Deep Brain Stimulation

Deep brain stimulation (DBS) is increasingly used for the treatment of patients with severe Parkinson's disease and other movement disorders, but the technique and science behind it is still poorly understood by most clinicians. This book is intended to provide an overview of the use of deep brain stimulation for movement disorders and to provide an introduction to the developing areas of DBS for psychiatric disease. The first part of the book covers the varying surgical techniques involved in implanting electrodes into various deep nuclei within the brain. The neurophysiological techniques involved in this process and the complex issue of programming the implanted stimulator in order to optimize therapeutic efficacy and minimize stimulation induced adverse effects. The second part of the book describes how to select appropriate patients for DBS and describes the results of DBS treatment for Parkinson's disease, dystonia and various tremors, as well as psychiatric conditions. Edited by three of the world's leading experts in the DBS field, this pocketbook provides neurologists, trainees, and specialist nurses with an overview of the therapeutics use of DBS. Contents......Page 6 Preface......Page 10 Contributors......Page 12 Abbreviations......Page 16 Part 1 – DBS – Surgical techniques......Page 18 1 Subthalamic nucleus stimulation in Parkinson’s disease......Page 20 2 Globus pallidus stimulation......Page 28 3 Thalamic stimulation......Page 36 4 Pedunculopontine nucleus DBS in advanced Parkinson’s disease......Page 44 Part 2 – DBS – Operative physiological techniques and post-operative stimulator programming......Page 52 5 Microelectrode recording and microstimulation for target mapping......Page 54 6 Operative physiological techniques: perioperative macroelectrode recording......Page 66 7 Test stimulation......Page 76 8 DBS stimulator programming......Page 82 Part 3 – DBS for movement disorders......Page 90 9 Selecting appropriate Parkinson’s patients for Deep Brain Stimulation (DBS)......Page 92 10 The long term results of STN stimulation for Parkinson’s disease......Page 100 11 The long term results of GPi stimulation for Parkinson’s disease......Page 112 12 Post-STN DBS Parkinson’s disease......Page 118 13 Selecting appropriate dystonic patients for GPi stimulation......Page 124 14 The results of GPi stimulation for generalized dystonia......Page 132 15 The results of GPi stimulation for focal and segmental dystonia......Page 144 16 Selecting appropriate tremor patients for DBS......Page 156 17 The results of DBS for tremor......Page 174 Part 4 – DBS for psychiatric conditions......Page 186 18 Deep brain stimulation for Gilles de la Tourette syndrome......Page 188 19 DBS for obsessive-compulsive disorder......Page 196 20 Cingulate area 25 DBS for depression......Page 204 Part 5 – Mathematical modelling of DBS......Page 210 21 Modelling approaches to DBS......Page 212 Appendix – Useful links......Page 220 D......Page 222 I......Page 223 N......Page 224 R......Page 225 V......Page 226 Z......Page 227 Contents 6 Preface 10 Contributors 12 Abbreviations 16 Part 1 – DBS – Surgical techniques 18 1 Subthalamic nucleus stimulation in Parkinson’s disease 20 2 Globus pallidus stimulation 28 3 Thalamic stimulation 36 4 Pedunculopontine nucleus DBS in advanced Parkinson’s disease 44 Part 2 – DBS – Operative physiological techniques and post-operative stimulator programming 52 5 Microelectrode recording and microstimulation for target mapping 54 6 Operative physiological techniques: perioperative macroelectrode recording 66 7 Test stimulation 76 8 DBS stimulator programming 82 Part 3 – DBS for movement disorders 90 a) Parkinson’s disease 92 9 Selecting appropriate Parkinson’s patients for Deep Brain Stimulation (DBS) 92 10 The long term results of STN stimulation for Parkinson’s disease 100 11 The long term results of GPi stimulation for Parkinson’s disease 112 12 Post-STN DBS Parkinson’s disease 118 b) Dystonia 124 13 Selecting appropriate dystonic patients for GPi stimulation 124 14 The results of GPi stimulation for generalized dystonia 132 15 The results of GPi stimulation for focal and segmental dystonia 144 c) Tremor 156 16 Selecting appropriate tremor patients for DBS 156 17 The results of DBS for tremor 174 Part 4 – DBS for psychiatric conditions 186 18 Deep brain stimulation for Gilles de la Tourette syndrome 188 19 DBS for obsessive-compulsive disorder 196 20 Cingulate area 25 DBS for depression 204 Part 5 – Mathematical modelling of DBS 210 21 Modelling approaches to DBS 212 Appendix – Useful links 220 Index 222 A 222 B 222 C 222 D 222 E 223 F 223 G 223 H 223 I 223 L 224 M 224 N 224 O 225 P 225 Q 225 R 225 S 226 T 226 V 226 W 227 X 227 Z 227 Dbs: Surgical Techniques -- Subthalamic Nucleus Stimulation In Parkinson's Disease -- Globus Pallidus Stimulation -- Thalamic Stimulation -- Pedunculopontine Nucleus Dbs In Advanced Parkinson's Disease -- Dbs: Operative Physiological Techniques And Post-operative Stimulator Programming -- Microelectrode Recording And Microstimulation For Target Mapping -- Operative Physiological Techniques: Perioperative Macroelectrode Recording -- Test Stimulation -- Dbs Stimulator Programming -- Dbs For Movement Disorders -- Parkinson's Disease -- Seleting Appropriate Parkinson's Patients For Deep Brain Stimulation (dbs) -- Long Term Results Of Stn Stimulation For Parkinson's Disease -- Long Term Results Of Gpi Stimulation For Parkinson's Disease -- Post-stn Dbs Parkinson's Disease -- Dystonia -- Selecting Appropriate Dystonic Patients For Gpi Stimulation -- Results Of Gpi Stimulation For Generalized Dystonia -- Results Of Gpi Stimulation For Focal And Segmental Dystonia -- Tremor -- Selecting Appropriate Tremor Patients For Dbs -- Results Of Dbs For Tremor -- Dbs For Psychiatric Conditions -- Deep Brain Stimulation For Gilles De La Tourette Syndrome -- Dbs For Obsessive-compulsive Disorder -- Cingulate Area 25 Dbs For Depression -- Mathematical Modelling Of Dbs -- Modelling Approaches To Dbs. Edited By Peter Bain ... [et Al.]. Includes Bibliographical References And Index. Deep brain stimulation (DBS) is increasingly used for the treatment of patients with severe Parkinson's disease and other movement disorders, but the technique and science behind it is still poorly understood by most clinicians. This book is intended to provide an overview of the use of deep brain stimulation for movement disorders and provide an introduction to the developing arena of DBS for psychiatric disease. The first part of the book covers the varying surgical techniques involved in implanting electrodes into various deep nuclei within the brain. The neurophysiological techniques involved in this process and the complex issue of programming the implanted stimulator in order to optimise therapeutic efficacy and minimise stimulation induced adverse effects. The second part of the book describes how to select appropriate patients for DBS and describes the results of DBS treatment for Parkinson's disease, dystonia and various tremors, as well as psychiatric conditions. Edited by three of the world's leading experts in the DBS field, this pocketbook will provide neurologists, trainees and specialist nurses with an overview of the therapeutics use of DBS "This practical handbook provides an overview of the use of DBS for the treatment of movement disorders and psychiatric disease. This book will serve as a useful guide for neurologists, neurosurgeons, neurophysiologists, and trainees in these specialties, as well as for movement disorder specialists and specialist nurses. It will also prove useful to psychiatrists interested in modern psychosurgery and scientists studying the pathophysiology of movement disorders."--BOOK JACKET This handbook provides an overview of the use of deep brain stimulation (DBS) for the treatment of movement disorders as well as an introduction to the developing area of DBS for the management of psychiatric disease.