MRC Brain Network Dynamics Unit, University of Oxford, Oxford, UK.
Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.
Nat Biotechnol. 2019 Sep;37(9):1024-1033. doi: 10.1038/s41587-019-0244-6. Epub 2019 Sep 2.
Deep brain stimulation (DBS) is an effective treatment for common movement disorders and has been used to modulate neural activity through delivery of electrical stimulation to key brain structures. The long-term efficacy of stimulation in treating disorders, such as Parkinson's disease and essential tremor, has encouraged its application to a wide range of neurological and psychiatric conditions. Nevertheless, adoption of DBS remains limited, even in Parkinson's disease. Recent failed clinical trials of DBS in major depression, and modest treatment outcomes in dementia and epilepsy, are spurring further development. These improvements focus on interaction with disease circuits through complementary, spatially and temporally specific approaches. Spatial specificity is promoted by the use of segmented electrodes and field steering, and temporal specificity involves the delivery of patterned stimulation, mostly controlled through disease-related feedback. Underpinning these developments are new insights into brain structure-function relationships and aberrant circuit dynamics, including new methods with which to assess and refine the clinical effects of stimulation.
深部脑刺激（DBS）是一种有效的治疗常见运动障碍的方法，通过向关键脑结构传递电刺激来调节神经活动。刺激在治疗帕金森病和特发性震颤等疾病方面的长期疗效，鼓励其在广泛的神经和精神疾病中的应用。然而，即使在帕金森病中，DBS 的采用仍然有限。最近 DBS 在重度抑郁症中的临床试验失败，以及在痴呆症和癫痫中的治疗效果有限，正在促使进一步的发展。这些改进侧重于通过互补的、空间和时间上特定的方法与疾病回路进行交互。空间特异性通过使用分段电极和场导向来促进，而时间特异性涉及模式化刺激的传递，主要通过与疾病相关的反馈来控制。这些发展的基础是对大脑结构-功能关系和异常回路动力学的新见解，包括评估和完善刺激临床效果的新方法。
