How does deep brain stimulation work? Present understanding and future questions
How does deep brain stimulation work? Present understanding and future questions
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DOI：
10.1097/00004691-200401000-00006
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发表时间：
2004-01-01
影响因子：
2.4
通讯作者：
Vitek, JL
中科院分区：
文献类型：
--
作者：
McIntyre, CC;Savasta, M;Vitek, JL
丘脑或基底神经节的高频脑深部刺激（DBS）代表了用于治疗几种医学难治性运动障碍（例如，帕金森病、特发性震颤和肌张力障碍）。此外，DBS用于其他神经和精神疾病的新临床应用（例如，癫痫症和强迫症）已经向前跃进。虽然DBS在治疗运动障碍方面是有效的，并且正在迅速探索用于治疗其他神经系统疾病，但对其作用机制的科学理解仍然不清楚，并且在科学界仍存在争议。DBS技术在当前和未来治疗应用中的优化将取决于治疗作用机制的识别。本综述的目的是解决目前的知识的影响，高频刺激在中枢神经系统和评论的功能意义的知识揭示DBS的机制。DBS的机制有四种假说：去极化阻滞、突触抑制、突触抑制和刺激诱导的病理网络活动调节。使用微透析，神经记录，功能成像和神经建模实验的结果，作者解决了主要的假设，并试图调和已被认为是从不同的研究模式的相互矛盾的结果。
High-frequency deep brain stimulation (DBS) of the thalamus or basal ganglia represents an effective clinical technique for the treatment of several medically refractory movement disorders (e.g., Parkinson's disease, essential tremor, and dystonia). In addition, new clinical applications of DBS for other neurologic and psychiatric disorders (e.g., epilepsy and obsessive-compulsive disorder) have been vaulted forward. Although DBS has been effective in the treatment of movement disorders and is rapidly being explored for the treatment of other neurologic disorders, the scientific understanding of its mechanisms of action remains unclear and continues to be debated in the scientific community. Optimization of DBS technology for present and future therapeutic applications will depend on identification of the therapeutic mechanism(s) of action. The goal of this review is to address the present knowledge of the effects of high frequency stimulation within the central nervous system and comment on the functional implications of this knowledge for uncovering the mechanism(s) of DBS. Four general hypotheses have been developed to explain the mechanism(s) of DBS: depolarization blockade, synaptic inhibition, synaptic depression, and stimulation-induced modulation of pathologic network activity. Using the results from microdialysis, neural recording, functional imaging, and neural modeling experiments, the authors address the main hypotheses and attempt to reconcile what have been considered conflicting results from different research modalities.