Current understanding of neurostimulation for Parkinson's disease

Specific mechanisms underlying the therapeutic effects of neurostimulation in Parkinson's disease remain a topic of discussion and intense study. Understanding these mechanisms can serve as the foundation for developing and selecting more effective parameters to relieve the symptoms of Parkinson's disease, maximize the advantages, and reduce the adverse effects and need for surgical intervention. The article discusses existing models of motor control in the basal ganglia in healthy individuals and in PD from the point of view of neuromodulation (changes in the impulse flow model, oscillatory model), as well as the current understanding of the mechanisms of action of deep brain stimulation (DBS): the block depolarization hypothesis, neural interference hypothesis, synaptic depression hypothesis, synaptic modulation hypothesis, and the DBS astrocytes hypothesis. Factors such as DBS location and neurostimulation parameters, affecting the clinical outcome, are considered in detail. The neuroprotective effect of DBS is also touched on.