He arrived a bit late because he had to implant a new battery in someone. A battery? "Sure," says Professor Yasin Temel with an engaging smile. As a neurosurgeon at Maastricht University Medical Centre, he is involved in developing a new, unique technique for treating people with some of the most difficult and complex brain disorders by stimulating the deepest parts of the brain. It's called Deep Brain Stimulation. But that battery is something else... And he acts as if it's nothing.
Deep brain stimulation
Was this morning's operation also Deep Brain Stimulation? "It was. That patient has Tourette's syndrome and is troubled by all sorts of tics and obsessive-compulsive neuroses. These are often patients that can no longer be sufficiently helped with medicines or behavioural therapy. And because of this they are often under extreme pressure. In such cases, a brain operation is considered. We've implanted two electrodes and that's had a good effect. The patient can now 'switch' his behaviour as he needs. So this approach is not just the solution to a specific problem but also enables the patient to intervene in his own behaviour and adjust it. The electrodes are close to the areas that we want to stimulate in the brain. That is a long, complex operation because you have to pass the electrodes very precisely through the patient's head. After that, the electrodes have to be controlled from outside and at the moment that's still done with an external power supply in the form of a battery that is inserted in the abdomen or under the collarbone."
Big things are happening, even though they are very small. Through Deep Brain Stimulation, we can make a huge difference to patients who previously could not be helped.
Isn’t it yet possible to leave the battery where it is and have it recharged from the outside, like an electric toothbrush, for example? The neurosurgeon smiles warmly but seriously, as you would expect when you ask a question to which you already know the answer.
We've been researching brain stimulation for 15 years now
"We started with the first operations in 1999. And then we embarked on a sort of voyage of discovery. We discovered unique areas in the brain and we learned a lot about stimulating the human brain. My fascination lies in understanding human behaviour – why and how we behave the way we do. But we also stumbled on entirely different parts of the brain quite unintentionally. For example, we have been to areas of the brain that can cause erectile dysfunction. How does that work? Well, it's actually quite simple. We've learned that you can 'just' switch an erection on and off with the aid of electrical stimulation."
How does that stimulation work then?
"Take the situation when you're waiting at traffic lights, for example. The light is on red and you have your feet on the pedals. Then suddenly, you get a stimulus from the green light, which goes through your eyes to the brain. There, it's as if a switch is flicked and your feet come into action. Can we influence this action and reaction? Accelerate it? That's the big question. In the case of this operation, we could reduce the reaction speed by half. It might sound like science fiction but could we then increase our thinking speed as we wish, like the 'Six million dollar man'- the futuristic TV series in the 1970s in which a man gets superhuman abilities with the help of advanced technology?"
We can make him better, stronger, faster!
We have the technology.
We have the capability to make the world’s first bionic man.
Steve Austin will be that man.
Better than he was before.
Better, stronger, faster.
Yasin Temel laughs.
"Of course, the aim is not to promote desirable behaviour; the aim is to learn from research and to continue to understand better what we can and can't do. We can already help someone with Parkinson's disease very effectively. And we've learned that depression is a mood that we can influence with Deep Brain Stimulation in many cases. For example, we have discovered an area that can produce an acute panic attack. This is how we have gathered so much knowledge about the brain in the last fifteen years. But our most important discovery is that a lot of behaviour is pre-programmed. Brain circuits are almost like connections that can be activated by external brain stimulation."
That we can all really help patients as a team counts much more for me than personal success.
The driving force is the patient
"It's all about the patient. One of the satisfying sides is that here you work directly with patients – that you can talk to them and explain things about an examination or treatment personally. That plays a major role not just for me as a neurosurgeon but also for the other specialists. After all, one of their tasks is to give the patient intensive supervision before and after the intervention and to prepare them for it. We put the patient first. Society expects us to gather information, and then use that information as well as possible to combat diseases and prevent them if possible. That's how we make society better. That's why we make grateful use of all the opportunities for collaboration and also to connect with others outside. We were appointed at the Maastricht University Medical Center to develop new knowledge."
"In my opinion, knowledge...knowledge..." Temel weighs his thoughts carefully and then explains. "You know, nobody really owns knowledge. Knowledge doesn't belong to someone; it belongs to us all and we must share it. And it is almost literally of vital importance that we continue to develop knowledge."
"I think that we're unique here in Maastricht with regard to the models we use. We establish the link between understanding and relating behaviour to neuropsychological effects and we use deep brain stimulation to point the way."
When you look around you, you can see that we’re getting older and that neurological diseases will be a big problem in the future. The number of people getting Parkinson’s disease will increase.
And what about the future? How would you like to progress?
"I'd like to see the arrival of more and more scientists who both know the patients and can treat them – and who also know the biological processes. Discoveries were being made in the lab but the patient himself derived little benefit from them because they were not communicated. So I believe in a generation of scientists who are very good at researching the patient's problems and are also very good at treating the patient – 'making the patient better' based on their research."
The real impossibility is yet to come
"When you look at current demographic developments in society, you can see that we're all getting increasingly older. When you look at the forecast of the World Health Organization, you can see that getting older in the future will be increasingly accompanied by developing neurodegenerative diseases – that 10 to 20 per cent of the people will develop a form of dementia; that after the age of sixty, the incidence of Parkinson's disease will rise enormously. We're living longer but we want to stay healthy. And it's precisely that research into staying healthy longer, and preventing diseases, that is such a major focus at the Maastricht University Medical Center."