Transcript: Deep Brain Stimulation for Alzheimer's | Mar 04, 2020

Steve sits in the studio. He's slim, clean-shaven, in his fifties, with short curly brown hair. He's wearing a gray suit, white shirt, and spotted purple tie.

A caption on screen reads "@spaikin, @theagenda."

Steve says HERE'S SOMETHING THAT SOUNDS IMPOSSIBLE: NON-INVASIVE BRAIN SURGERY. OR, PERHAPS MORE FAR-FETCHED, HOW ABOUT BRAIN IMPLANTS THAT CAN RESTORE MEMORIES LOST TO THOSE WITH ALZHEIMER'S DISEASE. UNBELIEVABLE, AND YET BEING PIONEERED RIGHT HERE IN THE PROVINCE OF ONTARIO, THANKS TO DR. ANDRES LOZANO. HE IS A NEUROSURGEON AT UNIVERSITY HEALTH NETWORK'S KREMBIL NEUROSCIENCE CENTRE AND THE DAN FAMILY CHAIR IN NEUROSURGERY AT U OF T, AND WE WELCOME HIM TO EXPLAIN HOW SUCH THINGS CAN ACTUALLY BE POSSIBLE.

Andres is in his late fifties, clean-shaven, with short salt and pepper hair. He's wearing glasses, a blue suit, white shirt and pale blue tie.

Steve continues SO NICE TO MEET YOU.

Andres says GREAT TO BE HERE. THANK YOU.

Steve says LET'S START WITH JUST A BASIC DEFINITION, DEEP BRAIN STIMULATION IS WHAT YOU'RE INTO. WHAT IS THAT?

The caption changes to "Andres Lozano. University of Toronto."
Then, it changes again to "Healing Power of Electrodes."

Andres says IT IS IMPLANTING ELECTRODES IN THE BRAIN TO BE ABLE TO DELIVER ELECTRIC CURRENTS ON AN ONGOING BASIS, TO BE ABLE TO ADJUST THE ACTIVITY OF THE BRAIN USING ELECTRICITY.

Steve says WE'RE GOING TO BRING A PICTURE UP HERE AND FOR THOSE WHO ARE LISTENING ON PODCAST, I'M GOING TO ASK YOU TO SORT OF DESCRIBE WHAT'S IN THE PICTURE AND THE SIGNIFICANCE THEREOF. HERE WE GO.

A picture shows a person in profile, with a cross-section of their open head revealing their brain in hues of blue and a specific area in the middle of the brain painted purple, where a metal pin is inserted, connected to a cable that travels outside of the skull and connects to a small electronic device.

Andres says SO WHAT WE HAVE IS... WE DRILL A HOLE ABOUT THE SIZE OF A DIME IN THE SKULL, AND THROUGH THAT HOLE WE IMPLANT AN ELECTRODE. THE ELECTRODE IS ROUGHLY THE SIZE OF A STRAND OF SPAGHETTI, AND THAT ELECTRODE THEN RESTS PERMANENTLY IN THE BRAIN AND IT IS CONNECTED THROUGH AN EXTENSION CABLE THAT RUNS UNDERNEATH THE SKIN TO A BATTERY PACK OR A PACEMAKER THAT IS USUALLY UNDERNEATH THE COLLARBONE. AND SO WITH THIS BATTERY, YOU ARE ABLE TO DELIVER ELECTRICAL CURRENT TO ANY PART OF THE BRAIN...

Steve says TO WHAT END?

Andres says TO CHANGE THE ACTIVITY OF THAT PART OF THE BRAIN. SO IN SOME CASES, AREAS OF THE BRAIN ARE UNDERPERFORMING AND WE'RE ABLE TO RAMP UP THEIR ACTIVITY. IN OTHER CASES, THEY ARE OVERACTIVE, SO WE'RE ABLE TO SHUT DOWN OR DIMINISH THEIR ACTIVITY, VERY MUCH LIKE A DERMA SWITCH IN THE BRAIN. WE'RE ABLE TO TURN AREAS OF THE BRAIN UP OR DOWN USING ELECTRICAL CURRENTS.

Steve says YOU'VE ACTUALLY BROUGHT SOME EXAMPLES OF THESE THINGS HERE. WE'RE GOING TO FRUSTRATE PEOPLE AGAIN LISTENING ON PODCAST BECAUSE THEY'RE NOT GOING TO BE ABLE TO SEE THEM. LET'S DO A SHOW AND TELL. CAN YOU TELL US WHAT YOU'VE GOT HERE?

Andres picks up a flexible, thin metal pole and says THIS IS THE ACTUAL ELECTRODE THAT GETS IMPLANTED INTO THE BRAIN, AND IT IS ROUGHLY THE SIZE OF A STRAND OF SPAGHETTI, LIKE I SAID, AND IT HAS MULTIPLE CONTACTS AND WE'RE ABLE TO PLACE THIS ANYWHERE IN THE BRAIN, BUT OF COURSE WHERE YOU PUT IT IS CRUCIAL. THE THREE MOST IMPORTANT THINGS IN BRAIN SURGERY ARE LIKE REAL ESTATE, LOCATION, LOCATION, LOCATION. AND REALLY MAKING AN ERROR OF 1 MILLIMETRE CAN BE THE DIFFERENCE BETWEEN HAVING A SUCCESS AND A FAILURE.

Steve says WHAT'S THAT MADE OUT OF?

Andres says SO THIS IS MADE OUT OF PLATINUM IRIDIUM METAL AND A PLASTIC SLEEVE. SO THIS GOES INTO THE BRAIN AND IT STAYS THERE FOREVER, IT STAYS THERE FOR DECADES. AND THROUGH THIS ELECTRODE, WE HOOK IT UP TO A BATTERY, THAT LOOKS SOMETHING LIKE THIS.

He picks up a small square device and says THIS GETS IMPLANTED UNDERNEATH YOUR COLLARBONE, UNDER THE SKIN, AND THIS THEN POWERS THE ELECTRICAL CURRENT. WE CAN DELIVER ELECTRICAL IMPULSES TO THE BRAIN 24 HOURS A DAY. THESE BATTERIES LAST ABOUT FIVE YEARS AND THEN THEY HAVE TO BE CHANGED. WE ALSO HAVE RECHARGEABLE BATTERIES NOW SO THAT THE PATIENTS CAN RECHARGE AND THEY LAST FOR 25 YEARS.

Steve says DOES IT FEEL AT ALL UNCOMFORTABLE TO HAVE THIS UNDER THE SKIN?

Andres says NOT REALLY. IT'S VERY SIMILAR TO A CARDIAC PACEMAKER. AND HUNDREDS OF THOUSANDS OF PEOPLE HAVE THOSE. AND SO FAR THIS DEEP BRAIN STIMULATION SYSTEM HAS BEEN IMPLANTED IN ABOUT 200,000 PATIENTS IN THE WORLD, MOSTLY FOR PARKINSON'S DISEASE.

Steve says WHAT ELSE HAVE YOU GOT THERE?

Andres picks up a small handheld controller and says THIS IS IT. THIS IS THE ENTIRE SYSTEM. THIS IS THE CONTROLLER. SO YOU CAN CONTROL HOW MUCH ELECTRICITY IS DELIVERED AND YOU CAN SWITCH CHANNELS IF YOU LIKE, VERY MUCH LIKE... THINK OF IT AS A RADIO STATION.

Steve says CAN YOU HOLD IT UP THERE?

Andres says YOU CAN TURN THINGS UP AND DOWN, SO YOU CAN CHOOSE THE CONTACT AND YOU CAN TURN IT UP AND DOWN TO TURN AREAS OF THE BRAIN ON OR OFF, TURN THEM UP OR DOWN TO REGULATE THEIR ACTIVITY.

Steve says AGAIN, FOR THOSE LISTENING, THAT LOOKS LIKE A TYPICAL REMOTE CONTROL YOU'D USE FOR A TELEVISION SET.

Andres says EXACTLY. THAT'S THE IDEA. WE CAN IMPLANT THESE ELECTRODES ANYWHERE IN THE BRAIN AND WE CAN TURN UP AREAS THAT ARE UNDERPERFORMING OR TURN DOWN AREAS THAT ARE EXCESSIVELY ACTIVE.

The caption changes to "Connect with us: Twitter: @theagenda; Facebook, agendaconnect@tvo.org, Instagram."

Steve says DON'T TAKE THIS THE WRONG WAY, BUT THAT STUFF DOESN'T LOOK ALL THAT FANCY, YOU KNOW WHAT I'M SAYING? I'M SURE THERE'S MILLIONS OF DOLLARS OF RESEARCH THAT WENT INTO MAKING THEM HAPPEN BUT YOUR LITTLE PIECE OF SPAGHETTI THERE JUST LOOKS LIKE ANY OTHER WIRE.

Andres says IT IS EXACTLY THAT. WE HAVE A WAY OF GETTING ACCESS TO THE BRAIN AND DELIVERING ELECTRICAL CURRENT. AND THIS IS THE CURRENT STATE OF AFFAIRS. THIS IS SOMETHING THAT WILL BE PRIMITIVE IN THE NEXT 20 OR 30 YEARS, BUT TODAY, THIS IS THE RESULT OF 30 OR 40 YEARS OF WORK AND THIS IS WHERE WE ARE NOW.

Steve says WHERE DID THE NOTION OF DOING THIS KIND OF BRAIN STIMULATION COME FROM IN THE FIRST PLACE, THAT IF YOU DID THIS, YOU MIGHT ACTUALLY BE ABLE TO MAKE SOME PROGRESS ON ALZHEIMER'S OR PARKINSON'S OR WHATEVER?

Andres says IT GOES BACK TO PEOPLE LIKE DR. PENFIELD WHO WAS STIMULATING THE BRAIN AND PRODUCING MEMORIES IN THE BRAIN, AND SO THE IDEA WAS, DURING SURGERY AND THE BRAIN IS EXPOSED, YOU CAN APPLY ELECTRICAL CURRENT, AND IN DOING SO, THAT BRAIN REVEALS ITSELF TO YOU. IT REVEALS ITS FUNCTIONS. IN THE CASE OF DR. PENFIELD, HE WAS ABLE TO ELICIT SOME VIVID MEMORIES. SO THE SAME PRINCIPLE. WE CAN MAP OUT THE ENTIRE AREAS OF THE BRAIN BY APPLYING ELECTRICAL CURRENT AND THEY TELL US WHAT THEY DO. IN SOME CASES THEY PROVOKE A MOVEMENT, A SENSATION, A VISION, OR A MEMORY. THAT'S DONE ACUTELY. NOW WE HAVE THE ABILITY TO DO IT NOT JUST DURING SURGERY BUT WE CAN DO IT 24-7 BECAUSE WE CAN IMPLANT THESE PERMANENT ELECTRODES THAT STIMULATE ON AN ONGOING BASIS.

Steve says I'M GOING TO ASK OUR DIRECTOR, SHELDON OSMOND, IF YOU WOULD, SHELDON, I'M IN THE MIDDLE OF PAGE 2. THE THREE-SHOT.

A picture with three brain scan images appears on screen. The one on the left shows a brain lit up in hues of red, teal and blue, and reads "Normal." The one in the middle shows a black area in the middle and reads "Mild cognitive impairment." The one on the right has almost no blue areas and a large black area and reads "Alzheimer's disease."

Steve continues THERE IT IS RIGHT THERE. DOCTOR, CAN YOU TAKE US THROUGH THIS? AND FOR PEOPLE LISTENING ON PODCAST, WE HAVE GOT THREE SHOTS OF ESSENTIALLY THE BRAIN. ONE NORMAL. ONE SHOWING MILD COGNITIVE IMPAIRMENT. AND ONE WITH FULL-BLOWN ALZHEIMER'S. CAN YOU SORT OF EXPLAIN THE DIFFERENCE AMONG THESE THREE SHOTS THAT WE'RE LOOKING AT RIGHT NOW?

Andres says WELL, THE FUNDAMENTAL PROBLEM IN ALZHEIMER'S DISEASE IS THAT THERE ARE AREAS OF THE BRAIN THAT ARE MALFUNCTIONING AND IN FACT THEY ARE DIMMING AND SHUTTING DOWN. AND WE CAN TELL THIS BECAUSE THE BRAIN USES GLUCOSE AS A FUEL, AND WE CAN MEASURE HOW MUCH GLUCOSE OR FUEL THE BRAIN IS USING. UNDER NORMAL CIRCUMSTANCES, THE ENTIRE BRAIN USES GLUCOSE AND THE AREAS IN RED REPRESENT THE NORMAL AMOUNTS OF GLUCOSE IN A NORMAL INDIVIDUAL. AS YOU DEVELOP MILD COGNITIVE IMPAIRMENT, WHICH IS A PRECURSOR, A STEP TOWARDS ALZHEIMER'S, AND THEN FINALLY TO FULL-BLOWN ALZHEIMER'S, THERE ARE AREAS OF THE BRAIN THAT CHANGE IN THAT THEY NO LONGER USE GLUCOSE, AND THEY ARE SEEN AS THE AREAS THAT TURN PROGRESSIVELY BLUE.

Steve says THE SHOT ON THE LEFT LOOKS ALL NICE AND COLOURFUL. AND THE THIRD ONE IS... I MEAN, IT'S ALMOST ALL BLACK.

Andres says IT'S ALMOST ALL BLACK. WHAT WE'RE REALLY LOOKING AT IS THE OUTER RIBBON OF THE BRAIN WHERE WE SEE, IN CONTRAST TO THE NORMAL, IT'S FULLY RED ALL AROUND, BUT IN ALZHEIMER'S DISEASE, IT IS GETTING BLUE. AND THAT INDICATES THAT THOSE AREAS OF THE BRAIN ARE USING LESS AND LESS GLUCOSE. AND AS THE ILLNESS PROGRESSES, THE ENTIRE BRAIN WOULD TURN BLUE BECAUSE THERE WOULD BE A PROGRESSIVE SHUTDOWN OF MORE AND MORE AREAS. SO BASICALLY THE AREAS OF THE BRAIN ARE NO LONGER ACTIVE. THE ACTIVITY IS DOWN. IT'S AS IF THE LIGHTS WERE OUT AND THESE AREAS OF THE BRAIN... IN THESE AREAS OF THE BRAIN, AND AS THE ILLNESS PROGRESSES, MORE AND MORE AREAS OF THE BRAIN SHUTS DOWN, AND AS THE ILLNESS PROGRESSES, MORE AND MORE PROBLEMS ARISE WITH YOUR MEMORY, COGNITIVE FUNCTION, LANGUAGE, ET CETERA.

Steve says THOSE THREE SHOTS WE SAW, WERE THOSE PICTURES TAKEN WITH AN MRI?

Andres says THEY WERE TAKEN WITH A PET SCAN.

Steve says THE NEXT GENERATION UP.

Andres says THEY WERE TAKEN WITH RADIOACTIVE GLUCOSE. IF YOU'RE USING A NORMAL AMOUNT, YOUR BRAIN IS RED. AND IF NOT, YOUR BRAIN IS BLUE. THE PROBLEM WITH ALZHEIMER'S IS THERE IS LESS AND LESS GLUCOSE BEING USED SO THE BRAIN IS NOT BURNING ANY FUEL. THE BRAIN IS NOT ACTIVE. SO WHAT WE WANT TO DO IS, CAN WE TURN THOSE AREAS OF THE BRAIN BACK ON? CAN WE USE ELECTRICITY TO TURN THE LIGHTS BACK ON IN THOSE AREAS OF THE BRAIN THAT ARE DIMMING AND ARE BROWNING OUT AND IN FACT SHUTTING DOWN?

Steve says WHAT'S THE ANSWER TO THAT QUESTION SO FAR?

Andres says THE ANSWER IS PROBABLY.

Steve says PROBABLY. WHICH IS BETTER THAN MAYBE. WHY ARE WE AT "PROBABLY" TODAY?

Andres says BECAUSE WE HAVE NOW OPERATED ON ABOUT 50 PATIENTS WITH ALZHEIMER'S DISEASE TO STIMULATE AREAS OF THE BRAIN, AND WE KNOW THAT IN MANY OF THESE PATIENTS, WE ARE ABLE TO TURN THESE AREAS BACK ON. SO THE MESSAGE IS IN ALZHEIMER'S, THE LIGHTS ARE OUT IN SOME PARTS OF THE BRAIN, BUT THERE IS SOMEONE HOME AND WE CAN ACTUALLY TURN THESE AREAS BACK ON. AND THE HOPE IS WHEN WE TURN THESE AREAS BACK ON, WHEN THEY USE GLUCOSE ONCE AGAIN, THEIR FUNCTIONS WILL RETURN.

Steve says WE GOT A CLIP OF THIS, ACTUALLY. DR. SUZUKI DID A DOCUMENTARY ABOUT THIS AND WE HAVE A CLIP WE WANT TO SHARE WITH PEOPLE RIGHT NOW. I GUESS THIS IS ABOUT 6 YEARS AGO. IS THIS YOU DOING DEEP BRAIN STIMULATION?

Andres says IT IS. IT'S IN THE OPERATING ROOM WITH A LADY CALLED MYRA.

Steve says SHELDON, IF YOU WOULD? LET'S ROLL THIS CLIP.

A clip plays on screen with the caption "Untangling Alzheimer's. 2013."
In the clip, Andres stands inside an operating room with sophisticated machines. A woman lies on an operating table, awake, with plastics concealing the back of her head.

Andres says MYRA, WE'RE GOING TO TURN THE MACHINE ON. YOU TELL US IF YOU FEEL ANYTHING, OKAY?

Myra says OKAY. IT LOOKS LIKE THERE'S A GROUP OF PEOPLE.

Andres says RIGHT. THERE'S SOME PEOPLE?

Myra says I BELIEVE THAT THEY'RE PEOPLE, BUT I CAN'T SAY FOR SURE.

Andres says ANYBODY YOU RECOGNIZE?

Myra says UM... WELL, IT'S HARD TO TELL.

Andres says HARD TO TELL.

Myra says YEAH.

Andres says IS THIS LIKE A NEW SCENE OR IS IT A SCENE FROM YOUR PAST?

Myra says I WOULD... OH, JEEPERS.

Andres says IS IT SOMETHING YOU'VE SEEN BEFORE OR IS IT SOMETHING BRAND NEW?

Myra says UH... MAYBE...

Andres says ARE YOU FEELING WARM...

A male voice says WITH A FEW MORE VOLTS APPLIED, REMARKABLY, THE DETAILS OF THE IMAGE GET SHARPER.

Myra says WE'VE LIVED IN THIS PALATIAL PLACE IN SCOTLAND WHERE...

The voice says FROM DEEP WITHIN MOIRA'S BRAIN, A CHILDHOOD MEMORY SURFACES.

Myra says WE JUST HAD ALL KINDS OF PARKLAND TO RUN AROUND IN...

Andres says THAT JUST CAME INTO YOUR MIND NOW?

Andres says WHEN I SAW THAT, BECAUSE THE WAY THAT THE PICTURE IS...

Andres says RIGHT.

Myra says IT'S GROUPED.

Andres says OKAY.

Myra says AND I'M PRETTY SURE IT'S A GROUPING OF MY SISTER AND MY BROTHER.

The clip ends.

The caption changes to "Turning the lights back on."

Steve says NOW, LET'S JUST, SHELDON, GO TO THE NEXT PAGE AND SHOW THE NEXT SHOT, BECAUSE WHAT SHE JUST DESCRIBED, WE HAVE PICTURES OF THAT AS WELL. DO YOU WANT TO TAKE US THROUGH THAT TRYPTIC.

Three drawings appear on screen. The one on the left shows a man standing outside a house. The next one shows the same image, adding a slide. The third image contains all the elements but is set at night, with the man holding a flashlight.

Andres says TO TEST WHETHER WE'RE IN THE RIGHT LOCATION, WE APPLY ELECTRICAL CURRENT IN THIS MEMORY AREA IN THE BRAIN. ONE OF THE REMARKABLE THINGS WE FOUND IS THE PATIENTS HAVE VIVID MEMORIES OF EVENTS IN THEIR PAST, AND DEPENDING ON HOW MUCH CURRENT WE APPLY, THE DETAILS AND THE VIVIDNESS OF THE RECOLLECTION CAN BE INCREASED. AND SO WHEN YOU APPLY A LOW AMOUNT OF CURRENT, AS IN THIS CASE, THIS PARTICULAR PATIENT IN THE OPERATING ROOM AT A LOW CURRENT FELT HE WAS OUTSIDE, WASN'T ENTIRELY CLEAR WHY HE WAS OUTSIDE HIS HOUSE. WE INCREASED THE CURRENT A LITTLE BIT, AND THEN HE SEES, A HA, HE'S LOOKING FOR HIS SON THAT'S PLAYING OUTSIDE HIS HOUSE. AND WE INCREASE THE CURRENT EVEN MORE, AND NOW THE FULL DETAILS OF THE SCENE. IT'S NIGHTTIME. HE'S LOOKING FOR HIS SON WITH THE FLASHLIGHT. IT'S ACTUALLY HALLOWEEN. THERE ARE LANTERNS. SO YOU GET A VERY RICH EXPERIENCE. SO THERE'S A DOSE RESPONSIVENESS WHERE THE MORE CURRENT WE PUT INTO THE CIRCUIT, THE MORE VIVID THE RECOLLECTION OF THE SCENES CAN BE.

Steve says PRESUMABLY THERE IS AN AMOUNT OF CURRENT BEYOND WHICH YOU CAN'T GO.

Andres says THAT'S RIGHT. THERE'S A LIMIT AND WE DON'T WANT TO CAUSE ANY DAMAGE EITHER. SO THERE IS A LIMIT TO HOW HIGH WE CAN GO. IT'S INTERESTING, WITH MOIRA, THAT WE ASKED HER ABOUT THE SCENE, AND SHE RECOLLECTED... MOIRA WAS 65 AND WE ASKED HER... SHE SAID SHE WAS WITH HER BROTHERS AND SISTERS IN SCOTLAND WHEN SHE WAS 8. AND I ASKED HER SUBSEQUENTLY, WHEN'S THE LAST TIME YOU THOUGHT ABOUT THAT SCENE WITH YOUR BROTHERS AND SISTERS? AND SHE HAD NEVER THOUGHT ABOUT IT SINCE AGE 8. SO SOMEHOW THAT MEMORY WAS LOCKED IN HER BRAIN TO BE REDISCOVERED WHEN WE APPLIED ELECTRICITY TO HER MEMORY CIRCUITS.

Steve says HOW MUCH SUCCESS CAN YOU REPLICATE THAT SCENARIO WITH?

Andres says WELL, WE ARE ABLE TO ELICIT THESE VIVID MEMORIES IN ABOUT HALF OF THE PATIENTS. OUR GOAL IS NOT TO ELICIT OLD MEMORIES. THAT'S NOT OUR OBJECTIVE. OUR OBJECTIVE IS TO PUT THE BRAKES ON THE DEVELOPMENT OF ALZHEIMER'S DISEASE. ALL HAVE MILD ALZHEIMER'S DISEASE. WE HAVE EVIDENCE WE MAY BE ABLE TO SUSTAIN AND DRIVE THESE CIRCUITS AND SLOW DOWN THE PROGRESSION OF THE ILLNESS. THAT'S REALLY OUR ULTIMATE GOAL, IS CAN WE DEVELOP A THERAPY THAT IS SAFE AND MAY PROTECT PEOPLE FROM DETERIORATING WITH THEIR ALZHEIMER'S DISEASE.

Steve says LET ME TAKE YOU BACK TO THE THING WE WERE TALKING ABOUT JUST A LITTLE BIT EARLIER, THE PET SCAN. IS THERE A WAY TO DIAGNOSE ALZHEIMER'S WITHOUT USING THESE PET SCANNERS WHICH ARE OF COURSE INCREDIBLY EXPENSIVE AND RATHER RARE IN THE PROVINCE?

The caption changes to "Watch us anytime: tvo.org, Twitter: @theagenda, Facebook Live, YouTube."

Andres says THE BEST WAY OF DIAGNOSING ALZHEIMER'S IS BY AUTOPSY, UNFORTUNATELY. SO THE CLINICAL... THE BEST NEUROLOGISTS ARE WRONG ABOUT A THIRD OF THE TIME. SO WHEN WE SEE A COMBINATION OF MEMORY IMPAIRMENT, WHEN WE SEE THAT THE BRAIN IS SHRINKING, WHEN WE SEE THAT THERE'S LESS GLUCOSE BEING USED IN THE BRAIN AND WE SEE THE ACCUMULATION OF SPECIFIC PROTEINS, THEN WE ARE QUITE CERTAIN THAT THE DIAGNOSIS IS ALZHEIMER'S. THAT'S ONE OF THE CHALLENGES, IS HOW DO WE TAKE DEMENTIA, AN ILLNESS THAT WAS CHARACTERIZED BY... ACROSS MANY SPHERES AND CAN WE SUB CLASSIFY IT INTO ALZHEIMER'S DISEASE VERSUS MANY OF THE OTHER CAUSES OF DEMENTIA.

Steve says DEMENTIA IS A WHOLE BUNCH OF DIFFERENT KINDS OF...

Andres says DEMENTIA MEANS YOU HAVE A COGNITIVE IMPAIRMENT AND ALZHEIMER'S IS THE MOST COMMON CAUSE OF IT BUT IT IS ONLY ONE CAUSE.

Steve says PRESUMABLY YOU COULD BE DOING A LOT MORE OF THIS IF YOU HAD MORE BUDGET, RIGHT? THAT'S ONE OF THE BOTTOM LINES HERE.

Andres says WELL, YOU KNOW, RIGHT NOW WE ARE IN A RESEARCH STUDY. SO WE HAVE DESIGNED A CLINICAL TRIAL WHERE WE WILL OPERATE ON 150 PATIENTS WITH ALZHEIMER'S DISEASE THAT HAVE MILD ALZHEIMER'S DISEASE THAT ARE TAKING THEIR MEDICATIONS AND THESE PATIENTS WILL BE IMPLANTED WITH THESE ELECTRODES, AND IN HALF OF THEM, WE WILL NOT TURN ON THE ELECTRODES FOR A YEAR, AND IN THE OTHER HALF WE WILL TURN THEM ON RIGHT AWAY. THIS IS BECAUSE WE NEED A CONTROL GROUP. SO AFTER A YEAR, WE WILL KNOW WHETHER THE PATIENTS THAT HAD THE ELECTRICITY ARE DOING BETTER, WHETHER WE'VE BEEN ABLE TO PUT THE BRAKES ON THE ILLNESS. AND SO THIS IS WHERE WE ARE NOW. WE'RE RECRUITING. WE JUST RECRUITED PATIENT NUMBER 5, SO WE HAVE 145 MORE TO GO. SO THIS IS BEING DONE IN SEVERAL CENTRES IN EUROPE, IN THE UNITED STATES, AND HERE IN TORONTO.

Steve says SO THIS IS A STUDY THAT'S GOING ON ALL OVER THE WORLD.

Andres says A MULTI-CENTRE TRIAL.

Steve says MULTI-CENTRE, OKAY. THIS SEEMS PROMISING. HOW EXCITED ARE YOU BY IT?

The caption changes to "Andres Lozano. University Health Network."

Andres says OBVIOUSLY VERY EXCITED BECAUSE IT IS A COMPLETELY DIFFERENT APPROACH TO ALZHEIMER'S DISEASE. PAST APPROACHES HAVE FOCUSED ON TRYING TO REDUCE THE ABNORMAL PROTEINS THAT ACCUMULATE AND BILLIONS OF DOLLARS HAS BEEN SPENT ON THIS WITHOUT MUCH IMPACT. AND SO NOW WE ARE TREATING ALZHEIMER'S DISEASE WITH A VERY DIFFERENT APPROACH, WHICH IS TO TRY TO RESTORE THE ACTIVITY OF THE BRAIN USING ELECTRICITY. SO IT'S A VERY DIFFERENT APPROACH. WE'VE BEEN DOING THIS FOR PARKINSON'S DISEASE FOR MANY YEARS AND HAVE HAD TREMENDOUS SUCCESS. SO THE IDEA IS THEN TO TAKE WHAT WE'VE LEARNT IN PARKINSON'S DISEASE WHERE WE'RE TREATING A MOTOR CIRCUIT AND NOW TREAT A CIRCUIT INVOLVED IN MEMORY AND COGNITION TO SEE WHETHER WE CAN BOOST UP ITS FUNCTION.

Steve says IF THIS GOES WELL, PRESUMABLY THIS GOES FROM A STUDY OF 150 PEOPLE TO BEING YOUR REGULAR APPLICATION FOR AN ENTIRE PROVINCE'S POPULATION, RIGHT?

Andres says YES.

Steve says WHICH MEANS THOUSANDS UPON THOUSANDS OF PEOPLE COULD EXPERIENCE THIS AT SOME POINT?

Andres says WELL, IN CANADA THERE ARE ROUGHLY 500,000 PEOPLE WITH ALZHEIMER'S. IN THE WORLD, THERE ARE 50 MILLION. THERE ARE 20 MILLION IN CHINA. THIS NUMBER IS GOING TO TRIPLE IN THE NEXT 30 YEARS. AND SO THIS IS A HUGE NUMBER BECAUSE THE POPULATION IS AGING AND SO THE INCIDENCE OF ALZHEIMER'S IS GOING UP.

Steve says INTERESTINGLY ENOUGH, YOU MET IN THE HALLWAY, BEFORE COMING INTO THIS STUDIO, WITH THE GUY WE HAD ON IN THE LAST SEGMENT, WHO IS MISSING AN EYE BUT PUTS, YOU KNOW, CYBORG TECHNOLOGY, I GUESS IS WHAT HE CALLED IT, SO HE CAN TAKE MOVIES WITH THIS CAMERA IN HIS EYE. AND YOU TWO KIND OF HAD A CUTE CONVERSATION OUT THERE ABOUT HOW YOU WERE GOING TO HOOK HIM UP. WHERE DID YOU GUYS LAND ON THAT EVENTUALLY?

Andres says WELL, THE WHOLE IDEA IS THAT PEOPLE THAT HAVE IMPAIRMENTS, LIKE A VISUAL IMPAIRMENT, WE MIGHT BE ABLE TO HAVE A CAMERA AND INPUT THOSE ELECTRICAL SIGNALS BACK INTO THE BRAIN AND MAKE ARTIFICIAL VISION. SO THAT'S AN EXAMPLE WHERE WE MIGHT BE ABLE TO RESTORE VISION. WE MIGHT BE ABLE TO RESTORE MOVEMENT, ET CETERA. BY USING IMPLANTABLE TECHNOLOGY TO HARNESS THE BRAIN THAT IS JUST WAITING TO BE USED AND GIVE IT SOME INPUTS.

Steve says BUT AT THE MOMENT, HE'S GOT A PORTABLE CAMERA THAT IS THE SHAPE OF AN EYE THAT HE POPS IN WHENEVER HE WANTS TO DO HIS THING. AND DID I HEAR RIGHT? DID I HEAR YOU SAY YOU THOUGHT YOU MIGHT BE ABLE TO CONNECT THAT TO SOMETHING IN HIS BRAIN TO MAKE HIM SEE?

Andres says SO THE IDEA IS TO HAVE THAT BRAIN... TO USE HIS BRAIN, TO IMPLANT A CABLE BETWEEN HIS CAMERA AND THE BRAIN DIRECTLY SO THAT HE CAN SEE AND HIS BRAIN CAN PROCESS THAT VISUAL INFORMATION. SO THAT'S THE IDEA.

Steve says ARE THERE DAYS WHEN YOU THINK YOU'RE IN AN EPISODE OF STAR TREK OR SOMETHING? THIS IS REAL SCIENCE FICTION, ISN'T IT?

Andres says WELL, IT'S ALL BASED ON HOW THE BRAIN WORKS BY PROCESSING ELECTRICAL SIGNALS AND IF WE'RE ABLE TO HARNESS ELECTRICAL SIGNALS IN OUR ENVIRONMENT AND INPUT THEM INTO THE BRAIN, WE CAN CREATE THAT INTERFACE BETWEEN THE OUTSIDE WORLD AND THE BRAIN. SO THERE'S NO REASON WHY WE CANNOT USE THIS TO RESTORE VISION, RESTORE MEMORY, RESTORE MOVEMENT IN HUMANS.

Steve says I GOT TIME FOR ONE MORE QUESTION IN THERE, CONTROL ROOM? I WANT TO GET NUMBER 11 IN HERE. HIGH INTENSITY FOCUS ULTRASOUND. THAT IS SOMETHING YOU HAVE PIONEERED THAT APPARENTLY IS NOW COVERED BY ONTARIO'S HEALTH INSURANCE PLAN, OHIP. WHAT IS THAT?

The caption changes to "Pioneering biotech treatments."

Andres says WELL, WHAT WE'VE BEEN TALKING ABOUT TODAY SO FAR IS IMPLANTING ELECTRODES IN THE BRAIN. BUT WHAT IF YOU WERE ABLE TO OPERATE ON THE BRAIN WITHOUT OPENING THE SKULL? WHAT IF YOU WERE ABLE TO USE EXTERNAL SOURCES OF ENERGY TO ACTIVATE THE BRAIN OR TO MAKE LESIONS IN THE BRAIN. THIS IS WHAT IS DONE WITH HIGH INTENSITY FOCUS ULTRASOUND. SO WE USE A THOUSAND BEAMS OF SOUND THROUGH THE SKULL AND AIM THEM IN A SPECIFIC SPOT IN THE BRAIN. IT TURNS OUT THAT 90 PERCENT OF THE ULTRASOUND IS BLOCKED BY THE SKULL. THE SKULL DOESN'T LIKE SOUND GOING THROUGH IT. BUT 10 PERCENT DOES GET THROUGH. AND IF YOU SUM MATE A THOUSAND BEAMS ONTO ONE SPOT, YOU GET ENOUGH ENERGY TO ACTUALLY CHANGE THE ACTIVITY OF THOSE NEURONS OR TO DESTROY THEM. SO WE'RE ABLE TO OPERATE ON THE BRAIN WITHOUT OPENING THE HEAD. IN THIS WAY WE'RE ABLE TO DO OUTPATIENT SURGERY TO TREAT PATIENTS WITH TREMOR AND MANY OTHER CONDITIONS, HOPEFULLY.

Steve says YOU'VE GOT A PRETTY INTERESTING JOB, DON'T YOU?

Andres says IT'S A WONDERFUL JOB.

The caption changes to "Producer: Patricia Kozicka, @TrishKozicka."

Steve says YES, IT IS. THAT'S DR. ANDRES LOZANO. HE'S, WOW, WHAT HE'S DOING. FROM THE UNIVERSITY HEALTH NETWORK. HE IS THE DAN FAMILY CHAIR OF NEUROSURGERY AT THE UNIVERSITY OF TORONTO AS WELL. GREAT TO HAVE YOU IN AT TVO TONIGHT.

The caption changes to "Subscribe to The Agenda Podcast: tvo.org/theagenda."

Andres says THANK YOU.

Watch: Deep Brain Stimulation for Alzheimer's