VISION FOR THE FUTURE CREATES HISTORY. To determine the evolution and manner in which science, technology, and society will unfold requires vision. The ability to imagine what can be and work towards that goal. Without creativity, without passion, and without perseverance, we are lost to roam shiftless and blind like a ship without a sail in the night. - Eric C. Leuthardt
What is the one thing that a patient with epilepsy wants? Is it for the seizures to stop? To be off the medications? The top of the list that I hear time and time again is this – to be able to drive a car. Without a doubt seizures are dangerous and socially debilitating (image going about your day to day life with the thought of abruptly losing consciousness). Due to their epilepsy, these patients are legally prohibited from driving because their seizures put them at risk for getting into an accident. At first glance, that of course sounds inconvenient, but to my patients it often means everything. The question is why? Why is driving so important? I think as we delve into the answer it tells us something about how humans have evolved in the modern era.
To answer the question I would cite some work done by Atsushi Iriki’s lab at the Riken Brain Science Institute in Japan. He did some interesting experiments with monkeys in which he trained them to use rakes to pull a morsel of food toward themselves while recording brain activity with electrodes. The electrodes were in the post-central gyrus, a part of the brain involved with sensory perception as it relates to our bodies. So if someone touches your hand there will be increased neuronal firing in that part of the brain. Similarly, Iriki identified neurons that would start to fire when you touched the monkey’s hands. After they were trained to use the rake when they touched the rake, the same activity appeared. Thus, according to that monkey’s brain, in a very real way that tool became a part of his body.
What does that have to do with epileptics driving cars? From monkeys to humans, the tools we use quite literally become a part of who we are. We perceive them as a part of our body. One of the most fundamental tools in modern society is the automobile. It is our new legs in a mechanized environment. Actually, its probably more than that – in addition to mobility we associate cars with our lifestyles, economic class, and personalities (people who drive Hummers are usually quite different from people who drive Minis) Thus, when a patient with epilepsy looses the ability to use a car, he or she has a lost a part of themselves. Essentially, they have lost a physical expression of their persona and, more importantly, they have lost their ability to navigate a specialized environment where most resources are beyond physical walking distance. Interestingly, a patient whose legs are paralyzed have more independence and freedom in the world at large than a patient with epilepsy. Whereas four hundred years ago in a small medieval village, the exact opposite would be true. From a personal standpoint as a surgeon who treats spinal cord injury and epilepsy, whenever I am able to intervene and recover leg function or cure their seizures, the patient’s psychology of being returned to independence is almost exactly the same.
Please don’t confuse my praise of a car as materialistic. Rather, the point here is to show that the boundary of what we call our bodies (according to our brain’s physiology) is more gray than what we would like to believe. Going into the future new “body extensions” will be cropping up with increasing speed and diversity. How many people today feel handicapped without their smart phones, their ipads, or their laptops? More than materialistic desire, the adoption of ever increasing capability is part of how we as humans are built. There is an innate cortical plasticity to take on new functionalities and incorporate those elements into our cognitive model of “me.” It is this cognitive flexibility that allowed our ancestors to first use tools (such as a rake) to advance our ability to survive and proliferate. Interestingly, with the advent of novel human machine interfaces (iphones, cars, and brain computer interfaces), we will see the emergence of new and more impressive capabilities and the emergence of new disabilities when those capabilities are taken away. Thus, you never get free lunch – even if you get it with a rake.