Volume 12, Issue 2 pp. 85-103

Evolution of Deep Brain Stimulation: Human Electrometer and Smart Devices Supporting the Next Generation of Therapy

Kendall H. Lee MD, PhD

Kendall H. Lee MD, PhD

Department of Neurosurgery and Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA;

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Charles D. Blaha PhD

Charles D. Blaha PhD

Department of Psychology, University of Memphis, Memphis, TN, USA;

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Paul A. Garris PhD

Paul A. Garris PhD

Department of Biological Sciences, Illinois State University, Normal, IL, USA;

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Pedram Mohseni PhD

Pedram Mohseni PhD

Electrical Engineering and Computer Science Department, Case Western Reserve University, Cleveland, OH, USA;

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April E. Horne MBA

April E. Horne MBA

Division of Engineering, Mayo Clinic, Rochester, MN, USA;

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Kevin E. Bennet MBA

Kevin E. Bennet MBA

Division of Engineering, Mayo Clinic, Rochester, MN, USA;

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Filippo Agnesi MS

Filippo Agnesi MS

Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA;

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Jonathan M. Bledsoe MD

Jonathan M. Bledsoe MD

Department of Neurosurgery and Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA;

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Deranda B. Lester MS

Deranda B. Lester MS

Department of Psychology, University of Memphis, Memphis, TN, USA;

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Chris Kimble MS

Chris Kimble MS

Division of Engineering, Mayo Clinic, Rochester, MN, USA;

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Hoon-Ki Min MS

Hoon-Ki Min MS

Neuroscience Research Institute, Gachon University of Medicine and Science, Incheon, South Korea

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Young-Bo Kim MD, PhD

Young-Bo Kim MD, PhD

Neuroscience Research Institute, Gachon University of Medicine and Science, Incheon, South Korea

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Zang-Hee Cho PhD

Zang-Hee Cho PhD

Neuroscience Research Institute, Gachon University of Medicine and Science, Incheon, South Korea

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First published: 20 April 2009
Citations: 55
Address correspondence and reprint requests to: Kendall Lee, MD, PhD, Departments of Neurosurgery and Physiology and Biomedical Engineering, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA. Email: [email protected]

ABSTRACT

Deep brain stimulation (DBS) provides therapeutic benefit for several neuropathologies, including Parkinson disease (PD), epilepsy, chronic pain, and depression. Despite well-established clinical efficacy, the mechanism of DBS remains poorly understood. In this review, we begin by summarizing the current understanding of the DBS mechanism. Using this knowledge as a framework, we then explore a specific hypothesis regarding DBS of the subthalamic nucleus (STN) for the treatment of PD. This hypothesis states that therapeutic benefit is provided, at least in part, by activation of surviving nigrostriatal dopaminergic neurons, subsequent striatal dopamine release, and resumption of striatal target cell control by dopamine. While highly controversial, we present preliminary data that are consistent with specific predications testing this hypothesis. We additionally propose that developing new technologies (e.g., human electrometer and closed-loop smart devices) for monitoring dopaminergic neurotransmission during STN DBS will further advance this treatment approach.

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