BRAINSTORM

Thinking Makes it Go

2012-01-28T13:33:00.000-08:00

Illustration by Leandro Castelao

Brains and machines have been flirting for decades, but at several centers around the country they are now getting married. Brain surgeon and neuroscientist Edward Chang is the focus of my story about the union, just out in San Francisco magazine. Chang and his colleagues at the UC Berkeley-UCSF Center for Neural Engineering and Prosthetics (CNEP) are developing brain-computer interfaces, including one that will read words from paralyzed patients' brains and give them voice through a prosthetic device. Jan Rabaey is developing mirco-arrays that will read electrical signals from the cortex's surface and transmit signals through the skull to devices outside. Michel Maharbiz is even talking about "brain dust," networked wireless nanosensors, each the size of a dust mote, that could be distributed throughout the entire brain like artificial neurons and wirelessly communicate with computers in the outside world. “It’s still a vision for the future, but we think it could work,” he says.

Big Picture on BMI

2012-01-17T06:57:00.000-08:00

This week's Big Picture Science examines brain-machine interfaces (BMIs). Guests include engineer of the tiny Jan Rabaey, at the Center for Neural Engineering and Prostheses, who is developing wireless micro-electrode grids that can send signals out of human brains; Human Connectome researcher Arthur Toga, a UCLA cartographer of human brain function; UCSF neuroscientist Brad Voytek, who studies attention and memory in ECoG-implanted epilepsy patients; and senior UCSC neurobiologist Michael Gazzaniga, author of the recent book Who's In Charge?: Free Will and the Brain. The interviews are excellent, and the show opens up with my 13-year-old son Leo and me playing Mind Flex, an EEG-based game that we got for Christmas.

Pinpointing the Laughter Zone

2011-12-04T22:29:00.001-08:00

Abnormal growths near the part of the
hypothalamus called the mammillary
bodies cause laughing seizures.

There's nothing funny about gelastic epilepsy. It hits young children, worsens with time, and can lead to several devastating seizure types as well as developmental and behavioral problems. But still, the kids who have this very rare epilepsy are laughing. They can't help it.

The part of the brain responsible for laughter appears to be located on the underside of the hypothalamus, a place disturbed by all of the growths, called hypothalmic hamartomas, known to cause laughing epilepsy. This discovery was one byproduct of research examining 100 cases of gelastic epilepsy to determine how the locations and sizes of hamartomas resulted in different symptoms and outcomes. The research, recently published in the journal BRAIN, and discussed by a panel of neuroscientists at the AES meeting in Baltimore on Sunday, showed that while variously sized tumors found in proximity to different parts of the hypothalamus had different expressions, all of those causing laughter were adjacent to the part of the hypothalamus known as the mammillary bodies.

"We've known for decades that hamartomas in the hypothalamuscause laughing seizures," said Stanford neurologists Josef Parvizi, lead author of the study. "But that's like saying the problem is coming from a city. Wewanted to see exactly which district in that city were involved to help us understand the networks that underlielaughter. Justknowing it was in the hypothalamus was not enough."

Parvizi collaborated with John Kerrigan at the Barrow Neurological Institute in Phoenix, which Parvizi calls "the Mecca for hypothalmic hamartoma research." Their paper, which also examined the different outcomes of children with different sized tumors, and tumors adjacent to different parts of the hypothalamus, concluded that however large they are, and wherever they are located, quick diagnosis and removal of hamartomas is key to a good outcome. "If you let this condition linger," says Parvizi, "you are going to run into trouble."

Because in many cases the first expression of the disease is laughing seizures, gelastic epilepsy often goes long undiagnosed. Especially, for some reason, in girls. The girls in the study had surgery, on average, about 60 months later than the boys. Why? Parvizi could only speculate: "Maybe because if a boy is laughing it is considered more abnormal than if a girl is. But I don't know."

Inside the Heads of Epilepsy Patients

2011-12-04T04:53:00.001-08:00

On the exhibits floor of the 75th Anniversary American Epilepsy conference in Baltimore this weekend there are many new ways to get inside the heads of epilepsy patients. NeuroPace, for example, is a brain implant that detects the coming of a seizure and responds with electrical stimulation the part of the brain causing the trouble. It's a remarkable device...and it was predicted with amazingly high fidelity by Michael Chrichton as far back as 1971 in his novel (later turned into a movie) Terminal Man. The clinical trial in Chrichton's story don't turn out so well, but its just a novel. Still, let's hope we really know what we're doing as we start installing computers inside of people's heads. There are high hopes, I should say, for NeuroPace. I share them.

Meanwhile, two floors above, in the ballroom of the Baltimore Conference Center neurologist Steven Schachter gave the Judith Hoyer Lecture on Epilepsy. Schachter does some work on high-tech translational medicine at Harvard, where he is a professor of neurology. But he also started the journal Epilepsy and Behavior, was the president of the American Epilepsy Society, and achieved about a half a dozen other things that would put an ordinary epileptologist on the map. Schachter is also the most humane neurologist I've met. He is dedicated to stopping his patients' seizures, yes, but also to helping them wrestle with the other demons that often accompany epilepsy: stigma, employment limitations, loneliness, alienation, depression. He also collects artwork made by people with epilepsy, which he uses both to gain insight into their experience and even to help guide diagnoses and treatment. In a conference that's understandably focused on epileptic brains, Schachter's talk was typically focused on people with epilepsy.

Also part of the Judith Hoyer Lecture was a magnificent performance of a composition by Cynthia Folio. Titled When the Spirit Catches You, the piece is a musical portrait of a Folio's daughter's seizures. Permormed by the seven-member Relache Ensemble, the piece was moody, caucophenous, dreamy, and melancholy. It ends with a child's music box winding down sadly, but sweetly. It is a moving and engaging piece and I hope it is performed again and again. (A four-minute excerpt of the half-hour-long piece is here.)

Shachter's good talk and Folio's performance were recorded and reportedly will be posted on YouTube, so keep a sharp eye out for them.

For more on the AES's annual meeting in Baltimore, follow Lisa Boyland's good blog on the Epilepsy Foundation site.

Where does "Epilepsy" Come From?

2011-09-30T14:44:00.000-07:00

Shakespeare said Caesar had
"the falling sickness" but that
Othello had "epilepsy."

It's still premature to say where epilepsy itself comes from, but there's a feature on Science Friday's website's "Science Diction" page about the origins of the word. Apparently, "epilepsy" took over describing seizure disorders when the expressions "the falling sickness" and "the sacred disease" fell out of fashion in the early 1600s. Medical historian Howard Markel notes that Shakespeare, in 1599, calls Julius Caesar's seizures symptoms "the falling sickness." Four years later, the Bard's Othello is described as having "fallen into an epilepsy." Those occurrences, Markel argues (on scant evidence, I think), mark the English shift from the old usage to the modern one.

The word "epilepsy" comes from the Greek "epilambanem," which means to "grab," "seize" or "take possession of." Since in those days many people thought epilepsy was caused by spirit possession, the word probably had a double meaning: first, to shake as if grabbed, and second, to be taken over by a spirit.

Brain Reading 101

2011-09-29T10:37:00.000-07:00

Christopher Walken in dream recording
machine from the film Brainstorm (1983)

Jack Gallant and his labmates at UC Berkeley reconstructed the "internal perceptions" of human subjects watching film clips. It's amazing work, and may mark significant progress toward a kind of machine-based brain reading.

“This is a major leap toward reconstructing internal imagery,” said Professor Gallant, in a press release about the research. “We are opening a window into the movies in our minds.”

The demonstration, published in the Sept. 2 issue of the journal Current Biology, went like this: Subjects lay in fMRI machines that recorded the brain activity in their visual cortex while they watched film clips. Gallant took those "recordings" and used algorithm driven computer searches to "translate" those recordings into other, similar images taken randomly off of YouTube. The YouTube clips were a kind of image palate from which the original footage was reconstructed. Several reconstructions from different subjects were averaged together to get a blurry, dream-like video sequence that roughly, and eerily correspondes to the original video. You can see the result in this dyptic, which shows the video that the subjects watched, on the left, and the reconstruction from their brain scans on the right.

The Gallant group is reading from the relatively straightforward visual cortex. Trying to interpret "thought" patterns in the cerebral cortex or distributed processes like memory and emotion would be much, much more complex. Machines that could make meaningful reproductions of thoughts, emotions, or memories may be decades off, but they are coming. And we probably aren't ready for the ethical, legal, and emotional challenges (and opportunities) that will accompany that kind of tech. Or maybe we are: we already create representations of our internal lives all the time by doing art and having conversations. In fact, aren't the original film clips already more-or-less high-fi representations of the minds of their original directors mediated through another technology: film?

Animal Rights Amygdala

2011-09-11T11:41:00.000-07:00

Your right amygdala can't
resist the pygmy marmoset.

When you see a human face, neurons in your amygdala wake up and take note. But when you see an animal, whether cute or menacing, the amygdala in your right hemisphere jumps to its feet and starts to dance. Caltech and UCLA neuroscientists found that while pictures of humans evoked strong neuronal responses in the amygdalas of 41 human research subjects, the responses were far stronger, and faster, to images of animals. The amygdala, a two-lobed part of the limbic system buried deep in the medial temporal lobes of each brain hemisphere, is a key player in emotional reaction and processing emotional memory.

The researchers, led by Caltech postdoc Florian Mormann, suggests that we are hard-wired to respond emotionally--and thus pay close attention to--animals of all kinds. This may reflect the important role animals have played throughout human history as predators, prey, and potential allies.

The response to images of animals was especially marked in the right amygdala, perhaps reflecting the right hemisphere's commitment to processing "unexpected and biologically relevant stimuli, or with changes in the environment," according to Mormann in the Caltech press release.

The research is open to all kinds of interpretation, but it makes one thing clear: animals are important to us. We knew that already, but still, it's interesting to see it reflected in the deepest, most primal reflexes of the old brain.

The study, like so many at the coolest edges of neuroscience today, was conducted in the brains of epilepsy patients. These generous men and women were already wired up with single-neuron-reading intra-cortical electrodes in preparation for surgery and volunteered their brains for study while they were at it. Itzak Fried, the surgeon who installed the electrodes for this study, uses them to find the foci of his patients' seizures and to conduct other research in the meantime. He has been the key to several other important studies, including the identification of the first human mirror neurons.

The paper was published in the August 28, 2011 issue of Nature Neuroscience.

29th IEC: Treatment Chasm

2011-09-05T00:45:00.000-07:00


Whose names were writ in water.

The last day of a good conference is a little sad. The orphaned sessions are under attended and the presenters make self-deprecating quips about their tiny audiences. Posters are coming down and the booths set up by pharmaceuticalcompanies and medical publishers and manufacturers of vegus nerve implants,intracranial monitoring electrodes, deep-brain stimulators and new super-sensitive EEG machines areall being disassembled and carted out. Most delegates have snuck out early toexplore the Vatican or the Coliseum, or to hit the tony boutiques on ViaCorsa, or to eat some of the best food on Earth.

It's a special breed that stays to the bitter end. And of those who stayed to the end of the 29th International Epilepsy Congress, many had also shut down IEP meetings past. TanyaSpensley, for example, has been to at least half a dozen, she told me,including those in Singapore, Paris, Budapest, and Lisbon. And she is alreadylooking forward to the 30^th IEC in Montreal in 2013.

Spensley is a good example of the many remarkable activistsI met at the IEC who dedicate themselves to making life better for people withepilepsy. She is a Londoner, and active in her local epilepsy group there, butfor several years she has also been going to Gambia, in Africa, organizing tobring medication and epilepsy education to a country of 1.7 million people thathas not a single EEG machine, where people with epilepsy are thought to becontagious and are shunned, unmarriageable, and often get no medical treatmentat all.

“I often wish I could show my friends in the UK--who whinge abouthaving to wait for service or the inconvenience of the healthcare system--whatit’s like in Gambia, where some lucky families have to travel for days just toget medication they can just barely afford.”

The difference between the treatment of epilepsy in thedeveloped and undeveloped worlds is not really a “gap.” It’s a chasm!

And Spensley is dedicated to bridging that chasm the best asingle smart and dedicated person can. Quixotic? Perhaps. Heroic? Absolutely!If you’re trying to reduce the suffering of people with epilepsy, you can get ahuge bang for your buck in places like Gambia. Delivering the most basic AEDsto those who are responsive to them can, for a few dollars a month, turn adifficult and convulsive life into a much easier one free of seizures. It islow-hanging and excellent fruit; not exactly easy to pick, but ripe and readyfor those who want to contribute time and/or money. To contact Spensley, lookat her website www.epilepsyfootprint.com

When the Congress finally wound down and the organizers andIEC officers were shaking hands and hugging goodbye, my friend took me to anold and beautiful graveyard in the Ostiense district of Rome. The greatEnglish poet Keats, who died inRome of tuberculosis at 25, is buried there. It is a poignant place: beautifulbut full of loss. Keats’s death was so much more that a personal tragedy. Itwas a loss for the world.

How many other talented and beautiful young people withunique and penetrating insights, too, die before their time? Thousands eachyear are taken by their epilepsy in the developed world alone. In developingcountries, any guess at a number would be a wild one--these young men and womenare not even counted--but it must be in the tens or hundreds of thousands.

For whatever reasons, Yeats, broken and bitter at the end ofhis short life, wanted an anonymous place to rest and, believing he would soonbe forgotten, he asked that his grave bear this inscription: “Here lies onewhose name was writ in water.” Ironic, perhaps, that since his death nearly twocenturies ago, his name has been writ in water again and again by the tears ofsentimental admirers who pilgrim there.

How many unrecognized poets, and artists, and engineers, andgentle or ferocious souls of all kinds, whose lives might have been spared witha little medication or understanding from their communities or families, or attentionfrom a doctor, lie instead in unmarked, and unmourned, graves around the world? Yes, the end of a good conference is always a little sad.

29th IEC: Battling Stigma, Slow But Real Progress

2011-09-01T04:46:00.000-07:00

Stigma is the question,
courage the anther.

It’s a common--and fair--complaint that epilepsy isn’t getting its share; it doesn’t get the research dollars it deserves, nor the social attention. Funding lags behind less disabling disorders with lower prevalence, and public understanding lags just as far. That’s the case after many decades of hard and excellent work by organizations like the Epilepsy Foundation and The Epilepsy Society on the US front and The International Bureau for Epilepsy and the International League Against Epilepsy on the international one. It is easy to get discouraged.

I had a fascinating discussion today with neurologist Mark Cook, Chair of Medicine at St. Vincent’s hospital at the University of Melbourne. He was speculating about possible neuro-psychological explanations for epilepsy's troubles. People may react to seizures the way children react to the sight of a snake, he says: deep-seated, reflexive fear. If a person faints in public, people draw in close, catch them, care for them. Too often, when a person seizes in public, the crowd draws back in fear and, yes, revulsion. The idea that the stigma of epilepsy is more than simply social, that there is an instinctive aversion, makes the job of the epilepsy advocate a lot harder. Yes, it is very easy to get discouraged.

But the International Epilepsy Congress (IEC) I've been attending in Rome is an antidote. You can’t spend three days surrounded by the dedicated doctors, researchers, and epilepsy advocates here and not feel hope for progress. And that progress will benefit everyone, not just epilepsy patients. Since 240 BC, when Hippocrates wrote On the Sacred Disease, the first medical textbook, epilepsy studies have advanced the cutting edge of neuroscience. Many, if not most, of the major landmarks in the understanding of the human brain have come from epilepsy patients and the doctors and scientists who attended to them. It’s still true.

Deep brain stimulation, brain machine interfaces, the use of viral vectors, stem cells, and anti-inflammatory agent are all frontiers being pushed back by modern epilepsy research. So, too, are optogenetics, deep brain stimulation, and the use of high-density EEG-fMRI imaging, not just for looking at seizures, but also for studying the brains of people with epilepsy between seizures.

On the social side, Mike Glynn, president of the International Bureau for Epilepsy (IBE), reports encouraging signs of progress among the those trying to correct pervasive misconceptions about epilepsy and the prejudice that stems from them. The increased focus on SUDEP, for instance, and the pressure placed on neurologists around the world to talk to the patients about it is a “huge step forward,” he said in an interview today.

“It’s a difficult discussion for everyone. But especially doctors,” he said. “And it was a brave move on the part of Solomon Moshe [President of the International League Against Epilepsy] to make it the focus of the Congress' Presidential Symposium, which was attended by an overflow crowd of 1,500 delegates.

Glynn’s organization is also working hard to seed projects that will help people with epilepsy in the developing world. “The IBE has given 50 small grants in the developing world over the past five years to initiate programs that aid people with epilepsy. An example of one that is working well, Glynn says, is in Zambia, where local activist Anthony Zimba has created an employment program for epilepsy patients. Five volunteers from the epilepsy community, organized and inspired by Zimba, are running the program, which sustains dozens of people who would otherwise have no way to make a living. They have cleared an area of scrubland for use in raising chickens for sale and growing fruit for jam production, also for sale. That the program is volunteer-run is extraordinary, says Glynn, because the stigma of epilepsy in Zambia is tremendous. "No one wants to be identified with the disease," he says.

“It takes great courage for a person to identify oneself as epileptic in Zambia,” says Glynn. “And because of that courage, the project is working and growing.”

Working in the face of deeply held (perhaps even instinctual) prejudice and fear, progress in epilepsy advocacy always requires the courage and determination of individuals, whether researchers such as Solomon Moshe, or volunteers with epilepsy, such as Anthony Zimba, developing programs to help their countrymen.

There is plenty of courage and determination at this IEC and because of it, progress toward greater understanding--of the brain, the disorder, and for each other--marches forward.

29th IEC: Day Two: Can Epilepsy be Cured by Meditation? Can it be Cured at all?

2011-08-31T02:08:00.000-07:00

What is epilepsy? The simplest working definition boils down to "the propensity to have seizures." Does that mean that if drugs help a patient stop seizing, the patient’s epilepsy is cured? Most neurologists act that way; once seizure-free for two years, a patient is typically sent on their way unless they seize again.

But there’s a growing consensus that epilepsy goes far beyond seizures. In the words of Harvard epileptologist Frances Jenzen, “seizures are often just the tip of the iceberg.” The underwater part can include all kinds of “co-morbidities” including persistent memory and cognitive problems, depression, headaches, and socialization problems. There is a hearty debate about whether these conditions are a part of the epilepsy or are caused by it. Some argue that the brain problems that caused the seizures to begin with also cause some or all of these problems. Others suggest that maybe the comorbid conditions are byproducts of having seizures. But either way, a fascinating discussion at one of today’s IEC sessions shows that for many patients, the end of seizures does not mean the end of their epilepsy-related problems.

Mary Lou Smith, a psychology professor at the University of Toronto, discussed longitudinal studies of whether cognitive, academic, social, emotional, and behavioral effects linger even when a patient’s seizures are controlled with surgery or drugs. Unfortunately, she says “the impact is substantial, even for those in remission and off of their anti-epileptic drugs.” Marriage rates are lower, IQ is lower, and self reported quality-of-life still lags behind the general population.

Even patients who’ve had successful surgery, are off all medication, and have had no seizures for five years continue to suffer. Though this group scores the same as a control group for seven other quality of life measurements, they remain less well adjusted when it comes to social function.

But for most others, who remain on medication, things look less rosy. “Stigma plays an important role in the lingering effects, but it doesn’t explain everything,” Smith says. “There may well still be underlying neurologic issues and other kinds of social and psychological issues, too.”

Smith is not minimizing the hardships caused by seizures themselves. “A life without them is definitely easier than a life with then,” she says. “But it is not necessarily better.” And it almost certainly is not all better.

Would continued treatment by doctors help? Or perhaps other kinds of interventions? Teaching compnsating techniques for memory loss, say, or treatment for anxiety or depression?

“It makes sense that they would help,” says Smith. “But the studies haven’t been done. We’ve gone through the research phase of documenting the problem, and now its time to start exploring solutions.”

Meditation and Other Alternatives

Another promising session looked at “Alternative, Spiritual, and Traditional Therapies for Epilepsy.” Speakers discussed ancient and traditional Chinese medicine, traditional Latin American and African treatments for and beliefs about epilepsy, and the effect of meditation on epilepsy. No reliable evidence was cited that traditional therapies were effective at treating epilepsy. In fact, the combination of impotent and sometimes brutal treatments (one African treatment entails putting the heads of epileptic patients into latrines) and the litany of depressing traditional explanations for epilepsy (e.g. spirit occupation, bad winds, contact with a woman who has had an abortion) was very discouraging. The most hopeful talk was the last one, about meditation, delivered by UCLA neurologist Jerome Engel who clearly thinks there is some value there. Engel described reasons to believe that meditation might help control seizures (it increases hippocampus growth, increases fiber connectivity throughout the brain, it generates lots of activity in the mesial temporal lobe, where a lot of epilepsy is focused.) But at the end of that positive litany, he acknowledged that the studies on meditation and seizure control were equivocal at best: some even suggested that meditation could bring seizures on!

“There’s still no really good control study of the effect of meditation on epilepsy,” he finally concluded. Anticlimactic? You bet. But honest. Dr. Engel said he’s had one NIH grant application to do such a study turned down but he’s waiting on another. Let’s hope he gets it and so his next talk will have some harder data.

29th International Epilepsy Congress 2011: a.k.a. InterUberEpFest

2011-08-30T05:03:00.000-07:00

Raphael's seizure

If you’re reading this you have probably known an epileptologist or two. So you can begin to imagine how remarkable—daunting frankly--it is to have 4,000 of them in one hotel talking about epilepsy from sun up to sun down. That’s the situation here in Rome at the 29^th International Epilepsy Congress, from where I will post from time to time over the next four days. I am calling it InterUberEpFest 2011 and it is nonstop talk about epilepsy, epilepsy, epilepsy, in every language and from just about every imaginable point of view.

It is fitting that this conference is unfolding in Rome. For one thing, the city was home to two of the most famous epileptics in history: Julius Caesar and Michelangelo, and though one has been dead two thousand years and the other nearly half a millennium, evidence of their extraordinarily creative lives and characters are all over this amazing city. For another, this years Congress celebrates the Jubilee of the International Bureau for Epilepsy, which was formed at a meeting here in Rome fifty years ago. In the decades since then, the IBE has worked hard around the world—though with a European focus--to turn social views of epilepsy on their head. The prevailing stigma and lack of support for epilepsy research so prevalent early in the 20^th century, are hard to imagine now. We have come a long way, and it’s important not to lose sight of that. But we have a long way to go still.

The attitudinal distance we still need to cover was highlighted in this morning’s big session on Unexplained Death from Epilepsy, or SUDEP. Doctors, and particularly American doctors, have come under a lot of criticism for their reluctance to discuss the possibility of death from epilepsy with their patients or, in case of children with epilepsy, with their families. Susan Axelrod, founder of the Citizens United for Research in Epilepsy (CURE,) was the first speaker at this morning’s session, and she gave an impassioned plea for better patient-doctor communication about SUDEP. She described her own experience as a cancer patient; even in the traumatic moments of her original diagnosis, her doctor never pretended that her illness was not potentially lethal. Only because he shared the truth with her could they collaborate to fashion the best plan to keep her alive. Yet epilepsy patients are routinely deprived of that realistic evaluation.

Axelrod’s daughter, Lauren, had her first seizure at 7-months-old. In the traumatic early years of Lauren’s epilepsy, the Axelrods spent weeks in the hospital, ran through 20 different AEDs, and attended the hundreds of doctor’s appointments such prescription and re-prescription entails, but never once did a doctor tell them that Lauren’s life might be in danger. And yet it most certainly was…and still is.

Also in the session was renowned Baylor epileptologist and researcher Jeffrey Noebels, who has done seminal work locating SUDEP genes. He said that at least in some cases SUDEP could now more accurately be called SDEP, because identification of a genetic mutation that causes an iron-channel defect that links seizures and sudden cardiac malfunction, took the “unexplained” out of at least one kind of SUDEP. A signature EKG form now allows epileptologists to screen for that disorder, and Nobels recommends that EKGs be routinely conducted on patients with seizures.

I have to rush back to the conference. But I want to mention another excellent session today in which Harvard neuroscience professor Steven Schachter gave a riveting account of the artworks he has collected from patients with epilepsy over the decades. Art is often a nuanced but powerful way of communicating the suffering, isolation, and anxiety that often accompanies epilepsy, says Schacter, and while making art can have great therapeutic value, a doctor’s clinical attention to it can also have diagnostic value.

While Schacter’s talk emphasized the suffering of epilepsy patients, another talk in this session, by Australian doctoral student and artist Jim Chamblis, looked at research suggesting that, in his words, “epilepsy, which is most often perceived as disabling, in some circumstances can actually be enabling by enhancing creativity.” Now that’s turning stigma on its head!

David Eagleman's Brave New World

2011-07-06T21:07:00.000-07:00

Brains are everywhere this month (the covers of SciAm and WIRED), and so is their hottest new commentator, David Eagleman. He was profiled in a long and riveting New Yorker feature, he has a controversial piece about brains and the law in The Atlantic that is an excerpt from his new book, Incognito: The Secret Lives of the Brain, and his bestselling fictional collection of "thought experiments," Sum: Forty Tales From the Afterlives is preparing to take the stage as an opera in London. The young, excitable and handsome Baylor University assistant professor makes brain science look sexy and fun. And he knows it.

"There are an infinite number of boring things to do in science," he told New Yorker writer Burkard Bilger. "But we live these short life spans. Why not do the coolest thing in the world?" That, of course, is to study brains!

While his new book examines the role of the unconscious, the New Yorker piece looks at his research on the brain's various timekeeping mechanisms (this work involves, among other things, scaring subjects nearly to death by dropping them from great heights and studying Brian Eno's brain while he plays the drums), but he also specializes in synesthesia (his book about synesthesia, Wednesday is Indigo Blue, came out in 2009), neuroplasticity (his book LiveWired: How the Brain Reconfigures Itself will be out next year,) predicting the future of everything (his book Why the Net Matters: How the Internet Will Save Civilization was published in 2009), and, on the side, the mind-body problem.

The Atlantic excerpt argues for taking a more neuroscience-focused approach to criminal justice. "When a criminal stands in front of the judge's bench today, the legal system wants to know whether he is blameworthy," Eagleman writes. "I submit that this is the wrong question. The choices we make are inseparably yoked to our neural circuitry, and therefore we have no meaningful way to tease the two apart. The more we learn, the more the seemingly simple concept of blameworthiness becomes complicated, and the more the foundations of our legal system are strained."

As brain science gains traction, he argues, more and more criminal behavior will be seen as pathological, not reprehensible. This is an old argument, to be sure, but with some new twists. Polymath Eagleman and his colleagues are developing a kind of neurofeedback device that they hope will help offenders to gain control of their impulses and just say no to drugs, burglary, assault, and sexual abuse. It's brain training for criminals.

Eagleman embodies what is fascinating, fun, and hopeful, about modern neuroscience. He also reflects what is a little scary and naive about it; a belief that, as he says, "we are our brains" and that our problems are essentially brain problems that can be addressed and solved as such. At 40, he has decades still to mature and deepen, and I have no doubt he will. So watch this guy. (Actually, you can watch him right here talking about "Reality and its Future" at a TEDx lecture. Or right here, where he is talking to PopTech about Possibilianism.... Oh, didn't I mention that Eagleman is also the figurehead of a new quasi-serious (a)religious movement based on his observation that "we know way too little to commit to a position of strict atheism, but we know way too much to commit to any particular religious story."

Software as Medicine

2011-06-17T08:38:00.000-07:00

If the improvised explosive device (I.E.D.) is the signature weapon of the Iraq and Afghanistan wars, then traumatic brain injury (T.B.I.) is the emblematic malady. It's exhausting, controversial, vaguely defined, hard to treat, and expensive. And shock waves of human suffering emanate from each case. Even its mildest form can cause memory, sleep, and concentration problems, depression, alienation, and often PTSD-like anxiety attacks. Suicide rates among T.B.I. patients are high. Epilepsy is much more common among patients with even mild brain injuries. So too are unemployment, divorce, and domestic violence.

Posit Science's Mike Merzenich has long thought that brain training software programs could be ideal tools not only for sharpening aging brains, but also for fixing damaged ones. They get into the brain through the senses and engage it to make incremental changes in neuronal structure that cumulatively amount to a medical intervention. That's the idea anyway. A story of mine in today's New York Times looks at a new Department of Defense study of Posit's software to try to help veterans with traumatic brain injury to recover lost cognitive function. Posit's software is also being studied by Sophia Vinogradov at UCSF for its effectiveness treating schizophrenia. More about that story soon.

Why Powerful Men Behave Badly

2011-06-11T07:03:00.000-07:00

Power on.

One partial explanation for all the recent bad behavior among powerful men in office is explored in NPR science correspondent Shankar Vedantam's light but interesting piece on All Things Considered yesterday.
Vedantam interviews social Dutch psychologist Joris Lammers who finds activation in the brains of both men and women quickly shifts from areas associated with risk aversion (staying out of trouble) to those associated with reward seeking (getting laid) when subjects are given just a little bump up to their sense of power.
Even more interesting, Jon Maner, at Florida State, finds that students given a brief feeling of power were more likely to start flirting with an opposite-sex stranger sitting next to them. Add power, the flirting rises. Subtract power, it dips. "Power-holders tended to touch their subordinates more, they maintained more direct eye contact. They behaved in an overall more flirtatious manner," says Manner. Men and women both, and to the same degree.
And the more power Maner's subjects have, the more likely they are to overestimate their own desirability and to interpret the behavior of others as flirtatious. In other words, says Vedantam, "when you say 'hello' to someone, an ordinary person thinks you said "hello." A powerful person thinks you meant 'hel-lo.'" It doesn't take a lot of power, either. "A small amount of money in a short laboratory interaction was sufficient to elicit this overestimation of sexual interest," says Maner.

Joined at the Mind?

2011-05-29T08:21:00.000-07:00

A remarkable story in today's NYT Magazine profiles Tatiana and Krista Hogan, four-year-old twins who are joined at the head and share a neural bridge between their thalimi, the brain centers that process sensory information. Reporter Susan Dominus does a great job exploring the medical, philosophical, and social questions raised by the twins' circumstance. There is strong evidence that when one girl sees, hears, tastes, or feels something, the other experiences it, too. Despite their extraordinary neuronal connection, the girls remain (even when it is a struggle) distinct individuals. And despite the fact that the rest of us do not share neurons, we sure do share insights, sensations, emotions, and experiences with one another. All the time. Sharing a brain may give you a head start toward sharing your mind, but it's not necessary.

Source Code: BMIs in Sci-Fi

2011-04-18T09:41:00.000-07:00

The BMI is our sci-fi obsession. For good reason.

A good brain-machine interface (BMI) makes everything possible. At least it's the key to good late-model science fiction. "The Matrix's" head plug, through which humans are fed their illusory digital worlds; "Avatar's" less invasive full-body tanning-salon connections and "Surrogate's" EEG-like helmets, through which users connect to their robot proxies; "Inception's" contraption--who the hell knows where that thing plugged in, but it plugged in somewhere;"Eternal Sunshine of the Spotless Mind's" read-write fMRI-like device that could locate and erase memories. All were functional in-out ports to the human brain and so keys to either a) "freeing" the mind from the "constraints" of the body, or b) "enslaving" the mind (and its body) to the controllers of the BMI. Or, more often, both.

A new absorbing and fun BMI-enabled movie, "Source Code," by "Moon" director Duncan Jones, and starring Jake Gyllenhaal, Michelle Monaghan, and Vera Farmiga, plays around with multi-verse theory and free will.

Gyllenhaal plays an army sergeant with an I/O port in his brain that enables him to travel, via the (pretty much unexplained--"it's math"--) "source code," into the recent past to investigate a terrorist plot. Actually, he appears to be traveling through time, but is really traveling through memory. The train explosion that kills him over and over again has already taken place and everyone he meets --including love-interest Monagham--is already dead. He's not supposed to keep the train from exploding--it's too late for that--but to find the perp and avert a bigger, future, nuclear attack.

Like the Bill Murray character in "Groundhog Day," Gyllenhaal has multiple chances to do the job. And like "Groundhog Day," each replay is slightly skewed depending on his perceptions and actions. And finally, like "Groundhog Day"--and like real life--the first reruns are extravagantly spent getting a clue about what kind of world we're dealing with and why it matters. The rest are spent trying to exercise our wills and defy the tyranny of circumstance.

That sounds heavy, but it's a fun, tightly-directed movie, well acted by all three leads. And it's romantic, which is something since the Gyllenhaal and Monaghan characters only have a couple of minutes on the train to work with. And, if you've got any geek in you--and you must if you're reading this--the film's got a fresh parallel-universes theme that will either delight you or push your buttons, depending on your feelings about infinite inflation and multi-verse cosmological models.

It's also realistic in one important way. (Spoiler alert!) The Gyllenhaal character is, in the film's primary universe, actually a locked-in-syndrome paraplegic, a victim of a helicopter crash in Afghanistan; he doesn't know it, but he is "technically dead." A portion of his brain is still vital enough, though, to plug into a BMI, sending his consciousness and body image temporarily into the memories of others. Okay, here's the realistic part: In our world, too, it is patients with disabilities who are having BMIs implanted to let them control wheelchairs, prosthetic limbs, and computer cursors with their thoughts.

Lest you hope (or fear!) just any old port into the brain will function as a USB-like device enabling all kinds of brain apps, it's key to note that reading directional command signals from the motor cortex (which neuroscientist can already do) is a far cry from importing or exporting anything like a complex thought, belief, or memory. The best scientific understanding of what constitutes thoughts, say, is so elementary today that the reality of importing or exporting them from the brain via computer (BMI) is a long way off. Just how long off, though, and just how we might prepare for that day, are important questions worthy of as much scientific, philosophical, ethical, and cinematic attention as we can throw their way.

Autism and Epilepsy

2011-04-13T14:45:00.000-07:00

Synapse: #2 = synaptic vesicle

Thirty percent of children diagnosed with autism also suffer from epilepsy, a conundrum that has led neuroscientists to search for shared underlying mechanisms or causal connections. One intriguing but controversial theory, posed by clinical neuroscientist Aditi Shankardas is that many children diagnosed with autism are actually suffering from persistent sub-clinical epileptic seizures that can be unveiled with electroencephalography (eeg) and treated with anti-convulsants. Watch Shankardas's TED lecture and expect to see more on her here soon, when I have tracked down her bonafides.

Better-documented progress deciphering the epilepsy-autism connection was published online in Human Molecular Genetics this week. A team led by Patrick Cossette, a neurologist at the Université de Montréal, has pinpointed a mutation of the synapsin gene--SYN1--that can lead to both epilepsy and autism by deregulating the function of synapses. The synapsin gene plays a key role in forming the membrane that surrounds neurotransmitters before they make their way to a neuron's synapse, where they influence neighboring neurons. These membranes, also known as synaptic vesicles, regulate how and when neurotransmitters are released. The team discovered the gene while studying one large French-Canadian family all of whom have epilepsy and many of whom also suffer from autism.

For more on epilepsy's comorbidities, including autism, see my article "Epilepsy as a Spectrum Disorder" in EpilepsyUSA.

Before You Know It, You've Decided

2011-03-24T14:28:00.000-07:00

UCLA brain lab examines free will.

Whenever you are ready to, touch your index finger to the end of your nose. No hurry. Just do it when you want to.

Have you done it yet? No? That's fine. Take your time. But as soon as you're ready, touch your nose. Finished? Good.

If UCLA professor Itzhak Fried and his collaborators had just now been looking into your brain--through tiny super-sensitive electrodes that pick up firing signals from individual neurons--chances are pretty good that they could have predicted when you were going to touch your schnoz before the conscious "you" did. By as much as a full second and a half! Does this call into question the freedom of your will? I don't think so; for one thing, just because a decision is not conscious doesn't mean it's not "free." Even so, showing that awareness of a decision may only arrive sometime after an action has been initiated by other parts of the brain is interesting enough regardless of what it suggests about free will.

The experiment--published in the February 10, 2011, Neuron, and described by Daniela Schiller and David Carmel this week in Scientific American--went like this: Fried's team implanted electrodes into the brains of 12 epilepsy patients who were being prepared for surgery. The temporary implants were required to precisely pinpoint the areas where seizures were originating. But once in place, the researchers used the electrodes to watch individual neurons fire while asking the patients to press a button whenever they wanted to. The subjects were watching a hand sweeping around a clock face and would report to the researchers the exact time that they made the decision to push.

Not surprisingly, the experiment engaged a lot of neurons in the supplementary motor area, a part of the frontal lobe known to be involved in movement planning. More interesting is that many of these brain cells began firing in a way that predicted button pushing a full second and a half before the person reported having made a decision. At seven-tenths of a second, there was a crescendo of neural firing, enough to let Fried's group predict the timing of the coming action with 80 percent accuracy. Not bad.

Fried, who specializes in epilepsy surgery and neuroresearch, has long been looking at the brain for insights to questions otherwise locked in the realm of philosophy. His team identified the first human mirror neurons, sometimes described as the roots of empathy, and shed much light on the nature of memory, recognition, and other key issues. Once again patients with epilepsy, and the doctors who try to understand and help them, are pushing back the frontiers of neuroscience.

Computers with Brain Envy

2011-03-16T17:07:00.000-07:00

Stanford Professor Kwabena Boahen

In my post about Watson a couple of weeks back, I said I'd rather see the algorithm responsible for Ken Jenning's processing power than the one behind IBM's supercomputer's success. Well, I went to a meeting of science writers last week and heard a talk by Stanford professor Kwabena Boahen, who heads the Brain's in Silicon lab at Stanford, and he's wondering the same thing. Only he's doing something about it.

Boahen started his talk, which was essentially like the TED lecture he gave a couple of years ago, by highlighting the extravagant relative inefficiency of computers. A computer processing information at a speed nearing the brain's uses about 100,000 times as much energy as the three pounds of tapioca sealed in bone balanced on your spine. To run such a computer, IBM's Blue Gene for instance, requires the power it takes to keep 1,200 US homes humming. Your brain can do the same job on a bowl of Ramen. Boahen wants to know how the brain does it, and to build computers that are equally efficient.

While "the accuracy of our computers is dependent on an extravagant use of energy," writes Douglass Fox in his good profile of Boahen in Esquire, "the brain uses something messier called population coding of information, in which intelligence emerges from the capacity of hundreds of thousands of extremely low-energy brain cells to synchronize their pulses." If I get the gist, the approach is so "massively parallel," so that, Boahen says, "it is a network in the literal sense of the word; the net does the work." And apparently, Boahen projects, his biomorphic chips may one day be 1,000 times more efficient than a standard computer's.

His Neurogrid computer platform actually emulates neurological ion channel activity to simulate the "softwired' way the brain turns its transistors on and off. Currently, it simulates about a million neurons and six billion synapses in real biological time. Your brain's got about a hundred billion neurons and a quadrillion synaptic connections, so Boahen has quite a way to go. But good luck to him.

Brains and Machines

2011-02-22T16:37:00.000-08:00

It's Singularity TIME

Hooking brains to machines is the focus of an upcoming book (Beyond Boundaries: The New Neuroscience of Connecting Brains with Machines) by Duke neuroscientist Miguel Nicolelis excerpted in the February 2011 Scientific American.
   The piece is a rhapsodic forecast of the not-too-far-off day, Nicolelis says, when brain-machine interfaces (BMIs) bring about "the liberation of the human brain from the physical constraints imposed by the body."
   He maps the way forward, as he sees it, through the brain-wave-controlled prosthetic devices his lab  develops, then mind-controlled software and on-body neural apps, to a day, still perhaps a few decades off, when we may be participating in "a conscious network of brains, a collectively thinking true brain net," that may not only allow us to "communicate back and forth with one another just by thinking, but also to vividly experience what (our) counterparts feel and perceive..." (Don't we kind of do that already?)
   We will wake up one morning, he says, and realize that we have "given birth to a new species altogether." This new animal would be able to "explore remote environments through avatars and artificial tools controlled by thought alone." The environments he's talking about include "the depths of the oceans to the confines of supernovae, even to the tiny cracks of intracellular space inside our own bodies."
   Fun, right?! And potentially profitable, too. The movement's Thomas Edison will be the guy (possibly Nicolelis himself, he suggests) who safely and reliably links, with a two-way in-out connection, the machine world with the neural one: a USB port for the brain. Invest now!

* * *

   Meanwhile, the cover story of this week's Time Magazine, looks at Ray Kurzweil's prediction of the "singularity," an event that makes Nicolelis's look pedestrian. The singularity is that future moment when machines become intelligent, adept, and fast enough to create ever more intelligent, adept, and fast machines causing a kind of screaming feedback loop of "progress." After that, says Kurzweil, all bets are off; the only thing he can say for sure is that the post-singularity word won't resemble this one. Not at all.
  The article is exhilarating as a thought experiment, but way out there as science journalism goes, despite the fact that the author of the piece, Lev Grossman, writes blithely that, though the inevitability of the singularity sounds like science fiction (and Yes it does!), it isn't. At least, Grossman says, "no more than a weather forecast is science fiction. It's not a fringe idea."
  It may or may not be an accurate prediction, but it is most certainly fringe. That's why it's fun to read about and, for the moment anyway, not simply terrifying.

Ken Jennings's Algorithms

2011-02-18T11:38:00.000-08:00

WATSON

After his shellacking by IBM's supercomputer Watson, Jeopardy! superstar Ken Jennings posted an article in Slate about how it felt to be whooped by a machine. "I felt honored," he says. "My puny human brain, just a few bucks worth of water, salts, and proteins, hung in there just fine against a jillion-dollar supercomputer."

And it's true. The humans were amazing.

In his Slate piece, Jennings writes that "the computer's techniques for unraveling Jeopardy! clues sounded just like mine.... I felt convinced that under the hood my brain was doing more or less the same thing." Well, while there are some engineers at IBM who have a pretty good idea what was going on under Watson's hood, nobody could give you a very good account of what was happening under Jennings's brainpan.

Marvin Minsky at MIT says he'll be able to tell us how big a milestone Watson's victory is when he sees the papers (if IBM publishes them) describing the algorithms behind the digital player. But the paper I want to see is the one describing Ken Jennings's algorithms. Watson's processors occupy ten refrigerator-sized units in the IBM HQ and require their own power plant to run. Jennings's processors are folded neatly into a seamless three-pound assemblage of cells that will run for 90 years on veges and water.

Let's go neuroscience, tell us how Jennings does it! At this rate, we'll have a hi-fi facsimile of human intelligence long before we know the basics of how the real thing works.

Nap v. Med: Don't Sweat It.

2011-02-01T18:16:00.000-08:00

"The Rememberer"

For great audio of a sleeping cat's brain listen to this episode of Radio Lab at 3 minutes and 45 seconds. Better yet, listen to the whole thing and learn many facts and theories about sleep, including one fine explanation for the evolutionary popularity of having two brain hemispheres. Titled "Sleep," it's from Season 3 (2007), but listen anyway; old Radio Labs don't die, they just grow stronger.

The point of the sleeping cat sound: there is a storm of neuronal activity going on in the sleeping brain. Just because sleep is beautiful, doesn't mean it isn't hard work. That's true at midnight and in the middle of the afternoon, when I do my sweetest and most productive snoozing. Twenty minutes sometime between two and three o'clock and my 49-year-old brain feels fourteen again. There are coherent neuroscientific explanations, and more and more sleep scientists are describing them. For example, a Berkeley study led by psychologist Matthew Walker shows an hour-long nap dramatically boosts and restores brain power. He says, among other things, it refreshes the hippocampus' ability to form new memories.

On the other hand, the most emailed piece in yesterday's New York Times was titled "How Meditation May Change the Brain," by Sindya N. Bhanoo. It points to a new study published in the January 30 issue of the journal Psychiatry Research Neuroimaging finding that people who meditated for about half an hour a day for two months had increased gray matter in their hippocampi (read "memory machines") and and reduced gray matter in their anygdalae (read "road-rage machines.") That can't be bad.

But which is better, napping or meditating? Neurocience has not weighed in yet. So take you're pick. If you're too type-A to snooze on the clock, go ahead and sit instead. Either way, you're doing your brain a favor.

As a bonus for those who've read this far. here's a lovely piece by novelist Cathleen Schine, in RealSimple, about the blissful benefits available to those willing and able to sleep while others work.

Chopin: Art and Epilepsy

2011-01-25T13:51:00.000-08:00

Frédéric Chopin (1810-1849)

Van Gough, Dostoevsky, da Vinci, Giorgio de Chirico, Michelangelo, and Dickens are all argued to have had epilepsy. Their diagnoses are mostly ex post facto and speculative, and some of are more controversial than others, but there definitely seems to be some kind of association between epilepsy and the making of great and revolutionary art.

A Spanish radiologist at the Xeral-Calde Hospital Complex in Lugo, Spain, has just published a study in the latest issue of Medical Humanities arguing that Frédéric Chopin should be added to the roster of genius artists suffering from temporal lobe epilepsy (TLE).

A close reading of Chopin’s diaries and letters, and of Chopin’s lover George Sands’s first-hand accounts, reveal a young composer suffering from symptoms that look a lot like TLE, says the radiologist, Manuel Varquez Caruncho. Chopin’s complex, recurring, short, and predominantly visual hallucinations are much more symptomatic of TLE than schizophrenia or medication poisoning, the leading alternative hypotheses. Chopin’s hallucinations—he once walked out of a concert in the middle of performing a piece because he saw strange creatures spilling out of his piano—lasted a maximum of a couple of minutes, and Chopin could remember and discuss them clearly. They were also recurring; all of which suggests TLE.

Artists with epilepsy whose seizures are focused in one part of the brain may have heightened sensibilities that relate to that region’s function. Van Gough’s use of wild and otherworldly colors, for example, may partly be a product of his intense vision-modifying seizures. Others experience amplified smells, sounds, or even ecstatic—and sometimes, religious--emotions in association with their seizures. Sometimes these alterations are subtle; sometimes they are overwhelming. Dostoevsky said of his auras, “I would feel the most complete harmony in myself and in the whole world and this feeling was so strong and sweet that for a few seconds of such bliss I would give ten or more years of my life, even my whole life perhaps.”

When these extraordinary modes of experience are combined with extraordinary expressive talent (as they will inevitably be, given how common epilepsy is) the product may be a paradigm-shifting artist. Chopin, if Caruncho is right, certainly fits the bill.

The Lost Prince: Epilepsy on the Screen

2011-01-07T12:03:00.000-08:00

Daniel Williams as Prince John

Tom Hooper's excellent film, The King's Speech focuses on the stammering of King George VI. In the film, George's speech therapist asks the king about his younger brother, Prince John. George says that "Johnny was a sweet boy who died of epilepsy at 13." Never having heard of a British prince with epilepsy, I looked up Prince John and found my way to a very good 2003 BBC production about his short life, The Lost Prince. While The King's Speech focuses on the years just prior to WWII, The Lost Prince is set two decades earlier at the outset of WWI. Both films use the personal disabilities of princes, brothers, to shed royally-tinted light on those times and wars.

The Lost Prince's direct portrayal of seizures is hard to watch... but worth it. Few things are more scary to see for the first time than a child having a seizure. But by the third or fourth time, compassion starts to eclipse horror. Every family living with epilepsy reaches that point, but it would be great if society at large could as well. The horror response, and the fear those with epilepsy have of evoking it, conserves epilepsy's persistent stigma and bolsters its aura of shame. Exposure to realistic portrayals of seizures may help.

The Lost Prince also captures the remarkable resilience of children with epilepsy and the perspective they bring to those around them. As the royal family struts and wrings their hands over picayune protocol and the "horrors" of perceived and real slights, Prince John opts out and instead draws funny and incisive portraits of the family's follies. He is the only one brave enough to speak up when the emperor has no clothes. Having a child with epilepsy--and, in the case of John, learning disabilities as well--can bring a quick and corrective perspective shift in families. But that was a shift the royal family wasn't prepared to make. At least not until the death of the delightful young prince, probably from status epilepticus--a seizure that won't stop--at age 13.

After the funeral, Prince George, still a teenager, tells John's devastated nanny that his brother "was the only one of us who was really allowed to be himself." It is no small consolation. As for Prince George, his stammering is not portrayed in The Lost Prince. One royal disability at a time, I guess. A good excuse to see both films.

Foes of Flow: The King's Speech & The Fighter

2011-01-04T10:12:00.000-08:00

King George VI in search of flow

Monarchies put a lot of stock in continuity, so stammering interrupts royal speech in a particularly discomforting way. I’m sure, though, that a disabling stutter is just as agonizing for a working-class bloke or a trauma-torn vet. You’ll know what I mean if you’ve seen The King’s Speech. If you haven’t, go see it soon; Colin Firth and Geoffrey Rush definitely deserve the year’s Oscar for Best Friendship.

We all want continuity--what Mihaly Csikszentmihalyi calls “flow”--in whatever realms we care about most: our speech, writing, economy, relationships, sport, music, dance…the morning commute. It goes by many names (swing, pace, groove, the zone, grace) but it is singularly recognizable, beautiful, and satisfying.

All kinds of things keep us from achieving flow, but some of the most painful, and a theme of both The King’s Speech and this year’s other great holiday film, The Fighter, are the psychological impediments that inhibit continuity, even when, physically, it should be achievable. The protagonists in both movies are hobbled by psychological forces that have physical consequences. And both required radical treatments that addressed the psychological roots of their problems: in one case, a boxer’s inability to flow to victory, the key was detachment from his dysfunctional family; in the other, a king’s inability to deliver a pivotal speech, the key was the therapeutic honesty of a challenging but compassionate friend.

Also mortal foes of flow are physical problems (like epilepsy and stuttering) that interrupt the continuity of consciousness in ways that have disabling psychological and psychiatric consequences. A seizure is the ultimate interruption of flow; and the constant threat of one is enough to make a confident person’s experience sputter and jerk. Half of those who suffer from uncontrolled epilepsy also are depressed.

The mysterious relationship between the brain and the mind--between the physical and the psychological--may be the key scientific and medical question of the century. And it is nowhere more intriguingly and painfully played out than in psychogenic illness, such as many non-epileptic seizure disorders and much stammering. These disorders are as important to study as they are difficult to get a handle on.

PNES: A Seizure by Any Other Name is Just as Bleep!

2010-12-05T11:33:00.000-08:00

Is "non-epileptic seizure" an oxymoron?

To quote Bill Clinton, "Words matter."
Last night, at the American Epilepsy Society conference in San Antonio, I saw a debate between Salim Benbadis, a neurologist from Tampa, and Curt LaFrance, a psychiatrist and neurologist from Providence. These doctors were wrestling over whether the word "seizures" belongs in the diagnosis of "psychogenic non-epileptic seizures." (Also known as PNES.) These are seizure-like events on the outside, with no corresponding epileptic EEG activity on the inside. They are considered a kind of conversion disorder, usually caused by a trauma suffered by a patient who can't effectively process the associated emotions or express them verbally. PNES patients often end up in emergency departments where they're typically prescribed antiepileptic drugs, not to be properly diagnosed unless lucky enough to be seen by an epileptologist (often years after onset) who can definitively reach a PNES diagnosis with a video-monitored EEG. Even after getting properly diagnosed, the patients often get punted back and forth between neurologists--who say the patient's problems are psychological and not in the neuro bailiwick--and psychiatrists who see the seizures as neurological events and thus outside their domain.

Given that they aren't epileptic in any way, should these events be called "seizures" at all? Benbadis opened the argument saying that the word "seizure" creates confusion in his newly-diagnosed PNES patients. "I talk to them for half-an-hour explaining what they have and at the end they say, 'But do I still have seizures?' If I answer 'yes,' it can wipe out everything I've just explained." Better to call them "attacks" or "spells" or "episodes," he said.

Benbadis also argued that English dictionaries, both medical and non, associate "seizure" with epilepsy in the first or second definition. The association is a fact of modern usage, he said, and it is "very misleading" to use it to describe a non-epileptic event. It misleads the patient, certainly, but also the medical community.

LaFrance countered that the word "seizure" originally meant "to be taken hold of" and did not imply epilepsy. PNES patients are indeed "taken hold of" by their seizure-like events, he said. We should not surrender to the modern usage, he argued, simply because it's popular. More essential, though, was LaFrance's point that at first re-diagnosis, the PNES patient is being evicted from both the epilepsy and neurology communities. To kick the patient out of the "seizure" community at the same time, could leave them homeless, so to speak, and feeling still more vulnerable and betrayed.

"The practical reason for keeping the word "seizure" is that it validates the patient's experience and forms an alliance with the clinician." That alliance, says LaFrance, will be essential for effective treatment.

The Stanford psychiatrist moderating the debate, John Barry, synthesized the two positions, arguing that it may not really matter what you call the events, as long as you both 1) clearly convey the message that while they are not epilepsy, they are no less real, and 2) preserve the therapeutic bond.

Beneath the linguistics, but revealed by them, is a deeper struggle. Benbadis is not trained to care for these patients, he says, and he doesn't want to. He has enough work to do just tending his epilepsy patients, whom he can help. As long as the "attacks" that plague PNES patients are said to be "seizures," those patients will keep flooding his clinic. "Seizures" are things neurologists are obliged to treat; while psychological "attacks" or "episodes" are not.

Tanvir Syed is the exception who proves the rule. The one epileptologist in the audience who argued for keeping the word "seizure," the Cleveland-based Syed actually enjoys treating the many PNES patients who find their way to his clinic. He doesn't bother sending them to psychiatry; he knows they'll just boomerang back. And the psychiatrists don't really know how to help them anyway.

And how does Syed treat his PNES patients? "With meditation," he says. "Teaching them to meditate gives them the strength of mind to deal with the emotions associated with their trauma."

I'm writing a long-form piece on PNES, so much more about this later.

Epilepsy as a Spectrum Disorder

2010-11-19T10:03:00.000-08:00

“Seizures are often only the tip of the epilepsy iceberg,” says Frances Jensen, M.D., professor of neurology at Harvard Medical School and director of epilepsy research at Children’s Hospital in Boston. “We’re beginning to pay attention to what’s down below. Often that includes other serious problems, too,” she says in my article, Epilepsy as a Spectrum Disorder, in the current issue of EpilepsyUSA.

Depression, migraines, learning disorders, autism, ADHD, and Alzheimer's all have high associations with epilepsy.
Unfortunately, many clinicians only have time--or the inclination, or the expertise--to treat seizures. If they can get a patient's seizures under control, they often consider their jobs complete, while the patients continue to suffer quietly from other less salient conditions.

The upside of recognizing these associations is that with emerging insights into the relationship between epilepsy and other psychiatric and neurological problems, neuroscientists are getting a more comprehensive picture of the deeper workings of the whole brain. A consensus is emerging among researchers that epilepsy is better viewed, and treated, not simply as a disorder defined by seizures, but as something more complex and nuanced, more explicitly interrelated with other illnesses.

That's one reason many top neuroscientists argue epilepsy research should be a priority investment. When we understand what causes seizures, on a deep level, we'll also have keys to the doors of many other brain-related problems. And to an understanding of the well functioning brain, too.

Present Moment Happy Moment

2010-11-12T13:53:00.000-08:00

Matt Killingsworth reports in the current issue of Science that happiness and a focus on the present moment are closely associated. In his ongoing study, the Harvard doctoral student uses an iPhone app to track the happiness of about 2,500 participants who agree to be interrupted several times a day and report on their activities, there degree of "mind wandering" (i.e, how focused they are on what they are doing), and how happy they are. People reported the highest level of happiness, and the lowest degree of mind wandering, when they were having sex. No surprise there, I guess. More revelatory, though, was the high association between happiness and less ecstatic activities that require subjects to be "in the moment." When our minds wander, we tend to be less happy. When we're paying attention to what we're doing and where we are, we tend to be happier. And Killingsworth found that mind wandering more often than not precedes a dip in happiness, he said on today's Science Friday, suggesting--but hardly proving--a causal relationship. It may not be the most rigorous study around, but participants might at least learn a thing or two about what activities are associated with their own happiness. After every 50 text replies to its queries, the lab sends you a report on your own activities and associated levels of happiness. You can join the study, long as you're an iPhoner, at http://www.trackyourhappiness.org/

Update: on Tuesday Nov 16 the Science Times' John Tierney did an interesting story on the same study.

A Pale Hereafter

2010-11-06T17:04:00.000-07:00

Afterlife in an airport terminal.

Hereafter, the new Clint Eastwood film, opens powerfully with a tsunami sweeping through a tropical tourist town; this is kick-ass action filmmaking; scary, emotional, surprising. It blew me out of the water. The main character, though, Marie LeLay, a journalist well-played by Cecile de France, was blown into the water, where she was hurtled whitewater rapids style through the streets of the town. We see her lose consciousness as she drifts deeper, eyes open, through the surreal flooded world. It is an extraordinary experience--for her…and for us--sufficiently so to be life changing. By comparison, what happens next, when she is presumably dead, is just dull. She sees a bunch of foggy figures standing around in a kind of bright airport terminal; the look like they're waiting on line for nothing.

When she’s pulled away from the gate of death by a couple of medics, things get vivid again. But thereafter, she keeps referring to this amazing transformative experience that she insists can’t possibly be explained in any other way than by the existence of a hereafter. The only amazing experience we saw, though, was in the here…and that was very cool. The “hereafter,” by comparison, was just a hardly-worth-writing-home-about dream.

And anyway, the experience people have just before they might have died says nothing more about death than conscious life does. Anyone who can describe a near-death experience didn’t die. Their heart and brain may have been in extraordinary states, which would explain their extraordinary experiences. But those states are no more like death than walking on the plank is like drowning.

I love a good movie about the afterlife; The Sixth Sense, for instance, is one of my favorites. So I was looking forward to Hereafter, which won singing reviews from the NYT and the SF Chronicle. If you want to know what the film is like, though, read David Denby’s thrashing in The New Yorker.

More of HM

2010-10-26T08:19:00.000-07:00

Henry Molaison's digitized brain.

Here is another story about HM, this one, in the November Esquire, even longer and more thorough than the one I pointed to in my last post. It is by Luke Dittrich, who happens also to be the grandson of William Beecher Scoville, the surgeon who removed Molaison's hippocampus. This piece sheds some interesting light on Scoville and on the fascinating work of UC San Diego neuroanatomist Jacopo Annese, director of the Brain Observatory. Anesse was in charge of freezing HM's brain just after the experimental subject died two years ago. Then he thinly sliced it and took high-resolution images of each section to record it at a single-neuron level. The images will be digitized and reconstructed to make a publicly-available, explorable, 3-D rendition of what is already the most studied brain in history.

One thing has been bugging me a little, though. Why did the ambitious Scotville decide to remove both lobes of HM's hippocampus in the first place? Wouldn't it have been prudent to first remove one side and see if the seizures stopped? Was Scotville really just trying to quell HM's seizures, or was he also putting himself on the neuroscience map by revealing the function of those then-still-mysterious parts of the limbic system? If the latter, it deepens HM's already unfathomable martyrdom.

WE Remember, Because HM Forgot

2010-10-20T14:26:00.000-07:00

Henry Gustav Molaison

So many big moments in the history of neuroscience are the products of efforts to understand or treat epilepsy. Look for instance at this fine recent story by Mo Costandi in the Guardian memorializing one of the most important figures in the field, a man who for decades was known simply as HM. Henry Molaison (whose full name was only released upon his death two years ago) had been dogged by seizures since childhood and was so desperate to shake them that, in 1953, he agreed to have his hippocampus removed. His surgeon knew HM's seizures were originating there, but no one knew what the side effects would be. The surgery had its intended effect; his seizures were reduced from dozens a year to about two. But in exchange for that gain, he lost the ability to make new memories, a condition known as severe anterograde amnesia.

The main character in Memento, the excellent movie about an amnesiac driven to keep progressing into the future by preserving his past with Post-Its, annotated Polaroids, and tattoos, was purportedly modeled after Molaison.

Before Molaison, most neuroscientists believed memory to be distributed all through the brain. The first paper about the case, published by Molaison's surgeon, William Beecher Scoville, and neuroscientist Brenda Milner (both at the Montreal Neurological Institute) showed that though even without his hippocampus Molaison could still retain small amounts of information for short periods of time, he couldn't store them anywhere before they were supplanted by new ones. This suggested, for the first time, that memory has distinct long- and short-term components. Memory research has never been the same, and today no one doubts the central role of that weird little seahorse-shaped part of the limbic system known as the hippocampus in creating and quickening new memories; it is now arguably the most intensively studied part of the brain.

Molaison died two years ago, at 82, but his brain (still being studied at the Brain Observatory UC San Diego) is still revealing secrets about the nature of memory and what makes it work--and cease working.

It's hard to say where memory research would be today if it weren't for Molaison and his epilepsy; possibly decades behind where it is now. Let's not forget him...or the many other courageous and generous patients with epilepsy who shed so much light on this field.

GPS and Your Brain: Do You Know Where You're Going, Or Just How to Get There?

2010-09-30T15:24:00.000-07:00

Nearly all of us have an innate ability to navigate. But there are the few hundred known cases of what neurologists call "developmental topographical disorientation" (DTP), or the inability to get from here to there, even if "there" is right around the corner. This very good article, "Global Impositioning Systems," by Canadian journalist Alex Hutchinson, in The Walrus, looks at the work of neuroscientists studying DTP to learn how most of us navigate most of the time.

The piece poses there are two main navigational approaches or techniques and that while we employ both, everyone leans more heavily on one or the other. The first, which relies more on activity in the hippocampus, constructs cognitive maps based on relationships between landmarks. People who use the second, which plugs into the caudate nucleus, develop and memorize instructions (e.g. turn right at the ice skating rink and then left at the cheesesteak place). The former, hippocampus-based way, Hutchinson says, is versatile and generalizable. The second strategy, learning directions, works okay, unless the cheesesteak place is bought out by a Starbucks...which is pretty likely. Reading between the lines, Hutchinson is suggesting that people adopt the first strategy don't just know how to get from a to b, they actually know where they are, and where they're going.

The more we rely on GPS systems, Hutchinson's sources say, the less exercise the hippocampus-based system gets. Brain images show exercise of the hippocampus makes it grow. Neglect makes it shrink.

The take home message: over-reliance on GPS may get us there, but at the cost of knowing where it's at.

Fake Realities vs Real Representations

2010-09-03T17:05:00.000-07:00

Yesterday, for a CITRIS story I’m writing about tele-immersion, I interviewed Oliver Kreylos, an engineer at UC Davis who develops virtual 3D environments out of huge data sets (think MRIs or big geological models) that researchers can “enter into.” Users will soon be able to don a pair of goggles and a Wii controller and walk on into a virtual 3D environment shared by other researchers and a giant 3D model of, say, a patient’s brain, which they can move around and examine from all sides or, if they want to, go into and look for aneurisms.

Kreylos made the great point that 3D movies, unlike his virtual environments (which are made with lots of cameras recording from lots of different perspectives), aren’t really 3D at all. They just give you an illusion of depth by combining two fixed-position images. But then, in the 3D movie theater, when you move your head, the image doesn’t respond appropriately and you feel betrayed; your brain says, “Hey, this is fake!” Whereas, a 2D image presents itself as an image, not a reality. There is no betrayal. Maybe that's why I like 2D movies better. Three-D seems like a fake reality, while 2D is a real representation.

My 12-year-old son Leo made a similar point after watching Avatar in 3D. “We get to see 3D all the time,” he said. “If you pay to go to the movies it should be something different and special...like 2D.”

Eternal Sunshine of the Traumatized Mind

2010-08-27T17:33:00.000-07:00

Terry McDermott's good book, 101 Theory Drive: A Neuroscientist's Quest for Memory, tells the story of Gary Lynch a UC Irvine biologist who's spent his entire career looking for the material basis of memory in the brain. According to Lynch's hypothesis, the brain employs Long Term Potentiation (LTP) to convert experience into lasting synaptic relationships. Once considered fringe, the LTP explanation of memory--physical connections between brain cells are made stronger when they communicate, making subsequent communication more efficient--is now mainstream. But the precise mechanisms remained a mystery until Lynch's lab began to shed light on them in the past few years.

The juice is in the details, but basically Lynch found that synapses change their relationships to their neighbors by changing the shape of their dendritic spines. I'll come back to the book soon (when I finish it), but I have to mention it now because instead of finishing McDermott I just watched Eternal Sunhine of the Spotless Mind, the 2004 Oscar winning movie about memory erasing technology. It's a great film, even more fun to watch than 101 Theory Drive is to read. I can't help drawing a line between the two since Gary Lynch's Big Hope is that by explaining LTP he can then begin to locate individual memories, to make, in his words, a "memory map" of the brain. That's essentially what Dr. Howard Mierzwiak, played by Tom Wilkinson, does in Eternal Sunshine. He explains that there is an emotional core which gives away the location of each of our memories and, out of his shabby little Brooklyn clinic, Mierzwiak maps his patients' painful memories and removes them like errant hairs.

In mid-treatment, Joel Barish (Jim Carrey), who is trying to escape the agony of his broken heart, realizes that his memories are, well, important, even if they hurt. He and his ex, played by Kate Winslet, play hide-and-seek through Barish's memory, hiding (camouflaged by emotional traumas) in unexpected memory regions (like exile under the kitchen table from Barish's childhood) that the good doctor can't find...or can't conscience removing.

A real memory-altering therapy is being studied at Massachusetts General Hospital, according to an excellent article by Charles Slack in the current issue of Proto. Harvard psychiatrist Roger Pitman is giving propranolol, a beta-blocker commonly used to regulate heartbeats in arrhythmia patients, to soldiers suffering from Post Traumatic Stress Disorder (PTSD). Propranolol seems to counteract the effect of stress hormones that bloom when traumatic memories are recalled. The test subjects keep the memory, but seem to lose the intense emotion associated with it. Not yet tried, as far as I know, on suffering lovers, like the Jim Carrey and Kate Winslet characters in Eternal Sunshine. But if it works, its just a matter of time before psychiatrists use it to erase all kinds of memory pain. Imagine the power of being able to regulate the emotional volume of bad memories. Especially if you had a memory map to guide you. For one thing, you could keep sending traumatized soldiers back into the killing fields again and again. Or hapless romantics back into the battlefields of love.

Good? Bad? I don't know.

What's That Movie Called?: Memory in Film

2010-08-19T09:29:00.000-07:00

There’s a movie I can never remember the name of. It’s about a man who has no short-term memory. It begins with the letter “M,” but it isn’t a person’s name. "Manifest?" No, it has something to do with memory. I know it! I know it! I’ve seen the film twice and it is excellent, a tour de force, but I can’t remember the name! "Manifest!" No! Damn!

In this movie—it’s on the tip of my tongue--Guy Pearce plays Leonard, who suffers from anterograde amnesia, which is a loss of the ability to create new memories. Memories from before the trauma that caused the amnesia remain intact and accessible. New memories never make it from the hippocampus, where memories first form, to wherever they’d be stored for long-term retrieval. Leonard earned his amnesia by interrupting two men who were attacking his wife; he gets a hard whack on the head. He can recall events from before the accident, but nothing new sticks.

To compensate, Leonard surrounds himself with mnemonic aids, fills his pockets with annotated Polaroid photographs and Post-Its. His most striking device, though, for those bits he really can't afford to forget, is the drawing of rich-text tattoos all over his body.
It’s a murder mystery, told in reverse, that is stunningly, delightfully, reelingly complex. The plot gets less and less clear the more you learn. Until the end, when everything becomes clear...or at least coherent.

Leonard's memory loss is so poignant, maybe, because it's a caricature of the normal human condition. Our experience leaks through the sieves of our memories, while only a few rare bits make their way to long-term storage. It's hard not to mourn the extravagant waste of that. But it's also the secret to our sanity and the coherence of our lives; the trick to memory is not just knowing what to preserve, it's the ability to drop whatever dilutes and confuses the story without adding value. And as this movie reveals, the forces that determine what we preserve, and the stories we weave with that material, are not always conscious. Or honest. You can play the film instantly on Netflix and if you’re interested in memory you should.

Of course, there’s an epilepsy angle: one of the most common causes of anterograde amnesia is temporal lobe surgery, usually for epilepsy with a focus in the medial temporal lobe. Also, some kinds of temporal lobe seizures themselves mess with the same brain areas, and can cause temporary bouts of anterograde amnesia. The hippocampus, and all of the stuff surrounding it, regulates the acquisition of short-term memory. Damaging it is like firing the librarian who files the books to the shelves. New volumes keep coming in, and you can see them as they do, but they quickly get lost in the pile and are impossible track, let alone read.

Memento! Of course, the movie is called Memento!

My next blog should be about TOT (tip of the tongue), a bonafide neurological phenomenon. It's also called Presque vu, from the French for “almost seen.” You know the feeling, it’s when a word or name you know well is right there, but not accessible. "Memento" is one that I, for some reason, have a hell of a time accessing. William James described TOT, back in 1890, as “a (memory) gap that is intensely active.” It feels like there’s a repulsive force involved, not just a lack of connection. That’s why we sometimes need to Jerry-rig our own memories, to overwhelm those "intensely active" gaps. Maybe I should have “Memento” tattood on my thumb. What do you think?

Exposing Sudden Death from Epilepsy

2010-07-30T10:13:00.000-07:00

A thought provoking and disturbing story in Tuesday’s Times focuses on sudden death from epilepsy (Sudep), describing it as epilepsy’s “silent killer.” “Silent” may be a stretch, but it is certainly under-discussed in clinical settings and under-studied in labs. I’m writing a book about epilepsy and I had no idea that it was as pervasive a killer of epileptics as Aliyah Baruchin reports. According to the piece, “Sudep accounts for up to 18 percent of all deaths in people with epilepsy, by most estimates; those with poorly controlled seizures have an almost 1 in 10 chance of dying over the course of a decade.”

Given that about 50 million people suffer from epilepsy worldwide, we're talking about hundreds of thousands of Sudep deaths each year. And yet, American doctors rarely tell their patients with epilepsy about Sudep. The reason they don’t, Baruchin reports, is that it would pose too heavy a psychological burden on patients who are already hard-hit by the everyday difficulties of seizures. If there isn’t really anything patients can do about it, why tell them, doctors ask. (I suspect, from my own experience, American doctors also fail to discuss Sudep because they don’t have time.) Baruchin’s piece, good as it is, begs an important question here: Is there anything you can do to prevent Sudep even if you know about it? She reports that in Britain anti-Sudep products, like mattress alarms and structured pillows, are sold to ward off Sudep during sleep. But she presents no evidence that those products do anything at all or are even recommended by doctors in the UK.

Nonetheless, if patients face a heightened risk of dying from their epilepsy, they have a right to know. And doctors have the responsibility to tell them, even if it takes time and causes discomfort. Truth matters. For one thing, without some kind of collective acknowledgement of Sudep, it won’t get the attention it deserves from brain scientists.

Too often, doctors and scientists alike treat epilepsy simply as recurring seizures. But it is so much more. Disabling as they are, “seizures are often only the tip of the epilepsy iceberg,” says Frances Jensen, MD, professor of neurology at Harvard Medical School and director of epilepsy research at Children’s Hospital in Boston. “We’re beginning to pay attention to what’s down below. Often that includes other serious problems, too.” One of those other serious problems is the propensity to die suddenly and without warning. That deserves attention.

Robert Galambos Predicted Key Role of Glial Cells in Brain

2010-07-26T13:10:00.000-07:00

The great neruoscientist Robert Galambos had a Eureka! moment while flying on an airplane in 1960. He realized that the much-maligned glial cells, which make up about half of the mass of the human brain and 90 percent of its cells, were just as important to mental functions as the much-celebrated neurons. "I know how the brain works!" his NYT obit says he exclaimed on the plane. That may have been an overstatement, but he was certainly ahead of his time in recognizing the importance of glial cells. At the time, though, his fixation on the importance of glia cost him his job at Walter Reed, where he'd done seminal work on the neuroscience of perception. All turned out for the best though; Galambos went on to co-found the excellent neuroscience department at UC San Diego, where he continued to do research long after he retired at age 81. Turned out he was dead right about glia, which have since been shown to be key players in all kinds of brain functions. For a quick rundown on the emerging understanding of the role of glia--and how they might play a major role in epilepsy in particular--see my July piece in EpilepsyUSA, "The Glia Club: Glia take center stage in new studies of the brain and epilepsy."

Paniruddh Patel on Music and the Brain

2010-06-06T08:58:00.000-07:00

I just want to point to a delightful interview with Aniruddh Patel in the NYT. Patel, senior fellow at the Neurosciences Institute in San Diego and author of Music, Language, and the Brain, tells Claudia Dreifus how he went from studying ants with E.O. Wilson to music neuroscience. There's a brief but evocative discussion of the evolutionary roots of human musicality and of some new clinical applications for stroke victims. Best of all though, is the link to the YouTube video of Snowball, the dancing Cockatoo. If you haven't already seen it, you must.

Brain Games Take Hit from Brits

2010-04-22T11:03:00.000-07:00

The bad news first: A large study in Great Britain shows that people are spending millions of dollars on brain-gym-type exercises that don’t actually strengthen their cognitive powers. The good news: plenty of better, less expensive, more fun, more social, more wholesome things probably do boost your brain power.

The study, a collaboration between researchers the Medical Research Council Cognition and Brain Sciences Unit in Cambridge and BBC Lab UK website, was published in Nature online on Tuesday. It divided a small army of 11,430 test subjects down into three groups. The first spent at least ten minutes a day, three days a week, doing exercises that focused on problem-solving. The second group, spent the same amount of time doing exercises that focused on short-term memory, attention, visuo-spatial abilities and math; these were similar to the kinds of cognitive workout commercial brain-strengthening products push. The third batch, the control group, spent the same amount of time using the web, or whatever resources they wanted, looking up answers to esoteric questions. Over the study’s six-week period, the first two groups improved a little bit at the skills they were practicing, but those improvements didn’t translate to more general cognitive abilities such as memory, reasoning and learning. Basically, practicing games makes you better at the games, but not better at thinking.

Adrian Owen, who led the study, is a neuroscientist at the Medical Research Council Cognition and Brain Sciences Unit in Cambridge. He says that hope that brain software will make you smarter is “completely unsupported.”

I argued that the science didn’t prove the validity of brain training both in my first blog entry here and in an article I wrote for San Francisco Magazine last year. After interviewing lots of top neuroscientists, none of whom spent their time on brain training software, I asked them what they did to keep themselves sharp. No big surprises, but the secret to success is sometimes hidden in the obvious: they all agreed that the brain likes to ride atop a healthy body, it like the oxygen hit it gets from aerobic exercise, it likes to be engaged in meaningful activity (aka work that matters), good food, and probably sex. Sounds better than playing computer games, doesn’t it?

Placebo: Buy Shares Now!

2010-03-13T16:00:00.000-08:00

Please don’t ever say “just the placebo effect.” Placebos are potent treatments that kick the butts of many billion-dollar drugs. And their price can’t be beat.

In his wide-ranging New Yorker piece, “Head Case,” about the state of psychopharmacology (is it evil or merely useless?), Louis Menand reviews Irving Kirsch’s book The Emperor’s New Drugs (Basic; $23.95). Kirsch, a psychologist in the UK, argues that antidepressants are just (I hate that!) expensive placebos. While they usually do a little better than placebos in drug trials, Kirsh argues that there is no good way to protect the double-blind nature of such trials; most antidepressants have side effects such as nausea, restlessness, and dry mouth. Once a patient detects those, he knows he’s on the drug side of the trial. A patient feeling no side effects may assume he’s taking sugar pills and may get more depressed than he was to begin with, amplifying the minimal statistical gap. Great point, but...

Well, read the whole piece. It’s fascinating. I certainly don’t want to minimize the importance of hucksterism and venality in the psychopharmacology business, and I want to write more about it soon, but I just want to say here what I always do when I hear about billion-dollar drugs that don’t beat placebos in trials: Let’s invest in the placebo effect! It helps at least a third of severely depressed patients. And it also helps patients with Parkinson’s, and chronic pain, some kinds of epilepsy, and many, many other serious conditions. When we figure out what’s going on with placebos, doctors--or clerks for that matter-- may be able to prescribe them honestly, inexpensively, and in good conscience and make millions of people better. And a little side benefit: we’ll begin to map the current no-man’s land extending the broad distance between neurology (the science of the brain) and psychology (the science of the mind). That should bring with it some other exciting (anti-depressing!) philosophical benefits, too.

Depression's Adaptive Value

2010-03-01T07:06:00.000-08:00

Johah Lehrer’s interesting piece, The Upside of Depression, in the Feb 28 NYT Magazine argues for the adaptive value of depression. The basic idea, taken from evolutionary psychology, is that depression must have an important survival value or it would have been selected out long, long ago. Certainly, Lehrer’s sources argue, it wouldn't as prevalent as it is today. Depression, they say, is like an emergency brake, forcing patients to halt, disregard distractions, and focus on a central problem. Like any emergency system, it can malfunction and cause big problems of its own. Suicide, for example, certainly isn't adaptive.

But the point of Lehrer's article is that patients who are simply given anti-depressants may not address the root cause of their depression. Andy Thomson, a psychiatrist at the University of Virginia, tells the story of a patient “who came in and said she needed to reduce her dosage. I asked her if the antidepressants were working, and she said something I’ll never forget," Thomson says. “‘Yes, they’re working great,’ she told me. ‘I feel so much better. But I’m still married to the same alcoholic son of a bitch. It’s just now he’s tolerable.’ ”

Lehrer doesn’t talk about it in his piece, but there must be profound society-wide ramifications of broadly quelling individual discomfort with anti-depressants. There are global-scale versions of that “alcoholic son of a bitch” and we live with and tolerate them at our peril. Are widespread war and famine depressing enough to stop us in our tracks and move us to re-consider the compulsively consumptive behaviors that make them possible? How about threats from environmental collapse, nuclear annihilation, or terrorism? If we disable the idiot lights of our personal depressions with drugs, then we may also disable the collective ones too, allowing ourselves to march cheerfully along toward a very depressing future. That would be maladaptive in the extreme.

Brains Don’t Buy Tickets, Moviegoers Do

2010-01-30T13:02:00.000-08:00

A provocative and funny piece in February’s WIRED examines a San Diego company’s efforts to evaluate films by giving fMRIs to people watching them. The firm, MindSight Neuromarketing, sticks people into an MRI and shows them clips while watching their brains for amygdalar action. Because the little almond-shaped nuclei in the brain are associated with intense emotions, the premise is that if they light up, the movie maker is doing something right. Journalist Scott Brown has his tongue in his cheek when he says that he looks forward to films that will redline his amygdala activation nonstop and when he predicts that “movie houses will become crack dens with cup holders, and I’ll lie there mainlining pure viewing pleasure for hours.”
My favorite part though, is that the movie-loving test subjects “often… tell a human researcher one thing while the fMRI reveals they’re feeling the opposite.”
Subject: No, Dr. Cinema, I didn’t like the chess scene, it was boring.
Researcher: Actually, you loved it. You just thought it was boring you.
Who is a director going to believe, the fMRI or the human?
Letting fMRI guide your film would be like asking the idiot lights on your dashboard to tell you where to drive. Maybe they have something important to say once in a while, but they’ll suck at finding the scenic route to Mendocino.
Anyway, if you are into redlining your amygdalae, there’s plenty of material out there already that can make it glow till it drops. And THAT is boring.
Bottom line, directors may flirt with MindSight-type feedback for a couple of years, but will soon realize that people buy movie tickets, not amygdalae.

King, Gandhi, and Mirror Neurons

2010-01-16T14:20:00.000-08:00

Yesterday would have been Martin Luther King’s 82^nd birthday. King’s practice of compassionate non-violence had many roots, but one was the Gandhian notion of satyagraha, which is a Sanskrit word that means something like “strength in truth.” The truth Gandhi referred to was that human beings are inextricably connected to each other, not just because we matter to one another, but for deeper, more fundamental reasons. And that is as true of our enemies as it is of our allies. At least Gandhi and King thought so. Contemplating the importance of King’s legacy, and the value of empathy (both the adaptive value in an evolutionary sense and the social value), I asked the excellent UCLA neuroscientist and physician Marco Iacoboni whether he thought that we could strengthen our own mirror neurons and thus our ability to empathize with others. Here is Iacoboni’s reply:

First of all, we know that neurons tend to be extraordinarily plastic, they can adapt and change their properties on the basis of experience. It would be an anomaly if mirror neurons did not have similar properties. More specifically, there is some circumstantial evidence that mirror neurons can be altered by use. In monkeys, tool-use mirror neurons (say, a grasping cell that responds to the sight of somebody using a tool to grasp an object) had not been observed for many years, but recently they have been recorded. Event though we cannot be sure they weren't already there, it is likely that the repeated observation of tool use actions generated these properties in these neurons. Also, when monkeys are trained to use reverse pliers (that is, pliers that require the monkey to open the fingers, rather than closing them), the neurons that used to fire for closing the fingers when the monkey used the regular pliers, also fire when the monkey opens the fingers while using the reverse pliers. Mirror neurons (that is, the subset of motor neurons that also respond to the sight of these actions) follow the same pattern.

In humans, imaging studies show that ballet dancers activate premotor regions more when they watch ballet video clips compared to capoeira video clips. Capoeira dancers do the opposite, they activate more premotor regions while watching capoeira video clips. In another study, ballerinas activate premotor regions more when they watch moves that only female dancers make, and male dancers activate premotor regions more when they watch male moves (like lifting a ballerina).

Transcranium magnetic stimulation (TMS) reveals similar evidence. Motor activation is higher in basketball players when they watch basketball, compared to non players. We published a study few years ago that shows that American subjects activate the motor system more when they watch an American making gestures than they do when watching a Nicaraguan.

Taken together, both theoretical considerations and empirical data suggest that mirror neurons can be altered by use. This is potentially extremely important for interventions, for instance in autism.

But in principle, we can all become more empathic by training more mirror neurons.

In other words, one reliable way to cultivate empathy, in ourselves and in our children, is to practice it.

If your interested in more, by all means check out his fascinating book Mirroring People.

Here's another radical quote by a famously empathic person:

You know, there's a lot of talk in this country about the federal deficit. But I think we should talk more about our empathy deficit -- the ability to put ourselves in someone else's shoes; to see the world through the eyes of those who are different from us -- the child who's hungry, the steelworker who's been laid-off, the family who lost the entire life they built together when the storm came to town. When you think like this -- when you choose to broaden your ambit of concern and empathize with the plight of others, whether they are close friends or distant strangers -- it becomes harder not to act; harder not to help.

That's the voice of Barach Obama.

Avatar: The Art and Science of Plugging In

2009-12-29T10:57:00.000-08:00

This is the launch of my new feature on brains and the movies. I've been waiting for a good first-run movie to start with. Avatar is it.

For one, it’s a great film. For another, the plot is built around neural interface technology and interspecies neural networks. James Cameron's story has earthlings invading Pandora, a planet somewhere in the Andromeda galaxy, where there are deposits of unobtanium, a super-valuable, anti-gravity, superconducting material. The earthlings are trying to get the large, beautiful, cat-like, Paleolithic Na’vi people to move their village off of a huge, underground source of the stuff. To do that, they’re trying to infiltrate Na’vi society with human-Na’vi hybrid clones that can be remotely controlled by human operators. Barring that option, they will simply wipe out the Na’vi.

Interesting to me, from a brainlover’s point of view, is the idea that an organism could be remotely operated, or “inhabited,” if you had sufficient wireless bandwidth combined with the right kind of interface, which, in this case, would be a B-to-B (brain-to-brain) interface, with the second brain being a biologically-engineered, modified clone of the humans. There’s a ton of work on brain-computer interfaces and in decades to come, as computers become more like brains, and as we develop better computer models of our brains, this will be come less and less fiction and more and more science. Whether cloning technology goes anywhere, or should, is another (also fascinating) question. (Right now the hottest B-to-B tech is called language.)

But we can already operate a cursor with brain-computer interfaces controlled by brain waves. And the neural-interface technology that’s portrayed in the high-tech human machines in Avatar are well on their way, too. A few months ago I wrote a story about Jacob Rosen, a UC Santa Cruz researcher who is developing this stuff. I asked him yesterday if he recognized any of the technology in the film and he said, “The neural links in the movie are exactly the bioports that I am working on.”

National Geographic’s good January cover story is about bioports, too.

More broadly interesting is the Gaia-like interconnectedness of all the organisms living on Pandora, and the evo-bio-tech that makes it possible. The anthropologist studying the planet, played by Sigourney Weaver, has discovered that each organism is like a single neuron in a vast neural network constituting the planet’s “brain.” The Na’vi a have long, braided, mane-like appendages that end in little ports that they can plug into other organisms to communicate with them. This way they link up with the dragon-like creatures they ride on, or the big, sacred tree they worship and that acts as the repository of their collective wisdom. This interconnectedness finally comes to their rescue against the human invaders.

We humans don’t have ports, or tails, like the Na’vi, but we do have ways to plug into the natural world (and into each other) and doing so often and well will be key to our survival, too. No one doubts that we are all part of something bigger (evolution, life, Gaia) but staying in touch with that requires a little practice in a modern world obsessed with individuality and independence. Maybe that’s one big adaptive value of prayer, or meditation, or surfing (water and maybe web (is Wikipedia, our big tree?), too), or dancing, or--lets not forget--romance.

Will we one day be able to directly experience life through others, the way the human avatars do in the movie? Probably, if we don’t wipe ourselves out first. In the meantime, watching movies like Avatar is a pretty great stand-in. And 3-D makes is seem pretty direct. We’re already endowed with a nervous system that permits amazing acts of wireless empathy. For now, let’s work with that.

Soldiers and their Seizures

2009-12-06T08:33:00.000-08:00

Brenda Patoine has written an interesting and ominous piece about the coming tidal wave of seizure disorders among veterans returning from Iraq. Traumatic brain injury (TBI) has always been associated with a high incidence of epilepsy, which may show up months, and often years, after the initial injury. Many soldiers returning from Iraq and Afghanistan have begun to have seizures and many many more will begin to, even as they settle unsuspectingly back in to life at home. The article, on the Epilepsy Foundation's website, cites 1985 study of vets who’d suffered traumatic brain injury in Vietnam found that 50 percent developed seizure disorders within a few years of returning home.
Patoine writes:

"No one knows how many of those troops with brain injuries will eventually develop epilepsy. But with an estimated 1.4 million troops who have served or are currently serving in Iraq, even the most conservative statistics portend a looming crisis of post-TBI neurologic problems.…”

Patoine goes on to quote Marc Dichter at the University of Pennsylvania who pleas for preventive action for these high-risk soldiers. “Basically, we’ve been waiting for epilepsy to happen and then seeing if we can treat it… Why aren’t we paying attention to the development of epilepsy, as we do for every other medical disease?” he asks.

Pantione then outlines a few trials that look at how well various anti-seizure meds work as prophylactics for seizures if they are administered soon after the initial injury. That’s a worthwhile approach, sure, but is administering anti-seizure meds as a prevention really the whole deal? I don't know, but either the article failed to describe other avenues of research, or they aren’t happening. Have VA docs looked for patterns in the EEGs of soldiers with TBI but still no seizures, for example, to see which ones develop epilepsy and which ones don’t? Some people are more likely to develop seizures after brain injury, while others have more resilience due to, say, greater adaptive plasticity, or some other mechanism. What about the increase of gabapentin after injury and its influence on the growth of new synaptic connections; might that acceleration of healing growth also make brains more susceptible to seize? Or maybe (probably) those soldiers who become epileptic would have been more likely to begin seizing anyway; the injury just pushes them over the line. If that's the case, what made them so? Is there a genetic link? How about the specific kind and location and intensity of the brain injury? Are those details being tracked as determinants of seizure onset? And finally, how many of these seizures are psychogenic non-epileptic seizures (PNES)? Do VA doctors really know?

This would be a great time to study these things, both for the soon-to-be epileptic soldiers with head injuries and for the millions of non combatants who are going to begin having seizures in the years to come but don't know it. If we can identify their propensity, and mitigate it, before the onset of full-blown seizures, that would be a huge advance.

Seizure Dogs: An Alternate Explanation

2009-11-04T08:05:00.000-08:00

I’ve been wanting to write a story about seizure dogs for years, ever since I heard about their ability to sense the onset of epileptic seizures before their masters have any idea that they are going to seize. There’s so little documented material, though, that I kept putting off the story. So I was surprised and fascinated (panicked, actually) to see a piece about dog intelligence in the Sunday NYT that opens with tell of Jet, a seizure dog in New Jersey that, among other amazing talents, puts its body in a position on the floor to break the seizure fall of his master before she even knows she’s going to have one.

The Times piece, by Sarah Kershaw, acknowledges that there is still “mystery” about how dogs can detect seizures before they occur, but it fails to look skeptically at whether the dogs are really able to predict--in a way that no neurologists can—when a seizure is going to occur.

The piece goes on, credulously, I think, to cite “Hungarian researchers [who] reported in a study last year that a guide dog for a blind and epileptic person became anxious before its master suffered a seizure and was taught to bark and lick the owner’s face and upper arm when it detected an onset, three to five minutes before the seizure.” The dog not only “knows more than we thought,” he knows more than any neurologist I’ve ever met or heard of and is more sensitive to the subtle electrical happening in the brain before a seizure than any fMRI or EEG. As explanation for this amazing feat of prediction, Kenshaw suggests, maybe that the dog may be “picking up on behavioral changes or smelling something awry.”

I hate to throw a wet, skeptical blanket on dog lovers, romantics, and telepathy fans, but there might be another, and really fascinating and important, explanation for how the Hungarian dog knows that seizures are coming. I think the dog can predict seizures because its predictions bring them on.

I know how crazy that sounds. But consider this fact, which blew my mind when I read it earlier this year: tens of thousands, possibly hundreds of thousands, of Americans who are diagnosed with uncontrolled epilepsy do not have epilepsy at all. They have real seizures all right, and those seizures look like epileptic seizures, but they aren’t caused by uncontrolled electrical activity in their brains, like epileptic seizures are. Rather, they are what neurologists call “psychogenic non-epileptic seizures,” or PNES, which can only be definitively diagnosed using video-monitored EEG. The patient is hooked up to an EEG, which monitors the electrical activity in his or her brain, and is also video taped so that the seizure behavior can be compared to the EEG. The patients are in no way putting on a show; they fully believe they have epilepsy and generally accept diagnosis and treatment when the real roots of their seizures are exposed.

Here’s the thing, patients with PNES tend to be highly suggestible. When they are told, in an epilepsy clinic, while attached to an EEG and while being videotaped, that a seizure will be provoked, say, by flashing lights, or the administration of a saline solution, the procedures do tend to bring on PNES-type seizures. Such strategies do not tend to catalyze epileptic seizures. The PNES patients, whose seizures have psychological rather than neurological roots, follow the lead of their examiners and can often be fairly easily “guided” toward seizing.

Here’s the Freakanomics moment: Undoubtedly, some of the seizure-dog-owning patients who believe they have epilepsy are actually suffering from PNES. And these very suggestible patients could well be seizing in response to their dog's behavior. When that Hungarian dog starts to lick his master’s forearm, warning her that she is going to have a seizure, that suggestion could well be enough to induce a psychogenic seizure. The dog and the patient are engaging in a kind of folie à deux.

All you’d need to trash this hypothesis is one patient whose seizure dog could be proved to reliably predict real epileptic seizures, as opposed to apparently-epileptic-but-actually-psychogenic ones. If my hunch is right, though, and I have a hunch it is, it would certainly behoove anyone with a working seizure dog who they think can predict the future, to get themselves to an epilepsy clinic for a video EEG to see if the root of their seizures might be something other than epilepsy. Psychogenic seizures are treatable, but not with anti-seizure medications. And if you are unnecessarily suffering the side-effects and expenses of treatment for epilepsy, but don’t have it, that would be very, very good to know.

I’m not opposed to researching miracle dogs that can smell seizures that haven’t happened, though I’d rather not have to pay for it. But if I’m right, the research projects worth spending real money on are those that would lead to an understanding of how PNES works and how better to better treat it.
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Illustration by Ross Macdonald, from NYT, Oct. 31, 2009

Schitzophrenic Phenobarb: Good, Bad, and Ugly

2009-10-23T08:54:00.000-07:00

Phenobarbital is one of the oldest and most potent pharmacological treatments for epilepsy, and it is still, nearly a century after its discovery, the most widely used anti-seizure med in the world. But it has a checkered past. And now it's use in young, developing brains has been linked, in animal models, to an increased likelihood of schizophrenia later in life.

Phenobarb was invented in early 20th-century Germany and used as a potent tranquilizer for more than a decade before a young German doctor, Alfred Hauptmann, discovered that it not only calmed his epileptic patients' nerves, but, in many cases, it also suppressed their seizures. In the 80-plus years since, phenobarb has prevented more seizures--probably by several orders of magnitude--than any other anti-epileptic drug. Its widespread adoption marked a huge step forward in the treatment of epilepsy. When phenobarb replaced bromide--which was both nasty and ineffective--as the treatment of choice for seizure disorders, many patients gained complete control of their seizures and many more were able to leave institutions and resume normal--even if not completely seizure-free--lives.

The barbiturate has has relieved huge amounts of suffering. But it has caused suffering, too.

In one of the sickest mis-applications in pharmacological history, overdoses of phenobarbital, then under the brand name Luminal, were used by German eugenicists, many of whom were doctors, in the state-sponsored program of killing children born with deformities or diseases (including epilepsy.)

Now, according to a paper just presented in Chicago by a team of researchers from Georgetown University Medical Center, phenobarbital has been linked to a rise in schizophrenia-like conditions in the developing brains of animals. Guillermo Palchik, a doctoral student at Georgetown's department of pediatrics, said that the study raises doubts about the long-term safety of prescribing phenobarbital to infants.

According to Palchik and colleagues, an association between early childhood seizures and an increased likelihood of schizophrenia later in life has long been recognized. But do the seizures cause brain damage that leads to schizophrenia? Or does brain damage caused by phenobarb in regions of the brain associated with schizophrenia explain the trend? The question remains unanswered, but the new Georgetown study suggests an urgent need to take a longer, harder look at the drug end.

Epilepsy's Window to the Brain

2009-10-19T18:43:00.000-07:00

Los Angeles Times writer Karen Kaplan wrote a good description of an experiment designed to see whether Broca's area really does divide the task of uttering a word with Wernicke's area, as long claimed in neuroanatomy texts. The researchers, at Harvard and UC San Diego, showed subjects a series of 240 distinct words and asked them to "pronounce" the words in their minds. Some of the words required conversion into another tense before being "pronounced." Meanwhile, the researchers watched what happened in Brocas's area, and found that there was activity there associated with 1) selecting a word, 2) deciding on a tense, and 3) mapping out how that word will be pronounced with the mouth. Nothing at all interesting happened in Wernicke's area. Broca's does it all! In less than half a second!

"The finding will make many textbooks obsolete," writes Kaplan.

The result is interesting enough on its own, but more remarkable to me is the methodology employed. See, fMRI doesn't picture the brain at a high enough resolution, or quickly enough, to record this kind of activity. Instead, the researchers needed tiny electrodes implanted deep into the brains of the subjects to measure super fast and subtle reactions at ultra-high resolutions. But no review board was going to--nor should it--approve an experiment that requires brain surgery, no matter how interesting the results might be. Once again, epilepsy steps in to drive neuro-discovery as generous patients, and ingenious, multi-tasking neurosurgeons, offer their services (and/or their brains). The surgeons, in preparation for surgical treatment of epilepsy, are conducting a procedure called intracranial electrophysiology (ICE), in which they implant dozens of electrodes in the area of an epileptic patient's brain to precisely detect where the patient's seizures are starting and where healthy neurons are just doing their thing. The procedure allows neurosurgeons to cut only the pathogenic tissue, leaving behind all the important, good stuff. It takes several days, during which there is a wide open window into the portions of the patient's brain where the electrodes are inserted. If the patient is willing, and if the surgeon is interested, and if the part of the brain being explored is of interest to a neurobiologist who gets word of the surgery, the situation is ripe for research, like the Brooca's area study. Such a scene also led to discovery of the first mirror neurons in human brains (see my news piece in New Scientist) and many other cutting-edge studies. As ICE becomes more common, and as researchers increasingly include it in their repertoire of tools, other textbook chapters will be laid to rest as well.

For centuries, since Hippocrates at least, efforts to understand, describe, and treat epilepsy have been nudging, or hurtling, neuroscience forward. In fact, the reason we know as much as we do about the functional geography of most parts of the human brain--including the general functions of Broca's and Wernicke's areas, is because of earlier explorations inside the brains of epileptics. And there's no sign the trend is turning.

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Photo caption: Neurosurgeons implant electrodes deep into the human brain in order to locate the foci of seizures. While the electrodes are in, they can be used for basic research, such as the study described in Karan Kaplan's LA Times, piece. This remarkable X-ray photo is by Ned T. Sahin, the UC San Diego neurobiologist who was the lead author on the Broca's Area study, which appeared in last Friday's issue of Science.

Brooks on the Brain: The Young and the Neuro

2009-10-13T12:14:00.000-07:00

In today’s column, David Brooks reports on the Social and Affective Neuroscience Society’s conference last week in NYC. He says about the crack young neuro-scientists there, “When you spoke with them, you felt yourself near the beginning of something long and important.” Let’s hope so. But let's not lose our heads yet.

While the kinds of studies these guys conduct will stir up interesting clues and insights about what makes us tick--and what sometimes makes us explode, and what sometimes makes us blow other people up--and that is thrilling, unless you’re trying to raise funds for your own research, it seems best to resist irrational exuberance about the value of consigning various brain states to emotions and behaviors. Brooks suggests that “this work will someday give us new categories, which will replace misleading categories like ‘emotion’ and ‘reason.’” Maybe. Maybe not.

He gives the example of Saaid A. Mendoza and David M. Amodio of New York University, whose work shows that reminding people to be fair may correct for reflexive prejudice that occurs in as little as 170 milliseconds in the anterior cingulate cortices when people racially discriminate. But what does that tell us that we don’t already know? That we should remind ourselves to be fair? Okay. And where would we be left if the study showed us otherwise? Would we give up trying to teach journalists to be fair, to compensate for their own prejudices? Would we stop bothering to try to make our kids aware of their biases?

Brooks is right to be enthusiastic. Neuroscience is in a thrilling stage. Absolutely. But it would be a big mistake to bank on the idea that the study of brain states will show us a way toward solving the crisis in the Middle East, or toward solving the social injustice we've come to take in stride here in the US. We can't just blame those problems on our brains. Nor are we likely to find ultimate solutions there. Brains don't go to war, people do.

Epilepsy and the Mind-Brain Problem

2009-10-08T12:39:00.000-07:00

In his good essay, "Reflections On Epilepsy," in the current issue of Philosophy Now, neurologist Raymond Tallis looks at what epilepsy may reveal about the argument that consciousness boils down to various brain states. An excerpt:

“If neural impulses in a solitary brain were sufficient to make up a world – as opposed to simulating bits of worlds under very abnormal circumstances – then we should not be able to distinguish between having a series of epileptic fits and living with epilepsy – or, indeed, living without epilepsy. I used to shudder when I heard people with epilepsy referred to as ‘epileptics’. By identifying the patient with his brain condition, it collapsed the distance between the latter and the person who coped with it (and decided whether my advice was any good or not). This was not only dehumanizing but also metaphysically wrong.”

Tallis makes the old, basic, and I find convincing, point that brains are necessary but not sufficient conditions for consciousness. His approach is resonant with the thoughtful Berkeley philosopher Alva Noe, who argued in his book "Out of Our Heads," that we are not our brains. (See my Salon interview with Noe.) But I especially like the way Tallis, who used to run an epilepsy clinic and is also a novelist and poet, exploits his experience watching patients with seizure disorders lose and regain consciousness. Having seen hundreds of generalized seizures myself, I concur that it is when the seizing person’s mind reassembles, after the electrical storm is over and the necessary neural orchestration has been resumed, that consciousness becomes possible. But at that early postictal point, consciousness is only a possibility. Only when the person who's had the seizure is back in the world with you--maybe they blink, say a few words, ask where they are--is anyone ready to call them actually conscious.

While Tallis’s essay hardly settles the question of the identity of brain and mind, it does suggest a fresh and fascinating way to get some traction on the subject by looking at real consciousness in real people with a real disorder (epilepsy), which conducts all kinds of natural experiments that, for my research money, blow Hilary Putnam's "Brain in a Vat" out of the water.

Twenty four hundred years ago, Hippocrates’ book “On the Sacred Disease,” argued that epilepsy should be treated as a physical phenomenon and not a spiritual one. It was the birth of medical science. And efforts to understand and treat epilepsy have remained at the center of progress in neuroscience ever since. So it makes sense that epilepsy would have a lot of teach us today as science and philosophy continue to struggle to clarify the relationship between brains and minds.

None So Blind: Anton’s Syndrome

2009-10-02T12:34:00.000-07:00

We fill in blind spots all the time to keep our perception of the world flowing and making sense. Earlier this week I interviewed Stanford neuroscientist Ben Barres, who recounted a staggering feat of such patching.

An elderly patient was brought into the ER by her family because she'd been "bumping into things and acting strange." Barres, a Cornell medical resident at the time, gave her a full neurological exam, which she passed with flying colors, until, that is, he asked her how many fingers he held up. "Five," she said. He’d been holding up three. He kept his hand down and asked again. "Three," she said. Barres passed his hand near the patient’s face; she didn’t blink. "How's your vision?" he asked. "Fine," she said. But her vision wasn't fine. She was totally blind.

A recent stroke had whacked her visual cortex so that although her brain was getting visual data, it couldn’t interpret it. The stroke had also cut off communication between the visual cortex and the speech-language areas of the brain causing a kind of cortical blindness called Anton’s syndrome. The patient could not see a thing, but she didn’t know it yet. And, not believing she was blind, the patient’s brain invented a plausible visual "patch," from other sensory data… and a strong dose of imagination. "The power of denial," says Barres, "is also at play." (I guess so!) Amazing the hoops the brain goes through to fill in blind spots (in this case, the entire visual field) and preserve a coherent, and tolerable, picture of the world.

Remember to Forget

2009-09-28T13:41:00.000-07:00

Mental Floss Magazine posted a fascinating article about super-autobiographical memory last week. The piece profiles four adults who share the ability to recall tiny, seemingly insignificant details from long ago. The possibility that everything we experience is stored somewhere in our brain goes back to experiments by British neurosurgeon Wilder Penfield, who provoked specific, long-forgotten memories in his patients by touching parts of their temporal lobes with an electric probe. One epileptic patient relived a childhood experience of smelling burnt toast each time Penfield stimulated a particular location on her cortex.
If the people profiled in Mental Floss can control their access to the huge database in their brains, why can’t the rest of us? The coming decades may explain why, or they may show us how we can recover long-forgotten details, too. But I suspect that we will also learn that our ability to forget—to flush destructive or superfluous data or memories--is at least as important as our ability to remember. Especially if the data we’re talking about contains viral components that can keep our brains pinwheeling while other key bits of data--our lives-- pass us by. Those of us who can’t remember every episode of Flipper should thank our lucky stars.
One hot and relevant area of current research focuses on the role of attention in helping the brain decide what to hold onto and what to flush. Take a look, for instance, at this Journal of Neuroscience paper by Adam Gazzaley and Theodore P. Zanto showing how "top-down" attention is related to memory acquisition. Choosing what to remember and what to let slide sounds good, but I wonder if our conscious minds can always be trusted to know what's important to remember and what's not?

Upping the Pace in Brainy Rat Race

2009-09-23T22:04:00.000-07:00

In a clever experiment on lab rats, Taiwanese researchers found that while a pleasurable run may significantly improve cognition, a painfully challenging one boosts it more. The study is described in an article by Gretchen Reynolds in Sunday’s New York Times. The research, conducted at the National Cheng Kung University in Taiwan, had some rats run at their own pace on cage wheels, which they apparently enjoy, and forced others to keep up a higher pace on treadmills, which they don’t like so much. Both groups performed better at various brain-dependent tasks than a control group--which used brain fitness software, but did not exercise--but the second, harder-running group of mice did better than the first. In explanation, Henriette van Praag, an investigator in the Laboratory of Neurosciences at the National Institute on Aging, tells Reynolds: ‘“It appears that various growth factors must be carried from the periphery of the body into the brain to start a molecular cascade there,” creating new neurons and brain connections. For that to happen, “you need a fairly dramatic change in blood flow.”

A Safer, Sexier Approach to Brain Fitness

2009-09-23T11:31:00.000-07:00

While brain fitness software might help some to recover lost cognitive function and memory power-- especially the stuff with serious research behind it like Posit Science's--there are a few things that neuroscientists pretty much all agree are good for your brain. I focused research for my story about brain training at the Keck Center for Integrative Neuroscience at UCSF, where I asked some of the world's top neuroscientists what they did to keep their own brains humming. Not a single one (except Michael Merzenich, the founder and president of Posit) said they used brain fitness software. Instead, they cited exercise, challenging their minds by mastering new skills (memorize a poem, learn to tango, study a new language, publish another paper), eating well (foods with lots of antioxidants such as blueberries and walnuts, and foods with Omega-3 fatty acids), and engaging in stress relieving activities (hiking, music, meditation, sex). All the researchers also agreed that meaningful work helps a lot; the attention that comes from caring about what you’re trying to do is key to engaging your brain’s learning and memory functions. It's a small survey of scientists, not science, but, assuming they are rational, it's probably good advice. Anyway, their approach is not only good for the brain, it’s what someone with a good head would probably want to do anyway.

Brain Fitness Software: Hype or Bologna?

2009-09-20T09:52:00.000-07:00

Here in the San Francisco Bay Area, KQED Radio, the biggest local NPR station, is well into its Fall fund-raising drive. Once again, it’s promoting--as a gift to big donors--“brain fitness” products from Posit Science in San Francisco. I’ve used the software, which is supposed to stimulate users' brains to make new connections and fortify important ones, and I don’t think its going to hurt anyone. It might well even help. But the KQED announcers’ repeated promise that it is “scientifically proven to make you smarter and help you recover lost brain function” is bunk, as I found researching this skeptical article about the burgeoning brain fitness movement for San Francisco Magazine. It’s notoriously hard to test this kind of software scientifically, the placebo effect alone blows the current studies out of the water, and the efforts to do so have produced ambiguous results, at best. Take a look at this buyer beware statement from the Stanford Center on Longevity.