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

Translator: Joseph Geni Reviewer: Morton Bast

Prevodilac: Jelena Kovačević Lektor: Mile Živković

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

Jedna od stvari koje želim da razjasnim odmah na početku

is that not all neurosurgeons wear cowboy boots.

jeste to da ne nose svi neurohirurzi kaubojske čizme.

I just wanted you to know that.

Samo sam želeo to da znate.

So I am indeed a neurosurgeon,

Ja sam zaista neurohirurg

and I follow a long tradition of neurosurgery,

dolazim iz duge tradicije neurohirurgije,

and what I'm going to tell you about today

a ono o čemu ću vam danas govoriti

is adjusting the dials in the circuits in the brain,

jeste podešavanje brojčanika u moždanim kolima,

being able to go anywhere in the brain

mogućnost pristupanja bilo kom delu mozga

and turning areas of the brain up or down

i podešavanja delova mozga

to help our patients.

kako bismo pomogli pacijentima.

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

Kao što sam rekao, neurohirurgija ima dugu tradiciju.

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

Ona postoji već oko 7.000 godina.

In Mesoamerica, there used to be neurosurgery,

U Mezoamerici je postojala neurohirurgija

and there were these neurosurgeons that used to treat patients.

i postojali su neurohirurzi koji su lečili pacijente.

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

Znali su da mozak igra ulogu

in neurological and psychiatric disease.

u neurološkim i psihijatrijskim oboljenjima.

They didn't know exactly what they were doing.

Nisu tačno znali šta rade.

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

Nije se mnogo toga promenilo, uzgred. (Smeh)

But they thought that,

Ali su mislili

if you had a neurologic or psychiatric disease,

da ako imate neurološki ili psihijatrijski poremećaj

it must be because you are possessed

uzrok tome mora da je to

by an evil spirit.

što vas je opseo zloduh.

So if you are possessed by an evil spirit

I zato ako vas je opseo zloduh

causing neurologic or psychiatric problems,

koji prouzrokuje neurološke i psihijatrijske probleme,

then the way to treat this is, of course,

najbolji način da se to reši, je, naravno,

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

bušenje rupe u vašoj lobanji kako bi zloduh mogao da pobegne.

So this was the thinking back then,

Ovako su razmišljali u to vreme

and these individuals made these holes.

i ovi pojedinci su bušili ovakve rupe.

Sometimes the patients were a little bit reluctant

Ponekad pacijenti baš i nisu želeli

to go through this because, you can tell that

da prolaze kroz ovo, jer, kao što možete da pretpostavite,

the holes are made partially and then, I think,

rupe su bile delimične, mislim,

there was some trepanation, and then they left very quickly

došlo je do neke trepanacije, i onda su brzo prestali

and it was only a partial hole,

i to je bila samo delimična rupa

and we know they survived these procedures.

i znamo da su ljudi preživljavali ove zahvate.

But this was common.

Ali ovo je bilo uobičajeno.

There were some sites where one percent

Bilo je lokacija gde je jedan procenat

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

svih lobanja imao ove rupe i zato možemo da vidimo

that neurologic and psychiatric disease is quite common,

da su neurološka i psihijatrijska oboljenja česta

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

i bila su poprilično česta pre 7.000 godina.

Now, in the course of time,

Vremenom smo

we've come to realize that

došli do zaključka

different parts of the brain do different things.

da različiti delovi mozga rade različite stvari.

So there are areas of the brain that are dedicated

Postoje delovi mozga koji su zaduženi

to controlling your movement or your vision

za kontrolu pokreta ili za vid

or your memory or your appetite, and so on.

ili za pamćenje, apetit i tako dalje.

And when things work well, then the nervous system

I kada stvari teku kako treba,

works well, and everything functions.

onda nervni sistem radi kako treba i sve funkcioniše.

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

Ali ponekad ne ispadne sve baš kako treba

and there's trouble in these circuits,

i dolazi do problema u ovim kolima

and there are some rogue neurons that are misfiring

i neki buntovni neuroni ne rade kako treba

and causing trouble, or sometimes they're underactive

i stvaraju se problemi, ili ponekad nisu dovoljno aktivni

and they're not quite working as they should.

i ne rade baš onako kako bi trebalo.

Now, the manifestation of this

Kako će se ovo ispoljiti

depends on where in the brain these neurons are.

zavisi od toga gde se u mozgu ovi neuroni nalaze.

So when these neurons are in the motor circuit,

Kada su ovi neuroni u motornom kolu,

you get dysfunction in the movement system,

dolazi do poremećaja pokreta

and you get things like Parkinson's disease.

i stvari poput Parkinsonove bolesti.

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

Kada je zastoj u kolu koje upravlja raspoloženjem,

you get things like depression,

dolazi do stvari poput depresije,

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

a kada je to u kolu koje upravlja pamćenjem i kognitivnim fukcijama,

then you get things like Alzheimer's disease.

dolazi do stvari poput Alchajmerove bolesti.

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

Ono što smo mi uspeli da uradimo je da odredimo

where these disturbances are in the brain,

gde se ovi poremećaji nalaze u mozgu

and we've been able to intervene within these circuits

i uspeli smo da se umešamo u ova kola u mozgu

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

kako bismo ih ili uključili ili isključili.

So this is very much like choosing the correct station

Ovo je slično biranju radio stanice

on the radio dial.

na brojčaniku radija.

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

Kada odaberete stanicu, bila to džez ili operska stanica,

in our case whether it be movement or mood,

u našem slučaju, bili to pokreti ili raspoloženje,

we can put the dial there,

ostavljamo brojčanik na toj poziciji

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

i onda drugim dugmetom podešavamo jačinu zvuka,

to turn it up or turn it down.

pojačavamo ili smanjujemo.

So what I'm going to tell you about

Ono o čemu ću vam govoriti

is using the circuitry of the brain to implant electrodes

je upotreba moždanih kola za ugradnju elektroda

and turning areas of the brain up and down

pomoću kojih pojačavamo ili smanjujemo rad delova mozga

to see if we can help our patients.

da vidimo da li možemo da pomognemo pacijentima.

And this is accomplished using this kind of device,

To postižemo ovakvim uređajima

and this is called deep brain stimulation.

i to se zove dubinska stimulacija mozga.

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

Ono što radimo jeste postavljanje ovih elektroda u mozak.

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

Ponovo pravimo rupe u mozgu, veličine novčića,

putting an electrode in, and then this electrode

postavljamo elektrodu,

is completely underneath the skin

i onda je ona u potpunosti ispod kože,

down to a pacemaker in the chest,

do pejsmekera u grudnom košu,

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

i sa daljinskim upravljačem, veoma sličnom onom za televiziju

we can adjust how much electricity we deliver

podešavamo količinu energije koju puštamo

to these areas of the brain.

u određene delove mozga.

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

Možemo ih pojačati ili smanjiti, uključiti ili isključiti.

Now, about a hundred thousand patients in the world

Oko stotinu hiljada pacijenata na svetu

have received deep brain stimulation,

je imalo duboku stimulaciju mozga

and I'm going to show you some examples

i pokazaću vam samo neke primere

of using deep brain stimulation to treat disorders of movement,

korišćenja duboke stimulacije mozga za lečenje poremećaja kretnje,

disorders of mood and disorders of cognition.

poremećaja raspoloženja i kognitivnih poremećaja.

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

To izgleda ovako nekako kada je u mozgu.

You see the electrode going through the skull into the brain

Vidimo elektrodu koja prolazi kroz lobanju do mozga

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

i možemo je postaviti bilo gde u mozgu.

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 neurohirurga, jer možemo dospeti

just about anywhere in the brain quite safely now.

do bilo koje tačke u mozgu, i to poprilično bezbedno.

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

Prvi primer koji ću vam pokazati je primer pacijenta

with Parkinson's disease,

sa Parkinsonovom bolešću.

and this lady has Parkinson's disease,

Ova gospođa ima Parkinsonovu bolest

and she has these electrodes in her brain,

i ima ove elektrode u mozgu,

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

Pokazaću vam kakva je ona

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

kada su elektrode isključene i pokazuje simptome Parkinsonove

and then we're going to turn it on.

i kakva je kada ih uključimo.

So this looks something like this.

To izgleda otprilike ovako.

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

Elektrode su sada isključene i vidimo da ona ima tremor.

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

(Video) Čovek: U redu. Žena: Ne mogu. Čovek: Možete li da pokušate da dodirnete moj prst?

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

(Video) Čovek: To je malo bolje. Žena: Ta strana je bolja.

We're now going to turn it on.

Sada ćemo ih uključiti.

It's on. Just turned it on.

Uključene su. Upravo sam ih uključio.

And this works like that, instantly.

I to funkcioniše ovako, u trenutku.

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

A razlika između ovakvog podrhtavanja i nepodrhtavanja -

(Applause)

(Aplauz)

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

Razlika između podrhtavanja i nepodrhtavanja povezana je sa ponašanjem

of 25,000 neurons in her subthalamic nucleus.

25.000 neurona u njenom subtalamičkom jezgru.

So we now know how to find these troublemakers

Sada znamo kako da pronađemo ove probleme

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

i kažemo im: "Gospodo, sada je dosta.

We want you to stop doing that."

Hoćemo da prestanete s tim."

And we do that with electricity.

To radimo uz pomoć struje.

So we use electricity to dictate how they fire,

Strujom određujemo kako će se aktivirati

and we try to block their misbehavior using electricity.

i strujom zaustavljamo neželjena ponašanja.

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

Tako u ovom slučaju suzbijamo aktivnost abnormalnih neurona.

We started using this technique in other problems,

Počeli smo da primenjujemo ovu tehniku i u drugim slučajevima,

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

pa ću vam ispričati o fascinantnom problemu

that we encountered, a case of dystonia.

sa kojim smo se suočili, o slučaju distonije.

So dystonia is a disorder affecting children.

Distonija je oboljenje koje pogađa decu.

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

To je genetsko oboljenje, i manifestuje se u pokretima grčenja,

and these children get progressively more and more twisting

a kod ove dece se to progresivno razvija

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

sve dok više ne mogu da dišu, dok ne dobiju ranice,

urinary infections, and then they die.

urinarne infekcije, i onda umiru.

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

I tako je 1997. trebalo da vidim ovog dečaka,

perfectly normal. He has this genetic form of dystonia.

sasvim normalnog. Ima genetski oblik distonije.

There are eight children in the family.

U porodici ima osmoro dece.

Five of them have dystonia.

Od njih petoro ima distoniju.

So here he is.

Dakle, evo ga.

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

Dečak ima devet godina, bio je sasvim normalan do šeste,

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

i onda su počeli grčevi u telu, prvo u desnom stopalu,

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

zatim u levom, onda u desnoj ruci, a potom i u levoj,

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

zatim u trupu, i sve dok nije stigao,

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

tokom perioda od jedne do dve godine od nastupa bolesti

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

više nije mogao da hoda, ni da stoji.

He was crippled, and indeed the natural progression

Bio je obogaljen i zapravo, pošto se ovo vremenom pogoršava

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

prirodan tok stvari je da im se telo postepeno izvrće

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

i postepeno postaju onesposobljeni, i mnoga od ove dece ne prežive.

So he is one of five kids.

Dakle on je jedno od petoro dece.

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

Jedini način na koji je mogao da se kreće je ovako, puzeći na stomaku.

He did not respond to any drugs.

Nije reagovao ni na kakve lekove.

We did not know what to do with this boy.

Nismo znali šta da radimo s njim.

We did not know what operation to do,

Nismo znali kakvu operaciju bismo mogli da uradimo,

where to go in the brain,

na kom delu mozga,

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

ali na osnovu postignuća s Parkinsonovom bolešću

we reasoned, why don't we try to suppress

zaključili smo da možemo da probamo

the same area in the brain that we suppressed

da suzbijemo aktivnost iste oblasti u mozgu

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

kao u slučaju s Parkinsonovom, i da vidimo šta će se desiti.

So here he was. We operated on him

Operisali smo ga,

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

nadajući se da će mu biti bolje. Nismo bili sigurni.

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

I evo ga sada, ponovo u Izraelu gde i živi,

three months after the procedure, and here he is.

tri meseca posle operacije.

(Applause)

(Aplauz)

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

Na osnovu ovog rezultata, ovo je sada operacija

that's done throughout the world,

koja se praktikuje svuda po svetu,

and there have been hundreds of children

i hiljade dece je

that have been helped with this kind of surgery.

na ovaj način dobilo pomoć.

This boy is now in university

Ovaj dečak 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 onih slučajeva u mojoj karijeri

that I have ever done in my entire career,

kojim sam bio najzadovoljniji,

to restore movement and walking to this kind of child.

kada sam vratio mogućnost pokreta i hoda ovakvom detetu.

(Applause)

(Aplauz)

We realized that perhaps we could use this technology

Shvatili smo da bismo možda mogli da koristimo ovu tehnologiju,

not only in circuits that control your movement

ne samo u kolima koja kontrolišu pokrete

but also circuits that control other things,

već i u kolima koja kontrolišu druge stvari

and the next thing that we took on

i sledeća stvar koje smo se prihvatili

was circuits that control your mood.

su bila kola koja kontrolišu raspoloženje.

And we decided to take on depression,

Rešili smo da se prihvatimo depresije,

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

i razlog zbog kojeg smo odabrali baš depresiju je to što je tako česta

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

i kao što znate, postoji mnogo načina da se ona leči

with medication and psychotherapy,

lekovima i psihoterapijom,

even electroconvulsive therapy,

čak i elektroterapijom,

but there are millions of people,

ali postoje milioni ljudi

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

i još uvek ima 10 ili 20 procenata pacijenata sa depresijom

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

koji ne reaguju, i oni su ti kojima želimo da pomognemo.

And let's see if we can use this technique

Hajde da vidimo možemo li da koristimo ovu tehniku

to help these patients with depression.

da pomognemo pacijentima koji pate od depresije.

So the first thing we did was, we compared,

Prvo što smo uradili bilo je upoređivanje

what's different in the brain of someone with depression

mozga osobe koja je depresivna

and someone who is normal,

i osobe koja je normalna.

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

Uradili smo PET skeniranje da bismo videli protok krvi u mozgu

and what we noticed is that in patients with depression

i primetili smo da su kod pacijenata sa depresijom,

compared to normals,

u poređenju sa normalnima,

areas of the brain are shut down,

neki delovi mozga isključeni,

and those are the areas in blue.

i to su ove oblasti plave boje.

So here you really have the blues,

Ovde ima dosta plavog,

and the areas in blue are areas that are involved

i ti plavi delovi su oni zaduženi

in motivation, in drive and decision-making,

za motivaciju, želju i odlučivanje,

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

i zaista, ako ste ozbiljno depresivni kao što su ovi pacijenti bili

those are impaired. You lack motivation and drive.

ove oblasti mozga su vam oštećene. Fali vam motivacija i želja.

The other thing we discovered

Sledeća stvar koju smo otkrili

was an area that was overactive, area 25,

je oblast koja je bila preaktivna, oblast 25,

seen there in red,

koja je obojena u crveno,

and area 25 is the sadness center of the brain.

i oblast 25 je centar za tugu.

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

Ako bih vas sad rastužio, kada bih vas recimo naterao

the last time you saw your parent before they died

da se setite kada ste poslednji put videli svoje roditelje

or a friend before they died,

ili prijatelja pre nego što su umrli,

this area of the brain lights up.

ova oblast u mozgu bi se aktivirala.

It is the sadness center of the brain.

To je centar za tugu u mozgu.

And so patients with depression have hyperactivity.

Kod pacijenata sa depresijom je hiperaktivan.

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

Oblast za tugu u mozgu je užarena.

The thermostat is set at 100 degrees,

Termostat je podešen na 100 stepeni

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

a ostale oblasti mozga, koje uključuju želju i motivaciju su isključene.

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

Pitali smo se možemo li postaviti elektrode u ovim oblastima tuge,

and see if we can turn down the thermostat,

i ako smanjimo termostat

can we turn down the activity,

možemo li smanjiti i aktivnost,

and what will be the consequence of that?

i koje će biti posledice toga.

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

Tako smo nastavili i ugradili elektrode kod pacijenata sa depresijom.

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

Ovaj posao je uradila moja koleginica Helen Mejberg iz Emorija.

And we placed electrodes in area 25,

Postavili smo elektrode u oblasti 25

and in the top scan you see before the operation,

i na slici u vrhu možete videti da je pre operacije

area 25, the sadness area is red hot,

oblast 25, centar za tugu u mozgu crven

and the frontal lobes are shut down in blue,

a da su frontalni režnjevi ugašeni, u plavoj boji,

and then, after three months of continuous stimulation,

i onda posle tri meseca kontinuirane stimulacije

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

24 sata na dan ili 6 meseci kontinuirane stimulacije

we have a complete reversal of this.

vidimo potpuni preokret.

We're able to drive down area 25,

Uspeli smo da smanjimo aktivnost oblasti 25

down to a more normal level,

na normalan nivo

and we're able to turn back online

i uspeli smo da vratimo aktivnost

the frontal lobes of the brain,

frontalnih režnjeva u mozgu.

and indeed we're seeing very striking results

Zaista, vidimo veoma impresivne rezultate

in these patients with severe depression.

kod ovih pacijenata sa teškom depresijom.

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

Sada smo na kliničkim ispitivanjima, i to u trećoj fazi ispitivanja,

and this may become a new procedure,

pa ovo može postati nova procedura

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

ako je bezbedna i ako otkrijemo da je efikasna,

to treat patients with severe depression.

za lečenje pacijenata sa teškom depresijom.

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

Pokazao sam vam da možemo koristiti dubinsku stimulaciju mozga

to treat the motor system

da utičemo na pokrete

in cases of Parkinson's disease and dystonia.

u slučajevima Parkinsonove bolesti i distonije.

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

Pokazao sam vam da je možemo koristiti da utičemo na raspoloženje

in cases of depression.

u slučajevima depresije.

Can we use deep brain stimulation to make you smarter?

Možemo li koristiti dubinsku stimulaciju mozga da učinimo ljude pametnijim?

(Laughter)

(Smeh)

Anybody interested in that?

Je li neko zainteresovan za to?

(Applause)

(Aplauz)

Of course we can, right?

Naravno da možemo, zar ne?

So what we've decided to do is

Ono što smo odlučili da uradimo je

we're going to try to turbocharge

pokušaj turbo punjenja

the memory circuits in the brain.

memorijskih kola u mozgu.

We're going to place electrodes within the circuits

Postavićemo elektrode kroz kola

that regulate your memory and cognitive function

koja regulišu pamćenje i kognitivne funkcije

to see if we can turn up their activity.

da vidimo možemo li da povećamo njihovu aktivnost.

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

Naravno, nećemo to raditi kod normalnih ljudi.

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

Radićemo to kod onih koji imaju kognitivne deficite

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

i za to smo odabrali pacijente sa Alchajmerovom bolešću

who have cognitive and memory deficits.

koji ih imaju.

As you know, this is the main symptom

Kao što znate, to je glavni simptom

of early onset Alzheimer's disease.

kod rane pojave Alchajmerove bolesti.

So we've placed electrodes within this circuit

Tako smo postavili elektrode kroz ova kola

in an area of the brain called the fornix,

u oblasti mozga koja se zove forniks,

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

koja je put unutar i izvan tog memorijskog kola,

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

sa ciljem da vidimo možemo li uključiti to memorijsko kolo

and whether that can, in turn, help these patients

i možemo li pomoći ovim pacijentima

with Alzheimer's disease.

sa Alchajmerovom bolešću.

Now it turns out that in Alzheimer's disease,

Ispostavlja se da kod Alchajmerove bolesti

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

postoji veliki poremećaj potrošnje glukoze u mozgu.

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

Mozak je jako halapljiv kad je glukoza u pitanju.

It uses 20 percent of all your --

Koristi oko 20 procenata sve vaše -

even though it only weighs two percent --

iako je to težak samo 2 procenta -

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

koristi 10 puta više glukoze nego sto bi trebalo u odnosu na svoju težinu.

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

Dvadeset posto glukoze iz tela koristi mozak

and as you go from being normal

i kako se od normalnog stanja krećete ka

to having mild cognitive impairment,

blagom kognitivnom pogoršanju,

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

što prethodi Alchajmerovoj, sve do Alchajmerove bolesti,

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

neki delovi mozga prestaju da koriste glukozu.

They shut down. They turn off.

Gase se. Isključuju se.

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

Zaista, vidimo da ove oblasti crvene boje

around the outside ribbon of the brain

oko spoljašnje strane mozga

are progressively getting more and more blue

postepeno postaju sve više i više plave

until they shut down completely.

dok se u potpunosti ne isključe.

This is analogous to having a power failure

Ovo je slično nestanku struje

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

u oblasti mozga, i to regionalnom nestanku struje.

So the lights are out in parts of the brain

Tako nema svetla u nekim delovima mozga

in patients with Alzheimer's disease,

kod pacijenata sa Alchajmerovom bolešću,

and the question is, are the lights out forever,

i pitanje je da li su svetla ugašena zauvek

or can we turn the lights back on?

ili ih ipak možemo ponovo uključiti.

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

Možemo li naterati te delove mozga da ponovo koriste glukozu?

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

Evo šta smo uradili. Ugradili smo elektrode u forniks

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

pacijenata sa Alchajmerovom bolešću, uključili smo ih

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

i posmatrali šta se dešava sa upotrebom glukoze u mozgu.

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

Zaista, kao što vidite u vrhu, pre operacije plavi delovi

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

su delovi koji koriste manje glukoze nego što je normalno,

predominantly the parietal and temporal lobes.

pogotovo parijetalni i temporalni režanj.

These areas of the brain are shut down.

Ovo su oblasti mozga koje su isključene.

The lights are out in these areas of the brain.

Svetla su ugašena u ovim delovima mozga.

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

Ugradili smo DBS elekrode i čekali mesec dana

or a year, and the areas in red

ili godinu, i oblasti crvene boje

represent the areas where we increase glucose utilization.

pokazuju gde se povećala potrošnja glukoze.

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

I zaista smo uspeli da nateramo ove oblasti mozga

that were not using glucose to use glucose once again.

koje nisu koristile glukozu da počnu ponovo to da rade.

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

Dakle zaključak je ovde da su u slučaju Alchajmerove bolesti

the lights are out, but there is someone home,

svetla ugašena, ali kući još uvek nekog ima

and we're able to turn the power back on

i možemo struju da vratimo

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

u ove delove mozga, i kako to radimo

we expect that their functions will return.

očekujemo da će se vratiti i funkcija tih delova.

So this is now in clinical trials.

Ovo je sada na kliničkom ispitivanju.

We are going to operate on 50 patients

Operisaćemo 50 pacijenata

with early Alzheimer's disease

sa ranom Alchajmerovom bolešću

to see whether this is safe and effective,

da proverimo da li je bezbedno i efikasno,

whether we can improve their neurologic function.

da li možemo da poboljšamo neurološku funkciju.

(Applause)

(Aplauz)

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

Poruka sa kojom vas danas ostavljam je

indeed, there are several circuits in the brain

da postoje neke oblasti mozga

that are malfunctioning across various disease states,

koje ne funkcionišu dobro kroz razna stanja bolesti,

whether we're talking about Parkinson's disease,

bilo da se radi o Parkinsonovoj bolesti,

depression, schizophrenia, Alzheimer's.

depresiji, šizofreniji, Alchajmerovoj.

We are now learning to understand what are the circuits,

Sada učimo kako da razumemo šta su kola,

what are the areas of the brain that are responsible for

koji su delovi mozga odgovorni

the clinical signs and the symptoms of those diseases.

za kliničke znake i simptome ovih bolesti.

We can now reach those circuits.

Sada možemo dopreti do tih kola.

We can introduce electrodes within those circuits.

Možemo ugraditi elektrode u ta kola.

We can graduate the activity of those circuits.

Možemo beležiti aktivnost tih kola.

We can turn them down if they are overactive,

Možemo im smanjiti aktivnost ako su preaktivna,

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

ako uzrokuju probleme koji se osećaju svuda po mozgu.

or we can turn them up if they are underperforming,

ili im povećati aktivnost ako nisu dovoljno aktivna,

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

i tako možemo pomoći

the overall function of the brain.

celokupnom radu mozga.

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

Posledica ovoga je, naravno, da smo u mogućnosti

to modify the symptoms of the disease,

da modifikujemo simptome bolesti,

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

ali nisam vam još rekao da postoje i naznake

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

mogućnosti popravke oštećenih delova mozga korišćenjem elektriciteta

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

i to je nešto što ostaje da se u budućnosti vidi,

we not only change the activity but also

da li možemo ne samo menjati aktivnost

some of the reparative functions of the brain

već i uvesti neke

can be harvested.

regenerativne funkcije mozga.

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

Predviđam da ćemo videti veliki pomak

of indications of this technique.

u indikaciji ove tehnike.

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

Videćemo kako će elektrode biti postavljane za mnoge poremećaje mozga.

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

Jedna od najzanimljivijih stvari u vezi sa ovim

it involves multidisciplinary work.

je to što uključuje multidisciplinarni rad.

It involves the work of engineers, of imaging scientists,

Uključuje rad inženjera, naučnika optike,

of basic scientists, of neurologists,

naučnika, neurologa,

psychiatrists, neurosurgeons, and certainly at the interface

psihijatara, neurohirurga, i naravno interakciju

of these multiple disciplines that there's the excitement.

ovih nekoliko disciplina zbog čega je uzbudljivo.

And I think that we will see that

Mislim da ćemo videti

we will be able to chase more of these evil spirits

da ćemo moći da teramo više ovih zloduha

out from the brain as time goes on,

iz mozga tokom vremena

and the consequence of that, of course, will be

i da će posledica toga, naravno

that we will be able to help many more patients.

biti to da ćemo moći da pomognemo većem broju pacijenata.

Thank you very much.

Puno vam hvala.