Slide 1 - University of Texas at Dallas

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					 Healing the Human Brain:
The Next Medical Revolution
       Michael P. Kilgard




    University of Texas at Dallas
Dendrites




 Axons
We hold these truths to be self-evident...
Alzheimer’s Disease




                      Affects 4 million
                      Americans.
                      12 million predicted
                      by 2040.
Hearing Loss




               23 million Americans suffer irreversible hearing loss.
                                                  1 million are deaf.
Migraine and Chronic Pain




                            75 million Americans with chronic pain.
Substance Abuse




                  22 million
                  Americans are
                  drug or alcohol
                  dependent.
Anxiety Disorders        25,000,000


Depression               19,000,000


Epilepsy                 2,500,000


Schizophrenia            2,000,000


Traumatic Brain Injury   750,000 / year


Stroke                   700,000 / year


Autism                   500,000


Multiple Sclerosis       400,000
Fantastic…




             and Fragile
      Mind vs. Brain
•   Creative        •   Meat
•   Ever-Changing   •   Mostly Fat
•   Ever-Active     •   Boring
•   Beautiful       •   Ugly
•   Enduring        •   Fragile
Map of the Body Surface
                                   Cortex


Path from Skin to Brain
                          Touch
                          Cortex




                                   Midbrain




                          Finger   Medulla




                                   Spinal Cord
 Brain Map



Thumb

Index

Middle

Ring


Little
            Thumb




                            Middle
Brain Map




                    Index




                                            Little
                                     Ring
                                Amputation Causes the
                                   Map to Reorganize
Can learning really change the brain?
Performance Improves with Practice




                                         0 1 2 3 4 5 6 7
                   Detection Threshold
                                                  0        5   10    15 20    25   30
                                                               Days of Practice
Learning Causes the
 Brain to Reorganize
                                   Cortex


Path from Skin to Brain
                          Touch
                          Cortex




                                   Midbrain




                          Finger   Medulla




                                   Spinal Cord
Learning Causes the
 Brain to Reorganize
No Reorganization
Without Attention
Fantastic…




             and Fragile
Problem:
  Decreased attention span due to attention to pain




  Chronic Pain =
   Synchronous                  Stress/Anxiety
  Spontaneous
     Activity




   Cortical Map
  Reorganization




  Strain or Injury
             Tinnitus
 Uncomfortable sensation of ringing in the ears in the
  absence of external sound.
    14 million Americans have tinnitus.
    Interferes with daily activity in 1 million.
 No effective treatment to eliminate tinnitus.
    Associated with hearing impairment due to aging,
     noise exposure or ototoxic drugs.
    The dominant theory is that pathological plasticity
     plays a critical role.
 Tinnitus severity is correlated with extent of map
  expansion.
Tinnitus



Normal Map
Today most neurological and psychiatric disorders
       are neither preventable nor curable.




     Will this always be true?
             +
Polio coat          Immune
 proteins        system irritant


 = immunity
        How can we direct
neural plasticity to heal the brain?
   Electrical stimulation can be used
       to direct neural plasticity.




Nucleus
Basalis
Nucleus basalis stimulation directs powerful
    and highly specific neural plasticity
                               Science, 1998




              Best Frequency
                                               NB
Stimulating NB paired with different sounds alters:
•    Frequency Maps
     - in primary auditory cortex       - Science, 1998

     - in non-primary auditory cortex   – J. Neurophys, 2007

     - in subcortical structures        – Suga, 2003

•   Selectivity                         – Science, 1998

•   Sensitivity                         – J.   Neurophys, 2001

•   Temporal Processing                 – Nature Neuroscience, 1998

•   Sequence Selectivity, and           – PNAS, 2001

•   Synchrony                           – Hearing Research, 2007

•   for more than a month,              – unpublished

•   and improves discrimination.        – unpublished
Problem:                                                 Solution:
  Decreased attention span due to attention to ringing    Auditory cortex Map Plasticity

                                                                                     ACh

     Tinnitus =                                                               Nucleus
    Synchronous                  Stress/Anxiety                               Basalis
    Spontaneous
      Activity

                                                                                LC


  Auditory Cortex
 Map Reorganization                                       Cochlea              NTS



   Hearing Loss or
                                                                            Vagal Nerve
   Noise Exposure                                                    +      Stimulation
   How to stimulate plasticity
without deep brain stimulation?
Vagus Nerve Stimulation (VNS)

           NB


           NTS
Potential
Tinnitus
Therapy
                        Laptop
                     • Supervise Rehabilitation
                     • Deliver physical stimuli
                     • Collect data
                     • Deliver nerve stimulation

Patient interface                        Vagus Nerve
• Sound generator                        Stimulator
• Force transducer
• Images & movies
• EEG
  Potential VNS-facilitated Therapies
VNS + Tones                     -   Tinnitus
VNS + Touch                     -   Chronic Pain
VNS + Skilled movement          -   Motor Impairments
VNS + Cognitive therapy         -   Cognitive Impairments
VNS + Desensitization therapy   -   PTSD / Anxiety
VNS + Speech therapy            -   Communication
                                    disorders
          VNS-facilitated Rehabilitation




Tinnitus Rehab     Motor Rehab     PTSD Rehab
Human recording video
Blast-induced Brain Injury
       - Tinnitus (26%)
       - Hearing loss (48%)
       - Chronic Pain (83%)
       - Motor Impairments (62%)
       - Cognitive Impairments (88%)
       - Communication (50%)
       - PTSD / Anxiety (42%)
       - Depression (37%)
       - Epilepsy (?)

         Stats from Sayer, 2008
UT Dallas
 Michael Kilgard    Tinnitus and motor deficits
 Larry Cauller      Wireless VNS and pain
 Christa McIntyre   PTSD
 Marco Atzori       Epilepsy
 Emily Tobey        Hearing loss
 JB Lee             Device construction
 Jin Liu            Device design
 Phillip Loizou     Signal processing
 Sandi Chapman      TBI
 John Hart          PTSD
 Michael Devous     UTSW - Imaging

 MicroTransponder, Inc.
 Today most neurological and psychiatric disorders
        are neither preventable nor curable.




How will the world look when they are?
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posted:7/23/2011
language:English
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