REVIEW

Advances in Deep Brain Stimulation: analyzing the metabolic and hemodynamic effects on neural pathways and remote regions. A comprehensive narrative review

Avanços na Estimulação Cerebral Profunda: analisando os efeitos metabólicos e hemodinâmicos nas vias neurais e regiões remotas. Uma revisão narrativa abrangente

  • Rafael Antonio Peres Borba (1)
  • Edvaldo Soares (2)    Edvaldo Soares (2)
  Views: 357
  Downloads: 7

Resumo

Introdução: A estimulação cerebral profunda (DBS) é uma técnica de neuromodulação que utiliza eletrodos implantados para regular redes neurais. Apesar de suas aplicações terapêuticas em distúrbios neurológicos e psiquiátricos, seu impacto na hemodinâmica e no metabolismo ainda é pouco compreendido. Neuroimagens, como PET e SPECT, ilustram esses efeitos, mas os estudos variam em demografia de pacientes, métodos de análise e tamanhos de amostra. Objetivo: Este estudo tem como objetivo realizar uma revisão narrativa da pesquisa sobre os efeitos metabólicos e hemodinâmicos da DBS. Métodos: Realizamos uma pesquisa no PubMed para estudos clínicos que vinculam DBS, fluxo sanguíneo cerebral e metabolismo cerebral. Nossa revisão incluiu 29 artigos, extraindo dados sobre condições dos pacientes, alvos da DBS, parâmetros, detalhes de imagem e resultados da estimulação. Resultados: A DBS afeta principalmente os locais estimulados, aumentando a captação de ligantes e se estendendo a regiões cerebrais vizinhas. Os efeitos locais variam de acordo com o núcleo estimulado, mas a maioria dos estudos mostra efeitos remotos, sugerindo que as mudanças induzidas pela estimulação se propagam por sistemas neurais conectados. As alterações específicas dependem da região cerebral estimulada e da tarefa, seja em repouso ou durante o movimento. Locais de estimulação semelhantes tendem a produzir resultados comparáveis em

Palavras-chave

Estimulação cerebral profunda; Fluxo sanguíneo cerebral; Metabolismo cerebral

Abstract

Introduction: Deep brain stimulation (DBS) is a neuromodulation technique using implanted electrodes to regulate neural networks. Despite its therapeutic applications in neurological and psychiatric disorders, its impact on hemodynamics and metabolism remains poorly understood. Neuroimaging like PET and SPECT illustrate these effects, but studies vary in patient demographics, analysis methods, and sample sizes. Objective: This study aims to conduct a narrative review of the research on metabolic and hemodynamic effects of DBS. Methods: We conducted a PubMed research for clinical studies linking DBS, cerebral blood flow, and brain metabolism. Our review included 29 articles, extracting data on patient conditions, DBS targets, parameters, imaging details, and stimulation outcomes. Results: DBS primarily affects stimulated sites, increasing ligand uptake and extending to neighboring brain regions. Local effects vary by the stimulated nucleus, but most studies show remote effects, suggesting that stimulation-induced changes propagate through connected neural systems. The specific alterations depend on the stimulated brain region and the task, whether at rest or during movement. Similar stimulation sites tend to yield comparable outcomes across diseases. Conclusion: Our review highlights DBS therapeutic effects on hemodynamics and metabolism at stimulation sites and in connected neural systems. Nonetheless, more research with consistent data collection is needed to fully understand DBS effects across diseases and neural networks.

Keywords

Deep brain stimulation; Cerebral blood flow; Brain metabolism

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1MS, Medical student, Faculdade de Medicina de Marília, Marília, SP, Brazil.

2PhD, Professor Doutor, Universidade Estadual Paulista, Marília, SP, Brazil.

 

Received Dec 13, 2023

Accepted Jan 16, 2024

JBNC  Brazilian Journal of Neurosurgery

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