The neurologists are about to descend on London. Tim Radford on the great brain show
Thursday June 14, 2001
It is the ultimate virtual reality headset, internally fitted, issued shrink-wrapped at birth to everybody on the planet. It weighs a few pounds, but just to keep it ticking over consumes about a fifth of the body's energy requirements. It is the control centre of life, the focus of human identity, and a think tank able to embrace not just all human history, but the epic story of the universe and old jokes from Monty Python as well.
And when it goes wrong, it shuts down, distorts or discolours the world around it. But, puzzlingly, it is also beginning to understand itself. More than 5,000 neurologists and neuroscientists are about to descend on London for the World Congress of Neurology at Earls Court, on Sunday to begin five days of debate about dementia, stroke, epilepsy, multiple sclerosis and the neuro- muscular diseases. They can do this with growing confidence because - with huge advances in scanning technology - they can look inside a head. They can watch the brain at work, they can make three-dimensional maps of its geography, they can observe where London taxi drivers store "the knowledge", they can eavesdrop on the hallucinations of a schizophrenic volunteer, they can watch Alzheimer's disease at its destructive work.
And, says Chris Kennard, a neuroscientist at Imperial College school of medicine, at last they can do something. "There are far more conditions that we can actually treat - not necessarily cure and not necessarily remove all the neurological deficit - but there are big areas where we have made significant progress," he says.
This is still not entirely true of the big danger: stroke. In the last 10 years, he says, the clinicians have shown that if you can get the patient to the right specialists very quickly - in the first three to six hours after a stroke - you could reduce mortality by 25%. Germany and the US are leading the way. "We have to move into a scenario where a brain attack is no different to a heart attack in terms of the speed with which people have to deal with it. "
There are steps forward in understanding and dealing with epilepsy, there is the promise of foetal cell trans plants to help Parkinson's disease, there are genetic studies that could throw light on afflictions such as multiple sclerosis as well as schizophrenia and manic depression.
"It is going to move psychiatry and neurology much closer together. A while ago, people were saying there was not a biological cause for these conditions; now there clearly is and it is a matter of determining what it is," says Kennard.
Colin Blakemore, professor of phsyiology at Oxford, agrees. In his life time, neurology has moved from a discipline of diagnosis rather than treatment, to one of treatment but not cure. The next hope is for rapid advances to the development of genuine cures.
"We have hopes of really revolutionary developments that are not just pipe dreams - for example the Alzheimer vaccine. There could be no better advertisement for two things - genetic modification as a research tool and the use of animals. In two years we have moved from pure bench science on genetically manipulated mice to clinical trials with the vaccine on one of the most horrendous, incurable diseases," he says. Science, he reckons, could be able to do these things without actually having to understand the thing it is doing the understanding with.
"You have to distinguish between really understanding how it works and being able to deal with its problems. It is rather like a highly skilled engineer who could tackle the maintenance of a computer without knowing a thing about silicon chip technology or computer science.
"Different kinds of understanding might be needed for treatment. We could have a cure for schizophrenia, and be able to treat everybody, get rid of it without really understanding the cause of the hallucinations, the voices, the thought control, the paranoia," he says. "That's great because if we had to know how the brain worked before we could tackle brain disease we would have to wait another 100 years."
If humans can understand events that happened 15 billion years ago, when a state of nothing moved from nothing to perhaps a whole family of universes, then perhaps the brain could be relatively easy.
The brain might be astonishing, but it is still just molecular hardware, part of the body. It can be studied, and observed. And marvelled at.
"There are a million billion connections in the human brain," says Prof Blakemore. "Since the human lifespan is a billion seconds, that means we are making a million connections per second the whole of our lives. That gives an idea of the scale of the problem."
• World Congress of Neurology, June 17-22, Earls Court, London