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

Full transcript of Michael Okun and Kelly Foote’s TEDx Talk: How to control the brain at TEDxUF conference.

Full speakers’ bio:

Michael Okun – Neurologist

Kelly Foote – Neurosurgeon

 

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Michael Okun – Neurologist

Your brain controls everything.

Kelly Foote – Neurosurgeon

And we can control your brain.

Michael Okun: 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 going to talk at all. But it turns out, what we’re going to 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.

Kelly Foote: So, we are going to start a little bit by talking about the brain. Your brain is a living supercomputer. As we learned 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 axons and dendrites, and at those connections, which are called synapses, it’s estimated that there are 100 trillion 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 are wired together in functional circuits, and those functional circuits control everything you do and everything you are.

Michael Okun: Now, when those circuits, become dysfunctional, 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 whack, 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.

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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).

Kelly Foote: 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.

Michael Okun: Let me show you another example. The next woman that we’re going to 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?

Kelly Foote: So, how fun is our job! 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 Davenport, Iowa, who has the same disease as Howard Hughes 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 psychiatrist’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.

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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 behaviors.

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 behavioral 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.

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 (deep brain stimulators) 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.”

And I calmed her down and I said, “Woh, woh, wait a minute. Number one, you were at the movie theater last night, and number two, that really grosses me out too! I think you are going to be OK.”