Mind over matter: an analysis of the mechanism of deep brain stimulation in the treatment of Parkinson’s Disease

Abstract

Relevance: In a population of increasing longevity, neurological disorders are becoming more prevalent - placing a large strain on NHS resources and funding, as well as an emotional burden on those affected and their families. One such example is Parkinson’s Disease (PD). This neurodegenerative disorder of the basal ganglia is characterised by a progressive loss of nigrostriatal dopaminergic transmission, commonly presenting as tremor, bradykinesia, rigidity, postural instability, akinesia, and impairments in cognition. Deep brain stimulation (DBS) has proven a successful approach to treating PD despite its mechanism of action being unclear. Summary: Three main problems of counteractive outcomes present when identifying a common mechanism of DBS within targets. Firstly, contrasting actions of DBS are required to explain DBS between targets, such as the GPe and GPi. Secondly, conflicting studies have reported both excitatory and inhibitory action of DBS within the same targets. Finally, the treatment has also paradoxically proven effective in treating hyperkinetic disorders, such as Dystonia. There remains no conclusive model for the treatment’s mechanism. Take Home Messages: To deliver effective treatment and care, it is important for doctors to understand the mechanism of action of procedures they are performing. Hence further investigation into PD aetiology and DBS action is required.