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深部脑刺激 (查看源代码)

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Deep brain stimulation (DBS) is a neurosurgical procedure involving the placement of a medical device called a neurostimulator, which sends electrical impulses, through implanted electrodes, to specific targets in the brain (the brain nucleus) for the treatment of movement disorders, including Parkinson's disease, essential tremor, dystonia, and other conditions such as obsessive-compulsive disorder (OCD) and epilepsy. While its underlying principles and mechanisms are not fully understood, DBS directly changes brain activity in a controlled manner.

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脑深部电刺激(DBS)是'''神经外科手术（[[neurosurgery|neurosurgical]])'''中的操作之一，包括放置一种叫做'''神经刺激器( [[neurostimulator]])'''的医疗设备，通过植入的'''电极([[electrode]])'''将电脉冲发送到大脑([[brain]])中的特定目标('''脑核([[Nucleus (neuroanatomy)|brain nucleus]])''') ，治疗包括'''帕金森病([[Parkinson's disease]])、原发性震颤([[essential tremor]])、肌张力障碍([[dystonia]])'''<ref name="Kringelbach" />和其他疾病，如'''强迫症([[Obsessive–compulsive disorder|obsessive-compulsive disorder]])~~'''和'''癫痫~~([[epilepsy]])'''，引起的运动障碍。虽然其基本原理和机制尚不完全清楚，DBS 是一种可控的直接改变大脑活动的方式.<ref name="Hammond" /><ref name="garcia" />。

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脑深部电刺激(DBS)是'''神经外科手术（[[neurosurgery|neurosurgical]])'''中的操作之一，包括放置一种叫做'''神经刺激器( [[neurostimulator]])'''的医疗设备，通过植入的'''电极([[electrode]])'''将电脉冲发送到大脑([[brain]])中的特定目标('''脑核([[Nucleus (neuroanatomy)|brain nucleus]])''') ，治疗包括'''帕金森病([[Parkinson's disease]])、原发性震颤([[essential tremor]])、肌张力障碍([[dystonia]])'''<ref name="Kringelbach" />和其他疾病，如'''强迫症([[Obsessive–compulsive disorder|obsessive-compulsive disorder]])和癫痫([[epilepsy]])'''，引起的运动障碍。虽然其基本原理和机制尚不完全清楚，DBS 是一种可控的直接改变大脑活动的方式.<ref name="Hammond" /><ref name="garcia" />。

DBS has been approved by the [[Food and Drug Administration]] as a treatment for essential tremor and [[Parkinson's disease]] (PD) since 1997.<ref name=":0">{{Cite web|url=https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm451152.htm|title= FDA approves brain implant to help reduce Parkinson's disease and essential tremor symptoms|website=FDA|access-date=May 23, 2016|quote=The first device, Medtronic’s Activa Deep Brain Stimulation Therapy System, was approved in 1997 for tremor associated with essential tremor and Parkinson’s disease.}}</ref> DBS was approved for [[dystonia]] in 2003,<ref name=":1">[http://knbc-tvhealth.ip2m.com/index.cfm?pt=itemDetail&item_id=97349&site_cat_id=470 'Brain pacemaker' treats dystonia.] KNBC TV, April 22, 2003. Retrieved October 18, 2006.</ref> Obsessive–compulsive disorder (OCD) in 2009, and [[epilepsy]] in 2018.<ref name=":2">{{Cite web|url=http://newsroom.medtronic.com/phoenix.zhtml?c=251324&p=irol-newsArticle&ID=2345882|title= Medtronic Receives FDA Approval for Deep Brain Stimulation Therapy for Medically Refractory Epilepsy|website=newsroom.medtronic.com|access-date=2018-12-18}}</ref><ref name=":3">{{cite web|url=https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm149529.htm|title=FDA Approves Humanitarian Device Exemption for Deep Brain Stimulator for Severe Obsessive-Compulsive Disorder|work=FDA}}</ref><ref name=gildenberg>{{cite journal|vauthors = Gildenberg PL|title = Evolution of neuromodulation|journal = Stereotactic and Functional Neurosurgery|volume = 83|issue = 2–3|pages = 71–79|year = 2005|pmid = 16006778|doi = 10.1159/000086865|s2cid = 20234898}}</ref> DBS has been studied in clinical trials as a potential treatment for [[chronic pain]] for various affective disorders, including [[major depressive disorder|major depression]]. It is one of few neurosurgical procedures that allow [[Blind experiment|blinded studies]].<ref name="Kringelbach"/>

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DBS has been approved by the Food and Drug Administration as a treatment for essential tremor and Parkinson's disease (PD) since 1997. DBS was approved for dystonia in 2003,'Brain pacemaker' treats dystonia. KNBC TV, April 22, 2003. Retrieved October 18, 2006. Obsessive–compulsive disorder (OCD) in 2009, and epilepsy in 2018. DBS has been studied in clinical trials as a potential treatment for chronic pain for various affective disorders, including major depression. It is one of few neurosurgical procedures that allow blinded studies.

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1997年，DBS 已经被'''美国食品和药物管理局([[Food and Drug Administration]])'''~~批准用于治疗~~'''~~原发性震颤和帕金森病~~([[Parkinson's disease]])'''<ref name=":0" />。2003年被批准,以“脑起搏器”的方法用于'''肌张力障碍([[dystonia]])'''<ref name=":1" /> ，2009年被批准用于强迫症，2018年用于癫痫<ref name=":2" /><ref name=":3" /><ref name="gildenberg" />。DBS 已经在临床试验中被研究用作各种情感障碍(包括'''重度抑郁症([[major depressive disorder|major depression]])''')的'''慢性疼痛([[chronic pain]])'''的潜在治疗方法。这是少数允许'''盲法研究( [[Blind experiment|blinded studies]])'''的神经外科手术之一<ref name="Kringelbach" />。

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1997年，DBS 已经被'''美国食品和药物管理局([[Food and Drug Administration]])'''批准用于治疗原发性震颤和'''帕金森病([[Parkinson's disease]])'''<ref name=":0" />。2003年被批准,以“脑起搏器”的方法用于'''肌张力障碍([[dystonia]])'''<ref name=":1" /> ，2009年被批准用于强迫症，2018年用于癫痫<ref name=":2" /><ref name=":3" /><ref name="gildenberg" />。DBS 已经在临床试验中被研究用作各种情感障碍(包括'''重度抑郁症([[major depressive disorder|major depression]])''')的'''慢性疼痛([[chronic pain]])'''的潜在治疗方法。这是少数允许'''盲法研究( [[Blind experiment|blinded studies]])'''的神经外科手术之一<ref name="Kringelbach" />。

== Medical use ==

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* DBS of the PPN may help with freezing of gait, while DBS of the thalamus may help with tremor. These targets are not routinely utilized.

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DBS用于治疗帕金森病的一些无法用药完全控制的症状<ref name="NINDS" /><ref name="USDHHS" /> 。卫生及公众服务部。美国食品药品管理局批准植入大脑刺激器控制震颤。10,2015.应用高频(> 100hz)刺激丘脑内侧、苍白球和丘脑下核三个靶结构来模拟损伤的临床效果。和 Melamed，e，2007。帕金森病及相关疾病。第一版。爱丁堡: Elsevier。这是建议的人谁有帕金森病的运动波动和震颤不充分控制的药物，或对药物不耐受，只要他们没有严重的神经精神问题。大脑的四个区域已经用神经刺激器治疗帕金森病。这些是内苍白球、丘脑、丘脑下核和脚桥核。然而，大多数常规 DBS 手术的目标要么是内侧苍白球，要么是丘脑下核。

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DBS用于治疗帕金森病的一些无法用药完全控制的症状.<ref name="NINDS" /><ref name="USDHHS" /> 。卫生及公众服务部。美国食品药品管理局批准植入大脑刺激器控制震颤。10,2015.应用高频(> 100hz)刺激丘脑内侧、苍白球和丘脑下核三个靶结构来模拟损伤的临床效果。和 Melamed，e，2007。帕金森病及相关疾病。第一版。爱丁堡: Elsevier。这是建议的人谁有帕金森病的运动波动和震颤不充分控制的药物，或对药物不耐受，只要他们没有严重的神经精神问题。大脑的四个区域已经用神经刺激器治疗帕金森病。这些是内苍白球、丘脑、丘脑下核和脚桥核。然而，大多数常规 DBS 手术的目标要么是内侧苍白球，要么是丘脑下核。

* 苍白球内侧的深部脑震荡减少称为运动障碍的无法控制的颤抖运动。这使病人能够服用足够数量的药物(尤其是左旋多巴) ，从而更好地控制症状。

* 丘脑下核的 DBS 可以直接减轻帕金森症的症状。这使得减少剂量的抗帕金森病药物。

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Generally DBS is associated with 30–60% improvement in motor score evaluations.

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一般来说，DBS 与运动成绩评定的30-60% ~~的改善有关<ref name="Dallapiazza2018" />。~~

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一般来说，DBS 与运动成绩评定的30-60% 的改善有关。

=== Tourette syndrome ===

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DBS has been used experimentally in treating adults with severe [[Tourette syndrome]] who do not respond to conventional treatment. Despite widely publicized early successes, DBS remains a highly [[Biomedical research|experimental]] procedure for the treatment of Tourette's, and more study is needed to determine whether long-term benefits outweigh the risks.<ref name="Singer2011">{{cite book|vauthors = Singer HS|title = Hyperkinetic Movement Disorders|chapter = Tourette syndrome and other tic disorders|journal = Handbook of Clinical Neurology|volume = 100|pages = 641–57|date = March 2005|pmid = 21496613|doi = 10.1016/B978-0-444-52014-2.00046-X|isbn = 9780444520142}} Also see {{cite journal|vauthors = Singer HS|title = Tourette's syndrome: from behaviour to biology|journal = The Lancet. Neurology|volume = 4|issue = 3|pages = 149–59|date = March 2005|pmid = 15721825|doi = 10.1016/S1474-4422(05)01012-4|s2cid = 20181150}}</ref><ref name=Robertson2011>{{cite journal|vauthors = Robertson MM|title = Gilles de la Tourette syndrome: the complexities of phenotype and treatment|journal = British Journal of Hospital Medicine|volume = 72|issue = 2|pages = 100–07|date = February 2011|pmid = 21378617|doi = 10.12968/hmed.2011.72.2.100}}</ref><ref name=Du2010>{{cite journal|vauthors = Du JC, Chiu TF, Lee KM, Wu HL, Yang YC, Hsu SY, Sun CS, Hwang B, Leckman JF|title = Tourette syndrome in children: an updated review|journal = Pediatrics and Neonatology|volume = 51|issue = 5|pages = 255–64|date = October 2010|pmid = 20951354|doi = 10.1016/S1875-9572(10)60050-2|doi-access = free}}</ref><ref ~~name=":4"~~>[[Tourette Association of America|Tourette Syndrome Association]]. [https://web.archive.org/web/20051122154536/http://tsa-usa.org/news/DBS-Statement.htm Statement: Deep Brain Stimulation and Tourette Syndrome.] Retrieved November 22, 2005.</ref> The procedure is well tolerated, but complications include "short battery life, abrupt symptom worsening upon cessation of stimulation, hypomanic or manic conversion, and the significant time and effort involved in optimizing stimulation parameters".<ref name=Malone>{{cite journal|vauthors = Malone DA, Pandya MM|title = Behavioral neurosurgery|journal = Advances in Neurology|volume = 99|pages = 241–47|year = 2006|pmid = 16536372}}</ref> As of 2006, five people with TS had been reported on; all experienced reduction in tics and the disappearance of obsessive-compulsive behaviors.<ref name=Malone/>

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DBS has been used experimentally in treating adults with severe [[Tourette syndrome]] who do not respond to conventional treatment. Despite widely publicized early successes, DBS remains a highly [[Biomedical research|experimental]] procedure for the treatment of Tourette's, and more study is needed to determine whether long-term benefits outweigh the risks.<ref name="Singer2011">{{cite book|vauthors = Singer HS|title = Hyperkinetic Movement Disorders|chapter = Tourette syndrome and other tic disorders|journal = Handbook of Clinical Neurology|volume = 100|pages = 641–57|date = March 2005|pmid = 21496613|doi = 10.1016/B978-0-444-52014-2.00046-X|isbn = 9780444520142}} Also see {{cite journal|vauthors = Singer HS|title = Tourette's syndrome: from behaviour to biology|journal = The Lancet. Neurology|volume = 4|issue = 3|pages = 149–59|date = March 2005|pmid = 15721825|doi = 10.1016/S1474-4422(05)01012-4|s2cid = 20181150}}</ref><ref name=Robertson2011>{{cite journal|vauthors = Robertson MM|title = Gilles de la Tourette syndrome: the complexities of phenotype and treatment|journal = British Journal of Hospital Medicine|volume = 72|issue = 2|pages = 100–07|date = February 2011|pmid = 21378617|doi = 10.12968/hmed.2011.72.2.100}}</ref><ref name=Du2010>{{cite journal|vauthors = Du JC, Chiu TF, Lee KM, Wu HL, Yang YC, Hsu SY, Sun CS, Hwang B, Leckman JF|title = Tourette syndrome in children: an updated review|journal = Pediatrics and Neonatology|volume = 51|issue = 5|pages = 255–64|date = October 2010|pmid = 20951354|doi = 10.1016/S1875-9572(10)60050-2|doi-access = free}}</ref><ref>[[Tourette Association of America|Tourette Syndrome Association]]. [https://web.archive.org/web/20051122154536/http://tsa-usa.org/news/DBS-Statement.htm Statement: Deep Brain Stimulation and Tourette Syndrome.] Retrieved November 22, 2005.</ref> The procedure is well tolerated, but complications include "short battery life, abrupt symptom worsening upon cessation of stimulation, hypomanic or manic conversion, and the significant time and effort involved in optimizing stimulation parameters".<ref name=Malone>{{cite journal|vauthors = Malone DA, Pandya MM|title = Behavioral neurosurgery|journal = Advances in Neurology|volume = 99|pages = 241–47|year = 2006|pmid = 16536372}}</ref> As of 2006, five people with TS had been reported on; all experienced reduction in tics and the disappearance of obsessive-compulsive behaviors.<ref name=Malone/>

DBS has been used experimentally in treating adults with severe Tourette syndrome who do not respond to conventional treatment. Despite widely publicized early successes, DBS remains a highly experimental procedure for the treatment of Tourette's, and more study is needed to determine whether long-term benefits outweigh the risks. Also see Tourette Syndrome Association. Statement: Deep Brain Stimulation and Tourette Syndrome. Retrieved November 22, 2005. The procedure is well tolerated, but complications include "short battery life, abrupt symptom worsening upon cessation of stimulation, hypomanic or manic conversion, and the significant time and effort involved in optimizing stimulation parameters". As of 2006, five people with TS had been reported on; all experienced reduction in tics and the disappearance of obsessive-compulsive behaviors.

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DBS 已经用于治疗成人重度图雷特氏综合症，常规治疗无效。尽管早期的成功被广泛宣传，DBS 对于图雷特综合症的治疗仍然是一个高度实验性的过程，并且需要更多的研究来确定长期的好处是否大于风险<ref name="Singer2011" /><ref name="Robertson2011" /><ref name="Du2010" /><ref name=":4" /> 。也可以参考美国图雷特氏综合症协会。声明: 深部脑部刺激和图雷特氏综合症。22,2005.该手术耐受性良好，但并发症包括”电池寿命短、刺激停止后突然症状恶化、狂躁或躁狂转换，以及优化刺激参数所需的大量时间和精力”"<ref name="Malone" /> 。截至2006年，已有5人报告患有 TS，他们的抽搐症状都有所减轻，强迫行为也都消失了<ref name="Malone" />。

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DBS 已经用于治疗成人重度图雷特氏综合症，常规治疗无效。尽管早期的成功被广泛宣传，DBS 对于图雷特综合症的治疗仍然是一个高度实验性的过程，并且需要更多的研究来确定长期的好处是否大于风险。也可以参考美国图雷特氏综合症协会。声明: 深部脑部刺激和图雷特氏综合症。22,2005.该手术耐受性良好，但并发症包括”电池寿命短、刺激停止后突然症状恶化、狂躁或躁狂转换，以及优化刺激参数所需的大量时间和精力”。截至2006年，已有5人报告患有 TS，他们的抽搐症状都有所减轻，强迫行为也都消失了。

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The procedure is invasive and expensive, and requires long-term expert care. Benefits for severe Tourette's are not conclusive, considering less robust effects of this surgery seen in the [[Netherlands]]. Tourette's is more common in [[pediatric]] populations, tending to remit in adulthood, so in general this would not be a recommended procedure for use on children. Because diagnosis of Tourette's is made based on a history of symptoms rather than analysis of neurological activity, it may not always be clear how to apply DBS for a particular person. Due to concern over the use of DBS in [[management of Tourette syndrome|Tourette syndrome treatment]], the [[Tourette Association of America]] convened a group of experts to develop recommendations guiding the use and potential [[clinical trials]] of DBS for TS.<ref ~~name=":5"~~>{{cite journal|vauthors = Mink JW, Walkup J, Frey KA, Como P, Cath D, Delong MR, Erenberg G, Jankovic J, Juncos J, Leckman JF, Swerdlow N, Visser-Vandewalle V, Vitek JL|title = Patient selection and assessment recommendations for deep brain stimulation in Tourette syndrome|journal = Movement Disorders|volume = 21|issue = 11|pages = 1831–38|date = November 2006|pmid = 16991144|doi = 10.1002/mds.21039|url = https://deepblue.lib.umich.edu/bitstream/2027.42/55891/1/21039_ftp.pdf|hdl = 2027.42/55891|s2cid = 16353255|hdl-access = free}}</ref>

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The procedure is invasive and expensive, and requires long-term expert care. Benefits for severe Tourette's are not conclusive, considering less robust effects of this surgery seen in the [[Netherlands]]. Tourette's is more common in [[pediatric]] populations, tending to remit in adulthood, so in general this would not be a recommended procedure for use on children. Because diagnosis of Tourette's is made based on a history of symptoms rather than analysis of neurological activity, it may not always be clear how to apply DBS for a particular person. Due to concern over the use of DBS in [[management of Tourette syndrome|Tourette syndrome treatment]], the [[Tourette Association of America]] convened a group of experts to develop recommendations guiding the use and potential [[clinical trials]] of DBS for TS.<ref>{{cite journal|vauthors = Mink JW, Walkup J, Frey KA, Como P, Cath D, Delong MR, Erenberg G, Jankovic J, Juncos J, Leckman JF, Swerdlow N, Visser-Vandewalle V, Vitek JL|title = Patient selection and assessment recommendations for deep brain stimulation in Tourette syndrome|journal = Movement Disorders|volume = 21|issue = 11|pages = 1831–38|date = November 2006|pmid = 16991144|doi = 10.1002/mds.21039|url = https://deepblue.lib.umich.edu/bitstream/2027.42/55891/1/21039_ftp.pdf|hdl = 2027.42/55891|s2cid = 16353255|hdl-access = free}}</ref>

The procedure is invasive and expensive, and requires long-term expert care. Benefits for severe Tourette's are not conclusive, considering less robust effects of this surgery seen in the Netherlands. Tourette's is more common in pediatric populations, tending to remit in adulthood, so in general this would not be a recommended procedure for use on children. Because diagnosis of Tourette's is made based on a history of symptoms rather than analysis of neurological activity, it may not always be clear how to apply DBS for a particular person. Due to concern over the use of DBS in Tourette syndrome treatment, the Tourette Association of America convened a group of experts to develop recommendations guiding the use and potential clinical trials of DBS for TS.

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这种手术具有侵入性，费用昂贵，需要长期的专家护理。考虑到在荷兰进行的这种手术效果较差，重度抽动秽语综合症的益处还不能下结论。抽动秽语综合症在儿童群体中更为常见，成年后趋于缓解，所以一般不推荐在儿童身上使用这种疗法。因为妥瑞氏症的诊断是基于症状的历史而不是神经活动的分析，所以如何为特定的人应用 DBS 并不总是很清楚。出于对 DBS 用于图雷特氏综合症治疗的担忧，美国图雷特协会召集了一个专家小组，为 DBS 用于 TS ~~的使用和潜在的临床试验提出建议<ref name=":5" />。~~

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这种手术具有侵入性，费用昂贵，需要长期的专家护理。考虑到在荷兰进行的这种手术效果较差，重度抽动秽语综合症的益处还不能下结论。抽动秽语综合症在儿童群体中更为常见，成年后趋于缓解，所以一般不推荐在儿童身上使用这种疗法。因为妥瑞氏症的诊断是基于症状的历史而不是神经活动的分析，所以如何为特定的人应用 DBS 并不总是很清楚。出于对 DBS 用于图雷特氏综合症治疗的担忧，美国图雷特协会召集了一个专家小组，为 DBS 用于 TS 的使用和潜在的临床试验提出建议。

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Robertson reported that DBS had been used on 55 adults by 2011, remained an experimental treatment at that time, and recommended that the procedure "should only be conducted by experienced functional neurosurgeons operating in centres which also have a dedicated Tourette syndrome clinic".<ref name=Robertson2011/> According to Malone ''et al.'' (2006), "Only patients with severe, debilitating, and treatment-refractory illness should be considered; while those with severe [[Personality disorder|personality disorders]] and substance-abuse problems should be excluded."<ref name=Malone/> Du ''et al.'' (2010) say, "As an invasive therapy, DBS is currently only advisable for severely affected, treatment-refractory TS adults".<ref name=Du2010/> Singer (2011) says, "pending determination of patient selection criteria and the outcome of carefully controlled clinical trials, a cautious approach is recommended".<ref name=Singer2011/> Viswanathan ''et al.'' (2012) say DBS should be used for people with "severe functional impairment that cannot be managed medically".<ref ~~name=":6"~~>{{cite journal|vauthors = Viswanathan A, Jimenez-Shahed J, Baizabal Carvallo JF, Jankovic J|title = Deep brain stimulation for Tourette syndrome: target selection|journal = Stereotactic and Functional Neurosurgery|volume = 90|issue = 4|pages = 213–24|year = 2012|pmid = 22699684|doi = 10.1159/000337776|doi-access = free}}</ref>

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Robertson reported that DBS had been used on 55 adults by 2011, remained an experimental treatment at that time, and recommended that the procedure "should only be conducted by experienced functional neurosurgeons operating in centres which also have a dedicated Tourette syndrome clinic".<ref name=Robertson2011/> According to Malone ''et al.'' (2006), "Only patients with severe, debilitating, and treatment-refractory illness should be considered; while those with severe [[Personality disorder|personality disorders]] and substance-abuse problems should be excluded."<ref name=Malone/> Du ''et al.'' (2010) say, "As an invasive therapy, DBS is currently only advisable for severely affected, treatment-refractory TS adults".<ref name=Du2010/> Singer (2011) says, "pending determination of patient selection criteria and the outcome of carefully controlled clinical trials, a cautious approach is recommended".<ref name=Singer2011/> Viswanathan ''et al.'' (2012) say DBS should be used for people with "severe functional impairment that cannot be managed medically".<ref>{{cite journal|vauthors = Viswanathan A, Jimenez-Shahed J, Baizabal Carvallo JF, Jankovic J|title = Deep brain stimulation for Tourette syndrome: target selection|journal = Stereotactic and Functional Neurosurgery|volume = 90|issue = 4|pages = 213–24|year = 2012|pmid = 22699684|doi = 10.1159/000337776|doi-access = free}}</ref>

Robertson reported that DBS had been used on 55 adults by 2011, remained an experimental treatment at that time, and recommended that the procedure "should only be conducted by experienced functional neurosurgeons operating in centres which also have a dedicated Tourette syndrome clinic". According to Malone et al. (2006), "Only patients with severe, debilitating, and treatment-refractory illness should be considered; while those with severe personality disorders and substance-abuse problems should be excluded." Du et al. (2010) say, "As an invasive therapy, DBS is currently only advisable for severely affected, treatment-refractory TS adults". Singer (2011) says, "pending determination of patient selection criteria and the outcome of carefully controlled clinical trials, a cautious approach is recommended". Viswanathan et al. (2012) say DBS should be used for people with "severe functional impairment that cannot be managed medically".

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据 Robertson 报道，到2011年，DBS 已经在55名成年人身上使用，在当时仍然是一种试验性的治疗方法，并且建议这种手术“应该只由有经验的功能性神经外科医生进行，这些医生所在的中心还有一个专门的图雷特氏综合症诊所”<ref name="Robertson2011" />。根据马龙等人的说法。(2006年) ，“只有患有严重的、使人衰弱的和治疗难以治愈的疾病的患者才应该被考虑; ~~而那些有严重的人格障碍和物质滥用问题的患者应该被排除在外<ref name="Robertson2011" /> 。”杜等人。~~(2010)说，“作为一种侵入性治疗，DBS 目前仅适用于严重受影响、治疗难治性 TS ~~的成年人”<ref name="Du2010" />。Singer~~ (2011年)~~说，“在确定患者选择标准和仔细控制的临床试验结果之前，建议采取谨慎的方法”<ref name="Singer2011" /> 。维斯瓦纳森等人。~~(2012)表示，DBS ~~应该用于“严重功能障碍且无法医学治疗”的患者<ref name=":6" />。~~

+

据 Robertson 报道，到2011年，DBS 已经在55名成年人身上使用，在当时仍然是一种试验性的治疗方法，并且建议这种手术“应该只由有经验的功能性神经外科医生进行，这些医生所在的中心还有一个专门的图雷特氏综合症诊所”。根据马龙等人的说法。(2006年) ，“只有患有严重的、使人衰弱的和治疗难以治愈的疾病的患者才应该被考虑; 而那些有严重的人格障碍和物质滥用问题的患者应该被排除在外。”杜等人。(2010)说，“作为一种侵入性治疗，DBS 目前仅适用于严重受影响、治疗难治性 TS 的成年人”。Singer (2011年)说，“在确定患者选择标准和仔细控制的临床试验结果之前，建议采取谨慎的方法”。维斯瓦纳森等人。(2012)表示，DBS 应该用于“严重功能障碍且无法医学治疗”的患者。

== Adverse effects ==

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动脉供血的不良影响 DBS 植入术中可能出血的动脉造影。

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DBS carries the risks of major surgery, with a complication rate related to the experience of the surgical team. The major complications include hemorrhage (1–2%) and infection (3–5%).<ref ~~name=":7"~~>{{cite journal|vauthors = Doshi PK|title = Long-term surgical and hardware-related complications of deep brain stimulation|journal = Stereotactic and Functional Neurosurgery|volume = 89|issue = 2|pages = 89–95|date = April 2011|pmid = 21293168|doi = 10.1159/000323372|s2cid = 10553177}}</ref>

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DBS carries the risks of major surgery, with a complication rate related to the experience of the surgical team. The major complications include hemorrhage (1–2%) and infection (3–5%).<ref>{{cite journal|vauthors = Doshi PK|title = Long-term surgical and hardware-related complications of deep brain stimulation|journal = Stereotactic and Functional Neurosurgery|volume = 89|issue = 2|pages = 89–95|date = April 2011|pmid = 21293168|doi = 10.1159/000323372|s2cid = 10553177}}</ref>

DBS carries the risks of major surgery, with a complication rate related to the experience of the surgical team. The major complications include hemorrhage (1–2%) and infection (3–5%).

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DBS 带有大手术的风险，并发症的发生率与手术团队的经验有关。主要并发症包括出血(1-2%)和感染(3-5%)~~<ref name=":7" />~~。

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DBS 带有大手术的风险，并发症的发生率与手术团队的经验有关。主要并发症包括出血(1-2%)和感染(3-5%)。

−

The potential exists for [[Neuropsychiatry|neuropsychiatric]] side effects after DBS, including [[apathy]], [[hallucinations]], [[hypersexuality]], [[cognitive dysfunction]], [[Clinical depression|depression]], and [[euphoria]]. However, these effects may be temporary and related to (1) correct placement of electrodes, (2) open-loop VS closed loop stimulation , meaning a constant stimulation or an [[A.I.]] monitoring delivery system<ref ~~name=":8"~~>{{cite journal|authors = Scangos, K.W., Makhoul, G.S., Sugrue, L.P.|title = State-dependent responses to intracranial brain stimulation in a patient with depression|journal = Nat Med|year = 2021|volume = 27|issue = 2|pages = 229–231|doi = 10.1038/s41591-020-01175-8|pmid = 33462446|issn=1078-8956|pmc = 8284979}}</ref> and (3) calibration of the stimulator, so these side effects are potentially reversible.<ref>{{cite journal|vauthors = Burn DJ, Tröster AI|title = Neuropsychiatric complications of medical and surgical therapies for Parkinson's disease|journal = Journal of Geriatric Psychiatry and Neurology|volume = 17|issue = 3|pages = 172–80|date = September 2004|pmid = 15312281|doi = 10.1177/0891988704267466|doi-access = free}}</ref>

+

The potential exists for [[Neuropsychiatry|neuropsychiatric]] side effects after DBS, including [[apathy]], [[hallucinations]], [[hypersexuality]], [[cognitive dysfunction]], [[Clinical depression|depression]], and [[euphoria]]. However, these effects may be temporary and related to (1) correct placement of electrodes, (2) open-loop VS closed loop stimulation , meaning a constant stimulation or an [[A.I.]] monitoring delivery system<ref>{{cite journal|authors = Scangos, K.W., Makhoul, G.S., Sugrue, L.P.|title = State-dependent responses to intracranial brain stimulation in a patient with depression|journal = Nat Med|year = 2021|volume = 27|issue = 2|pages = 229–231|doi = 10.1038/s41591-020-01175-8|pmid = 33462446|issn=1078-8956|pmc = 8284979}}</ref> and (3) calibration of the stimulator, so these side effects are potentially reversible.<ref>{{cite journal|vauthors = Burn DJ, Tröster AI|title = Neuropsychiatric complications of medical and surgical therapies for Parkinson's disease|journal = Journal of Geriatric Psychiatry and Neurology|volume = 17|issue = 3|pages = 172–80|date = September 2004|pmid = 15312281|doi = 10.1177/0891988704267466|doi-access = free}}</ref>

The potential exists for neuropsychiatric side effects after DBS, including apathy, hallucinations, hypersexuality, cognitive dysfunction, depression, and euphoria. However, these effects may be temporary and related to (1) correct placement of electrodes, (2) open-loop VS closed loop stimulation , meaning a constant stimulation or an A.I. monitoring delivery system and (3) calibration of the stimulator, so these side effects are potentially reversible.

−

DBS 有可能导致神经精神方面的副作用，包括冷漠、幻觉、性欲亢进、认知功能障碍、抑郁和欣快感。然而，这些影响可能是暂时的，并且与(1)正确放置电极，(2)开环 VS ~~闭环刺激有关，这意味着持续的刺激或人工智能。监测传输系统<ref name=":8" />和~~(3)校准刺激器，所以这些副作用是潜在的可逆的。

+

DBS 有可能导致神经精神方面的副作用，包括冷漠、幻觉、性欲亢进、认知功能障碍、抑郁和欣快感。然而，这些影响可能是暂时的，并且与(1)正确放置电极，(2)开环 VS 闭环刺激有关，这意味着持续的刺激或人工智能。监测传输系统和(3)校准刺激器，所以这些副作用是潜在的可逆的。

Because the brain can shift slightly during surgery, the electrodes can become displaced or dislodged from the specific location. This may cause more profound complications such as [[personality]] changes, but electrode misplacement is relatively easy to identify using [[CT scan]]. Also, complications of surgery may occur, such as bleeding within the brain. After surgery, swelling of the brain tissue, mild disorientation, and sleepiness are normal. After 2–4 weeks, a follow-up visit is used to remove [[Surgical suture|sutures]], turn on the neurostimulator, and program it.{{citation needed|date=November 2013}}

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因为在手术过程中大脑可能会轻微移动，电极可能会从特定位置移位或移位。这可能会导致更深刻的并发症，如个性的改变，但电极错位是相对容易识别使用 CT 扫描。此外，手术并发症也可能发生，如脑出血。手术后，脑组织肿胀，轻度迷失方向和嗜睡是正常的。2-4周后，随访取出缝线，打开神经刺激器，并对其进行编程。

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Impaired swimming skills surfaced as an unexpected risk of the procedure; several Parkinson's disease patients lost their ability to swim after receiving deep brain stimulation.<ref ~~name=":9"~~>{{Cite web|url=https://www.medpagetoday.com/geriatrics/parkinsonsdisease/83610|title=Deep Brain Stimulation May Put Parkinson's Patients at Risk for Drowning|date=2019-11-27|website=www.medpagetoday.com|language=en|access-date=2019-12-09}}</ref><ref ~~name=":10"~~>{{Cite journal|last1=Bangash|first1=Omar K.|last2=Thorburn|first2=Megan|last3=Garcia-Vega|first3=Jimena|last4=Walters|first4=Susan|last5=Stell|first5=Rick|last6=Starkstein|first6=Sergio E.|last7=Lind|first7=Christopher R. P.|date=May 2016|title=Drowning hazard with deep brain stimulation: case report|journal=Journal of Neurosurgery|volume=124|issue=5|pages=1513–16|doi=10.3171/2015.5.JNS15589|issn=1933-0693|pmid=26566200|doi-access=free}}</ref>

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Impaired swimming skills surfaced as an unexpected risk of the procedure; several Parkinson's disease patients lost their ability to swim after receiving deep brain stimulation.<ref>{{Cite web|url=https://www.medpagetoday.com/geriatrics/parkinsonsdisease/83610|title=Deep Brain Stimulation May Put Parkinson's Patients at Risk for Drowning|date=2019-11-27|website=www.medpagetoday.com|language=en|access-date=2019-12-09}}</ref><ref>{{Cite journal|last1=Bangash|first1=Omar K.|last2=Thorburn|first2=Megan|last3=Garcia-Vega|first3=Jimena|last4=Walters|first4=Susan|last5=Stell|first5=Rick|last6=Starkstein|first6=Sergio E.|last7=Lind|first7=Christopher R. P.|date=May 2016|title=Drowning hazard with deep brain stimulation: case report|journal=Journal of Neurosurgery|volume=124|issue=5|pages=1513–16|doi=10.3171/2015.5.JNS15589|issn=1933-0693|pmid=26566200|doi-access=free}}</ref>

Impaired swimming skills surfaced as an unexpected risk of the procedure; several Parkinson's disease patients lost their ability to swim after receiving deep brain stimulation.

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游泳能力受损表现为一个意想不到的风险程序; ~~几个帕金森病患者失去了他们的能力，在接受深度脑刺激后游泳<ref name=":9" /><ref name=":10" />。~~

+

游泳能力受损表现为一个意想不到的风险程序; 几个帕金森病患者失去了他们的能力，在接受深度脑刺激后游泳。

== Mechanisms ==

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The exact mechanism of action of DBS is not known.<ref ~~name=":11"~~>{{cite book |author1=Mogilner A.Y. |author2=Benabid A.L. |author3=Rezai A.R. |chapter=Chronic Therapeutic Brain Stimulation: History, Current Clinical Indications, and Future Prospects |editor1=Markov, Marko |editor2=Paul J. Rosch |title=Bioelectromagnetic medicine |publisher=Marcel Dekker |location=New York |year=2004 |pages=133–51 |isbn=978-0-8247-4700-8}}</ref> A variety of hypotheses try to explain the mechanisms of DBS:<ref ~~name=":12"~~>{{cite journal|vauthors = McIntyre CC, Thakor NV|title = Uncovering the mechanisms of deep brain stimulation for Parkinson's disease through functional imaging, neural recording, and neural modeling|journal = Critical Reviews in Biomedical Engineering|volume = 30|issue = 4–6|pages = 249–81|year = 2002|pmid = 12739751|doi = 10.1615/critrevbiomedeng.v30.i456.20}}</ref><ref ~~name=":13"~~>{{cite journal|vauthors = Herrington TM, Cheng JJ, Eskandar EN|title = Mechanisms of deep brain stimulation|journal = Journal of Neurophysiology|volume = 115|issue = 1|pages = 19–38|date = January 2016|pmid = 26510756|pmc = 4760496|doi = 10.1152/jn.00281.2015}}</ref>

+

The exact mechanism of action of DBS is not known.<ref>{{cite book |author1=Mogilner A.Y. |author2=Benabid A.L. |author3=Rezai A.R. |chapter=Chronic Therapeutic Brain Stimulation: History, Current Clinical Indications, and Future Prospects |editor1=Markov, Marko |editor2=Paul J. Rosch |title=Bioelectromagnetic medicine |publisher=Marcel Dekker |location=New York |year=2004 |pages=133–51 |isbn=978-0-8247-4700-8}}</ref> A variety of hypotheses try to explain the mechanisms of DBS:<ref>{{cite journal|vauthors = McIntyre CC, Thakor NV|title = Uncovering the mechanisms of deep brain stimulation for Parkinson's disease through functional imaging, neural recording, and neural modeling|journal = Critical Reviews in Biomedical Engineering|volume = 30|issue = 4–6|pages = 249–81|year = 2002|pmid = 12739751|doi = 10.1615/critrevbiomedeng.v30.i456.20}}</ref><ref>{{cite journal|vauthors = Herrington TM, Cheng JJ, Eskandar EN|title = Mechanisms of deep brain stimulation|journal = Journal of Neurophysiology|volume = 115|issue = 1|pages = 19–38|date = January 2016|pmid = 26510756|pmc = 4760496|doi = 10.1152/jn.00281.2015}}</ref>

The exact mechanism of action of DBS is not known. A variety of hypotheses try to explain the mechanisms of DBS:

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DBS ~~的确切作用机制尚不清楚<ref name=":11" /> 。各种各样的假说试图解释~~ DBS 的机制:~~<ref name=":12" /><ref name=":13" />~~

+

DBS 的确切作用机制尚不清楚。各种各样的假说试图解释 DBS 的机制:

# Depolarization blockade: Electrical currents block the neuronal output at or near the electrode site.

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# Antidromic activation either activating/blockading distant neurons or blockading slow axons

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# 去极化阻滞: 电流阻断电极附近的神经元输出。

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# 去极化阻滞: 电流阻断电极附近的神经元输出。# 突触抑制: 通过激活与刺激电极附近的神经元有突触连接的轴突终末来间接调节神经元的输出。# 神经元异常振荡活动的去同步化 # 逆向激活或激活/阻塞远处的神经元或阻塞缓慢的轴突

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# 突触抑制: 通过激活与刺激电极附近的神经元有突触连接的轴突终末来间接调节神经元的输出。

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# 神经元异常振荡活动的去同步化

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# 逆向激活或激活/阻塞远处的神经元或阻塞缓慢的轴突~~<ref name="garcia" />~~

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DBS represents an advance on previous treatments which involved [[pallidotomy]] (i.e., surgical ablation of the [[globus pallidus]]) or [[thalamotomy]] (i.e., surgical ablation of the thalamus).<ref ~~name=":14"~~>{{cite journal|vauthors = Machado A, Rezai AR, Kopell BH, Gross RE, Sharan AD, Benabid AL|s2cid = 18194178|title = Deep brain stimulation for Parkinson's disease: surgical technique and perioperative management|journal = Movement Disorders|volume = 21 Suppl 14|issue = Suppl 14|pages = S247–58|date = June 2006|pmid = 16810722|doi = 10.1002/mds.20959}}</ref> Instead, a thin lead with multiple electrodes is implanted in the globus pallidus, [[nucleus ventralis intermedius thalami]], or [[subthalamic nucleus]], and electric pulses are used therapeutically. The lead from the implant is extended to the [[implanted pulse generator|neurostimulator]] under the skin in the chest area.{{citation needed|date=January 2017}}

+

DBS represents an advance on previous treatments which involved [[pallidotomy]] (i.e., surgical ablation of the [[globus pallidus]]) or [[thalamotomy]] (i.e., surgical ablation of the thalamus).<ref>{{cite journal|vauthors = Machado A, Rezai AR, Kopell BH, Gross RE, Sharan AD, Benabid AL|s2cid = 18194178|title = Deep brain stimulation for Parkinson's disease: surgical technique and perioperative management|journal = Movement Disorders|volume = 21 Suppl 14|issue = Suppl 14|pages = S247–58|date = June 2006|pmid = 16810722|doi = 10.1002/mds.20959}}</ref> Instead, a thin lead with multiple electrodes is implanted in the globus pallidus, [[nucleus ventralis intermedius thalami]], or [[subthalamic nucleus]], and electric pulses are used therapeutically. The lead from the implant is extended to the [[implanted pulse generator|neurostimulator]] under the skin in the chest area.{{citation needed|date=January 2017}}

DBS represents an advance on previous treatments which involved pallidotomy (i.e., surgical ablation of the globus pallidus) or thalamotomy (i.e., surgical ablation of the thalamus). Instead, a thin lead with multiple electrodes is implanted in the globus pallidus, nucleus ventralis intermedius thalami, or subthalamic nucleus, and electric pulses are used therapeutically. The lead from the implant is extended to the neurostimulator under the skin in the chest area.

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DBS 代表了先前苍白球切开术(即手术切除苍白球)或丘脑切开术(即手术切除丘脑)治疗方法的进步<ref name=":14" /> 。取而代之的是，在苍白球、中间丘脑腹侧核或丘脑下核内植入一个带有多个电极的薄导线，并用电脉冲进行治疗。植入物的导线延伸到胸部皮肤下的神经刺激器。

+

DBS 代表了先前苍白球切开术(即手术切除苍白球)或丘脑切开术(即手术切除丘脑)治疗方法的进步。取而代之的是，在苍白球、中间丘脑腹侧核或丘脑下核内植入一个带有多个电极的薄导线，并用电脉冲进行治疗。植入物的导线延伸到胸部皮肤下的神经刺激器。

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Its direct effect on the physiology of brain cells and [[neurotransmitters]] is currently debated, but by sending high-frequency electrical impulses into specific areas of the brain, it can mitigate symptoms<ref ~~name=":15"~~>{{cite journal|vauthors = Moro E, Lang AE|title = Criteria for deep-brain stimulation in Parkinson's disease: review and analysis|journal = Expert Review of Neurotherapeutics|volume = 6|issue = 11|pages = 1695–705|date = November 2006|pmid = 17144783|doi = 10.1586/14737175.6.11.1695|s2cid = 20857769}}</ref> and directly diminish the side effects induced by PD medications,<ref ~~name=":16"~~>{{cite journal|vauthors = Apetauerova D, Ryan RK, Ro SI, Arle J, Shils J, Papavassiliou E, Tarsy D|title = End of day dyskinesia in advanced Parkinson's disease can be eliminated by bilateral subthalamic nucleus or globus pallidus deep brain stimulation|journal = Movement Disorders|volume = 21|issue = 8|pages = 1277–79|date = August 2006|pmid = 16637040|doi = 10.1002/mds.20896|s2cid = 42122286}}</ref> allowing a decrease in medications, or making a medication regimen more tolerable.{{citation needed|date=January 2017}}

+

Its direct effect on the physiology of brain cells and [[neurotransmitters]] is currently debated, but by sending high-frequency electrical impulses into specific areas of the brain, it can mitigate symptoms<ref>{{cite journal|vauthors = Moro E, Lang AE|title = Criteria for deep-brain stimulation in Parkinson's disease: review and analysis|journal = Expert Review of Neurotherapeutics|volume = 6|issue = 11|pages = 1695–705|date = November 2006|pmid = 17144783|doi = 10.1586/14737175.6.11.1695|s2cid = 20857769}}</ref> and directly diminish the side effects induced by PD medications,<ref>{{cite journal|vauthors = Apetauerova D, Ryan RK, Ro SI, Arle J, Shils J, Papavassiliou E, Tarsy D|title = End of day dyskinesia in advanced Parkinson's disease can be eliminated by bilateral subthalamic nucleus or globus pallidus deep brain stimulation|journal = Movement Disorders|volume = 21|issue = 8|pages = 1277–79|date = August 2006|pmid = 16637040|doi = 10.1002/mds.20896|s2cid = 42122286}}</ref> allowing a decrease in medications, or making a medication regimen more tolerable.{{citation needed|date=January 2017}}

Its direct effect on the physiology of brain cells and neurotransmitters is currently debated, but by sending high-frequency electrical impulses into specific areas of the brain, it can mitigate symptoms and directly diminish the side effects induced by PD medications, allowing a decrease in medications, or making a medication regimen more tolerable.

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~~它对脑细胞和神经递质生理机能的直接影响目前还存在争议，但通过向大脑特定区域发送高频电脉冲，它可以缓解症状<ref name=":15" />，直接减轻~~ PD ~~药物引起的副作用<ref name=":16" />，减少药物治疗，或使药物治疗更能耐受。~~

+

它对脑细胞和神经递质生理机能的直接影响目前还存在争议，但通过向大脑特定区域发送高频电脉冲，它可以缓解症状，直接减轻 PD 药物引起的副作用，减少药物治疗，或使药物治疗更能耐受。

== Components and placement ==

喵喵子

17

个编辑