Department of Neurosurgery, Hannover Medical School, Hannover, Germany.
Department of Neurosurgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
Nat Rev Neurol. 2021 Feb;17(2):75-87. doi: 10.1038/s41582-020-00426-z. Epub 2020 Nov 26.
Deep brain stimulation (DBS) is a neurosurgical procedure that allows targeted circuit-based neuromodulation. DBS is a standard of care in Parkinson disease, essential tremor and dystonia, and is also under active investigation for other conditions linked to pathological circuitry, including major depressive disorder and Alzheimer disease. Modern DBS systems, borrowed from the cardiac field, consist of an intracranial electrode, an extension wire and a pulse generator, and have evolved slowly over the past two decades. Advances in engineering and imaging along with an improved understanding of brain disorders are poised to reshape how DBS is viewed and delivered to patients. Breakthroughs in electrode and battery designs, stimulation paradigms, closed-loop and on-demand stimulation, and sensing technologies are expected to enhance the efficacy and tolerability of DBS. In this Review, we provide a comprehensive overview of the technical development of DBS, from its origins to its future. Understanding the evolution of DBS technology helps put the currently available systems in perspective and allows us to predict the next major technological advances and hurdles in the field.
脑深部刺激术（DBS）是一种神经外科手术，可实现靶向基于回路的神经调节。DBS 是帕金森病、原发性震颤和肌张力障碍的标准治疗方法，也正在积极研究其他与病理性回路相关的疾病，包括重度抑郁症和阿尔茨海默病。现代 DBS 系统借鉴了心脏领域的技术，由颅内电极、延长线和脉冲发生器组成，在过去二十年中发展缓慢。随着工程和成像技术的进步以及对大脑疾病的认识不断提高，DBS 的应用方式有望发生重大改变。电极和电池设计、刺激模式、闭环和按需刺激以及传感技术方面的突破有望提高 DBS 的疗效和耐受性。在这篇综述中，我们全面概述了 DBS 的技术发展历程，从起源到未来。了解 DBS 技术的发展有助于正确看待当前可用的系统，并让我们能够预测该领域的下一个重大技术进步和障碍。
