Neuromodulation. Comprehensive Textbook of Principles, Technologies, and Therapies

NEUROMODULATION
List of Contributors
Foreword
Volume 1
Volume 2
Volume 3
Other Neuromodulation Definitions and Terms
References
Further Reading
VIII A -
Spinal Cord Stimulation for Pain Control
INTRODUCTION
References
43 - Physiology and Pathophysiology of Chronic Pain
Physiology and Pathophysiology of Chronic Pain
Physiology and Pathophysiology of Chronic Pain
Physiology and Pathophysiology of Chronic Pain
Pain Pathogenesis
Nociceptors
Peripheral Mechanisms of Chronic Pain
Nerve, Root, and Spinal Mechanisms
Spinal and Subcortical Pain Signaling
Cortical and Subcortical Signaling
Conclusion
References
44 - Management Strategies for Chronic Pain
Introduction
Evaluation of the Patient With Chronic Pain
Management of the Patient With Chronic Pain
Pharmacological Modalities
Acetaminophen/Nonsteroidal Antiinflammatory Drugs
Anticonvulsants/Antidepressants
Opioids
Interventional Pain Medicine
Pain Psychology and Complementary Medicine
Neuromodulation
Medical Considerations for Neuromodulation
Conclusion
References
Further Reading
45 - History of Spinal Cord Stimulation
Surgical Procedures for Pain Control
Historical Uses of Electrical Stimulation
The Gate-Control Theory of Pain
Peripheral Nerve Stimulation
Dorsal Column Stimulation
Early Devices
General Clinical Application
Screening Methods
Device Manufacturers
Scientific Progress
Technical Progress
“Totally Implantable” Systems
Rechargeable Systems
Paresthesia Mapping
Reimbursement
Refinement of Selection Criteria
New Technology
Conclusions
Acknowledgments
References
46 - Functional Magnetic Resonance Imaging in the Neuromodulation of Pain
Introduction
Functional Imaging Modalities
Functional Magnetic Resonance Imaging
Spinal Cord Stimulation
Arterial Spin Labeling
Magnetic Resonance Tractography
Clinical Applications
Chronic Low Back Pain
Trigeminal Neuralgia
Conclusion
References
47 - The Development of Algorithms for Pain Care Including Neuromodulation Therapies: Introducing the SAFE Principles
Introduction
Prior Algorithms to Chronic Pain Treatment
The SAFE Principles
Safety
Appropriateness
Time to Fiscal Neutrality
Efficacy
Summary
Conclusion
References
48 - Neurostimulation for the Treatment of Complex Regional Pain Syndrome
Introduction
Spinal Cord Stimulation
Efficacy in Treating CRPS
Benefits and Risks of Spinal Cord Stimulation
The Role of SCS in the Comprehensive Interdisciplinary Treatment Model of CRPS
Patient Selection and the Screening Trial
Patient Management
Cost Effectiveness
Dorsal Root Ganglion Stimulation
Peripheral Nerve Stimulation
References
49 - Spinal Cord Stimulation for Peripheral Neuropathic Pain
Overview
History and Mechanisms of Action of Spinal Cord Stimulation
Peripheral Neuropathic Pain and Conventional Spinal Cord Stimulation
General Recommendations
Neuroanatomic Location Roots
Failed Back Surgery Syndrome
Postherpetic Neuralgia
Neuroanatomic Location Plexus
Plexopathy (Traumatic)
Neuroanatomical Location: Peripheral Nerve
Painful Diabetic Polyneuropathy
Complex Regional Pain Syndrome
Phantom Limb Pain
Current Research and Future Directions
(Possible) Indicators for Better Outcome
Timing
Allodynia
Other Techniques Beyond Conventional Neuromodulation
Future Directions
References
50 - Spinal Cord Stimulation for the Treatment of Low Back Pain
Introduction
Spinal Cord Stimulation Without Paresthesia
Other Stimulation Targets for Low Back Pain
Comparative Efficacy Studies and the Role of Spinal Cord Stimulation
Neuropathic Low Back Pain
Conclusion
References
51 - Complications of Spinal Cord Stimulation
Introduction
Background
Overview of Complications
Identification and Management of Complications
Patient Selection
Postoperative Complications
Complications Related to Hardware
Lead Migration and Fracture
Pain From Implanted Hardware
Complications Related to Biological Causes
Infection and Hypersensitivity Reactions
Postoperative Noninfectious Fluid Collection
Traumatic Injury
Tolerance
Conclusion
References
52 - Clinical Aspects of Burst Stimulation for Pain Control
Introduction
Introducing Burst Stimulation
A Hypothesis on the Mechanisms of Action
Clinical Outcomes of Burst Stimulation
Pain Reduction and Further Improvement of Pain Reduction
Recapturing Pain
Paresthesia
Patient Preference
Other Outcomes and Adverse Events
Cost Effectiveness of Burst Stimulation
Future Directions
Conclusion
Disclosure
References
Further Reading
53 - Dorsal Root Ganglion Stimulation for Pain Control
Dorsal Root Ganglion Stimulation: The Intervention
The DRG’s Role in Pain
DRG Stimulation
Implantation: Surgical Considerations
Preimplantation Planning
Lead Implantation
Securing the Leads
Trial Period Options
INS Placement
Programming
Follow-up
Outcomes
The European Experience
The Australian Experience
Worldwide Experience
Conclusions
Acknowledgments
Conflict of Interest Statement
References
54 - Ten Kilohertz (10kHz) High-Frequency Spinal Cord Stimulation
Introduction
Clinical Data
Chronic Back and Leg Pain
Upper-Extremity and Neck Pain
Peripheral Neuropathy
Clinical Outcomes of SCS Using Other Higher Frequencies
Safety
Patient Selection: Psychological Evaluation for Implantable Devices
Implantation Technique
Discussion and Conclusions
References
55 - A Review of Spinal Cord Stimulation Cost Studies
Introduction
General Considerations About Spinal Cord Stimulation Cost Studies
Ways to Study Cost
Review of Cost Studies
Cost Studies Based on Technology or Treatment Choices
First SCS Cost Study Compared Pre/PostSCS Healthcare Use
Outpatient Percutaneous Electrodes Versus Inpatient Paddles
Inpatient SCS Cost
Impact of the Treatment Continuum on PostSCS Healthcare Costs
Technological Improvements and Cost of SCS
Modeling Cost Impact of Rechargeable Batteries
Modeling High-Frequency SCS Costs in Patients With FBSS
Impact of Complications
Complications and Costs of Percutaneous Versus Paddle Electrodes
Retrospective Analysis of the Cost of Complications
Studies in Failed Back Surgery Syndrome/Low Back Pain
First Full Report on Cost of SCS
Health Technology Assessment From WHO
SCS Versus “Chronic Maintenance”
Snapshot of Cost and Effectiveness of SCS for FBSS in One Practice
Patients Serving as Their Own Controls Reveal SCS Payback Date
Long-Term Costs in FBSS Patients Who Passed Versus Those Who Failed an SCS Screening Trial
Long-Term Prospective Multisite Cost-Effectiveness Analysis
Use of Models for Analyzing the Cost Effectiveness and Cost Utility of SCS in FBSS Patients
Three-Way Analysis of Long-Term Cost Utility and Cost Effectiveness From a Cross-Over RCT of SCS Versus Reoperation for FBSS
Six-Month Comparison of Healthcare Costs, Health Resources Use, and QOL in FBSS: Predictable Results, Interesting Problems
Cost Study Based on a Criticized Clinical Study
Modeling Costs of Three Treatments for FBSS
Real-World 24-Month Cost-Effectiveness and Cost-Utility Analysis
Modeling Cost Utility of SCS Versus Reoperation for FBSS in Colombia
Studies in Ischemic Pain
Cost–Utility Analysis for SCS Used to Treat Angina
Another Early Indication That SCS is Cost Effective in Angina
Reduction of Hospitalizations in Angina Patients Treated With SCS
Patients Serving as Their Own Controls Reveal the SCS Payback Date
Immediate Cost Savings With SCS Versus Bypass Surgery
Second Cost–Utility Analysis in Angina Patients
Retrospective Cost–Benefit Study in Angina Patients
Cost Effectiveness of SCS Versus Percutaneous Myocardial Laser Revascularization
Comparison of Costs and Outcomes Between SCS and Enhanced External Counterpulsation
Problems With Patient Selection, Techniques, and Equipment Cast Doubt on Cost and Effectiveness Conclusions of an RCT in Patient...
Cost Description in Patients With Renal Failure and Ischemia
Studies in Chronic Regional Pain Syndrome
Studies Relying on a Randomized Comparison of SCS Plus Physical Therapy Versus Physical Therapy Alone
Prospective CRPS Cost Study
Study in Spasticity
Single Study of the Cost of SCS in Spasticity Omits Details
Mixed Indications
Retrospective Cost–Benefit Analysis of Two Neurostimulation Techniques for Several Indications
Study Models SCS Cost Effectiveness in Four Indications
Cost of SCS in Neuropathic Pain and Angina
Impact of SCS Treatment on Healthcare Budgets
Reviews of the SCS Cost Literature: It Is a Fool’s Errand to Review Reviews
First SCS Cost Literature Review
Another Look at CRPS
Review Focusing on FBSS
Health Technology Assessment of SCS for Ischemic or Neuropathic Pain
Reimbursement
National Effort to Link SCS Reimbursement With Continuous Quality Improvement
Differential Effect of Two Types of Reimbursement on SCS Outcomes
How Can the Cost Effectiveness of SCS Be Optimized
Appropriate Patient Selection
Appropriate Techniques
Improving Equipment
Additional Considerations
Position of SCS on Treatment Algorithms
Cost Impact of Conducting a Screening Trial
Conclusions
References
Further Reading
VIII B - Peripheral Nerve Stimulation for Pain Control
INTRODUCTION
References
56 - Anatomy and Physiology Related to Peripheral Nerve Stimulation
Nerve Trunks
Fascicular Anatomy
Blood Supply of Peripheral Nerves
Neural Electrode Interface
Conclusion
References
57 - Peripheral Nerve Stimulation for Pain Suppression
Introduction
Multiple Theories Exist as to the Exact Mechanism/s Through Which PNS Achieves Pain Relief
PNS Has a Long History of Success, But Existing Technology and Early Methods of Implantation Previously Required Precise Neurosu...
Leads Initially Designed for Spinal Cord Stimulation Have Been Used for PNS, But Studies Indicated That Technology Designed Spec...
New Technique Introduced to Overcome Barriers to PNS
Peripheral Field Stimulation
Ultrasound Guidance Improves Outcomes
Recent FDA Clearance of Next-Generation PNS Systems May Enable the Potential of PNS Documented in Research Studies to Be Transla...
StimQ PNS System Has Received FDA Clearance
StimRouterTM Neuromodulation System Has Received FDA Clearance
SPRINT® PNS System Has Received FDA Clearance
Other Investigational PNS Systems Are in Development
Conclusion
Disclosures
References
58 - Peripheral Nerve Stimulation for Facial Pain
Introduction
Mechanism of Action of Peripheral Nerve Stimulation
Patient Selection for Peripheral Nerve Stimulation
Efficacy of Peripheral Nerve Stimulation for Facial Pain
Electrical Stimulation of Infraorbital and Supraorbital Nerves
Trigeminal Branch Stimulation
Electrical Stimulation of Auriculotemporal Nerve
Combination Neuromodulation Therapies
Adverse Events and Serious Adverse Events
Summary
References
59 - Combined Spinal Cord Stimulation and Peripheral Nerve Field Stimulation for the Treatment of Chronic Back and Neck Pain
Introduction
Combined SCS and PNFS for Low Back Pain
Combined SCS and PNFS for Neck Pain
Adverse Events
Programming
Advantages of Combination Therapy
Summary
References
60 - Percutaneous Peripheral Nerve Stimulation for the Management of Postoperative Pain
Existing Treatments for Postoperative Pain
History: Treating Postoperative Pain With Electrical Stimulation
Percutaneous Peripheral Nerve Stimulation for Postoperative Pain
Ultrasound Guidance for Percutaneous Lead Insertion
Open-Coil Lead: Design and Safety Profile
Stimulation Paradigm
Clinical Studies of Percutaneous PNS for Postoperative Pain
Future Directions
Acknowledgments
References
61 - Peripheral Nerve Field Stimulation for Intractable Pain
Introduction
Mechanisms of Action
Equipment
Technique
Indications
Using Two Different Systems at the Same Time
PNfS and TENS
Can PNfS Be Used to Treat Nociceptive Pain
Complications
Results
Conclusions
References
Further Reading
62 - Occipital Nerve Stimulation for Treatment of Intractable Headache Syndromes
Introduction
Medical Treatment of Headache Disorders
Neurosurgical Diagnosis and Management of Occipital Pain
Neurology and Chronic Headaches
Neuromodulation
Occipital Nerve Anatomy
ONS Implant Technique
Intraoperative Stimulation Testing
Electrode Fixation and Tunneling
Implantable Pulse Generator Implantation
Summary of Technique Elements
Results
ONSTIM 2010 Study (Medtronic Inc.)
St. Jude (2012)
PRISM 2009 (Boston Scientific)
Complications
Mechanisms of Action
Disruptive Innovations
Conclusions
References
63 - Neuromodulation for Headaches—Sphenopalatine Ganglion Stimulation
Introduction
Diagnostic Criteria of the Primary Headache Disorders Targeted With SPG Inhibition
SPG Anatomy and Headache Pathophysiology
Brief History of the Role of SPG Modulation in Headache Treatment
Randomized Controlled Trial
Summary of the Safety and Efficacy Data
Acute Efficacy From the RCT
Preventive Efficacy From the RCT
Overall Efficacy Responses From the RCT
Open-Label Efficacy Data
Registry and Safety Data
Proof of Concept of SPG Neuromodulation in Cluster Headache
The Future
Conclusions
References
VIII C -
Intrathecal Therapies for Pain Control and the Control of Spasticity
INTRODUCTION
Reference
64 - Relevant Anatomy for Spinal Drug Delivery
Introduction
Relevant Anatomy
Spinal Cord
Nerve Root
Vertebral Column
Ligaments of the Spine
Blood Supply to the Spinal Cord
Spinal Cord Venous System
The Epidural Space
The Vacuum Effect
Anatomical Issues and Considerations
Innervation of the Spinal Dura
Cerebral Spinal Fluid Dynamics, Flow, Production, Volume, and Overview
Nerve Root Size and Volume
Spinal Tracts
Surgical Techniques Spinal Drug Delivery
Positioning of Patients for Intrathecal Drug Delivery Systems
Fluoroscopic Imaging
Needle Placement
Catheter Placement
Needle Removal
Epidural Placement
Radiological Confirmation of Catheter Placement
Distribution of Agents
Conclusion
References
65 - Evolution of the Spinal Delivery of Opiate Analgesics
Introduction
Neuraxial Drugs: The First 20Years
Delivery System
Drugs
Spinal Anesthesia
Neuraxial Morphine
Neuraxial Opiates: The Last 40Years
Preclinical Studies on the Analgesic Actions of Neuraxial Opiates
Early Clinical Studies on the Analgesic Actions of Neuraxial Opiates
Discovery of the Underlying MOA for Spinal Opiate Actions
Identification of Subtypes of Opioid Receptors: Mu, Delta, Kappa
Development of Catheter-Based Infusion Techniques
Evolution of the Neuraxial Delivery of Targeted Therapeutics
Epidural Versus Intrathecal Delivery
Intrathecal Pharmacokinetics
Other Intrathecal Analgesics
Opioids
Nonopioid Agents
Developing Concerns Over Spinal Drug Safety
Side-Effects of IT Administration of Opiates
Effects on Physiological Functions
Hyperalgesia
Clonus
Tolerance
Granuloma
Concluding Commentary
References
66 - Pharmacology of Intrathecal Therapy
Introduction
Indications
Pharmacokinetics and Pharmacodynamics
Opioids
Local Anesthetics
Ziconotide
Clonidine
CSF and Catheter Placement
Agent Selection
Morphine
Ziconotide
Fentanyl
Hydromorphone
Bupivacaine
Clonidine
Future Therapy
Summary
References
Further Reading
67 - Cerebrospinal Fluid Dynamics and Intrathecal Delivery
Introduction
Understanding Dynamic CSF Flow
Introduction to Pulsatile CSF Dynamics and CSF–Parenchyma–Vasculature Coupling
Respiratory Influence on CSF Flow
Geometry-Induced Flow Phenomena (Nerve Roots and Trabeculae)
Cilia-Induced CSF Flow in the Cerebral Ventricles
Acquisition of CNS Anatomy
CSF Flow Measurements
PC MRI
Four-Dimensional MRI
Current Developments
CSF Production and Reabsorption
Classical Hypothesis
The New Hypothesis of CSF Production and Reabsorption in the Brain
Osmotic Gradient-Driven Flow
The Role of Perivascular Spaces on Tracer Transport
Intrathecal Drug Transport and Delivery
Intrathecal Administration Therapy
Cerebrospinal Fluid Pulsation
Infusion Type: Bolus Versus Drug Pump
Impact of Drug Chemistry on Pharmacokinetics
In Vitro and Mathematical Models for Predicting IT Drug Dispersion
In Vitro Models of the CNS
In Silico Models of IT Delivery
Nanoparticles for Magnetically Guided Therapies
Modeling Limitations of the Perivascular Space
Design of Optimal Therapies for Intrathecal Administration
Future Directions and Open Questions
Open Issues
References
68 - Exploring Nonopioid Analgesic Agents for Intrathecal Use
Introduction
Adenosine
Mechanism of Action
Clinical Evidence
Closing Remarks
Resiniferatoxin
Mechanism of Action
Clinical Evidence
Closing Remarks
Oxytocin
Mechanism of Action
Clinical Evidence
Closing Remarks
Midazolam
Mechanism of Action
Clinical Evidence
Closing Remarks
Gabapentin
Mechanism of Action
Clinical Evidence
Closing Remarks
Neostigmine
Mechanism of Action
Clinical Evidence
Closing Remarks
Conclusion
References
Further Reading
69 - Potent Neurotoxins for Cancer Pain Treatment: Resiniferatoxin and Saporin
Introduction
Resiniferatoxin
History
Mechanism of Action
Preclinical Data
Resiniferatoxin and Cancer Pain
Future Directions for Resiniferatoxin
Saporin
History
Pathophysiology
Safety and Efficacy of Saporin
Substance-P–Saporin and Cancer Pain
The Future for Substance-P–Saporin
Conclusion
References
70 - The Development of Guidelines for Intrathecal Therapies for Pain Control. History and Present Guidelines
Introduction
PACC 2000
PACC 2003
PACC 2007
PACC 2012
PACC 2016
Conclusion
References
71 - Compounding for Intrathecal Analgesic Agents
Introduction
What Is Compounding
Standards for Compounding
Regulatory Considerations
Regulatory Issues—State
Regulatory Issues—Federal
Avoidable Errors and Their Tragic Consequences
Standards
Facility Standards
Equipment Standards
Cleaning and Disinfection of the Sterile Compounding Facility
Personnel Training and Testing
Gowning
Fingertip Assessments
Environmental Monitoring
Surface Sampling
The Compounding Process
Filtration
Endotoxins
Stability Considerations
Provider Liability
Conclusion
References
72 - Intrathecal Baclofen Therapy for the Control of Spasticity
Introduction
Patient Selection
Patient Selection for IBT
IBT Trialing
Therapy Initiation
Therapy Maintenance
Summary
References
VIII D - INTRACRANIAL PROCEDURES FOR CHRONIC PAIN
INTRODUCTION
73 - Deep Brain Stimulation for Pain
Relevant History of the Topic Including Developments Over the Past Decade
Review of the Current Knowledge Base of the Topic
Summary of the Safety and Efficacy Data
Discussion of Future Trends and Pathways to Expanding the Knowledge Base
Dual Target Stimulation
Understanding the Insertional Effect
Modulation of the Affective Component of Pain
References
IX -
NEUROMODULATION FOR MOVEMENT DISORDERS
INTRODUCTION
74 - Deep Brain Stimulation in Parkinson’s Disease
Introduction
Deep Brain Stimulation in Parkinson’s Disease
Selection Criteria for DBS in PD
Target Selection and Surgical Technique
Treatment Planning: Indirect and Direct Targeting
Surgical Procedure: Awake and Asleep DBS
Postoperative Complications
Deep Brain Stimulation Programming in Parkinson’s Disease
Side-Effects of Deep Brain Stimulation
Conclusion
References
75 - Deep Brain Stimulation for Tremor
Historical Perspective
Pertinent Anatomy, Physiology, and Disease Pathophysiology
Rationale for Neuromodulation, Target Selection, and Approach
Indications and Patient Selection Criteria
Implant Procedure Details
Programming and Other Points of Consideration
Most Recent Literature
Complications and Avoidance
What the Future Holds (Next 5Years)
Conclusions
References
76 - Deep Brain Stimulation for Dystonia
Introduction
Diagnosis and Classification of Dystonia
Medical Therapy for Dystonia
Surgical Therapy for Dystonia
The DBS Procedure
Patient Selection
Surgical Procedure
Stereotactic Technique
Anatomical Targeting
Microelectrode Recording
DBS Surgery in Children
Macroelectrode Stimulation
Implantation of the Pulse Generator
Programming the Device
Clinical Results
Indicators of DBS Response
Stimulation Frequency
Longevity of Response
Pallidal DBS in Cervical Dystonia
Pallidal DBS for Primary Cranial–Cervical Dystonia (Meige Syndrome)
Pallidal DBS for Secondary Dystonia
Complications of DBS Therapy
Alternative Targets for Deep Brain Stimulation in Dystonia
Conclusions
Acknowledgment
References
77 - Deep Brain Stimulation in Tourette Syndrome
Introduction
Diagnosis and Prevalence
Treatment of Tourette Syndrome
Surgical Treatment of Tourette Syndrome
Historical Perspective
Deep Brain Stimulation
Selection Criteria and Surgical Evaluation
Inclusion Criteria
Exclusion Criteria
Surgical Procedure and Perioperative Management
Stimulation Parameters
Present and Future Perspectives
References
78 - Surgical Management of Hemifacial Spasm and Meige Syndrome
Hemifacial Spasm
Introduction
Etiology and Pathophysiology
Clinical Manifestations
Diagnosis
Clinical Diagnosis
Neuroradiologic Evaluations
Additional Methods
Management
Medical Treatment
Microvascular Decompression
Operative Technique
Patient Positioning
Scalp Incision to Craniectomy
Dural Incision and Exposure
Decompression of the Offending Vessel
Closure
Intraoperative Monitoring
Surgical Outcome
Complications
Conclusions
Meige Syndrome
Introduction
Clinical Manifestations and Pathophysiology
Management
Operative Techniques of Globus Pallidus Interna Deep Brain Stimulation
Outcome and Complications
Conclusions
References
79 - Deep Brain Stimulation of the Pedunculopontine Tegmental Nucleus Improves Static Balance in Parkinson’s Disease
Introduction
Methods and Materials
Patients
Stabilometry and Postural Instability
Statistics
Results
Discussion
Highlights
Acknowledgments
References
80 - Infusion Therapy for Movement Disorders
Review of the Current Knowledge Base of the Topic
GDNF and NTN
Preclinical Studies of GDNF and NTN Delivery for PD
Intraventricular Administration of GDNF and NTN in Rodents
Intraventricular Administration of GDNF and NTN in Nonhuman Primates
Clinical Trials of Intraventricular Infusion of GDNF for PD
Localized Intraparenchymal Delivery of GDNF in Rodents
Intraputamenal Delivery of GDNF and NTN in Nonhuman Primate Studies
Chronic Intraputamenal Infusion of GDNF and Related Toxicity
Clinical Trials of Intraputamenal Delivery of GDNF
A Multicenter Randomized Controlled Trial of Intraputamenal GDNF Infusion for PD
Clinical Trials of Intraputamenal AAV-NTN Gene Therapy
Convection-Enhanced Delivery of GDNF to the Brain
The Rationale for Chronic Intermittent CED
Alternative Neurotrophins—The CDNF/MANF Family
Reference
Further Reading
X -
Neurostimulation for Epilepsy
INTRODUCTION
References
81 - Epilepsy: Anatomy, Physiology, Pathophysiology, and Disorders
Introduction
Diagnosis of Epilepsy
Pathophysiology
Pathophysiology of Temporal Lobe Epilepsy
Prognosis—Drug-Resistant Epilepsy
Neurostimulation for the Control of Seizures in Humans
References
Further Reading
82 - Vagal Nerve Simulation
NCP Device Components
Theoretical Basis of VNS
Clinical Utility of VNS
Efficacy
Use in Children
Cost Analysis
Advantages of VNS
Patient Satisfaction
Patient Selection
Alternative Uses of VNS
Operative Procedure
General Considerations
Relevant Anatomy
Operative Procedure in Detail
Lead Removal or Revision
Complications and Adverse Events
References
Further Reading
83 - Deep Brain Stimulation for Epilepsy
Introduction
Limbic Network as Conduit of Seizure Propagation
Deep Brain Stimulation of the Anterior Nucleus of the Thalamus
Rationale
Trials Before SANTE
The SANTE Trial
The Problem of Anatomical Localization
Deep Brain Stimulation of the Hippocampus
Rationale
Clinical Evidence
Problem of Memory Impairment
Future Directions
Deep Brain Stimulation Side-Effects and Complications
Conclusions
References
Further Reading
84 - Closed-Loop Responsive Stimulation for Epilepsy
Introduction
The Burden of Epilepsy
A History of Stimulation
Closed Loop Neurostimulation
The Pivotal Trial
Long-Term Results
Mechanisms of Action
The Responsive Neurostimulator System
Responsive Neurostimulator System Candidates
Device Description
Surgical Technique
System Features
Future Directions
Conclusion
References
Further Reading
XI -
NEUROMODULATION FOR BEHAVIORAL AND COGNITIVE DISORDERS
INTRODUCTION
85 - Deep Brain Stimulation for Obsessive–Compulsive Disorder
Introduction
Pathophysiology of Obsessive–Compulsive Disorder
Deep Brain Stimulation for Obsessive–Compulsive Disorder
Anterior Limb of Internal Capsule
Ventral Capsule and Ventral Striatum
Nucleus Accumbens
Subthalamic Nucleus
Inferior Thalamic Peduncle
Other Targets
Patient Selection, Team Approach, and Ethical Considerations
Surgical Techniques of Deep Brain Stimulation Implantation
Conclusion
References
86 - High-Intensity Focused Ultrasound Surgery for the Treatment of Obsessive–Compulsive Disorder
Introduction
Neural Circuitry of Obsessive–Compulsive Disorder
History of High-Intensity Focused Ultrasound
Principles of Transcranial Magnetic-Resonance-Guided Focused Ultrasound Surgery
High-Intensity Focused Ultrasound
Magnetic-Resonance-Guided Focused Ultrasound Surgery
Bilateral Thermal Capsulotomy With MRgFUS as a Treatment for Obsessive–Compulsive Disorder
Patient Selection
Surgical Procedures
Follow-Up Examination and Clinical Evaluations
Clinical Results of the Bilateral Thermal Capsulotomy Using MRgFUS
Clinical Outcomes
Adverse Events
Controversial Issues
Skull-Related Factors: Skull Density Ratio and Skull Volume
MR-Induced Vertigo
Limitation of the Treatment Area According to the Transducer Frequency
Conclusions
References
87 - Deep Brain Stimulation for Highly Refractory Depression
Introduction
Treatment of Depression
Pharmacotherapies
Treatment of Refractory Patients
Brain Stimulation Techniques
Development of DBS in Neuropsychiatry
History
Affect and Mood Effects Observed During Depth Electrode Stimulation
DBS for Obsessive–Compulsive Disorder
Technical Aspects of DBS
Implantation
Stimulation Technique
Customizing Therapy
DBS for Primarily Depressive Illness
Stimulation Targets for Depression
Subgenual Cingulate Cortex
Ventral Capsule/Ventral Striatum
Nucleus Accumbens
Superolateral Branch of the Medial Forebrain Bundle
Lateral Habenula
Inferior Thalamic Peduncle
Issues Independent of DBS Target
Do Early Effects of Stimulation Have Prognostic Value
Mechanism(s) of Action of DBS
Adverse Effects
Ethical Considerations
Perspective
Long-Term Follow-Up
Research Protocols for Investigational Treatment With DBS
Summary
Future Directions
References
Further Reading
88 - Neuromodulation in Anorexia Nervosa
Introduction
Clinical Aspects
Neurobiology and Neuroimaging
Clinical Treatment and Refractory Anorexia Nervosa Nervosa
Neuromodulation
Deep Brain Stimulation
Ethical Aspects
Conclusions
References
89 - Deep Brain Stimulation for Alcoholism
Introduction and Background
Scientific Rationale for the Use of DBS for Alcoholism
Animal Studies
Human Studies
Mechanisms of Action
References
90 - Surgical Treatment for Refractory Drug Addiction
Overview
The Development of Stereotactic Surgery for Drug Addiction
The Pathophysiology of Drug Addiction
Neurosurgical Procedures
Mechanisms
Future Expectations
Conclusions
References
91 - Subgenual Cingulate Deep Brain Stimulation for Treatment-Resistant Depression
Introduction
Overview of MDD
Diagnosis of MDD
Antidepressants and Psychotherapy
Treatment-Resistant Depression
Surgical Interventions for MDD: Background
Ablative Surgery
Deep Brain Stimulation
DBS of the Subgenual Cingulate Cortex
Rationale
A Network Model of MDD
The SCC as a Critical Region in the Regulation of Mood
Feasibility Study of SCC DBS
Efficacy and Safety of SCC DBS
Safety of SCC DBS
Issues in Optimizing Patient Outcomes in SCC DBS
Patient Selection for SCC DBS
Targeting the SCC
Basics of Diffusion-Weighted Imaging
Development of DWI-Based Targeting Methods for SCC DBS
Implementation
Mechanisms of Action
Summary and Future Directions
References
92 - Cortical Stimulation for Depression
Introduction
Electroconvulsive Therapy
Transcranial Magnetic Stimulation
Transcranial Direct Current Stimulation
Transcranial Direct Current Stimulation as an Instrument to Modulate Cortical Excitability
Safety of Transcranial Direct Current Stimulation
Transcranial Direct Current Stimulation Versus Antidepressant Medications
Future Directions
Conclusion
References