Tronnier V, Rasche D
Department of Neurosurgery, Universitätsklinikum Schleswig-Holstein, Lübeck, Germany.
Handb Clin Neurol. 2013;116:343-51. doi: 10.1016/B978-0-444-53497-2.00028-0.
Cortical stimulation, either transcranial or by means of electrodes implanted epidurally or subdurally, is used increasingly to treat neuropsychiatric diseases. In cases where transcranial stimulation gives only short-term success, implanted electrodes can yield results that are similar but long-term. Epidural stimulation is used widely to treat chronic neuropathic pain, whereas newer fields are in movement disorders, tinnitus, depression, and functional rehabilitation after stroke. For epidural stimulation, computational models explain the geometry of stimulation parameters (anodal, cathodal, and bifocal) and are used for targeting to yield the best clinical results. Nevertheless, the role of the cerebrospinal fluid layer also has to be taken into consideration. Subdural or intrasulcal stimulation allows a more focused stimulation with lower current intensities. This advantage, however, is counterbalanced by a higher complication rate with regard to epileptic seizures, subdural or intracerebral hemorrhages, and wound infections.
皮质刺激，无论是经颅刺激还是通过硬膜外或硬膜下植入电极进行刺激，越来越多地用于治疗神经精神疾病。在经颅刺激仅取得短期成功的情况下，植入电极可产生类似但长期的效果。硬膜外刺激广泛用于治疗慢性神经性疼痛，而新的应用领域则包括运动障碍、耳鸣、抑郁症以及中风后的功能康复。对于硬膜外刺激，计算模型解释刺激参数（阳极、阴极和双焦点）的几何形状，并用于靶向定位以产生最佳临床效果。然而，脑脊液层的作用也必须予以考虑。硬膜下或脑沟内刺激能够以较低的电流强度进行更有针对性的刺激。然而，这一优势被癫痫发作、硬膜下或脑内出血以及伤口感染方面较高的并发症发生率所抵消。
