关于注释的说明
在下面的参考文献里,读者会看到针对有趣细节、特例、历史掌故及学术问题的评论。评论以黑点(●)来表示。
题词
1.“18世纪犹太哈西德教派谚语”:C.Stern,ed.,Gates of Repentance:The New Union Prayerbook for the Days of Awe(New York:Central Conference of American Rabbis,1978),p.3.
2.“人生苦短,艺术永恒”:由我的同事和朋友Waller R.Newell翻译。
引论
1.“一如麦吉尔大学前医学院长亚伯拉罕·福克斯(Abraham Fuks)所说,征服这个概念,为日常医学实践带来了许多军事性的比喻”:A.Fuks,“The Military Metaphors of Modern Medicine,”in Z.Li and T.L.Long,eds.,The Meaning Management Challenge(Oxford,UK:Inter-Disciplinary Press,2010),pp.57-68.
2.●“医学是对抗疾病的‘战斗’”:17世纪中叶,人称“英国的希波克拉底”的托马斯·西德纳姆(Thomas Sydenham),这样描写疾病:“我穷尽了泻药和凉爽药,以及饮食手段来攻击敌人”;“要跟一整队危险的敌人抗争,这场战斗,可不适合懒人”;“我不断研究疾病,我了解它的特点,我满怀自信地冲锋向前消灭它。”The Works of Thomas Sydenham,trans.R.G.Latham(London:Sydenham Society,1848-50),1:267,1:33,2:43。
第1章 医生得了病,又自己治好了
1.疼痛历史上最重要的文章:R.Melzack and P.Wall,“Pain Mechanisms:A New Theory,”Science 150,no.3699(1965):971-79.
2.●德国生理学家曼弗雷德·齐默尔曼:出自1978年在蒙特利尔召开的第二次疼痛世界大会(Second World Congress on Pain)。M.Zimmermann and T.Herdegen,“Plasticity of the Nervous System at the Systemic,Cellular and Molecular Levels:A Mechanism of Chronic Pain and Hyperalgesia,”in G.Carli and M.Zimmermann,eds.,Towards the Neurobiology of Chronic Pain(Amsterdam:Elsevier,1996),pp.233-59,233.
3.《影响疼痛的主要因素》:“Central Influences on Pain,”in C.W.Slipman et al.,eds.,Interventional Spine:An Algorithmic Approach(Philadelphia:Saunders Elsevier,2008),pp.39-52.
4.“一旦设置到了慢性档,疼痛就更加难以治疗了”:同上,p.40.
5.期待又在我们感受到的疼痛水平中扮演了重要角色:G.L.Moseley,“A Pain Neuromatrix Approach to Patients with Chronic Pain,”Manual Therapy 8,no.3(2003):130-40;G.L.Moseley,“Reconceptualising Pain According to Modern Pain Science,”Physical Therapy Reviews 12(2007):169-78,172.
6.“中枢神经系统的输出”:Moseley,“Reconceptualising Pain,”172.
7.“大脑……给予了反击”:Moskowitz,“Central Influences,”p.44.
8.一项对慢性手部疼痛肿胀患者的巧妙研究:G.L.Moseley et al.,“Visual Distortion of a Limb Modulates the Pain and Swelling Evoked by Movement,”Current Biology 18,no.22(2008):R1047-48.
9.普雷斯顿:C.Preston and R.Newport,“Analgesic Effects of Multi-Sensory Illusions in Osteoarthritis,”Rheumatology(Oxford)50,no.12(2011):2314-15.
10.患者……安慰剂……大多心理不稳定……“缺少真实性”:A.K.Shapiro and E.Shapiro,The Powerful Placebo:From Ancient Priest to Modern Physician(Baltimore:Johns Hopkins University Press,1997),p.39.
11.●托尔·维奇:T.D.Wager et al.,“Placebo-Induced Changes in fMRI in the Anticipation and Experience of Pain,”Science 303(2004):1162-67;T.D.Wager et al.,“Placebo Effects in Human Opioid Activity During Pain,”Proceedings of the National Academy of Sciences 104,no.26(2007):11056-61;T.D.Wager,“The Neural Bases of Placebo Effects in Pain,”Current Directions in Psychological Science 14,no.4(2005):175-79.Tor Wager’s personal story is recounted in I.Kirsch,The Emperor’s New Drugs:Exploding the Antidepressant Myth(New York:Basic Books,2010).
12.如果响应非常迅速,是安慰剂反应:F.M.Quitkin et al.,“Heterogeneity of Clinical Response During Placebo Treatment,”American Journal of Psychiatry 148,no.2(1991):193-96.
13.安慰剂响应者更容易出现复发:F.M.Quitkin et al.,“Different Types of Placebo Response in Patients Receiving Antidepressants,”American Journal of Psychiatry 148,no.2(1991):197-203;F.M.Quitkin et al.,“Placebo Run-In Period in Studies of Depressive Disorders,”British Journal of Psychiatry 173(1998):242-48.
14.安慰剂效应能够持续多个星期:T.J.Kaptchuk et al.,“Components of Placebo Effect:Randomized Controlled Trial in Patients with Irritable Bowel Syndrome,”British Medical Journal 336,no.7651(2008):999-1003.
15.盖伊·蒙哥马利:G.Montgomery and I.Kirsch,“Mechanisms of Placebo Pain Reduction:An Empirical Investigation,”Psychological Science 7,no.3(1996):174-76.
第2章 一个从帕金森综合征症状中“走”出来的人
1.胶质细胞……帮助……对大脑进行接线和重新接线:R.D.Fields,The Other Brain(New York:Simon&Schuster,2009),p.24.
2.弗兰克·柯林斯和同事们发现了GDNF:L-F.H.Lin et al.,“GDNF:A Glial Line-Derived Neurotrophic Factor for Midbrain Dopaminergic Neurons,”Science 260,no.5111(1993):1130-32;Fields,Other Brain,p.180.
3.在实验室用动物做的实验……发现锻炼可增加GDNF:M.J.Zigmond et al.,“Triggering Endogenous Neuroprotective Processes Through Exercise in Models of Dopamine Deficiency,”Parkinsonism and Related Disorders 15,supp.3(2009):S42-45.
4.●不吃药的话,大多数人都会……丧失行走能力:W.Poewe,“The Natural History of Parkinson’s Disease,”Journal of Neurology 253,supp.7(2006):vii2-vii16.由于几乎所有的病人都服药,很难知道“不服药”的帕金森综合征会是什么样子。Poewe找到了对照药物研究:一组病人服用药物,另一组病人停药,转而服用安慰剂。他从患者衰退的速度推断,没有药物,帕金森综合征会在“不到10年内”导致严重残疾。他发现,这一估算跟医生们在19世纪及20世纪前半叶的记叙相符。
5.药效会逐渐消退:E.R.Kandel et al.,eds.,Principles of Neural Science,4th ed.(New York:McGraw-Hill,2000),p.862.
6.患上痴呆症的风险比普通情况高6倍:Poewe,“Natural History of Parkinson’s.”
7.玛格丽特·霍恩和马尔文·亚尔:M.M.Hoehn and M.D.Yahr,“Parkinsonism:Onset,Progression and Mortality,”Neurology 17(1967):427-42.
8.●大脑黑质:黑质是所谓的基底节结构群的一部分,一般来说,基底节包括尾状核、壳核、苍白球、黑质和丘脑底核。基底节参与处理主动运动控制和日常行为及习惯。它可以起到制动作用,抑制机动性运动。当这个“制动器”释放,运动系统就变得活跃。基底节活化还会带来行为的切换。帕金森综合征患者在尝试切换到新活动时,往往会“冻结”。患病者有可能走路时看到人行道上有一条线或者小的障碍物,就“卡在了自己的道上”,无法迈过去,因为这需要改变步幅。
9.大脑的多巴胺,约80%都集中在……基底神经节:Kandel et al.,Principles of Neural Science,p.862.
10.药物引起的运动障碍,是……不如人意的神经可塑性变化造成的结果:B.Picconi et al.,“Loss of Bidirectional Striatal Synaptic Plasticity in L-DOPA-Induced Dyskinesia,”Nature Neuroscience 6,no.5(2003):501-6。出现运动障碍的大鼠“突触可塑性改变了形式”“纹状体突触产生异常信息存储”,此外还有化学畸变。健康的大脑必须能够同时加强、削弱自己的突触。削弱可能需要遗忘,或删除不再需要的连接,甚至允许该网络做一些新的事情。有一种削弱类型叫作突触去增益(synaptic depotentiation)。作者指出,“运动障碍的病例没有表现出去增益能力。皮层纹状体突触丧失了这种双向可塑性,或许会导致病理性地存储不必要的运动信息,从而带来异常运动模式的养成或表达。”(p.504)
11.还没有找到治疗方案能明显放缓病情进展的:Poewe,“Natural History of Parkinson’s.”
12.电刺激可“卡住”异常启动放电的回路:J.Bugaysen et al.,“The Impact of Stimulation Induced Short-Term Synaptic Plasticity on Firing Patterns in the Globus Pallidus of the Rat,”Frontiers in Systems Neuroscience 5(article 16)(2011):1-8.
13.亨廷顿病性痴呆……快走……发病时间明显推迟:T.Y.C.Pang et al.,“Differential Effects of Voluntary Physical Exercise on Behavioral and BDNF Expression Deficits in Huntington’s Disease Transgenic Mice,”Neuroscience 141,no.2(2006):569-84.
14.佩珀自费出版了一本小书:J.Pepper,There Is Life After Being Diagnosed with Parkinson’s Disease(South Africa:John Pepper and Associates CC,2003).He later renamed the book Reverse Parkinson’s Disease(Pittsburgh:Rose Dog Books,2011).
15.四大症状:几乎所有的神经学教科书都会提到帕金森综合征有四大症状,但这四大到底包括哪些症状,它们往往表述不一。或许,这只是出于爱凑“四大”的习惯表达方式而已,说清四大具体是什么反而不重要了。此外,这还说明一点:分清哪些症状属于帕金森综合征的核心症状很困难。
16.“帕金森综合征的特点”:I.Litvan,“Parkinsonian Features:When Are They Parkinson Disease,”Journal of the American Medical Association 280,no.19(1998):1654-55.
17.得了帕金森综合征的人分为两类:同上。
18.●他花了3个月的时间让左脚支撑自己的体重:那个时代的理疗教材有时会提出,分析患者的步态很重要。但哪怕是当今最具前瞻性的教材,如《帕金森综合征的神经康复》(Neurorehabilitation in Parkinson’s Disease),也并不指望理疗能逆转运动衰退。“在很大程度上,治疗的目的是要帮助人们尽量长时间地维持当前运动能力,使之适应其功能水平不可避免的下降。”M.Trail et al.,Neurorehabilitation in Parkinson’s Disease:An Evidence-Based Treatment Model(Thorofare,NJ:Slack,2008),p.24.
19.基底神经节……把复杂的动作序列和想法编织到一起:L.F.Koziol and D.E.Budding,Subcortical Structures and Cognition:Implications for Neuropsychological Assessment(New York:Springer,2008),p.99.
20.如果基底神经节的多巴胺系统不再运作……人就难以……学习新的思考认知序列:O.Nagy et al.,“Dopaminergic Contribution to Cognitive Sequence Learning,”Journal of Neural Transmission 114,no.5(2007):607-12.
21.黑质……负责发起自动化的行为序列:Koziol and Budding,Subcortical Structures and Cognition,p.43.
22.患有帕金森综合征的英国足球运动员:O.Sacks,Awakenings(New York:Vintage Books,1999;repr.of 1990 edition;originally published 1973),p.10.
23.“所有帕金森综合征患者的核心问题是”:同上,p.345.
24.迈克尔·齐格蒙德博士小组……锻炼……出现帕金森症状的概率较小:Zigmond et al.,“Triggering Endogenous Neuroprotective Processes.”
25.精神病治疗药物。通常,患者不再服用这些药物,帕金森症状就逆转了:“有研究报告指出,16%的案例进而确诊了患有特发性帕金森综合征。这些人很可能在未来进入帕金森综合征的某个阶段,但待议的药物‘暴露’了潜在的多巴胺不足问题。”Drug-Induced Parkinsonism information sheet,Parkinson’s Disease Society of the United Kingdom,https://www.parkinsons.org.uk/sites/default/files/publications/download/english/fs38_druginducedparkinsonism.pdf.
26.绝大多数可逆:K.Ray Chaudhuri and J.Nott,“Drug-Induced Parkinsonism,”in K.D.Sethi,ed.,Drug-Induced Movement Disorders(New York:Marcel Dekker,2004),61-75.
27.多年来,医生并不建议帕金森综合征患者锻炼:M.A.Hirsch and B.G.Farely,“Exercise and Neuroplasticity in Persons Living with Parkinson’s Disease,”European Journal of Physical and Rehabilitation Medicine 45,no.2(2009):215-29.
28.只有12%~15%的患者建议进行物理治疗:同上,p219.
29.锻炼甚至可能恶化:同上,p215-29.
30.携带人类ALS基因的雌性小鼠……恶化:N.C.Stam et al.,“Sex-specific Behavioural Effects of Environmental Enrichment in a Transgenic Mouse Model of Amyotrophic Lateral Sclerosis,”European Journal of Neuroscience 28,no.4(2008):717-23.
31.在起居室里自由溜达……更好地完成问题解决测试:D.O.Hebb,“The Effects of Early Experience on Problem Solving at Maturity,”American Psychologist 2(1947):306-7.
32.范·布拉格……转轮:H.van Praag et al.,“Running Increases Cell Proliferation and Neurogenesis in the Adult Mouse Dentate Gyrus,”Nature Neuroscience 2,no.3(1999):266-70.
33.汉南和……德伦医生……亨廷顿病性痴呆……延缓了疾病的初始发作:A.van Dellen et al.,“Delaying the Onset of Huntington’s in Mice,”Nature 404(2000):721-22.
34.转轮……延缓……亨廷顿病性痴呆发作:T.Y.C.Pang et al.,“Differential Effects of Voluntary Physical Exercise on Behavioral and BDNF Expression Deficits in Huntington’s Disease Transgenic Mice,”Neuroscience 141,no.2(2006):569-84.
35.“特别擅长处理新颖信息”:E.Goldberg,The New Executive Brain(New York:Oxford University Press,2009),pp.254-55.
36.延缓帕金森综合征、老年痴呆症、癫痫发病:J.Nithianantharajah and A.J.Hannan,“Enriched Environments,Experience-Dependent Plasticity and Disorders of the Nervous System,”Nature Review:Neuroscience 7,no.9(2006):697709;J.Nithianantharajah and A.J.Hannan,“The Neurobiology of Brain and Cognitive Reserve:Mental and Physical Activity as Modulators of Brain Disorders,”Progress in Neurobiology 89,no.4(2009):369-82。下面的基础研究文章介绍了环境的丰富化怎样延缓了亨廷顿病性痴呆的痴呆问题:J.Nithianantharajah et al.,“Gene-Environment Interactions Modulating Cognitive Function and Molecular Correlates of Synaptic Plasticity in Huntington’s Disease Transgenic Mice,”Neurobiology of Disease 29,no.3(2008):490-504.
37.跟百忧解一样好的效果:T.Renoir et al.,“Treatment of Depressive-Like Behaviour in Huntington’s Disease Mice by Chronic Sertraline and Exercise,”British Journal of Pharmacology 165,no.5(2012):1375-89;J.J.Ratey and E.Hagerman,Spark:The Revolutionary New Science of Exercise and the Brain(New York:Little Brown,2008).
38.雷特氏综合征:M.Kondo et al.,“Environmental Enrichment Ameliorates a Motor Coordination Deficit in a Mouse Model of Rett Syndrome—Mecp2 Gene Dosage Effects and BDNF Expression,”European Journal of Neuroscience 27,no.12(2008):3341-50.
39.类精神分裂症小鼠……其效果和抗精神病药物治疗的效果同样明显:C.E.McOmish et al.,“Phospholipase C-b1 Knockout Mice Exhibit Endophenotypes Modeling Schizophrenia Which Are Rescued by Environmental Enrichment and Clozapine Administration,”Molecular Psychiatry 13,no.7(2008):661-72.
40.对这些疾病带遗传易感性的小鼠……恰当的锻炼和认知刺激……有助于补偿:Nithianantharajah and Hannan,“Neurobiology of Brain and Cognitive Reserve.”
41.20世纪50年代……一些帕金森综合征患者似乎得到了锻炼的好处:D.S.Bilowit,“Establishing Physical Objectives in the Rehabilitation of Patients with Parkinson’s Disease(Gymnasium Activities),”Physical Therapy Review 36,no.3(1956):176-78.
42.●6-OHDA……可能会导致人类患上帕金森样疾病:K.Jellinger et al.,“Chemical Evidence for 6-Hydroxydopamine to Be an Endogenous Toxic Factor in the Pathogenesis of Parkinson’s Disease,”Journal of Neural Transmission Supplement 46(1995):297-314。这些帕金森综合征动物模型并不是该疾病的完美复制品,因为这些药物是一次性地让多巴胺损失,而帕金森综合征是渐进的。6-OHDA类似大脑里在神经元之间传递信号的化学物质。它氧化后会导致大脑细胞死亡,包括产生多巴胺的细胞。A.D.Smith and M.J.Zigmond,“Can the Brain Be Protected Through Exercise?Lessons from an Animal Model of Parkinsonism,”Experimental Neurology 184,no.1(2003):31-39.
43.●这些帕金森综合征样动物……完全恢复:J.L.Tillerson et al.,“Exercise Induces Behavioral Recovery and Attenuates Neurochemical Deficits in Rodent Models of Parkinson’s Disease,”Neuroscience 119,no.3(2003):899-911。这些动物每分钟跑15米,约合每小时0.9千米。它们一天跑450米。每次跑步中间休息3小时。Sheila Mun-Bryce对帕金森综合征和神经可塑性做了精彩总结,她这样说:“在6-OHDA和MPTP两个分组里,治疗方案里包括了锻炼的动物,行为都恢复了。相较而言,长久保持静态,多巴胺耗尽的动物表现出了持久的行为缺陷。身体运动活跃的动物,只要每天锻炼两次,行为上就可长久不表现出缺陷。”S.Mun-Bryce,“Neuroplasticity:Implications for Parkinson’s Disease,”in Trail et al.,Neurorehabilitation in Parkinson’s Disease,p.46.
44.“增加跑步和环境的丰富性,能极大地减少多巴胺细胞损耗……”:Zigmond et al.,“Triggering Endogenous Neuroprotective Processes,”S42-45,S43.
45.锻炼……神经生长因子……保护患有帕金森综合征动物的大脑:同上。
46.人类的帕金森综合征降低了黑质中GDNF的含量:N.B.Chauhan et al.,“Depletion of Glial Cell Line-Derived Neurotrophic Factor in Substantia Nigra Neurons of Parkinson’s Disease Brain,”Journal of Chemical Neuroanatomy 21,no.4(2001):277-88.
47.BDNF还可以保护神经元免受退化:H.S.Oliff et al.,“Exercise-Induced Regulation of Brain-Derived Neurotrophic Factor(BDNF)Transcripts in the Rat Hippocampus,”Molecular Brain Research 61,no.1-2(1998):147-53.
48.无法跑动的大鼠产生的BDNF较少:J.Widenfalk et al.,“Deprived of Habitual Running,Rats Downregulate BDNF and TrkB Messages in the Brain,”Neuroscience Research 34(1999):125-32.
49.自发在转轮上锻炼的小鼠,BDNF增加:Oliff et al.,“Exercise-Induced Regulation.”
50.BDNF还可以保护神经元:C.W.Cotman and N.C.Berchtold,“Exercise:A Behavioral Intervention to Enhance Brain Health and Plasticity,”Trends in Neurosciences 25,no.6(2002):295-301,296 box 1.
51.BDNF……神经元的生长也会随着锻炼而增加:L.Marais et al.,“Exercise Increases BDNF Levels in the Striatum and Decreases Depressive-Like Behavior in Chronically Stressed Rats,”Metabolic Brain Disease 24,no.4(2009):587-97.
52.锻炼可增强动物的学习能力:S.Vaynman et al.,“Hippo-campal BDNF Mediates the Efficacy of Exercise on Synaptic Plasticity and Cognition,”European Journal of Neuroscience 20,no.10(2004):2580-90.
53.久坐的生活方式……是……显著危险因素之一:S.Vaynman and F.Gomez-Pinilla,“License to Run:Exercise Impacts Functional Plasticity in the Intact and Injured Central Nervous System by Using Neurotrophins,”Neurorehabilitation and Neural Repair 19,no.4(2005):283-95,290.
54.●神经机能联系不能(diaschisis):“diaschisis”这个词来自希腊语的“彻底断开”,医生们用来形容“彻底休克”,它是俄罗斯-瑞士裔神经病理学家Constantin von Monakow于1914年首次提出的。他认为,大脑损伤并不像大多数人认为的那样仅限于局部。
55.受伤之后,大脑立刻出现“能源危机”:C.C.Giza and D.A.Hovda,“The Neurometabolic Cascade of Concussion,”Journal of Athletic Training 36,no.3(2001):228-35,232.
56.受伤的大脑特别脆弱,因为……能量太低:同上,232.
57.习得性废用在帕金森综合征中扮演了重要角色:J.L.Tillerson and G.W.Miller,“Forced Limb-Use and Recovery Following Brain Injury,”Neuroscientist 8,no.6(2002):574-85.
58.禁锢……运动带来的好处完全丧失:J.L.Tillerson et al.,“Forced Limb-Use Effects on the Behavioral and Neurochemical Effects of 6-Hydroxydopamine,”Journal of Neuroscience 21,no.12(2001):4427-35.
59.●“身体活动减少不仅仅是帕金森综合征的一种症状,或许也强化了疾病的潜在退行”:J.L.Tillerson et al.,“Forced Nonuse in Unilateral Parkinsonian Rats Exacerbates Injury,”Journal of Neuroscience 22,no.15(2002):6790-99.Tillerson、Zigmond和Miller是这样证明的:他们给大鼠的单个脑半球注射了低剂量的6-OHDA,让动物的多巴胺损失20%,不足以使之产生症状。接着,把一些动物未受影响的肢体固定住。7天后,取下固定模具,奇怪的事情发生了:注射了药物损失了20%多巴胺的大脑半球,其多巴胺损失猛烈提升到了60%。简单地说,短暂地剥夺行动能力,极大地加速了疾病发作的速度。多巴胺的产生是极富动态的。
60.从轮椅上一跃而起,去救溺水的人:Sacks,Awakenings,p.10.
61.在自行车上,他似乎完全正常:A.H.Snijders and B.R.Bloem,“Images in Clinical Medicine:Cycling for Freezing of Gait,”New England Journal of Medicine 1,no.362(2010):e46.For a film of the man riding,see doi:10.1056/NEJMicm0810287.
62.●针对平衡进行锻炼:David Blatt医生,现年54岁,来自俄勒冈州的科瓦利斯。他40多岁时被确诊患上了帕金森综合征,但只表现出了极少量的症状,仍然是个职业级的滑雪高手。他认为,疾病发作如此缓慢,原因是他的锻炼计划专门挑战平衡系统。他认为他的锻炼计划发挥了作用,触发神经生长因子。他锻炼单腿站立、弯腰,站在“博苏球”(健身房里用来锻炼平衡感的一种不稳定的充气软球)上保持平衡、杂耍。D.Blatt,“Physician,Heal Thyself:A Corvallis Doctor with Parkinson’s Disease Finds Help in Exercise—for Himself and His Patients,”Corvallis Gazette Times,July 10,2010.
63.结果的价值越大,人们付出行动实现该结果的速度越快:R.Shadmerh and S.Mussa-Ivaldi,Biological Learning and Control:How the Brain Builds Representation,Predicts Events,and Makes Decisions(Cambridge,MA:MIT Press,2012),pp.291-93.
64.现帕金森综合征患者能够……做出机动性动作:P.Mazzoni et al.,“Why Don’t We Move Faster?Parkinson’s Disease,Movement Vigor,and Implicit Motivation,”Journal of Neuroscience 27,no.27(2007):7105-16,7115.
65.“机会成本”:Y.Niv and M.Rivlin-Etzion,“Parkinson’s Disease:Fighting the Will?”Journal of Neuroscience 27,no.44(2007):11777-79.
66.“运动系统有独立的动机回路”:Mazzoni et al.,“Why Don’t We Move Faster?”7115.
67.借助有意识的行走技术规避前一回路:Y.Niv et al.,“A Normative Perspective on Motivation,”Trends in Cognitive Sciences 10,no.8(2006):375-81,377.Niv、Joel和Dayan指出,习惯性动作(如正常行走)是在纹状体的外侧部分以及依赖多巴胺的神经元里处理的。非习惯性的、以目标为导向的动作,则由一套不同的回路处理,包括额叶和纹状体的中间部分。我相信,约翰·佩珀在有意识行走技术(密切关注每一个动作及其目的)里依赖的就是非习惯性、以目标为导向的运动。
68.●“慌张步态……是不由自主慌慌张张起来的”:Sacks,Awakenings,p.6.
69.●“这样的人会陷入一种僵硬甚至凝固的生理机能冲突”:同上,pp.7-8。萨克斯指出,运动迟缓的病人在思考时,思路也很缓慢、凝滞,用术语来说,就是精神机能迟钝(bradyphrenia,p.8)。然而,就算是这些迟钝的患者,在外人眼里显得僵硬,却并不是单纯地被动;相反,萨克斯写道,说他们“陷入困境”或许是更合适。“被动或迟钝的外表是假象:这种受阻碍的运动不能,在任何意义上都不等同于空闲或宁静状态,(套用德昆西的说法)‘……并非迟钝的产物,而是……来自势均力敌,无限的活动,无限的胶着。’”萨克斯进而提出,威廉·詹姆斯说的“人类有两种意志,一种是‘阻碍性’意志、一种是‘爆发性’意志”,就适用于帕金森综合征的心理状态:“前者统治时,就难于甚至不可能执行正常活动;而后者占上风时,就挡不住不正常的行为。虽然詹姆斯用这些词来形容意志的神经质反常,但同样适用于我们所说意志的‘帕金森反常’情况(p.7n)。我想知道,约翰是不是比大多数帕金森综合征患者更多地处在爆发性意志下,让他得以采取行动,发明出步行技术。按照家人的说法,约翰一直是个非常活跃积极的人,所以,很难判断,在这个患病多年的男人身上,他活跃的性质是否跟疾病相关。”
70.“将剧烈锻炼放在帕金森综合征治疗的核心地位”:J.E.Ahlskog,“Does Vigorous Exercise Have a Neuroprotective Effect in Parkinson’s?”Neurology 77,no.3(2011):288-94.
71.低强度锻炼,由患者自行选择步速:L.M.Shulman et al.,“Randomized Clinical Trial of 3 Types of Physical Exercise for Patients with Parkinson Disease,”Journal of the American Medical Association:Neurology(formerly Archives of Neurology),70,no.2(2013):183-90.
72.额尔古纳(Ergun Uc)……步行……让患者的帕金森运动症状得到改善:Ergun Y.Uc et al.,“Phase I/II Randomized Trial of Aerobic Exercise in Parkinson Disease in a Community Setting,”Neurology 83(2014):published online.
73.●埃尔伍德医生……突破性的研究……老年痴呆症:P.Elwood et al.,“Healthy Lifestyles Reduce the Incidence of Chronic Disease and Dementia:Evidence from the Caerphilly Cohort Study,”PLoS ONE 8,no.12(2013).
74.●卡迪夫的研究……克服了此前11项研究存在的设计问题:其他研究发现,运动可以预防老年痴呆症,但这项研究是突破的原因在于,它克服了此前多项老年痴呆症研究中存在的一个问题。人在临床上尚未表现出症状很久之前,老年痴呆症就有可能在大脑里启动。如果一项研究指出,一个从不锻炼、大量饮酒、不关注体重的人得了老年痴呆症,科学家们怎么能够确定是哪些“不良行为”导致痴呆症的呢?或许他早就有了低度的老年痴呆症,所以才做出了糟糕的选择。在科学界,这就是所谓的反向因果关系问题。科学家们认为,不良行为导致疾病,但也有可能因果关系要反过来,很早就患上老年痴呆症的人(很早就被医生们盯上了),也是那些不愿意锻炼或健康饮食的人。短期研究很容易犯这个错误,即研究只短暂跟踪受试者,只截取受试者的简短生活快照。在卡迪夫大学的研究公布之前,11项研究中有10项指出,中年锻炼与老年痴呆症风险降低相关,但均非长期研究。而卡迪夫研究跟踪了患者30年,所有最终患上早期老年痴呆症的人都被排除在了数据分析之外。因此,卡迪夫的研究人员知道,如果一个人不锻炼,不效法其他健康行为,那不是因为他已经患上了老年痴呆症。
75.“只有百分比极低的人……携带了……阿尔海默病的遗传模式”:T.Chow,The Memory Clinic(Toronto:Penguin,2013),p.69.
76.“和基因组成……互动”:同上,p.70.
77.“也不足以产生阿尔茨海默病”:同上,p.72.
78.2011年的另一项突破性研究:J.Ahlskog et al.,“Physical Exercise as a Preventive or Disease-Modifying Treatment of Dementia and Brain Aging,”Mayo Clinic Proceedings 86,no.9(2011):876-84.
79.海马体明显扩大:K.I.Erickson et al.,“Exercise Training Increases Size of Hippocampus and Improves Memory,”Proceedings of the National Academy of Sciences 108,no.7(2011):3017-22.
80.9年以后,海马体都是增大:K.I.Erickson et al.,“Aerobic Fitness Is Associated with Hippocampal Volume in Elderly Humans,”Hippocampus 19(2009):1030-39.
81.70岁以上的人群,15%都患有这样那样的痴呆症:M.D.Hurd et al.,“Monetary Costs of Dementia in the United States,”New England Journal of Medicine 368,no.14(2013):1326-34.
82.“90+”……绝大多数都没得老年痴呆症:M.M.Corrada et al.,“Prevalence of Dementia After Age 90:Results from the 90+Study,”Neurology 71,no.5(2008):337-43.
第3章 神经可塑性痊愈的阶段
1.中风……仍然活着……表现出了萎缩或废弃的迹象:L.V.Gauthier et al.,“Atrophy of Spared Gray Matter Tissue Predicts Poorer Motor Recovery and Rehabilitation Response in Chronic Stroke,”Stroke 43,no.2(2012):453-57.
2.卡尔·普里布拉姆:K.H.Pribram,The Form Within:My Point of View(Westport,CT:Prospecta Press,2013).
3.大脑……没有淋巴系统:R.D.Fields,The Other Brain(New York:Simon&Schuster,2009),p.42.
4.限制-诱导疗法……触发……神经刺激:L.V.Gauth-ier et al.,“Remodeling the Brain:Plastic Structural Brain Changes Produced by Different Motor Therapies After Stroke,”Stroke 39,no.5(2008):1520-25.
5.促进生长、节约能量:R.M.Sapolsky,Why Zebras Don’t Get Ulcers,3rd ed.(New York:St.Martin’s Griffin,2004),p.23.
6.关闭交感神经系统,似乎能改善……:turning off the sympathetic system appears to improve:M.E.Hasselmo et al.,“Noradrenergic Suppression of Synaptic Transmission May Influence Cortical Signal-to-Noise Ratio,”Journal of Neurophysiology 77,no.6(1997):3326-39.
7.在睡眠中,神经胶质会打开特殊通道:L.Xie et al.,“Sleep Drives Metabolite Clearance from the Adult Brain,”Science 342,no.6156(2013):373-77.
第4章 通过光对大脑重新接线
1.南丁格尔:F.Nightingale,Notes on Nursing:What It Is and Is Not(London:Harrison,1860).
2.弗朗西斯·克里克……打开特定的神经元:F.H.Crick,“Thinking About the Brain,”Scientific American 241(1979):219-32.See also G.Stix,“A Light in the Brain,”Scientific American 302(2010):18-20.
3.●卡尔·戴瑟罗特……光遗传学……对患者似乎并无益处:戴瑟罗特最近表示,他不主张“把光置入人体,进行直接的治疗应用。”置入光纤涉及“放入外源蛋白,谁知道会引发什么样的免疫反应。较之它在基础科学上的作用,治疗作用微乎其微。”Presentation at Mount Sinai Hospital,Department of Psychiatry,University of Toronto,January 11,2013.
4.沃德负责的婴儿渐渐好转起来:R.H.Dobbs and R.J.Cremer,“Phototherapy,”Archives of Disease in Childhood 50,no.11(1975):833-36;R.J.Cremer et al.,“Influence of Light on the Hyperbilirubinaemia,”Lancet 1,no.7030(1958):1094-97.
5.罗马人甚至制定了“光线权”的法律:R.Hobday,The Light Revolution:Health,Architecture and the Sun(Findhorn,Scotland:Findhorn Press,2006).
6.●光合作用:二氧化碳+水+光能,制造出:糖+氧气。实际的方程是6CO2+6H2O+光能=C6H12O6+6O2。
7.古埃及……放置在阳光下以获得医治效果:H.Gyry,“Medicine in Ancient Egypt,”in H.Selin,ed.,Encyclopedia of the History of Science,Technology,and Medicine in Non-Western Cultures,2nd ed.(New York:Springer,2008),pp.1508-18,1513.
8.把……正在康复的患者放在阳光照射的房间里:J.M.Walch et al.,“The Effect of Sunlight on Postoperative Analgesic Medication Use:A Prospective Study of Patients Undergoing Surgery,”Psychosomatic Medicine 67(2005):157-63.
9.阿里蒂亚斯……“……疾病是阴霾”:Aretaeus,“On the Therapeutics of Acute Diseases,”in F.Adams,ed.,The Extant Works of Aretaeus,the Cappadocian(London:Sydenham Society,1856),p.387.
10.还发现了其他感光细胞:D.M.Berson et al.,“Phototransduction by Retinal Ganglion Cells That Set the Circadian Clock,”Science 295,no.5557(2002):1070-73;S.Hattar et al.,“Melanopsin-Containing Retinal Ganglion Cells:Architecture,Projections,and Intrinsic Photosensitivity,”Science 295,no.5557(2002):1065-70.
11.视交叉上核又发送消息到我们的松果体:Y.Isobe and H.Nishino,“Signal Transmission from the Suprachiasmatic Nucleus to the Pineal Gland Via the Paraventricular Nucleus:Analysed from Arg-Vasopressin Peptide,rPer2 mRNA and AVP mRNA Changes and Pineal AA-NAT mRNA After the Melatonin Injection During Light and Dark Periods,”Brain Research 1013(2004):204-11.
12.生活在盐沼里的盐杆菌:J.Spudich,“Color-Sensing in the Archaea:A Eukaryotic-Like Receptor Coupled to a Prokaryotic Transducer,”Journal of Bacteriology 175(1993):7755-61;J.M.Allman,Evolving Brains(New York:Scientific American Library,1999),p.7.
13.感光化学开关和放大器:K.Martinek and I.V.Ber-ezin,“Artificial Light-Sensitive Enzymatic Systems as Chemical Amplifiers of Weak Light Signals,”Photochemistry and Photobiology 29(1979):637-50.
14.艾尔伯特·圣乔其……电荷转移,分子往往会改变颜色:A.Szent-Gyrgyi,Introduction to a Submolecular Biology(New York:Academic Press,1960),pp.54,80-81;A.Szent-Gyrgyi,Bioelectronics:A Study in Cellular Regulations,Defense,and Cancer(New York:Academic Press,1968),pp.19,26-27,43.
15.某个特定的波长有助于身体组织愈合:T.I.Karu,“Irradiation with He-Ne Laser Increases ATP Level in Cells Cultivated in Vitro,”Journal of Photochemistry and Photobiology B:Biology 27(1995):219-23,219.
16.1瓦的激光……是……1000倍以上:B.B.Laud,Lasers and Non-Linear Optics(New Delhi,India:Wiley Eastern,1991),p.4.
17.●伤势极重,皮肤无法闭合:这些照片,不少可见于卡恩的三卷著作:F.Kahn,Low Intensity Laser Therapy in Clinical Practice,3 vols.(Toronto:Meditech International,2008).
18.●激光触发了动物正常软骨的再生长:M.D.C.Cressoni et al.,“Effect of GaAIAs Laser Irradiation on the Epiphyseal Cartilage of Rats,”Photomedicine and Laser Surgery 28,no.4(2010):527-32.Cressoni和同事指出,激光提高了软骨的厚度和软骨细胞(或软骨生成细胞)的数量;Y.-S.Lin et al.,“Effects of Helium-Neon Laser on the Mucopolysaccharide Induction in Experimental Osteoarthritic Cartilage,”Osteoarthritis and Cartilage 14,no.4(2006):377-83.
19.低强度激光在治疗人类骨关节炎上也表现出了效果:P.P.Alfredo et al.,“Efficacy of Low Level Laser Therapy Associated with Exercises in Knee Osteoarthritis:A Randomized Double-Blind Study,”Clinical Rehabilitation 26,no.6(2011):52333;A.Gur et al.,“Efficacy of Different Therapy Regimes of Low-Power Laser in Painful Osteoarthritis of the Knee:A Double-Blind and Randomized-Controlled Trial,”Lasers in Medicine and Surgery 33(2003):330-38.
20.纳瑟尔……研究过激光治疗中风:M.A.Naeser et al.,“Acupuncture in the Treatment of Paralysis in Chronic and Acute Stroke Patients—Improvement Correlated with Specific CT Scan Lesion Sites,”International Journal of Acupuncture and Electrotherapeutics Research 19(1994):227-49;M.A.Naeser et al.,“Acupuncture in the Treatment of Hand Paresis in Chronic and Acute Stroke Patients:Improvement Observed in All Cases,”Clinical Rehabilitation 8(1994):127-41;M.A.Naeser et al.,“Improved Cognitive Function After Transcranial,Light-Emitting Diode Treatments in Chronic,Traumatic Brain Injury:Two Case Reports,”Photomedicine and Laser Surgery 29,no.5(2010):351-58;M.A.Naeser and M.R.Hamblin,“Potential for Transcranial Laser or LED Therapy to Treat Stroke,Traumatic Brain Injury,and Neurodegenerative Disease,”Photomedicine and Laser Surgery 29,no.7(2011):443-46.
21.激光刺激……面部……穴位:M.A.Naeser et al.,“Laser Acupuncture in the Treatment of Paralysis in Stroke Patients:A CT Scan Lesions Site Study,”American Journal of Acupuncture 23,no.1(1995):13-28.
22.●发射的光的精确频率……可以……控制:此情况对应的术语为“相干性”(coherence),意思是,激光器发出的光频率是“输入光信号的相干复制。”A.E.Siegman,Lasers(Mill Valley,CA:University Science Books,1986),p.4.
23.促进皮肤组织里胶原纤维的生长:S.A.Carney et al.,“Effect of the Radiation on Skin Biochemistry,”British Journal of Industrial Medicine 25,no.3(1968):229-34.
24.●激光触发ATP产生:能增加ATP的光,必须要有特定的波长。俄国科学家Tiina Karu指出,波长415、602、633和650纳米的光能提升的ATP产生。然而,波长477、511和554纳米的光就没这样的作用。Karu,“Irradiation with He-Ne Laser.”
25.●激光还可以提高氧气的耗用:如果经过波长为365或436纳米的光照射,细胞会消耗更多的氧。出处同上。
26.一道光的颜色是它包含了多少能量的量度:H.Chung et al.,“The Nuts and Bolts of Low-Level Laser(Light)Therapy,”Annals of Biomedical Engineering 40,no.2(2012):516-33.
27.激光在最需要的地方能发挥良好效果:J.Tafur and P.J.Mills,“Low-Intensity Light Therapy:Exploring the Role of Redox Mechanisms,”Photomedicine and Laser Surgery 26,no.4(2008):323-28,324.
28.●培养皿里的人体细胞……合成更多的DNA:人类细胞响应波长为404、620、680、760和830纳米的光合成DNA。酵母则响应波长404、570、620、680和760纳米的光生长。T.I.Karu,“Photobiological Fundamentals of Low-Powered Laser Therapy,”IEEE Journal of Quantum Electronics QE-23,no.10(1987):1703-17.
29.阳光……释放血清素:G.W.Lambert et al.,“Effect of Sunlight and Season on Serotonin Turnover in the Brain,”Lancet 360,no.9348(2002):1840-42.
30.“存在适用的最优剂量”:Chung et al.,“Nuts and Bolts of Low-Level Laser(Light)Therapy.”
31.低强度激光都有助于受损神经:S.Rochkind,“Photoengineering of Neural Tissue Repair Processes in Peripheral Nerves and the Spinal Cord:Research Development with Clinical Applications,”Photomedicine and Laser Surgery 24,no.2(2006):151-57.
32.颅神经也能痊愈:J.J.Anders et al.,“Phototherapy Promotes Regeneration and Functional Recovery of Injured Peripheral Nerve,”Neurological Research 26(2004):233-39.
33.激光照射大鼠大脑胚胎细胞,能让它们重新萌发新连接:S.Rochkind,“Phototherapy in Peripheral Nerve Regeneration:From Basic Science to Clinical Study,”Neurosurgical Focus 26,no.2(2009):1-6.
34.激光……刺激人类神经祖细胞中ATP的产生:U.Oron et al.,“GaAs(808 nm)Laser Irradiation Enhances ATP Production in Human Neuronal Cells in Culture,”Photomedicine and Laser Surgery 25,no.3(2007):180-82.
35.奥隆……在大脑受过外伤(重物砸中其头部)的小鼠身上测试了相同的激光:A.Oron et al.,“Low-Level Laser Therapy Applied Transcranially to Mice Following Traumatic Brain Injury Significantly Reduces Long-Term Neurological Deficits,”Journal of Neurotrauma 24(2007):651-56.
36.中过风的大鼠:A.Oron et al.,“Low-Level Laser Therapy Applied Transcranially to Rats After Induction of Stroke Significantly Reduces Long-Term Neurological Deficits,”Stroke 37(2006):2620-24.
37.减少……瘢痕形成:U.Oron et al.,“Low Energy Laser Irradiation Reduces Formation of Scar Tissue Following Myocardial Infarction in Rats and Dogs,”Circulation 103(2001):296-301.
38.血液低强度激光照射法:E.N.Meshalkin and V.S.Ser-gievskii,Primenenie pryamogo lazernogo izlucheniya v eksperimental’noi i klin-icheskoi meditsine(Application of Direct Laser Radiation in Experimental and Clinical Medicine)(Novosibirsk:Nauka,1981).
39.一项光的研究,已证实了这种认知上的益处:D.W.Barrett and F.Gonzalez-Lima,“Transcranial Infrared Laser Stimulation Produces Beneficial Cognitive and Emotional Effects in Humans,”Neuroscience 230(2014):13-23.
40.利用光降低了上述蛋白质的水平……阿尔茨海默病:S.Purushothuman et al.,“Photobiomodulation with Near Infrared Light Mitigates Alzheimer’s Disease-Related Pathology in Cerebral Cortex—Evidence from Two Transgenic Mouse Models,”Alzheimer’s Research and Therapy 6,no.1(2014):1-13.
41.视网膜损伤:B.T.Ivansic and T.Ivandic,“Low-Level Laser Therapy Improves Vision in a Patient with Retinitis Pigmentosa,”Photomedicine and Laser Surgery 32,no.3(2014):1-4.
42.光疗……改善了阿尔茨海默病患者神经元之间受损的连接:C.Meng,et al.,“Low-Level Laser Therapy Rescues Dendrite Atrophy via Upregulating BDNF Expression:Implications for Alzheimer’s Disease,”Journal of Neuroscience 33,no.33(2013):13505-17.
第5章 莫舍·费登奎斯:物理学家、黑带和治疗师
1.●1940年6月,一名年轻的犹太人……逃脱:我对费登奎斯个人历史的主要信息来源是跟他亲密朋友亚拉伯罕·贝尼尔(现年90多岁)、他的学生和追随者阿娜特·贝尼尔、马里恩·哈里斯、大卫·泽马赫-贝辛等人的采访和谈话。Garet Newell的“A Biographical Moshe Feldenkrais”,Feldenkrais Journal,no.7(Winter 1992)也有帮助。Mark Reese精彩但有失过分简短的“A Biography of Moshe Feldenkrais”扩充成了费登奎斯重要传记Moshe Feldenkrais:A Life in Movement(San Rafael,CA:Feldenkrais Press,2014)。费登奎斯在行李箱里偷运机密的故事,也收录在这本书里。此外还有费登奎斯自述的建立;他在The Elusive Obvious一书中的自传性介绍;他所著的柔道书籍,尤其是Higher Judo:Groundwork;他和Karl Pribram的谈话录音;Carl Ginsburg的“Berstein and Feldenkrais:The Fathers of Movement Science”,Feldenkrais Journal,no.12(1997-98);以及Dennis Leri,“Feldenkrais and Judo,”Newsletter of the Feldenkrais Guild,In Touch,2004。对费登奎斯理论的总体介绍,我最喜欢的是Embodied Wisdom:The Collected Papers of Moshe Feldenkrais,ed.E.Beringer(Berkeley,CA:North Atlantic Books,2010)。
2.行李箱里装着法国科学界的机密和资料:M.Reese,Moshe Feldenkrais:A Life in Movement.See Chapter 3.
3.“手术有可能不成功吗”:M.Feldenkrais,“Image,Movement,and Actor:Restoration of Potentiality:A Discussion of the Feldenkrais Method and Acting,Self-Expression and the Theater”(1966),in Feldenkrais,Embodied Wisdom,pp.93-111,95.
4.“我觉得自己都快疯了”:M.Feldenkrais,The Elusive Obvious,or Basic Feldenkrais(Capitola,CA:Meta Publications,1981),p.45.
5.“身体所有部件之间的微妙潜意识连接”:M.Reese,“Moshe Feldenkrais’s Work with Movement:A Parallel Approach to Milton Erickson’s Hypnotherapy,”in Jeffrey K.Zeig,ed.,Ericksonian Psychotherapy,vol.1,Structures(New York:Brunner/Mazel,1985),p.415.
6.“身体的任何部分,运动时都不可能不受其他部分的影响”:M.Feldenkrais,Body and Mature Behavior:A Study of Anxiety,Sex,Gravitation and Learning(1949;reprinted Berkeley,CA:Frog Ltd.,2005),p.76.
7.“我更着迷于观察怎么做一个动作”:Feldenkrais,Elusive Obvious,p.90.167“I believe...that the unity of mind and body”:M.Feldenkrais,“Mind and Body”(1964),in Embodied Wisdom,p.28.
8.“生活分为躯体和精神两套的概念……已经过时了”:Feldenkrais,Body and Mature Behavior,p.191.
9.“他本来可以得诺贝尔物理学奖”:Anat Baniel,interview by author.
10.“最漫长的学徒期”:Feldenkrais,Elusive Obvious,p.246.
11.“智人”:同上,p.63.
12.“精神……开始对大脑功能进行编程”:同上,p.26.
13.“神经基质……自我组织”:同上
14.“我的基本观点是”:Feldenkrais,Embodied Wisdom,p.94.
15.当动物……执行任务,却没有给予关注的时候:N.Doidge,The Brain That Changes Itself(New York:Viking,2007),pp.68,337.
16.“如果我举着一根铁棍”:M.Feldenkrais,Awareness Through Movement:Health Exercises for Personal Growth(1972;reprinted New York:HarperCollins,1990),p.59.
17.非常细微地抬头或低头:Feldenkrais,Embodied Wisdom,p.7.
18.“想法和动作之间的延迟”:Feldenkrais,Awareness Through Movement,p.45.
19.“别太较真,别太跃跃欲试”:Feldenkrais,Elusive Obvious,p.94.
20.“你们不要判断怎么去做动作”:Reese,“Feldenkrais’s Work with Movement,”p.418.
21.埃斯特·瑟伦:E.Thelen and L.B.Smith,A Dynamic Systems Approach to the Development of Cognition and Action(Cambridge,MA:MIT Press,1994).
22.“完全拜倒”:Esther Thelen,“A Dynamic Systems Approach and the Feldenkrais Method,”2012.
23.杰出的柔道大师……组织得“更妥帖”:M.Feldenkrais,Higher Judo:Groundwork(1952;reprinted Berkeley,CA:Blue Snake Books,2010),pp.32-36.
24.“身为教师,我可以加快你们的学习进度”:M.Feldenkrais,Body Awareness as Healing Therapy:The Case of Nora(Berkeley,CA:Somatic Resources and Frog,1977),p.xiv.
25.“这不是一个关于消除错误的问题”:M.Feldenkrais and H.von Foer-ster,“A Conversation,”Feldenkrais Journal 8(1993):17-30,18.
26.“我没有一套能适用所有人的现成固定技术”:Feldenkrais,Body Awareness as Healing Therapy,p.9.
27.“一个技能,无法像从前那样执行”:同上,p.71.
28.“我对自己很恼火”:同上,p.30.
29.“我大喜过望”:同上,p.31.
30.“这是两具身体的共生体”:同上,p.45.
31.“一个新的集合”:Feldenkrais,Elusive Obvious,pp.3-4.
32.就像是跳舞:同上,p.9.
33.“恢复不是一个正确的词语”:Feldenkrais,Body Awareness as Healing Therapy,p.48.
34.“‘进步’……渐进改良”:同上,p.37.
35.“费登奎斯从对习惯的认识出发”:C.Ginsburg,introductory comments to M.Feldenkrais,The Master Moves(Cupertino,CA:Meta Publications,1984),p.7.
36.“打开膝盖容易得多了吧”:A.Rosenfeld,“Teaching the Body How to Program the Brain Is Moshe’s‘Miracle,’”Smithsonian 1,no.10(1981):52-58,54.
37.动中觉知课程也可以拉长肌肉:J.Stephens et al.,“Lengthening the Hamstring Muscles Without Stretching Using‘Awareness Through Movement,’”Physical Therapy 86(2006):1641-50.
38.包含了大脑近80%的神经元:S.Herculano-Houzel,“Coordinated Scaling of Cortical and Cerebellar Numbers of Neurons,”Frontiers in Neuroanatomy 4,no.12(2010):1-8,5.
39.持久性的缺陷,而且小脑据信可塑性有限:L.F.Koziol and D.E.Budding,Subcortical Structures and Cognition(New York:Springer,2009);D.Riva and C.Giorgi,“The Contribution of the Cerebellum to Mental and Social Functions in Developmental Age,”Fiziologiia Cheloveka 26,no.1(2000):27-31.
40.“孩子们从经验里学习”:A.Baniel,Kids Beyond Limits:The Anat Baniel Method for Awakening the Brain and Transforming the Life of Your Child with Special Needs(New York:Perigee,2012),p.25.
41.抛投技术看起来“简直就像是假的”:Feldenkrais,Embodied Wisdom,p.154.
42.“在柔道里……不能改变……很糟糕”:Feldenkrais,Higher Judo,p.94.
43.“应该始终记住,‘固定’……不是事情的实际状态”:同上,p.55.
44.●费登奎斯病得很重,行将离世,亚拉伯罕·贝尼尔:费登奎斯的临终故事,是亚拉伯罕·贝尼尔在一次私人沟通中所讲。
第6章 一位盲人学会了看
1.●眼睛静止,却动个不停:M.Andreas Laurentius,A Discourse of the Preservation of the Sight:Of Melancholike Diseases;of Rheumes,and of Old Age,trans.R.Surphlet,Shakespeare Association Facsimiles no.15(1599;London:Humphrey Milford/Oxford University Press,1938).Laurentius was physician to France’s Henri IV.
2.许多常见眼科问题:W.H.Bates,The Bates Method for Better Eyesight Without Glasses(New York:Henry Holt,1981);T.R.Quackenbush,ed.,Better Eyesight:The Complete Magazines of William H.Bates(Berkeley,CA:North Atlantic Books,2001);L.Angart.Improve Your Eyesight Naturally(Carmarthen,Wales,and Bethel,CT:Crown House Publishing,2012);A.Huxley,The Art of Seeing(Toronto:Macmillan of Canada,1943).
3.●切除了晶状体……仍然能够调整焦点:W.H.Bates,Perfect Sight Without Glasses(New York:Press of Thos B.Brooks,1920).有关这一争议的更详尽讨论,参见T.R.Quackenbush,Relearning to See(Berkeley,CA:North Atlantic Books,1997),pp.50-56.
4.●查尔斯·达尔文的父亲罗伯特发现……眼睛……运动:R.W.Darwin and E.Darwin,“New Experiments on the Ocular Spectra of Light and Colours,”Philosophical Transactions of the Royal Society 76(January 1786):313-48.For an excellent review of the history of microsaccades,see M.Rolfs,“Microsaccades:Small Steps on a Long Way,”Vision Research 49,no.20(2009):2415-41,2416.
5.微扫视受到……抑制:J.K.Stevens et al.,“Paralysis of the Awake Human:Visual Perceptions,”Vision Research 16,no.1(1976):93-98.
6.视网膜……信息……开始衰减:S.Martinez-Conde et al.,“Microsaccades:A Neurophysiological Analysis,”Trends in Neurosciences 32,no.9(2009):463-75.
7.大约70%的亚洲人现在都是近视:K.Rose et al.,“The Increasing Prevalence of Myopia:Implications for Australia,”Clinical and Experimental Ophthalmology 29,no.3(2001):116-20.
8.重度近视……可能导致……:T.L.Young,“The Molecular Genetics of Human Myopia:An Update,”Optometry and Vision Science 86,no.1(2009):E8-22.
9.动物不再使用某一身体部位时:N.Doidge,The Brain That Changes Itself(New York:Viking,2007),pp.58-59.
10.当人们闭上眼睛,可视化地想象一个简单物体:同上,pp.203,268.
11.金斯伯格……一共上了7次课:D.Webber,“What Does It Mean to See Clearly:The Inside View,”Feldenkrais Journal no.23(2009):23.
12.减少车祸:K.K.Ball et al.,“Cognitive Training Decreases Motor Vehicle Collision Involvement of Older Drivers,”Journal of the American Geriatrics Society 58,no.11(2010):2107-13;J.D.Edwards et al.,“Cognitive Speed of Processing Training Delays Driving Cessation,”Journals of Gerontology,Series A,Biological Sciences and Medical Sciences 64,no.12(2009):1262-67.
13.以计算机为基础的练习能重新拓展视野:I.Mueller et al.,“Recovery of Visual Field Defects:A Large Clinical Observational Study Using Vision Restoration Therapy,”Restorative Neurology and Neuroscience 25(2007):563-72;J.G.Romano et al.,“Visual Field Changes After a Rehabilitation Intervention:Vision Restoration Therapy,”Journal of the Neurological Sciences 273(2008):70-74.
14.苏珊·巴里……《目光修复》:S.R.Barry,Fixing My Gaze:A Scientist’s Journey into Seeing in Three Dimensions(New York:Basic Books,2009).See also O.Sacks,“Stereo Sue,”New Yorker,June 19,2006;O.Sacks,The Mind’s Eye(New York:Alfred A.Knopf,2010).
15.视网膜……发送名为Otx2的蛋白质:S.Sugiyama et al.,“Experience-Dependent Transfer of Otx2 Homeoprotein into the Visual Cortex Activates Postnatal Plasticity,”Cell 134(2008):508-20.
16.“眼睛告诉大脑什么时候转入可塑状态”:T.Hensch,“Interview:Trigger for Brain Plasticity Identified:Signal Comes,Surprisingly,from Outside the Brain,”Children’s Hospital Boston news release,August 7,2008;reposted in ScienceDaily,August 9,2008.
第7章 重置大脑的设备
1.●一种启动模式,非常类似……触摸:目前,他们把114个电极划分成16个区域,每个区域由3×3个电极构成。启动一开始,每个区域的左上角就激活,接着电波传到右侧。
2.但为什么是刺激舌头呢:J.C.Wildenberg et al.,“Sustained Cortical and Subcortical Neuromodulation Induced by Electrical Tongue Stimulation,”Brain Imaging and Behavior 4(2010):199-211;Y.Danilov et al.,“New Approach to Neurorehabilitation:Cranial Nerve Noninvasive Neuromodulation(CN-NINM)Technology,”Proceedings of SPIE 9112(2014):91120L-1-91120L-10.
3.●舌尖上有15000~50000条神经纤维:舌头上分布着若干条神经。按尤里的说法,每一条舌神经(舌头的左右两侧各有一条)有10000~33000条触觉纤维(总计20000~66000条纤维)。大部分都集中在舌尖。另一条神经,鼓索(面神经的一条分支)处理味觉和痛觉。它有3000~5000条纤维(两侧共计6000~10000条纤维)。因此,两侧都算的话,舌头上总计有26000~76000条神经。“脑桥”只刺激舌头前面6平方厘米的区域,而非所有的纤维。尤里估计,该设备刺激的纤维数量在15000~50000条。相比而言,听觉神经具有30000纤维。A.T.Rasmussen,“Studies of the Eighth Cranial Nerve of Man,”Laryngoscope 50(1940):67-83.
4.●舌神经:是三叉神经的一条分支。
5.两条关键的经脉:B.Frantzis,Opening the Energy Gates of Your Body:Qigong for Lifelong Health(Berkeley,CA:North Atlantic Books,2006),p.100.
6.用这些舌头上的穴位……:J.G.Sun et al.,“Randomized Control Trial of Tongue Acupuncture Versus Sham Acupuncture in Improving Functional Outcome in Cerebral Palsy,”Journal of Neurology,Neurosurgery and Psychiatry 75,no.7(2004):1054-57;V.C.N.Wong et al.,“Pilot Study of Positron Emission Tomography(PET)Brain Glucose Metabolism to Assess the Efficacy of Tongue and Body Acupuncture in Cerebral Palsy,”Journal of Child Neurology 21,no.6(2006):455-61;V.C.N.Wong et al.,“Pilot Study of Efficacy of Tongue and Body Acupuncture in Children with Visual Impairment,”Journal of Child Neurology 21,no.6(2006):455-61.
7.为脊髓受伤……的截瘫患者设计避孕套:F.Borisoff et al.,“The Development of a Sensory Substitution System for the Sexual Rehabilitation of Men with Chronic Spinal Cord Injury,”Journal of Sexual Medicine 7,no.11(2010):3647-58.
8.●某些波浪模式让人入睡:电波可以由电极阵列定时启动的方式来产生。比如说他们在设备上安装150根电极。把电极分成6组,每组25个,排成5×5的阵列,并且每一个电极都设定好启动时间。这样一来,中间的25个电极可以先启动,接着周围的电极再启动,总之,让波从中心电极往外扩展。也可以让外面的电极阵列先启动,接着再向内来到中心的电极。
9.●谢丽尔·切尔茨是他们的第一个病人:Y.P.Danilov et al.,“Efficacy of Electrotactile Vestibular Substitution in Patients with Peripheral and Central Vestibular Loss,”Journal of Vestibular Research 17(2007):119-30;B.S.Robinson et al.,“Use of an Electrotactile Vestibular Substitution System to Facilitate Balance and Gait of an Inpidual with Gentamicin-Induced Bilateral Vestibular Hypo-function and Bilateral Transtibial Amputation,”Journal of Neurologic Physical Therapy 33,no.3(2009):150-59;Y.Danilov and M.Tyler,“Brainport:An Alternative Input to the Brain,”Journal of Integrative Neuroscience 4,no.4(2005):537-50.For the vision device,see,P.Bach-y-Rita et al.,“Vision Substitution by Tactile Image Projection,”Nature 221,no.5184(1969):963-64.
10.《能否用2%残存的神经组织恢复功能》:P.Bach-y-Rita,“Is It Possible to Restore Function with Two-Percent Surviving Neural Tissue?”Journal of Integrative Neuroscience 3,no.1(2004):3-6.
11.●俄罗斯睡眠机能治愈失眠症一样:对失眠问题,俄罗斯普遍使用电疗睡眠机来代替安眠药。在俄罗斯,尤里的朋友及同事Valery P.Lebedev是睡眠机学领域的先驱人物。机器使用5~25赫兹的频率来诱发睡意,还用75~78赫兹的峰值频率来诱导麻醉。Lebedev的作品是俄语所写。见V.P.Lebedev,Transcranial Electrical Stimulation,Experimental and Clinical Research:A Collection of Articles(St.Petersburg:Russian Academy,Pavlov Institute of Physiology,2005),vol.2。北美市场也有大量的经颅微电流刺激疗法设备,比如Fisher Wallace stimulator,是脱胎于俄罗斯技术而来。CES设备即将获FDA批准用于失眠、抑郁和焦虑问题。
12.大多数确诊为轻度脑外伤的人,3个月内就能恢复:M.A.McCrea,Mild Traumatic Brain Injury and Post-Concussion Syndrome:The New Evidence Base of Diagnosis and Treatment(New York:Oxford University Press,2008),p.ix.
13.创伤性脑损伤是年轻人残疾和死亡的首要原因:同上,p.3.
14.●反复脑震荡会让早发性阿尔茨海默病……的发生率提高19倍:A.Schwartz,“Dementia Risk Seen in Players in N.F.L.Study,”New York Times,September 29,2009;K.M.Guskiewicz et al.,“Association Between Recurrent Concussion and Late-Life Cognitive Impairment in Retired Professional Football Players,”Neurosurgery 57,no.4(2005):719-26.For a picture of these brains,see“Images of Brain Injuries in Athletes,”New York Times,December 3,2012.
15.恢复以后,又随着时间的推移不断恶化,这有可能是大脑的退行性过程所致:C.Till et al.,“Postrecovery Cognitive Decline in Adults with Traumatic Brain Injury,”Archives of Physical Medicine and Rehabilitation 89,no.12,supp.(2008):S25-34.
16.●他们……用功能性磁共振成像机观察她的大脑活动:J.C.Wildenberg et al.,“High-Resolution fMRI Detects Neuromodulation of Inpidual Brainstem Nuclei by Electrical Tongue Stimulation in Balance-Impaired Inpiduals,”NeuroImage 56,no.4(2011):2129-37.
17.中间神经元……信号……到来时机最优:G.Buzáki,Rhythms of the Brain(New York:Oxford University Press,2006),p.77.
18.●单个的光受体并未进化得可以处理这么大的波动范围,但……中间神经元的帮助,光受体可以适应它:按照尤里的说法,视觉神经科学家把我们处理的光范围看成11个对数单位的区域。但每一个光受体只处理两个对数单位的对数范围。中间神经元让我们检测全范围(11个对数单位)的信号,因为有一组内稳态中间神经元可以以一种极富动态的方式激发或抑制与自己相连的神经元,使得视觉网络的范围达到最优,适应平均视觉环境。参见J.Walraven et al.,“The Control of Visual Sensitivity:Receptoral and Postreceptoral Processes,”in L.Spillman and J.S.Werner,eds.,Visual Perception:The Neurophysiological Foundations(Toronto:Academic Press,1977),pp.81-82,88-90;O.Marin,“Interneuron Dysfunction in Psychiatric Disorders,”Nature Reviews Neuroscience 13(2012):107-20;A.Maffei and A.Fontanini,“Network Homeostasis:A Matter of Coordination,”Current Opinion in Neurobiology 19,no.2(2009):168-73.
19.●中间神经元还能帮忙让信号更锐利清晰:它们靠的是抑制信号,使之在网络中不至扩散得太过广泛。通过一个称为侧抑制(lateral inhibition)的过程,它们不让信号变得太过弥散,或是对附近的神经元造成不当影响,干扰其信号。中间神经元也可通过反馈,在发送信号后关闭神经元,使之不再轰炸所连接的其他神经元。(若非如此,我们看到的图像、听到的声音就会持续太长时间,甚至超出其实际时长。)尤里说,这一功能,就类似大脑在尖峰序列的末端打上句号。
20.著名小说家诺曼·梅勒……“人存在的每一刻,不是有所成长……”:N.Mailer,Advertisements for Myself(New York:Berkley,1959),p.355.
21.公布了对多发性硬化症的试验性研究:M.Tyler et al.,“Non-invasive Neuromodulation to Improve Gait in Chronic Multiple Sclerosis:A Randomized Double Blind Controlled Pilot Trial,”Journal of Neuroengineering and Rehabilitation 11(2014):79.
22.●该神经炎反射的细节:神经炎反射是医学博士、神经外科医生兼科学家Kevin Tracey,以及Ulf Andersson医学博士最近发现的。他们用电刺激迷走神经,迅速治愈了一个因类风湿关节炎致残的人。患者住在波斯尼亚的莫斯塔尔,手部、腕部、肘部和腿部多年来都有着难忍的疼痛。一枚小型心脏起搏器类的设备通过外科手术植入他的身体,像“脑桥”那样,为迷走神经注入尖峰。起搏器的一条电极直接顺着导线插入迷走神经。研究团队打开电刺激,患者在临床上得到了缓解。该设备能够完成常规药物(抑制免疫系统,而且全都有着巨大的副作用)做不到的事情。
迷走神经之所以叫做“迷走”,因为它像流浪汉一样大范围、散漫地遍布全身,从脑干延伸到胸部再进入腹部。它调节许多身体功能,包括消化、心脏速率和膀胱控制等。它的左侧分支接收来自主要器官的感觉,也将信号从大脑分配到主要器官。它还调节最近发现的神经炎反射。
炎症触发产生“细胞因子”,帮助人们抵御感染;但如果炎症转为慢性,这些细胞因子就会变得对组织有毒害作用。风湿性关节炎和多发性硬化症一样,是自身免疫性疾病,即人的免疫系统产生炎症,把人体细胞视为外来入侵者进行攻击。细胞因子积聚在软骨和关节,引起疼痛和组织破坏。
Kevin J.Tracey、Mauricio Rosas-Ballina和同事们描述了神经炎反射(及其神经与免疫成分)怎样寄居在迷走神经当中。这一反射里的输入信号察知炎症水平,如果炎症水平过高,可以将其关闭。机制如下:迷走神经将信号发送到T细胞(漂浮在血液里的免疫系统细胞),让神经递质乙酰胆碱(常用于向大脑发送信号的化学物质)停止刺激炎症的细胞因子的产生。
大脑通过这一神经炎反射影响免疫系统,这个发现有着重要的意义,因为诸如多发性硬化症、创伤性脑外伤、痴呆症、自闭症、抑郁症等多种脑部疾病,以及部分学习障碍(还有炎性肠病、多种类型的心脏疾病、动脉粥样硬化、癌症、糖尿病,以及所有的自身免疫疾病)都有着巨大的炎症元素。遗憾的是,我们用来抑制炎症和免疫系统的药物,有可能很危险,甚至导致死亡,而且经常没有作用。
“脑桥”从舌头上传送刺激,进入脑干里名为孤束核(也就是迷走神经传入输入的区域)的细胞群中。有许多迹象表明,“脑桥”有助于迷走神经调节身体。例如,如果患者的血压过低,“脑桥”能将之升至正常。如果血压过高,它能自己降到正常(以求实现内稳态)。一名男子说,每当他使用“脑桥”,就能感觉自己的肠道开始运动,这是设备开始调节消化系统(有可能是通过迷走神经进行调节)的迹象。多发性硬化症患者有时发现,使用“脑桥”能改善自己的膀胱控制。
发现神经炎反射是一项重大突破。种种身心训练,如冥想、催眠、气功和瑜伽式呼吸,从神经可塑性上利用思想来训练神经炎反射,治疗某些类型的炎症疾病。参见M.Rosas-Ballina and K.J.Tracey,“The Neurology of the Immune System:Neural Reflexes Regulate Immunity,”Neuron 64(2009):28-32;U.Andersson and K.J.Tracey,“A New Approach to Rheumatoid Arthritis:Treating Inflammation with Computerized Nerve Stimulation,”Cerebrum,Dana Foundation,March 21,2012,www.dana.org/news/cerebrum/detail.aspx?id=36272.
第8章 声音的桥梁
1.柏拉图:Plato,The Republic,trans.Benjamin Jowett(New York:C.Scribner’s Sons,1871),bk.3,401d.
2.“我有一种不可动摇的直觉”:A.A.Tomatis,The Conscious Ear:My Life of Transformation Through Listening(Barrytown,NY:Station Hill Press,1991),p.2.
3.“我的出生”:同上,pp.1-2.
4.“挤压机”:T.Grandin,“Calming Effects of Deep Touch Pressure in Patients with Autistic Disorder,College Students,and Animals,”Journal of Child and Adolescent Psychopharmacology 2,no.1(1992):63-72;J.Anderson,“Sensory Intervention with the Preterm Infant in the Neonatal Intensive Care Unit,”American Journal of Occupational Therapy 40,no.1(1986):9-26;T.M.Field et al.,“Tactile-Kinesthetic Stimulation Effects on Preterm Neonates,”Pediatrics 77,no.5(1986):654-58;S.A.Leib et al.,“Effects of Early Intervention and Stimulation on the Preterm Infant,”Pediatrics 66,no.1(1980):83-89.
5.“从来不容易”:Tomatis,Conscious Ear,p.4.
6.“我已经谨慎地反复想过了”:同上,p.12.
7.●只能听到自己新的演唱范围:托马迪斯后来证实这个假设,卡鲁索有三个朋友告诉他,说因为卡鲁索的右耳遭到手术伤害,他们跟卡鲁索一起时,总是走在他左边。托马迪斯分析了另一位杰出歌剧演唱家贝尼亚米诺·吉里(Beniamino Gigli),发现他的发声范围也有相同的限制。
8.“这就像是……卡鲁索得益……”:Tomatis,Conscious Ear,p.53.
9.●“耳朵……只是大脑皮层的外部属性”:A.A.Tomatis,“Music,and Its Neuro-Psycho-Physiological Effects.Appendix:‘The Three Integrators,’”translated by Terri Brown,presentation to the thirteenth Conference of the International Society for Music Education,London,Ontario,August 17,1978.The“three integrators”theory appeared in A.A.Tomatis,La Nuit Uterine(Paris:Stock,1981),pp.108-34.
10.“所有人,无一例外地,感到幸福感增加了”:Tomatis,Conscious Ear,p.55.
11.像火车头咆哮而过的那样尖叫的孩子:K.Barthel,“The Neurobiology of Sound and Its Effect on Arousal and Regulation,”presentation to the Integrated Listening Systems conference,Denver,CO,September 21,2011,p.9.
12.中耳这些收听对话所用的肌肉,由大脑调节:S.W.Porges,The Polyva-gal Theory:Neurophysiological Foundations of Emotions,Attachment,Communication,Self-Regulation(New York:W.W.Norton,2011),p.220.
13.听觉皮层对这些频率的映射区域就会在数分钟内膨胀:J.Fritz et al.,“Rapid Task-Related Plasticity of Spectrotemporal Receptive Fields in Primary Auditory Cortex,”Nature Neuroscience 6,no.11(2003):1216-23;J.C.Middlebrooks,“The Acquisitive Auditory Cortex,”Nature Neuroscience 6,no.11(2003):1122-23.
14.●它们要先从他的左耳前往大脑右半球:右侧听觉通路较短的原因之一与喉返神经(削弱喉部力量,监控右耳)相关。左侧的喉返神经比右侧更长,因为我们的心脏在身体左侧,所以左喉返神经必须绕过连接心脏的大血管。P.Madaule,When Listening Comes Alive:A Guide to Effective Learning and Communication(Norval,ON:Moulin,1994),p.42.
15.●延迟长达0.4秒:Tomatis,Conscious Ear,pp.50-51.
16.右耳……听到更高的语言频率:同上,p.52.
17.“所有事情……似乎都容易得惊人,就连英语也不例外”:Madaule,When Listening Comes Alive,p.11.
18.“这就好像,经过滤的母亲的声音”:同上,p.73.
19.D.W.温尼科特:D.W.Winnicott,“Birth Memories,Birth Trauma and Anxiety”(1949),in Through Paediatrics to Psycho-Analysis:Collected Papers(New York:Basic Books,1975),pp.174-93.
20.“尚在胎儿阶段就察觉到的唯一声音”:Tomatis,Conscious Ear,p.127.
21.“我作为早产儿的亲身经历”:同上。
22.●耳内骨骼就长到了成年大小:这一点在1670年就为人所知了。G.B.Elliott and K.A.Elliott,“Some Pathological,Radiological and Clinical Implications of the Precocious Development of the Human Ear,”Laryngoscope 74(1964):1160-71.
23.播放每一位准妈妈的声音录音:B.S.Kisilevsky et al.,“Effects of Experience on Fetal Voice Recognition,”Psychological Science 14,no.3(2003):220-24.
24.新生婴儿更喜欢妈妈的声音:A.J.DeCasper et al.,“Of Human Bonding:Newborns Prefer Their Mothers’Voices,”Science 208,no.4448(1980):1174-76.
25.更喜欢妊娠最后6周听到的母亲所讲的故事:A.J.DeCasper and M.J.Spence,“Prenatal Maternal Speech Influences Newborns’Perception of Speech Sounds,”Infant Behavior and Development 9,no.2(1986):133-50.
26.●新生儿立刻能分辨出“母语”:Moon、Lagercrantz和Kuhl是新生儿语言及可塑性专家,他们指出,在子宫内接触一种语言,会影响人对这种语言的感知能力。C.Moon et al.,“Language Experienced in Utero Affects Vowel Perception After Birth:A Two-Country Study,”Acta Paediatrica 102,no.2(2012):156-60.
27.新生儿在出生之前,就具备了对母语敏感的神经网络:B.S.Kisilevsky et al.,“Fetal Sensitivity to Properties of Maternal Speech and Language,”Infant Behavior and Development 32,no.1(2009):59-71.
28.“语言,也具备一种身体上的维度”:Tomatis,Conscious Ear,p.137.
29.“我们可以想象,未出生的孩子”:Madaule,When Listening Comes Alive,pp.82-83.
30.待产羔羊……致命的大脑缺氧……不一定会杀死所有大脑细胞……减少神经元分支的数量,以及神经元之间突触连接的数量:J.M.Dean et al.,“Prenatal Cerebral Ischemia Disrupts MRI-Defined Cortical Microstructure Through Disturbances in Neuronal Arborization,”Science Translational Medicine 5,no.168(2013):1-11(168ra7).
31.“我们的发现结果对这一假设提出了怀疑”:同上。
32.●旋转后眼震:有关这一现象,参见“when the rotation is suddenly stopped,nystagmus[occurs]in the opposite direction,”see A.Fisher et al.,Sensory Integration:Theory and Practice(Philadelphia:F.A.Davis,1991),p.81.
33.随着皮层的演进、体积的增加,皮层下结构也大为发展,进行了修正:S.Herculano-Houzel,“Coordinated Scaling of Cortical and Cerebellar Numbers of Neurons,”Frontiers in Neuroanatomy 4,no.12(2010):1-8.
34.●他易怒,难以管教,一动怒就无法安抚:你可以到下面聆听中心的网站上见识乔丹的脾气,还有正在帮助https://listeningcentre.com/,点击页面最底下的链接,见视频The Child That You Do Have。
35.对传入的感觉过度敏感,尤其是声音:E.Gomes et al.,“Auditory Hypersensitivity in Autistic Spectrum Disorder,”Pro Fono 20,no.4(2008):279-84.
36.“几十年来,大多数医生都告诉家长,自闭症……基因出了问题”:M.Herbert and K.Weintraub,The Autism Revolution(New York:Ballantine Books,2012),p.5.See also M.R.Herbert,“Translational Implications of a Whole-Body Approach to Brain Health in Autism:How Transduction Between Metabolism and Electrophysiology Points to Mechanisms for Neuroplasticity,”in V.W.Hu,ed.,Frontiers in Autism Research:New Horizons for Diagnosis and Treatment(Hackensack,NJ:World Scientific,2014).
37.●“数百个基因”:M.Herbert,“Autism Revolution,”presentation at Autism Research Institute Conference,Fall 2012,with slides.See also Herbert and Weintraub,Autism Revolution,p.31.
38.许多自闭症儿童都有免疫系统异常:P.Goines and J.Van de Water,“The Immune System’s Role in the Biology of Autism,”Current Opinion in Neurology 23,no.2(2010):111-17,115.
39.●他们的胃肠道感染……患病率很高:H.M.R.T.Parracho et al.,“Differences Between the Gut Microflora of Children with Autistic Spectrum Disorders and That of Healthy Children,”Journal of Medical Microbiology 54,no.10(2005):987-91.Seventy percent of autistic children have a history of GI symptoms,twice the rate of children with normal development.M.Valicenti-McDermott et al.,“Frequency of Gastrointestinal Symptoms in Children with Autistic Spectrum Disorders and Association with Family History of Autoimmune Disease,”Developmental and Behavioral Pediatrics 27,no.2(2006):S128-136.
40.●脐带血里平均有200种主要的有毒化学物质:很多关心自闭儿童的人都报告说,将有毒化学物质的接触控制在最低限度后,孩子的情况有了改善。Herbert and Weintraub,Autism Revolution,pp.35,42,125.每年数千种人工化学物质进入环境,大部分的长期健康影响未作检测。人们公认毒素对免疫系统有负面影响。参见P.Grandjean et al.,“Serum Vaccine Antibody Concentrations in Children Exposed to Perfluorinated Compounds,”Journal of the American Medical Association 307,no.4(2012):391-97.See also S.Goodman,“Tests Find More Than 200 Chemicals in Newborn Umbilical Cord Blood,”Scientific American(2009).
41.炎症在“小脑上尤其惊人”:D.L.Vargas et al.,“Neurological Activation and Neuroinflammation in the Brain of Patients with Autism,”Annals of Neurology 57,no.1(2005):67-81,77.
42.来自母亲的抗体:The studies are reviewed in Goines and Van de Water,“Immune System’s Role.”
43.母亲……23%携带这类抗体……:D.Braunschweig et al.,“Autismipecific Maternal Autoantibodies Recognize Critical Proteins in Developing Brain,”Translational Psychiatry 3(2013):e277,doi:10.1038/tp.2013.50.
44.猴子……显示出与自闭症儿童类似的症状:M.D.Bauman et al.,“Maternal Antibodies from Mothers of Children with Autism Alter Brain Growth and Social Behavior Development in the Rhesus Monkey,”Translational Psychiatry 3(2013):e278,doi:10.1038/tp.2013/47.
45.抗体水平也很高:A.Enstrom et al.,“Increased IgG4 Levels in Children with Autism Disorder,”Brain,Behavior,and Immunity 23,no.3(2009):389-95.
46.●是否会触发一小部分孩子中的待议炎症,目前尚存争议:我们经常在媒体上听到,所有的医学专家都认为接种疫苗无风险,是安全的,不可能伤害孩子。但主流医学的观点反倒更加微妙。美国疾病控制中心发布过一份34页的《接种疫苗禁忌症及注意事项》(Guide to Vaccine Contraindications and Precautions)。禁忌症是一个医学术语,指的是不应使用某一治疗干预手段、或对其加以调整的情形,比如有些人对疫苗(或其中的某种成分)有着明显反应,甚或威胁生命;也有人有着异常的免疫系统,感染过某种疾病;也有人之前有过不良反应,等等。一般的医疗共识是,疫苗有时对某些人有害,出于这个原因,有些疫苗已经撤出市场。对自闭症患者的关键问题,有些潜在患有自闭症的孩子,是否属于疫苗的禁忌或注意范围?这些孩子是否得到了专门的研究?赫伯特在《自闭症革命》中描述了这些孩子有些什么外貌特点。一些专家说,这一群体尚未与疫苗接种联系起来进行过研究。加州大学戴维斯分校MIND研究所(世界顶尖的自闭症及炎症研究机构)主任David Amaral医生在PBS最近的一次特别节目中说到有自闭症风险的孩子,“对这些孩子来说,接种疫苗或许是将之推至自闭症边缘的环境因素。我认为最最重要的是,要努力弄清这一小群孩子身上到底有什么弱点,使某种疫苗对他们这么危险。”新出现的个性化疫苗学(vaccinomics)旨在为人的基因谱和个人病史设计个性化的疫苗,它承认我们当前使用的统一规格疫苗不够完美,对某些人来说,某些现行疫苗可能无效,对另一些人来说,某些疫苗甚至有害。参见M.W.Moyer,“Vaccinomics:Scientists Are Devising Your Personal Vaccine,”in Scientific American(June 24,2010),https://www.scien tificamerican.com/article/vaccinomics-personal-vaccine/。本章讨论的乔丹·罗森和“蒂莫西”,都是在18个月时接种疫苗后的一个星期内,就患上了自闭症。
47.慢性炎症扰乱神经回路的建立:R.H.Lee et al.,“Neurodevelopmental Effects of Chronic Exposure to Elevated Levels of Pro-Inflammatory Cytokines in a Developing Visual System,”Neural Development 5,no.2(2010):1-18.
48.“连接不足”:M.A.Just et al.,“Cortical Activation and Synchronization During Sentence Comprehension in High-Functioning Autism:Evidence of Underconnectivity,”Brain:A Journal of Neurology 127,no.8(2004):1811-21.
49.大脑正前方的神经元……连接很糟糕:S.E.Schipul et al.,“Inter-regional Brain Communication and Its Disturbance in Autism,”Frontiers in Systems Neuroscience 5,no.10(2011),doi:10.3389/fnsys.2011.00010.
50.其他脑区则表现出“连接过度”:R.Coben and T.E.Myers,“Connectivity Theory of Autism:Use of Connectivity Measures in Assessing and Treating Autistic Disorders,”Journal of Neurotherapy 12,no.2(2008):161-79.
51.艾布拉姆斯……在自闭症儿童身上……听觉皮层区域,跟大脑的皮层下奖励中心连接不足:D.A.Abrams et al.,“Underconnectivity Between Voice-Selective Cortex and Reward Circuitry in Children with Autism,”Proceedings of the National Academy of Sciences 110,no.29(2013):12060-65.