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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". 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".
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".
Robertson 报告说，截至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Malone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="Malone" />。Du 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" />。Viswanathan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 ==
== Adverse effects ==
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 sutures, turn on the neurostimulator, and program it.
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 sutures, turn on the neurostimulator, and program it.
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（[[personality]] ）'''的改变，但电极错位使用'''CT扫描（[[CT scan]]）'''相对容易识别。此外，手术并发症也可能发生，如脑出血。手术后，脑组织肿胀、轻度定向障碍和嗜睡均属正常。2-4周后，进行随访，拆除缝合线，打开神经刺激器，并对其进行编程。
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.<ref name=":10">{{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=":11">{{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.
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.
游泳技能受损被认为是该手术的一个意外风险;几名帕金森氏症患者在接受脑深部刺激后失去了游泳能力<ref name=":10" /><ref name=":11" />。
== Mechanisms ==
== Mechanisms ==
# 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。# 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
# 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。
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>{{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}}