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TEDxCaltech

Andres Lozano: Parkinson's, depression and the switch that might turn them off

アンドレス・ロザーノ: パーキンソン病・うつ病を消せるかもしれないスイッチ

January 18, 2013

脳深部刺激療法は、非常に精密な脳神経外科の技術です。脳のいかなる場所にでも電極が配置され、ラジオのダイヤルやサーモスタットを調節するように、誤作動しているニューロンを活性化・不活性化し、脳の不全機能を正常化します。この驚くべき技術により、パーキンソン病患者の震えを即座に止めたり、アルツハイマー病に蝕まれた脳の領野を正常に戻すことが出来ます。 (TEDxCaltech にて撮影)

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

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Double-click the English subtitles below to play the video.
まず最初に断っておきたい事があります
00:12
One of the things I want to establish right from the start
脳神経外科医がみんなブーツを
履いているわけではありませんので
00:14
is that not all neurosurgeons wear cowboy boots.
悪しからず(笑)
00:17
I just wanted you to know that.
私は脳神経外科医で
00:19
So I am indeed a neurosurgeon,
長い歴史を持つ脳神経学の仕事に
携わっています
00:22
and I follow a long tradition of neurosurgery,
今日みなさんにお話しするのは
00:26
and what I'm going to tell you about today
00:27
is adjusting the dials in the circuits in the brain,
あらゆる脳神経回路を
ダイヤル調節するように調節し
00:29
being able to go anywhere in the brain
機能を活性・不活性化したりして
00:31
and turning areas of the brain up or down
患者を治療する方法です
00:34
to help our patients.
今 言いましたように脳神経外科には
00:36
So as I said, neurosurgery comes from a long tradition.
00:39
It's been around for about 7,000 years.
長い歴史があり 約7千年にもなります
メソアメリカにも脳神経手術が存在し
00:43
In Mesoamerica, there used to be neurosurgery,
患者を治療していた
脳神経外科医がいました
00:46
and there were these neurosurgeons that used to treat patients.
00:50
And they were trying to -- they knew that the brain was involved
彼らは 脳が神経病や精神病に
関係があることを知っていました
00:54
in neurological and psychiatric disease.
正確には把握していませんでしたが
00:56
They didn't know exactly what they were doing.
今とあまり変わりませんね(笑)
00:59
Not much has changed, by the way. (Laughter)
しかし彼らの考えは
01:01
But they thought that,
神経・精神病の原因は
01:03
if you had a neurologic or psychiatric disease,
悪霊にとり憑かれることで
01:05
it must be because you are possessed
01:08
by an evil spirit.
01:10
So if you are possessed by an evil spirit
神経や精神に問題が生じるので
01:12
causing neurologic or psychiatric problems,
治療のためには
01:15
then the way to treat this is, of course,
頭蓋骨に穴をあけて悪霊を
追い出さなければならない
01:17
to make a hole in your skull and let the evil spirit escape.
というものでした
01:23
So this was the thinking back then,
01:24
and these individuals made these holes.
これがその穴です
時には 患者は
かなり抵抗したようです
01:28
Sometimes the patients were a little bit reluctant
01:31
to go through this because, you can tell that
というのも
複数 開けかけられた
跡があるからです
01:34
the holes are made partially and then, I think,
いくらか穿孔しすばやく
切り上げたものと考えられます
01:36
there was some trepanation, and then they left very quickly
01:38
and it was only a partial hole,
一部開けられた穴は1つで
この手術を受けて
生き延びたのだと分かります
01:40
and we know they survived these procedures.
これが当時のやり方で
01:42
But this was common.
01:43
There were some sites where one percent
遺跡の中には
見つかった頭蓋骨の1%に
穴があることもあり
01:45
of all the skulls have these holes, and so you can see
神経・精神疾患は
01:47
that neurologic and psychiatric disease is quite common,
7千年前も
かなり よくあった事がわかります
01:51
and it was also quite common about 7,000 years ago.
時代が進むにつれ
01:55
Now, in the course of time,
脳の領野別の機能が
01:57
we've come to realize that
01:59
different parts of the brain do different things.
分かってきました
運動や視覚や
02:02
So there are areas of the brain that are dedicated
あるいは記憶や食欲などを
コントロールする領域などに
02:03
to controlling your movement or your vision
02:06
or your memory or your appetite, and so on.
脳が割り当てられていて
物事がうまくいくときは 
神経系機能がうまく働き
02:09
And when things work well, then the nervous system
02:11
works well, and everything functions.
すべて正常に機能しています
しかしときには 
物事があまりうまく行かず
02:13
But once in a while, things don't go so well,
脳神経回路にトラブルが起こり
02:15
and there's trouble in these circuits,
誤作用している変異ニューロンが
02:18
and there are some rogue neurons that are misfiring
問題を引き起こしたり
機能を鈍くしたりして
02:20
and causing trouble, or sometimes they're underactive
正常に機能しないことがあります
02:24
and they're not quite working as they should.
その事により起こる病気は
02:26
Now, the manifestation of this
変異ニューロンが
脳のどこにあるかによります
02:28
depends on where in the brain these neurons are.
変異ニューロンが
運動系の回路にある時は
02:31
So when these neurons are in the motor circuit,
運動系の機能不全に陥り
02:33
you get dysfunction in the movement system,
パーキンソン病のようなものに罹ります
02:36
and you get things like Parkinson's disease.
心的状態を制御する回路に
機能不全がある場合は
02:38
When the malfunction is in a circuit that regulates your mood,
02:41
you get things like depression,
うつ病のようなものに罹ります
また記憶と認知機能を
制御する回路にある場合は
02:43
and when it is in a circuit that controls your memory and cognitive function,
アルツハイマー病の
ようなものに罹ります
02:47
then you get things like Alzheimer's disease.
そこで我々ができることは
02:50
So what we've been able to do is to pinpoint
正確に障害のある箇所を突き止め
02:52
where these disturbances are in the brain,
脳神経回路に介入して
02:55
and we've been able to intervene within these circuits
機能を調整することです
02:58
in the brain to either turn them up or turn them down.
これはちょうどラジオのダイヤルで
03:01
So this is very much like choosing the correct station
調節して正しい局を選ぶようなものです
03:04
on the radio dial.
03:06
Once you choose the right station, whether it be jazz or opera,
ジャズであれ オペラであれ
一度正しい局を選択すれば —
03:08
in our case whether it be movement or mood,
神経学的には 運動であったり
心的状態であったりですが—
03:11
we can put the dial there,
そこにダイヤルを設置し
もうひとつのボタンを
使用して音量を調整し
03:13
and then we can use a second button to adjust the volume,
強めたり弱めたりできます
03:15
to turn it up or turn it down.
それで 次にお話することは
03:17
So what I'm going to tell you about
電極が埋め込まれた脳神経回路の
03:19
is using the circuitry of the brain to implant electrodes
領野の機能を強めたり弱めたりして
03:23
and turning areas of the brain up and down
03:25
to see if we can help our patients.
患者の脳機能を調節する
03:27
And this is accomplished using this kind of device,
脳深部刺激療法の装置についてです
03:29
and this is called deep brain stimulation.
脳に このように電極を埋め込みます
03:32
So what we're doing is placing these electrodes throughout the brain.
03:35
Again, we are making holes in the skull about the size of a dime,
10セント硬貨サイズの穴を
昔同様 頭蓋骨に開け
電極を挿入し
03:39
putting an electrode in, and then this electrode
配線は完全に皮膚の下に埋めんで
03:41
is completely underneath the skin
胸のペースメーカーまで導きます
03:43
down to a pacemaker in the chest,
ちょうどテレビのリモコンのようにして
03:45
and with a remote control very much like a television remote control,
03:50
we can adjust how much electricity we deliver
ターゲットとなる領域に
送る電力を
03:53
to these areas of the brain.
リモコンで調整し
強めたり弱めたり
つけたり消したりできます
03:55
We can turn it up or down, on or off.
現在 世界のおよそ10 万人の患者が
03:58
Now, about a hundred thousand patients in the world
脳深部刺激療法を受けています
04:00
have received deep brain stimulation,
症例をお見せしましょう
04:02
and I'm going to show you some examples
脳深部刺激療法を用いて 運動障害や
04:03
of using deep brain stimulation to treat disorders of movement,
気分障害・認知症疾患を治療した例です
04:06
disorders of mood and disorders of cognition.
電極が埋め込まれた脳内の状態です
04:11
So this looks something like this when it's in the brain.
頭蓋骨を通って電極が
脳に入っているのが見えます
04:13
You see the electrode going through the skull into the brain
04:15
and resting there, and we can place this really anywhere in the brain.
こうして脳のあらゆる場所に
配置できます
私がよく言う事ですが
04:19
I tell my friends that no neuron is safe
どんなニューロンも
神経外科医から隠れることはできません
04:21
from a neurosurgeon, because we can really reach
なぜなら脳内 何処でも
確実に安全に届くからです
04:23
just about anywhere in the brain quite safely now.
最初にお見せするのは
04:26
Now the first example I'm going to show you is a patient
パーキンソン病患者の例です
04:28
with Parkinson's disease,
この女性はパーキンソン病を患っており
04:30
and this lady has Parkinson's disease,
脳には電極が埋め込まれてあります
04:32
and she has these electrodes in her brain,
彼女の様子をお見せしましょう
04:34
and I'm going to show you what she's like
04:36
when the electrodes are turned off and she has her Parkinson's symptoms,
電極がオフのとき
パーキンソン病の症状があります
電極をオンにします
04:39
and then we're going to turn it on.
このような感じです
04:42
So this looks something like this.
電極は今オフで震えが見られます
04:44
The electrodes are turned off now, and you can see that she has tremor.
医師:大丈夫 
患者:できないわ
04:49
(Video) Man: Okay. Woman: I can't. Man: Can you try to touch my finger?
医師:私の指に触れられる?
04:52
(Video) Man: That's a little better. Woman: That side is better.
医師:少し良くなった
患者:そちら側の方がいいわ
電極をオンにします
04:56
We're now going to turn it on.
今オンになりました
05:00
It's on. Just turned it on.
このように直ちに効果が現れます
05:06
And this works like that, instantly.
震えの有無の違いは—
05:09
And the difference between shaking in this way and not --
(拍手)
05:12
(Applause)
震えの有無の違いは
視床下核における
05:17
The difference between shaking in this way and not is related to the misbehavior
2万5千個のニューロンの
誤作動と関係しています
05:21
of 25,000 neurons in her subthalamic nucleus.
問題のニューロンを見つけ出し
05:25
So we now know how to find these troublemakers
「いい加減にして」
05:27
and tell them, "Gentlemen, that's enough.
「やめて欲しい」と
05:29
We want you to stop doing that."
電気で制御します
05:30
And we do that with electricity.
電気を使い
ニューロンの興奮具合を見て
05:31
So we use electricity to dictate how they fire,
誤作動をブロックし
05:35
and we try to block their misbehavior using electricity.
変異ニューロンの
活動を抑制しているのです
05:38
So in this case, we are suppressing the activity of abnormal neurons.
我々はこの手法を
他の疾患にも使い始めました
05:42
We started using this technique in other problems,
興味深い問題について
お伝えしましょう
05:44
and I'm going to tell you about a fascinating problem
05:46
that we encountered, a case of dystonia.
ジストニアのケースに
遭遇した事があります
05:49
So dystonia is a disorder affecting children.
ジストニアは子供たちを襲う病気です
遺伝性疾患で ねじれを引き起こし
05:51
It's a genetic disorder, and it involves a twisting motion,
徐々により酷いねじれになり
05:54
and these children get progressively more and more twisting
体が痛くなるまでよじれ
息が出来なくなり
05:57
until they can't breathe, until they get sores,
尿路感染症を起こし 死に至ります
05:59
urinary infections, and then they die.
1997年に
この少年を診るよう依頼されました
06:01
So back in 1997, I was asked to see this young boy,
彼は他に問題はなかったのですが
遺伝的ジストニアがありました
06:05
perfectly normal. He has this genetic form of dystonia.
06:08
There are eight children in the family.
家族には8人子どもがいて
そのうち5人にジストニアがありました
06:10
Five of them have dystonia.
その少年です
06:13
So here he is.
少年は9歳で
6歳まで健常児でしたが
06:15
This boy is nine years old, perfectly normal until the age six,
最初に右足がねじれ始め
06:19
and then he started twisting his body, first the right foot,
左足 右腕 そして左腕
さらに体幹と進みました
06:24
then the left foot, then the right arm, then the left arm,
06:27
then the trunk, and then by the time he arrived,
彼が到着した時には
発症から1〜2年経っていて
06:31
within the course of one or two years of the disease onset,
もはや歩くことも立つこともできず
06:33
he could no longer walk, he could no longer stand.
身体不自由になっていました
この病気によく見られる進行です
06:36
He was crippled, and indeed the natural progression
06:38
as this gets worse is for them to become progressively twisted,
悪化するにつれ次第にねじれて
身体不自由になり
06:42
progressively disabled, and many of these children do not survive.
子どもたちの多くは生き残れません
彼は 今話した5人の子の1人です
06:48
So he is one of five kids.
06:50
The only way he could get around was crawling on his belly like this.
このように腹這いで
動き回るしかありませんでした
どんな薬も効き目がありませんでした
06:54
He did not respond to any drugs.
この少年に何をすべきか分からず
06:56
We did not know what to do with this boy.
06:58
We did not know what operation to do,
どんな手術をすべきか
07:00
where to go in the brain,
脳内のどこを治療標的にしたら
良いかも分かりませんでした
07:02
but on the basis of our results in Parkinson's disease,
しかしパーキンソン病に
おける成果にもとづいて
07:05
we reasoned, why don't we try to suppress
抑制を試みようと判断しました
07:07
the same area in the brain that we suppressed
パーキンソン病で抑制した
脳内の同じ箇所を抑制し
07:10
in Parkinson's disease, and let's see what happens?
どうなるか見てみようと
回復を期待して 手術をしました
07:14
So here he was. We operated on him
回復を期待して 手術をしました
07:15
hoping that he would get better. We did not know.
これが 現在の彼です
イスラエルに戻っています
07:19
So here he is now, back in Israel where he lives,
術後3ヵ月の彼です
07:23
three months after the procedure, and here he is.
(拍手)
07:27
(Applause)
この成果を元に
07:36
On the basis of this result, this is now a procedure
この手術が現在
世界中で行われています
07:39
that's done throughout the world,
何百人という子どもたちが
07:40
and there have been hundreds of children
このような手術で助けられています
07:41
that have been helped with this kind of surgery.
この少年は今大学生になり
07:45
This boy is now in university
07:47
and leads quite a normal life.
ごく普通の生活を送っています
これはジストニアの子の
運動と歩行を回復するために
07:50
This has been one of the most satisfying cases
今までの経歴の中で行った手術の中で
07:52
that I have ever done in my entire career,
最も満足のいく術例の1つです
07:54
to restore movement and walking to this kind of child.
(拍手)
07:57
(Applause)
我々はこの技術を
08:03
We realized that perhaps we could use this technology
運動回路の制御だけでなく
08:06
not only in circuits that control your movement
他の回路にも使えるのではと考え
08:09
but also circuits that control other things,
次に
08:10
and the next thing that we took on
気分を司る回路の制御をするため
08:12
was circuits that control your mood.
うつ病に取り組むことに決めました
08:15
And we decided to take on depression,
うつ病が蔓延しているのも
選んだ理由です
08:17
and the reason we took on depression is because it's so prevalent,
ご存知のように
うつ病に対する治療法は
08:19
and as you know, there are many treatments for depression,
薬や心理療法と多くあり
08:22
with medication and psychotherapy,
電気けいれん療法までもあります
08:24
even electroconvulsive therapy,
しかし何百万人もの
08:26
but there are millions of people,
うつ病患者の10〜20%には
そういう治療は効きません
08:27
and there are still 10 or 20 percent of patients with depression
そんな患者こそを
助けたいと思っています
08:30
that do not respond, and it is these patients that we want to help.
うつ病患者を助けるために
08:33
And let's see if we can use this technique
使えるかどうか見てみましょう
08:35
to help these patients with depression.
まず最初に
08:37
So the first thing we did was, we compared,
うつ病患者と健常者の脳で
08:39
what's different in the brain of someone with depression
何が異なるか比較しました
08:41
and someone who is normal,
具体的に脳の血流を見るため
PET 画像を撮りました
08:43
and what we did was PET scans to look at the blood flow of the brain,
うつ病患者と健常者を比較して
08:46
and what we noticed is that in patients with depression
気づいたのは
08:48
compared to normals,
脳のある領野で
08:51
areas of the brain are shut down,
機能が停止していることです
08:52
and those are the areas in blue.
08:53
So here you really have the blues,
まさにブルー(憂うつ)の箇所です
08:55
and the areas in blue are areas that are involved
その青い箇所が
動機、 意欲、 意思決定に
関与している領野です
08:58
in motivation, in drive and decision-making,
実際 重度なうつ状態になると
09:01
and indeed, if you're severely depressed as these patients were,
それらの領野の機能が損なわれ
動機と意欲に欠けることになります
09:04
those are impaired. You lack motivation and drive.
他に分かった事は
09:06
The other thing we discovered
過活動であった領野
領野25です
09:08
was an area that was overactive, area 25,
赤で見られます
09:11
seen there in red,
領野25は悲哀の中枢です
09:12
and area 25 is the sadness center of the brain.
人を悲しませた場合
たとえば私があなたに
09:15
If I make any of you sad, for example, I make you remember
死ぬ前に最後に見た親や
09:18
the last time you saw your parent before they died
友人を思い出させた場合
09:20
or a friend before they died,
脳のこの領野が点灯します
09:22
this area of the brain lights up.
脳の悲哀の中枢です
09:23
It is the sadness center of the brain.
うつ病患者はここが活動過剰なので
09:25
And so patients with depression have hyperactivity.
悲哀の領野は赤くなっています
09:28
The area of the brain for sadness is on red hot.
ここが最大限に活動する一方で
09:30
The thermostat is set at 100 degrees,
意欲と動機に関与する
脳の他の領野は停止します
09:33
and the other areas of the brain, involved in drive and motivation, are shut down.
そこで悲哀の領野に電極を配置し
09:36
So we wondered, can we place electrodes in this area of sadness
サーモスタットを下げて温度調節するように
09:39
and see if we can turn down the thermostat,
活動を抑えることができないだろうか
09:41
can we turn down the activity,
その結果どうなるだろうかと考え
09:43
and what will be the consequence of that?
うつ病患者に電極を埋め込みました
09:45
So we went ahead and implanted electrodes in patients with depression.
これはエモリー大学の私の同僚
ヘレン・メイバーグとの共同研究結果です
09:48
This is work done with my colleague Helen Mayberg from Emory.
09:51
And we placed electrodes in area 25,
領野25に電極を配置しました
09:53
and in the top scan you see before the operation,
一番上のスキャン画像が手術前です
領野25
悲哀の領野は過活動の赤で
09:55
area 25, the sadness area is red hot,
前頭葉が青で停止しています
09:57
and the frontal lobes are shut down in blue,
そして術後3ヵ月
10:00
and then, after three months of continuous stimulation,
1日24 時間 6ヵ月の継続的な刺激を与え
10:02
24 hours a day, or six months of continuous stimulation,
完全な逆転が実現しました
10:05
we have a complete reversal of this.
領野25を抑制することができ
10:07
We're able to drive down area 25,
より正常であるレベルにまで
10:10
down to a more normal level,
再び脳の前頭葉を
10:12
and we're able to turn back online
戻すことができました
10:14
the frontal lobes of the brain,
このように重度のうつ病患者において
10:15
and indeed we're seeing very striking results
非常に著しい成果が見られています
10:17
in these patients with severe depression.
現在は第3相臨床試験中で
10:20
So now we are in clinical trials, and are in Phase III clinical trials,
重度のうつ病の患者を治療するために
10:22
and this may become a new procedure,
安全かつ有効であると分かれば
10:25
if it's safe and we find that it's effective,
これが新しい治療になるかもしれません
10:27
to treat patients with severe depression.
脳深部刺激療法は
10:31
I've shown you that we can use deep brain stimulation
運動系の治療に使えることを
10:34
to treat the motor system
パーキンソン病とジストニアの症例で示し
10:36
in cases of Parkinson's disease and dystonia.
心的回路の治療に使えることを
10:38
I've shown you that we can use it to treat a mood circuit
うつ病の症例で示しました
10:41
in cases of depression.
ではより賢くなるために
10:42
Can we use deep brain stimulation to make you smarter?
脳深部刺激療法を
使えないでしょうか?
(笑)
10:47
(Laughter)
興味ありませんか?
10:49
Anybody interested in that?
(拍手)
10:52
(Applause)
もちろんできますよね?
10:54
Of course we can, right?
そこで我々は
10:57
So what we've decided to do is
脳内の記憶回路を
10:59
we're going to try to turbocharge
加速しようと決めました
11:02
the memory circuits in the brain.
活動を加速できるかどうか見るため
11:04
We're going to place electrodes within the circuits
記憶と認知機能を制御する回路に
11:06
that regulate your memory and cognitive function
電極を配置します
11:09
to see if we can turn up their activity.
現在 健常者には行いません
11:12
Now we're not going to do this in normal people.
認知障害がある患者に行います
11:14
We're going to do this in people that have cognitive deficits,
我々はアルツハイマー病患者への
治療を選択しました
11:18
and we've chosen to treat patients with Alzheimer's disease
認知障害・記憶障害を抱える患者です
11:21
who have cognitive and memory deficits.
ご存知のように認知障害・記憶障害は
11:24
As you know, this is the main symptom
アルツハイマー病の主な早期症状です
11:26
of early onset Alzheimer's disease.
そこで脳弓と呼ばれる脳の領域の回路内に
11:28
So we've placed electrodes within this circuit
11:30
in an area of the brain called the fornix,
電極を配置しました
脳弓は記憶が出たり
入ったりする高速道路です
11:32
which is the highway in and out of this memory circuit,
そこで記憶回路をオンにして
11:35
with the idea to see if we can turn on this memory circuit,
アルツハイマー病患者に
役立つかどうか
11:38
and whether that can, in turn, help these patients
見ようと電極配置したのです
11:42
with Alzheimer's disease.
ところがアルツハイマー病では
11:44
Now it turns out that in Alzheimer's disease,
脳でのブドウ糖消費において
重大な問題が判明しました
11:46
there's a huge deficit in glucose utilization in the brain.
ブドウ糖消費にかけては
脳は少し貪欲です
11:50
The brain is a bit of a hog when it comes to using glucose.
脳のブトウ糖消費量は
人体のブトウ糖消費量の20%です
11:54
It uses 20 percent of all your --
11:55
even though it only weighs two percent --
脳の重量は体重のほんの
2%であるにも拘らず
11:57
it uses 10 times more glucose than it should based on its weight.
その10倍もの割合—
人体の総ブドウ糖消費量の20 % が
脳によって使用されます
12:00
Twenty percent of all the glucose in your body is used by the brain,
12:03
and as you go from being normal
正常の状態から
軽度の認知機能障害の状態に
なるというのは
12:05
to having mild cognitive impairment,
アルツハイマーの前兆で
果てはアルツハイマー病になり
12:07
which is a precursor for Alzheimer's, all the way to Alzheimer's disease,
12:10
then there are areas of the brain that stop using glucose.
脳のある領野ではブドウ糖消費を止め
12:12
They shut down. They turn off.
機能が停止してしまうということです
確かに 回りの赤い領野は
次第に青で覆われて行き
12:15
And indeed, what we see is that these areas in red
確かに 回りの赤い領野は
次第に青で覆われて行き
12:17
around the outside ribbon of the brain
機能が完全に停止するまで
続いているのが分かります
12:19
are progressively getting more and more blue
機能が完全に停止するまで
続いているのが分かります
12:21
until they shut down completely.
これは停電と似ています
12:24
This is analogous to having a power failure
脳の領野における部分的な停電です
12:27
in an area of the brain, a regional power failure.
アルツハイマー病の患者は
12:29
So the lights are out in parts of the brain
脳のある部分で電灯が
消えているようなものです
12:32
in patients with Alzheimer's disease,
12:34
and the question is, are the lights out forever,
電灯は永遠に消えるのでしょうか
12:37
or can we turn the lights back on?
それともまた点灯することが
できるのでしょうか
脳の領野がブドウ糖を
また使えるようにできるでしょうか
12:39
Can we get those areas of the brain to use glucose once again?
そこでアルツハイマー病の患者の脳弓に
12:43
So this is what we did. We implanted electrodes in the fornix
電極を埋め込みオンにして
12:45
of patients with Alzheimer's disease, we turned it on,
脳のブドウ糖消費に何が
起こるか見ました
12:48
and we looked at what happens to glucose use in the brain.
一番上が手術前です
12:51
And indeed, at the top, you'll see before the surgery,
青はブドウ糖消費が
正常時よりも少ない領野
12:55
the areas in blue are the areas that use less glucose than normal,
大部分は頭頂葉と側頭葉です
12:58
predominantly the parietal and temporal lobes.
これらの脳の領野は停止しています
13:00
These areas of the brain are shut down.
電灯が消えているようなものです
13:02
The lights are out in these areas of the brain.
DBS電極を配置し
1ヵ月から1年待ちます
13:05
We then put in the DBS electrodes and we wait for a month
赤の領野が
13:08
or a year, and the areas in red
ブドウ糖消費を増やした領野です
13:09
represent the areas where we increase glucose utilization.
ブドウ糖を消費していなかった領野を
13:12
And indeed, we are able to get these areas of the brain
再びブドウ糖を消費する領野に
することができました
13:14
that were not using glucose to use glucose once again.
つまりアルツハイマー病では
13:18
So the message here is that, in Alzheimer's disease,
電灯は消えているけれども
家に誰かがいて
13:20
the lights are out, but there is someone home,
13:23
and we're able to turn the power back on
また点灯できるということで
我々の方法で 脳のこれらの領野に
13:25
to these areas of the brain, and as we do so,
機能が戻ることが期待されます
13:27
we expect that their functions will return.
現在は臨床試験中です
13:30
So this is now in clinical trials.
初期のアルツハイマー病の
13:32
We are going to operate on 50 patients
50人の患者に手術を
13:34
with early Alzheimer's disease
これが安全かつ効果的かどうか
13:36
to see whether this is safe and effective,
神経学的機能を改善できるか見るため
行う計画です
13:38
whether we can improve their neurologic function.
(拍手)
13:41
(Applause)
今日皆さんにお伝えしたいことは
13:48
So the message I want to leave you with today is that,
さまざまな病態にわたって
13:51
indeed, there are several circuits in the brain
正常に作動しない
脳神経回路がありますが
13:54
that are malfunctioning across various disease states,
パーキンソン病であれ
13:58
whether we're talking about Parkinson's disease,
うつ病、統合失調症
アルツハイマー病であれ
14:00
depression, schizophrenia, Alzheimer's.
どの脳神経回路や領野が
14:03
We are now learning to understand what are the circuits,
臨床徴候と病気の症状に関与しているか
14:06
what are the areas of the brain that are responsible for
理解しようと我々は研究しています
14:08
the clinical signs and the symptoms of those diseases.
今や それらの神経回路に
14:11
We can now reach those circuits.
到達し電極を埋め込み
14:13
We can introduce electrodes within those circuits.
回路の活動を修正することが可能です
14:16
We can graduate the activity of those circuits.
脳の至る場所で感知される
トラブルを引き起こしているような
14:19
We can turn them down if they are overactive,
過剰活動の場合は弱めることができ
14:22
if they're causing trouble, trouble that is felt throughout the brain,
機能が低下している場合は
強めることができます
14:25
or we can turn them up if they are underperforming,
14:28
and in so doing, we think that we may be able to help
そうすることで
全体的に脳機能の改善が
可能になるかもしれません
14:30
the overall function of the brain.
という事は もちろん
14:32
The implications of this, of course, is that we may be able
病状を改善させられる
かもしれないとういうことです
14:35
to modify the symptoms of the disease,
まだお話していませんが
電気を使用して
14:37
but I haven't told you but there's also some evidence
損傷した領野も修復できるだろう
という事も分かっています
14:39
that we might be able to help the repair of damaged areas of the brain using electricity,
これは将来に向けて重大なことです
14:43
and this is something for the future, to see if, indeed,
活動そのものだけでなく
14:46
we not only change the activity but also
脳機能自体の修復も
可能だという事です
14:48
some of the reparative functions of the brain
脳機能自体の修復も
可能だという事です
14:50
can be harvested.
この技術の適用は大きく拡がるだろうと
14:52
So I envision that we're going to see a great expansion
予想しています
14:55
of indications of this technique.
多くの脳疾患に電極が
配置されることでしょう
14:57
We're going to see electrodes being placed for many disorders of the brain.
最もエキサイティングなことの1つは
15:00
One of the most exciting things about this is that, indeed,
あらゆる分野
15:03
it involves multidisciplinary work.
15:05
It involves the work of engineers, of imaging scientists,
技術者
医用画像科学や基礎分野の科学者
15:07
of basic scientists, of neurologists,
神経学者、精神科医
脳神経外科医
などとの共同作業—
15:10
psychiatrists, neurosurgeons, and certainly at the interface
お互い刺激し合う複数分野との
連携で成り立っているということです
15:12
of these multiple disciplines that there's the excitement.
15:15
And I think that we will see that
そして将来
時が経つにつれ
さらに多くの悪霊を
15:18
we will be able to chase more of these evil spirits
脳から追い払うことができるようになり
15:22
out from the brain as time goes on,
15:23
and the consequence of that, of course, will be
その結果もちろん
より多くの患者を助けることが
できるようになるでしょう
15:25
that we will be able to help many more patients.
15:28
Thank you very much.
ありがとうございました
Translator:Yuka Rieser
Reviewer:Reiko O Bovee

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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.

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.

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