<p><a href="https://peterattiamd.com/edwardchang/?utm_source=podcast-feed&utm_medium=referral&utm_campaign=250908-pod-stuartmcgill&utm_content=250908-pod-edwardchang-podfeed"> View the Show Notes Page for This Episode</a></p> <p><a href="https://peterattiamd.com/subscribe/?utm_source=podcast-feed&utm_medium=referral&utm_campaign=250908-pod-edwardchang&utm_content=250908-pod-edwardchang-podfeed"> Become a Member to Receive Exclusive Content</a></p> <p><a href="https://peterattiamd.com/newsletter/?utm_source=podcast-feed&utm_medium=referral&utm_campaign=250908-pod-edwardchang&utm_content=250908-pod-edwardchang-podfeed"> Sign Up to Receive Peter's Weekly Newsletter</a></p> <p>Edward Chang is a neurosurgeon, scientist, and a pioneering leader in functional neurosurgery and brain-computer interface technology, whose work spans the operating room, the research lab, and the engineering bench to restore speech and movement for patients who have lost these capabilities. In this episode, Edward explains the evolution of modern neurosurgery and its dramatic reduction in collateral damage, the experience of awake brain surgery, real-time mapping to protect critical functions, and the split-second decisions surgeons make. He also discusses breakthroughs in brain-computer interfaces and functional electrical stimulation systems, strategies for improving outcomes in glioblastoma, and his vision for slimmer, safer implants that could turn devastating conditions like ALS, spinal cord injury, and aggressive brain tumors into more manageable chronic illnesses.</p> <p><strong>We discuss:</strong></p> <ul type="disc"> <li>The evolution of neurosurgery and the shift toward minimally invasive techniques [2:30];</li> <li>Glioblastomas: biology, current treatments, and emerging strategies to overcome its challenges [10:45];</li> <li>How brain mapping has advanced from preserving function during surgery to revealing how neurons encode language and cognition [16:30];</li> <li>How awake brain surgery is performed [22:00];</li> <li>How brain redundancy and plasticity allow some regions to be safely resected, the role of the corpus callosum in epilepsy surgery, and the clinical and philosophical implications of disconnecting the hemispheres [26:15];</li> <li>How neural engineering may restore lost functions in neurodegenerative disease, how thought mapping varies across individuals, and how sensory decline contributes to cognitive aging [39:15];</li> <li>Brain–computer interfaces explained: EEG vs. ECoG vs. single-cell electrodes and their trade-offs [48:30];</li> <li>Edward's clinical trial using ECoG to restore speech to a stroke patient [1:01:00];</li> <li>How a stroke patient regained speech through brain–computer interfaces: training, AI decoding, and the path to scalable technology [1:10:45];</li> <li>Using brain-computer interfaces to restore breathing, movement, and broader function in ALS patients [1:28:15];</li> <li>The 2030 outlook for brain–computer interfaces [1:34:00];</li> <li>The potential of stem cell and cell-based therapies for regenerating lost brain function [1:38:00];</li> <li>Edward's vision for how neurosurgery and treatments for glioblastoma, Parkinson's disease, and Alzheimer's disease may evolve by 2040 [1:42:15];</li> <li>The rare but dangerous risk of vertebral artery dissections from chiropractic neck adjustments and high-velocity movements [1:44:45];</li> <li>How Harvey Cushing might view modern neurosurgery, and how the field has shifted from damage avoidance to unlocking the brain's functions [1:46:15]; and</li> <li>More.</li> </ul> <p>Connect With Peter on <a href="https://twitter.com/PeterAttiaMD">Twitter</a>, <a href="https://www.instagram.com/peterattiamd/">Instagram</a>, <a href="https://www.facebook.com/peterattiamd/">Facebook</a> and <a href="https://www.youtube.com/channel/UC8kGsMa0LygSX9nkBcBH1Sg">YouTube</a></p>
Actionable Insights
1. Correct Hearing Loss to Preserve Cognition
Actively address and correct any hearing loss, even if unrecognized, because it can accelerate age-related memory loss and lead to cognitive decline due to sensory deprivation.
2. Avoid Aggressive Neck Adjustments
Refrain from severe aggressive movements or certain chiropractic neck adjustments, as they are statistically proven to cause vertebral artery dissection, a rare but highly severe injury.
3. Choose Medicine to Bend Civilization’s Arc
Consider a career in medicine, especially in fields like neurosurgery and neuroengineering, as it offers a unique opportunity to combine science, medicine, and technology to solve complex problems and significantly impact civilization.
4. Utilize BCI for Speech Restoration
For individuals with severe paralysis and loss of speech, explore brain-computer interfaces (BCI) that decode brain activity to restore communication through synthesized speech or text. This technology interprets brain signals to transform them into a useful communication form.
5. Pursue Early BCI Intervention
For conditions leading to speech loss, seek early intervention with BCI technology, as the brain’s original speech-related activity patterns are more preserved and easier to decode, leading to faster and more effective outcomes.
6. Use BCI for Rehabilitation
Consider BCI technology not only for prosthetic function but also as a tool to augment and accelerate rehabilitation. Direct brain feedback and repeated volitional attempts can strengthen affected muscles and aid in regaining natural function.
7. Combine BCI with FES
For conditions like ALS affecting motor function, explore combining brain-computer interfaces with functional electrical stimulation (FES). This approach bypasses damaged nerves to directly stimulate muscles for coordinated movement, such as breathing or limb control.
8. Explore Cell Transplant for Parkinson’s
Investigate advanced cell-based therapies for Parkinson’s disease, specifically the transplantation of stem cells or engineered cells into the substantia nigra. These therapies aim to replace degenerated dopaminergic neurons with better control over dopamine release and delivery.
9. Prioritize Brain Mapping in Surgery
When undergoing brain surgery for tumors or seizures in critical areas, ensure brain mapping is performed to precisely identify and protect vital language and motor function regions. This helps balance maximal resection with preserving neurological function.
10. Maximize Glioblastoma Resection
For glioblastoma, aim for the most extensive surgical resection possible, as studies have shown a direct correlation between the extent of tumor removal and prolonged patient survival.
11. Utilize Glioblastoma Genetic Profiling
For glioblastoma, seek genetic profiling of the tumor in academic medical centers to identify specific mutations. This information is crucial for tailoring and personalizing chemotherapy and other targeted treatments.
12. Explore Immune-Based Glioblastoma Therapies
Investigate emerging immune-based strategies that aim to overcome glioblastoma’s ability to suppress the immune system. Enabling the immune system to recognize and target the tumor could unlock future therapeutic options.
13. Utilize Focused Ultrasound for BBB Opening
Explore focused ultrasound as a non-invasive method to temporarily open the blood-brain barrier in targeted brain regions. This technique can enhance the delivery of molecularly specific therapeutic agents to the brain.
14. Consider Corpus Callosotomy for Seizures
For patients with severe, medically recalcitrant drop attack seizures, a partial corpus callosotomy can be considered. This procedure severs connections between hemispheres to prevent rapid seizure propagation, reducing loss of consciousness and injury risk.
15. Actively Vocalize During BCI Training
When training a brain-computer interface for speech restoration, it is critical to actively attempt to vocalize the desired words. This volitional intent to speak is the most important factor for the algorithm to effectively decode brain activity patterns.
16. Leverage Brain Plasticity for Recovery
Understand that the brain exhibits significant plasticity, allowing functions to reorganize and shift to other areas over time, especially with slow-growing lesions. This inherent adaptability can aid in recovery and influence surgical planning.
17. Investigate Bioengineering for Neurological Therapies
For future neurological therapies, consider exploring bioengineering solutions such as engineered cells and organoids. This approach moves beyond traditional electronics to leverage biological systems for computing and interfacing with the brain.
18. Advance Health Knowledge
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