Neuromodulation. Comprehensive Textbook of Principles, Technologies, and Therapies

NEUROMODULATION
Copyright
Dedication
List of Contributors
Foreword
Volume 1
Volume 2
Volume 3
Other Neuromodulation Definitions and Terms
References
Further Reading
I -
DEFINING NEUROMODULATION
INTRODUCTION
1 - Perspectives on the History of Neuromodulation-Relevant Societies
Introduction
Perspectives on the History of the Neuromodulations Societies: Societies for Stereotactic and Functional Neurosurgery
A Perspective on the History of the Neuromodulation Societies; The Early History of the International Neuromodulation Society
Formation of International Chapters
A Perspective on the History of the International Neuromodulation Society
Birth of a Chapter: History of the North American Neuromodulation Society
References
2 - Psychological Issues and Evaluation for Patients Undergoing Implantable Technology
Introduction
Selective Literature Review
Historical and Recommended Approach to the Psychological Evaluation
Assessment
Individual Patient (Microsystem)
Ancillary Relationships (Mesosystems)
Contextual Effects (Exosystems)
Cultural Effects (Macrosystems)
Life Experiences (Chronosystems)
Assessment Recommendations
Summary
References
Further Reading
3 - Anatomy of the Nervous System
Gross Structures
Brain
Spinal Cord
Autonomic Nervous System
Sensory System
Pyramidal Motor System
References
4 - Clinical Study Designs for Neuromodulation
Introduction
Study Design: General
Study Population
Study Endpoints
Statistical Considerations
Blinding
Grading Evidence
Cui Bono
Conclusions
References
Further Reading
II - INTRODUCTION TO THE BRAIN INITIATIVE
5 - The Brain Initiative—Implications for a Revolutionary Change in Clinical Medicine via Neuromodulation Technology
Introduction – The BRAIN Initiative
History
Initial Government Contributors
Initial Private Sector Partners
NIH Planning Efforts
BRAIN Initiative Programs for Neuromodulation Therapies
NIH BRAIN Programs for Neuromodulation Therapies
NIH Programs to Support Noninvasive Neuromodulation Strategies
BRAIN Initiative: Noninvasive Neuromodulation—Mechanisms and Dose–Response Relationships for Targeted Central Nervous System Eff...
Brain Initiative: Noninvasive Neuromodulation—New Tools and Techniques for Spatiotemporal Precision
Invasive Neuromodulation Strategies
Next-Generation Invasive Devices for Recording and Modulation in the Human CNS
The BRAIN Initiative Public–Private Partnership Program
Big Data and Ethics of Neuromodulation
BRAIN Initiative: Data Archives for the BRAIN Initiative
BRAIN Initiative: Integration and Analysis of BRAIN Initiative Data
Research on the Ethical Implications of Advancements in Neurotechnology and Brain Science
DARPA Programs for Neuroscience and Neurotechnology
Revolutionizing Prosthetics Program Phase 3
Reliable Neural-Interface Technology
Restoring Active Memory
Systems-Based Neurotechnology for Emerging Therapies
Neuro Function, Activity, Structure, and Technology
Neural Engineering System Design
Targeted Neuroplasticity Training
Reorganization and Plasticity to Accelerate Injury Recovery
Restorative Encoding Memory Integration Neural Device
FDA Support of BRAIN Neuromodulation Therapy Programs
National Science Foundation Neuromodulation Initiatives
Beyond “The BRAIN”: Related Programs
DARPA Programs
Hand Proprioception and Touch Interfaces
Electrical Prescriptions
NIH Programs
Stimulating Peripheral Activity to Relieve Conditions
Conclusion
References
Further Reading
III -
FUNDAMENTALS AND MECHANISMS OF NEUROMODULATION
INTRODUCTION
6 - Fundamentals of Electrical Stimulation
Overview
Some Basic Concepts
Resting Potential Across the Axon Membrane
Voltage-Gated Ion Channels
Action Potentials
Electrically Generating Action Potentials
Choosing the Duration of the Stimulus
Electrochemistry of Stimulating Electrodes
Electrode Behavior Under Pulsed Conditions
Monophasic Pulses
Biphasic Pulses, Balanced Charge, and Imbalanced Charge
How Stimulus Waveform Choices Affect Tissues
Current–Voltage Stimulation
References
7 - The Safe Delivery of Electrical Currents and Neuromodulation
Introduction
Mechanisms of Stimulation-Induced Tissue Damage
Electrode Reactions and Excitotoxicity
Electrode Reactions
Excitotoxicity and “Mass Action” Damage to Neurons
Charge/Phase and Charge Density Dependence of Tissue Damage
Role of the Electrode Material
Off-Target Stimulation Side Effects
Charge Balance and Stimulation Waveforms
Other Electrode Considerations
Nonuniform Current Distributions
Future Trends in Stimulation Waveforms – Inhibitory Electrical Stimulation
High-Frequency Stimulation for Blocking
DC Conduction Block
Regulatory Considerations
Additional Practical Considerations
References
8 - Waveforms for Neural Stimulation
Introduction
Performance Requirements for Stimulation Waveforms
Nondamaging
Selectivity
Efficiency
Excitation Properties With Conventional Rectangular Pulses
Threshold
Strength–Duration Relationship
Charge–Duration Relationship
Power–Duration Relationship
Energy–Duration Relationship
Stimulation Pulse Polarity
Monophasic Stimuli: Cathodic Versus Anodic Pulses
Monophasic Versus Biphasic Stimuli
Alternative Waveform Shapes to Enhance Performance
Effect of Waveform on Energy Required for Stimulation
Waveforms to Enhance Stimulation Selectivity
Unbalanced Waveforms to Reduce Risk of Corrosion
Acknowledgments
References
9 - Neuromodulation and Neuronal Plasticity
Introduction
Topographic Organization of the Central Nervous System: Historical Overview
Neuronal Plasticity in Disease States
Chronic Pain
Movement Disorders
Neurostimulation and Neuronal Plasticity
Conclusion
References
10 - Fundamentals of Kilohertz Frequency Alternating Current Nerve Conduction Block of the Peripheral Nervous System
Introduction
History
Characteristics of KHFAC Block
Electrical Parameters for KHFAC Block
Rapidity of Block
Reversibility
Partial Block
Electrode Designs for KHFAC Block
Mechanisms
Caveats for KHFAC Waveforms
Clinical Applications and Future Trends
References
11 - MRI and fMRI for Neuromodulation
Introduction
Why Do Patients With Implantable Neuromodulation Devices Need MRI
MRI as a Diagnostic Tool in Functional Neurosurgery
Leveraging of MRI-Based Diagnostics for Advancing Neuromodulation: The Role of Functional Neuroimaging
MRI-Based Therapeutics: Focused Ultrasound Ablation for Neurological Disorders
Conclusion
References
Further Reading
12 - Patient-Specific Modeling of Deep Brain Stimulation
Deep Brain Stimulation
Patient-Specific DBS Models
Modeling Neural Stimulation
Quantifying the Neural Response to DBS
Clinical Application of DBS Models
Conclusions
Acknowledgments
Conflict of Interest Statement
References
13 - Big Data and Deep Brain Stimulation
Neurodegenerative Diseases Are Common Diseases With Significant Public Health Burden
Neurological Data Are Complex
Patient-Centric and Personal Health Information
Integration With Clinical Workflow
Assuring Data Quality and Completeness
Integration of Spatial and Temporal Data
Ready for Sensing and Clinical Surveillance Data
Respecting the Privacy and Ethical Implications of Neuroscience Research
Security From the Ground Up
Fostering Data Sharing
Data Normalization
Custom Patient-Based Medicine
Conclusion
Acknowledgments
Disclosure
References
Further Reading
14 - Fundamentals of Burst Stimulation of the Spinal Cord and Brain
Historical Context of Burst Stimulation
What Is so Special About Burst Firing in the Brain
Burst Stimulation of Auditory Cortex for Tinnitus
Burst Stimulation for Pain
Working MOA of Burst Stimulation
What Stimulation Parameters Are Important for Pain Suppression
Burst Frequency
Spike Frequency
Pulse Width
Number of Pulses
Amplitude
Interspike Interval
Total Charge
Is Burst Stimulation Applicable to the Entire Nervous System
Future Trends
New Indications and New Stimulation Targets
Modifications of the Burst Stimulation Design
Conclusion
References
15 - Spinal Cord Stimulation: Mechanisms of Action
Introduction
Historical Review and Current Technology
Conventional Spinal Cord Stimulation
High-Frequency Spinal Cord Stimulation
Burst Spinal Cord Stimulation
Spinal Nociceptive Transmission
Mechanisms of Action Overview
Activation of the Dorsal Column
Suppression of Dorsal Horn Neuronal Activity and Sensitization
Conventional Tonic Spinal Cord Stimulation
High-Frequency Spinal Cord Stimulation
Burst Spinal Cord Stimulation
Modulation of Spinal Pain Microcircuitry
Supraspinal Mechanisms
Stimulation Parameters
Neurochemical Mechanisms
GABA
Serotonergic, Cholinergic, and Adrenergic Mechanisms
Other Mechanisms
High-Frequency Spinal Cord Stimulation
Background
Mechanisms of Action of High-Frequency Spinal Cord Stimulation
Computational Modeling
Animal Studies
Summary
Use of the Electrically Evoked Compound AP to Study Types of Fibers Activated by SCS
Background
ECAP Measurement
Summary
Future Directions
Conclusions
References
16 - Fundamentals and Mechanisms of Dorsal Root Ganglion Stimulation
Introduction
The DRG as a Target for Neuromodulation
Mechanisms of Pain Relief
Outcomes of DRG Stimulation
Conclusions
Authorship Statement
Conflict of Interest Statement
References
17 - Mechanisms of Action of Deep Brain Stimulation: A Review
Introduction
Five Hypotheses for Mechanism(s) of Action of Deep Brain Stimulation
Depolarization Block Hypothesis
Neural Jamming/Neural Modulation Hypothesis of Tremor
Synaptic Depression Hypothesis
Synaptic Modulation Hypothesis
Deep Brain Stimulation–Astrocyte Hypothesis
Conclusions
Acknowledgments
References
18 - Vagus Nerve Stimulation: Mechanism of Action
Anatomy of the Vagus Nerve
The History of Vagus Nerve Stimulation
Electrical Activation of Vagus Nerve Fibers
The Nucleus of the Solitary Tract as a Relay for Central Effects of Vagus Nerve Stimulation
Anticonvulsant Effects of Vagus Nerve Stimulation
Antidepressant Mechanisms
Analgesic Mechanisms
Mechanisms Underlying Effects of Vagus Nerve Stimulation on Cognition
Cardiac Effects of Vagus Nerve Stimulation
Anti-Inflammatory Effects of Vagus Nerve Stimulation
Conclusions
References
19 - Mechanisms of Action of Sacral Nerve and Peripheral Nerve Stimulation for Disorders of the Bladder and Bowel
Introduction
Neural Control of Lower Urinary Tract and Distal Bowel
Putative Mechanisms of Neuromodulation
Clinical Studies of the Mechanisms of SNS
Does SNS Target Efferent or Afferent Axons
Importance of Proximity of Spinal Neuromodulatory Pathways and Pelvic Visceral Reflex Circuitry
Does Neuromodulation Target Normal or Pathologic Mechanisms
Experimental Studies of Neuromodulation in Animal Models
Sacral Nerve Stimulation
Mechanisms Underlying the Enhancement of Urine Storage by SNS
Mechanisms of SNS Modulation of Bowel Function
Modulation of Bladder Function by Peripheral Nerve Stimulation
Experimental Models in Cats and Rats
Properties of the Different Types of Neuromodulation
Site of Action
Role of CNS GABA and Opioid Peptides in Neuromodulation
Role of Glutamatergic Mechanisms in Neuromodulation
Role of Serotonergic Mechanisms in PNS
Drug–Neuromodulation Combination Therapy
Treatment of LUT Dysfunction After SCI
Future Directions
References
IV - Technology and Devices
INTRODUCTION
Further Reading
20 - Electrodes for the Neural Interface
Introduction
Neural Science Fundamentals
Anatomic Organization
Major Divisions of the Nervous System
Size
Structure and Organization—Peripheral Nervous System
Somatotopic Organization
Organization of the Autonomic Nervous System
Organization of the Central Nervous System
Organization of the Spinal Cord
Summary
Vascular Anatomy
Peripheral Nervous System Vasculature
Central Nervous System Vasculature
Tissue Electrical Impedance
Tissue Mechanical Properties
Surrounding Space and Tissue
Neural Behavior in Response to Applied Electric Fields
Electric Fields Produced by Neural Behavior
Design Principles for Neural Interface Electrodes
Location Selection
Proximity to the Neurons
Risk/Benefit Ratio
Material and Processing Technology
Complexity of Function Required From the Electrode
Electromagnetic Fields
Stimulation
Blocking
Recording
Tissue Response
Other Design Considerations
Implant Procedure
Removability
Neural Interface Electrode Examples
Surface Electrodes
Organ-Based Electrodes
Muscle
Cochlear
Retina
Peripheral Nervous System Electrodes
Extraneural
Interfascicular
Intrafascicular
Regeneration
General
Central Nervous System Electrodes
Superficial and Distal Central Nervous System Interfaces
Deeper Central Nervous System Structures
Deep Brain Stimulation
Conclusion
References
21 - Implantable Neural Stimulators
Introduction
Implantable Neural Stimulator Technology
Physical Design and Materials for the Stimulator
The Neural Interface: Electrodes and Leads
Stimulating and Processing Circuitry
The Power System
Device Communication and Telemetry
Sensors for Device Command and Closed-Loop Control
Future Directions in Implantable Neurostimulator Technology
References
Further Reading
22 - Microstimulators: Minimally Invasive Implantable Neuromodulatory Devices
Background
Definition of a Microstimulator
Technical Aspects of Microstimulators
Packaging
Electrodes
Powering Microstimulators
Battery-Powered Microstimulators
Passive Microstimulators
MRI Compatibility
Regulatory Requirements
Microstimulator Human Factors
Clinical Experience with Microstimulators
Bion
Poststroke Shoulder Subluxation
Poststroke Hand Contracture
Knee Osteoarthritis
Foot Drop
Overactive Bladder
Severe Headache
Ischial Pressure Ulcers
BlueWind
Autonomic Technologies
Bioness
StimWave
Oculeve
Nyxoah
Valencia Technologies
Commercial Interest in Microstimulators
Challenges and Future Directions
Powering
Biocompatibility
Feedback-Controlled Therapy
Conclusion
References
23 - Designing Neuromodulation Devices for Feedback Control
Overview
Spinal Cord Stimulation for Treatment of Chronic Pain
History and Scientific Evidence
Technology Landscape
Medtronic RestoreSensor
Saluda Evoke
Cortical and Vagus Nerve Stimulation for Treatment of Epilepsy
History and Scientific Evidence
Technology Landscape
Cyberonics AspireSR
Neuropace RNS
Deep Brain Stimulation for Treatment of Movement Disorders
History and Scientific Evidence
Technology Landscape
Medtronic Activa PC+S
Wearable Motion Sensing
Design Strategies for Future Neuromodulation Devices for Feedback Control
Modular and Configurable Devices
Flexibility Through Firmware Upgrades
Algorithm Prototyping
Application–Programming Interfaces
Cloud Connectivity and Data Analytics
References
24 - MRI Safety and Neuromodulation Systems
Introduction
Static Magnetic Fields
Gradient Magnetic Fields
Radiofrequency Fields
MRI Safety and Screening Patients for MRI Procedures
MRI Procedures and Implanted Medical Devices: Neuromodulation Systems
Interactions Between the MRI Environment and Implanted Medical Devices
Injuries or Device Damage Related to the Static Magnetic Field
Injuries or Device Damage Related to Gradient Magnetic Fields
Excessive Heating and Device Damage Related to RF Energy
Evaluation of MRI Issues for Neuromodulation Systems
MRI Procedures and Neuromodulation Systems
Deep Brain Stimulation
Medtronic DBS Systems, MR Conditional—Medtronic Inc
Abbott and St. Jude Medical DBS Systems, MR Unsafe—Abbott and St. Jude Medical
Boston Scientific DBS Systems, MR Unsafe—Boston Scientific
Reported MRI Safety Issues With DBS Systems
Spinal Cord Stimulation Systems
SCS Systems, MR Conditional—Medtronic Inc
SCS System, MR Conditional - Boston Scientific, Valencia, CA
SCS Systems, MR Conditional—Abbott and St. Jude Medical
Axium DRG System, MR Unsafe—Abbott and St. Jude Medical
Freedom 4 Epidural SCS System, MR Conditional—Stimwave Technologies Inc
Sprint PNS System, MR Unsafe—SPR Therapeutics
Other Commercially Available Neuromodulation Systems
Argus II Retinal Prosthesis System, MR Conditional—Second Sight Medical Products Inc
Enterra Gastric Electrical Stimulation Therapy System, MR Unsafe—Medtronic Inc
InterStim Sacral Nerve Stimulation System, MR Conditional—Medtronic Inc
Axonics Sacral Neuromodulation System, MR Conditional—Axonics Modulation Technologies Inc
Vagus Nerve Stimulation System, MR Conditional—LivaNova and Cyberonics
Implantable Infusion Systems
Prometra Programmable Pumps, MR Conditional—Flowonix Medical Inc
MedStream Programmable Infusion System, MR Conditional—Codman & Shurtleff Inc
SynchroMed Infusion Systems, MR Conditional—Medtronic Inc
IsoMed Constant Flow Infusion System, MR Conditional—Medtronic Inc
Conclusions
References
V -
BRAIN, COMPUTER AND MACHINE INTERFACING
INTRODUCTION
25 - Brain–Computer Interfaces: Why Not Better
Introduction
Brain–Computer Interface Clinical Goals
Basic Elements of a Brain–Computer Interface
Fundamental Neuroscience Advances
Signals: What to Record
Location: Where to Record
Smart Sampling
Computation: The Challenge of Better Decoding
Technological Challenges
Neural Interfaces
Technology of Electronics
Synthesis
Acknowledgments
References
26 - Noninvasive Brain–Computer Interfaces
Introduction
Overview of This Chapter
Electroencephalography
Metabolic Activity
Brain–Computer Interfaces to Replace Function
Introduction
Communication Functions
Simple Communication Functions
Complex Communication Functions
Control Functions
Computer Functions
Worn Robotic Devices
Mobile Robotic Devices
Future Directions
Brain–Computer Interfaces to Restore Function
Introduction
Devices That Produce Limb Movements
Functional Electrical Stimulation
Orthoses
Brain–Computer Interfaces for Restoration
Upper Limb
Lower Limb
Brain–Computer Interfaces to Enhance Function
Introduction
User State
Error Detection
Sleep
Image Recognition
Neuromarketing
Brain–Computer Interfaces to Improve Function
Introduction
Improvements to Motor Function
Improvements to Other Functions
Summary of the Current State of Noninvasive Brain–Computer Interfaces
Scientific and Technical Basis
Translating Brain–Computer Interfaces From Scientific Endeavors Into Clinically and Commercially Successful Technologies
Commercialization Potential of Various Noninvasive Brain–Computer Interface Technologies
Conclusions
Acknowledgments
References
27 - Invasive Brain–Computer Interfaces for Functional Restoration
Introduction
Recording Technologies Used in Invasive Brain–Computer Interfaces
Stereoencephalography Electrodes
Electrocorticography Electrodes
Penetrating Microelectrodes
Cortical Areas and Signals of Interest for Invasive Brain–Computer Interfaces
Cortical Areas for Recording and Stimulation
Cortical Signals and Features
Neural Decoding
Current Applications of Invasive Brain–Computer Interfaces for Motor Restoration
Two-Dimensional Cursor Movementsand Virtual Typing
Robotic Limb Control
Restoration of Paralyzed Arm and HandMovements
Current Challenges and Future Directions of Invasive Brain–Computer Interfaces
Electrode Longevity and Robustness
Cortical Signal Stability
Fully Implantable and Miniaturized Wireless Brain–Computer Interfaces
Restoring Natural Motor Function and Sensation
References
28 - Prospects for a Robust Cortical Recording Interface
Motivation, Progress, and Challenges for Intracortical Recording Electrodes
Motivation
Progress
Challenges
Commonly Used Electrodes for Intracortical Recording
The Utah Electrode Array
Michigan-Style Microelectrodes
Microwires
Electrocorticography
Electroencephalography
Optical Microelectrodes
Summary of Intracortical Recording Electrode Failure Mechanisms
Neuroinflammatory Underpinnings
The Biological Response to Electrode Implantation
Overview
Soluble Factors Kill Neurons, Degrade and Corrode Implanted Materials, and Maintain the Inflammatory Response
Insoluble Factors Serve a Vital Role in Healing and Regeneration but Also Isolate Neurons Electrically and Physically From the R...
Neuronal Loss at the Electrode–Tissue Interface Attenuates the Source Signal
Intracortical Electrode Technologies to Evade the Inflammatory Response and Improve Long-Term Performance
Drug Administration
Broad-Spectrum Anti-Inflammatory Agents
Targeted Anti-Inflammatory Agents
Drug/Coating Combinations
Antioxidants
Neurotrophic Factors
Material Selection/Surface Properties, Coatings
Cell Adhesion Proteins
Hydrogel and Other Nonfouling Surfaces
Soluble Factor (Cytokine) Sinks
Conductive Polymers
Material Selection/Bulk Properties
Flexible Substrates
Dynamically Softening Materials
Nanomaterials/Carbon Nanotubes
Implantation Technique and System Design
Avoidance of Vasculature
Shape and Speed of Insertion
Floating Versus Tethered Lead Wires
Perspectives on the Future of Neural Recording Interfaces
Acknowledgments
References
29 - Advances in Invasive Brain–Computer Interface Technology and Decoding Methods for Restoring Movement and Future Applications
Introduction
Historical Perspective
Restoring Movement in Quadriplegia
Designing and Developing Effective Brain–Computer Interface Systems
Neural/Brain Interface
Amplifying and Digitizing Neural Activity
Robust Neural Features for Long-Term Decoding
Neural Decoding Algorithms
Conclusion
References
VI -
EMERGING TECHNOLOGIES AND TECHNIQUES
INTRODUCTION
30 - Gene-Based Neuromodulation
Introduction
Gene Therapy Vectors
Viral Vectors
AAV Vectors
LV Vectors
HSV Vectors
Adenoviral Vectors
Control of Transgene Expression
Promotor Selection
Regulatable Expression Systems
Additional Gene Therapy Approaches
Human Clinical Safety and Efficacy Data for CNS Gene Therapy
Genetic Diseases
Canavan Disease
Batten Disease (Late Infantile Neuronal Ceroid Lipofuscinosis)
X-Linked Adrenoleukodystrophy
Ongoing Gene Therapy Considerations for Genetic Diseases of the CNS
Neurodegenerative Diseases
Parkinson Disease
Alzheimer Disease
Brain Tumors
Discussion of Future Trends and Pathways to Expanding the Knowledge Base
Novel Disease Targets
Epilepsy
Neuropsychiatric Disease
Novel Modulatory Gene Therapy Approaches
Optogenetics: A Form of Gene Therapy
Chemogenetics
Magnetogenetics/Radiogenetics
Novel Approaches for Noninvasive Gene Delivery
Systemic Gene Delivery
Magnetic Resonance Imaging–Guided Focused Ultrasound
References
31 - Focused Ultrasound Ablation for Neurological Disorders
Introduction
Initial Applications of Focused Ultrasound Ablation for Neurosurgery
Transcranial Focused Ultrasound Ablation for Neurosurgery
Essential Tremor
Parkinson Disease
Obsessive-Compulsive Disorder
Epilepsy
Oncology
Future Developments
Summary
References
32 - Implanted Sensors in Neuromodulation via Electrical Stimulation
Introduction
Sensing and Using Sensed Data
Compound Action Potential Recording
Sensing Brain Electrophysiology During DBS
Sensing Spinal Cord Electrophysiology During SCS
Concluding Remarks
References
33 - Gaming for the Brain: Video Gaming to Rehabilitate the Upper Extremity After Stroke
Rehabilitation Gaming Can Address Major Care Disparities
The Pros and Cons of Available Gaming Technologies
Theoretical Differences That Favor Gaming Rehabilitation
Theoretical Differences That Favor Conventional Therapy
Comparative Effectiveness of Rehabilitation Gaming Systems
Future Directions
References
34 - The Use of New Surgical Technologies for Deep Brain Stimulation
Introduction
Precise Identification of Targets and Improved Stereotactic Targeting
Indirect Targeting
Direct Targeting and Its Implications
Substrates of DBS Efficacy and the Origin of Connectivity-Based Targeting
Stimulation Titration For Modulation of Dysfunctional Networks With DBS
Closed-Loop Stimulation
Directional Electrodes
Novel Stimulation Parameters
Conclusions
References
35 - Neuromodulation Using Optogenetics and Related Technologies
Introduction
History of Optogenetics
Implementation and Technical Considerations
Optogenetic Effector Delivery
Light Delivery, Tissue Penetration, and Scattering
Toxicity and Nonoptogenetic Effects
Duty Cycle/Stimulation Parameters
Amenable Brain Targets
Rebound and Unexpected Effects of Opsins
Optogenetic Tools
Light-Sensitive Transporters
Bacteriorhodopsin
Archaerhodopsins
Halorhodopsins
Light-Sensitive Ion Channels
Nonselective Cation Channels
Anion Channel Rhodopsins
A Light-Sensitive Potassium Channel
Alternate Applications
Related Technologies
Designer Receptors Exclusively Activated by Designer Drugs
Luminopsins
Light-Controlled G Protein–Coupled Receptors
Translation and Prospects for Clinical Use
Hurdles for Translation
Applications
Recovery of Vision
Movement Disorders
Epilepsy
Sensory Restoration
Neuropsychiatric Disorders
Disorders of Sleep–Wake and Coma
Prostheses, Brain–Machine Interfaces, and Closed-Loop Systems
Nonneuronal Applications
Resources
References
VII - SURGICAL PROCEDURES AND TECHNIQUES
INTRODUCTION
36 - Deep Brain Stimulation: Surgical Technique
Introduction
Stereotactic Frame-Based Approach
“Frameless” Approach
Comparison
Image Acquisition
Target Localization
The Surgical Procedure
Physiologic Confirmation
MER and Microstimulation
Electrode Implantation and Fixation
Intraoperative Image-Based DBS Surgery – “Awake Versus Asleep DBS”
MRI
CT
Pulse Generator Implantation
Complications
Programming
References
37 - Spinal Cord Stimulation: Placement of Surgical Leads via Laminotomy: Techniques and Benefits
Introduction
Common Indications
Failed Back Surgery Syndrome
Complex Regional Pain Syndrome
Patient Selection
Psychological Screening
Opiate Use
Screening Trials
Anatomic Mapping
Lead Geometry and Canal Morphometry
Surgical Technique
Complication Avoidance
Future Directions
References
38 - Subcutaneous Peripheral Nerve Field Stimulation for Intractable Pain
Introduction
Patient Selection
Surgical Implantation
Electrode Implantation
Electrode Internalization and Implantation of Spinal Cord Stimulation Generator
PNFS for Chronic Pain/Low Back Pain
Adverse Events
Advantages of PNFS Therapy
Summary
References
39 - Surgical Placement of Leads for Occipital Nerve Stimulation
Introduction
Trial Stimulation
Permanent Implant – Percutaneous Wire Electrodes
Permanent Implant – Paddle Electrode
Wireless Trial and Permanent Implants
Conclusion
References
Further Reading
40 - Surgical Technique: Intrathecal Medication Delivery System Implantation
Surgical Planning/Preoperative Considerations
Positioning and Surgical Preparation
Catheter Insertion
Pump Preparation and Insertion
Closure
Postoperative Considerations
References
41 - Neuroprosthetic Surgical Strategies for Neuromuscular Stimulation
Introduction
Inclusion Criteria: Better Clinical Outcomes and Lessening the Risk for Complications
Surgical Procedure: Details of Implantation for a Networked Neuroprosthesis for Hand Function
Surgical Preparation
Prophylactic Antibiotics
Surgical Procedure
Trunk Control Electrode Placement
Upper Extremity Electrode Placement
Final Coupling
Postoperative Management
Postoperative Surveillance
Infection Risk After Surgery
Magnetic Resonance Imaging
Complications and Their Resolution
Revision Surgery
Neuroprosthesis Removal
Muscular and Nerve Electrode Removal
Forward Compatibility
References
42 - The Surgical Technique of Vagus Nerve Stimulator Implantation
Introduction
Surgical Anatomy
Operative Technique
Replacement of the Electrode Lead
Replacement of the Pulse Generator
Complications of Surgery
Conclusion
References