BEIRUT: When Mohammad Koubeissi readied his epileptic patient for a routine exam, he did not know he was about to discover the on-off switch for consciousness.
As the director of George Washington University’s Epilepsy Center zapped a region called the “claustrum” deep in the patient’s brain with a mild electric current, a blank stare took hold of her eyes.
She stopped talking and making new memories.
What Koubeissi had apparently discovered was a key – a switch that turned his patient’s consciousness on or off.
“This is a phenomenon that is unique,” Koubeissi said. “We have not seen a single spot in the brain that, when stimulated, can result in all those things together – unresponsiveness, blank stares, inability to form memories, and so forth.”
The results, and their conclusions, were published in the journal Epilepsy and Behavior.
Koubeissi’s patient had been suffering from epilepsy. After failing to respond to medication, he had recommended surgery.
Before epilepsy patients are subjected to surgery, doctors place electrodes in their scalp to try and identify the focal point of the seizures, or in the brain to identify the origin of the seizures and to map the patient’s brain, in order to avoid removing portions of it that are responsible for functions like movement and speech.
The mapping can be done by stimulating the electrodes inside the brain with electrical charges. For instance, if a patient’s hand moves when a particular electrode is stimulated, doctors can deduce that that region of the brain is involved in movement.
When the electrode near the region known as the claustrum was stimulated and the patient froze, Koubeissi initially thought the electric charge had caused “aphasia” – turning off the language processing portion of the brain. But he could not explain why it had also turned off memory formation and movement.
“I went home and kept thinking about it all the time,” he said.
Then an epiphany. Scientists had for years hypothesized that the claustrum, a region deep inside the brain, was inextricably linked to consciousness. It was a sort of orchestra conductor – connected to all the crucial networks that control things like speech, memory, motor movement, visual and audio processing, emotions, among others. Koubeissi began connecting the dots, realizing he’d found the key that could turn off all these networks.
He repeated the procedure the next day, and 10 times out of 10, it happened again.
To prove that he had not simply turned off her language processing ability, Koubeissi asked her to repeat a word several times. Midway through the process, he stimulated the claustrum. Her words became confused and slurred, eventually trailing off, rather than abruptly halting.
To show that her memory and ability to follow commands were also impaired, he would ask her to repeat words after him. After repeating the first two words, he stimulated the claustrum. She stopped repeating words after him, and did not realize that he had uttered those words at all.
“The finding suggests that this is a spot connected with the majority, if not all, of the networks that process consciousness,” he said.
Koubeissi likens it to a well-lit, ornamented Christmas tree.
“What we found was the electric plug that’s connected to all these light bulbs,” he said. “When we unplugged that, the whole tree ceased to function.”
He also calls it the “maestro” coordinating the work of the body’s major neural networks.
The study has its limitations, since it has been conducted on a single patient.
But if Koubeissi’s conclusion that the claustrum is indeed this focal point for consciousness is verified, it could have major implications.
The find could be used in an attempt to revive coma patients in a vegetative state, in the study of epilepsy treatment, or to gain a greater understanding of mental illnesses like schizophrenia.
And it could also open doors to questions of a more philosophical bent, such as whether animals, or even man-made machines, can be considered conscious.
But the results of the research are also a sign that there is much yet to be discovered around us, if only we keep an open mind, he said.
“Fascinating phenomena are not infrequent in medical practice and scientific research,” Koubeissi said. “What we have to do is keep our eyes opened.”
Koubeissi’s research focuses on finding novel treatments and surgeries for epilepsy, and he said his research will continue in that field.
It dates back to his time at the American University of Beirut, where the Lebanese doctor from the city began studying mathematics while also delving into pre-medicine courses.
The turning point was a course in animal physiology that explained how behaviors are often linked to biological processes. He studied, for instance, the singing of canaries and how it affects hormones and mating behavior in the bird.
“When I discovered that studying the biology can actually explain a lot of our behavior, that was an extremely intriguing, fascinating area for me,” he said.
He would go on to join the AUB medical school, where he decided he wanted to be a neurologist, specifically one who treats epilepsy, because of its potential to offer great insights into the functioning of the brain.
After graduating from medical school, Koubeissi spent a year conducting epilepsy research at AUB, before moving to New York University for clinical training. After graduating in 2004, he joined Johns Hopkins University and later Case Western Reserve University, before arriving at George Washington University.
Koubeissi’s advice for burgeoning university students is to seek out what entices them.
“If you have a passion, pursue it,” he said. “Don’t ask where it’s going to take you or whether it’s going to be eventually rewarding or not.”
“If you pursue your passion, whether it’s in art or science, you will have a much better chance at answering chronic questions and at being happy on a day-to-day basis, which I think must be the ultimate goal of everyone,” he added.