My 25 Stimulating Years with DBS in Parkinson's Disease.
My 25 Stimulating Years with DBS in Parkinson's Disease.
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DOI：
10.3233/jpd-179007
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发表时间：
2017
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影响因子：
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通讯作者：
Hariz M
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文献类型：
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作者：
Hariz M
2017年是现代脑深部电刺激（DBS）诞生30周年，DBS由Benabid，Pollak等人于1987年推出，最初针对运动丘脑治疗震颤，随后针对丘脑底核（DBS）治疗晚期帕金森病（PD）症状。正如大卫马斯登在1994年所说的那样，多巴胺DBS无疑是“自左旋多巴以来最重要的发现”。2014年，拉斯克-德贝基临床医学研究奖授予了Benabid和DeLong，以“荣誉两位开发丘脑底核深部脑刺激的科学家”。由于其在改善PD症状方面的有效性，并且因为它是唯一允许彻底减少药物治疗的PD手术，所以DBS仍然是今天PD的主要手术程序。DBS的未来改进包括提供“闭环”、“按需”刺激的可能性，因为高度初步的研究表明，它可以改善轴性和非轴性症状，并减少构音障碍等副作用。尽管丘脑底核DBS是目前用于PD患者的主要外科手术，但并非所有患者都适合DBS;作为一名功能性神经外科医生，25年来从事各种外科手术，其目的不是拯救生命，而是改善患者的生活质量，我认为手术应该根据患者的个人症状和需要量身定制，它的安全性至关重要
The year 2017 marks the 30th anniversary of the birth of modern deep brain stimulation (DBS), which was introduced by Benabid, Pollak et al. in 1987, initially targeting the motor thalamus to treat tremor, and subsequently targeting the subthalamic nucleus (STN) for treatment of symptoms of advanced Parkinson’s disease (PD). STN DBS is undoubtedly “the most important discovery since levodopa”, as stated by David Marsden in 1994. In 2014, The Lasker– DeBakey Clinical Medical Research Award to “honor two scientists who developed deep brain stimulation of the subthalamic nucleus”, was bestowed upon Benabid and DeLong. STN DBS remains today the main surgical procedure for PD, due to its effectiveness in ameliorating PD symptoms and because it is the only surgical procedure for PD that allows a radical decrease in medication. Future improvements of DBS include the possibility to deliver a “closed-loop”, “on demand” stimulation, as highly preliminary studies suggest that it may improve both axial and appendicular symptoms and reduce side effects such as dysarthria. Even though DBS of the subthalamic nucleus is the main surgical procedure used today for patients with PD, all patients are not suitable for STN DBS; as a functional neurosurgeon performing since more than 25 years various surgical procedures the aim of which is not to save life but to improve the patient’s quality of life, I consider that the surgery should be tailored to the patient’s individual symptoms and needs, and that its safety is paramount.