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  • Review Article
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Insights into the mechanisms of deep brain stimulation

Nature Reviews Neurology volume 13, pages 548–554 (2017)Cite this article

Subjects

Key Points

  • Deep brain stimulation (DBS) is a well-established functional neurosurgical technique that is used to treat a variety of neurological disorders, but the mechanisms underpinning its therapeutic efficacy remain unclear

  • As DBS was first used in Parkinson disease (PD), much of our current understanding of this technique stems from PD-related studies; however, insights have also been gained from other conditions, including dystonia, intractable pain and psychiatric disorders

  • The time course and patterns of symptom improvement vary considerably among conditions that are treatable by DBS

  • Initial views on the mechanisms of DBS were based on the classic 'rate model', in which the motor symptoms of PD were attributed to altered neuronal firing rates in the basal ganglia

  • Recent observations indicate that DBS acts through multifactorial mechanisms, including immediate neuromodulatory effects, synaptic plasticity, and long-term neuronal reorganization

  • In light of this complexity, a change in the terminology from deep brain 'stimulation' to deep brain 'neuromodulation' is proposed

Abstract

Despite long-term and widespread use of deep brain stimulation (DBS) in a variety of neurological conditions, the underlying mechanisms of action have been elusive. Growing evidence suggests that DBS acts through multimodal mechanisms that are not limited to inhibition and excitation of basal ganglia circuits. DBS also seems to act over variable time spans — for example, the effects on tremor are immediate, whereas the effects on dystonia emerge over several weeks — suggesting that large networks are targeted. Studies reviewing the use of DBS in pain and obsessive–compulsive disorder have demonstrated direct involvement of axonal fibres rather than grey matter. In this Review, we draw on clinical and experimental data to examine the various hypotheses that have been put forward to explain the effects of DBS. In agreement with several other experts, we suggest that the term 'deep brain stimulation' warrants modification. A potentially more accurate term is 'deep brain neuromodulation', as the mode of action spans an array of therapeutic effects over a variable period of time, and is not just limited to 'stimulation' of the basal ganglia brain centres. Terms such as 'electrical neuro-network modulation' may be useful for applications in which deep brain structures are not the primary target.

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Figure 1: Timing of the effects of deep brain stimulation.

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Authors and Affiliations

  1. Department of Neurosurgery, King's College Hospital, Denmark Hill, London, SE5 9RS, UK

    Keyoumars Ashkan

  2. Guy's, King's and St Thomas' School of Medicine, Great Maze Pond, London, SE1 9RT, UK

    Priya Rogers

  3. Department of Medical Neurobiology, The Hebrew University of Jerusalem, Hadassah Medical School, P.O.B. 12272, Jerusalem, 91120, Israel

    Hagai Bergman

  4. Department of Neurosurgery, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Birmingham, B15 2TH, UK

    Ismail Ughratdar

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P.R., H.B. and I.U. researched data for the article. K.A. and P.R. discussed the content. K.A, P.R. and I.U. wrote the article. K. A., H.B. and I.U. reviewed and edited the manuscript before submission.

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Correspondence to Keyoumars Ashkan.

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Ashkan, K., Rogers, P., Bergman, H. et al. Insights into the mechanisms of deep brain stimulation. Nat Rev Neurol 13, 548–554 (2017). https://doi.org/10.1038/nrneurol.2017.105

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