J Korean Med Assoc.  2013 Aug;56(8):695-701. 10.5124/jkma.2013.56.8.695.

Deep brain stimulation: mechanism, surgical procedure, and clinical applications

• Hwang JH
• Paek SH
• Jeon BS

• KMID: 1847871
• DOI: http://doi.org/10.5124/jkma.2013.56.8.695

Abstract

Advances in deep brain stimulation (DBS) in relation to neuroimaging techniques and with intraoperative electrophysiological microrecordings and stimulations have replaced ablative procedures for medication-refractory movement disorders such as Parkinson's disease, dystonia, and essential tremor. DBS is an effective surgical treatment for these conditions and is now being extended to psychiatric diseases such as obsessive-compulsive disorder, depression, and addiction. Despite the proven clinical improvement by DBS, its precise mechanism of action remains unclear. Clinical improvement depends on the selection of the appropriate patients and the precise implantation of the stimulation electrodes, which is based on careful stereotactic targeting and extensive electrophysiological monitoring of the target area. Further studies are being performed to better understand the mechanism of action and identify new anatomical targets and clinical applications of DBS. We briefly introduce the surgical procedure and current clinical applications of DBS in this review.

Keyword

Deep brain stimulation; Surgical procedures; Parkinson disease; Essential tremor; Dystonia

MeSH Terms

Brain
Deep Brain Stimulation
Depression
Dystonia
Electrodes
Essential Tremor
Humans
Movement Disorders
Neuroimaging
Obsessive-Compulsive Disorder
Parkinson Disease

Figure

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  Figure 1 Anatomical targeting (A) and microelectrode recordings (B) of the ventrointermedius (Vim) nucleus. Vci, ventrocaudalis internus; Vop, ventrooralis posterior.

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  Figure 2 Implanted pulse generator (A) and electrode (B) (courtesy of Medtronic).

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  Figure 3 Postoperative X-ray showing placement of the electrodes (A) and pulse generators (B).

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  Figure 4 Postoperative magnetic resonance imaging showing implantation of the electrodes. (A) Essential tremor (ventrolateral intermedius), (B) Parkinson disease (subthalamic nucleus), (C) dystonia (globus pallidus internus), and (D) obsessive-compulsive disorder (nucleus accumbens).

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