Department of Clinical Neuroscience, Umeå University, Umeå, Sweden.
UCL Institute of Neurology, Queen Square, London, UK.
Stereotact Funct Neurosurg. 2023;101(6):395-406. doi: 10.1159/000533430. Epub 2023 Oct 16.
The advent of deep brain stimulation (DBS) of the subthalamic nucleus (STN) for Parkinson's disease 30 years ago has ushered a global breakthrough of DBS as a universal method for therapy and research in wide areas of neurology and psychiatry. The literature of the last three decades has described numerous concepts and practices of DBS, often branded as novelties or discoveries. However, reading the contemporary publications often elicits a sense of déjà vu in relation to several methods, attributes, and practices of DBS. Here, we review various applications and techniques of the modern-era DBS and compare them with practices of the past.
Compared with modern literature, publications of the old-era functional stereotactic neurosurgery, including old-era DBS, show that from the very beginning multidisciplinarity and teamwork were often prevalent and insisted upon, ethical concerns were recognized, brain circuitries and rational for brain targets were discussed, surgical indications were similar, closed-loop stimulation was attempted, evaluations of surgical results were debated, and controversies were common. Thus, it appears that virtually everything done today in the field of DBS bears resemblance to old-time practices, or has been done before, albeit with partly other tools and techniques. Movement disorders remain the main indications for modern DBS as was the case for lesional surgery and old-era DBS. The novelties today consist of the STN as the dominant target for DBS, the tremendous advances in computerized brain imaging, the sophistication and versatility of implantable DBS hardware, and the large potential for research.
Many aspects of contemporary DBS bear strong resemblance to practices of the past. The dominant clinical indications remain movement disorders with virtually the same brain targets as in the past, with one exception: the STN. Other novel brain targets - that are so far subject to DBS trials - are the pedunculopontine nucleus for gait freezing, the anteromedial internal pallidum for Gilles de la Tourette and the fornix for Alzheimer's disease. The major innovations and novelties compared to the past concern mainly the unmatched level of research activity, its high degree of sponsorship, and the outstanding advances in technology that have enabled multimodal brain imaging and the miniaturization, versatility, and sophistication of implantable hardware. The greatest benefit for patients today, compared to the past, is the higher level of precision and safety of DBS, and of all functional stereotactic neurosurgery.
30 年前，深部脑刺激（DBS）技术被应用于丘脑底核（STN）治疗帕金森病，这一全球突破使 DBS 成为神经病学和精神病学多个领域治疗和研究的通用方法。过去 30 年的文献描述了许多 DBS 概念和实践，这些概念和实践通常被贴上“新颖”或“发现”的标签。然而，在阅读当代出版物时，人们常常会对一些 DBS 方法、属性和实践产生似曾相识的感觉。在这里，我们回顾了现代 DBS 的各种应用和技术，并将其与过去的实践进行了比较。
与现代文献相比，旧时代的功能立体定向神经外科出版物，包括旧时代的 DBS，表明从一开始，多学科和团队合作就常常盛行并得到坚持，伦理问题得到了认识，脑回路和脑靶点的合理性得到了讨论，手术适应证相似，尝试了闭环刺激，手术结果的评估存在争议，争议很常见。因此，如今 DBS 领域所做的几乎所有事情都与过去的实践相似，或者以前就已经做过，尽管使用的工具和技术部分不同。运动障碍仍然是现代 DBS 的主要适应证，就像神经外科手术和旧时代 DBS 一样。今天的创新包括 STN 作为 DBS 的主要靶点，计算机化脑成像的巨大进步，可植入 DBS 硬件的复杂性和多功能性，以及巨大的研究潜力。
当代 DBS 的许多方面与过去的实践有很强的相似性。主要的临床适应证仍然是运动障碍，其脑靶点与过去基本相同，只有一个例外：STN。其他新的脑靶点——目前还处于 DBS 试验阶段——是治疗步态冻结的苍白球内侧部、治疗 Gilles de la Tourette 的内前苍白球和治疗阿尔茨海默病的穹窿。与过去相比，主要的创新和新颖之处主要在于无与伦比的研究活动水平、高度的赞助以及技术的卓越进步，这些进步使多模态脑成像以及可植入硬件的小型化、多功能性和复杂性成为可能。与过去相比，如今患者最大的受益是 DBS 以及所有功能立体定向神经外科的精度和安全性更高。
