Emery N. Brown | |
---|---|
Born | 1957 (age 66–67) Ocala, Florida, USA |
Alma mater | Harvard University |
Known for | Systems neuroscience Computational neuroscience Mechanisms of anesthesia Neural signal processing |
Awards | Gruber Neuroscience Prize |
Scientific career | |
Fields | Neuroscience Systems neuroscience Statistics Anesthesiology Computational neuroscience Bioengineering |
Institutions | Harvard Medical School Massachusetts Institute of Technology Massachusetts General Hospital |
Emery Neal Brown (born 1957) [1] is an American statistician, computational neuroscientist, and anesthesiologist. He is the Warren M. Zapol Professor of Anesthesia at Harvard Medical School and at Massachusetts General Hospital (MGH), and a practicing anesthesiologist at MGH. At MIT he is the Edward Hood Taplin Professor of Medical Engineering and professor of computational neuroscience, the associate director of the Institute for Medical Engineering and Science, and the Director of the Harvard–MIT Program in Health Sciences and Technology.
In 2015, Brown was elected a member of the National Academy of Engineering for the development of neural signal processing algorithms for understanding memory encoding and modeling of brain states of anesthesia. Brown is one of only 19 individuals who has been elected to all three branches of the National Academies of Sciences, Engineering, and Medicine, as well as the first African American and the first anesthesiologist to be elected to all three National Academies. [2] [3] [4] [5] [6]
In 2020, he was awarded the Swartz Prize for Theoretical and Computational Neuroscience. In 2022 he was awarded the Gruber Neuroscience Prize, alongside theoretical neuroscientists Larry Abbott, Terrence Sejnowski and Haim Sompolinsky.
Brown was born and grew up in Ocala, Florida, where he attended Fessenden Elementary and Middle Schools, Osceola Junior High School and North Marion High School. He graduated from Phillips Exeter Academy, in Exeter, New Hampshire in 1974 after spending the second semester of his senior year at Exeter in the School Year Abroad Program studying Spanish in Barcelona, Spain. [7] In 1978, he received his Bachelor of Arts (magna cum laude) in applied mathematics from Harvard College. [3] [7] Following graduation, Brown received an International Rotary Foundation Fellowship to study mathematics at the Institut Fourier des Mathèmatiques Pures in Grenoble, France. [7]
Upon returning from Grenoble, he entered the Harvard Medical School MD/PhD Program. He received his Master of Arts and PhD in statistics from Harvard University in the years 1984 and 1988 respectively. He received his MD (magna cum laude) in 1987 from Harvard Medical School. [3]
Brown completed his internship in internal medicine in 1989 at the Brigham and Women's Hospital, a research fellowship in endocrinology at the Brigham and Women's Hospital in 1992 and his residency in anesthesiology at MGH in 1992. In 1992, Brown joined the staff in the Department of Anesthesia at MGH and the faculty at Harvard Medical School. In 2005 he joined the faculty at Massachusetts Institute of Technology. [7]
Currently, Brown is the Warren M. Zapol Professor of Anesthesia at Harvard Medical School, the Edward Hood Taplin Professor of Medical Engineering at MIT's Institute for Medical Engineering and Science, and a professor of Computational Neuroscience at MIT. [3] In addition to his professorial positions, Brown serves as the Director of the Neuroscience Statistics Research Laboratory at the Massachusetts Institute of Technology, the co-director of the Harvard-MIT Division of Health Sciences and Technology and an associate director of MIT's Institute for Medical Engineering & Science. [3] Brown also works as an anesthesiologist at MGH. [4]
Brown has published widely on topics in Computational Neuroscience and Anesthesiology. [8] Brown is the principal investigator of the Neuroscience Statistics Research Laboratory at MGH and MIT, where he currently conducts his research. [9]
Brown developed statistical methods to characterize the properties of the human circadian system (biological clock) from core temperature data recorded under the constant routine and free-running and forced desynchrony protocols. Through the early part of his career, Brown collaborated with circadian researchers to apply his methods to answer fundamental research questions in circadian physiology. Brown's statistical methods were critical for: estimating accurately the period and internal time on human circadian clocks from continuous core temperature measurement; [10] [11] showing that bright lights could be used to shift the phase of the human circadian clock; [12] properly timed administration of light and dark periods could be used to realign the internal clocks of shift workers with external time; [13] and that, contrary to beliefs at the time, the period of the human biological clock, like that of other animals, was closer to 24 hours rather than 25 hours. [14]
Brown later focused his statistics research on developing signal processing algorithms and statistical methods for neuronal data analysis. He developed a state-space point process (SSPP) paradigm to study how neural systems maintain dynamic representations of information. [15] For the analysis of neural spiking activity and binary behavioral tasks represented as multivariate or univariate point processes (0-1 events that occur in continuous time), his research produced analogs of the Kalman filter, Kalman smoothing, sequential Monte Carlo algorithms, and combined state and parameter estimation algorithms commonly applied to continuous-valued time series observations.
Brown used his methods to: show that ensembles of neurons in the rodent hippocampus maintained a highly accurate representation of the animal's spatial location; [16] track the formation of neural receptive fields on a millisecond time scale; [17] [18] [19] track concurrent changes in neural activity and behavior during learning experiments; [20] decode how groups of motor neurons represent movement information; [21] and track burst suppression in patients under general anesthesia. [22]
Brown applied the state-space paradigm to: analyze learning in behavioral neuroscience experiments; [23] [24] [25] study the relationship between learning and changes in hippocampal function in humans; [26] assess the efficacy of deep brain stimulation in enhancing behavior performance in humans and non-human primates; [27] and define precisely changes in levels of consciousness under propofol-induced general anesthesia. [28]
With Partha Mitra, Brown co-founded and co-directed the Neuroinformatics Summer Course at the Marine Biological Laboratory in Woods Hole, MA from 2002 to 2006. He co-directs with Robert Kass the biannual Statistical Analysis of Neural Data Conference at the Carnegie Mellon University Center for the Neural Basis of Cognition. [29] [30] He co-authored a textbook in neuroscience data analysis with Robert Kass and Uri Eden. [31]
Unraveling the mystery of general anesthesia is another major question facing modern medicine. [5] In 2004, Brown began a systems neuroscience research program to study the mechanisms of anesthetic action by forming and leading an interdisciplinary collaboration of anesthesiologists, neuroscientists, a statistician, a neurosurgeon, neurologists, bioengineers and a mathematician at MGH, MIT and Boston University. [32] In 2007 he received an NIH Director's Pioneer Award to support this research making him, the first anesthesiologist and the first statistician to receive this award. [33] His anesthesiology research has made fundamental theoretical and experimental contributions to understanding the neurophysiology of general anesthesia. In two seminal papers, [34] [35] Brown provided the first systems neuroscience analysis of how anesthetics act at specific receptors in specific neural circuits to produce commonly observed altered arousal states. This analysis provided an essential missing link between the substantial body of research on the molecular pharmacology of anesthetic action and the behavioral responses commonly seen in anesthetized patients. Brown also shows that, contrary to common dogma general anesthesia is not sleep, but rather a reversible coma. [34]
Brown's research group has provided detailed insights into how anesthetics produce unconsciousness. The brain is not shut off under general anesthesia. Instead, anesthetics induce highly structured oscillations between key brain regions. These oscillations, which are readily visible in standard electroencephalogram (EEG) recordings, alter arousal by impairing normal communication between regions. This is analogous to what happens when an epilepsy patient loses consciousness with the appearance of the regular, hypersynchronous oscillations of a seizure. Anesthetic-induced oscillations are also akin to what happens when a hum in a phone line makes it impossible to sustain a normal conversation. [34] [35]
Brown has performed many studies on the properties of propofol-induced anesthesia in particular. He found that propofol-induced unconsciousness is mediated simultaneously by two different oscillatory processes. The first is strong coherent alpha oscillations (8 to 10 cycles per second) between the cortex and the thalamus (26–28) and the second is strong incoherent cortical slow-wave oscillations (<1 cycle per second). [36] [37] [38] The alpha oscillations impair communication between the thalamus and cortex. The slow waves restrict to narrow time intervals the times at which cortical neurons can discharge, thus making it difficult to sustain communication within the cortex. [37] Furthermore, each anesthetic has a different EEG signature reflecting different neural circuit mechanism-actions. These signatures change with age and the anesthetic dose. [39] [40] A practical implication of this finding is that the EEG can be used in real-time to monitor accurately the anesthetic state of patients. Brown's group has developed an online teaching program to train anesthesiologists on this monitoring approach. [41]
Brown and colleagues are establishing a new paradigm for waking patients up following general anesthesia. They have shown that the anesthetic state can be rapidly reversed by administering methylphenidate (Ritalin) [42] or activation of dopaminergic systems. [43] This suggests a new, feasible way to actively restore cognitive function in patients after anesthesia and sedation. They have received FDA approval to undertake a clinical trial to test this idea in humans (NCT 02051452). [44] [45] [46] They have also shown that burst-suppression, a state of profound brain inactivation seen in deep general anesthesia, hypothermia, coma and developmental brain disorders, can be simply explained by a unifying neural-metabolic model. [47] Brown's group have also shown that burst suppression can be precisely controlled to maintain a therapeutic, medically induced coma. This research uses a closed-loop control system based on his SSPP paradigm. [48] [49] This could have important implications for treating patients, such as Gabby Giffords, Michael Schumaker, Malala Yousafzai, and Joan Rivers, who sustain brain injuries or have intracranial hypertension and require a medically induced coma to facilitate brain recovery.
Brown's anesthesiology research has been featured on National Public Radio, [50] in Scientific American, [51] the MIT Technology Review, [5] the New York Times [52] and in TEDMED [53] 2014.
Brown has served on numerous national panels and advisory committees. Most recently he served on the NIH BRAIN Initiative Working Group. [54] His current committee service includes being a member of the Burroughs-Wellcome Fund Board of Directors, [55] the NSF Mathematical and Physical Sciences Advisory Committee, [56] the NIH Council of Councils, [57] the Board of Trustees of the International Anesthesia Research Society, [58] the Scientific Advisory Committee of CURE Epilepsy [59] and the Governing Council of the American Academy of Arts and Sciences. [60]
Brown has received a number of awards throughout his career, including: the Robert Wood Johnson Minority Medical Faculty Development Fellowship, [61] an NSF Minority Career Development Fellowship, an National Institute of Mental Health Independent Scientist Award, [62] the Jerome Sacks Award from the National Institute of Statistical Sciences for Outstanding Cross Disciplinary Research, [3] an NIH Director's Pioneer Award, [3] an NIH Director's Transformative Research Award, [3] a Guggenheim Fellowship, [3] and the American Society of Anesthesiologists Award for Excellence in Research. [3] Brown was named as one of America's leading doctors by Black Enterprise Magazine [63] and was named one of Get Konnected's GK50 Boston's 50 Most Influential People of Color in Healthcare & Life Sciences [64] In 2018, Brown received the Dickson Prize in Science for his work on the statistical analysis of neuronal data and research on anesthesia. One of Carnegie Mellon's nominators, Professor Robert E. Kass, noted that Brown is the "world's expert on statistical analysis of neuronal data" and that Brown's work on anesthesia has been "truly transformative" for the field. [65] [66]
Brown has presented several memorial lectures, including: the American Society of Anesthesiology's Lewis H. Wright Memorial Lecture [67] and John W. Severinghaus Lecture in Translational Science [68] and the Institute of Mathematical Sciences Medallion Lecture. [69]
Brown is a fellow of the American Institute for Medical and Biological Engineering, the American Statistical Association, the IEEE, the American Association for the Advancement of Sciences, and the American Academy of Arts and Sciences. Brown was inducted into the Florida Inventors Hall of Fame. [70] Brown is a member of all three branches of the National Academies, which are the National Academy of Medicine, the National Academy of Sciences and the National Academy of Engineering. [3] [62] He is the first African American and the first anesthesiologist elected to all three branches. [71] In 2020, he was awarded the Swartz Prize for Theoretical and Computational Neuroscience. [72] In 2022 he was awarded the Gruber Neuroscience Prize. [73]
General anaesthetics are often defined as compounds that induce a loss of consciousness in humans or loss of righting reflex in animals. Clinical definitions are also extended to include an induced coma that causes lack of awareness to painful stimuli, sufficient to facilitate surgical applications in clinical and veterinary practice. General anaesthetics do not act as analgesics and should also not be confused with sedatives. General anaesthetics are a structurally diverse group of compounds whose mechanisms encompass multiple biological targets involved in the control of neuronal pathways. The precise workings are the subject of some debate and ongoing research.
Ketamine is a dissociative anesthetic used medically for induction and maintenance of anesthesia. It is also used as a treatment for depression and pain management. It is a novel compound that was derived from phencyclidine in 1962 in pursuit of a safer anesthetic with fewer hallucinogenic effects.
Anesthesia or anaesthesia is a state of controlled, temporary loss of sensation or awareness that is induced for medical or veterinary purposes. It may include some or all of analgesia, paralysis, amnesia, and unconsciousness. An individual under the effects of anesthetic drugs is referred to as being anesthetized.
Sevoflurane, sold under the brand name Sevorane, among others, is a sweet-smelling, nonflammable, highly fluorinated methyl isopropyl ether used as an inhalational anaesthetic for induction and maintenance of general anesthesia. After desflurane, it is the volatile anesthetic with the fastest onset. While its offset may be faster than agents other than desflurane in a few circumstances, its offset is more often similar to that of the much older agent isoflurane. While sevoflurane is only half as soluble as isoflurane in blood, the tissue blood partition coefficients of isoflurane and sevoflurane are quite similar. For example, in the muscle group: isoflurane 2.62 vs. sevoflurane 2.57. In the fat group: isoflurane 52 vs. sevoflurane 50. As a result, the longer the case, the more similar will be the emergence times for sevoflurane and isoflurane.
General anaesthesia (UK) or general anesthesia (US) is a method of medically inducing loss of consciousness that renders a patient unarousable even with painful stimuli. This effect is achieved by administering either intravenous or inhalational general anaesthetic medications, which often act in combination with an analgesic and neuromuscular blocking agent. Spontaneous ventilation is often inadequate during the procedure and intervention is often necessary to protect the airway. General anaesthesia is generally performed in an operating theater to allow surgical procedures that would otherwise be intolerably painful for a patient, or in an intensive care unit or emergency department to facilitate endotracheal intubation and mechanical ventilation in critically ill patients. Depending on the procedure, general anaesthesia may be optional or required. Regardless of whether a patient may prefer to be unconscious or not, certain pain stimuli could result in involuntary responses from the patient that may make an operation extremely difficult. Thus, for many procedures, general anaesthesia is required from a practical perspective.
Propofol is the active component of an intravenous anesthetic formulation used for induction and maintenance of general anesthesia. It is chemically termed 2,6-diisopropylphenol. The formulation was approved under the brand name Diprivan. Numerous generic versions have since been released. Intravenous administration is used to induce unconsciousness after which anesthesia may be maintained using a combination of medications. It is manufactured as part of a sterile injectable emulsion formulation using soybean oil and lecithin, giving it a white milky coloration.
Awareness under anesthesia, also referred to as intraoperative awareness or accidental awareness during general anesthesia (AAGA), is a rare complication of general anesthesia where patients regain varying levels of consciousness during their surgical procedures. While anesthesia awareness is possible without resulting in any long-term memory of the experience, it is also possible for victims to have awareness with explicit recall, where they can remember the events related to their surgery.
The ventrolateral preoptic nucleus (VLPO), also known as the intermediate nucleus of the preoptic area (IPA), is a small cluster of neurons situated in the anterior hypothalamus, sitting just above and to the side of the optic chiasm in the brain of humans and other animals. The brain's sleep-promoting nuclei, together with the ascending arousal system which includes components in the brainstem, hypothalamus and basal forebrain, are the interconnected neural systems which control states of arousal, sleep, and transitions between these two states. The VLPO is active during sleep, particularly during non-rapid eye movement sleep, and releases inhibitory neurotransmitters, mainly GABA and galanin, which inhibit neurons of the ascending arousal system that are involved in wakefulness and arousal. The VLPO is in turn innervated by neurons from several components of the ascending arousal system. The VLPO is activated by the endogenous sleep-promoting substances adenosine and prostaglandin D2. The VLPO is inhibited during wakefulness by the arousal-inducing neurotransmitters norepinephrine and acetylcholine. The role of the VLPO in sleep and wakefulness, and its association with sleep disorders – particularly insomnia and narcolepsy – is a growing area of neuroscience research.
Neurosurgical anesthesiology, neuroanesthesiology, or neurological anesthesiology is a subspecialty of anesthesiology devoted to the total perioperative care of patients before, during, and after neurological surgeries, including surgeries of the central (CNS) and peripheral nervous systems (PNS). The field has undergone extensive development since the 1960s correlating with the ability to measure intracranial pressure (ICP), cerebral blood flow (CBF), and cerebral metabolic rate (CMR).
Burst suppression is an electroencephalography (EEG) pattern that is characterized by periods of high-voltage electrical activity alternating with periods of no activity in the brain. The pattern is found in patients with inactivated brain states, such as from general anesthesia, coma, or hypothermia. This pattern can be physiological, as during early development, or pathological, as in diseases such as Ohtahara syndrome.
Sean C. Mackey is an American scientist, anesthesiologist and pain medicine specialist. Since 2012, he has served as the Redlich Professor of Anesthesiology, Perioperative and Pain Medicine, Neurosciences and Neurology at Stanford University. He has been the Chief of the Division of Pain Medicine since 2007 and the Director and Founder of the Systems Neuroscience and Pain Laboratory (SNAPL) since 2002. Previously, he practiced anesthesiology and co-founded Stanford's regional anesthesia program in 2000.
Nicholas Peter Franks FRS FRSB has been Professor of Biophysics and Anaesthetics at Imperial College London since 1993. His research focuses on how general anaesthetics act at the cell and molecular levels as well as with neuronal networks. Franks holds patents on use of xenon gas as a neuroprotectant and has published research on the use of the anesthetic properties of xenon.
Obstetric anesthesia or obstetric anesthesiology, also known as ob-gyn anesthesia or ob-gyn anesthesiology, is a sub-specialty of anesthesiology that provides peripartum pain relief (analgesia) for labor and anesthesia for cesarean deliveries ('C-sections').
Warren M. Zapol was the emeritus Anesthetist-in-Chief at Massachusetts General Hospital (1994-2008) and the Reginald Jenney Distinguished Professor of Anaesthesia at Harvard Medical School. From 1994 to 2008, Zapol served as anesthetist-in-chief at MGH and was the director of the MGH Anesthesia Center for Critical Care Research until his death.
Patrick Lee Purdon is an American biomedical engineer whose research focuses on neuroscience, neuroengineering, and clinical applications. He holds the Nathaniel M. Sims Endowed Chair in Anesthesia Innovation and Bioengineering at Massachusetts General Hospital and is an associate professor of anaesthesia at Harvard Medical School. Purdon received his Ph.D. in biomedical engineering from Massachusetts Institute of Technology in 2005. His research in neuroengineering encompasses the mechanisms of anesthesia, Alzheimer’s disease and brain health, anesthesia and the developing brain, neural signal processing, and the development of novel technologies for brain monitoring. He has published over 90 peer-reviewed publications, is an inventor on 16 pending patents, and is a Fellow of the American Institute for Medical and Biological Engineering. Purdon has won many awards, including the prestigious National Institutes of Health Director’s New Innovator Award, and his work has been covered in the popular media, including programs on Radiolab and NPR.
Maryam M. Shanechi is an Iran-born American neuroengineer. She studies ways of decoding the brain's activity to control brain-machine interfaces. She was honored as one of MIT Technology Review's Innovators under 35 in 2014, one of the Science News 10 scientists to watch in 2019, and a National Finalist for the Blavatnik Awards for Young Scientists in 2023. She is Dean's Professor in Electrical and Computer Engineering, Computer Science, and Biomedical Engineering at the USC Viterbi School of Engineering, and a member of the Neuroscience Graduate Program at the University of Southern California.
James Edward Cottrell is the Chair Emeritus, Department of Anesthesiology at SUNY Downstate Medical Center in New York City. He serves as a member of the New York State Board of Regents and is an avid collector of contemporary fine-art.
Alex Bekker is a physician, author and academic. He is a professor and chair at the Department of Anesthesiology, Rutgers New Jersey Medical School. He is also professor at the Department of Physiology, Pharmacology & Neurosciences. He serves as the Chief of Anesthesiology Service at the University Hospital in Newark.
Beverley Anne Orser is a Canadian anesthesiologist. As a professor at the University of Toronto, Orser was elected a member of the National Academy of Medicine for "her discovery of the unique pharmacological properties of extrasynaptic GABA-A receptors and their mechanistic role in anesthetic- and inflammation-induced impairment of memory, and for her leadership in academic anesthesiology.
Fan Wang is a neuroscientist and professor in the MIT Department of Brain and Cognitive Sciences. She is an investigator at the McGovern Institute for Brain Research. Wang is known for her work identifying neural circuits underlying touch, pain, and anesthesia; and the development of a technique for capturing activated neuronal ensembles (CANE) to label and manipulate neurons activated by stimuli or behavioral paradigms.