Back تحفيز عميق للدماغ Arabic Estimulació cerebral profunda Catalan Hloubková mozková stimulace Czech Deep Brain Stimulation Danish Tiefe Hirnstimulation German Estimulación cerebral profunda Spanish تحریک عمقی مغز Persian Syväaivostimulaatio Finnish Stimulation cérébrale profonde French גירוי מוחי עמוק HE

Deep brain stimulation

Deep brain stimulation
DBS-probes shown in X-ray of the skull (white areas around maxilla and mandible represent metal dentures and are unrelated to DBS devices)
SpecialtyNeurosurgery
ICD-10-PCSnij
MeSHD046690
MedlinePlus007453

Deep brain stimulation (DBS) is a type of neurostimulation therapy in which an implantable pulse generator is surgically implanted below the skin of the chest and connected by leads to the brain to deliver controlled electrical impulses. These charges therapeutically disrupt and promote dysfunctional nervous system circuits bidirectionally in both ante- and retrograde directions.[1] Though first developed for Parkinsonian tremor, the technology has since been adapted to a wide variety of chronic neurologic disorders.[2]

The usage of electrical stimulation to treat neurologic disorders dates back thousands of years to ancient Greece and dynastic Egypt. The distinguishing feature of DBS, however, is that by taking advantage of the portability of lithium-ion battery technology, it is able to be used long term without the patient having to be hardwired to a stationary energy source. This has given it far more practical therapeutic application as compared its earlier non mobile predecessors.[3]

The exact mechanisms of DBS are complex and not fully understood, though it is thought to mimic the effects of lesioning by disrupting pathologically elevated and oversynchronized informational flow in misfiring brain networks.[4][5][6] As opposed to permanent ablation, the effect can be reversed by turning off the DBS device.[7] Common targets include the globus pallidus, ventral nuclear group of the thalamus, internal capsule and subthalamic nucleus. It is one of few neurosurgical procedures that allows blinded studies,[8] though most studies to date have not taken advantage of this discriminant.[9]

Since its introduction in the late 1980s, DBS has become the major research hotspot for surgical treatment of tremor in Parkinson's disease,[10] and the preferred surgical treatment for Parkinson's, essential tremor and dystonia. Its indications have since extended to include obsessive-compulsive disorder, refractory epilepsy, chronic pain, Tourette's syndrome, and cluster headache.[11] In the past three decades, more than 244,000 patients worldwide have been implanted with DBS.[12][13]

DBS has been approved by the Food and Drug Administration as a treatment for essential and Parkinsonian tremor since 1997 and for Parkinson's disease since 2002.[14] It was approved as a humanitarian device exemption for dystonia in 2003,[15] obsessive–compulsive disorder (OCD) in 2009[16] and epilepsy in 2018.[17][18] DBS has been studied in clinical trials as a potential treatment for chronic pain, affective disorders, depression, Alzheimer's disease and drug addiction, amongst others.

  1. ^ Castrioto, A; Lhommée, E; Moro, E; Krack, P (March 2014). "Mood and behavioural effects of subthalamic stimulation in Parkinson's disease". The Lancet. Neurology. 13 (3): 287–305. doi:10.1016/S1474-4422(13)70294-1. PMID 24556007.
  2. ^ Lozano, AM; Hutchison, WD; Kalia, SK (25 July 2017). "What Have We Learned About Movement Disorders from Functional Neurosurgery?". Annual Review of Neuroscience. 40: 453–477. doi:10.1146/annurev-neuro-070815-013906. PMID 28772097.
  3. ^ Benabid, AL; Pollak, P; Louveau, A; Henry, S; de Rougemont, J (1987). "Combined (thalamotomy and stimulation) stereotactic surgery of the VIM thalamic nucleus for bilateral Parkinson disease". Applied Neurophysiology. 50 (1–6): 344–6. doi:10.1159/000100803. PMID 3329873.
  4. ^ García MR, Pearlmutter BA, Wellstead PE, Middleton RH (16 September 2013). "A slow axon antidromic blockade hypothesis for tremor reduction via deep brain stimulation". PLOS ONE. 8 (9): e73456. Bibcode:2013PLoSO...873456G. doi:10.1371/journal.pone.0073456. PMC 3774723. PMID 24066049.
  5. ^ Hollunder, Barbara (March 2024). "Mapping dysfunctional circuits in the frontal cortex using deep brain stimulation". Nature Neuroscience. 27 (3): 573–586. doi:10.1038/s41593-024-01570-1. ISSN 1097-6256. PMC 10917675. PMID 38388734.
  6. ^ Grill, Warren M. (May 2004). "Deep brain stimulation creates an informational lesion of the stimulated nucleus". NeuroReport. 15 (7): 1137–1140. doi:10.1097/00001756-200405190-00011. PMID 15129161.
  7. ^ Morris JG, Owler B, Hely MA, Fung VS (2007). "Hydrocephalus and structural lesions". Parkinson's Disease and Related Disorders, Part II. Handbook of Clinical Neurology. Vol. 84. pp. 459–478. doi:10.1016/S0072-9752(07)84055-3. ISBN 978-0-444-52893-3. OCLC 1132129865. PMID 18808964.
  8. ^ Kringelbach ML, Jenkinson N, Owen SL, Aziz TZ (August 2007). "Translational principles of deep brain stimulation". Nature Reviews. Neuroscience. 8 (8): 623–635. doi:10.1038/nrn2196. PMID 17637800. S2CID 147427108.
  9. ^ Bucur, M; Papagno, C (June 2023). "Deep Brain Stimulation in Parkinson Disease: A Meta-analysis of the Long-term Neuropsychological Outcomes". Neuropsychology Review. 33 (2): 307–346. doi:10.1007/s11065-022-09540-9. PMC 10148791. PMID 35318587.
  10. ^ Zeng, J; Chu, H; Lu, Y; Xiao, X; Lu, L; Li, J; Lai, G; Li, L; Lu, L; Xu, N; Wang, S (2023). "Research status and hotspots in the surgical treatment of tremor in Parkinson's disease from 2002 to 2022: a bibliometric and visualization analysis". Frontiers in Aging Neuroscience. 15: 1157443. doi:10.3389/fnagi.2023.1157443. PMC 10565824. PMID 37829141.
  11. ^ Jitkritsadakul, O; Bhidayasiri, R; Kalia, SK; Hodaie, M; Lozano, AM; Fasano, A (September 2017). "Systematic review of hardware-related complications of Deep Brain Stimulation: Do new indications pose an increased risk?". Brain Stimulation. 10 (5): 967–976. doi:10.1016/j.brs.2017.07.003. PMID 28739219.
  12. ^ Sandoval-Pistorius, SS; Hacker, ML; Waters, AC; Wang, J; Provenza, NR; de Hemptinne, C; Johnson, KA; Morrison, MA; Cernera, S (8 November 2023). "Advances in Deep Brain Stimulation: From Mechanisms to Applications". The Journal of Neuroscience : The Official Journal of the Society for Neuroscience. 43 (45): 7575–7586. doi:10.1523/JNEUROSCI.1427-23.2023. PMC 10634582. PMID 37940596.
  13. ^ Jakobs, M; Fomenko, A; Lozano, AM; Kiening, KL (April 2019). "Cellular, molecular, and clinical mechanisms of action of deep brain stimulation-a systematic review on established indications and outlook on future developments". EMBO Molecular Medicine. 11 (4). doi:10.15252/emmm.201809575. PMC 6460356. PMID 30862663.
  14. ^ "FDA approves brain implant to help reduce Parkinson's disease and essential tremor symptoms". FDA. Retrieved May 23, 2016. The first device, Medtronic's Activa Deep Brain Stimulation Therapy System, was approved in 1997 for tremor associated with essential tremor and Parkinson's disease.
  15. ^ Phillips S (17 June 2007). "'Brain pacemaker' for a rare disorder". NBC News. Archived from the original on April 28, 2021.
  16. ^ "FDA Approves Humanitarian Device Exemption for Deep Brain Stimulator for Severe Obsessive-Compulsive Disorder". FDA.
  17. ^ "Medtronic Receives FDA Approval for Deep Brain Stimulation Therapy for Medically Refractory Epilepsy" (Press release). Medtronic. 1 May 2018.
  18. ^ Gildenberg PL (2005). "Evolution of neuromodulation". Stereotactic and Functional Neurosurgery. 83 (2–3): 71–79. doi:10.1159/000086865. PMID 16006778. S2CID 20234898.

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