ABOUT THE SPEAKER
Andres Lozano - Neurosurgeon
The chair of neurosurgery at the University of Toronto, Andres Lozano has pioneered the use of deep brain stimulation for treating Parkinson’s, depression, anorexia and Alzheimer’s disease.

Why you should listen

Andres Lozano remembers the most satisfying case of his career – helping a boy with a genetic form of dystonia which had twisted his body to the point where he was only able to crawl on his stomach. While he didn’t respond to drugs, he responded wonderfully to deep brain stimulation. Three months after surgery, he was walking like a normal child. He’s now a college student leading a normal life.

Lozano is a pioneer in deep brain stimulation. His team has mapped out areas of the human brain and pioneered novel surgical approaches to treat disorders like Parkinson’s disease, depression, dystonia, anorexia, Huntington’s and Alzheimer’s disease. The chairman of neurosurgery at the University of Toronto, he holds both the R.R. Tasker Chair in Functional Neurosurgery at the Krembil Neuroscience Centre and a Tier 1 Canada Research Chair in Neuroscience.

Lozano has over 400 publications, serves on the board of several international organizations and is a founding member of the scientific advisory board of the Michael J. Fox Foundation. He has received a number of awards including the Olivecrona Medal and the Pioneer in Medicine award, has been elected a Fellow of the Royal Society of Canada and the Canadian Academy of Health Sciences and has received the Order of Spain.

More profile about the speaker
Andres Lozano | Speaker | TED.com
TEDxCaltech

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

安德烈斯洛薩諾 (Andres Lozano): 按個鈕就能解決帕金森氏症和憂鬱症

Filmed:
1,477,742 views

「深層腦部刺激」 (deep brain stimulation) 越來越精準。藉由這項科技,外科醫生能將電極置入腦部,並像選擇電台或調整溫度般,調升或調降訊號以改善病情。從一位罹患帕金森氏症女士,在刺激後立刻停止肢體顫動,到阿茲海默症病人恢復腦部功能,我們看到了這項科技帶來的巨大改變。 攝於:TEDxCaltech
- 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

Double-click the English transcript below to play the video.

00:12
One of the things I want to establish建立 right from the start開始
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演講前我想先澄清一下
00:14
is that not all neurosurgeons神經外科醫生 wear穿 cowboy牛仔 boots靴子.
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不是每位神經外科醫師都穿牛仔靴
(譯注:指已故名醫 Fred Epstein)
00:17
I just wanted you to know that.
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我只是想讓你們知道這點
00:19
So I am indeed確實 a neurosurgeon神經外科醫生,
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我確實是個神經外科醫師
00:22
and I follow跟隨 a long tradition傳統 of neurosurgery神經外科,
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追隨著神經外科手術的悠久傳統
00:26
and what I'm going to tell you about today今天
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今天我要和各位分享
00:27
is adjusting調整 the dials錶盤 in the circuits電路 in the brain,
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如何調整大腦迴路中的旋鈕
00:30
being存在 able能夠 to go anywhere隨地 in the brain
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我們可以深入大腦的每個角落
00:32
and turning車削 areas of the brain up or down
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把該區域的訊號調高或調低
00:34
to help our patients耐心.
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以改善病況
00:36
So as I said, neurosurgery神經外科 comes from a long tradition傳統.
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就像我說的
神經外科手術歷史悠久
00:39
It's been around for about 7,000 years年份.
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7 千年前就已存在
00:43
In Mesoamerica中美洲, there used to be neurosurgery神經外科,
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中美洲曾施行神經外科手術
00:46
and there were these neurosurgeons神經外科醫生 that used to treat對待 patients耐心.
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這圖就是當時為病人動手術的情況
00:50
And they were trying to -- they knew知道 that the brain was involved參與
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他們嘗試這麼做—
00:54
in neurological神經 and psychiatric精神病 disease疾病.
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因為知道腦和神經或精神疾病有關
00:57
They didn't know exactly究竟 what they were doing.
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他們不太確定自己在做什麼
00:59
Not much has changed, by the way. (Laughter笑聲)
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我們現在也差不多 (笑聲)
01:02
But they thought that,
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但他們認為
01:03
if you had a neurologic神經 or psychiatric精神病 disease疾病,
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如果你有神經或精神疾病
01:05
it must必須 be because you are possessed擁有
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你一定是被
01:08
by an evil邪惡 spirit精神.
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惡靈附身
01:10
So if you are possessed擁有 by an evil邪惡 spirit精神
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附在你身上的惡靈
01:12
causing造成 neurologic神經 or psychiatric精神病 problems問題,
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造成了神經或精神疾病
01:15
then the way to treat對待 this is, of course課程,
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治療方式當然就是
01:17
to make a hole in your skull頭骨 and let the evil邪惡 spirit精神 escape逃逸.
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在腦袋上打洞以釋放惡靈
01:23
So this was the thinking思維 back then,
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這是當時的思維
01:24
and these individuals個人 made製作 these holes.
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這些人打了這些洞
01:28
Sometimes有時 the patients耐心 were a little bit reluctant不情願
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有時病人不太願意接受手術
01:31
to go through通過 this because, you can tell that
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你們可以從
01:34
the holes are made製作 partially部分 and then, I think,
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不完整的切口看出
01:36
there was some trepanation環鋸術, and then they left very quickly很快
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有些使用了環鋸術,但草草結束
01:38
and it was only a partial局部 hole,
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留下不完整的洞口
01:40
and we know they survived倖存 these procedures程序.
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我們知道,手術後病人活了下來
01:42
But this was common共同.
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這種手術在當時非常普遍
01:44
There were some sites網站 where one percent百分
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有些地區
01:45
of all the skulls頭骨 have these holes, and so you can see
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約 1% 的人頭骨上有這種洞
01:48
that neurologic神經 and psychiatric精神病 disease疾病 is quite相當 common共同,
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可見當時神經和精神疾病很普遍
01:51
and it was also quite相當 common共同 about 7,000 years年份 ago.
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7000 年前就已如此
01:55
Now, in the course課程 of time,
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順著時間推移
01:57
we've我們已經 come to realize實現 that
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我們逐漸瞭解
02:00
different不同 parts部分 of the brain do different不同 things.
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大腦的不同區域,有不同的功能
02:02
So there are areas of the brain that are dedicated專用
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有特定區域負責
02:03
to controlling控制 your movement運動 or your vision視力
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控制行動、視覺、
02:06
or your memory記憶 or your appetite食慾, and so on.
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以及記憶、胃口等
02:09
And when things work well, then the nervous緊張 system系統
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如果一切正常,神經系統
02:11
works作品 well, and everything functions功能.
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就正常,每個功能也就正常
02:13
But once一旦 in a while, things don't go so well,
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但偶爾會有問題
02:15
and there's trouble麻煩 in these circuits電路,
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迴路出現故障
02:18
and there are some rogue流氓 neurons神經元 that are misfiring啞火
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有些問題神經細胞沒訊號
02:21
and causing造成 trouble麻煩, or sometimes有時 they're underactive減退
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會造成麻煩,有時則是訊號太弱
02:24
and they're not quite相當 working加工 as they should.
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表現不如預期
02:26
Now, the manifestation表現 of this
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至於會造成什麼影響
02:28
depends依靠 on where in the brain these neurons神經元 are.
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則和腦神經細胞所在位置有關
02:31
So when these neurons神經元 are in the motor發動機 circuit電路,
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如果這些神經細胞在運動迴路
02:33
you get dysfunction功能障礙 in the movement運動 system系統,
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運動系統會無法正常運作
02:36
and you get things like Parkinson's帕金森氏 disease疾病.
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因此會得到帕金森氏症之類的疾病
02:38
When the malfunction故障 is in a circuit電路 that regulates調整對象 your mood心情,
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當負責情緒的迴路出現問題時
02:41
you get things like depression蕭條,
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會得到憂鬱症之類的疾病
02:44
and when it is in a circuit電路 that controls控制 your memory記憶 and cognitive認知 function功能,
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當控制記憶與認知的迴路故障時
02:47
then you get things like Alzheimer's老年癡呆症 disease疾病.
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會得到阿茲海默症之類疾病
02:50
So what we've我們已經 been able能夠 to do is to pinpoint查明
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我們能準確定位
02:53
where these disturbances騷亂 are in the brain,
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腦中的異常區域
02:55
and we've我們已經 been able能夠 to intervene干預 within these circuits電路
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並能介入大腦中的這些迴路
02:58
in the brain to either turn them up or turn them down.
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將其訊號調高或調低
03:02
So this is very much like choosing選擇 the correct正確 station
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很像在收音機上
03:04
on the radio無線電 dial撥號.
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先選擇想聽的電台
03:06
Once一旦 you choose選擇 the right station, whether是否 it be jazz爵士樂 or opera歌劇,
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例如選了爵士樂或歌劇電台
03:09
in our case案件 whether是否 it be movement運動 or mood心情,
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對我們來說,則是運動或情緒
03:11
we can put the dial撥號 there,
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我們就可以在那裡放入調節器
03:13
and then we can use a second第二 button按鍵 to adjust調整 the volume,
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再用第二個旋鈕調整音量
03:16
to turn it up or turn it down.
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調高或調低
03:18
So what I'm going to tell you about
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所以我要和你們說的
03:19
is using運用 the circuitry電路 of the brain to implant注入 electrodes電極
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是藉由植入腦中的電極
03:23
and turning車削 areas of the brain up and down
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調整腦部某區域訊號的高低
03:25
to see if we can help our patients耐心.
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來看是否可以改善病況
03:27
And this is accomplished完成 using運用 this kind of device設備,
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這都仰賴一種儀器
03:29
and this is called deep brain stimulation促進.
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我們稱之為「深層腦部刺激」
03:32
So what we're doing is placing配售 these electrodes電極 throughout始終 the brain.
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將電極置入腦部各個區域
03:35
Again, we are making製造 holes in the skull頭骨 about the size尺寸 of a dime十分錢,
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同樣在頭骨打個硬幣大小的洞
03:39
putting an electrode電極 in, and then this electrode電極
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置入電極
03:41
is completely全然 underneath the skin皮膚
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這些電極完全在皮膚底下
03:43
down to a pacemaker起搏器 in the chest胸部,
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像是胸腔內的心律調節器
03:45
and with a remote遠程 control控制 very much like a television電視 remote遠程 control控制,
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遙控器就像電視的遙控器
03:50
we can adjust調整 how much electricity電力 we deliver交付
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我們能調整電流強度
03:53
to these areas of the brain.
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以及刺激的腦部區域
03:55
We can turn it up or down, on or off.
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可以調整強、弱、開、關
03:58
Now, about a hundred thousand patients耐心 in the world世界
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現在全球約有 10 萬個病患
04:00
have received收到 deep brain stimulation促進,
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接受深層腦部刺激
04:02
and I'm going to show顯示 you some examples例子
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接下來要展示一些案例
04:03
of using運用 deep brain stimulation促進 to treat對待 disorders障礙 of movement運動,
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利用深層腦部刺激治療運動失調、
04:06
disorders障礙 of mood心情 and disorders障礙 of cognition認識.
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情緒失調、認知失調
04:11
So this looks容貌 something like this when it's in the brain.
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它在腦中看起來就像這樣
04:13
You see the electrode電極 going through通過 the skull頭骨 into the brain
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你可以看到電極穿過頭骨進入腦部
04:16
and resting休息 there, and we can place地點 this really anywhere隨地 in the brain.
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放置在那裡—可以放到任何地方
04:19
I tell my friends朋友 that no neuron神經元 is safe安全
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我曾和朋友說,沒有任何神經細胞
04:21
from a neurosurgeon神經外科醫生, because we can really reach達到
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是神經外科醫師碰不到的
我們現在可以…
04:23
just about anywhere隨地 in the brain quite相當 safely安然 now.
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安全的對大腦任何部位手術
04:26
Now the first example I'm going to show顯示 you is a patient患者
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我要展示的第一個例子
04:29
with Parkinson's帕金森氏 disease疾病,
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是位帕金森氏症的病患
04:30
and this lady淑女 has Parkinson's帕金森氏 disease疾病,
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這位女士患有帕金森氏症
04:32
and she has these electrodes電極 in her brain,
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而她腦部有這些電極
04:35
and I'm going to show顯示 you what she's like
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若把電源關掉
04:36
when the electrodes電極 are turned轉身 off and she has her Parkinson's帕金森氏 symptoms症狀,
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她就會出現帕金森氏症的症狀
04:39
and then we're going to turn it on.
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然後我們開啟電源
04:42
So this looks容貌 something like this.
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看起來就會像這樣
04:44
The electrodes電極 are turned轉身 off now, and you can see that she has tremor.
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電源關閉,你可以看到她在抖動
04:49
(Video視頻) Man: Okay. Woman女人: I can't. Man: Can you try to touch觸摸 my finger手指?
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(影片)男:好的 女:我做不到
男:請試試看碰我的手指
04:53
(Video視頻) Man: That's a little better. Woman女人: That side is better.
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(影片)男:有好一點
女:這邊表現比較好
04:56
We're now going to turn it on.
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現在要把電源打開
05:00
It's on. Just turned轉身 it on.
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打開了,只要打開
05:06
And this works作品 like that, instantly即刻.
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立即見效
05:09
And the difference區別 between之間 shaking發抖 in this way and not --
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抖動和穩定的…
05:12
(Applause掌聲)
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(掌聲)
05:17
The difference區別 between之間 shaking發抖 in this way and not is related有關 to the misbehavior不當行為
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抖動和穩定的差別,和她腦部
05:21
of 25,000 neurons神經元 in her subthalamic丘腦底 nucleus.
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視丘下核的 2 萬 5 千個
神經細胞異常有關
05:25
So we now know how to find these troublemakers鬧事
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我們已知道怎麼找出問題神經細胞
05:28
and tell them, "Gentlemen先生們, that's enough足夠.
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並告訴它們:「嘿!這太超過了,
05:29
We want you to stop doing that."
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我們希望你們停止。」
05:30
And we do that with electricity電力.
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我們藉由電流刺激達成
05:32
So we use electricity電力 to dictate聽寫 how they fire,
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我們用電流控制神經細胞的反應
05:35
and we try to block their misbehavior不當行為 using運用 electricity電力.
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也用電流阻斷其失常行為
05:38
So in this case案件, we are suppressing抑制 the activity活動 of abnormal不正常 neurons神經元.
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此例是抑制不正常神經細胞的反應
05:42
We started開始 using運用 this technique技術 in other problems問題,
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我們將這個技術用在其他問題上
05:44
and I'm going to tell you about a fascinating迷人 problem問題
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下面是我們碰到的一個很棒的案例
05:46
that we encountered遇到, a case案件 of dystonia張力障礙.
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稱為肌張力不全症
05:49
So dystonia張力障礙 is a disorder紊亂 affecting影響 children孩子.
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肌張力不全症是影響兒童的病變
05:51
It's a genetic遺傳 disorder紊亂, and it involves涉及 a twisting盤曲 motion運動,
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是遺傳性疾病,會有扭轉的動作
05:55
and these children孩子 get progressively逐步 more and more twisting盤曲
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而這些兒童的動作會越來越扭曲
05:57
until直到 they can't breathe呼吸, until直到 they get sores,
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直到不能呼吸、直到覺得疼痛、
05:59
urinary尿 infections感染, and then they die.
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泌尿系統感染,然後走向死亡
06:01
So back in 1997, I was asked to see this young年輕 boy男孩,
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1997 年我被找去看這個小男孩
06:05
perfectly完美 normal正常. He has this genetic遺傳 form形成 of dystonia張力障礙.
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看來正常,但有肌張力不全症基因
06:08
There are eight children孩子 in the family家庭.
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他家中有八個小孩
06:10
Five of them have dystonia張力障礙.
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其中五個有肌張力不全症
06:13
So here he is.
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這是他
06:15
This boy男孩 is nine years年份 old, perfectly完美 normal正常 until直到 the age年齡 six,
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這時男孩九歲,他六歲前完全正常
06:20
and then he started開始 twisting盤曲 his body身體, first the right foot腳丫子,
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從右腳開始,他開始扭轉肢體
06:24
then the left foot腳丫子, then the right arm, then the left arm,
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然後是左腳、右手、左手
06:27
then the trunk樹幹, and then by the time he arrived到達,
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接著是軀幹,當他被送進來時
06:31
within the course課程 of one or two years年份 of the disease疾病 onset發病,
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距離病發只有一到兩年的時間
06:34
he could no longer walk步行, he could no longer stand.
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他已經不能行走或站立
06:36
He was crippled, and indeed確實 the natural自然 progression級數
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他的腿跛了,事實上隨著疾病惡化
06:39
as this gets得到 worse更差 is for them to become成為 progressively逐步 twisted扭曲,
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肢體扭曲的情形會加重
06:42
progressively逐步 disabled, and many許多 of these children孩子 do not survive生存.
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殘障日漸嚴重,許多孩子無法存活
06:48
So he is one of five kids孩子.
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他是五個孩子之一
06:50
The only way he could get around was crawling爬行 on his belly肚皮 like this.
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他想行動時,只能趴在地上爬行
06:54
He did not respond響應 to any drugs毒品.
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他的病情不能藉由藥物控制
06:56
We did not know what to do with this boy男孩.
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我們對他的病症無計可施
06:58
We did not know what operation手術 to do,
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我們不知該對他腦部的
07:00
where to go in the brain,
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哪個區域進行手術
07:02
but on the basis基礎 of our results結果 in Parkinson's帕金森氏 disease疾病,
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但從治療帕金森氏症的經驗
07:05
we reasoned理由, why don't we try to suppress壓制
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我們推論:為何不抑制
07:07
the same相同 area in the brain that we suppressed抑制
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造成帕金森氏症的同一區域?
07:10
in Parkinson's帕金森氏 disease疾病, and let's see what happens發生?
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並觀察後續發展
07:14
So here he was. We operated操作 on him
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他當時像這樣,我們動了手術
07:16
hoping希望 that he would get better. We did not know.
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希望他能好轉,但我們沒有把握
07:19
So here he is now, back in Israel以色列 where he lives生活,
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他現在像這樣,回到以色列的家
07:24
three months個月 after the procedure程序, and here he is.
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這是他手術過後三個月的樣子
07:28
(Applause掌聲)
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(掌聲)
07:36
On the basis基礎 of this result結果, this is now a procedure程序
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藉由這次經驗,這項手術
07:39
that's doneDONE throughout始終 the world世界,
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已在全世界施行
07:40
and there have been hundreds數以百計 of children孩子
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已經有數百名兒童
07:41
that have been helped幫助 with this kind of surgery手術.
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受惠於這項手術
07:46
This boy男孩 is now in university大學
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這個孩現在已上大學
07:48
and leads引線 quite相當 a normal正常 life.
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過著正常的生活
07:50
This has been one of the most satisfying滿意的 cases
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這是我從醫多年來
07:52
that I have ever doneDONE in my entire整個 career事業,
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最有成就感的個案
07:54
to restore恢復 movement運動 and walking步行 to this kind of child兒童.
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使這類病童恢復移動和行走的能力
07:57
(Applause掌聲)
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(掌聲)
08:04
We realized實現 that perhaps也許 we could use this technology技術
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我們瞭解到這項科技
08:07
not only in circuits電路 that control控制 your movement運動
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不只可以用來控制運動
08:09
but also circuits電路 that control控制 other things,
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也可以控制其他事情
08:11
and the next下一個 thing that we took on
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下一個我們著手的
08:12
was circuits電路 that control控制 your mood心情.
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是控制情緒的迴路
08:15
And we decided決定 to take on depression蕭條,
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我們決定針對憂鬱症
08:17
and the reason原因 we took on depression蕭條 is because it's so prevalent流行,
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我們選擇憂鬱症是因為它很普遍
08:19
and as you know, there are many許多 treatments治療 for depression蕭條,
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而且你們也知道
08:22
with medication藥物治療 and psychotherapy心理治療,
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雖然有藥物、心理治療、
08:24
even electroconvulsiveelectroconvul​​sive therapy治療,
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甚至電痙攣治療
08:26
but there are millions百萬 of people,
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但是在數百萬人中
08:27
and there are still 10 or 20 percent百分 of patients耐心 with depression蕭條
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仍有 10 到 20% 的患者無法治癒
08:30
that do not respond響應, and it is these patients耐心 that we want to help.
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這些患者就需要我們的幫忙
08:33
And let's see if we can use this technique技術
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讓我們來看看這項科技
08:35
to help these patients耐心 with depression蕭條.
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能否改善憂鬱症的病情
08:38
So the first thing we did was, we compared相比,
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首先我們比較
08:39
what's different不同 in the brain of someone有人 with depression蕭條
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憂鬱症患者腦部和
08:41
and someone有人 who is normal正常,
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正常人的不同之處
08:43
and what we did was PET寵物 scans掃描 to look at the blood血液 flow of the brain,
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我們用正子掃描腦部血流
(PET scan)
08:46
and what we noticed注意到 is that in patients耐心 with depression蕭條
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我們注意到憂鬱症患者
08:49
compared相比 to normals法線,
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與正常人相較
08:51
areas of the brain are shut關閉 down,
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腦部有些地方停工了
08:52
and those are the areas in blue藍色.
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這些地方呈現藍色
08:53
So here you really have the blues藍調,
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所以你就感到憂鬱了
(譯註:憂鬱與藍色為雙關語)
08:55
and the areas in blue藍色 are areas that are involved參與
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這些藍色區域
08:59
in motivation動機, in drive駕駛 and decision-making做決定,
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和動機、驅力、決策有關
09:01
and indeed確實, if you're severely嚴重 depressed鬱悶 as these patients耐心 were,
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如果你的憂鬱和病人一樣嚴重
09:04
those are impaired受損. You lack缺乏 motivation動機 and drive駕駛.
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你會缺乏動機和驅力
09:07
The other thing we discovered發現
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我們發現的另一件事是
09:08
was an area that was overactive過度活躍, area 25,
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有個區域過度活躍
09:11
seen看到 there in red,
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就是呈現紅色的第 25 區
09:12
and area 25 is the sadness center中央 of the brain.
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第 25 區是腦部的悲傷中心
09:15
If I make any of you sad傷心, for example, I make you remember記得
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2873
如果我讓你感到悲傷
09:18
the last time you saw your parent before they died死亡
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例如讓你回想起親人或朋友
09:20
or a friend朋友 before they died死亡,
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去世前的最後一面
09:22
this area of the brain lights燈火 up.
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這個區域就會活化
09:23
It is the sadness center中央 of the brain.
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這是大腦的悲傷中心
09:25
And so patients耐心 with depression蕭條 have hyperactivity多動症.
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憂鬱症患者發病時
09:28
The area of the brain for sadness is on red hot.
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大腦的悲傷中心運作到達高峰
09:30
The thermostat恆溫器 is set at 100 degrees,
209
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好像溫度被設定在 100 度
09:33
and the other areas of the brain, involved參與 in drive駕駛 and motivation動機, are shut關閉 down.
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動機和驅力等區域則完全停工
09:36
So we wondered想知道, can we place地點 electrodes電極 in this area of sadness
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我們想,如果把電極置於悲傷中心
09:39
and see if we can turn down the thermostat恆溫器,
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調降溫度調節器的溫度
09:41
can we turn down the activity活動,
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以隆低這個區域的活性
09:43
and what will be the consequence後果 of that?
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會產生什麼後果呢?
09:45
So we went ahead and implanted植入 electrodes電極 in patients耐心 with depression蕭條.
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我們將電極植入憂鬱症患者腦部
09:48
This is work doneDONE with my colleague同事 Helen海倫 Mayberg梅貝格 from Emory埃默里.
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我和艾默瑞大學 (Emory) 同事
海倫梅伯格 (Helen Mayberg) 合作
09:51
And we placed放置 electrodes電極 in area 25,
217
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1934
將電極置於第 25 區
09:53
and in the top最佳 scan掃描 you see before the operation手術,
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2285
上面那張是手術前的掃瞄
09:55
area 25, the sadness area is red hot,
219
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25 區,即悲傷中心,呈現紅色
09:57
and the frontal前面的 lobes are shut關閉 down in blue藍色,
220
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前額葉完全停工,呈現藍色
10:00
and then, after three months個月 of continuous連續 stimulation促進,
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24 小時持續刺激三個月、
10:02
24 hours小時 a day, or six months個月 of continuous連續 stimulation促進,
222
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3015
六個月後
10:05
we have a complete完成 reversal翻轉 of this.
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情況完全逆轉
10:07
We're able能夠 to drive駕駛 down area 25,
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25 區的活化程度
10:10
down to a more normal正常 level水平,
225
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已降低到正常水準
10:12
and we're able能夠 to turn back online線上
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前額葉則
10:14
the frontal前面的 lobes of the brain,
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重新開機上線
10:15
and indeed確實 we're seeing眼看 very striking引人注目 results結果
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我們在重度憂鬱症患者身上
10:17
in these patients耐心 with severe嚴重 depression蕭條.
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的確看到了驚人的效果
10:20
So now we are in clinical臨床 trials試驗, and are in Phase IIIIII clinical臨床 trials試驗,
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我們現在正進行第三期臨床試驗
10:23
and this may可能 become成為 a new procedure程序,
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有可能成為新的治療方式
10:25
if it's safe安全 and we find that it's effective有效,
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只要證實能安全有效的
10:27
to treat對待 patients耐心 with severe嚴重 depression蕭條.
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治療重度憂鬱症患者
10:31
I've shown顯示 you that we can use deep brain stimulation促進
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剛才展示了使用深層腦部刺激
10:34
to treat對待 the motor發動機 system系統
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治療運動系統相關疾病
10:36
in cases of Parkinson's帕金森氏 disease疾病 and dystonia張力障礙.
236
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如帕金森氏症、肌張力不全症
10:39
I've shown顯示 you that we can use it to treat對待 a mood心情 circuit電路
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2385
也可以治療情緒迴路疾病
10:41
in cases of depression蕭條.
238
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如憂鬱症
10:43
Can we use deep brain stimulation促進 to make you smarter聰明?
239
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4545
那是否可用深層腦部刺激
讓你變聰明?
10:47
(Laughter笑聲)
240
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2096
(笑聲)
10:49
Anybody任何人 interested有興趣 in that?
241
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有人有興趣嗎?
10:52
(Applause掌聲)
242
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(掌聲)
10:54
Of course課程 we can, right?
243
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當然沒問題,對吧?
10:57
So what we've我們已經 decided決定 to do is
244
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2214
我們決定
10:59
we're going to try to turbocharge渦輪增壓
245
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要試著
11:02
the memory記憶 circuits電路 in the brain.
246
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2205
替腦中的記憶迴路充電
11:04
We're going to place地點 electrodes電極 within the circuits電路
247
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2736
將電極植入
11:07
that regulate調節 your memory記憶 and cognitive認知 function功能
248
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控制記憶與認知的迴路中
11:09
to see if we can turn up their activity活動.
249
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看是否可增加其活性
11:13
Now we're not going to do this in normal正常 people.
250
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1938
我們不會拿正常人實驗
11:15
We're going to do this in people that have cognitive認知 deficits赤字,
251
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3652
而是用在有認知缺陷的患者身上
11:18
and we've我們已經 chosen選擇 to treat對待 patients耐心 with Alzheimer's老年癡呆症 disease疾病
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我們嘗試治療阿茲海默症患者
11:22
who have cognitive認知 and memory記憶 deficits赤字.
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他們有認知和記憶的問題
11:24
As you know, this is the main主要 symptom症狀
254
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1939
如各位所知,這是
11:26
of early onset發病 Alzheimer's老年癡呆症 disease疾病.
255
674207
2423
阿茲海默症早期的主要症狀
11:28
So we've我們已經 placed放置 electrodes電極 within this circuit電路
256
676630
2194
我們把電極放在
11:30
in an area of the brain called the fornix穹窿,
257
678824
1995
腦中一個稱為穹窿的區域
11:32
which哪一個 is the highway高速公路 in and out of this memory記憶 circuit電路,
258
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2778
是進出記憶體迴路的高速公路
11:35
with the idea理念 to see if we can turn on this memory記憶 circuit電路,
259
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3428
看看是否可以開啟記憶迴路
11:39
and whether是否 that can, in turn, help these patients耐心
260
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3249
進而能幫助
11:42
with Alzheimer's老年癡呆症 disease疾病.
261
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阿茲海默症的患者
11:44
Now it turns out that in Alzheimer's老年癡呆症 disease疾病,
262
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2318
先前發現,阿茲海默症患者的腦部
11:46
there's a huge巨大 deficit赤字 in glucose葡萄糖 utilization採用 in the brain.
263
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利用葡萄糖有嚴重缺陷
11:50
The brain is a bit of a hog when it comes to using運用 glucose葡萄糖.
264
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3418
腦部是大量消耗葡萄糖的地方
11:54
It uses使用 20 percent百分 of all your --
265
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1760
儘管只佔體重的 2%
11:56
even though雖然 it only weighs two percent百分 --
266
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卻消耗了人體總量的 20%
11:57
it uses使用 10 times more glucose葡萄糖 than it should based基於 on its weight重量.
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腦的葡萄糖消耗量是重量的 10 倍
12:00
Twenty二十 percent百分 of all the glucose葡萄糖 in your body身體 is used by the brain,
268
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20% 的葡萄糖用在腦部
12:03
and as you go from being存在 normal正常
269
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從正常的腦部
12:05
to having mild溫和 cognitive認知 impairment減值,
270
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2193
到輕微的認知失常
12:08
which哪一個 is a precursor先導 for Alzheimer's老年癡呆症, all the way to Alzheimer's老年癡呆症 disease疾病,
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再發展成阿茲海默症
12:10
then there are areas of the brain that stop using運用 glucose葡萄糖.
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腦部有些區域停止利用葡萄糖
12:13
They shut關閉 down. They turn off.
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停工了、關機了
12:15
And indeed確實, what we see is that these areas in red
274
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事實上,我們可以看到
12:17
around the outside ribbon色帶 of the brain
275
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1767
腦中央帶狀區的外圈,由紅色
12:19
are progressively逐步 getting得到 more and more blue藍色
276
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2276
逐漸變藍
12:21
until直到 they shut關閉 down completely全然.
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直到完全停工
12:24
This is analogous類似 to having a power功率 failure失敗
278
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2359
好像是腦中停電了
12:27
in an area of the brain, a regional區域性 power功率 failure失敗.
279
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形成區域性供電異常
12:29
So the lights燈火 are out in parts部分 of the brain
280
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阿茲海默症患者的部分大腦
12:32
in patients耐心 with Alzheimer's老年癡呆症 disease疾病,
281
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好像停電而陷入黑暗
12:34
and the question is, are the lights燈火 out forever永遠,
282
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2409
問題是,電力中斷是永久性的呢
12:37
or can we turn the lights燈火 back on?
283
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還是我們有辦法恢復?
12:40
Can we get those areas of the brain to use glucose葡萄糖 once一旦 again?
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可以讓這些區域再利用葡萄糖嗎?
12:43
So this is what we did. We implanted植入 electrodes電極 in the fornix穹窿
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我們把電極植入穹窿
12:45
of patients耐心 with Alzheimer's老年癡呆症 disease疾病, we turned轉身 it on,
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活化阿茲海默症患者此一區域
12:48
and we looked看著 at what happens發生 to glucose葡萄糖 use in the brain.
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然後觀察大腦利用葡萄糖的狀況
12:52
And indeed確實, at the top最佳, you'll你會 see before the surgery手術,
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上面那張是手術前
12:55
the areas in blue藍色 are the areas that use less glucose葡萄糖 than normal正常,
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藍色區域葡萄糖用量比正常值少
12:58
predominantly主要 the parietal頂葉 and temporal lobes.
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主要是在患者的顳葉
13:00
These areas of the brain are shut關閉 down.
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腦的這些區域停工了、
13:02
The lights燈火 are out in these areas of the brain.
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停電了
13:05
We then put in the DBSDBS electrodes電極 and we wait for a month
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我們放入深層腦部刺激電極
13:08
or a year, and the areas in red
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一個月後、一年後再觀察
13:09
represent代表 the areas where we increase增加 glucose葡萄糖 utilization採用.
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紅色區域表示葡萄糖消耗量增加
13:12
And indeed確實, we are able能夠 to get these areas of the brain
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所以我們確實可讓
13:15
that were not using運用 glucose葡萄糖 to use glucose葡萄糖 once一旦 again.
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本來不使用葡萄糖的區域恢復使用
13:18
So the message信息 here is that, in Alzheimer's老年癡呆症 disease疾病,
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結果顯示,阿茲海默症患者腦部
13:20
the lights燈火 are out, but there is someone有人 home,
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雖然停電了,但仍有人在家
13:23
and we're able能夠 to turn the power功率 back on
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而我們可以
13:25
to these areas of the brain, and as we do so,
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讓這些區域的電力恢復
13:27
we expect期望 that their functions功能 will return返回.
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我們預期功能也會恢復
13:30
So this is now in clinical臨床 trials試驗.
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這正在臨床試驗階段
13:32
We are going to operate操作 on 50 patients耐心
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我們要對 50 位
13:34
with early Alzheimer's老年癡呆症 disease疾病
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早期阿茲海默症病患進行手術
13:36
to see whether是否 this is safe安全 and effective有效,
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確認是否安全有效
13:38
whether是否 we can improve提高 their neurologic神經 function功能.
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是否可改善他們神經的功能
13:41
(Applause掌聲)
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(掌聲)
13:49
So the message信息 I want to leave離開 you with today今天 is that,
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我想傳達給各位的訊息是
13:52
indeed確實, there are several一些 circuits電路 in the brain
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腦部不同迴路的異常
13:54
that are malfunctioning故障 across橫過 various各個 disease疾病 states狀態,
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和不同的病變有關
13:58
whether是否 we're talking about Parkinson's帕金森氏 disease疾病,
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我們討論了帕金森氏症、
14:00
depression蕭條, schizophrenia精神分裂症, Alzheimer's老年癡呆症.
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憂鬱症、精神分裂症和阿茲海默症
14:03
We are now learning學習 to understand理解 what are the circuits電路,
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我們正學習了解這些迴路
14:06
what are the areas of the brain that are responsible主管 for
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還有對應的腦部區域
14:09
the clinical臨床 signs跡象 and the symptoms症狀 of those diseases疾病.
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以及對應的臨床症狀
14:11
We can now reach達到 those circuits電路.
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我們有能力觸及這些迴路
14:13
We can introduce介紹 electrodes電極 within those circuits電路.
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並在這些迴路中放入電極
14:16
We can graduate畢業 the activity活動 of those circuits電路.
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我們可調節這些迴路的活動
14:19
We can turn them down if they are overactive過度活躍,
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如果太活躍,並造成腦部的問題
14:22
if they're causing造成 trouble麻煩, trouble麻煩 that is felt throughout始終 the brain,
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我們可以將它調低
14:25
or we can turn them up if they are underperforming表現不佳,
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如果活躍程度不足,則可調高
14:28
and in so doing, we think that we may可能 be able能夠 to help
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我們認為藉此可幫助
14:30
the overall總體 function功能 of the brain.
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腦部的整體功能
14:33
The implications啟示 of this, of course課程, is that we may可能 be able能夠
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這些結果顯示
14:35
to modify修改 the symptoms症狀 of the disease疾病,
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我們可以緩和疾病的症狀
14:37
but I haven't沒有 told you but there's also some evidence證據
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我還沒告訴你們有證據顯示
14:39
that we might威力 be able能夠 to help the repair修理 of damaged破損 areas of the brain using運用 electricity電力,
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電流可協助修復腦部損傷
14:44
and this is something for the future未來, to see if, indeed確實,
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這些都是未來的展望
14:46
we not only change更改 the activity活動 but also
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我們不只可以調整腦部活躍程度
14:48
some of the reparative彌補的 functions功能 of the brain
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也可以看到大腦修復受損功能
14:50
can be harvested收穫.
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的成果
14:52
So I envision預見 that we're going to see a great expansion擴張
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我預期未來將會廣泛應用
14:55
of indications適應症 of this technique技術.
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這項科技
14:57
We're going to see electrodes電極 being存在 placed放置 for many許多 disorders障礙 of the brain.
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將看到用電極改善多種腦部問題
15:00
One of the most exciting扣人心弦 things about this is that, indeed確實,
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而其中最令人興奮的
15:03
it involves涉及 multidisciplinary多學科 work.
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是它包含了跨領域的合作
15:05
It involves涉及 the work of engineers工程師, of imaging成像 scientists科學家們,
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包括工程師、影像學家、
15:08
of basic基本 scientists科學家們, of neurologists神經學家,
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基礎科學家、神經學家、
15:10
psychiatrists精神科醫生, neurosurgeons神經外科醫生, and certainly當然 at the interface接口
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精神醫師、神經外科醫師通力合作
15:13
of these multiple disciplines學科 that there's the excitement激動.
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跨領域合作是令人興奮的
15:16
And I think that we will see that
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我想我們會看到
15:18
we will be able能夠 to chase more of these evil邪惡 spirits
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隨著時間推移,越來越多惡靈
15:22
out from the brain as time goes on,
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會被趕出腦袋
15:24
and the consequence後果 of that, of course課程, will be
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結果當然就是
15:26
that we will be able能夠 to help many許多 more patients耐心.
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我們可以幫助更多的病患
15:28
Thank you very much.
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謝謝大家
Translated by Hao-Wei Chang
Reviewed by Allen Li

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ABOUT THE SPEAKER
Andres Lozano - Neurosurgeon
The chair of neurosurgery at the University of Toronto, Andres Lozano has pioneered the use of deep brain stimulation for treating Parkinson’s, depression, anorexia and Alzheimer’s disease.

Why you should listen

Andres Lozano remembers the most satisfying case of his career – helping a boy with a genetic form of dystonia which had twisted his body to the point where he was only able to crawl on his stomach. While he didn’t respond to drugs, he responded wonderfully to deep brain stimulation. Three months after surgery, he was walking like a normal child. He’s now a college student leading a normal life.

Lozano is a pioneer in deep brain stimulation. His team has mapped out areas of the human brain and pioneered novel surgical approaches to treat disorders like Parkinson’s disease, depression, dystonia, anorexia, Huntington’s and Alzheimer’s disease. The chairman of neurosurgery at the University of Toronto, he holds both the R.R. Tasker Chair in Functional Neurosurgery at the Krembil Neuroscience Centre and a Tier 1 Canada Research Chair in Neuroscience.

Lozano has over 400 publications, serves on the board of several international organizations and is a founding member of the scientific advisory board of the Michael J. Fox Foundation. He has received a number of awards including the Olivecrona Medal and the Pioneer in Medicine award, has been elected a Fellow of the Royal Society of Canada and the Canadian Academy of Health Sciences and has received the Order of Spain.

More profile about the speaker
Andres Lozano | Speaker | TED.com