Bionic Human Series, Part 4 - How Close Are We to the Bionic Brain?
Hello everyone I'm Nick Desai I'm the founder of a company here in Southern California called Heal you may have heard about heal.com 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deep brain probes with only four to eight electrode contacts which gives you continent-level access of the brain these outdated devices focus on single targets and have no way of adjusting stimulation dosing without going to see a doctor every couple of months and the problem here is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 suthanalab.com 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 clinicaltrials.um I believe.gov (clinicaltrials.gov) 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 clinicaltrials.gov 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
