TEDxCaltech
Andres Lozano: Parkinson's, depression and the switch that might turn them off
Andres Lozano : Parkinsonova bolest, depresija i prekidač koji bi ih mogao isključiti
Filmed:
Readability: 4.3
1,477,742 views
Duboka stimulacija mozga postaje vrlo precizna. Ova tehnika omogućuje kirurzima da postave elektrode u gotovo bilo koji dio mozga te da ih pojačaju ili stišaju – kao radio ili termostat – kako bi ispravili poremećaj. Dramatičan pogled na novu tehniku, u kojoj žena s Parkinsonovom bolešću odmah prestaje drhtati, a regije mozga razorene Alzheimerovom bolešću vraćaju se u život. (Snimljeno na TEDxCaltech)
Andres Lozano - Neurosurgeon
The chair of neurosurgery at the University of Toronto, Andres Lozano has pioneered the use of deep brain stimulation for treating Parkinson’s, depression, anorexia and Alzheimer’s disease. Full bio
The chair of neurosurgery at the University of Toronto, Andres Lozano has pioneered the use of deep brain stimulation for treating Parkinson’s, depression, anorexia and Alzheimer’s disease. Full bio
Double-click the English transcript below to play the video.
00:12
One of the things I want to establish right from the start
0
401
2316
Jedna od stvari koje odmah želim naglasiti
00:14
is that not all neurosurgeons wear cowboy boots.
1
2717
3030
je da ne nose svi neurokirurzi kaubojske čizme.
00:17
I just wanted you to know that.
2
5747
2179
Samo sam želio da to znate.
00:19
So I am indeed a neurosurgeon,
3
7926
2409
Dakle, ja sam zbilja neurokirurg,
00:22
and I follow a long tradition of neurosurgery,
4
10335
3927
i slijedim dugu tradiciju neurokirurgije,
00:26
and what I'm going to tell you about today
5
14262
1593
i ono o čemu ću vam danas govoriti
00:27
is adjusting the dials in the circuits in the brain,
6
15855
2318
je podešavanje brojčanika u krugovima mozga,
00:30
being able to go anywhere in the brain
7
18173
1955
mogućnost da bilo gdje u mozgu
00:32
and turning areas of the brain up or down
8
20128
2419
pojačamo ili stišamo regije
00:34
to help our patients.
9
22547
2212
kako bismo pomogli našim pacijentima.
00:36
So as I said, neurosurgery comes from a long tradition.
10
24759
2950
Dakle, kao što sam rekao, neurokirurgija ima dugu tradiciju.
00:39
It's been around for about 7,000 years.
11
27709
3552
Postoji gotovo 7 000 godina.
00:43
In Mesoamerica, there used to be neurosurgery,
12
31261
3725
U Srednjoj Americi postojala je neurokirurgija
00:46
and there were these neurosurgeons that used to treat patients.
13
34986
3768
i neurokirurzi koji su liječili pacijente.
00:50
And they were trying to -- they knew that the brain was involved
14
38754
3911
Oni su pokušavali -- oni su znali da je mozak uključen
00:54
in neurological and psychiatric disease.
15
42680
2352
u neurološke i psihijatrijske bolesti.
00:57
They didn't know exactly what they were doing.
16
45032
2161
Nisu točno znali što rade.
00:59
Not much has changed, by the way. (Laughter)
17
47193
2814
Usput, nije se toliko toga promijenilo. (Smijeh).
01:02
But they thought that,
18
50007
1873
Ali oni su mislili da
01:03
if you had a neurologic or psychiatric disease,
19
51880
2003
ako imate neurološku ili psihijatrijsku bolest,
01:05
it must be because you are possessed
20
53883
2591
to je zasigurno zato što ste opsjednuti
01:08
by an evil spirit.
21
56474
2352
zlim duhom.
01:10
So if you are possessed by an evil spirit
22
58826
1969
Dakle, ako ste opsjednuti zlim duhom
01:12
causing neurologic or psychiatric problems,
23
60795
2820
koji vam uzrokuje neurološke ili psihijatrijske probleme,
01:15
then the way to treat this is, of course,
24
63615
2021
tada je naravno jedini način da se to liječi
01:17
to make a hole in your skull and let the evil spirit escape.
25
65636
5683
napraviti rupu u lubanji kako bi zao duh pobjegao.
01:23
So this was the thinking back then,
26
71319
1378
To je bilo tadašnje razmišljanje,
01:24
and these individuals made these holes.
27
72697
4144
i te su osobe pravile rupe.
01:28
Sometimes the patients were a little bit reluctant
28
76841
2983
Ponekad su se pacijenti opirali
01:31
to go through this because, you can tell that
29
79824
2415
postupku jer se vidi da su
01:34
the holes are made partially and then, I think,
30
82239
2451
rupe napravljene djelomično. Mislim
01:36
there was some trepanation, and then they left very quickly
31
84690
2015
da su nakon trepanacije vrlo brzo otišli
01:38
and it was only a partial hole,
32
86705
1901
i ostala je samo djelomična rupa,
01:40
and we know they survived these procedures.
33
88606
2316
ali znamo da su preživjeli te postupke.
01:42
But this was common.
34
90922
1208
To je bilo često.
01:44
There were some sites where one percent
35
92130
1266
Postoje neka mjesta gdje jedan posto
01:45
of all the skulls have these holes, and so you can see
36
93396
2725
svih lubanja ima takve rupe. Kao što vidite,
01:48
that neurologic and psychiatric disease is quite common,
37
96121
3194
neurološke i psihijatrijske bolesti su prilično učestale,
01:51
and it was also quite common about 7,000 years ago.
38
99315
4433
i također su bile učestale prije otprilike 7,000 godina.
01:55
Now, in the course of time,
39
103748
2153
Tijekom godina,
01:57
we've come to realize that
40
105901
2220
došli smo da zaključka da
02:00
different parts of the brain do different things.
41
108121
2258
različiti dijelovi mozga rade različite stvari.
02:02
So there are areas of the brain that are dedicated
42
110379
1187
Tako postoje dijelovi mozga koji su posvećeni
02:03
to controlling your movement or your vision
43
111566
2693
kontroli pokreta ili vida
02:06
or your memory or your appetite, and so on.
44
114259
2949
ili pamćenja ili apetita i tako dalje.
02:09
And when things work well, then the nervous system
45
117208
2734
I kada sve dobro radi, tada i živčani sustav
02:11
works well, and everything functions.
46
119942
1669
dobro radi i sve funkcionira.
02:13
But once in a while, things don't go so well,
47
121611
2247
Ali ponekad, sve ne radi tako dobro,
02:15
and there's trouble in these circuits,
48
123858
2542
i dođe do problema u tim sklopovima,
02:18
and there are some rogue neurons that are misfiring
49
126400
2704
i postoje neki nestašni neuroni koji krivo okidaju
02:21
and causing trouble, or sometimes they're underactive
50
129104
3179
i uzrokuju nevolju, ili su ponekad premalo aktivni
02:24
and they're not quite working as they should.
51
132283
2544
i ne rade baš kao što bi trebali.
02:26
Now, the manifestation of this
52
134827
2137
Kako će se to manifestirati
02:28
depends on where in the brain these neurons are.
53
136964
2484
ovisi o tome gdje se u mozgu nalaze ti neuroni.
02:31
So when these neurons are in the motor circuit,
54
139448
2422
Kada su neuroni u motornom krugu
02:33
you get dysfunction in the movement system,
55
141870
2412
dobijete disfunkciju u sustavu za pokretanje
02:36
and you get things like Parkinson's disease.
56
144282
2166
i stvari kao što je Parkinsonova bolest.
02:38
When the malfunction is in a circuit that regulates your mood,
57
146448
3296
Kada je problem u krugu koji regulira raspoloženje,
02:41
you get things like depression,
58
149744
2284
dobijete stvari kao što je depresija,
02:44
and when it is in a circuit that controls your memory and cognitive function,
59
152028
3824
a kada je u krugu koji kontrolira pamćenje i kognitivne funkcije,
02:47
then you get things like Alzheimer's disease.
60
155852
2521
dobijete stvari kao što je Alzheimerova bolest.
02:50
So what we've been able to do is to pinpoint
61
158373
2723
Ono što smo uspjeli napraviti je istaknuti
02:53
where these disturbances are in the brain,
62
161096
2307
gdje se te disfunkcije nalaze u mozgu,
02:55
and we've been able to intervene within these circuits
63
163403
3037
i uspjeli smo se umiješati u te krugove
02:58
in the brain to either turn them up or turn them down.
64
166440
3656
u mozgu kako bismo ih pojačali ili stišali.
03:02
So this is very much like choosing the correct station
65
170096
2284
Dakle, ovo je prilično slično odabiranju prave stanice
03:04
on the radio dial.
66
172380
1975
na radiju.
03:06
Once you choose the right station, whether it be jazz or opera,
67
174355
2649
Jednom kada ste izabrali pravu stanicu, bio to jazz ili opera,
03:09
in our case whether it be movement or mood,
68
177004
2333
u našem slučaju bio to pokret ili raspoloženje,
03:11
we can put the dial there,
69
179337
1966
možemo postaviti birač tamo
03:13
and then we can use a second button to adjust the volume,
70
181303
2771
i koristiti drugi gumb kako bismo prilagodili glasnoću -
03:16
to turn it up or turn it down.
71
184074
2009
pojačali ili stišali.
03:18
So what I'm going to tell you about
72
186083
1228
Ono o čemu ću vam pričati
03:19
is using the circuitry of the brain to implant electrodes
73
187311
4058
je umetanje elektroda u krugove mozga
03:23
and turning areas of the brain up and down
74
191369
2468
i pojačavanje ili stišavanje regija mozga
03:25
to see if we can help our patients.
75
193837
1704
kako bi pomogli našim pacijentima.
03:27
And this is accomplished using this kind of device,
76
195541
2333
To nam omogućuje korištenje ove vrste uređaja,
03:29
and this is called deep brain stimulation.
77
197874
2461
a zove se duboka stimulacija mozga.
03:32
So what we're doing is placing these electrodes throughout the brain.
78
200335
3071
Ono što radimo je umetanje elektroda kroz mozak.
03:35
Again, we are making holes in the skull about the size of a dime,
79
203406
3949
Pravimo rupe u lubanji otprilike veličine novčića,
03:39
putting an electrode in, and then this electrode
80
207355
2151
umećemo elektrodu unutra, i kada je ta elektroda
03:41
is completely underneath the skin
81
209506
2228
potpuno ispod kože,
03:43
down to a pacemaker in the chest,
82
211734
2090
kao pacemaker u prsima,
03:45
and with a remote control very much like a television remote control,
83
213824
4528
tada s upravljačem vrlo sličnim TV upravljaču,
03:50
we can adjust how much electricity we deliver
84
218352
2979
možemo prilagoditi koliko struje dovodimo
03:53
to these areas of the brain.
85
221331
2068
tim regijama mozga.
03:55
We can turn it up or down, on or off.
86
223399
2891
Možemo ih pojačati ili stišati, uključiti ili isključiti.
03:58
Now, about a hundred thousand patients in the world
87
226290
2655
sada je oko sto tisuća pacijenata na svijetu
04:00
have received deep brain stimulation,
88
228945
1876
primilo duboku stimulaciju mozga,
04:02
and I'm going to show you some examples
89
230821
1154
i pokazat ću vam neke primjere
04:03
of using deep brain stimulation to treat disorders of movement,
90
231975
2711
u korištenju duboke stimulacije mozga u liječenju poremećaja pokreta,
04:06
disorders of mood and disorders of cognition.
91
234686
4514
raspoloženja i razmišljanja.
04:11
So this looks something like this when it's in the brain.
92
239200
2739
Otprilike ovako izgleda kada je u mozgu.
04:13
You see the electrode going through the skull into the brain
93
241939
2235
Vidite da elektroda ide kroz lubanju u mozak
04:16
and resting there, and we can place this really anywhere in the brain.
94
244174
3183
i stoji tamo, a mi ju možemo postaviti stvarno bilo gdje u mozak.
04:19
I tell my friends that no neuron is safe
95
247357
2460
Govorim svojim prijateljima da nijedan neuron nije siguran
04:21
from a neurosurgeon, because we can really reach
96
249817
2182
od neurokirurga, jer mi sada stvarno možemo dosegnuti
04:23
just about anywhere in the brain quite safely now.
97
251999
2566
bilo koji dio mozga prilično sigurno.
04:26
Now the first example I'm going to show you is a patient
98
254565
2520
Sada ću vam kao prvi primjer pokazati pacijenticu
04:29
with Parkinson's disease,
99
257085
1710
s Parkinsonovom bolešću.
04:30
and this lady has Parkinson's disease,
100
258795
1987
Ova dama ima Parkinsonovu bolest,
04:32
and she has these electrodes in her brain,
101
260782
2310
i ima elektrode u mozgu,
04:35
and I'm going to show you what she's like
102
263092
1282
pokazat ću vam kakva je
04:36
when the electrodes are turned off and she has her Parkinson's symptoms,
103
264374
3507
kada su elektrode isključene i ona ima simptome Parkinsonove bolesti,
04:39
and then we're going to turn it on.
104
267881
2333
a onda ćemo ih uključiti.
04:42
So this looks something like this.
105
270214
2695
Dakle izgleda ovako.
04:44
The electrodes are turned off now, and you can see that she has tremor.
106
272909
4505
Sada su elektrode isključene i možete vidjeti da drhti.
04:49
(Video) Man: Okay. Woman: I can't. Man: Can you try to touch my finger?
107
277420
3719
(Video) Muškarac: OK. Žena: Ne mogu. Muškarac: Možete li dotaknuti moj prst?
04:53
(Video) Man: That's a little better. Woman: That side is better.
108
281139
3625
Video) Muškarac: Ovo je malo bolje. Žena: Ta strana je bolja.
04:56
We're now going to turn it on.
109
284764
3792
Sada ćemo uključiti uređaj.
05:00
It's on. Just turned it on.
110
288556
4438
Uključen je. Upravo smo ga uključili.
05:06
And this works like that, instantly.
111
294561
3263
I radi ovako, trenutačno.
05:09
And the difference between shaking in this way and not --
112
297824
2982
I razlika između drhtanja i ne drhtanja –
05:12
(Applause)
113
300806
4601
(Pljesak)
05:17
The difference between shaking in this way and not is related to the misbehavior
114
305407
4105
Razlika između ovakvog drhtanja i ne drhtanja povezana je s nedoličnim ponašanjem
05:21
of 25,000 neurons in her subthalamic nucleus.
115
309512
3973
25,000 neurona u njenoj subtalamičkoj jezgri.
05:25
So we now know how to find these troublemakers
116
313485
2576
Dakle znamo pronaći te izgrednike
05:28
and tell them, "Gentlemen, that's enough.
117
316061
1391
i reći im: „Gospodo, bilo je dosta.
05:29
We want you to stop doing that."
118
317452
1334
Želimo da to prestanete raditi“.
05:30
And we do that with electricity.
119
318786
1222
To napravimo pomoću struje.
05:32
So we use electricity to dictate how they fire,
120
320008
3414
Koristimo struju da diktiramo kako ispaljuju,
05:35
and we try to block their misbehavior using electricity.
121
323422
3462
i pokušavamo blokirati njihovo nedolično ponašanje strujom.
05:38
So in this case, we are suppressing the activity of abnormal neurons.
122
326884
3444
U ovom slučaju prigušujemo aktivnost abnormalnih neurona.
05:42
We started using this technique in other problems,
123
330328
2562
Počeli smo koristiti ovu tehniku i u drugim problemima,
05:44
and I'm going to tell you about a fascinating problem
124
332890
1402
ispričat ću vam o jednom fascinantnom problemu
05:46
that we encountered, a case of dystonia.
125
334292
3168
s kojim smo se susreli, slučaj distonije.
05:49
So dystonia is a disorder affecting children.
126
337460
2505
Distonija je poremećaj koji zahvaća djecu.
05:51
It's a genetic disorder, and it involves a twisting motion,
127
339965
3062
To je genetski poremećaj, uključuje zakrečuće pokrete,
05:55
and these children get progressively more and more twisting
128
343027
2824
ta se djeca progresivno sve više zakreću
05:57
until they can't breathe, until they get sores,
129
345851
1991
sve dok ne mogu disati, dobiju čireve,
05:59
urinary infections, and then they die.
130
347842
2031
urinarne infekcije, i onda umru.
06:01
So back in 1997, I was asked to see this young boy,
131
349873
3373
Godine 1997. pozvali su me da vidim ovog malog dječaka,
06:05
perfectly normal. He has this genetic form of dystonia.
132
353246
2956
potpuno normalnog. On ima genetički tip distonije.
06:08
There are eight children in the family.
133
356202
2219
Ima osmero djece u njihovoj obitelji.
06:10
Five of them have dystonia.
134
358421
3359
Petero od njih ima distoniju.
06:13
So here he is.
135
361780
2185
Dakle, evo ga.
06:15
This boy is nine years old, perfectly normal until the age six,
136
363965
4186
Ovaj dječak ima 9 godina, bio je potpuno normalan do šeste godine,
06:20
and then he started twisting his body, first the right foot,
137
368151
4395
onda je počeo zakretati svoje tijelo, prvo desno stopalo,
06:24
then the left foot, then the right arm, then the left arm,
138
372546
3420
pa lijevo stopalo, pa desnu ruku, pa lijevu ruku,
06:27
then the trunk, and then by the time he arrived,
139
375966
3247
pa trup, i do vremena kada je stigao,
06:31
within the course of one or two years of the disease onset,
140
379213
2940
otprilike jednu do dvije godine od početka bolesti,
06:34
he could no longer walk, he could no longer stand.
141
382153
2320
više nije mogao hodati, nije mogao stajati.
06:36
He was crippled, and indeed the natural progression
142
384473
2698
Bio je osakaćen, i doista uobičajena progresija
06:39
as this gets worse is for them to become progressively twisted,
143
387171
3555
kako bolest postaje gora je da postanu sve više zakrenuti,
06:42
progressively disabled, and many of these children do not survive.
144
390726
5690
progresivno onesposobljeni, i mnoga od ove djece ne prežive.
06:48
So he is one of five kids.
145
396416
2028
On je jedno od petero djece.
06:50
The only way he could get around was crawling on his belly like this.
146
398444
4094
Jedini način na koji se mogao kretati je ovakvo puzanje na trbuhu.
06:54
He did not respond to any drugs.
147
402538
1956
Nije reagirao ni na kakve lijekove.
06:56
We did not know what to do with this boy.
148
404494
1940
Nismo znali što da radimo s ovim dječakom.
06:58
We did not know what operation to do,
149
406434
2116
Nismo znali koju operaciju da napravimo,
07:00
where to go in the brain,
150
408550
2194
gdje da idemo u mozak,
07:02
but on the basis of our results in Parkinson's disease,
151
410744
2773
ali na temelju naših rezultata s Parkinsonovom bolešću,
07:05
we reasoned, why don't we try to suppress
152
413517
2005
razmišljali smo, zašto ne bi probali prigušiti
07:07
the same area in the brain that we suppressed
153
415522
3097
isti dio mozga koji smo prigušili
07:10
in Parkinson's disease, and let's see what happens?
154
418619
3655
kod Parkinsonove bolesti, da vidimo što će se dogoditi?
07:14
So here he was. We operated on him
155
422274
1787
Bio je tamo. Operirali smo ga
07:16
hoping that he would get better. We did not know.
156
424061
3874
nadajući se da će mu biti bolje. Nismo znali.
07:19
So here he is now, back in Israel where he lives,
157
427935
4127
Ovo je on sada, natrag u Izraelu gdje živi,
07:24
three months after the procedure, and here he is.
158
432062
4053
tri mjeseca nakon postupka, evo ga.
07:28
(Applause)
159
436115
4950
(Pljesak)
07:36
On the basis of this result, this is now a procedure
160
444669
2621
Na temelju tog rezultata, ovo je sada postupak
07:39
that's done throughout the world,
161
447290
1248
koji se radi u cijelome svijetu,
07:40
and there have been hundreds of children
162
448538
1295
i stotinama je djece
07:41
that have been helped with this kind of surgery.
163
449833
4207
već pomogla ova vrsta operacije.
07:46
This boy is now in university
164
454040
2117
Dječak je sada na fakultetu
07:48
and leads quite a normal life.
165
456157
2036
i vodi prilično normalan život.
07:50
This has been one of the most satisfying cases
166
458193
2368
Ovo je bio jedan od najispunjavajućih pothvata
07:52
that I have ever done in my entire career,
167
460561
1979
koje sam ikada napravio u cijeloj svojoj karijeri,
07:54
to restore movement and walking to this kind of child.
168
462540
3377
vratiti pokret i hodanje ovakvom djetetu.
07:57
(Applause)
169
465917
6255
(Pljesak)
08:04
We realized that perhaps we could use this technology
170
472172
2869
Shvatili smo da bismo možda mogli koristiti ovu tehnologiju
08:07
not only in circuits that control your movement
171
475041
2172
ne samo u krugovima za kontrolu pokreta,
08:09
but also circuits that control other things,
172
477213
1952
nego također u krugovima koji kontroliraju druge funkcije,
08:11
and the next thing that we took on
173
479165
1147
i sljedeća stvar koje smo se prihvatili
08:12
was circuits that control your mood.
174
480312
2993
bili su krugovi koji kontroliraju raspoloženje.
08:15
And we decided to take on depression,
175
483305
2076
Odlučili smo se prihvatiti depresije
08:17
and the reason we took on depression is because it's so prevalent,
176
485381
2259
zato što je toliko raširena,
08:19
and as you know, there are many treatments for depression,
177
487640
2544
i kao što znate, postoji puno terapija za depresiju,
08:22
with medication and psychotherapy,
178
490184
2037
uz lijekove i psihoterapiju,
08:24
even electroconvulsive therapy,
179
492221
2062
čak i elektrokonvulzivnu terapiju,
08:26
but there are millions of people,
180
494283
1334
ali ima na milijune ljudi,
08:27
and there are still 10 or 20 percent of patients with depression
181
495617
2792
i još uvijek postoji 10 ili 20 posto pacijenata s depresijom
08:30
that do not respond, and it is these patients that we want to help.
182
498409
3252
s depresijom koji ne odgovaraju, i tim pacijentima želimo pomoći.
08:33
And let's see if we can use this technique
183
501661
2103
Pogledajmo možemo li koristiti ovu tehniku
08:35
to help these patients with depression.
184
503764
2239
kako bi pomogli tim pacijentima s depresijom.
08:38
So the first thing we did was, we compared,
185
506003
1850
Prva stvar koju smo napravili je bila da smo usporedili
08:39
what's different in the brain of someone with depression
186
507853
1824
što je drukčije u mozgu nekoga sa depresijom
08:41
and someone who is normal,
187
509677
1668
i nekoga tko je zdrav,
08:43
and what we did was PET scans to look at the blood flow of the brain,
188
511345
3460
napravili smo PET skeniranje kako bismo pogledali protok krvi kroz mozak,
08:46
and what we noticed is that in patients with depression
189
514805
2369
i primijetili smo da su kod pacijenata s depresijom,
08:49
compared to normals,
190
517174
2045
u usporedbi sa zdravim ljudima,
08:51
areas of the brain are shut down,
191
519219
1498
dijelovi mozga isključeni,
08:52
and those are the areas in blue.
192
520717
1265
i ti su dijelovi plavi.
08:53
So here you really have the blues,
193
521982
1620
Ovdje imamo plavu boju,
08:55
and the areas in blue are areas that are involved
194
523602
3573
i plavo obojani dijelovi su uključeni
08:59
in motivation, in drive and decision-making,
195
527175
2656
u motivaciju, polet i donošenje odluka
09:01
and indeed, if you're severely depressed as these patients were,
196
529831
2495
i doista, ako ste izrazito depresivni kao što su ovi pacijenti bili,
09:04
those are impaired. You lack motivation and drive.
197
532326
2692
oni su onesposobljeni. Nedostaje vam motivacije i poleta.
09:07
The other thing we discovered
198
535018
1879
Druga stvar koju smo otkrili,
09:08
was an area that was overactive, area 25,
199
536897
2489
bilo je jedno preaktivno područje, područje 25,
09:11
seen there in red,
200
539386
1588
ovdje obojeno crveno.
09:12
and area 25 is the sadness center of the brain.
201
540974
2657
Područje 25 je centar za tugu u mozgu.
09:15
If I make any of you sad, for example, I make you remember
202
543631
2873
Kada bih nekoga od vas učinio tužnim, na primjer kada bih vas podsjetio
09:18
the last time you saw your parent before they died
203
546504
2287
na zadnji put kada ste vidjeli roditelja prije nego što je umro,
09:20
or a friend before they died,
204
548791
1633
ili prijatelja prije nego što je umro,
09:22
this area of the brain lights up.
205
550424
1206
ovo bi se područje mozga uključilo.
09:23
It is the sadness center of the brain.
206
551630
1723
To je područje mozga za tugu.
09:25
And so patients with depression have hyperactivity.
207
553353
3212
I pacijenti s depresijom imaju hiperaktivnost.
09:28
The area of the brain for sadness is on red hot.
208
556565
2178
Područje za tugu je žarko crveno,
09:30
The thermostat is set at 100 degrees,
209
558743
2657
termostat je na 100 stupnjeva,
09:33
and the other areas of the brain, involved in drive and motivation, are shut down.
210
561400
3128
a druga područja mozga, uključena u polet i motivaciju su isključena.
09:36
So we wondered, can we place electrodes in this area of sadness
211
564528
2997
Pitali smo se, možemo li postaviti elektrode u područje za tugu
09:39
and see if we can turn down the thermostat,
212
567525
2429
tugu i vidjeti možemo li smanjiti termostat,
09:41
can we turn down the activity,
213
569954
1713
možemo li smanjiti aktivnost,
09:43
and what will be the consequence of that?
214
571667
2122
i koja će biti posljedica toga?
09:45
So we went ahead and implanted electrodes in patients with depression.
215
573789
3127
Krenuli smo i umetnuli elektrode u pacijente s depresijom.
09:48
This is work done with my colleague Helen Mayberg from Emory.
216
576916
2487
Ovo je posao obavljen s mojom kolegicom Helen Mayberg sa sveučilišta Emory.
09:51
And we placed electrodes in area 25,
217
579403
1934
Postavili smo elektrode u područje 25,
09:53
and in the top scan you see before the operation,
218
581337
2285
na gornjoj slici vidite prije operacije,
09:55
area 25, the sadness area is red hot,
219
583622
2286
područje 25, centar za tugu je žarko crven
09:57
and the frontal lobes are shut down in blue,
220
585908
2394
i frontalni režnjevi su prigušeni u plavoj,
10:00
and then, after three months of continuous stimulation,
221
588302
2408
a zatim, nakon tri mjeseca neprekidne stimulacije,
10:02
24 hours a day, or six months of continuous stimulation,
222
590710
3015
24 sata dnevno, ili 6 mjeseci neprekidne stimulacije,
10:05
we have a complete reversal of this.
223
593725
1774
imamo potpuni obrat ovoga.
10:07
We're able to drive down area 25,
224
595499
2839
Sposobni smo prigušiti područje 25
10:10
down to a more normal level,
225
598338
1952
na normalniju razinu,
10:12
and we're able to turn back online
226
600290
2036
i u mogućnosti smo ponovo uključiti
10:14
the frontal lobes of the brain,
227
602326
1308
frontalne režnjeve mozga,
10:15
and indeed we're seeing very striking results
228
603634
1869
i doista vidimo vrlo upečatljive rezultate
10:17
in these patients with severe depression.
229
605503
2747
kod ovakvih pacijenata s jakom depresijom.
10:20
So now we are in clinical trials, and are in Phase III clinical trials,
230
608250
2902
Sada smo na kliničkim ispitivanjima, i to u fazi III kliničkih ispitivanja,
10:23
and this may become a new procedure,
231
611152
2543
i ovo bi mogao postati novi postupak,
10:25
if it's safe and we find that it's effective,
232
613695
2183
ako bude siguran i ako otkrijemo da je učinkovit,
10:27
to treat patients with severe depression.
233
615878
3674
za liječenje pacijenata s teškom depresijom.
10:31
I've shown you that we can use deep brain stimulation
234
619567
2960
Pokazao sam vam kako možemo koristiti duboku stimulaciju mozga
10:34
to treat the motor system
235
622527
2087
za liječenje motoričkog sustava
10:36
in cases of Parkinson's disease and dystonia.
236
624614
2446
u slučaju Parkinsonove bolesti i distonije.
10:39
I've shown you that we can use it to treat a mood circuit
237
627060
2385
Pokazao sam vam kako ju možemo koristiti u terapiji krugova za raspoloženje
10:41
in cases of depression.
238
629445
1650
u slučaju depresije.
10:43
Can we use deep brain stimulation to make you smarter?
239
631095
4545
Možemo li koristiti duboku stimulaciju mozga da vas učinimo pametnijima?
10:47
(Laughter)
240
635640
2096
(Smijeh)
10:49
Anybody interested in that?
241
637736
2566
Je li netko zainteresiran za to?
10:52
(Applause)
242
640302
2300
(Pljesak)
10:54
Of course we can, right?
243
642602
2988
Naravno da možemo, zar ne?
10:57
So what we've decided to do is
244
645590
2214
Ono što smo odlučili učiniti je
10:59
we're going to try to turbocharge
245
647804
2421
da pokušamo primijeniti veliki napon
11:02
the memory circuits in the brain.
246
650225
2205
na memorijske krugove u mozgu.
11:04
We're going to place electrodes within the circuits
247
652430
2736
Postavit ćemo elektrode unutar krugova
11:07
that regulate your memory and cognitive function
248
655166
2676
koji reguliraju memoriju i kognitivnu funkciju
11:09
to see if we can turn up their activity.
249
657842
3270
da vidimo možemo li pojačati njihovu aktivnost.
11:13
Now we're not going to do this in normal people.
250
661112
1938
Nećemo ovo raditi kod zdravih ljudi.
11:15
We're going to do this in people that have cognitive deficits,
251
663050
3652
Napravit ćemo to kod ljudi koji imaju manjak kognitivnih sposobnosti
11:18
and we've chosen to treat patients with Alzheimer's disease
252
666702
3459
i odlučili smo liječiti pacijente s Alzheimerovom bolešću
11:22
who have cognitive and memory deficits.
253
670161
2107
koji imaju kognitivne i memorijske gubitke.
11:24
As you know, this is the main symptom
254
672268
1939
Kao što znate, to je glavni simptom
11:26
of early onset Alzheimer's disease.
255
674207
2423
ranog nastupa Alzheimerove bolesti.
11:28
So we've placed electrodes within this circuit
256
676630
2194
Postavili smo elektrode unutar kruga
11:30
in an area of the brain called the fornix,
257
678824
1995
u dijelu mozga koji se zove forniks,
11:32
which is the highway in and out of this memory circuit,
258
680819
2778
koji je cesta za ulaz i izlaz ovog memorijskog kruga,
11:35
with the idea to see if we can turn on this memory circuit,
259
683597
3428
s idejom da vidimo možemo li uključiti taj memorijski krug
11:39
and whether that can, in turn, help these patients
260
687025
3249
i može li to pomoći pacijentima
11:42
with Alzheimer's disease.
261
690274
2309
s Alzheimerovom bolešću.
11:44
Now it turns out that in Alzheimer's disease,
262
692583
2318
Pokazalo se da u Alzheimerovoj bolesti
11:46
there's a huge deficit in glucose utilization in the brain.
263
694901
4072
postoji ogroman gubitak u iskorištavanju glukoze u mozgu.
11:50
The brain is a bit of a hog when it comes to using glucose.
264
698973
3418
Mozak je pomalo proždrljiv kada je u pitanju uporaba glukoze.
11:54
It uses 20 percent of all your --
265
702391
1760
Koristi 20 posto od cijelog vašeg unosa
11:56
even though it only weighs two percent --
266
704151
1515
iako teži samo dva posto tjelesne mase,
11:57
it uses 10 times more glucose than it should based on its weight.
267
705666
3145
koristi 10 puta više glukoze nego što bi trebao po svojoj težini.
12:00
Twenty percent of all the glucose in your body is used by the brain,
268
708811
2583
Dvadeset posto od sve glukoze u vašem tijelu koristi mozak,
12:03
and as you go from being normal
269
711394
2430
i kako idete od zdravlja
12:05
to having mild cognitive impairment,
270
713824
2193
preko blagih kognitivnih poremećaja,
12:08
which is a precursor for Alzheimer's, all the way to Alzheimer's disease,
271
716017
2455
koji prethode Alzheimerovoj bolesti, sve do Alzheimerove bolesti,
12:10
then there are areas of the brain that stop using glucose.
272
718472
2689
dijelovi mozga prestaju koristiti glukozu.
12:13
They shut down. They turn off.
273
721161
2295
Isključe se. Prestanu raditi.
12:15
And indeed, what we see is that these areas in red
274
723456
2282
I doista, ono što vidimo je da ove crvene regije
12:17
around the outside ribbon of the brain
275
725738
1767
oko vanjskog dijela mozga
12:19
are progressively getting more and more blue
276
727505
2276
progresivno postaju sve više i više plave
12:21
until they shut down completely.
277
729781
3172
sve dok se potpuno ne ugase.
12:24
This is analogous to having a power failure
278
732953
2359
Ovo je ekvivalent nestanku energije
12:27
in an area of the brain, a regional power failure.
279
735312
2543
u području mozga, regionalni nestanak struje.
12:29
So the lights are out in parts of the brain
280
737855
2397
Svjetla su ugašena u dijelovima mozga
12:32
in patients with Alzheimer's disease,
281
740252
2598
kod pacijenata s Alzheimerovom bolešću
12:34
and the question is, are the lights out forever,
282
742850
2409
i pitanje je, jesu li svjetla zauvijek ugašena
12:37
or can we turn the lights back on?
283
745259
2861
ili ih možemo ponovo upaliti?
12:40
Can we get those areas of the brain to use glucose once again?
284
748120
3236
Možemo li potaknuti te dijelove mozga da ponovo koriste glukozu?
12:43
So this is what we did. We implanted electrodes in the fornix
285
751356
2550
Ovo smo napravili. Ugradili smo elektrode u forniks
12:45
of patients with Alzheimer's disease, we turned it on,
286
753906
2613
pacijenata s Alzheimerovom bolešću, i uključili ih,
12:48
and we looked at what happens to glucose use in the brain.
287
756519
3511
gledajući što se događa s potrošnjom glukoze u mozgu.
12:52
And indeed, at the top, you'll see before the surgery,
288
760030
3262
I zaista, gore vidite prije operacije,
12:55
the areas in blue are the areas that use less glucose than normal,
289
763292
3364
područja koja su plava koriste manje glukoze nego što je normalno,
12:58
predominantly the parietal and temporal lobes.
290
766656
2208
pretežno parijetalni i temporalni režnjevi.
13:00
These areas of the brain are shut down.
291
768864
1710
Ti dijelovi mozga su isključeni.
13:02
The lights are out in these areas of the brain.
292
770574
2675
U njima su svjetla isključena.
13:05
We then put in the DBS electrodes and we wait for a month
293
773249
2954
Tada smo umetnuli DBS elektrode i čekali mjesec
13:08
or a year, and the areas in red
294
776203
1391
ili godinu, i crveno obojana područja
13:09
represent the areas where we increase glucose utilization.
295
777594
3307
područja predstavljaju dijelove gdje smo povećali iskorištavanje glukoze.
13:12
And indeed, we are able to get these areas of the brain
296
780901
2120
I doista, sposobni smo potaknuti te dijelove mozga
13:15
that were not using glucose to use glucose once again.
297
783021
3514
koji nisu koristili glukozu da je ponovo počnu iskorištavati.
13:18
So the message here is that, in Alzheimer's disease,
298
786535
2352
Poruka u ovome je da su u Alzheimerovoj bolesti
13:20
the lights are out, but there is someone home,
299
788887
2329
svjetla isključena, ali netko je kod kuće,
13:23
and we're able to turn the power back on
300
791216
2149
i mi smo u mogućnosti ponovo uključiti struju
13:25
to these areas of the brain, and as we do so,
301
793365
2306
tim dijelovima mozga i kada to napravimo,
13:27
we expect that their functions will return.
302
795671
2936
očekujemo da će se njihove funkcije vratiti.
13:30
So this is now in clinical trials.
303
798607
2127
Ovo je sada na kliničkim ispitivanjima.
13:32
We are going to operate on 50 patients
304
800734
1901
Operirat ćemo 50 pacijenata
13:34
with early Alzheimer's disease
305
802635
1978
s ranom Alzheimerovom bolešću
13:36
to see whether this is safe and effective,
306
804613
2057
kako bismo vidjeli je li sigurno i učinkovito,
13:38
whether we can improve their neurologic function.
307
806670
2979
možemo li poboljšati njihove neurološke funkcije.
13:41
(Applause)
308
809649
7480
(Pljesak)
13:49
So the message I want to leave you with today is that,
309
817129
2948
Poruka s kojom vas danas želim ostaviti jest
13:52
indeed, there are several circuits in the brain
310
820077
2604
da zaista neki krugovi u mozgu krivo rade
13:54
that are malfunctioning across various disease states,
311
822681
3926
u različitim bolesnim stanjima,
13:58
whether we're talking about Parkinson's disease,
312
826607
2208
bilo da pričamo o Parkinsonovoj bolesti,
14:00
depression, schizophrenia, Alzheimer's.
313
828815
3082
depresiji, shizofreniji, Alzheimeru.
14:03
We are now learning to understand what are the circuits,
314
831897
3030
Sada učimo razumjeti koji su krugovi,
14:06
what are the areas of the brain that are responsible for
315
834927
2202
koja su područja mozga odgovorna
14:09
the clinical signs and the symptoms of those diseases.
316
837129
2520
za kliničke znakove i simptome takvih poremećaja.
14:11
We can now reach those circuits.
317
839649
2306
Sada možemo dosegnuti te krugove.
14:13
We can introduce electrodes within those circuits.
318
841955
2632
Možemo umetnuti elektrode unutar tih krugova.
14:16
We can graduate the activity of those circuits.
319
844587
2982
Možemo podešavati aktivnost tih krugova.
14:19
We can turn them down if they are overactive,
320
847569
3252
Možemo ju smanjiti ako su previše aktivni,
14:22
if they're causing trouble, trouble that is felt throughout the brain,
321
850821
2957
ako uzrokuju nevolju, nevolju koja se osjeća kroz mozak,
14:25
or we can turn them up if they are underperforming,
322
853778
2581
ili ih možemo pojačati ako preslabo rade
14:28
and in so doing, we think that we may be able to help
323
856359
2393
, i mislimo da tako možemo pomoći
14:30
the overall function of the brain.
324
858752
2340
cjelokupnoj funkciji mozga.
14:33
The implications of this, of course, is that we may be able
325
861092
2554
Ovo implicira da ćemo možda moći
14:35
to modify the symptoms of the disease,
326
863646
2310
ublažiti simptome bolesti,
14:37
but I haven't told you but there's also some evidence
327
865956
1909
ali nisam vam rekao da također postoje dokazi
14:39
that we might be able to help the repair of damaged areas of the brain using electricity,
328
867865
4163
da bismo mogli pomoći popraviti oštećena područja mozga koristeći struju,
14:44
and this is something for the future, to see if, indeed,
329
872028
2452
i to je nešto za budućnost, da vidimo možemo li
14:46
we not only change the activity but also
330
874480
2239
ne samo promijeniti aktivnost nego i
14:48
some of the reparative functions of the brain
331
876719
2014
možemo li potaknuti neke popravljačke
14:50
can be harvested.
332
878733
1555
funkcije mozga.
14:52
So I envision that we're going to see a great expansion
333
880288
3047
Predviđam da ćemo vidjeti veliki razvoj
14:55
of indications of this technique.
334
883335
2452
učinaka ove tehnike.
14:57
We're going to see electrodes being placed for many disorders of the brain.
335
885787
2779
Vidjet ćemo elektrode koje se umeću zbog mnogih poremećaja mozga.
15:00
One of the most exciting things about this is that, indeed,
336
888566
2959
Jedna od najuzbudljivijih stvari u ovome je da, zaista,
15:03
it involves multidisciplinary work.
337
891525
1847
uključuje multidisciplinarni rad.
15:05
It involves the work of engineers, of imaging scientists,
338
893372
2802
Uključuje rad inženjera, znanstvenika koji se služe slikovnom dijagnostikom,
15:08
of basic scientists, of neurologists,
339
896174
2202
temeljnih znanosti, neurologa,
15:10
psychiatrists, neurosurgeons, and certainly at the interface
340
898376
2752
psihijatara, neurokirurga, i svakako je sučelje
15:13
of these multiple disciplines that there's the excitement.
341
901128
2941
tih mnogih disciplina uzbudljivo.
15:16
And I think that we will see that
342
904069
2757
Mislim da ćemo vidjeti kako
15:18
we will be able to chase more of these evil spirits
343
906826
3436
ćemo biti u mogućnosti progoniti sve više od onih zlih duhova
15:22
out from the brain as time goes on,
344
910262
1896
kako vrijeme prolazi,
15:24
and the consequence of that, of course, will be
345
912158
1902
i posljedica će toga, naravno, biti
15:26
that we will be able to help many more patients.
346
914060
2272
da ćemo moći pomoći još mnogim pacijentima.
15:28
Thank you very much.
347
916332
1250
Puno vam hvala.
ABOUT THE SPEAKER
Andres Lozano - NeurosurgeonThe chair of neurosurgery at the University of Toronto, Andres Lozano has pioneered the use of deep brain stimulation for treating Parkinson’s, depression, anorexia and Alzheimer’s disease.
Why you should listen
Andres Lozano remembers the most satisfying case of his career – helping a boy with a genetic form of dystonia which had twisted his body to the point where he was only able to crawl on his stomach. While he didn’t respond to drugs, he responded wonderfully to deep brain stimulation. Three months after surgery, he was walking like a normal child. He’s now a college student leading a normal life.
Lozano is a pioneer in deep brain stimulation. His team has mapped out areas of the human brain and pioneered novel surgical approaches to treat disorders like Parkinson’s disease, depression, dystonia, anorexia, Huntington’s and Alzheimer’s disease. The chairman of neurosurgery at the University of Toronto, he holds both the R.R. Tasker Chair in Functional Neurosurgery at the Krembil Neuroscience Centre and a Tier 1 Canada Research Chair in Neuroscience.
Lozano has over 400 publications, serves on the board of several international organizations and is a founding member of the scientific advisory board of the Michael J. Fox Foundation. He has received a number of awards including the Olivecrona Medal and the Pioneer in Medicine award, has been elected a Fellow of the Royal Society of Canada and the Canadian Academy of Health Sciences and has received the Order of Spain.
Andres Lozano | Speaker | TED.com