Pralong Etienne, Pollo Claudio, Villemure Jean-Guy, Debatisse Damien
Neurosurgery, CHUV, 1011 Lausanne, Switzerland.
Mov Disord. 2007 Oct 15;22(13):1879-84. doi: 10.1002/mds.21506.
Besides clinical efficacy, the mechanisms of action of deep brain stimulation (DBS) are still debated. To shed light on this complex issue, we have taken the opportunity to record the response of globus pallidus internus (GPi) neurones to 100 Hz stimulations in a case of Lesch-Nyhan syndrome (LNS) where four pallidal electrodes were implanted. Three types of response were observed, 2/19 neurones were unaffected by DBS. About 7/19 neurones were inhibited during DBS stimulation and 10/19 neurones were excited during DBS stimulation. Both effects ceased when DBS was turned off. Inhibited neurones were situated lower that exited ones on the trajectory (1.25 and 4.65 mm above the center of GPi respectively). These observations suggest that locally DBS induces a reversible inhibition of neurone firing rate while at the same time distantly exciting the main afferents to and/or efferents from the GPi. Both actions would result in a strong GPi inhibition that does not preclude increased outflow from the GPi.
除了临床疗效外，深部脑刺激（DBS）的作用机制仍存在争议。为了阐明这个复杂的问题，我们利用一个植入了四个苍白球电极的莱施-奈恩综合征（LNS）病例，记录了苍白球内侧部（GPi）神经元对100Hz刺激的反应。观察到三种类型的反应，19个神经元中有2个不受DBS影响。在DBS刺激期间，约19个神经元中有7个被抑制，19个神经元中有10个在DBS刺激期间被兴奋。当DBS关闭时，两种效应均停止。被抑制的神经元在轨迹上的位置低于兴奋的神经元（分别在GPi中心上方1.25和4.65毫米处）。这些观察结果表明，局部DBS会引起神经元放电率的可逆抑制，同时在远处兴奋GPi的主要传入神经和/或传出神经。这两种作用都将导致GPi的强烈抑制，但并不排除GPi流出增加。
