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1.
脑深部电刺激(deep brain stimulation,DBS)是近20年来神经外科领域发展最迅猛的技术。DBS是通过刺激发生器发出的高频电脉冲信号刺激脑神经核团或神经传导束来调节异常的神经环路。DBS已经成为治疗特发性震颤、帕金森病、肌张力障碍等运动障碍病的常规手术方法。自1997年深部脑刺激通过美国FDA认证用于治疗特发性震颤以来,已有超过数万名运动障碍患者接受该疗法,而国内脑深部电刺激最早在1999年应用于帕金森病临床治疗,迄今也有数千例患者接受了植入手术。近年,脑起搏器的临床适应症不断扩大,从最初的运动障碍病逐渐发展到治疗其他神经和精神疾病,如抽动秽语综合征、强迫症、抑郁症、神经性厌食症、难治性疼痛、癫痫、植物状态和阿尔茨海默病等,虽然DBS的治疗机理还不很清楚,但可以预见未来DBS将成为众多神经和精神疾病的重要治疗方法。  相似文献   

2.
深部脑刺激(deep brain stimulation,DBS)已在临床上广泛用于治疗帕金森病等疾病引起的运动障碍,它在难治性癫痫、顽固性强迫症等其他脑中枢神经系统疾病的治疗上也展现出良好的应用前景.经过30多年的临床应用、动物实验和计算模型仿真等多方面的研究,DBS的机制也逐渐明朗.虽然尚无定论,但已取得许多重要进展.本文从电生理角度分析和总结了有关DBS机制的发展历程.从早期的抑制论和兴奋论到目前主导的调控论;从关注刺激位点的神经元活动,到发现神经元胞体与轴突活动的去耦合,再到高频刺激诱导的间歇性轴突阻滞,以及由此轴突活动可能导致的投射区神经元群体的去同步活动.这一系列研究进展表明DBS具有复杂的神经网络调控机制.了解DBS的作用机制对于提高其疗效、开发新刺激模式以及扩大临床应用的范围都具有重要意义.  相似文献   

3.
深部脑刺激(deep brain stimulation,DBS)已成为治疗帕金森病等运动障碍疾病的常规方法之一,并且在许多其他神经和精神疾病的治疗中也具有良好的应用前景.但是,目前常规DBS采用单通道恒定脉冲间隔的高频刺激(high frequency stimulation,HFS),刺激模式缺少多样化,限制了DBS在临床上的推广应用.为了开发更多DBS刺激模式,用于改善疗效、拓展应用范围、并节省刺激器的电能,近年来研究人员基于去同步调控机制,在脉冲序列的时间模式和空间排布两方面开发了DBS新模式.主要包括:变频序列(包括规则变频和随机变频)、不同空间位点上的多通道异步刺激以及变频和多通道两者的结合.这些新刺激模式能够提高DBS的临床疗效、降低刺激能耗,在帕金森病以及癫痫、强迫症和微意识障碍等其他脑疾病的治疗中都展现了良好的应用前景.更值得关注的是,多通道异步刺激不仅在刺激期间具有更好的即时疗效,而且刺激结束后还能长时间保持疗效,具有刺激后效应.这个特性突破了常规DBS主要为即时效应的局限性,展现了DBS新前景.本文在概述常规DBS模式及其去同步调控机制的基础上,综述变频脉冲刺激和多通道刺激等新型DBS模式,可以为促进DBS的发展提供有价值的信息.  相似文献   

4.
目的 深部脑刺激(deep brain stimulation,DBS)利用持续的电脉冲高频刺激(high-frequency stimulation,HFS)调控神经元的活动,可望用于治疗更多脑疾病。为了深入了解HFS的作用机制,促进DBS的发展,本文研究轴突HFS在引起轴突阻滞期间神经元胞体的改变。方法 在麻醉大鼠海马CA1区的锥体神经元轴突上施加脉冲频率为100 Hz的1 min逆向高频刺激(antidromic high-frequency stimulation,A-HFS)。为了研究胞体的响应,利用线性垂直排列的多通道微电极阵列,记录刺激位点上游CA1区锥体神经元胞体附近各结构分层上的诱发电位,包括A-HFS脉冲诱发的逆向群峰电位(antidromic population spike,APS)以及A-HFS期间施加的顺向测试脉冲诱发的顺向群峰电位(orthodromic population spike,OPS),并计算诱发电位的电流源密度(current-source density,CSD),用于分析A-HFS期间锥体神经元胞体附近动作电位的生成和传导。结果 锥体神经...  相似文献   

5.
底丘脑核(subthalamic nucleus,STN)是基底神经节(basal ganglia)环路中唯一的兴奋性谷氨酸能核团,不仅是经典间接通路中的关键节点,而且接受皮层的直接投射从而构成超直接通路(hyperdirect pathway),甚至被认为是驱动整个基底神经节活动的起搏器。STN由于其在基底神经节环路功能中的重要地位而成为临床上神经外科深部脑刺激(deep brain stimulation,DBS)治疗帕金森病(Parkinson’s disease,PD)的首选靶区之一。尽管STN-DBS可显著改善PD运动障碍,但其发挥效应的神经机制至今不明。本文简要综述了STN的传入、传出联系及它们在基底神经节环路中的功能,特别讨论了STN-DBS改善PD运动障碍机制的假说和最新研究进展。我们认为,对STN-DBS作用机制的认识不仅有助于临床PD治疗策略的发展,也有助于对基底神经节环路功能的深入理解。  相似文献   

6.
脑刺激是神经科学研究的重要手段,传统的经颅磁刺激和经颅电刺激等脑刺激方法尽管能调控运动功能(包括减轻运动性障碍疾病的运动障碍、提高运动能力等),但存在空间分辨率低且无法刺激深部脑组织的局限性.近年来迅速发展的深部脑刺激(deep brain stimulation,DBS)、光遗传学、经颅超声刺激(transcranial ultrasound stimulation,TUS)、时间干涉(temporal interference,TI)等精准定位脑刺激方法,具有空间分辨率高、可聚焦深部脑组织等优点.本文综述了上述几种脑刺激方法的原理、特点,对运动功能调控的研究进展,以及面临的挑战和发展前景,从而为神经科学研究提供更好的研究工具,为临床实践提供更多的干预治疗手段.  相似文献   

7.
深部脑刺激(deep brain stimulation,DBS)在许多神经系统疾病的临床治疗上都展现出良好的应用前景,然而,其作用机制尚不明确.常规DBS采用高频刺激(high frequency stimulation,HFS)的脉冲序列,这种窄脉冲最容易激活神经元结构中的轴突部分,通过轴突的投射,将HFS的作用传播至下游神经元.因此,为了探讨DBS的作用机制,并鉴于海马脑区是治疗癫痫和痴呆症等疾病的重要靶点,我们研究了海马区轴突HFS对于下游神经元的作用.对麻醉大鼠的海马CA1区传入神经通路Schaffer侧支施加1 min的100 Hz高频刺激,记录并提取下游CA1区锥体神经元和中间神经元的单元锋电位.计算锋电位的发放率,以及它们与刺激脉冲之间的锁相值(phase-locking value,PLV)和潜伏期,以定量分析HFS期间神经元动作电位发放的变化趋势.结果显示,在传入轴突上施加HFS时,初期会诱发下游神经元群体同步产生动作电位(即群峰电位).在HFS后期(群峰电位消失之后),两类神经元的单元锋电位发放仍然持续,并且发放率较稳定.但是,锋电位与刺激脉冲之间的锁相性逐渐减弱、潜伏期逐渐延长.而且,与中间神经元相比较,锥体神经元锋电位的锁相性更弱、潜伏期更长.这些结果表明,持续的轴突HFS可以诱导下游神经元产生非同步的活动,高频脉冲刺激引起的不完全轴突传导阻滞可能是导致该现象产生的主要原因.本文的研究为揭示脑刺激的作用机制提供了重要信息.  相似文献   

8.
闭环刺激是深部脑刺激(deep brain stimulation,DBS)的重要发展方向之一,有望用于治疗多种脑神经系统疾病.与常规开环的长时间持续刺激不同,闭环刺激通常采用短促的高频脉冲序列.而神经元对于高频刺激的响应存在暂态过程,在初期的短时间内会发生很大变化,从而影响闭环刺激的作用.为了研究这种暂态过程,在大鼠海马CA1区传出轴突纤维(alveus)上施加不同频率的恒频以及随机变频的逆向高频刺激(antidromic high-frequency stimulation,A-HFS),并以逆向诱发的群峰电位(antidromically-evoked population spike,APS)的幅值作为指标来考察神经元群体的响应.研究结果表明,100、133和200 Hz的恒频A-HFS初期,APS迅速衰减,脉冲频率越高,APS衰减越快.平均不到1 s时间内APS的幅值就会下降一半以上,100 Hz时的平均半衰期为~0.96 s,频率增加1倍至200 Hz时,平均半衰期缩短至~0.21 s.使用100~200 Hz范围内实时微调脉冲间隔的随机变频刺激,则可以显著延缓神经元响应的衰减速度,延长刺激作用的维持时间.这些结果可以为短促闭环刺激等DBS新模式的开发提供依据.  相似文献   

9.
为了正确检测和研究高频电刺激(high frequencystimulation,HFS)期间神经元的动作电位发放活动,进而深入揭示深部脑刺激治疗神经系统疾病的机制,本课题研究HFS期间锋电位波形的变化.在麻醉大鼠海马CA1区的输入神经通路Schaffer侧支上,施加1~2 min时长的100或者200 Hz顺向高频刺激(orthodromic-HFS,O-HFS),利用微电极阵列采集刺激下游神经元的多通道锋电位信号,并获得由O-HFS经过单突触传导激活的中间神经元的单元锋电位波形及其特征参数.结果表明,O-HFS使得锋电位的幅值明显减小而半高宽明显增加,以基线记录为基准计算百分比值,O-HFS期间锋电位的降支幅值和升支幅值分别可减小20%和40%左右,半高宽则增加10%以上.并且,在大量神经元同时产生动作电位期间,或者在比200 Hz具有更大兴奋作用的100 Hz刺激期间,锋电位波形的改变更多,幅值的减小可达50%,宽度的增加可达20%.可以推测,高频电刺激对于神经元的兴奋作用可能升高细胞膜电位,从而改变细胞膜离子通道的活动特性,导致动作电位波形的改变.这些结果支持深部脑刺激具有兴奋性调节作用的假说,对于正确分析高频电刺激期间神经元锋电位活动具有指导意义,也为进一步研究深部脑刺激(DBS)治疗脑神经系统疾病的机制提供了重要线索.  相似文献   

10.
脑起搏器     
脑起搏器在医学术语上称“脑深部刺激系统(DBS)”,其外形及工作原理与心脏起搏器类同。DBS由植入脑内的刺激电极、埋在胸部皮下的脉冲发生器和皮下导线组成。脑内电极质地柔软,直径1.2mm,电极头端有4个刺激触点,供刺激选用。脉冲发生器大小为6×6×0.5cm,为整个系统的核心部分,持续发出高频脉冲电刺激,通过皮下导线传递到脑内电极,抑制不正常的脑核团放电,消除帕金森病症状。整个刺激系统均埋在皮下,不影响日常工作和生活。可根据病情选择不同的刺激触点、频率、强度及脉宽等参数,通过体外电脑程控调节,以达到最佳刺激效果,调节时病人无…  相似文献   

11.
In a modeling study we show that desynchronization stimulation may have powerful anti-kindling effects. For this, we incorporate spike-timing-dependent plasticity into a generic network of coupled phase oscillators, which serves as a model network of synaptically interacting neurons. Two states may coexist under spontaneous conditions: a state of uncorrelated firing and a state of pathological synchrony. Appropriate stimulation protocols make the network learn or unlearn the pathological synaptic interactions, respectively. Low-frequency periodic pulse train stimulation causes a kindling. Permanent high-frequency stimulation, used as golden standard for deep brain stimulation in medically refractory movement disorders, basically freezes the synaptic weights. In contrast, desynchronization stimulation, e.g., by means of a multi-site coordinated reset, has powerful long-term anti-kindling effects and enables the network to unlearn pathologically strong synaptic interactions. We propose desynchronization stimulation for the therapy of movement disorders and epilepsies.  相似文献   

12.
High-frequency electrical stimulation of specific brain structures, known as deep brain stimulation (DBS), is an effective treatment for movement disorders, but mechanisms of action remain unclear. We examined the time-dependent effects of DBS applied to the entopeduncular nucleus (EP), the rat homolog of the internal globus pallidus, a target used for treatment of both dystonia and Parkinson’s disease (PD). We performed simultaneous multi-site local field potential (LFP) recordings in urethane-anesthetized rats to assess the effects of high-frequency (HF, 130 Hz; clinically effective), low-frequency (LF, 15 Hz; ineffective) and sham DBS delivered to EP. LFP activity was recorded from dorsal striatum (STR), ventroanterior thalamus (VA), primary motor cortex (M1), and the stimulation site in EP. Spontaneous and acute stimulation-induced LFP oscillation power and functional connectivity were assessed at baseline, and after 30, 60, and 90 minutes of stimulation. HF EP DBS produced widespread alterations in spontaneous and stimulus-induced LFP oscillations, with some effects similar across regions and others occurring in a region- and frequency band-specific manner. Many of these changes evolved over time. HF EP DBS produced an initial transient reduction in power in the low beta band in M1 and STR; however, phase synchronization between these regions in the low beta band was markedly suppressed at all time points. DBS also enhanced low gamma synchronization throughout the circuit. With sustained stimulation, there were significant reductions in low beta synchronization between M1-VA and STR-VA, and increases in power within regions in the faster frequency bands. HF DBS also suppressed the ability of acute EP stimulation to induce beta oscillations in all regions along the circuit. This dynamic pattern of synchronizing and desynchronizing effects of EP DBS suggests a complex modulation of activity along cortico-BG-thalamic circuits underlying the therapeutic effects of GPi DBS for conditions such as PD and dystonia.  相似文献   

13.
Hauptmann C  Tass PA 《Bio Systems》2007,89(1-3):173-181
We study possible anti-kindling effects of the standard high-frequency deep brain stimulation (HFDBS) and of a desynchronizing multisite coordinated reset stimulation (MCRS) theoretically in a mathematical model of the subthalamic nucleus (STN). The latter is an effective target for deep brain stimulation (DBS) in patients suffering from Parkinson's disease (PD). Depending on the structures being activated, electrical pulses may have excitatory and/or inhibitory impact. According to our simulation results MCRS may achieve robust long-term anti-kindling (i.e., curative) effects, irrespectively, of the ratio between excitatory and inhibitory impact. This means, that during MCRS the STN unlearns its pathologic synaptic connections and reestablishes a physiological level of connectivity. In contrast, HFDBS has anti-kindling effects only if its impact is predominantly excitatory. Our results are relevant for selecting appropriate locations for DBS electrodes. In fact, even with HFDBS we may expect anti-kindling effects, provided the target is properly chosen.  相似文献   

14.
Continuous high-frequency deep brain stimulation (DBS) is a widely used therapy for advanced Parkinson's disease (PD) management. However, the mechanisms underlying DBS effects remain enigmatic and are the subject of an ongoing debate. Here, we present and test a closed-loop stimulation strategy for PD in the 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) primate model of PD. Application of pallidal closed-loop stimulation leads to dissociation between changes in basal ganglia (BG) discharge rates and patterns, providing insights into PD pathophysiology. Furthermore, cortico-pallidal closed-loop stimulation has a significantly greater effect on akinesia and on cortical and pallidal discharge patterns than standard open-loop DBS and matched control stimulation paradigms. Thus, closed-loop DBS paradigms, by modulating pathological oscillatory activity rather than the discharge rate of the BG-cortical networks, may afford more effective management of advanced PD. Such strategies have the potential to be effective in additional brain disorders in which a pathological neuronal discharge pattern can be recognized.  相似文献   

15.
Following the successful application of deep brain stimulation (DBS) in the treatment of Parkinson's disease and promising results in clinical trials for obsessive compulsive disorder and major depression, DBS is currently being tested in small patient-populations with eating disorders and addiction. However, in spite of its potential use in a broad spectrum of disorders, the mechanisms of action of DBS remain largely unclear and optimal neural targets for stimulation in several disorders have yet to be established. Thus, there is a great need to examine site-specific effects of DBS on a behavioural level and to understand how DBS may modulate pathological behaviour. In view of the possible application of DBS in the treatment of disorders characterized by impaired processing of reward and motivation, like addiction and eating disorders, we examined the effect of DBS of the nucleus accumbens (NAcc) on food-directed behavior. Rats were implanted with bilateral stimulation electrodes in one of three anatomically and functionally distinct sub-areas of the NAcc: the core, lateral shell (lShell) and medial shell (mShell). Subsequently, we studied the effects of DBS on food consumption, and the motivational and appetitive properties of food. The data revealed a functional dissociation between the lShell and mShell. DBS of the lShell reduced motivation to respond for sucrose under a progressive ratio schedule of reinforcement, mShell DBS, however, profoundly and selectively increased the intake of chow. DBS of the NAcc core did not alter any form of food-directed behavior studied. DBS of neither structure affected sucrose preference. These data indicate that the intake of chow and the motivation to work for palatable food can independently be modulated by DBS of subregions of the NAcc shell. As such, these findings provide important leads for the possible future application of DBS as a treatment for eating disorders such as anorexia nervosa.  相似文献   

16.
Deep brain stimulation (DBS) was introduced as a treatment for patients with parkinsonism and other movement disorders in the early 1990s. The technique rapidly became the treatment of choice for these conditions, and is now also being explored for other diseases, including Tourette syndrome, gait disorders, epilepsy, obsessive-compulsive disorder, and depression. Although the mechanism of action of DBS remains unclear, it is recognized that DBS works through focal modulation of functionally specific circuits. The fact that the same DBS parameters and targets can be used in multiple diseases suggests that DBS does not counteract the pathophysiology of any specific disorder, but acts to replace pathologic activities in disease-affected brain circuits with activity that is more easily tolerated. Despite the progress made in the use of DBS, much remains to be done to fully realize the potential of this therapy. We describe some of the most active areas of research in this field, both in terms of exploration of new targets and stimulation parameters, and in terms of new electrode or stimulator designs.  相似文献   

17.
The subthalamic nucleus (STN) plays a central role in movement actuation and manifestation of movement disorders (i.e., tremor, rigidity, akynesia and postural instability) in Parkinson's disease (PD) patients. Moreover, it has been recently revealed that an opportune electrical stimulation of the STN, called deep brain stimulation (DBS), can strongly contribute to the annihilation of the PD-related motor disorders. Currently, a great effort is made both in Medicine, Neurosciences and Engineering for understanding and modeling in details how the STN works, how PD determines its pathological behavior and DBS restores the correct motor function.The paper is organized in two parts. Firstly some stochastic properties of the STN electrical activity are obtained by analyzing a preliminary set of experimental data coming from microelectrode recordings (MERs) in two PD patients who underwent the surgical implantation of DBS electrodes. Then, a nonlinear, stochastic, continuous-state model describing the global electrical behavior of the STN in PD patients is proposed. It is inspired by the fundamental physiologic features of the subthalamic cells and a fictitious vector state is introduced to represent the main dynamics. Its numerical parameters and stochastic properties are chosen by fitting the available data.  相似文献   

18.
Wichmann T  Delong MR 《Neuron》2006,52(1):197-204
In the 1960s, ablative stereotactic surgery was employed for a variety of movement disorders and psychiatric conditions. Although largely abandoned in the 1970s because of highly effective drugs, such as levodopa for Parkinson's disease (PD), and a reaction against psychosurgery, the field has undergone a virtual renaissance, guided by a better understanding of brain circuitry and the circuit abnormalities underlying movement disorders such as PD and neuropsychiatric conditions, such as obsessive compulsive disorder. High-frequency electrical deep brain stimulation (DBS) of specific targets, introduced in the early 1990s for tremor, has gained widespread acceptance because of its less invasive, reversible, and adjustable features and is now utilized for an increasing number of brain disorders. This review summarizes the rationale behind DBS and the use of this technique for a variety of movement disorders and neuropsychiatric diseases.  相似文献   

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