Deep brain stimulation: new techniques.
Deep brain stimulation: new techniques.
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DOI：
10.1016/s1353-8020(13)70045-2
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发表时间：
2014-01-01
影响因子：
4.1
通讯作者：
Hariz, Marwan
中科院分区：
文献类型：
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作者：
Hariz, Marwan
深度脑刺激（DBS）的硬件技术和传递刺激的方式自25年前现代DBS时代开始以来并没有显著的发展。然而，新技术正在沿着几个方向发展。植入式脉冲发生器（IPG）的新特性允许电流在多极导线的不同触点之间分成可变比例。另一种设计包括引线，它允许从定向放置的电极接触处选择性地控制电流，从而向特定方向传递刺激，甚至产生一个定向形状的电场，该电场将符合目标大脑的解剖结构，避免邻近结构，从而避免副作用。闭环自适应刺激技术正在开发中，它可以跟踪大脑目标的病理局部场电位，并在检测到病理活动时，根据需要，自动提供刺激以抑制病理活动。这一特点可能有助于“按需”进行DBS治疗，而不是持续治疗。最后，成像技术的进步提供了“新的”大脑靶点，并越来越多地允许DBS准确地进行，同时避免了微电极记录的风险。
The technology of the hardware used in deep brain stimulation (DBS), and the mode of delivering the stimulation have not significantly evolved since the start of the modern era of DBS 25 years ago. However, new technology is now being developed along several avenues. New features of the implantable pulse generator (IPG) allow fractionation of the electric current into variable proportions between different contacts of the multi-polar lead. Another design consists in leads that allow selective current steering from directionally placed electrode contacts that would deliver the stimulation in a specific direction or even create a directional shaped electric field that would conform to the anatomy of the brain target aimed at, avoiding adjacent structures, and thus avoiding side effects. Closed loop adaptive stimulation technologies are being developed, allowing a tracking of the pathological local field potential of the brain target, and delivering automatically the stimulation to suppress the pathological activity as soon as it is detected and for as long as needed. This feature may contribute to a DBS therapy "on demand", instead of continuously. Finally, advances in imaging technology are providing "new" brain targets, and increasingly allowing DBS to be performed accurately while avoiding the risks of microelectrode recording.