How does deep brain stimulation work?

摘要

Deep brain stimulation (DBS) presents the promise of effective treatment for central nervous system disorders that are resistant to other available treatments. Deep brain stimulation has been reported to be effective in Parkinson's disease, essential tremor, pain syndromes, and medication resistant obsessive-compulsive disorder (OCD). Deep brain stimulation has also been reported to exert a remarkably large antidepressant effect in open-label, single blind lead-in, and long-term follow-up studies, even in patients in whom aggressive medication strategies and electrocon-vulsive therapy have failed (1). This is notable, given the expected low placebo response in such refractory patients. However, expectancy of benefit from invasive procedures such as DBS can be high, and the results of a sham-controlled randomized trial have yet to be published, although a large-scale trial is presently underway. Amidst the excitement about this exciting treatment that permits the translation of knowledge with regard to pathological circuits into a focal therapeutic circuit modulation, there looms a vexing and as yet unanswered question: How does it work?