Neuromodulation : comprehensive textbook of principles, technologies, and therapies. Volume 1 / edited by Elliot S. Krames, P. Hunter Peckham, Ali R. Rezai

"Neuromodulation: Comprehensive Textbook of Principles, Technologies, and Therapies, Second Edition, serves as a comprehensive and in-depth reference textbook covering all aspects of the rapidly growing field of neuromodulation. Since the publication of the first edition seven years ago, there has been an explosion of knowledge in neuromodulation, optogenetics, bioelectronics medicine and brain computer interfacing. Users will find unique discussions of the fundamental principles of neuromodulation and therapies, and how they are applied to the brain, spinal cord, peripheral nerves, autonomic nerves and various organs. The book focuses on comprehensive coverage of spinal cord stimulation, non-interventional and interventional brain stimulation, peripheral nerve stimulation, and the emerging fields of neuromodulation, including optogenetics and bioelectronics medicine"--Publisher's description 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