雑誌文献を検索します。書籍を検索する際には「書籍検索」を選択してください。

検索

書誌情報 詳細検索 by 医中誌

Japanese

Deep brain stimulation for involuntary movements Chikashi Fukaya 1 , Yo-ichi Katayama 1 1Department of Neurological Surgery, Nihon University School of Medicine, Division of Applied System Neurosciece, Graduate School of Medical Science Keyword: deep brain stimulation , parkinson's disease , dystonia , tremor pp.869-875
Published Date 2006/12/10
DOI https://doi.org/10.11477/mf.1431100407
  • Abstract
  • Look Inside
  • Reference

 In an attempt to control hypokinetic and hyperkinetic movement disorders, deep brain stimulation(DBS)has been developed during the last two decades by several investigators. In 1987, Benabid and his colleagues suggested the usefulness of high-frequency stimulation of the ventral intermediate nucleus of the thalamus for treating drug-resistant tremors and avoiding the adverse effects of thalamotomy. Since then, DBS has been used as an alternative to lesions in functional neurosurgery of movement disorder, and more recently, it has been applied to the treatment of epilepsy, obsessive-compulsive disorders, and cluster headache, and it has other applications in experimental models.

 Regarding the treatment of movement disorders, results of recent clinical studies have demonstrated that DBS affords great benefits regarding daily activities of patients with Parkinson's disease(PD), essential tremor, dystonia, and poststroke hyperkinetic movement disorders. We have treated patients with movement disorders by DBS of the thalamic nuclei ventralis oralis(Voa/Vop)et intermedius(Vim),globus pallidus internus(GPi), and subthalamic nucleus(STN). The site of permanent electrode placement was identified using magnetic resonance imaging and multiunit extracellular recording. The implantable pulse generator was internalized after postoperative test stimulation for one week. The stimulation parameters were modified by physicians at each follow-up visit on the basis of neurological examination findings, as well as the patient's report concerning activities of daily living.

 The advantages of DBS include reversibility and controllability of stimulation. In addition, DBS carries a smaller risk of side effects, particularly when employed bilaterally. Thalamic DBS is useful for controlling tremor that is unresponsive to medication. DBS of the STN and the GPi improves the motor function of PD patients mainly during the off-period. Moreover, STN-DBS attenuates levodopa-induced dyskinesia through the reduction of dopa requirement, whereas GPi-DBS directly attenuates dopa-induced dyskinesia. In addition, GPi-DBS is very useful for controlling symptoms of idiopatic generalized dystonia. According to some reports, there were few serious adverse effects associated with DBS. Generally, the operative mortality is less than 1%. The incidences of hemorrhage are in the range of about 1-6%, and the incidences of device-related complications, such as infection or skin erosion, are in the range of 3-26%. DBS is clinically effective in well-selected patients and should be considered as a treatment option for patients with medically refractory movement disorders.

 Despite its clinical usefulness, the mechanism of efficacy is still unclear. There is no current proof that long-term DBS is able to reset neural networks, or to induce profound modifications of functional organization. Several researchers proposed hypotheses concerning the mechanism underlying the efficacy of DBS, which might involve the following 1)jamming of neural transmission, 2)direct inhibition of spike initiation at the level of the membrane that may be due to the activation of inhibitory terminals, 3)functional changes due to a decrease or an increase in the amount of neurotransmitter released, and 4)retrograde activation of upstream neural structures. From the viewpoint of basic neuroscience, the development of DBS is intriguing. Investigation regarding the mechanism underlying the efficacy of DBS may provide us a clue that may further clarify various processes in central nervous system.


Copyright © 2006, Igaku-Shoin Ltd. All rights reserved.

基本情報

電子版ISSN 1882-1243 印刷版ISSN 0001-8724 医学書院

関連文献

もっと見る

文献を共有