High-frequency stimulation in Parkinson's disease: more or less?

Trends Neurosci. 2005 Apr;28(4):209-16. doi: 10.1016/j.tins.2005.02.005.

Abstract

Deep-brain stimulation at high frequency is now considered the most effective neurosurgical therapy for movement disorders. An electrode is chronically implanted in a particular area of the brain and, when continuously stimulated, it significantly alleviates motor symptoms. In Parkinson's disease, common target nuclei of high-frequency stimulation (HFS) are ventral thalamic nuclei and basal ganglia nuclei, such as the internal segment of the pallidum and the subthalamic nucleus (STN), with a preference for the STN in recent years. Two fundamental mechanisms have been proposed to underlie the beneficial effects of HFS: silencing or excitation of STN neurons. Relying on recent experimental data, we suggest that both are instrumental: HFS switches off a pathological disrupted activity in the STN (a 'less' mechanism) and imposes a new type of discharge in the upper gamma-band frequency that is endowed with beneficial effects (a 'more' mechanism). The intrinsic capacity of basal ganglia and particular STN neurons to generate oscillations and shift rapidly from a physiological to a pathogenic pattern is pivotal in the operation of these circuits in health and disease.

Publication types

  • Review

MeSH terms

  • Animals
  • Basal Ganglia / physiopathology
  • Basal Ganglia / radiation effects
  • Deep Brain Stimulation*
  • Dose-Response Relationship, Radiation
  • Humans
  • Neural Networks, Computer
  • Neurons / physiology
  • Neurons / radiation effects
  • Parkinson Disease / therapy*
  • Subthalamic Nucleus / cytology
  • Subthalamic Nucleus / radiation effects
  • Time Factors