TEDxCaltech
Andres Lozano: Parkinson's, depression and the switch that might turn them off
Andres Lozano: Parkinson, depresion dhe celesi qe mund ti fike ata.
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Stimulimi i thellle i trurit po behet gjithnje e me preciz. Kjo nderhyrje i lejon kirurget qe te vendosin elektroda ne pothuajse cdo pjese te trurit, dhe ti aktivizojme apo blokojme - si butonat e radios apo termostatit- per te ndrequr keqfunksionimin. Nje veshtrim dramatik ne teknikat me te fundit, nderkohe qe nje grua me Parkinson resht se dridhuri ne moment sepse zonat e mberthyera nga Alzheimeri risillen ne jete. (Filmuar ne 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
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Gjëja që dua të bëj të qartë që nga fillimi
00:14
is that not all neurosurgeons wear cowboy boots.
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është qe jo të gjithë neurokirurgët veshin çizme kauboy.
00:17
I just wanted you to know that.
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Doja vetëm që ta dinit.
00:19
So I am indeed a neurosurgeon,
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Jam një neurokirurg,
00:22
and I follow a long tradition of neurosurgery,
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dhe ndjek një traditë të gjatë neurokirurgjie,
00:26
and what I'm going to tell you about today
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dhe sot do ju flas për
00:27
is adjusting the dials in the circuits in the brain,
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rregullimin e funksioneve në qarqet cerebrale,
00:30
being able to go anywhere in the brain
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te besh te mundur per te hyre në çdo pjesë të trurit
00:32
and turning areas of the brain up or down
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dhe te stimulosh ose te bllokosh zonat cerebrale
00:34
to help our patients.
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per te ndihmuar pacientet tone.
00:36
So as I said, neurosurgery comes from a long tradition.
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Si thash me pare, neurokirurgja ka nje tradite te gjate.
00:39
It's been around for about 7,000 years.
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Ka rreth 7 000 vite.
00:43
In Mesoamerica, there used to be neurosurgery,
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Ne Ameriken Qendrore, ka ekzistuar neurokirurgjia,
00:46
and there were these neurosurgeons that used to treat patients.
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dhe ka patur neurokirurge qe trajtonin paciente.
00:50
And they were trying to -- they knew that the brain was involved
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Dhe ata perpiqeshin--e dinin qe truri kishte te bente
00:54
in neurological and psychiatric disease.
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me semndjet neurologjike dhe psikiatrike.
00:57
They didn't know exactly what they were doing.
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Por nuk e dinin plotesisht se cfare po benin.
00:59
Not much has changed, by the way. (Laughter)
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Jo shume ka ndryshuar qe atehere. (Te qeshura)
01:02
But they thought that,
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Por ata mendonin se,
01:03
if you had a neurologic or psychiatric disease,
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shkaku i nje semundje neurologjike ose psikiatrike,
01:05
it must be because you are possessed
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duhej te ishte nje shpirt i lig
01:08
by an evil spirit.
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qe zoteronte te semuret.
01:10
So if you are possessed by an evil spirit
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Pra, nese je i poseduar nga nje shpirt i lig
01:12
causing neurologic or psychiatric problems,
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qe shkakton probleme neurologjike dhe psikiatrike,
01:15
then the way to treat this is, of course,
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menyra per ta trajtuar kete, pa dyshim, eshte
01:17
to make a hole in your skull and let the evil spirit escape.
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te hapesh nje brime ne kafke dhe ta lesh shpirtin e keq te dale.
01:23
So this was the thinking back then,
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Ky ka qene mendimi ne ato kohera,
01:24
and these individuals made these holes.
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dhe keto persona benin brima te ketilla.
01:28
Sometimes the patients were a little bit reluctant
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Ndonjehere pacientet nuk ishin entuziaste
01:31
to go through this because, you can tell that
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per ta bere kete procedure, sepse
01:34
the holes are made partially and then, I think,
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brimat jane bere pjeserisht e me pas, mendoj,
01:36
there was some trepanation, and then they left very quickly
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sepse shikojme nje shpim parcial dhe pacienti
01:38
and it was only a partial hole,
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ka ikur pa e mbaruar proceduren,
01:40
and we know they survived these procedures.
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dhe ne e dime qe ata nuk vdisnin nga keto procedura.
01:42
But this was common.
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Por kjo ishte dicka e zakonshme.
01:44
There were some sites where one percent
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Ne disa vende, ku nje perqind
01:45
of all the skulls have these holes, and so you can see
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e te gjitha kafkave kishte keto brima, dhe mund te kuptoni se
01:48
that neurologic and psychiatric disease is quite common,
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semundjet neurologjike dhe psikiatrike ishin goxha te perhapura,
01:51
and it was also quite common about 7,000 years ago.
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dhe ishte dicka mjaft e zkonshme rreth 7000 vjet me pare.
01:55
Now, in the course of time,
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Tani, me kalimin e kohes,
01:57
we've come to realize that
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ne kemi arritur te kuptojme se
02:00
different parts of the brain do different things.
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pjese te ndryshme te trurit bejne gjera te ndryshme.
02:02
So there are areas of the brain that are dedicated
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Ka zona te trurit qe jane te pergjegjshme
02:03
to controlling your movement or your vision
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per te kontrolluar levizjet ose te parit tone
02:06
or your memory or your appetite, and so on.
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ose memorjen a oreksin dhe keshtu me rradhe.
02:09
And when things work well, then the nervous system
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Dhe kur gjerat ecin mire, atehere sistemi nervor
02:11
works well, and everything functions.
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ecen mire, dhe gjithcka funksionon.
02:13
But once in a while, things don't go so well,
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Por ngandonjehere, gjerat nuk shkojne kaq mire,
02:15
and there's trouble in these circuits,
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dhe shfaqen probleme ne keto qarqe,
02:18
and there are some rogue neurons that are misfiring
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ku disa neurone rebele nuk funksionojne ashtu si duhet dhe
02:21
and causing trouble, or sometimes they're underactive
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shkaktojne probleme, ose ne raste te tjera ato s'jane aq aktive
02:24
and they're not quite working as they should.
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dhe nuk funksionojne ashtu si duhet.
02:26
Now, the manifestation of this
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Tani, konseguenca e kesaj
02:28
depends on where in the brain these neurons are.
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varet se ne cilen pjese te trurit jane keto neurone.
02:31
So when these neurons are in the motor circuit,
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Nqse keto neurone jane ne qarkun motorik,
02:33
you get dysfunction in the movement system,
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atehere ka disfunkionim ne sistemin e levizjes,
02:36
and you get things like Parkinson's disease.
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dhe shkaktohen semundje si Parkinson.
02:38
When the malfunction is in a circuit that regulates your mood,
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Kur keqfunksionimi eshte ne nje qark qe rregullon humorin,
02:41
you get things like depression,
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mund te shkaktojne psh depresionin,
02:44
and when it is in a circuit that controls your memory and cognitive function,
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dhe kur problemi eshte ne qarkun qe kontrollon memorjen dhe funksionet njohese,
02:47
then you get things like Alzheimer's disease.
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sic ndodh ne rastin e Alzheimer..
02:50
So what we've been able to do is to pinpoint
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Pra, ajo qe kemi arritur te bejme eshte te verifikojme
02:53
where these disturbances are in the brain,
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ku jane keto crregullime ne tru,
02:55
and we've been able to intervene within these circuits
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dhe kemi mundur te nderhyjme ne keto qarqe te trurit
02:58
in the brain to either turn them up or turn them down.
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duke i fikur ose i ndezur ato.
03:02
So this is very much like choosing the correct station
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Pak a shume, e gjithe kjo procedure eshte si te nderrosh kanale
03:04
on the radio dial.
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ne radio.
03:06
Once you choose the right station, whether it be jazz or opera,
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Ne momentin qe zgjedh kanalin e duhur, qofte opera a muzike Xhez,
03:09
in our case whether it be movement or mood,
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ne rastin tone, qofte levizje a gjendje humori,
03:11
we can put the dial there,
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ne e mbajme kanalin aty,
03:13
and then we can use a second button to adjust the volume,
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dhe me nje buton tjeter mund te kontrollojme volumin,
03:16
to turn it up or turn it down.
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per ta ulur ose ngritur.
03:18
So what I'm going to tell you about
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Ajo per te cilen do t'ju flas
03:19
is using the circuitry of the brain to implant electrodes
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eshte perdorimi i qarqeve te trurit per vendosjen e elektrodave
03:23
and turning areas of the brain up and down
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dhe fikjen ose ndezjen e zonave te vecanta te trurit
03:25
to see if we can help our patients.
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per te pare nese mund ti ndihmojme pacientet tane.
03:27
And this is accomplished using this kind of device,
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Dhe kjo mundesohet nga perdorimi i nje paisjeje,
03:29
and this is called deep brain stimulation.
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qe quhet stimulim i thelle i trurit.
03:32
So what we're doing is placing these electrodes throughout the brain.
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Ajo qe bejme eshte vendosja e elektrodave ne pjese te ndryshme te trurit.
03:35
Again, we are making holes in the skull about the size of a dime,
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Mjafton te bejme brima ne tru, me madhesine e nje 10 lekeshi,
03:39
putting an electrode in, and then this electrode
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ne menyre qe te fusim nje elektrode brenda, dhe kjo
03:41
is completely underneath the skin
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eshte krejt nen lekure
03:43
down to a pacemaker in the chest,
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deri ne nje pacemaker ne gjoks,
03:45
and with a remote control very much like a television remote control,
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dhe me nje telekomande te ngjashme me ate te televizorit,
03:50
we can adjust how much electricity we deliver
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ne kontrollojme se sa elektricitet i percojme
03:53
to these areas of the brain.
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pjeseve te vecanta te trurit.
03:55
We can turn it up or down, on or off.
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Mund ta ulim ose ta ngrejme, sikunder mund ta fikim ose ndezim.
03:58
Now, about a hundred thousand patients in the world
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Tani, rreth 100.000 paciente ne bote
04:00
have received deep brain stimulation,
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kane marre stimulim te thelle te trurit,
04:02
and I'm going to show you some examples
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dhe do t'ju tregoj disa shembuj
04:03
of using deep brain stimulation to treat disorders of movement,
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ku kjo praktike eshte perdorur per te trajtuar semundje qe prekin levizjen,
04:06
disorders of mood and disorders of cognition.
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semundje te humorit dhe ato konjiktive.
04:11
So this looks something like this when it's in the brain.
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Ja si duket pak a shume kur eshte ne tru.
04:13
You see the electrode going through the skull into the brain
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Ju shihni se si elektrodat duken kur hyne ne tru
04:16
and resting there, and we can place this really anywhere in the brain.
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dhe ne mund ti vendosim kudo ne tru.
04:19
I tell my friends that no neuron is safe
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I them shokeve te mi, qe asnje neuron nuk eshte i sigurt
04:21
from a neurosurgeon, because we can really reach
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nga nje neurokirurg, sepse ne mund te shkojme
04:23
just about anywhere in the brain quite safely now.
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pothuajse kudo ne tru dhe pa shkaktuar demtime.
04:26
Now the first example I'm going to show you is a patient
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Tani, shembulli i pare qe do t'ju tregoj eshte nje pacient
04:29
with Parkinson's disease,
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me semundjen e Parkinsonit,
04:30
and this lady has Parkinson's disease,
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kjo grua vuan nga kjo semundje,
04:32
and she has these electrodes in her brain,
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dhe ne i kemi vendosur elektrodat ne tru,
04:35
and I'm going to show you what she's like
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e tani do ju tregojme se si duket
04:36
when the electrodes are turned off and she has her Parkinson's symptoms,
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kur elektrodat jane te fikura,
04:39
and then we're going to turn it on.
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dhe pasi ti kemi ndezur ato.
04:42
So this looks something like this.
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Ja se si duket.
04:44
The electrodes are turned off now, and you can see that she has tremor.
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Elektrodat jane fikur dhe ju mund te shihni qe ajo dridhet.
04:49
(Video) Man: Okay. Woman: I can't. Man: Can you try to touch my finger?
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(Video) Burri: OK. Gruaja: Nuk mundem. Burri: A mund te prekni gishtin tim?
04:53
(Video) Man: That's a little better. Woman: That side is better.
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(Video) Burri: Kjo eshte me mire. Gruaja: Kjo ane eshte me mire.
04:56
We're now going to turn it on.
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Tani do ta ndezim.
05:00
It's on. Just turned it on.
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Eshte e ndezur. Sapo e ndezem.
05:06
And this works like that, instantly.
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Dhe ja se si funksionon, pernjehere.
05:09
And the difference between shaking in this way and not --
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Dhe differenca ndermjet te dridhures ne kete menyre dhe jo--
05:12
(Applause)
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(Duartrokitje)
05:17
The difference between shaking in this way and not is related to the misbehavior
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Pra diferenca ne dridhje ose jo, varet nga sjellja e keqe e
05:21
of 25,000 neurons in her subthalamic nucleus.
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25,000 neuroneve ne berthamen e nentalmusit te saj.
05:25
So we now know how to find these troublemakers
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Keshtuqe, ne tashme e dime se ku ti gjejme keto rremujaxhinj
05:28
and tell them, "Gentlemen, that's enough.
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dhe ti themi, "Zoterinj, boll me.
05:29
We want you to stop doing that."
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Duhet ti jepni fund kesaj qe po beni."
05:30
And we do that with electricity.
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Dhe kete e bejme me elektricitet.
05:32
So we use electricity to dictate how they fire,
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Pra, perdorim elektricitetin per te diktuar se si funksionojne ato,
05:35
and we try to block their misbehavior using electricity.
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dhe perpiqemi qe sjelljen e tyre te keqe ta ndalojme nepermjet elektricitetit.
05:38
So in this case, we are suppressing the activity of abnormal neurons.
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Pra, ne kete rast, ne po ndalojme sjelljen jo normale te neuroneve.
05:42
We started using this technique in other problems,
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Nisem ta perdorim kete taktike dhe ne probleme te tjera,
05:44
and I'm going to tell you about a fascinating problem
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dhe do t'ju tregoj rreth nje problemi tjeter me te cilin u ndeshem,
05:46
that we encountered, a case of dystonia.
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nje rast distonie.
05:49
So dystonia is a disorder affecting children.
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Distonia eshte nje semundje qe prek femijet.
05:51
It's a genetic disorder, and it involves a twisting motion,
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Eshte nje crregullim gjenetik, i cili shoqerohet me nje levizje gjarperushe,
05:55
and these children get progressively more and more twisting
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e cila perkeqesohet ne menyre te vazhdueshme
05:57
until they can't breathe, until they get sores,
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deri ne momentin qe femijet nuk marrin me fryme, u krijohen plage,
05:59
urinary infections, and then they die.
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infeksion urinar, deri ne vdekje.
06:01
So back in 1997, I was asked to see this young boy,
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Ne vitin 1997, mu kerkua te shijha kete djalosh,
06:05
perfectly normal. He has this genetic form of dystonia.
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i cili ishte plotesisht normal. Ai vuante nga nje forme e dystonise e trasheguar.
06:08
There are eight children in the family.
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Familja kishte tete femije.
06:10
Five of them have dystonia.
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Pese prej tyre me distoni.
06:13
So here he is.
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Ja tek eshte djali.
06:15
This boy is nine years old, perfectly normal until the age six,
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Ai eshte nente vjec dhe plotesisht normal deri ne moshen gjashte vjecare.
06:20
and then he started twisting his body, first the right foot,
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kur ai nisi te perdredhe trupin, ne fillim kemben e djathte,
06:24
then the left foot, then the right arm, then the left arm,
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pastaj te majten, me pas krahun e djathte, pastaj te majtin,
06:27
then the trunk, and then by the time he arrived,
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me vone belin, dhe ne momentin kur erdhi te me takonte,
06:31
within the course of one or two years of the disease onset,
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ne nje ose dy vjet qe ishte shfaqur semundja,
06:34
he could no longer walk, he could no longer stand.
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ai nuk ishte i zoti te ecte, as te qendronte ne kembe.
06:36
He was crippled, and indeed the natural progression
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Ai ishte invalid, dhe me te vertete ky progresion natyror
06:39
as this gets worse is for them to become progressively twisted,
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i perkeqesimit do te thote qe keto femije sa vine e behen me shume te sperdhredhur,
06:42
progressively disabled, and many of these children do not survive.
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te pamundur, dhe nje pjese e mire e tyre nuk mbijetojne.
06:48
So he is one of five kids.
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Ja pra, nje prej pese femijeve.
06:50
The only way he could get around was crawling on his belly like this.
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E vetmja menyre per te levizur ishte barkasi keshtu.
06:54
He did not respond to any drugs.
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Ilacet nuk i benin efekt.
06:56
We did not know what to do with this boy.
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Nuk dinim si te vepronim me kete djale.
06:58
We did not know what operation to do,
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Nuk dinin se cfare nderhyrje te benim,
07:00
where to go in the brain,
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ne cilen pjese te trurit te nderhynim,
07:02
but on the basis of our results in Parkinson's disease,
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por bazuar ne rezultatet qe patem me Parkinsonin,
07:05
we reasoned, why don't we try to suppress
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menduam, pse te mos shtypim
07:07
the same area in the brain that we suppressed
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te njejten zone ne tru qe shtypem
07:10
in Parkinson's disease, and let's see what happens?
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ne rastin e Parkinsonit, dhe te shihnim se c'do ndodhte?
07:14
So here he was. We operated on him
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Dhe ja tek eshte djali. Ne e kryem nderhyrjen
07:16
hoping that he would get better. We did not know.
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duke shpresuar qe do te behej me mire. Nuk ishim te sigurt.
07:19
So here he is now, back in Israel where he lives,
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Dhe ja tek eshte ai tani, ne Israel ku jeton,
07:24
three months after the procedure, and here he is.
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tre muaj pas nderhyrjes, ja tek eshte.
07:28
(Applause)
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(Duartrokitje)
07:36
On the basis of this result, this is now a procedure
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Ne baze te ketij rezultati, kjo eshte kthyer ne nje procedure
07:39
that's done throughout the world,
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e cila kryhet ne mbare boten,
07:40
and there have been hundreds of children
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dhe nepermjet se ciles qindra femije
07:41
that have been helped with this kind of surgery.
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jane ndihmuar te permiresohen.
07:46
This boy is now in university
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Djali eshte tashme ne universitet
07:48
and leads quite a normal life.
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dhe ben nje jete mjaft normale.
07:50
This has been one of the most satisfying cases
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Ky ka qene nje nga rastet me te kenaqshme
07:52
that I have ever done in my entire career,
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qe kam bere ndonjehere ne karrieren time,
07:54
to restore movement and walking to this kind of child.
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ti risjell levizshmerine dhe te ecurin ketyre femijeve.
07:57
(Applause)
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(Duartrokitje)
08:04
We realized that perhaps we could use this technology
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Kuptuam se ndoshta mund te perdornim kete teknologji
08:07
not only in circuits that control your movement
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jo vetem ne qarqet qe kontrollojne levizshmerine
08:09
but also circuits that control other things,
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por edhe ne ato qarqe qe kontrollojne gjera te tjera,
08:11
and the next thing that we took on
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dhe gjeja tjeter qe morem persiper
08:12
was circuits that control your mood.
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ishin qarqet qe kontrollojne humorin.
08:15
And we decided to take on depression,
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Vendosem te merreshim me depresionin,
08:17
and the reason we took on depression is because it's so prevalent,
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dhe kemi zgjedhur depresionin sepse eshte shume i perhapur,
08:19
and as you know, there are many treatments for depression,
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dhe sic e dini, ka shume trajtime per depresionin,
08:22
with medication and psychotherapy,
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me mjekime dhe psikoterapi,
08:24
even electroconvulsive therapy,
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bile edhe me terapi elektrokonvulsive,
08:26
but there are millions of people,
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por nder miliona njerez,
08:27
and there are still 10 or 20 percent of patients with depression
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rreth 10 ose 20 perqind e pacienteve nuk u pergjigjen
08:30
that do not respond, and it is these patients that we want to help.
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ketyre metodave, dhe keto jana pacientet qe duam te ndihmojme.
08:33
And let's see if we can use this technique
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Le te shohim ne mund ti perdorim keto teknika
08:35
to help these patients with depression.
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per te ndihmuar pacientet me depresion.
08:38
So the first thing we did was, we compared,
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Gjeja e pare qe beme, eshte te krahasuarit
08:39
what's different in the brain of someone with depression
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e diferencave qe ekzistojne ndermjet trurit te dikujt me depresion
08:41
and someone who is normal,
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dhe dikujt tjeter qe eshte normal,
08:43
and what we did was PET scans to look at the blood flow of the brain,
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nepermjet nje skanimi PET e cila dallon qarkullimin e gjakut ne tru,
08:46
and what we noticed is that in patients with depression
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dhe kemi vene re ishte qe te pacientet me depresion
08:49
compared to normals,
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krahesuar me normalet,
08:51
areas of the brain are shut down,
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ka zona te trurit qe jane fikura, joaktive
08:52
and those are the areas in blue.
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dhe keto zona jane zonat blu.
08:53
So here you really have the blues,
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Ketu jane zonat blu,
08:55
and the areas in blue are areas that are involved
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dhe zonat ne blu jane zonat qe kane lidhje me
08:59
in motivation, in drive and decision-making,
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motivacionin, vullnetin dhe vendimmarrjen,
09:01
and indeed, if you're severely depressed as these patients were,
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dhe nese je teper i depresuar, si keto paciente,
09:04
those are impaired. You lack motivation and drive.
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ato jane jashte funksionimit. Te mungon motivacioni dhe vullneti.
09:07
The other thing we discovered
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Gjeja tjeter qe zbuluam
09:08
was an area that was overactive, area 25,
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ishte nje zone qe kishte hiperaktivitet, zona 25,
09:11
seen there in red,
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e paraqitur ketu me te kuqe,
09:12
and area 25 is the sadness center of the brain.
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dhe zona 25 eshte qendra e trishtimit te trurit.
09:15
If I make any of you sad, for example, I make you remember
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Nese dua t'ju trishtoj, per shembull, ju bej te kujtoni
09:18
the last time you saw your parent before they died
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heren e fundit qe keni pare prinderit para se te vdisnin
09:20
or a friend before they died,
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ose nje mik para se te nderroje jete,
09:22
this area of the brain lights up.
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kjo pjese e trurit ndricohet.
09:23
It is the sadness center of the brain.
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Eshte zona e trishtimit ne tru.
09:25
And so patients with depression have hyperactivity.
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Njerezit qe vuajne nga depresioni kane hiperaktivitet.
09:28
The area of the brain for sadness is on red hot.
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Zona e trurit per trishtimin eshte ne te kuqe te ndezur.
09:30
The thermostat is set at 100 degrees,
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Termostati shenon 100 grade celcius,
09:33
and the other areas of the brain, involved in drive and motivation, are shut down.
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dhe zonat e tjera te trurit, pergjegjese per vullnetin dhe motivacionin, jane te fikura.
09:36
So we wondered, can we place electrodes in this area of sadness
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Dhe menduam, a do te ish e mundur te vendosim elektroda ne zonen e trishtimit
09:39
and see if we can turn down the thermostat,
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dhe te shohim nese mund ta ulim pak termostatin,
09:41
can we turn down the activity,
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te ulim aktivitetin,
09:43
and what will be the consequence of that?
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dhe cfare pasojash mund te kete kjo?
09:45
So we went ahead and implanted electrodes in patients with depression.
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Me kete ne mendje, vendosem te poziciononim elektroda tek pacientet me depresion.
09:48
This is work done with my colleague Helen Mayberg from Emory.
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Kete e kam bere ne bashkepunim me kolegen time te Universitetit Emory, Helen Mayberg.
09:51
And we placed electrodes in area 25,
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579403
1934
Vendosen elektroda ne zonen 25,
09:53
and in the top scan you see before the operation,
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ketu siper shihni zonen para nderhyrjes,
09:55
area 25, the sadness area is red hot,
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zona 25, ajo e trishtimit eshte e kuqe e ndezur,
09:57
and the frontal lobes are shut down in blue,
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dhe lobet ballore jane te fikura dhe me ngjyre blu,
10:00
and then, after three months of continuous stimulation,
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dhe me pas, pas tre muajsh stimulim te vazhdueshem,
10:02
24 hours a day, or six months of continuous stimulation,
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24 ore ne dite, ose stimulim i vazhdueshem per gjashte muaj,
10:05
we have a complete reversal of this.
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kemi nje kthim te plote te situates.
10:07
We're able to drive down area 25,
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Ishim ne gjendje ta ngadalsonim aktivitetin ne zonen 25,
10:10
down to a more normal level,
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ne nje nivel me normal,
10:12
and we're able to turn back online
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dhe ishim ne gjendje ti rikthenim ne funksionim
10:14
the frontal lobes of the brain,
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lobet ballore te trurit,
10:15
and indeed we're seeing very striking results
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dhe me rezultate te shkelqyera
10:17
in these patients with severe depression.
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tek pacientet me depresion te rende.
10:20
So now we are in clinical trials, and are in Phase III clinical trials,
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Tanime ndodhemi ne fazen e III te provave klinike,
10:23
and this may become a new procedure,
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dhe kjo mund te kthehet ne nje procedure te re,
10:25
if it's safe and we find that it's effective,
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nese eshte e sigurt dhe efikase,
10:27
to treat patients with severe depression.
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ne trajtimin e pacienteve me depresion te rende.
10:31
I've shown you that we can use deep brain stimulation
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Ju tregova sot, se mund te perdoret stimulim i thelle i trurit
10:34
to treat the motor system
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per te trajtuar sistemin motorik
10:36
in cases of Parkinson's disease and dystonia.
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ne rastin e Parkinson-it dhe distoni-se.
10:39
I've shown you that we can use it to treat a mood circuit
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Ju tregova si mund te perdoret qe te trajtohet qarku i humorit
10:41
in cases of depression.
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ne rast depresioni.
10:43
Can we use deep brain stimulation to make you smarter?
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A mund te perdorim stimulim te thelle te trurit per t'u bere me te zgjuar?
10:47
(Laughter)
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(Te qeshura)
10:49
Anybody interested in that?
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Ka ndonje te interesuar per kete te fundit?
10:52
(Applause)
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(Duartrokitje)
10:54
Of course we can, right?
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Patjeter qe mundemi, apo jo?
10:57
So what we've decided to do is
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Atehere, ajo qe vendosem te bejme eshte
10:59
we're going to try to turbocharge
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do perpiqemi te karikojme
11:02
the memory circuits in the brain.
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qarqet e memorjes ne tru.
11:04
We're going to place electrodes within the circuits
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Do te vendosim elektroda ne qarkun
11:07
that regulate your memory and cognitive function
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qe rregullon memorjen dhe funksionet njohese
11:09
to see if we can turn up their activity.
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per te pare nese mund ta shtojme aktivitetin.
11:13
Now we're not going to do this in normal people.
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Kjo nuk do te provohet ne njerez normal.
11:15
We're going to do this in people that have cognitive deficits,
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Kjo do te kryhet ne njerez qe kane mangesi njohese,
11:18
and we've chosen to treat patients with Alzheimer's disease
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dhe kemi vendosur te zgjedhim paciente qe vuajne nga Alzhaimer
11:22
who have cognitive and memory deficits.
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te cilet kane humbur memorjen.
11:24
As you know, this is the main symptom
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672268
1939
Sikunder dhe mund ta dini, kjo eshte simptoma
11:26
of early onset Alzheimer's disease.
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2423
e pare e Alzheimer.
11:28
So we've placed electrodes within this circuit
256
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2194
Keshtu vendosem elektroda brenda ketij qarku
11:30
in an area of the brain called the fornix,
257
678824
1995
ne ate pjese te trurit qe quhet forniks,
11:32
which is the highway in and out of this memory circuit,
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2778
qe sherben si autostrade per dhe nga qarku i memorjes,
11:35
with the idea to see if we can turn on this memory circuit,
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me idene per te pare nese mund ta riaktivizojme kete qark,
11:39
and whether that can, in turn, help these patients
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dhe qe kjo, si rrjedhoje, ti ndihmoje keto paciente
11:42
with Alzheimer's disease.
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qe vuajne nga Alzheimer.
11:44
Now it turns out that in Alzheimer's disease,
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Tanime dihet qe kur vuan nga Alzheimer,
11:46
there's a huge deficit in glucose utilization in the brain.
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ka nje deficit te madh perdorimit te glukozes ne tru.
11:50
The brain is a bit of a hog when it comes to using glucose.
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Truri, eshte nje llupes i madh glukoze.
11:54
It uses 20 percent of all your --
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Perdor 20% te te gjithe glukozes --
11:56
even though it only weighs two percent --
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ndonese peshon vec dy perqind--
11:57
it uses 10 times more glucose than it should based on its weight.
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perdor 10 here me shume glukoze se sa duhet bazuar ne peshen e tij.
12:00
Twenty percent of all the glucose in your body is used by the brain,
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Njezet perqind e te gjithe glukozes ne trup perdoret nga truri,
12:03
and as you go from being normal
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dhe ndersa behet kalimi nga normal
12:05
to having mild cognitive impairment,
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ne te paturit e paaftesive njohese,
12:08
which is a precursor for Alzheimer's, all the way to Alzheimer's disease,
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c'ka eshte nje pararendes i Alzheimer-it, derisa ajo shfaqet plotesisht,
12:10
then there are areas of the brain that stop using glucose.
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dhe disa pjese te trurit nuk perdorin me glukoze.
12:13
They shut down. They turn off.
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Ato fiken, shuhen.
12:15
And indeed, what we see is that these areas in red
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Dhe ne te verete, ajo cka veme re eshte qe keto zona ne te kuqe
12:17
around the outside ribbon of the brain
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ne fjongon e jashtme te trurit
12:19
are progressively getting more and more blue
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behen ne menyre progresive gjithnje e me blu
12:21
until they shut down completely.
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deri ne momentin qe fiken plotesisht.
12:24
This is analogous to having a power failure
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Kjo eshte analoge me te pesuarit te nje nderprerje elektriciteti
12:27
in an area of the brain, a regional power failure.
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ne nje zone te trurit, nje nderprerje rajonale.
12:29
So the lights are out in parts of the brain
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Pra, dritat fiken ne nje pjese te trurit
12:32
in patients with Alzheimer's disease,
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tek pacientet me semundjen e Alzheimer-it,
12:34
and the question is, are the lights out forever,
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dhe pyetja eshte, a eshte nderprere elektriciteti pergjithnje,
12:37
or can we turn the lights back on?
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apo mund te rikthehet ai?
12:40
Can we get those areas of the brain to use glucose once again?
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A mund ti bejme keto zona te trurit qe te perdorin serish glukoze?
12:43
So this is what we did. We implanted electrodes in the fornix
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Dhe kjo ishte ajo c'ka beme. Vendosem elektroda ne forniksin
12:45
of patients with Alzheimer's disease, we turned it on,
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e pacienteve me Alzheimer, i ndezem,
12:48
and we looked at what happens to glucose use in the brain.
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dhe ndenjem te shihnim se cfare ndodhte me glukozen ne tru.
12:52
And indeed, at the top, you'll see before the surgery,
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Dhe ne te vertete, ne krye, do te shihni para nderhyrjes,
12:55
the areas in blue are the areas that use less glucose than normal,
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zonat ne blu jane ato qe perdorin me pak glukoze se normalisht,
12:58
predominantly the parietal and temporal lobes.
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kryesisht lobi parietal dhe temporal.
13:00
These areas of the brain are shut down.
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Keto zona te trurit jane te fikura.
13:02
The lights are out in these areas of the brain.
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Dritat jane te fikura ne kete zone te trurit.
13:05
We then put in the DBS electrodes and we wait for a month
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Vendosim elektrodat DBS dhe presim per nje muaj
13:08
or a year, and the areas in red
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ose nje vit, dhe zonat e kuqe
13:09
represent the areas where we increase glucose utilization.
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perfaqesojne zonat te cilat e kane rritur perdorimin e glukozes.
13:12
And indeed, we are able to get these areas of the brain
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Dhe ne te vertete, ishim ne gjendje qe ti benim keto zona te trurit
13:15
that were not using glucose to use glucose once again.
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te cilat nuk perdornin glukoze, ta riperdorin ate.
13:18
So the message here is that, in Alzheimer's disease,
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Pra, mesazhi eshte i thjeshte. Ne te semuret me Alzheimer
13:20
the lights are out, but there is someone home,
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dritat jane fikur, por eshte dikush ne shtepi,
13:23
and we're able to turn the power back on
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dhe ne jemi te afte ta kthejme elektricitetin
13:25
to these areas of the brain, and as we do so,
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ne ato pjese te trurit, dhe duke bere keshtu,
13:27
we expect that their functions will return.
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presim qe funksionet e tyre do te kthehen.
13:30
So this is now in clinical trials.
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Edhe kjo eshte tani ne prova klinike.
13:32
We are going to operate on 50 patients
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1901
Do te nderhyjme kirurgjikisht ne 50 paciente
13:34
with early Alzheimer's disease
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802635
1978
me Alzheimer fillestar
13:36
to see whether this is safe and effective,
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2057
per te pare se sa e sigurt dhe efikase eshte kjo metode,
13:38
whether we can improve their neurologic function.
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dhe nese mund te permiresojme funksionet e tyre neurologjike.
13:41
(Applause)
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(Duartrokitje)
13:49
So the message I want to leave you with today is that,
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Mesazhi qe dua te percjell sot eshte qe,
13:52
indeed, there are several circuits in the brain
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ekzistojne disa qarqe ne tru
13:54
that are malfunctioning across various disease states,
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3926
te cilet nuk jane duke funksionuar ne varesi te fazave te semundjeve,
13:58
whether we're talking about Parkinson's disease,
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2208
qofte kur flasim per Parkinson,
14:00
depression, schizophrenia, Alzheimer's.
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depresion, skizofreni, Alzheimer.
14:03
We are now learning to understand what are the circuits,
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3030
Ne tanime po kuptojme kush jane qarqet,
14:06
what are the areas of the brain that are responsible for
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2202
kush jane zonat e trurit qe jane pergjegjese
14:09
the clinical signs and the symptoms of those diseases.
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2520
per shenjat klinike dhe simptomat e ketyre semundjeve.
14:11
We can now reach those circuits.
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2306
Tashme mund te arrijme tek to.
14:13
We can introduce electrodes within those circuits.
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Mund te vendosim elektroda ne keto qarqe.
14:16
We can graduate the activity of those circuits.
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Mund ta gradojme aktivitetin e ketyre qarqeve.
14:19
We can turn them down if they are overactive,
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Mund ti fikim nese jane hiperaktive,
14:22
if they're causing trouble, trouble that is felt throughout the brain,
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2957
nese po shkaktojne probleme, qe ndjehen ne mbare turin,
14:25
or we can turn them up if they are underperforming,
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ose mund ti ndezim nese funksionojne pak,
14:28
and in so doing, we think that we may be able to help
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dhe keshtu, mendojme se mund te jemi te afte te ndihmojme
14:30
the overall function of the brain.
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funksionimin e pergjithshem te trurit.
14:33
The implications of this, of course, is that we may be able
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2554
Implikimet e kesaj, eshte qe ne mund te jemi te afte
14:35
to modify the symptoms of the disease,
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2310
per te modifikuar simptomat e semundjes,
14:37
but I haven't told you but there's also some evidence
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1909
por ajo c'ka nuk ju kam thene eshte qe ka te dhena
14:39
that we might be able to help the repair of damaged areas of the brain using electricity,
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4163
qe mund te riparojme zonat e demtuara te trurit nepermjet elektricitetit,
14:44
and this is something for the future, to see if, indeed,
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2452
dicka kjo per tu pare ne te ardhmen, nese do jemi ne gjendje
14:46
we not only change the activity but also
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jo vetem te ndryshojme aktivitetin por edhe
14:48
some of the reparative functions of the brain
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disa funksione riparuese te trurit
14:50
can be harvested.
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qe mund te rifitohen.
14:52
So I envision that we're going to see a great expansion
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Parashikoj qe do te kemi nje shtrirje te gjere
14:55
of indications of this technique.
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te dhenash dhe teknikash.
14:57
We're going to see electrodes being placed for many disorders of the brain.
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Do te shohim vendosjen e elektrodave per shume semundje ne tru.
15:00
One of the most exciting things about this is that, indeed,
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Nje nga elementet me te spikatur te gjithe kesaj, eshte
15:03
it involves multidisciplinary work.
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fakti qe kerkon pune multidisiplinare.
15:05
It involves the work of engineers, of imaging scientists,
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Kerkon punen e inxhinjereve, shkencetareve te imazhit,
15:08
of basic scientists, of neurologists,
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shkencetarve, neurologve,
15:10
psychiatrists, neurosurgeons, and certainly at the interface
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psikiatrave, neurokirurgve, dhe eshte ne piken e takimit
15:13
of these multiple disciplines that there's the excitement.
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te ketyre disiplinave ku qendron bukuria.
15:16
And I think that we will see that
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Dhe mendoj se do ta shohim kete
15:18
we will be able to chase more of these evil spirits
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dhe do te jemi te afte te debojme me teper shpirtra te ligj
15:22
out from the brain as time goes on,
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jashte trurit me kalimin e kohes,
15:24
and the consequence of that, of course, will be
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dhe pasoja e saj, do te jete
15:26
that we will be able to help many more patients.
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te ndihmuarit e me shume pacienteve.
15:28
Thank you very much.
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Faleminderit Shume.
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