Aldehri Majed, Temel Yasin, Alnaami Ibrahim, Jahanshahi Ali, Hescham Sarah
Department of Neurosurgery, Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands.
Division of Neuroanatomy, Department of Anatomy, King Khalid University, Abha, Saudi Arabia.
Surg Neurol Int. 2018 Mar 7;9:58. doi: 10.4103/sni.sni_342_17. eCollection 2018.
Dementia is among the leading causes of severe and long-term disability worldwide, decreasing the quality of life of individuals and families. Moreover, it induces an enormous economic burden on societies. The most prevalent cause of dementia is Alzheimer's disease (AD). Because current treatment options for AD are limited, deep brain stimulation (DBS) has been considered.
The aim of this review is to survey the current understanding regarding the effects of DBS in AD and possibly shed light on the mechanisms of DBS in AD. We searched PubMed and Cochrane for various studies in English literature describing DBS in patients with AD and relevant preclinical studies. All related studies published from December 2013 to March 2017 were included in this review.
Our understanding of the neural circuitry underlying learning and memory in both rodent models and human patients has grown over the past years and provided potential therapeutic targets for DBS such as the fornix and the nucleus basalis of Meynert. Clinical results indicate that DBS is most beneficial for patients who are in the early stages of AD. Potential mechanisms of action of DBS in AD comprise long-term structural plasticity, including hippocampal enlargement as well as enhanced neurotransmitter release.
It is still premature to conclude that DBS can be used in the treatment of AD, and the field will wait for the results of ongoing and future clinical trials.
痴呆症是全球严重和长期残疾的主要原因之一,降低了个人和家庭的生活质量。此外,它还给社会带来了巨大的经济负担。痴呆症最常见的病因是阿尔茨海默病(AD)。由于目前AD的治疗选择有限,深部脑刺激(DBS)已被纳入考虑范围。
本综述的目的是调查目前对DBS治疗AD效果的理解,并可能阐明DBS治疗AD的机制。我们在PubMed和Cochrane数据库中检索了英文文献中描述AD患者DBS治疗的各种研究以及相关的临床前研究。2013年12月至2017年3月发表的所有相关研究均纳入本综述。
在过去几年中,我们对啮齿动物模型和人类患者学习与记忆的神经回路的理解有所加深,并为DBS提供了潜在的治疗靶点,如穹窿和Meynert基底核。临床结果表明,DBS对处于AD早期阶段的患者最为有益。DBS治疗AD的潜在作用机制包括长期的结构可塑性,包括海马体增大以及神经递质释放增强。
得出DBS可用于治疗AD的结论仍为时过早,该领域将等待正在进行和未来临床试验的结果。