TEDxCaltech
Andres Lozano: Parkinson's, depression and the switch that might turn them off
安德烈斯 洛萨诺: 帕金森氏综合症、抑郁症和关闭它们的开关
Filmed:
Readability: 4.3
1,477,742 views
大脑深部电击术变得相当精准。借由这项科技，外科医生几乎能将电极置入大脑的任何区域,像电台或恒温器的调节旋钮一项,增强或减弱回路信号。一位罹患帕金森氏综合症的妇女，在电击后立即停止肢体抖动，以及老年痴呆症患者脑部功能恢复，我们看到这项科技带来的巨大改变。（摄于：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
演讲开始之前我想先说明一件事，
00:14
is that not all neurosurgeons wear cowboy boots.
1
2717
3030
那就是并不是所有的精神科医生都穿马丁靴。
00:17
I just wanted you to know that.
2
5747
2179
就是想让你们知道而已。
00:19
So I am indeed a neurosurgeon,
3
7926
2409
所以我确实是一位神经外科医生，
00:22
and I follow a long tradition of neurosurgery,
4
10335
3927
而我从事的神经外科学历史也十分悠久，
00:26
and what I'm going to tell you about today
5
14262
1593
今天我要和大家说的是
00:27
is adjusting the dials in the circuits in the brain,
6
15855
2318
现在神经外科学让我们能够到达人脑中的任意位置，
00:30
being able to go anywhere in the brain
7
18173
1955
将任意部分激活或休眠，
00:32
and turning areas of the brain up or down
8
20128
2419
并以此来调整在大脑回路中的“调节控制器”，
00:34
to help our patients.
9
22547
2212
最终达到治疗的目的。
00:36
So as I said, neurosurgery comes from a long tradition.
10
24759
2950
我刚刚讲过，神经外科学由来已久，
00:39
It's been around for about 7,000 years.
11
27709
3552
大约在7000年前就已经兴起了。
00:43
In Mesoamerica, there used to be neurosurgery,
12
31261
3725
在中美洲文化发源的地方，神经外科学就有所发展，
00:46
and there were these neurosurgeons that used to treat patients.
13
34986
3768
那时就有治疗病痛的神经外科医生。
00:50
And they were trying to -- they knew that the brain was involved
14
38754
3911
那些医生想要——他们知道
00:54
in neurological and psychiatric disease.
15
42680
2352
神经系统疾病和精神病都与大脑有关。
00:57
They didn't know exactly what they were doing.
16
45032
2161
他们并不完全知道自己在做什么。
00:59
Not much has changed, by the way. (Laughter)
17
47193
2814
其实现在状况也没有多大变化。（笑声）
01:02
But they thought that,
18
50007
1873
但他们觉得，
01:03
if you had a neurologic or psychiatric disease,
19
51880
2003
如果你患有神经系统或者精神方面的疾病，
01:05
it must be because you are possessed
20
53883
2591
那一定是因为
01:08
by an evil spirit.
21
56474
2352
你被邪神控制住了。
01:10
So if you are possessed by an evil spirit
22
58826
1969
所以，如果你因为被邪神所控
01:12
causing neurologic or psychiatric problems,
23
60795
2820
患上了神经系统或者精神方面的疾病，
01:15
then the way to treat this is, of course,
24
63615
2021
那治疗的方法当然就是
01:17
to make a hole in your skull and let the evil spirit escape.
25
65636
5683
在你的脑壳上打一个孔，把邪神放出来。
01:23
So this was the thinking back then,
26
71319
1378
所以，这就是过去的理解方式
01:24
and these individuals made these holes.
27
72697
4144
他们在病人的脑壳上打洞。
01:28
Sometimes the patients were a little bit reluctant
28
76841
2983
有时候病人会有点不情愿接受打洞
01:31
to go through this because, you can tell that
29
79824
2415
因为你可以看得出来
01:34
the holes are made partially and then, I think,
30
82239
2451
洞并没有完全打完。
01:36
there was some trepanation, and then they left very quickly
31
84690
2015
我觉得当时的医生可能在脑壳上钻了几，下病人就飞快逃走了
01:38
and it was only a partial hole,
32
86705
1901
所以洞并没有完全打好，
01:40
and we know they survived these procedures.
33
88606
2316
但我们知道病人还是都活了下来。
01:42
But this was common.
34
90922
1208
但这样的开颅手术在那时是很常见的。
01:44
There were some sites where one percent
35
92130
1266
在一处遗址所发掘出的头骨中
01:45
of all the skulls have these holes, and so you can see
36
93396
2725
大约有百分之一有这样的洞，
01:48
that neurologic and psychiatric disease is quite common,
37
96121
3194
所以神经系统和精神疾病是很普遍的，
01:51
and it was also quite common about 7,000 years ago.
38
99315
4433
在7000年前也是一样的。
01:55
Now, in the course of time,
39
103748
2153
到了目前，随着时间的推移，
01:57
we've come to realize that
40
105901
2220
我们逐渐认识到
02:00
different parts of the brain do different things.
41
108121
2258
大脑的不同区域有不同功能。
02:02
So there are areas of the brain that are dedicated
42
110379
1187
有特定的区域
02:03
to controlling your movement or your vision
43
111566
2693
用来控制你的运动或者视野
02:06
or your memory or your appetite, and so on.
44
114259
2949
或者记忆力或者你的食欲等。
02:09
And when things work well, then the nervous system
45
117208
2734
如果一切正常，神经系统
02:11
works well, and everything functions.
46
119942
1669
也就正常，每个功能也就正常。
02:13
But once in a while, things don't go so well,
47
121611
2247
但偶尔也会出现问题，
02:15
and there's trouble in these circuits,
48
123858
2542
回路会出现故障，
02:18
and there are some rogue neurons that are misfiring
49
126400
2704
一些异常的神经细胞就就会失效，造成问题，
02:21
and causing trouble, or sometimes they're underactive
50
129104
3179
或者有的时候，神经细胞不够活跃，
02:24
and they're not quite working as they should.
51
132283
2544
没有达到预期功能，
02:26
Now, the manifestation of this
52
134827
2137
出现这样的症状
02:28
depends on where in the brain these neurons are.
53
136964
2484
与大脑的神经细胞所在的位置有关。
02:31
So when these neurons are in the motor circuit,
54
139448
2422
当神经细胞在驱动回路时，
02:33
you get dysfunction in the movement system,
55
141870
2412
运动系统就不能正常工作，
02:36
and you get things like Parkinson's disease.
56
144282
2166
会产生类似于帕金森氏综合症一样的疾病，
02:38
When the malfunction is in a circuit that regulates your mood,
57
146448
3296
当负责情绪的回路出现问题时，
02:41
you get things like depression,
58
149744
2284
会产生像抑郁症一样的疾病，
02:44
and when it is in a circuit that controls your memory and cognitive function,
59
152028
3824
当负责记忆和认知功能的回路出现故障时，
02:47
then you get things like Alzheimer's disease.
60
155852
2521
会产生像阿兹海默症一样的疾病。
02:50
So what we've been able to do is to pinpoint
61
158373
2723
因而我们能做的就是定位
02:53
where these disturbances are in the brain,
62
161096
2307
大脑中的异常区域，
02:55
and we've been able to intervene within these circuits
63
163403
3037
并且介入大脑中的这些回路
02:58
in the brain to either turn them up or turn them down.
64
166440
3656
或调整回路中信号的强弱。
03:02
So this is very much like choosing the correct station
65
170096
2284
就像使用收音机的调台旋钮，
03:04
on the radio dial.
66
172380
1975
选择想听的频道。
03:06
Once you choose the right station, whether it be jazz or opera,
67
174355
2649
一旦选择了，无论是爵士或者歌剧，
03:09
in our case whether it be movement or mood,
68
177004
2333
就像选择运动神经或情绪神经，
03:11
we can put the dial there,
69
179337
1966
我们就把调节器的旋钮放在那儿，
03:13
and then we can use a second button to adjust the volume,
70
181303
2771
然后用另一个旋钮来调整音量，
03:16
to turn it up or turn it down.
71
184074
2009
调高或者调低。
03:18
So what I'm going to tell you about
72
186083
1228
所以，我要说的是
03:19
is using the circuitry of the brain to implant electrodes
73
187311
4058
借由植入大脑回路中的电极
03:23
and turning areas of the brain up and down
74
191369
2468
来调整大脑中某些区域的信号强弱
03:25
to see if we can help our patients.
75
193837
1704
来看我们是否能帮助病人。
03:27
And this is accomplished using this kind of device,
76
195541
2333
使用这种装置就能完成，
03:29
and this is called deep brain stimulation.
77
197874
2461
这被称为大脑深部电击术。
03:32
So what we're doing is placing these electrodes throughout the brain.
78
200335
3071
我们将电极置入大脑的各个区域
03:35
Again, we are making holes in the skull about the size of a dime,
79
203406
3949
同样，在脑壳上打个硬币大小的洞，
03:39
putting an electrode in, and then this electrode
80
207355
2151
置入电极
03:41
is completely underneath the skin
81
209506
2228
使其完全在皮肤下
03:43
down to a pacemaker in the chest,
82
211734
2090
就像是胸腔内的心律调节器，
03:45
and with a remote control very much like a television remote control,
83
213824
4528
就像电视机的遥控器一样
03:50
we can adjust how much electricity we deliver
84
218352
2979
我们能够调整电流强度
03:53
to these areas of the brain.
85
221331
2068
以及刺激相应的脑部区域。
03:55
We can turn it up or down, on or off.
86
223399
2891
我们可以调强，调弱，开关。
03:58
Now, about a hundred thousand patients in the world
87
226290
2655
现在，全球约有10万病人
04:00
have received deep brain stimulation,
88
228945
1876
已接受了大脑深部电击术，
04:02
and I'm going to show you some examples
89
230821
1154
接下来我将给大家你们展示几个案列
04:03
of using deep brain stimulation to treat disorders of movement,
90
231975
2711
通过大脑深部电击术来治疗运动失调,
04:06
disorders of mood and disorders of cognition.
91
234686
4514
情绪失调和认知失调。
04:11
So this looks something like this when it's in the brain.
92
239200
2739
它在脑中看起来就像这样。
04:13
You see the electrode going through the skull into the brain
93
241939
2235
你可以看到电极穿过脑壳进入脑部
04:16
and resting there, and we can place this really anywhere in the brain.
94
244174
3183
停留在那里，我们可以把它放到大脑的任何位置。
04:19
I tell my friends that no neuron is safe
95
247357
2460
我告诉我的朋友，没有任何神经细胞，
04:21
from a neurosurgeon, because we can really reach
96
249817
2182
是神经外科医生碰不到的，我们现在可以
04:23
just about anywhere in the brain quite safely now.
97
251999
2566
安全的对大脑任何部位做手术了。
04:26
Now the first example I'm going to show you is a patient
98
254565
2520
我要给大家展示的第一个案列
04:29
with Parkinson's disease,
99
257085
1710
是位帕金森氏综合症的病人。
04:30
and this lady has Parkinson's disease,
100
258795
1987
这位女士患有帕金森氏综合症，
04:32
and she has these electrodes in her brain,
101
260782
2310
她的脑部有这些电极，
04:35
and I'm going to show you what she's like
102
263092
1282
我要给你们展示的是
04:36
when the electrodes are turned off and she has her Parkinson's symptoms,
103
264374
3507
当电源关闭时，她的帕金森病症表现，
04:39
and then we're going to turn it on.
104
267881
2333
然后我们打开电源。
04:42
So this looks something like this.
105
270214
2695
就会变成这样。
04:44
The electrodes are turned off now, and you can see that she has tremor.
106
272909
4505
现在电源关闭了，你们看到，她在颤抖。
04:49
(Video) Man: Okay. Woman: I can't. Man: Can you try to touch my finger?
107
277420
3719
（视频）男：好的。女：我做不到。男：你能试着碰下我的手指吗？
04:53
(Video) Man: That's a little better. Woman: That side is better.
108
281139
3625
（视频）男：有好一点。女：那边比较好。
04:56
We're now going to turn it on.
109
284764
3792
现在要把电源打开。
05:00
It's on. Just turned it on.
110
288556
4438
打开了。
05:06
And this works like that, instantly.
111
294561
3263
只要打开，就立即见效。
05:09
And the difference between shaking in this way and not --
112
297824
2982
抖动和稳定的区别
05:12
(Applause)
113
300806
4601
（掌声）
05:17
The difference between shaking in this way and not is related to the misbehavior
114
305407
4105
抖动和稳定的区别
05:21
of 25,000 neurons in her subthalamic nucleus.
115
309512
3973
和她的丘脑下核的25000个神经细胞有关。
05:25
So we now know how to find these troublemakers
116
313485
2576
我们已知道怎么找出这些问题细胞
05:28
and tell them, "Gentlemen, that's enough.
117
316061
1391
并告诉它们“嘿，玩够了。
05:29
We want you to stop doing that."
118
317452
1334
我们想让你们停止。”
05:30
And we do that with electricity.
119
318786
1222
我们可以用电流。
05:32
So we use electricity to dictate how they fire,
120
320008
3414
所以我们想使用电流来控制神经细胞的反应，
05:35
and we try to block their misbehavior using electricity.
121
323422
3462
并且通过电流阻断异常行为。
05:38
So in this case, we are suppressing the activity of abnormal neurons.
122
326884
3444
此例是抑制不正常细胞的反应。
05:42
We started using this technique in other problems,
123
330328
2562
我们将这种技术用在其他问题上，
05:44
and I'm going to tell you about a fascinating problem
124
332890
1402
下面是我们遇到的一个很棒问题的案例，
05:46
that we encountered, a case of dystonia.
125
334292
3168
称为肌张力障碍。
05:49
So dystonia is a disorder affecting children.
126
337460
2505
肌张力障碍是影响儿童的病变，
05:51
It's a genetic disorder, and it involves a twisting motion,
127
339965
3062
它是遗传疾病，会有扭曲的动作，
05:55
and these children get progressively more and more twisting
128
343027
2824
这些儿童会越来越扭曲
05:57
until they can't breathe, until they get sores,
129
345851
1991
直到不能呼吸，直到觉得病痛，
05:59
urinary infections, and then they die.
130
347842
2031
泌尿系统感染，最终走向死亡。
06:01
So back in 1997, I was asked to see this young boy,
131
349873
3373
回到1997年，我应要求去看望这个小男孩，
06:05
perfectly normal. He has this genetic form of dystonia.
132
353246
2956
他看起来很正常，但他有肌张力障碍的基因。
06:08
There are eight children in the family.
133
356202
2219
一家有8个孩子，
06:10
Five of them have dystonia.
134
358421
3359
5个有肌张力障碍。
06:13
So here he is.
135
361780
2185
这就是他。
06:15
This boy is nine years old, perfectly normal until the age six,
136
363965
4186
这个男孩9岁，6岁前完全正常，
06:20
and then he started twisting his body, first the right foot,
137
368151
4395
然后他身体开始扭曲，先是右腿，
06:24
then the left foot, then the right arm, then the left arm,
138
372546
3420
然后是左腿、右臂、左臂，
06:27
then the trunk, and then by the time he arrived,
139
375966
3247
然后是躯干，等他来的时候，
06:31
within the course of one or two years of the disease onset,
140
379213
2940
距离病发有1～2年的时间，
06:34
he could no longer walk, he could no longer stand.
141
382153
2320
他已经不能行走和站立。
06:36
He was crippled, and indeed the natural progression
142
384473
2698
他的腿跛了，事实上随着病情恶化，
06:39
as this gets worse is for them to become progressively twisted,
143
387171
3555
肢体扭曲的情形会加重，
06:42
progressively disabled, and many of these children do not survive.
144
390726
5690
残障日益加重，许多孩子无法存活。
06:48
So he is one of five kids.
145
396416
2028
他是五个孩子之一。
06:50
The only way he could get around was crawling on his belly like this.
146
398444
4094
他想行动时，只能趴在地上爬行。
06:54
He did not respond to any drugs.
147
402538
1956
药物已不起任何作用。
06:56
We did not know what to do with this boy.
148
404494
1940
我们对他的病症无计可施。
06:58
We did not know what operation to do,
149
406434
2116
我们不知道，
07:00
where to go in the brain,
150
408550
2194
该对他脑部的哪个区域进行什么手术，
07:02
but on the basis of our results in Parkinson's disease,
151
410744
2773
但从帕金森氏综合症的的经验，
07:05
we reasoned, why don't we try to suppress
152
413517
2005
我们推论，何不尝试抑制
07:07
the same area in the brain that we suppressed
153
415522
3097
造成帕金森氏综合症的同一区域，
07:10
in Parkinson's disease, and let's see what happens?
154
418619
3655
看看会发生什么？
07:14
So here he was. We operated on him
155
422274
1787
于是我们对他进行了手术
07:16
hoping that he would get better. We did not know.
156
424061
3874
希望他能好转。我们当时没有把握。
07:19
So here he is now, back in Israel where he lives,
157
427935
4127
这是现在的他，回到了以色列的家，
07:24
three months after the procedure, and here he is.
158
432062
4053
这是他手术过后3个月的样子。
07:28
(Applause)
159
436115
4950
（掌声）
07:36
On the basis of this result, this is now a procedure
160
444669
2621
借由这次经验，这项手术
07:39
that's done throughout the world,
161
447290
1248
已在全世界施行，
07:40
and there have been hundreds of children
162
448538
1295
已有数百名儿童
07:41
that have been helped with this kind of surgery.
163
449833
4207
受惠于这项手术。
07:46
This boy is now in university
164
454040
2117
这个男孩现在已上大学
07:48
and leads quite a normal life.
165
456157
2036
过着正常的生活。
07:50
This has been one of the most satisfying cases
166
458193
2368
这是我从医多年来
07:52
that I have ever done in my entire career,
167
460561
1979
最满意的一个案例。
07:54
to restore movement and walking to this kind of child.
168
462540
3377
使这类病童恢复运动和行走能力。
07:57
(Applause)
169
465917
6255
（掌声）
08:04
We realized that perhaps we could use this technology
170
472172
2869
我们认识到也许这项科技
08:07
not only in circuits that control your movement
171
475041
2172
不仅可以控制运动
08:09
but also circuits that control other things,
172
477213
1952
还能控制于其他方面，
08:11
and the next thing that we took on
173
479165
1147
我们研究的下一个课题
08:12
was circuits that control your mood.
174
480312
2993
是控制情绪的回路。
08:15
And we decided to take on depression,
175
483305
2076
我们决定治疗抑郁症，
08:17
and the reason we took on depression is because it's so prevalent,
176
485381
2259
我们之所以选择它是因为它很普遍，
08:19
and as you know, there are many treatments for depression,
177
487640
2544
而且你们也知道，治疗抑郁症的方法有多种，
08:22
with medication and psychotherapy,
178
490184
2037
有药物治疗和心理治疗，
08:24
even electroconvulsive therapy,
179
492221
2062
甚至有电休克疗法，
08:26
but there are millions of people,
180
494283
1334
但在数百万人中，
08:27
and there are still 10 or 20 percent of patients with depression
181
495617
2792
仍然有百分之十到二十的患者
08:30
that do not respond, and it is these patients that we want to help.
182
498409
3252
无法治愈，就是这些患者需要我们的帮助。
08:33
And let's see if we can use this technique
183
501661
2103
让我们来看看这项科技
08:35
to help these patients with depression.
184
503764
2239
能否改善抑郁症患者的病情。
08:38
So the first thing we did was, we compared,
185
506003
1850
我们做的第一件事情是，比较
08:39
what's different in the brain of someone with depression
186
507853
1824
抑郁症患者的脑部
08:41
and someone who is normal,
187
509677
1668
和正常人脑部的不同之处，
08:43
and what we did was PET scans to look at the blood flow of the brain,
188
511345
3460
我们通过正电子发射层析扫描来查看脑部血流的流向，
08:46
and what we noticed is that in patients with depression
189
514805
2369
我们注意到抑郁症患者
08:49
compared to normals,
190
517174
2045
与正常人相比较，
08:51
areas of the brain are shut down,
191
519219
1498
脑部某些地方停工了，
08:52
and those are the areas in blue.
192
520717
1265
这些地方呈现蓝色。
08:53
So here you really have the blues,
193
521982
1620
所以你就感到抑郁了，
08:55
and the areas in blue are areas that are involved
194
523602
3573
这些蓝色区域和
08:59
in motivation, in drive and decision-making,
195
527175
2656
动机，驱动力和决策有关，
09:01
and indeed, if you're severely depressed as these patients were,
196
529831
2495
如果你的抑郁和这些病人一样严重，
09:04
those are impaired. You lack motivation and drive.
197
532326
2692
你会缺乏动机和驱动力。
09:07
The other thing we discovered
198
535018
1879
我们发现的另一件事是
09:08
was an area that was overactive, area 25,
199
536897
2489
有个区域过于活跃，
09:11
seen there in red,
200
539386
1588
就是呈现红色的25号区域，
09:12
and area 25 is the sadness center of the brain.
201
540974
2657
25号区域是大脑的悲伤中心。
09:15
If I make any of you sad, for example, I make you remember
202
543631
2873
如果我让你悲伤，比如，我让你回想起
09:18
the last time you saw your parent before they died
203
546504
2287
亲人或朋友
09:20
or a friend before they died,
204
548791
1633
去世前的最后一面，
09:22
this area of the brain lights up.
205
550424
1206
脑部的这个区域就会启动。
09:23
It is the sadness center of the brain.
206
551630
1723
这是大脑的悲伤中心。
09:25
And so patients with depression have hyperactivity.
207
553353
3212
抑郁症患者发病时，
09:28
The area of the brain for sadness is on red hot.
208
556565
2178
大脑的悲伤中心运作到最高峰。
09:30
The thermostat is set at 100 degrees,
209
558743
2657
好像调节器的温度被设定在100度，
09:33
and the other areas of the brain, involved in drive and motivation, are shut down.
210
561400
3128
动机和驱动力等区域完全停工。
09:36
So we wondered, can we place electrodes in this area of sadness
211
564528
2997
我们想，如果把电极置于悲伤中心，
09:39
and see if we can turn down the thermostat,
212
567525
2429
降低温度，
09:41
can we turn down the activity,
213
569954
1713
以降低这个区域的活跃性，
09:43
and what will be the consequence of that?
214
571667
2122
结果又会是怎样的呢？
09:45
So we went ahead and implanted electrodes in patients with depression.
215
573789
3127
我们将电极植入抑郁症患者的脑部。
09:48
This is work done with my colleague Helen Mayberg from Emory.
216
576916
2487
我和在Emory大学的同事Helen Mayberg一起合作。
09:51
And we placed electrodes in area 25,
217
579403
1934
我们将电极置入25号区域，
09:53
and in the top scan you see before the operation,
218
581337
2285
最上面那张是手术前扫描
09:55
area 25, the sadness area is red hot,
219
583622
2286
的25号区域，即悲伤中心，呈现红色，
09:57
and the frontal lobes are shut down in blue,
220
585908
2394
脑前额叶部完全停工，呈现蓝色，
10:00
and then, after three months of continuous stimulation,
221
588302
2408
每天24小时连续刺激，连续3个月，
10:02
24 hours a day, or six months of continuous stimulation,
222
590710
3015
6个月后
10:05
we have a complete reversal of this.
223
593725
1774
情况完全逆转。
10:07
We're able to drive down area 25,
224
595499
2839
25号区域的活跃程度，
10:10
down to a more normal level,
225
598338
1952
已降低到正常水准，
10:12
and we're able to turn back online
226
600290
2036
脑前额叶，
10:14
the frontal lobes of the brain,
227
602326
1308
则重新上线，
10:15
and indeed we're seeing very striking results
228
603634
1869
我们从这些重度抑郁症患者的身上
10:17
in these patients with severe depression.
229
605503
2747
看到了惊人的结果。
10:20
So now we are in clinical trials, and are in Phase III clinical trials,
230
608250
2902
我们正进行3期临床试验，
10:23
and this may become a new procedure,
231
611152
2543
这有可能成为新的治疗方式，
10:25
if it's safe and we find that it's effective,
232
613695
2183
只要证实是否能安全，有效的
10:27
to treat patients with severe depression.
233
615878
3674
治疗重度抑郁症患者。
10:31
I've shown you that we can use deep brain stimulation
234
619567
2960
刚才向大家展示的是使用大脑深部刺激电击术
10:34
to treat the motor system
235
622527
2087
治疗动力系统的相关疾病
10:36
in cases of Parkinson's disease and dystonia.
236
624614
2446
比如帕金森氏综合症和肌张力障碍。
10:39
I've shown you that we can use it to treat a mood circuit
237
627060
2385
大家看到了它能够治疗情绪回路的疾病，
10:41
in cases of depression.
238
629445
1650
比如抑郁症。
10:43
Can we use deep brain stimulation to make you smarter?
239
631095
4545
那能否用大脑深部电击术让你变得更聪明呢？
10:47
(Laughter)
240
635640
2096
（笑声）
10:49
Anybody interested in that?
241
637736
2566
有人有兴趣吗？
10:52
(Applause)
242
640302
2300
（掌声）
10:54
Of course we can, right?
243
642602
2988
当然可以对吧？
10:57
So what we've decided to do is
244
645590
2214
我们决定
10:59
we're going to try to turbocharge
245
647804
2421
要试着
11:02
the memory circuits in the brain.
246
650225
2205
给大脑中的记忆回路充电。
11:04
We're going to place electrodes within the circuits
247
652430
2736
将电极置入
11:07
that regulate your memory and cognitive function
248
655166
2676
控制记忆和认知的回路，
11:09
to see if we can turn up their activity.
249
657842
3270
来看能够增强它们的活跃性。
11:13
Now we're not going to do this in normal people.
250
661112
1938
我们不会拿正常人做实验。
11:15
We're going to do this in people that have cognitive deficits,
251
663050
3652
而是用在有认知缺陷的患者身上，
11:18
and we've chosen to treat patients with Alzheimer's disease
252
666702
3459
我们尝试治疗老年痴呆症
11:22
who have cognitive and memory deficits.
253
670161
2107
他们的认知和记忆有缺陷。
11:24
As you know, this is the main symptom
254
672268
1939
如各位所知，这是
11:26
of early onset Alzheimer's disease.
255
674207
2423
早期老年痴呆症的主要症状。
11:28
So we've placed electrodes within this circuit
256
676630
2194
我们放置电极的位置
11:30
in an area of the brain called the fornix,
257
678824
1995
称为穹窿，
11:32
which is the highway in and out of this memory circuit,
258
680819
2778
它是进出记忆回路的高速公路，
11:35
with the idea to see if we can turn on this memory circuit,
259
683597
3428
看看是否能够开启记忆回路，
11:39
and whether that can, in turn, help these patients
260
687025
3249
进而是否可以帮助
11:42
with Alzheimer's disease.
261
690274
2309
老年痴呆症的患者。
11:44
Now it turns out that in Alzheimer's disease,
262
692583
2318
结果发现老年痴呆症患者的脑部，
11:46
there's a huge deficit in glucose utilization in the brain.
263
694901
4072
对葡萄糖的利用有严重的缺陷。
11:50
The brain is a bit of a hog when it comes to using glucose.
264
698973
3418
脑部是大量消耗葡萄糖的地方。
11:54
It uses 20 percent of all your --
265
702391
1760
尽管只占体重的百分之二
11:56
even though it only weighs two percent --
266
704151
1515
却消耗人体总量的百分之二十
11:57
it uses 10 times more glucose than it should based on its weight.
267
705666
3145
脑部葡萄糖的消耗量是其本身质量的10倍
12:00
Twenty percent of all the glucose in your body is used by the brain,
268
708811
2583
人体总量百分之二十的葡萄糖用在脑部，
12:03
and as you go from being normal
269
711394
2430
从正常的脑部
12:05
to having mild cognitive impairment,
270
713824
2193
到轻微的认知损伤，
12:08
which is a precursor for Alzheimer's, all the way to Alzheimer's disease,
271
716017
2455
再发展成为老年痴呆症，
12:10
then there are areas of the brain that stop using glucose.
272
718472
2689
脑部有些区域停止利用葡萄糖。
12:13
They shut down. They turn off.
273
721161
2295
停工了。关机了。
12:15
And indeed, what we see is that these areas in red
274
723456
2282
事实上，我们可以看到
12:17
around the outside ribbon of the brain
275
725738
1767
脑中央带状区的外圈
12:19
are progressively getting more and more blue
276
727505
2276
由红色逐渐变蓝
12:21
until they shut down completely.
277
729781
3172
直到完全停工。
12:24
This is analogous to having a power failure
278
732953
2359
好像是大脑停电了
12:27
in an area of the brain, a regional power failure.
279
735312
2543
形成区域性供电异常。
12:29
So the lights are out in parts of the brain
280
737855
2397
老年痴呆症的患者的部分大脑，
12:32
in patients with Alzheimer's disease,
281
740252
2598
好像因停工而陷入异常，
12:34
and the question is, are the lights out forever,
282
742850
2409
问题是，电力中断是永久性的呢，
12:37
or can we turn the lights back on?
283
745259
2861
还是我们有办法恢复？
12:40
Can we get those areas of the brain to use glucose once again?
284
748120
3236
可以让这些区域再利用葡萄糖吗？
12:43
So this is what we did. We implanted electrodes in the fornix
285
751356
2550
我们把电极植入穹窿
12:45
of patients with Alzheimer's disease, we turned it on,
286
753906
2613
以激活老年痴呆症患者的这一区域，
12:48
and we looked at what happens to glucose use in the brain.
287
756519
3511
并观察大脑利用葡萄糖的情况。
12:52
And indeed, at the top, you'll see before the surgery,
288
760030
3262
上面那张是手术前，
12:55
the areas in blue are the areas that use less glucose than normal,
289
763292
3364
蓝色区域葡萄糖的用量比正常的少，
12:58
predominantly the parietal and temporal lobes.
290
766656
2208
主要是在顶骨和大脑的颞叶。
13:00
These areas of the brain are shut down.
291
768864
1710
大脑的这些区域停工了。
13:02
The lights are out in these areas of the brain.
292
770574
2675
这些区域停电了。
13:05
We then put in the DBS electrodes and we wait for a month
293
773249
2954
我们放入大脑深部电击电极并等待一个月
13:08
or a year, and the areas in red
294
776203
1391
或一年，红色区域
13:09
represent the areas where we increase glucose utilization.
295
777594
3307
代表葡萄糖的利用率在增加。
13:12
And indeed, we are able to get these areas of the brain
296
780901
2120
所以，我们确实可以让大脑中
13:15
that were not using glucose to use glucose once again.
297
783021
3514
本该不使用葡萄糖的区域重新恢复使用。
13:18
So the message here is that, in Alzheimer's disease,
298
786535
2352
结果显示，老年痴呆症的患者，
13:20
the lights are out, but there is someone home,
299
788887
2329
虽然停电了，但仍有人在家
13:23
and we're able to turn the power back on
300
791216
2149
我们可以
13:25
to these areas of the brain, and as we do so,
301
793365
2306
让这些区域的电力恢复，
13:27
we expect that their functions will return.
302
795671
2936
我们预期它们的功能也会恢复。
13:30
So this is now in clinical trials.
303
798607
2127
这正在临床试验阶段，
13:32
We are going to operate on 50 patients
304
800734
1901
我们对50位
13:34
with early Alzheimer's disease
305
802635
1978
早期老年痴呆症患者做了手术，
13:36
to see whether this is safe and effective,
306
804613
2057
确认是否安全有效
13:38
whether we can improve their neurologic function.
307
806670
2979
是否能改善他们神经的功能。
13:41
(Applause)
308
809649
7480
（掌声）
13:49
So the message I want to leave you with today is that,
309
817129
2948
我要传给各位的讯息是，
13:52
indeed, there are several circuits in the brain
310
820077
2604
脑部不同回路的异常
13:54
that are malfunctioning across various disease states,
311
822681
3926
和不同的疾病有关，
13:58
whether we're talking about Parkinson's disease,
312
826607
2208
我们讨论了帕金森氏综合症，
14:00
depression, schizophrenia, Alzheimer's.
313
828815
3082
抑郁症，精神分裂症，老年痴呆症。
14:03
We are now learning to understand what are the circuits,
314
831897
3030
我们现在在学习了解这些回路，
14:06
what are the areas of the brain that are responsible for
315
834927
2202
还有对应的脑部区域
14:09
the clinical signs and the symptoms of those diseases.
316
837129
2520
以及对应的临床症状。
14:11
We can now reach those circuits.
317
839649
2306
我们现在可以碰触这些回路。
14:13
We can introduce electrodes within those circuits.
318
841955
2632
并在其中中放入电极。
14:16
We can graduate the activity of those circuits.
319
844587
2982
我们可以控制它们的活动，
14:19
We can turn them down if they are overactive,
320
847569
3252
如果它们太活跃
14:22
if they're causing trouble, trouble that is felt throughout the brain,
321
850821
2957
引发问题，影响大脑运转，我们可以将它们调低，
14:25
or we can turn them up if they are underperforming,
322
853778
2581
如果它们不太活跃，则可调高，
14:28
and in so doing, we think that we may be able to help
323
856359
2393
我们认为由此可以帮助
14:30
the overall function of the brain.
324
858752
2340
整个大脑的功能。
14:33
The implications of this, of course, is that we may be able
325
861092
2554
这意味着我们能够
14:35
to modify the symptoms of the disease,
326
863646
2310
缓和疾病的症状，
14:37
but I haven't told you but there's also some evidence
327
865956
1909
但我还没有告诉大家，有迹象表明
14:39
that we might be able to help the repair of damaged areas of the brain using electricity,
328
867865
4163
电流可以帮助修复大脑受损区域，
14:44
and this is something for the future, to see if, indeed,
329
872028
2452
这些都是未来的愿景，
14:46
we not only change the activity but also
330
874480
2239
我们不仅可以调整脑部活动，
14:48
some of the reparative functions of the brain
331
876719
2014
还能实现大脑受损功能
14:50
can be harvested.
332
878733
1555
得到修复。
14:52
So I envision that we're going to see a great expansion
333
880288
3047
我预期这项技术在未来
14:55
of indications of this technique.
334
883335
2452
将会得到广泛的应用。
14:57
We're going to see electrodes being placed for many disorders of the brain.
335
885787
2779
我们将看到电极被用于修复多种脑部问题，
15:00
One of the most exciting things about this is that, indeed,
336
888566
2959
而其中最令人振奋的是，
15:03
it involves multidisciplinary work.
337
891525
1847
它还涉及跨领域的合作。
15:05
It involves the work of engineers, of imaging scientists,
338
893372
2802
包括工程师，影像科学家，
15:08
of basic scientists, of neurologists,
339
896174
2202
基础科家学，神经病学家，
15:10
psychiatrists, neurosurgeons, and certainly at the interface
340
898376
2752
精神医师，神经外科医师通力合作，
15:13
of these multiple disciplines that there's the excitement.
341
901128
2941
这样的跨领域合作是最令人兴奋的。
15:16
And I think that we will see that
342
904069
2757
我想将来有一天
15:18
we will be able to chase more of these evil spirits
343
906826
3436
随着时间的推移
15:22
out from the brain as time goes on,
344
910262
1896
越来越多的邪恶将被赶出脑袋，
15:24
and the consequence of that, of course, will be
345
912158
1902
结果当然是，
15:26
that we will be able to help many more patients.
346
914060
2272
更多的病人能够得到救治。
15:28
Thank you very much.
347
916332
1250
非常感谢。
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