Breakthrough (2015) s01e03 Episode Script
Decoding The Brain
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§ NARRATOR: What makes you who you are? Are you just a robot following a program? Can we change, and should we change, the traumatic memories that ruin lives? The answers lie in the web of electrical impulses inside your skull.
Your brain is an incredible piece of organic machinery that produces something far greater than its component parts.
Breakthrough science lets us study those parts as never before, uncovering the hidden processes that form our identities and offering new hope for those with brain disorders.
MOHAMAD KOUBEISSI: The brain is an electrical system.
That's how we measure um, the brain activity.
The cells communicate by sending electrical pulses to one another.
NARRATOR: Mohamad Koubeissi is the director of George Washington University Hospital's Epilepsy Center.
His pioneering research is revealing how the electrical storms of the brain produce memory and consciousness, and how we can help those whose brains misfire.
MOHAMAD KOUBEISSI: Early in my medical school years I decided to become an epileptologist because it's the specialty that will allow you to study the brain millimeter by millimeter and centimeter by centimeter through cortical stimulation mapping.
NARRATOR: To map what goes on inside the brain, Mohamad implants tiny electrodes in his patients' skulls.
He then sends pulses to these electrodes, gradually increasing the current, sometimes with dramatic results.
Recently, he inserted an electrode next to a small region called the claustrum.
The claustrum is uniquely connected to other parts of the brain.
MOHAMAD KOUBEISSI: When we were doing the mapping, we were surprised to see what stimulation of the claustrum resulted in.
I asked her to read, and I discovered that stimulation of this one electrode which is in the claustrum made her stop reading, and have no memory to what happened during the stimulation.
FEMALE: When I was 21, 28, my mother died after a decade-long illness NARRATOR: When Mohamad sends a 14 milliamp electric pulse into the claustrum, the patient freezes mid-sentence.
It's as if her conscious mind has been switched off.
MOHAMAD KOUBEISSI: Cognitively she is completely impaired.
Uh no language function.
No memory function.
No responsiveness.
FEMALE: We drove the country road out to her place.
NARRATOR: When the current is reduced, she picks up exactly where she left off.
FEMALE: I taught English at a small cottage in the Bay Area.
MOHAMAD KOUBEISSI: The findings led to some authors to naming the claustrum the on-off switch of consciousness.
Which based on this case is actually pretty accurate.
NARRATOR: This was an incredible finding.
But it is just one of the many ways he's exploring the brain, and pushing forward the treatment of disorders of consciousness.
Mohamad has also developed a new way to treat people with severe epilepsy.
He's looking for volunteers willing to have electrical stimulators permanently installed in their brains.
But there are no guarantees it will work, because the human brain may be the most complex object in the universe.
To neuroscientist Steve Ramirez, the complexity of nature tells us much about the inner workings of the human brain.
STEVE RAMIREZ: So let's zoom our microscope in at the level of a single H2O molecule.
So if you ask yourself what an H2O molecule tells you about the property of wetness, probably tells you a little bit but not that much.
Now when you combine trillions and trillions of molecules of H2O, you end up getting something that resembles drops of water.
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§ Now those drops of water, when you combine them, and you combine trillions and trillions of drops of water, you end up getting something as amazing as a river.
Think about those molecules of H2O as single neurons.
A single neuron tells you a little bit, but not the whole story.
Now when you begin combining those brain cells on the order of 80 to 100 billion of those interacting with one another, then you get these properties that begin to emerge like memory, like consciousness.
These tiny pieces of brain tissue, 80 billion brain cells, are what make you.
They produce everything you've ever felt, experienced love, the hated, the cried, the works.
NARRATOR: Steve believes our identities are built on memory.
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§ STEVE RAMIREZ: You think about memory, it is the thing that thread and unifies our overall sense of being.
So without it we become stuck in time, right? And we lose our identity.
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§ NARRATOR: But how reliable is memory, even in a well-functioning brain? STEVE RAMIREZ: We used to think that memories were really stable, that you form one memory and it's not ever changing, it's just stabilized in your brain and that memory forever is.
So now we know that for all intents and purposes, when you recall a memory, you're constantly updating it with new information.
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§ NARRATOR: Every time you revisit a memory, it becomes vulnerable, it can be changed.
Say, for instance, two people on a date end up at a bar.
Things go well.
Later, the woman recalls the scene.
But each time she remembers it, small details may change.
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§ Over time, the details add up.
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§ And the same thing is happening to her date.
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§ Each time he revisits the memory, it subtly alters.
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§ Until eventually, he and she have very different memories of what the bar looked like that night, how they were dressed, or even how they behaved.
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§ The changes in memory can be especially dramatic if one person's feelings about the other have changed.
A good memory can turn bad.
Psychologist Bill Hirst of New York's New School has found that memory is not carved in stone, it's written in sand.
BILL HIRST: People think of memory as involving the storage of information like a library, you store away information and it sits there waiting to be retrieved.
But memory is not like that at all.
You basically, um, construct the memory on the run.
NARRATOR: But some memories belong to a special category, memories of traumatic events that affect millions.
These are called flashbulb memories.
December 7th, 1941, a date which will live in infamy.
NARRATOR: The biggest flashbulb event in recent history was the terrorist attack of Sept.
11th, 2001.
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Oh my god! Jesus [BLEEP.]
Christ! NARRATOR: It presented a unique opportunity to look at how memories form and shift over time.
BILL HIRST: Psychologists, every time some horrifying thing happens in the world, they rush out into the street and they interview people.
I've never seen nothing like it in my life.
BILL HIRST: So when 9-11 occurred, I and a bunch of other psychologists from around the United States, ran out onto the streets and asked people where were they when they learned about the attack of 9-11 And then we have followed them up one year later, three years later, and ten years later.
NARRATOR: When it comes to flashbulb memories, everyone remembers the basic facts of the traumatic event, but the memories of their own actions and feelings blur over time.
BILL HIRST: If you ask the average American, will you remember where you were when you learned about 9-11, almost everyone will say absolutely.
And the fact of the matter is, they won't.
NARRATOR: To demonstrate this phenomenon, we gathered actors to read transcripts representative of the 9-11 study.
CHRIS: I was in my apartment in Brooklyn.
I didn't see the first plane hit but I heard it.
NARRATOR: One year later, the story has changed.
CHRIS: I was on the street.
I heard a booming noise, uh, an explosion.
I saw smoke- BILL HIRST: What you find is that the accuracy declines dramatically the first years.
If you compare what they said one day later, two days later, with what they said one year later, the accuracy rate is about 61 percent, I believe.
Uh, so there's a great deal we're forgetting.
CHRIS: I was on the street BILL HIRST: They believe 100 percent that this memory, which 40 percent of the time is wrong, is absolutely positively right.
CHAD: I was in class at school.
I was in the library.
BILL HIRST: And once you persist with an error, it becomes your memory, right or wrong.
TONYA: I called my boyfriend first but couldn't get through.
I know I tried to reach my parents first but couldn't get through on the phone.
NARRATOR: When remembering factual details, people got things wrong about 40 percent of the time.
But when it came to remembering their emotions, they were wrong 60 percent of the time.
BILL HIRST: And the errors that they made tended to reflect their current state.
So, those people that had a pretty stable emotional state across the 10-year period, tended to be fairly accurate in their memories over that ten-year period.
CHARLES: I-I-I was scared, you know, what, what's gonna happen? First of all, um, you know, I'm 40 miles from home.
I - I gotta go through the city.
I have to get home.
I - I was, upset.
I was pretty calm when the first plane hit.
When the second one hit, I knew this was an attack.
I was pretty concerned NARRATOR: Your current emotional state affects how you remember things, particularly how you remember your emotions at the time.
But in some cases the emotional traumas we suffer are so intense, they can never be escaped.
SPAN Style="text-align:left;"ts traumatize millions but, for some,/SPAN those events leave psychic scars that last a lifetime and lead to Post Traumatic Stress Disorder.
This woman witnessed the September 11th attacks firsthand.
MYLES: I remembered specifically going into one of our conference rooms, getting ready for, for a meeting.
And through, it was in the corner of where we were at the time.
It was on Ninety-Five Green Street.
And in that corner I saw the second plane.
It was just so close to, um, to our office, to our window and I could - I swear I - I thought I could see people inside.
And as I followed the plane, it went right into the South Tower.
And I - I lost it.
I still can't talk to people about it.
Um, at least not voluntarily.
Um, and, um, so I - I don't think that my feelings have changed.
NARRATOR: Traumatic experiences change people's lives.
With no warning, the pain of the initial trauma can come roaring back with devastating effects.
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§ What if we could separate the pain from those memories? Steve Ramirez's work at MI may alleviate the suffering of millions with PTSD, or lead to a world where no one can be certain if their memories are real.
That work is being conducted at the lab of Nobel Prize-winning biologist Susumu Tonegawa.
STEVE RAMIREZ: The kind of research that I've been doing is twofold.
Try to figure out what are the basic building blocks of memories, and then can we hijack that system and actually try to give it some kind of therapeutic value.
So imagine that we can use something like memory, for example, as a weapon to combat certain psychiatric disorders.
NARRATOR: By studying the brains of rodents, the Tonegawa lab has made major discoveries about the workings of the hippocampus.
The hippocampus consolidates information from short-term memory to long-term memory.
It's one of the first regions of the brain damaged by Alzheimer's Disease.
The facts of a memory seem to be stored here.
But the emotional components of memory are scattered across the brain.
This got Steve to thinking, if he altered the brain cells that retain emotional memory, could he change a happy memory to a sad one, or vice versa? With a new tool called optogenetics, he set out to do just that.
STEVE RAMIREZ: We can now go into the brain and modulate it at the speeds that it communicates on, at the millisecond level.
That's amazing because we can actually go in and deconstruct the brain in real time.
You know, we're very privileged to be actually living through a very real revolution in neuroscience right now.
NARRATOR: Optogenetics combines genetic engineering and laser technology.
This rodent has been genetically altered with DNA from algae.
Its neurons are sensitive to light.
Next, fiber optic cables are implanted into the parts of the brain holding onto a memory.
STEVE RAMIREZ: So when we're done with that brain surgery, we now have animals that have optic fibers in the brain that can deliver light onto the brain cells that are light sensitive.
So these brain cells have that light-sensitive switch that lets us flick a memory on or off.
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§ NARRATOR: MIT did not allow us to film Steve's experiment.
So here's Steve's first breakthrough recreated in pixels A rodent is put into a chamber with red walls.
It gets a mild shock to its feet and forms a memory that the chamber is dangerous.
When Steve drops the animal into a blue room, it happily explores until Steve activates the neurons that hold the fear memory.
The rodent immediately freezes.
STEVE RAMIREZ: We were able to artificially reactivate that memory and introduce fearful information into that memory.
So that when you put the animal back in the box, they now showed fear behavior.
NARRATOR: Christmas 2014, Steven implanted a false memory.
Another animal was put into the red chamber with no shock.
The next day it was put into the blue chamber.
While giving the rodent a mild shock, Steve activated the memory of the red room.
The next day the animal was put back into the peaceful red room with no shock, and it froze with fear.
A false memory had been formed.
STEVE RAMIREZ: We were able to activate this memory and bring it back online, and then artificially infuse negative information to it to change the contents of that memory.
I kind of had that I can't believe that just worked feeling.
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§ NARRATOR: Since then, Steve has managed to reverse the effect, to turn unhappy memories into happy ones.
But there are obvious ethical problems with altering memories, or implanting artificial ones.
This could conceivably lead to a frightening new style of brainwashing, ultimately making us question everything we think is true.
STEVE RAMIREZ: If memory manipulation were to ever make its way to humans, you don't give it to the entire population of Massachusetts, you give it to the clinically relevant population of people who actually need it the war veteran, the assault victim, the person riddled with PTSD or anxiety or depression.
NARRATOR: Optogenetics is a major step forward in research technology, but so far it is only used in animals.
Can we ever really be certain that altering our mental circuitry will have drastic effects on who we are and how we behave? NARRATOR: The brain is a precision instrument.
Outside of conscious awareness, small bits of flesh control a wide range of functions.
But until the invention of brain imaging, we had little idea of how those bits of flesh behave.
MRI, short for Magnetic Resonance Imaging, lets us see the inner workings of the brain in real-time.
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§ While many people have had MRIs, few know how they work.
It's all about excitement exciting atomic nuclei.
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§ This paint contains luminous zinc sulfide.
The zinc atoms absorb light energy.
When the lights go out, the atoms release that energy, which makes them phosphorescent.
Similarly, when the water molecules in your body are hit with a high magnetic field, they emit radio waves.
It's possible to detect those signals and use them to create maps of your inner terrain.
Which is exactly what physicist and physician John Schenck did in the 1980s, when he brought the MRI to a whole new level precision mapping the brain.
His team created the first human brain image at a magnetic field strength 4 times higher than ever used before.
No one was certain the machine was safe for humans.
So John climbed into it himself.
JOHN SCHENCK: It was quite a risk, and it was a big step forward.
I got in the magnet and was the person being imaged, and one of my colleagues was running the scanner, and finally in the middle of the night we actually got, got our first image.
I realized that this was going to make a big a change in the whole field.
NARRATOR: Today, virtually every hospital in the developed world has an MRI machine.
And being able to see inside the brain launched a revolution in neuroscience.
John has scanned his own brain nearly every year since 1983.
And MRI has gotten vastly more powerful over those years.
JOHN SCHENCK: This is my brain here.
I'm 75 now and this, I'm pretty happy with the way this looks.
But you can see some changes in it from when I was younger.
The ventricles in the central part of the brain are larger now that happens to most of us as we get along - but overall given the age factor and so on, the wear and tear over the years, it still looks pretty good! § [MUSIC.]
§ NARRATOR: Today, John and his colleagues at GE are testing a new process that lets them see iron deposits in the brain better than ever before.
This makes it possible to study a tiny region called the Habenula, which may be linked to serious depression.
JOHN SCHENCK: The Habenula is very, very deep inside the center of the brain and it's quite surprising we're able to see it as well as we do in this technique.
The iron in the Habenula allows us to get a more precise image that actually can characterize how the Habenula is performing, and may give us some insights into the development and treatment, proper treatment, of depression.
NARRATOR: Human brains are built out of many of these tiny but vital clumps of tissue.
They generate the complex neural networks that control our behavior.
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§ By wiring the brain with electrodes, Mohamad Koubeissi can see those networks in action.
These are the electrical patterns that form a human mind.
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§ MOHAMAD KOUBEISSI: The EEG records the electrical activity of the brain in real time.
The tracings that we see on top of one another, each one of them corresponds to the electrical activity between two different points on the scalp.
You will notice this rhythmicity very regular brain waves which build up in frequency and voltage.
NARRATOR: During an epileptic seizure, parts of the brain get stuck in a loop, and consciousness shuts down.
MOHAMAD KOUBEISSI: A lot of neurons, they start firing synchronously in an abnormal fashion, instead of each brain cell doing its own thing physiologically.
A lot of them, they do like a group dance that disrupts normal function.
It's like in a city, you're asking 50 percent of the population to do the same thing at the same time.
It disrupts the city because the carpenter won't be a carpenter then, and the writer won't be a writer.
And the doctor won't be a doctor, so they'll be doing the same thing.
This is kind of an analogy to what's happening during a seizure.
NARRATOR: When a seizure takes hold, consciousness shuts down, but the body keeps running.
Essentially you become a robot, driven by a vast number of subconscious processes.
But do we control those subconscious networks or do they control us? NARRATOR: Neuroscientist John Dylan-Haynes is conducting controversial research that explores just how little conscious control we have over the decisions we make.
JOHN DYLAN-HAYNES: Ou conscious mind can only focus on a small selection of all the stimuli that are around us, that impinge on our senses.
NARRATOR: While our conscious minds pay attention to one part of the world, other parts of the brain work in the background.
JOHN DYLAN-HAYNES: For example, when we walk along a busy street and we have to dodge away from cars or people or obstacles, a lot of this just happens automatically.
We don't have to think about it happening.
These unconscious routines take over a lot of the chores of our day-to-day life.
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§ In a way, one could think of consciousness as the tip of the iceberg of our mental processes.
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§ NARRATOR: But if the unconscious guides most of our actions, it calls into question the deeply-held belief that we are all free to choose our destinies.
What if we aren't? A few years ago, John conducted experiments using MRI to monitor the brain when people make decisions.
He found that humans unconsciously make decisions up to seven seconds before the conscious mind comes into play.
The conscious mind essentially takes credit for decisions the rest of the brain already made.
JOHN DYLAN-HAYNES: You can see it schematically here.
So this is a timeline.
And this is when they think they're making up their minds, and this is the information we have about their upcoming decision.
You can see it starts several seconds before they think they're making up their mind.
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§ NARRATOR: John doesn't claim this applies to complex decisions, such as whether to buy a house.
But most of the time we seem to be running on auto-pilot.
Can our conscious minds jump back into the driver's seat when they need to? Or is it just a story the brain tells itself? John decided to find out.
JOHN DYLAN-HAYNES: In previous experiments we found that it is possible to predict people's decisions several seconds before they think they're making up their mind.
So one possible explanation is that this is like a chain of domino stones.
You throw over the first one and it takes a few seconds until the final one that leads to the decision is toppled over.
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§ Now the question we're addressing here is whether this is a necessary chain that is outside the control of the person, or whether a person can intervene in this chain, for example by taking out the last domino in this long sequence and stopping the decision being made.
In this experiment we record people's brain activity with EEG.
They are placed in a situation that is what we call a dual game.
The person sees a green light on the computer screen and their task is to press a button with their foot.
Now if they press the button with their foot while the light is green, they gain a point.
And if they press the button with their foot when the light is red, they lose a point.
Now this seems really easy because all you have to do is to press down the button with your foot when the light is green, but sneakily we measure their brain activity and as soon as we notice that the person is preparing the movement, we turn the light red so that they lose points.
NARRATOR: John didn't think the decision-making process could be interrupted, but he was surprised to find out he was wrong.
JOHN DYLAN-HAYNES: What the experiment shows is, people can cancel these movements until the really, really late stage.
So during these seven seconds that we found in previous experiments, where the brain predicts the decision, people can still revert this decision until a really, really late stage.
NARRATOR: It appears the conscious level of the brain can intercede when it wants to.
JOHN DYLAN-HAYNES: I think the conscious mind and the unconscious mind are complementary.
They help each other.
Because the unconscious decisions that we make are also shaped by conscious thoughts.
So if you, for example, decide you want to stop smoking, then you can consciously deliberately try and reprogram yourself so that you don't then make these bad unconscious decisions.
So I think they kind of play hand-in-hand, and the conscious will also have an influence on the unconscious.
NARRATOR: But for people with brain disorders, such as epilepsy, the conscious mind often shuts down completely as the brain becomes locked in a repetitive cycle.
In severe cases, these seizures damage memory and fragment personality.
YAKOV KRUG: I have uh, memory problems.
My wife and I and the family used to have many, many fun times.
Now when my kids or my wife are talking about one of those fun things that we did, I honestly say that I don't remember any of it.
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§ NARRATOR: 10 years ago, Yakov Krug a lawyer in Baltimore developed meningitis.
He recovered, but was left with a severe case of epilepsy.
He can no longer work.
Constant seizures are erasing his personality.
Yakov's wife Esther - a doctor and their five children do their best to cope.
But he is slipping away.
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§ ESTHER KRUG: Whenever the seizure occurs, it affects the circuits of the brain that are responsible for memory and for emotional well-being.
Esther: Oh, do you remember this one? YAKOV: No? ESTHER: Do you remember this one? YAKOV: Yeah.
YAKOV KRUG: I don't uh, feel anything, I don't remember anything.
Sometimes I see strange things.
When it becomes seizure I lose my consciousness and I don't remember anything after that.
I don't think the kids were very excited about this one.
ESTHER: They were, they were, look at this.
They were very excited.
He used to be an extremely eloquent speaker.
He used to be a very good writer.
You can't see any of that, and it doesn't really come back almost ever.
NARRATOR: Danette Cunningham suffers from seizures that leave her dazed and fearing for her sanity.
DANETTE CUNNINGHAM: It started in 2013.
Um, just having a regular day, driving, and I just passed out behind the wheel.
And totaled the car.
About four months later when I got a new car and started driving again, it happened again.
At that time, going to the hospital, they figured out that it was a seizure.
From what I'm told, I do a lot of shaking.
Sometimes it gets really bad and I have voices in my head that aren't mine.
You know that thought when you think to yourself, it's usually your voice? Mine sometimes is not my own voice.
I get my days where I just can't deal with it at all.
And I just go into my room and close it off and stay there, for hours or days sometimes when I just can'tcause it's just so hard not being me.
NARRATOR: Sometimes epilepsy can be treated with drugs, or by removing the malfunctioning parts of the brain.
But it all depends on where the seizures originate.
In Danette and Yakov's cases, the seizures originate in the hippocampus.
Digging in here could destroy their already fragile personalities.
Until recently, they seemed beyond treatment.
But now, Dr.
Mohamad Koubeissi believes he has found a way to help them.
Mohamad plans to implant devices that send electric pulses into the hippocampus.
He believes this will suppress seizures.
It's a pioneering treatment, a bold experiment that could offer hope for millions if it succeeds.
But will it? Danette Cunningham and her friend Sharon are headed to the hospital.
In a few hours, surgeons will start threading thin electrodes into her skull - a procedure that could rewire her brain and ultimately end her uncontrollable seizures.
DANETTE: It has to happen in order for me to be me again.
I wish I didn't have to go through this, but um, I - I need to be whole again, so NARRATOR: Not far behind is Yakov Krug and his wife Esther.
ESTHER: Hannah? Uh, we're in the hospital.
How are you doing? Yes.
How are the boys? ESTHER KRUG: Everybody's stressed out.
I don't know of any procedure that's even minimally invasive that a family member needs to undergo and everyone else is calm and cool about it and nobody really is worried.
This is a brain surgery.
DANETTE CUNNINGHAM: You know, it's getting closer to the actual surgery point so, I'm getting a little nervous.
You know, no one's you know looking forward to surgery but, I do want to be me again.
NARRATOR: Now Yakov and Danette begin their journey into the far frontier of neuroscience.
DOCTOR: Okay, one more form for me.
This is the body mapping form NARRATOR: Surgeons will implant groups of electrodes in their brains.
Most of the electrodes monitor brain waves.
They will only be in for a few days.
But one electrode - the Deep Brain Stimulator - is permanent.
This will send electric pulses into a fiber track connected to the hippocampus.
And if it works, it will suppress their seizures.
Yakov and Danette are sedated and have their heads locked in metal frames.
A sudden cranial movement could result in irreversible brain damage.
Guiding wires through the delicate channels of the brain takes great skill, because no two brains are alike.
MOHAMAD KOUBEISSI: There is no universal brain anatomy.
There are some generalities that apply to most people, but uh, everybody has their own unique anatomy.
NARRATOR: Fortunately, new technology gives surgeons a way to operate with a minimum of risk.
MOHAMAD KOUBEISSI: I think it looks great on all sequences.
NARRATOR: The surgical team uses a three-dimensional roadmap created by fusing an MRI and a CT scan.
DR.
SHIELDS: We cannot see inside the brain, so we are trying to do a virtual run-through to allow us to predict where we're going to start in the skull and where we're going to end up with the tip of our electrodes.
This computer allows us to make a 3D model of the brain, and then practice running down the electrode how we would insert it.
This system allows us to actually place it in a trajectory that avoids any bad structures like vessels, or other structures that could bleed.
NARRATOR: They will not need to open up the skull.
Probes will be driven into the brain guided by a Global Positioning System linked to the 3D image.
The entry points are prepped and the trajectories are plotted.
Everything is ready to go.
But will all of this preparation be enough? § [MUSIC.]
§ NARRATOR: Now tiny holes are drilled into the skull.
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§ After each hole is drilled, the surgeons slide monitoring electrodes into the brain.
SHIELDS: Pull it back a little bit.
That's good.
NARRATOR: The electric wire inside this needle is less than the thickness of a human hair.
SHIELDS: If you get something between one and two that tells me that I'm in too deep.
KOUBEISSI: I think I'm seeing some evoked responses between zero and two now.
NARRATOR: These electrodes will allow Mohamad to listen to Danette's brain waves over the next few days.
MOHAMAD KOUBESSI What we are trying to do here is to put electrodes on both sides of the brain to confirm that the areas of seizure onset are the hippocampi, which are the structures that are important for memory.
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§ NARRATOR: Now the surgical team prepares for the main event implanting the Deep Brain Stimulator in the hippocampus.
SHIELDS: Okay, let's go back up to three and four.
This is right hippocampus, right amygdala.
NARRATOR: This wire is thicker the width of a knitting needle and difficult to place.
MOHAMAD KOUBEISSI: The last deep brain stimulation electrode is the trickiest because uh, the target is not as clearly defined anatomically as the other structures.
NARRATOR: Mohamad sends a burst of power into the electrode.
MOHAMAD: So let me try the same zero positive, one negative.
NARRATOR: If the electrode's position is off by even a tiny bit, the plan won't work.
They move the electrode a fraction of a millimeter.
Success.
They hit their target.
A breakthrough operation to implant an electrical stimulator five-inches deep inside the brain.
MOHAMAD: Yeah, we're very happy.
This is what we hoped for in terms of placement.
We are exactly where we intended.
The hard part of the surgery is over now.
NARRATOR: But there's more.
On the eight monitors planted throughout Danette's brain, there's a sudden change.
It's a sign that even at this preliminary stage, the stimulator may suppress her seizures.
Later, Yakov's surgery goes just as well.
MOHAMAD: So that's, that's great.
Perfect.
NARRATOR: The monitoring and stimulating wires are placed in the brain without incident.
MOHAMAD KOUBEISSI: For Yakov, we hope that the deep brain stimulation can restore his memory.
Either by a direct beneficial effect on the memory, or via decreasing seizures, or both.
But I'm optimistic that this treatment may uh, result in improving memory processing, regardless even of seizure reduction.
So we'll see.
We have to wait and see.
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§ Two days later.
Mohamad has kept Yakov under constant surveillance.
He is watching for seizures.
MOHAMAD: Alright, I just need a seizure.
NARRATOR: Mohamad actually hopes to see a seizure to confirm that he put the Deep Brain Stimulators in the right place.
MOHAMAD KOUBESSI These are the tracings of the brainwaves recorded from the electrodes that were implanted in the brain.
The brainwaves, as you can see, they're kind of like smooth waves, right? But all of a sudden you will see something that is spiky.
And often this signifies irritability of the type that uh, predisposes for generation of epileptic seizures.
So we've seen a lot of these.
Like in an earthquake you will have to wait for it to happen.
You cannot control when it happens.
That's why we monitor continuously for days.
NARRATOR: It will take time for Danette and Yakov's brains to heal.
After that, Mohamad can turn on their stimulators and see what happens.
A month later, Danette is back home and Mohamad remotely activated her Deep Brain Stimulator four days ago.
DANETTE CUNNINGHAM Since I've been home I haven't had a seizure so that's pretty good cause I was having them all the time.
Danette: She thought her friends had all gone home, but look, they're in her bed.
All: [laughing.]
DANETTE: You like that? BOY: Yeah! NARRATOR: She is beginning to enjoy life again with her daughter and grandchildren.
DANETTE CUNNINGHAM If I can get my entire life the way it was before the seizures back, that would be amazing.
I'm not sure if that will ever happen, I may have to adjust to a new life, but if I can just go back to me, it would be amazing.
MOHAMAD KOUBEISSI: The preliminary data demonstrated seizure reduction by 92 percent.
You often hope to reduce seizures by 40 percent or 50 percent.
To see such dramatic decrease without affecting any cognitive function, without any clear side effects, is a major breakthrough.
§ [MUSIC.]
§ NARRATOR: Mohamad's research has opened a window into the inner workings of the mind.
But much of the brain remains uncharted territory.
MOHAMAD KOUBEISSI: Will the brain be ever capable of putting apart itself and assembling itself back like an expert does with a Swiss watch? As of now I can tell you that if the brain is a complex Swiss watch, the best neuroscientists we have are like first graders.
NARRATOR: At the simplest level, the brain is an electrical system.
The fires of the mind produce everything that makes us human: science, art, emotion.
But the most unique feature of the human brain is its capacity to look at itself, [LIGHTNING SOUND.]
in all its mystery.
§ [ELECTRICAL DISCHARGE SOUND.]
§ [MUSIC.]
§ NARRATOR: What makes you who you are? Are you just a robot following a program? Can we change, and should we change, the traumatic memories that ruin lives? The answers lie in the web of electrical impulses inside your skull.
Your brain is an incredible piece of organic machinery that produces something far greater than its component parts.
Breakthrough science lets us study those parts as never before, uncovering the hidden processes that form our identities and offering new hope for those with brain disorders.
MOHAMAD KOUBEISSI: The brain is an electrical system.
That's how we measure um, the brain activity.
The cells communicate by sending electrical pulses to one another.
NARRATOR: Mohamad Koubeissi is the director of George Washington University Hospital's Epilepsy Center.
His pioneering research is revealing how the electrical storms of the brain produce memory and consciousness, and how we can help those whose brains misfire.
MOHAMAD KOUBEISSI: Early in my medical school years I decided to become an epileptologist because it's the specialty that will allow you to study the brain millimeter by millimeter and centimeter by centimeter through cortical stimulation mapping.
NARRATOR: To map what goes on inside the brain, Mohamad implants tiny electrodes in his patients' skulls.
He then sends pulses to these electrodes, gradually increasing the current, sometimes with dramatic results.
Recently, he inserted an electrode next to a small region called the claustrum.
The claustrum is uniquely connected to other parts of the brain.
MOHAMAD KOUBEISSI: When we were doing the mapping, we were surprised to see what stimulation of the claustrum resulted in.
I asked her to read, and I discovered that stimulation of this one electrode which is in the claustrum made her stop reading, and have no memory to what happened during the stimulation.
FEMALE: When I was 21, 28, my mother died after a decade-long illness NARRATOR: When Mohamad sends a 14 milliamp electric pulse into the claustrum, the patient freezes mid-sentence.
It's as if her conscious mind has been switched off.
MOHAMAD KOUBEISSI: Cognitively she is completely impaired.
Uh no language function.
No memory function.
No responsiveness.
FEMALE: We drove the country road out to her place.
NARRATOR: When the current is reduced, she picks up exactly where she left off.
FEMALE: I taught English at a small cottage in the Bay Area.
MOHAMAD KOUBEISSI: The findings led to some authors to naming the claustrum the on-off switch of consciousness.
Which based on this case is actually pretty accurate.
NARRATOR: This was an incredible finding.
But it is just one of the many ways he's exploring the brain, and pushing forward the treatment of disorders of consciousness.
Mohamad has also developed a new way to treat people with severe epilepsy.
He's looking for volunteers willing to have electrical stimulators permanently installed in their brains.
But there are no guarantees it will work, because the human brain may be the most complex object in the universe.
To neuroscientist Steve Ramirez, the complexity of nature tells us much about the inner workings of the human brain.
STEVE RAMIREZ: So let's zoom our microscope in at the level of a single H2O molecule.
So if you ask yourself what an H2O molecule tells you about the property of wetness, probably tells you a little bit but not that much.
Now when you combine trillions and trillions of molecules of H2O, you end up getting something that resembles drops of water.
§ [MUSIC.]
§ Now those drops of water, when you combine them, and you combine trillions and trillions of drops of water, you end up getting something as amazing as a river.
Think about those molecules of H2O as single neurons.
A single neuron tells you a little bit, but not the whole story.
Now when you begin combining those brain cells on the order of 80 to 100 billion of those interacting with one another, then you get these properties that begin to emerge like memory, like consciousness.
These tiny pieces of brain tissue, 80 billion brain cells, are what make you.
They produce everything you've ever felt, experienced love, the hated, the cried, the works.
NARRATOR: Steve believes our identities are built on memory.
§ [MUSIC.]
§ STEVE RAMIREZ: You think about memory, it is the thing that thread and unifies our overall sense of being.
So without it we become stuck in time, right? And we lose our identity.
§ [MUSIC.]
§ NARRATOR: But how reliable is memory, even in a well-functioning brain? STEVE RAMIREZ: We used to think that memories were really stable, that you form one memory and it's not ever changing, it's just stabilized in your brain and that memory forever is.
So now we know that for all intents and purposes, when you recall a memory, you're constantly updating it with new information.
§ [MUSIC.]
§ NARRATOR: Every time you revisit a memory, it becomes vulnerable, it can be changed.
Say, for instance, two people on a date end up at a bar.
Things go well.
Later, the woman recalls the scene.
But each time she remembers it, small details may change.
§ [MUSIC.]
§ Over time, the details add up.
§ [MUSIC.]
§ And the same thing is happening to her date.
§ [MUSIC.]
§ Each time he revisits the memory, it subtly alters.
§ [MUSIC.]
§ Until eventually, he and she have very different memories of what the bar looked like that night, how they were dressed, or even how they behaved.
§ [MUSIC.]
§ The changes in memory can be especially dramatic if one person's feelings about the other have changed.
A good memory can turn bad.
Psychologist Bill Hirst of New York's New School has found that memory is not carved in stone, it's written in sand.
BILL HIRST: People think of memory as involving the storage of information like a library, you store away information and it sits there waiting to be retrieved.
But memory is not like that at all.
You basically, um, construct the memory on the run.
NARRATOR: But some memories belong to a special category, memories of traumatic events that affect millions.
These are called flashbulb memories.
December 7th, 1941, a date which will live in infamy.
NARRATOR: The biggest flashbulb event in recent history was the terrorist attack of Sept.
11th, 2001.
[EXLPOSION SOUND.]
Oh my god! Jesus [BLEEP.]
Christ! NARRATOR: It presented a unique opportunity to look at how memories form and shift over time.
BILL HIRST: Psychologists, every time some horrifying thing happens in the world, they rush out into the street and they interview people.
I've never seen nothing like it in my life.
BILL HIRST: So when 9-11 occurred, I and a bunch of other psychologists from around the United States, ran out onto the streets and asked people where were they when they learned about the attack of 9-11 And then we have followed them up one year later, three years later, and ten years later.
NARRATOR: When it comes to flashbulb memories, everyone remembers the basic facts of the traumatic event, but the memories of their own actions and feelings blur over time.
BILL HIRST: If you ask the average American, will you remember where you were when you learned about 9-11, almost everyone will say absolutely.
And the fact of the matter is, they won't.
NARRATOR: To demonstrate this phenomenon, we gathered actors to read transcripts representative of the 9-11 study.
CHRIS: I was in my apartment in Brooklyn.
I didn't see the first plane hit but I heard it.
NARRATOR: One year later, the story has changed.
CHRIS: I was on the street.
I heard a booming noise, uh, an explosion.
I saw smoke- BILL HIRST: What you find is that the accuracy declines dramatically the first years.
If you compare what they said one day later, two days later, with what they said one year later, the accuracy rate is about 61 percent, I believe.
Uh, so there's a great deal we're forgetting.
CHRIS: I was on the street BILL HIRST: They believe 100 percent that this memory, which 40 percent of the time is wrong, is absolutely positively right.
CHAD: I was in class at school.
I was in the library.
BILL HIRST: And once you persist with an error, it becomes your memory, right or wrong.
TONYA: I called my boyfriend first but couldn't get through.
I know I tried to reach my parents first but couldn't get through on the phone.
NARRATOR: When remembering factual details, people got things wrong about 40 percent of the time.
But when it came to remembering their emotions, they were wrong 60 percent of the time.
BILL HIRST: And the errors that they made tended to reflect their current state.
So, those people that had a pretty stable emotional state across the 10-year period, tended to be fairly accurate in their memories over that ten-year period.
CHARLES: I-I-I was scared, you know, what, what's gonna happen? First of all, um, you know, I'm 40 miles from home.
I - I gotta go through the city.
I have to get home.
I - I was, upset.
I was pretty calm when the first plane hit.
When the second one hit, I knew this was an attack.
I was pretty concerned NARRATOR: Your current emotional state affects how you remember things, particularly how you remember your emotions at the time.
But in some cases the emotional traumas we suffer are so intense, they can never be escaped.
SPAN Style="text-align:left;"ts traumatize millions but, for some,/SPAN those events leave psychic scars that last a lifetime and lead to Post Traumatic Stress Disorder.
This woman witnessed the September 11th attacks firsthand.
MYLES: I remembered specifically going into one of our conference rooms, getting ready for, for a meeting.
And through, it was in the corner of where we were at the time.
It was on Ninety-Five Green Street.
And in that corner I saw the second plane.
It was just so close to, um, to our office, to our window and I could - I swear I - I thought I could see people inside.
And as I followed the plane, it went right into the South Tower.
And I - I lost it.
I still can't talk to people about it.
Um, at least not voluntarily.
Um, and, um, so I - I don't think that my feelings have changed.
NARRATOR: Traumatic experiences change people's lives.
With no warning, the pain of the initial trauma can come roaring back with devastating effects.
§ [MUSIC.]
§ What if we could separate the pain from those memories? Steve Ramirez's work at MI may alleviate the suffering of millions with PTSD, or lead to a world where no one can be certain if their memories are real.
That work is being conducted at the lab of Nobel Prize-winning biologist Susumu Tonegawa.
STEVE RAMIREZ: The kind of research that I've been doing is twofold.
Try to figure out what are the basic building blocks of memories, and then can we hijack that system and actually try to give it some kind of therapeutic value.
So imagine that we can use something like memory, for example, as a weapon to combat certain psychiatric disorders.
NARRATOR: By studying the brains of rodents, the Tonegawa lab has made major discoveries about the workings of the hippocampus.
The hippocampus consolidates information from short-term memory to long-term memory.
It's one of the first regions of the brain damaged by Alzheimer's Disease.
The facts of a memory seem to be stored here.
But the emotional components of memory are scattered across the brain.
This got Steve to thinking, if he altered the brain cells that retain emotional memory, could he change a happy memory to a sad one, or vice versa? With a new tool called optogenetics, he set out to do just that.
STEVE RAMIREZ: We can now go into the brain and modulate it at the speeds that it communicates on, at the millisecond level.
That's amazing because we can actually go in and deconstruct the brain in real time.
You know, we're very privileged to be actually living through a very real revolution in neuroscience right now.
NARRATOR: Optogenetics combines genetic engineering and laser technology.
This rodent has been genetically altered with DNA from algae.
Its neurons are sensitive to light.
Next, fiber optic cables are implanted into the parts of the brain holding onto a memory.
STEVE RAMIREZ: So when we're done with that brain surgery, we now have animals that have optic fibers in the brain that can deliver light onto the brain cells that are light sensitive.
So these brain cells have that light-sensitive switch that lets us flick a memory on or off.
§ [MUSIC.]
§ NARRATOR: MIT did not allow us to film Steve's experiment.
So here's Steve's first breakthrough recreated in pixels A rodent is put into a chamber with red walls.
It gets a mild shock to its feet and forms a memory that the chamber is dangerous.
When Steve drops the animal into a blue room, it happily explores until Steve activates the neurons that hold the fear memory.
The rodent immediately freezes.
STEVE RAMIREZ: We were able to artificially reactivate that memory and introduce fearful information into that memory.
So that when you put the animal back in the box, they now showed fear behavior.
NARRATOR: Christmas 2014, Steven implanted a false memory.
Another animal was put into the red chamber with no shock.
The next day it was put into the blue chamber.
While giving the rodent a mild shock, Steve activated the memory of the red room.
The next day the animal was put back into the peaceful red room with no shock, and it froze with fear.
A false memory had been formed.
STEVE RAMIREZ: We were able to activate this memory and bring it back online, and then artificially infuse negative information to it to change the contents of that memory.
I kind of had that I can't believe that just worked feeling.
§ [MUSIC.]
§ NARRATOR: Since then, Steve has managed to reverse the effect, to turn unhappy memories into happy ones.
But there are obvious ethical problems with altering memories, or implanting artificial ones.
This could conceivably lead to a frightening new style of brainwashing, ultimately making us question everything we think is true.
STEVE RAMIREZ: If memory manipulation were to ever make its way to humans, you don't give it to the entire population of Massachusetts, you give it to the clinically relevant population of people who actually need it the war veteran, the assault victim, the person riddled with PTSD or anxiety or depression.
NARRATOR: Optogenetics is a major step forward in research technology, but so far it is only used in animals.
Can we ever really be certain that altering our mental circuitry will have drastic effects on who we are and how we behave? NARRATOR: The brain is a precision instrument.
Outside of conscious awareness, small bits of flesh control a wide range of functions.
But until the invention of brain imaging, we had little idea of how those bits of flesh behave.
MRI, short for Magnetic Resonance Imaging, lets us see the inner workings of the brain in real-time.
§ [MUSIC.]
§ While many people have had MRIs, few know how they work.
It's all about excitement exciting atomic nuclei.
§ [MUSIC.]
§ This paint contains luminous zinc sulfide.
The zinc atoms absorb light energy.
When the lights go out, the atoms release that energy, which makes them phosphorescent.
Similarly, when the water molecules in your body are hit with a high magnetic field, they emit radio waves.
It's possible to detect those signals and use them to create maps of your inner terrain.
Which is exactly what physicist and physician John Schenck did in the 1980s, when he brought the MRI to a whole new level precision mapping the brain.
His team created the first human brain image at a magnetic field strength 4 times higher than ever used before.
No one was certain the machine was safe for humans.
So John climbed into it himself.
JOHN SCHENCK: It was quite a risk, and it was a big step forward.
I got in the magnet and was the person being imaged, and one of my colleagues was running the scanner, and finally in the middle of the night we actually got, got our first image.
I realized that this was going to make a big a change in the whole field.
NARRATOR: Today, virtually every hospital in the developed world has an MRI machine.
And being able to see inside the brain launched a revolution in neuroscience.
John has scanned his own brain nearly every year since 1983.
And MRI has gotten vastly more powerful over those years.
JOHN SCHENCK: This is my brain here.
I'm 75 now and this, I'm pretty happy with the way this looks.
But you can see some changes in it from when I was younger.
The ventricles in the central part of the brain are larger now that happens to most of us as we get along - but overall given the age factor and so on, the wear and tear over the years, it still looks pretty good! § [MUSIC.]
§ NARRATOR: Today, John and his colleagues at GE are testing a new process that lets them see iron deposits in the brain better than ever before.
This makes it possible to study a tiny region called the Habenula, which may be linked to serious depression.
JOHN SCHENCK: The Habenula is very, very deep inside the center of the brain and it's quite surprising we're able to see it as well as we do in this technique.
The iron in the Habenula allows us to get a more precise image that actually can characterize how the Habenula is performing, and may give us some insights into the development and treatment, proper treatment, of depression.
NARRATOR: Human brains are built out of many of these tiny but vital clumps of tissue.
They generate the complex neural networks that control our behavior.
§ [MUSIC.]
§ By wiring the brain with electrodes, Mohamad Koubeissi can see those networks in action.
These are the electrical patterns that form a human mind.
§ [MUSIC.]
§ MOHAMAD KOUBEISSI: The EEG records the electrical activity of the brain in real time.
The tracings that we see on top of one another, each one of them corresponds to the electrical activity between two different points on the scalp.
You will notice this rhythmicity very regular brain waves which build up in frequency and voltage.
NARRATOR: During an epileptic seizure, parts of the brain get stuck in a loop, and consciousness shuts down.
MOHAMAD KOUBEISSI: A lot of neurons, they start firing synchronously in an abnormal fashion, instead of each brain cell doing its own thing physiologically.
A lot of them, they do like a group dance that disrupts normal function.
It's like in a city, you're asking 50 percent of the population to do the same thing at the same time.
It disrupts the city because the carpenter won't be a carpenter then, and the writer won't be a writer.
And the doctor won't be a doctor, so they'll be doing the same thing.
This is kind of an analogy to what's happening during a seizure.
NARRATOR: When a seizure takes hold, consciousness shuts down, but the body keeps running.
Essentially you become a robot, driven by a vast number of subconscious processes.
But do we control those subconscious networks or do they control us? NARRATOR: Neuroscientist John Dylan-Haynes is conducting controversial research that explores just how little conscious control we have over the decisions we make.
JOHN DYLAN-HAYNES: Ou conscious mind can only focus on a small selection of all the stimuli that are around us, that impinge on our senses.
NARRATOR: While our conscious minds pay attention to one part of the world, other parts of the brain work in the background.
JOHN DYLAN-HAYNES: For example, when we walk along a busy street and we have to dodge away from cars or people or obstacles, a lot of this just happens automatically.
We don't have to think about it happening.
These unconscious routines take over a lot of the chores of our day-to-day life.
§ [MUSIC.]
§ In a way, one could think of consciousness as the tip of the iceberg of our mental processes.
§ [MUSIC.]
§ NARRATOR: But if the unconscious guides most of our actions, it calls into question the deeply-held belief that we are all free to choose our destinies.
What if we aren't? A few years ago, John conducted experiments using MRI to monitor the brain when people make decisions.
He found that humans unconsciously make decisions up to seven seconds before the conscious mind comes into play.
The conscious mind essentially takes credit for decisions the rest of the brain already made.
JOHN DYLAN-HAYNES: You can see it schematically here.
So this is a timeline.
And this is when they think they're making up their minds, and this is the information we have about their upcoming decision.
You can see it starts several seconds before they think they're making up their mind.
§ [MUSIC.]
§ NARRATOR: John doesn't claim this applies to complex decisions, such as whether to buy a house.
But most of the time we seem to be running on auto-pilot.
Can our conscious minds jump back into the driver's seat when they need to? Or is it just a story the brain tells itself? John decided to find out.
JOHN DYLAN-HAYNES: In previous experiments we found that it is possible to predict people's decisions several seconds before they think they're making up their mind.
So one possible explanation is that this is like a chain of domino stones.
You throw over the first one and it takes a few seconds until the final one that leads to the decision is toppled over.
§ [MUSIC.]
§ Now the question we're addressing here is whether this is a necessary chain that is outside the control of the person, or whether a person can intervene in this chain, for example by taking out the last domino in this long sequence and stopping the decision being made.
In this experiment we record people's brain activity with EEG.
They are placed in a situation that is what we call a dual game.
The person sees a green light on the computer screen and their task is to press a button with their foot.
Now if they press the button with their foot while the light is green, they gain a point.
And if they press the button with their foot when the light is red, they lose a point.
Now this seems really easy because all you have to do is to press down the button with your foot when the light is green, but sneakily we measure their brain activity and as soon as we notice that the person is preparing the movement, we turn the light red so that they lose points.
NARRATOR: John didn't think the decision-making process could be interrupted, but he was surprised to find out he was wrong.
JOHN DYLAN-HAYNES: What the experiment shows is, people can cancel these movements until the really, really late stage.
So during these seven seconds that we found in previous experiments, where the brain predicts the decision, people can still revert this decision until a really, really late stage.
NARRATOR: It appears the conscious level of the brain can intercede when it wants to.
JOHN DYLAN-HAYNES: I think the conscious mind and the unconscious mind are complementary.
They help each other.
Because the unconscious decisions that we make are also shaped by conscious thoughts.
So if you, for example, decide you want to stop smoking, then you can consciously deliberately try and reprogram yourself so that you don't then make these bad unconscious decisions.
So I think they kind of play hand-in-hand, and the conscious will also have an influence on the unconscious.
NARRATOR: But for people with brain disorders, such as epilepsy, the conscious mind often shuts down completely as the brain becomes locked in a repetitive cycle.
In severe cases, these seizures damage memory and fragment personality.
YAKOV KRUG: I have uh, memory problems.
My wife and I and the family used to have many, many fun times.
Now when my kids or my wife are talking about one of those fun things that we did, I honestly say that I don't remember any of it.
§ [MUSIC.]
§ NARRATOR: 10 years ago, Yakov Krug a lawyer in Baltimore developed meningitis.
He recovered, but was left with a severe case of epilepsy.
He can no longer work.
Constant seizures are erasing his personality.
Yakov's wife Esther - a doctor and their five children do their best to cope.
But he is slipping away.
§ [MUSIC.]
§ ESTHER KRUG: Whenever the seizure occurs, it affects the circuits of the brain that are responsible for memory and for emotional well-being.
Esther: Oh, do you remember this one? YAKOV: No? ESTHER: Do you remember this one? YAKOV: Yeah.
YAKOV KRUG: I don't uh, feel anything, I don't remember anything.
Sometimes I see strange things.
When it becomes seizure I lose my consciousness and I don't remember anything after that.
I don't think the kids were very excited about this one.
ESTHER: They were, they were, look at this.
They were very excited.
He used to be an extremely eloquent speaker.
He used to be a very good writer.
You can't see any of that, and it doesn't really come back almost ever.
NARRATOR: Danette Cunningham suffers from seizures that leave her dazed and fearing for her sanity.
DANETTE CUNNINGHAM: It started in 2013.
Um, just having a regular day, driving, and I just passed out behind the wheel.
And totaled the car.
About four months later when I got a new car and started driving again, it happened again.
At that time, going to the hospital, they figured out that it was a seizure.
From what I'm told, I do a lot of shaking.
Sometimes it gets really bad and I have voices in my head that aren't mine.
You know that thought when you think to yourself, it's usually your voice? Mine sometimes is not my own voice.
I get my days where I just can't deal with it at all.
And I just go into my room and close it off and stay there, for hours or days sometimes when I just can'tcause it's just so hard not being me.
NARRATOR: Sometimes epilepsy can be treated with drugs, or by removing the malfunctioning parts of the brain.
But it all depends on where the seizures originate.
In Danette and Yakov's cases, the seizures originate in the hippocampus.
Digging in here could destroy their already fragile personalities.
Until recently, they seemed beyond treatment.
But now, Dr.
Mohamad Koubeissi believes he has found a way to help them.
Mohamad plans to implant devices that send electric pulses into the hippocampus.
He believes this will suppress seizures.
It's a pioneering treatment, a bold experiment that could offer hope for millions if it succeeds.
But will it? Danette Cunningham and her friend Sharon are headed to the hospital.
In a few hours, surgeons will start threading thin electrodes into her skull - a procedure that could rewire her brain and ultimately end her uncontrollable seizures.
DANETTE: It has to happen in order for me to be me again.
I wish I didn't have to go through this, but um, I - I need to be whole again, so NARRATOR: Not far behind is Yakov Krug and his wife Esther.
ESTHER: Hannah? Uh, we're in the hospital.
How are you doing? Yes.
How are the boys? ESTHER KRUG: Everybody's stressed out.
I don't know of any procedure that's even minimally invasive that a family member needs to undergo and everyone else is calm and cool about it and nobody really is worried.
This is a brain surgery.
DANETTE CUNNINGHAM: You know, it's getting closer to the actual surgery point so, I'm getting a little nervous.
You know, no one's you know looking forward to surgery but, I do want to be me again.
NARRATOR: Now Yakov and Danette begin their journey into the far frontier of neuroscience.
DOCTOR: Okay, one more form for me.
This is the body mapping form NARRATOR: Surgeons will implant groups of electrodes in their brains.
Most of the electrodes monitor brain waves.
They will only be in for a few days.
But one electrode - the Deep Brain Stimulator - is permanent.
This will send electric pulses into a fiber track connected to the hippocampus.
And if it works, it will suppress their seizures.
Yakov and Danette are sedated and have their heads locked in metal frames.
A sudden cranial movement could result in irreversible brain damage.
Guiding wires through the delicate channels of the brain takes great skill, because no two brains are alike.
MOHAMAD KOUBEISSI: There is no universal brain anatomy.
There are some generalities that apply to most people, but uh, everybody has their own unique anatomy.
NARRATOR: Fortunately, new technology gives surgeons a way to operate with a minimum of risk.
MOHAMAD KOUBEISSI: I think it looks great on all sequences.
NARRATOR: The surgical team uses a three-dimensional roadmap created by fusing an MRI and a CT scan.
DR.
SHIELDS: We cannot see inside the brain, so we are trying to do a virtual run-through to allow us to predict where we're going to start in the skull and where we're going to end up with the tip of our electrodes.
This computer allows us to make a 3D model of the brain, and then practice running down the electrode how we would insert it.
This system allows us to actually place it in a trajectory that avoids any bad structures like vessels, or other structures that could bleed.
NARRATOR: They will not need to open up the skull.
Probes will be driven into the brain guided by a Global Positioning System linked to the 3D image.
The entry points are prepped and the trajectories are plotted.
Everything is ready to go.
But will all of this preparation be enough? § [MUSIC.]
§ NARRATOR: Now tiny holes are drilled into the skull.
§ [MUSIC.]
§ After each hole is drilled, the surgeons slide monitoring electrodes into the brain.
SHIELDS: Pull it back a little bit.
That's good.
NARRATOR: The electric wire inside this needle is less than the thickness of a human hair.
SHIELDS: If you get something between one and two that tells me that I'm in too deep.
KOUBEISSI: I think I'm seeing some evoked responses between zero and two now.
NARRATOR: These electrodes will allow Mohamad to listen to Danette's brain waves over the next few days.
MOHAMAD KOUBESSI What we are trying to do here is to put electrodes on both sides of the brain to confirm that the areas of seizure onset are the hippocampi, which are the structures that are important for memory.
§ [MUSIC.]
§ NARRATOR: Now the surgical team prepares for the main event implanting the Deep Brain Stimulator in the hippocampus.
SHIELDS: Okay, let's go back up to three and four.
This is right hippocampus, right amygdala.
NARRATOR: This wire is thicker the width of a knitting needle and difficult to place.
MOHAMAD KOUBEISSI: The last deep brain stimulation electrode is the trickiest because uh, the target is not as clearly defined anatomically as the other structures.
NARRATOR: Mohamad sends a burst of power into the electrode.
MOHAMAD: So let me try the same zero positive, one negative.
NARRATOR: If the electrode's position is off by even a tiny bit, the plan won't work.
They move the electrode a fraction of a millimeter.
Success.
They hit their target.
A breakthrough operation to implant an electrical stimulator five-inches deep inside the brain.
MOHAMAD: Yeah, we're very happy.
This is what we hoped for in terms of placement.
We are exactly where we intended.
The hard part of the surgery is over now.
NARRATOR: But there's more.
On the eight monitors planted throughout Danette's brain, there's a sudden change.
It's a sign that even at this preliminary stage, the stimulator may suppress her seizures.
Later, Yakov's surgery goes just as well.
MOHAMAD: So that's, that's great.
Perfect.
NARRATOR: The monitoring and stimulating wires are placed in the brain without incident.
MOHAMAD KOUBEISSI: For Yakov, we hope that the deep brain stimulation can restore his memory.
Either by a direct beneficial effect on the memory, or via decreasing seizures, or both.
But I'm optimistic that this treatment may uh, result in improving memory processing, regardless even of seizure reduction.
So we'll see.
We have to wait and see.
§ [MUSIC.]
§ Two days later.
Mohamad has kept Yakov under constant surveillance.
He is watching for seizures.
MOHAMAD: Alright, I just need a seizure.
NARRATOR: Mohamad actually hopes to see a seizure to confirm that he put the Deep Brain Stimulators in the right place.
MOHAMAD KOUBESSI These are the tracings of the brainwaves recorded from the electrodes that were implanted in the brain.
The brainwaves, as you can see, they're kind of like smooth waves, right? But all of a sudden you will see something that is spiky.
And often this signifies irritability of the type that uh, predisposes for generation of epileptic seizures.
So we've seen a lot of these.
Like in an earthquake you will have to wait for it to happen.
You cannot control when it happens.
That's why we monitor continuously for days.
NARRATOR: It will take time for Danette and Yakov's brains to heal.
After that, Mohamad can turn on their stimulators and see what happens.
A month later, Danette is back home and Mohamad remotely activated her Deep Brain Stimulator four days ago.
DANETTE CUNNINGHAM Since I've been home I haven't had a seizure so that's pretty good cause I was having them all the time.
Danette: She thought her friends had all gone home, but look, they're in her bed.
All: [laughing.]
DANETTE: You like that? BOY: Yeah! NARRATOR: She is beginning to enjoy life again with her daughter and grandchildren.
DANETTE CUNNINGHAM If I can get my entire life the way it was before the seizures back, that would be amazing.
I'm not sure if that will ever happen, I may have to adjust to a new life, but if I can just go back to me, it would be amazing.
MOHAMAD KOUBEISSI: The preliminary data demonstrated seizure reduction by 92 percent.
You often hope to reduce seizures by 40 percent or 50 percent.
To see such dramatic decrease without affecting any cognitive function, without any clear side effects, is a major breakthrough.
§ [MUSIC.]
§ NARRATOR: Mohamad's research has opened a window into the inner workings of the mind.
But much of the brain remains uncharted territory.
MOHAMAD KOUBEISSI: Will the brain be ever capable of putting apart itself and assembling itself back like an expert does with a Swiss watch? As of now I can tell you that if the brain is a complex Swiss watch, the best neuroscientists we have are like first graders.
NARRATOR: At the simplest level, the brain is an electrical system.
The fires of the mind produce everything that makes us human: science, art, emotion.
But the most unique feature of the human brain is its capacity to look at itself, [LIGHTNING SOUND.]
in all its mystery.