深部脑刺激作用机制的探讨

UNCOVERING THE MECHANISM OF DEEP BRAIN STIMULATION

深部脑刺激器(deepbrainstimulator),也经常被称为脑起搏器,是可植入人体设备,并连续不断地传送刺激脉冲到深部脑组织的特定区域,即所谓的深部脑刺激(deepbrainstimulation,DBS)。迄今为止,深部脑刺激是治疗严重顽固抗药性运动障碍疾病(如帕金森病,原发性震颤及肌张力异常等)的最有效的外科治疗手段之一。此外,广大的科研工作者也不断地探索应用DBS治疗其他神经及精神异常(如,癫痫和强迫症)的新的临床应用。尽管应用DBS治疗运动障碍非常有效,并也迅速被探索性地应用到其他神经障碍治疗中,但其作用机制仍然不是十分清楚,成为学者们争论的热点。DBS治疗效果的作用机制通常有两种基本的观点:高频刺激抑制学说及高频刺激兴奋学说。基于最近发表的关于中枢神经系统内的高频刺激效应的资料、数据及相关评论,两种机制共存并发挥作用的DBS作用假说被提出,认为DBS通过施加高频刺激干扰并控制了核团病理性紊乱随机活动,同时施加兴奋性刺激到其他基底节的网络,以实现对帕金森病的治疗。

Deep brain stimulators, often called ＂pacemaker for the brain＂ , are implantable devices which continuously deliver impulse stimulation to specific targeted nucleus of deep brain structure, namely deep brain stimulation （DBS）. To date, deep brain stimulation （DBS） is the most effective clinical technique for the treatment of several medically refractory movement disorders （e.g., Parkinson＇s disease, essential tremor, and dystonia）. In addition, new clinical applications of DBS for other neurologic and psychiatric disorders （e.g., epilepsy and obsessive-compulsive disorder） have been vaulted forward. Although DBS has been effective in the treatment of movement disorders and is rapidly being explored for the treatment of other neurologic disorders, the scientific understanding of its mechanisms of action remains unclear and continues to be debated in the scientific community. General, there are two viewpoints on the effects of DBS： （1） DBS generates a functional ablation by suppressing or inhibiting the structure being stimulated; （2） DBS results in activation patterns in the stimulated area that override pathological area activity. Based on present data and comment on the effects of high-frequency stimulation within the central nervous system, the hypothesis that two effects are coexist and work together is proposed, that is to say, as same time as stimulation-induced disruption of activity in pathologic area, a high-frequency tonic rhythm is also introduced to rest network.