Mechanisms of Deep Brain Stimulation
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Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is now considered as a treatment of choice for patients suffering from certain neurological and psychiatric disorders such as Parkinson’s disease, tremor, dystonia, and obsessive–compulsive disorders. However, its mechanisms of action are still debated. In this chapter, we describe and discuss how DBS works based on experimental data from animal models and clinical data from patients.
The stimulation frequencies commonly used in clinical applications range between 130 and 185 Hz, involving a fairly complex interaction of inhibitory and excitatory effects, both locally and at a distance from the stimulated target. The majority of studies have shown that these frequencies induced a functional inactivation of targeted structures by depolarization block mechanism and/or by stimulation of axons (e.g., of GABA-mediated afferent neurons). Additional consequences include changes in glial activity, synaptic transmission, and the development of neuroplasticity by increasing neurogenesis, augmented levels of trophic factors, changes in the expression of receptors, and the volume of brain structures.
Thus, DBS exerts its therapeutic effects through multiple complex mechanisms. A better understanding of its mechanisms may refine its use and improve the efficacy of this therapy.
KeywordsDeep brain stimulation High-frequency stimulation Subthalamic nucleus Neurological disorders Psychiatric disorders Animal models
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