The Active Electrode in the Living Brain: The Response of the Brain Parenchyma to Chronically Implanted Deep Brain Stimulation Electrodes

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dc.contributor.authorEvers, Judith-
dc.contributor.authorLowery, Madeleine M.- by the Congress of Neurological Surgeonsen_US
dc.identifier.citationOperative Neurosurgeryen_US
dc.description.abstractBACKGROUND: Deep brain stimulation is an established symptomatic surgical therapy for Parkinson disease, essential tremor, and a number of other movement and neuropsychiatric disorders. The well-established foreign body response around implanted electrodes is marked by gliosis, neuroinflammation, and neurodegeneration. However, how this response changes with the application of chronic stimulation is less well-understood. OBJECTIVE: To integrate the most recent evidence from basic science, patient, and postmortem studies on the effect of such an "active"electrode on the parenchyma of the living brain. METHODS: A thorough and in-part systematic literature review identified 49 papers. RESULTS: Increased electrode-tissue impedance is consistently observed in the weeks following electrode implantation, stabilizing at approximately 3 to 6 mo. Lower impedance values are observed around stimulated implanted electrodes when compared with unstimulated electrodes. A temporary reduction in impedance has also been observed in response to stimulation in nonhuman primates. Postmortem studies from patients confirm the presence of a fibrous sheath, astrocytosis, neuronal loss, and neuroinflammation in the immediate vicinity of the electrode. When comparing stimulated and unstimulated electrodes directly, there is some evidence across animal and patient studies of altered neurodegeneration and neuroinflammation around stimulated electrodes. CONCLUSION: Establishing how stimulation influences the electrical and histological properties of the surrounding tissue is critical in understanding how these factors contribute to DBS efficacy, and in controlling symptoms and side effects. Understanding these complex issues will aid in the development of future neuromodulation systems that are optimized for the tissue environment and required stimulation protocols.en_US
dc.publisherOxford University Pressen_US
dc.rightsThis is a pre-copyedited, author-produced PDF of an article accepted for publication in Operative Neurosurgery following peer review. The definitive publisher-authenticated version Judith Evers, PhD, Madeleine Lowery, BE PhD, The Active Electrode in the Living Brain: The Response of the Brain Parenchyma to Chronically Implanted Deep Brain Stimulation Electrodes, Operative Neurosurgery, Volume 20, Issue 2, February 2021, Pages 131–140, is available online at:
dc.subjectDeep brain stimulationen_US
dc.subjectGlial scaren_US
dc.subjectElectrode-tissue interfaceen_US
dc.subjectHigh-frequency stimulationen_US
dc.subjectLong-term measurementen_US
dc.subjectSubthalamic nucleusen_US
dc.subjectParkinson's Diseaseen_US
dc.subjectConstant currenten_US
dc.subjectTissue responseen_US
dc.subjectCharge densityen_US
dc.titleThe Active Electrode in the Living Brain: The Response of the Brain Parenchyma to Chronically Implanted Deep Brain Stimulation Electrodesen_US
dc.title.alternativeActive Electrode in the living brainen_US
dc.statusPeer revieweden_US
dc.neeo.contributorLowery|Madeleine M.|aut|-
item.fulltextWith Fulltext-
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