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

Translator: Joseph Geni Reviewer: Morton Bast

Prevoditelj: Senzos Osijek Recezent: Ivan Stamenković

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

Jedna od stvari koje odmah želim naglasiti

is that not all neurosurgeons wear cowboy boots.

je da ne nose svi neurokirurzi kaubojske čizme.

I just wanted you to know that.

Samo sam želio da to znate.

So I am indeed a neurosurgeon,

Dakle, ja sam zbilja neurokirurg,

and I follow a long tradition of neurosurgery,

i slijedim dugu tradiciju neurokirurgije,

and what I'm going to tell you about today

i ono o čemu ću vam danas govoriti

is adjusting the dials in the circuits in the brain,

je podešavanje brojčanika u krugovima mozga,

being able to go anywhere in the brain

mogućnost da bilo gdje u mozgu

and turning areas of the brain up or down

pojačamo ili stišamo regije

to help our patients.

kako bismo pomogli našim pacijentima.

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

Dakle, kao što sam rekao, neurokirurgija ima dugu tradiciju.

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

Postoji gotovo 7 000 godina.

In Mesoamerica, there used to be neurosurgery,

U Srednjoj Americi postojala je neurokirurgija

and there were these neurosurgeons that used to treat patients.

i neurokirurzi koji su liječili pacijente.

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

Oni su pokušavali -- oni su znali da je mozak uključen

in neurological and psychiatric disease.

u neurološke i psihijatrijske bolesti.

They didn't know exactly what they were doing.

Nisu točno znali što rade.

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

Usput, nije se toliko toga promijenilo. (Smijeh).

But they thought that,

Ali oni su mislili da

if you had a neurologic or psychiatric disease,

ako imate neurološku ili psihijatrijsku bolest,

it must be because you are possessed

to je zasigurno zato što ste opsjednuti

by an evil spirit.

zlim duhom.

So if you are possessed by an evil spirit

Dakle, ako ste opsjednuti zlim duhom

causing neurologic or psychiatric problems,

koji vam uzrokuje neurološke ili psihijatrijske probleme,

then the way to treat this is, of course,

tada je naravno jedini način da se to liječi

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

napraviti rupu u lubanji kako bi zao duh pobjegao.

So this was the thinking back then,

To je bilo tadašnje razmišljanje,

and these individuals made these holes.

i te su osobe pravile rupe.

Sometimes the patients were a little bit reluctant

Ponekad su se pacijenti opirali

to go through this because, you can tell that

postupku jer se vidi da su

the holes are made partially and then, I think,

rupe napravljene djelomično. Mislim

there was some trepanation, and then they left very quickly

da su nakon trepanacije vrlo brzo otišli

and it was only a partial hole,

i ostala je samo djelomična rupa,

and we know they survived these procedures.

ali znamo da su preživjeli te postupke.

But this was common.

To je bilo često.

There were some sites where one percent

Postoje neka mjesta gdje jedan posto

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

svih lubanja ima takve rupe. Kao što vidite,

that neurologic and psychiatric disease is quite common,

neurološke i psihijatrijske bolesti su prilično učestale,

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

i također su bile učestale prije otprilike 7,000 godina.

Now, in the course of time,

Tijekom godina,

we've come to realize that

došli smo da zaključka da

different parts of the brain do different things.

različiti dijelovi mozga rade različite stvari.

So there are areas of the brain that are dedicated

Tako postoje dijelovi mozga koji su posvećeni

to controlling your movement or your vision

kontroli pokreta ili vida

or your memory or your appetite, and so on.

ili pamćenja ili apetita i tako dalje.

And when things work well, then the nervous system

I kada sve dobro radi, tada i živčani sustav

works well, and everything functions.

dobro radi i sve funkcionira.

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

Ali ponekad, sve ne radi tako dobro,

and there's trouble in these circuits,

i dođe do problema u tim sklopovima,

and there are some rogue neurons that are misfiring

i postoje neki nestašni neuroni koji krivo okidaju

and causing trouble, or sometimes they're underactive

i uzrokuju nevolju, ili su ponekad premalo aktivni

and they're not quite working as they should.

i ne rade baš kao što bi trebali.

Now, the manifestation of this

Kako će se to manifestirati

depends on where in the brain these neurons are.

ovisi o tome gdje se u mozgu nalaze ti neuroni.

So when these neurons are in the motor circuit,

Kada su neuroni u motornom krugu

you get dysfunction in the movement system,

dobijete disfunkciju u sustavu za pokretanje

and you get things like Parkinson's disease.

i stvari kao što je Parkinsonova bolest.

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

Kada je problem u krugu koji regulira raspoloženje,

you get things like depression,

dobijete stvari kao što je depresija,

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

a kada je u krugu koji kontrolira pamćenje i kognitivne funkcije,

then you get things like Alzheimer's disease.

dobijete stvari kao što je Alzheimerova bolest.

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

Ono što smo uspjeli napraviti je istaknuti

where these disturbances are in the brain,

gdje se te disfunkcije nalaze u mozgu,

and we've been able to intervene within these circuits

i uspjeli smo se umiješati u te krugove

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

u mozgu kako bismo ih pojačali ili stišali.

So this is very much like choosing the correct station

Dakle, ovo je prilično slično odabiranju prave stanice

on the radio dial.

na radiju.

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

Jednom kada ste izabrali pravu stanicu, bio to jazz ili opera,

in our case whether it be movement or mood,

u našem slučaju bio to pokret ili raspoloženje,

we can put the dial there,

možemo postaviti birač tamo

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

i koristiti drugi gumb kako bismo prilagodili glasnoću -

to turn it up or turn it down.

pojačali ili stišali.

So what I'm going to tell you about

Ono o čemu ću vam pričati

is using the circuitry of the brain to implant electrodes

je umetanje elektroda u krugove mozga

and turning areas of the brain up and down

i pojačavanje ili stišavanje regija mozga

to see if we can help our patients.

kako bi pomogli našim pacijentima.

And this is accomplished using this kind of device,

To nam omogućuje korištenje ove vrste uređaja,

and this is called deep brain stimulation.

a zove se duboka stimulacija mozga.

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

Ono što radimo je umetanje elektroda kroz mozak.

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

Pravimo rupe u lubanji otprilike veličine novčića,

putting an electrode in, and then this electrode

umećemo elektrodu unutra, i kada je ta elektroda

is completely underneath the skin

potpuno ispod kože,

down to a pacemaker in the chest,

kao pacemaker u prsima,

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

tada s upravljačem vrlo sličnim TV upravljaču,

we can adjust how much electricity we deliver

možemo prilagoditi koliko struje dovodimo

to these areas of the brain.

tim regijama mozga.

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

Možemo ih pojačati ili stišati, uključiti ili isključiti.

Now, about a hundred thousand patients in the world

sada je oko sto tisuća pacijenata na svijetu

have received deep brain stimulation,

primilo duboku stimulaciju mozga,

and I'm going to show you some examples

i pokazat ću vam neke primjere

of using deep brain stimulation to treat disorders of movement,

u korištenju duboke stimulacije mozga u liječenju poremećaja pokreta,

disorders of mood and disorders of cognition.

raspoloženja i razmišljanja.

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

Otprilike ovako izgleda kada je u mozgu.

You see the electrode going through the skull into the brain

Vidite da elektroda ide kroz lubanju u mozak

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

i stoji tamo, a mi ju možemo postaviti stvarno bilo gdje u mozak.

I tell my friends that no neuron is safe

Govorim svojim prijateljima da nijedan neuron nije siguran

from a neurosurgeon, because we can really reach

od neurokirurga, jer mi sada stvarno možemo dosegnuti

just about anywhere in the brain quite safely now.

bilo koji dio mozga prilično sigurno.

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

Sada ću vam kao prvi primjer pokazati pacijenticu

with Parkinson's disease,

s Parkinsonovom bolešću.

and this lady has Parkinson's disease,

Ova dama ima Parkinsonovu bolest,

and she has these electrodes in her brain,

i ima elektrode u mozgu,

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

pokazat ću vam kakva je

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

kada su elektrode isključene i ona ima simptome Parkinsonove bolesti,

and then we're going to turn it on.

a onda ćemo ih uključiti.

So this looks something like this.

Dakle izgleda ovako.

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

Sada su elektrode isključene i možete vidjeti da drhti.

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

(Video) Muškarac: OK. Žena: Ne mogu. Muškarac: Možete li dotaknuti moj prst?

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

Video) Muškarac: Ovo je malo bolje. Žena: Ta strana je bolja.

We're now going to turn it on.

Sada ćemo uključiti uređaj.

It's on. Just turned it on.

Uključen je. Upravo smo ga uključili.

And this works like that, instantly.

I radi ovako, trenutačno.

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

I razlika između drhtanja i ne drhtanja –

(Applause)

(Pljesak)

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

Razlika između ovakvog drhtanja i ne drhtanja povezana je s nedoličnim ponašanjem

of 25,000 neurons in her subthalamic nucleus.

25,000 neurona u njenoj subtalamičkoj jezgri.

So we now know how to find these troublemakers

Dakle znamo pronaći te izgrednike

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

i reći im: „Gospodo, bilo je dosta.

We want you to stop doing that."

Želimo da to prestanete raditi“.

And we do that with electricity.

To napravimo pomoću struje.

So we use electricity to dictate how they fire,

Koristimo struju da diktiramo kako ispaljuju,

and we try to block their misbehavior using electricity.

i pokušavamo blokirati njihovo nedolično ponašanje strujom.

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

U ovom slučaju prigušujemo aktivnost abnormalnih neurona.

We started using this technique in other problems,

Počeli smo koristiti ovu tehniku i u drugim problemima,

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

ispričat ću vam o jednom fascinantnom problemu

that we encountered, a case of dystonia.

s kojim smo se susreli, slučaj distonije.

So dystonia is a disorder affecting children.

Distonija je poremećaj koji zahvaća djecu.

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

To je genetski poremećaj, uključuje zakrečuće pokrete,

and these children get progressively more and more twisting

ta se djeca progresivno sve više zakreću

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

sve dok ne mogu disati, dobiju čireve,

urinary infections, and then they die.

urinarne infekcije, i onda umru.

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

Godine 1997. pozvali su me da vidim ovog malog dječaka,

perfectly normal. He has this genetic form of dystonia.

potpuno normalnog. On ima genetički tip distonije.

There are eight children in the family.

Ima osmero djece u njihovoj obitelji.

Five of them have dystonia.

Petero od njih ima distoniju.

So here he is.

Dakle, evo ga.

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

Ovaj dječak ima 9 godina, bio je potpuno normalan do šeste godine,

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

onda je počeo zakretati svoje tijelo, prvo desno stopalo,

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

pa lijevo stopalo, pa desnu ruku, pa lijevu ruku,

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

pa trup, i do vremena kada je stigao,

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

otprilike jednu do dvije godine od početka bolesti,

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

više nije mogao hodati, nije mogao stajati.

He was crippled, and indeed the natural progression

Bio je osakaćen, i doista uobičajena progresija

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

kako bolest postaje gora je da postanu sve više zakrenuti,

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

progresivno onesposobljeni, i mnoga od ove djece ne prežive.

So he is one of five kids.

On je jedno od petero djece.

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

Jedini način na koji se mogao kretati je ovakvo puzanje na trbuhu.

He did not respond to any drugs.

Nije reagirao ni na kakve lijekove.

We did not know what to do with this boy.

Nismo znali što da radimo s ovim dječakom.

We did not know what operation to do,

Nismo znali koju operaciju da napravimo,

where to go in the brain,

gdje da idemo u mozak,

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

ali na temelju naših rezultata s Parkinsonovom bolešću,

we reasoned, why don't we try to suppress

razmišljali smo, zašto ne bi probali prigušiti

the same area in the brain that we suppressed

isti dio mozga koji smo prigušili

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

kod Parkinsonove bolesti, da vidimo što će se dogoditi?

So here he was. We operated on him

Bio je tamo. Operirali smo ga

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

nadajući se da će mu biti bolje. Nismo znali.

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

Ovo je on sada, natrag u Izraelu gdje živi,

three months after the procedure, and here he is.

tri mjeseca nakon postupka, evo ga.

(Applause)

(Pljesak)

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

Na temelju tog rezultata, ovo je sada postupak

that's done throughout the world,

koji se radi u cijelome svijetu,

and there have been hundreds of children

i stotinama je djece

that have been helped with this kind of surgery.

već pomogla ova vrsta operacije.

This boy is now in university

Dječak je sada na fakultetu

and leads quite a normal life.

i vodi prilično normalan život.

This has been one of the most satisfying cases

Ovo je bio jedan od najispunjavajućih pothvata

that I have ever done in my entire career,

koje sam ikada napravio u cijeloj svojoj karijeri,

to restore movement and walking to this kind of child.

vratiti pokret i hodanje ovakvom djetetu.

(Applause)

(Pljesak)

We realized that perhaps we could use this technology

Shvatili smo da bismo možda mogli koristiti ovu tehnologiju

not only in circuits that control your movement

ne samo u krugovima za kontrolu pokreta,

but also circuits that control other things,

nego također u krugovima koji kontroliraju druge funkcije,

and the next thing that we took on

i sljedeća stvar koje smo se prihvatili

was circuits that control your mood.

bili su krugovi koji kontroliraju raspoloženje.

And we decided to take on depression,

Odlučili smo se prihvatiti depresije

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

zato što je toliko raširena,

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

i kao što znate, postoji puno terapija za depresiju,

with medication and psychotherapy,

uz lijekove i psihoterapiju,

even electroconvulsive therapy,

čak i elektrokonvulzivnu terapiju,

but there are millions of people,

ali ima na milijune ljudi,

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

i još uvijek postoji 10 ili 20 posto pacijenata s depresijom

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

s depresijom koji ne odgovaraju, i tim pacijentima želimo pomoći.

And let's see if we can use this technique

Pogledajmo možemo li koristiti ovu tehniku

to help these patients with depression.

kako bi pomogli tim pacijentima s depresijom.

So the first thing we did was, we compared,

Prva stvar koju smo napravili je bila da smo usporedili

what's different in the brain of someone with depression

što je drukčije u mozgu nekoga sa depresijom

and someone who is normal,

i nekoga tko je zdrav,

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

napravili smo PET skeniranje kako bismo pogledali protok krvi kroz mozak,

and what we noticed is that in patients with depression

i primijetili smo da su kod pacijenata s depresijom,

compared to normals,

u usporedbi sa zdravim ljudima,

areas of the brain are shut down,

dijelovi mozga isključeni,

and those are the areas in blue.

i ti su dijelovi plavi.

So here you really have the blues,

Ovdje imamo plavu boju,

and the areas in blue are areas that are involved

i plavo obojani dijelovi su uključeni

in motivation, in drive and decision-making,

u motivaciju, polet i donošenje odluka

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

i doista, ako ste izrazito depresivni kao što su ovi pacijenti bili,

those are impaired. You lack motivation and drive.

oni su onesposobljeni. Nedostaje vam motivacije i poleta.

The other thing we discovered

Druga stvar koju smo otkrili,

was an area that was overactive, area 25,

bilo je jedno preaktivno područje, područje 25,

seen there in red,

ovdje obojeno crveno.

and area 25 is the sadness center of the brain.

Područje 25 je centar za tugu u mozgu.

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

Kada bih nekoga od vas učinio tužnim, na primjer kada bih vas podsjetio

the last time you saw your parent before they died

na zadnji put kada ste vidjeli roditelja prije nego što je umro,

or a friend before they died,

ili prijatelja prije nego što je umro,

this area of the brain lights up.

ovo bi se područje mozga uključilo.

It is the sadness center of the brain.

To je područje mozga za tugu.

And so patients with depression have hyperactivity.

I pacijenti s depresijom imaju hiperaktivnost.

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

Područje za tugu je žarko crveno,

The thermostat is set at 100 degrees,

termostat je na 100 stupnjeva,

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

a druga područja mozga, uključena u polet i motivaciju su isključena.

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

Pitali smo se, možemo li postaviti elektrode u područje za tugu

and see if we can turn down the thermostat,

tugu i vidjeti možemo li smanjiti termostat,

can we turn down the activity,

možemo li smanjiti aktivnost,

and what will be the consequence of that?

i koja će biti posljedica toga?

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

Krenuli smo i umetnuli elektrode u pacijente s depresijom.

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

Ovo je posao obavljen s mojom kolegicom Helen Mayberg sa sveučilišta Emory.

And we placed electrodes in area 25,

Postavili smo elektrode u područje 25,

and in the top scan you see before the operation,

na gornjoj slici vidite prije operacije,

area 25, the sadness area is red hot,

područje 25, centar za tugu je žarko crven

and the frontal lobes are shut down in blue,

i frontalni režnjevi su prigušeni u plavoj,

and then, after three months of continuous stimulation,

a zatim, nakon tri mjeseca neprekidne stimulacije,

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

24 sata dnevno, ili 6 mjeseci neprekidne stimulacije,

we have a complete reversal of this.

imamo potpuni obrat ovoga.

We're able to drive down area 25,

Sposobni smo prigušiti područje 25

down to a more normal level,

na normalniju razinu,

and we're able to turn back online

i u mogućnosti smo ponovo uključiti

the frontal lobes of the brain,

frontalne režnjeve mozga,

and indeed we're seeing very striking results

i doista vidimo vrlo upečatljive rezultate

in these patients with severe depression.

kod ovakvih pacijenata s jakom depresijom.

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

Sada smo na kliničkim ispitivanjima, i to u fazi III kliničkih ispitivanja,

and this may become a new procedure,

i ovo bi mogao postati novi postupak,

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

ako bude siguran i ako otkrijemo da je učinkovit,

to treat patients with severe depression.

za liječenje pacijenata s teškom depresijom.

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

Pokazao sam vam kako možemo koristiti duboku stimulaciju mozga

to treat the motor system

za liječenje motoričkog sustava

in cases of Parkinson's disease and dystonia.

u slučaju Parkinsonove bolesti i distonije.

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

Pokazao sam vam kako ju možemo koristiti u terapiji krugova za raspoloženje

in cases of depression.

u slučaju depresije.

Can we use deep brain stimulation to make you smarter?

Možemo li koristiti duboku stimulaciju mozga da vas učinimo pametnijima?

(Laughter)

(Smijeh)

Anybody interested in that?

Je li netko zainteresiran za to?

(Applause)

(Pljesak)

Of course we can, right?

Naravno da možemo, zar ne?

So what we've decided to do is

Ono što smo odlučili učiniti je

we're going to try to turbocharge

da pokušamo primijeniti veliki napon

the memory circuits in the brain.

na memorijske krugove u mozgu.

We're going to place electrodes within the circuits

Postavit ćemo elektrode unutar krugova

that regulate your memory and cognitive function

koji reguliraju memoriju i kognitivnu funkciju

to see if we can turn up their activity.

da vidimo možemo li pojačati njihovu aktivnost.

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

Nećemo ovo raditi kod zdravih ljudi.

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

Napravit ćemo to kod ljudi koji imaju manjak kognitivnih sposobnosti

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

i odlučili smo liječiti pacijente s Alzheimerovom bolešću

who have cognitive and memory deficits.

koji imaju kognitivne i memorijske gubitke.

As you know, this is the main symptom

Kao što znate, to je glavni simptom

of early onset Alzheimer's disease.

ranog nastupa Alzheimerove bolesti.

So we've placed electrodes within this circuit

Postavili smo elektrode unutar kruga

in an area of the brain called the fornix,

u dijelu mozga koji se zove forniks,

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

koji je cesta za ulaz i izlaz ovog memorijskog kruga,

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

s idejom da vidimo možemo li uključiti taj memorijski krug

and whether that can, in turn, help these patients

i može li to pomoći pacijentima

with Alzheimer's disease.

s Alzheimerovom bolešću.

Now it turns out that in Alzheimer's disease,

Pokazalo se da u Alzheimerovoj bolesti

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

postoji ogroman gubitak u iskorištavanju glukoze u mozgu.

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

Mozak je pomalo proždrljiv kada je u pitanju uporaba glukoze.

It uses 20 percent of all your --

Koristi 20 posto od cijelog vašeg unosa

even though it only weighs two percent --

iako teži samo dva posto tjelesne mase,

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

koristi 10 puta više glukoze nego što bi trebao po svojoj težini.

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

Dvadeset posto od sve glukoze u vašem tijelu koristi mozak,

and as you go from being normal

i kako idete od zdravlja

to having mild cognitive impairment,

preko blagih kognitivnih poremećaja,

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

koji prethode Alzheimerovoj bolesti, sve do Alzheimerove bolesti,

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

dijelovi mozga prestaju koristiti glukozu.

They shut down. They turn off.

Isključe se. Prestanu raditi.

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

I doista, ono što vidimo je da ove crvene regije

around the outside ribbon of the brain

oko vanjskog dijela mozga

are progressively getting more and more blue

progresivno postaju sve više i više plave

until they shut down completely.

sve dok se potpuno ne ugase.

This is analogous to having a power failure

Ovo je ekvivalent nestanku energije

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

u području mozga, regionalni nestanak struje.

So the lights are out in parts of the brain

Svjetla su ugašena u dijelovima mozga

in patients with Alzheimer's disease,

kod pacijenata s Alzheimerovom bolešću

and the question is, are the lights out forever,

i pitanje je, jesu li svjetla zauvijek ugašena

or can we turn the lights back on?

ili ih možemo ponovo upaliti?

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

Možemo li potaknuti te dijelove mozga da ponovo koriste glukozu?

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

Ovo smo napravili. Ugradili smo elektrode u forniks

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

pacijenata s Alzheimerovom bolešću, i uključili ih,

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

gledajući što se događa s potrošnjom glukoze u mozgu.

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

I zaista, gore vidite prije operacije,

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

područja koja su plava koriste manje glukoze nego što je normalno,

predominantly the parietal and temporal lobes.

pretežno parijetalni i temporalni režnjevi.

These areas of the brain are shut down.

Ti dijelovi mozga su isključeni.

The lights are out in these areas of the brain.

U njima su svjetla isključena.

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

Tada smo umetnuli DBS elektrode i čekali mjesec

or a year, and the areas in red

ili godinu, i crveno obojana područja

represent the areas where we increase glucose utilization.

područja predstavljaju dijelove gdje smo povećali iskorištavanje glukoze.

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

I doista, sposobni smo potaknuti te dijelove mozga

that were not using glucose to use glucose once again.

koji nisu koristili glukozu da je ponovo počnu iskorištavati.

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

Poruka u ovome je da su u Alzheimerovoj bolesti

the lights are out, but there is someone home,

svjetla isključena, ali netko je kod kuće,

and we're able to turn the power back on

i mi smo u mogućnosti ponovo uključiti struju

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

tim dijelovima mozga i kada to napravimo,

we expect that their functions will return.

očekujemo da će se njihove funkcije vratiti.

So this is now in clinical trials.

Ovo je sada na kliničkim ispitivanjima.

We are going to operate on 50 patients

Operirat ćemo 50 pacijenata

with early Alzheimer's disease

s ranom Alzheimerovom bolešću

to see whether this is safe and effective,

kako bismo vidjeli je li sigurno i učinkovito,

whether we can improve their neurologic function.

možemo li poboljšati njihove neurološke funkcije.

(Applause)

(Pljesak)

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

Poruka s kojom vas danas želim ostaviti jest

indeed, there are several circuits in the brain

da zaista neki krugovi u mozgu krivo rade

that are malfunctioning across various disease states,

u različitim bolesnim stanjima,

whether we're talking about Parkinson's disease,

bilo da pričamo o Parkinsonovoj bolesti,

depression, schizophrenia, Alzheimer's.

depresiji, shizofreniji, Alzheimeru.

We are now learning to understand what are the circuits,

Sada učimo razumjeti koji su krugovi,

what are the areas of the brain that are responsible for

koja su područja mozga odgovorna

the clinical signs and the symptoms of those diseases.

za kliničke znakove i simptome takvih poremećaja.

We can now reach those circuits.

Sada možemo dosegnuti te krugove.

We can introduce electrodes within those circuits.

Možemo umetnuti elektrode unutar tih krugova.

We can graduate the activity of those circuits.

Možemo podešavati aktivnost tih krugova.

We can turn them down if they are overactive,

Možemo ju smanjiti ako su previše aktivni,

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

ako uzrokuju nevolju, nevolju koja se osjeća kroz mozak,

or we can turn them up if they are underperforming,

ili ih možemo pojačati ako preslabo rade

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

, i mislimo da tako možemo pomoći

the overall function of the brain.

cjelokupnoj funkciji mozga.

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

Ovo implicira da ćemo možda moći

to modify the symptoms of the disease,

ublažiti simptome bolesti,

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

ali nisam vam rekao da također postoje dokazi

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

da bismo mogli pomoći popraviti oštećena područja mozga koristeći struju,

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

i to je nešto za budućnost, da vidimo možemo li

we not only change the activity but also

ne samo promijeniti aktivnost nego i

some of the reparative functions of the brain

možemo li potaknuti neke popravljačke

can be harvested.

funkcije mozga.

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

Predviđam da ćemo vidjeti veliki razvoj

of indications of this technique.

učinaka ove tehnike.

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

Vidjet ćemo elektrode koje se umeću zbog mnogih poremećaja mozga.

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

Jedna od najuzbudljivijih stvari u ovome je da, zaista,

it involves multidisciplinary work.

uključuje multidisciplinarni rad.

It involves the work of engineers, of imaging scientists,

Uključuje rad inženjera, znanstvenika koji se služe slikovnom dijagnostikom,

of basic scientists, of neurologists,

temeljnih znanosti, neurologa,

psychiatrists, neurosurgeons, and certainly at the interface

psihijatara, neurokirurga, i svakako je sučelje

of these multiple disciplines that there's the excitement.

tih mnogih disciplina uzbudljivo.

And I think that we will see that

Mislim da ćemo vidjeti kako

we will be able to chase more of these evil spirits

ćemo biti u mogućnosti progoniti sve više od onih zlih duhova

out from the brain as time goes on,

kako vrijeme prolazi,

and the consequence of that, of course, will be

i posljedica će toga, naravno, biti

that we will be able to help many more patients.

da ćemo moći pomoći još mnogim pacijentima.

Thank you very much.

Puno vam hvala.