摘要
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.
Deep brain stimulation(DBS)has been applied widely in clinic to treat movement disorders such as Parkinson’s disease.It also shows great prospects in the treatments of intractable epilepsy,refractory obsessive-compulsive disorder,and other diseases of the central nervous system in brain.Over the past three decades,the mechanisms of DBS have emerged gradually based on multiple lines of evidence in clinical applications,in animal experiments,and in simulations of computational models.Important advances in DBS mechanisms have been achieved although final conclusions are still under debate.This review analyzes and summarizes the development of DBS theories from electrophysiological perspectives:from the original theory of inhibitions or excitations to the recent prevalent theory of modulations; from focusing on neuronal activity locally at stimulation sites to discovering the decoupling of somatic and axonal responses,and further to discovering the intermittent depolarization block of axons induced by high frequency stimulations,together with de-synchronous activity presumably caused by axonal activity in population neurons in the projection brain regions.The series of advances indicate that DBS has complex mechanisms in modulating the neuronal networks.Understanding the mechanisms of DBS has significance for improving DBS therapies,for developing new stimulation modes,and for extending its clinical applications.
作者
封洲燕
郭哲杉
王兆祥
FENG Zhou-Yan;GUO Zhe-Shan;WANG Zhao-Xiang(Key Laboratory of Biomedical Engineering of Education Ministry, College of Biomedical Engineering and Instrumentation Science, Zhejiang University, Hangzhou 310027, China)
出处
《生物化学与生物物理进展》
SCIE
CAS
CSCD
北大核心
2018年第12期1197-1203,共7页
Progress In Biochemistry and Biophysics
基金
国家自然科学基金资助项目(30970753).
关键词
深部脑刺激
兴奋作用
抑制作用
去耦合
轴突阻滞
deep brain stimulation
excitatory effects
inhibitory effects
decoupling
axonal block
