Bionic Human Series, Part 4 - How Close Are We to the Bionic Brain?

Bionic Human Series, Part 4 - How Close Are We to the Bionic Brain?

Show Video

Hello everyone I'm Nick Desai I'm the founder of  a company here in Southern California called Heal   you may have heard about we do doctor  house calls and telehealth for primary care um I'm   a UCLA I'm a alumni from the school of engineering  before it was the Samueli school of engineering   uh back in 1992 and I'm really excited to host a  panel about how close we are to the bionic brain   and uh we have three incredible scientists with  us today uh Dr. Dejan Markovic from the school of   engineering Dr. uh Nanthia Suthana from uh the  Department of Neurosurgery and uh from the school  

of medicine and Dr. Nader Pouratian from the  Department of Neurosurgery also at the school   uh yep in school of medicine um so without  further delay I want to quickly get the   panelists uh introduced uh let them  make their opening remarks um and then   introduce themselves and their topics and  then we will get into a lively discussion   uh Dr. Markovic if you can get us  started off that would be phenomenal uh sure uh do we have a slideshare or uh There we go great so I'm Dejan Markovic   I'm faculty at UCLA electrical and  computer engineering department   and I build neurotechnology to help address  brain disease such as depression and anxiety   chronic pain Alzheimer's disease These are enormous and growing unmet   needs in medicine today the economic burden in the  U.S exceeds a trillion per year to manage these   problems and many patients if you look into this  journey have spent years trying one medication   after another with no relief and there are many  times where clinicians have nothing left to offer   and one of the most promising approaches to  addressing this is to use implantable medical   devices for deep brain stimulation or DBS which  so far has shown to work in Parkinson's disease   and movement disorders and has very limited  success in epilepsy if you go to the next slide uh believe it or not today's DBS devices use  the same technology of cardiac pacemakers from   three decades ago you can see the chest-based  device that is used in Parkinson's disease that's   implanted about 10,000 patients per year worldwide  and you can see the head-based device for epilepsy   that's implanted in only 300 patients per year  and both of these devices use deep brain probes   with only four to eight electrode contacts which  gives you continent-level access of the brain   these outdated devices focus on single targets  and have no way of adjusting stimulation dosing   without going to see a doctor every couple of  months and the problem here is that uh clinical   success in Parkinson's disease does not translate  to other indications because of major limitations   in existing implantable medical devices there  is very limited technology that leads to limited   therapy and limited adoption we need devices  that can access and manipulate brain networks   to stimulate multiple brain regions and  use recordings to intelligently self-adjust   and optimize therapy and minimize side effects  simply to say we need tools that are at the   right scale the success in treating of Parkinson's  disease and cochlear implant are good because the   tools are the right scale but for everything else  we lack technology so let's go to the next slide  Accessing deep brain networks is possible  today in clinical epilepsy monitoring and   DARPA invested uh 33 million  dollars in our team at UCLA and UCSF   to develop research technology capable of  interacting with functional brain networks   and here you see in the top left a trial  device that is based on that technology   We've been using this external trial device in  human subject experiments at UCLA under IRB and   the device is meant to replace bulky and expensive  clinical equipment that you see on the right   while providing higher fidelity neuromodulation  and these recordings from a human patient show   concordance with that clinical neo-encoding system  that is much larger and more expensive than our   system we are doing stimulations and recordings  to build real world evidence and data platform   for future FDA submission and we envision a  medical device as a service approach that combines   modern brain computer interfaces and data  analytics for brain network modulation to address   these major medical and social needs so I look  forward to the discussion tonight and uh thank you  Thank you Dr. Markovic certainly some eye opening  I sat up myself in looking at some of this data   and and the advances that can be made in sort  of the primitive state that we're in um we'll   go next to Dr. Nanthia Suthana um she will uh  talk about some of her work in the space as well Hi everyone good evening so I'm an assistant  professor at UCLA I have a lab there really   working in collaboration with Dejan Markovich  and others to understand the mechanisms in the   human brain that support everyday functions such  as memory emotion but also what what happens when   these systems are malfunctioning in disorders  neurological disorders and psychiatric disorders   and I work with individuals who have an already  implanted electrode system in their in their brain   for epilepsy for treating epilepsy and here's  an example patient here I could start the video   showing them in our lab they have a system  implanted deep in the brain hippocampus   area important for memory and we're monitoring  their movements with these motion trackers that   are on body and using those ceiling mounting  cam ceiling mounted cameras that you see  The individuals can also wear scalp EG headsets  and VR and AR headsets eye tracking biometrics   to record heart rate and other physiological  measurements and while we gather this data   we can answer questions about you know basic  human behavior in a more naturalistic setting   which is relevant for also translating  into the real world where you know a lot   of times these therapies you know falter  given that they've been tested in the lab  So we're studying memory with real relevance to  Alzheimer's disease and other disorders that have   impairments in memory such as  traumatic brain injury and epilepsy   we're also working with patients who have  post-traumatic stress disorder where the memory   impairment is not an issue of you know forgetting  but unwanted remembering in cases where you see   illustrated here a trigger such as fireworks  in veterans whom we work with can trigger   you know a traumatic memory from their  time in uh in battle and so this this uh   unwanted reminder it can be very debilitating  and for patients who don't respond to traditional   methods of treatment we have a clinical trial to  implant an FDA approved system for treatment of   their seizures and using a signal that we identify  to trigger that treatment so that is an ongoing   clinical trial that's open for recruitment and the  next slide I'll show you how we're working with   engineering Dejan Markovich to test out the  bedside device that will eventually be implanted  So the goal is you know right now we're  working with systems that are technologically   out you know sort of old and not up to date but  we can understand these um I think there's a video   at the bottom there I don't know if you want to  play this is one of our patients with an implanted   system walking around and you can see I guess the  video doesn't play does it play okay but you can   see on the bottom right that the eyes are being  tracked motion is being tracked while the data is   being recorded and the goal is eventually to move  into using these more high fidelity miniaturized   wireless systems to gather signals such as from  single neurons and do programmatic stimulation  So I have here on the top right some actual single  neuron waveforms that were recorded with this   system in individuals who are you know walking  around in their hospital stay in the epilepsy   monitoring unit and on the bottom left you can see  example stimulation pulses that are sent through   these systems as well so we're making quite a  bit of progress you know with Dejan Dr. Markovic  

to improve upon these technologies such that  eventually we can improve upon the neuroscience   and the basic science knowledge that we have to  inform therapies and that's all I have thank you Thank you Dr. Suthana it's obvious that you can  do incredible things in the brain and we still   can't get zoomed to play a video so you know  the trade-offs of modern science right right um   and last but certainly not least uh  Dr. Pouratian and if you could give   a uh intro to yourself and your  work then we can get into a Q&A Sure I'm uh Nader Pouratian I'm  a professor of neurosurgery and   my day job is as a clinician so I am stereotyping  a functional neurosurgeon as part of that   I implant devices in people's brains like you  heard about from Dr. Markovic for primarily for   Parkinson's disease and essential tremors  so movement disorders those are deep brain   stimulators but I also participate in clinical  trials uh with existing technologies to try   and treat a spectrum of diseases that we currently  don't have FDA approval so we heard a lot about um   the new technologies that we need to develop I  want to paint a little bit of a rosier picture   that we can still treat a lot of diseases  we definitely need new devices we need to   understand the physiology we need to do  the neuroscience uh like uh Dr. Suthana uh   is doing and many others are doing uh but we  have a lot of capabilities to do things now so   just to give you an idea we have clinical trials  of brain stimulation for depression we have   clinical trials of a special device that was  designed in collaboration with industry to   provide artificial vision for people who are blind  I we have a clinical trial in collaboration with   one of my partners here at UCLA Dr. Ausaf Bari  to use deep brain stimulation for chronic pain  

collaborations looking at how the brain controls  the heart and how signals from the heart go to   the brain so looking at diseases that we don't  traditionally think about as neurological or   psychiatric diseases and how the brain and spinal  cord might play into that um and finally you know   we have trials where we're placing electrodes  chronically in people who are spinal cord   injury patients people who are quadriplegics  um in a collaboration that we have with uh   Richard Anderson at Caltech uh in a brain  computer interface trial to see how people who   have spinal cord injuries can  directly control a computer a cursor   uh on the screen and um add functionality  that they may have lost to their injuries so   um I think there's a lot that we need to do but  there's a lot that we can actively do right now   we do need better devices which is why we're  here to talk about this uh we do need better uh   more neuroscience but there's a lot of exciting  things that we're doing uh here and now Great uh thank you Dr. Pouratian and um okay  first of all just to the audience if you want   to ask questions please put them in the Q&A what  I will try to do is pick the common themes read   them out loud and get them answered from our  our panel of experts um I'll start out with   a few questions that did that did come in  before right which is the first question is   obviously one of the recurring themes of that  you all three talked about is the ability to help   people with chronic pain Alzheimer's everything  from Alzheimer's to chronic pain to depression   these different dimensions of disease  how with the exception of the very early   systems that Dr. Markovic talked about  how close are we to your innovations   actually helping in a hospital in a bedside  setting for real patients at any scale Dejan you can answer I can take a shot at it obviously this  is a long journey and there are many   uh steps uh we need to take in order to  safely roll this out to uh the real world   uh so the first step in uh on that journey  is to use a trial device which is attaching   electronics with the capability for advanced  sensing and stimulation and closed loop   to uh existing implantable electrode arrays for a  short period of time and we are using this kind of   a really uh excellent opportunity of epilepsy  monitoring where patients spend two to three   weeks in hospital to have to track the location  of their seizure for for uh resective surgery or   alternative uh intervention and so that's  kind of the first step to demonstrate that   this technology does its intended functionality  and then beyond that we will have to really commit a significant amount of resources to make  this technology uh into an implantable device   that requires qualification units and significant  investment to do a multi-stage clinical trial uh   before we can go to uh pre-market approval so the  overall journey from zero to pre-market approval   is you know depending on how efficiently it's  executed but it's on the order of you know seven   to ten years I would say so we are quite far away  but it's not because of the technology the lack of   uh technology demonstrations it's really the lack  of that kind of a funding and the opportunity to   carry this over to the next step this is uh  research and development technology and uh   there is a quite a bit that's necessary to get the  product level maturity and since we are university   we certainly appreciate the  opportunity to do this early R&D but we   do also have appetite and experience in  technology transition with the right-minded   investment uh we will uh gladly jump  on the opportunity to do this right Great and and one of the other questions at the  very other end of the spectrum is when people   when the average person including me sees a  topic like the bionic brain right yeah surely   there's part of us that thinks about people  with disease but then we also think about   you know augmented capabilities and and super  human and The Six Million Dollar Man if you're   old enough to remember that tv show and you  know true bionics is the work you're doing   specific for helping people with  disease or will it also be leveraged   for augmented capabilities or enhancing  someone with their full faculties Yeah I would say from technology point of  view just to quickly uh kind of tackle that   and then Nader can speak a lot more from the um  clinical perspective and Nanthia as well from   translational that i in my view everything starts  and ends in a clinic meaning that we first need to   really address big medical needs in order to  establish credibility and really ethically justify   implantation of technology in the human  body and once we get there and we're   really reaching desirable outcomes in the  clinical world then of course we can really   learn more about the brain and provide various  kinds of assistive options that would benefit users So I I can make a couple comments about it  I I think uh the focus of all of our work   uh is right now to help people who have some  form of disease and loss of function in life   and I don't mean loss of function like weakness  but it's loss of the ability to participate in   everyday life whether it be from Parkinson's  disease or epilepsy or dementia but it's   very easy to think about how  these devices could be extended to enhancing function and we don't have to go very  far to think about it because that's what happened   in the world of cosmetic surgeries right plastic  surgery was not um always about um or is not   only about uh cosmetics um it's to help people  who may have had injuries of other sorts and   then there's cosmetic surgery which  is meant to enhance and there has been   talk about you know what is the role of cosmetic  neurosurgery and I think we'll have to face that   uh but in our field you know  there is a lot of work in ethics   uh to try and think about that actively  and make sure that it doesn't get uh   abused but uh enhancement is is hopefully in the  future a distant future not in the near future Cool and and of the audience question so far  there's a common theme in the first several   questions right which is one ask once they  all basically hover around this question is   what are the limitations of the systems  you're building and what is the limitation   in improving them is it things  like battery life or scar tissue   or how long the system can last before you have  to replace it or is it the size do we need to   improve our understanding of the science of the  brain or the engineering and just make smaller   circuitry or surgical techniques where is the  lit limiting reagents to big leaps forward All of the above I think Nanthia mouthed that  at the same time as I said it uh it it really   is uh all of those things and um it's a great  question because it really gets to you know why   the three of us are here and speaking which is  that it's a multi-disciplinary field so I as a   neurosurgeon I'm also a neuroscientist but I as  a neurosurgeon can't advance the field by myself   I need neuroscientists like Nanthia who help us  understand the brain and how it functions but I   also need engineers like Dejan who can help design  the devices but we also need bioengineers who can   look at the the tissue interface and thinking  about the scar we need people who specialize in   powering these devices whether it's externally  powered or internally powered or Dejan I'm sure   we'll want to comment on you know harnessing  internal energies and powering devices that way  It's a hugely multi-disciplinary field and  you know part of the question really is   do we need a single device that can do everything  or do we design purpose-built devices and there's   two different strategies about that and you know  Dejan's device is somewhat not somewhat it's   very flexible and it can have many applications  whereas for example the clinical trial that I have   for brain stimulation for blindness is really  purpose-built it could be adapted for other uses   but we you know as we designed that we  really thought about well what is it   that we have to do to be able to do what  we want to do for people who are blind   and so there's different strategies but  it takes a team and not just one person Great and so so let me just ask for example  to you Dr. Suthana when you work with Dr.   Markovic and I'm not you know obviously  you're working very closely together but   and this is also a follow-up question from  the from the audience is that is it is your   understanding of the neuroscience of the brain  waiting on his ability of circuitry or is his   ability of circuitry and you know small waiting  on your understanding of of the core neuroscience um I think it's it's neither well both are waiting  for each other but in in in a way that it can be   done in parallel I think if we waited on either in  either direction we would lose out on great great   opportunities so um we really work in parallel  so you know for example with the devices that are   already existing there are many discoveries that  we've made and things that we can make with those   but yes with with the new devices we can make much  more so it's sort of you know I think it requires   constant communication and collaboration  between the two sides you know engineering   part you know development but also the  neuroscience to kind of make sure we're   you know all going in the in the direction  together as a team and inform each other if   there are things that we learn uh while we're  going forward if we if I learned something on   the neuroscience side that could prioritize  certain develop on the development on the   engineering side you know that's something  I'll tell I'll talk to the engineers about   on a you know sort of day-to-day basis  we're very close when we work together so   in fact we share a student together that we  co-mentor that works on a lot of these issues yeah And are there parts of the brain uh Dr. Markovic  had shown a thing where different pain and   different symptoms happen in the brain are there  parts of the brain occipital lobe or motor cortex   or prefrontal or whatever I'm I've said everything  I know about the brain in that question by the   way but um are there parts of the brain that  we understand better or worse or is it we're   looking at all these different areas is there an  area that might be easier to figure out or harder Who wants to take that one It's such an interesting question because there  are parts of the brain that we think we understand   more but as our technologies improve and we're  able to study the brain with greater precision   we realize that there's so  much more that we don't know   so if you look at like the frontal  lobes you know we're really involved in   emotion and psychiatric disease and and other  we there's a lot we don't know about that area   um and we feel like we know a lot more about  the motor systems like how the brain controls   movement but it turns out we still don't know  a lot about that area also so they're relative   scales but I would I guess the answer is there's a  whole lot more that we don't know than we know and   the technologies are helping us discover uh that  black box that we we haven't quite gotten into  There's also one other difference too is that some  of the behaviors let's say sensory motor behaviors   are more easily replicated in the lab or simulated  in the lab versus you know emotion and memory and   these things are harder to stimulate in the lab  which is why my lab and others are pushing to   try to understand the brain in more naturalistic  behaviors such that when we get these therapies   they're actually going to work in the person as  they're living their life and so you know with   these deep learning machine learning methods we  could start to look at very complex data during   natural naturalistic behavior that we couldn't  even tease apart you know years ago and now we   could start to look at them and and try to find  out relationships with the neural neural activity And to add to that I guess uh the other aspect  is there are areas that are easier to access   uh but you know then there are also certain  properties that are very complex and difficult   to understand like in the sensory  motor area which is uh relatively   easy to access uh and brain networks are  topographic meaning that uh neurons in the   vicinity uh do similar things and it says  coordinating in in the same outcome whereas   some of the more difficult to access areas  like the work that Nanthia is doing in memory   are non-topographic and although you know it's  first of all difficult to access and second once   you get there you realize things are very very  kind of complex and inspires and so from from   that point of view I think the accessibility  to those functionally relevant areas and the   ability to understand what's in there first of  all before we can then translate that to do some   kind of a useful intervention is is is really  the very very interesting and complex challenge And and similarly looking at  are the you know I speak from   literally personal experience a week ago  my father-in-law had a neural surgery at   spinal surgery at UCLA to fuse his discs with the  colleague of Dr. Pouratian Dr. Daniel Liu right  

and and that kind of pain pinched nerve herniated  disc in the back it's been around forever   50 years ago people had it people have it  now right and the the methods are advanced   but they're they're relatively similar whereas  diseases like Alzheimer's more people people are   living longer we're seeing more people with them  are there diseases that are better understood   and if so does that help create these kinds of  therapeutics as in because we understand the   disease or the pain better we can solve it  quicker or are those two things not related I'll let you go first So um again these are really uh great questions  because medicine makes progress sort of in two   different ways one is by luck when we don't  really understand the mechanisms or we do   something out of convenience and in other ways  in other cases we move forward because we have   you know a good understanding about um how  the brain or the body works then we develop   an intervention to get in there so you know some  of the most common medications you know aspirin   we didn't really know how it worked until um  after it was used for a long time um but getting   it back to what we do brain stimulation so the  brain stimulation that we use for Parkinson's   disease was based on a very sound theory about  how the brain is connected and where we should   put electrodes in order to treat Parkinson's  disease and it led to a very effective therapy   but at the same time you know we have other  therapies where um you know so non-invasive   stimulation trans-cranial magnetic stimulation  uh that's used for depression you know that was   a lot of work was done to show that it was  effective before we really understood much   about how it works and we still have a lot  more to do to understand how it works so   these fields have to sort of move forward  in parallel but the one warning I will give   is um you know probably about a decade ago we  went through a period in our field where you know   a well-known neurosurgeon at least amongst  neurosurgeons said there's no part of the   brain that's safe from a neurosurgeon um and uh  it was true and so we had all these trials where   everyone would say I'm gonna put an electrode  here I'm gonna put an electrode there and you   know a lot of people were implanted  with a lot of devices and we didn't   learn a whole lot and so we've put the brakes  on that sort of as a field not literally but   we've pulled back and said let's be a little bit  more methodical let's study these patients that   we implant let's learn something from everyone  that we implant so that you know we're trying   to help people while we're trying to learn and  advance the field so I think we've seen a really   important pivot that is making a huge impact  and moving us forward in the right direction interesting Is there um one of the questions that that  one of the audience members asked and and   I think comes to mind whenever we talk about  this is there's work to understand the actual   human brain and to put electrodes in it and to  give people relief from pain and all that and   then there's this other field over here that I  want to talk deep learning machine learning AI   right is that is the work there of  value to the work you do and vice versa uh Dejan we have a student shared between  us who is working on this or this challenge   and yeah it's it's very much integral I wouldn't  consider it outside of it at all I I think that   it all needs to come together in order to  make our goals happen so they're very useful   in you know the brain is complex the signals  we're recording is complex we need those tools   to parse through them in order to tell help inform  us about when is best to should deliver treatment   uh and so you know we really need  to incorporate both at the same time I would say that uh there is a lot of  interesting um parallels and inspirations uh   between technology and biology but one thing that  we really need to be cautioned is that technology   and biology have fundamentally different operating  principles and just to illustrate that you know   I like to use the analogy that in transportation  that we didn't build um airplanes by mimicking the   flapping of the wings of the birds although people  did try to build airplanes like that in the early   early days but technology solved the problem in  a way that technology does and the fundamental   difference between the computer uh and and and the  uh brain is that brain is really the root of human   intelligence is the memory and our ability to  predict uh future events based on the patterns in   the past experience where the computer just does  the mindless execution of the list of instructions   and so I think you know we need to kind of step  back and really rethink how in the brain also   because of the memory and in this whole  prediction he has ten times more tenfold   more uh feedback paths than the feed-forward  paths which is why training of neural networks   is very difficult however the the concepts  of adaptive signal processing and learning   are definitely useful in many applications since  we see even like useful technologies like natural   language processing and virtual assistants  and many other examples which can have a   specialized uh learning based type of approaches   that I think we can benefit and certainly  that applies also to brain data analytics Fascinating and you know the first one of these  sessions that I I did uh was on neural prosthetics   and there was a hand surgeon a very famous UCLA  hand surgeon whose name I don't remember now but   he's not sorry yes Dr. Azari yes yes  thank you um and he said something that   was related to a questions I just got from the  audience which is he said that we always try to   build systems that connect as close to the  affected area as in if it's for the hand we   try to work with the periphery nervous system  in the hand rather than in the brain as close   because we can get more fidelity there is that  true of your work as in is deep brain stimulation   for is the right way to address these  issues or can it be done at the periphery   if you have back pain or arm pain or  whatever can it be done at the periphery So I'll I'll take that one uh there are  multiple highways into the nervous system   and there's you know there's highways that flow  in there's highways that flow out the advantage   of going more peripheral in the nervous system so  out to the nerves is that you're letting the brain   do what it needs to do so for someone who's  an amputee you know controlling the hand well   you know the signal comes from the brain  then it goes to the spinal cord it gets   some processing spinal cord then it goes out to  the nerves if you can go out to the nerves then   you've let the brain which is much smarter  than us do everything that needs to do and   decode the signal you've got a really high signal  to noise ratio and you can do what you need to do   but there are some diseases where the the  disease is actually in the brain and so if   you go out to the periphery you may not be getting  an effective signal it's a it's a garbled signal   to begin with so um I guess the there's two  answers to your question one is it depends on   the disease it depends on what's going on and  it depends on where you can get good signals   but we can work with any signal it  turns out if we do enough analyses   if we use enough computational neuroscience  to decode it and understand how the intention   or the behavior relates to the brain signals Interesting and Dr. Suthana I'll ask you this   one from the audience uh in part because from  our last session you were very quotable and   and in part because you're being  uncharacteristically quiet today so um uh I   would love the tweet that gets out there that gets  people you know it goes live in the twitter sphere   which is what do you think of Neuralink is their  stuff a bunch of hooey or is it ever going to work Oh great thanks for that no but um you know  it's there's a lot of positives about this   uh you know the hype around Neuralink and I'd say  the positives are that you know people are paying   attention to this this field and getting excited  about it to put resources into it which that's   what really is needed to get it done I'd say you  know on the techno technology side and Dejan can   say more about that in terms of uh what they're  trying to do there's a lot of promise to it   in terms of moving the field forward and the  neuroscience behind it I I'd say their goals   are a different thing sort of in terms of  their over sort of arching goals of you know   merging our brains with a computer and so on and  so forth you know may not be necessarily realistic   but um from the technology side you know  there's definitely some promising work   there that I look forward to  seeing Dejan what do you think Yes I agree that technology has uh I would  say more of the science appeal uh the way   that it's positioned to really get  to access uh with a higher density   uh more neurons at a given time  and so on and I think there is a   great progress in the interface technology the  electrode arrays and while I have a chance now to   say at that interface brain computer brain machine  interface I would like to honor the legacy of UCLA   that is the founding place from brain computer  interface our computer science department uh uh   coined the term Professor Vidal in  1973 on that brain computer interface   defined that term and demonstrated two-dimensional  navigation of a cursor in a two-dimensional   computer space uh based on the activity of motor  neurons basically and so I think if you look   into that uh the that whole framework is a very  significant um uh in in in uh the event that is   even replicated today to a large degree and so  I think Neuralink is really kind of more in that   territory with with their technology and uh there  is a quite a bit of work to to translate that uh   into into therapeutic technology because when you  talk about therapeutic stimulation is mandatory   you just don't open brain to record and have fun  but there is a lot of development required to get   into the therapeutic space and be able to modulate  networks and be therapeutically efficacious Interesting and and there's some really great  questions coming in from the audience now thank   you audience um for these great questions so  one is when and and I'll expand on a question   that somebody asked one is when you create let's  say you could create a device and it worked and   it's solved x y z issue right and let's say it's  chronic pain or or uh anxiety or depression or   whatever these things is it eliminating uh this  is the question uh Dr. Suthana said you would   answer live is it eliminating it or is it the  tricking the brain into thinking is it curing   it or is it tricking the brain into thinking  well you don't actually feel pain anymore or you   don't actually feel fear anymore anxiety anymore What are we actually what are these devices doing   ooh that's a that's a harder question than I  thought it would be it's weird it's weird I   can't see the the Q&A unlike last time so I might  have been clicking on things without knowing what   they're asking but I'm going to stop trying  to figure out what's going on there but that's   probably why I'm quiet okay so I mean but that is  a relevant uh question regarding fear because we   are doing a clinical trial to use a device  to do closed-loop stimulation where we can   where we will try to detect when this uh you know  trigger is is happening to elicit fear that is   unwanted and and un um you know in a situation  that is safe and so you know we are we have had   two patients implanted so far that have shown  great improvement with a continuous stimulator   and now we're going into you know looking at  closed loop stimulation so you know there's   there's some evidence to suggest that this  this can be effective in I don't know if I   would say eliminating the fear because we  still need to understand how it's working   but at least you know minimizing the detrimental  impact that it has on the patient where they may   completely dissociate and freeze and you  know not be functional in their daily life   versus let's say the trigger goes off and they can  continue to interact with others they can continue   to be present and you know function whether that  person whether the experience is is you know   completely eliminated or not I mean we still we  still don't know much about how that's working but   um yeah there's some promising results going  on right now suggesting that we can it can be   effective in fear anxiety uh hate I don't  know about yet we're not testing that but Um and although if you fear and anxiety are what  drive hate right so maybe solving one of the other   uh Dr. Pouratian I I think you mark that  you were going to answer this question but   do these devices that we're talking about in this  conversation become single patient solutions or   are they is are they repeatable right when we have  a therapeutic you know today's most popular one   that we're all talking about is the COVID vaccine  which works for most people or all people or   or or pills that work for millions of people  do these devices get so custom that they're   this one's for Bob and this one's for  for Beth or are they broadly applicable   so the devices themselves are hopefully broadly  applicable uh the current devices we have for   example to treat movement disorders are you  know we use the same one in everyone but the   new technologies like the ones that Dr. Markovic  are describing while it's the same hardware it's   this it's the signals that make it customizable  it's it's the ability to actually listen to the   brain and hear what's going on in the brain that  is specific to each individual patient and allows   the device to respond to those signals to identify  when you know maybe someone's more depressed or   maybe when someone's having a seizure or when some  disease is going on that is very patient specific   that that's what makes it customizable and that's  hopefully what we think will make these therapies   even more effective so it's building out what Dr.  Suthana just described so we have a generalized  

platform that is then custom customizable  and can learn and adapt to the individual   um patient there's one other question that's sort  of related to this and it's an interesting one if   I can comment on it is you know it doesn't matter  how much how does the brain treat these devices   you know from a physiological standpoint it's a  really interesting question um because you know if   you think about how we use a hammer you know when  you hold a hammer it turns out your brain almost   internalizes that hammer becomes an extension  of your body um and when we use these devices   you know we're very fixated when we start on  you know restoring normal brain function but   the brain is much smarter than we are and  sometimes all you need to do is give the   brain a helping hand and it will learn how to  use those devices in a way that's meaningful   to the person to the patient to their experience  to their life and it may not be life as we know it   but it can still provide a significant benefit and  improvement for someone so um we do we can't just   think about how we can change the brain but we  also need to think about how the brain interacts   with the device once it starts uh interact once it  starts stimulating it so it's a fascinating area  And I have a that's a just on that point I have  a related question that I think is for you or for   Dr. Suthana um and I'll take my own experience  I I had a micro discectomy when I was 43 I'm   sadly I'm 51 now but and after that surgery my  pain mostly went away but then it came back and   my wife who's a physician said what doctors say to  patients all the time get outside do some exercise   do physical therapy and and it really helped and  I thought there's no way this can work the same   way a surgery can or a pill can but guess what  it does right and that ties to a question about   non-invasive techniques right is doctors are more  and more understanding everyone should be mobile   no matter where what your pain level is be  more active be more mobile get more fresh   air see more green look at the ocean for all  the many of these issues right are those things   things that you look at as part of an overall  patient improvement are you focused strictly on   the electronics and chemistry where you can  affect a treatment and those are parts of the   broader medical wellness  domain that you don't look at I'll take a quick stab at that um  because it's something that's been   a sort of I guess a breakthrough in my own  thinking and I think you're absolutely right it   it's these devices are not necessarily therapeutic  in and of themselves uh so um you know someone has   high blood pressure the doctor doesn't just give a  medicine and say you know that's it but they tell   you to go exercise same thing you know this is  the experience I got from our clinical trial for   uh blindness we realize you know we don't  we're not just trying to give people some   kind of vision back but we need to have them go  live with this device they need to experience it   they need to have visual rehabilitation  learn how to use it and learn how to   adapt their life to this new implant that  they've had and so I'm a very strong believer   that all of these therapies do not  stand alone they're part of again this   theme of multi-disciplinary care so we have the  multidisciplinary team that's creating the devices   but then we have you know the neurosurgeons who  put it in the neurologists who helped manage it   the psychiatrist who helped manage it the  rehabilitation doctors who get people out   there it's it's really it's not a stand-alone  device it's that care is really critical  So and and so it's like the rest of healthcare  really where everything has to work to work   together right you need the physical therapist  and the mental health person and the prime all   these things working together which is which  is what I which is really interesting and and   reassuring in some ways I'm going to ask a very  specific question a a audience member asked   um which is can can the solutions you're working  on help a child who has suffered a left MCA   stroke I don't actually know what MCA  stands for in this case but you probably do   and the related issues such as seizures and  language processing delays visual processing   can this help you know we all want to help  children more than anything can this be   useful for a child or are we farther away from  further away from that than we'd like to be So for better or worse I think a lot of the  technologies that we are focusing on now um   are developing these technologies for groups   for larger groups more what we'd call  homogeneous groups so for example again   people with Parkinson's disease or people with  blindness when we start getting into more specific   groups like a a child that has a left MCA stroke  which is a specific territory of the brain that's   had a stroke it's harder to develop a specific  technology for that or interventions for that   um because there aren't that many people  who have that specific condition now it   doesn't mean that devices can't eventually  be used or adapted for those applications   and we're hopeful that again using a device  like what Dejan is designing that it is   all purpose enough that it can be  adapted to those other applications but   I don't think right now we have uh any active  uh clinical trials or specific applications  And a follow-up question to that  Dr. Suthana is our understanding   of the brain better in adults or  children or does it not matter Uh you know I mean I think in this particular  field a lot of the work we're doing is in   adults because of the additional risks you  know of course with surgery but we do have a   a study working with pediatric epilepsy patients  who do get electrodes implanted and you know we've   been discussing a potential clinical trial  for adolescent-related psychiatric disorders   so it's something that I think will come down the  line uh and follow the adult uh trials which are   obviously more prevalent right  now so I I wouldn't say it's   it you know it's not an area that we'll we'll  move into I think that it will come but you know   we want to make sure that of course the safety and  ethical considerations are well thought out there Right um so we're look we have about eight  minutes left and I want to have time for wind   up I'm going to ask a couple quick questions um  there are a bunch of audience ones I'll try to   run through them but a couple  quick ones to start off with   people are hearing this and people are  asking will this be available and recorded   and how can someone be a participant in a trial  and how do I get more involved this is so cool and   how do people get involved how do people  connect with UCLA about this incredible   work that that all of you are doing what is  the best way give 20 seconds from each of you  For us we have a website on my lab  website we have a   link to the PTSD clinical trial MCI also  one for mild cognitive impairment using   a non-invasive methodology there was a question  about non-invasive technologies which I can make   a comment if there's time uh and also clinical  trials oh go ahead on that one okay um I was just   gonna say you know for certain disorders it may  they may be effective these non-invasive therapies   in fact it's approved you know for depression  uh but you know it's tough because those those   those uh interventions require a person to go and  get treatment it's not being carried with them   constantly like a in implanted electrode would  so the effectiveness it can wear off they'd have   to go get treatments again and for disorders that  are involving deep brain areas like fear anxiety   memory Alzheimer's related PTSD those non-invasive  methods cannot reach those deep brain areas and so   you know for those that don't respond you know  they may come to us for um consideration of an   implanted electrode where they can carry that's  with them continuously and will work basically   moment to moment as they go forward like in the  case of epilepsy or PTSD when you don't know when   it can happen at any time that the seizure or  the trigger right and you want it you want your   therapy to be ready to deal with it so as far  as the clinical trial for PTSD it's open for   recruitment they can email me my emails on what  on google or on our website and   I ( also has a list  of all these clinical trials that are going on

cool and Dr. Markovic or Dr. Pouratian Um same here um we have uh our  information mostly uh available through   um internet and I'm just going to type here my  email uh for everybody feel free to reach out   we also have a lot of other related technologies  at least in my group I look into development of   technologies that globally benefit society I've  got technologies in the technology domain and   consumer applications and besides the neurotech  there is also associated technologies uh   for miniaturized uh intravascular cardiac  pacemakers and similar where a lot of these   miniaturization and advanced wireless power and  data techniques can really advance the quality   of care and you know data analytics is there as  well so a lot of techniques and I'm always happy   to hear new ideas and engage with those who  are interested so feel free to email with any   questions or ideas uh always appreciate that great Dr. Pouratian  I don't know if I have too much to add but yeah  lab websites and UCLA also has   a directory of all uh active clinical trials  that people can uh inquire about as well well Look I'm gonna make a comment to the audience that  I think is is really really important um this last   week we landed uh the the very very famously  the Perseverance Rover on Mars right with this   complex thing in a planet 40 million miles  away rotating it's incredible right and yet   the problem facing us right here at home is  a silver tsunami right 50 million Americans   will be living into their 90s is estimated the  next couple decades right people are getting older   they're living longer Alzheimer's dementia anxiety  depression chronic pain these are real things and   the cost is a trillion dollars now imagine what  it will be the other way to get involved is   obviously money right the money is if you ask any  of these scientists I guarantee they'll tell you   money is what is holding them up  more than anything else because   Neuralink can make a lot of noise and when you're  one of the richest people in the world you can do   things in a university setting that's advancing  basic science there has to be funding sources   and I think that's another interesting way to to  get involved um I will go for a last um I'm going   to ask one or two very quick audience questions  because uh Brian Kohler and I wouldn't say an   audience member's name out loud but he actually  works with me at Heal so I'm gonna ask a very   quick question he asked and then I'm gonna ask you  each for a closing comment um the brain learns how   to use the devices does that mean if we were able  to connect a device that can detect light outside   the physical visible spectrum that a person would  be able to see ultraviolet or infrared light   is that is that an example of what you mean Yes yes so for example the device that we use  has a camera that sees right now it's set for   visible light but we've talked about whether  the camera could use heat detection or could   use ultraviolet light so um and we've even heard  from people who do stuff for the military you   know could we use these devices in our soldiers  to help them detect things on the battlefield   so yes there are opportunities to give I guess  you can call super human powers uh to uh people Great okay closing comment Dr. Markovic Closing comment I think this is a very exciting  area that I believe there is a tremendous   opportunity given how outdated technology is  in medicine we do everything we can to advance   consumer applications and every year we have  new toys and gadgets and surprisingly we do   very little in comparison for health care and so  I think we see I see a great opportunity there   and like you mentioned there is a different uh  mechanism and the need for for uh developing and   scaling this up so I'm happy to uh engage in those  discussions and overall I think it's uh you know   great place where we are we can never get this  soon enough considering how many people need it   uh so I hope that there would be um  significant uh interest and uh um you know   support uh from the community  at large to pursue these ideas Great uh Dr. Pouratian in about 15-20 seconds I think it's a really exciting time I want to  add one more thing we haven't talked about safety   there's a huge emphasis on the safety  of these products and I think there's   um you know that's what keeps people away from  them but I want people to be reassured that   just as much as we're excited about how much it  can help we're making sure that these devices   are developed in a way that are safe and that  people will want to participate in these trials Great thank you and Dr. Suthana

Oh what can I add to that I agree very  exciting time it's changing very fast   when I was in grad school all of this work  pretty much didn't exist so everything we're   doing is brand new and I love that about  the field and also very exciting to see   multiple fields kind of come together so  you know chemists biologists engineers   clinicians all coming together to make this happen  and it's very exciting so thanks for having us Well it's a perfect segue to my last comment thank  you everyone thank you to Dr. Suthana Markovich   and Pouratian thank you to UCLA thank you to  everyone who attended I'll just say when I was in   grad school okay which is long before Dr. Suthana  Dr. Samueli was a professor at UCLA that went and   started a company called Broadcom and now the  school of engineering is named after him um and   David Geffen was a guy who liked to hang out with  some musicians in this thing called rap that very   few people had heard of back then and today the  school of medicine is named after him so each and   every one of us each and every person listening  and at UCLA and a student we all have a role to   play and don't ever limit yourself by where you  are now because look at where people can go when   we put our heads together and work together uh  thank you so much everyone thank you for attending   on behalf of UCLA and the scientists it's been a  thrill to do all of these and good night everybody

2021-04-19 18:59

Show Video

Other news