Deep brain stimulation for respiratory airway relaxation in asthma

Upper (e.g. bronchial) airways become constricted in people with asthma or chronic obstructive pulmonary disease. The bronchial smooth muscle contraction is mediated by the parasympathetic nervous system, while the relaxation is mediated by the sympathetic nervous system. The periaqueductal gray matter of the midbrain (PAG) and subthalamic nucleus (STN) are involved in maintaining the bronchial relaxation. The electrical stimulation of the PAG is approved for chronic pain and electrical stimulation of the STN – for movement disorders (Parkinson disease and dystonia). A new study by a group of neurosurgeons from Oxford, United Kingdom evaluated the effects of the PAG and STN stimulation with DBS electrodes on the bronchial airway function. They found that activation of both brain structures in awake human subjects produced similar increases in the airway flow of 10-12%, with some patients exhibiting even larger increases (up to 30%). While similar effects were seen in both PAG and STN, the used stimulation frequencies were quite different: 7-40 Hz in PAG and 130-180 Hz in STN. It is important to mention that PAG is considered to be a major integration center for multiple autonomic functions, such as cardiovascular responses, thermoregulation, respiration, bladder and bowel voiding, arousal, and rapid-eye-movement (REM) sleep. This study raises an important question whether asthma is a neurological disorder that can be treated by neuromodulation?

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