Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Mov Disord. 2011 Oct;26(12):2232-8. doi: 10.1002/mds.23842. Epub 2011 Jun 28.
Deep brain stimulation is effective for a wide range of neurological disorders; however, its mechanisms of action remain unclear. With respect to Parkinson's disease, the existence of multiple effective targets suggests that putamen stimulation also may be effective and raises questions as to the mechanisms of action. Are there as many mechanisms of action as there are effective targets or some single or small set of mechanisms common to all effective targets? During the course of routine surgery of the globus pallidus interna in patients with Parkinson's disease, the deep brain stimulation lead was placed in the putamen en route to the globus pallidus interna. Recordings of hand opening and closing during high-frequency and no stimulation were made. Speed of the movements, based on the amplitude and frequency of the repetitive hand movements as well as the decay in amplitude, were studied. Hand speed in 6 subjects was statistically significantly faster during active deep brain stimulation than the no-stimulation condition. There were no statistically significant differences in decay in the amplitude of hand movements. High-frequency deep brain stimulation of the putamen improves bradykinesia in a hand-opening and -closing task in patients with Parkinson's disease. Consequently, high-frequency deep brain stimulation of virtually every structure in the basal ganglia-thalamic-cortical system improves bradykinesia. These observations, together with microelectrode recordings reported in the literature, argue that deep brain stimulation effects may be system specific and not structure specific.
深部脑刺激对广泛的神经紊乱有效；然而，其作用机制仍不清楚。对于帕金森病而言，存在多个有效的靶点，提示刺激壳核可能也是有效的，并引发了关于作用机制的问题。是否存在与有效靶点一样多的作用机制，或者是否存在一些单一的或小的作用机制适用于所有有效的靶点？在帕金森病患者的苍白球内侧的常规手术过程中，深部脑刺激导线被置于通往苍白球内侧的壳核中。在高频和无刺激期间记录手部的张开和闭合。基于手部重复运动的幅度和频率以及幅度衰减，研究运动速度。在 6 名受试者中，与无刺激条件相比，主动深部脑刺激期间手部速度在统计学上显著更快。手部运动幅度的衰减没有统计学上的显著差异。壳核的高频深部脑刺激改善了帕金森病患者手部开合任务中的运动迟缓。因此，基底节-丘脑-皮质系统中的几乎每个结构的高频深部脑刺激都改善了运动迟缓。这些观察结果与文献中报道的微电极记录一起表明，深部脑刺激的效果可能是系统特异性的，而不是结构特异性的。
