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eNeuro. 2017 Sep 22;4(5). pii: ENEURO.0140-17.2017. doi: 10.1523/ENEURO.0140-17.2017. eCollection 2017 Sep-Oct.

Subthalamic Nucleus Deep Brain Stimulation: Basic Concepts and Novel Perspectives.

Author information

1
Division of Neurosurgery Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
2
Division of Neuroimaging, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
3
Division of Neurosurgery, Department of Neurology, University of São Paulo Medical School, São Paulo, Brazil.
4
Department of Radiology, University of São Paulo Medical School, São Paulo, Brazil.
5
Department of Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Clinic of Würzburg, Würzburg, Germany.
6
Department of Biomedical Image Analysis, Eindhoven University of Technology, Eindhoven, The Netherlands.
7
Department of Neurosurgery, Maastricht University Medical Center, Maastricht, The Netherlands.
8
Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands.
9
Department of Cognitive Neuroscience, Maastricht University, Maastricht, The Netherlands.
10
Instituto de Ensino e Pesquisa Hospital Sírio-Libanês, São Paulo, Brazil.

Abstract

Over the last decades, extensive basic and clinical knowledge has been acquired on the use of subthalamic nucleus (STN) deep brain stimulation (DBS) for Parkinson's disease (PD). It is now clear that mechanisms involved in the effects of this therapy are far more complex than previously anticipated. At frequencies commonly used in clinical practice, neural elements may be excited or inhibited and novel dynamic states of equilibrium are reached. Electrode contacts used for chronic DBS in PD are placed near the dorsal border of the nucleus, a highly cellular region. DBS may thus exert its effects by modulating these cells, hyperdirect projections from motor cortical areas, afferent and efferent fibers to the motor STN. Advancements in neuroimaging techniques may allow us to identify these structures optimizing surgical targeting. In this review, we provide an update on mechanisms and the neural elements modulated by STN DBS.

KEYWORDS:

anatomy; deep brain stimulation; mechanisms; neuroimaging; physiology; plasticity; subthalamic nucleus

PMID:
28966978
PMCID:
PMC5617209
DOI:
10.1523/ENEURO.0140-17.2017
[Indexed for MEDLINE]
Free PMC Article

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