Cooper I S, Upton A R, Amin I
Appl Neurophysiol. 1982;45(3):209-17. doi: 10.1159/000101601.
Motor disorders of disinhibition may be modified by prosthetic mobilization of CNS inhibitory mechanisms by chronic electrical stimulation of the cerebellar cortex (CCS) and by deep brain stimulation of the thalamus and internal capsule (DBS). Reduction in spasticity, abnormal movements, intractable epilepsy and aggressive behavior has been reported after CCS, although negative results in human and animal studies have been published. No adverse neurologic, psychologic or intellectual effects of stimulation have occurred after 7 years of CCS, although subclinical histological changes may occur in the cerebellar cortex under the electrodes. CCS has been shown to produce physiological changes in evoked potentials, motoneurone excitability, epileptic discharges in the EEG and quantitative changes in movement. Surface and deep thalamic recordings have shown reduced amplitudes of somatosensory responses after CCS. Over the last 2 years we have employed chronic deep brain stimulation (DBS) in 49 patients with clinically useful results in half the patients. The technique allows reversible modification of movement disorders, and the technique can be used on the second side after a previous thalamectomy. Physiological testing, direct thalamic recordings and quantitative analysis of movement have allowed assessment of optimal rate and voltage of stimulation. For some intractable movement disorders DBS has effected significant therapeutic results when all other therapeutic techniques have failed.
通过对小脑皮质进行慢性电刺激（CCS）以及对丘脑和内囊进行脑深部电刺激（DBS）来激活中枢神经系统抑制机制，可改善去抑制性运动障碍。尽管CCS在人体和动物研究中出现过阴性结果，但仍有报道称，CCS后痉挛、异常运动、难治性癫痫和攻击性行为有所减少。CCS持续7年后，未出现刺激相关的不良神经、心理或智力影响，不过电极下方的小脑皮质可能会出现亚临床组织学变化。研究表明，CCS可引起诱发电位、运动神经元兴奋性、脑电图中的癫痫放电以及运动方面的定量变化。表面和深部丘脑记录显示，CCS后体感反应的幅度降低。在过去两年中，我们对49例患者采用了慢性脑深部电刺激（DBS），半数患者取得了临床有效结果。该技术可对运动障碍进行可逆性调节，并且在先前进行丘脑切除术后可应用于另一侧。生理测试、直接丘脑记录和运动定量分析有助于评估最佳刺激频率和电压。对于一些难治性运动障碍，当所有其他治疗技术均无效时，DBS已取得显著的治疗效果。
