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[用于精神疾病的深部脑刺激:历史基础]

[Deep brain stimulation for psychiatric disorders: historical basis].

作者信息

Huys D, Möller M, Kim E-H, Hardenacke K, Huff W, Klosterkötter J, Timmermann L, Woopen C, Kuhn J

机构信息

Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinik Köln, Kerpener Str. 62, 50937 Köln, Deutschland.

出版信息

Nervenarzt. 2012 Sep;83(9):1156-68. doi: 10.1007/s00115-011-3309-4.

Abstract

Deep brain stimulation (DBS), which is already established as an effective treatment for movement disorders, such as Parkinson's disease, is increasingly being considered as a therapy option for mental diseases. Due to the increasing number of successful applications of DBS for otherwise therapy-resistant psychiatric diseases, DBS is becoming more and more of interest in fields of fundamental research as well as clinical care. However, the stimulation system is a medical product which has to be neurosurgically implanted and this fact is often used to draw certain analogies to earlier psychosurgical approaches in the era of Freeman. But, looking at the historical development of DBS, as is the aim of the present systematic and literature-based overview, it becomes obvious that DBS did not arise exclusively from the inglorious period of psychosurgery. In fact, two partly in parallel evolving lines of medical progress have contributed to the development of DBS as it is applied today. One of these lines is the use of lesional neurosurgical procedures, such as incision of capsules and cingulotomy, which in contrast to psychosurgical interventions in the era of Freeman, is aimed at subcortical structures and provides important basic knowledge for the choice of target points. In addition DBS is rooted in the application of an electrical charge with the goal to stimulate neuronal networks.

摘要

深部脑刺激(DBS)已被确立为治疗运动障碍(如帕金森病)的有效方法,越来越多地被视为治疗精神疾病的一种选择。由于DBS在治疗难治性精神疾病方面成功应用的案例越来越多,它在基础研究和临床护理领域越来越受到关注。然而,刺激系统是一种必须通过神经外科手术植入的医疗产品,这一事实常常被用来与弗里曼时代早期的精神外科手术方法进行某些类比。但是,正如本基于系统和文献的综述的目的那样,回顾DBS的历史发展,很明显DBS并非完全源自精神外科手术的不光彩时期。事实上,两条部分并行发展的医学进步路线促成了如今应用的DBS的发展。其中一条路线是使用损伤性神经外科手术,如囊切开术和扣带回切开术,与弗里曼时代的精神外科干预不同,这些手术针对的是皮层下结构,并为靶点的选择提供了重要的基础知识。此外,DBS还源于为刺激神经元网络而施加电荷的应用。

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