Shirvalkar Prasad, Sellers Kristin K, Schmitgen Ashlyn, Prosky Jordan, Joseph Isabella, Starr Philip A, Chang Edward F
Department of Anesthesiology (Pain Management), University of California San Francisco, San Francisco, CA 94143, USA.
Department of Neurological Surgery, University of California San Francisco, San Francisco, CA 94143, USA.
J Clin Med. 2020 Sep 29;9(10):3155. doi: 10.3390/jcm9103155.
Early studies of deep brain stimulation (DBS) for various neurological disorders involved a temporary trial period where implanted electrodes were externalized, in which the electrical contacts exiting the patient's brain are connected to external stimulation equipment, so that stimulation efficacy could be determined before permanent implant. As the optimal brain target sites for various diseases (i.e., Parkinson's disease, essential tremor) became better established, such trial periods have fallen out of favor. However, deep brain stimulation trial periods are experiencing a modern resurgence for at least two reasons: (1) studies of newer indications such as depression or chronic pain aim to identify new targets and (2) a growing interest in adaptive DBS tools necessitates neurophysiological recordings, which are often done in the peri-surgical period. In this review, we consider the possible approaches, benefits, and risks of such inpatient trial periods with a specific focus on developing new DBS therapies for chronic pain.
早期针对各种神经系统疾病的脑深部电刺激（DBS）研究涉及一个临时试验期，在此期间植入电极被外置，即从患者大脑引出的电触点与外部刺激设备相连，以便在永久植入前确定刺激效果。随着各种疾病（如帕金森病、特发性震颤）的最佳脑靶点定位更加明确，此类试验期已不再受青睐。然而，脑深部电刺激试验期正经历现代复兴，至少有两个原因：（1）对抑郁症或慢性疼痛等新适应症的研究旨在确定新靶点；（2）对适应性DBS工具的兴趣日益浓厚，这需要进行神经生理学记录，而这通常在围手术期进行。在本综述中，我们考虑此类住院试验期的可能方法、益处和风险，特别关注为慢性疼痛开发新的DBS疗法。
