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

Translator: Joseph Geni Reviewer: Morton Bast

Translator: Neila Cosme Reviewer: Servizo de Normalización Lingüística

Algo que quero deixar claro dende o comezo

é que non todos os neurocirurxiáns levan botas de vaqueiro.

Só quería que o soubésedes.

Eu son neurocirurxián,

One of the things I want to establish right from the start

e sigo unha longa tradición de neurocirurxía,

is that not all neurosurgeons wear cowboy boots.

I just wanted you to know that.

e hoxe vouvos falar

So I am indeed a neurosurgeon,

sobre axustar os controis dos circuítos cerebrais,

ir a calquera lugar do cerebro

and I follow a long tradition of neurosurgery,

e acender ou apagar certas áreas

and what I'm going to tell you about today

para axudar os pacientes.

is adjusting the dials in the circuits in the brain,

Como dixen, a neurocirurxía ten unha longa tradición.

being able to go anywhere in the brain

Leva existindo dende hai 7000 anos.

and turning areas of the brain up or down

to help our patients.

En Mesoamérica, había neurocirurxía,

So as I said, neurosurgery comes from a long tradition.

con neurocirurxiáns que trataban pacientes

It's been around for about 7,000 years.

Sabían que o cerebro estaba involucrado

In Mesoamerica, there used to be neurosurgery,

and there were these neurosurgeons that used to treat patients.

en trastornos neurolóxicos e psiquiátricos.

Non sabían exactamente o que facían.

And they were trying to -- they knew that the brain was involved

Non cambiaron moito as cousas. (Risas)

Crían que, se tiñas unha enfermidade neurolóxica ou psiquiátrica,

in neurological and psychiatric disease.

They didn't know exactly what they were doing.

era porque estabas posuído

Not much has changed, by the way. (Laughter)

por un espírito maligno.

But they thought that,

E, se estás posuído por un espírito maligno

if you had a neurologic or psychiatric disease,

que che causa problemas neurolóxicos e psiquiátricos,

it must be because you are possessed

a forma de tratalo, por suposto,

by an evil spirit.

é facer un buraco no cranio e deixar que o espírito maligno escape.

So if you are possessed by an evil spirit

causing neurologic or psychiatric problems,

Así pensaban naquel tempo,

then the way to treat this is, of course,

e facíanse estes buracos.

to make a hole in your skull and let the evil spirit escape.

Ás veces, os pacientes eran un pouco reticentes

So this was the thinking back then,

a someterse a isto, xa que

and these individuals made these holes.

os buracos facíanse de forma parcial e logo

Sometimes the patients were a little bit reluctant

había unha trepanación e marchaban moi rápido.

Era un orificio parcial,

to go through this because, you can tell that

e sabemos que sobrevivían a estes procedementos.

the holes are made partially and then, I think,

E era moi común.

Hai algúns xacementos onde o 1 %

there was some trepanation, and then they left very quickly

de todos os cranios teñen orificios, e así vese

and it was only a partial hole,

and we know they survived these procedures.

que as doenzas neurolóxicas e psiquiátricas son comúns,

But this was common.

e tamén o eran hai 7000 anos.

There were some sites where one percent

of all the skulls have these holes, and so you can see

Co paso do tempo,

that neurologic and psychiatric disease is quite common,

démonos conta de que

and it was also quite common about 7,000 years ago.

cada parte do cerebro fai unha cousa distinta.

Hai áreas dedicadas

Now, in the course of time,

ao control do movemento ou da visión

we've come to realize that

ou da memoria ou do apetito, e así sucesivamente.

different parts of the brain do different things.

Cando as cousas funcionan ben, o sistema nervioso funciona ben

So there are areas of the brain that are dedicated

to controlling your movement or your vision

e todo funciona.

Porén, de vez en cando, as cousas non van ben

or your memory or your appetite, and so on.

e hai problemas neses circuítos,

And when things work well, then the nervous system

con neuronas rebeldes que fallan

works well, and everything functions.

e causan problemas, ou ás veces están pouco activas

But once in a while, things don't go so well,

and there's trouble in these circuits,

e non funcionan como deberían.

and there are some rogue neurons that are misfiring

As manifestacións disto

dependen de onde estean esas neuronas no cerebro.

and causing trouble, or sometimes they're underactive

Cando esas neuronas están no circuíto motor,

and they're not quite working as they should.

temos disfunción no sistema motor,

Now, the manifestation of this

e dá lugar, por exemplo, ao párkinson.

depends on where in the brain these neurons are.

Cando o problema está nun circuíto que regula o estado de ánimo,

So when these neurons are in the motor circuit,

you get dysfunction in the movement system,

dá lugar a depresión,

e cando é nun circuíto que controla a memoria e a función cognitiva,

and you get things like Parkinson's disease.

When the malfunction is in a circuit that regulates your mood,

dá lugar a enfermidades como o alzhéimer.

you get things like depression,

O que fomos capaces de facer é localizar

and when it is in a circuit that controls your memory and cognitive function,

onde están estas alteracións no cerebro,

then you get things like Alzheimer's disease.

e puidemos intervir neses circuítos

So what we've been able to do is to pinpoint

do cerebro para acendelos ou apagalos.

where these disturbances are in the brain,

É moi parecido a escoller a emisora correcta

and we've been able to intervene within these circuits

no dial da radio.

Unha vez escolles a emisora, sexa de jazz ou de ópera,

in the brain to either turn them up or turn them down.

ou, neste caso, sexa movemento ou estado de ánimo,

So this is very much like choosing the correct station

podemos pór aí o dial

on the radio dial.

e utilizar un segundo botón para axustar o volume,

Once you choose the right station, whether it be jazz or opera,

subilo ou baixalo.

in our case whether it be movement or mood,

Entón, vouvos falar

de usar os circuítos do cerebro para implantar eléctrodos

we can put the dial there,

and then we can use a second button to adjust the volume,

e acender ou apagar áreas cerebrais

to turn it up or turn it down.

para tentar axudar os pacientes.

So what I'm going to tell you about

is using the circuitry of the brain to implant electrodes

Isto conséguese utilizando este dispositivo

e chamámoslle estimulación cerebral profunda.

and turning areas of the brain up and down

O que facemos é colocar estes eléctrodos no cerebro.

to see if we can help our patients.

And this is accomplished using this kind of device,

De novo, facemos buracos no cranio do tamaño dunha moeda,

and this is called deep brain stimulation.

inserimos un eléctrodo e este eléctrodo

So what we're doing is placing these electrodes throughout the brain.

queda debaixo da pel,

Again, we are making holes in the skull about the size of a dime,

vai ata un marcapasos no peito

e, cun control a distancia coma o da televisión,

putting an electrode in, and then this electrode

is completely underneath the skin

podemos axustar canta electricidade lle chega

down to a pacemaker in the chest,

and with a remote control very much like a television remote control,

a estas áreas do cerebro.

Podemos subilas ou baixalas, acendelas ou apagalas.

Sobre cen mil pacientes no mundo

we can adjust how much electricity we deliver

recibiron estimulación cerebral profunda.

to these areas of the brain.

Mostraeivos algúns exemplos

We can turn it up or down, on or off.

do uso da ECP para tratar trastornos do movemento,

Now, about a hundred thousand patients in the world

trastornos do estado de ánimo e trastornos da cognición.

have received deep brain stimulation,

and I'm going to show you some examples

of using deep brain stimulation to treat disorders of movement,

Así se ve o dispositivo no cerebro.

O eléctrodo atravesa o cranio ata o cerebro

disorders of mood and disorders of cognition.

e queda alí; podemos poñelo en calquera parte do cerebro.

So this looks something like this when it's in the brain.

Eu sempre digo que ningunha neurona está a salvo

You see the electrode going through the skull into the brain

dun neurocirurxián, porque podemos chegar

a todo o cerebro de forma segura.

and resting there, and we can place this really anywhere in the brain.

I tell my friends that no neuron is safe

O primeiro exemplo que vos vou mostrar é unha paciente con párkinson.

from a neurosurgeon, because we can really reach

Esta muller sofre párkinson

just about anywhere in the brain quite safely now.

e ten os eléctrodos no seu cerebro.

Now the first example I'm going to show you is a patient

Vouvos mostrar como é

cando os eléctrodos están apagados e mostra os síntomas do párkinson

with Parkinson's disease,

and this lady has Parkinson's disease,

e despois imos acendelos.

and she has these electrodes in her brain,

Isto é o que vemos.

and I'm going to show you what she's like

when the electrodes are turned off and she has her Parkinson's symptoms,

Os eléctrodos están apagados agora, e podemos ver que ten tremores.

and then we're going to turn it on.

So this looks something like this.

(Vídeo) Home: Pode tentar tocar o meu dedo?

The electrodes are turned off now, and you can see that she has tremor.

(Vídeo) Home: Mellor. Muller: Este lado está mellor.

Agora imos acendelo.

(Video) Man: Okay. Woman: I can't. Man: Can you try to touch my finger?

Está aceso. Acaba de acendelo.

(Video) Man: That's a little better. Woman: That side is better.

We're now going to turn it on.

E funciona tal que así, de forma instantánea.

It's on. Just turned it on.

E a diferenza entre tremer así e non facelo…

(Aplausos)

And this works like that, instantly.

And the difference between shaking in this way and not --

A diferencia entre tremer ou non facelo está relacionada co mal funcionamento

(Applause)

de 25 000 neuronas no núcleo subtalámico.

The difference between shaking in this way and not is related to the misbehavior

Sabemos como atopar estas alborotadoras

e dicirlles: “Señoras, xa está ben. Paren!”.

of 25,000 neurons in her subthalamic nucleus.

Facémolo con electricidade.

Usamos a electricidade para indicar como disparan.

So we now know how to find these troublemakers

Tentamos bloquear o seu mal funcionamento utilizando a electricidade.

and tell them, "Gentlemen, that's enough.

We want you to stop doing that."

And we do that with electricity.

Neste caso, estamos a suprimir a actividade anormal das neuronas.

So we use electricity to dictate how they fire,

Comezamos a usar a técnica para outros problemas.

and we try to block their misbehavior using electricity.

Falareivos dun asunto fascinante

So in this case, we are suppressing the activity of abnormal neurons.

que nos atopamos, un caso de distonía.

A distonía é un trastorno que afecta a nenos.

We started using this technique in other problems,

É un trastorno xenético, e consiste nun movemento de torsión.

and I'm going to tell you about a fascinating problem

that we encountered, a case of dystonia.

Estes nenos retórcense máis e máis de forma progresiva

So dystonia is a disorder affecting children.

ata que non poden respirar e teñen chagas,

It's a genetic disorder, and it involves a twisting motion,

infeccións urinarias e morren.

En 1997, pedíronme que visitase un neno,

and these children get progressively more and more twisting

perfectamente normal. Tiña unha forma xenética de distonía.

until they can't breathe, until they get sores,

urinary infections, and then they die.

Hai oito nenos na familia.

So back in 1997, I was asked to see this young boy,

Cinco deles teñen distonía.

perfectly normal. He has this genetic form of dystonia.

Aquí está.

Este neno ten nove anos e era perfectamente normal ata os seis,

There are eight children in the family.

Five of them have dystonia.

cando se lle empezou a retorcer o corpo. Primeiro, o pé dereito;

So here he is.

This boy is nine years old, perfectly normal until the age six,

despois, o pé esquerdo, o brazo dereito, o brazo esquerdo;

and then he started twisting his body, first the right foot,

despois, o tronco e, cando chegou,

nun ou dous anos dende a aparición da enfermidade,

then the left foot, then the right arm, then the left arm,

xa non podía camiñar nin manterse en pé.

then the trunk, and then by the time he arrived,

Estaba inválido, e a progresión natural

segundo empeora é retorcerse de forma progresiva,

within the course of one or two years of the disease onset,

he could no longer walk, he could no longer stand.

quedar discapacitado, e moitos dos nenos non sobreviven.

He was crippled, and indeed the natural progression

as this gets worse is for them to become progressively twisted,

El é un de cinco nenos.

progressively disabled, and many of these children do not survive.

A única forma de se mover era gatear apoiado na barriga desta forma.

Non respondía a ningún medicamento.

So he is one of five kids.

Non sabiamos que facer con el.

The only way he could get around was crawling on his belly like this.

Non sabiamos como operalo,

onde ir no seu cerebro,

He did not respond to any drugs.

pero, seguindo os resultados no caso do párkinson,

We did not know what to do with this boy.

pensamos: por que non intentamos reprimir

We did not know what operation to do,

a mesma área cerebral que reprimimos

where to go in the brain,

but on the basis of our results in Parkinson's disease,

na enfermidade do párkinson, e vemos que ocorre?

we reasoned, why don't we try to suppress

Así estaba el. E operámolo

the same area in the brain that we suppressed

esperando que mellorara. Non sabiamos.

in Parkinson's disease, and let's see what happens?

Aquí está, de volta en Israel, onde vive.

So here he was. We operated on him

Tres meses despois do procedemento e aquí está.

hoping that he would get better. We did not know.

So here he is now, back in Israel where he lives,

(Aplausos)

three months after the procedure, and here he is.

(Applause)

Ante ese resultado, agora este procedemento

úsase por todo o mundo,

e hai centros de nenos que se beneficiaron deste tipo de cirurxía.

On the basis of this result, this is now a procedure

O neno está agora na universidade

that's done throughout the world,

e leva unha vida normal.

and there have been hundreds of children

that have been helped with this kind of surgery.

Este foi un dos casos máis satisfactorios

en que traballei en toda a miña carreira:

This boy is now in university

devolver o movemento e a capacidade de camiñar a estes nenos.

and leads quite a normal life.

This has been one of the most satisfying cases

(Aplausos)

that I have ever done in my entire career,

to restore movement and walking to this kind of child.

Decatámonos de que igual podiamos usar esa tecnoloxía

(Applause)

non só en circuítos que rexen o movemento,

senón tamén nos que controlan outras cousas,

e os seguintes elixidos

We realized that perhaps we could use this technology

foron os que rexen o estado de ánimo.

Decidimos centrarnos na depresión,

not only in circuits that control your movement

e a razón é que é tan frecuente

but also circuits that control other things,

and the next thing that we took on

e, como sabedes, hai moitos tratamentos para ela,

was circuits that control your mood.

con medicación e psicoterapia,

And we decided to take on depression,

mesmo con terapia electroconvulsiva,

and the reason we took on depression is because it's so prevalent,

pero hai millóns de persoas,

and as you know, there are many treatments for depression,

e segue a haber un 10 ou 20 % de pacientes con depresión

with medication and psychotherapy,

que non responden, e son eses pacientes os que queremos axudar.

even electroconvulsive therapy,

Vexamos se podemos usar esta técnica

but there are millions of people,

and there are still 10 or 20 percent of patients with depression

para axudar estes pacientes con depresión.

Primeiro, comparamos as diferenzas entre o cerebro de alguén con depresión

that do not respond, and it is these patients that we want to help.

And let's see if we can use this technique

e o de alguén normal

e realizamos escáneres TEP para observar o fluxo de sangue no cerebro.

to help these patients with depression.

So the first thing we did was, we compared,

Démonos conta de que os pacientes con depresión,

what's different in the brain of someone with depression

a diferenza dos normais,

and someone who is normal,

tiñan áreas do cerebro apagadas.

and what we did was PET scans to look at the blood flow of the brain,

Son as áreas en azul.

Aquí temos as zonas azuis,

and what we noticed is that in patients with depression

e estas áreas azuis son as que están involucradas

compared to normals,

na motivación, o desexo e a toma de decisións.

areas of the brain are shut down,

and those are the areas in blue.

So here you really have the blues,

Se tes unha depresión grave, como estes pacientes,

and the areas in blue are areas that are involved

tes esas áreas deterioradas. Fáltache motivación e desexo.

in motivation, in drive and decision-making,

Outra cousa que descubrimos

foi unha área hiperactiva, a área 25,

and indeed, if you're severely depressed as these patients were,

velaí en vermello.

those are impaired. You lack motivation and drive.

A área 25 é o centro da tristeza do cerebro.

The other thing we discovered

Se vos entristezo, por exemplo, facéndovos recordar

was an area that was overactive, area 25,

a última vez que vistes os vosos pais antes de morreren ou un amigo,

seen there in red,

and area 25 is the sadness center of the brain.

esta área acéndese.

If I make any of you sad, for example, I make you remember

É o centro da tristeza do cerebro.

E os pacientes con depresión téñena hiperactiva.

the last time you saw your parent before they died

or a friend before they died,

A área para a tristeza está en vermello vivo.

this area of the brain lights up.

O termóstato está a 100 graos,

It is the sadness center of the brain.

As outras, involucradas no desexo e a motivación, están apagadas.

And so patients with depression have hyperactivity.

The area of the brain for sadness is on red hot.

Preguntámonos: poderiamos colocar eléctrodos nesa área da tristeza

The thermostat is set at 100 degrees,

e ver se podemos baixar o termóstato,

and the other areas of the brain, involved in drive and motivation, are shut down.

se podemos baixar a actividade?

Cales serían as súas consecuencias?

So we wondered, can we place electrodes in this area of sadness

Así que implantamos eléctrodos en pacientes con depresión.

and see if we can turn down the thermostat,

Este traballo fixémolo con Helen Mayberg, de Emory.

can we turn down the activity,

and what will be the consequence of that?

Colocamos eléctrodos na área 25.

No escáner superior obsérvase antes da operación

So we went ahead and implanted electrodes in patients with depression.

a área 25, a da tristeza, en vermello forte

This is work done with my colleague Helen Mayberg from Emory.

e os lóbulos frontais están apagados en azul.

And we placed electrodes in area 25,

Tras tres meses de estimulación continuada,

and in the top scan you see before the operation,

24 horas ao día, ou seis meses de estimulación continuada,

area 25, the sadness area is red hot,

and the frontal lobes are shut down in blue,

temos unha inversión disto.

Somos capaces de reducir a área 25

and then, after three months of continuous stimulation,

ata un nivel máis normal

24 hours a day, or six months of continuous stimulation,

e somos quen de volver acender

we have a complete reversal of this.

os lóbulos frontais,

We're able to drive down area 25,

e vemos resultados moi sorprendentes

nestes pacientes con depresión grave.

down to a more normal level,

Agora estamos en ensaios clínicos, na fase III,

and we're able to turn back online

the frontal lobes of the brain,

e isto pode converterse nun novo procedemento,

and indeed we're seeing very striking results

in these patients with severe depression.

se é seguro e vemos que é eficaz para tratar pacientes con depresión grave.

So now we are in clinical trials, and are in Phase III clinical trials,

and this may become a new procedure,

Vimos que podemos usar estimulación cerebral profunda

if it's safe and we find that it's effective,

para tratar o sistema motor

to treat patients with severe depression.

en casos de párkinson e distonía.

Tamén para tratar o circuíto do estado de ánimo

I've shown you that we can use deep brain stimulation

en casos de depresión.

to treat the motor system

Podemos empregala para volvernos máis intelixentes?

in cases of Parkinson's disease and dystonia.

I've shown you that we can use it to treat a mood circuit

(Risas)

in cases of depression.

Alguén interesado niso?

Can we use deep brain stimulation to make you smarter?

(Aplausos)

Por suposto que podemos, verdade?

(Laughter)

Anybody interested in that?

Entón, o que decidimos facer foi

intentar turboalimentar

(Applause)

Of course we can, right?

os circuítos da memoria no cerebro.

Imos colocar eléctrodos nos circuítos

So what we've decided to do is

que regulan a memoria e a función cognitiva

we're going to try to turbocharge

para ver se se pode aumentar a súa actividade.

the memory circuits in the brain.

We're going to place electrodes within the circuits

Non faremos isto en persoas normais.

that regulate your memory and cognitive function

Faremos isto en persoas con déficits cognitivos,

to see if we can turn up their activity.

e decidimos tratar pacientes coa enfermidade do alzhéimer.

Now we're not going to do this in normal people.

que teñen déficits cognitivos e de memoria.

We're going to do this in people that have cognitive deficits,

Como sabedes, ese é o síntoma principal

do alzhéimer de aparición temperá.

and we've chosen to treat patients with Alzheimer's disease

Así que colocamos eléctrodos neste circuíto

who have cognitive and memory deficits.

nunha área do cerebro chamada fórnix,

As you know, this is the main symptom

a vía de entrada e saída desde circuíto da memoria,

of early onset Alzheimer's disease.

coa idea de ver se se pode acender este circuíto,

So we've placed electrodes within this circuit

in an area of the brain called the fornix,

e se iso pode, pola súa banda, axudar a estes pacientes

which is the highway in and out of this memory circuit,

coa enfermidade do alzhéimer.

with the idea to see if we can turn on this memory circuit,

Resulta que, no alzhéimer,

hai un gran déficit de utilización da glicosa no cerebro.

and whether that can, in turn, help these patients

with Alzheimer's disease.

O cerebro é un pouco aproveitado cando se trata do uso da glicosa.

Now it turns out that in Alzheimer's disease,

Consume o 20 % de todo,

there's a huge deficit in glucose utilization in the brain.

aínda que solo pesa un 2 %.

Emprega dez veces máis glicosa do que debería segundo o seu peso.

The brain is a bit of a hog when it comes to using glucose.

O 20 % de toda a glicosa do voso corpo consúmea o cerebro,

It uses 20 percent of all your --

e ao pasar de estar normal

even though it only weighs two percent --

it uses 10 times more glucose than it should based on its weight.

a ter un leve deterioro cognitivo,

que é un precursor do alzhéimer, ata chegar á enfermidade,

Twenty percent of all the glucose in your body is used by the brain,

xa hai áreas do cerebro que deixan de usar glicosa.

and as you go from being normal

to having mild cognitive impairment,

Detéñense. Apáganse.

O que se observa é que estas áreas en vermello

which is a precursor for Alzheimer's, all the way to Alzheimer's disease,

arredor da banda externa do cerebro

then there are areas of the brain that stop using glucose.

se volven cada vez máis e máis azuis

They shut down. They turn off.

ata que se apagan completamente.

And indeed, what we see is that these areas in red

Isto é análogo a ter un corte de corrente

around the outside ribbon of the brain

nunha área do cerebro, un corte de corrente rexional.

are progressively getting more and more blue

until they shut down completely.

As luces están apagadas nalgunhas partes do cerebro

This is analogous to having a power failure

dos pacientes con alzhéimer.

A pregunta é: están as luces apagadas para sempre

in an area of the brain, a regional power failure.

So the lights are out in parts of the brain

ou pódense volver acender?

Podemos facer que esas áreas volvan usar glicosa?

in patients with Alzheimer's disease,

and the question is, are the lights out forever,

O que fixemos foi implantar eléctrodos no fórnix

or can we turn the lights back on?

de pacientes con alzhéimer, conectámolos

Can we get those areas of the brain to use glucose once again?

e observamos o que acontecía co uso da glicosa no cerebro.

So this is what we did. We implanted electrodes in the fornix

Na parte superior, podedes ver antes da cirurxía

of patients with Alzheimer's disease, we turned it on,

as áreas en azul que son as que empregan menos glicosa do normal,

and we looked at what happens to glucose use in the brain.

principalmente os lóbulos parietal e temporal.

And indeed, at the top, you'll see before the surgery,

Esas áreas do cerebro están apagadas.

As luces están apagadas nesas zonas do cerebro.

the areas in blue are the areas that use less glucose than normal,

Logo colocamos os eléctrodos de ECP e agardamos un mes ou un ano.

predominantly the parietal and temporal lobes.

These areas of the brain are shut down.

As áreas en vermello

representan as áreas onde aumentou o emprego de glicosa.

The lights are out in these areas of the brain.

Conseguiuse que esas áreas do cerebro

We then put in the DBS electrodes and we wait for a month

que non estaban a utilizar glicosa a utilizasen de novo.

or a year, and the areas in red

represent the areas where we increase glucose utilization.

A mensaxe aquí é que, na enfermidade do alzhéimer,

And indeed, we are able to get these areas of the brain

as luces están apagadas, pero hai alguén na casa

e pódese volver levar a electricidade

that were not using glucose to use glucose once again.

ata esas áreas do cerebro e, cando isto se fai,

So the message here is that, in Alzheimer's disease,

agardamos que volvan tamén as súas funcións.

the lights are out, but there is someone home,

Isto atópase agora en ensaios clínicos.

and we're able to turn the power back on

Imos operar 50 pacientes

to these areas of the brain, and as we do so,

con alzhéimer temperán

we expect that their functions will return.

para ver se isto é seguro e eficaz,

So this is now in clinical trials.

se se pode mellorar a súa función neurolóxica.

We are going to operate on 50 patients

(Aplausos)

with early Alzheimer's disease

to see whether this is safe and effective,

whether we can improve their neurologic function.

(Applause)

A mensaxe que quero que levedes hoxe é que,

en efecto, hai varios circuítos no cerebro

que non funcionan de forma correcta nalgunhas enfermidades,

So the message I want to leave you with today is that,

ben esteamos a falar de párkinson,

indeed, there are several circuits in the brain

depresión, esquizofrenia ou alzhéimer.

that are malfunctioning across various disease states,

Estamos aprendendo a entender cales son os circuítos,

whether we're talking about Parkinson's disease,

cales son as áreas do cerebro responsables

depression, schizophrenia, Alzheimer's.

das manifestacións clínicas e síntomas desas enfermidades.

We are now learning to understand what are the circuits,

Agora podemos chegar ata eses circuítos.

Podemos colocar eléctrodos neses circuítos.

what are the areas of the brain that are responsible for

Podemos graduar a actividade deses circuítos.

the clinical signs and the symptoms of those diseases.

We can now reach those circuits.

Podemos baixalos se están demasiado activos,

We can introduce electrodes within those circuits.

se causan problemas que afectan a todo o cerebro,

We can graduate the activity of those circuits.

ou podemos subilos se teñen un baixo rendemento

We can turn them down if they are overactive,

e, facendo isto, cremos poder axudar

if they're causing trouble, trouble that is felt throughout the brain,

a función xeral do cerebro.

or we can turn them up if they are underperforming,

As implicacións disto son que quizais poidamos

modificar os síntomas da enfermidade,

and in so doing, we think that we may be able to help

pero non vos dixen que tamén hai probas

the overall function of the brain.

de que podemos reparar áreas danadas do cerebro con electricidade.

The implications of this, of course, is that we may be able

to modify the symptoms of the disease,

Isto é algo para o futuro: ver se, efectivamente,

but I haven't told you but there's also some evidence

podemos cambiar a actividade, masi tamén

that we might be able to help the repair of damaged areas of the brain using electricity,

se algunha das funcións reparadoras do cerebro se poden recuperar.

Así que prevexo que veremos unha grande expansión

and this is something for the future, to see if, indeed,

we not only change the activity but also

nas indicacións desta técnica.

some of the reparative functions of the brain

Veremos o uso de eléctrodos para tratar moitos trastornos do cerebro.

can be harvested.

So I envision that we're going to see a great expansion

Unha das cousas máis emocionantes disto é que

of indications of this technique.

implica traballo multidisciplinario.

Inclúe o traballo de enxeñeiros, científicos de imaxe,

We're going to see electrodes being placed for many disorders of the brain.

One of the most exciting things about this is that, indeed,

científicos básicos, neurólogos,

psiquiatras, neurocirurxiáns e, sen dúbida, na confluencia

it involves multidisciplinary work.

It involves the work of engineers, of imaging scientists,

destas múltiples disciplinas está a emoción.

E penso que veremos

of basic scientists, of neurologists,

psychiatrists, neurosurgeons, and certainly at the interface

que somos capaces de botar máis espíritos malignos

of these multiple disciplines that there's the excitement.

fóra do cerebro segundo pasa o tempo

And I think that we will see that

e as consecuencias disto serán

que poderemos axudar moitos máis pacientes.

we will be able to chase more of these evil spirits

Moitas grazas.

out from the brain as time goes on,

and the consequence of that, of course, will be

that we will be able to help many more patients.

Thank you very much.