Mitchell Kyle T, Starr Philip A
Department of Neurology, Duke University, Durham, NC, United States.
Department of Neurosurgery, University of California, San Francisco, San Francisco, CA, United States.
Handb Clin Neurol. 2020;168:153-161. doi: 10.1016/B978-0-444-63934-9.00012-3.
Deep brain stimulation (DBS) is a technique for invasive subcortical neuromodulation using a totally implantable permanent device. DBS is an effective therapy for movement disorders and is under investigation for the treatment of many other conditions including Tourette syndrome, epilepsy, and depression. Traditional DBS is limited by labor-intensive manual programming, high current requirements, and lack of responsiveness to fluctuations in the patient's signs and symptoms. The field is moving toward adaptive closed loop systems with stimulation modulated by peripheral or intracranial sensors, a technique often described as "smart neuromodulation." Advances in the understanding of brain rhythms associated with specific neurologic symptoms and the introduction of novel bidirectional neural interfaces are facilitating investigative studies of closed loop stimulation in movement disorders. These studies suggest the potential for greater efficacy with fewer adverse effects. It may be possible to generalize the hardware platforms and control strategies developed to other brain disorders.
深部脑刺激（DBS）是一种使用完全可植入的永久性装置进行有创皮层下神经调节的技术。DBS是治疗运动障碍的有效疗法，目前正在研究用于治疗许多其他病症，包括图雷特综合症、癫痫和抑郁症。传统的DBS受到劳动密集型手动编程、高电流需求以及对患者体征和症状波动缺乏反应性的限制。该领域正在朝着具有由外周或颅内传感器调制刺激的自适应闭环系统发展，这种技术通常被称为“智能神经调节”。对与特定神经症状相关的脑节律的理解进展以及新型双向神经接口的引入，正在促进对运动障碍中闭环刺激的研究。这些研究表明了在减少不良反应的情况下提高疗效的潜力。有可能将开发的硬件平台和控制策略推广到其他脑部疾病。
