Mechanisms of deep brain stimulation.
Deep brain stimulation (DBS) is widely used for the treatment of movement disorders including Parkinson's disease, essential tremor, and dystonia and, to a lesser extent, certain treatment-resistant neuropsychiatric disorders including obsessive-compulsive disorder. Rather than a single unifying mechanism, DBS likely acts via several, nonexclusive mechanisms including local and network-wide electrical and neurochemical effects of stimulation, modulation of oscillatory activity, synaptic plasticity, and, potentially, neuroprotection and neurogenesis. These different mechanisms vary in importance depending on the condition being treated and the target being stimulated. Here we review each of these in turn and illustrate how an understanding of these mechanisms is inspiring next-generation approaches to DBS.
Nayef Al-Rodhan Laboratories, Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; and therrington@mgh.harvard.edu.
Todd M
TM
Herrington
Nayef Al-Rodhan Laboratories, Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Neurosurgery, The Johns Hopkins Hospital, Baltimore, Maryland.
Jennifer J
JJ
Cheng
Nayef Al-Rodhan Laboratories, Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts;
Emad N
EN
Eskandar
D000818:Animals; D058256:Brain Waves; D046690:Deep Brain Stimulation; D020820:Dyskinesias / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D010300:Parkinson Disease / Q000503:physiopathology / Q000628:therapy*
Parkinson's disease; basic science of clinical practice; deep brain stimulation; dystonia; obsessive-compulsive disorder; tremor