Deep brain stimulation (DBS) is an effective surgical treatment for medication-refractory hypokinetic and hyperkinetic movement disorders, and it is being explored for a variety of other neurological and psychiatric diseases. Deep brain stimulation has been Food and Drug Administration-approved for essential tremor and Parkinson disease and has a humanitarian device exemption for dystonia and obsessive-compulsive disorder. Neurostimulation is the fruit of decades of both technical and scientific advances in the field of basic neuroscience and functional neurosurgery. Despite the clinical success of DBS, the therapeutic mechanism of DBS remains under debate. Our objective is to provide a comprehensive review of DBS focusing on movement disorders, including the historical evolution of the technique, applications and outcomes with an overview of the most pertinent literature, current views on mechanisms of stimulation, and description of hardware and programming techniques. We conclude with a discussion of future developments in neurostimulation.
"Externally-generated electrical currents applied to the electrodes then stimulate the surrounding brain tissue and eventually alleviate the patients3 debilitating symptoms. While new applications and brain targets for DBS continue to emerge (Hariz et al., 2013), DBS of the subthalamic nucleus (STN) or globus pallidus (GP) interna have – over the past two decades (Miocinovic et al., 2013) – become well-established treatment options for movement symptoms associated with Parkinson3s disease (PD). "
[Show abstract][Hide abstract] ABSTRACT: During implantation of deep-brain stimulation (DBS) electrodes in the target structure, neurosurgeons and neurologists commonly observe a "microlesion effect" (MLE), which occurs well before initiating subthalamic DBS. This phenomenon typically leads to a transitory improvement of motor symptoms of patients suffering from Parkinson's disease (PD). Mechanisms behind MLE remain poorly understood. In this work, we exploited the notion of ranking to assess spontaneous brain activity in PD patients examined by resting-state functional magnetic resonance imaging in response to penetration of DBS electrodes in the subthalamic nucleus. In particular, we employed a hypothesis-free method, eigenvector centrality (EC), to reveal motor-communication-hubs of the highest rank and their reorganization following the surgery; providing a unique opportunity to evaluate the direct impact of disrupting the PD motor circuitry in vivo without prior assumptions. Penetration of electrodes was associated with increased EC of functional connectivity in the brainstem. Changes in connectivity were quantitatively related to motor improvement, which further emphasizes the clinical importance of the functional integrity of the brainstem. Surprisingly, MLE and DBS were associated with anatomically different EC maps despite their similar clinical benefit on motor functions. The DBS solely caused an increase in connectivity of the left premotor region suggesting separate pathophysiological mechanisms of both interventions. While the DBS acts at the cortical level suggesting compensatory activation of less affected motor regions, the MLE affects more fundamental circuitry as the dysfunctional brainstem predominates in the beginning of PD. These findings invigorate the overlooked brainstem perspective in the understanding of PD and support the current trend towards its early diagnosis.
"It is thought that DBS regularizes neuronal patterns preventing the transmission of pathologic bursting and oscillatory activity in the brain. This results in improved processing of the sensomotor information and alleviation of motor symptoms (Miocinovic et al., 2013). Often there is a significant reduction in the daily levodopa dose, when STN is stimulated (Benabid et al., 2009; Malhado-Chang et al., 2008). "
Clinical neurophysiology: official journal of the International Federation of Clinical Neurophysiology 02/2015; DOI:10.1016/j.clinph.2015.01.021 · 3.10 Impact Factor
"It involves the stereotactic implantation of electrodes in neuroanatomical targets where stimulation is applied via a stimulator device implanted subcutaneously (Tye et al., 2009). DBS provides a focal electrical network modulation, affecting several brain circuits of interest for neurosurgery, neurology and psychiatry involving movement, neurosensitive, neurobehavioral , cognitive, and psychiatric disorders (Dallapiazza et al., 2014; Miocinovic et al., 2013). When compared to previous ablative neurosurgical procedures such as capsulotomy or cingulotomy, DBS is considered non-destructive, reversible, and adjustable (Greenberg et al., 2008). "
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