Future prospects of brain stimulation
Neurological Research. 2000-04-01; 22(3): 237-246
DOI: 10.1080/01616412.2000.11740666
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1. Neurol Res. 2000 Apr;22(3):237-46. doi: 10.1080/01616412.2000.11740666.
Future prospects of brain stimulation.
Benabid AL(1), Koudsié A, Pollak P, Kahane P, Chabardes S, Hirsch E, Marescaux
C, Benazzouz A.
Author information:
(1)Inserm U 318, CHU of Grenoble, France.
Chronic high frequency (130 Hz) stimulation (HFS) of the thalamic target Vim has
replaced thalamotomy as a treatment of tremor of various origins and was
extended to two other targets (Subthalamic nucleus (STN) and the medial pallidus
(GPi)), since 1993 based on recent experimental data in rats and monkeys. STN
appears to be a target of major interest, able to control the three cardinal
symptoms and to allow the decrease or suppression of levodopa treatment, which
then suppresses also levodopa induced dyskinesias. The mechanisms of action of
HFS are not fully understood, but are definitely related to high frequency and
are probably different depending on the target. Inhibition of cellular activity
or of network functions could be induced, by jamming of a retroactive loop for
tremor, or by shutdown of neurotransmitter release in STN. All cardinal symptoms
are alleviated from tremor to akinesia and rigidity. The effects remain stable
over more than five years chronic HFS of STN, as the method of choice when a
surgical procedure is indicated for the treatment of Parkinson’s disease and
even more when a bilateral procedure is necessary. Recent data show that STN
stimulation could be useful in the treatment of dystonia as well as some forms
of epilepsies. It is therefore possible that DAS in STN as well as in other
targets could become a potent therapeutic tool in the future for neurological
disorders. The future of brain stimulation will depend on new technologies (new
circuits, electrodes, web based programmers), waveforms (alternatives to square
waves, random distribution), targets (hypothalamic nuclei, locus coeruleus) and
indications (dystonia, epilepsy, eating disorders.
DOI: 10.1080/01616412.2000.11740666
PMID: 10769816 [Indexed for MEDLINE]