Despite long-term and widespread use of deep brain stimulation (DBS) in a variety of neurological conditions, the underlying mechanisms of action have been elusive. Growing evidence suggests that DBS acts through multimodal mechanisms that are not limited to inhibition and excitation of basal ganglia circuits. DBS also seems to act over variable time spans — for example, the effects on tremor are immediate, whereas the effects on dystonia emerge over several weeks — suggesting that large networks are targeted. Studies reviewing the use of DBS in pain and obsessive–compulsive disorder have demonstrated direct involvement of axonal fibres rather than grey matter. In this Review, we draw on clinical and experimental data to examine the various hypotheses that have been put forward to explain the effects of DBS. In agreement with several other experts, we suggest that the term 'deep brain stimulation' warrants modification. A potentially more accurate term is 'deep brain neuromodulation', as the mode of action spans an array of therapeutic effects over a variable period of time, and is not just limited to 'stimulation' of the basal ganglia brain centres. Terms such as 'electrical neuro-network modulation' may be useful for applications in which deep brain structures are not the primary target.

中文翻译：

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深入了解脑深部刺激的机制

尽管在各种神经系统疾病中长期广泛地使用了深部脑刺激（DBS），但潜在的作用机制却难以捉摸。越来越多的证据表明，DBS通过多峰机制发挥作用，而这种机制不仅限于抑制和激发基底神经节回路。DBS似乎还可以在可变的时间范围内起作用-例如，对震颤的影响是即时的，而对肌张力障碍的影响则是在数周内出现的-这表明已将大型网络作为目标。回顾DBS在疼痛和强迫症中的使用的研究表明，轴索纤维直接参与了治疗，而非灰质。在本综述中，我们将利用临床和实验数据来检验提出的各种假设，以解释DBS的作用。与其他几位专家达成共识，我们建议对术语“深层脑刺激”进行修改。一个潜在的更准确的术语是“深部大脑神经调节”，因为其作用方式跨越了可变时间段内的一系列治疗效果，而不仅限于“刺激”基底神经节脑中枢。诸如“电神经网络调制”之类的术语可能适用于大脑深部结构不是主要目标的应用。