Deep Brain Stimulation Programming: Principles and Practice

Hardcover | April 16, 2010

byErwin B. Montgomery

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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 healthcareprofessionals 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 underlyingconcepts 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 toensure 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 suggestfundamental 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 ofthe brain.

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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 healthcareprofessionals seem hesitant to embrace this thera...

Dr. Montgomery's research interests are in motor neurophysiology of the basal ganglia, pathophysiology of Parkinson's disease and in the therapeutic mechanisms of action of Deep Brain Stimulation. His works spans human and non-human primate research and computational modeling and simulations. He received his MD degree from the State...

other books by Erwin B. Montgomery

Deep Brain Stimulation Programming: Principles and Practice
Deep Brain Stimulation Programming: Principles and Prac...

Kobo ebook|Apr 13 2010

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Format:HardcoverDimensions:208 pages, 10 × 7 × 0.98 inPublished:April 16, 2010Publisher:Oxford University PressLanguage:English

The following ISBNs are associated with this title:

ISBN - 10:0199738521

ISBN - 13:9780199738526

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Table of Contents

Abbreviations1. IntroductionPrinciples of Effective and Efficient ProgrammingProximate Effects and Distal Interventions: What the Brain Sees versus What You SeeThe Basis of DBS EffectsCommentary 1.1, The Case for Deep Brain StimulationCommentary 1.2, The Future of Deep Brain Stimulation2. Principles of DBS Electronics3. Principles of ElectrophysiologyTherapeutic Mechanisms Versus Delivery of TherapyCommentary 3.1, Sorting out DBS and PharmacotherapyCommentary 3.2, Antidromic Activation as a Mechanism of DBS ActionControlling the Flow of Electrical ChargesCurrent Intensity in Monopolar and Bipolar Electrode ConfigurationsCommentary 3.3, The DBS System4. DBS SafetyThe Potential Psychosocial Consequences of DBS5. The Issue of DBS FrequencyCommentary 5.1, Emergence of Therapeutic Low-Frequency DBS6. Approaches to ProgrammingOptimizing Battery LifeThe Special Case of the U-Shaped ResponseCommentary 6.1. The Paradox of Worsening Function with Increasing Strength of DBS: The U-shaped ResponseOptimizing Therapeutic Effects and Minimizing Side EffectsAn Algorithm for Selecting Electrode Configurations7. Approach to Subthalamic Nucleus DBS for Parkinson's DiseaseRegional Anatomy of the Subthalamic NucleusSide Effects Created by the Position of the DBS Lead Relative to the Subthalamic NucleusApproach to Subthalamic Nucleus DBS for Parkinson's Disease8. Approach to Globus Pallidus InternalRegional anatomy of the Globus Pallidus Internal SegmentSide Effects Resulting from the Position of the DBS Lead Relative to the Globus Pallidus InternaApproaches to Globus Pallidus Interna DBS for Parkinson's DiseaseTreating Dystonia with DBS of the Globus Pallidus InternaTreating Hyperkinetic Disorders9. Approach to Thalamic DBSRegional Anatomy of the Ventral Intermediate ThalamusSide Effects Resulting from the Position of the DBS Lead Relative to the Ventral Intermediate ThalamusEffects of DBS on Speech and SwallowingAn Approach to Thalamic DBS for Tremor10. Helpful Programming HintsConduct a Monopolar SurveyAlways Increase the Voltage to Clarify Any Side EffectsCheck Therapeutic Impedances on Commercial IPGsConfirm that the Parameters under Patient Control are within Safe LimitsSystematically Document all Clinical Responses to all DBS Stimulation Parameters and Electrode ConfigurationsAlways Reset Counters and Trouble-Shoot Inconsistent ResponsesAdvise Patents to Take Their DBS Devices with Them to Emergency Rooms or Doctor's VisitsBe Patient and Persistent!When in Doubt, Turn the Pulse Generator Off and WaitTrouble Shooting11. The Basic Unit of Information in the BrainCommentary 11.1, The Curious Case When Inhibition is not Inhibition12. What DBS Tells Us about Physiology and Pathophysiology13. Variability in the Latency of Responses to DBS14. Oscillator Basics15. Paradoxes in DBSAppendix 1. Index to Side DBS Effects, by Side Effect and Site of StimulationAppendix 2. Aids to Programming: Paper DocumentationParkinson's DiseaseCerebellar Outflow Tremor or Essential TremorDystoniaDyskinesiaTourette's SyndromeAppendix 3. Aid to Programming: Algorithm and Check List for Electrode ConfigurationsReferencesGlossaryIndex