Brain activity revealed through your skin: stress, sleep and seizures | Rosalind Picard | TEDxNatick

While using a wristband to measure stress in a person who could not speak, Rosalind Picard, a scientist and professor at the MIT Media Lab, measured an unusual signal on the surface of the skin -- revealing unexpected connections between electrical activity deep in the brain and changes that show up on the wrist during stress, sleep, seizures, and dangerous periods following seizures, which can lead to sudden unexpected death in epilepsy, called SUDEP. You might help save a life by learning about these findings and sharing them with people you know.

Rosalind Picard is a professor at the MIT Media Lab. She is credited with starting the field of Affective Computing, giving computers emotional intelligence. She also developed the first wearables that sense affective data and can help people with epilepsy, autism, and too much stress in their lives. Her inventions have led to start-up companies such as Affectiva and Empatica.

This talk was given at a TEDx event using the TED conference format but independently organized by a local community. Learn more at http://ted.com/tedx

This story begins

when my students at MIT
and I were building new technology

to help people understand
the emotions of others.

We were working with people
on the autism spectrum

like this little boy here,

and we created technology
to read facial expressions,

which you can get in your phone today
thanks to the work of Affectiva.

But while we were creating this,

and I was talking with one
of my friends with autism,

who actually talked by typing,
she said to me,

"Roz, you've got it wrong.

Our biggest problem is not
understanding other people's emotions,

it's you understanding our emotions."

And at first I thought,
"Oh dear, it's me."

And indeed, I have room to improve.

But it turns out
we all have room to improve.

And as I asked her,

"Well, what are the emotions
that we're missing,

that you most wish we could understand?"

She said, "There's huge anxiety
and stress that we're experiencing.

Many times, the environment,
the lights, the sounds, the smells

are driving us crazy,
and we're about to explode,

and yet on the outside we may look
just like we're shutting down.

So we're being misread."

And I realized we had built technology
in our lab years before

that measures something
called electrodermal activity.

That's a big word that is referring
to a general phenomenon

whereby your skin becomes more conductive
when you get more nervous,

when your sympathetic nervous system,

your autonomic - sounds like automatic,
but it's autonomic nervous system -

that controls your heart beating,
your lungs breathing,

all of these parts
of your body automatically.

When the sympathetic branch of that
goes high in fight or flight

or with general excitement,
it can make your hands sweaty.

And even when you don't feel sweaty,
it can make electrical changes

that we can sense
on the surface of the skin.

Now, this was traditionally done
with wires and electrodes in the lab,

and that was not very portable.

At the Media Lab, we developed ways
to measure it from the wrist,

and the ankles,
and other places on the body.

The first time that I saw
the skin conductance data 24/7

was this picture from an MIT student.

What you see here are
seven days of data, 24 hours a day.

If we zoom in, you'll see
that there are places

where the skin conductance
is going really high,

where, again, there's more excitement,
or more emotional load,

or more cognitive load.

In this case we see MIT homework sets

(Laughter)

caused quite a lot of activation.

Now, to my utter surprise,
sleep also caused a lot of activation,

which was not what I expected.

In fact, sleep is often
the biggest peak of the day.

And the reason for this
is still a mystery.

But some of the things
you're going to hear shortly,

I think, are about to give us
more insight into this mystery.

And also I have to admit,
to the embarrassment of we MIT professors,

the low point every day
was classroom activity.

(Laughter)

Once we got the data continuously,
not in the lab but in real life,

we started learning all kinds of things,

and there were a number
of very exciting surprises,

and I'm going to tell you
the story of one of them.

And this one happened

when a young man working
as an undergrad in my lab

came to me at the end of the semester,

and he said, "Professor Picard,
could I please borrow one of those sensors

for my little brother?
He has autism. He can't speak.

And I want to see
what's stressing him out."

And I said, "Sure. In fact,
don't just take one, take two."

Because it was a long winter break,

and they were hand built
with wires hanging out back then,

and they often broke.

So he takes the two sensors;
he puts them on his little brother.

And back at MIT, I go to my computer,
and I look at the screen,

and I see data like I just showed you
for this little boy.

This day looked pretty normal.

This day looked pretty normal.

I go to the next day, and my jaw drops.

He had put the sensors on the left
and right wrist at the same time.

Okay.

And one of the wrists,
the data had gone so high,

that the sensor must be broken.

We have stressed people out at MIT
every way I can imagine.

Qualifying exams.

Public speaking.

We have measured
Boston driver stress - huge peaks.

But nothing as big
as what I saw on this little boy.

And the weird thing was
it was on one side and not the other.

The other side wasn't responsive at all.

And I thought,

with my electrical engineering hat on:
How can this happen?

How can - unless the sensors are broken -

how can you be excited on one side
of your body and not the other?

This just didn't make sense.

After a lot of debugging
that I won't go into here,

I finally gave up, and I did something
I've never done before,

I called a student at home on vacation.

(Laughter)

"Hi. How's your Christmas going?
How's your little brother?

Hey, any idea what happened to him - "
and I gave him the exact date and time.

And he said, "I don't know,
I'll check the diary."

Diary?! MIT student keeps a diary?!

Quick prayer.

He comes back;
he has the exact date and time.

He checks it with me, and he says,

"That was minutes before
he had a grand mal seizure."

Now, I didn't know, really,
what a seizure was.

I started to do some research.

Next thing I know,
I'm on the phone with Dr. Joe Madsen,

head of neurosurgery
at Children's Hospital, Boston.

"Hi Dr. Madsen.
My name's Dr. Rosalind Picard.

Could you tell me, is it possible
that somebody could have

a huge sympathetic nervous system surge

many minutes before a grand mal seizure?"

And he says,

"Probably not.

(Laughter)

But, you know, we've
sometimes had patients

who have hair stand on end
on one arm before a seizure."

I said, "On one arm?"

And I told him that this didn't just
happen the way it usually happens,

it happened on only one side.

And he got interested,

and we got Institutional
Review Board approval,

the ethics board at the hospital,
we built a lot more sensors,

we enrolled families fully consented,
where they are bringing their children in

not only to have around-the-clock
monitoring of EEG for the brain waves,

ECG for the heart,

but now EDA, electrodermal activity,
for the skin conductance.

And here's an example of what we saw.

This is data from a 17-year-old boy,

and what you see
is the skin conductance here.

And in the middle is the sleep.

Those are the biggest peaks
I was showing you from the MIT student.

Well, those are like
little baby maple trees

next to the three other peaks

that are like redwoods
coming out of the data.

The other three peaks
are grand mal seizures.

And we found 100 percent
of grand mal seizures

had a significant increase in the signal
that we could measure on the wrist.

That signal in a grand mal
is also accompanied by convulsive motion

that you see under the three red lines
in the little blue boxes.

That shows a lot
of accelerometer activity.

Now, most of the sensors
on the market today

that people with epilepsy could use
only measure that movement,

and that can be confused
with brushing your teeth,

strumming the guitar -

you get a lot of false alarms.

But through this accidental finding,

we're able to combine it
with the skin conductance

and get a more accurate detector.

And we also asked:
Why are these so big and so long?

The seizure's only a couple of minutes.

And this response is lasting
much longer than a normal stress response.

Was it that the person
was convulsing so much

that they got sweaty?

No, it turns out it's completely unrelated

to the length - or strength
of the convulsions.

But it turns out to be related to -
it was really surprising to me -

I learned that while most seizures -

and here is brainwave activity
from a seizure;

on the left, you see it
kind of going crazy;

this is EEG traces from the scalp -
most of them end

and then the brain activity looks normal.

But here it's going flat
after the seizure.

And that suppression happens -
well, was observed,

in 100 percent of the published cases

where a patient happened to be wearing
an EEG when they had a seizure,

nobody was with them,
and they passed away after the seizure.

Now, fortunately,
death in epilepsy is rare.

But it turns out it's more common
than death from SIDS, from AIDS,

and from house fires in the US.

It's called Sudden
Unexpected Death in Epilepsy,

and I bet most people here
have never heard of it.

And yet, if you look at the statistics
of neurological disorders,

and here we see the years of lost life
for people with stroke

and ALS - Lou Gehrig's disease -

or multiple sclerosis
or Alzheimer's or Parkindson's,

SUDEP is number two on this chart.

It needs to be better known.

As I learned more about seizures,

I learned that they're
kind of like little electrical fires.

You can start like a little brush fire.

And it can stay localized in your brain,

and it can simply cause
an unusual sensory experience,

or déjà vu.

You may not see anything outwardly
that is going on differently

when the seizure is happening inside.

But the more dangerous seizures
can make you unconscious

and can cause these convulsions,

and those are called
the grand mal seizures.

Now, you wouldn't build a house today
without having a smoke detector.

And yet, SUDEP kills more people
in the US every year than house fires,

and patients are sent home

not only without some kind
of equivalent of a smoke detector,

but without even the ability to talk
to a lot of people about what's going on.

So that led to this short clip
I'm going to show you next.

(Video) Rosalind Picard: Our device
is designed to detect unexpected seizures.

Embrace is designed to save lives
for a lot of people with epilepsy.

Seizures can seriously hurt
or even kill people,

and we need an alert to intervene.

One in 26 people in the US
will develop epilepsy at some point

during their lifetime.

Everybody with epilepsy
should be able to have a device

that alerts a friend
or a family member to come help

at the time that they might need it.

(Music)

(Video ends)

(Applause)

Thanks to the teamwork of Empatica

in partnership
with the Epilepsy Foundation

and the ability of new
crowdsourcing sites like Indiegogo

to reach the public,

this project was fully funded.

And, for the first time I've ever seen
in crowdfunding of a cool new technology,

not only were devices able to be gotten

to people who could afford one,

but through the partnership
with the Epilepsy Foundation

and some generous anonymous donors,

we were able to give a device -
for each one that was purchased -

to a child and a family
who could not afford a $200 device.

Now, I've told you a quick story here,

but we're not over yet.

This story started with trying to help
understand and communicate emotion better

in an individual with autism
and express the anxiety.

Today, thanks to
the hard work of Empatica,

I'm able to wear a device
that measures my autonomic stress.

It can gently vibrate
and tell me that it's going up, privately.

Or, if I choose, I can have the signal
sent to somebody who I care about,

who I know I can trust.

It reminds me of when the director
of the Media Lab said years ago,

"Roz, when are you going
to build me the mood ring

that tells me my wife's mood
before I go home?"

(Laughter)

Well, now we can tell somebody
a little bit more about the stress

contributing to your mood.

The same device can also now -

has the potential to help people
with autism communicate what's going on

even when they can't do it verbally.

And the device also has the ability
to run an algorithm on board

that can detect those unusual events
that might be a grand mal seizure,

and bring an alert so that somebody
can come and check on you.

Because we've learned
that when somebody is there,

SUDEP is a lot less likely to happen.

And the person who comes there

may not have to do anything more
than simply say the name,

or turn the person over,
or ask if they're okay.

Simply touching or stimulating a person
very gently after a grand mal seizure

and helping them get in a safe position
could help them take that next breath

and help that seizure
not be the terminal kind.

Now, as I was telling about this work
to one of my friends,

he said to me,

"Oh, Roz, I have epilepsy."

"What?! You have epilepsy?

You've been my friend for 20 years

and you've never told me
you have epilepsy?

Why didn't you tell me?"

And he said,

"Well, I just have felt uncomfortable
telling anybody that I have seizures,

and I don't have them very frequently."

Epilepsy is stigmatized,

and that needs to change.

And we can do that here today,
we can begin that process of change.

And to begin that process of change,

I'm going to introduce you
to somebody very special.

First a word or two of background.

Imagine being 13 years old
and lying on this surgical table

with your head under that big lamp.

Now, fortunately, the surgeon at the end
is Dr. Joe Madsen, who's amazing.

But he's about to cut
a big hole in your skull

and go into your brain deep
with sharp objects

and reconfigure some things.

I don't know about you, but I would
not want to volunteer for this.

This is a very scary surgery.

And this is Bailey Dwyer on the right,
who has just gone through this surgery

and is recovering nicely.

Bailey's very brave,

and she's also very courageous
and generous in another way.

I know this looks like a teenager
dressing up for Halloween as a zombie,

right?

It's really cool to put on the fake blood
and the gauze and all that stuff.

But this is the real thing.

Bailey has wires
coming out of her head here

that go not just
under the surface of the skin,

they go deep into the brain,

into the regions of the brain involved
in memory, emotion, attention,

and other vital processes.

And Bailey graciously volunteered

to not only have
what she needed to have done,

but to participate
in scientific experiments

that enable all of us
to benefit from and learn

more about how these
deep regions of the brain operate,

how they map to other things
we can measure on the surface of the body,

and how we can use this information
to help lots of other people.

People like Bailey are my heroes.

And I want you to join me right now
in welcoming to our stage Bailey Dwyer.

(Applause)

Bailey Dwyer: First,
thank you, Roz, for introducing me.

I'll start by saying my name is Bailey
and I'm a junior at Brookline High School.

When I was in eighth grade,
I had two brain surgeries for my epilepsy.

I currently do softball
and am studying for my SATs.

When I had my brain surgery,

I was scared to tell anyone
of why I would be away

because I was worried
about how they would stereotype me.

It's important to educate people
on what epilepsy is

and get rid of the stigma around it.

By raising the issue
and telling people what it is

will not only raise awareness
but save many lives.

Thank you.

(Applause)

Roz Picard: Bailey,
you drove here today too, right?

BD: I did, yes

RP: Yes!

What does it say
about our culture today

when a young high school student

cannot tell his or her friends

about why they're going away
from school for a while

to have major brain surgery?

We can change that. You can change that.

And all you have to do
when you leave here today

is chat about it, talk to people about it.

Ask your friends if they have epilepsy.

Tell them what you learned
about here today.

In doing this, together,
we can destigmatize this,

we can help people get better treatment,

and by doing this,
you may also help to save a life.

Thank you!

(Applause)