Essential Neuromodulation (eBook)

Cover 2
Front matter 2
Essential Neuromodulation 2
Copyright 5
Contents 6
Contributors 10
Introduction 12
Part I - The Neuromodulation Approach 14
Chapter 1 - The Neuromodulation Approach 16
Introduction 16
History 17
Applications 21
Ethics 22
Cost 24
References 27
Part II - Regions of Application 30
Chapter 2 - Cerebral – Surface 32
History 33
Anatomical constraints on targeting 34
Can cortical stimulation be optimized through modeling? 37
MI as a paradigm of cortical stimulation 42
Mechanism of action and parameters considerations 44
Comparing techniques of cortical stimulation 49
References 52
Chapter 3 - Cerebral – Deep 60
Introduction 60
The thalamus 60
Globus pallidus pars internus (GPi) 66
Subthalamic nucleus (STN) 69
PedunculoponTine nucleus (PPN) 70
Deep cerebral targets for psychiatric illness 71
Hypothalamus 73
Conclusion 74
References 75
Commentary on Cerebral – Deep 82
References 84
Chapter 4 - Spinal – Extradural 86
Introduction 86
Epidural spinal cord stimulation: the procedure 88
Epidural stimulation to target specific disease states 92
Contraindications to SCS 97
Programming the epidural leads 99
Conclusion 101
References 101
Commentary on Spinal – Extradural 105
Mechanisms 105
Practice structure contribution 106
References 107
Chapter 5 - Peripheral Nerve 108
Introduction 108
General principles of PNS 108
Specific PNS applications 111
Vagal nerve stimulation 113
Conclusion 114
References 114
Commentary on Peripheral Nerve 118
Part III - The Neuromodulation Therapy Interface 120
Chapter 6 - The Electrode – Materials and Configurations 122
Physical basis of the electrode/electrolyte interface 122
Charge injection across the electrode–electrolyte interface during electrical stimulation 127
Charge injection for extracellular stimulation of excitable tissue 133
Mechanisms of damage 135
Design compromises for efficacious and safe electrical stimulation 138
Materials used as electrodes for charge injection and reversible charge storage capacity 142
Size and shape considerations 150
References 152
Commentary on The Electrode – Materials and Configurations 160
Delivery of electrical energy 160
Optimizing neural atitivation 162
Injury produced by electrical stimulatiation 163
Chapter 7 - The Electrode – Principles of the Neural Interface: Axons and Cell Bodies 166
Introduction 166
Electrode–brain interface 166
Electric field 167
Stimulated neural elements 169
Cable equation and activating function 169
Direct neural activation 170
Indirect synaptic modulation 171
Stimulation-induced network activity 172
References 173
Considerations for Quantitative Modeling of Excitation and Modulation of CNS neurons 175
Introduction 175
Part one: generation of potentials in tissue 176
Part two: effects of extracellular potential on neurons 177
Part three: network effects of CNS stimulation 179
References 180
Chapter 8 - The Electrode – Principles of the Neural Interface: Circuits 182
Evidence in support of a DBS systems effect hypothesis 183
Evidence related to DBS systems versus local effects hypotheses 188
Regarding evidence for the DBS local effect ­hypothesis 190
Evidence for the DBS systems effect hypothesis 190
Implications of DBS for the physiology and pathophysiology of the BG–TH–CTX system 198
Intellectual antecedents to the DBS local effect 199
Implications of the DBS systems effect hypothesis on future surgical therapies 200
Final note 200
References 201
Commentary on The Electrode - Principles of the Neural Interface: Circuits 204
Chapter ­ 9 Device ­Materials, ­Handling, and ­Upgradability 206
Introduction 206
Neurostimulator form factor and materials 206
Lead system configuration and materials 211
Safety considerations 215
Conclusions 219
References 219
Commentary on Device Materials Handling, and Upgradability 222
References 223
Chapter 10 - Electronics 226
The history of SCS devices 226
The first implanted dorsal column stimulators 227
Electronics for spinal cord stimulation 231
Future 251
References 253
Commentary on Electronics 257
Basic definitions in pulse delivery 257
Current, charge density and dissipated energy in the example of spatial targeting of axon fibers 258
Spatial selectivity engineering by multielectrode grids 258
Temporal selectivity engineering based on interleaving 259
Constant current and voltage stimulation 260
Engineering aspects of the electronic circuits 262
Concluding remarks 264
References 264
Chapter 11 - Power 266
Overview 266
Power requirements 266
System power requirements 268
Patient compliance and cost considerations 272
Power source options 272
References 277
Commentary on The Electrode – Power 279
Part IV - Placing Neuromodulation in the Human Body 282
Chapter 12 - Surgical Techniques 284
Introduction 284
Emphasizing the physiological target 284
Being attuned to nuances (tissue, physiology, and the patient) 286
Assuring that intraoperative resources are adequate for decision making 291
Conclusions 292
References 293
Commentary on Surgical Techniques 294
Reference 294
Chapter 13 - Trials and Their Applicability 296
Introduction 296
Intrathecal infusion trials 296
Needle placement for intrathecal pump placement 299
Spinal cord stimulation trials 302
Selected reading 307
Commentary on Trials and Their Applicability 308
Neuroaxial opioids 308
Neurostimulation 309
References 311
Chapter ­ 14 Limiting ­Morbidity 314
Infection 315
Hemorrhage 317
Injury of nervous tissue 319
Cerebrospinal fluid leak 322
Placing the device into the wrong compartment 324
Hardware migration 325
Hardware erosion 327
Hardware malfunction/fracture/disconnection 328
Granuloma formation 329
Other issues 331
References 331
Commentaryon LimitingMorbidity 334
Infection/erosion 334
CSF leak following intrathecal catheter placement 335
Complicatiations following SCS paddle lead implantatiantation 336
Lead fracture 336
Part V - Troubleshooting and Repair 338
Chapter ­ 15 Intraoperative Evaluation 340
Introduction 340
Principles of assessment 341
Non-invasive testing 347
Intraoperative testing 353
Testing methodology 354
Examples 355
Conclusion 357
References 358
Part VI - Postoperative Management 362
Chapter 16 - Programming – DBS Programming 364
Introduction 364
Overview 364
Process 366
Initial programming session 369
Follow up 374
Maintenance 379
Alternative programming methods 380
Patient control 381
Conclusion 382
References 382
Commentary on Programming – DBS Programming 385
Chapter 17 - Programming – SCS 388
Introduction 388
Anatomical considerations in spinal cord stimulation 388
Programmable aspects of stimulation 392
Intraoperative programming 398
Postoperative programming 400
Conclusions 405
References 406
Commentary on Programming – SCS 408
References 409
Chapter ­ 18 Safety ­Concerns and ­Limitations 410
Patient activity and environmental concerns 410
Medical imaging 415
Medical and surgical interventions 418
Conclusions 421
References 421
Commentaryon Safety Concerns and Limitations 424
Part VII - The End User 426
Chapter 19 - Expectations and Outcomes 428
Expectations and outcomes 428
Deep brain stimulation for movement disorders 428
Spinal cord stimulation for pain 433
Motor cortex stimulation for neuropathic pain 434
Vagal nerve stimulation for epilepsy 435
Expectations of the patient 436
Considerations from a patient´s perspective: psychology of pill burden 437
Conclusions 438
References 438
Commentaryon Expectations and Outcomes 442
Chapter 20 - Neuromodulation Perspectives 448
Introduction 448
Should we say DBS-HF or simply ­DBS? 449
Targeting 449
Anesthesia 452
How to choose best practice? 453
Suicide and cognitive effects 456
Mechanism of action 457
Should we go back to lesioning and unilateral implantation? 458
Costs 460
Evidence-based medicine (­EBM) and clinical trials 460
Alternative methods and conclusion 463
Commentaryon Neuromodulation Perspectives 464
History as the future 464
The DBS frequency story 467
The surgical procedure, including anesthesia, from the neurophysiologist/neurologist perspective 470
The art, and hopefully, the science of choosing the best practice 471
Reflecting prospectively 473
References 475
Appendix 478
Index 496