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New targets for DBS

Alim Louis Benabid1, Napoleon Torres

  • 1Clinatec, LETI-Minatec, Grenoble, France. alimlouis@aol.com

Parkinsonism & Related Disorders
|December 15, 2011
PubMed

Insights

Deep brain stimulation (DBS) has evolved beyond its initial uses, now targeting new areas like the subthalamic nucleus for Parkinson's disease symptoms and the subgenual cortex for depression. Research continues to uncover novel applications for neurological and psychiatric conditions.

Area of Science:

  • Neurosurgery
  • Neurology
  • Psychiatry

Background:

  • Deep brain stimulation (DBS) has expanded from ablative neurosurgery targets like the VIM thalamus for tremor.
  • Early applications included pallidum for Parkinson's disease (PD) tremor and dyskinesias, and internal capsule for obsessive-compulsive disorder (OCD).
  • Advances in basic research enabled new DBS targets due to its favorable characteristics (low morbidity, reversibility, adaptability).

Purpose of the Study:

  • To explore the extension of DBS to novel targets based on evolving scientific understanding.
  • To investigate the efficacy of DBS for a wider range of neurological and psychiatric disorders.
  • To highlight serendipitous findings and potential new therapeutic avenues.

Main Methods:

  • Extension of high-frequency DBS techniques to established ablative neurosurgery targets.
  • Application of DBS to targets identified through basic research, such as the subthalamic nucleus (STN) and pedunculopontine nucleus (PPN).
  • Exploration of basal ganglia and limbic system targets for psychiatric and cognitive disorders.

Main Results:

  • STN DBS effectively treats the motor symptoms of Parkinson's disease.
  • PPN DBS shows promise for gait disorders in PD.
  • New targets like the subgenual cortex (CG 25) and accumbens nucleus are explored for depression, addiction, and anorexia nervosa.
  • Thalamic intralaminar nuclei are investigated for minimally conscious states.
  • Unexpected effects, such as STN in OCD and limbic effects from VMH stimulation, suggest potential for treating cognitive impairment and memory deficits.

Conclusions:

  • DBS has a continually expanding therapeutic scope, driven by both scientific research and serendipitous discoveries.
  • Novel targets in the basal ganglia and limbic system offer new treatment possibilities for complex psychiatric and cognitive conditions.
  • Ethical considerations are paramount as DBS applications broaden.

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