更改

== Mechanisms ==

== Mechanisms ==

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.<ref name=":12">{{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=":13">{{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=":14">{{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:

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

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:

DBS 的确切作用机制尚不清楚<ref name=":12" /> 。各种各样的假说试图解释 DBS 的机制:<ref name=":13" /><ref name=":14" />

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

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

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

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

# 去极化阻滞: 电流阻断电极附近的神经元输出。

# 去极化阻滞:电流阻断神经元在电极处或电极附近的输出。

# 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。

# 突触抑制:通过激活与刺激电极附近的神经元突触连接的轴突末梢，引起神经元输出的间接调节。

# 神经元异常振荡活动的去同步化。

# 神经元异常振荡活动的去同步。

# 逆向激活或激活/阻塞远处的神经元或阻塞缓慢的轴突。

# 反向激活激活/阻滞远端神经元或阻滞慢轴突<ref name="garcia" />。

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).<ref name=":15">{{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.

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.

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。

DBS是对以往'''苍白球切开术（ [[pallidotomy]]）'''(即，苍白球外科消融)或'''丘脑切开术（[[thalamotomy]]）'''(即，丘脑外科消融)治疗的一种进步<ref name=":15" /> 。取而代之的是，将一个带有多个电极的细导线植入苍白球、'''腹外侧核（[[nucleus ventralis intermedius thalami]]）'''或'''丘脑下核（ [[subthalamic nucleus]]）'''，电脉冲用于治疗。植入物的导线延伸到胸部皮肤下的'''神经刺激器（[[implanted pulse generator|neurostimulator]]）'''。

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<ref name=":16">{{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=":17">{{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.

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.

== Components and placement ==

== Components and placement ==