TEDxCaltech
Andres Lozano: Parkinson's, depression and the switch that might turn them off
Andre Lozano (Andres Lozano): Parkinsonova bolest, depresija i prekidač koji ih može isključiti
Filmed:
Readability: 4.3
1,477,742 views
Dubinska stimulacija mozga postaje veoma precizna. Ova tehnika omogućava hirurzima da postave elektrode u gotovo svakom delu mozga, i da pojačavaju ili smanjuju njihov rad - poput brojčanika na radiju ili termostata - da bi ispravili nepravilnosti. Ovo je dramatičan uvid u nove tehnike, kada žena sa Parkinsonovom bolešću u trenutku prestaje da se trese i kada se delovi mozga oslabljeni Alchajmerovom bolešću vraćaju 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 želim
da razjasnim odmah na početku
da razjasnim odmah na početku
00:14
is that not all neurosurgeons wear cowboy boots.
1
2717
3030
jeste to da ne nose svi neurohirurzi
kaubojske čizme.
kaubojske čizme.
00:17
I just wanted you to know that.
2
5747
2179
Samo sam želeo
to da znate.
to da znate.
00:19
So I am indeed a neurosurgeon,
3
7926
2409
Ja sam zaista neurohirurg
00:22
and I follow a long tradition of neurosurgery,
4
10335
3927
dolazim iz duge tradicije neurohirurgije,
00:26
and what I'm going to tell you about today
5
14262
1593
a ono o čemu ću vam
danas govoriti
danas govoriti
00:27
is adjusting the dials in the circuits in the brain,
6
15855
2318
jeste podešavanje brojčanika
u moždanim kolima,
u moždanim kolima,
00:30
being able to go anywhere in the brain
7
18173
1955
mogućnost pristupanja
bilo kom delu mozga
bilo kom delu mozga
00:32
and turning areas of the brain up or down
8
20128
2419
i podešavanja delova mozga
00:34
to help our patients.
9
22547
2212
kako bismo pomogli pacijentima.
00:36
So as I said, neurosurgery comes from a long tradition.
10
24759
2950
Kao što sam rekao, neurohirurgija
ima dugu tradiciju.
ima dugu tradiciju.
00:39
It's been around for about 7,000 years.
11
27709
3552
Ona postoji već
oko 7.000 godina.
oko 7.000 godina.
00:43
In Mesoamerica, there used to be neurosurgery,
12
31261
3725
U Mezoamerici je postojala neurohirurgija
00:46
and there were these neurosurgeons that used to treat patients.
13
34986
3768
i postojali su neurohirurzi
koji su lečili pacijente.
koji su lečili pacijente.
00:50
And they were trying to -- they knew that the brain was involved
14
38754
3911
Znali su
da mozak igra ulogu
da mozak igra ulogu
00:54
in neurological and psychiatric disease.
15
42680
2352
u neurološkim i psihijatrijskim
oboljenjima.
oboljenjima.
00:57
They didn't know exactly what they were doing.
16
45032
2161
Nisu tačno znali šta rade.
00:59
Not much has changed, by the way. (Laughter)
17
47193
2814
Nije se mnogo toga promenilo, uzgred.
(Smeh)
(Smeh)
01:02
But they thought that,
18
50007
1873
Ali su mislili
01:03
if you had a neurologic or psychiatric disease,
19
51880
2003
da ako imate neurološki
ili psihijatrijski poremećaj
ili psihijatrijski poremećaj
01:05
it must be because you are possessed
20
53883
2591
uzrok tome mora da je to
01:08
by an evil spirit.
21
56474
2352
što vas je opseo zloduh.
01:10
So if you are possessed by an evil spirit
22
58826
1969
I zato ako vas je opseo zloduh
01:12
causing neurologic or psychiatric problems,
23
60795
2820
koji prouzrokuje neurološke
i psihijatrijske probleme,
i psihijatrijske probleme,
01:15
then the way to treat this is, of course,
24
63615
2021
najbolji način da se to reši,
je, naravno,
je, naravno,
01:17
to make a hole in your skull and let the evil spirit escape.
25
65636
5683
bušenje rupe u vašoj lobanji
kako bi zloduh mogao da pobegne.
kako bi zloduh mogao da pobegne.
01:23
So this was the thinking back then,
26
71319
1378
Ovako su razmišljali u to vreme
01:24
and these individuals made these holes.
27
72697
4144
i ovi pojedinci su bušili
ovakve rupe.
ovakve rupe.
01:28
Sometimes the patients were a little bit reluctant
28
76841
2983
Ponekad pacijenti
baš i nisu želeli
baš i nisu želeli
01:31
to go through this because, you can tell that
29
79824
2415
da prolaze kroz ovo, jer,
kao što možete da pretpostavite,
kao što možete da pretpostavite,
01:34
the holes are made partially and then, I think,
30
82239
2451
rupe su bile delimične, mislim,
01:36
there was some trepanation, and then they left very quickly
31
84690
2015
došlo je do neke trepanacije,
i onda su brzo prestali
i onda su brzo prestali
01:38
and it was only a partial hole,
32
86705
1901
i to je bila samo delimična rupa
01:40
and we know they survived these procedures.
33
88606
2316
i znamo da su ljudi
preživljavali ove zahvate.
preživljavali ove zahvate.
01:42
But this was common.
34
90922
1208
Ali ovo je bilo uobičajeno.
01:44
There were some sites where one percent
35
92130
1266
Bilo je lokacija
gde je jedan procenat
gde je jedan procenat
01:45
of all the skulls have these holes, and so you can see
36
93396
2725
svih lobanja imao ove rupe
i zato možemo da vidimo
i zato možemo da vidimo
01:48
that neurologic and psychiatric disease is quite common,
37
96121
3194
da su neurološka
i psihijatrijska oboljenja česta
i psihijatrijska oboljenja česta
01:51
and it was also quite common about 7,000 years ago.
38
99315
4433
i bila su poprilično česta
pre 7.000 godina.
pre 7.000 godina.
01:55
Now, in the course of time,
39
103748
2153
Vremenom smo
01:57
we've come to realize that
40
105901
2220
došli do zaključka
02:00
different parts of the brain do different things.
41
108121
2258
da različiti delovi mozga
rade različite stvari.
rade različite stvari.
02:02
So there are areas of the brain that are dedicated
42
110379
1187
Postoje delovi mozga
koji su zaduženi
koji su zaduženi
02:03
to controlling your movement or your vision
43
111566
2693
za kontrolu pokreta ili za vid
02:06
or your memory or your appetite, and so on.
44
114259
2949
ili za pamćenje,
apetit i tako dalje.
apetit i tako dalje.
02:09
And when things work well, then the nervous system
45
117208
2734
I kada stvari teku kako treba,
02:11
works well, and everything functions.
46
119942
1669
onda nervni sistem radi kako treba
i sve funkcioniše.
i sve funkcioniše.
02:13
But once in a while, things don't go so well,
47
121611
2247
Ali ponekad ne ispadne sve
baš kako treba
baš kako treba
02:15
and there's trouble in these circuits,
48
123858
2542
i dolazi do problema
u ovim kolima
u ovim kolima
02:18
and there are some rogue neurons that are misfiring
49
126400
2704
i neki buntovni neuroni
ne rade kako treba
ne rade kako treba
02:21
and causing trouble, or sometimes they're underactive
50
129104
3179
i stvaraju se problemi,
ili ponekad nisu dovoljno aktivni
ili ponekad nisu dovoljno aktivni
02:24
and they're not quite working as they should.
51
132283
2544
i ne rade baš onako kako bi trebalo.
02:26
Now, the manifestation of this
52
134827
2137
Kako će se ovo ispoljiti
02:28
depends on where in the brain these neurons are.
53
136964
2484
zavisi od toga gde se u mozgu
ovi neuroni nalaze.
ovi neuroni nalaze.
02:31
So when these neurons are in the motor circuit,
54
139448
2422
Kada su ovi neuroni
u motornom kolu,
u motornom kolu,
02:33
you get dysfunction in the movement system,
55
141870
2412
dolazi do poremećaja pokreta
02:36
and you get things like Parkinson's disease.
56
144282
2166
i stvari poput Parkinsonove bolesti.
02:38
When the malfunction is in a circuit that regulates your mood,
57
146448
3296
Kada je zastoj u kolu
koje upravlja raspoloženjem,
koje upravlja raspoloženjem,
02:41
you get things like depression,
58
149744
2284
dolazi do stvari poput depresije,
02:44
and when it is in a circuit that controls your memory and cognitive function,
59
152028
3824
a kada je to u kolu koje upravlja
pamćenjem i kognitivnim fukcijama,
pamćenjem i kognitivnim fukcijama,
02:47
then you get things like Alzheimer's disease.
60
155852
2521
dolazi do stvari poput
Alchajmerove bolesti.
Alchajmerove bolesti.
02:50
So what we've been able to do is to pinpoint
61
158373
2723
Ono što smo mi uspeli da uradimo
je da odredimo
je da odredimo
02:53
where these disturbances are in the brain,
62
161096
2307
gde se ovi poremećaji
nalaze u mozgu
nalaze u mozgu
02:55
and we've been able to intervene within these circuits
63
163403
3037
i uspeli smo da se umešamo
u ova kola u mozgu
u ova kola u mozgu
02:58
in the brain to either turn them up or turn them down.
64
166440
3656
kako bismo ih
ili uključili ili isključili.
ili uključili ili isključili.
03:02
So this is very much like choosing the correct station
65
170096
2284
Ovo je slično biranju radio stanice
03:04
on the radio dial.
66
172380
1975
na brojčaniku radija.
03:06
Once you choose the right station, whether it be jazz or opera,
67
174355
2649
Kada odaberete stanicu,
bila to džez ili operska stanica,
bila to džez ili operska stanica,
03:09
in our case whether it be movement or mood,
68
177004
2333
u našem slučaju,
bili to pokreti ili raspoloženje,
bili to pokreti ili raspoloženje,
03:11
we can put the dial there,
69
179337
1966
ostavljamo brojčanik na toj poziciji
03:13
and then we can use a second button to adjust the volume,
70
181303
2771
i onda drugim dugmetom
podešavamo jačinu zvuka,
podešavamo jačinu zvuka,
03:16
to turn it up or turn it down.
71
184074
2009
pojačavamo ili smanjujemo.
03:18
So what I'm going to tell you about
72
186083
1228
Ono o čemu ću vam govoriti
03:19
is using the circuitry of the brain to implant electrodes
73
187311
4058
je upotreba moždanih kola
za ugradnju elektroda
za ugradnju elektroda
03:23
and turning areas of the brain up and down
74
191369
2468
pomoću kojih pojačavamo ili smanjujemo
rad delova mozga
rad delova mozga
03:25
to see if we can help our patients.
75
193837
1704
da vidimo da li možemo
da pomognemo pacijentima.
da pomognemo pacijentima.
03:27
And this is accomplished using this kind of device,
76
195541
2333
To postižemo ovakvim uređajima
03:29
and this is called deep brain stimulation.
77
197874
2461
i to se zove dubinska stimulacija mozga.
03:32
So what we're doing is placing these electrodes throughout the brain.
78
200335
3071
Ono što radimo jeste
postavljanje ovih elektroda u mozak.
postavljanje ovih elektroda u mozak.
03:35
Again, we are making holes in the skull about the size of a dime,
79
203406
3949
Ponovo pravimo rupe u mozgu,
veličine novčića,
veličine novčića,
03:39
putting an electrode in, and then this electrode
80
207355
2151
postavljamo elektrodu,
03:41
is completely underneath the skin
81
209506
2228
i onda je ona
u potpunosti ispod kože,
u potpunosti ispod kože,
03:43
down to a pacemaker in the chest,
82
211734
2090
do pejsmekera u grudnom košu,
03:45
and with a remote control very much like a television remote control,
83
213824
4528
i sa daljinskim upravljačem,
veoma sličnom onom za televiziju
veoma sličnom onom za televiziju
03:50
we can adjust how much electricity we deliver
84
218352
2979
podešavamo količinu energije
koju puštamo
koju puštamo
03:53
to these areas of the brain.
85
221331
2068
u određene delove mozga.
03:55
We can turn it up or down, on or off.
86
223399
2891
Možemo ih pojačati ili smanjiti,
uključiti ili isključiti.
uključiti ili isključiti.
03:58
Now, about a hundred thousand patients in the world
87
226290
2655
Oko stotinu hiljada pacijenata na svetu
04:00
have received deep brain stimulation,
88
228945
1876
je imalo duboku stimulaciju mozga
04:02
and I'm going to show you some examples
89
230821
1154
i pokazaću vam samo neke primere
04:03
of using deep brain stimulation to treat disorders of movement,
90
231975
2711
korišćenja duboke stimulacije mozga
za lečenje poremećaja kretnje,
za lečenje poremećaja kretnje,
04:06
disorders of mood and disorders of cognition.
91
234686
4514
poremećaja raspoloženja
i kognitivnih poremećaja.
i kognitivnih poremećaja.
04:11
So this looks something like this when it's in the brain.
92
239200
2739
To izgleda ovako nekako
kada je u mozgu.
kada je u mozgu.
04:13
You see the electrode going through the skull into the brain
93
241939
2235
Vidimo elektrodu koja prolazi
kroz lobanju do mozga
kroz lobanju do mozga
04:16
and resting there, and we can place this really anywhere in the brain.
94
244174
3183
i možemo je postaviti bilo gde
u mozgu.
u mozgu.
04:19
I tell my friends that no neuron is safe
95
247357
2460
Govorim svojim prijateljima
da nijedan neuron nije siguran
da nijedan neuron nije siguran
04:21
from a neurosurgeon, because we can really reach
96
249817
2182
od neurohirurga,
jer možemo dospeti
jer možemo dospeti
04:23
just about anywhere in the brain quite safely now.
97
251999
2566
do bilo koje tačke u mozgu,
i to poprilično bezbedno.
i to poprilično bezbedno.
04:26
Now the first example I'm going to show you is a patient
98
254565
2520
Prvi primer koji ću vam pokazati
je primer pacijenta
je primer pacijenta
04:29
with Parkinson's disease,
99
257085
1710
sa Parkinsonovom bolešću.
04:30
and this lady has Parkinson's disease,
100
258795
1987
Ova gospođa ima Parkinsonovu bolest
04:32
and she has these electrodes in her brain,
101
260782
2310
i ima ove elektrode u mozgu,
04:35
and I'm going to show you what she's like
102
263092
1282
Pokazaću vam kakva je ona
04:36
when the electrodes are turned off and she has her Parkinson's symptoms,
103
264374
3507
kada su elektrode isključene
i pokazuje simptome Parkinsonove
i pokazuje simptome Parkinsonove
04:39
and then we're going to turn it on.
104
267881
2333
i kakva je kada ih uključimo.
04:42
So this looks something like this.
105
270214
2695
To izgleda otprilike ovako.
04:44
The electrodes are turned off now, and you can see that she has tremor.
106
272909
4505
Elektrode su sada isključene
i vidimo da ona ima tremor.
i vidimo da ona ima tremor.
04:49
(Video) Man: Okay. Woman: I can't. Man: Can you try to touch my finger?
107
277420
3719
(Video) Čovek: U redu. Žena: Ne mogu.
Čovek: Možete li da pokušate da dodirnete moj prst?
Čovek: Možete li da pokušate da dodirnete moj prst?
04:53
(Video) Man: That's a little better. Woman: That side is better.
108
281139
3625
(Video) Čovek: To je malo bolje.
Žena: Ta strana je bolja.
Žena: Ta strana je bolja.
04:56
We're now going to turn it on.
109
284764
3792
Sada ćemo ih uključiti.
05:00
It's on. Just turned it on.
110
288556
4438
Uključene su.
Upravo sam ih uključio.
Upravo sam ih uključio.
05:06
And this works like that, instantly.
111
294561
3263
I to funkcioniše ovako,
u trenutku.
u trenutku.
05:09
And the difference between shaking in this way and not --
112
297824
2982
A razlika između ovakvog podrhtavanja
i nepodrhtavanja -
i nepodrhtavanja -
05:12
(Applause)
113
300806
4601
(Aplauz)
05:17
The difference between shaking in this way and not is related to the misbehavior
114
305407
4105
Razlika između podrhtavanja i nepodrhtavanja
povezana je sa ponašanjem
povezana je sa ponašanjem
05:21
of 25,000 neurons in her subthalamic nucleus.
115
309512
3973
25.000 neurona
u njenom subtalamičkom jezgru.
u njenom subtalamičkom jezgru.
05:25
So we now know how to find these troublemakers
116
313485
2576
Sada znamo kako da
pronađemo ove probleme
pronađemo ove probleme
05:28
and tell them, "Gentlemen, that's enough.
117
316061
1391
i kažemo im:
"Gospodo, sada je dosta.
"Gospodo, sada je dosta.
05:29
We want you to stop doing that."
118
317452
1334
Hoćemo da prestanete s tim."
05:30
And we do that with electricity.
119
318786
1222
To radimo uz pomoć struje.
05:32
So we use electricity to dictate how they fire,
120
320008
3414
Strujom određujemo
kako će se aktivirati
kako će se aktivirati
05:35
and we try to block their misbehavior using electricity.
121
323422
3462
i strujom zaustavljamo
neželjena ponašanja.
neželjena ponašanja.
05:38
So in this case, we are suppressing the activity of abnormal neurons.
122
326884
3444
Tako u ovom slučaju suzbijamo aktivnost
abnormalnih neurona.
abnormalnih neurona.
05:42
We started using this technique in other problems,
123
330328
2562
Počeli smo da primenjujemo ovu tehniku
i u drugim slučajevima,
i u drugim slučajevima,
05:44
and I'm going to tell you about a fascinating problem
124
332890
1402
pa ću vam ispričati
o fascinantnom problemu
o fascinantnom problemu
05:46
that we encountered, a case of dystonia.
125
334292
3168
sa kojim smo se suočili,
o slučaju distonije.
o slučaju distonije.
05:49
So dystonia is a disorder affecting children.
126
337460
2505
Distonija je oboljenje
koje pogađa decu.
koje pogađa decu.
05:51
It's a genetic disorder, and it involves a twisting motion,
127
339965
3062
To je genetsko oboljenje,
i manifestuje se u pokretima grčenja,
i manifestuje se u pokretima grčenja,
05:55
and these children get progressively more and more twisting
128
343027
2824
a kod ove dece
se to progresivno razvija
se to progresivno razvija
05:57
until they can't breathe, until they get sores,
129
345851
1991
sve dok više ne mogu da dišu,
dok ne dobiju ranice,
dok ne dobiju ranice,
05:59
urinary infections, and then they die.
130
347842
2031
urinarne infekcije,
i onda umiru.
i onda umiru.
06:01
So back in 1997, I was asked to see this young boy,
131
349873
3373
I tako je 1997. trebalo da
vidim ovog dečaka,
vidim ovog dečaka,
06:05
perfectly normal. He has this genetic form of dystonia.
132
353246
2956
sasvim normalnog.
Ima genetski oblik distonije.
Ima genetski oblik distonije.
06:08
There are eight children in the family.
133
356202
2219
U porodici ima osmoro dece.
06:10
Five of them have dystonia.
134
358421
3359
Od njih petoro 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
Dečak ima devet godina,
bio je sasvim normalan do šeste,
bio je sasvim normalan do šeste,
06:20
and then he started twisting his body, first the right foot,
137
368151
4395
i onda su počeli grčevi u telu,
prvo u desnom stopalu,
prvo u desnom stopalu,
06:24
then the left foot, then the right arm, then the left arm,
138
372546
3420
zatim u levom, onda u desnoj ruci,
a potom i u levoj,
a potom i u levoj,
06:27
then the trunk, and then by the time he arrived,
139
375966
3247
zatim u trupu,
i sve dok nije stigao,
i sve dok nije stigao,
06:31
within the course of one or two years of the disease onset,
140
379213
2940
tokom perioda od jedne do dve godine
od nastupa bolesti
od nastupa bolesti
06:34
he could no longer walk, he could no longer stand.
141
382153
2320
više nije mogao da hoda,
ni da stoji.
ni da stoji.
06:36
He was crippled, and indeed the natural progression
142
384473
2698
Bio je obogaljen i zapravo,
pošto se ovo vremenom pogoršava
pošto se ovo vremenom pogoršava
06:39
as this gets worse is for them to become progressively twisted,
143
387171
3555
prirodan tok stvari je
da im se telo postepeno izvrće
da im se telo postepeno izvrće
06:42
progressively disabled, and many of these children do not survive.
144
390726
5690
i postepeno postaju onesposobljeni,
i mnoga od ove dece ne prežive.
i mnoga od ove dece ne prežive.
06:48
So he is one of five kids.
145
396416
2028
Dakle on je jedno
od petoro dece.
od petoro dece.
06:50
The only way he could get around was crawling on his belly like this.
146
398444
4094
Jedini način na koji je mogao da se kreće
je ovako, puzeći na stomaku.
je ovako, puzeći na stomaku.
06:54
He did not respond to any drugs.
147
402538
1956
Nije reagovao
ni na kakve lekove.
ni na kakve lekove.
06:56
We did not know what to do with this boy.
148
404494
1940
Nismo znali šta da radimo s njim.
06:58
We did not know what operation to do,
149
406434
2116
Nismo znali kakvu operaciju
bismo mogli da uradimo,
bismo mogli da uradimo,
07:00
where to go in the brain,
150
408550
2194
na kom delu mozga,
07:02
but on the basis of our results in Parkinson's disease,
151
410744
2773
ali na osnovu postignuća
s Parkinsonovom bolešću
s Parkinsonovom bolešću
07:05
we reasoned, why don't we try to suppress
152
413517
2005
zaključili smo da možemo
da probamo
da probamo
07:07
the same area in the brain that we suppressed
153
415522
3097
da suzbijemo aktivnost
iste oblasti u mozgu
iste oblasti u mozgu
07:10
in Parkinson's disease, and let's see what happens?
154
418619
3655
kao u slučaju s Parkinsonovom,
i da vidimo šta će se desiti.
i da vidimo šta će se desiti.
07:14
So here he was. We operated on him
155
422274
1787
Operisali 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 bili sigurni.
Nismo bili sigurni.
07:19
So here he is now, back in Israel where he lives,
157
427935
4127
I evo ga sada,
ponovo u Izraelu gde i živi,
ponovo u Izraelu gde i živi,
07:24
three months after the procedure, and here he is.
158
432062
4053
tri meseca posle operacije.
07:28
(Applause)
159
436115
4950
(Aplauz)
07:36
On the basis of this result, this is now a procedure
160
444669
2621
Na osnovu ovog rezultata,
ovo je sada operacija
ovo je sada operacija
07:39
that's done throughout the world,
161
447290
1248
koja se praktikuje svuda po svetu,
07:40
and there have been hundreds of children
162
448538
1295
i hiljade dece je
07:41
that have been helped with this kind of surgery.
163
449833
4207
na ovaj način dobilo pomoć.
07:46
This boy is now in university
164
454040
2117
Ovaj dečak 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 onih slučajeva
u mojoj karijeri
u mojoj karijeri
07:52
that I have ever done in my entire career,
167
460561
1979
kojim sam bio najzadovoljniji,
07:54
to restore movement and walking to this kind of child.
168
462540
3377
kada sam vratio mogućnost
pokreta i hoda ovakvom detetu.
pokreta i hoda ovakvom detetu.
07:57
(Applause)
169
465917
6255
(Aplauz)
08:04
We realized that perhaps we could use this technology
170
472172
2869
Shvatili smo da bismo možda mogli
da koristimo ovu tehnologiju,
da koristimo ovu tehnologiju,
08:07
not only in circuits that control your movement
171
475041
2172
ne samo u kolima
koja kontrolišu pokrete
koja kontrolišu pokrete
08:09
but also circuits that control other things,
172
477213
1952
već i u kolima
koja kontrolišu druge stvari
koja kontrolišu druge stvari
08:11
and the next thing that we took on
173
479165
1147
i sledeća stvar
koje smo se prihvatili
koje smo se prihvatili
08:12
was circuits that control your mood.
174
480312
2993
su bila kola
koja kontrolišu raspoloženje.
koja kontrolišu raspoloženje.
08:15
And we decided to take on depression,
175
483305
2076
Rešili smo
da se prihvatimo depresije,
da se prihvatimo depresije,
08:17
and the reason we took on depression is because it's so prevalent,
176
485381
2259
i razlog zbog kojeg smo odabrali baš depresiju
je to što je tako česta
je to što je tako česta
08:19
and as you know, there are many treatments for depression,
177
487640
2544
i kao što znate,
postoji mnogo načina da se ona leči
postoji mnogo načina da se ona leči
08:22
with medication and psychotherapy,
178
490184
2037
lekovima i psihoterapijom,
08:24
even electroconvulsive therapy,
179
492221
2062
čak i elektroterapijom,
08:26
but there are millions of people,
180
494283
1334
ali postoje milioni ljudi
08:27
and there are still 10 or 20 percent of patients with depression
181
495617
2792
i još uvek ima 10 ili 20 procenata
pacijenata sa depresijom
pacijenata sa depresijom
08:30
that do not respond, and it is these patients that we want to help.
182
498409
3252
koji ne reaguju, i oni su ti
kojima želimo da pomognemo.
kojima želimo da pomognemo.
08:33
And let's see if we can use this technique
183
501661
2103
Hajde da vidimo možemo li
da koristimo ovu tehniku
da koristimo ovu tehniku
08:35
to help these patients with depression.
184
503764
2239
da pomognemo pacijentima
koji pate od depresije.
koji pate od depresije.
08:38
So the first thing we did was, we compared,
185
506003
1850
Prvo što smo uradili
bilo je upoređivanje
bilo je upoređivanje
08:39
what's different in the brain of someone with depression
186
507853
1824
mozga osobe
koja je depresivna
koja je depresivna
08:41
and someone who is normal,
187
509677
1668
i osobe koja je normalna.
08:43
and what we did was PET scans to look at the blood flow of the brain,
188
511345
3460
Uradili smo PET skeniranje
da bismo videli protok krvi u mozgu
da bismo videli protok krvi u mozgu
08:46
and what we noticed is that in patients with depression
189
514805
2369
i primetili smo da su
kod pacijenata sa depresijom,
kod pacijenata sa depresijom,
08:49
compared to normals,
190
517174
2045
u poređenju sa normalnima,
08:51
areas of the brain are shut down,
191
519219
1498
neki delovi mozga isključeni,
08:52
and those are the areas in blue.
192
520717
1265
i to su ove oblasti plave boje.
08:53
So here you really have the blues,
193
521982
1620
Ovde ima dosta plavog,
08:55
and the areas in blue are areas that are involved
194
523602
3573
i ti plavi delovi su oni zaduženi
08:59
in motivation, in drive and decision-making,
195
527175
2656
za motivaciju,
želju i odlučivanje,
želju i odlučivanje,
09:01
and indeed, if you're severely depressed as these patients were,
196
529831
2495
i zaista, ako ste ozbiljno depresivni
kao što su ovi pacijenti bili
kao što su ovi pacijenti bili
09:04
those are impaired. You lack motivation and drive.
197
532326
2692
ove oblasti mozga su vam oštećene.
Fali vam motivacija i želja.
Fali vam motivacija i želja.
09:07
The other thing we discovered
198
535018
1879
Sledeća stvar koju smo otkrili
09:08
was an area that was overactive, area 25,
199
536897
2489
je oblast koja je bila preaktivna,
oblast 25,
oblast 25,
09:11
seen there in red,
200
539386
1588
koja je obojena u crveno,
09:12
and area 25 is the sadness center of the brain.
201
540974
2657
i oblast 25 je centar za tugu.
09:15
If I make any of you sad, for example, I make you remember
202
543631
2873
Ako bih vas sad rastužio,
kada bih vas recimo naterao
kada bih vas recimo naterao
09:18
the last time you saw your parent before they died
203
546504
2287
da se setite kada ste poslednji put
videli svoje roditelje
videli svoje roditelje
09:20
or a friend before they died,
204
548791
1633
ili prijatelja pre nego što su umrli,
09:22
this area of the brain lights up.
205
550424
1206
ova oblast u mozgu bi se aktivirala.
09:23
It is the sadness center of the brain.
206
551630
1723
To je centar za tugu u mozgu.
09:25
And so patients with depression have hyperactivity.
207
553353
3212
Kod pacijenata sa depresijom
je hiperaktivan.
je hiperaktivan.
09:28
The area of the brain for sadness is on red hot.
208
556565
2178
Oblast za tugu u mozgu
je užarena.
je užarena.
09:30
The thermostat is set at 100 degrees,
209
558743
2657
Termostat je podešen
na 100 stepeni
na 100 stepeni
09:33
and the other areas of the brain, involved in drive and motivation, are shut down.
210
561400
3128
a ostale oblasti mozga,
koje uključuju želju i motivaciju su isključene.
koje uključuju želju i motivaciju su isključene.
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 ovim oblastima tuge,
elektrode u ovim oblastima tuge,
09:39
and see if we can turn down the thermostat,
212
567525
2429
i ako smanjimo termostat
09:41
can we turn down the activity,
213
569954
1713
možemo li smanjiti i aktivnost,
09:43
and what will be the consequence of that?
214
571667
2122
i koje će biti posledice toga.
09:45
So we went ahead and implanted electrodes in patients with depression.
215
573789
3127
Tako smo nastavili i ugradili elektrode
kod pacijenata sa depresijom.
kod pacijenata sa depresijom.
09:48
This is work done with my colleague Helen Mayberg from Emory.
216
576916
2487
Ovaj posao je uradila moja koleginica
Helen Mejberg iz Emorija.
Helen Mejberg iz Emorija.
09:51
And we placed electrodes in area 25,
217
579403
1934
Postavili smo elektrode
u oblasti 25
u oblasti 25
09:53
and in the top scan you see before the operation,
218
581337
2285
i na slici u vrhu možete videti
da je pre operacije
da je pre operacije
09:55
area 25, the sadness area is red hot,
219
583622
2286
oblast 25,
centar za tugu u mozgu crven
centar za tugu u mozgu crven
09:57
and the frontal lobes are shut down in blue,
220
585908
2394
a da su frontalni režnjevi
ugašeni, u plavoj boji,
ugašeni, u plavoj boji,
10:00
and then, after three months of continuous stimulation,
221
588302
2408
i onda posle tri meseca
kontinuirane stimulacije
kontinuirane stimulacije
10:02
24 hours a day, or six months of continuous stimulation,
222
590710
3015
24 sata na dan
ili 6 meseci kontinuirane stimulacije
ili 6 meseci kontinuirane stimulacije
10:05
we have a complete reversal of this.
223
593725
1774
vidimo potpuni preokret.
10:07
We're able to drive down area 25,
224
595499
2839
Uspeli smo da smanjimo
aktivnost oblasti 25
aktivnost oblasti 25
10:10
down to a more normal level,
225
598338
1952
na normalan nivo
10:12
and we're able to turn back online
226
600290
2036
i uspeli smo da vratimo aktivnost
10:14
the frontal lobes of the brain,
227
602326
1308
frontalnih režnjeva u mozgu.
10:15
and indeed we're seeing very striking results
228
603634
1869
Zaista, vidimo veoma
impresivne rezultate
impresivne rezultate
10:17
in these patients with severe depression.
229
605503
2747
kod ovih pacijenata
sa teškom depresijom.
sa teškom 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 trećoj fazi ispitivanja,
i to u trećoj fazi ispitivanja,
10:23
and this may become a new procedure,
231
611152
2543
pa ovo može postati
nova procedura
nova procedura
10:25
if it's safe and we find that it's effective,
232
613695
2183
ako je bezbedna
i ako otkrijemo da je efikasna,
i ako otkrijemo da je efikasna,
10:27
to treat patients with severe depression.
233
615878
3674
za lečenje pacijenata
sa teškom depresijom.
sa teškom depresijom.
10:31
I've shown you that we can use deep brain stimulation
234
619567
2960
Pokazao sam vam da možemo koristiti
dubinsku stimulaciju mozga
dubinsku stimulaciju mozga
10:34
to treat the motor system
235
622527
2087
da utičemo na pokrete
10:36
in cases of Parkinson's disease and dystonia.
236
624614
2446
u slučajevima Parkinsonove bolesti
i distonije.
i distonije.
10:39
I've shown you that we can use it to treat a mood circuit
237
627060
2385
Pokazao sam vam da je možemo koristiti
da utičemo na raspoloženje
da utičemo na raspoloženje
10:41
in cases of depression.
238
629445
1650
u slučajevima depresije.
10:43
Can we use deep brain stimulation to make you smarter?
239
631095
4545
Možemo li koristiti dubinsku stimulaciju mozga
da učinimo ljude pametnijim?
da učinimo ljude pametnijim?
10:47
(Laughter)
240
635640
2096
(Smeh)
10:49
Anybody interested in that?
241
637736
2566
Je li neko zainteresovan za to?
10:52
(Applause)
242
640302
2300
(Aplauz)
10:54
Of course we can, right?
243
642602
2988
Naravno da možemo,
zar ne?
zar ne?
10:57
So what we've decided to do is
244
645590
2214
Ono što smo odlučili
da uradimo je
da uradimo je
10:59
we're going to try to turbocharge
245
647804
2421
pokušaj turbo punjenja
11:02
the memory circuits in the brain.
246
650225
2205
memorijskih kola u mozgu.
11:04
We're going to place electrodes within the circuits
247
652430
2736
Postavićemo elektrode kroz kola
11:07
that regulate your memory and cognitive function
248
655166
2676
koja regulišu pamćenje
i kognitivne funkcije
i kognitivne funkcije
11:09
to see if we can turn up their activity.
249
657842
3270
da vidimo možemo li da
povećamo njihovu aktivnost.
povećamo njihovu aktivnost.
11:13
Now we're not going to do this in normal people.
250
661112
1938
Naravno, nećemo to raditi
kod normalnih ljudi.
kod normalnih ljudi.
11:15
We're going to do this in people that have cognitive deficits,
251
663050
3652
Radićemo to kod onih koji imaju
kognitivne deficite
kognitivne deficite
11:18
and we've chosen to treat patients with Alzheimer's disease
252
666702
3459
i za to smo odabrali
pacijente sa Alchajmerovom bolešću
pacijente sa Alchajmerovom bolešću
11:22
who have cognitive and memory deficits.
253
670161
2107
koji ih imaju.
11:24
As you know, this is the main symptom
254
672268
1939
Kao što znate,
to je glavni simptom
to je glavni simptom
11:26
of early onset Alzheimer's disease.
255
674207
2423
kod rane pojave Alchajmerove bolesti.
11:28
So we've placed electrodes within this circuit
256
676630
2194
Tako smo postavili elektrode
kroz ova kola
kroz ova kola
11:30
in an area of the brain called the fornix,
257
678824
1995
u oblasti mozga
koja se zove forniks,
koja se zove forniks,
11:32
which is the highway in and out of this memory circuit,
258
680819
2778
koja je put unutar i izvan
tog memorijskog kola,
tog memorijskog kola,
11:35
with the idea to see if we can turn on this memory circuit,
259
683597
3428
sa ciljem da vidimo možemo li uključiti
to memorijsko kolo
to memorijsko kolo
11:39
and whether that can, in turn, help these patients
260
687025
3249
i možemo li pomoći
ovim pacijentima
ovim pacijentima
11:42
with Alzheimer's disease.
261
690274
2309
sa Alchajmerovom bolešću.
11:44
Now it turns out that in Alzheimer's disease,
262
692583
2318
Ispostavlja se
da kod Alchajmerove bolesti
da kod Alchajmerove bolesti
11:46
there's a huge deficit in glucose utilization in the brain.
263
694901
4072
postoji veliki poremećaj potrošnje
glukoze u mozgu.
glukoze u mozgu.
11:50
The brain is a bit of a hog when it comes to using glucose.
264
698973
3418
Mozak je jako halapljiv kad je
glukoza u pitanju.
glukoza u pitanju.
11:54
It uses 20 percent of all your --
265
702391
1760
Koristi oko 20 procenata sve vaše -
11:56
even though it only weighs two percent --
266
704151
1515
iako je to težak samo 2 procenta -
11:57
it uses 10 times more glucose than it should based on its weight.
267
705666
3145
koristi 10 puta više glukoze nego sto bi trebalo
u odnosu na svoju težinu.
u odnosu na svoju težinu.
12:00
Twenty percent of all the glucose in your body is used by the brain,
268
708811
2583
Dvadeset posto glukoze iz tela
koristi mozak
koristi mozak
12:03
and as you go from being normal
269
711394
2430
i kako se od normalnog stanja
krećete ka
krećete ka
12:05
to having mild cognitive impairment,
270
713824
2193
blagom kognitivnom pogoršanju,
12:08
which is a precursor for Alzheimer's, all the way to Alzheimer's disease,
271
716017
2455
što prethodi Alchajmerovoj,
sve do Alchajmerove bolesti,
sve do Alchajmerove bolesti,
12:10
then there are areas of the brain that stop using glucose.
272
718472
2689
neki delovi mozga prestaju
da koriste glukozu.
da koriste glukozu.
12:13
They shut down. They turn off.
273
721161
2295
Gase se.
Isključuju se.
Isključuju se.
12:15
And indeed, what we see is that these areas in red
274
723456
2282
Zaista, vidimo da ove
oblasti crvene boje
oblasti crvene boje
12:17
around the outside ribbon of the brain
275
725738
1767
oko spoljašnje strane mozga
12:19
are progressively getting more and more blue
276
727505
2276
postepeno postaju
sve više i više plave
sve više i više plave
12:21
until they shut down completely.
277
729781
3172
dok se u potpunosti
ne isključe.
ne isključe.
12:24
This is analogous to having a power failure
278
732953
2359
Ovo je slično nestanku struje
12:27
in an area of the brain, a regional power failure.
279
735312
2543
u oblasti mozga,
i to regionalnom nestanku struje.
i to regionalnom nestanku struje.
12:29
So the lights are out in parts of the brain
280
737855
2397
Tako nema svetla u
nekim delovima mozga
nekim delovima mozga
12:32
in patients with Alzheimer's disease,
281
740252
2598
kod pacijenata sa
Alchajmerovom bolešću,
Alchajmerovom bolešću,
12:34
and the question is, are the lights out forever,
282
742850
2409
i pitanje je da li su svetla
ugašena zauvek
ugašena zauvek
12:37
or can we turn the lights back on?
283
745259
2861
ili ih ipak možemo
ponovo uključiti.
ponovo uključiti.
12:40
Can we get those areas of the brain to use glucose once again?
284
748120
3236
Možemo li naterati te delove mozga
da ponovo koriste glukozu?
da ponovo koriste glukozu?
12:43
So this is what we did. We implanted electrodes in the fornix
285
751356
2550
Evo šta smo uradili. Ugradili smo
elektrode u forniks
elektrode u forniks
12:45
of patients with Alzheimer's disease, we turned it on,
286
753906
2613
pacijenata sa Alchajmerovom bolešću,
uključili smo ih
uključili smo ih
12:48
and we looked at what happens to glucose use in the brain.
287
756519
3511
i posmatrali šta se dešava
sa upotrebom glukoze u mozgu.
sa upotrebom glukoze u mozgu.
12:52
And indeed, at the top, you'll see before the surgery,
288
760030
3262
Zaista, kao što vidite u vrhu,
pre operacije plavi delovi
pre operacije plavi delovi
12:55
the areas in blue are the areas that use less glucose than normal,
289
763292
3364
su delovi koji koriste manje glukoze
nego što je normalno,
nego što je normalno,
12:58
predominantly the parietal and temporal lobes.
290
766656
2208
pogotovo parijetalni
i temporalni režanj.
i temporalni režanj.
13:00
These areas of the brain are shut down.
291
768864
1710
Ovo su oblasti mozga
koje su isključene.
koje su isključene.
13:02
The lights are out in these areas of the brain.
292
770574
2675
Svetla su ugašena
u ovim delovima mozga.
u ovim delovima mozga.
13:05
We then put in the DBS electrodes and we wait for a month
293
773249
2954
Ugradili smo DBS elekrode
i čekali mesec dana
i čekali mesec dana
13:08
or a year, and the areas in red
294
776203
1391
ili godinu,
i oblasti crvene boje
i oblasti crvene boje
13:09
represent the areas where we increase glucose utilization.
295
777594
3307
pokazuju gde se povećala
potrošnja glukoze.
potrošnja glukoze.
13:12
And indeed, we are able to get these areas of the brain
296
780901
2120
I zaista smo uspeli da nateramo
ove oblasti mozga
ove oblasti mozga
13:15
that were not using glucose to use glucose once again.
297
783021
3514
koje nisu koristile glukozu
da počnu ponovo to da rade.
da počnu ponovo to da rade.
13:18
So the message here is that, in Alzheimer's disease,
298
786535
2352
Dakle zaključak je ovde da su
u slučaju Alchajmerove bolesti
u slučaju Alchajmerove bolesti
13:20
the lights are out, but there is someone home,
299
788887
2329
svetla ugašena,
ali kući još uvek nekog ima
ali kući još uvek nekog ima
13:23
and we're able to turn the power back on
300
791216
2149
i možemo struju da vratimo
13:25
to these areas of the brain, and as we do so,
301
793365
2306
u ove delove mozga,
i kako to radimo
i kako to radimo
13:27
we expect that their functions will return.
302
795671
2936
očekujemo da će se vratiti
i funkcija tih delova.
i funkcija tih delova.
13:30
So this is now in clinical trials.
303
798607
2127
Ovo je sada
na kliničkom ispitivanju.
na kliničkom ispitivanju.
13:32
We are going to operate on 50 patients
304
800734
1901
Operisaćemo 50 pacijenata
13:34
with early Alzheimer's disease
305
802635
1978
sa ranom Alchajmerovom bolešću
13:36
to see whether this is safe and effective,
306
804613
2057
da proverimo da li je
bezbedno i efikasno,
bezbedno i efikasno,
13:38
whether we can improve their neurologic function.
307
806670
2979
da li možemo da poboljšamo
neurološku funkciju.
neurološku funkciju.
13:41
(Applause)
308
809649
7480
(Aplauz)
13:49
So the message I want to leave you with today is that,
309
817129
2948
Poruka sa kojom
vas danas ostavljam je
vas danas ostavljam je
13:52
indeed, there are several circuits in the brain
310
820077
2604
da postoje neke oblasti mozga
13:54
that are malfunctioning across various disease states,
311
822681
3926
koje ne funkcionišu dobro
kroz razna stanja bolesti,
kroz razna stanja bolesti,
13:58
whether we're talking about Parkinson's disease,
312
826607
2208
bilo da se radi
o Parkinsonovoj bolesti,
o Parkinsonovoj bolesti,
14:00
depression, schizophrenia, Alzheimer's.
313
828815
3082
depresiji, šizofreniji,
Alchajmerovoj.
Alchajmerovoj.
14:03
We are now learning to understand what are the circuits,
314
831897
3030
Sada učimo kako da razumemo
šta su kola,
šta su kola,
14:06
what are the areas of the brain that are responsible for
315
834927
2202
koji su delovi mozga odgovorni
14:09
the clinical signs and the symptoms of those diseases.
316
837129
2520
za kliničke znake
i simptome ovih bolesti.
i simptome ovih bolesti.
14:11
We can now reach those circuits.
317
839649
2306
Sada možemo dopreti
do tih kola.
do tih kola.
14:13
We can introduce electrodes within those circuits.
318
841955
2632
Možemo ugraditi elektrode
u ta kola.
u ta kola.
14:16
We can graduate the activity of those circuits.
319
844587
2982
Možemo beležiti aktivnost tih kola.
14:19
We can turn them down if they are overactive,
320
847569
3252
Možemo im smanjiti aktivnost
ako su preaktivna,
ako su preaktivna,
14:22
if they're causing trouble, trouble that is felt throughout the brain,
321
850821
2957
ako uzrokuju probleme koji
se osećaju svuda po mozgu.
se osećaju svuda po mozgu.
14:25
or we can turn them up if they are underperforming,
322
853778
2581
ili im povećati aktivnost
ako nisu dovoljno aktivna,
ako nisu dovoljno aktivna,
14:28
and in so doing, we think that we may be able to help
323
856359
2393
i tako možemo pomoći
14:30
the overall function of the brain.
324
858752
2340
celokupnom radu mozga.
14:33
The implications of this, of course, is that we may be able
325
861092
2554
Posledica ovoga je, naravno,
da smo u mogućnosti
da smo u mogućnosti
14:35
to modify the symptoms of the disease,
326
863646
2310
da modifikujemo simptome bolesti,
14:37
but I haven't told you but there's also some evidence
327
865956
1909
ali nisam vam još rekao
da postoje i naznake
da postoje i naznake
14:39
that we might be able to help the repair of damaged areas of the brain using electricity,
328
867865
4163
mogućnosti popravke oštećenih delova mozga
korišćenjem elektriciteta
korišćenjem elektriciteta
14:44
and this is something for the future, to see if, indeed,
329
872028
2452
i to je nešto što ostaje
da se u budućnosti vidi,
da se u budućnosti vidi,
14:46
we not only change the activity but also
330
874480
2239
da li možemo
ne samo menjati aktivnost
ne samo menjati aktivnost
14:48
some of the reparative functions of the brain
331
876719
2014
već i uvesti neke
14:50
can be harvested.
332
878733
1555
regenerativne funkcije mozga.
14:52
So I envision that we're going to see a great expansion
333
880288
3047
Predviđam da ćemo videti
veliki pomak
veliki pomak
14:55
of indications of this technique.
334
883335
2452
u indikaciji ove tehnike.
14:57
We're going to see electrodes being placed for many disorders of the brain.
335
885787
2779
Videćemo kako će elektrode biti postavljane
za mnoge poremećaje mozga.
za mnoge poremećaje mozga.
15:00
One of the most exciting things about this is that, indeed,
336
888566
2959
Jedna od najzanimljivijih stvari
u vezi sa ovim
u vezi sa ovim
15:03
it involves multidisciplinary work.
337
891525
1847
je to što uključuje multidisciplinarni rad.
15:05
It involves the work of engineers, of imaging scientists,
338
893372
2802
Uključuje rad inženjera, naučnika optike,
15:08
of basic scientists, of neurologists,
339
896174
2202
naučnika, neurologa,
15:10
psychiatrists, neurosurgeons, and certainly at the interface
340
898376
2752
psihijatara, neurohirurga,
i naravno interakciju
i naravno interakciju
15:13
of these multiple disciplines that there's the excitement.
341
901128
2941
ovih nekoliko disciplina
zbog čega je uzbudljivo.
zbog čega je uzbudljivo.
15:16
And I think that we will see that
342
904069
2757
Mislim da ćemo videti
15:18
we will be able to chase more of these evil spirits
343
906826
3436
da ćemo moći da teramo
više ovih zloduha
više ovih zloduha
15:22
out from the brain as time goes on,
344
910262
1896
iz mozga tokom vremena
15:24
and the consequence of that, of course, will be
345
912158
1902
i da će posledica toga, naravno
15:26
that we will be able to help many more patients.
346
914060
2272
biti to da ćemo moći
da pomognemo većem broju pacijenata.
da pomognemo većem broju pacijenata.
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