How to control the brain: Michael Okun and Kelly Foote at TEDxUF


Translator: Claudia Farias
Reviewer: Elisabeth Buffard Michael Okun: Your brain controls everything. Kelly Foote: And we can control your brain. (Laughter) MO: Now, you might be wondering
why a neurologist and a neurosurgeon are talking together. Most people that know the traditional roles of neurologists and neurosurgeons,
they know that there’s not much chance
we’re gonna talk at all. But it turns out,
what we’re gonna tell you about today, it takes a “we”, it takes a team. And in fact,
there is a whole bunch of people that have to stand behind us to do what makes this happen. KF: So, we are going to start a little bit
by talking about the brain. Your brain is a living super computer. As we learnt earlier, there are
a hundred billion neurons in the brain. And each one of those neurons
has the capacity to fire. That is to say, to send an on signal — we call it an action potential —
to other neurons that it’s connected to. Neurons have two states, on or off. Your brain speaks a binary language
just like your computer. These neurons are interconnected with living wires called axones and dendrites, and at those connections,
which are called synapses, it’s estimated that there are
100 trillon synapses in the human brain. So, we’re up to speed. The neurons in the brain tend to be
clustered in functional units called nuclei, and then those nuclei wire together in functional circuits,
and those functional circuits control everything you do
and everything you are. MO: Now, when those circuits,
become disfunctional, what happens? Bad things happen. That’s when patients come to see us, Parkinson’s disease,
Tourette syndrome, tremor… and there’s a lot
of really smart people out there who’ve tried to figure out
what happens to cause these diseases. Maybe there’s a piece
of the DNA that gets left out, maybe there’s a chemical
that’s out of wack, maybe there’s a protein
that is accumulating in the brain. Whatever the reason, we actually can’t see
the dysfunction in this set of diseases. We can point to an MRI scan
but we can’t see a problem because it’s not structural. So, what we need to do is
we need to find that circuit that’s misfiring and we need to apply electricity in something that’s called
Deep Brain Stimulation (DBS). KF: So, why on earth would we
put an electrode in someone’s brain and try to control it? Are we mad scientists? Maybe, but
we’ll come back to that question. First, let me show you
what we are talking about. This is a gentleman
in our operating room, who has essential tremor. There are a group of neurons in his brain that control the movement of his hand
and that are firing in synchrony in a pathologic way;
and, this is what it produces. When we can identify
those neurons in his brain, deliver electrical stimulation to that place and interrupt that malfunctioning circuit… this is what happens. MO: Let me show you another example. The next woman that we’re gonna show you,
she has multiple sclerosis. She is trying to hold that arm still. She says that it’s useless to her. This is quite embarrassing, and in fact the neurons in the brain
that are causing this, there’s so much dysfunction that we’ll actually have to put
two of these DBS leads into the brain. We’ll insert two wires
into the brain to get this. How cool is that! (Applause) KF: So, how fun is our job! (Laughter) If you think that’s fun, let me tell you the story
of another one of our patients that will blow your mind. This young woman
from Devenport, Iowa, who has the same disease
as Howard Huges died of, called Obsessive Compulsive Disorder
or OCD. She is obsessed
with fears of being contaminated, everything out there is dirty to her and she is paralyzed by these fears. She won’t touch anything. In fact, when she came to see us the first time, she refused to sit down in
our psychriatrist’s office for her first interview. Let me tell you about her life. She’s had Obsessive Compulsive Disorder
for a long time. But when she got pregnant,
her symptoms got a lot worse. And of course everybody said,
you know, “it’s the hormones, I’m sure when
you deliver the baby everything will be OK.” Well, it wasn’t.
It got a lot worse. And then, two years later,
Child Protective Services is threatening to take
her 2-year-old daughter away because she can’t stop washing her. Her baby is red and scaly and tender. Now, here is the cruel thing
about Obsessive Compulsive Disorder: these patients have insight. She knows
that she is hurting her baby, she knows
that her obsessions are irrational, she knows she is driving away
the people that love her… and she has no power
to stop these behaviours. If you can imagine,
her husband is pretty tired of it. Let me tell you about his experience. He goes to work, he comes home from work,
he pulls his car into the garage, closes the door behind him
so that he can strip naked and launder his “contaminated clothes” in a special laundry facility
that she’s set up outside the house. And then, he walks into the house
and takes a “decontamination shower” with a special soap
that she has deemed acceptable, so that he would be allowed
to walk into his home naked and clean. She can’t leave the house, so he does all the shopping. He comes home
from the grocery store, and, of course, all the packages
at the grocery store are “contaminated”. So there’s the ritual of opening every can of soup
and every box of cereal and transferring the content of those packages into some clean container that she says
is OK to bring into the house. So, as you might imagine,
this is a marriage that is strained. So… she is desperate
and she’s tried everything. She’s a smart lady. She’s taken all the medication, she’s been
through in-patient behavioural therapy programs, nothing’s working. She heard about our research
and she contacted us. And we implanted
two deep brain stimulators in her brain in the area of the brain that we thought would be likely to help quiet
these obsessive thoughts that are plaguing her. And, to make a long story short, this is her today. It worked and it was
pretty damned exciting to us. (Applause) Now, I have to say that at one point
she did call me in a panic. She said, “Dr. Foote, something is terribly wrong,
my DBS have stopped working because I was at the movie theater last night
and I was walking across the floor and it was really sticky
and I was completely grossed out.” (Laughter) And I calmed her down and I said,
“Woh, wait a minute. Number one, you were
at the movie theater last night, and number two,
that really grosses me out too! (Laughs) I think you are gonna be OK.” So, to me, the most intriguing thing
about this case is that we are moving beyond
using deep brain stimulation to treat movement disorders
like Parkinson’s disease and tremor, which now we know we can do, and it looks like we are gonna
be able to address malfunctioning other circuits in the brain
like limbic circuitry that cause problems like depression and OCD. MO: You know, Kelly,
let me take that idea just maybe one step further. I’m gonna tell you something
that’s gonna blow your mind. There is a place in the brain
called the nucleus accumbens, and a lot of scientists believe
this is the final common pathway for where pleasure lives. It’s the reward center,
it’s the motivation center. If you take a heroine addict and you put him in a functional MRI scanner,
a fancy MRI scanner, you give him his drug of choice, this area lights up,
the nucleus accumbens. If you take a graduate student
and you put her in the scanner, and you give her chocolate
or you tell her, “Why don’t you pretend like
you’re having a sexual fantasy?” This area lights up,
the nucleus accumbens. So, it turns out
in these patients that had OCD, we’re stimulating
very close to that area. And what I’m gonna show you next
is a patient with OCD, where we’re gonna tickle that area inside
the operating room and see what happens. (Video)
Man: [unclear] next condition is now… (Girl laughing) Oh, man! Man: Describe what you’re feeling right now. Girl: I feel happy. (Laughter) MO: I – feel – happy. Now we’ve done it. Now we’ve crossed into that territory where some of you are beginning
to feel uncomfortable in your seats. Is this something — is this a technology where
we can actually disrupt your thoughts? Your emotions?
We can control them? KF: Should we control the way you feel? (Laughter) Maybe we are mad scientists. (Laughter) Well,obviously, this is powerful stuff and we’re excited about it. But hopefully just as obviously, we need some ethical guiding principle to guide us on this journey
into the electric brain. And we’re gonna
propose one in a minute but first Mike has one more patient story. MO: Let me introduce you to Chris. Chris is a young man who was normal two years before this video was shot. And now, his muscles
have turned against him. He has a disease called Distonia,
where the muscles fight against each other, and often leave him to suffer in
these abnormal and uncomfortable postures. Now, if we take Chris and we try to find the region in the brain,
that circuit we talked about that’s causing
the disruption in his motor loop, in the motor area
that’s causing his muscles to do this; if we take Chris
and we put DBS electrodes into him, and we turn them on… nothing happens. But, if we wait, if we wait, and we let the electrical stimulation set in, what we’re gonna see
is that very slowly, over time, over days, weeks, months…
KF: Long, long time. MO: Long time (Laughter). KF: We may have to wait
a long time. MO: Centuries! What we’re gonna see is,
slowly, that electrical stimulation is gonna begin to work on that circuit. His hands are gonna become loose, he’s gonna be able to tap his fingers. Suddenly he can
move his arms with fluidity. His neck is starting to loosen up, his back is starting to loosen up,
he is even looking at his hand saying, I’m not sure
how my hand can do this. Very slowly the brain is reprogramming, it’s reorganizing this circuit
in response to the electricity that’s coming out of that implantable electrode;
it’s remodeling Chris’s brain. Now, one day Chris is gonna wake up. He’s gonna tell his mum,
“Mum, I think I can walk again.” And he will… KF: And he did!
(Applause) MO: So, what’ve we learnt? KF: Well, we’ve learnt
that the brain is a super computer, and that we can tweak it
with Deep Brain Stimulation. MO: You know, I think we can
summarize this in three points: identify, intervene and personalize. Identify the abnormal circuit in the brain, intervene with Deep Brain Stimulation, and personalize the approach, tailor the approach
to the symptoms of the sufferer. KF: And we should point out also that I believe we’re just
scratching the surface here. This is powerful technology
and if you think about it, any malfunctioning circuit in the brain that’s causing
a problem for a human being, if we can figure out
where that mulfunction is, there’s the potential for us to modulate
that mulfunctioning circuit to help that person. So, let’s come back to that question
that we posed earlier — not the mad scientist question, the question about an ethical principle, and the question about why on earth would we implant an electrode
in someone’s brain to try to control it? And the answer is,
and should always be, to alleviate human suffering. Your brain contols everything. MO: And we can control your brain. (Laughter)
(Applause)

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