What conditions are amenable to treatment by DBS? What are the mechanisms of action of DBS? What effect does DBS have on the function of brain circuits? We address these controversial issues and emphasize the need for future investigations. Despite these realized and potential advances in treatment, controversy swirls around a number of clinically relevant and basic mechanistic issues. Furthermore, many have touted the potential benefit of DBS of selected brain regions for other movement disorders such as dystonia or Tourette syndrome, as well as a variety of disorders such as pain, depression, and obsessive compulsive disorder (OCD). Placement of high frequency stimulating electrodes in the region of the ventral intermediate nucleus of the thalamus (VIM) can markedly reduce tremor in these conditions, and stimulation of either the subthalamic nucleus (STN) or the internal segment of the globus pallidus (GPi) may not only reduce tremor, but also decrease bradykinesia, rigidity, and gait impairment that plague people with PD. Although we review relevant clinical issues, we emphasize the importance of current and future investigations on these topics.ĭeep brain stimulation (DBS) has provided dramatic clinical benefit for people with essential tremor (ET) and Parkinson disease (PD). Investigations of the mechanisms of action of DBS have the potential to clarify fundamental issues such as the functional anatomy of selected brain circuits and the relationship between activity in those circuits and behavior. Such studies have importance that extends beyond clinical therapeutics. Yet, the precise mechanism of action of DBS remains uncertain. Multiple groups are attempting to extend this mode of treatment to other conditions. Similarly, stimulation of the subthalamic nucleus or the internal segment of the globus pallidus can substantially reduce bradykinesia, rigidity, tremor, and gait difficulties in people with PD. Stimulation of the ventral intermediate nucleus of the thalamus can dramatically relieve tremor associated with essential tremor or Parkinson disease (PD). Deep brain stimulation (DBS) has provided remarkable benefits for people with a variety of neurologic conditions.
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