Abstract
Over the course of the development of deep brain stimulation (DBS) into a well-established therapy for Parkinson’s disease, essential tremor, and dystonia, its utility as a potential treatment for autonomic dysfunction has emerged. Dysfunction of autonomic processes is common in neurological diseases. Depending on the specific target in the brain, DBS has been shown to raise or lower blood pressure, normalize the baroreflex, to alter the caliber of bronchioles, and eliminate hyperhidrosis, all through modulation of the sympathetic nervous system. It has also been shown to improve cortical control of the bladder, directly induce or inhibit the micturition reflex, and to improve deglutition and gastric emptying. In this review, we will attempt to summarize the relevant available studies describing these effects of DBS on autonomic function, which vary greatly in character and magnitude with respect to stimulation target.
Highlights
Deep brain stimulation (DBS) has evolved into a well-established therapy for Parkinson’s disease [1], essential tremor [2], and dystonia [2], as well as a therapy for multiple sclerosis [3], cluster headache [4], Tourette syndrome [5], and obsessive-compulsive disorder [6]
In addition to the primary symptoms treated by DBS, many groups have investigated its effect on autonomic functions at various target sites in the brain [12,13]
Using sensory thalamus DBS to control for the effect of pain relief, and globus pallidus interna (GPi) DBS to control for improvement in general motor function, they showed that PAG DBS and subthalamic nucleus (STN) DBS both increase peak expiratory flow rate (PEFR) [45]
Summary
Deep brain stimulation (DBS) has evolved into a well-established therapy for Parkinson’s disease [1], essential tremor [2], and dystonia [2], as well as a therapy for multiple sclerosis [3], cluster headache [4], Tourette syndrome [5], and obsessive-compulsive disorder [6]. In addition to the primary symptoms treated by DBS, many groups have investigated its effect on autonomic functions at various target sites in the brain [12,13]. In Parkinson’s disease and multiple sclerosis, for example, patients are afflicted with varying manifestations of dysautonomia including orthostatic and cardiovascular dysregulation, lower urinary tract dysfunction, sudomotor dysfunction, and gastrointestinal disturbances [15,17,19,20,21]. We will attempt to summarize the research available describing the effects of DBS on autonomic function
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