2013 Probing and Regulating Dysfunctional Circuits Using Deep Brain Stimulation文章.pdfVIP

Neuron Review Probing and Regulating Dysfunctional Circuits Using Deep Brain Stimulation Andres M. Lozano1,* and Nir Lipsman1 1Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, Krembil Neuroscience Center, University of Toronto, Toronto, ON M5T 2S8, Canada *Correspondence: lozano@uhnresearch.ca /10.1016/j.neuron.2013.01.020 Despite the best available medical treatments, many patients continue to be disabled by neurologic and psychiatric disorders, resulting in a large unmet need. Advances in imaging and neurophysiology over the last two decades have led to a reinterpretation of some neurologic and psychiatric conditions as primarily disorders of circuit function, or ‘‘circuitopathies.’’ These developments have been accompanied by advances in neurosurgical techniques with the increasingly widespread utilization of deep brain stimulation (DBS) to recalibrate dysfunctional circuits. The versatility of DBS as both a probe and modulator of neural circuits is making it a powerful tool to study the human brain, helping provide important details of the pathophysi- ology of circuit dysfunction. We are currently in a phase of active investigation to determine which circuits and disorders could be treated with DBS. Here we review recent advances in the DBS field and discuss potential future directions in targeted intracranial neuromodulation. Introduction deep brain stimulation (DBS) offers a portal into the workings and The burden of neurological and psychiatric illness in society is dynamics of brain circuits in relation to behavior and cognition. substantial and will increase at a rapid rate in the next few For certain patients who have failed conventional therapies, decades (WHO, 2004). While our understanding of the