Mechanism of Deep Brain Stimulation

Chiken, Satomi; Nambu, Atsushi

doi:10.1177/1073858415581986

Cited by 303 publications

(163 citation statements)

References 98 publications

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“…Multiple clinical trials have shown that high frequency DBS therapy can be superior to best medical therapy for motor complications in PD (8–10, 29). Despite clear efficacy of DBS in PD, its mechanism is not well understood and different hypotheses have been proposed (30, 31). Although, discussion of these hypotheses is beyond the scope of this article, it is suggested that DBS, through its excitatory and inhibitory effects on the targeted nucleus, disrupts abnormal information within cortico-basal ganglia-thalamic neural circuits, which results in improvement of motor symptoms (30, 31).…”

Section: Resultsmentioning

confidence: 99%

Deep Brain Stimulation and Sleep-Wake Disturbances in Parkinson Disease: A Review

et al. 2018

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Sleep-wake disturbances are common non-motor manifestations in Parkinson Disease (PD). Complex pathophysiological changes secondary to neurodegeneration in combination with motor symptoms and dopaminergic medications contribute to development of sleep-wake disturbances. The management of sleep complaints in PD is important as this symptom can affect daily activities and impair quality of life. Deep brain stimulation (DBS) is an effective adjunctive therapy for management of motor symptoms in PD. However, its effect on non-motor symptoms including sleep-wake disturbances is not widely understood. In this article, we reviewed studies assessing the effect of DBS at various therapeutic targets on sleep-wake disturbances. Of the studies examining the role of DBS in sleep-wake disturbances, the effect of subthalamic nucleus stimulation is most widely studied and has shown improvement in sleep quality, sleep efficiency, and sleep duration. Although, studies investigating changes in sleep with stimulation of thalamus, globus pallidus interna, and pedunculopontine nucleus are limited, they support the potential for modulation of sleep-wake centers with DBS at these sites. The mechanism by which DBS at different anatomical targets affects sleep-wake disturbances in PD is unclear and may involves multiple factors, including improved motor symptoms, medication adjustment, and direct modulation of sleep-wake centers.

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Section: Resultsmentioning

confidence: 99%

Deep Brain Stimulation and Sleep-Wake Disturbances in Parkinson Disease: A Review

et al. 2018

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“…While lesioning procedures (eg, pallidotomy or thalamotomy) are carried out using radiofrequency ablation or gamma knife radiosurgery, DBS (eg, pallidal or thalamic DBS) uses high-frequency electrical stimulation of the targeted nuclei. Although the therapeutic mechanisms of action are not completely understood, ablative surgeries are believed to destroy abnormally hyperactive circuits in deep brain nuclei, while DBS suppresses abnormally excessive activity in the motor circuitry without significant destruction of the brain tissue 68,69. Neurostimulation, therefore, has largely replaced neuroablation to treat refractory dyskinesias because it is less invasive, adjustable for maximal symptomatic benefit, and reversible in case of adverse effects.…”

Section: Introductionmentioning

confidence: 99%

Post-stroke dyskinesias

Nakawah¹,

Lai²

2016

NDT

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Strokes, whether ischemic or hemorrhagic, are among the most common causes of secondary movement disorders in elderly patients. Stroke-related (vascular) movement disorders, however, are uncommon complications of this relatively common disease. The spectrum of post-stroke movement disorders is broad and includes both hypo- and hyperkinetic syndromes. Post-stroke dyskinesias are involuntary hyperkinetic movements arising from cerebrovascular insults and often present with mixed phenotypes of hyperkinesia which can sometimes be difficult to classify. Nevertheless, identification of the most relevant motor phenotype, whenever possible, allows for a more specific phenomenological categorization of the dyskinesia and thus helps guide its treatment. Fortunately, post-stroke dyskinesias are usually self-limiting and resolve within 6 to 12 months of onset, but a short-term pharmacotherapy might sometimes be required for symptom control. Functional neurosurgical interventions targeting the motor thalamus or globus pallidus interna might be considered for patients with severe, disabling, and persistent dyskinesias (arbitrarily defined as duration longer than 12 months).

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“…Electric currents of certain pulsing protocols make it possible to increase, suppress, or distort neuronal activity in the circuits near a particular electrode. 5 This approach has been successfully used to alleviate the symptoms associated with medication-refractory action or resting tremor in patients with essential tremor (ET) or Parkinson’s disease. 14,44,46 The main strength of DBS is that it provides stimulation throughout the lifetime of the implanted device, which generally results in lasting treatments.…”

mentioning

confidence: 99%

Neuromodulation with transcranial focused ultrasound

Kubanek

2018

Neurosurgical Focus

145

124

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The understanding of brain function and the capacity to treat neurological and psychiatric disorders rest on the ability to intervene in neuronal activity in specific brain circuits. Current methods of neuromodulation incur a tradeoff between spatial focus and the level of invasiveness. Transcranial focused ultrasound (FUS) is emerging as a neuromodulation approach that combines noninvasiveness with focus that can be relatively sharp even in regions deep in the brain. This may enable studies of the causal role of specific brain regions in specific behaviors and behavioral disorders. In addition to causal brain mapping, the spatial focus of FUS opens new avenues for treatments of neurological and psychiatric conditions. This review introduces existing and emerging FUS applications in neuromodulation, discusses the mechanisms of FUS effects on cellular excitability, considers the effects of specific stimulation parameters, and lays out the directions for future work.

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Mechanism of Deep Brain Stimulation

Cited by 303 publications

References 98 publications

Deep Brain Stimulation and Sleep-Wake Disturbances in Parkinson Disease: A Review

Deep Brain Stimulation and Sleep-Wake Disturbances in Parkinson Disease: A Review

Post-stroke dyskinesias

Neuromodulation with transcranial focused ultrasound

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