>>WELCOME, EVERYBODY.
IT IS GREAT TO BE HERE WITH YOU
ALL TODAY FOR THIS DAY OF
LECTURES FROM ACTION POTENTIAL
TO FREE WILL, OR MARK'S
RETIREMENT, WHATEVER YOU WANT TO
CALL IT.
IT HAS BEEN GREAT TO ORGANIZE
AND GREAT SUPPORT, IT HAS BEEN
BRIAN, SAVINA AND -- AND I THINK
THAT'S WHY NINDS GIVES US THE
SUPPORT FOR THE MEETING, BECAUSE
REALLY THEY WANTED TO SEE THE
LAST -- OF MARK.
SO FOR THAT, YOU WILL BE SEEING
THROUGH THE DAY A FEW OF THE
FACES, THERE IS A DISCLAIMER,
SOME FACES DON'T MATCH THE
NAMES, SOME NAMES MAY BE
MISSING, BUT THIS REPRESENTS ALL
THE PEOPLE -- NOT ALL THE
PEOPLE -- MOST OF THE PEOPLE
THAT WE CAN TRACK THAT HAVE
PASSED THROUGH HMCS, SO THAT
SHOWS A LITTLE BIT OF THE IMPACT
MARK HAS HAD IN OUR SCIENTIFIC
COMMUNITY.
WE ARE NOT GOING TO SEE ALL THE
FACES TODAY, BUT SOME PEOPLE
FROM THIS POSTER WILL BE
TALKING.
THIS IS THE AGENDA FOR TODAY.
IT'S PACKED BUT WE'LL TRY TO
MAKE IT SMOOTHER THAN THE START.
APOLOGIZE FOR THOSE WAITING IN
LINE BEFORE.
THE ONES HERE.
BUT WE'LL HAVE A GREAT DAY.
BRIAN?
>>THANK YOU ALL FOR JOINING US.
WE ARE REALLY FORTUNATE TO HAVE
A GREAT ARRAY OF SPEAKERS WHO
HAVE DONATED THEIR TIME AND MADE
THE TRAVEL FROM ALL OVER THE
GLOBE.
WE HAVE THAILAND, EUROPE, INDIA,
ACROSS THE U.S., SO A SPECIAL
CAST HERE OF THOSE WHO HAVE
KNOWN MARK THROUGH THE YEARS AND
GONE ON TO ESTABLISH THEIR OWN
CAREERS AND HAVE SHARED SOME
STORIES WITH US, SCIENCE AS WELL
AS PROBABLY LIKELY SOME STORIES
ABOUT MARK AND THEIR TIME HERE
AT THE HMCS.
I WANT TO THANK ALL OF THOSE
ATTENDING AS WELL AS THOSE IN
PERSON AND WE HAVE A LARGE
NUMBER WHO SIGNED UP ONLINE AS
WELL, SO WE ARE VIDEO RECORDING
THIS, SO HOPEFULLY WE'LL BE ABLE
TO SHARE THIS WITH OTHERS IN THE
FUTURE AS WELL.
SO THANK YOU ALL FOR MAKING IT,
AND WE'RE GOING TO GET STARTED
HERE REAL SOON.
>>THANK YOU, EVERYONE.
THANKS FOR COMING.
SO WE'LL GET GOING.
A REMINDER WE HAVE REFRESHMENTS
OUTSIDE, THERE WILL BE LUNCH AND
PLEASE STAY AT THE END AND IF
YOU COME AND GO, MAKE SURE
YOU'RE HERE AT THE END BECAUSE
WE'LL HAVE A SMALL RECEPTION AND
WE'D APPRECIATE IF EVERYBODY IS
THERE.
WITH THAT, WE'RE GOING TO GET
STARTED.
THE START WASN'T VERY SMOOTH BUT
WE PROMISE THAT MARK'S NEXT
RETIREMENT, WE'RE GOING TO GET
IT JUST RIGHT.
[LAUGHTER]
SO TO START US OUT, WE ARE
THANKFUL TO HAVE DR. KOROSHETZ,
NINDS DIRECTOR, AND DR. DIAMOND,
THE SCIENTIFIC DIRECTOR, SO
WALTER, DO YOU WANT TO GO FIRST?
THANK YOU.
>>ONCE AGAIN, I HAVE TO SAY
THANKS TO THE BSC.
DIFFERENT CONTEXT THIS TIME.
SO I'M THE DIRECTOR OF NINDS,
AND IT'S KIND OF BITTERSWEET,
YOU KNOW, BE HERE WISHING MARK
GOOD LUCK AS HE RETIRES, AS YOU
CAN IMAGINE, HE'S BEEN JUST A
FANTASTIC FORCE HERE AT NINDS.
SO WE'RE GOING TO MISS HIM IF
HE'S NOT AROUND AS MUCH BUT I'M
HOPING HE'LL STICK AROUND.
OUR MISSION AT NINDS IS TO TRY
TO FIGURE OUT HOW THE NERVOUS
SYSTEM WORKS AND TO USE THAT
KNOWLEDGE TO REDUCE SUFFERING
DUE TO NEUROLOGICAL DISORDERS,'S
THAT'S WHAT WE'RE ALL ABOUT, AND
THAT'S WHY THE TAXPAYER FUNDS
US, SO MOST OF OUR MONEY GOES
OUT TO UNIVERSITIES, BUT THE
INTRAMURAL PROGRAM IS -- WE SET
UP TO BE A REALLY SPECIAL PLACE
WHERE PEOPLE CAN LOOK AT THE
THINGS THAT THEY'RE INTERESTED
IN AND VISION A PATH TO KIND OF
LEARN MORE IN THE AREA OF THEIR
INTERESTS, AND THEN LET THEM GO
AT IT.
SO IT'S A SPECIAL PLACE BECAUSE
IT'S NOT NECESSARILY DRIVEN BY
THE WINDS OF FUNDING OR THE
WINDS OF POPULARITY.
PEOPLE CAN DO WHATEVER THEY FEEL
IS IMPORTANT.
AND AS LONG AS IT'S IMPORTANT,
FUNDING WILL CONTINUE, THEIR
RESEARCH WILL THRIVE, AND SO
WHEN YOU THINK OF PEOPLE WHO
BENEFIT FROM COMING
INTRAMURALLY, I THINK MARK IS
REALLY THE QUINTESSENTIAL NINDS
INVESTIGATOR, BECAUSE -- AND
YOU'LL HEAR TODAY AS YOU FOLLOW
HIS CAREER, HE JUST MOVED AND
MOVED WHERE THE SCIENCE TOOK
HIM, AND EVERYWHERE HE WENT, HE
MADE INSIGHTS THAT CHANGED ALL
THE LIVES OF THE PEOPLE IN THIS
ROOM, AND SO THAT'S A REAL
TESTAMENT.
BUT PROBABLY THE MOST POIGNANT
TESTAMENT TO MARK'S CAREER, I
THINK.
SO PEOPLE COME IN WITH DIFFERENT
IDEAS ON WHAT THEY WANT TO DO
WITH THEIR CAREERS, AND MARK IS
AMONG -- SOME OF THE PEOPLE
DECIDED THAT THEIR SUBJECT OF
INVESTIGATION WAS GOING TO BE
THE HUMAN.
SO HERE WE HAVE PEOPLE DOING
MICE TO MARMOSETS TO HUMANS, AND
I THINK THAT FROM MY BACKGROUND,
WHICH WAS SIMILAR TO MARK'S, THE
THOUGHT THAT TRYING TO
UNDERSTAND HOW WE OPERATE AS
INDIVIDUALS IS REALLY SOMETHING
THAT CAN ONLY BE EXPLORED BY
LOOKING AT HUMAN BEHAVIOR, HUMAN
DISORDERS, BUT IN THINKING ABOUT
THE WAY DO IT, MARK, I THINK
LIKE MANY PEOPLE IN THAT
GENERATION, COMING OUT OF THAT
SPACE, LOOKED AT NEUROPHYSIOLOGY
AS THE KEY.
AND SO THE NEUROLOGIST IS A
PATTERN RECOGNIZER.
WE SEE PATIENTS, WE RECOGNIZE
THINGS, BUT TO TRY AND
UNDERSTAND WHAT THE BASIS IS, WE
NEED TOOLS TO IB TEAR TO INTERE
NERVOUS SYSTEM AND THAT'S WHERE
PHYSIOLOGY HAS GROWN AND GROWN
UNDER MARK'S TUTELAGE OVER THE
LAST 40 YEARS TO JUST INCREASE
OUR ABILITIES TO SEE WHAT'S
GOING ON IN THE BRAIN AND IN
NORMAL AS WELL AS PEOPLE WITH
DIFFERENT DISORDERS,
PARTICULARLY TREMOR, DYSTONIA,
AND THEN MOVING TO FUNCTIONAL
NEUROLOGICAL DISORDERS, AND LOTS
OF OTHER THINGS IN BETWEEN.
AND AS I MENTIONED EARLIER, THIS
IS USUALLY DONE IN A TEAM
SETTING AND SO PEOPLE COME IN,
THEY JOIN THE TEAM, THEY LEARN
FROM MARK, AND THEN WHAT THEY
LEARNED ALLOWS THEM TO MOVE OUT
AND MOVE ON TO THEIR PASSION IN
SCIENCE AND THAT'S WHAT A LOT OF
PEOPLE IN THIS ROOM HAVE BEEN
ABLE TO DO BECAUSE OF NOT THE
FLUFF BUT THE REAL HONEST TO
GOODNESS INSIGHTS INTO HOW THE
BRAIN WORKS, THAT PEOPLE HAVE
GOTTEN FROM MARK.
AS I SAID RIGHT IN THE
BEGINNING, OUR GOAL AT NINDS IS
TO REDUCE SUFFERING OF PEOPLE
WHO SUFFER WITH NEUROLOGICAL
DISORDERS.
THESE ARE NOT PLEASANT THINGS TO
HAVE, AS ALL OF YOU KNOW.
AND SO REDUCING THE SUFFERING IS
WHAT IT'S ALL ABOUT, AND YOU
HAVE TO UNDERSTAND WHAT'S GOING
ON TO BE ABLE TO DO THAT.
BUT MARK CERTAINLY TOOK FORAYS
WITH BOTOX, WITH TREATMENT OF
TREMOR, AND TRYING TO ACTUALLY
IMPROVE TREAT.
TREATMENT.
CERTAINLY HIS WORK IN
NEUROPHYSIOLOGY HAS IMPROVED THE
DIAGNOSIS, WHICH IS THE FIRST
STEP IN DEVELOPING ANY
TREATMENT, AND SO THERE'S PEOPLE
AROUND THE WORLD WHO DON'T KNOW
MARK WHO ARE BENEFITING FROM THE
WORK HE DID.
AND SO JUST TO WRAP UP, I JUST
WANT TO SAY THAT, AGAIN, FROM
THE NINDS, WE REALLY APPRECIATE
ALL YOU DID, MARK, ALL OVER
THESE YEARS, AND WE WERE HAPPY
TO PAY FOR THE AIRLINE TICKETS.
[LAUGHTER]
OF COURSE I THINK THE OTHER
THING THAT MARK DID WHICH PEOPLE
WILL TALK ABOUT IS THAT HIS
IMPACT WASN'T BETWEEN THESE
WALLS, WHICH WEREN'T HERE WHEN
HE CAME, BUT NOW THEY'RE HERE,
BUT ALSO ACROSS THE COUNTRY AND
PARTICULARLY INTERNATIONALLY
WORKING WITH THE WORLD
FEDERATION OF NEUROLOGY, MARK'S
IMPRINT GOES REALLY GLOBALLY AND
SO TAKING SCIENCE GLOBALLY,
GIVEN ALL THE POLITICS AND ALL
THAT STUFF, THE SCIENCE IS
REALLY PROBABLY THE BEST WAY OF
COMMUNICATING ACROSS THESE
MULTIPLE COUNTRIES AND MARK WAS
CLEARLY AT THE TOP OF THAT GAME,
SO WE REALLY THANK YOU FOR THAT.
AND AGAIN, YOU'LL HEAR A LOT
FROM PEOPLE TODAY.
INTERESTED TO SEE WHERE THE
GHOST IS IN THE MACHINE, THE
GHOST IN THE MACHINE, REALLY?
OKAY, GOOD.
LOTS OF THINGS WE'LL LEARN, BUT
I THINK THE MAIN THING WE'LL
LEARN WAS THAT MARK WAS A GREAT
ROLE MODEL FOR ALL OF US TO
FOLLOW, AND LOOK FORWARD TO THE
EVENTS OF TODAY.
AND NOW I'D JUST LIKE TO ASK
JEFF DIAMOND, WHO REPRESENTS THE
INTRAMURAL PROGRAM, HE'S THE
ACTING SCIENTIFIC DIRECTOR OF
THE NINDS INTRAMURAL PROGRAM TO
SAY A COUPLE WORDS.
JEFF?
[APPLAUSE]
>>THANKS, WALTER.
GOOD MORNING, EVERYONE.
SO I GUESS PROBABLY ONE OF THE
MOST IMPORTANT THINGS THAT HAS
EVER HAPPENED IN THE HISTORY OF
OUR INTRAMURAL PROGRAM ACTUALLY
HAPPENED AT NIMH.
I GUESS IN THE LATE 60s, WHEN
MARK WENT AFTER GETTING HIS
BACHELOR'S AND HIS M.D. AT
HARVARD, CAME HERE TO DO A
FELLOWSHIP WITH ETESIA TISAKA IN
NIMH, I BELIEVE.
IT WAS JUST A ONE OR TWO-YEAR
FELLOWSHIP, HE ALSO DID A
FELLOWSHIP IN LONDON BEFORE
RETURNING TO BOSTON TO CONTINUE
HIS NEUROLOGY TRAINING, BUT IN
THAT SHORT TIME WITH TISAKA, HE
STUDIED THE PHYSIOLOGY AND
ACTUALLY IMAGED THE SQUID GIANT
AXON TO FORM THE BASIS FOR HIS
ENTIRE CAREER, AND I SAY THAT'S
REALLY IMPORTANT BECAUSE
SOMETHING MUST HAVE HAPPENED
DURING THAT TIME THAT ALLOWED
NIH TO LURE HIM AWAY FROM
HARVARD A FEW YEARS LATER TO
COME HERE IN 1984 AS THE
CLINICAL DIRECTOR, AND ALSO, OF
COURSE, THE CHIEF OF THE HUMAN
MOTOR CONTROL SECTION.
WHICH IS A MUCH BETTER ACRONYM
THAN BSC.
I SUFFERED A SERIES OF
INVOLUNTARY MOVEMENTS WHEN THOSE
LETTERS CAME UP.
IF YOU WERE TO INTRODUCE MARK,
YOU'RE VERY TEMPTED TO GO BIG,
AND SAY THINGS ON A GRAND SCALE,
BECAUSE PEOPLE A LOT OF TIMES
TALK METRICS AND NUMBERS, AND
WITH MARK, THOSE NUMBERS ARE
ALMOST SORT OF INCOMPREHENSIBLE,
THE NUMBERS OF PAPERS HE'S
PUBLISHED IN VARIOUS ASPECTS OF
THE FIELD.
WALTER ALREADY ALLUDED TO HIS
ENTHUSIASTIC TRAVEL SCHEDULE.
THAT IS NEARLY LEGENDARY AND IN
NINDS, HE'S GIVEN MANY, MANY
HUNDREDS OF TALKS AROUND THE
WORLD.
BUT I GREW UP IN THIS INSTITUTE,
I GOT HERE IN 1999, WHICH I USED
TO THINK WAS A LONG TIME AGO,
AND I CAN JUST SAY FROM THAT
STANDPOINT WHAT IT'S BEEN LIKE
HAVING -- COMING TO A THIS
COMMUNITY AS A PURELY BASIC
SCIENTIST AND SEEING THE
PRESENCE THAT MARK HAD AND THE
INFLUENCE THAT HE HAD, CERTAINLY
ON CLINICAL SIDE OF THE HOUSE,
BUT ALSO IN US BECAUSE IK
SCIENTI -- INUS BASIC SCIENTISTT
OF ONE OF THE BEST
MANIFESTATIONS OF THAT PART OF
OUR FIELD.
AND REMEMBER, OF COURSE, MARK'S
TALKS AT OUR RETREATS.
HE WAS KIND ENOUGH TO INVITE ME
ONE TIME TO SIT IN AND CRITIQUE
HIS BSC PRESENTATION.
WHICH WAS A FUN EXPERIENCE.
I REMEMBER HIM ENGAGING IN A
PHILOSOPHICAL DEBATE WITH
MICHAEL O'DONOVAN ABOUT FREE
WILL AT ONE OF OUR RETREATS.
AND I ALSO HAD THE PLEASURE TO
SERVE FOR A SMALL PORTION OF
MARK'S 21-YEAR TENURE ON THE
PROMOTION AND TENURE COMMITTEE
IN NINDS.
SO THE TALKS TODAY ARE GOING TO
ADDRESS THE INTERNATIONAL SCOPE
OF MARK'S WORK AND THE INFLUENCE
THAT IT'S HAD ON THE FIELD.
I'M CHOOSING TO JUST MENTION FOR
A MOMENT THE INFLUENCE THAT HE
HAD IN A MENTORING AND
INSPIRATIONAL CAPACITY EVEN IN
PEOPLE WHO WEREN'T DIRECTLY
CONNECTED WITH THE HMCS.
SO MARK, THANK YOU VERY MUCH FOR
EVERYTHING YOU'VE GIVEN THE
INSTITUTE, AND THANK YOU,
EVERYONE, FOR COMING AND I LOOK
FORWARD TO A GREAT DAY OF TALKS.
THANKS.
>>WELCOME, EVERYBODY.
I HAVE BEEN GIVEN THE EARLY DAYS
BECAUSE I'M OLD BUT I'M NOT AS
OLD AS LEO.
AND IF JEFF IS STILL HERE, 1999
IS NOTHING.
I'M GOING TO TAKE YOU, PRETTY
EARLY, TO MARK'S FIRST -- AT
LEAST HIS FIRST PAPER IN HUMAN
MOTOR CONTROL, WHICH WAS FROM
WHEN HE WAS A RESIDENT.
AND IT WAS WRITTEN WITH BOB --
AND BOB YOUNG, WHEN I TRAINED
THERE IN LESS PRESTIGIOUS
CIRCUMSTANCES.
THIS IS A PAPER ABOUT THE EMG
ANALYSIS -- DURING SMOOTH,
GRADED AND QUICK BALLISTIC
MOVEMENTS.
THIS WAS AN OLD TOPIC BUT THE
INTRODUCTION STATES THE FIELD
NEEDED A LITTLE BIT OF
HOUSEKEEPING.
BUT IT'S REALLY THE FIRST ENDS
OF THE DISCUSSION WHERE MARK
SHOWS HIS HAND, AND THIS IS
CLEARLY ABOUT MORE THAN SECURING
SOME LOOSE ENDS, AND IT REALLY
IS ABOUT HOW THE NERVOUS SYSTEM
CONTROLS MOVEMENT.
AND AS WE'RE GOING TO HEAR
TODAY, MARK INTENDED TO CHASE
THAT MOTOR COMMAND TO ITS
ULTIMATE ORIGINS.
AND IT'S ALSO WORTH NOTING THAT
IN 1975, A YOUNG SCIENTIST COULD
HAVE IMPLANTED BEHAVING ANIMAL
AND RECORDED THE ACTIVITY OF
INDIVIDUAL CELLS.
BUT THIS APPROACH WAS UNIQUELY
CLINICAL, UNIQUELY HUMAN, AND AS
I THINK YOU'LL SEE, REALLY
PROVIDED VERY IMPORTANT
INSIGHTS.
SO WHAT'S IN THE PAPER?
WHEN SOMEONE MAKES A SMOOTH
CONTROLLED MOVEMENT, THE AGONIST
MUSCLE, IN THIS CASE, THE
BICEPS, GENERATES A -- IS
ACTIVATED, AS ANYONE WOULD
EXPECT, AND THERE ARE NO
SURPRISES THERE.
BUT WHEN SOMEONE MAKES A FAST
MOVEMENT, SAY A JERKY ELBOW
FLEXION, THERE'S A BURST IN THE
AGONIST MUSCLE AND A BURST IN
THE ANTAGONIST MUSCLE FOLLOWED
USUALLY BY A BURST IN THE
AGONIST MUSCLE AGAIN.
AND MARK TOOK HIS
CHARACTERISTICALLY SYSTEMATIC
AND QUANTITATIVE APPROACH TO
DIVIDING THE PHENOMENON INTO
PHASES, MEASURING THEM AND
NAMING THEM.
AND THIS PHENOMENON WAS AN
ACTIVE TOPIC OF CONVERSATION IN
1975, BUT ALSO WHEN I JOINED
MARK'S GROUP IN 1989, IT WAS
STILL BEING TALKED ABOUT A GREAT
DEAL, AND I THOUGHT FOR A LONG
TIME THAT MARK HAD DISCOVERED
IT.
HOWEVER, IT WAS FIRST DESCRIBED
IIN THE 1920s.
BUT NOBODY REALLY HAD AN
ADEQUATE UNDERSTANDING OF IT AT
THAT POINT.
SO THIS ANTAGONIST BURST MADE SO
LITTLE SENSE THAT PEOPLE
INTERPRETED IT AS BEING POSSIBLY
A SEGMENTAL REFLEX RESPONSE TO
THE ACTION OF THE -- OF THE
AGONIST, WHICH PUT A STRETCH ON
THE ANTAGONIST MUSCLE.
BUT IN ORDER TO RULE THAT OUT,
MARK AND HIS COLLEAGUES FIRST
APPLIED EQUAL FORCES TO THE
LIMB, AND FOUND THAT THE PATTERN
WAS INTACT, BUT THEN DROPPED ONE
OF -- REDUCED ONE OF THE FORCES
DURING THE REACTION TIME FOR THE
MOVEMENT, UNLOADING THE
ANTAGONIST MUSCLE, AND
EFFECTIVELY DESTRETCHING IT
COMPLETELY TO SEE IF THE
ANTAGONIST BURST REMAINED.
AND YOU CAN SEE THIS CAUSES A
LITTLE BIT OF MECHANICAL
OVERSHOOT IN THE MOVEMENT, IN
THE DIRECTION OF THE AN TAG M A,
BUT THE MOVEMENT IS INTACT AND
THE ANTAGONIST BURST IS STILL
THERE EVEN IN A COMPLETELY
UNLOADED MUSCLE.
SO THE REFLEX WAS EFFECTIVELY
RULED OUT.
ANOTHER THING THEY DISCOVERED
USING THIS PRELOADING OF THE
LIMB BEFORE MOVEMENT WAS THAT
THE MOVEMENT COMMAND ACTUALLY
BEGINS WITH INHIBITION OF THE
ANTAGONIST, AND YOU CAN SEE
BEFORE THE AGONIST BURST, THE
ANTAGONIST GOES QUIET, AND THIS
WAS COMPLETELY OCCULT, YOU
WOULD -- YOU COULD USE H
REFLEXES AT THE TIME WHICH SOME
PEOPLE MAY HAVE DONE.
BUT THIS WAS ANOTHER -- THIS IS
THE LEADING EDGE OF THE COMMAND
HERE.
AND TO FURTHER TEST THE REFLEX
HYPOTHESIS, THEY ALSO STUDIED A
NATURALLY DEAFFERENTED PATIENT
WITH A PAN SENSORY NEUROPATHY,
WHO HAD VERY LITTLE CONSCIOUS
SENSATION, AND LO AND BEHOLD,
THE PATTERN OF
AGONIST/ANTAGONIST AND A LITTLE
BIT OF AGONIST WAS PRESENT IN
THIS PATIENT TOO.
SO THIS WAS A CENTRALLY GENERAL
NATEED PHENOMENON.
WHICH IS WHAT THEY CONCLUDED,
AND THIS STATEMENT IS FROM THE
DISCUSSION AND IT MAY SEEM
OBVIOUS BUT IT IS NOT IN ANY WAY
TRIVIAL.
THE TRY PHASIC PATTERN IS REALLY
A SIGNATURE OF CENTRAL MOVEMENT
COMMAND, AND IT CONTAINS ALL THE
INFORMATION NECESSARY TO SPECIFY
THE TRAJECTORY IN THE END POINT
OF A BALLISTIC MOVEMENT.
AND IT MUST LOGICALLY BE ALTERED
IN DISEASE STATES WHERE MOVEMENT
IS ABNORMAL AND MOREOVER MAPPING
THOSE DIFFERENCES IN MOVEMENT ON
TO CHANGES IN THIS PATTERN IN
DISEASE OUGHT TO PROVIDE
INSIGHTS.
SO THAT'S WHAT THEY DID.
IN CEREBELLAR DISEASE, THE
BURSTS ARE PRESENT, BUT TOO
LONG, AND INCOORDINATED IN TIME.
THE INHIBITION OF THE ANTAGONIST
ONLY BEGINS AND ONLY BEGINS
PARTIALLY WITH THE ONSET OF
AGONIST ACTIVITY.
AND IN PARKINSON DISEASE, THE
BURSTS ARE PRESENT, AGONIST,
ANTAGONIST, BUT THEN AGONIST AND
ANTAGONIST AGAIN.
IN A CYCLICAL WAY.
AS THOUGH THE FIRST PATTERN
WASN'T ENOUGH TO GET THE
MOVEMENT GOING AND CONTINUOUS
ACTIVITY HAD TO BE GENERATED IN
ORDER TO REACH THE END POINT.
AND THIS WAS ELABORATED LATER
INTO REALLY A RATHER ELEGANT
SYNTHESIS THEY CONCLUDED BASED
ON THE DATA THAT BRADY KINETIC
PATIENTS HAD TO PRODUCE MULTIPLE
CYCLES BECAUSE THE BASAL GANGLIA
DIDN'T PROVIDE THE NECESSARY
WHAT THEY CALLED ENERGY TO
GENERATE THE LIMB MOVEMENT.
AND THIS WAS A MAJOR ADVANCE
OVER CURRENT THEORIES OF BRADY
KIENESIA WHICH INCLUDED THINGS
LIKE MECHANICAL MUSCLE VISCOSITY
AND COACTIVATION, WHICH CLEARLY
WEREN'T PRESENT AND THIS WAS
ACTUALLY VERY STRONG SUPPORT FOR
THE IDEA THAT THE BASAL GANGLIA
SELECTIVELY SELECTED MOVEMENT AD
PRIORITIZED MOVEMENT SETS UNDER
THE INFLUENCE OF THE DOPAMINE
REWARD SYSTEM.
THE DOGMA UNDERWENT REFINEMENT
UNDER THE INFLUENCE OF C.D.
MARSTEN AND FOUND THIS MORE
ABSTRACT FORMULATION WHERE
THINGS ARE EXPRESSED IN TERMS OF
FORCES AND GOALS OF MOVEMENT TO
THE DESIRED PLACE.
AND BY 1996, THE PHENOMENON HAD
BEEN INVESTIGATED ACROSS A
VARIETY OF DISEASES AND THERE
WAS REALLY A STRING OF INSIGHTS
AVAILABLE JUST FROM THIS SIMPLE
EMG RECORDING ABOUT THE NATURE
OF THESE DISEASES WHOSE
PHYSIOLOGY WAS REALLY JUST BEING
CONCEPTUALIZED.
SO BY THE LATE 80s, IT BECAME
EASY ENOUGH TO LOOK AT THAT
MOTOR COMMAND UP AT THE OTHER
END OF THE NEURAL AXIS AND
INTEREST IN THE EMG DURING
MOVEMENT FADED SOMEWHAT.
BUT PEOPLE ARE STILL SCRATCHING
THEIR HEADS ABOUT THIS DAMN
THING.
WHY THE CNS GENERATES THESE
ANTAGONIST BURSTS.
I HAVE NO IDEA WHAT A BANG-BANG
MODEL IS.
IT SOUNDS NOT SAFE FOR WORK
POTENTIALLY.
BUT I DO KNOW THESE GUYS
WOULDN'T BE AS FAR ALONG IF IT
WEREN'T FOR THE INSIGHTS THAT
MARK HAD HAD ABOUT THIS
PHENOMENON AND THE INTEREST THAT
HE GENERATED IN IT.
I'M GOING TO LEAVE YOU WITH A
QUOTE FROM GILBERT REIL, THE
PHILOSOPHER, WHO WAS A GREAT
ENEMY OF THE MIND-BODY DUALITY,
AND HE REALLY FELT THAT THE BODY
WAS THE MIND.
AND THAT ANY DISTINCTION WAS
ABSURD.
I THINK ALL OF US AS
REDUCTIONISTS AGREE.
BUT I THINK MARK'S CAREER FROM
THIS EARLY DECODING OF
PERIPHERAL SIGNALS FROM BRAIN
COMMANDS TO HIS LATER AND VERY
IMPORTANT INQUIRIES INTO THE
BASIS OF VOLITION AND FREE WILL
ITSELF HAVE DONE A GREAT DEAL TO
BUST THIS PARTICULAR GHOST, AND
WITH THAT, I WILL CONCLUDE.
[APPLAUSE]
OUR NEXT SPEAKER IS DR. LEWIS
WHEATON, ASSOCIATE PROFESSOR OF
BIOLOGICAL SCIENCES AT GEORGIA
TECH UNIVERSITY.
>>SO WHEN I JOINED THE LAB, I'M
A WHOLE LOT YOUNGER THAN ERIC,
DEFINITELY YOUNGER THAN LEO,
SINCE WE'RE AGING EACH OTHER
RIGHT NOW.
WHEN I CAME INTO THE LAB, I WAS
VERY CURIOUS ABOUT THE
INTERSECTION OF COGNITIVE
CONTRIBUTIONS WITHIN THE MOTOR
SYSTEM, AND IT WAS EXCITING TO
KNOW WHEN I JOINED THAT THIS WAS
SOMETHING THAT MARK WAS ALSO
INTERESTED IN, AND I GOT TO THAT
KIND OF THROUGH AN ODD ROUTE.
WHEN I WAS EARLY ON, READ THAT
PARTICULAR BOOK, WHEN I WAS
EARLY IN GRAD SCHOOL AND I HAD
THE UNIQUE OPPORTUNITY TO --
BECAUSE MARK HAD COME TO THE
UNIVERSITY OF MARYLAND TO GIVE A
TALK, I HAPPENED TO ASK HIM IF I
COULD LEARN SOME MORE ABOUT THE
HUMAN MOTOR CONTROL SYSTEM, AND
HE SAID, WELL, SURE!
YOU CAN DO THAT.
SO I JOINED HIS LAB VERY SOON
AFTER THAT INITIAL MEETING.
IN ONE OF THOSE VERY INITIAL
MEETINGS, THOUGH, HE SENT ME ON
AN ERRAND TO LEARN MORE ABOUT
THE INTERACTION OF THE COGNITIVE
AND MOTOR SYSTEM, BACK IN THE
DAY WHERE YOU COULDN'T READILY
GET PDFs ONLINE OF ARTICLES,
HE TOLD ME TO GO AND FIND TWO
LITTLE WIMPY PAPERS ABOUT
DISCONNECTION SYNDROMES IN
ANIMALS AND MAN.
HE SAID THEY WOULD BE A LITTLE
LONG.
SO I DUTIFULLY WENT DOWN TO THE
LIBRARY AND FOUND THE VOLUMES OF
BRAIN THAT THEY WERE PUBLISHED
IN, AND I DIDN'T REALIZE THAT
THESE WOULD BE ABOUT 150 PAGES
WORTH OF PAPERS THAT I NEEDED TO
READ TO UNDERSTAND MORE ABOUT
THE TOPIC WE'RE GOING TO TALK
ABOUT TODAY.
I DID NOT READ ALL 150 PAGES OF
THAT WORK, BUT I DID FOCUS QUITE
A BIT ON THE APRAXIAS.
FOR A LONG TIME, AND I'LL TOUCH
ON A MOMENT HERE I THINK
SOMETHING THAT'S REALLY
INTERESTING WITH THE APRAXIAS
AND KIND OF HOW A LOT OF THIS
REALLY DEVELOPED, THE APRAXIAS,
WHILE DEFINED SEVERAL DIFFERENT
WAYS AND KIND OF HAVING
DIFFERENT LEVELS OF APRAXIA, SO
TO SPEAK, THESE FOUR
PARTICULARLY HAVE BEEN UTILIZED
MOST FREQUENTLY.
AND I GOT REALLY EXCITED AND
MARK WAS REALLY INTRIGUED ABOUT
THIS IDEA OF I IDEOMOTOR APRAXI,
THESE INDIVIDUALS WHO BY VIRTUE
AS FAR AS WHAT WE WERE LOOKING
AT BY VIRTUE OF HAVING A STROKE,
SUDDENLY COULD NOT MAKE TOOL USE
OR GESTURE MOVEMENTS WITH THEIR
HANDS BILATERALLY.
THEY STILL UNDERSTOOD WHAT THEY
WERE SUPPOSED TO DO, THEY STILL
UNDERSTOOD PERHAPS WHAT THE TOOL
WAS AND WHAT A TOOL MIGHT BE
USED FOR.
THEY JUST COULDN'T DEVELOP THE
MOTOR PLAN FOR THIS PARTICULAR
ONE.
AND RELATED TO THAT,
PARTICULARLY THE LAST TWO, SPILL
OVER INTO MORE ACTION-BASED
IDEAS, SO HOW YOU CARRY OUT A
SERIES OF TASKS OR THE ABSOLUTE
LOSS OF TOOL KNOWLEDGE AS A
WHOLE.
THESE VERY FASCINATING HISTORY
WHICH I LEARNED IN PART FROM
READING THAT ARTICLE AND IN PART
FROM WORKING WITH MARK OVER THE
YEARS, GOING BACK TO REALLY
PRIMITIVE DEFINITIONS THAT
EMERGED IN THE 1800s, AND THEN
A REALLY IMPRESSIVE VOLUME OF
LITERATURE IN THE EARLY 1900s
KIND OF ENDING IN 1920 BEFORE
THINGS WENT SILENT UNTIL ABOUT
1965.
IT WAS THE PAPERS FROM NORMAN
GESCHWENN THAT I WAS HIGHLY
REFERRED TO BY MARK TO READ
BECAUSE OF THIS DISCONNECTION
ASPECT, THIS IDEA THAT PERHAPS
VERBAL INPUT, LANGUAGE INPUT FOR
MOTOR COMMAND COULD PERHAPS
MAYBE NOT SO TO SPEAK MAKE ITS
WAY INTO THE MOTOR SYSTEM TO
HELP PLAN AND ORGANIZE A
MOVEMENT.
MANY PEOPLE SINCE, IN THE
EIGHTIES, KIND OF SPILLED OUT TO
HELP DEVELOP APRAXIA.
MANY OF THESE INDIVIDUALS THAT
YOU SEE LISTED HERE WERE A PART
OF A CONFERENCE THAT WE HAD HERE
BACK IN ABOUT 2004 THAT MARK WAS
HAPPY TO HELP ORGANIZE HERE ON
APRAXIA.
AND I DEFINITELY ALWAYS
APPRECIATED THAT OPPORTUNITY AS
A YOUNG STUDENTS.
SO WHEN WE FIRST GOT TALKING
ABOUT THIS, I WOULD GO TO HIS
OFFICE AND WE WOULD TALK ABOUT
PAPERS LIKE THESE.
THIS EMPHASIS THAT MOTOR AND
ACTION, SO TO SPEAK, COULD
INVOLVE VARIOUS -- BEYOND THE
MOTOR CORTEX, SOME OF THIS WORK
BEING DONE RIGHT HERE AT NIH,
WHERE PEOPLE WERE TRYING TO
UNDERSTAND THAT YOU COULD THINK
ABOUT MOTOR IMAGERY AND YOU
COULD GET ENGAGEMENT IN PREMOTOR
AREAS, AND AS WELL, EVEN WORK
THAT I PERSONALLY FOUND VERY
EXCITING, WAS THIS IDEA THAT YOU
COULD SHOW PEOPLE PICTURES OF
TOOLS AND SHOW PEOPLE PICTURES
OF JUST THINGS THAT MAKE NO
SENSE, AND THAT SOMEHOW THESE
WOULD ENGAGE OTHER BRAIN AREAS
AND YOU'VE GOT US THINKING A BIT
ABOUT APRAXIA, AND STARTING WITH
A VERY BASIC QUESTION, INSTEAD
OF STARTING WITH AN
UNDERSTANDING OF WHAT IS
APRAXIA, AND WHAT ARE THE
ORIGINS OF APRAXIA, WHY DON'T WE
START TO UNDERSTAND THE BASIC
ASPECTS OF PRAXIS CONTROL IN
HUMANS.
WHAT DOES THAT ACTUALLY LOOK
LIKE, WHAT ARE THE NEURAL AREAS
INVOLVED IN THAT, AND WHAT CAN
WE LEARN FROM THAT AS IT RELATES
TO APRAXIA.
SO IN THE EARLY TWO THOUSANDS,
ERIC MENTIONED A BIT ABOUT THIS
PARTICULAR SIGNAL, SO WE HAD
SOME PEOPLE, WE PUT -- THESE
WERE ALL HEALTHY PEOPLE AND WE
HAD PEOPLE PANTOMIME OR PRETEND
HOW TO MAKE A COUPLE DIFFERENT
MOVEMENTS WITH THEIR HANDS.
SO THIS IS WAVING GOODBYE,
PEACE, AN OKAY SIGN, AND ALSO
USING SCISSORS, A SCREWDRIVER,
AND USING A HAMMER.
SO THEY WOULD JUST DO THESE
MOVEMENTS IN A SELF-PACED TASK,
AND SINCE WE WERE LOOKING AT
EEG, WE WERE INTERESTED IN
LOOKING AT THE EMERGENCE OF THIS
EARLY SLOW RISING NEGATIVITY,
COMMONLY AT THE TIME, LOCALIZED
MAINLY OVER SENSORY MOTOR AREAS,
PARTICULARLY CONTRALATERALLY.
WHAT WAS VERY EXCITING TO MARK
AS WE WERE DOING THIS, AND I
THINK DOING HIS DUE DILIGENCE,
HE MADE ME PROVE OVER AND OVER
AND OVER AGAIN THAT THIS SIGNAL
WAS ACTUALLY REAL, BUT WE SAW
THAT THIS SIGNAL WAS ACTUALLY
EMERGING INITIALLY IN THE
POSTERIOR PARIETAL AREAS AS
INDICATED BY BLUE IN THESE
FIGURES, AND THEN IT EXPANDED
INTO PREMOTOR AND MOTOR AREAS,
WHICH WAS A BIT UNIQUE FOR THE
TIME.
ADDITIONALLY WITH THAT, WE
WANTED TO UNDERSTAND
PARTICULARLY THE NETWORKS THAT
WERE ENGAGED IN THESE AREAS.
SO WHAT DO THE NETWORKS LIKE
LIKE THAT WERE DOING THIS?
FORTUNATELY THERE WAS A GOOD
HISTORY OF PEOPLE DOING NETWORK
ANALYSES OF EEG IN THE LAB, AND
SO WE GOT TO BOTH DEVELOP THE
TECHNIQUE AND THEN APPLY THAT
TECHNIQUE WITH THIS PARTICULAR
STUDY.
ONE OF MY FAVORITE PAPERS TO
THIS DAY IS THE ONE THAT YOU SEE
OVER HERE BECAUSE OF A TECHNIQUE
THAT IS REFERRED TO AS IMAGINARY
COHERENCE, WHICH I LOVE TO TRY
TO DESCRIBE TO PEOPLE, AND THAT
IS ACTUALLY NOT IMAGINARY, IT IS
ACTUALLY REAL, BUT IT IS ALSO
NOT REAL BECAUSE IT'S IMAGINARY.
[LAUGHTER]
IT'S A PHENOMENAL, PHENOMENAL
SERIES TO GIVE TO STUDENTS ON
SIGNAL PROCESSING.
SO WE DEVELOPED THIS TECHNIQUE,
AND THIS WAS A LOT OF FUN TO DO,
IT WAS A LOT OF HARD WORK TO
DEVELOP THIS, BUT WE APPLIED
THIS TECHNIQUE TO THE
AFOREMENTIONED STUDY THAT I JUST
DESCRIBED, WHERE WE DISCOVERED
THAT THERE WERE CERTAIN
CONNECTIONS PARTICULARLY BETWEEN
PARIETAL AND MOTOR AREAS,
PARIETAL AND PREMOTOR AREAS THAT
WERE INVOLVED IN THE EARLY
PLANNING PHASE MERGING AS
CONNECTIONS BETWEEN THESE BRAIN
AREAS, WHICH WAS REALLY A LOT OF
FUN.
AND THAT LED TO AN EXPLOSION OF
WORK COMING OUT OF THE LAB AT
THE TIME WITH SEVERAL PEOPLE --
IT'S GREAT TO HAVE THIS
COMMUNITY THROUGH HUMAN MOTOR
CONTROL SECTION THAT I'VE BEEN
ABLE TO KEEP IN TOUCH WITH OVER
THE YEARS WHO HAVE DONE SEVERAL
STUDIES IN FMRI AND ELECTROCOURT
COGGRAPHY TO TRY TO UNDERSTAND A
CERTAIN UNDERSTANDING OF CERTAIN
TOOL-RELATED BEHAVIORS, THIS
INTERSECTION OF COGNITIVE SYSTEM
RELATED TO MOTOR DEMANDS,
INTEREST IN MOTOR SYSTEMS, AND
HOW THE COGNITIVE ASPECTS OF
WHAT YOU WANT TO DO PARTICULARLY
FROM A TOOL USE BEHAVIOR CONNECT
TO YOUR MOTOR PLANNING
EXECUTION.
WHAT'S REALLY FUN IS THAT
EXPANDS QUITE A BIT INTO A LOT
OF DOMAINS AND I THINK CERTAINLY
MARK'S ENTHUSIASM TO TAKE THIS
ON HAS REALLY SPILLED OUT INTO A
LOT OF OTHER STUDIES WHETHER
IT'S IN MY LAB OR OTHER LABS
AROUND THE WORLD THAT ARE TRYING
TO UNDERSTAND THINGS SUCH AS
THIS, UNDERSTANDING CONTEXT OF
ACTION.
SO IF YOU SEE AN ACTION THAT IS
CORRECT BASED ON A NORMAL
STRUCTURAL DEFINITION OF
BEHAVIOR AND THEN YOU SEE AN
ACTION LIKE THIS THAT IS
INCORRECT, YOU WOULDN'T
NECESSARILY NORMALLY DO THAT,
THAT THERE IS, PERHAPS, A NEURAL
DIFFERENCE BETWEEN THESE TWO
MEDIATED BY DIFFERENT NEURAL
NETWORKS, ONE, THE CORRECT IN
RED AND THE GREEN WOULD BE THE
INCORRECT THERE.
YOU CAN ALSO EVALUATE USING EEG
TO BE ABLE TO UNDERSTAND, AGAIN,
THAT THERE ARE CERTAIN
SUBNETWORKS AND NETWORKS WHICH
MAY COME BACK TO WHY
PARTICULARLY PEOPLE THAT CAN'T
NECESSARILY DIFFERENTIATE THE
TWO TEND TO HAVE LESIONS IN THIS
REGION HERE.
PERHAPS THEY CAN'T DISTINGUISH
BETWEEN CORRECT AND INCORRECT
ACTION.
AND AS WELL SOMETHING THAT WE'VE
SPENT A BIT OF TIME WITH IN MY
LAB IS UNDERSTANDING HOW
MULTIPLE SYSTEMS HELP TO
INTERACT WITH THIS TYPE OF
BEHAVIOR.
I REMEMBER DISTINCTLY A
CONVERSATION, ONE OF THE FIRST
PAPERS THAT I EVER PRESENTED AT
OUR JOURNAL CLUB IN THE LAB MANY
YEARS AGO WAS ACTUALLY IN OUR
TRACKING PAPER RELATED TO MOTOR
PERFORMANCE, AND I FEEL LIKE
MANY TIMES I'VE COME FULL CIRCLE
WITH THAT BECAUSE A LOT OF THE
WORK WE'RE DOING THAT WAS
ACTUALLY WITH EYE TRACKING WHICH
HAS BEEN VERY EXCITING TO LOOK
AT CONNECTIONS BETWEEN EYE
TRACKING, MOTOR PERFORMANCE
PARTICULARLY WITH SOME OF THESE
PRAXIS MOTOR SKILLS AS WE'VE
DISCUSSED, AND THIS IS AN
EXAMPLE WHERE WE'VE BEEN ABLE TO
LOOK AT HOW CERTAIN NEURAL
ACTIVATION PATTERNS OVER
PARIETAL AREAS AND FRONTAL AREAS
ARE CONNECTED TO EITHER THE
UNDERSTANDING OF THE TOOL OR ARE
MORE RELATED TO THE EYE MOVEMENT
PLANNING SIGNAL ITSELF.
SUCH THAT THERE IS A POTENTIAL
DISSOCIATION WE CAN MAKE IN THE
NEURAL SIGNALS FOR EYE MOVEMENT
OVER PRY T PARIETAL FRONTAL -- N
DO SIMILAR THINGS WITH
INDIVIDUALS THAT ARE DEALING
WITH STROKE THAT HAVE APRAXIA AS
WELL.
AND THEN FINALLY, THIS HAS ALSO
EXPANDED INTO AN UNDERSTANDING
OF SOMETHING LIKE LIMB LOSS, HOW
CAN LIMB LOSS AFFECT THIS AS
WELL?
GETTING BACK TO THIS IDEA OF
PRAXIS BEHAVIOR BUT IN THIS CASE
SOMEBODY WITH AN AMPUTATION THAT
IS REACHING FOR A COFFEE MUG
VERSUS SOMEBODY WITH SOUND LIMBS
REACHING FOR A COFFEE MUG AND
THE FACT THAT IF YOU HAVE
INDIVIDUALS WITH AMPUTATION
REACHING FOR A COFFEE MUG, YOU
SEE ACTIVATION OF LEFT PARIETAL
FRONTAL AREAS WHICH IS NICE AND
FAIRLY PREDICTABLE.
HOWEVER, IF YOU ARE AN AMPUTEE
WATCHING SOMEBODY WITH SOUND
LIMBS DOG THE SAME THING, A LOT
OF THAT IS SITTING OVER IN THE
RIGHT HEMISPHERE.
WHAT I'VE ALWAYS FOUND
FASCINATING ABOUT THIS IS THAT
THIS REALLY ECHOES A FINDING
THAT WE EVEN SAW IN PEOPLE WITH
APRAXIA.
INDIVIDUAL WITH APRAXIA SHARE A
SIMILAR SHIFT IN LATERALIZATION
FOR THEIR NEURAL NETWORKS
RELATED TO PRAXIS PLANNING.
I'D LIKE TO END BY JUST SAYING
THIS BRIEFLY.
PRESENTLY A FEW GRAD STUDENTS, A
FEE UNDERGRADS ARE IN THE LAB,
BUT ONE OF THE THINGS THAT'S
VERY EXCITING TO ME AND ALWAYS
HAS BEEN EXCITING TO ME IS THAT
I GET THE OPPORTUNITY TO BOTH
SEND ALL OF MY STUDENTS ON A
FISHING EXPEDITION FOR THOSE
DISCONNECTION SYNDROMES IN
ANIMALS AND MAN PAPER, JUST LIKE
I WAS, TELL THEM THEY HAVE TO
READ IT AND I'M SURE THEY DON'T,
JUST LIKE I DID, BUT WHAT'S
REALLY, REALLY COOL IS SEEING A
GENERATION OF STUDENTS BENEFIT
FROM SOME OF THE SAME
EXPERIENCES THAT I TRY TO
CULTIVATE IN MY LAB NOW BECAUSE
OF THE INFLUENCE OF YOU, MARK.
SO I REALLY APPRECIATE ALL OF
YOUR MENTORSHIP ALONG THE WAY
AND ALL OF YOUR GUIDANCE, AND I
WILL END THERE.
THANK YOU SO MUCH.
[APPLAUSE]
SO IT'S A PLEASURE TO BE HERE.
THANK YOU VERY MUCH TO THE
ORGANIZERS FOR INVITING ME.
SO WHAT I WOULD LIKE TO SHARE
WITH YOU TODAY IS ESSENTIALLY
HOW DID A FELLOW FEEL THOSE
DAYS?
WHAT DID IT FEEL LIKE TO BE A
FELLOW IN THE LAB?
AND LET'S SEE IF I CAN MANAGE
THIS RIGHT.
SO THIS IS A VERY OLD PICTURE,
AND IT'S SORT OF A PHOTO -- THE
PROBLEM IS THAT FROM THOSE DAYS,
I DON'T HAVE MUCH.
I WAS VERY SURPRISED, TRYING TO
GO BACK INTO IT.
SO HERE WE ARE SEEING SOME OF
THE PLAYERS IN THOSE EARLY DAYS,
1985, I SUPPOSE THIS WAS, OR 6,
WITH JOHN, JULIE WHO YOU HAVE
HEARD IN GRAND ROUNDS AT THE
NINDS, BOJI, FANTASTIC GUY FROM
BULGARIA WHO WAS AT THE TIME IN
THE LAB AND THE YOUNGER VERSION
OF ME.
SO YES, EARLY DAYS.
WHAT DID IT FEEL LIKE TO WORK IN
MARK'S LAB DURING THOSE EARLY
DAYS?
WELL, I'M GOING TO TELL YOU AT
LEAST THREE OF THE FEATURES THAT
WERE PARTICULARLY STRIKING FOR
ME LOOKING BACK.
THE FIRST ONE IS THAT THE LAB
FELT DEFINITELY LIKE AN
INCUBATOR.
AN INCUBATOR OF IDEAS, OF
ATTITUDES, OF QUESTIONS TO ASK.
THE SECOND ONE WAS AN
ENVIRONMENT OF GREAT AND
REMARKABLE EXCITEMENT.
A PLACE WHERE YOU -- I'M SORT OF
AN EARLY RISER IN THE MORNING,
AND I WOKE UP AND I COULDN'T GET
MYSELF AWAY FROM RUNNING MY WAY
TO THE LAB AND GETTING TOGETHER
WITH COLLEAGUES THERE TO DO
THINGS.
A TIME WHERE THAT EXCITEMENT LED
TO RUN EXPERIMENTS FOR EXAMPLE
THAT TOOK TWO, THREE HOURS,
SOMETIMES FOUR HOURS TO DO, AT A
PACE OF THREE EXPERIMENTS A DAY.
UNHEARD OF, IMPOSSIBLE NOWADAYS
OBVIOUSLY, BUT A TREMENDOUS
AMOUNT OF EXCITEMENT.
AND THE PLACE THAT WAS A LITTLE
BIT LIKE A PERMANENT -- WE WERE
LIVING A PERMANENT STORM,
HURRICANE OF IDEAS FLOWING BACK
AND FORTH IN EVERY DIRECTION,
ALWAYS SORT OF -- WHERE MARK WAS
ALWAYS SORT OF PLAYING THIS
PERFECT BALANCE BETWEEN LETTING
THE FELLOWS -- RUN WILD, AT THE
SAME TIME SORT OF CHANNELS THE
DIRECTION OF THE EXPERIMENTS AND
ATTITUDES TOWARDS THE MOST
LIKELY SUCCESSFUL AND PRODUCTIVE
OUTCOMES.
SO THIS IS WHAT THE LAB WAS IN
THOSE DAYS OR FELT LIKE, BEING
IN THE LAB IN THOSE DAYS.
SO I'M GOING TO JUST TAKE ONE
EXAMPLE OF HOW THIS PERFECT
STORM OF IDEAS EVOLVED IN A
GIVEN THEME, AND THE THEME WAS
THE THEME OF STUDIES IN BLIND
INDIVIDUALS, WHICH IN MARK'S LAB
AS EVERYTHING HAS TO START IN
THE MOTOR CORTEX.
NO MATTER WHERE IT GOES LATER,
AS YOU WILL SEE, BUT IT'S GOT TO
START IN THE MOTOR CORTEX.
AND IN THESE FIRST MOTOR CORTEX
EXPERIMENTS, ONE WAS RUN BY
ALBERTO PASQUALIONI -- HE'S
CALLED ME OLD, AGE IS THE IN
EYES OF THE BEHOLDER AND HOW
LONG YOU HIKE.
SO YES, THIS IS ERIC HERE,
HIKING.
YOU ARE STILL HIKING?
[INAUDIBLE]
>>OKAY, OKAY.
NO NEED FOR PRETEXT AT THIS
POINT.
ANYWAY, IN THESE VERY EARLY
EXPERIMENTS, IN THESE AMAZINGLY
INTERESTING EXPERIMENTS WITH
ALBERTO AND ERIC HAVE DONE WAS
LOOK AT PATIENTS WHO WERE BLIND
FROM A VERY EARLY AGE, AND THEN
LOOK AT MAPS FROM THE FIRST
DORSAL INTEROSTIUM AFTER
TRANSPLANTING MAGNETIC
STIMULATION AFTER THESE
INDIVIDUALS WERE READING BRAILLE
FOR ABOUT A WEEK IN THIS CASE,
AND THEY WERE MAPPING THE MOTOR
CORTEX HE HERE, AND THEN
FOLLOWING -- YOU CAN SEE A
SMALLER MAP, THEN AGAIN ON A
SECOND WEEK, AT THE END OF THE
SECOND WEEK OF WORKING IN WHICH
IT GOES BACK UP, AND THE
CONCLUSION FROM THAT STUDY WAS
THAT THE RAPID MODULATION IN
MOTOR CORTICAL OUTPUTS IN
RELATION TO PRECEDING ACTIVITY
SEEMED TO BE THE RULE.
THESE MOTOR MAPS CHANGE WITH
ACTIVITY.
AND AFTER THIS IS WHEN THIS
RESEARCH WENT COMPLETELY
BERSERK.
THIS RESEARCH WENT PLACES SORT
OF COMPLETELY UNRELATED TO THE
MOTOR CORTEX.
AT THE TIME IN THE LAB, THEY DID
REMARK BELIEVE EXPERIMENTS IN
WHICH THEY WERE TRYING TO ASK
THE QUESTION, WELL, IF THE
OCCIPTAL CORTEX CAN'T SEE, THESE
GUYS ARE BLIND FROM ALMOST BIRTH
IN SOME CASES, OR VERY, VERY
YOUNG AGE, WHAT WOULD DO?
AND THE HYPOTHESIS WAS BROUGHT
UP IN THOSE IDEAS OR CULTURAL
ENVIRONMENT IN WHICH THE
HYPOTHESIS PUT FORWARD WAS THAT
PERHAPS THE OCCIPTAL CORTEX
COULD BE RECRUITED TO PERFORM A
DIFFERENT TASK.
AND IN FACT, WHAT THEY FOUND IS
ESSENTIALLY THAT IN THIS STUDY
THAT THE PRIMARY VISUAL AREAS OF
THE BRAIN GETS ACTIVATED WHEN
BLIND INDIVIDUALS PERFORM A
TACTILE DISCRIMINATION TASK.
SO W -- MAY BE ACTIVATED BY OTHR
SENSORY MODALITIES.
THESE BROUGHT UP THE SORT OF
NEXT QUESTION, OKAY, FINE, BUT
IS THIS ACTIVATION REALLY USEFUL
FOR THESE BLIND INDIVIDUALS?
IS THIS ACTIVATION JUST THE SORT
OF CORRELATE OF THE TASK
PERFORMANCE ITSELF OR THERE IS A
CAUSAL LINK BETWEEN THIS
ACTIVATION AND THIS PATIENT'S
REMARKABLE ABILITY TO READ
BRAILLE WITH A DEGREE OF TACTILE
DISCRIMINATIVE SKILLS THAT ARE
OUT OF PROPORTION FOR MOST OF US
SITTING HERE.
ABOABOUT THAT TIME I WAS COMING
BACK FROM RESIDENCY AT
GEORGETOWN AND TRIED TO LOOK AT
THESE QUESTIONS TOGETHER WITH
OTHERS LIKE, FOR EXAMPLE, A
REMARKABLE PERCUSSIONIST FROM
JAPAN HERE PLAYING SALSA AT A
DOWNTOWN CLUB IN ADAMS MORGAN OR
CHRISTIAN CARLOFF, A VERY GOOD
SALSA DANCER AS WELL, AND PABLO
NOW AT HOPKINS, CHRISTIAN WILL
BE TALKING A LITTLE BIT LATER.
SO IN THIS EXPERIMENT THAT WE
RAN AT THE TIME, WE LOOKED AT
THE INFLUENCE, TRYING TO FIND A
CAUSAL LINK BETWEEN THAT OW
OCCIPTAL ACTIVATION AND BRAILLE
READING, WE LOOK AT EARLY BLIND
INDIVIDUALS PERFORMING A TACTILE
DISCRIMINATION TASK, ESSENTIALLY
BRAILLE READING, AND LOOK AT THE
ABILITY TO READ WHEN DIFFERENT
PARTS OF THE BRAIN WERE
DISRUPTED WITH TMS.
SO THE RESULTS AT THAT POINT
WERE ESSENTIALLY COMPARING EARLY
BLIND INDIVIDUALS READING
BRAILLE WITH SIGHTED VOLUNTEERS
READING EMBOSSED LETTERS.
WHAT WAS FOUND WAS IN NORMAL OR
SIGHTED VOLUNTEERS AS WE WOULD
EXPECT, NND IN THE Y AXIS YOU SE
ERROR RATE.
SO MOST ERRORS READING EMBOSSED
LETTERS WERE FOUND WHEN
STIMULATING OR DISRUPTING THE
SENSORY MOTOR CORTEX AND NOT
MUCH WHEN STIMULATING MID
OCCIPITAL AREAS.
ON THE OTHER HAND, BRAILLE
READING WAS SUBSTANTIALLY -- TO
A MUCH LARGER EXTENT THAN AFTER
STIMULATION OF SENSORY MOTOR
CORTEX.
THE CONCLUSION FROM THAT STUDY
WERE THAT BLINDED FROM AN EARLY
AGE CAN CAUSE THE VISUAL CORTEX
TO BE RECRUITED TO A SUBSTANTIAL
FUNCTION AND RELEVANT ROLE IN
SOMATOSENSORY PROCESSING.
THEN CAME THE QUESTION, OKAY, IS
IT A WINDOW OF OPPORTUNITY FOR
THIS FORM OF FUNCTIONALLY
RELEVANT CROSS MODAL PLASTICITY?
AND THEN ROBERT WEEKS AT THE
TIME IN THE LAB ASKED --
PARTICIPATED IN ASKING THE
QUESTION OF HOW DO PERFORMANCE
IN THE LATE BLIND COMPARE WITH
EARLY BLIND?
AND YOU CAN SEE THE RESULTS
HERE, TMS WAS DELIVERED AS IN
THE PREVIOUS SLIDE TO A NUMBER
OF DIFFERENT AREAS IN A GROUP OF
EARLY BLIND INDIVIDUALS, AND
PEOPLE WHO BECAME BLIND LATER IN
LIFE AFTER AGE 14, 15, ACTUALLY
14.
YOU CAN SEE IN THE EARLY BLIND,
DISRUPTION OF MID OWE SIP CAL
AREAS COMPLETELY DISRUPTED BRAIN
READING WHILE STIMULATION OF
OCCIPITAL CORTEX DIDN'T AFFECT
MUCH READING IN LATE BLIND
INDIVIDUALS.
LEADING TO THE IDEA OR TO THE
CONCLUSION THAT
SUSCEPTIBILITY -- THAT THE MORE
SUSCEPTIBILITY PERIOD FOR
THESE -- MOTOR PLASTICITY THAT
DID NOT SEEM TO EXTEND BEYOND 14
YEARS OF AGE.
SO THE NEXT STUDY, BECAUSE YOU
SEE ONCE SOMETHING POPPED UP IN
THOSE DAYS IN THE LAB, THERE WAS
NO WAY NOT TO FOLLOW UP ON IT.
IT WAS NEVER ENDING ISSUES, NEW
QUESTIONS WERE POPPING UP AND A
NUMBER OF PEOPLE VERY EXCITED
WITH THESE FINDINGS WERE JUMPING
UP INTO NEW OR DIFFERENT
DIRECTIONS.
IN THIS CASE, INTERACTIONS WITH
WITH -- VERY INTERESTED IN
LOCALIZATION STUDIES, LED TO AN
EXPERIMENT IN WHICH ROBERT WEEKS
ASKED THE QUESTION OF WHAT
HAPPENS WITH AUDITORY
LOCALIZATION IN BLIND
INDIVIDUALS?
AND SO THEY STUDIED A GROUP OF
BLIND INDIVIDUALS, A GROUP OF
SIGHTED INDIVIDUALS AND WHAT YOU
ARE LOOKING AT HERE IS THE
INTERREGIONAL CORRELATION FOR
THE RIGHT -- AUDITORY
LOCALIZATION CONDITIONS FOR
SIGHTED, BLIND, AND THEIR
DIFFERENCES.
AND I WANTED TO POINT OUT THESE
TWO AREAS IN THIS STUDY IN WHICH
HOR WIT WAS INVOLVED IN AS WELL
THAT LED TO THE CONCLUSION ON A
DIFFERENT FRONT, THE RIGHT
OCCIPTAL CORTEX PARTICIPATION IN
A FUNCTIONAL NETWORK FOR
AUDITORY LOCALIZATION.
IN OTHER WORDS, THIS ACTIVATION
SHOWN HERE OR THIS DIFFERENCE IN
ACTIVATION SHOWN HERE ARE NOT
PRESENT IN SIGHTED INDIVIDUALS.
A FEW YEARS LATER, THEN, GEORGE
WHEATON AT THE TIME IN MY LAB
WORKED TOGETHER WITH ANOTHER
FELLOW IN MY LAB AND PETER
LOOKING AT THE QUESTION OF
NETWORK CONNECTIVITY.
WHY WAS THIS QUESTION
FUNCTIONALLY IMPORTANT?
WELL, THE QUESTION WAS, HOW CAN
TACTILE INFORMATION REACH THE
PRIMARY VISUAL CORTEX?
AND IN DISCUSSIONS AT THE TIME,
ONE POSSIBILITY WAS THAT THERE
WAS DIRECT THALAMOCORTICAL LINK
AND ANOTHER POSSIBILITY WAS THAT
THERE WAS SOME SORT OF LINK
BETWEEN THE SOMATOSENSORY CORTEX
AND THE NETWORK CORTEX.
SO WHAT TO SOME EXTENT GEORGE
DID AT THE TIME WAS TEST THE
HYPOTHESIS THAT PERHAPS THE LINK
BETWEEN S1 AND O1 WOULD BE
PARTICULARLY MORE DEVELOPED IN
EARLY BLIND INDIVIDUALS THAN IN
SIGHTED INDIVIDUALS.
HOW TO CHECK THAT, THOSE DAYS,
IN HUMANS, WELL, NOT MANY WAYS,
BUT WHAT HE DID WAS TRY TO LOOK
AT THE EFFECTS OF TMS DELIVERED
OVER THE PRIMARY SOMATOSENSORY
AREAS OR THE INFLUENCE OR THE
CONSEQUENCES OF TMS DELIVERED
OVER THIS ONE ON -- ACTIVATION
IN PRIMARY VISUAL AREAS.
AND THAT'S WHAT HE DID.
SO IN LOOKING AT THAT, BASICALLY
WHAT HE FOUND COMPARING THREE
GROUPS OF SUBJECTS, EARLY BLIND,
LATE BLIND AND SIGHTED
INDIVIDUALS, WAS THAT.
THE MAGNITUDE OF -- OF PET
ACTIVITY IN THE EARLY BLIND
GROUP SHOWN HERE IN THE SQUARES
WAS MUCH HIGHER THAN IN THE LATE
BLIND OR SIGHTED CONTROLS.
ALL TOGETHER, THIS INFORMATION
SUGGESTED THAT TACTILE
INFORMATION MAY REACH VISUAL
AREAS TO ENHANCE CORTICAL
ACTIVITY.
SORT OF WRAPPING UP THE EXTENT
TO WHICH WE WERE INVOLVED
STARTING IN 1995 TO THIS 2004
YEAR IS HERE IN WHICH --
PRESENTLY AT THE UNIVERSITY IN
ISRAEL, TOGETHER WITH -- ROYAL,
WHO'S NOW CHAIRMAN -- IN
GERMANY, RAN A STUDY IN WHICH
THEY LOOKED AT VERBAL PROCESSING
IN EARLY BLIND INDIVIDUALS.
AND WHAT THEY FOUND AGAIN
LOOKING THAT THE EXTENT TO WHICH
TMS OF DIFFERENT LOCATIONS
DISRUPTED VERBAL PROCESSING
TASKS WAS THAT THESE VERBAL
PROCESSING TASKS IN SIGHTED
CONTROLS WAS DISRUPTED BY
PERIPHERAL -- AND TO VERY LITTLE
EXTENT BY MID OCCIPITAL AREAS,
AND IN EARLY BLIND INDIVIDUALS,
THE MAGNITUDE OF DISRUPTION
INDUCED BY STIMULATION OF VISUAL
AREAS WAS MUCH HIGHER.
LEADING TO THE IDEA THAT -- OF
THE OCCIPITAL POLE ALSO
INTERFERE WITH VERBAL
PROCESSING.
NOW THERE ARE NOWADAYS A NUMBER
OF STUDIES IN A VARIETY OF
LEVELS, BUT I'M JUST REVIEWING
SOME FOR YOU THAT SOMEHOW
WERE -- NOT SOMEHOW -- THAT WERE
DEFINITELY INSPIRED BY MARK'S
EARLIER -- EARLY QUESTIONS AND
DIRECTIONS, YES, STARTING IN THE
MOTOR CORTEX AND AS WAS POINTED
OUT EARLIER, GOING MUCH WIDER
THAN THAT.
SO I GO BACK TO THESE SLIDES
JUST TO WRAP UP OF THIS CONCEPT
OF HOW DID IT FEEL TO BE IN THE
LAB THOSE EARLY DAYS?
WELL, IT FELT A LITTLE BIT LIKE
A MELTING POT OF IDEAS RUNNING
AT REMARKABLE SPEED AND
REMARKABLE OPENNESS AND
REMARKABLE EXCITEMENT.
AND FOR ALL THAT, MARK, WE ARE
VERY, VERY, VERY THANKFUL.
FINALLY, I WANT TO POINT TO
SOMEBODY WHO HAS NOT BEEN AN
HMCS GRAD, AND WHO'S THE PERSON?
WELL, MISSY.
WE WILL FIND OUT IN THE NEXT
WEEK OR SO IF IT'S THAT GREAT.
BUT, CAN YOU IMAGINE WHAT HE
WOULD DO IF HE WERE AN HMCS
GRADUATE?
THANK YOU VERY MUCH.
[APPLAUSE]
I HAVE THE DISTINCT PLEASURE OF
ONLY INTRODUCING PEOPLE TODAY
AND NOT SAYING ANYTHING ABOUT
THE IMPACT OF MARK HALLETT,
WHICH HAS BEEN IMMENSE
THROUGHOUT THE YEARS IF YOU'VE
ALREADY HEARD.
A VERY QUICK BRIEF STORY IS, I
WAS IN SWITZERLAND VISITING MY
WIFE'S COUSIN, FIRST COUSIN, WHO
HAPPENED TO BE SEEING A
NEUROLOGIST DOWN THE STREET.
AND THE NEUROLOGIST WAS HEIKE
RUSSMAN.
SO SHE WALKS IN AND SHE SAYS,
HEY, YOU KNOW, I TRAINED AT THE
NIH AND BLAH, BLAH, BLAH, AND MY
WIFE'S COUSIN GOES, HEY, SO DID
MY COUSIN IN LAW, HE TRAINED
THERE.
AND HE'S SITTING OUTSIDE.
I WALK IN, AND IT'S HEIKE.
THE IMPACT NOT ONLY IS AMAZING
IN THE CLINICAL WORLD, BUT IN
THE RESEARCH WORLD.
SO MARK, HATS OFF TO YOU FOR
DECADES OF AMAZING ACHIEVEMENT
AND AMAZING TRAINING.
NOW I HAVE THE DISTINCT PLEASURE
OF INTRODUCING OUR NEXT SPEAKER
FROM GERMANY.
MARK AND HE HAVE HAD A
TREMENDOUS COLLABORATIVE
HISTORY.
THEY HAVE ACCOMPLISHED A GREAT
DEAL IN NEUROLOGY, BUT AN
ACCOMPLISHMENT THAT YOU MAY NOT
KNOW ABOUT IS THAT THEY ALSO
WENT TO THE OPERA TOGETHER,
WHICH WAS THE -- ATTENDING THAT
OPERA WAS AN IMMENSE EFFORT, AND
PEOPLE DON'T GET TO THAT OPERA,
SO BOTH OF THEM HAVE ENJOYED
THAT, AND I WILL LET THE DOCTOR
PRESENT HIS WORK ON TREMORS.
>>WELL, MARK, LADIES AND
GENTLEMEN, IT'S REALLY A GREAT
PLEASURE TO BE HERE, AND WHEN I
HEARD THAT SOMETHING LIKE THIS
WILL HAPPEN HERE AT THE NIH, IT
WAS VERY CLEAR THAT I HAVE TO
COME HERE.
ACTUALLY I CAME FROM LOS ANGELES
BECAUSE THAT'S THE PLACE WHERE
MY SON CURRENTLY LIVES, AND BY
DOING THAT, I ENDED UP IN A CAR
ACCIDENT, MY TAXI DRIVER, AS HE
SAID, T-BONED A BMW.
[LAUGHTER]
THIS CAUSED, AS YOU CAN SEE, A
FULL CLOSURE OF THE FREEWAY, BUT
FORTUNATELY NO ONE WAS INJURED,
AND I WAS THINKING A MOMENT,
SHOULD I GO BACK OR WHAT SHOULD
I DO AND I THOUGHT, NO, IF MARK
CALLS, I HAVE TO GO.
OKAY.
SO OUR HISTORY IS A PRETTY LONG
ONE.
ACTUALLY, WE MET, I THINK IT WAS
IN THE LATE 80s, WHEN WE MET
ON SEVERAL CONGRESSES.
I WAS IMPRESSED BY THIS GUY WHO
DID THIS SPECTACULAR WORK WITH
DAVID MARSDEN, AND I HEARD THAT
HE HAS DONE HIS EXAM IN
VISBOTTEN, HIS BOARD EXAM, AND
THAT HE WAS WORKING NOW AT THE
NIH, AND THINKING A FEW DAYS
ABOUT WHETHER I SHOULD GO TO
LONDON OR TO WASHINGTON WAS VERY
CLEAR, IT CAN ONLY BE
WASHINGTON.
AND WE LIVED ACTUALLY IN A --
THIS WAS THE TEAM IN THESE DAYS.
SO YOU SEE A NUMBER OF BRIGHT
PEOPLE.
THEY ARE ALBRIGHT, BUT HERE IS
JOSEPH, STEVE, AS YOU CAN SEE
HERE, AND HERE IN THE BACK, YOU
SEE CAMILLA TORRO AND MANY
OTHERS WHICH I DON'T WANT TO
NAME AT THE MOMENT, AND ACTUALLY
WE DEVELOPED PLANS THERE, AND WE
CAME TO BETHESDA AND WE LIVED
THERE A LITTLE BIT LIKE A
CLASSICAL AMERICAN MIDDLE CLASS
FAMILY, VERY CLOSE TO THE NIH,
JUST IN WALKING DISTANCE, SO I
WALKED TO THE NIH IN THE
MORNING.
WE HAD A STATION WAGON AS YOU
CAN SEE PRETTY OLD BUT IT
WORKED, AND WE DROVE THROUGH THE
COUNTRY WITH THAT THING SO IT
WAS ONE OF THE BEST TIMES OF OUR
LIVES.
OKAY.
INSTEAD OF SAYING TOO MUCH, I
ONLY WANT TO INSIST ON ONE
POINT, AND THAT IS THE
CEREBELLUM AND TREMOR.
IN THESE DAYS, PEOPLE LIKE MARK
AND I WERE EXCITED BY THE FACT
THAT TREMOR CAN PROBABLY BE
EXPLAINED BY A MECHANISM THAT
RUDOLPHO HAS DISCOVERED WHICH
WAS THE IDLING MECHANISM THAT
CELLS TEND TO OSCILLATE IN
SITUATIONS THAT ARE -- WHEN THEY
ARE NOT ENGAGED AND THIS COMES
TO A RHYTHMICAL ACTIVATION AND
THIS IS INBORN RHYTHM SO TO SAY
OF THE SYSTEM.
THAT WAS ONE OF THE THINGS THAT
MARK AND I WERE FOND.
THE OTHER THING WAS THAT THIS
GUY, THOMAS THACH.
MANY OF YOU KNOW HIM.
HE WAS IN MY VIEW ONE OF THE
SMARTEST PHYSIOLOGISTS IN THESE
DAYS.
AND HE WAS INTERESTED IN
LEARNING AND ADAPTATION AND WHAT
HE DID WAS HE DEVELOPED A VERY
SIMPLE EXPERIMENT, DART WAS
THROWN TO A TARGET, AND YOU CAN
SEE THE -- IS PRETTY GOOD, AND
WHEN YOU PUT ON SPECTACLES WHICH
HAVE A PRISSMM, THEN YOU DISTORT
THE VIEW AND THE PERSON TARGETS
10 DEGREES PART OF IT, AND THEN
IN A LEARNING PROCESS, THIS
COMES BACK.
SO HE WAS INTERESTED IN GETTING
CEREBELLAR PATIENTS AND WE
THOUGHT THE CEREBELLUM MAY HAVE
SOMETHING TO DO WITH THIS.
AND THEN THERE WERE THE TWO OF
US.
I MEAN, I MENTIONED ALREADY THAT
WE AGREED THAT I COME TO
BETHESDA IN 1990, AND ACTUALLY
WE MADE THE FINAL ARRANGEMENTS
IN RIO IN '89 THAT WAS REALLY A
WONDERFUL TIME.
AND SO WHAT DID WE DO?
IN THESE DAYS, MARK WAS IN SOME
WAY THE PERSON IN THE WORLD THAT
HAS MUCH TO DO WITH TREMOR WHO
UNDERSTOOD THE PHYSIOLOGY OF
TREMOR AND THAT WAS WHAT I WAS
FASCINATED.
AND I CONTRIBUTED TO THAT, THAT
WE DEALT WITH SPECIFIC TREMOR, -
TREMOR WHICH IS VERY RARE AND WE
THOUGHT WHY DON'T WE TRY TO
COLLECT SUCH PATIENTS TO STUDY.
THE ONLY FORM OF TREMOR WHICH
HAS AN ANATOMIC QORS COURSE.
ANATOMIC COURSE.MOST TREMORS HAD
IDENTIFIABLE LESION BEHIND, THAT
IS THE OTHER EXAMPLE.
AND SO WE DID A NUMBER OF
ASSESSMENTS, WE LOOKED, FOR
EXAMPLE, AT THE MOVEMENTS OF THE
PALATE.
WHAT YOU WOULD SEE HERE IS A
MOVEMENT OF THE WHOLE PALATE.
SO THE SOFT PALATE, A MOVEMENT
THAT GOES UP AND DOWN, AND HERE
YOU WOULD SEE A MOVEMENT OF THE
OUTER PART OF THE PALATE WHICH
VERY MUCH DIFFERS FROM THAT
MOVEMENT HERE, AND THAT IS A
CONDITION CALLED ESSENTIAL
PALATAL TREMOR AND IS
SYMPTOMATIC IN THESE DAYS, THESE
TWO ENTITIES WERE NOT SEPARATED,
AND WE WERE THE ONES WHO LOOKED
INTO THIS BY SIMPLY COLLECTING
MANY PATIENTS AND LOOKING AT
THEM AND WE FOUND THIS PATTERN
TO BE A VERY DISTINCTIVE ONE.
CERTAINLY THE CLINICAL PICTURE
OF THESE TWO PATIENTS DIFFERS.
THEY HAVE ALMOST AS THE ONLY
COMPLAINT THE EAR CLICK, WHILE
THOSE PATIENTS HERE HAVE MUCH
MORE.
THE REASON FOR THIS IS THAT
THELY VAIT -- IS ACTIVATED IN
THE CASE OF THE SYMPTOMATIC
AND -- IS ACTIVATED IN CASE OF
THE ESSENTIAL PALATAL TREMOR.
THERE IS -- THERE ARE VERY MANY
ASPECTS BEHIND THAT WHICH I
WON'T TOUCH, BUT THE FIRST
FINDING THAT THE INFERIOR --
THAT WAS SUSPECTED AND KNOWN
FROM PATHOLOGICAL STUDIES BEFORE
THAT THIS CONDITION CAN BE SHOWN
ON MRI.
THIS IS THE CLASSICAL ESSENTIAL
PALATAL TREMOR, AND THIS IS THE
SITUATION OF SYMPTOMATIC PALATAL
TREMOR WHERE YOU CAN SEE THE
HYPERTROPHIED INFERIOR --.
SO THE FIRST FINDING THAT WE HAD
ONE FORM OF PALATAL TREMOR
WITHOUT AND THE OTHER WITH
HYPERTROPHIED INFERIOR --.
WE WERE LOOKING TO THE EYE
MOVEMENTS, AND IT IS ALREADY
KNOWN THAT THERE ARE DIFFERENT
FORMS OF EYE MOVEMENTS IN
SYMPTOMATIC PALATAL TREMOR IF
THEY OCCUR.
THEY CAN BE BILATERAL GOING UP
AND DOWN OR THEY CAN BE
LATERALIZED.
AND INDEED, THIS TO-CALLED
MIDCALL -- THISSO-CALLED MIDLING
LIKE THIS AND THAT IS ASSOCIATED
WITH BILATERAL OLIVARY
HYPERTROPHY THAT YOU CAN SEE
HERE AND THE LATERALIZED FORM IS
ASSOCIATED WITH A CONTRALATERAL
INFERIOR OLIVARY HYPERTROPHY.
SO INDEED WE FOUND SIGNS THAT
ARE LOCALIZING WITHIN THE
NERVOUS SYSTEM, AND LEARNED THIS
IN THIS WAY.
ONE OF THE QUESTIONS WAS, IS
THERE AN INFLUENCE OF THIS
RHYTHM ON TO THE EXTREMITY
MUSCLES, SO ON THE SPINAL CORD?
BECAUSE YOU KNOW WHEN YOU HAVE A
TREMOR, WE BELIEVE THAT THE
RHYTHMIC ACTIVITY COMING FROM
SOMEWHERE UP HERE HAS TO GO
DOWN, SO WE MUST FIND ANY SIGN
IN THE PERIPHERY THAT SHOWS THAT
THERE IS AN INFLUENCE ON THE
MOTOR NEURONS.
AND INDEED, THIS WAS VERY CLEAR,
UNILATERAL SYMPTOMATIC PALATAL
TREMOR HAD CONTRALATERAL
PROJECTIONS, BILATERAL
SYMPTOMATIC BILATERAL TREMOR
HEAD, BILATERAL PROJECTIONS, AND
THE KIND OF TEST THAT WE DID WAS
SIMPLY TO LOOK AT THE EMG AND TO
AVERAGE WITH THE CLICK OR WITH
THE FACIAL MOVEMENT IN CASE OF
THE SYMPTOMATIC TREMOR.
THIS COULD NOT BE FOUND IN
ESSENTIAL PA LA TA TREMOR, THESE
TWO ENTITIES DIFFERED
DRAMATICALLY.
I CANNOT RESIST SHOWING JUST
THIS PICTURE FROM THE LAB OF
MARK TOGETHER WITH CAMILLO TORO,
WITH WHOM I WORKED VERY CLOSELY
AND WE SPENT HOURS, DAYS AND
MONTHS IN THIS ROOM WAITING FOR
LEO TO COME FOR A CHAT AND
DISCUSS ALL KINDS OF THINGS.
IT WAS JUST A FANTASTIC
ATMOSPHERE.
AND THEN WITH TOM THACH VISITED
US.
HE GAVE A LECTURE AND THEN WE
THOUGHT, WHY DON'T WE LOOK AT
MOTOR LEARNING IN CEREBELLAR
DISEASE AND PALATAL TREMOR, AND
WE DID A LITTLE BIT OF A
DIFFERENT MOVEMENT.
WE JUST DID FAST ELBOW
MOVEMENTS, AND THEN WE CHANGED
THE GAME.
SO IN THAT SENSE, THERE WAS A
LEARNING INVOLVED BECAUSE THE
GAME WAS COMAING CH WAS CHANGEDA
MUCH HIGHER AMPLITUDE AND THE
PATIENTS HAD TO CORRECT.
WHAT THEY LEARNED -- THESE ARE
THE NORMAL CONTROLS -- IS A
CLASSICAL LEARNING CURVE THAT
YOU GET FROM THIS AND THESE ARE
THE CEREBELLAR PATIENTS AND THEY
DO MUCH WORSE.
AND THE PREDICTION WAS THAT
THERE'S A DIFFERENCE FOR THE TWO
PATIENT GROUPS WITH ESSENTIAL
AND SYMPTOMATIC PALATAL TREMOR
BECAUSE IN ONE GROUP, THERE IS
THE INPUT STRUCTURE, THE
INFERIOR OLIVE IS PETRIFIED AND
THAT IS HAVING ITS OWN RHYTHM.
THE BASIC IDEA BEHIND ALL OF
THIS WAS TO LOOK FOR NEGATIVE
SYMPTOMS OF TREMOR.
THE NEGATIVE SYMPTOM OF TREMOR
WOULD BE IN THIS CASE AN
ABNORMALITY OF THE CEREBELLAR
FUNCTION.
SO THAT WAS THE PREDICTION THAT
WE FIND AN ABNORMALITY IN
SYMPTOMATIC PALATAL TREMOR IN
THE SENSE THAT MOTOR LEARNING IS
AFFECTED.
AND INDEED, WE FOUND THAT YOU
CAN SEE IT HERE, THIS IS
ESSENTIAL PALATAL TREMOR, VERY
MUCH LIKE THE NORMAL SUBJECTS,
WHILE THIS IS SYMPTOMATIC
PALATAL TREMOR WITH A CLEARLY
WORSE LEARNING CURVE.
SO THIS IDEA WHICH CAME FROM THE
COLLABORATION IN THESE DAYS,
THIS HAD MANY RAMIFICATIONS OVER
THE COMING YEARS, BECAUSE
DIFFERENT GROUPS HERE IN
WASHINGTON AND ALSO MY GROUP AND
MANY OTHER GROUPS IN THE WORLD
LOOKED AT ABNORMALITIES,
PARTICULARLY IN ESSENTIAL
TREMOR, WHICH IS ANOTHER TREMOR
WHICH HAS NO KNOWN ANATOMY.
FOR THOSE YOU CAN SHOW THAT HAND
MOVEMENTS, MOTOR LEARNING,
RHYTHM GENERATION, CEREBELLAR
COGNITIVE FUNCTIONS ARE AFFECTED
AS A CONSEQUENCE OF THE
LATERAL -- THE HEMISPHERIC
MALFUNCTION WITHIN THE
CEREBELLUM.
EYE MOVEMENTS ARE DISTURBED AS A
CONSEQUENCE OF
VESTIBULO-CEREBELLAR FUNCTIONS
AND OTHER GAIT ARE DISTURBED.
OTHER FUNCTIONAL SYSTEMS ARE
PROBABLY NOT YET CLEAR OR AT
LEAST NOT YET RELATED TO THE
CEREBELLUM.
SO THIS WAS THE STORY HOW THESE
NEGATIVE SYMPTOMS OF ESSENTIAL
TREMOR CAME INTO PLAY, AND THE
OTHER ASPECT WHERE MARK WAS
PARTICULARLY INTERESTED WAS JUST
THE CLINICAL SYMPTOMS OF TREMOR,
AND HOW TO CLASSIFY THEM, AND,
THEREFORE, WE HAD A TASK FORCE
OF THE MBS AND WE MET FIRST TIME
IN LISBON, SO I THINK WE STARTED
IN 2012.
THE PAPER WAS PUBLISHED IN 2018,
SO YOU CAN -- YOU HAVE AN IDEA
HOW MUCH WE DISCUSSED ABOUT THIS
PAPER.
PROBABLY THE LONGEST WRITING
PERIOD FOR A PAPER THAT I EVER
HAD.
AND IN THAT PAPER CAME THE IDEA
OF ESSENTIAL TREMOR PLUS.
THIS IS MARK'S IDEA, I HAVE TO
SAY.
AND YOU KNOW HOW MUCH TROUBLE
THAT CREATED IN THE TREMOR WORLD
BECAUSE EVERYBODY SAID, WELL,
THIS IS NOT AN ENTITY, WE NEVER
THOUGHT THAT THIS IS AN ENTITY.
WHAT WE THOUGHT IS SIMPLY THAT
WE HAVE CLEARLY PA PARKINSONIAN
SYMPTOMS WHICH HAVE TREMOR
DISTONIC SYMPTOMS -- BUT THERE
ARE LOTS OF PATIENTS WHICH ONLY
HAVE SOFT SIGNS, WHICH DO NOT
ALLOW US TO DIAGNOSE PARKINSON'S
DISEASE, DYSTONIA, CEREBELLAR
DISEASE OR EVEN COGNITIVE
SYMPTOMS.
AND THAT IS MEANT BY THESE
CEREBELLAR SYMPTOMS AND IT WILL
STILL ENGAGE US.
CURRENTLY WE ARE DISCUSSING
ABOUT THE PATHOLOGY OF ESSENTIAL
TREMOR AND THERE IS HUGE
CONTROVERSY IN THE WORLD OF
TREMOR ABOUT THIS QUESTION
WHETHER THIS EXISTS OR NOT.
WE WILL GET THE ANSWER HOPEFULLY
IN THE NEXT 10 YEARS.
WELL, MY STORY WITH MARK WAS NOT
ENDING IN BETHESDA.
WE HAD REALLY THREE -- WE MET
SOMEWHERE IN '84, SO IT WAS MORE
OR LESS THREE DECADES THAT WE
HAVE BEEN WORKING TOGETHER.
AND ON MANY OCCASIONS.
THIS WAS ONE OF THE OCCASIONS
FOR EXAMPLE, IN MUNICH DURING
THE MBS CONGRESS AND WE CONTINUE
TO DISCUSS OUR COMMON QUESTIONS,
PUBLISHED A LOT OF PAPERS
TOGETHER.
MARK WAS VISITING US ON SEVERAL
OCCASIONS.
HE WAS THE ONE WHO WAS LEADING
THE SHIP HERE, AS YOU CAN SEE,
AND WE BOTH SET SAILS TOGETHER,
AND MARK WAS REALLY FOR GERMANY
AN IMPORTANT PERSON, AND
IMPORTANT SCIENTIST IN
NEUROLOGY.
THESE ARE ONLY SOME OF THE
PUPILS THAT HE HAS.
HELGE, WHO IS HERE IN THE ROOM,
HELGE AND I, WE COMPETE FOR
BEING THE FIRST GERMAN VISITOR.
HE WAS THE FIRST TO COME AND I
WAS THE FIRST TO GO.
BUT INDEED WE SPENT THE TIME
THERE TOGETHER.
IT WAS JUST FANTASTIC.
AND YOU SEE THE MANY NAMES.
AND THIS IS COMPLETELY
INCOMPLETE.
I STOPPED AT SOME POINT.
SO MARK IS VERY WELL-KNOWN IN
GERM KNEGERMANY, AND HE GOT THEG
MEDAL OF THE GERMAN SOCIETY.
THIS IS THE HIGHEST HONOR THAT
WE HAVE IN OUR SOCIETY.
AND WE ARE VERY PROUD TO HAVE
HIM AND THAT HE HAS SO MUCH
INFLUENCED GERMAN NEUROLOGY OVER
THE YEARS.
WHAT I CAN'T BELIEVE IS THAT
MARK WILL RETIRE.
I THINK HE WILL STOP GETTING
MONEY, BUT HE WILL NOT RETIRE.
AND IT'S VERY CLEAR THAT HE WILL
CONTINUE TO BE AVAILABLE FOR ALL
OF US FOR DISCUSSIONS, FOR
INTERACTIONS, FOR MEETINGS
SOMEWHERE ON THE GLOBE, AND I'M
PRETTY SURE THAT WE WILL
CONTINUE OUR CLOSE RELATIONS AND
I'M VERY THANKFUL FOR THAT.
THANK YOU VERY MUCH, MARK.
[APPLAUSE]
>>OUR NEXT SPEAKER -- CAN YOU
HEAR ME?
OUR NEXT SPEAKER WILL BE
DR. BRIAN BURMAN.
HE IS THE PROFESSOR OF NEUROLOGY
AND THE BEAMIS ENDOWED CHAIR AT
VIRGINIA COMMONWEALTH
UNIVERSITY, AND HE'LL BE TALKING
ABOUT HIS EXPERTISE.
>>THANK YOU.
THIS HAS BEEN SUCH GREAT
INFORMATIVE TALKS SO FAR AND
VERY TOUCHING AS WELL.
SO I THOUGHT I'D DO SOMETHING
COMPLETELY DIFFERENT.
JUST KIDDING.
THAT WENT FLAT.
DISCLOSURES.
NO FINANCIAL DISCLOSURES.
I HAVE ONE SLIDE I'LL SHOW THAT
HAS SOME FUNDING FROM DYSTONIA
MEDICAL RESEARCH FOUNDATION AND
THE RESEARCH FOUNDATION.
OF COURSE THIS IS A TALK ON
DYSTONIA AND MARK AND WE'LL BE
TALKING A LITTLE ABOUT LOSS OF
INHIBITION.
I HAVE BEEN KNOWN TO EXHIBIT
DISINHIBITED BEHAVIORS AT TIMES.
I'M GOING TO TRAY TO KEEP IT IN
CHECK TODAY.
SO WHERE TO START?
IT'S A LONG HISTORY WITH MARK
AND DYSTONIA.
SO I WENT BACK AND LOOKED AT
SOMETHING INTERESTING.
THIS IS A TALK FROM 1886 BY
FRANK WOODBURY, AND HE WAS
GIVING A PRESENTATION AT THE
PHILADELPHIA COUNTY MEDICAL
SOCIETY.
I JUST THINK IT INTERESTING,
HE'S TALKING ABOUT HOW TO
PREVENT WRITER'S CRAMP.
THIS IS 1886.
AT THE TIME, THEY SAID LET'S
CALL THIS A COORDINATED BUSINESS
NEUROSEES.
HIGHLIGHTED HOW THEY'RE JUST
FOUND IN EVERY WALK OF LIFE.
SO THIS WAS HAPPENING TO THE
TYPESETTERS, TO THE TELEGRAPH
OPERATORS, THE TAILORS,
CARPENTERS, BALLET DANCERS.
SO I WONDERED, IS HAND DYSTONIA
RARE?
JUST THE WAY THEY -- THAT IT CAN
AFFECT SO MANY DIFFERENT FOLKS.
THEN I WENT DOWN THE RABBIT
HOLE, I READ THE WHOLE
PRESENTATION, HOW ALL WRITERS
RECOGNIZE THE STRONG EMOTIONAL
ELEMENT IN THE DISEASE.
THIS HINTED A LITTLE BIT HOW IT
WAS THOUGHT TO BE A HYSTERICAL
OR FUNCTIONAL ILLNESS FOR A
WHILE.
BUT REALLY IN THIS 1886
DISCUSSION, IT WAS VERY MINOR AT
THAT POINT.
AND THEY FOCUSED ON HOW TO
PREVENT IT AND THEY SAID THE
AMOUNT OF ACTUAL WORK BEING THE
SAME, IT'S THE PERSON WHOSE MIND
IS BEING EXERCISED MOST WHO'S
LIKELY TO BE ATTACKED BY
WRITER'S CRAMP THAN HE WHO
MERELY WRITES AUTOMATICALLY.
SO MY SUGGESTION IS, IF YOU'RE
TALKING NOTES RIGHT NOW, TRY NOT
TO DO TOO MUCH THINKING.
KEEP IT LIGHT.
SPEAKING OF ERB, I DID NOT NOT
KNOW YOU RECEIVED THE ERB MEDAL
SO THAT'S PRETTY APPROPRIATE.
IT'S INTERESTING IN 18 1886, ITS
INVOLVING THE BASAL GANGLIA AT
THE TIME AND ASSOCIATED WITH
COORDINATION OF MUSCULAR
MOVEMENTS FOR MORE COMPLEX
ACTIONS.
SO I THOUGHT THAT WAS AN
INTERESTING INSIGHT AT THIS
TIME.
AND THEN JUST TO HIGHLIGHT WHAT
THEY THOUGHT ABOUT FOR
PREVENTION, WELL, THE TYPEWRITER
HAD JUST BEEN INVENTED SO THEY
JUST SAID I WOULD CONSIDER THIS
A VERY EFFICIENT METHOD AT
PREVENTING WRITER'S CRAMP.
SO IF YOU WANT TO PICK UP A PEN,
THEN IT WOULD JUST BE FOR
PLEASURE AND FUN AND YOU
WOULDN'T GET WRITER'S CRAMP.
SO JUST KEEP THAT IN MIND.
THE PROBLEM WITH FOCAL DYSTONIA
REALLY GOT A RENEWED INTEREST BY
DAVID MARSDEN BACK IN THE 70s,
AND 1976, HE PUBLISHED THIS
PAPER, HE WAS TALKING ABOUT HOWL
IT REALLY SEEMED THAT THIS ISN'T
A FUNCTIONAL DISORDER, THESE
DIFFERENT FORMS OF ADULT ONSET
FOCAL DYSTONIA RUN IN FAMILIES,
AND THAT ONE FAMILY MEMBER MIGHT
PRESENT WITH ONE TYPE AND
ANOTHER FAMILY MEMBER WITH
ANOTHER.
AND SO THIS IS SORT OF THE
BEGINNING OF SORT OF THE MORE MO
DEN INVESTIGATION OF PHYSIOLOGY
OF FOCAL DYSTONIA.
THAT WAS IN '76.
I'76 ACTUALLY WAS THE SAME TIME
MARK WAS OUT IN CAMBRIDGE FOR A
FELLOWSHIP.
100TH MEETING OF THE SOCIETY.
PICTURED HERE WITH THE THREE
Ms WHICH INCLUDES DAVID
MARSDEN AS WELL AS A PH.D.
STUDENT OF DAVE MARSDEN.
MARK AT THIS TIME WAS REALLY
STARTING TO FOCUS ON PHYSIOLOGY
AS YOU'VE LEARNED FROM SOME OF
THE OTHER TALKS.
SO I HAD TO DID BACK A LITTLE
BIT FURTHER FROM FELLOWSHIP INTO
MEDICAL SCHOOL.
SO I DON'T KNOW HOW MANY PEOPLE
KNOW THIS, BUT WHEN MARK WAS IN
MEDICAL SCHOOL, HIS FIRST YEAR,
AFTER HIS FIRST YEAR, HE WAS --
WORKED IN THE LAB OF DAVID HUBEL
AND TORSTEN WIESEL.
THESE TWO WERE AWARDED THE NOBEL
PRIZE FOR PHYSIOLOGY AND
MEDICINE IN 1981 AND THAT WAS
FOR THEIR WORK AROUND CENTRAL
SURROUND INHIBITION IN THE
VISUAL SYSTEM.
SO NOTING HOW THESE CELLS WOULD
HELP REFINE AND FOCUS NEURONAL
ACTIVITY SO THE SENSORY SYSTEM
COULD BE MORE FOCUSED, SO IT WAS
REALLY QUITE A BREAKTHROUGH.
THIS IS THE FIRST TIME THAT IT
HAD BEEN EXPLORED.
BUT SOON AFTER, PEOPLE STARTED
TO THINK ABOUT THE MOTOR SYSTEM
AS WELL, AND JONATHAN MEAN AMONG
OTHERS LOOKED AT THE BASAL
GANGLIA AS A POTENTIAL SOURCE OF
HOW THE MOTOR SYSTEM MIGHT HELP
FOCUS ITS ACTIVITY, PREVENTING
UNWANTED MOVEMENTS AND ENHANCING
THE DESIRED MOVEMENTS.
SO THIS IS SOMETHING THAT I
THINK SET OFF A LIGHT BULB IN
MARK SO HE REALLY SAW THIS AS A
POTENTIAL TO SORT OF EXPLAIN
WHAT HAPPENS IN DYSTONIA.
SO SHORTLY AFTER, HE STARTED
REALLY DESCRIBING THE
NEUROPHYSIOLOGY OF DYSTONIA IN
CONTEXT OF THE CENTER SURROUND
AND THE LOSS OF SURROUNDING
INHIBITION AS A POTENTIAL
ETIOLOGY, AND SPECIFICALLY THIS
KIND OF HIGHLIGHT SOME OF THE
FEATURES THAT WE ALL KNOW ABOUT
DYSTONIA, INCLUDING MOTOR
OVERFLOW, WHERE YOU SORT OF HAVE
A LOSS OF THAT ABILITY TO
INHIBIT MOVEMENTS OF ADJACENT
MUSCLES, AND THEN EVEN PERHAPS
FOR MERO DYST -- LARGER LOSS OFE
GROUP FAR AWAY BUT STILL WITH
INHIBITION.
NOW MODERN TECHNOLOGY, WE'RE
ABLE TO SEE INSIDE MARK'S BRAIN,
AND REPRESENT HOW HE THINKS AND
PICTURES DYSTONIA.
AS YOU ALL KNOW, HE PROBABLY
FOCUSES A LOT MORE ON THE HANDS.
NOT THAT HE DOESN'T LOOK AT THE
NECK OR THE EYES, BUT HE'S BEEN
VERY INTERESTED IN HAND DYSTONIA
AND JUST HOW WE MOVE FROM ONE
FINGER AT A TIME.
-- TO WRITE MANY PAPERS I
COULDN'T LIST ALL HERE, SO JUST
HIGHLIGHTING THAT THEY STARTED
TO COME OUT IN 2004, AND THESE
ARE OFTEN WHERE WE'RE USING
TRANSCRANIAL MAGNETIC
STIMULATION WITH PAIRED
STIMULATION AND EVALUATING A
NUMBER OF FEATURES SHORT IN
THE -- INHIBITION.
I PICKED UP ANOTHER PAPER FROM
2008, THE YEAR I JOINED BUT ALSO
THE NUMBER OF FOLKS WHO ARE HERE
OR ARE ON VIRTUAL, AND IT ALSO
KIND OF HIGHLIGHTS SOME OF THE
DETAIL THAT GOT RAISED IN
EARLIER TALKS TODAY THAT MARK
WAS REALLY LOOKING AT SURROUND
INHIBITION AND JUST LOOKING AT
INITIATION OF A MOVEMENT OR
MAINTENANCE OF A MOVEMENT, SO HE
ALWAYS KEPT AN EYE ON THESE
DETAILED FACTORS OF DIFFERENT
WAYS THAT MOVEMENT COULD BE
STUDIED WITH THESE TOOLS.
HE ALSO LOOKED AT IMAGING, WHICH
IS MY FIELD, A BIT, AND EARLY ON
IN THE 90s, THEY FIGURED OUT
THEY COULD DO SOME EDITED
SPECTRA THAT WAS BASED ON
MOLECULES, I'LL LEAVE SOME OF
THE SCIENCE OUT BUT WHERE THIS
GABA PEAK IS, IT KIND OF BURIED
IN ALL THESE OTHER MOLECULES,
THEY WERE ABLE TO EXTRACT THAT
OUT AND DETECT LEVELS OF GABA IN
PARTICULAR BRAIN REGIONS.
SO ANOTHER STUDY THEY DID WITH
LUCINE LEVY, THIS WAS IN
HAPPENED DYSTONIA PATIENTS,
THEIR RIGHT HAND WAS AFFECTED
AND THEIR LEFT BRAIN SHOWED
REDUCED GABA.
NOW THE TECHNIQUE AT THAT TIME
WAS A 1.5 TESLA, LOW POWER
MAGNET, THE VOXELS ARE VERY
LARGE.
IT'S NOT CLEAR THIS FINDING WILL
STAND, BUT IT WAS REPEATED AND
WE DID SEE WITH A 3T THEY WERE
REDUCED BUT NOT QUITE
SIGNIFICANT ENOUGH AS .59, BUT
THIS COULD BE DETECTED WITH GABA
SPECTROSCOPY SO I SAID MARK I
THINK I'D LIKE TO DO A STUDY ON
THIS, WHAT DO YOU THINK ABOUT
THE THALAMUS?
IN TYPICAL MARK FASHION, HE
SAYS, SURE!
HE'S VERY OPEN THIS WAY, HE'S
LIKE, YOU WANT TO DO THAT,
SOUNDS INTERESTING.
I SAID, YEAH, THALAMUS, IT
CONNECTS THE MOTOR AND THE
SENSORY, IT'S AN IMPORTANT NODE
IN THE SENSORY MOTOR NETWORK,
AND IT HAS A LOT OF GABERGIC
NEURONS, INTRANEURONS IN IT.
OKAY.
SO DID FIND THAT IN SEVERAL
DYSTONIA PATIENTS, THEY HAD
ABOUT 14% REDUCED GABA IN THE
THALAMUS, AND I THOUGHT THIS WAS
AN INTERESTING FINDING, BUT
REVIEWERS KEPT SAYING, WHY THE
THALAMUS?
WHY DID YOU PICK THAT?
SO WENT TO GET IT PUBLISHED, AND
NOW WORKING ON EXPANDING THIS TO
SORT OF LOOKING AT THE NETWORK
ALL AT THE SAME TIME.
SO THIS IS A STUDY I HAVE GOING
ON AT THE MOMENT LOOKING AT SEER
RAL DYSTONIA -- AND SO FAR
THERE'S SOME INTERESTING RESULTS
THAT GLUTAMINE AND GLUTAMATE,
THAT THE EXCITATORY ASPECT SEEMS
TO BE REALLY IMPORTANT.
THESE ARE PRELIMINARY DATA.
CORRELATED WITH THE DYSTONIA
SEVERITY, AND THEN THE GABA
LEVELS IN THE CEREBELLUM SORT OF
HAVE THE OPPOSITE REACTION, THE
LOWER THEY ARE, THE MORE SEVERE
THE BLEPHAROSPASM.
IT'S NOT GOING TO BE VALID ONCE
I GET A FEW MORE SUBJECTS SO WE
CAN ALL MOVE ON AND GO BACK TO
TALKING ABOUT MARK.
SORE ONE STUDY THAT CAME OUT
THAT REALLY SPARCED HIS INTEREST
WAS BY NANCY -- SHE WAS AT UCSF
AT THE TIME AND SHE LOOKED AT
THIS REPETITIVE STRAIN MODEL IN
TWO MONKEYS AND HAD THEM -- I
DON'T THINK IT WAS LEARNING HOW
TO USE A KEYBOARD, BUT IT WAS
REPETITIVE INJURIES, AND THEN
LOOKED AT THEIR PRIMARY -- AND
THEIR BRAINS AND FOUND THEIR
SOMATOSENSORY CORTEX IN THE
MONKEYS WI HAD BEEN ALTERED.
SO THIS WAS PRETTY INTERESTING.
THIS WAS EARLY ON IN THE 90s,
AND PEOPLE HADN'T THOUGHT ABOUT
THE SENSORY SYSTEM MUCH WHEN IT
COMES TO DYSTONIA, EXCEPT MARK
HAD.
THE YEAR BEFORE HE ALREADY
STARTED WRITING EDITORIALS AND
REVIEWS AND DOING RESEARCH ON
WHETHER DYSTONIA MIGHT BE A
SENSORY DISORDER, NOT A MOTOR
DISORDER.
THAT GOT PEOPLE THINKING.
SO HE STARTED DOING SOME WORK AT
THIS TIME, THIS WAS IN THE
90s, AND FOUND THE
SOMATOSENSORY YOU THINK LUS IN
DYSTONIA OF THE HAND WAS
ABNORMAL.
THERE'S FURTHER STUDIES DONE
SHOWING SPATIAL -- TO REALLY
PICK UP STEAM, MARK WAS DOING
MORE RESEARCH WITHIN THE SENSORY
COMPONENT OF DYSTONIA, AND GOT
REALLY EXCITED ABOUT PERHAPS
USING THIS KNOWLEDGE AS A WAY TO
TREAT THESE PATIENTS.
SO HE WORKED WITH KIRSTEN ZUNER
TO TRAINL PATIENTS WITH FOCAL
HAND DYSTONIA HOW TO READ
BRAILLE.
SORT OF A FASCINATING STUDY.
I JUST THINK THESE ARE VERY
CREATIVE AND INTERESTING
APPROACHES.
SO HE TAUGHT THE PATIENTS HOW TO
READ BRAILLE BRAILLE AND THEN BR
SPATIAL -- AND THEIR DISABILITY
LESSENED.
DISCRIMINATION IMPROVED AND THE
SEVERITY LESSENED WITH THIS
BRAILLE.
TRAINING.
NOW, THREE OF THE PATIENTS WHO
ARE ENROLLED IN THE STUDY
CONTINUE TO WORK ON THEIR
BRAILLE READING AFTER A YEAR'S
TIME AND THEY'VE STILL FOUND
THAT AFTER A YEAR, THAT THEY
HAVE IMPROVEMENT.
SO THIS ISN'T THERAPY FOR
EVERYONE BUT IT'S AN INTERESTING
CONCEPT THAT THERE MAY BE
BENEFIT FROM THIS TYPE OF
SENSORY TRAINING.
SO FROM THE MOTOR SYSTEM, LOSS
OF INHIBITION, TO THE SENSORY
SYSTEM, IT'S BECOMING CLEAR
THROUGHOUT THE RESEARCH AS WELL
THAT DYSTONIA IS KIND OF A
CLASSIC NETWORK DISORDER AND
THAT THE SENSORY MOTOR SYSTEM
ARE INTEGRATED IN THIS
DISRUPTION WITHIN THIS
INTEGRATION THAT LIKELY UNDER
LIES THE PHYSIOLOGY.
MARK HAS DONE MUCH IN HIS CAREER
TO SORT OF HIGHLIGHT THE ACTUAL
PATHOLOGICAL PROCESSES AND LOSS
OF INHIBITION THAT ARE
CONTRIBUTING TO THESE DISORDERS.
I THINK THAT THE ROLE OF THE
SENSORY ASPECT OF DYSTONIA IS
NEXT STAGE TO REALLY SORT OF
EXPLORE WHAT IS GOING ON IN THIS
DISORDER, AND HE HAS HELPED
LAUNCH A LOT OF THOSE
INVESTIGATIONS ACROSS THE GLOBE.
IN ADDITION TO SENSORY MOTOR
INTEGRATION, MARK'S REAL
STRENGTH, I WILL SAY, IS HIS
HUMAN INTEGRATION.
AND THIS IS A DIRECT QUOTE: THE
PEOPLE ARE JUST AS IMPORTANT AS
THE RESEARCH.
AND I THINK THAT THAT IS
HIGHLIGHTED HERE TODAY THAT
YOU'RE HEARING.
THIS IS A PICTURE PREPANDEMIC AT
THE MBS IN HONG KONG, WHERE
EVERY YEAR WE WOULD ALL TRY TO
MEET AT WHATEVER CONFERENCES AND
GET TOGETHER AND REFLECT ON OUR
TRAINING AND JUST WHAT WE WERE
DOING, SO HE BRINGS PEOPLE
TOGETHER, SO I JUST HAVE ALWAYS
VALUED THAT.
ALL RIGHT.
SO QUICK FLASHBACK, 2010, MAKE
THIS QUICK.
THE WORLD CUP WAS HELD IN SOUTH
AFRICA.
AND YOU'RE ALL ON THE EDGE OF
YOUR SEATS, IT WAS SPAIN WHO WON
THIS ONE, BUT TO THIS DATE, NO
AFRICAN COUNTRY HAS DONE AS WELL
AS MOROCCO, SO I HAVE TO ROOT
FOR THEM, BUT MESSI AND THE
ARGENTINIANS OF COURSE ARE AT
THE TOP OF OUR LIST.
2010 WAS ALSO THE TIME WHEN THE
iPAD WAS FIRST ANNOUNCED, SO
BUT ALSO LEGEND HAS IT THAT IT
WAS THE BEST CLASS OF FELLOWS AT
THE NIH, AND AS YOU MIGHT SEE IN
THE MIDDLE THERE, THERE'S A FEW
OF US WHO ARE STANDING UP HERE
AT THE FRONT.
SO ANYWAY, I JUST WANT TO SAY
BEST WISHES IN YOUR RETIREMENT.
I KNOW YOU'RE GOING TO CONTINUE
TO DO GREAT WORK AND I REALLY
APPRECIATE YOUR LISTENING TO MY
IDEAS AND YOUR GUIDANCE,
SUPPORT, AND WHO DOESN'T LOVE A
MENTOR WHO WILL EMAIL YOU BACK
AT 5:00 IN THE MORNING AND SAY,
YEAH, THAT SOUNDS GOOD, LET'S
MEET THEN.
JUST -- HE'S VERY RESPONSIVE AND
REALLY APPRECIATE ALL THAT
YOU'VE DONE FOR ME.
THANK YOU.
>>OUR NEXT SPEAKER IS
DR. CODREN LONGU, WENT ON TO
LEAD THE PARKINSON'S CLINIC,
THEN WENT ON TO EXTRAMURAL AND
IS NOW WORKING AT PFIZER AS
GLOBAL CLINICAL LEAD FOR RARE
DISEASES IN NEUROLOGY.
AND AFTER HIS TALK, JUST A
REMINDER THAT THERE WILL BE A
COFFEE BREAK AND THEN THE
PICTURE WILL BE AT NOON, NOT
AFTER THE COFFEE BREAK.
>>THANK YOU.
AND YES, I'M AWARE I'M THE ONE
BETWEEN YOU AND THE BREAK, SO
I'LL BE RELATIVELY QUICK HERE.
SO I'LL COVER A COUPLE OF AS
EXPECT OF NEUROLOGY AND FOCUS ON
CLINICAL NEUROLOGY THAT HAVE
MARK'S SIGNATURE ALL OVER THE
HISTORY, BOT LIE NUMB TOXIN
TREATMENT AND DEEP BRAIN
STIMULATION.
AS HE JUST MENTIONED, MY
AFFILIATION WITH THE NIH IS AS A
SPECIAL VOLUNTEER.
I'M AN EMPLOYEE OF PFIZER.
I WILL TALK ABOUT THERAPIES
NEITHER I NOR MY COMPANY HAVE A
SPECIFIC INTEREST IN THIS, AND I
WILL MENTION OFF LABEL
THERAPIES.
I SAY THAT MOSTLY BECAUSE I
NEVER REMEMBER WHAT'S APPROVED
FOR WHAT, SO IT WILL DEFINITELY
BE OFF LABEL.
[LAUGHTER]
THE HISTORY OF BOT LIE NUMB
TOXIN IS REALLY VERY
INTERESTING.
I STILL REPEAT THIS, I CAN'T
CITE THE PAPER BUT I DO BELIEVE
IT'S THE MOST POWERFUL HUMAN
TOXIN PER UNIT OF WEIGHT.
SO THIS IS PRETTY POWERFUL
STUFF.
VERY INTERESTINGLY, THE
THERAPEUTIC POTENTIAL WAS
PROPOSED AS SOON AS IT WAS
INITIALLY DESCRIBED IN THE EARLY
19TH CENTURY.
THAT IDEA, HOWEVER, WAS
ABANDONED HOWEVER IT WAS A
CONSIDERED A POTENTIAL AGENT OF
BIOLOGICAL WARFARE AND THERE
WERE STUDIES DONE ON THIS DURING
WORLD WAR II ACTUALLY.
AFTER THAT HISTORY, ANIMAL
EXPERIMENTS WERE DONE IN THE
1970s AND THE FIRST HUMAN
STUDIES WERE DONE BY ALLEN
SCOTT, STARTING IN THE LATE
70s, LOOKING AT THIS AS A
POTENTIAL THERAPY FOR EXTRA
STRABISMUS, JUST USING THE TOXIN
FOR WHAT IT DOES, WHICH IS
WEAKENING MUSCLES.
A COUPLE INTERESTING MOMENTS IN
THE HISTORY OF THIS.
DR. SCOTT WAS APPLYING FOR
FUNDING FOR THESE IDEAS AND
DR. HALLETT WAS CONSULTED
BECAUSE SOMEBODY SAID, HEY, YOU
KNOW ABOUT PHYSIOLOGY, YOU AGREE
THIS IS CRAZY, RIGHT?
THIS GUY WANTS TO STUDY THIS
TOXIN, AND IN VERY CLASSIC MARK
FA SHORNTION HE REPLIED, YES,
IT'S ABSOLUTELY CRAZY BUT IT'S
ALSO LIKELY TO WORK.
SO THEN MARK WENT ON TO ACTUALLY
AMONG THE CLINIC WAS ONE OF THE
FIRST ADOPTER, ONE OF THE FIRST
CLINICS USING BOTULINUM TOXIN
FOR THERAPY AND THE FIRST WITH
PROMINENT FOCAL HAND DYSTONIA
INTEREST.
A COUPLE OF OTHER INTERESTING
MOMENTS IN THE HISTORY OF
BOTULINUM TOXIN, INITIALLY IT
WAS CALLED -- IT WAS BOUGHT
BY -- AT THE TIME.
ANOTHER INTERESTING CONSULTATION
WHERE THEY ASKED MARK IF --
WE'RE THINKING OF BUYING THIS,
DO YOU THINK IT'S A GOOD IDEA?
HE SAID YES, IT'S A GOOD IDEA.
WHICH PROBABLY HAD A BIG
INFLUENCE ON WHAT HAPPENED LATER
ON.
SO THEN WE KNOW THAT THAT TOOK
ON AN ENTIRE LIFE AND NUMEROUS
OTHER COMPANIES HAVE
DEVELOPED -- NOT NUMEROUS BUT
SEVERAL OTHER COMPANIES
DEVELOPED TOXINS, AND NOW IT'S
BECOME FAIRLY COMMONPLACE.
I'VE LEARNED THE FIRST
INJECTIONS WERE DONE IN THE ICU
BECAUSE PEOPLE WERE WORRIED
ABOUT THIS, NOW WE'RE DOING IT A
LOT MORE RELAXED.
IF YOU LOOK AT THE HISTORY OF
THIS, YOU WILL SEE FIRST OF ALL
EARLY WORK FROM THE GROUP HERE,
FIRST PUBLICATIONS USING
BOTULINUM FOR TREATMENT OF FOCAL
DYSTONIA.
THEN YOU'LL SEE MARK PUBLISHING
ON THE MECHANISM OF ACTION AND
REALLY LOOKING AT THIS AS THE
UNDERSTANDING OF THE MECHANISM
WAS EVOLVING.
YOU SEE TWO PAPERS FROM '94 AND
UPDATES IN 2018, AND YOU'LL SEE
MARK, PROMINENT MEMBER OF THE
GROUPS PUBLISHING THE GUIDELINES
THAT THIS ACTUALLY TELLS
EVERYONE ABOUT THE APPROPRIATE
USE OF THIS.
AND THE BOTULINUM CLINIC AT THE
NIH HAS REALLY BEEN A
LONG-STANDING CENTER AND A
RESOURCE FOR RESEARCH
PRODUCTIVITY, REALLY IMPORTANT
CLINICAL WORK AND REALLY
IMPORTANT EDUCATIONAL ACTIVITY.
SO GENERATIONS OF FELLOWS HAVE
GONE THROUGH LEARNING HOW TO DO
THIS.
THE PROTOCOL IS -- I DON'T KNOW
IF IT'S THE OLDEST BUT IT'S ONE
OF THE OLDEST PROTOCOLS RUNNING
IN THE CLINICAL CENTER.
YOU SEE '85, THAT'S THE YEAR THE
PROTOCOL WAS STARTED.
YOU CAN READ ABOUT OUR CLINIC,
THERE ARE SOME FAMOUS SUBJECTS
AND PATIENTS WHO ARE HAVE COME
TO OUR CLINIC.
A LOT OF MUSICIANS WHO HAVE
RECEIVED OR ARE STILL RECEIVING
THEIR TREATMENT HERE.
AND LIKE I SAID, A LOT OF
TEACHING, A COUPLE OF PICTURES,
YOU CAN SEE HOW RIVETTING MY
TALKING IS BY HOW EXCITED THE
DOCTOR IS TO LISTEN TO ME, AND
WE DID A LOT OF TRAINING ON THE
ULTRASOUND GUIDANCE JUST FOR
DISCLAIMER, I'M NOT ACTUALLY
BEING INJECTED THERE, WE WERE
JUST DOING A DEMONSTRATION.
THAT'S WHAT BARBARA TOLD ME TO
SAY.
SO THERE'S BEEN REALLY FOUR
DECADES OF RESEARCH OUTPUT HERE.
I'LL JUST HIGHLIGHT A COUPLE OF
PAPERS.
BECAUSE THIS HAS BEEN GOING ON
SO LONG, SOME OF THE INTERESTING
WORK HAS COME HERE LOOKING AT
LONG TERM RESPONSES.
SO AS EARLY AS 1994, THIS WAS
THE CLINIC WHERE THE LONGEST
FOLLOW-UP HAD HAPPENED FOR
TREATMENT OF FOCAL HAND
DYSTONIA.
AND THEN THE CLINIC CONTINUED
AND ACTUALLY WHEN I JOINED AS A
FELLOW, I DID ANOTHER LONG TERM
FOLLOW-UP.
THIS TIME IT WAS MORE THAN 10
YEARS, WE HAD PARTICIPANTS AS
LONG AS 20 YEARS IN THE CLINIC.
SO WE WERE ABLE TO SHOW SOME OF
THE CHARACTERISTICS OF THE
RESPONSE TO BOTULINUM TOXIN,
PARTICULARLY FOR FOCAL HAND
DYSTONIA INTERESTINGLY THE
DURATION OF RESPONSE IS A LOT
LONGER FOR FOCAL HAND THAN IN
OTHER INDICATIONS FOR A VARIETY
OF REASONS.
RELATIVELY RECENTLY, THE
FIRST -- FOR ULTRASOUND GUIDED
PROCEDURES CAME OUT OF THE NIH
GROUP, DR. -- SPEARHEADED THIS.
AND ALTHOUGH IN A TINY BIT MORE
DETAIL ON AN INTERESTING RELATED
PROJECT.
AS A REMINDER TO EVERYONE OF THE
MECHANISM OF ACTION, SO ALL THE
BOTULINUM TOXINS MESS WITH THE
SNARE COMPLEX WHICH ATTACHES --
PHYSICALS TO THE MEMBRANE
SPECIFICALLY BOTCH LIE NIN TOXIN
A -- ONE OF THE COMPONENTS, SO
ONE OF OUR PATIENTS ACTUALLY
CAME TO MARK AND SAID, DO YOU
KNOW THEY HAVE BOTOX IN A CREAM,
SO THEY USED THE BRAND NAME
BECAUSE IT WORKS FOR WRINKLES SO
THEY HAVE SUBSTANCES LIKE
BOTULINUM IN A CREAM, AND THINK
ABOUT WHAT MOST OF US WILL DO
WHEN THEY HEAR THIS FROM A
PATIENT, PATIENTS ARE CONFUSED
THEY THINK THAT ANYTHING THAT
REMOVES WRIN ELS IS BOTOX.
NOT IF YOU'RE MARK HALLETT.
YOU READ ABOUT IT AND FIND OUT
ACTUALLY THEY'RE RIGHT AND THIS
IS A TRANSDERMAL HEXA PEPTIDE
THAT INHIBITS IT SO IT KIND OF
IS LIKE BOTULINUM IN A CREAM,
AND THIS IS AN EXAMPLE FRL THE
COSMETICS LITERATURE WHERE THIS
WAS BEING PUBLISHED, HPT BEEN
USED MEDICALLY, SO WE DID ENTER
A PARTNERSHIP -- OUR FIRST STUDY
USING THE MOLECULE FOR TREATMENT
OF BLEPHAROSPASM IN OUR
PATIENTS.
THIS LED TO PROOF OF CONCEPT
LEVEL OF EVIDENCE.
THE INTERESTING STUDY TO DESIGN,
BECAUSE PATIENTS WERE RECEIVING
AN EFFECTIVE THERAPY SO INSTEAD
OF STOPPING THEIR BOTULINUM
TREATMENT, WE RECRUITED PATIENTS
RECEIVING THEIR INJECTION
EXACTLY AT THREE MONTHS AND THEN
WE IN A BLINDED FASHION PLACEBO
CONTROLLED, THEY STARTED USING
THE CREAM AND WE SAW THAT THE
ONES USING THE ACTIVE TREATMENT
WERE GOING A LOT LONGEING IN
THEY WERE GOING BACK TO THE
SEVERITY REQUIRING INJECTION.
UNFORTUNATELY I'M NOT SURE WHERE
THE STUDY STANDS NOW BECAUSE THE
COMPANY TOOK THE MOLECULE TO
DEVELOP FURTHER AND I HAVEN'T
HEARD A LOT.
I'M HOPING SOMEBODY IS STILL
WORKING ON THIS BECAUSE I THINK
IT REMAINS A VERY GOOD IDEA.
THEN I'LL SWITCH FOCUS TO THE
OTHER HALF OF MY TALK, DEEP
BRAIN STIMULATION, AND AGAIN
I'LL DO A QUICK RUN THROUGH THE
HISTORY OF THIS THERAPY, SO I
WON'T GO INTO A LOT OF DETAIL,
IT'S ON THE BACKGROUND OF OF
LESIONAL THERAPIES.
FROM NOVEL AND EXPERIMENTAL TO
ESTABLISHED IN COMMON, AND THE
PROGRESS HERE HAS PARALLELLED
ADVANCES IN PHYSIC PHYSIOLOGY AD
YOU'LL UNDERSTAND WHY YOU'LL SEE
MARK'S INVOLVEMENT THROUGHOUT
THE HISTORY.
THIS WAS APPROVED IN THE UNITED
STATES FIRST IN '96 FOR TREMOR
AND THEN FOR PARKINSON'S AND
MARK WAS ACTUALLY IN THE
ADVISORY COMMITTEE FOR BOTH OF
THESE APPROVALS.
DON'T KNOW TO WHAT EXTENT.
I THINK SOME OF THESE
DELIBERATIONS ARE PUBLIC SO I
CAN SAY THIS.
HIS VOICE WAS ACTUALLY THE ONE
THAT TURNED THE DISCUSSION WHICH
WAS KIND OF TURNING AGAINST
APPROVING THIS THERAPY AND AGAIN
MUCH LIKE THE BOTULINUM ABOVE,
YES, SOUNDS A LITTLE CRAZY BUT
IT COULD WORK.
YOU'LL SEE THROUGH ALL THE YEARS
SINCE THEN, MARK HAD THE STRONG
VOICE IN TERMS OF DISCUSSING THE
MECHANISM OF ACTION AND HOW IT
ACTUALLY WORKS.
AND I HAVE THE GREAT FORTUNE OF
BEING PART OF SETTING UP THE DBS
PROGRAM AT THE NIH IN 2011, SO
WE'VE BEEN HAVING THE DBS
PROGRAM SINCE THEN, WHICH HAS
BEEN A GREAT SOURCE OF
SCIENTIFIC OUTPUT AND TRAINING
AND SETTING UP THE PROGRAM WAS
WONDERFUL.
THIS IS JUST SETTING UP THE
FRAME AND ALL THE CALIBRATION
AND I'M GOING TO SHOW YOU AN
INTERESTING THING THAT YOU GET
TO DO WHEN YOU SET UP THE
PROGRAM.
I'M ACTUALLY GOING TO VIOLATE
HIPAA AND TELL YOU THE NAME OF
OUR FIRST PATIENT, AND IF THAT'S
NOT BAD ENOUGH, I'M GOING TO
SHOW YOU A PICTURE OF ARE OUR
FIRST PATIENT.
IT TURNS OUT THAT WH WATERMELONS
ARE GREAT MODELS FOR TESTING
GIET DANCE SYSTEMS BECAUSE YOU
CAN TARGET THE SEEDS INSIDE THE
WATERMELON.
SO THIS IS OUR FIRST PATIENT IN
THE OPERATING ROOM AND IT REALLY
CAUSED SOME INTERESTING
REACTIONS WHEN THIS WAS
HAPPENING.
HERE'S THE PICTURE OF MARK,
OFTEN, IN THE OPERATING ROOM
WHEN WE WERE LOOKING AT
PHYSIOLOGY.
GREAT SOURCE OF SCIENTIFIC
OUTPUT AGAIN, AND YOU CAN SEE
THE NOT REA -- THIS WAS VERY EAR
THE PROGRAM STARTED, WE LOOKED
AT THE DYNAMICS OF THE
IMPEDANCE, WHICH REALLY EXPLAINS
A LOT OF THE VARIABILITY EARLY
ON AFTER SUBJECTS ARE IMPLANTED,
YOU SEE THIS SIGNIFICANT DROP IN
THE IMPEDANCE AT THE TISSUE
ELECTRODE INTERFACE WHICH IS THE
REASON WE DELAYED PROGRAMMING BY
MORE THAN A MONTH AFTER
IMPLANTATION.
SOME INTERESTING WORK, THIS WAS
PROBABLY THE FIRST PUBLICATION
LOOKING AT INTRAOPERATIVE
PHYSIOLOGY WHEN SOMEBODY
HAPPENED TO OPERATE ON
PSYCHOGENIC DYSTONIA, WHICH
OTHERWISE WASN'T KNOWN.
AND I'M GOING TO HIGHLIGHT THE
PROGRAM THAT BERLICH IS NOW
RUNNING THAT I THINK THEY HAVE
RECRUITED EVERYBODY OR IS IN
PROCESS USING DEEP BRAIN
STIMULATION FOR FOCAL HAND
DYSTONIA FOR MUSICIANS.
ONE OF THE PAPERS, ONE OF THE
PROJECTS WE RAN AND IT WAS A LOT
OF FUN USING DTI IMAGING
STUDYING THE DBS EFFECTS AND
DEFINING PARADIGMS.
SO THIS USED IN-HOUSE DEVELOPED
TOOLS TO SOME EXTENT.
THIS WAS THE PAPER THAT SILVINA
LED IN TERMS OF DEVELOPING THE
PROCESSING SOFTWARE FOR
LOCALIZING ELECTRODES AND THEN
ANALYZING THE -- AND ESSENTIALLY
THE TRACTS THAT ARE ACTIVATED,
THIS IS THE DBS ELECTRODE AND
YOU MODEL THE DEVELOPMENT OF
TISSUE ACTIVATED AND DEPENDING
ON THAT, YOU BUILD THESE MAPS OF
THE TRACTS THAT ARE ACTUALLY
CONNECTED WITH THE VOLUME OF
TISSUE ACTIVATED.
SO N ORAN NORA LED THE WORK ON Y
APPLIING THIS.
WE PUBLISHED THIS NICE PAPER
LOOKING AT THE PATTERNS OF THE
NUCLEUS, DEEP BRAIN STIMULATION
AND THEIR CONNECTIVITY WHICH
ACTUALLY WAS ABLE TO CONFIRM
SOME LONG-STANDING ASSUMPTIONS
BUT THEY'VE NEVER BEEN PROVEN IN
TERMS OF HOW DBS WORKS.
WE ACTUALLY MADE THE COVER OF
"BRAIN" THEN, AND THIS PAPER
COMES FROM, AGAIN, CALIBRATION
WORK LOOKING AT HOW THE IMAGING
WOULD WORK, SO THIS IS ACTUALLY
MRI RECONSTRUCTED AND THE ACTUAL
BRAIN OF ONE OF OUR TEAM
MEMBERS.
BUT I'M NOT ALLOWED TO SAY WHO I
THINK FOR PRIVACY REASONS SO I'M
GOING TO MAKE UP A NAME AND SAY
THIS IS SOMEBODY NAMED SROBINA.
THIS IS WHAT THIS PAPER SHOWED,
THE ACTIVATION OF THE TRACTS AND
THIS IS THE PICTURE LOOKING AT
THE VE -- THIS WAS HIGHLIGHTED S
ONE OF THE CONNECTIONS IN THE
ACTIVE AND -- ELECTRODES, AND
REFLECTING THE PATHWAY.
SO I SAID I'D KEEP IT SHORT, SO
I JUST HIGHLIGHTED A COUPLE OF
THINGS THAT REALLY HAVE MARK'S
IMPRINT ON THEM.
AND I'M GOING TO END WITH --
WELL, ACTUALLY A LITTLE BIT MORE
ABOUT THE DBS PROGRAM OF THE ONE
OF THE VERY VALUABLE COMPONENTS
HERE IS ALL THE TRAINING, SO I
GOT THIS FROM KAREEM RECENTLY,
HE HAD SEVEN RESIDENTS AND OTHER
FELLOWS RUNNING THROUGH, EVEN
THOUGH THIS ISN'T A DBS FOCUSED
ACTIVITY, DEFINITELY THERE'S A
BIG INFLUENCE HERE.
AND THEN I ESTIMATED ABOUT 15
MOVEMENT DISORDER FELLOWS WHO
HAVE ROTATED BETWEEN MY TIME AND
THAT SO I THINK THAT'S ROUGHLY
ACCURATE.
AND WE ALSO HAD A LOT OF OTHER
TRAINEES WHO HAVE REALLY GONE ON
TO USE WHAT THEY HAVE LEARNED
HERE.
SO JUST AS MARK WAS SAYING, THE
HUGE FAMILY AND THE GENERATIONS
OF FELLOWS AND THEN GRAND
FELLOWS AND GREAT GRAND FELLOWS
AND WE CAN APPLY THAT TO OTHER
TRAINEES AS WELL.
THIS WAS A CUTE THANK YOU CARD
FOR ONE OF OUR STUDENTS WHO
WORKED WITH US AT THE BEGINNING
OF THE DBS PROGRAM AND SHE LEFT
THIS THANK YOU CARD ON MY DESK.
I WANT TO HIGHLIGHT THIS IS HER
ARTISTIC I IMAGINATION, SHE DID
NOT IN FACT WITNESS DBS LEADS
COMING OUT OF THE PATIENT'S
NOSE.
SO WITH THAT, I WANT TO ADD MY
THANKS TO EVERYONE FOR
PARTICIPATING AND DEFINITELY MY
THANKS TO MARK, WHO INFLUENCED
OUR CAREER IN A LOT OF WAYS AND
TAUGHT US A LOT MORE THAN
SCIENCE, AND REALLY GRATEFUL TO
BE PART OF THIS FAMILY AND HAVE
HAD ACCESS TO MARK AND LEARNING
FROM HIM SCIENCE AND MORE THAN
SCIENCE.
SO TO ILLUSTRATE THAT EVERYBODY
KIND OF BECOMES PART OF THIS
FAMILY.
THIS IS MARK HOLDING MY INFANT
DAUGHTER A FEW YEARS AGO, AND I
KNOW THIS LOOKS VERY CUTE, BUT
BIT OF A WARNING HERE.
THIS CHILD, A LITTLE MORE THAN
FOUR YEARS LATER, STARTED
SPONTANEOUSLY GROWING BRAINS.
SO THIS IS A WARNING THAT IF YOU
LET MARK HOLD YOUR BABIES, HE IS
TURNING THEM INTO
NEUROSCIENTISTS.
THANK YOU.
[APPLAUSE]
>>THANK YOU, DR. LUNGU.
LOW GIST PARTICULARLY WE WILL
HAVE A BREAK NOW.
THREE TALKS THAT ARE GOING TO BE
IN THE IMAGING.
I MIMAGINE, IMAGING, MOVEMENTS.
I WILL START WITH THE FIRST TALK
TO TRY TO CATCH UP ON TIME.
SO I AM STAFF SCIENTIST IN HMCS,
AND I GUESS I COULD SAY ONE OF
THE LAST PEOPLE STANDING,
GETTING TO THE END OF THE MONTH
UNTIL WE CLOSE, AND WHEN I
JOINED THE LAB, MY EXPERIENCE
WAS IN FMRI SO I THOUGHT WE WILL
DO A LOT OF BOLD IMAGING AND I E
WAS A LAW BEYOND BOLD.
SO THAT WAS THE TITLE FOR THE
TALK BUT SOON ENOUGH AS I SENT
TO MY ORGANIZERS THEY TOLD ME
THAT I NEED TO DO SOME CHANGES
AND THE TITLE SHOULD BE TO
BOLDLY GO WHERE NO ONE HAS GONE
BEFORE.
I'M NOT A MOVIE BUFF OR -- SO I
STARTED LOOKING AND OF COURSE
THAT SOUNDS RIGHT, BUT WHAT IS
THE SIMILARITY WITH MARK AND I
KEPT THINKING YEAH, WE CAN SAY
THE WORDS, BUT ACTUALLY, I FOUND
THAT IN ARE SOME SIMILARITIES IN
THE BACKGROUND.
OF COURSE THIS IS BEFORE MY TIME
BUT THE TIME I JOINED THE LAB IN
2008, THESE WERE YOU HOW WE
LOOKED LIKE.
AND WE LOST THE TIES AND GOT A
LITTLE BIT MORE INFORMAL.
SO ENOUGH WITH PICTURES.
THIS IS ACTUALLY A PICTURE, THE
ONE THAT BRIAN SHOWED, IT WAS A
BIG CHANGE IN THE TEAM AND MOST
OF THE PEOPLE HERE LEFT, THE NEW
PEOPLE WERE COMING IN AND MARK
HAD THESE -- HAD BEEN WORKING A
LOT ON DISORDERS OF VOLITION, A
TOPIC WE HAD BEEN STUDYING.
THERE WERE THESE GREAT PAPERS,
SOME WERE SHOWN EARLIER AS WELL.
I THINK WE HAD A GOOD TRANSITION
OF PEOPLE, LEWIS WAS SHOWING
SOME OF THE PAPERS, SO THERE WAS
INTEREST IN TRYING TO FIGURE OUT
WHERE THE TICKS ARE GENERATED,
HOW THEY ARE GENERATED, WHAT
HAPPENS WHEN YOU SLEEP WITH
THESE AREAS.
SO MARK TOLD ME WHEN WE -- WHAT
WE WERE GOING TO BE DOING WAS
NEUROFEEDBACK, BUT IN THE
SCANNER.
SO WE SET UP TO WORK WITH -- TO
DO SOME REALTIME FMRI AND I
GUESS BRIAN AND I WERE LOOKING
AT EACH OTHER WHEN HE JOINED AND
TRYING TO FIGURE OUT HOW WE WILL
DO IT, BUT IT WORKED, IT WAS
GREAT EFFORT BUT I THINK THIS
WAS ONE OF THE DEFINITELY FIRST
FMRI NEUROFEEDBACK IN MOVEMENT
DISORDERS AND ALSO ONE OF THE
FIRST THAT WE DID WITH
CONNECTIVITY.
BUT OF COURSE NOTHING WORKED
SMOOTH FROM THE BEGINNING.
YOU NEED TO GO THROUGH IRB
APPROVAL SO THE ORIGINAL IDEA OF
THIS WAS TO WORK ON TOURETTE'S,
TICS, TO SEE WHETHER WE CAN GET
PATIENTS TO CONTROL THE TICS IN
THE SCANNER.
BECAUSE THE IRB TOLD US FIRST WE
NEED TO DO ON HEALTHY
VOLUNTEERS, WE WERE SOMEHOW
CREATIVE ON HOW TO STUDY THIS.
MARK HAS DONE SOME OF THE
STUDIES ON LINKED SUPPRESSION
AND WE BUILT TOGETHER A PARADIGM
TO WORK THIS WAY.
WE LEARNED THINGS ON THE WAY,
BOTH ABOUT THE BRAIN AND THE
IMPORTANCE OF THE ANTERIOR
INSULA ONED ARCH BUT ALSO SOME
DIFFERENT WAYS TO LOOK AT THE
DATA.
WHAT I'M SHOWING HERE ARE
DIFFERENT CONTRASTS OF WHETHER
YOU LOOK AT SOMETHING -- REALLY
FOLLOWING WHAT HAPPENED WITH THE
BRAIN, YOU CAN HAVE VERY, VERY
DIFFERENT MAPS AND WE FIND
THAT -- IT WAS VERY INTERESTING,
THE INSULA HAVE THESE RAMP OF
INCREASING ACTIVATION OF THE
URGE AND THAT'S WHAT WE WERE
TRYING TO MODEL IT WITH THE
PATIENTS, AND THERE ARE A LOT OF
HIDDEN ACTIVITIES DEPENDING ON
HOW WE LOOK AT THEM, YOU MAY
FIND OR NOT.
SO WE ALSO DID AS I MENTIONED
BEFORE SOME OF THE CONNECTIVITY,
ALSO SOME OF THE FIRST PAPERS
WHERE WE LOOK AT THE EFFECT OF
NEUROMODULATION THROUGH
NEUROFEEDBACK, THROUGH FMRI
NEUROFEEDBACK.
SOMETIMES WE LEARN THAT THE
AREAS MAY NOT CHANGE THAT MUCH
THE WAY THAT THEY ACTIVATION,
BUT THE FULL STORY IS NOT ONLY
IN THE ACTIVATIONS AS WE HEARD
IN THE TALKS THIS MORNING, MARK
HAS BEEN AN EARLY PLAYER IN
LOOKING AT NETWORKS AND
CONNECTIVITY IN THE BRAIN AND
THIS IS ANOTHER WAY THAT WE HAVE
LOOKED AT THAT, SO WE LOOK AT
THE EFFECT THAT NEUROFEEDBACK
WOULD HAVE ON THAT.
BUT WE DIDN'T LOSE TRACK OF
STUDY ON TOURETTE'S.
THIS IS THE TEAM WITH HAVE TO
THE DIFFERENT STUDIES, AND WE
LOOKED WITH DIFFERENT
MODALITIES, WE LOOKED AT
CONNECTIVITY, WE LOOKED AT
ACTIVATIONS, WE LOOK AT -- WE
LOOK AT MRS, WE KEEP THEM
FINDING THESE SAME GROUP OF
AREAS FOR ELEMENT IN THE
CONNECTIVITY OF THE ANTERIOR
INSULA.
-- FOR THIS PART.
SO WE KEEP MOVING ON THE STUDIES
THAT WE DO, WE DO A LOT OF
DIFFERENT DISEASES, SO I'M
TRYING TO GIVE A LITTLE OVERVIEW
OF THINGS THAT HAVE HAPPENED.
AND YOU MAY ASK WHY THIS
PICTURE, WE ARE AT A MEETING
WITHOUT MARK.
UNFORTUNATELY MARK COULDN'T MAKE
IT AND I THINK IT'S JUST -- I
HAVEN'T BEEN IN A MEETING WITH
MARK THAT I DIDN'T ORGANIZE
SO MARK, HOPEFULLY DON'T MAKE US
DO ANOTHER ONE.
SO UNFORTUNATELY MARK DIDN'T
MAKE TO THIS MEETING IN PERSON
AND I'M NOT GOING TO TALK ABOUT
FUNCTIONAL MOVEMENT DISORDERS TO
A DISEASE WE HAVE STUDIED DEEPLY
ALONG -- FOR A LONG TIME,
BUTTERY IS GOING TO BE TALKING
ABOUT THAT LATER TODAY.
WE DID ANOTHER LONG PROTOCOL
WITH PARKINSON'S, AND THIS WAS
AT A TIME -- THIS PROTOCOL WAS
APPROVED IN 2012, IT WAS GOING
TO GO FOR 10 YEARS AND NOW WE
PROBABLY REMEMBER MARK TELLING
US, WELL, I'M STARTING THIS
PROTOCOL, BUT I'M NOT GOING TO
BE AT NIH BY THE TIME THAT IT'S
DONE.
SO YOU'RE RIGHT, THE PROTOCOL IS
NOT DONE.
SO -- BUT 10 YEARS HAVE PASSED
SO WE CAN LOOK AT IT EITHER WAY.
BUT THIS IS VERY INTERESTING AND
THERE'S STILL A LOT OF THINGS TO
KEEP WORKING, BUT THE WAY THAT
WE LOOK IS WE HAVE THE CENTER
FOR PARKINSON'S AND A LOT OF
DIFFERENT ASPECTS THAT COULD
AFFECT THE DISEASE, AND WE TRIED
TO TACKLE WITH IMAGING THE
DIFFERENT WAYS THAT WE CAN
STUDY.
SO THIS INVOLVES LIKE THE
TRADITIONAL THINGS TO LOOK AT
DTI OR FMRI BUT ALSO WE GOT TO
NEW TECHNIQUES LIKE TRYING TO
LOOK AT FREE WATER SO THE
COMPARTMENTS, TRYING TO
UNDERSTAND WHAT IS BEHIND THE
SIGNALS OR WHY THE DIFFUSION
DATA LOOKS DIFFERENT IN THE
REGULAR STUDIES.
WE DID SOME WITH -- NOT FOR OUR
POPULATION BUT WE STARTED MIXING
DATA WITH GENETICS, WE LOOK AT
SPECTROSCOPY THAT ONE DAY MARK
TOLD US LIKE, HERE'S THE THING
WE SHOULD LOOK AND WE GOT A COIL
AND WE DID SOME IMAGING ON THAT
AS WELL.
SO WITH CONNECTIVITY, AND FMRI
LIKE THE TRADITIONAL THING, WE
ALSO WENT TO NEW HORIZONS.
WE LOOKED AT NOT ONLY THE
ACTIVATION AND THE CONNECTIVITY,
BUT WE STARTED LOOKING AT THE
DYNAMIC CONNECTIVITY AS WELL.
THIS IS IN COLLABORATION WITH
TONY THAT WAS VISITING HERE FROM
A COUPLE YEARS AGO FROM CHINA
SHOULD BE ONLINE TODAY, SO THE
IDEA IS THAT WE HAVE LOOKED
FIRST AT SOME OF THESE NETWORKS
WITH -- SENSORY MOTOR NETWORK
WHEN WORKING MAINLY HOW -- AND
MARK WERE VERY INTERESTED IN THE
SEQUENCE EFFECT AND TRYING TO
SEE HOW WE CAN GET INFORMATION
FOR THAT THROUGH IMAGING SO IN
THE FIRST PAPER WE LOOK AT STUDY
CONNECTIVITY IN THESE NETWORKS.
WE TRIED TO FIGURE OUT HOW THIS
IS CHANGING, HOW WE UNDERSTAND
THE DIFFERENT PARTS, HOW THESE
NETWORKS WORK TOGETHER AND WE
COULD SEE A VERY DISTINCTIVE
OVER TIME INTERPLAY BETWEEN THE
SENSORY MOTOR CORTEX AND THE
THREE CONTROL NETWORKS.
AND WE COULD START DIVIDING UP
AND SEE HOW THE DIFFERENT
REGIONS, THE CONNECTIVITY
BETWEEN THE SENSORY MOTOR
NETWORKS AND THE CONTROL
NETWORKS CHANGE BETWEEN HEALTHY
CONTROLS AND PARKINSON PATIENTS,
BUT ALSO HOW THESE CONNECTIONS
CHANGE WHEN THE PATIENT IS ON
AND OFF MEDICATION.
I MENTIONED ABOUT THE
SPECTROSCOPY AND I'M NOT GOING
TO GET TOO MUCH INTO THESE
BECAUSE WE HAVE SUBJECTS, IT'S
HARD TO IMAGE PARTICIPANTS
WITHOUT MOVING ON A LONG SCAN ON
7 TESLA SO WE DIDN'T HAVE THAT
MANY AND THIS IS WORK IN
PROGRESS EVEN THOUGH IT WAS
STARTED A LONG TIME AGO.
BUT THAT'S ONE OF THE NEW AND
DIFFERENT THINGS THAT WE HAVE
MOVED THROUGH THE YEARS.
I'M NOT GOING TO TALK ABOUT THE
DTI BUT ALSO THIS WAS A VERY
INVOLVING PROJECT WHERE WE
STARTED, OH, WE CAN FOLLOW -- ON
THE LEADS AND WE HAVE DTI IMAGES
AND WE CAN SEE WHERE THESE
CONNECT AND TRY TO UNDERSTAND
WHAT WE ARE DOING AND THE WHOLE
PROJECTS TURN OUT INTO WE NEED
TO CREATE THE TOOLS TO DO THAT,
LIKE HAVE BEEN WITH MANY OF
THESE PROJECTS LIKE REALTIME
FMRI, THE SPEC T SPECTROSCOPY, T
OF TIMES WE WE TAKE THE
CHALLENGE AND HAVE THE QUESTIONS
TO ASK AND GET THE TOOLS AND THE
RESULTS.
BUBUT DYSTONIA IS A BIG PART OF
THE LAB.
WE'LL GET A LITTLE BIT MORE.
SO MARK HAS BEEN GIVING TALKS
FOR MANY TIMES.
I CAN'T BELIEVE THAT PICTURE,
SOMEONE SAYS 2011 BUT I THINK
IT'S OLDER THAN THAT, I THINK
MAYBE THE SECOND ONE IS AROUND
2015.
SO WE'VE SEEN MARK GIVING TALKS
AND SEEING PATIENTS BUT WE ALSO
HAVE SEEN MARK HELPING OUT IN
THE LAB WHEN WE GET ONE OF THE
MANY FLOODINGS THAT WE HAVE HAD
OVER THE YEARS.
HE'S NOT SHY TO COMING CLOSE TO
NEW YEAR'S AND RUINING THE PLANS
AND SAVE THE EQUIPMENT SO WE CAN
KEEP DOING GREAT SCIENCE.
ONE OF THE STUDIES WE HAVE SPENT
A LOT OF TIME TALKING AND TRYING
TO UNDERSTAND IS TASK
SPECIFICITY.
THIS IS WORK WE DID WITH CECILE
WHO'S IN INDIA RIGHT NOW AND
LIMA, SO IT WAS A VERY COMPLEX
TASK, WITH THREE -- PATIENTS
CONTROLS AND WE TRIED TO
UNDERSTAND WHAT IS UNIQUE ABOUT
WRITING WITH THE RIGHT HAND FOR
A PATIENT WITH WRITER'S CRAMP.
SO WE LOOK AT MANY THINGS AND
THEMES WE HAVE SEEN COMING IN
THE EARLY TALKS AND PRACTICES
WITH FRONTAL PARIETAL AREAS, WE
SEE THEM COMING BACK IN THESE
STUDIES, THERE HAVE BEEN OTHER
STUDIES FOLLOW-UP WITH TMS, WITH
EEG WHICH KIND OF REINFORCE THE
MALFUNCTION OF THESE AREAS OR
THE COMMUNICATION BETWEEN THESE
AREAS.
WE NOT ONLY DID BOLD AS I
MENTIONED BEFORE, AND I GUESS
IT'S A PROJECT THAT BRIAN KIND
OF WAS STUDYING THEN FINALLY
KARIN MENTE TOOK OVER WHERE WE
TRIED TO LOOK AT THE CHOLINERGIC
SYSTEM IN DYSTONIA, AND THIS
INVOLVED GETTING SLIDES FOR THE
BRAIN AND LOOK AT THE STAINS
FROM HEALTHY CONTROLS, SOME
STAINS THAT WILL HAVE
POSITIVE -- SOME CERVICAL
DYSTONIA PATIENTS FROM WHICH
THEY FIND SOME WERE POSITIVE BUT
SOME DID NOT.
THIS IS IN THE PBM.
AND WE WANTED TO DO -- WE FIND A
COLLABORATION WITH SOME PEOPLE
IN BRAZIL THAT GAVE US GREAT
IMAGES AND WE WERE ABLE TO
FOLLOW UP ON GETTING SOME
DIFFUSION IMAGE FROM THESE AREAS
AS WELL.
FOLLOWING THE CHOLINERGIC
SYSTEM, WE ALSO TRIED TO PRESENT
ONGOING PROJECT, BUT ALSO
STARTED BY KARIN MENTE FOLLOWED
BY PANOS AND WITH THE PET
DEPARTMENT, WE LOOKED AT THE
CHOLINERGIC SYSTEM IN THE WHOLE
BRAIN.
WE SPENT MANY HOURS TRYING TO
UNDERSTAND WHAT IS THE DATA,
EVEN THOUGH WE HAVE SOME --
TRYING TO UNDERSTAND WHAT THINGS
ARE GENERIC, WHAT THINGS ARE
SPECIFIC TO THE BRAIN AREA, HOW
THESE THINGS CAN WORK AND GOOD
POINTS THAT IS ALWAYS VERY
INTERESTING TO DISCUSS WITH MARK
ON WHAT IS THE SIGNAL, RIGHT?
NOT JUST LOOKING AT THE NUMBERS,
OKAY, THIS IS THE RESULT BUT
REALLY TRYING TO UNDERSTAND WHAT
IS IT WE'RE LOOKING -- WHERE IS
THE SIGNAL COMING FROM, WHAT IS
THE RAW DATA, AND MAKE SURE THAT
WHAT WE ARE LOOKING AT IS NOT AN
ARTIFACT.
ONE OF THE LAST PROJECTS WE HAVE
BEEN WORKING ALSO INVOLVES
DYSTONIA AND THIS HAS BEEN
TALKED BEFORE, SURROUND
INHIBITION THAT HAS BEEN A
CONCEPT THAT MARK HAS BEEN
WORKING FOR MANY YEARS, AND WE
HAVE FMRI WITH PET, TMS
EXPERIMENT THROUGH THE YEARS,
BUT WHAT WE TRIED TO DO IN
THESE, AND I SHOULD PUT THE
BACKGROUND FOR THIS PROJECT, I
THINK, I DON'T REMEMBER THE YEAR
BUT THEY CAME TO MARK'S OFFICE
TO START WORKING ON LAMINAR
BASAL FMRI AND I DON'T KNOW WHY
THIS IS MOVING BY ITSELF, BUT
ANYWAYS, HE CAME TO TALK TO MARK
AND WE STARTED THIS PROJECT.
WE FIGURED THE POPULATION TO
STUDY -- I'M SORRY THIS IS
MOVING BY ITSELF.
SO WE SET UP A STUDY IN A
7 TESLA SCANNER, WE LOOK AT A
FEW PATIENTS AND WE WERE ABLE TO
SEE BOTH IN THE SENSORY AREA THE
DISTRIBUTION OF THE
REPRESENTATION THAT AS WAS
TAUGHT BEFORE, NOT ONLY AT THE
BEHAVIOR AND ELECTROPHYSIOLOGY
CAN BE DIFFERENT IN THE HAND
DYSTONIA PATIENTS BUT ALSO WE
CAN SEE THE ACTIVATIONS IN THE
FMRI AT THE LEVEL OF THE CONE.
SO WE CAN SEE THE SPATIAL
DISTRIBUTION IS DIFFERENT.
WE ALSO SEE THE LAYER SO THESE
WE ARE LOOKING THROUGH THE
CORTICAL STRIPE AND WE CAN SEE A
DIFFERENCE BETWEEN AN AFFECTED
SIDE AND THE AFFECTED SIDE OF
THE PATIENTS, AND I CAN SAY THAT
AN AFFECTED SIDE LOOKS IN THE
DEEPER LAYERS, SUPERVISOR VISUAL
LAYERS, SIMILAR TO WHAT THE
HEALTHY VOLUNTEER SIGNAL WILL
LOOK.
SO WE CAN START LOOKING INTO NOW
WHERE ARE THESE REGIONS -- HOW
THE LAYERS ARE PRODUCING THESE
MAYBE SURROUNDING VISION AND
WITH A NEW SEQUENCES MAYBE WE
CAN EXTRAPOLATE TO OTHER PARTS
ON THE BRAIN AND KEEP MAYBE
GOING TO THE -- AND SO MARK, YOU
WILL NEED TO STAY AROUND AND
HELP.
SO -- BUT I THINK YOU HAVE MUCH
INTERESTING THINGS TO SEE
GROWING, ALL THESE NUMBER OF
PEOPLE GROWING, AND GETTING TO
DEVELOP THEIR CAREERS AND I
THINK YOU HAVE NEUROLOGISTS IN
TRAINING THERE TO MENTOR
PERSONALLY.
SO CONGRATULATIONS AND HAPPY
RETIREMENT.
[APPLAUSE]
NOW WILL BE RICK HALMICH NEXT TO
THE TALK.
HE WAS HERE IN 2015, AND WE WERE
JUST TALKING FOR ONLY FOUR
MONTHS, IT HAS BEEN MUCH, MUCH
LONGER, THE ACTIVITY AND THE
IMPACT HE'S HAD HAS BEEN GREAT,
SO IT'S GREAT TO HAVE YOU HERE
TODAY.
>>THANK YOU VERY MUCH, SAL
VE, SILVINA,AND THANK YOU VERY .
MARK HAS MEANT MUCH FOR THE
FIELD OF TREMOR AND THE
DEVELOPMENT OF MANY CLINICAL
RESEARCHERS INCLUDING ME.
MY INTEREST IN TREMOR ACTUALLY
STARTED AT THE END OF MY PH.D.
THESIS, AROUND 2010.
WHEN THIS PAPER CAME OUT WRITTEN
BY HALLETT AND DORSCHEL, ARE WE
MAKING PROGRESS IN THE
UNDERSTANDING OF TREMOR IN
PARKINSON'S DISEASE?
THIS IS FOR THE ANNALS OF
NEUROLOGY.
THEY HIGHLIGHTED VARIOUS OPEN
QUESTIONS IN THE FIELD.
FOR EXAMPLE, THE FACT THAT
PARKINSON'S DISEASE HARBORS
SEVERAL TREMORS.
THEY CAME UP WITH FIVE TYPES OF
ACTION TREMORS IN PARKINSON'S
DISEASE, WHICH MIGHT HAVE A
DIFFERENT PATHOPHYSIOLOGY.
THE FACT THAT MULTIPLE CIRCUITS
ARE INVOLVED NOT ONLY THE BASAL
GANGLIA BUT ALSO OTHER CIRCUITS
SUCH AS THE CEREBELLAR CIRCUIT,
AND THAT THE ROLE OF DOPAMINE IS
UNCLEAR, BECAUSE MANY PATIENTS
WITH PARKINSON'S DISEASE DO NOT
RESPOND TO DOPAMINERGIC THERAPY
IN TERMS OF THEIR TREMOR.
SO THAT WAS VERY FASCINATING TO
ME.
AND -- WELL, WHAT WE DID IS
INVITE MARK HALLETT AND GUENTHER
DEUSHEL.
THERE HE IS, I'M ON THE RIGHT
SIDE, MI MARK IS IN THE MIDDLE D
GUENTHER IS ALSO THERE.
MARK IS SMILING IN THE MIDDLE,
GIVING HIS BLESSING.
AND THAT WAS ACTUALLY THE START
OF THE COLLABORATION.
SO WE GOT TOGETHER WITH THIS
GROUP OF PEOPLE AND WROTE A
REVIEW PAPER FURTHER MARKING THE
AREAS OF UNCERTAINTY IN
PARKINSON'S DISEASE TREMOR AND
ALSO GIVING SOME SOLUTIONS AND
HYPOTHESIS.
BUT BEFORE GOING INTO THAT, I
WANT TO GO ONE STEP BACK AND
REALLY LOOK AT THE
PHENOMENONNOLOGY OF TREMOR.
WHAT I LEARNED BEING IN THE LAB
IS THAT -- WELL, TO MAKE AN
IMPACT IN THE PATHOPHYSIOLOGY OF
MOVEMENT DISORDERS, IT ALL
STARTS WITH A GOOD CLINICAL EYE
TO ASK THE RIGHT QUESTIONS AND
THEN USE THE SUPERPOWERS WE HAVE
IN NEUROPHYSIOLOGY TO TRY AND
ANSWER THEM.
SO I WANT TO START WITH A VIDEO.
SO THIS IS A PATIENT WITH
PARKINSON'S DISEASE TREMOR ON
HIS RIGHT SIDE, RIGHT LEG.
AND HE'S NOW MAKING MENTAL
CALCULATIONS AND YOU SEE THAT
THE TREMOR IS INCREASING A LOT,
WHICH IS A TYPICAL PHENOMENON
THAT WE SEE.
TREMOR IS WORSE DURING STRESS.
AND WHEN HE MAKES A VOLUNTARY
MOVEMENT, WHAT YOU SEE HAPPENING
IS THAT THE TREMOR DISAPPEARS.
SO THAT IS A PHENOMENON THAT WE
CALL RESETTING.
AND THE MORE BRISK OR DYNAMIC
THE MOVEMENT IS, THE MORE
SUCCESSFUL IT IS IN ABOLISHING
THE TREMOR.
THIS PATIENT DOES NOT HAVE A
KINETIC TREMOR, SO WHEN HE MOVES
HIS HANDS TO THE NOSE, YOU DON'T
SEE A VERY MARKED TREMOR.
BUT WHAT IS INTERESTING IS WHEN
HE STARTS TO TAP WITH HIS RIGHT
HAND, IS THAT AFTER A FEW TAP,
THE TREMOR COMES BACK.
SO WHAT YOU'VE JUST SEEN IS REEE
MER JESSSEEN ISRE-EMERGENCE KIN.
WHAT IS EVEN PERHAPS MORE
INTERESTING IS WHEN I TRY TO
INCREASE THE DYNAMICS IN HIS
VOLUNTARY MOVEMENT BY ASKING HIM
TO NOW T NOT TAP WITH TWO FINGET
TO ALTERNATE HIS TAPPING BETWEEN
DIFFERENT FINGER, THE TREMOR
DOES NOT COME BACK, EVEN IF HE
DOES THIS FOR QUITE A LONG TIME.
AND THIS IS A PHENOMENON THAT
REALLY TOUCHES UPON A CONCEPT
THAT MARK HAS INTRODUCED FOR
PARKINSON'S TREMOR, NAMELY THAT
IT IS A TREMOR OF STABILITY,
THAT IT IS NOT A RESTING TREMOR
THAT IS CLASSICAL FOR
PARKINSON'S DISEASE BUT A TREMOR
OF STABILITY.
IT ALSO RAISES A LOT OF
QUESTIONS BECAUSE WHAT IS MOTOR
STABILITY IF MOTOR STABILITY CAN
BE TAPPING WITH TWO FINGERS,
THEN WHERE IS THE BORDER WITH --
WELL, MOTOR DYNAMICS?
WHAT WE HAVE SEEN IN THIS VIDEO
IS TREMOR AMPLITUDE WAXES AND
WANES, INCREASES MARKEDLY DURING
STRESS AND COGNITIVE
COACTIVATION AND OCCUR MAINLY
DURING MOTOR STABILITY.
SO NOW MOVING TO THE
PATHOPHYSIOLOGY, WHAT WAS NOTED
IN THE 2010 PAPER IS THAT MARK
SONS DIPARKINSON'S DISEASE IS
ASSOCIATED WITH TWO DIFFERENT
CIRCUITS.
THERE'S -- ACTIVITY IN THE BASAL
GANGLIA BUT ALSO IN NODES OF THE
SAIR BELOW THALAMIC CORTICAL
CIRCUIT.
MANY OF YOU HAVE PROBABLY SEEN
THIS, WE HAVE ELABORATED ON THAT
WITH IMAGING FMRI LOOKING AT
WHICH BRAIN REGIONS ARE
ASSOCIATED WITH SPONTANEOUS
FLUCTUATIONS IN TREMOR AMPLY
TEUD DURING SCANNING AND WE SEE
MARKED ACTIVITY IN THE
CEREBELLAR THALAMIC CORTICAL
CIRCUIT.
HOWEVER WE ALSO SAW TRANSIENT
ACTIVITY IN THE BASAL GANGLIA
ALONG THE ONSET OF TREMOR
EPISODES, IN THE GLOBUS
PALLIDUS, AND IN CONTRAST, IT
DID NOT CORRELATE WITH THE
FLUCTUATIONS IN TREMOR POWER,
PER SE.
SO THIS LED TO DIMMER SWITCH
HYPOTHESIS THAT WE PUT FORWARD
IN THE BRAIN PAPER THAT I
MENTIONED, WHERE THE TREMOR IS
TRIGGERED BY ACTIVITY IN THE
BASAL GANGLIA, AND THEN THE
CEREBELLAR THALAMIC -- MAINTAINS
OR AMPLIFIES THE TREMOR.
THIS HAS BEEN REPLICATED USING A
VERY DIFFERENT SET OF TECHNIQUES
BY PETER LAURO, ALSO A FELLOW
WORKING WITH MARK AND SILVINA AT
THE TIME I WAS THERE, AND THEY
USED RECORDINGS OF THE CORTEX
AND DEEP RECORDINGS IN THE STN
IN 10 PARKINSON'S DISEASE
PATIENTS, AND USING THE EXCEL
ACCELEROMETER, THEY DEMONSTRATED
THREE CONDITIONS SO THERE WERE
NO TREMOR EPISODES, THERE WERE
TREMOR ONSET EPISODES AND THERE
WERE EPISODES OF SUSTAINED
TREMOR.
AND WHEN THEY LOOKED AT
DIFFERENCES IN CONNECTIVITY
WITHIN THE CIRCUIT, THEY FOUND
THAT DURING THE TREMOR ONSET,
THERE WAS A DRIVE FROM THE BASAL
GANGLIA TO DIFFERENT REGIONS IN
THE CORTEX, WHICH WAS REVERSED
DURING PERIODS OF SUSTAINED
TREMOR.
SO THESE DATA VERY NICELY SHOW
THAT INDEED THE BASAL GANGLIA
SEEM TO BE MOST INTERESTED
DURING THE ONSET OF TREMOR
EPISODES AND NOT SO MUCH DURING
THE -- WELL, MAINTENANCE OR
AMPLIFICATION OF TREMOR.
SO GOING BACK TO THE OBSERVATION
THAT PARKINSON DISEASE TREMOR
INCREASES DURING STRESS, WHY IS
THAT THE CASE?
TO LOOK FURTHER INTO THAT, WE
SUUSED FMRI IN 33 PATIENTS EITHR
ASKING THEM TO REST, DO NOT
PERFORM ANYTHING, OR PERFORM A
COGNITIVE MENTAL ARITHMETIC
TASK, AND WE MEASURED TREMOR
AMPLITUDE, BRAIN ACTIVITY AND
PUPIL DIAMETER DURING THIS TASK.
AND WHAT WE FOUND IS THAT
COGNITIVE STRESS INCREASES
TREMOR AMPLITUDE QUITE MARKEDLY
BUT ALSO HEART RE RATE WAS
INCREASED AND PUPIL DIAMETER WAS
INCREASED, AND THIS SUGGESTS
THAT FIRING IN THE NEUROEP
NERGIC SYSTEM MAY PLAY A ROLE IN
TRIGGERING THIS TREMOR.
LOOKING IN BRAIN ACTIVITY, WE
SAW ACTIVITY IN THE
CEREBELLAR -- WHEN WE LOOKED AT
BRAIN ACTIVITY -- WE FOUND
ACTIVITY IN A SALIENCE NETWORK
IN PARIETAL PREMOTOR REGIONS AND
ALSO SI -- ALSO COFLUCTUATING WH
CHANGES IN PUPIL DIAMETER DURING
SCANNING.
WHEN TRYING TO EXPLAIN HOW THESE
TWO NETWORKS RELATE WITH EACH
OTHER, THERE WERE TWO HYPOTHESES
TO EXPLAIN THIS.
ONE IS THAT PARKINSON'S DISEASE
TREMOR IS DISINHIBITED DURING
COGNITIVE TASKS SO THAT THE
COGNITIVE NETWORK THAT BECOMES
ENGAGED DOESN'T INHIBIT THE
TREMOR ANYMORE SO IT BECOMES
AMPLIFIED.
AND ANOTHER POSSIBILITY IS THAT
THIS SALIENCE NETWORK STRESS
SENSITIVE NETWORK ACTUALLY
ACTIVELY EXCITES TREMOR IN THIS
CEREBELLAR -- THESE TWO
HYPOTHESES HAVE DIFFERENT
PREDICTIONS WITH REGARD TO THE
EFFECTIVE CONNECTIVITY BETWEEN
THESE TWO NETWORKS.
AND THAT COULD BE TESTED, WHICH
IS WHAT WE DID USING PATIENT
MODEL SELECTION PROCEDURE, AND
WE FOUND THAT THE EVIDENCE FOR
EXCITATION BETWEEN THESE TWO
NETWORKS WAS MUCH LARGER,
SUPPORTING THE IDEA THAT THIS
SALIENCE NETWORK ACTUALLY
EXCITES TREMULOUS ACTIVITY.
THIS WAS PARTICULARLY EVIDENT --
WHICH ALSO CORRELATED WITH
INDIVIDUAL DIFFERENCES IN PUPIL
DIAMETER AND THIS FITS WITH
RECENT IDEAS THAT TREMOR
DOMINANT PATIENTS HAVE
RELATIVELY PRESERVED FUNCTION IN
THE THALAMUS.
SO THE INTERIM CONCLUSION FROM
THESE DATA IS THAT AROUSAL
DURING A COGNITIVE TASK
AMPLIFIES PARKINSON'S TREMOR BY
INCREASED TOP-DOWN INTERACTIONS
BETWEEN A STRESS ACTIVE -- AND
THE TREMOR CIRCUITRY, AND THAT
THERE ARE ALSO INCREASED
BOTTOM-UP POTENTIALLY
NORADRENERGIC EFFECTS ON TO THE
THALAMUS.
THIS BRINGS ME BACK TO THE
DIMMER SWITCH MODEL BECAUSE IT
RAISES THE QUESTION HOW DO
SPONTANEOUS FLUCTUATIONS IN
CEREBRAL AROUSAL STATES EXPLAIN
THE WAXING AND WANING OF
PARKINSON'S TREMOR AT REST?
AND TO LOOK INTO THAT, ONE CAN
CONSIDER THE FACT THAT ADDRESSED
BRAIN DISPLAYS CONTINUOUS
CHANGES IN LARGE SCALE
SEGREGATION AND INTEGRATION.
AND THESE CHANGES IN SEGREGATION
AND INTEGRATION CAN BE
QUANTIFIED AND THEY HAVE BEEN
SHOWN TO BE INFLUENCED BY
NORADRENALINE WHICH INCREASES
THE INTEGRATIVE STATE OF THE
BRAIN AND THIS IS BEING
HYPOTHESIZED TO BE MEDIATED BY
THE THALAMUS.
IF THAT IS TRUE, ONE CAN ASK, DO
SPONTANEOUS INCREASES IN
CEREBRAL INTEGRATION INDEED LEAD
TO PARKINSON'S TREMOR.
SUCH THAT DURING EPISODES OF A
SEGREGATED BRAIN STATE, THERE'S
LITTLE TREMOR, AND DURING
EPISODES OF AN INTEGRATED STATE,
THERE IS MORE TREMOR.
TO DO THAT, PEOPLE IN MY LAB
HAVE RECENTLY PERFORMED THIS
STUDY LOOKING AT 40 PARKINSON'S
DISEASE PATIENTS BEFORE A
RESTING STATE SCAN AND ALSO A
COGNITIVE LOADING TASK.
AND BRAIN INTEGRATION WAS
QUANTIFIED USING THE APPROACH
WHERE WE LOOK AT INTEGRATION
BETWEEN 375 REGIONS OF INTEREST,
AND WE THEN LOOKED WHETHER BRAIN
INTEGRATION CHANGED BETWEEN
THREE DIFFERENT EPISODES, NAMELY
REST WHEN THERE WAS NO TREMOR OR
PRE-TREMOR EPISODES.
WHEN THERE WAS NOT MUCH TREMOR
YET IN THE ACCELEROMETERSIGNAL
AND THE TREMOR EPISODES
THEMSELVES.
AND WHAT WE FOUND IS THAT -- ON
THE LEFT YOU SEE THE TREMOR
SIGNAL SO BASED ON THE
ACCELEROMETRY BEFORE AND AFTER
THE ONSET OF TREMOR.
SO FIRST LINE IS THE ONSET OF
TREMOR AND ON THE Y AXIS IS THE
CHANGE IN TREMOR VERSUS THE REST
CONDITION.
WHAT WE SEE IS THAT CEREBRAL
INTEGRATION REALLY PEAKS AT THE
ONSET OF TREMOR, BUT IT ALREADY
STARTS TO INCREASE UP TO
15 SECONDS BEFORE THE TREMOR
FIRST EMERGES.
THE BRAIN REGIONS MOST
ASSOCIATED WITH THIS INTEGRATION
ARE THE THALAMUS AND ALSO
FRONTAL PARIETAL REGIONS.
AND WHEN WE LOOKED AT PERIPHERAL
STRESS READOUTS SUCH AS PUPIL
DIAMETER AND HEART RATE, WE
FOUND THAT THEY WERE INDEED
INCREASED DURING THE TREMOR BUT
NOT SO MUCH BEFORE THE TREMOR.
SO THAT SEEMED TO BE SPECIFIC
FOR THIS CEREBRAL INTEGRATION
PARAMETER.
SO CONCLUDING ON THAT, WE CAN
SAY THAT INTERPRETIVE BRAIN
STATES WHICH MAY BE LINKED TO
AROUSAL PERCEIVE THE ONSET OF
PARKINSON'S TREMOR BY UP TO
15 SECONDS AND HENCE PLAY A
CAUSAL ROLE IN TUMOR GENERATION.
OF COURSE THIS REMAINS FMRI SO
WE CANNOT BE SURE ABOUT THAT.
AND THAT CEREBRAL INTEGRATION
MIGHT DO THIS BY ENABLING
ABNORMAL SIGNALS FROM THE BASAL
GANGLIA TO REACH THE
CEREBELLAR -- CORTEX WITHIN
THE -- CIRCUIT OR BOTH.
THESE ARE VERY NEW DATA, SO I'M
VERY CURIOUS WHAT MARK WILL SAY,
BUT I'M SURE I WILL LEARN HIS
OPINION DURING LUNCH.
SO THAT BRINGS ME TO THE LAST
PART.
SO OF COURSE WE KNOW FROM FMRI
STUDIES THAT THERE'S THIS
CIRCUIT BUT WE DON'T KNOW IF
THEY'RE CAUSALLY RELATED TO THE
TREMOR.
THAT IS A PROJECT THAT I SET OUT
TO INVESTIGATE AT THE NIH IN
2015.
WHERE WE INVESTIGATED 14
PARKINSON'S DISEASE PATIENTS
WITH BOTH RESTING TREMOR AND
REEMERGENT TREMOR.
ORIGINALLY THE IDEA WAS TO ALSO
INCLUDE A GROUP OF PATIENTS WHO
HAD PURE POSTURAL TREMOR SO A
TREMOR AT A HIGHER FREQUENCY
THAT WAS NOT REEME REEMERGENT TR
BUT THAT WAS DIFFICULT IN FOUR
MONTHS SO WE COULD NOT FIND
ENOUGH PATIENTS TO MAKE A GOOD
COMPARISON.
WE APLIE APPLIED TMS OVER THE MR
CORTEX OR CEREBELLUM, QUANTIFIED
WITH THE TREMOR RESET INDEX AND
TREMOR AMPLITUDE QUANTIFIED WITH
TREMOR POWER AND TREMOR
FREQUENCY.
THE STUDENTS IN MY GROUP ALSO
CAME BACK TO ALSO ENJOY MARK'S
LAB AND FINISH SOME OF THAT DATA
COLLECTION LATER.
THESE ARE A FEW PHOTOS FROM MY
TIME THERE IN THE LAB.
I MET ALL THESE WONDERFUL
PEOPLE.
MOST OF YOU ARE ALSO HERE TODAY,
REALLY HELPED AND INSPIRED ME.
FELT TO BE PART OF THAT FAMILY,
STILL ARE, AND WE USED A RESET
INDEX THAT WAS DESCRIBED HERE IN
THIS PAPER BY MARK AND PASCAL
FROM 1994 WHERE THEY SHOWED THAT
A TMS PULSE OVER THE MOTOR
CORTEX CAN BRIEFLY REMOVE TREMOR
AND THEN IT COMES BACK AT A
DIFFERENT PHASE AS IT WAS
BEFORE, AND THIS RESETTING
PHENOMENON SHOWS THAT THE REGION
THAT IS BEING STIMULATED IS PART
OF THE OSCILLATOR OF THE TREMOR.
ON THE RIGHT YOU SEE A PICTURE
OF THE LAB WHERE WE DID ALL THE
EXPERIMENTS WHERE ALL THE MAGIC
HAPPENS AND WHAT WE FOUND IS
THAT TMS OF THE PRIMARY MOTOR
CORTEX WAS VERY EFFECTIVE IN
RESETTING BOTH REST TREMOR AND
REEMERGENT TREMOR.
WHILE TMS OVER THE CEREBELLUM
ONLY DID THAT FOR RE-EMERGENT
TREMOR, BUT NOT FOR REST TREMOR.
THIS WAS CONSISTENT BY ANOTHER
STUDY FROM THE GROUP OF ROBERT
CHEN WHERE THEY ALSO SHOWED THAT
FOR A GROUP OF PARKINSON
PATIENTS.
AND WHEN WE LOOKED AT THE EFFECT
OF THE TMS PULSE ON TREMOR
AMPLITUDE, WE FOUND THAT THE
AMPLITUDE WAS BRIEFLY REDUCED
AFTER TMS OVER THE PRIMARY MOTOR
CORTEX FOR BOTH TYPES OF TREMOR.
AND THIS EFFECT WAS NOT SEEN FOR
EITHER TREMOR AFTER TMS OVER THE
CEREBELLUM.
SO WE CONCLUDED THAT THE
CEREBELLUM IS PART OF THE
OSCILLATOR FOR REEMERGENT TREMOR
BUT NOT REST TREMOR.
AND THAT THE MOTOR CORTEX BUT
NOT THE CEREBELLUM CONTROLS THE
AMPLITUDE OF BOTH TYPES OF
PARKINSON'S DISEASE TREMOR.
AND THIS BRINGS ME TO MY LAST
SLIDE.
I WOULD REALLY LIKE TO THANK
YOU, MARK, FOR A DECADE OF
MENTORSHIP, FRIENDSHIP AND
COLLABORATION.
I'VE LEARNED A LOT IN YOUR LAB,
NOT ONLY SCIENTIFICALLY BUT ALSO
ABOUT HOW TO IMPROVE
COLLABORATIONS, HOW TO COMBINE
CLINICAL WORK WITH MORE
MECHANISTIC RESEARCH IN AN
EFFECTIVE MANNER, AND THANK YOU
FOR ALL THE SUPPORT YOU'VE
GIVEN.
[APPLAUSE]
>>THANK YOU, RICK.
THE NEXT SPEAKER WILL BE
CHRISTIAN GERLOFF.
YOU UNFORTUNATELY, THEY COULDN'T
TAKE A FLIGHT THAT WILL MAKE HIM
BE ON TIME.
AND THE TEAM HERE MADE IT HAPPEN
AND HE'S GOING TO JOIN US ON
ZOOM.
SO WHILE HEAR SETTING HIM UP,
HE'S ALREADY CONNECTED BUT WHILE
THEY ARE BRINGING HIM UP, I'LL
DO A QUICK ANNOUNCEMENT SO THE
PHOTO IS GOING TO HAPPEN RIGHT
AFTER THE NEXT TALK.
WHAT THE PHOTOGRAPHER ASKS IS
THAT WE ALL CONSOLIDATE IN THIS
PART OF THE ROOM IN BETWEEN THE
TWO MICROPHONES AND THE FRONT,
AND TRY TO MAKE LIKE A TRIANGLE
SO WE ALL FIT.
SHE'S GOING TO STAND ON THE
STAGE.
AND THEY WILL DO SOMETHING WITH
THE LIGHTS.
SO THAT'S THE FIRST
ANNOUNCEMENT.
WE'LL REPEAT IT WHEN THE TIME
COMES BUT HOPEFULLY WE GET A
GOOD PICTURE OF EVERYBODY IN
PERSON.
UNFORTUNATELY WE WERE NOT ABLE
TO GET VIDEO FROM THE PEOPLE
LOGGING IN VIRTUALLY BUT WE
HEARD THAT THINGS ARE GOING
SMOOTH ON THE VIRTUAL WORLD AND
THEY'RE HEARING US AND SEEING
US -- I MEAN SEEING THE SCREEN
WELL, SO THAT'S GOOD NEWS.
THERE WERE OVER 100 PEOPLE
CONNECTED.
SO THANK YOU, EVERYBODY, FOR
BEING THERE AND THERE'S
CHRISTIAN FROM HAMBURG JOINING
US, SO THANK YOU FOR JOINING US
AT LEAST VIRTUALLY AND YOU CAN
TAKE THE MICROPHONE.
>>THANK YOU, SILVINA.
HI, MARK.
HI, EVERYBODY.
OBVIOUSLY I'M NOW THE LAST THING
THAT'S IN BETWEEN YOU AND LUNCH.
LIKE YESTERDAY, THE LAST THING
BETWEEN ME AND YOU WAS
LUFTHANSA.
IF I WERE LUFTHANSA, YOU WOULD
NEVER EAT.
SO UNFORTUNATELY YESTERDAY THEY
WERE SUPER EFFECTIVE IN AFTER
ACTUALLY SEVEN HOURS AT THE
AIRPORT NOT GETTING ME ANYWHERE.
BUT SO I'M VERY HAPPY TO HAVE
THE OPPORTUNITY TO JOIN YOU BY
ZOOM, AND I'M ALSO HAPPY TO
BRING THE GREETINGS OF THE
GERMAN SOCIETY OF NEUROLOGY,
WHERE YOU'RE AN HONORARY MEMBER
AND ALSO.
UNIVERSITY OF HAMBURG WHERE YOU
HAVE AN HONORARY DOCTORATE, AND
OF MY FAMILY, MY WIFE AVA, WHO
AS YOU KNOW HAS BIRTHDAY ON THE
SAME DAY AS YOU HAVE.
AND FOR TODAY, I'M GOING TO
SHARE MY PRESENTATION NOW.
I THOUGHT I'M GOING TO START
SHARING A FEW REMARKABLE MOMENTS
WITH MARK, AND THEN JUST GETTING
A GLIMPSE ON SOME REMARKABLE
RESEARCH WITH MARK.
REMARKABLE MOMENTS, THERE ARE
REALLY PLENTY.
THIS IS A SHOT FROM A PRIVATE
PARTY, 1996, I WAS THERE 95, 96,
97, AND IT WAS REALLY VERY
SIMILAR, AS HAS BEEN SAID, I
WASN'T EVEN THREE YEARS IN
GERMANY OR SURE I WAS GOING TO
STAY WITH NEUROLOGY, BUT WHILE I
WAS IN MARK'S LAB, ALSO LEO CAME
INTO THE TEAM AND WE REALLY HAD
A GREAT TIME.
SO WHEN I WAS IN MARK'S LAB IN
THE HMCS, SOMETHING HAPPENED,
AND THIS WAS VERY EFFECTIVE AND
MADE ME STAY IN NEUROLOGY AND
NEUROSCIENCE, SO THANK YOU VERY
MUCH, MARK, AND MARK HAD ALREADY
AT THE TIME A MAGIC TOUCH AND
THIS MAGIC TOUCH HAS MULTIPLIED
AND BY NOW INFLUENCED MANY, MANY
PEOPLE, YOUNG PEOPLE THROUGH
MANY GENERATIONS AND I KNOW THAT
IT IS NOT THE CASE ONLY FOR ME
AS A FELLOW BUT FOR MANY OTHER
FELLOWS OF YOURS, MARK.
NOW THE TITLE OF MY TALK ON
MULTIMODAL IMAGING AND STROKE
PROBABLY WAS INSPIRED A BIT BY
THIS PAPER HERE, WHICH WAS ONE
PAPER THAT WAS JUST GREAT
WORKING WITH MARK FOR ACTUALLY
MANY, MANY YEARS ON THIS PAPER.
ALTHOUGH THERE ARE FINALLY ONLY
11 PATIENTS BUT THOSE WERE SO
CONSISTENT AND SO SPECIAL THAT
WE THEN DID A LOT OF MULTIMODAL
IMAGING TMS OR PET SCANNING AT
THE TIME TMS EEG, AND I THINK IT
TURNED OUT A VERY NICE PAPER AND
I CAN ONLY TELL EVERYBODY IN THE
YOUNGER ONES ESPECIALLY IN THE
AUDIENCE IF YOU WANT TO BE ON
THE COVER PAGE THEN IT'S REALLY
GOOD TO DO RESEARCH WITH MARK
BECAUSE WITH MARK, YOU CAN END
UP ON THE COVER PAGE OF
VIRTUALLY ALL IMPORTANT
JOURNALS, MAYBE MORE IMPORTANT
THAN "THE WASHINGTON POST," WAS
ACTUALLY THIS BRAIN PAPER SO WE
MADE IT ON THE COVER PAGE.
IT WAS ALSO ESTHETICALLY
ATTRACTIVE, BUT I THINK THE
MAJOR POINT IN BRAIN AND THROUGH
THIS PAPER AS MANY OTHER PAPERS
IN BRAIN, BRAIN IS CERTAINLY MY
FAVORITE JOURNAL BECAUSE YOU CAN
REALLY STAY AND TELL STORIES.
AND THAT IS THE REASON THAT I
LEARNED FROM MARK THAT YOU LOOK
IN MORE THAN JUST ONE MODALITY
AND IF SEVERAL MODALITIES GIVE
YOU A GOOD ANSWER THAT IS
CONSISTENT, THEN YOU ARE
STARTING TO UNDERSTAND WHAT'S
ACTUALLY GOING ON.
MARK HAS JOINED ME THROUGHOUT MY
LIFE SINCE 1995 IN MY CAREER AND
THIS WAS ONE OF THE ABSOLUTE
HIGHLIGHTS AND STILL GRATEFUL,
JODI, MARK, YOU CAME TO OUR
WEDDING AND THE NICE THING ABOUT
THAT IS HERE'S AVA AND WE ARE
TWO NIH PLANTS AND WE BASICALLY
MET AT NIH IN THE 14TH FLOOR OF
BUILDING NUMBER 10, PLAYING
VOLLEYBALL AND OUT OF THIS
ACTUALLY CAME A WEDDING AND WE
ARE STILL TOGETHER, AND YOU MET
OUR KIDS AT THE TIME A BIT
SMALLER, NOW ALREADY 22 AND
TWINS.
THEY CAN STILL REMEMBER YOU VERY
WELL, AND ALSO BECAUSE, AND
THAT'S SOME MORE REMARKABLE
MOMENTS, YOU SPENT COMING TO
GERMANY, VISITING US IN ALL
KINDS OF OCCASIONS AND
SITUATIONS, SO I MOVED TO
HAMBURG IN 2006, AND ALONG THE
PATH, WE ENDED UP WRITING A
SCIENTIFIC COMMENTARY IN 2010
FOR BRAIN BASED ON A PAPER, IN
THE SAME YEAR YOU CAME TO
HAMBURG, WE HAD A NICE WALK
ALONG THE RIVER, QUITE COLD AND
ICY ON THE RIVER AND THIS WAS
THE COMMENTARY.
AND THIS I SHOW BECAUSE FIRST OF
ALL WE ENDED UP ON THE COVER
PAGE AGAIN.
SECOND OF ALL, IT WAS ONE MORE
MOMENT WHEN I SAW HOW MUCH --
HOW GOOD YOUR INSTINCT AND YOUR
KNOWLEDGE, YOUR WHOLE SPIRIT IS
IN DISCOVERING NEW DIRECTIONS
WHERE THE FIELD MOVES TO, AND
THEN ALREADY ALWAYS KNOWING MORE
THAN THE OTHERS USUALLY.
SO IN THIS CASE, IT WAS ABOUT
SMALL WORLDNESS AND HOW TO
DESCRIBE NETWORKS AND COMPLEX
CONFIGURATIONS AND THIS WAS
BECAUSE WE BOTH REVIEWED THE
PAPER AND THEN WROTE TOGETHER
THE SCIENTIFIC COMMENTARY TO IT
IN BRAIN AND INTERESTINGLY,
BRAIN MADE OUT OF OUR FOUR
BRAINS, THEY MADE FIVE, AND IN
THE BEGINNING I DIDN'T
UNDERSTAND BUT THEN I UNDERSTOOD
IT WAS ACTUALLY THE TIME OF THE
OLYMPIC GAMES.
AND THEY JUST WON A GOLD SO IT
WAS A NICE STORY ANYWAY.
AND YOU WERE ALSO PRESENT AND
THIS WAS ANOTHER REMARKABLE
MOMENT AT OUR ANNUAL MEETING OF
THE GERMAN SOCIETY IN NEUROLOGY
IN 2012 AND YOU GAVE A TALK THAT
WAS REALLY SUPER INSPIRING TERM
NEUROLOGY WORLDWIDE AND ONE OF
YOUR MAJOR POINTS WAS WHILE WE
ARE CONSIDERING STROKE,
DEMENTIA, NEURODEGENERATIVE
DISORDERS, MS, THESE DISEASES WE
CONSIDER THE MAJOR CHALLENGE IN
NEUROLOGY, BUT WORLDWIDE, IT'S
TOTALLY DIFFERENT, LOOK AT THE
INFECTIOUS DISEASES.
SO NOW AFTER TWO YEARS OF THE
PANDEMIC, I GUESS EVERYBODY HAS
UNDERSTOOD THIS BUT YOU SAID
THAT ALREADY IN 2012.
NOW, SCIENCE, ONE VERY INSPIRING
ASPECT THAT I FELT IN YOUR LAB
AT THIS EXCITING CULTURE OF
DISCUSSING OF RESPECT OF TAKING
EVERYBODY SERIOUSLY, NO MATTER
HOW SENIOR, HOW JUNIOR AND VERY
EARLY ON THE BRAIN AS A
CONNECTED NETWORK IS SOMETHING
THAT WE CAN ONLY UNDERSTAND IF
WE NOT ONLY LOOK AT REGIONAL
ACTIVITIES BUT WE ALSO NEED TO
UNDERSTAND HOW THEY INTERACT.
SO WE WORKED A LOT ON VARIOUS
CONNECTIVITY METRICS, AS IT'S
BEEN TERMED SOMETIMES TODAY, AND
I THOUGHT FOR THE NEXT FEW
MINUTES, I'M JUST GOING TO SHOW
YOU A LITTLE BIT WHERE YOUR
INSPIRATION LED TO AND WHERE WE
ARE CURRENTLY MOVING TO.
SO PROBABLY MOVE A LITTLE MORE
TOWARDS ELABORATED CONNECTIVITY
METRICS, TOWARDS CONNECT OMICS
AND LARGER COHORTS.
YOU'LL SEE WHAT I MEAN WITH
THAT.
NOW HERE'S ONE EXAMPLE, THE
FIRST EXAMPLE, AND IT ACTUALLY
ALSO AFFECTS A FELLOW WHO WAS AT
NIH FOR A COUPLE YEARS TOGETHER
WITH LEO AND YOU HAVE ALSO MET
HER, I'M SURE.
SO SHE WORKED ON A COHORT OF
STROKE PATIENTS THAT A FEW MORE,
ABOUT 30 THAT WE HAD FOLLOWED
MORE THAN A YEAR AND THEY HAVE A
MULTIMODAL ASSESSMENT WITH EEG
FUNCTIONAL MRI STRUCTURAL MRI
AND OTHERS AND VERY DEEP
CLINICAL PHENOTYPING, AND POINT
WAS WHAT DIFFERENTIATED THESE
PATIENTS FROM CONTROLS, NETWORK
DYNAMICS, COHERENCE, AND CAME UP
WITH A SURPRISINGLY FOCAL
DIFFERENCE WHICH WAS REALLY VERY
MUCH CONCENTRATED ON THE
INTERACTION BETWEEN PRIMARY
MOTOR CORTEX, EVERYTHING STARTS
AND GOES THROUGH THE PRIMARY
MOTOR CORTEX AND THE ANTERIOR
INTERPARIETAL SULCUS.
WHY AM I SHOWING THIS HERE
BECAUSE IN PARALLEL, THEY LOOKED
AT THE SAME DATA, THE SAME
PATIENTS IN FUNCTIONAL MRI,
DYNAMIC CAUSAL MODELING, BOLD --
AND FOUND ESSENTIALLY THE SAME
INTERACTION BETWEEN PRIMARY
MOTOR CORTEX AND BY CONVERGING
ACROSS TWO DIFFERENT METHODS OF
MEASUREMENT BUT ALSO COMPLETELY
DIFFERENT METRICS, COHERENCE
VERSUS DYNAMIC CAUSAL MODELING,
CAME UP WITH THE SAME FOCUS OF
INTERACTION AND I THINK THIS IS
EXACTLY WHAT I LEARNED WITH YOU,
YOU CAN PERHAPS MAKE SOMETHING
OUT OF IT IN TERMS OF FUNCTIONAL
MEANING, BEHAVIORAL MEANING,
THEN YOU'RE APPROACHING WHAT'S
HAPPENING IN THE BRAIN.
MARLENA COULD MAKE THIS MOVE
BECAUSE SHE HAD ENOUGH DATA TO
CORRELATE HER RESULTS WITH
PARAMETERS LIKE -- THIS WAS
REALLY DURING THE COURSE OF
RECOVERY OF THESE PATIENTS, AND
WHAT WE SAW IS THAT PATIENTS
THAT ARE MORE SEVERELY AFFECTED
AND HAVE MORE NEED FOR
REORGANIZATION AT HIGHER
PARIETAL FUNCTIONAL COUPLING IN
THIS MEASURE AND SEEMS THAT THIS
IS AN ATTEMPT TO COMPENSATE, THE
STORY IS EVIDENTLY NOT CLEAR
YET, WE'LL KEEP WORKING ON THIS
BUT THIS WAS A VERY GOOD EXAMPLE
FOR MULTIMODAL AND DEEP
PHENOTYPING ASSESSMENT.
ANOTHER EXAMPLE IS ACTUALLY
RELATING TO THE SAME DATASET,
LOOKING AT STRUCTURAL
CONNECTOMICS.
SO THE IDEA IS TO GET STRUCTURE
INTO THE EQUATION, AND HERE HE
USED REMEMBER OUR SCIENTIFIC
COMMENTARY FROM 2010 ALREADY,
BUT HE REALLY SUCCESSFULLY USED
SMALL WORLDNESS PARAMETERS TO
LOOK AT THE ANATOMY CHANGES AND
HOW IT RELATES TO UPPER
EXTREMITY MOTOR DEFICIT AND
BEYOND SHOWING THAT THE NETWORK
EFFICIENCY IS DONE IN THAT
HEMISPHERE, HE COULD ACTUALLY
NARROW IT DOWN TO A SPECIFIC
SUBNETWORK RELATED TO MOTOR
CONTROL.
AND THE THIRD EXAMPLE RELATES TO
LARGER COHORTS.
PERHAPS WE NEED LARGER NUMBERS,
AND AFTER GOING BACK FROM NIH
AND THEN MOVING TO HAMBURG,
OBVIOUSLY WHEN WE DO CLINICAL
TRIALS WE HAVE DIFFERENT IDEAS
ABOUT SAMPLE SIZES, WE TALKED
ABOUT 200, 500 OR MORE PATIENTS.
IN OUR BASIC SCIENCE STUDIES, WE
LOOK MORE MAYBE AT 20, WE LOOK
AT FIVE, WE LOOK AT 50, BUT AS
YOU KNOW, IT'S SUPER COSTLY AND
TIME-CONSUMING TO STUDY NEW
THINGS WITH NEW TECHNOLOGIES AND
A LARGE GROUP OF PATIENTS.
NEFORT THE LESS WE HAVE TO BRING
THESE FIELDS TOGETHER IF YOU
WANT TO MAKE A DIFFERENCE IN THE
SENSE OF TRANSLATION.
SO WE WERE VERY LUCKY TO GET
MONEY FUNDING FROM THE FOR
CLINICAL TRIAL, BASICALLY THE
CONCEPT THAT IF YOU DO AN MRI,
YOU CAN FIGURE OUT BECAUSE OF
DIFFERENT BEHAVIORS AND
DIFFERENT SEQUENCES THAT SOME
PATIENTS THAT HAVE THE STROKE
DURING THE NIGHT WHICH ARE 15 TO
20% OF ALL STROKE PATIENTS WHERE
YOU DON'T KNOW THE ONSET OF THE
STROKE THAT YOU CAN STILL DETECT
THEM AS POTENTIAL CANDIDATES FOR
THROMBOLYSIS AND JUST TO CUT A
LONG STORY SHORT, THIS WAS A
POSITIVE TRIAL AND IT WORKED OUT
AND HOW WE CAN REALLY TREAT
THESE PATIENTS BUT WHAT'S NICE
IN TERMS OF BASIC SCIENCE IS WE
HAVE ACUTE MRIs OF FIVE
PATIENTS AND ALSO ACUTE
FOLLOW-UP OF MRI BETWEEN 22 AND
36 HOURS AFTER TREATMENT WITH
THESE PATIENTS.
AND A MATHEMATICIAN AND
NEUROLOGIST SET OUT TO DO A
MEDIATION ANALYSIS TO SEE HOW
NETWORK DISCONNECTION MIGHT
RELATE TO THE THERAPY EFFECT IN
THESE PATIENTS AND IN THIS
STUDY.
AS I SAID ABOUT 503 PATIENTS, HE
LOOKED AT ALL THE MRIs AND
DETECTED THE LESION PATTERNS AND
TRANSFORMED IT INTO STANDARDS
BASE AND LOOKED AT THE
DISCONNECTION IN THOSE GROUPS
SEPARATED BY PLACEBO ARM AND THE
TREATMENT ARM, AND THIS IS JUST
AN OVERVIEW TO GIVE YOU A VISUAL
ON THAT.
THE DARKER THE COLORS, THE MORE
INTENSE THE COLORS, THE HIGHER
THE DEGREE OF DISCONNECTION AND
THOSE ARE THE MRIs THAT YOU
TAKE ABOUT 24 HOURS AFTER
TREATMENT AND YOU SEE THERE'S A
HIGHER DEGREE OF DISCONNECTION
IN THE PLACEBO GROUP.
THEN OF COURSE THE QUESTION IS,
IS THIS JUST A CONSEQUENCE OF
LESION SIZE BUT IT WAS ALREADY
SOMEHOW SPECIFIC TO INFERIOR
FRONTAL POST CENTRAL -- THIS WAS
NOT JUST BECAUSE THOSE REGIONS
WERE CLOSE TO THE LESIONS OR
WHERE THE LESION SITES.
AND AT THE END, STATISTICALLY,
THEY COULD SHOW THAT THE
DISCONNECTION DEGREE IN THE
ALTEPLASE TREATED GROUP IS LESS
SO IT'S -- THE MEDIATION
ANALYSIS SHOWED VERY CLEARLY
THAT THIS IS AN EFFECT, IT'S A
SIGNIFICANT IMPACT OF THE
DISCONNECTION PROGRESSION BUT
NOT OF LESION GROWTH OR LESION
SIZE ON FUNCTIONAL OUTCOME.
SO HERE I THINK IT'S A NICE
EXAMPLE HOW PACE IK SCIENCE WHAT
I LEARNED IN YOUR LAB AS AN HMCS
FELLOW CAN ALSO BE TRANSLATED
NOW INTO LARGER COHORTS AND BE
VERY USEFUL IN UNDERSTANDING
RELEVANT CLINICAL EFFECTS.
SO TO SUM UP, THIS IS, BY THE
WAY, A PICTURE WHEN YOU GOT YOUR
HONORARY DOCTORATE IN HAMBURG IN
2017.
TO SUM UP, YOU'RE DEFINITELY MY
GREATEST MENTOR.
YOUR IDEAS AND LEADERSHIP HAVE
INFLUENCED MULTIPLE GENERATIONS
AND ME DEFINITELY A LOT.
AND I'M VERY PROUD AND HAPPY TO
BE PART OF THIS COMMUNITY OF
YOUR COMMUNITY, AND I WOULD
REALLY LOVE TO BE THERE.
THERE'S A COUPLE MORE PICTURES
FROM WHEN YOU GOT YOUR DOCTORATE
IN HAMBURG, AND FOR THAT, I STOP
SCREEN SHARING AND I'M BACK.
THANK YOU VERY MUCH.
[APPLAUSE]
>>THANK YOU, CHRISTIAN.
SO WE ARE NOW GOING TO HAVE THE
PICTURE AND THE LUNCH BREAK
>>WELCOME BACK
MY NAME IS Dr. MARI AND
I'M ONE OF Dr. HALLETT'S
FORMER FELLOWS AS WELL AND I
HOPE SOME OF YOU GOT LUNCH AND
WILL BE READY FOR THE AFTERNOON.
THIS NEXT BLOCK IS IS MOSTLY
ABOUT EDUCATION AND I LIKE TO
SAY THAT MARK'S IMPACT AS FAR AS
SCIENTIFIC CONTRIBUTIONS ARE
PARALLEL IF NOT OUT SHINED BY
EDUCATION AND HE HAS HAD A
GLOBAL IMPACT.
WE'LL HAVE MANY ASPECTS.
THIS IS THE LONGEST BLOCK OF THE
DAY.
THE FIRST SPEAKER IS Dr. MARI
FROM THE FOUNDATION OF THE
ADVANCE EDUCATION IN THE
SCIENCES AND SERVING THE NIH AND
THE BIOMEDICAL COMMUNITY SINCE
1959.
>>WELL, HI HAD.
THANK YOU SO MUCH FOR THE
OPPORTUNITY TO BE THERE THIS
AFTERNOON AND TO TELL YOU A
LITTLE BIT ABOUT THE FOUNDATION
FOR ADVANCES EDUCATION IN THE
SCIENCES HERE AT THE NIH.
AND AS HE MENTIONED, MY NAME IS
MELINDA MAR IS FOR ADVANCES
EDUCATION IN THE SIGNSES AND
FAES WAS FOUNDED OVER 60 YEARS
AGO TO BE ONE OF THE NIH'S
EDUCATION PARTNERS AND SO I'D
LIKE TO START OFF BY TELLING YOU
A LITTLE BIT ABOUT OUR ACADEMIC
INITIATIVES.
OUR ACADEMIC INITIATIVES FALL
INTO TWO BUCKETS.
DEPENDING ON YOUR GOALS.
OUR COURSES OR OUR WORKSHOPS.
OUR COURSES ARE REALLY DESIGNED
TO PROVIDE A DEEP DIVE INTO THE
THEORY AND THE APPLICATION OF
VARIOUS CONCEPTS WHEREAS OUR
WORKSHOPS ARE DESIGNED TO
QUICKLY GIVE YOU THE KNOWLEDGE
THAT YOU MIGHT NEED TO MAYBE
APPLY A NEW CONCEPT OR A NEW
TECHNIQUE INTO YOUR RESEARCH.
OUR COURSES ARE CREDIT-BEARING
SO IF IT'S AN INDIVIDUAL WHO IS
INTERESTED IN PURSUING A DEGREE
PROGRAM, OUR CREDIT IS DO
TRANSFER WHERE OUR WORKSHOPS ARE
SIMPLY PASS/FAIL.
ALL OF OUR INITIATIVES RIGHT NOW
ARE DELIVERED FULLY ON-LINE.
SO, THEY'RE ACCESSIBLE TO
EVERYONE, EVERYWHERE IN THE
WORLD, YOU DON'T HAVE TO BE
LOCATED HERE ON THE BETHESDA
CAMPUS OR WITH THE NIH AND IF
YOU ARE INTERESTED IN THE TOPICS
THAT WE OFFER, WE WELCOME YOU
INTO ALL OF OUR ON-LINE COURSES.
ALL OF OUR INITIATIVES ARE
DESIGNED ACCORDING TO
RESEARCH-BACKED BEST-PRACTICES
FOR HOW ADULTS LEARN AND HOW
ADULTS LEARN BEST ON-LINE.
WE PROVIDE HIGHLY ENGAGING
EXPERIENCES, RELEVANT
EXPERIENCES AND DESIGNED TO GIVE
OUR STUDENTS THE KNOWLEDGE THAT
THEY NEED TO ADVANCE THEIR
SKILLS AND THEIR SCIENCE
QUICKLY.
I'D ALSO LIKE TO TALK A LITTLE
BIT ABOUT SOME OF OUR TEACHING
OPPORTUNITIES THAT WE HAVE WITH
FAES.
SO, IF YOU HAVE AN IDEA FOR A
COURSE, BUT YOU KNOW, MAYBE YOU
FEEL LIKE OH GOSH IT'S
TIME-CONSUMING AND IT SEEMS
CAN'TING, WE PROVIDE FULL SCALE
SUPPORT FOR EVERY ASPECT OF
COURSE DEVELOPMENT ASK DELIVERY
AND AGAIN, WE ALSO, AS WE TRAIN
OUR FACULTY, WE TRAIN THEM AGAIN
IN THOSE BEST TEACHING PRACTICES
TO ENSURE THAT WE HAVE A
HIGH-QUALITY, HIGHLY ENRICHING
EXPERIENCE FOR OUR STUDENTS.
SO I REALLY INVITE YOU TO CHECK
OUT US IF YOU HAVE NOT
INVESTIGATED WHAT WE OFFER
BEFORE AT FAES.ORG.
AND I JUST WITH A COUPLE
REMAINING MINUTES HERE, I'D LIKE
TO TELL YOU ABOUT THE OTHER WAYS
WE SUPPORT THE NIH AS WELL.
SO, IN ADDITION TO ALL OF OUR
ACADEMIC INITIATIVES WE SPONSOR
MUSIC AND CULTURALISM ON CAMPUS
AS WELL AS LEADERSHIP,
NETWORKING EVENTS, AND FAES WAS
DESIGNED TO BRING SCIENTISTS
TOGETHER AND HELP SHARE THEIR
SCIENCE WITH EACH OTHER AND O
THSO IT'SAN OPPORTUNITY TO BRING
EVERYBODY TOGETHER AND ALLOW
THEM TO COMMUNICATE ABOUT OUR
SCIENCE SO WE CAN BRING IT TO A
WIDER AUDIENCE SO THAT.
WE REALLY APPRECIATE THE
OPPORTUNITY TO SUPPORT THIS
SYMPOSIUM AND TELL YOU MORE
ABOUT OUR INITIATIVES.
IF YOU ARE INTERESTED IN TAKING
CLASSES WITH US, TEACHING
CLASSES WITH US, EVERYTHING'S
ON-LINE, HIGHLY FLEXIBLE AND
ACCESSIBLE SO CHECK OUT WHAT WE
HAVE TO OFFER AND THANK YOU
AGAIN.
[APPLAUSE]
>>THANK YOU FOR THAT OVERVIEW
OF THE FAES.
MOVING TO OUR NEXT SPEAKER, I
WOULD LIKE TO ASK Dr. JOE
JANKOVIC TO TELL US APPROXIMATE
THE FAMED ASPEN COURSE.
GOOD AFTERNOON, EVERYONE.
I'M DELIGHTED AND HONORED TO
PARTICIPATE IN THIS EVENT
HONORING MARK HALLETT.
I MUST SAY WHEN I HEARD ABOUT
FESTSCHRIFT.
I HAD TO LOOK IT UP IN THE
DICTIONARY AND IT'S HONORING A
RESPECTED PERSON, ESPECIALLY AN
ACADEMIC AND IT'S THE ONLY THING
Dr. HALLETT FITS THAT DEFINITIO.
THIS MORNING WE FOCUSED ON MARK
AS A SCIENTIST AND THIS
AFTERNOON'S SESSION WILL BE
FOCUSING ON MARK HALLETT AS AN
EDUCATOR AND THAT IS THE TOPIC A
I WANTED TO FOCUS ON AND
HIGHLIGHT DURING MY
REPRESENTATION.
SO, AS YOU KNOW, MARK HAS MANY,
MANY INTERESTS AND MANY LOVES.
HE HAS THREE MAIN LOVES, JUDY
AND HIS FAMILY, BEING THE MOST
IMPORTANT LOVE.
WORK IS PROBABLY THE SECOND MOST
IMPORTANT LOVE AND TRAVEL I THE
THIRD MOST IMPORTANT LOVE.
THIS IS MARK HALLETT'S ANNUAG
HIS FAMILY AND IT'S CLEARLY THE
MOST IMPORTANT LOVE IN HIS LIFE.
HE AND I SHARE MANY INTERESTING
INCLUDING PHOTOGRAPHY AND AND O
I'M GOING TO ACTUALLY SHARE WITH
YOU MANY, MANY PICTURES THAT I
HAVE TAKEN OVER THE YEARS AND I
HAVE KNOWN MARK LONGER THAN MOST
OF YOU AND WE'VE SHARED MANY,
MANY HAPPY OCCASION AND I WANT
TO SHARE THOSE WITH YOU.
FOCUSING MAINLY ON THE ASPEN
COURSE.
SO, WHEN THE MOVEMENT IS ON
SOCIETY STARTED WITH DAVID
MARSDEN, AND MYSELF AS THE FIRST
THREE PRESIDENTS, OF THE SOCIETY
WE FELT THAT THERE WAS OF A NEED
FOR AN EDUCATIONAL PROGRAM FOR
OTHER PRACTITIONERS AND
TRAINEESES AND WE ASKED VENUES
AND SETTLED ON ASPEN WHICH I
CALLED IT DISNEY LAPPED FOR DISS
BECAUSE IT HAS EVERYTHING YOU
WANT.
IT HAS AMBIANCE AND BEAUTIFUL
AND HIKING AND ALL THE OUTDOOR
ACTIVITIES.
ASPEN INSTITUTE HAS EVERYTHING
THAT ANY ADULT ENJOYS
PARTICULARLY THOSE OF US WHO ARE
SOMEWHAT STIMULATED BY THESE
KIND OF ACTIVITIES.
SO THIS IS TAKEN AT THE TIME OF
THE FIRST ASPEN COURSE, 1991
WITH STAN FAHN AND DAVID
MARSDEN, UNFORTUNATELY, STAN
CANNOT WITH US TODAY BECAUSE OF
ILLNESS.
AND I CHERISH THE MOMENTS WHEN
WE SPENT TIME TOGETHER IN THE
FIRST 10 YEARS OF THE ASPEN
COURSE AND THROUGH 1991 AND 998,
DAVID AND I WERE DOING FACULTY
AND UNFORTUNATELY IN 1998, DAVID
MARSDEN DIED HERELY AND BETHESDA
AND VISITING FELLOW WITH MARK
AND SO BECAUSE OF THE UNTIMELY
PASSING OF DAVID WE OBVIOUSLY
HAD TO LOOK FOR OTHER FACULTY
AND MARK HALLETT AND PETER
JENNER TO JOIN US SO THE FOUR OF
US BETWEEN 1999 AND 2008 AND
WHEN PETER JENNER DROPPED OUT
AND MARK, STAN AND I AND FACULTY
BECAUSE 2009 AND 2016.
AFTER 20 YEARS OF AFFILIATION
WITH THE UNIVERSITY, THE
MOVEMENT IS SOCIETY TOOK OVER
THE COURSE AS THE PROVIDER OF
THE CME CREDIT AND WE ALSO START
EXPANDING THE FACULTY INCLUDED
LETTERS IN THE ANINCLUDE --OVERS
BENEFITED FROM THE ASPEN COURSE.
MARK, PETER AND I USED O HANGOUT
AND DURING THE COURSE AND
OPINIONS AND AS PEP AND THEY HAD
A WONDERFUL TIME IN 2007 AND
STAN AND I PUBLISHED THE FIRST
VOLUME WHICH WAS ALSO
CONTRIBUTED TO MARK HALLETT AND
PETER JENNER AND WE DEDICATED
THE VOLUME TO DAVID MARSDEN SO
DAVID MARSDEN PLAYED AN
EXTREMELY IMPORTANT ROLE IN THE
DEVELOPMENT OF THE FIELD OF
MOVEMENT DISORDERS AND AS A
MENTOR TO MARK AND SO MANY OF
US SO WE'RE GRATEFUL TO DAVID.
ONE OF MY BIGGEST REGRETS, I
HAVE NOT VIDEOTAPED DAVID'S
LECTURES IN MEETINGS BECAUSE
DAVID WAS ONE OF THE MOST
ELOQUENT SPEAKERS AND DURING THE
ASPEN COURSE, I CHILDREN
REFERRED TO THEM AS JAMES POND
AND HE WAS A CONNOISSEUR OF GOOD
LIVING.
BETWEEN 2009 AND 2015, THE THREE
OF US CONTINUED TO UP THE COURSE
AND THERE WAS A BANNER ACROSS
THE MAIN STREET IN ASPEN AND IN
STAN AND MARK AND I PUBLISHED
THE MOVEMENT DISORDERS AND WE
WERE VERY PROUD OF THAT ADDITION
AND IN 2015 WE CELEBRATED THE
15th ANNIVERSARY OF THE ASPEN
COURSE AND IT WAS THE LAST TIME
WE WERE JUST THREE OF US WERE
THE FACULTY AND WE EXPANDED TO
INCLUDE OTHER PEOPLE THAT I
MENTIONED AND IN 2016 AND HERE
FELLOW AND OTHER TRAINEES THAT
CAME TO THE 2016 MEETING AND
AGAIN WE ENJOYED DINEING AND
OPINIONS AND OTHER PLACES IN
ASPEN.
THIS IS A PICTURE FROM 2017,
2017 PARTICIPANTS, 2018 AND
2019.
AGAIN, MANY PARTICIPANTS AND ON
THE 30th ANNIVERSARY OF THE
ASPEN COURSE, I WAS INVITED BY
THE WOMAN OF THE SOCIETY TO
WRITE A ARTICLE IN OUR
NEWSLETTER CALLED "MOVING ALONG"
WHERE I SORT OF REVIEWED THE
HISTORY OF THE ASPEN COURSE AND
PROVIDED SOME PERSPECTIVE ON THE
COURSE.
UNFORTUNATELY, BECAUSE OF THE
COVID EPIDEMIC, OUR 2020 COURSE
WAS VIRTUALLY HELD AND THEN
FINALLY THIS YEAR, WE WERE AGAIN
IN-PERSON AND DURING THIS YEAR,
ALL THE PARTICIPANTS IN THE
ASPEN COURSE RECEIVED A FREE
COPY OF THE THIRD EDITION OF THE
MANY MOVEMENT DISORDER BOOK
WHICH WAS AUTHORED NOT JUST BY
ME BUT MARK, Dr. OKUN AND
CAMILLA AND STANLEY FAHN.
THIS IS A TWEET I CAME ACROSS BY
MARK HALLETT A FEW WEEKS BEFORE
OUR '22 COURSE WHERE HE SAID
LOOKING FORWARD TO THE ASPEN
COURSE THIS YEAR, FINALLY
IN-PERSON AGAIN AND GREAT
SETTING FOR A GREAT COURSE TAKEN
AT THE JOHN DEN FER MEMORIAL IN
AS DEN.
SO THIS IS OUR FACULTY FOR 2022
COURSE AND JUST TO THIS PICTURE
TO HIGHLIGHT SOME OF THE UNIQUE
ASPECTS OF MARK'S EDUCATIONAL
ABILITIES.
IT'S MUCH SAID THAT MARK IS UP
WITH OF THE UNIQUE PEOPLE THAT
CAN MAKE COMPLEX CONCEPTS SIMPLE
AND HE MUCH USED THESE DIAGRAMS.
HE IS FAMOUS FOR HIS DIAGRAMS.
THIS IS ONE OF MANY THAT HE
SHOWS DURING HIS ASPEN LECTURE.
THIS YEAR, FOR THE FIRST TIME,
ALL THE PRESENTERS FOR OUR
WEDNESDAY NIGHT VIDEO RUNS WERE
ALL WOMAN AND IT'S HIGHLIGHT
INSIDE THIS PICTURE AND IT'S
ALWAYS AN ENJOYABLE EVENING WHEN
WE INVITE FELLOWS AND OTHER
PARTICIPANTS TO SHOW THEIR
UNIQUE CASES.
AND THIS IS AGAIN, A GROUP
PICTURE FROM THE 22 MEETING.
OVER THE YEARS, WE'VE BEEN
FORTUNATE TO RECEIVES VARIETY OF
GIFTS FROM THE PARTICIPANTS AND
THIS PARTICULAR INDIVIDUAL FROM
MEXICO HAS ATTENDED THE COURSE
EIGHT TIMES AND ALMOST EACH TIME
HE PRESENTS US WITH A VARIETY OF
GIFTS.
SO THIS IS AN EVALUATION FROM
HALLETT LAST YEAR.
YOU CAN SEE 97% OF THE
PARTICIPANTS RESPONDED THEY
WOULD RECOMMEND SOURCE TO A
COLLEAGUE.
I WOULD LIKE TO KNOW WHO THE
OTHER 3% OF THE PEOPLE ARE.
[LAUGHTER]
BUT OVER ALL, THE EVALUATION
ALWAYS HAS BEEN OUTSTANDING
LARGELY BECAUSE OF MARK'S
CONTRIBUTIONS.
SO, AS YOU CAN IMAGINE, OVER THE
YEARS, MARK AND I HAD MANY, MANY
ENJOYABLE ACTIVITIES IN AND
AROUND ASPEN, AND ONE OF THE
REASONS WHY WE CHOSE ASPEN
BECAUSE THE ASPEN MUSIC
FESTIVAL, FED, LAST NIGHT, I HAD
THE CHANCE TO TELL THE STORY
ABOUT RENEE FLEMING PICTURED
HERE.
IN ADDITION TO MUSIC WHICH IS
EVEN NOT ONLY AT THE MUSIC 10
BUT THE HARRIS HALL AND OTHER
PLACES AND ON THE STREETS OF
ASPEN AND THERE'S ALSO ASPEN
INSTITUTE WHICH IS PROBABLY THE
MOST PRESTIGIOUS THINK-TANK IN
THE WORLD AND WHERE VARIETY OF
WELL-KNOWN, HIGHLY REGARDED
PEOPLE SPEAK.
SO Dr. HALLETT IS WELL-KNOWN
FOR AWARDS AND LEADERSHIP
POSITIONS HIGHLIGHTED LAST NIGHT
AND THIS MORNING.
HE IS ALSO A MAN OF VISION.
AND OVER THE YEARS, I'VE HAD THE
OPPORTUNITY TO START OR INITIATE
OF OR HELP ANYTHING INITIATE THE
RESEARCH FOUNDATION AND MORE
IMPORTANTLY THE RESEARCH
FOUNDATION THAT I WAS THE
ORIGINAL CHAIRMAN OF THE
ADVISORY BOARD HERE HE THEN TOOK
OVER AND BRIAN IS IS NOW GOING
TO BE THE NEW CHAIRMAN OF THE
SCIENTIFIC ADVISORY BOARD OF THE
RESEARCH FOUNDATION.
MARK HALLETT PLAYED A BIG ROLE
IN THE DEVELOPMENT OF THE
SOCIETY WHICH MOST OF YOU KNOW
IS IS THE UMBRELLA ORGANIZATION
FOR ALL MOVEMENT DISORDERS.
HE WAS I THINK A FIFTH PRESIDENT
OF THE SOCIETY AND I INVITE YOU
TO LOOK AT WEBSITE OF THE
SOCIETY THAT HAS A NUMBER OF
PRESIDENTIAL PERSPECTIVES
INCLUDING MARK'S PERSPECTIVES
SO, I'VE BEEN FORTUNATE TO BE
INVOLVED IN MARK FORMING A
NUMBER OF ORGANIZATIONS AND I'M
JUST HIGHLIGHTING SOME OF THEM
HERE INCLUDING THE MOVEMENT
DISORDER SOCIETY.
I NEVER CONSIDERED MARK AS MY
MENTOR, ALTHOUGH I HAVE LEARNED
SO MUCH FROM HIM, NOT JUST ABOUT
MOTOR CONTROL AND MOTOR
PHYSIOLOGY BUT ALSO ABOUT
HUMANITY.
THE OTHER MENNORS IN MY LIFE
WERE BUD ROLLAND AND STAN FOND
SO FUNNY I JUST WANTED TO
CONGRATULATE MARK ON HIS
RETIREMENT AND I THINK PICKLE
BALL IS IN YOUR FUTURE AND I'M
GOING TO STEP DOWN AND KISS THE
RING AND YOU ARE INVITE TO GO
OU.>>THANK YOU FOR THAT
PICTURE-HEAVY OVERVIEW AND
OVERVIEW AND CONTINUING WITH
MARK'S IMPACT GLOBALLY AND WE
WILL HEAR ABOUT HIS IMPACT
EDUCATIONALLY AND LOCALLY OR
REGIONALLY AND STEVE RICH WILL
TELL US ABOUT THE REGIONAL
MOVEMENT DISORDER QUARTERLY
MEETINGS.
>>I'M HAPPY TO PARTICIPATE AND
GIVE YOU ANOTHER GLIMPSE OF MARK
AS AN EDUCATOR.
JOE TALKED ABOUT APP
INTERNATIONAL PROGRAM BUT WE'VE
HAD A COMPARABLE, VERY
SUCCESSFUL REGIONAL PROGRAM
GOING ON NOW FOR 32 YEARS HERE.
THIS WAS STARTED, I'LL TELL YOU,
A NUMBER OF YEARS AGO.
THE BALTIMORE-WASHINGTON
REGIONAL MOVEMENT DISORDERS
DINNER CONFERENCE BUT TWO
CONFERENCES AGO, WE DECIDED TO
NAME THIS FOR MARK AND IT'S NOW
KNOWN AS THE MARK HALLETT
MOVEMENT DISSEN CONFERENCE.
THIS WAS STARTED IN 1990.
I WAS AT JOHNS HOPKINS THEN AND
IT WAS A VERY INFORMAL MEETING.
WE DIDN'T HAVE REGULAR SCHEDULE
AND WE WENT BACK AND FOURTH
BETWEEN LATE AFTERNOON AND
EVENING MEETINGS WITH HOPKINS
AND RESEARCH PRESENTATIONS AND
WE WOULD HAVE A VERY CASUAL LOW
BUDGET DINNER AND WE SHOWED
VIDEO TAPES OF INTERESTING
PATIENTS TO EACH AND OVER THE
YEARS, THIS EXPANDED AND WE
ADDED OTHER CENTERS IN THE
REGION TO OUR PROGRAM AND I'LL
GO THROUGH THOSE IN A MOMENT.
WE'VE BEEN SUPPORTED OVER THE
YEARS, BY UNRESTRICTED GRANTS
FROM PHARMA AND WE'VE BEEN
MEETING QUARTERLY NOW SINCE 1990
AND EVEN DURING COVID, WE
CONTINUED TO MEET VIRTUALLY AND
WE WOULD ALWAYS ABOUT TO THE
HOSTS AREA FOR THE MEETING,
DIFFERENT HOTELS AND THEIR
INSTITUTIONS AND THAT MEANT THAT
EACH MEETING, SOMEONE WAS VERY
INCONVENIENCED AND OTHER PEOPLE
WEREN'T.
IT'S DIFFICULT SOMETIMES AS YOU
KNOW DRIVING AROUND THE
BALTIMORE AND THE WASHINGTON
BELT WAY SO THAT 10 YEARS AGO,
FOR CONSISTENCY AND SO THAT
EVERYONE WOULD HAVE A MODEST
COMMUTE, WE STARTED MEETING EACH
TIME IN COLOMBIA, AT THE
SHERATEN, NOW CALLED THE MARRY
WEATHER.
GENERALLY THE FORMAT OF THE
MEETING, IT'S CONSISTENT AND WE
START OFF WITH A BRIEF RECEPTION
AND PHARMA IS ABLE TO DISPLAY
THERE.
NEXT WE HAVE TWO RESEARCH
PRESENTATIONS THAT ARE ABOUT 10
OR 15 MINUTES EACH.
WE TRIED TO HIGHLIGHT FELLOWS OR
JUNIOR FACULTY MEMBERS TO GIVE
THEM AN OPPORTUNITY.
AND THEN AFTER THAT, WE HAVE A A
DINNER AND VIDEO TAPES AND WE
END AT 10:00.
WE TRY TO HAVE THE MOST JUNIOR
PEOPLE PRESENT THEIR VIDEOS
FIRST AND DISCUSSION OF THE
VIDEOS.
THE PARTICIPATING INTERESTS
CENTERS, AND WE ROTATE THE HOST.
STILL AT THE NIH AND I DON'T
KNOW WHO WILL TAKE OVER FOR YOU,
MARK, AS THE NIH HOST FROM HERE.
WE NEED A VOLUNTEER.
I MOVED TO THE UNIVERSITY OF
MARYLAND IN 2002, AND JOHNS
HOPKINS WITH KELLY MILLS, YOU
CAN SEE THEIR PICTURES HERE,
GEORGETOWN AND FERNANDO PEGAN
AND HOPKINS AND STEVE GRILL AND
ANOTHER FELLOW OF MARK AND EJAZ
IS FROM KAISER AND WALTER REED
WITH KEVIN CANARD AND PRITHA GHO
IS SH FROM GEORGE TOWN.
THINKING ABOUT OUR MEETINGS, IT
SEEMS THAT MANY OF THEM TO ME
REFLECT SO MUCH OF WHAT YOU'VE
BEEN ABOUT AND WHAT WE'VE HEARD
FROM EVERYONE THAT IS TALKED TO
AND SPOKEN HERE.
FIRST IS RESEARCH.
THAT'S REALLY THE FIRST TALKS
THAT WE HAVE IN EACH OF OUR
MEETINGS AND CLEARLY IT'S BEEN A
HUGE THEME OF YOUR CAREER.
PATIENT CARE.
BECAUSE OFTEN TIMES PEOPLE BRING
IN VIDEO TAPES OF UNDIAGNOSED
PATIENTS AND ASK FOR A GROUP
OPINION.
IT'S VERY USEFUL IN THAT REGARD.
LEARNING FROM OUR PATIENTS AND
IT'S BEEN THE THEME WITH YOUR
HUMAN INVESTIGATIONS BUT
SIMILARLY, WITH OUR VIDEO
CONFERENCE WHERE IT'S NOT ALWAYS
A DIAGNOSTIC PROBLEM, BUT OFTEN
SHOWING AN INTERESTING FINDINGS
AND OR A RARE TAKE ON SOMETHING
COMMON AND THE PROMOTION OF
TRAINEES WE HIGHLIGHT FELLOWS
AND JUNE INVESTIGATORS FOR THEIR
TALK AND IT'S A NICE VENUE FOR
THEM.
EDUCATION CLEARLY AND WE ALWAYS
STARRED OFF AS WE DO IN MOVEMENT
AS MOVEMENT DISORDER SPECIALISTS
WE DISAGREE ABOUT BASIC THINGS
LIKE PHENOMMOLOGY BUT IT'S PART
OF IT AS WELL AND IT'S SOMETHING
WE ALL ENJOY ABOUT THE FIELD BUT
I THINK THAT AN IMPORTANT PART
OF YOUR CAREER HAS BEEN TO
DEFINE BETTER THE PHENOMMOLOGY
AND THESE ARE PRESENTED BUT I
WANT TO HIGHLIGHT HERE,
SOMETHING I THINK WILL BE
PRESENTED LATER AND 9 THEME WAS
TO SNICKER AND GET THESE PEOPLE
OUT OF THE OFFICE WITH NOTHING
TO OFFER AND SIGH SKY TERRORISTS
WERE THE SAME AND YOU YONGE
SEVERAL OTHER PEOPLE HAVE BEEN
RESPONSIBLE FOR RECOGNIZING THAT
THESE ARE PEOPLE WHO KIND OF
TALK WOULD WALTER SAID BEFORE,
THAT THEY'RE REALLY SUFFERING
FROM A NEUROLOGICAL RECOGNIZING
THEY'RE IN NEED OF OUR CARE AND
OUR ATTENTION AND PARTICULARLY
RESEARCH ABOUT FUNCTIONAL
NEUROLOGICAL DISORDERS AND I
THINK YOU'VE REALLY HELPED BRIM
THEM OUT OF THE BACK WATER HERE
AND ONE THING THAT WE HAVE IN
OUR GROUP AND THIS WAS MENTIONED
EARLIER WITHIN YOUR LAB IS
EVERYONE GETS A VOICE AND AFTER
WE SHOW THE CASE WE USUALLY ASK
THE MOST UNION PEOPLE IN THE
ROOM AND FOR THEIR CONTINUES AND
WE SORT OF OF THEY'RE PARTS OF
OUR MEETING AS WELL THAT I THINK
WE ENJOY INTERACTING WITH EACH
OTHER AND WE'RE FORTUNATE WE
HAVE A FEW INTERESTS OF MOVEMENT
DISORDERS AND WE ALL GET ALONG
WELL BECAUSE OF THE MEETING AND
ONE REALLY IMPORTANT PART OF OUR
CONFERENCE, AND I THINK THAT
MARK, YOUR CAREER HAS BEEN
PROFESSIONAL FUN THAT I THINK WE
HAVE A GOOD TIME AT THE COP
FRENS AND THAT OBVIOUSLY THEY
TAKE THEIR WORK VERY SERIOUSLY
AND THEY WORK HARD AND YOU'VE
BEEN A REMARKABLE MENTOR AND
IT'S PERSON THAT CAN MAKE WORK
FUN AND IT'S A QUALITY OF YOURS
THAT MADE YOU SUCH A MAGNET FOR
TRAINEES AND COLLEAGUES SO AGAIN
THANK YOU FOR YOUR CONTRIBUTION
TO MULTIPLE AREAS AND BEING A
MENTOR AND ROLE MODEL AND I WANT
TO MAKE AN ANNOUNCEMENT THE NEXT
MARK HALLETT
BALTIMORE-WASHINGTON REGIONAL
MOVEMENT DISORDER CONFERENCE IS
FEBRUARY 16th.
NOW PRIOR TO COVID, THE WAY WE
USED TO SET THE DATE WAS AFTER
ONE MEETING I WOULD SEND AN
E-MAIL AROUND AND BECAUSE MARK
TRAVELED SO MUCH, HE ALWAYS TOLD
US WHEN HE WOULD BE IN TOWN AND
EVERYONE SORT OF HAD TO MOVE IT
IT AROUND.
I WOULD LIKE TO SEE YOU ALL AT
OUR NEXT CONFERENCE AND IT'S AN
IMPORTANT PART OF MARK'S CAREER
AND IT'S A PRIVILEGE TO BE YOUR
FRIEND AND COLLEAGUE FOR ALL
THESE YEARS.
THANK YOU.
[APPLAUSE]
>>THANK YOU SO MUCH, STEVE.
I WOULD LIKE TO ADD A QUICK
ANECDOTE TO HOW MUCH MARK SERVED
AS A ROLE MODEL IN THESE DIGITAL
MEETINGS WHEN I WAS AT HOPKINS
AND I WAS THE PERSON COMPLETING
ALL THESE DIFFERENT ENTITIES
BEING FORMER MARK FELLOWS NOT
AND I MODERATED THE FIRST
SESSION, THERE WAS A VERY
UNUSUAL SITUATION WHICH SORT OF
COME INTO THE FRIENDSHIP WHICH
IS GENERALLY THE CASE IN THESE
MEETINGS WHERE ONE SPEAKER
DESCRIBED HER WORK IN MPH AND
ONE OF OUR SENIOR MEMBERS STOOD
UP AND QUESTIONED WHETHER NPH
EVEN EXISTED AND SHE RAN OUT
CRYING AND THERE WAS A COMPLETE
MELTDOWN AND I WAS THE MODERATOR
AND I'M LIKE, WHAT DO I DO NOW
SO MARK SAVED THE DAY.
HE STOOD UP AND HE EXPLAINED
THAT MPH, THERE'S NO QUESTION
WHETHER IT EXISTS BUT WHETHER
WE'RE OVER DIAGNOSING IT AND
CALMED THE MOOD AND KIND OF PUT
IT BACK TO THE TRACK OF
FRIENDSHIP AND COLLEGIALITY AND
SO I LEARNED A GREAT DEAL AS TO
HOW TO BE PRESENT AND HOW TO
HANDLE A CHALLENGING SITUATION
LIKE THAT WAS AND SO THANK YOU,
MARK, FOR ALL THAT GUIDANCE AND
BEING A ROLE MODEL.
AND SO NOW, WE WENT FROM
INTERNATIONAL AND GLOBAL
EDUCATIONAL COVERAGE TO REGIONAL
AND THEN WE GO BACK TO
INTERNATIONAL AND Dr. PATTAMON
WILL TELL US MORE ABOUT THE
EDUCATION ROLE OF MOVEMENT
DISORDERS.
>>THANK YOU, VERY MUCH.
THIS IS MY GREAT HONOR TO BE
HERE TODAY TO ENJOY THE
RETIREMENT CELEBRATIONS.
I'M A FORMER FELLOWS AT HMCS IN
2014-2016 FROM BANGKOK,
THAILAND.
I'M VERY HAPPY TO TALK ABOUT
Dr. HALLETT CONTRIBUTIONS TO
THE INTERNATIONAL EDUCATION OF
MOVEMENT DISORDERS.
THIS IS I PICTURE I TOOK WHEN I
FIRST CAME TO THE CLINICAL
CENTERS IN MAY OF 2014.
I WAS SURPRISED TO SEE THE
CANADIAN GOOSE IN FRONT OF THE
BUILDING SINCE NIH IS LOCATED
WHERE CAPITOL CITIES.
O I WALKED INTO THE BUILDING 10
AND TRIED MY BEST TO FIND THE
HMCS LAB AND EVEN KNOWS, IT
TAKES A WHILE TO FIND YOUR ROOM.
I THINK ALL INTERNATIONAL
FELLOWS, WHO ARE INTERESTED IN
NEW MOVEMENT DISORDERS MIGHT
READ THIS HAND BACK BECAUSE I
READ IT IT AND I HAVE YOU AS
INSPIRATIONS AND THEN I LOOK
INTO THE WEBSITE NIH AND I FOUND
THAT I CAN LEARN DIRECTLY FROM
YOU, IN THE RESEARCH FELLOWSHIP
PROGRAM.
SINCE MOVEMENT DISORDER
FELLOWSHIP PROGRAM HAS BEEN IN
THE EARLY 1980s, MORE THAN 100 0
INTERNATIONAL FELLOWS OVER ALL
OVER THE WORLD AND HAVE TIME TO
TALK ABOUT EVERYBODY BUT I AM
GOING TO MENTION THE ONES HERE
TODAY.
WE ARE NOW PROFESSOR WHO JUST
TALKED VERY GREAT TALK IN THE
TREMORS SO I GOOGLE AND I FOUND
THAT HE IS A FORMER FELLOWS IN
1991 TO 1992 AND HE IS FROM EEN
SO EVERYONE THAT HIS MAIN
CONTRIBUTIONS TO THE WORLD ARE
CLINICAL AND TREMOR AND IN NEURO
MODULATIONS.
MOVING TO THE AMERICAN AND PAN
PACIFIC CONTINENT PROFESSOR CHAN
HERE TODAY AS WELL, WAS TRAINED
BY Dr. HALLETT DURING 1995 TO
1998 AND HE BUILT A LAB IN
TORONTO, CAN AND MADE IT IT
FAMOUS IN THE WORLD OF DISORDERS
AND IN 2014 AND 2016 I MET MANY
HERE AND CAREEN WHO ARE NOW VERY
ACTIVE IN THE MDS TASK FORCE AND
FUNCTIONAL DISORDER AND GOING TO
THE EASTERN PART OF THE WORLD,
IT'S A WORLD FAMOUS NEUROLOGIST
SO HE ONCE WORKED WITH Dr.
HALLETT.
IN 2003 AND 2005 AND EVERYONE
READS A ARTICLE ABOUT POTENTIAL
AND WRITTEN BY THE PROFESSOR AND
THAT I AM SPARED US AND LET US
LEARN A LOT ABOUT MOVEMENT IN
FROM ASIA IS USED AND SO I HAVE
HEARD A LOT ABOUT YOU AND THAT
BECAUSE YOU ARE FORMER FELLOWS
BEFORE I CAME TO NIH BUT I KNOW
THAT
ARE ACTIVE IN THE MDS-AOS AND
WHAT WE HAVE LEARNED AS A
FELLOWS I'M SURE THAT WE'VE
LEARNED CLINICAL SKILLS IN
MOVEMENT DISORDERS AND WE HAVE
CLINICS FOR GENERAL MOVEMENT
DISORDERS AND THEY PRESENT DISK
AND WE'RE IMPRESSED HOW Dr.
HALLETT HAD INFORMATION OR HIS
WAY WITH INTO AND OTHER THAN
THAT WE CAN SEE THAT YOU HAVE A
I MOVEMENT DISORDER SPECIALIST
BUT YOU STILL MEET THE GENERAL
NEUROLOGICAL EXAM BEAUTIFULLY
AND I'M VERY IMPRESSED.
EVERYONE CAN DISCUSS AND MAKE A
COMMENT IN OUR
CASE THAT'S WHY WHY WE CAN LEARN
A LOT OF EXPERIENCE IN THE
CLAIM.
AND AS PROFESSOR MENTIONED THEY
CAN PARTICIPATE IN THE ASPEN
COURSE AND OTHER THAN WE GET TO
KNOW EACH AND WE HAVE A BICYCLE
COURSE TOGETHER ALONG A
BEAUTIFUL VIEW OF COLORADO.
WE HAVE LEARNED A LOT OF
RESEARCH SKILLS FROM Dr.
HALLETT.
NOT ONLY HOW TO USE THIS FANCY
EQUIPMENT, AND AT FIRST I DIDN'T
KNOW WHY WE HAD TO HAVE A
MEETING EVERY WEDNESDAY BUT NOW
I APPRECIATE THAT WE CAN HELP
EACH OTHER TO FOLLOW-UP AND
RECOGNIZE PROBLEMS AND RESOLVE
TMS ARE THE MAIN EQUIPMENT FOR
STUDYING CLIP CALF MOVEMENT
DISORDER HERE AND I DIDN'T KNOW
ANYTHING ABOUT THESE THINGS
BEFORE I CAME TO THE NIH.
O SO, I STARTED TO BE A SUBJECT
FIRST AND I CAN CONDUCT MY OWN
PROJECT.
THIS IS WHAT WE LEARNED AND HOW
TO START FROM THE BEGINNING.
AND THEN YOU CAN DO IT.
Dr. HALLETT TEACHES HOW TO
PERFORM TREMOR STUDY AND WE CAN
APPLY THIS TECHNIQUE WHEN WE GO
BACK TO OUR COUNTRY AND BUILD
OUR OWN LAB FOR CLINICAL
RESEARCH.
WE ALSO LEARNED HOW TO PERFORM
EGG AND BACKGROUND IMAGING AND
THE RESULT AND I THINK OF THE
PRINCIPLE AND TECHNIQUE HELPS US
A LOT TO DIAGNOSE COMPLICATED
MOVEMENT DISORDERS AND
FUNCTIONSAL IMAGING IS FOR DOING
RESEARCH HERE AND MOST FELLOW
HAVE THE OPPORTUNITIES TO
PERFORM MRA AND USE TECHNIQUE TO
ANALYZE THE DATA AND EXPORT
PATHO PHYSIOLOGIES OF MOVEMENT
DISORDERS AND I ALSO LEARNED TO
PERFORM AND DO THE SCALE HERE
AND I APPRECIATE I CAN DO IT.
THE MOST IMPORTANT THING IS WE
LEARN HOW TO WORK AS A TEAM.
YOU CAN SEE THAT WE'RE
INTERNATIONAL TEAM.
FELLOWS ARE FROM MANY COUNTRIES.
TEAMWORK CAN CREATE GREAT WORKS,
EDUCATIONAL ENVIRONMENTS AND
MAKE YOU BECOME A BETTER PERSON
WHEN YOU CAN BE PART OF A
SUCCESSFUL TEAM.
WE ALSO WENT TO THE PARK AND WE
CAN BRING OUR FAMILY MEMBERS TO
ENJOY OUR GROUPS AND THAT MAKES
US FEEL LIKE WE ARE NOT ONLY A
COLLEAGUES BUT WE ARE A FAMILY
OF HMCS.
AND Dr. HALLETT IS A GREAT
MENTOR AND EVERYONE KNOWS THAT
HIS DOOR IS ALWAYS OPEN YOU AND
YOU KNOCK ON THE DOOR AND ASK
ANY QUESTIONS.
WHEN WE SEE EACH OTHER IN THE
CONFERENCE AFTER, WE FINISH OUR
FELLOWSHIPS, HE ALWAYS SUPPORTS
US.
YOU CAN CONSULT AND ASK FOR HIS
OPINION.
HE ASKS ABOUT YOUR LIFE OUTSIDE
YOUR WORK AS WE.
HE RECEIVED MANY LIFETIME
ACHIEVEMENT AWARDS AND BECOMES A
TOP SCIENTIST IN NEURO SCIENCE
IN THE WORLD.
HE CAN ENHANCE OUR
OPPORTUNITIES.
CAREEN, WHO IS WITH US TODAY
TOO, SHE RECEIVED JUNIOR AWARD
IN 2016 FROM THE WORK SHE'S DONE
IN FELLOWSHIP PROGRAMS AND SARAH
RECEIVED THE LEADERSHIP AWARDS
AS WELL.
AS INTERNATIONAL FELLOWS, WE GET
A LOT OF FRIENDSHIP, NETWORK AND
COLLABORATORS FROM ALL OVER THE
WORLD.
AND OUR NETWORKS CAN BE ENHANCED
OUTSIDE THE NEUROLOGY WORLD SO
INCLUDING OUR DOCTORS, AND
NURSES AND SO ELAINE IS WITH US
TODAY SO I APPRECIATE YOUR HELP
WHEN I WAS A FELLOW.
AND WE ALSO HAVE AN OPPORTUNITY
TO WORK WITH YOUNG COLLEAGUES.
THEY ARE NOW GRADUATED FROM THE
MEDICAL SCHOOLS AND THEY HAVE
BEEN TRAINING AS A RESIDENT.
I THINK WE OBTAIN STILL AS A
MENTOR AND WE CAN THESE FOR
MENTORING OUR STUDENTS AND YOUNG
MEMBERS IN OUR GROUP.
AND MORE OVER, I'M VERY HAPPY
THAT I HAVE A RESEARCH BUDDY,
SOFIE, AND WE HELP EACH IN
EVERYTHING BESIDES RESEARCH AND
WE ARE BEST FRIENDS.
DOING RESEARCH WITH A FRIEND IS
WARM AND FUN.
WHEN YOU ENJOY WHAT YOU ARE
DOING, YOU CAN DO YOUR BEST.
AND I ALSO ENJOY EXPERIENCING
FOUR CEASE ON AT NIH BECAUSE IN
THAILAND, WE JUST HAVE ONE
SEASON, HOT SEASON.
NO FOUR SEASONS AT ALL.
AND I ALSO APPRECIATE THAT IN MY
OF EXPERIMENT APPROXIM IN THE NY
REGIONS.
Dr. HALLETT TAUGHT US TO BE
SIMPLE, HUMBLE, KIND AND LOVE
WHAT YOU ARE DOING.
AND WE'VE PROMISED THAT WE WILL
CONTINUE TO DO RESEARCH AND
CONTRIBUTE TO THE WORLD.
THANK YOU, VERY MUCH.
[APPLAUSE]
>>THANK YOU SO MUCH, FOR THAT
INSPIRING, WONDERFUL OVERVIEW
AND SO WE HEARD PLENTY OF Dr.
HALLETT'S INTERNATIONAL IMPACT
ON MOVEMENT DISORDER EDUCATION
AND WE HEARD ABOUT THE ASPEN
COURSE AND NOW LET'S COMBINE AND
HEAR ABOUT ASPEN AND INDIA FROM
Dr. PANDEY.
>>VERY GOOD AFTERNOON AND IT
WAS REALLY INSPIRING TALK FROM
MY COLLEAGUE FROM THAILAND AND I
WAS ASKED TO SUGGEST A TITLE FOR
THE TALK AND ONE OF MY FELLOWS
SAID THAT THIS CAN BE THE BEST
TITLE FOR MARK HALLETT.
MARK'S MARKS ARE EVERYWHERE.
I THINK THIS JUSTIFY HOW HE HAS
BEEN TRAINING THE FELLOWS ALL
OVER THE WORLD.
AND WE ARE REALLY PROUD OF THAT.
SO, MY FIRST INCOMPETENTER INTEK
HALLETT I WAS DOING RESIDENCY IN
INDIA AND I WAS ASSIGNED TOPIC
TO DO A VISUAL IN PATIENT AND WE
WROTE THIS PAPER AND SUBMITTED
IT IT TO THE NEURO PHYSIOLOGY
AND Dr. HALLETT WAS THE EDITOR
OF THIS JOURNAL.
THE FIRST DRAFT THE STANDARD WAS
HIGH AND HE WROTE BACK TO US,
LOOK, IT'S VERY HIGH AND DO YOU
THINK THAT THIS WOULD BE
CONSIDERED?
THEN I OF CALLED AND OF DID THE
VOLUNTEERS AND I REALLY SAW THAT
THE STANDARD IS IS REALLY HIGH
AND WE SENT THE MANUSCRIPT AND
THIS WAS ACCEPTED.
I KNOW HOW MEDICAL Dr. HALLETT
IS AND THEN I GOT AN OPPORTUNITY
TO DO A FELLOWSHIP AT NIH, WHICH
WAS SPONSORED BY DEPARTMENT OF
BIOTECH LOGICAL OF INDIA AND
DURING THE FELLOWSHIP I LEARNED
SO MANY THINGS.
LIKE, APART FROM DOING THE
CLINICAL PHYSIOLOGY AND THE
MOVEMENT DISORDER TRAINING.
HOW DO I INTERACT WITH THE
PEOPLE AND Dr. HALLETT AND A
VERY GOOD FRIEND, APART HAVE A
VERY GOOD MENTOR.
HE IS A VERY GOOD FRIEND.
HE KNOWS HOW TO UP LIFT ANYONE.
HE KNOWS HOW TO MENTOR ANYONE.
AND HE ALWAYS USED TO INTERACT
AND MAYBE THERE WAS A ANNUAL
PARTY EVERY YEAR AND MOST OF THE
FELLOWS WHO HAVE BEEN TRAINED
AND HE KNOWS THAT HE HAS A VERY
PERSONAL TOUCH WHILE HE
INTERACTS WITH THE FELLOWS.
AND THIS IS THE PHOTOGRAPH, THIS
IS THE LAST PHOTOGRAPH HE HAS
BEEN GIVING A FAIR BIT TO ME AND
HE WAS CLEAR AND CONSCIOUS THAT
I AM A VEGETARIAN AND I REMEMBER
I WENT TO HIS HOUSE A COUPLE OF
TIMES AND HE WAS VERY METICULOUS
ABOUT THAT AND THAT VEGETARIAN
FOOD IS SERVED.
SO HE TAKES CARE OF EVERY SMALL
THINGS WHATEVER HE DOES.
COMING TO SOME INTERESTING
CASES, SO, I GOT AN IT
OPPORTUNITY TO SEE IN CLINICS
AND I WILL JUST POINT TWO CASES.
THE FIRST CASE WHERE THE POST
TRAUMATIC SHOULDER DIS MOVEMENT
DISORDER OF THREE CASES AND YOU
CAN SEE THIS PATIENTS WAS A
16-YEAR-OLD FEMALE PATIENT AND
SHOULDER MOVEMENT ON THE RIGHT
SIDE AND WE HAD A GREAT TIME
DECIDING IF IT WAS DYSFUNCTIONAL
AND THE PATIENT IS DOING THE
LEFT HAND IT'S NOT MOVING FROM
IT'S NOT DISAPPEARING AND IT WAS
DIFFICULT TO DIFFERENTIATE.
THEN, THE SECOND PATIENT, A
YOUNG PATIENT, 17-YEARS-OLD
FEMALE, AND HEMIDYSTONIA AND IT
WAS THE EYE-OF-THE-TIGER SIGN
BUT IT WAS ONLY ON ONE SIDE AND
WHEN THE EYE IMAGES WERE DONE,
IT WAS SHOWING INFARC SO IT WAS
NOT THE EYE OF THE TIGER SIGN
BECAUSE OF SOME NEURO METABOLIC
CONDITION BUT BECAUSE OF THE
POST DISORDER AND SUBSEQUENTLY
WE'VE BEEN WORKING A LOT ON
MOVEMENT DISORDER AND MUSCULAR
SKELETAL DISORDER AND TAKING
MOVEMENT FROM THIS PATIENTS AND
TAKING IT FROM THIS PATIENTS WE
HAVE THE MOVEMENT DISORDER STUDY
GROUP AND I GIVE ALL THE CREDIT
TO Dr. HALLETT WHO GENERATED
THE INTEREST AND WORKING IN THIS
HAD.
Dr. HALLETT IS VERY METICULOUS
AND THERE WAS A ANNUAL
PHOTOGRAPH HERE AND I'VE SEEN SO
MANY THIS MORNING SO, BEFORE HE
TAKES THE ACTUAL PHOTOGRAPH, YOU
CAN SEE HE TAKES A PICTURE OF
MAYBE JUST BEHIND THE BUILDING.
HE GOES AND SEE IF THE PICTURE
OR NOT AND THEN HE SITS AROUND
AND ALL THE FELLOW JOINS AND
IT'S BEEN.
SO HE IS SO METICULOUS.
HE PLANS PROGRAMMING HAPPENING
AND IT HAPPENS FOR THREE OR FOUR
DAYS.
HE GOES AT SEVEN IN THE MORNING
AND JUST DOES COMING ELSE AND
COMES BACK AND THEM HE DOES THE
ACTUAL PHOTOGRAPHING.
FOR MARK HALLETT TO INDIA IN
2003, HE CAME TO INDIA FOR THE
FIRST TIME AND IT WAS DURING THE
HE WAS IN INDIA WITH HIS FAMILY
MEMBER AND THIS IS A PHOTOGRAPH
OF IN 2003 AND ASPEN COURSE WAS
CONDUCTED IN INDIA SIX TIMES SO
Dr. JANKOVIC AND THE FIRST WAS
CONDUCTED IN 2003 IN OOTY A CITY
IN THE NORTH INDIA AND THERE WAS
A SECOND ASPEN COURSE IN GOA AND
I WAS FORTUNATE WITHIN THIS
THIRD COURSE AND IN 2010 AND IN
2011 AGAIN IN AGRA AND THE LAST
ASPEN COURSE WAS IN 2012 YOU CAN
SEE Dr. HALLETT, Dr. STANLEY
FAHN AND SO ASPEN COURSE WAS
GOING ON IN INDIA UNTIL 2012 AND
AFTER THAT IT WAS STOPPED.
AND MOVEMENT DISORDERS SOCIETY
OF INDIA WAS FORMED IN 2016 AND
WE HAD INVITED Dr. HALLETT TO
BE A PART OF THIS DURING THE
FIRST MEETING.
AND JUST BEFORE THE PANDEMIC
STRIKE, Dr. HALLETT VISITED
TWO MORE TIMES IN INDIA AND THIS
IS IN 2019 AND WE HAD A
TRADITIONAL INDIAN WELCOME AND
THIS IS 2020 THAT WAS IN THE
MOVEMENT DISORDER OF SOCIETY
INDIA MEETING.
THERE ARE MANY FOLLOW UPS AND
ONE OF THE FOLLOWING AND THEY
HAVE BEEN PRACTICING IN MUMBAI
AND SHE SEND HER KIND WORDS TO
Dr. HALLETT.
WITH A COUPLE OF PHOTOGRAPHS.
SHE REMINDED ME TO INCLUDE.
AND THIS IS THE PHOTOGRAPH OF
THE Dr. HALLETT AND SO SHE HAS
SENT HER KIND WISHES Dr.
HALLETT TO YOU AND I'M JUST
GOING TO CONVEY TO HER.
WE ALL HAVE BEEN PRACTICING
MOVEMENT DISORDERS ALL OVER THE
WORLD.
BUT INDIA MOVEMENT DISORDERS IS
A LITTLE DIFFERENT.
I WILL JUST SHOW HOW IT'S
DIFFERENT.
SO, THIS IS SPINAL SEBREE Y'ALL
DEGENERATION WITH SLOW EYE
MOVEMENTS.
IT'S THAT SLOW EYE MOVEMENTS.
IT'S JELLY-LIKE EYE MOVEMENT AND
THIS IS VERY CHARACTERISTIC
FEATURE AND IF YOU SEE FROM A
DISTANCE, THEY HAVE A LOT OF
TREMOR BUT THEY WILL BE
CLASSIFIED BECAUSE THEY HAVE A
LOT OF TREMOR AND THEY VERY MILD
ATEXI AND THOSE SEE WELL AND UP
WITH OF THE MOST CHARACTERISTICS
PICTURE OF THE PATIENTS IS THE
OVER ALL COMMUNITY.
THEY BELONG TO A SINGLE FAMILY
THAT COMMUNITY IS VERY RICH AND
THEY MARRY IN THE SAME COMMUNITY
AGAIN AND AGAIN AND THIS HAS
BEEN PREVALENT IN THIS
PARTICULAR FAMILY.
IT LOOKS LIKE PARKINSON'S.
HE HAS BEEN TAKING IT FOR THE
LAST 10 YEARS BUT HE IS
DIAGNOSED WITH PARKINSON'S
DISEASE BUT HE IS NOT A CASE OF
PARKINSON'S DISEASE.
AND THIS IS THE PATIENT WAS
PRESENTED IN LAST YEAR VIDEO
CHALLENGE AND THIS PATIENTS IS
AGAIN A CASE OF SCA12.
IF YOU SEE THIS PATIENT, HE HAS
A TREMOR AND WHEN TONY ASKED TO
COMMENT ON THIS HE THIS IS IS A
LITTLE NEW TERMINOLOGY BUT HE
SAID THAT THIS IS THE WAY I WILL
DEFINE THIS TREMOR IN THE
PATIENTS.
SO THESE ARE SCA12 PATIENTS AND
THIS IS UNIQUE COMING FROM IND
INDIA.
ANOTHER PREVALENT IS SEEN IN
POPULATION AND IT'S STILL IT'S
QUITE COMMONLY SEEN AND APART
FROM THE SYDENHAM CHOREA AND
THIS IS WILSON'S DISEASE HE WAS
DIAGNOSED FUNCTIONAL TREMOR AND
HE WAS MAYBE STRUGGLING FOR A
YEAR UNTIL HE VISITED OUR CLINIC
AND WE EXAMINED HIM AND HE WAS
VERY SUGGESTIVE OF WILSON'S
DISEASE THE PATIENT WAS PUT ON A
DRUG AND AFTER SIX MONTHS HE IS
MUCH, MUCH, BETTER.
SO, YOU CAN SEE.
I THINK VIDEO IS NOT PLAYING.
SO, HIS SYMPTOMS IMPROVED A LOT.
ANOTHER MOVE IS ORDER OF THIS IS
IS QUITE COMMON IN INDIA IS
SSPE.
AFTER THE MEDIAL AND THIS
PATIENT HAD SSPE AND HE WAS
PRESENTED SSPE PATIENTS AND -- I
DON'T KNOW BUT IT'S NOT PLAYING.
OK.
I WILL MOVE AHEAD.
SO -- I THINK IT'S FROZEN.
>>OVERLOADED THE MEMORY.
WE ARE LUCKY THIS IS THE FIRST
BLOCK OF THE DAY WE'RE ON TIME.
I DON'T KNOW WHETHER THIS IS
GOING TO CHANGE THAT.
SO THIS IS THE WILSON PATIENT
AND AFTER SIX MONTHS OF THERAPY,
HE HAS COMPLETELY IMPROVED AND
HIS TREMOR HAS GONE AND HE IS
DOING WELL AND THIS IS THE
PATIENT OF SSPE.
HE HAS A MOVEMENT VERY SIMILAR
TO THE LMR AND WHAT IS
INTERESTING ABOUT THIS PATIENT
IS THAT THE MOMENT YOU GO CLOSE
TO THE PATIENT, THESE HAND
MOVEMENT STOPS.
THEY'RE STILL TIGHT MOVEMENT AND
IT APPEARS.
SO, IT IT LOOKS LIKE A BUT THE
MOVE YOU GO CLOSE TO THE
PATIENT.
AND TRY TO MAKE A VIDEO, HIS
COMES INTO THE PICTURE SO YOU
CAN SEE HERE.
IT'S SSPE PATIENT.
ANOTHER IMPORTANT TREMOR IN OUR
COUNTRY IS BECAUSE OF A LARGE
VEGETARIAN POPULATION AND THEY
PRESENT WITH A LOT OF TREMORS
AND YOU CAN SEE THAT THE TREMOR
IS PRESENTED IN TONGUE, HEAD,
AND LIKE THE HAIR AND ALSO
GETTING A COURSE AND THEY
IMPROVED COMPLETELY WITH THERAPY
AND VITAMIN B12 THERAPY OFFERED
TO THE CHILD AND THE MOTHER AS
WELL BECAUSE MANY OF THEM ARE
LIKE POORLY BREASTFED AND THEY
HAVE A B12 DEFICIENCY THE MOTHER
AS WELL.
SO, I WILL JUST FINISH MY SLIDE
WITH THIS -- THIS IS THE FAMOUS
QUOTE FROM GIT A AND IT STANDS
ARE INFORM THE TEACHER THE
REMOVER OF DARKNESS AND THE HAR
BINGER OF ENLIGHTENMENT.
HE CLEARS SUN STANCE, KNOWLEDGE
AND THE DESERVES THE WEEDS OF
IGNORANCE.
I SALUTE SUCH A GURU.
THANK YOU FOR ALL THE KNOWLEDGE
YOU HAVE GIVEN US.
[APPLAUSE]
EL.
>>THANK YOU FOR BRINGING THE
FLAVOR OF THE MEETING WITH THOSE
VIDEOS.
THIS WAS THE LAST PRESENTATION
IN THE ONLY BLOCK TODAY THAT WAS
KEPT ON TIME.
AND THAT GIVES US A FULL 20
MINUTES OF COFFEE BREAK
>>WE ARE GOING TO START THE
NEXT SESSION AND ADDRESSING
FUNCTIONSAL DISORDERS AND FREE
WILL AND TO START US OFF, NOT
FORTUNATELY, OUR FIRST SPEAKER,
COULDN'T BE WITH US IN-PERSON
TODAY AND JOHN STONE FROM THE
UNIVERSITY OF HE H EDINBURGH WIL
SPEAK ABOUT THE CONTRIBUTIONS OF
MARK HALLETT IN THE TERMS OF
FUNCTIONSAL NEUROLOGICAL
DISORDERS.
>>THANK YOU SO MUCH.
YEAH, I'M VERY SORRY NOT TO BE
THERE WITH YOU.
U.K. DOESN'T COPE WELL WITH SNOW
AND ICE AS YOU PROBABLY KNOW.
EVERYTHING JUST SHUTDOWN SO I
COULDN'T, MY PLANE WAS CANCELED
SO SORRY NOT TO BE THERE BUT
I'VE REALLY ENJOYED FOLLOWING
THE LAST COUPLE OF SESSION OWNS
LINE AND I'VE NEVER BEEN YOUR
FELLOW BUT I FEEL LIKE I HAVE
SINCE I'VE KNOWN YOU THE LAST 13
YEARS AND I'M GREAT TO HEAR
ABOUT ALL THE OTHER THINGS
YOU'VE BEEN DOING.
MARK IS THE FIRST PRESIDENT OF
THE OND AND I'LL TALK ABOUT HIS
MANY CONTRIBUTIONS OF THE FIELD
OF FND AND IT'S WONDERFUL YOU
HAVE A SESSION ON IT HERE TODAY.
THIS IS RACHEL WITH FND AND HOW
DISABLING IT IS.
THIS IS RACHEL'S UNIVERSITY
STUDENT FOR ABOUT A YEAR AND YOU
CAN SEE SOME DYSTONIA.
>>IN AN IDEAL HEALTH SERVICE
ALL DOCTORS AND PROFESSIONALS WE
WOULD BE MADE AWARE THIS
MOVEMENT AND BEING TREATED AS
NOT SO IT'S NOT REAL AND THAT
DOESN'T REALLY HELP US BECAUSE
WE'RE THINKING, OH, WHAT IS
WRONG WITH ME?
>>SO, IN THE 1990s, IT WAS A
TRAINEE IN NEUROLOGY AND IN THE
U.K. AND MANY OF YOU IN THE ROOM
WILL REMEMBER THAT PERIOD AND
HOW FND WAS TREATED, IT WAS
INTERESTING TO HEAR THE COMMENTS
ABOUT THIS CONFIRMING THAT.
IT WAS A DISORDER, IF YOU ONLY
HAD THE NEUROLOGY TEXTBOOK YOU
WONDEWONDERED IF IT EXISTED BECE
THERE WASN'T ANYTHING TO READ
ABOUT IT.
FROM A PSYCHE RAT TRICK
PERSPECTIVE, THERE WAS A GENERAL
VIEW AROUND THAT NIP BEING
DIAGNOSED WITH FND, PROBABLY WAS
A WRONG DIAGNOSIS SO YOU CAN
IGNORE IT THAT WAY.
THAT'S NOT THE CASE.
IT WAS A DIAGNOSIS OF EXCLUSION
AND IT WAS VERY UNSATISFACTORY
AND PURELY PSYCHIATRIC DISORDER
AND IT WAS FOR WHICH YOU HAD TO
HAVE A STRESS AND MANY
NEUROLOGISTS SOLVED THEIR LACK
OF KNOWLEDGE ABOUT THE PROBLEM
THAT THE PATIENTS WERE MA
LINGERING AND IT WAS CONSIDERED
A LOT OF TIME THAT WE DIDN'T
NEED TO WORRY ABOUT THEM, IF
THEY'RE NOT MALINGERING SO
THAT'S WHERE WE WERE IN THE
1990s.
AT THAT STAGE I WAS DOING MY
PH.D AND MARK AND OTHERS HAD
ORGANIZED THIS MEETING.
WE STAYED UP LATE WATCHING
VIDEOS OF PEOPLE WITH WHAT WE
CALLED PSYCHEDELIC MOVEMENT
DISORDERS AT THE TIME.
IT WAS SO EXCITING FOR ME TO SEE
THAT VERY WELL KNOWN AND
RESPECTED LEADERS LIKE MY
COLLEAGUES WERE TAKING AN
INTEREST IN THIS AND I HAVE NO
DOUBT THAT WE WOULD NOT BE WHERE
WE ARE WITHOUT HIS LEADERSHIP AT
THAT VERY EARLY STAGE.
AND THIS BOOK AROSE FROM THAT
STILL AND IT'S AN EXCELLENT
BOOK.
THIS IS A PAPER THAT MARK WROTE
IN 2006.
IT'S A GOOD EXAMPLE OF GETTING
TITLES RIGHT BECAUSE IT'S BEEN
CITED A LOT.
IT'S A CRISIS FOR NEUROLOGY AND
REEL MAKING IT CLEAR THIS IS NOT
JUST SOME MINOR ISSUE, THIS IS A
MAJOR ISSUE FOR NEUROLOGICAL
PRACTICE THAT WE HAD IGNORED ALL
THESE PATIENTS AND HAD NOT DONE
RESEARCH AND DIDN'T KNOW WHAT TO
DO ABOUT THEM.
AND IT WAS INTERESTING REREADING
THAT FOR THIS TALK BECAUSE
YOU'VE, LIKE MANY OF MY
ARTICLES, AT THE TIME, YOU WERE
FOCUSING QUITE A LOT ON
PSYCHIATRIC AND EVEN THEN YOU
ARE SAYING WELL IN MANY CASES,
WE DON'T REALLY KNOW IF THAT'S
THE CASE AND SOME CASES THERE'S
NO CONDITION AND EVEN IF IT IS
ALL, IF YOU CONSIDER IT IT
PSYCHIATRIC, THERE'S BASIC
QUESTIONS JUST NEEDING TO BE WE
HAD REALLY.
AND THEN MOVING ON FROM THE
ATLANTA MEETING, MARK ORGANIZED
WITH COLLEAGUES HERE THAT YOU
CAN ALL SEE AND NAMED A
SUBSEQUENT BOOK A BRILLIANT
CONFERENCE IN WASHINGTON, THIS
TIME ABOUT FOLKS WITH DISORDERS
AND EXPANDING INTO OTHER AREAS
OF FND AS WELL THIS WAS TAKE EP
BY THREE FELLOWS WHO DID AMAZING
WORK IN FND, CAREEN YOU WILL
HEAR FROM AND VALERIE AND YOU
WILL ALSO HEAR FROM AND THIS WAS
THE ROYAL COLLEGE OF PHYSICIANS
AT THE OPENING EVENT AND IN 2017
AND I JUST THOUGHT I WOULD RUN
VERY QUICKLY THROUGH SOME OF
MARK'S CONTRIBUTION TO FND AND
THEY'RE VERY WIDE AND COVERED
DIAGNOSIS AND MECHANISMS AND
TREATMENT AND JUST A FEW
HIGHLIGHTS REALLY.
I THINK PARTICULARLY THIS EARLY
STUDY IN NEUROLOGY ON EX SELL
ONLY TREE DIS TIP ISSUING
FUNCTIONAL FROM OTHER TYPES OF
TREMOR JUST POINTING OUT WHAT A
USEFUL TEST THE TREATMENT OR
TEST IS PROVIDING SOME OF THE
SUPPORT FOR THAT TEST AS WELL
AND THE WHACK A MOLE SCIENCE AND
OTHERS YOU WILL BE FAMILIAR
WITH.
YOU WILL HEAR ALL ABOUT BRAIN
MECHANISM AND FND SO I'LL LET
CAREEN AND VAL TELL YOU ABOUT
THOSE AND I'M A PARTICULAR FAN
OF THIS ONE, VAL, ON THAT YOU
DID IN NEUROLOGY AND LOOKING AT
PATIENTS WITH FUNCTIONAL TREMOR
COMPARING IT TO THEIR OWN
SIMULATED TREMOR I THOUGHT IT
WAS BRILLIANT AND FINDING
PROBLEMS WITH AGENCY NETWORKS
AND REALLY LIKE YOUR STRUCTURAL
STUDY CAREEN ON GRAY MATTER
DIFFERENCES.
AND OTHER PAPERS ON
CLASSIFICATIONS.
WE'VE GONE IN DIFFERENT
DIRECTIONS WITH STRESS AND
CORTISOL AND RESTING VALLE TONE
AND THIS PAPER HERE, ON
GENETICS.
OF COURSE IT IS IS HAPPENING IN
THE BRAIN, WHAT OTHER ORGAN WILL
IT BE.
OF COURSE IT WILL HAVE SOME
AGAIN ET AGAIN ET GENETIC COMPOS
ASKED TO WRITE A VE VIEW AND WE
WROTE IT WITH COLLEAGUES YOU CAN
SEE AND HE IS GOING TO BE THE
NEXT PRESIDENT AFTER OF FNDS AND
JEFF STAR AND QUITE A TORTURE US
PROCESS AND I'M SURE HE WILL
AGREE, MARK, GETTING THAT OVER
THE LINE AND THE NEUROLOGY AND A
PAPER REALLY THAT IS BRINGING IN
COGNITION AND DIZZINESS INTO THE
UMBRELLA OF FND REALLY IN TERMS
OF SHARED MECHANISMS AND
TREATMENTS.
AND I'M THINKING ABOUT A
TREATMENT AGAIN TO REALLY
INTERESTING STUFF HERE ABOUT
INTIMATE AND STIMULATION AND AND
PSYCHIATRIC PERSPECTIVE AS WELL
SO A REALLY WIDE AND IMPORTANT
CONTRIBUTION AND I THINK
PERSONALLY I THINK THE IMAGE IN
CONTRIBUTION IS THE BEST OF ANY
GROUP ANYWHERE THUS FAR IN FND.
BUT I SUPPOSE IT'S FOR ME, IT IS
THE MOST SINGULAR CONTRIBUTION,
MARK, IN THE FIELD BECAUSE IN
2014 OR 2015, I GOT A MESSAGE
FROM MARK TO SAY WOULD I HELP
HIM EDIT THIS HANDBOOK OF
NEUROLOGY AND MOST OF YOU WILL
KNOW THAT THIS IS A VEN NER ABLE
SERIES IN NEUROLOGY AND GOING
BACK TO 1968.
THEY NEVER HAD A VOLUME ON FND,
DESPITE THAT VERY LONG HISTORY.
SO, IT WAS FANTASTIC TO BE ABLE
TO HELP EDIT WITH MARK AND MY
COLLEAGUE HERE.
BRINGING TOGETHER ALL OF THESE
DIFFERENT AREAS OF FND AND
INCLUDING THINGS LIKE AUDITORY
PROBLEMS AND VISH TORI PROBLEMS
AND DIZZINESS AND THINGS THAT
HAVEN'T BEEN BROUGHT TOGETHER
FOR A VERY LONG TIME.
AND WE NOW HAVE A MODEL OF FND
WHICH SO MUCH MORE SOPHISTICATED
THAN THE ONE THAT WE WERE
GRAPPLING WITH 15 YEARS AGO.
AND WE DO INCLUDE STRESS AND
ADVERSITY AND PSYCHOLOGICAL
DISTRESS BUT ALSO HAVING ANOTHER
NEUROLOGICAL CONDITION AND
SOMETIMES THERE'S NO
VULNERABILITY AND WE'VE
RECOGNIZED, AS THEY WELL 100
YEARS AGO, ACTUALLY HAVING SOME
KIND RECOGNIZED
PATHOPHYSIOLOGICAL EVENT OR AN
INJURY OR INFECTION OR PSYCHO
PHYSIOLOGICAL EVENT, SUCH AS
PANIC ATTACKS, WERE VERY
IMPORTANT TRIGGERS AND HELPED US
UNDERSTAND WHY PEOPLE GOT
CERTAIN KINDS OF SYMPTOMS.
AND YES, HERE IS THE BRAIN IN
THE MIDDLE, OF COURSE, AND YOU
WILL HEAR MORE ABOUT THAT SOON.
BUT WE'RE REALLY USING
PREDICTIVE PROCESSING MODELS OF
THE RAIN TO UNDERSTAND FND AND
SO IT'S A DISORDER THAT SHOULD
EXIST REALLY IF YOU BELIEVE IN
THE PREDICTIVE PROCESSING MODELS
AND FEED FORWARD AND FEEDBACK,
LEAPS, ET CETERA.
IT OFTEN OBSCURE THE UNDER LINE
MECHANISMS AND PROBLEM ARE PART
OF THE CONDITION IN MANY CASE
AND MANY PERPETUATING FACTORS,
PARTICULARLY THE HEALTHCARE
SYSTEMS THAT WE ALL WORK IN
WHICH WHERE HEALTHCARE AS I
POINTED OUT, THEY HAVE NOT BEEN
SET UP, TRAINED TO DEAL WITH
THIS VERY COMMON PROBLEM THAT
THEY SEIZE BUT WE'RE OPTIMISTIC
THAT THIS IS A DISORDER THAT CAN
BE TREATED LIKE ANY OTHER WHEN
PEOPLE LEARN ABOUT IT.
SO, IT WAS REALLY MARK THAT
DROVE THAT HANDBOOK AND THE
HANDBOOK BROUGHT THE FIELDS
TOGETHER IN A REALLY
UNPRECEDENTED WAY AND MARK DROVE
THIS MEETING THAT WE HAD IN
EDINBURGH AND WE HAD A MEETING
AND A GREAT TIME OVER THREE DAYS
AND AS A CONSEQUENCE DECIDED WE
NEEDED TO FORM AN INTERNATIONAL
SOCIETY AND YOU CAN SEE US
HAVING OUR KNEES UP HERE.
SO MARK'S FIRST PRESIDENT OF
THAT SOCIETY AND FOR THE LAST
FEW YEARS, THIS IS MOSTLY HOW
I'VE SEEN YOU, M., ON ZOOM AND
HOPEFULLY WE CAN MEET UP
IN-PERSON BUT I'M AMAZED HOW
EFFICIENTLY YOU HAVE RUN THESE
MEETINGS.
I KNOW WHETHER YOUR INBOX IS A
ZERO INBOX WITH NOTHING ON IT.
MINE HAS DOZENS OF THINGS I
HAVEN'T DONE BUT YOUR EFFICIENT
SEIZE AND ORGANIZATION IS
LEGENDARY AND I REALLY HOP
EVIDENTLY DON'T THINK THIS IS
SOCIETY WOULD EXIST WITHOUT YOU.
SO, WE HAD A FOURTH MEETING IN
BOSTON, THIS JUNE, AND AFTER
LOTS OF PLANNING, BOSTON
UNIVERSITY.
APART FROM THE FACT MARK
COULDN'T COME, IT WAS
SUCCESSFUL.
HE WAS DETAINED AGAINST HIS
WILL.
HERE HE IS STARTING HIS
PRESIDENTIAL ADDRESS AND SO WE
HAD TO HAVE A DINNER WITHOUT
HIM.
DURING THAT TERM MARK WAS THIS
BECAUSE HE WAS GUIDING US AROUND
BY FACE TIME AND THAT WAS THE
FACULTY DINNER, THERE'S MARK
DOING THE TOUR EVEN THOUGH HE
COULDN'T BE THERE.
AND SO IT WAS A REALLY GREAT
EVENT.
AND WE'RE HAVING OUR NEXT
MEETING IN VERONA IN 2024.
I'M DELIGHTED THAT MARK,
ALTHOUGH HE IS RETIRING FROM NIH
THAT HE IS CONTINUING TO WORK
WITH THE FNDA AS CHAIRMAN OF THE
PROGRAM COMMITTEE AND THIS IS A
MEETING OF THAT JUST VERY
RECENTLY AND LIKE ALL SOCIETY,
INTERNATIONAL MEETINGS IT'S NOT
JUST THE MEETING IT'S ABOUT ALL
THE THINGS THAT HAPPENS BEFORE
AND AFTER ALL THE CONNECTIONS
THAT ARE MADE HUGE NUMBERS OF
THINGS GOING ON IN THE FND
RESEARCH AND CLIP CAL COMMUNITY
INCLUDING LOTS OF GLOBAL
INITIATIVES AND SO I THINK IT'S
WORTH REFLECTING BACK TO HOW
THINGS HAVE CHANGED, BECAUSE
THIS IS THIS IS THE SLIDE I PUT
UP EARLIER.
FND DISORDER THAT DOESN'T EXIST
AND WHERE THE DIAGNOSIS IS
PROBABLY WRONG THIS IS A COMMON
DISABLING CONDITION THAT A EARS
IN TEXTBOOKS AND THE DIAGNOSIS
IS MADE RELIABLY AS ANY OTHER
AND IT'S A DISORDER THAT PEOPLE
TALK ABOUT IT BEING INTERFACE
AND PROBABLY A DISORDER THAT
HELP US APPRECIATE AND WE
SHOULDN'T HAVE THOSE CATEGORIES
AND I THINK IT'S THAT PROFOUND
AND WE KNOWS THAT PATIENTS ARE
NOT SHARDLY MALINGERING AND
TREATMENT IS NEEDED AND THREE
RANDOMIZED CONTROL TRIALS HAVE
SHOWN IT CAN HELP MANY PATIENTS.
IN 2030 IS THE CRISIS AND THE
CRISIS IS NOT YET RESOLVED AND
WE STILL HAVE MANY PATIENTS FOR
HIM TO DIAGNOSE AND IT'S NOT
CERTAIN AND FOR WHOM WE DID NOT
HAVE TREATMENT.
THE PROGRESS AND
MULTI-DISCIPLINARY TEAMS AND I'M
PECK ENCOURAGED THAT IN THE
LAST, JUST IN THE LAST COUPLE OF
YEARS, THEY HAVE MANAGED TO GET
NND INTO THE AS A CORE TOPIC
WHERE IT'S BEEN VERY PERIPHERAL
SO I REALLY HOPE THAT THAT WILL
TREND WILL SPREAD OVER THE WORLD
SO THANK YOU, M., FOR EVERYTHING
YOU'VE DONE FOR FND AND I TOOL
HAPPY YOU'VE BEEN ABLE TO MOVE
US IN THIS AMAZING DIRECTION
THAT WE'RE GOING IN AND IT'S AN
HONOR TO BE ABLE TO INTRODUCE
THIS SESSION HERE AND YOUR
RETIREMENT.
YOU ASK SEE THAT WE'RE TWO
KNEWOLOGIST EXAMINES TWO
PSYCHIATRISTS IN A
MULTI-DISCIPLINARY TEAM.
SO, THERE'S GOING TO BE A LITTLE
BIT OF OVERLAP BETWEEN MY TALK
AND THAT OF JON STONE BUT
HOPEFULLY IT WILL SERVE TO SEM
ENTERCEMENT THE HUGE IMPACT MARK
HALLETT HAS HAD ON THE FIELD OF
FUNCTIONAL MOVEMENT DISORDERS
AND I'M REALLY PLEASED AND
REALLY HOPPERED TO BE GIVEN THE
OPPORTUNITY TO SPEAK TODAY AT
THIS CELEBRATION HONORING THE
WORK OF MARK.
JON HAS INTRODUCED THE TOPIC OF
FUNCTIONAL NEUROLOGICAL
DISORDERS AND THIS IS A TOPIC
THAT I'M SURE MANY OF YOU IN THE
AUDIENCE ARE FAMILIAR WITH SO
INDIVIDUALS WHO PRESENT WITH A
LOT ERT VOLUNTARY MOTOR OR
SENSORY FUNCTION AS PER DSN WITH
ANOTHER NEUROLOGICAL CONDITION
THAT CAUSES SIGNIFICANT CLINICAL
DISTRESS FOR THE PATIENTS WHO
ARE IMPACTED.
SO THIS PAPER SHOULD BE FAMILIAR
FOR ALL OF YOU AND AFTER JOHN'S
TALK, SO WE KNOW THAT DESPITE
THE FACT THESE PATIENTS PRESENT
TO NEUROLOGY CLINICS, IT WASN'T
UNTIL VERY RECENTLY THAT THEY
HAVE RECEIVED THE ATTENTION THAT
THEY DESERVE AND REALLY IT WAS
MARK HALLETT WHO IS UP WITH OF
THE PIONEERS AND THE FIELD WHO
RECOGNIZES WHAT HE PENNED AS
THIS CRISIS WITHIN FUNCTIONAL
MOVEMENT DISORDERS 15 YEARS AGO.
THIS STEMMED FROM THE LARGE
NUMBER OF PATIENTS PRESENTING TO
THE HIS WORK IS CRITICAL
ADDRESSING THIS CRISIS WITHIN
NEUROLOGY AND THROUGH OUGHT
COMBINATION OF KEY KEEN CLINICAL
OBSERVATIONS AND AS THAT HELP US
TO, ALONG WITH
NEUROPHYSIOLOGICAL AND
NEUROIMAGING TOOLS THAT HAVE
CONTRIBUTED TO ADVANCES IN OUR
ABILITY TO MAKE THE DIAGNOSIS TO
BETTER UNDERSTAND THE PATH OF
PHYSIOLOGY AND ULTIMATELY TO
RESULT IN ADVANCING OF THE
TREATMENT OF THIS CONTINUE WHICH
IS COMMON AND QUITE DISABLING TO
MANY.
BUT IN PARTS SECONDARY TO WORK
FROM MARK, FUNCTIONAL MOVEMENT
DISORDERS IS RECOGNIZED AS A
DIAGNOSIS OF INCLUSION AS JON
STONE STATED DIAGNOSED ON THE
BASIS OF POSITIVE CLINICAL
SCIENCE AND WORK FROM MARK'S LAB
HAS BEEN AND FROM MARK'S CLINIC
HAS BEEN INNS MENTAL IN DEFINING
A NUMBER OF THESE CLINICAL SIGNS
AS WELL AS PROMOTING THE USE OF
THESE POSITIVE CLINICAL SIGNS.
THE HALLETT LAB HAS BEEN ONE OF
THE LEADERS IN THE FIELD IN
TERMS OF ADVANCING THE
NEUROPHYSIOLOGICAL TOOLS THAT
ALLOW US TO UNDERSTAND THE
UNDERLYING PHYSIOLOGY AS WELL AS
TO AID IN THE DIAGNOSIS OF
FUNCTIONAL MOVEMENT DISORDERS.
AND SO INSTRUMENTAL IN THE
APPLICATION OF THESE NEURO
PHYSICAL' LOGICAL TOOLS
INCLUDING THE TREMOR STUDIES,
SHOWN HERE IS THE IT TEST WHEN
TAPPING THE TREMOR IN THE NOT
EFFECTED EXTREMITY CAN BE SEEN
TO ADOPT THE FREQUENCY OF A
CONTRA LATERAL TAPPING HAND.
Dr. HALLETT HAS ALSO BEEN A
LEADER IN THE APPLICATION OF EEG
BACKAVERAGING AND THE CONCEPT OF
A BEREITSHAFTSPOTENTIAL FOR A
MOVEMENT THAT USES VOLUNTARY MOT
ARE PATHWAYS SO THIS HAS
DEMONSTRATED MOVEMENTS IS SUCH
AS FUNCTIONAL USED VOLUNTARY
MOTOR PATHWAYS DESPITE THE FACT
THAT WE KNOW THAT PATIENTS
EXPERIENCE THE MOVEMENTS AS I AM
VOLUNTARY AND IT IN ADDITION TO
HELPING TO BETTER UNDERSTAND THE
PATHO PHYSIOLOGY THIS ALSO CAN
SERVE AS A VERY USEFUL CLINICAL
TOOL SO ALLOWING US TO
DIFFERENTIATE BETWEEN ENTITIES
SUCH AS FUNCTIONAL AND ORGANIC
MIOCLONES AND MYSELF AND OTHER
CLINICAL FELL WHOSE HAVE COME
THROUGH THE LAB, HAVE ALL
EXPERIENCED BOTH THE
FRUSTRATIONS OF RECORDING THOSE
MUCH 50 MOVEMENTS IN ORDER TO
ABSTAIN A POTENTIAL BUT THE
SATISFACTION OF COMPLETING THE
STUDIES AND THEN GOING TO MARK
WITH THE RECORDINGS AND THEN
ALSO BEING ABLE TO PROVIDE
PATIENTS WITH THIS LAB SUPPORTED
CRITERIA EVIDENCE THAT SUPPORTS
THEIR DIAGNOSIS.
THE WORK FROM THE HALLETT LAB IS
ALSO BEEN CRITICAL AT DEFINING
THE UNDERLYING PATHO PHYSIOLOGY
THROUGH THE USE OF NEUROIMAGING
SO WE'RE GOING TO BE HEAR ABOUT
THAT QUITE A BIT IN THE NEXT TWO
TALKS SO JUST BRIEFLY WHAT IS
SELF-AGENCY SO THIS IS A
SUBJECTIVE PERCEPTION THAT ONE
IS INITIATING EXECUTING AND
CONTROLLING ONCE OWN ACTIONS O
WE KNOW THEY OBJECTIVELY THEY
WERE WORK HAS SHOWN THAT THEY
USE VOLUNTARY MOTOR PATHWAYS SO
WARK FROM MARK'S COLLABORATORY
HAS BEEN KIT CAL IN DEFINING
ABNORMALITIES IN THIS
SELF-AGENCY NETWORK IN PATIENTS
WITH FUNCTIONAL MOVEMENT
DISORDERS.
WHERE THE FEED FORWARD FOR MOTOR
I AM TENSION ARE COMPARED WITH
THE FEEDBACK SIGNALS AFTER A
MOVEMENT HAS BEEN INITIATED, AND
COMPARED AT THIS SITE OF MULTI
MOTTAL INTEGRATION AND THE RIGHT
TEMPER JUNCTION.
AND A NUMBER OF STUDIES FROM THE
HALLETT LAB HAVE EXAM I AMED
IMPAIRMENT AND SELF-AGENCY AND
SHOWN ABNORMALITIES IN NEURAL
NETWORKS INCLUDE NORTH THIS
RIGHT TEMPORAL JUNCTION SO THIS
IS A STUDY JOHN ADD MENTIONED
EARLIER AND WITHIN SUBJECT BLOCK
DE DESIGN PERFORMED BY VALERIE
BOONE WHEN SHE WAS A FELLOW IN
MARK'S LAB COMPARING BRAIN
ACTIVITY WHEN PATIENTS WITH
FUNCTIONAL TREMOR, WERE
EXPERIENCING AS COMPARED TO
ACTIVITY WITHIN THOSE SAME
PATIENTS IT WAS BY HYPO ACTIVITY
OF THE TPJ.
THESE ABNORMAL NEURAL NETWORKS
INVOLVED IN SELF-AGENCIES WERE
ALSO EXPLORED IN A STUDY
PERFORMED BY FATIMA HUB WHEN HE
WAS A OF FELLOW IN MARK'S LAB
AND THERE THE SENSE OF
SELF-AGENCY WAS MANIPULATED
USING A VIRTUAL REALITY CYBER
THAT ARE DEFERLY ACTIVATED ON
THE LEVEL OF SELF-AGENCY
INCLUDING THE ANTERIOR AND AGAIN
THE TPJ AND WORK I CAN WHEN I
WAS A FELLOW IN MARK'S LAB, WE
LOOKED AT RESTING STATE
FUNCTIONAL CONNECTIVITY.
IN A RELATIVELY LARGE GROUP OF
PATIENTS WITH FUNCTIONAL
MOVEMENT DISORDERS AND AS
COMPARED TO CONTROLS AND WE
LOOKED AT THIS RESTING STATE
FUNCTIONAL CONNECTIVITY FROM THE
RIGHT T PJ WITH THIS INTEGRATION
SHOWN TO BE IMPORTANT IN THE
SELF-AGENCY NETWORK AND FOUND
THAT THERE IS IMPAIRED
CONNECTIVITY FROM THE RIGHT TPJ
TO A NUMBER OF SENSORY MOTOR
REGIONS IN PATIENTS WITH FMD SO
THESE ABNORMALITIES WERE AGAIN
PRESENT DURING THE RESTING
STATE, NOT DURING ANY MOVEMENTS
PER SE.
AND IMPORTANTLY THEY WERE ALSO
INDEPENDENT OF OTHER PSYCHIATRIC
CO-MORBIDITIES AND SO MORE OF A
FEATURE OF FUNCTIONSAL MOVEMENT
DISORDERS SPECIFICALLY.
SO, IT WORKED FROM MARK'S LAB
HAVE BEEN ALSO INSTRUMENTAL IN
FINDING OTHER NETWORK
ABNORMALITIES IN PATIENTS WITH
FUNCTIONAL DISORDERS SO WE KNOW
THESE PATIENTS HAVE HEIGHTENED
AROUSAL AND THEY CAN SHOW
SYMPTOM AMPLIFICATION DURING
EMOTIONAL VAL ENTER STATES SO
THESE FEATURES MAP ONTO THE
LIMBIC NETWORK AND STUDIES HAVE
SHOWN IN PARTICULAR THIS TYPIER
ACTIVITIES OF THE AMYGDALA IN
PATIENTS WITH FUNCTIONAL
MOVEMENT DISORDER SO THEY WERE
EXPOSED NEGATIVELY SPACES AND
PATIENTS WITH FUNCTIONSAL
MOVEMENT DISORDERS WERE SHOWN TO
HAVE AN ABNORMAL INCREASE IN
AMYGDALA ACTIVATION IN BOTH OF
THESE SETTINGS.
PATIENTS WITH FMD HAD ALTERED
CIRCUITRY BETWEEN THE LIMB I CAD
THEY HAD INCREASED CONNECTIVITY
BETWEEN THE SMA AND THE AMYGDALA
COMPARED TO CONTROLS WHEN THEY
WERE SUBJECTED TO EITHER
POSITIVELY OR NEGATIVELY VEIL
ENTER STIM YOU LA WORK HAS ALSO
SHOWN GRAY MATTER ALTERATIONS IN
PATIENTS WITH FUNCTIONAL
MOVEMENT SO WE SHOWED THERE ARE
KEY DIFFERENCES BETWEEN PATIENTS
AND CONTROLS IN COMPONENTS OF
THE LIMBIC AND SENSORY MOTOR
CIRCUITRY, ESPECIALLY THEIR
INCREASE VOLUME IN THE LEFT
AMYGDALA AND THE CEREBELLUM AND
IN THE BI THALAMUS AND THERE'S
DECREASED VOLUME IN THE SENSORY
MOTOR CORTEX IN PATIENTS WITH
FUNCTIONAL MOVEMENT DISORDERS.
AND AS A MOVEMENT DISORDER
NEUROLOGIST WHO HAS SEEN AND WHO
CONTINUES TO SEE A LOT OF
PATIENTS WITH FUNCTIONAL
MOVEMENT DISORDERS, YOU GET
ASKED ON A REGULAR BASIS, YOU
KNOW, WHY IS IT, WHY ME?
WHY IS THIS IMPACTING ME?
AND WORK FROM MARK HALLETT'S LAB
HAS REALLY HELPED TO ADDRESS IT
QUESTIONED AND IT WAS LED WHEN
HE WAS WORKING IN MARK'S LAB
THAT A GENE INVOLVED IN
SEROTONIN BIOSYNTHESIS IMPACTS
THE AGENCY OF ONSET OF
FUNCTIONAL MOVEMENT DISORDERS SO
CLINICAL FEATURES AND ALSO
IMPACT AMYGDALA OR FRONTAL
CONNECTIVITY OR IMPACT THE
NETWORKS IN THESE INDIVIDUALS SO
THE PATIENTS WITH THIS POLY
MORPHISM THEY SHOW CONNECTIVITY
AND IT IS IMPORTANT FOR
COGNITIVE A PRAISE OF STIMULI.
SO WHAT ARE WE DOING, AS A
CLINICIAN, YOU ALWAYS ARE
THINKING WHAT ARE YOU DOING WITD
ALSO, WHAT DO WE DO WITH THE
KNOWLEDGE THAT WE HAVE GAINED?
FOR DIAGNOSIS, FOR TREATMENTS,
AND WORK FROM MARK'S LAB HAS
BEEN INSTRUMENTAL ALSO IN SORT
OF PUSHING THE ENVELOPE
APPROXIMATE THAT REGARD SO THIS
IS A PAPER FROM THIS YEAR AND
USING SOME OF THE NODES THAT
HAVE BEEN IDENTIFIED AS BEING
IMPORTANT IN THIS HAD FMD
NETWORK AND THE WORK FROM MARK'S
LAB RECENTLY USED MACHINE
LEARNING APPROACH AND TO TRY TO
DISCRIMINATE FOLKS WITH
FUNCTIONAL MOVEMENT DISORDERS
FROM CONTROLS AND CAN BE USED AS
A DIAGNOSTIC TOOL AN AND ANOTHER
RECENT STUDY FROM THE LAB
COMBINED IMAGING AS A MOVE HE
WILL MEANS AND TO TARGET FRONTAL
AMYGDALA ABNORMALITIES IN
PATIENTS WITH FMD AND
CONNECTIVITY AND IDENTIFY THE
OBJECT TIM ALTAR HE ET IN TEACH
VICTIMS AND WERE DEMONSTRATED AS
WELL AS SYMPTOMATIC IMPROVEMENT
IN THESE INDIVIDUALS SO THIS ISL
IN THE PILOT STAGES SO WORK FROM
MARK'S LAB REALLY SETS THE STAGE
FOR TREATMENTS LIKE TO IN THE
FUTURE.
SO I'M USING THE SAME PAPER YOU
JUST SAW FROM JOHN AND SO,
AGAIN, WITH THIS IDEA THAT MARK
DEFINES FUNCTIONAL MOVEMENT
DISORDERS BACK IN OVER 15 YEARS
AS THIS CRISIS IN UROLOGY
HOWEVER, WORK FROM MARK AND WORK
FROM MARK'S GROUP HAS REALLY
MADE OF SIGNIFICANT STRIDES IN
OUR ABILITY TO MAKE THE
DIAGNOSIS AND MAKE A DIAGNOSIS
THAT IS BETTER ACCEPTED BY OUR
PATIENTS AND NEURO MISS LOGICAL
AND WE HAVE A BETTER
UNDERSTANDING OF THE TYPE OF
PHYSIOLOGY OF THIS HELPS US
COMPLAIN THE DISORDERS AND BOTH
TO OUR PATIENTS AS WELL AS TO
OUR COLLEAGUES AND ALLOWS THE
FIELD TO EXPLORE INNOVATIVE
PARADIGMS AND ALL OF THIS SERVES
TO IMPROVE THE PROGNOSIS FOR
THIS PREVIOUSLY VERY COMMON
PATIENTS POPULATION.
AND I WANTED TO TAKE THIS
OPPORTUNITY TO THANK Dr.
HALLETT WHO HAS BEEN A
INSPIRATION WITH ME AND HAS BEEN
AN INSPIRATION TO SO MANY PEOPLE
AND REALLY AN EX 'EM POLICE CAR'
MODEL OF A MENTOR AND SHOWN HERE
IT WAS THE BEST CLASS AND I JUST
FEEL FORTUNATE THAT I HAD THE
EXPERIENCE TO SPEND TIME IN
MARK'S LAB.
WE'LL END THERE.
[APPLAUSE]
>>OUR NEXT SPEAKER WAS VALERIE
VOON A FELLOW BEGIN NORTH 2004
IN MARK'S LAB AND IS COMING TO
US VIA EITHER CAMBRIDGE OR
SHANGHAI WHERE SHE HOLDS
PROFESSORSHIPS.
>>THANK YOU SO MUCH.
AND THANK YOU TO THE ORGANIZERS
FOR THIS OPPORTUNITY TO SPEAK AT
MARK'S.
IT'S A PLEASURE AND HONOR TO BE
ABLE TO DO SO.
I WAS ASKED TO TALK ABOUT
FUNCTIONAL NEWER ONLY CAL
DISORDERS AND WILL OR AGENCY.
THIS IS ISN'T THE TOPIC THAT I
COVER NOW AND I STOPPED ABOUT
FOUR YEARS AGO IN TERMS OF
STUDYING FUNCTIONAL DISORDERS
BUT AS A LARGE PART OF MY LIFE
FOR ABOUT 15 YEARS, SO, ALL
THINGS CONSIDERED, I'M HAPPY TO
TALK ABOUT THIS TOPIC.
I THINK I FIRST STARTED, I THINK
I SUSPECT I WAS ONE OF THE FIRST
FELLOWS TO TAKE ON IT IT FULL
TIME BACK IN.
I WAS THERE IN 2009 AND MY
UNDERSTANDING WAS THAT THERE IS
STILL AN ETHICS PROTOCOL WRITTEN
IN 2007 THAT IS ACTIVE TODAY AND
I CAN WRITE THAT PROTOCOL
ACTUALLY SO, IT'S REALLY NICE TO
BE ABLE TO KNOW THAT THERE'S A
LONGSTANDING IMPACT AND THIS
FIELD AND I WILL SAY WHEN WE
FIRST STARTED, IT WAS ACTUALLY
DIFFICULT TO GET SOME OF THE
PAPERS IT IT WAS WELL ACCEPTED
SO I'M REALLY GLAD TO SEE WHERE
THE FIELD HAS GONE NOW AND THIS
IS IN AND PUSHING FORWARD THIS
FIELD IN AND SO AT THE SAME TIME
I DID THE PHD IN NEUROSCIENCES
AND THROUGH THE GPP PROGRAM BUT
I WAS ON BEHAVIORAL ADDICTIONS
AND PARKINSON'S.
SO I THINK WE'RE ALL FAMILIAR OF
THIS PARTICULAR IMAGE.
I WILL SAY THE MEETING THAT I
WAS WORKING AS A PSYCHIATRIST
AND MARK HALLETT APPROACHED ME
AND SAID, DO YOU WANT TO BE A
FELL IN MY LAB AND I ACTUALLY
MOVED SO, ALL THINGS CONSIDERED,
MARK HAS BEEN AN AMAZING MENTOR
AND SUPERVISOR.
WHERE I AM NOW IS IN LARGE PART
RELATE TODAY HIM AND THEY CAN BE
PULLED TOGETHER SO THIS IS YOU
MIGHT BE FUNCTIONING AND MIGHT
PLAY A ROLE IN TERMS OF THE
PREDICTION OR EXPECTATION BEING
ABNORMAL AND THIS TOP-DOWN
ELEMENT AND AND PERHAPS THEN
SHIFTING AWAY FROM VOLUNTARY
MOVEMENT AND THAT BEING
ABHORRENT AND THIS ROLE OF
EMOTION AND OF HE HAD SUBJECTS
HE HAD TO MOVE IN THE SCANNER
AND THE BLOCK AND HE COMPARED
THEM WITH HEALTHY INDIVIDUALS,
FAYNEING PERRAL CEASE SO
COMPARING THIS FUNCTIONAL PAR
ALICE VERSUS AND DEMONSTRATING
THERE'S LOWER ACTIVITY IN THE
FREE FRONTAL CORTEX THAT WAS
LATERALIZED WHETHER IT'S
FUNCTIONAL SO REALLY
HIGHLIGHTING AT THAT POINT THAT
AND FACES FUNCTIONAL SYMPTOMS.
BAYS IT WAS INVOLVED IN ACTIONS
COLLECTIONS AND THAT PERHAPS
THIS IS UNDERLINE TENANT IS IS
RELEVANT THE PATIENT AS I CANNOT
MOVE AND I WILL NOT MOVE AND
IT'S NOT WILL THE MOVEMENT AND
HE HAD HAD SUGGESTED THAT THE
MOTOR EXECUTION IS INTACT AND
PERHAPS IT MIGHT BE THIS IS
SOMETHING THAT'S BEEN PICKED UP
THROUGHOUT THE COURSE OF THE
RESEARCH.
AGENCIES DEFINED BY CAREEN SO
THIS IDEA THIS SENSE THAT YOU
ARE NOT THE PERSON OR YOU ARE
SENSING THAT YOU ARE NOT THE
PERSON AND WHO AGAIN RATES OR IN
CONTROL OF THE OR PICK UP NOT ON
THIS IN THE NEXT COUPLE OF
SLIDES AND WE'LL GO THROUGH THIS
CLINICAL ASPECT AGAIN SO THIS IS
SOMETHING THAT CAREEN HAD
ALREADY POINTED OUT THIS IDEA
AND ENTRAINMENT AND SO THIS HERE
YOU SEE A PATIENT.
>>I'D LIKE YOU TO TAP WITH ME
AND WE'LL TALK OVER IT BUT I'M
NOT SURE IF I CAN.
AND NOW YOU JUST KEEP TAPPING ON
YOUR OWN.
SO, WHAT YOU SEE HERE IS SOMEONE
O WHO HAS A FUNCTIONAL TREMOR
AND THEY'RE ASKED TO THEN WITH
YOUR OTHER HAND VOLUNTARILY SO
THIS IS CARRYING HEAD POINTS OUT
FUNCTIONSAL SYMPTOMS AND THEY'RE
USING THE STAPLE IF YOU USE THE
SALE PATHWAY WHY IS IT
EXPERIENCING AS INVOLUNTARY.
I'M GOING TO GO THROUGH THIS A
LITTLE BIT MORE SO HERE WE TOOK
PATIENTS WITH PENSIONAL TREMORS
AND IT WAS STUDY TO RECRUIT AND
IT STARTED BEFORE I STARTED AND
TO SO BRUNO WAS THE FIRST FELLOW
WHO TOOK ON THIS PROJECT FOR
ABOUT THREE YEARS AND I THINK
THAT SHE, THERE WAS A MEETING IN
SHE MOVED TO HAWAII THE NEXT
YEAR AND THE NEXT ONE SHE MOVED
TO HAWAII AND I GUESS I CAME
ALONG AND THEN I AM MERITED THIS
PROJECT.
SO FOUR YEARS LATER, WHAT WE SEE
HERE IS THAT INI AM VOLUNTARY
MOVEMENTS IN THIS PATIENT
POPULATION IS DECREASE AND THE
RIGHT INFERIOR JUNCTION WHEN WE
THINK ABOUT RELEVANT TO THIS
PERRY OF THE FEED FORD MODEL OF
MOTOR CONTROL AND WHAT WE FEEL
LIKE WHEN YOU ARE THERE AND WHEN
YOU REACHED THE SENSATION AND
THE COLDNESS AND WHEN YOU HAVE
ACTUALLY MADE OF MOVEMENT YOU
HAVE THE SENSORY FEEDBACK THAT
OCCURRED AND SO THE ACTION AND
THE COMPARISON IS THEN IF IT
MATCHES YOU FEEL YOU ARE IN
CONTROL OF YOUR MOVEMENT SO IT'S
WHEN IT'S MATCHES AND THE KEY IS
THIS IS IMPLICIT AND IT'S
OCCURRING ALL THE TIME BECAUSE
WE FEEL A SENSE OF AGENCY ALL
THE TIME AND UNLESS SOMETHING IS
MISMATCHED.
SO THEN THE QUESTION IS, WHAT IS
THIS MISMATCH?
AND WHAT LEVEL IS IT AT?
AND IN OUR CASE, WE HAD SEEN
THAT SENSORY FEEDBACK APPEARED
RELATIVELY INTACT SO WE THOUGHT
AT THE LEVEL OF INTENTION, WHERE
THE PREDICTION MIGHT BE
IMPAIRED.
AGAIN, A LOT OF VERY NICE WORK
THAT CONTINUES WITH THE TPG AND
SO IN THE CONTEXT OF INVOLUNTARY
MOVEMENTS, WE SEE THIS DECREASED
CROSS TALK BETWEEN THE RIGHT TPJ
AND REGIONS INVOLVED IN THE
LIMBIC OR EMOTIONAL PROCESSING
SO THE VENTRAL TRY EIGHT AND
LOOKING AT THE RESTING STATE
FROM THIS DECREASE WITH SENSORY
MOTOR NETWORKS AND SO THIS TPJ
ASSOCIATED WITH A DECREASE AND
CROSS TALKING ACTIVITY AND
BETWEEN REGIONS AND INVOLVED IN
MOTOR NETWORKS AND VERY UPSTREAM
AND ALSO IN TERMS OF EMOTIONAL
PROCESSING.
WE THEN WENT ON TO LOOK AT MORE
CAREFULLY HARASS THE OUT ASPECTS
OFFS SUBJECT OF I AM TENSIONS
USING AND IT'S YOU SEE IT CLOCK
WITH A ARMOR A BALL MOVING
AROUND THE CIRCLE AND NUMBERS
AROUNDS THIS PAY ATTENTION TO
THE MOVEMENT AND YOU JUST REPORT
THE TIME YOU MADE THE MOVEMENT
AND THAT'S M.
AND THEN IN A SEPARATE BLOCK,
YOU ARE ASKED TO PAY ATTENTION
TO THE URGE TO MOVE SO IT'S
SEPARATE FROM THE MOVEMENT
ITSELF AND IT'S W.
AND YOU WOULD THINK THIS IS
ACTUALLY QUITE DIFFICULT TO
ASSOCIATE BUT HEALTHY PROVE
TIERS ASSOCIATES THIS WITH AND
HEALTH' VOLUNTEERS W IS USUALLY
REPORTED ABOUT 200 SECONDS AND
THERE'S A LOT OF IMPLICATIONS
WHICH I'M GOING TO GET IT AND
THEY DISCRIMINATE WITH THESE
TWO.
OK AND WHAT ABOUT THE UNDER LIKE
BRAIN REGIONS AND THIS IS REALLY
NICE WORK UNDER LIKE INTENTION
INCLUDES MANY OF THE AREAS WE
POINTED OUT AND PREFRONTAL AND
ONE OF THE KEY REGIONS IS THIS
CORTEX AND HERE IN LESION STUD'S
SO STROKE LESIONS AND PATIENTS
WHO HAVE HAD STROKES WE SEE
THEY'RE IMPAIRED PARADIGM SO
THEY HAVE DIFFICULTY BETWEEN THE
W AND M.
AND IN THE CORTICAL STIMULATION
STUDIES WHERE YOU STIMULATING
THE CORTEX YOU GET THIS WANTING
TO MOVE AND THIS KIND OF SENSE
OF WANT TO GO MOVE SO SUGGESTING
IT'S VERY UP TREATMENT IN TERMS
OF INTENTION.
SO WE RAN IT IT STUDY WITH
LIPIDS CLOCK IN THE FUNCTION NOR
LOGICAL DISORDER PATIENTS AND
WHAT YOU SEE HERE IS THIS
IMPAIRMENT IN DISTINGUISHING
WITHIN THE INTENTION TO MOVE
VERSUS THE MOVEMENT ITSELF.
THE INTENTION OR W MOVES MUCH
CLOSER TO THE MOVEMENT ITSELF
AND THAT IS BEEN REPLICATED IN
THE COUPLE STUDIES AND WE ALSO
LOOKED AT THIS WITH IMAGING AND
DEMONSTRATE INSIDE IMPAIRMENT OR
THE FND PATIENTS WHEN THEY'RE
PAYING ATTENTION TO THE
INTENTION ITSELF THEY HAVE A
DECREASE OF ACTIVITY IN THE
INTERIOR CORTEX ON RIGHT AND
IT'S SLIGHTLY DIFFERENT FROM THE
PHJ AND IT'S AND IT IS VERY
SIMILAR FOR EXACTLY WHAT YOU SEE
IN STUD'S FOR CORTICAL
SIMULATION AND STROKE PATIENTS.
SO JUST A VERY BRIEFLY
SUMMARIZED THIS WHAT WE SEE IS
THESE IMPAIRMENTS AND THESE
MOTOR CONTROL NETWORKS THAT ARE
UPSTREAM OF MOTOR PROCESSING IN
THE PRIDAL JUNCTION IN NOT
SUPPLEMENTARY MOTOR THIS
DECREASE IN CONNECTIVITY AND
PERHAPS INCREASED ACTIVITIES IN
THE THIS INTERACTION WITH MOTOR
LIMBIC PROCESSING SO THE IDEA
THAT PERHAPS THERE MIGHT BE AN
ABNORMALITY IN THE BELIEF OR THE
PREDICTION OF HOW AN INVOLUNTARY
COULD HER AND THE VOLUNTARY
ASPECT AND IT'S HYPER AWARENESS
OF THE INVOLUNTARY MOVEMENT AND
WE SEE THIS SHIFT PERHAPS AWAY
FROM AWARENESS OF INTENTION OF
THE THE VOLUNTARY MOVEMENTS.
AND I THINK WE'VE BEEN PICK UP
ASPECTS WITH REGARDS TO
EMOTIONAL PROCESSING.
SO WHAT DO I DO NOW?
WELL, I PICKED UP ON MARK'S
TENNEN SEE TO TRAVEL SO I
TRAVELED BETWEEN TWO COUNTRIES
AND BETWEEN CAMBRIDGE AND CHINA.
AND I HAVE SHIFTED AWAY INTO
ADDICTIONS AND COMPULSIVE
DISORDER BUT WHAT I WOULD
EMPHASIZE IS A LOT OF THE NOT
CONCEPTS ARE NOT DISSIMILAR SO
WHEN I'M PARSING OUT COGNITIVE
NEUROSCIENCE ELEMENTS AND THE
COMPUTATIONAL ELEMENTS, I'M
FOCUSING ON SELF-CONTROL AND
REPETITIVE BEHAVIOR AND TO
WHATEVER EXTENT THE THEORIES
ALSO HAVE IMPAIRMENTS, IN THE
CONCEPTS OF SELF-AGENCY OR THE
LOSS OF CONTROL, BUT JUST AT A
DIFFERENT STAGE AND LEVEL OF
THIS AND IN TERMS OF THIS
FEEDBACK AND LOOKING AT
REINFORCEMENT LEARNING AND THE
PROCESSING AND SHIFTING AWAY
FROM MOTOR SYSTEMS TOWARDS
PERHAPS MORE REWARD SYSTEMS AND
PICKING UP ALSO THE MODULATION
ASPECTS AND DEEP BRAIN
STIMULATION AND TMS AND
INTRACRANIAL RECORDINGS AND SO
VERY MUCH ANNOUNCED BY THIS
MULTI MODAL APPROACH AND FOR
MARK HALL ET'S LAB.
SO THIS IS THE LAST PART.
I THINK
HE IS A PSYCHIATRIST IN A
NEUROLOGIST'S BODY AND I SAY
THIS AS A MAJOR COMPLIMENT.
YOU THINK THAT WAY ANYWAY OF
YOURSELVES AND THAT SO I
POSSIBILITY AND WHAT DO YOU DO
IS HE OPENING COURTROOMED US TO
EXPLORE AND EVERYONE HAS BEEN
TALKING ABOUT CURIOSITY SO HE IS
A MAJOR ELEMENT AND I THINK THIS
IS IT'S A LITTLE BIT MORE THAN
THAT AND THEY CON STRAINS THIS
SO THAT WE'RE ABLE TO THE
RIGOROUS SCIENTIFIC APPROACH AND
WILD EXPLORATION AND AND
ANCHORED FROM A SCIENTIFIC
PERSPECTIVE AND HE IS AN
OUTSTANDING CLINICIAN AND
SCIENTISTS AND HE GAVE YOU A LOT
OF RESEARCH INDEPENDENT AND
REALLY BEING ABLE TO TALK ABOUT
BIG PICTURE BUT ALSO IN THE
DETAILS AND ON A PERSONAL LEVEL
FOR GENEROUS WITH HIS TIME AND
VERY SUPPORTIVE IN PATIENTS AND
I THINK THE THING THAT REALLY
COMES ACROSS I THINK SOME IN
HIGHLIGHTED THE IDEA OF
PROFESSIONAL FUND AND AGAIN I
WOULD REALLY EMPHASIZE THAT AND
THE ENJOYMENT OF RESEARCH WHICH
HE PASSES ON AND HOPEFULLY I'VE
BEEN ABLE TO BRING THAT UP.
SO THANK YOU, MARK.
>>THANK YOU, VERY MUCH.
SO, IT'S A GREAT PLEASURE AND
HONOR TO BE HERE AND I FEEL LIKE
A REAL OUTSIDER FOR EVERY
REASONS.
THE FIRST ONE IS THAT I DIDN'T
TRAIN WITH MARK AND PERHAPS I
SHOULD HAVE BUT I DIDN'T.
MY HOME DISCIPLINE IS NOT
NEUROLOGY AND I'VE HAD THE
PLEASURE OF COLLABORATING OF
COLLEAGUES IN MOVEMENT DISORDERS
OVER THE YEARS INCLUDING MARK,
AND I'VE BEEN THINKING FOR ABOUT
20 OR 25 YEARS ABOUT HOW THE
HUMAN MIND AND IT'S ROLE IN HAD
VOLITIONAL AND AUTONOMOUS ACTION
SO HOW CAN WE MAKE ACTIONS THAT
WE DECIDE TO MAKE THAT WE
AUTONOMOUSLY INITIATE AND THIS
IS THE PROBLEM BECAUSE ALL THE
PSYCHOLOGY IS BASED ON A
STIMULUS RESPONSE MODEL OF
ACTION AND THE MOST IMPORTANT
ABOUT THE HUMAN MIND IS YOU CAN
MAKE AN ACTION WITHOUT A
STIMULUS SO HOW DOES THAT WORK?
NOW, I HAVE ACTUALLY DONE SOME
TRAINING IN MOTION CONTROL AND I
HAVE BEEN FOLLOWING MARK'S WORK
IN MOTOR CONTROL FOR MANY YEARS
AND I RECOGNIZE THAT IT WAS VERY
INTERESTING AND THEN I WAS
REALLY A TON ISSUED TO SEE THIS
PAPER WHICH BURST INTO MY
CONSCIOUSNESS LIKE A MOM SHELL
IN 2007 BECAUSE I THOUGHT,
GOODNESS ME, NEUROLOGISTS
TALKING ABOUT FREE WILL, THIS IS
MOST UNEXPECTED AND IT SEEMS TO
BE INTERESTING CONVERGENCE
BETWEEN THE ENVIRONMENTAL AND
PHYSIOLOGICAL APPROACH SO THIS
IS A LOT MORE INTERESTING PAPER
WHICH I THINK IS IS JUST BRAVE
AND THERE WASN'T A PAPER LIKE
THIS IN NEUROLOGY FOR A GOOD
TIME AND WHAT DOES IT SAY?
THE DISTINCT IS A THAT MARK
POINTS OUT THAT WHAT WE CALL
FREE WILL AND I PUT IT IN QUOTES
AND WHAT WE CALL FREE WILL IS A
PERCEPTION OF THE IS
SELF-GENERATION OF ACTION AND
THIS TYPICALLY ACCOMPANIED OUR
VOLUNTARY MOVEMENT AND SO
THEY'RE REALLY IMPORTANT STEP IS
TO FREE FRAME THE FREE WILL
PROBLEM AS A PROBLEM IS
SUBJECTIVE PERCEPTION RATHER
THAN PHILOSOPHIES HAVE DEFINED
IT AS THE PROBLEM OF SEARCHING
FOR THE CAUSE OF THE ACTIONS,
SEARCHING FOR THE AND THAT TEND
TO BE END UP WITH INTERNET
REGRESS AND WITH GHOSTS IN THE
OPINION WHICH WE HEARD ABOUT AND
FOCUSING ON VOLITION AND I THINK
THAT WHY DID MARK SUDDENLY STOP
THINKING ABOUT FREE WILL, I
DON'T KNOW, I EXPECT THERE'S A
STRONG LINK TO HIS WORK ON FND
AS WE JUST HEARD.
I HAVE A LITTLE PART TO PLAY IN
THIS STORY OF HIS PAPER.
I WAS ASKED TO REVIEW THIS PAPER
AND I THOUGHT IT WAS REALLY,
REAM' INTERESTING.
REALLY INTERESTING.
I THOUGHT YOU GOT TO ACCEPT
THIS, THIS IS AN INTERESTING
PAPER BECAUSE IT OFFERS A NEW
METHOD TO STUDY THE SUBJECTIVE
PERCEPTION OF ONES ACTION AND IT
OFFERS A NEW WINDOW INTO
CONSCIOUS VOLITION.
REVIEWERS TWO AND THREE DIDN'T
ACTUALLY AGREE AND I THINK THE
PAPER WAS REJECTED AND I WAS IN
TOUCH WILDFIRE MARK ABOUT
SEVERAL MONTHS LATER ABOUT IT
AND I SAID, OH, BY THE WAY, I
SAW THIS DRAFT OF YOURS, PLEASE,
DO GET THAT PAPER PUBLISHED
SOMEWHERE WAS IT'S REALLY GOOD
AND I THINK I HOPE I WAS ABLE TO
ENCOURAGE YOU, NOT TO GIVE UP ON
THIS AND IT DID SUBSEQUENTLY
APPEAR IN THIS REALLY
INTERESTING PAPER AND I JUST
TAKE YOU THROUGH THIS BECAUSE
NOT I THINK AN ILLUSTRATION
SMART APPROACH OF THE MARK HAS
TAKE EP SO THE PROBLEM WITH
VOLITION IS THERE'S NOT MUCH TO
MEASURE.
SO IN MOVEMENT IN YOUR
PHYSIOLOGY, PEOPLE MEASURE
MOVEMENTS AND YOU CAN MEASURE A
MOVEMENT BUT IF YOU HAVE A
MOVEMENT SOMEONE MAKES THAT IS
AUTONOMOUS YOU CAN'T MEASURE SO
YOU CAN'T TELL ABOUT THE CAUSES
OF THE PROVEMENT BECAUSE YOU
CAN'T SEE THEM CLEARLY.
SO THE WAY THAT MARK APPROACHED
THIS WAS TO TAKE A STANDARD
SPONTANEOUS ACTION-TYPE DESIGN
WHERE YOU INSTRUCT THE
PARTICIPANT, MAKE THE ACTION,
WHENEVER YOU FEEL LIKE IT, JUST
NOW AND THEN WHEN YOU FEEL LIKE
IT, AND HERE IS THE CRUCIAL
POINT, THE EXPERIMENTER DELIVERS
AN OCCASIONAL AUDIO TONE AT
RANDOM TIMES AND SO WHILE YOU
ARE OCCASIONALLY PRESSING A KEY
WITH YOUR RIGHT HAND, YOU
SOMETIMES HEAR A TONE, A BEEP.
IF YOU HEAR A TONE, AND YOU FEEL
LIKE YOU ARE ABOUT TO ACT WHEN
THE TONE WEPT OFF, THEN PLEASE,
WITH HOLD YOUR ACTION AND DO
NOTHING.
SO THIS SOUNDS REALLY WEIRD AND
IT SOUNDS AS THOUGH IT SHOULDN'T
WORK, YOU ARE MAKING OCCASIONAL
ACTION AND IF YOU HEAR A TONE,
AND YOU FEEL YOU ARE ABOUT TO
MAKE ONE OF THOSE ACTIONS, THEN
DON'T.
WELL THIS SEEMS RIDICULOUS
BECAUSE THE CRITICAL CONDITION
IS THE CONDITION WHERE THE
PERSON DOESN'T MAKE ANY ACTIONS
SO WHAT ARE YOU GOING TO MEASURE
THERE?
YOU CAN'T EVEN MEASURE THE EMG
BUT THE CLEVER THING ABOUT THIS
PAPER, IF YOU THEN LOOK AT THE
DISTRIBUTION OF THE TONES
RELATIVE TO THE TIME OF ACTION,
WHICH YOU CAN SHOW HERE, SO THIS
IS A TIME OF ACTION AND THIS
HISS TA GRAM SHOWS THE NUMBER OF
TONES THAT OCCURRED IN EACH BIN
YOU JOINED THE PHONES OCCUR
PRETTY MUCH UNIFORMLY BECAUSE
THEY'RE BEING RANDOMLY GENERATED
ABOUT THE EXPERIMENT COMPUTER
BUT THERE'S A GAP HERE.
YOU DON'T TEND TO FIND THAT
THERE ARE MANY TONES OR IN THIS
PARTICIPANT ANY TONES, PRIOR TO
THE MOMENT OF THE ACTION ITSELF.
AND THIS IS THE KEY POINT, THE
KEY POINT THAT THESE TONES WERE
PLAGUED BY THE COMPUTER BUT
BECAUSE THEY OCCURRED AT THE
TIME THE PERSON FELT THEY WERE
GOING TO MOVE THE ACTION NEVER
HAPPENED AND THEREFORE IT WAS
NEVER SORT OF PRESENTED IN THIS
IT DOESN'T IF EGG IN THIS
ACTION-LOCKED PLOT SO THIS
CLEVER INSTRUCTION TO RESPOND TO
THE RANDOM PROBE BY WITHHOLDING
THE ACTION, ALLOWS YOU TO INFER
THE PERSON MUST HAVE HAD AN
EXPERIENCE THAT THEY WERE ABOUTO
ACT A SECOND OR TWO SECONDS
BEFORE THE ACTION ITSELF.
THIS IS A REALLY NICE APPROACH
BECAUSE THE CRITICAL THING IS
THAT ITTURES AT RANDOM AND MOST
STUDIES OF VOLITION ARE BASED ON
A POST-TALK SELF-REPORT WHERE
THE PERSON DECIDED TO MAKE AN
ACTION AND THEY MAKE AN ACTION
AND THEY TELL YOU SOMETHING
ABOUT WHAT THEY'VE JUST DONE AND
THIS IDEA OF TELLING SOMETHING
ABOUT WHAT YOU'VE JUST DONE,
ALLOWS FOR A LOT OF
PSYCHOLOGICAL REINTERPRETATION
ABOUT WHAT YOU JUST DID OR WHY
YOU JUST DID IT AND SO,
CONVENTIONAL METHODS OF STUDYING
VOLITION TEND TO INCLUDES BIASED
SAMPLING, THEY ARE A BUY AS THAT
OCCURS BECAUSE YOU ARE ONLY
ASKING THE QUESTION AFTER THE
ACTION.
HERE, BECAUSE THE TONES ARE
RANDOMLY CONTROLLED BY THE
EXPERIMENT, A LOT OF THOSE
BIASES, ARE AVOIDED.
SO THE CONCLUSION IS THAT THERE
MUST BE A LAT A LATE EXPERIENCEE
BY A UN BIAS METHOD SO IT'S A
NICE RESULT.
THE RESULTING MODEL, WHICH I
JUST REDRAWN A FIGURE FROM THE
PAPER S. THAT THERE MIGHT BE
SOME SIGNAL THAT LOOKS PERHAPS
NOT ACCIDENTALLY LIKE A
READINESS POTENTIAL WHICH GROWS
AND WHEN IT IT REACHES A GIVEN
LEVEL, IT IT TRIGGERS THE
MOVEMENT SO THE BLACK LINE IS
THE CAUSAL SIGNAL AND IT'S
HYPOTHESIZED THAT THERE MIGHT BE
SOME CONSCIOUS EXPERIENCE WHICH
OCCURS DURING THE GENERATION OF
THIS SIGNAL.
AND WHAT THEY MEASURED IS THE
MOMENT OF WHICH YOU BECOME
SPONTANEOUSLY AWARE THE ACTION
WILL HAPPEN AND YOU WOULD BE
AWARE THAT YOU HAVE THE WILL TO
ACCOUNT ACT IF THE PHONES
SOUNDING AND YOU HAD TO AND I
HAVE USED AND LATEN AWARENESS
THAT WE MUST HAVE SOME, WELL,
DEEP OR SOME LOWER AND AWARENESS
AND WE'RE ABOUT TO PERFORM AND
THIS IS QUITE INTERESTING
BECAUSE AS FAR AS I CAN TELL,
MOST PEOPLE IN AT LEAST IN NORTH
AMERICA DON'T THINK THIS.
AND THE VOLITION IN THE FIELD,
IS THAT OUR EXPERIENCE OF OUR
OWN VOLITION IS ALL MADE UP
AFTER THE EVENT AND IT'S ALL A
POST TALK RECONSTRUCTION AND
THIS MAY BE RELEVANT FOR
UNDERSTANDING DIFFERENT
DISORDERS OF VOLITION SO IT
MIGHT CHANGE THE WAY PEOPLE
EXPERIENCE VOLITION.
AND SO JUST VERY BRIEFLY,
INSPIRED BY MARK'S WORK, WE'VE
BEEN TRYING TO USE THIS KIND OF
RANDOM PROBE DESIGN AND WE'VE
CHANGED IT SO INSTEAD OF A ZONE
YOU ARE WATCHING A STREAM OF
LETTERS GOING PAST ON THE SCREEN
AND EVERY NOW AND THEN UP WITH
OF THE LETTERS IS ORANGE AND THE
TASK IS TO MAKE AN ACTION WITH
YOUR RIGHT HAND WHEN YOU FEEL
LIKE IT AND IF YOU GET
INTERRUPTED BY AN ORANGE LER, IF
APPROXIMATE YOU SEE AN ORANGE
LETTER AND YOU FEEL YOU ARE
ABOUT TO ACT WHEN THE ORANGE
LETTER OCCURRED, THEN PRESS WITH
YOUR LE LEFT HAND INSTEAD.
THIS IS NICE, BECAUSE THE
VOLITION IS SOMETHING PEOPLE ARE
PREPARING TO DO WITH THEIR RIGHT
HAND AND IF ZIZI THE ORANGE
LETTER THEY GIVE US A STIMULUS
RESPONSE TYPE REPORT WITH YOUR
LEFT HAND AND IT IS A WAY OF
THEM TELLING US, I'M AWARE THAT
I WANT TODAY ACTED WHEN I SAW
THE ORIGINAL LETTER SO IT'S ONE
OF THESE RESPONSE TO RAN DOME
PROBES.
IS IT WERE NOT TO ACT WHEN THE
ORANGE LETTER APPEARS CARRY ON
AS USUAL SO IT'S EXACTLY THE
SAME TRICK OF COMBINING INVITING
PEOPLE TO MAKE VOLUNTARY ACTIONS
WITH RANDOMLY PROBING THEM AND
SAYING, DID YOU OF HAVE THE
INTENTION TO ACT AT THAT TIME OR
NOT?
SO, WE DIDN'T LOOK AT THE
DISTRIBUTION OF ORANGE LETTERS
RELATIVE TO ACTION TIMES IN THE
SAME WAY, WE FOCUSED MORE ON THE
EEG AND IN THE CONDITION WHERE
PEOPLE WERE INTERRUPTED BY AN
ORANGE LETTER AND THEY TOLD US
USING A RESPONSE TO THE LEFT
HAND THEY WERE AWARE THEY WERE
ABOUT TO ACT, THAT THERE'S A
LOWER LEVEL OF BETA POWER THAN
IN THE CONDITION WHEN THEY'RE
INTERRUPTED BY THE ORANGE LETTER
AND THEY DIDN'T MAKE A RESPONSE
WITH THEIR LEFT HAND.
SO, HERE IS IS IT'S NORMALIZED
YOU CAN SEE THE REDUCED WHEN
PEOPLE HAVE THIS EXPERIENCE OF
YES, I'M ABOUT TO ACTOR I WAS
ABOUT TO ACT WHEN THE ORANGE
LETTER OCCURRED AND SO THE
CONCLUSION FROM THIS IS THAT AN
AWARENESS OF AN INTENTION TO ACT
IS ASSOCIATED WITH A REDUCTION
IN THE POWER WHICH IS A STANDARD
MEASURES THAT PEOPLE OFTEN USE
IN THE MOTOR CONTROL AND WE
ASKED THE SAME QUESTION ABOUT
THE READINESS AND WE DIDN'T FIND
ANY SIGNIFICANT RESULT SO
THERE'S AN INTERESTING QUESTION
TO BE ASKED ABOUT WHAT ARE THE
OPTIMAL BIOMARKERS OF CONSCIOUS
VOLITION.
SO I WANT TO END WITH A LITTLE
BIT OF WILD SPECULATION AND
THESE ARE IDEAS WE ASSOCIATE
WITH SHARING AND WITH MARK'S
WORK THROUGHOUT ALL HIS CAREER
AND THE REAL CONTRIBUTION WITH
MARK'S WORK ON FREE WILL IS TO
THINK ABOUT THE VOLUNTARY PART
OF THE VOLUNTARY MOTOR PATHWAY
AND BEING SOMEHOW RELATED TO THE
WAYS THAT THIS ACTIVITY OF THIS
PATHWAY IS EXPERIENCING.
IT'S RELATE TODAY SUBJECTIVE
PERCEPTION SO THIS IS A BRAILLE
MOVE FOR A MOTOR CONTROL
NEUROLOGIST AND WE HAVE TO THEN
ASK HOW, WHAT IS THE WAY THAT
THIS MOTOR PATHWAY TO GIVE RISE
TO SUBJECTIVE EXPERIENCES THAT I
DID THAT OR I WANT TODAY DO
THAT?
HOW IS SUBJECT VOLITION RELATED
TO THE MOTOR PATHWAY.
I DON'T KNOW, I DON'T KNOW
WHETHER MARK KNOWS.
I WOULD LIKE TO HEAR MORE BUT WE
CAN SPECULATE ON THE MODEL THAT
VOLITION IS A READ OUT OR A
LEVEL OF ACTIVITY IN A MOTOR
PATHWAY AND WHEN THIS PATHWAY IS
ACTIVE, NOT ONLY DO WE MOVE BUT
WE ALSO FEEL THAT WARE MOVING
AND WE ALSO KNOW THAT WE'RE
ABOUT TO MOVE.
AND THE SECOND POSSIBILITY, IS
THAT, THERE'S SOME SET OF NEURAL
ACTIVITIES WHICH WE DON'T
EXACTLY NO WHAT TH THEY ARE OR
WHICH TRIGGER THE ACTIVITY OF
THE MOTOR PATHWAY AND ALSO
TRIGGER ACTIVITIES IN A SEPARATE
DISTINCT PATHWAY WHICH IS
SEPARATE FROM THE PATHWAY THAT
GENERATES MOVEMENT AND SO THIS
TO ME IS REALLY INTERESTING.
THIS IS A LIT LIKE PERCEPTION
WHERE WE DON'T HAVE ANY PROBLEM
AT ALL SAYING THAT WHEN THERE'S
ACTIVITIES IN V1 WE SEE THINGS
AND MAYBE WHEN THERE'S ACTIVITY
IN THE MOTOR PATHWAY WE FEEL
VOLITION AND THIS PERHAPS IS A
LITTLE BIT MORE LIKE WHAT FND
FORCE US TO THINK ABOUT
ASSOCIATIONS BETWEEN MOVEMENT
AND VOLITION SO JUST TO CONCLUDE
LAST SLIDE THIS IS REALLY
REMARKABLE OVER THE YEARS AND
I'VE BEEN TO LOTS OF CONFERENCES
WITH PSYCHOLOGISTS AND
PHILOSOPHERS AND THEY'RE
CONFUSED AND IT'S BEEN WIDELY
APPRECIATED OUTSIDE OF NEURO
PHYSIOLOGY IN THOSE OTHER FIELDS
AND MARK'S WORK IS IN LARGE PART
RESPONSIBLE FOR THAT AND THE
SUBJECTIVE EXPERIENCE OF
VOLITION MAY BE FUNDAMENTAL TO
MOVEMENT IN HEALTH AND DISEASE
AND SO HOW DID THIS ALL HAPPEN?
WELL I JUST WANT TO HIGHLIGHT
FOUR THINGS WHICH PREPARED
ENTIRELY INDEPENDENTLY OF THE
LAST SPEAKERS' LAST SLIDE BUT
ACTUALLY SHOW A REMARKABLE MULTI
MODEL CONVERGENCE SO WHY IS IT
SO GOOD?
INTERESTING IDEAS, WIDE
KNOWLEDGE, CLEAR RESEARCH
QUESTIONS AND THIS IS WHY YOU'VE
CONTRIBUTE SOD MUCH TO THE FIELD
AND THANK YOU, VERY MUCH.
[APPLAUSE]
>>WE RECEIVED THAT MARK HAS HAD
SO, WE THOUGHT IT WOULD BE
APPROPRIATE NOW TOWARDS THE ENDS
TO HEAR IN A JOINT SESSION FROM
SOME OF HIS LATEST COLLABORATOR
AND TRAINEES AND SO I WILL ASK
THEM TO COME UP.
Dr. DEBRA, NOW RUNNING THE
MOVEMENT DISORDERS CLINICAL.
SOFIE CHO AND MARK'S LATEST
TRAINEES AND COLLABORATORS.
IT'S LATEST.
>>I'M SOFIE CHO AND I'M REALLY
HOPPERED TO BE GIVEN THIS
OPPORTUNITY TO SHARE MY STORIES
WITH Dr. HALLETT.
AND I BECAME INTERESTED IN
MOVEMENT DISORDERS DURING MY
EARLY YEARS OF POST GRADUATE
TRAINING AND I WAS PORT AT TO
RECEIVE SUPPORT FROM MY
RESIDENCY PROGRAM ATTENDING TO
ATTEND ASPEN COURSE WHICH WE
HEARD ABOUT FROM Dr. JANKOVIC
EARLIER TODAY AND MEETING Dr.
HALLETT AT THE TIME, FOR ME,
BECAUSE LIKE MEETING A BIG
HOLLYWOOD STAR.
I WAS REALLY INTRIGUED BY HIS
LECTURE AND START TO GROW MORE
IN MY MIND SO ON THE SECOND OR
THIRD DAY OF AS PEP COURSE, I
TOOK THE COURAGE TO APPROACH
Dr. HALLETT AND ASKED FOR ANY
OPPORTUNITIES TO SPEND MORE TIME
WITH HIM AND HE GRACIOUSLY GAVE
ME AN OPPORTUNITY SO DURING MY
THIRD YEAR OF NEUROLOGY
RESIDENCY I WAS FORTUNATE ENOUGH
TO TAKE ONE MONTH OF ELECTIVE
ORIENTATION IN HUMAN MOTOR
CONTROL SECTION AND TWO YEARS,
LATER, I CAME BACK TO NIH'S
CLINICAL FELLOW AND WHEN I MOVED
TO MARRY LAPPED TO START MY
FELLOWSHIP, I WAS IN A DIFFICULT
SITUATION.
I WAS A SINGLE MOM, LIVING APART
FROM MY HUSBAND, WITH MY
10-MONTH-OLD SON AND MANY DAYS I
HAD TO LEAVE WORK BECAUSE MY SON
WAS SICK OR GOT HURT OR FOR ANY
OTHER NORMAL EVENT THAT HAPPENS
TO AN INFANT AND Dr. HALLETT
WAS SUPPORTIVE DURING THIS
DIFFICULT TIME AND HE EVEN
SHARED HIS OWN EXPERIENCE WHEN
HE WAS A JUNE FACULTY HE TOLD ME
THAT HE WAS LIVING IN BOSTON IN
HIS FAMILY WAS IN MARYLAND AND
HE HAD TO FLY EVERY WEEKEND O TO
BE WITH HIS FAMILY AND IT WAS
HARD AND EVENTUALLY MADE HIM
MOVE TO MARYLAND TO NIH.
I WAS REALLY LUCKY TO HAVE A
MENTOR THAT UNDERSTOOD AND CARED
WHAT I WAS GOING THROUGH MY LIFE
AND SUPPORTING ME.
IIT MADE ME BELIEVE I COULD DO
THIS.
I LEARNED ALL KINDS OF NEURO
PHYSIOLOGY TO STUDY NORMAL AND
ABNORMAL MOVEMENT AND WE HEARD
EARLIER TODAY ABOUT SURROUND
INHIBITION AND Dr. HALLETT, AS
YOU SAW BEFORE, I WAS THE FIRST
TO DEMONSTRATE THE MOTOR CORTEX
LEVEL USING THE TMS AND TURNED
OUT THAT THE SURROUNDING
INNOVATION AT THE MOTOR CORTEX
LEVEL IS IS A PARENT AT THE CON
SET OF THE MOVEMENT BUT NOT
DURING THE MAINTENANCE PHASE AND
WE DID ANOTHER EXPERIMENT AND MY
RESEARCH BUDDY AND FOREVER DEAR
FRIEND, AND SHOWED THAT
CEREBELLUM MIGHT BE INVOLVED IN
MAMAINTAINING THE SELECTIVE
MOVEMENT AND WE USED TMS TO
STUDY TREMOR DIS TONIC TREMOR
AND WE HEARD FROM RICK ABOUT
THIS PAPER EARLIER TODAY AND WE
SHED STRONG LIGHTS AND MADE THEM
BLINK AND WE USED SPECIAL LENSES
TO BLOCK LIGHT AND SEE HOW IT
EFFECTED THEIR BLINKING AND SO,
AGAIN,
I CAME TO STUDY MOVEMENT AND I
LEARNED ALL THESE SKILLS FROM
DROP HALLETT BUT REALLY, YOU
KNOW, HE DOESN'T ONLY TEACH YOU
SKILLS, HE REALLY TEACHES YOU
HOW TO THINK AND NOT ONLY THAT,
HE REALLY MADE ALL OF US
TRAINEES, TO BELIEVE THAT WE'RE
PART OF ONE BIG HMCS FAMILY.
IT WAS REALLY IMPORTANT AND WE
HAD A LOT OF FUN AND WE ENJOYED
TOGETHER.
MOVING ON TO MY SECOND YEAR OF
MY FELLOWSHIP, SO I BECAME MORE
INTERESTED IN SENSORY MOTOR
INTEGRATION AND WE HEARD ABOUT
THAT EARLIER TODAY AND WE USED A
PAIRED ASSOCIATED STIMULATION
AND IN THE MOTOR CORTEX AND
STUDIED THAT THE NETWORK IN
MOTOR NETWORK PLASs ADVERTISE
TEE AND SHOWED THAT THE
PLASTICITY BETWEEN THIS NETWORK
WAS ONLY ABNORMALLY ENHANCED IN
DYSTONIA BUT NOT IN NON TEST
SPECIFIC DIS TONIA AND I ALSO
BECAME INTERESTED IN SENSORY
TRICKS AND HE REALLY ENCOURAGED
ME TO TAKE A DEEP DIVE SO I DID
THAT WITH EEG AND FMRI SO WE
FOUND SOME INTERESTING RESULTS
AS WELL TO SHOW THAT SMA PLAYS
AN IMPORTANT ROLE IN THE
PREPARATION PHASE BEFORE THE
HAPPENS AND AFTER TWO YEARS OF
WONDERFUL, WONDERFUL FELLOWSHIP
YEARS, I HAD TO LEAVE NIH DUE TO
VISA REQUIREMENTS.
I SHED A LOT OF TEARS ON
GRADUATION DAY.
I WANTED TO BE Dr. HALLETT'S
FELLOW FOREVER IF I COULD.
I HAD TO GROW UP.
I SO LEFT BUT FORTUNATELY
ENOUGH, I WAS ABLE TO COME BACK
TO NIH IN FOUR YEARS AND THIS
TIME AS A STAFF CLINICIAN TO
DIRECT THE CONSUL SURVEYS OF THE
NINDS BUT MY OF BOSS Dr. NED
HIRA LOUD MHERE, ALLOWED ME TO E
WITH MY GROUP SO I GOT
RECONNECTED AND HE HELPED ME TO
GET CONNECTED WITH WONDERFUL AND
SMART PEOPLE AND REALLY INSIDE
AND OUTSIDE AND NIH SO I MET
BUZZ HERE AND WORKED ON THIS FUN
PROJECTS TOGETHER AND I MET VIA
FROM TWO TALKS AND SO I AM
SPARED ME TO START THIS NEW
PROJECT AND USING THE
STIMULATION OF THE DLPFC AND
ACTIVELY RECRUIT SO MORE WORK
AND STORY HE'S TO BE CONTINUED.
I JUST WANTED TO THANK YOU FOR
MY HEART.
THANK YOU FOR TAKING ME AND
GUIDING ME TO WHERE I AM.
IT'S BEEN A DREAM-LIKE
OPPORTUNITY TO WORK ALONGSIDE
YOU.
AND WE'RE NOT READY TO LET YOU
GO.
AND I KNOW THAT YOU ARE NOT
GOING FAR AWAY.
SO I LOOK FORWARD TO CONTINUING
TO LEARN FROM YOUS.
SO THANK YOU SO MUCH.
[APPLAUSE]
>>HI, I'M DEBRA AND I AM A
STAFF CLINICIAN AND I JOINED
NINDS NEARLY SIX YEARS AGO NOW
AS A JUNE CLINICAL FACULTY
MEMBER AND I CONSIDERED MYSELF
VERY LUCKY TO LITERALLY KIND OF
WORK NEXT DOOR TO MARK.
I KNOW THAT A LOT OF MY
COLLEAGUES, WHEN THEY FIRST
STARTED, AS JUNIOR FACULTY, FELT
ISOLATED, PARTICULARLY, IN A SUB
SPECIALTY WHERE YOU KNOW, ALL OF
A SUDDEN, YOU ARE THE ONE WHO
MAY BE THE EXPERT IN THAT SUB
SPECIALTY BUT YOU ARE EARLY IN
YOUR CAREER.
IT WAS CERTAINLY
ANXIETY-RELIEVING TO KNOW THAT I
HAD ONE OF THE WORLD EXPERTS
RIGHT NEXT TO ME WHO WAS ALWAYS
AVAILABLE AND ABLE TO HELP ME
WHEN I NEEDED HELP SO, IT'S
CERTAINLY MADE THE TRANSITION
EASIER AND I ALWAYS HAD TO GAGE
WHEN I WOULD SEE A PATIENT THAT
I KIND OF STRUGGLED WITH.
MARK WAS ALWAYS MORE THAN HAPPY
TO DISCUSS THESE CASES AND SAY I
SAW SOMETHING WEIRD TODAY, WHAT
DO YOU THINK OF THIS AND IF HE
SAID, WOW, THAT'S VERY
INTERESTING, I'VE NEVER SEEN
THAT BEFORE, THAT WOULD BE MY
GAGE THIS WAS CASE REPORT WORTHY
AND IF MARK HADN'T SEEN IT
BEFORE, WELL, PROBABLY NO ONE
DID.
SO, IT WAS SUCH A GREAT WAY TO
REALLY STARTED IN CAREER AND
I'VE SAID MEDICAL SCHOOL THEY
TEACH YOU HOW TO DO EVERYTHING
IN THE CLIP I CAN BUT ONE THING
YOU DON'T GET A LOT OF TRAINING
IN IS HOW TO BE A GOOD LEADER.
AND I FEEL SO PRIVILEGED TO HAVE
HAD MENTORSHIP IN THAT AS WELL.
MARK AND I HAVE MET EVERY WEEK
AND CONTINUE TO MEET ONCE A WEEK
AND
WE DISCUSS EVERYTHING, SCIENCE
AND HOW TO LEAD A GROUP, YOU
KNOW, HOW TO DEAL WITH STAFF AND
HOW TO NAVIGATE IRBs AND ALL
OF THESE INNS AND OUTS OF
RESEARCH THAT PARTICULARLY AT
NIH A LOT OF OUR TRAINING
DOESN'T PREPARE US FOR THIS AND
I FEEL SO LUCKY TO HAVE SOMEONE
WHO IS WILLING TO TALK ME
THROUGH THIS AS I NAVIGATE THIS
AND YOU KNOW, HE REALLY CREATED
CLINIC THAT IS UNIQUE BECAUSE
THE CLINIC IS MAINLY TO RECRUIT
AND DO PRODUCTIVE RESEARCH AND
THAT BEING SAID IT'S ALSO AN
AMAZING LEARNING ENVIRONMENT AND
HE CREATED IT SO THAT ALL THE
THE CASES WOULD BE DISCUSSED AND
NOT ONLY WOULD THE CASES BE
DISCUSSED BUT THE IDEAS OF EVERY
PERSON IN THE ROOM WOULD BE
VALID AND THAT IS IS REALLY YOU
KNOW, ONE OF THE THINGS I
LEARNED FROM HIM TO LISTEN IT
YOUR PATIENTS AND I REMEMBER
TIMES WE'VE HAD SOME STUDENTS
JUST THERE FOR A FEW WEEKS AND
YOU KNOW, THEY NAME AND ASKED A
QUESTION AND SOMETIMES THEY'RE
UNIQUE PERSPECTIVE WOULD
ACTUALLY MAKE US THINK ABOUT THE
CASE IN A DIFFERENT WAY.
AND
, THE CLINIC NOT ONLY
SO,
, IT'S BEEN A GREAT PLACE TO
START MY CAREER AND GROW AND I
COULDN'T HAVE DONE THAT WITHOUT
MARK AND SO IT'S BEEN A
PRIVILEGE AND AN HONOR TO WORK
SIDE BY SIDE WITH YOU AND CALL
YOU MY COLLEAGUES FOR THE LAST
SIX YEARS AND BEST OF LUCK IN
YOUR RETIREMENT.
[APPLAUSE]
>>HELLO.
IT WAS HARDER ALREADY YESTERDAY
AND IT WAS HAPPEN HE'S TO SAY A
FEW WORDS AND I DON'T WANT TO
REPEAT HOW IMPORTANT WAS THIS
EXPERIENCE AND WORKING WITH THE
Dr. MARK HALLETT BECAUSE
YESTERDAY'S I USED MY BEST
JOKES.
[LAUGHTER]
AND WELL, MOST OF THE SPEAKERS
TODAY, THEY SAY WELL EVERYBODY
BASICALLY USED THE WORDS
"MOVEMENT DISORDERS" AND I DON'T
WANT TO BE ANY LESS -- I DON'T
WRACK WITH MOVEMENT DISORDERS SO
I USE THE SAME WORDS.
I HAD THIS OPPORTUNITY TO WORK
ON A SPECIAL PROJECT AND
SOMETIMES IT ALSO TOUCHED THE
MOVEMENT DISORDERS LIKE THE LAST
MANUSCRIPT WE'RE WORKING ON
ABOUT THE AND THE EXPERIMENTS SO
I WORKED ON SOMETHING THAT IS
MORE SIMILAR TO PATRICK EXPLAINS
WONDERFULLY BEFORE.
AND OF COURSE, AFTER PATRICK I
CANNOT SAY ANYTHING.
I WILL APPEAR LIKE NOT ADEQUATE
BUT I WOULD LIKE TO SAY
SOMETHING THAT MAYBE IT'S
ANOTHER QUALITY OF MARK HALLETT
THAT I THINK THAT IS VERY
INTERESTING, IT'S A NONE A NON.
WE DON'T HAVE A LOT OF OPENING H
PEOPLE AROUNDS AND NOT -- I CAME
HERE AND I WAS IT WAS THE FIRST
LAB MEETING ON WEDNESDAY, AND
THERE WAS A YOUNG GUY, HE WAS A
POSTBAC, PRESENTING A PROJECT
AND IT WAS VERY SMART GUY.
AND HE WAS SPEAKING, HE SPOKE
VERY FAST.
WE FINISHED THE MEETING, I WENT
TO A ROOM AND THERE WAS ANOTHER
COLLEAGUE OF MINE, ALSO ITALIAN,
SHE WAS LOOKING AT ME, LAUGHING
AND WAS LIKE, I UNDERSTAND A
WORD AND I THOUGHT I'M SCREWED.
[LAUGHTER]
AND OF COURSE, THINGS IMPROVED A
LOT BECAUSE IT'S JUST A MATTER
OF PRACTICE BUT THEN I SPOKE TO
THE GUY I WAS LIKE, MAN, I HAVE
TO TELL YOU, I DIDN'T
UNDERSTAND.
I'M A FAST SPEAKER, I'M SORRY.
SO HE STARTED LIKE DECREASING
THE SPEED OF HIS TALK AND I WAS
LIKE NO, YOU CAN GO BACK TO YOUR
ORIGINAL.
AND IT'S NOT THAT PROBLEM.
SO, THAT WAS A REAL GREAT
QUALITY.
YOU SPEAK REALLY CLEAR,
WONDERFUL WAY.
AND YEAH, I THINK THAT FOR
AMERICAN PEOPLE, IT'S NOT
MAYBE -- IT'S NOT MAKING A
DIFFERENCE BUT FOR ME, IT WAS
TOWARDS THE ENTIRE WORK.
AND I ENJOYED EVERYTHING IN THIS
EXPERIENCE BECAUSE THE WHOLE
GROUP WAS BEAUTIFUL.
I MOVED RECENTLY TO ANOTHER LAB
BUT I WAS LUCK YOU ENOUGH TO
STAY WHERE I WAS BEFORE.
I DIDN'T EVEN CHANGE MY DESK.
AND NOT BECAUSE I'M LAZY, THEY
ALLOWED ME TO STAY THERE.
SO I'M STILL IN TOUCH WITH THEM
EVERY DAY AND IT'S BEAUTIFUL.
WE'RE STILL LIKE I'M STILL
PREPARING THE COFFEE WHERE I WAS
BEFORE SO THAT'S BEAUTIFUL AND
ESPECIALLY BECAUSE WE STILL HAVE
A LOT OF WORK TO DO, WE ARE
STILL FINISHING TWO EXPERIMENTS,
WE HAVE ALL THE STAFF TO WRITE
DOWN AND ALL THE THINGS TO DO SO
PROBABLY, YEAH, REALLY NOTHING
IS REALLY CHANGING, I GUESS.
I'M SCARING YOU.
[LAUGHTER]
I DON'T WANT TO STEAL TIME SO
I'M DONE.
THANK YOU, VERY MUCH.
THANK YOU VERY MUCH, Dr.
HALLETT.
[APPLAUSE]
HI, I'M KYIA AND I SUPPOSE I'M
Dr. HALLETT'S LATEST POSTBAC
TRAINEE.
AND I ARE HAD THE GREAT
PRIVILEGE OF WORKING ALONGSIDE
HIM AND Dr. HALLETT FOR THE
LAST YEAR-AND-A-HALF ON THE FREE
WILL PROJEC PROJECT OR PROJECTS.
LIKE MOST OF THE PEOPLE THAT
HAVE SPOKEN TODAY, I DO NOT HOLD
AN MD OR A PH.D OR ANY POST
GRADUATE DEGREE OF ANY SORT SO
THIS EXPERIENCE HAS REALLY BEEN
A TIME FOR ME TO THINK WHAT I
WOULD LIKE TO DO WITH MY LIFE
AND I THINK THAT THERE'S NO ONE
BETTER THAN Dr. HALLETT TO
MENTOR ME THROUGH THAT PROCESS.
STARTING FROM THE MOMENT I CAME
IN, I WAS CONSTANTLY INSPIRED
NOT JUST HOW AMAZING OF A
NEUROLOGIST AND NEUROSCIENTIST
AND CRITICAL THINKER Dr.
HALLETT IS, BUT ALSO PARALLEL
DISPLAYS OF HUMILITY AND
OPENNESS TO THE OPINIONS OF
THOSE AROUND HIM, KIND OF LIKE
WHAT Dr. EURLIC TALKED ABOUT
WITH SOMEONE WITH SO MANY
ACCOMPLISHMENTS THROUGHOUT THEIR
CAREER.
IT WOULD BE EASY FOR Dr.
HALLETT TO OVERLOOK SOMEONE LIKE
ME, WHO HAS ONLY BEEN IN THIS
AREA FOR A HANDFUL OF YEARS, AND
WHAT I HAVE TO SAY.
I FIND WITH ALL OF OUR WEEKLY
MEETINGS AND WHEN I HAVE ANY
SUGGESTIONS ABOUT ANYTHING
RELATED TO THE NEURO PHYSIOLOGY
OF OUR PROJECTS, Dr. HALLETT
IS ALWAYS VERY KEEN TO LISTEN
AND VERY ATTENTIVE TO WHAT I
HAVE TO SAY.
IN A WAY THAT I HAVEN'T
EXPERIENCED IN A RESEARCH
POSITION BEFORE AND I REALLY
THINK THAT'S SUCH AN IMPORTANT
QUALITY BECAUSE IT JUST SHOWS
THAT THIS GENUINE INTEREST IN
ATTENTIVENESS TO EVERYONE AND
EVERYTHING AROUND HIM AND A WAY
THAT YOU DON'T SEE WITH MANY
PEOPLE NOWADAYS.
IT STRUCK ME AND IMPACT MEDICINE
AND REALLY CONFIRMED MY DESIRE
TO HOPEFULLY ONE DAY HAVE A
CAREER THAT COMES VERY, VERY,
VERY SHORT OF WHAT Dr. HALL ET
HAS DONE BECAUSE THERE'S NO ONE
THAT COULD LIVE UP TO WHAT YOU
HAVE DONE.
I'M CONSTANTLY AMAZED BY THIS
SENSE OF HUMILITY THAT YOU
DISPLAY AND HOW KEEN YOU ARE TO
LISTEN TOP EVERYONE AROUND YOU
AND IT JUST SHOWS THAT THIS IS
AN AREA OF GENUINE INTEREST TO
YOU.
SO, THANK YOU FOR ALL THAT
YOU'VE DONE AND LIKE EVAN A
SAID, NOT MUCH WILL CHANGE FOR
THE THREE OF US IN TERMS OF OUR
COLLABORATIONS BUT LOOKING
FORWARD TO CONTINUE WORKING WITH
YOU IN THIS NEXT CHAPTER.
[APPLAUSE]
>>THANK YOU.
>>THANK YOU, EVERYONE.
THIS WAS GREAT.
I REALLY APPRECIATE THE
WONDERFUL WORDS FROM EVERYONE.
AND NOW WE'RE --
>>LET'S WAIT FOR THE HUGS AND
SOMEONE CAN TAKE PICTURES OF
THEM.
SO, YEAH, WE'RE GETTING NOW OF
TO THE -- WE ARE GETTING TO
THE -- WE ARE GETTING TO THE END
OF TODAY BUT WE CAN'T GO WITHOUT
MARK'S REMARKS SO WE ARE WAITING
FOR YOU.
SO, IF YOU WILL WANT TO COME UP
OR YOU WANT TO TALK FROM THERE?
>>SO ONE THING WE WANT TO GIVE
YOU, SO WE ASKED PEOPLE, NOT
EVERYBODY IS HERE BUT A LOT OF
PEOPLE ARE ON-LINE AND EVERYBODY
WANTS TO SEND THEIR GREETINGS SO
WE DECIDED TO DO AN E-CARD SO
EVERYBODY CAN SIGN FOR IT.
IT IT TURNED OUT TO BE AN
E-BOOK.
[LAUGHTER]
SO, EVEN WE HAD TO CUT IT SHORT
BECAUSE THERE WAS SO MANY
SIGNATURES AND THINGS THAT WE
NEEDED TO SEND TO THE PRINTER
BUT YEAH, THIS IS YOUR E-CARD.
MOST OF THE PEOPLE THAT COULD
ARE HERE OR NOT, YOU HAVE PLENTY
OF TIME TO READ IT IN YOUR
RETIREMENT.
[LAUGHTER]
AND YEAH, WE LEFT THE PODIUM FOR
YOU FOR WHATEVER YOU WANT TO
SAY.
>>OK.
THANK YOU.
[APPLAUSE]
>>WELL, I'M SURE THAT NO ONE
HERE HAS ENJOY THIS MORE THAN I
HAVE.
IT WAS A MARVELOUS DAY.
THANK YOU TO THE ORGANIZING
COMMITTEE VERY MUCH FOR SETTING
THIS UP AND THANK YOU ALL FOR
COMING.
IT REALLY HAS BEEN A PLEASURE
TO, FOR ME TO SIT HERE AND HEAR
FROM ALL OF YOU ABOUT THIS AND I
DO HAVE TO THANK YOU ALL AND ALL
THE PEOPLE ON-LINE FOR DOING
THIS AS WELL.
AND A YOU HEARD.
AS I WAS SAYING LAST NIGHT, WE
HAD A DINNER AND MY WIFE AND SON
ARE HERE TOO AND THIS IS VERY
NICE.
I DID TALK ABOUT EVERYBODY
ELSE'S BEING PART OF, PART OF
THE FAMILY AND I DO HAVE THAT
FEELING THAT THE NUMBER OF YOU
HAVE MENTIONED THAT AS WELL THAT
WE HAVE A HUMAN MOTOR CONTROL
FAMILY AND I'M REALLY VERY
GRATEFUL FOR EVERYBODY TO BE
PARTICIPANTS IN THIS NICE
FAMILY.
SO WHAT I THOUGHT I WOULD DO IS
TO FIRST OF ALL, SAY THAT I FEEL
THAT I'VE HAD A VERY LUCKY
CAREER IN TERMS OF THE
EXPERIENCES THAT I'VE HAD.
PEOPLE HAVE TALKED ABOUT
MENTORSHIP AND I WANTED TO SAY
SOME THINGS ABOUT MY OWN
MENTORS, WHICH HAVE TRAINED ME
TO GIVE YOU SOME SORT OF SENSE
ABOUT WHERE I GOT TO AT THIS
PARTICULAR POINT.
SO, JUST TO START AT THE
BEGINNING, I HAVE TO THANK MY
FATHER FIRST.
HE WAS AN OPHTHALMOLOGIST AND A
VERY GOOD PERSON FOR ME TO
FOLLOW THE FIELD OF MEDICINE AND
HE DID A LOT OF EXCELLENT
CLINICAL WORK, HE WAS THE CHIEF
OF UVITIS IN PHILADELPHIA WHICH
IS IS ONE OF THE PREMIERE
HOSPITALS IN THE UNITED STATES.
HE HAD A BASIC LABORATORY
ACTUALLY AND TRYING TO
UNDERSTAND UVITIS AND THEY KNOW
AT THAT TIME, THERE WAS NOTHING
THAT WE KNEW ABOUT UVITIS AT ALL
AND I DON'T THINK THAT HE MADE
ANY MAJOR CONTRIBUTIONS TO THE
FIELD, BECAUSE IT WAS AN IMMUNE
LOGICAL DISORDER AND WE DIDN'T
KNOW ANYTHING ABOUT IMMUNOLOGY
OR HE DIDN'T.
THERE WASN'T ANYTHING NOPE ABOUT
IMMUNOLOGY AT THAT TIME.
HE WORKED HARD AT IT IT AND
CERTAINLY TRIED.
THE PERSON THAT GOT ME
INTERESTED IN THE TRAIN WAS MY
OF HIGH SCHOOL PSYCHOLOGY
TEACHER.
I TOOK A COURSE IN PSYCHOLOGY
AND HE WASES A SPECTACULAR
TEACHER THAT I HAD IN HIGH
SCHOOL AND TO GIVE YOU UNEXAMPLE
OF HOW GOOD HE WAS, HE GAVE US
IN ONE HOUR THE BEST TEST I'VE
HAD IN ONE HOUR.
AND I STILL REMEMBER THAN THIS
TEST.
WE GIVE YOU A SENSE ABOUT HIS
QUALITY AS WHERE WE STUDY
PHILOSOPHY AND MAYBE THAT'S AN
IMPORTANT PART OF WHERE WE NEEDS
AND AND THIS WAS A FABULOUS
TEST.
WE CAME INTO THE ROOM AND HE
SAID, WELL, THERE'S BEEN AN HOUR
TEST AND FOR THE FIRST 45
MINUTES, I WANT YOU TO SET UP A
GOVERNMENT WITH A DIFFERENT
PHILOSOPHER THAT WE STUDY.
WE WANT A PRESIDENT, SECRETARY
AND TREASURIES AND SECRETARY OF
THE ARMY AND SECRETARY OF STATE
OF AND VARIOUS JOBS AND TAKE
THEM AND PUT THEM IN THOSE
PARTICULAR POSITIONS AND SET UP
A GOVERNMENT.
THAT WAS REAL HE'D FUN REALLY FO
AND HE SAID THE NEXT 15 MINUTES,
I WANT YOU TO DESCRIBE WHY THE
GOVERNMENT YOU JUST SET UP WILL
FAIL.
[LAUGHTER]
AND IT WAS JUST FUN TO DO THAT
MANY PARTICULAR TEST AND ANY ME
EVENT, I TOLD THIS STORY BEFORE
AND WE ALL HAD TO DO TERM PAPERS
AND I WANT OUT DOING A TERM
PAPER ON FREUD AND SIGMUND FREUD
AND I GOT INTERESTED IN FREUD'S
IDEAS AND IT GOT ME INTERESTED
IN THE BRAIN.
AND SO I WANT OFF TO COLLEGE AND
COMING INTO A PHYSICIAN WHERE
YOU ARE THAT AGE YOU DON'T WANT
TO DO WHAT YOUR PARENTS DO YOU
WANT TO DO SOMETHING ELSE SO I
THOUGHT THAT MAYBE I WOULD BE
SOMETHING ELSE.
I MAJORED IN ASTR ASTRONOMY BUTI
DECIDED MEDICINE WAS A GOOD IDEA
AND IF I WAS GOING TO DO
MEDICINE TOYED, I HAD TO STUDY E
BRAIN BECAUSE THAT'S WHAT I WAS
INTERESTED IN AND MY FATHER SAID
I SHOULD BE AN ON TA MOL GIST
BUT I NEVER GAME INTO THAT AND
THE BRAIN WAS ALWAYS INTERESTING
AND IN ANY EVENT, ONE OF THE
THINGS THAT HAPPENED, I GUESS I
WAS PROBABLY EARLY -- I WAS IN
ANY JUNIOR YEAR, NORMAN AGAINWIN
GESHWISRAEL N WAS INVITED AND IT
TO HEAR HIM AND THOSE WHO DON'T
KNOW HE IS THE FATHER OF
BEHAVIORAL NEUROLOGY IN THE
UNITED STATES AND PERHAPS
FURTHER THAN THAT AND SO, HE
GAVE WHAT I WOUND UP HEARING HIM
LECTURE ON ABOUT 10 TIMES FOCUS
ON HIS PACES OF A LEXIA WITHOUT
A GRAPHIA AND HE POINTED OUT
CONNECTIVITY IN THE BRAIN AS
BEING CRITICAL AND YOU HEARD
ABOUT HIS TWO-PART PAPER THAT HE
WROTE THAT THE TIME AND I HAVE
READS AND ALSO I GOT ME
INTERESTING IN BRING
CONNECTIVITY AND WHICH SOMETHING
THAT HAS BEEN A CONTINUING
INTEREST OF MINE AND AS YOU'VE
HEARD.
THEN I -- LET'S SEE, SO THE
OTHER THING NOT AT COLLEGE I
SUPPOSE I HAD MENTION THAT I
ACTUALLY DID MY THESIS ON THE
LOBSTER HEART.
SO MY FIRST PHYSIOLOGY PROJECT
WAS ON THE LOBSTER HEART AND IT
WASN'T ON ACTION POTENTIALS, IT
WAS ON -- IT'S REAL HE'S FROM
LOBSTERS TO, FREE WILL, I GUESS.
THE LOBSTER HEART IS A NEURO
NEUROGENIC HEART, THERE'S A NINE
CELL GANG LEANNE GANGLIA HEART T
REGULATES THE HEART AND IT WAS A
LOT OF QUESTIONS ABOUT HOW THE
NETWORK OF THOSE NINE NEURONS
WORKS TO CONTROL THE HEART SO
AGAIN, THE SORT OF NETWORK, I
KEPT GETTING PUSHED INTO THE
IDEA OF NETWORKS AS BEING
PARTICULARLY CRITICAL AND
INTERESTING.
ANY ANY EVENT, I WENT OFF TO --
SORRY, I KEEP FOR GETTING ALL
THESE GOOD STORIES HERE.
THE OTHER PART THAT KEPT ME
INTERESTED IN THE BRAIN WAS
AROUND THAT TIME, THERE WAS AN
ENORMOUS INTEREST IN THE VISUAL
SYSTEM.
AND THERE WERE SERIES OF
LECTURES OVER AND OVER AGAIN
ABOUT HOW WE SEE.
GEORGE WALD GOT THE NOBEL PRIZE
FOR RODOBSON AND THEN HUBLIN
WIESEL AND EDMOND LAND
PARTICIPATED IN THESE HE IS THE
ONE THAT VENTED THE POLL A ROID
CAMERA BUT HE HAD VISION OF
COLOR VISION THAT WAS
INTERESTING.
A PROFESSOR AT MIT HAD THIS
FAMOUS PAPER WHAT THE FROGS EYE
TELLS THE FROG'S BRAIN.
AND FABULOUS LECTURER.
AFTER MY FIRST YEAR IN MEDICAL
SCHOOL, I HAD THE OPPORTUNITY TO
WORK WITH HUBLIN WEASEL THEY GOT
THE NOBEL PRIZE FOR SURROUND
INHIBITION IN THE VISUAL SYSTEM
AND THEY DIDN'T HAVE THE NOBEL
PRIZE YET WHEN I WAS WORKING FOR
THEM BUT THEY KNEW THEY WERE ON
TRACK I THINK.
AT THE TIME.
IN MY OF 28th SUMMER, WHICH
WAS THE ONLY OTHER SOMETIME THAT
I HAD SOME FREE SUMMER, IT WAS
MY LAST QUOTE FREE SUMMER, I HAD
THE OPPORTUNITY TO WORK IN THE
DEPARTMENT OF NORMAN GESHWIN SO
FROM HIS PARTICULAR STIMULATION
AND BACK WHEN I WAS IN COLLEGE I
HAD THE OPPORTUNITY TO SEE HIM
IN ACTION AND IN HIS DEPARTMENT
AND LEARN FROM HIM AT THAT TIME
AND HE ALSO ASSIGNED ME TOEL
WORK WITH A NEURO A MAT MIST,
DEPOCK PONKIA AND WE STUDIED THE
AUDITORY SYSTEM IN THE MONKEY
AND HE HIMSELF TURNED OUT TO BE
A FANTASTIC INDIVIDUAL.
HE CONTINUED TO WORK IN THE
FIELD OF NEURO ANATOMY UNTIL A
COUPLE YEARS AGO WHEN HE DIED HE
JUST KEPT ON WORKING AND
CONTRIBUTED TO ANNIE NORM AMOUNT
OF NEURO A M ANATOMY.
THE PAPER I WROTE WITH HIM
TURNED OUT TO BE MY FIRST
PUBLISHED PAPER AND WHATEVER I
LOOK AT MY OWN LIST OF PAPERS,
THAT'S ALWAYS THE FIRST WITHIN
THAT I SEE.
THERE'S A MEMORIAL ABOUT DEPOCK
THAT WILL BE DONE JEREMY, AT THE
MATS GENERAL IS ORGANIZING THAT
HE WAS VERY MUCH INVOLVED WITH
DEPOCK AS WELL AND I'M ONE OF
THE OLDEST FELLOWS AND I
REVISITED A SPECULATION, SO I
WRITTEN MY PART OF THE MEMORIAL
AND I SORT OF REVISITED A
SPECULATION THAT WE MADE IN THAT
PAPER SO SEE IF APPROXIMATE IT
WAS TRUE OR NOT AND HE WAS NOT
TO BE TRUE.
STILL WAS A GOOD PAPER.
ALL OF THE FACTS WERE CORRECT
BUT THE PARTICULAR SPECULATION
THAT IT WASN'T RIGHT BUT IT WAS
AN INTERESTING SPECULATION AND
THAT WE HAD DONE.
I HAD THE OPPORTUNITY TO HAVE
RAYMOND ADAMS AS MY OF MEDICAL
SCHOOL ADVISER AND ADAMS BEING
UP WITH OF THE PREMIERE
NEUROLOGISTS IN THE WORLD, OF
COURSE.
AND HE TOLD ME IN MY ELECTIVES,
WHEN I WAS MEDICAL SCHOOL, THAT
I HAD TO SPEND A MONTH WITH C
MILLER FISHER AND I HAD TO SPEND
A MONTH WITH DAVID KOGAN, THE
FOUNDER OF NEURO OPHTHALMOLOGY
AND THOSE ARE THE PEOPLE YOU
WOULD KNOW.
HE GAVE ME A LOT OF OTHER GOOD
ADVISE FOR OTHER FOLKS.
I GOT GOOD MENTORSHIP FROM
FISHER AND ADAMS AND KOGAN AND
THEN I WENT TO -- AFTER
INTERNSHIP, I CAME TO NIH'S AS
YOU HEARD.
I HAD A MENTOR AND AT THAT TIME,
I DID ACTION POTENTIAL AND TSAKI
WAS NATIVE JAPANESE AND HE WAS
FAMOUS FOR DISCOVERING -- AND
EXTREMELY IMPORTANT OBSERVATION.
HE PUBLISHED IN GERMAN DURING
WORLD WAR II.
HIS PAPER WAS NOT SEEN BY THE
ENGLISH-SPEAKING WORLD AT LEAST
HUCKSLY AND STANCELY, WHO
REDISCOVERED IT IT OR PUBLISHED
IT ABOUT FIVE YEARS LATER
CLAIMED THEY NEVER SEEN HIS
PUBLICATION AND SO THEY GOT
CREDIT FOR IT FOR A NUMBER OF
YEARS BUT IT WAS REALLY TSAKI
THAT MADE THAT OBSERVATION AND
PUBLISHED IT FIRST.
I LEARNED A LOT FROM HIM.
ALSO HOW TO WRITE ENGLISH.
PERHAPS TALKING ABOUT EVAN A AND
COMMUNICATING, HE WOULD SAY
LOOK, PEOPLE WHO ARE NOT NATIVE
ENGLISH SPEAKERS WON'T
UNDERSTAND THIS, UP TO WRITE IT
SO THAT ANYBODY CAN UNDERSTAND
IT AND WE WOULD SPEND HOURS EVEN
ON ONE SENTENCE TO MAKE SURE
THAT IT WAS CLEAR SO NOT ONLY
DID I LEARN MEMBRANE BIOPHYSICS
BUT I ALSO LEARNED HOW TO WRITE
MUCH BETTER FROM HIM.
I GIVE YOU A BETTER SENSE ABOUT
HOW LONG AGO IT WAS AND WE DID
MOST OF OUR CALCULATIONS BY
SLIDE RULE EX YOU GET THREE
SIGNIFICANT DIGITS.
WE GOT A COMPUTER IN THE
LABORATORY THAT I PROGRAMMED TO
DO THE ANALYSIS AND HE WAS VERY
SKEPTICAL OF COMPUTERS.
AND I'M NOT SURE THAT THAT'S
GOING TO HELP VERY MUCH BUT I
DID SOME ANALYSIS AND SHOWED IT
TO THEM AND HE TOOK OUT HIS
SLIDE RULE AND CHECKED ALL MY
CALCULATIONS AND HE SAID WELL,
MAYBE THIS IS GOING TO WORK.
[LAUGHTER]
AND ALSO TO TELL YOU HOW LONG
AGO THAT WAS, THERE WASN'T, THAT
WAS THE TIME THAT MEMBRANE
CHANNELS WERE PROPOSED AND WE
WEREN'T ALLOWED TO TALK ABOUT
THAT ACTUALLY.
AND OF COURSE THAT HAS CHANGED
BUT WE MADE SOME NICE
CONTRIBUTIONS ANYWAY.
THE ONE I'M MOST PROUD OF IS
MAKING THE FIRST DEMONSTRATION
THAT'S CALCIUM ACTUALLY WENT NO
THE AXO DURING AN ACTION PO TEM
SHALL.
IT WAS SPECULATED IT WAS TRUE
BUT IT HADN HADN'T BEEN PROVEN T
WAS ONE OF THE THINGS WE DID AT
THAT TIME.
I DID MY NEUROLOGY RESIDENCY AT
THAT HAVE TIME.
ADAMS AND FISHER WERE THE LEAD
NEUROLOGISTS AND DAVID COGAN WAS
STILL DOING OPHTHALMOLOGY AND
REALLY ABSOLUTELY SPECTACULAR
PEOPLE TO LEARN FROM AND AFTER
RESIDENCY, MY WIFE AND I DECIDED
THAT WE WANTED GO TO LONDON.
WE THOUGHT IT WOULD BE NICE TO
GO AWAY FOR A YEAR AND IT WAS A
DECISION I HAD TO MAKE OF WHO TO
WORK WITH.
I HAD SEEP SOME PAPERS FROM
DAVID MARSDEN WITH MARSDEN WORK
ON THE LONG LATE EP LATEN SEE D
I THOUGHT IT WAS INTERESTING SO
I WEPT TO VISIT HIM AND I ALSO
WAS CONSIDERING WORKING WITH TOM
SEARS, WHO WAS THE HEAD OF
PHYSIOLOGY AT QUEEN'S SQUARE AT
THAT TIME AND UP WITH OF THE
EDITORS OF THE JOURNAL OF
PHYSIOLOGY AND HE HAD BEEN DOING
SHOULD I DO MOTOR CONTROL WITH
HIM OR WHAT SHOULD I WORK WITH
TOM SEARS AND EVERYBODY SAID
SEARS.
SEARS WAS THE QUEEN'S SQUARE AND
HE WAS WELL NO ONE AND KNOWN HAD
ANY IDEA WHO MARSDEN WAS AND AT
THAT TIME AND IN FACT, HE WAS
ONLY A FEW-YEARS-OLDER THAN I
WAS.
HE HAD BEEN NAMED RELATIVELY
QUICKLY AS PROFESSOR OF
NEUROLOGY AT THE INSTITUTE OF
PSYCHIATRY AND SO IT WAS A YOUNG
GUY, NO ONE KNEW WHO HE WAS BUT
I LIKED THE WORK HE DID SO I
DECIDE TODAY DO THAT AND THAT
YEAR THAT I HAD IN FELLOWSHIP
WAS THE MOST PRODUCTIVE TIME
THAT I HAD HAVE PROBABLY HAD AND
IT WAS A REALLY SPECTACULAR YEAR
AND DAVID MARSDEN WAS A VERY
GOOD MENTOR FOR ME AND HE
CONTINUES TO BE INTERESTED IN MY
CAREER EVERY SINCE THAT TIME I
WAS WORKING WITH WITH HIM AND I
LEARNED A LOT ABOUT MENTORSHIP
AND ONE OF THE THINGS THAT
ACTUALLY SOFIE JUST MENTIONED IT
A LITTLE WHILE AGO, ONE OF THE
THINGS THAT HE ALWAYS DID IS NOT
ONLY DID WE TALK SCIENCE BUT WE
TALKED ABOUT HOW THINGS WERE
GOING IN YOUR PERSONAL TIME AND
HOW THE KIDS,
, WHAT'S GOING ON AND THAT WAS
VERY NICE AND I LEARNED THAT
FROM HIM AND AS WELL AND SO,
LOTS OF GOOD MENTORSHIP IN THAT
REGARD AND I TOOK MY FIRST JOB
AT THE BIG UM AND CAME TO NIH
AND I GUESS AT THIS POINT, YOU
HAVE, YOU DON'T HAVE MENTORS BUT
YOU HAVE SUPERVISORS AND I WOULD
SAY THAT ALL THE SUPERVISORS
THAT I'VE HAD HAVE BEEN TERRIFIC
AND SUPPORTIVE AND JUST SAID OF
I WAS IN BOSTON IT WAS RICK
TYLER AND I GOT HERE TO NIH
THERE WAS A WHOLE VARIETY OF
SUPERVISORS THAT I'VE HAD WHO
HAVE BEEN VERY HELPFUL AND
SUPPORTIVE TO ME OVER THE YEARS
AND THAT HAS BEEN TERRIFIC AS
WELL AND THAT BEGAN WITH WHEN I
FIRST CAME
THE SCIENTIFIC DIRECTOR, BARRIE
GOLDSTEEN WAS THE INSTITUTE
DIRECTOR AND I WAS CLINICAL
DIRECTOR AND THEY HAVE ALWAYS
BEEN SUPPORTIVE AND THE SUCCESS
OF PEOPLE THAT HAVE FOLLOWED AND
WALTER NOW BEING THE INSTITUTE
DIRECTOR HAS BEEN SUPPORTIVE AND
IN TERMS OF SCIENTIFIC DIRECTOR
YOU HEARD OF JEFF DIAMOND AND
LORD ROLE PROCEEDED HIM IN THAT
ROLE AND THEY WERE VERY
SUPPORTIVE AS WELL AND HAVING
SUPPORT IS IN THIS TYPE OF
ACTIVITIES IS VERY GOOD WE ARE
ALLOWED TO DO WHAT WE WANT TO DO
AND WE'RE GIVEN FREE REIGN TO
THINK ABOUT THINGS AND THAT IS
SORT OF FREEDOM I WANT TODAY
GIVE THE FELLOWS AS WELL.
I THINK THAT THE -- YOU'VE HEARD
THAT FROM A NUMBER OF FELLOWS
THAT THEY APPRECIATED THAT HAVE
AND I APPRECIATED THAT WHEN I
WAS A FELLOW ALLOWED TO DO A LOT
OF THINGS THAT I WANT TODAY DO
OWN MY OWN AND I THINK THAT I
TRIED TO DO THAT AS WELL AND TO
HAVE THE FELLOWS DO WHAT THEY
WANT TODAY DO WITHIN THE CONFINE
BUT, THAT GOT ME INTO TROUBLE
ONLY ONCE AND AND YOU'VE ALREADY
HEARD ABOUT THE LEO GAVE YOU AN
INTRODUCTION ABOUT OUR WORK ON
MULTI MODEL PLASITICITY AND WE
STARTED STUDYING THIS IN THE
MOTOR SYSTEM AND THEN WE BEGAN
TO BRANCH OUT IN OTHER
DIRECTIONS WHERE WE WERE GETTING
MULTI MODEL PLASTICITY BETWEEN
THE AUDITORY SYSTEM AND THE
VISUAL SYSTEM AND GET US US FAR
AWAY FROM THE MORTGAGOR SYSTEM
AND WE FACE THE BOARD OF
SCIENTIFIC COUNCILORS AND THE
BOARD OF SCIENTIFIC COUNCILORS
SAYS, WHAT DO YOU DOING, YOU
SHOULD BE STUDYING MOTOR
CONTROL.
THAT'S WHAT YOU ARE SUPPOSED TO
BE DOING SO WE HAD TO GIVE UP
FURTHER STUD SKIS GO BACK TO THE
STUDY OF MOTOR CONTROL AND OTHER
THAN THAT, WE'VE BEEN GIVEN A
RELATIVELY FREEHAND TO DO THE
DIFFERENT THINGS THAT WE WANT TO
DO AND SO, WHEN I CAME AND THIS
WOULD BE THE LAST PART OF WHAT I
WANT TODAY TO SAY HERE, WHEN I
CAME TO NIH, I SET UP THE HUMAN
APP MOTOR CONTROL SECTION AND
WHY WAS IT CALLED MOTOR CONTROL
RATHER THAN MOVEMENT DISORDERS?
BECAUSE THERE WAS NO MOVEMENT
DISORDERS AND FIELD YET AND WHEN
I CAME AND I WAS BASICALLY A
MOTOR PHYSICALLOLOGIST,
NEUROLOGIST, INTERESTED IN THE
WAY THE BRAIN MAKES MOVEMENT AND
IF PEOPLE ASKED ME MY GOAL, IT
WAS TO UNDERSTAND HOW THE BRAIN
WORKS AND THAT WAS WHAT I WAS
INTERESTED IN AND HOW IS BRAIN N
DOING AND HOW DOES IT CONTROL
MOVEMENT AND AND IN FACT, THE
FIRST PROJECT THAT I WAS
INTERESTED IN DOING, WAS STROKE
REHABILITATION AND YOU HEARD
SOMETHING ABOUT STROKE
REHABILITATION AND PLASTICITY
FROM LEE OWE FROM CHRISTIAN
REPRESENTING THE WAY WE START
THAT WORK IS SORT OF EXTREMELY
IMPORTANT IN RELATION TO BRAIN
PLASTICITY AND SPOKE IT
DEVELOPED AND OVER TIME AND I
GOT MORE AND MORE INTERESTED IN
OTHER MOVEMENT PROBLEMS THAT
THEY REPRESENTED AND LEO HAD
THAT AS A MAJOR INTEREST AND
TOOK THAT PART OF THE PROGRAM
OVER AND LIBERATING ME FOR BEING
ABLE TO WORK IN THE FIELD OF
MOVEMENT DISORDERS SO, OVER THE
COURSE OF MY CAREER THEN, I'VE
REALLY -- I'VE STARTED WITH
ACTION POTENTIALS AND LOBSTER
HEART AND TSAKI AND WORK THROUGH
WE WORKED OUR WAY UP AND TO MORE
EX MORE COMPLICATED THINGS AND
THAT WE HAD A INTEREST IN
MOVEMENT AND CONTROL, MOTOR
CONTROL, AND HOW AND WHERE THE
MOVEMENTS GET INITIATED FROM AND
YOU HEARD FROM LOIS ABOUT HOUR
STUDIES OF PRAXIS AND APRAXIA
AND THAT WAS THE LEFT SIDE OF
THE BRAIN.
THAT'S WHERE MOST OF THAT COMES
FROM.
THEN, AS I WAS THINKING ABOUT
THINGS, I SAID, WELL, WE'VE BEEN
STUDYING ALL SORTS OF MOVEMENTS
AND REFLEX MOVEMENTS AND ALL
SORTS OF THINGS BUT HOW ABOUT
VOLUNTARY MOVEMENT AND SO
PATRICK WAS SAYING.
I REALLY GOT INTERESTED IN THE
IDEA OF ABOUT WHAT IS VOLUNTARY?
WHAT COULD THAT BE AND SO WE
STARTED GETTING INTERESTED FIRST
STARTING WITH LIBIDS CLOCK
BUSINESS AND GOING ON AND DO
OTHER THINGS THAT YOU HAVE HEARD
ABOUT INCLUDING THE FINAL
EXPERIMENT THAT THEY ARE WORKING
ON NOW AND WE'RE HOPING TO GET
PUBLISHED BEFORE TOO LONG AND
THEN SOME FURTHER EXPERIMENTS,
THOSE ARE THE LAST EXPERIMENTS
THAT WE'RE DOING HERE AND YOU
HEARD ABOUT AGENCY AND THE TPJ
IT'S ON THE RIGHT SIDES OF THE
BRAIN.
WE HAVE MOVEMENTS FROM THE LEFT
SIDE OF THE BRAIN, THE PRAXIS
NETWORK AND WE ALSO FOUND
INTERESTINGLY THE TASK SPECIFIC
DYSTONIA IS A FAILURE OF ONE OF
THOSE CONNECTIONS IN THE LEFT
SIDE OF THE BRAIN THAT ONE OF
THOSE CONNECTIONS IN THE PRAXIS
NETWORK BECOMES ABNORMAL IN TASK
SPECIFIC DYSTONIA SO THE MORE
YOU KNOW ABOUT HOW THINGS WORK,
YOU CAN FIGURE OUT ABOUT PATHO
PHYSIOLOGY AND IN ANY EVENT,
THEN WHEN YOU COME TO VOLUNTARY
MOVEMENT IN AGENCY IT LOOKS LIKE
IT'S THE RIDE SIDE OF THE BRAIN
AND THAT IS MORE INTERESTING AND
YOU HAVE THESE CONTRASTING SIZE
OF THE BRAIN DOING SORT OF
DIFFERENT THINGS WITH RESPECT TO
MOVEMENT AND WE GOT INTERESTING
IN THE TPJ WITH RESPECT TO
AGENCY BUT THE T PJ REGION IS
REALLY MUCH MORE INTERESTING,
WELL, THAT'S PRETTY INTERESTING
BUT IT'S MORE INTERESTING THAN
THAT AND YOUR SENSE OF
SELF-SEEMS TO BE TO A CERTAIN EX
IT TENT RELATED TO US GOING ON
IN THE TPJ AND WE JUST MADE
ANOTHER OBSERVATION OF THE RIGHT
TPJ THAT I DON'T QUITE
UNDERSTAND FULLY YET BUT THIS IS
IN OUR STUDIES OF CHRONIC
FATIGUE SYNDROME THAT WE'VE BEEN
DOING WITH AVI AND PATRICK
BEDDARD AND THEY HAVE BEEN DOING
INTERESTING IMAGING IN PEOPLE
TRYING TO MAKE MOVEMENTS AND
BECOME FATIGUED AND UP WITH OF
THE MAJOR IMAGING ABNORMALITIES
IS A HYPO FUNCTION OF THE RIGHT
TPJ.
WELL, THAT IS ANOTHER THING THAT
IS GOING ON THERE.
WHAT'S THAT?
IS THAT AGENCY?
IS THAT SENSE OF SELF?
IS IT SOMETHING ELSE?
WHAT IS THE RIGHT TPJ DOING?
I DON'T KNOW YET.
[LAUGHTER]
MORE WORK TO DO.
WITH THAT IS AN IDEA FOR SOMEONE
TO PICK IT UP AND I'LL BE HAPPY
TO HELP THEM THINK ABOUT IT.
[LAUGHTER]
THANK YOU, ALL VERY MUCH FOR
YOUR INTEREST AND HELP AND
EVERYTHING HERE AND I WILL BE
RETIRING BUT NOT TOO MUCH.
THANK YOU.
[LAUGHTER]
[APPLAUSE]
ALL RIGHT.
SO WE'RE JUST WRAPPING UP.
WE HAVE A COUPLE MORE THINGS.
SOME WORDS TO HEAR FROM AVI NATH
THE CLINICAL DIRECTOR AND WALTER
WANTED TO TALK AND WE HAD
RECEPTION OUTSIDE.
SO, LOOK FORWARD TO SEEING YOU
OUT THERE.
>>WHAT A STELLAR CAREER.
UP BELIEVABLE.
SO I'M JUST GOING TO MAKE A FEW
REMARKS AND I HAVE A FEW SLIDES
TOO.
AND THEN WALTER WILL END.
SO EVERYBODY HAS A PERSONAL
STORY WITH Dr. HALLETT AND I
DO TOO.
HE PROBABLY DOESN'T REMEMBER
THIS, BUT IN 1988 TO HAVE 1990,
I WAS A CLIP CLIP CAL FELLOW HT
NID AND HE WAS THE CLIP CAL CLIR
AND I WAS WORKING AND LATER WITH
GENE MAJOR AND ONE DAY A WORK,
HE HAD TO SEE PATIENTS ON THE
COUNCIL SERVICE HE HAD A FELLOW
HE SAYS OK NOW I DON'T HAVE TO
DO IT MAYBE YOU SHOULD DO IT SO
I STARTED SEEING PATIENTS ON THE
COUNCIL SERVICE AND THE CLINICAL
DIRECTOR ROUNDS YOU HELD AND I
PRESENTED PATIENTS TOLL Dr.
HALLETT AND IT WAS VERY CLEAR
THAT HIS BREADTH AND DEPTH OF
KNOWLEDGE WAS UNBELIEVABLE AND
SO I LEARNED A LOT FROM HIM AND
DURING THOSE YEARS AND HE CAME
BACK HERE AND MANY YEARS LATER
AND NOW HE ASKED ME TO SERVE APP
THE EDITORIAL BOARD FOR PRACTICE
UPDATE WHICH HE IS THE
EDITOR-IN-CHIEF AND EVERY WEEK
WE GO OVER A SERIES OF PAPERS
AND AGAIN, I LEARN FROM HIS
COMMENTS.
IT'S UNBELIEVABLE HOW MUCH HE
KNOWS ABOUT GENERAL NEUROLOGY
AND EVERY ASPECT OF NEUROLOGY
AND IS ABLE TO KEEP UP-TO-DATE
ON ALL THE NEW DEVELOPMENT THIS
IS THE FIELD SO UNBELIEVABLE AND
THANK YOU VERY MUCH FOR THAT.
SO I DON'T HAVE A PICTURE OF US
FROM THE TIME BUT I DO HAVE ONE
FROM MUCH LATER SO I WANTED TO
SHARE WITH YOU.
A LOT OF PEOPLE HAVE TALKED
ABOUT MARK'S SCIENTIFIC
ACHIEVEMENTS BUT I WANT TO FOCUS
ON ANOTHER ASPECT HIS
ADMINISTRATIVE ACHIEVEMENTS.
SO, AS YOU KNOW, HE HAS BEEN THE
LONGEST SERVING CLINICAL
DIRECTOR OF NINDS AND HE USED TO
BE CALLED NINCDS AND LATER IT
WAS NINDS AND DURING THAT PERIOD
HE WAS ALSO THE CHAIR OF THE
MEDICAL BOARD AT THE CLINICAL
CENTER.
AND HE RECEIVED NUMEROUS AWARDS
AND JUST SEVERAL PAGES WORTH OF
AWARDS AND ONE THAT I WANTED TO
HIGHLIGHT HERE WAS A
DISTINGUISHED SERVICE MEDAL FROM
THE PUBLIC-HEALTH SERVICE AND IN
1999 AND HE SERVED ON
COMMITTEES, EVERY SEARCH
COMMITTEE HE HAS HAD HANDS IN
THIS AND CHAIRING THEM MOST
OFTEN.
TWO VERY IMPORTANT COMMITTEES
THAT HE CHAIRED ONE WAS THE
PROMOTION AND TENURE COMMITTEE
FOR NINDS WITH AN INFLUENCE FOR
OVER 20 YEARS, AND THE YOU'VE
THAT USED TO BE CALLED PICR BUT
IS NOW THE SCIENTIFIC REVIEW
COMMITTEE AND THIS IS WHERE ALL
CLINICAL PROTOCOLS GET REVIEWED
AND ALL THE RESEARCH IS REALLY
CLINICAL RESEARCH IS APPROVED
WITHIN NINDS SO YOU CAN SEE
THOSE TWO CRITICAL COMMITTEES
THROUGH THEM, MARK HAS REALLY
ANNOUNCED ALL CLINICAL RESEARCH
IN NINDS SINCE HE FIRST JOINED
THIS INSTITUTION.
SO, I SHOULD ALSO SAY THAT I HAD
OUR CLIP CAL TRIALS UNIT DO A
SEARCH TO SEE HOW MANY PROTOCOLS
MARK HAS BEEN A P.I. ON AT NINDS
AND THEY TOLD ME IT WAS CLOSE TO
120 PROTOCOLS HE HAS BEEN A P.I.
ON HIMSELF.
THAT'S A HUGE AMOUNT OF
CONTRIBUTION AND EVEN THOUGH, IF
YOU SEE THE PROTOCOLS THAT HE IS
ON, I THINK THERE ARE EIGHT OR
10 PROTOCOLS EVEN AS OF TODAY.
THERE ARE 20 FELLOWS ONLY THOSE
PROTOCOLS THAT ARE STILL ACTIVE.
SO, HE IS NOT RETIRING QUITE
YET.
I PULLED UP THIS PHOTOGRAPH
BECAUSE IT ACTUALLY HAS FOUR
CLINICAL DIRECTORS IN THIS
PICTURE AND THIS IS FROM 2014.
SO, YOU HAVE HENRY McFARLAND
HERE, AND YOU HAVE MARY K.
FLOORER I SAW HER A MINUTE AGO,
AND YOU HAVE MARK HALLETT AND
MYSELF.
SO YOU HAVE, THIS SHE IS RIGHT
HERE.
SO, THIS IS A RARE OPPORTUNITY
TO HAVE FOUR TOGETHER.
AND THIS IS A PAGE I GOT.
IF YOU JUST IMAGINE HOW MANY
EDITORIAL BOARDS SOMEONE CAN
SERVE.
THIS HAS TO BE IN THE GUINESS
BOOK OF WORLD RECORDS AND LOOKS
AT THE ONE HE IS STILL PRESENTLY
SERVING ON AND SO HE IS GOING TO
BE BUSY.
[LAUGHTER]
THANK YOU VERY MUCH, MARK, FOR
EVERYTHING THAT YOU'VE DONE AND
THERE'S AN ANNOUNCEMENT I WOULD
LIKE TO MAKE, THERE'S JUST
OVERWHELMING SUPPORT AND FOR
EVERYBODY TO INITIATE A LECTOR
SHIP IT IT WILL BE CALLED THE
MARK HALLETT LECTURESHIP AND
WE'RE JUST WORKING ON SOME OF
THE DETAILS BUT VERY SOON WE CAN
MAKE AN OFFICIAL ANNOUNCEMENT.
THIS IS AS GOOD AS OFFICIAL.
THANK YOU.
AND LASTLY I WANT TO THANK
EVERYBODY HERE.
CERTAINLY MARK DESERVES THE MOST
BUT FOR ALL OF YOU WHO HAVE
TRAVELED FROM ALL FAR PLACES,
ALL THE TRAINEES AND ALL THE
COLLABORATORS, FRIENDS AND
FAMILY AND THOSE WHO ARE ON-LINE
AND THOSE IN-PERSON I WANT TO
THANK EACH OF ONE OF WE LOOK
FORWARD TO OUR INTERACTING WITH
YOU MARK IN YOUR NEW ROLE.
THANK YOU.
[APPLAUSE]
>>WELL, MY JOB IS TO CLOSE OUT
THE SESSION.
IT WAS REALLY WONDERFUL TO BE
ABLE TO LISTEN TO THE STORIES
AND THE STORIES ARE THE THINGS
THAT YOU NEVER FORGET AND SOME
OF THE RESULTS EX THOSE LITTLE
AS I SAID IN THE BEGINNING, MARK
IS A QUINTESSENTIAL INTRAMURAL
INVESTIGATOR AND I THINK OF A
LOT OF GOOD POINTS WE SHOULD
TAKE HOME FROM TODAY'S.
I THINK THE FIRST OF WHICH IS
YOU GOT TO GET HOOKED WHEN YOU
ARE YOUNG SO WE HAVE TO GO AFTER
THESE YOUNG PEOPLE, WHEN THEY'RE
IN COLLEGE OR EVEN BEFORE
THEY'RE IN COLLEGE.
WHEN YOU ARE HOOKED, YOU ARE
HOOKED.
TO UNDERSTAND HOW THE BRAIN
WORKS.
I GUESS THE OTHER THING WHICH
WAS PRETTY OBVIOUS IS YOU DO
THIS RIGHT, IT'S A LOT OF FUN.
SO WE HAD A FUN TODAY, IT'S
OBVIOUS MARK HAD A LOT OF FUN
TOO.
THROUGH ALL THE YEARS WORKING
WITH GREAT PEOPLE AND MAKING
DISCOVERIES AND GETTING EXCITED
ABOUT WORKING IN RESEARCH, SO,
HOW DO WE BOTTLE IT THAT AND PUT
IT IN THE WATER SUPPLY OF THE
COUNTRY BUT I DON'T KNOW.
I WOULD LOVE TO TRY THAT.
I GUESS THE LAST THING IS THAT
THE GREAT THING ABOUT SCIENCE,
AND MARK, ILLUSTRATES THIS, IS
THAT IT'S THE GENERAL ROSS TEE F
BEING WILLING TO SAY YES AND I
HEAR ALL THE THESE PEOPLE
TALKING ABOUT YOU HAVE TO LEARN
HOW TO SAY NO AND I DON'T THINK
MARK EVER LEARNED HOW TO SAY NO
HE IS NOT THE ONLY ONE.
NOT SURE SAYING NO IS SUCH A
GOOD IDEA.
ANYWAY, HIS GENEROSITY LIVES IN
THE WORK AND THE SPIRIT OF AND
THE PERPAL STORIES AND EVERYONE
TALKED ABOUT SO THANK YOU FOR
COMING AND THANK YOU SO MUCH,
MARK.
[APPLAUSE]