Akademik Veri Yönetim Sistemi
The Neuroscience of Deep Brain Stimulation: Research and Clinical Applications, Elsevier, ss.345-373, 2026
Cerebellar deep brain stimulation (cDBS) has emerged as a novel and promising neuromodulatory intervention targeting the cerebellum and its afferent and efferent pathways for the treatment of movement disorders and motor recovery. While deep brain stimulation has been routinely applied to supratentorial and brainstem targets such as the subthalamic nucleus, globus pallidus internus, and ventral intermediate nucleus for Parkinson's disease, dystonia, and essential tremor, these approaches remain inadequate for refractory conditions like secondary dystonia, spasticity, ataxia, and complex tremors. Recent advances in neuroanatomical understanding and preclinical research have reignited interest in cerebellar circuits, particularly the dentate nucleus superior cerebellar peduncle as viable targets for neuromodulation. This chapter comprehensively reviews the historical evolution, anatomical and physiological basis, preclinical mechanisms, and clinical applications of cDBS. Preclinical and early human studies suggest that cDBS may modulate pathological oscillations and improve motor coordination, spasticity, dystonia, tremor, and ataxia through both synaptic and network-level plasticity. The therapeutic potential of cDBS in poststroke motor recovery and cerebral palsy has been demonstrated, with frequency-specific and target-specific effects. Surgical techniques, targeting strategies, and stimulation parameters are discussed in detail, along with the challenges posed by cerebellar anatomy and the need for individualized programming. In addition, the possible role of cDBS in epilepsy and closed-loop systems is explored. While clinical experience with cDBS remains limited, accumulating evidence from both animal models and pilot human studies supports its safety and efficacy in selected cases. Continued translational research and refinement of targeting, programming, and patient selection will be essential to establish cDBS as a standardized therapeutic modality.