Future prospects of brain stimlation

AL Benabid, A Koudsie, P Pollak, P Kahane… - Neurological …, 2000 - Taylor & Francis
AL Benabid, A Koudsie, P Pollak, P Kahane, S Chabardes, E Hirsch, C Marescaux…
Neurological research, 2000Taylor & Francis
Chronic high frequency (130 Hz) stimulation (HFS) of the thalamic target Vim has replaced
thalamotomy as a treatment of tremor of various origins and was extended to two other
targets (Subthalamic nucleus (STN) and the medial pallidus (CPO), since 1993 based on
recent experimental data in rats and monkeys. STN appears to be a target of major interest,
able to control the three cardinal symptoms and to allow the decrease or suppression of
levodopa treatment, which then suppresses also levodopa induced dyskinesias. The …
Abstract
Chronic high frequency (130 Hz) stimulation (HFS) of the thalamic target Vim has replaced thalamotomy as a treatment of tremor of various origins and was extended to two other targets (Subthalamic nucleus (STN) and the medial pallidus (CPO), since 1993 based on recent experimental data in rats and monkeys. STN appears to be a target of major interest, able to control the three cardinal symptoms and to allow the decrease or suppression of levodopa treatment, which then suppresses also levodopa induced dyskinesias. The mechanisms of action of HFS are not fully understood, but are definitely related to high frequency and are probably different depending on the target. Inhibition of cellular activity or of network functions could be induced, by jamming ofa retroactive loop for tremor, or by shutdown ofneurotransmitter release in STN. All cardinal symptoms are alleviated from tremor to akinesia and rigidity. The effects remain stable over more than five years chronic HFS of STN, as the method of choice when a surgical procedure is indicated for the treatment of Parkinson!s disease and even more when a bilateral procedure is necessary. Recent data show that STN stimulation could be useful in the treatment of dystonia as well as some forms of epilepsies. It is therefore possible that OAS in STN as well as in other targets could become a potent therapeutic tool in the future for neurological disorders. The future of brain stimulation will depend on new technologies (new circuits, electrodes, web based programmers), waveforms (alternatives to square waves, random distribution), targets (hypothalamic nuclei, locus coeruleus) and indications (dystonia, epilepsy, eating disorders). [Neural Res 2000; 22: 237-246]
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