceived. 'Unthinking fukcing animals'…how ironic.

  16. unless they have medical explanation, which they should've then shared in the comments, 19 people should burn in hell

  17. Angels and Demons in the brain. As an entertainer I find this science fascinating in that the good doctor here parallels theories of cognitive projection within one's own brain, thoughts and feelings, creative visualization, guided imagery to effect the movement of our own brain chemistry thus our moods of course through the arts. When we lose our ability to regulate on our own he and his colleagues offer hope where we would be otherwise helpless and that is great. Thank you Ted Talks.

  18. seems a touch intrusively weird though a much more precise approach than pharmaceuticals. wonder how big pharma will respond…create "supportive / collaborative" medications, funding studies to disprove the procedures' efficacy, or worse, its danger…

  19. How different are those brain implants compared to drugs for those with bi-polar or schizophrenics?

  20. Yep, but it will not completely alleviate their symptoms. I want something which will completely alleviate their symptoms. What could we do to turn on and off specific brain areas as well as regulate neurotransmitter activity?

  21. As someone with difficult to treat dysthymia, I am absolutely overjoyed that in the future no one will have to suffer as I do. I can't wait for the human race to finally uncover more secrets of how our brains function.

  22. How is a simple answer, you just click thumbs down. But why should anyone do it; opposition of course. But the point is why should be there opposition. So the comment should be:"Why should anyone want to dislike a video such this. 🙂

  23. My Wife had this procedure done twice, a year apart. The First went well .The second surgery was done by a different Dr. and turned out to be a nightmare. The 2nd probe struck and cut a small artery which caused a stroke. She needed immediate surgery to remove the probe and the pressure the blood was causing. She nearly died. The first probe was able to remain which still is functional. It has been a year now, She has some brain damage due to the stroke but she is getting better each day.

  24. Firstly do not assume where I stand on this matter. Secondly, to all the strong supporters of this, why don't you volunteer for this if it's such an amazing breakthrough?

  25. If the desease has reached. A point where it is so bad, why wouldn't one consider this potentially life threatening procedure? It looks very promising, and so little is known about the brain.

  26. Holy Crap. This is stunning. Instead of spending money on other people's troubles (funding war efforts to the tune of trillions), shouldn't we being supporting this spectacular bunch of technologies? The mind boggles at the implications. The evidence looks so very promising.

  27. Thank you very much for this great video.I am currently a participant in the Broaden Study for Depression.I`m at my eighth month and doing better.Deep Brain Stimulation has done for me what no drug or electroconvulsive therapy could do.Thanks also to Dr. Lozano and Dr. Mayberg for their great work in the field of Neurobiology.Also I would like to thank St. Jude Medical for making this clinical trial possible to help so many people who are truly suffering.In my own small way I`m glad I could help

  28. why is it necessary to put electrodes into the brain? isnt there a possibility to get the same effects with magnetic stimulation? i mean, magnetism and electricity have a lot in common i thought ?

  29. The next step will be non-invasive methods of achieving the same results, which there is good evidence that we can do via focussed electrical or ultrasonic stimulation, and then of course regenerating brain tissue or permanently rerouting brain circuitry to remove the need for continual stimulation altogether.

  30. @FreeFromWar Or the people who argue that misery or even general malaise are just part of the human condition, as if that is a fixed thing.  I also find there are a lot of people who are uncomfortable with the idea that most (if not all) of the suffering we deal with really is as 'simple' as less than optimally functioning circuitry in our brains instead of some ethereal thing like the mind.  Even agnostics or atheists.

  31. Don't let them convince you this is fool proof. People still die from the operation and complications afterwards. Sometimes it doesn't work even when successful or very limited benefit. They tinker with my aunt's settings all the time trying to find that Goldilocks zone and she is never quite right. That being said a lot of people do see improvement so way the risk against the possible reward.

  32. One day, when all of this technology is cracked. Someone will realise that if children have this treatment that they will develop super human abilities. 

  33. Thank you for share this vídeo. I just link this to a paper with the title "How the brain changes in Parkinson’s Disease? Recent research from the University of Modena and Reggio Emilia answer this question about Parkinson's Disease".

  34. My mom has Parkinson disease. How many on Parkinson disease have tried on? For surgery is the age is important? How much does it cost?

  35. I have just had DBS after living with PARKINSON'S DISEASE for 17 years. I was just 38 when first diagnòsed and over time it robbed me of my musicaĺ and teaching career, stole my hobbies and invaded my marriage. It ĺeft me wheelchair bound and a prisoner in my own home. Despite having remained positive fòr much òf that time towards the end Í was reaďý tò end my life as the quality was so poor and most òf the time ì was in tremendous pain from dystonia and dyskenesia. DBS has been my saviòur anď I çànñòt express iñ wòrds alonè mý gratitude to the piòneers of thìs proçedùrè and my own neurosurgeons whò used theìŕ skills to operate on me.

  36. I'm concerned with some thoughts about this. Would you think that directly controlling pathological behavior, such as depression, would ultimately leave the patient better off. Well, of course, but are we equipping ourselves with the right tools to fight our neuroses and fits? Shall we take on an attitude where everything can be measured and determined? What are the consequences?

  37. Great explanation, prayers for the parents who can't afford such surgery/procedure for their children facing those problems.

  38. I really came for that switch on depression, thinking it is a motivational switch, but it is a medical precise yew switch.

  39. It's not all that simple, is it Doctor? All of your glittering generalities lead to false hope. What is the success rate? Nothing to brag about right? I also dispute your definition of Dystonia as a childhood genetic disorder in that it is just as likely not a childhood nor genetic disorder and you know it. And DBS is successful in a small number of cases at any age, isn't it? I'd prefer Truth to Showmanship please.

  40. Dr Andres Lozano tenho minha vó que apresentou A doença de Alzheimer poderia se possivel agendar uma consulta com vc ?

  41. I don't agree with these studies.  The results might show improvement in
    these individual's function, mood and/or cognitive function but how would this be regulated?  Laws and regulations can be put into place to discourage unlawful activity, not prevent it.  The one thing that Lozano says in his presentation that scares me about this technology is no neuron is safe from a neurosurgeon.  This is terrifying because if this surgery were to be used for the wrong reasons, doctors/scientists could potentially create a superhuman.  Also, there is no mention of failure rates.  I understand the video is promoting these procedures but to fully understand what these procedures entail there needs to be discussion of success rates vs. failure rates.  Brain surgery is a very delicate procedure and I would have to believe that mistakes are made and patients are the ones that suffer.  Is the risk of surgery equal to the benefits?  These studies would also have to prove that there is no chance that this technology would not be misused once installed. Overall I would say the risks outweigh the benefits and there needs to be more research posted or a better representation of the research as a

  42. I don't know any details of this other than the video I'm watching. To relief pain and horrible symptoms is looks great. My problem: Do we want humanity on switches. Do we want to turn on and off happiness and sadness, bravery or cowardice, good behaviour or bad behaviour. Could we have a president of USA who could be switched on to love or hate. I don't want humanity on switches but it's good for rare situations. But not for the direction of humanity itself. The boy who twists himself it made him walk again and that's good, but we need to know more of what it did, like change his thought pattern etc.

  43. TТhis simрlееее ‘triсссk’ rеvеeеrsеееs Alzheimеr’s in 14 dауууs

  44. Check out the research approaching FDA approval to begin clinical trials for Parkinson's disease that transforms a patient's skin cells into dopamine producing neurons to replenish those lost in patients.

  45. GREAT INFORMATION AND VIDEO THANKS. Have PARKINSON starts of trimmers. WOW, this is great. PLEASE HELP.

  46. May 2018. A lot has happened since 2013. Radio waves are being used to treat essential tremor. The treatment is non-invasive. No chance of infection.

  47. Cannabis works for all of that too. The worst part is they are experimenting with methods that only treat symptoms in order to "normalize" people. The greatest artists and inventors in the history of humankind have most often been depressed, sometimes severely so. Maybe, just maybe, we should stop using the barbaric methods of trepanning and lobotomy and start looking for causes. Medicine isn't about the symptoms. This is a form of nerve stapling and is an abomination, even if it does help some people.

  48. all in all, besides being obvious treatment, it's also a frontier for creating brain interfaces, some of them invasive, nonetheless they could lead to revolution in how people interact with technology. drum and bass made by me with fragments of that brilliant and warm speech, just an exercise, TEDs like these get me more addicted to TEDs

  49. Go here and read on.
    Scary. The reporting on the results of experimental trial has been manipulated, conflict of interest not disclosed to patients, their adverse experiences misrepresented as "improved". Bad science. Chilling brave new world of lobotomy 2.0 may be upon us.
    Even lobotomy 1.0 was once hailed with Nobel prize – before the reality of the personality destroying brain surgery became obvious. I wonder why Dr. Lozano did not start his history intro with some cool lobotomy story.

  50. excellent neurosurgeon around the world and his department is the best too. All the success for them.

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