Annals of Clinical and Experimental NeurologyAnnals of Clinical and Experimental NeurologyАнналы клинической и экспериментальной неврологии2075-54732409-2533Eco-Vector78010.54101/ACEN.2022.2.10TechnologiesТехнологииReview ArticleCurrent understanding of neurostimulation for Parkinson's diseaseСовременные представления о механизмах нейростимуляции при болезни Паркинсонаhttps://orcid.org/0000-0002-6524-4490BrilEkaterina V.БрильЕкатерина Витальевна
Russian Federation

Cand. Sci. (Med.), Associate Professor, Department of neurology, Head, Movement disorders department

к.м.н., доцент, каф. неврологии, руководитель Федерального неврологического центра экстрапирамидных заболеваний и психического здоровья

e.brill@inbox.ruhttps://orcid.org/0000-0002-8179-5807BelovaElena M.БеловаЕлена Михайловна
Russian Federation

Cand. Sci. (Biol.), leading researcher

к.б.н., в.н.с.

e.brill@inbox.ruhttps://orcid.org/0000-0003-3885-2578SedovAleksey S.СедовАлексей Сергеевич
Russian Federation

Cand. Sci. (Biol.), senior researcher

к.б.н., с.н.с.

e.brill@inbox.ruhttps://orcid.org/0000-0002-6412-8148GamaleyaAnna A.ГамалеяАнна Александровна
Russian Federation

neurologist

врач-невролог группы функциональной нейрохирургии

agamaleya@mail.ruhttps://orcid.org/0000-0002-5776-3442PoddubskayaAnna A.ПоддубскаяАнна Андреевна
Russian Federation

neurologist

врач-невролог группы функциональной нейрохирургии

anna.poddubsk@gmail.comhttps://orcid.org/0000-0003-2168-2138FedorovaNatalia V.ФедороваНаталия Владимировна
Russian Federation

D. Sci. (Med.), Professor

д.м.н., профессор каф. неврологии

Natalia.fedorova@list.ruhttps://orcid.org/0000-0002-2120-0146TomskiyАleksey A.ТомскийАлексей Алексеевич
Russian Federation

Cand. Sci. (Med.), senior researcher, Head, Department of functional neurosurgery

к.м.н., с.н.с, рук. группы функциональной нейрохирургии

alexey_tomskiy@mail.ruRussian Medical Academy of Continuing Professional EducationФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования»Burnasyan Federal Medical Biophysical CenterФГБУ «Государственный научный центр Российской Федерации – Федеральный медицинский биофизический центр имени А.И. Бурназяна»Semenov Institute of Chemical Physics of the Russian Academy of SciencesФГБУН «Федеральный исследовательский центр химической физики имени Н.Н. Семенова Российской академии наук»N.N. Burdenko National Medical Research Center of NeurosurgeryФГАУ «Национальный медицинский исследовательский центр нейрохирургии имени академика Н.Н. Бурденко»3006202216289990311202114012022Copyright ©; 2022, Bril E.V., Belova E.M., Sedov A.S., Gamaleya A.A., Poddubskaya A.A., Fedorova N.V., Tomskiy А.A.Copyright ©; 2022, Бриль Е.В., Белова Е.М., Седов А.С., Гамалея А.А., Поддубская А.А., Федорова Н.В., Томский А.А.2022Bril E.V., Belova E.M., Sedov A.S., Gamaleya A.A., Poddubskaya A.A., Fedorova N.V., Tomskiy А.A.Бриль Е.В., Белова Е.М., Седов А.С., Гамалея А.А., Поддубская А.А., Федорова Н.В., Томский А.А.https://creativecommons.org/licenses/by/4.0https://annaly-nevrologii.com/pathID/article/view/780

Specific mechanisms underlying the therapeutic effects of neurostimulation in Parkinson's disease remain a topic of discussion and intense study. Understanding these mechanisms can serve as the foundation for developing and selecting more effective parameters to relieve the symptoms of Parkinson's disease, maximize the advantages, and reduce the adverse effects and need for surgical intervention. The article discusses existing models of motor control in the basal ganglia in healthy individuals and in PD from the point of view of neuromodulation (changes in the impulse flow model, oscillatory model), as well as the current understanding of the mechanisms of action of deep brain stimulation (DBS): the block depolarization hypothesis, neural interference hypothesis, synaptic depression hypothesis, synaptic modulation hypothesis, and the DBS astrocytes hypothesis. Factors such as DBS location and neurostimulation parameters, affecting the clinical outcome, are considered in detail. The neuroprotective effect of DBS is also touched on.

Конкретные механизмы, лежащие в основе терапевтических эффектов нейростимуляции при болезни Паркинсона, остаются предметом дискуссий и интенсивного изучения. Понимание этих механизмов может послужить основой для разработки и подбора более эффективных параметров для облегчения симптомов паркинсонизма, способных максимизировать преимущества и уменьшить побочные эффекты хирургического вмешательства. В статье обсуждаются существующие модели двигательного контроля в базальных ганглиях в норме и при БП с точки зрения эффектов нейромодуляции (модель изменения импульсного потока, осцилляторная модель), также современные представления о возможных механизмах действия нейростимуляции подкорковых структур (deep brain stimulation, DBS): гипотеза деполяризационного блока, гипотеза нейронных помех, гипотеза синаптической депрессии, гипотеза синаптической модуляции, гипотеза DBS-астроцитов. Подробно рассмотрены такие факторы, как локализация DBS и параметры нейростимуляции, влияющие на клинический исход. Затронута тема нейропротективного эффекта DBS.

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