Voges J, Krauss J K
Klinik für Neurologie und Klinik für Stereotaktische Neurochirurgie, Leibniz Institut für Neurobiologie Magdeburg, Klinikum der Otto-von-Guericke-Universität Magdeburg, Leipziger Strasse 44, Magdeburg, Germany.
Nervenarzt. 2010 Jun;81(6):702-10. doi: 10.1007/s00115-010-2937-4.
Deep brain stimulation (DBS) is an important component of the therapy of movement disorders and has almost completely replaced high-frequency coagulation of brain tissue in stereotactic neurosurgery. Despite the functional efficacy of DBS, which in parts is documented on the highest evidence level, the underlying mechanisms are still not completely understood. According to the current state of knowledge electrophysiological and functional data give evidence that high-frequency DBS has an inhibitory effect around the stimulation electrode whilst at the same time axons entering or leaving the stimulated brain area are excited leading to modulation of neuronal networks. The latter effect modifies pathological discharges of neurons in key structures of the basal ganglia network (e.g. irregular bursting activity, oscillations or synchronization) which are found in particular movement disorders such as Parkinson' s disease or dystonia. The introduction of technical standards, such as the integration of high resolution MRI into computer-assisted treatment planning, in combination with special treatment planning software have contributed significantly to the reduction of severe surgical complications (frequency of intracranial hemorrhaging 1-3%) in recent years. Future developments will address the modification of hardware components of the stimulation system, the evaluation of new brain target areas, the simultaneous stimulation of different brain areas and the assessment of different stimulation paradigms (high-frequency vs low-frequency DBS).
深部脑刺激（DBS）是运动障碍治疗的重要组成部分，在立体定向神经外科手术中几乎完全取代了脑组织的高频凝固术。尽管DBS具有功能疗效，部分疗效有最高证据水平的记录，但其潜在机制仍未完全了解。根据目前的知识状态，电生理和功能数据表明，高频DBS在刺激电极周围具有抑制作用，同时进入或离开受刺激脑区的轴突会被兴奋，从而导致神经网络的调制。后一种效应改变了基底神经节网络关键结构中神经元的病理性放电（例如不规则爆发活动、振荡或同步），这些放电在帕金森病或肌张力障碍等特定运动障碍中尤为常见。近年来，技术标准的引入，如将高分辨率MRI整合到计算机辅助治疗计划中，并结合特殊的治疗计划软件，对严重手术并发症（颅内出血频率为1 - 3%）的减少做出了重大贡献。未来的发展将涉及刺激系统硬件组件的改进、新脑靶点区域的评估、不同脑区的同时刺激以及不同刺激模式（高频与低频DBS）的评估。
