Center for Parkinson's Disease and Other Movement Disorders, Columbia University Medical Center, New York, NY, USA.
Exp Neurol. 2013 Sep;247:296-302. doi: 10.1016/j.expneurol.2013.02.001. Epub 2013 Feb 8.
Deep brain stimulation (DBS) has emerged as an important and potentially powerful treatment option for the management of carefully selected patients with advanced Parkinson's disease (PD) who are not adequately controlled by standard medication therapy. Though considerable advances have been made, the mechanisms underlying the therapeutic effects of DBS remain unclear despite its clinical efficacy. It is now widely held that both excitation and inhibition can occur secondary to stimulation, and it is suspected that abnormal synchronized oscillations may also be important in the mechanism of DBS. Other potentially important processes, including blood flow changes, local and upstream neurogenesis, and the modulation of neurotransmitters through stimulation of bordering astrocytes are also being investigated. Recent research has suggested that the temporal pattern of DBS stimulation is also an important variable in DBS neuromodulation, yet the extent of its influence on DBS efficacy has yet to be determined. As high stimulation frequency alone does not appear to be sufficient for optimal symptom suppression, attention to stimulation pattern might lead to more effective symptom control and reduced side effects, possibly at a lower frequency. Stimulation pattern may be potentially amenable to therapeutic modulation and its role in the clinical efficacy of DBS should be addressed through further focus and research.
深部脑刺激(DBS)已成为一种重要且潜在强大的治疗选择,可用于管理经过精心挑选的患有晚期帕金森病(PD)且标准药物治疗效果不佳的患者。尽管已经取得了相当大的进展,但尽管 DBS 具有临床疗效,但其治疗效果的机制仍不清楚。现在人们普遍认为,刺激会引起兴奋和抑制,并且怀疑异常同步振荡也可能在 DBS 的机制中起重要作用。其他潜在的重要过程,包括血流变化、局部和上游神经发生以及通过刺激毗邻星形胶质细胞来调节神经递质,也在研究中。最近的研究表明,DBS 刺激的时间模式也是 DBS 神经调节中的一个重要变量,但它对 DBS 疗效的影响程度尚未确定。由于高刺激频率本身似乎不足以实现最佳症状抑制,因此关注刺激模式可能会导致更有效的症状控制和减少副作用,并且可能在较低的频率下实现。刺激模式可能具有潜在的治疗调节性,其在 DBS 临床疗效中的作用应通过进一步的关注和研究来解决。