Okun Michael S
University of Florida Center for Movement Disorders & Neurorestoration, Gainesville, FL 32607, USA.
Rinsho Shinkeigaku. 2012;52(11):891-5. doi: 10.5692/clinicalneurol.52.891.
The success of chronic deep brain stimulation (DBS) and electrical neuro-network modulation (ENM) to address neurological and neuropsychiatric disorders has led the Food and Drug Administration (FDA), and also other worldwide regulatory agencies to grant approval for the use of DBS in specific disorders. In the United States, DBS is FDA approved for the treatment of advanced Parkinson's disease (PD), essential tremor (ET), obsessive compulsive disorder (OCD), and for dystonia. OCD and dystonia have been approved under a mechanism referred to as a humanitarian device exemption (HDE). However, as the field of DBS and ENM evolve there has been a shift in practice patterns from targeting diseases to targeting specific and disabling symptoms. This shift has been driving interdisciplinary DBS boards to collect, and to address symptom profiles in all potential DBS candidates. Based on a specific symptom profile, a strategic and personalized medicine approach can be undertaken. The personalized approach will take into consideration the brain target, a unilateral versus a bilateral procedure, and the potential for use of more than one DBS lead per brain hemisphere. Additionally, a personalized approach to DBS will also facilitate improved pre-operative medication adjustments, as well as optimal post-operative medication, behavioral, and device management.
慢性深部脑刺激（DBS）和电神经网络调制（ENM）在治疗神经和神经精神疾病方面的成功，促使美国食品药品监督管理局（FDA）以及其他全球监管机构批准在特定疾病中使用DBS。在美国，DBS已获得FDA批准，用于治疗晚期帕金森病（PD）、特发性震颤（ET）、强迫症（OCD）和肌张力障碍。OCD和肌张力障碍已根据一种称为人道主义设备豁免（HDE）的机制获得批准。然而，随着DBS和ENM领域的发展，实践模式已从针对疾病转向针对特定的致残症状。这种转变促使跨学科的DBS委员会收集并处理所有潜在DBS候选者的症状特征。基于特定的症状特征，可以采取战略和个性化医疗方法。个性化方法将考虑脑靶点、单侧与双侧手术，以及每个脑半球使用不止一个DBS电极的可能性。此外，DBS的个性化方法还将有助于改善术前药物调整，以及优化术后药物、行为和设备管理。
