Deep Brain Stimulation for Movement Disorders of Basal Ganglia Origin: Restoring Function or Functionality?

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• 作者：Thomas Wichmann ; Mahlon R. DeLong
• 关键词：Parkinson’s disease ; Dystonia ; Deep brain stimulation ; Oscillation ; Synchrony ; Pathophysiology ; Basal ganglia circuits
• 刊名：Neurotherapeutics
• 出版年：2016
• 出版时间：April 2016
• 年：2016
• 卷：13
• 期：2
• 页码：264-283
• 全文大小：670 KB
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• 作者单位：Thomas Wichmann (1) (2)
  Mahlon R. DeLong (1)
  
  1. Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
  2. Yerkes National Primate Research Center, Emory University, Atlanta, GA, USA
  
• 刊物主题：Neurosciences; Neurology; Neurosurgery; Neurobiology;
• 出版者：Springer US
• ISSN：1878-7479

文摘

Deep brain stimulation (DBS) is highly effective for both hypo- and hyperkinetic movement disorders of basal ganglia origin. The clinical use of DBS is, in part, empiric, based on the experience with prior surgical ablative therapies for these disorders, and, in part, driven by scientific discoveries made decades ago. In this review, we consider anatomical and functional concepts of the basal ganglia relevant to our understanding of DBS mechanisms, as well as our current understanding of the pathophysiology of two of the most commonly DBS-treated conditions, Parkinson’s disease and dystonia. Finally, we discuss the proposed mechanism(s) of action of DBS in restoring function in patients with movement disorders. The signs and symptoms of the various disorders appear to result from signature disordered activity in the basal ganglia output, which disrupts the activity in thalamocortical and brainstem networks. The available evidence suggests that the effects of DBS are strongly dependent on targeting sensorimotor portions of specific nodes of the basal ganglia-thalamocortical motor circuit, that is, the subthalamic nucleus and the internal segment of the globus pallidus. There is little evidence to suggest that DBS in patients with movement disorders restores normal basal ganglia functions (e.g., their role in movement or reinforcement learning). Instead, it appears that high-frequency DBS replaces the abnormal basal ganglia output with a more tolerable pattern, which helps to restore the functionality of downstream networks.