Deep Brain Stimulation Programming : Principles and Practice

Deep Brain Stimulation (DBS) is a remarkable therapy for an expanding range of neurological and psychiatric disorders. In many cases it is better than best medical therapy and succeeds even when brain transplants fail. Yet despite the remarkable benefits, many physicians and healthcare professionals seem hesitant to embrace this therapy. Post-operative programming of the DBS systems seems unfamiliar, even mysterious, and is viewed as difficult and time consuming. However, DBS programming is rational and can be efficient and effective if one understands the basing underlying concepts of electronics, electrophysiology, and the relevant regional anatomy. Even these principles can be relatively easy to grasp. The book helps the reader to obtain an intuitive understanding of the basic principles of electronics, electrophysiology and the relevant regional anatomy through the use of readily understood metaphors and numerous illustrations. In addition a number of tools are provided including algorithms to ensure efficient and thorough programming. Forms are provided to help with documentation. In addition, DBS related research provides a remarkable tool to understand how the brain works and what happens in diseases such as Parkinson's disease. Already long cherished theories of the pathophysiology of Parkinson's disease must be abandoned. Indeed, these DBS derived insights suggest fundamental revisions of theories of brain function are in order. The book provides an introduction to where some of the new theories may lead particularly with the growing awareness of the importance of oscillations in the brain's activities. The brain has more in common with electrical devices, such as computers, than it does to a stew of chemicals. DBS operates at the electrical level in the brain, which is fundamental to how the brain creates, manipulates and conveys information and may indeed be fundamental to the misinformation the results in the dysfunction related to disorders of the brain. For downloadable forms and other relevant material, please visit: http://www.uab.edu/DBS_PrinciplesAndPractice Contents......Page 16 Abbreviations......Page 20 1. Introduction......Page 24 Commentary 1.1. The Case for Deep Brain Stimulation......Page 25 Commentary 1.2. The Future of Deep Brain Stimulation......Page 26 Principles of Effective and Effcient Programming......Page 28 The Basis of DBS Effects......Page 29 2. Principles of DBS Electronics......Page 32 Note Regarding Impedances......Page 34 Therapeutic Mechanisms versus Delivery of Therapy......Page 38 Commentary 3.1. Sorting out DBS and Pharmacotherapy......Page 39 Commentary 3.2. Antidromic Activation as a Mechanism of DBS Action......Page 48 Controlling the Flow of Electrical Charges......Page 50 Current Intensity in Monopolar and Bipolar Electrode Configurations......Page 54 Commentary 3.3. The Ideal DBS System......Page 61 4. DBS Safety......Page 68 Potential Psychosocial Consequences of DBS......Page 71 5. The Issue of DBS Frequency......Page 72 Commentary 5.1. Emergence of Therapeutic Low-Frequency DBS......Page 73 Optimizing Battery Life......Page 78 The Special Case of the U-Shaped Response......Page 84 Commentary 6.1. The Paradox of Worsening Function with Increasing Strength of DBS: The U-Shaped Response......Page 86 Optimizing Therapeutic Effect and Minimizing Side Effects......Page 88 Algorithm for Selecting Electrode Configurations......Page 90 Side Effects Created by the Position of the DBS Lead Relative to the Subthalamic Nucleus......Page 96 Approach to Subthalamic Nucleus DBS for Parkinson's Disease......Page 101 Side Effects Resulting from the Position of the DBS Lead Relative to the Globus Pallidus Internal Segment......Page 104 Approaches to Globus Pallidus Internal Segment DBS for Parkinson's Disease......Page 106 Treating Dystonia with DBS of the Globus Pallidus Internal Segment......Page 107 Treating Hyperkinetic Disorders......Page 108 Side Effects Resulting from the Position of the DBS Lead Relative to the Ventral Intermediate Thalamus......Page 110 Effects of DBS on Speech and Swallowing......Page 113 An Approach to Thalamic DBS for Tremor......Page 114 Conduct a Monopolar Survey......Page 116 Systematically Document All Clinical Responses to All DBS Stimulation Parameters and Electrode Configurations......Page 117 Advise Patients to Take Their DBS Controlling Devices with Them to Emergency Rooms or Doctor Visits......Page 118 Troubleshooting......Page 119 11. The Basic Unit of Information in the Brain......Page 124 Commentary 11.1. The Curious Case in Which Inhibition Is Not Inhibition......Page 129 12. What DBS Tells Us about Physiology and Pathophysiology......Page 132 13. Variability in the Latency of Responses to DBS......Page 138 14. Oscillator Basics......Page 142 15. Paradoxes in DBS......Page 154 The Paradox of Variability in Latency Periods of DBS Effects......Page 155 The Paradox of Dissociating the Neurometabolic from the Electrophysiological Effects of DBS......Page 156 The Paradox of the "Dumb" Constant-Frequency DBS That Yet Restores Information......Page 157 By DBS Site......Page 160 Appendix 2. Aids to Programming: Paper Documentation......Page 162 Parkinson's Disease......Page 163 Dystonia......Page 166 Dyskinesia......Page 168 Tourette's Syndrome......Page 174 Appendix 3. Aid to Programming: Algorithm and Checklist for Electrode Configurations......Page 176 References......Page 188 Glossary......Page 192 C......Page 194 D......Page 195 G......Page 196 M......Page 197 P......Page 198 T......Page 199 X......Page 200 Principles of DBS electronics Principles of electrophysiology DBS safety The issue of DBS frequency Approaches to programming Approach to subthalamic nucleus DBS for Parkinson's disease Approach to globus pallidus internal Approach to thalamic DBS Helpful programming hints The basic unit of information in the brain What DBS tells us about physiology and pathophysiology Variability in the latency of responses to DBS Oscillator basics Paradoxes in DBS. Principles of DBS electronics Principles of electrophysiology DBS safety The issue of DBS frequency Approaches to programming Approach to subthalamic nucleus Approach to globus pallidus internal segment Approach to thalamic DBS Helpful programming hints The basic unit of information in the brain What DBS tells us about physiology and pathophysiology Variability in the latency of responses to DBS Oscillator basics Paradoxes in DBS.