Potential and limitations of chronic high-fr deep-brain stimulation in parkinson‘s disease

Abstract

Various stimulation techniques have been employed for treating neurologic disorders since the 1950s [ 5, 10, 12 - 16, 19, 21, 23 - 25, 27, 29, 32, 37, 38, 40, 53, 54, 56, 57, 65, 67 - 69 ]. However, lesional procedures were the predominant therapeutic strategy for permanently interrupting conduction pathways, although they were associated with many permanent side effects. Not until the 1980s were devices developed that, similar to pacemakers, allow for continuously stimulating central nervous structures. Such stimulation systems were initially used as spinal cord stimulators in treating chronic pain or spastic disorders. Stimulators for infl uencing deep areas of the brain or cranial nerves were developed in the late 1980s. Initial experience with treating tremor was gained with continuous stimulation of the ventrolateral thalamus [ 27, 28, 31, 34, 39, 41, 43, 46, 48, 52, 55, 58, 59, 63, 67 ]. The components of the neurostimulation system were fi rst tested in scientifi c studies and, since their certifi cation, have been used by many centers. Since the introduction of deepbrain stimulation (DBS), the indications for this procedure have been extended from treating tremor to akinesia, rigidity, and dystonia [ 1 - 4, 6 - 8, 11, 18, 20, 22, 23, 26, 30, 33 - 36, 42, 44, 45, 47, 49 - 52, 57, 62, 64, 66, 68, 70 ]. Different targets are used for stimulation with the subthalamic nucleus (STN), playing a key role in treating patients with extrapyramidal motor disorders such as Parkinson‘s disease.