Consciousness, Seizures, & Cortical Networks - The Blumenfeld Lab at Yale School of Medicine

Transcript

• 00:06Consciousness is what's important to
• 00:08us. It's all the things
• 00:09that we're aware of. It's
• 00:11it's what, keeps us awake.
• 00:13It's what makes us experience
• 00:15our lives moment to moment.
• 00:17It's what makes us able
• 00:19to function in the world.
• 00:20It's really what makes us
• 00:21human.
• 00:23When people have seizures, they
• 00:24often lose consciousness.
• 00:26They are unpredictable. They can
• 00:27happen any time day or
• 00:28night and have devastating consequences
• 00:31for people's quality of life.
• 00:37Our lab is interested in
• 00:38understanding
• 00:39normal consciousness,
• 00:41understanding how that is disrupted
• 00:42in disorders like epilepsy,
• 00:44and finally, how to try
• 00:46to improve or restore consciousness
• 00:48using therapeutic
• 00:49methods like brain stimulation.
• 00:51Consciousness depends on huge huge
• 00:53networks in the brain, including
• 00:54both the surface of the
• 00:55brain or the cortex and
• 00:56also deep structures in the
• 00:58brain like the thalamus and
• 00:59brain stem. The deep structures
• 01:00in the brain are critical
• 01:02for consciousness because they provide
• 01:05modulatory and arousal functions.
• 01:07And that's a key aspect
• 01:08of consciousness is being awake
• 01:10and being alert. And that's
• 01:11modulated and regulated
• 01:14on long timescales, for example,
• 01:15when you're asleep or when
• 01:16you're awake or when you're
• 01:17in a coma, when you're
• 01:19in a normal state of
• 01:19consciousness, or anesthesia or seizures.
• 01:22And also on shorter timescales,
• 01:23moment to moment,
• 01:25that affects what we're conscious
• 01:26of and what we're not
• 01:27conscious of. And that's controlled
• 01:30to a large extent by
• 01:31cortical circuits interacting with these
• 01:33deep structures in the brain,
• 01:34including the thalamus of the
• 01:35brain stem are multiple parallel
• 01:37systems that play this key
• 01:39role in controlling and regulating
• 01:40our consciousness.
• 01:47We use brain imaging as
• 01:49a key method to look
• 01:50at big scale circuits in
• 01:52the brain.
• 01:53We also use electrical recordings,
• 01:55which gives us much better
• 01:56resolution in time and more
• 01:58direct measurements of the activity
• 02:00of brain cells and brain
• 02:02circuits.
• 02:03We also measure in animal
• 02:05models neurotransmitters
• 02:06and neurons and look at
• 02:08at things on a very
• 02:09fundamental level.
• 02:10And in people, we look
• 02:12at other metrics of consciousness
• 02:14and of function and of
• 02:16brain activity, including
• 02:17eye movements, subtle dilation of
• 02:19the pupil, and blinks and
• 02:20tiny movements of the eyes
• 02:22called saccades. It can give
• 02:23us clues about what's happening
• 02:24during normal consciousness and impaired
• 02:26consciousness.
• 02:27And then we use machine
• 02:28learning and artificial intelligence to
• 02:30decode
• 02:31all these signals and understand
• 02:33what's going on in the
• 02:34brain and also what's going
• 02:35on with these surrogate markers
• 02:36like the the eye movements
• 02:37to be able to do
• 02:38things like knowing if someone's
• 02:40conscious or not of a
• 02:41particular stimulus without even asking
• 02:42them just based on their
• 02:43eye movements.
• 02:49We've just completed a clinical
• 02:51trial where people with a
• 02:53particular type of seizures, temporal
• 02:54lobe seizures.
• 02:55We implanted devices in patients
• 02:58where during those seizures, we
• 02:59first tried to stop the
• 03:00seizures with brain stimulation, like
• 03:02the way a defibrillator
• 03:04or a pacemaker works.
• 03:06If that didn't work, we
• 03:07had a second mode of
• 03:08stimulation, which was triggered by
• 03:10seizures that weren't successfully stopped
• 03:12and stimulated the thalamus to
• 03:13try to wake people up
• 03:14and make them more conscious
• 03:16during seizures. And we measured
• 03:18their behavior using smart, watch
• 03:20technology at home and monitored
• 03:22how well they were able
• 03:23to respond and interact during
• 03:25the seizures with or without
• 03:26this additional stimulation of the
• 03:28deep structures of the brain.
• 03:31Remarkably, we found that this
• 03:32treatment really helped the patients,
• 03:34really helped them improve their
• 03:35behavior,
• 03:36their responsiveness, and their ability
• 03:38to interact with the world
• 03:39during and after the seizures.
• 03:41So that's the kind of
• 03:41treatment
• 03:42approach that we're exploring further,
• 03:45where we can hopefully understand
• 03:46the brain circuits that are
• 03:47involved in normal and impaired
• 03:49consciousness and intervene to try
• 03:50to help patients with epilepsy
• 03:52and with other types of
• 03:53disorders.