Deep brain Stimulation (DBS) : A leap from history to the future

Abstract

Deep Brain Stimulation (DBS), as a revolutionary method of neuroregulation, has shown remarkable efficacy in the treatment of movement disorders such as Parkinson's disease and dystonia. In recent years, with the continuous advancement of technology and the expansion of research fields, DBS is gradually becoming a key tool in the exploration of complex neurological and psychiatric disorders. This paper briefly reviews the history, current research hotspots and future challenges of DBS, and sincerely invites academic colleagues to actively participate in the exploration and submission of this field.

History: From creation to prosperity

The origins of DBS technology can be traced back to functional neurosurgery in the 20th century. Early advances in functional localization technology enabled neurosurgeons to accurately locate intracranial structures and perform lesion excision with stereotactic devices, but these operations were often associated with irreversible nerve damage and significant side effects. In the 1950s, high-frequency electrical stimulation was first shown to be effective in inhibiting abnormal nerve signaling, thereby relieving symptoms of tremors and dyskinesia.

In the 1980s, a research team in Grenoble, France, pioneered the application of high-frequency stimulation to the subthalamic nucleus to treat Parkinson's disease, and achieved a therapeutic effect comparable to, but more adjustable and reversible than, focal resection surgery (Limousin et al., 1995). This milestone has been hailed as "another miracle in the treatment of Parkinson's disease after levodopa." Since then, DBS technology has been gradually promoted and expanded to other movement disorders and mental illness treatment areas.

Current research focus: the dual progress of technology and mechanism

In recent years, the development of DBS technology has entered a new stage of interdisciplinary and innovation-driven development. The following three directions are the main research hotspots at present:

(1) Exploration of new targets: In addition to the traditional subthalamic nucleus and medial pallidal nucleus, researchers are actively exploring potential new targets such as the amygdala, hypothalamus and mesencephalic limbic system. These regions may play a key role in mood regulation, memory improvement, and the treatment of anxiety disorders. For example, amygdala DBS for patients with depression has shown initial efficacy, opening up new avenues for psychiatric treatment (Davidson B et al., 2020).

(2) Closed-loop stimulation technology: Traditional DBS adopts continuous open-loop stimulation mode, while closed-loop stimulation technology promotes DBS to develop in a more personalized and accurate treatment direction through real-time monitoring of nerve electrophysiological signals and dynamic adjustment of stimulation parameters. In patients with Parkinson's disease, closed-loop stimulation using β-band (13-35 Hz) abnormal neural oscillatory activity as a feedback design has been shown to be effective in improving motor symptoms and reducing side effects (Neumann WJ et al., 2023).

(3) Mechanism of action: Current studies on the mechanism of DBS mainly focus on the oscillation of neural networks and the regulation of synaptic plasticity. For example, DBS can reduce abnormal neural oscillations in the β-band of Parkinson's patients, and affect cognitive function by inducing changes in synaptic plasticity such as long-term enhancement or long-term inhibition (Gao Y et al., 2024).

Challenges and opportunities

Despite the great success of DBS technology in the treatment of movement disorders, there are still many challenges to its application in other areas:

(1) Specific stimulation targets: Different patients have significantly different responses to DBS targets. How to identify the optimal target location according to the pathological characteristics and needs of patients through advanced imaging technology such as ultra-high field intensity (7T) magnetic resonance, combined with image reconstruction technology, is the focus of future research.

(2) Long-term efficacy and safety: The short-term efficacy of DBS has been proven, but its long-term efficacy is still controversial. Some patients experience reduced efficacy for several years after treatment, which may be related to disease progression or tolerance at the site of irritation. Device-related complications, such as electrode displacement and infection, also require further improvement.

(3) Mechanism of DBS in complex diseases: For psychiatric diseases and cognitive disorders, the mechanism of DBS is still in the stage of exploration due to the complexity of the disease mechanism itself. Paying attention to the mechanism of DBS at micro, mesoscopic and macro scales is helpful to form a comprehensive analysis of the mechanism of DBS.

Outlook and appeal

The development of DBS technology provides an important opportunity for the deep cross-integration of neuroscience and clinical medicine. In the future, the deep integration and continuous innovation of closed-loop stimulation technology, neuroimage navigation and artificial intelligence will promote DBS treatment to a higher level of personalization and precision.

As a multi-disciplinary frontier technology, the development process of DBS needs the joint efforts of researchers in various fields. The founding of the International Health Sciences Journal has established an important platform for academic exchanges in the field of neuroregulation. We sincerely invite academic colleagues to contribute actively, share research results, and promote the development of the field.