Clinatec, LETI-Minatec, Grenoble, France.
Parkinsonism Relat Disord. 2012 Jan;18 Suppl 1:S21-3. doi: 10.1016/S1353-8020(11)70009-8.
The specific effect of DBS at high frequency, discovered during a VIM thalamotomy, was extended to the older targets of ablative neurosurgery such as the pallidum, for tremor in Parkinson's disease (PD), dyskinesias, essential tremor, as well as the internal capsule to treat psychiatric disorders (OCD). A second wave of targets came from basic research, enabled by the low morbidity, reversibility, and adaptability of DBS. This was the case for the subthalamic nucleus (STN) which improves the triad of dopaminergic symptoms, and the pedunculopontine nucleus (PPN) for gait disorders in PD. The new concepts of the role of basal ganglia in psychiatric disorders indicate the subgenual cortex CG 25 for severe resistant depression, the accumbens nucleus for depression, anorexia nervosa, and addiction, and the thalamus intralaminar nuclei for minimally conscious states. Serendipity and a scientific approach have provided several instances where targets have produced unexpected effects (such as STN in OCD), as well as limbic effects observed during attempts at VMH stimulation for obesity: this might offer a novel way to treat mild cognitive impairment, or memory deficits reported in Alzheimer's disease. While these might provide solutions for as yet unsolved problems, attention must be paid to ethical considerations.
高频电刺激（DBS）在苍白球毁损术中发现的特定作用，被扩展到了其他的神经外科消融靶点，如治疗帕金森病（PD）震颤、运动障碍、原发性震颤以及治疗精神障碍（OCD）的内囊靶点。第二批靶点来自基础研究，这得益于 DBS 的低发病率、可逆转性和适应性。这种情况适用于改善多巴胺能症状三联征的丘脑底核（STN），以及治疗 PD 步态障碍的脑桥被盖核（PPN）。基底神经节在精神障碍中的作用的新概念表明，严重的难治性抑郁症的亚属皮质 CG25、伏隔核对抑郁症、神经性厌食症和成瘾、丘脑板内核对最小意识状态具有治疗作用。机缘巧合和科学方法提供了一些靶点产生意外效果的实例（如 OCD 中的 STN），以及在尝试 VMH 刺激治疗肥胖症时观察到的边缘效应：这可能为治疗轻度认知障碍或阿尔茨海默病报告的记忆缺陷提供一种新方法。虽然这些可能为尚未解决的问题提供解决方案，但必须注意伦理考虑。
