Chang Jing-Yu
Department of Physiology and Pharmacology, Wake Forest University School of Medicine, Winston-Salem, NC 27157-1083, USA.
J Pharmacol Exp Ther. 2004 Apr;309(1):1-7. doi: 10.1124/jpet.103.049718. Epub 2004 Jan 16.
Interest in brain stimulation therapies has been rejuvenated over the last decade and brain stimulation therapy has become an alternative treatment for many neurological and psychiatric disorders, including Parkinson's disease (PD), dystonia, pain, epilepsy, depression, and schizophrenia. The effects of brain stimulation on PD are well described, and this treatment has been widely used for such conditions worldwide. Treatments for other conditions are still in experimental stages and large-scale, well controlled studies are needed to refine the treatment procedures. In the treatment of intractable brain disorders, brain stimulation, especially transcranial magnetic stimulation (TMS), is an attractive alternative to surgical lesioning as it is relatively safe, reversible, and flexible. Brain stimulation, delivered either via deeply implanted electrodes or from a surface-mounted transcranial magnetic device, can alter abnormal neural circuits underlying brain disorders. The neural mechanisms mediating the beneficial effects of brain stimulation, however, are poorly understood. Conflicting theories and experimental data have been presented. It seems that the action of stimulation on brain circuitry is not limited to simple excitation or inhibition. Alterations of neural firing patterns and long-term effects on neurotransmitter and receptor systems may also play important roles in the therapeutic effects of brain stimulation. Future research on both the basic and clinical fronts will deepen our understanding of how brain stimulation works. Real-time computation of neural activity allows for integration of brain stimulation signals into ongoing neural processing. In this way abnormal circuit activity can be adjusted by optimal therapeutic brain stimulation paradigms.
在过去十年中，人们对脑刺激疗法的兴趣再度高涨，脑刺激疗法已成为许多神经和精神疾病的替代治疗方法，包括帕金森病（PD）、肌张力障碍、疼痛、癫痫、抑郁症和精神分裂症。脑刺激对帕金森病的影响已有详尽描述，这种治疗方法在全球范围内已广泛应用于此类病症。针对其他病症的治疗仍处于实验阶段，需要大规模、严格对照的研究来完善治疗程序。在治疗难治性脑部疾病时，脑刺激，尤其是经颅磁刺激（TMS），是手术损伤的一种有吸引力的替代方法，因为它相对安全、可逆且灵活。通过深部植入电极或表面安装的经颅磁装置进行的脑刺激，可以改变脑部疾病潜在的异常神经回路。然而，介导脑刺激有益效果的神经机制却知之甚少。已经出现了相互矛盾的理论和实验数据。似乎刺激对脑电路的作用并不局限于简单的兴奋或抑制。神经放电模式的改变以及对神经递质和受体系统的长期影响，在脑刺激的治疗效果中可能也起着重要作用。未来在基础和临床方面的研究将加深我们对脑刺激作用机制的理解。神经活动的实时计算能够将脑刺激信号整合到正在进行的神经处理过程中。通过这种方式，可以通过最佳的治疗性脑刺激范式来调整异常的电路活动。
