Deep Brain Stimulation Programming

Table of Contents Preface to the Second Edition Preface to the First Edition Abbreviations Chapter 1. Introduction The Fundamentals Still Pertain Principles of Effective and Efficient Programming The Basis of DBS Effects Chapter 2. Principles of DBS Electronics Electricity Electronics Note Regarding Impedances Chapter 3. Principles of Electrophysiology Therapeutic Mechanisms versus Delivery of Therapy The Neuron Neuronal Electronics Voltage Gated Ionic Conductance Channels and Action Potentials Downstream Secondary Issues Chapter 4. Controlling the Flow of Electrical Charges Orientation of the Lines of Electrical Force Orthodromic and Antidromic Conduction of Action Potentials Axon Diameter Electrode Configurations Current Intensity in Monopolar and Bipolar Electrode Configurations Segmented DBS Leads Chapter 5. DBS Safety The Range of Safety Concerns Injury Secondary to Electricity Medical Complications Adverse Effects Related to Activation of Neural Networks The Potential Psychosocial Consequences of DBS Chapter 6. Nervous System Responses to DBS Knowledge of Nervous System Responses versus Knowledge of Therapeutic Mechanisms Effects Mediated by Voltage-Gated Ionic Conductance Channels in the Neuronal Membrane Post-Hyperpolarization Rebound Excitation, Depolarization Blockade, and Neurotransmitter Exhaustion Dissociation of Effects on Action Potential Initiating Segment, Dendrites, and Cell Bodies Network Effects of DBS Critically Important Caveats Concerning Interpretation of Nervous System Responses to DBS Reentry Propagations and Resonance Synchronization Among Neurons Interactions Between DBS Pulse in Intrinsic Neuronal Mechanisms Effects on Behaviorally Related Intrinsic Neuronal Dynamic Temporal Evolution of Nervous System Responses Chapter 7. DBS Effects on Motor Control Orchestration of Motor Unit Activities Orchestration of Motor Unit Recruitment and De-Recruitment over Different Time Scales Lessons to be Learned Chapter 8. Pathophysiological Mechanisms The Globus Pallidus Interna Rate Theory Excessively High Beta Oscillations Excessive Synchronization of Neuronal Activities Excessive Bursting The Systems Oscillators Theory Chapter 9. Approaches to Programming Battery Life DBS Contact Nomenclature Prior to DBS Programming When to Program DBS Conceptual Approaches The Growing Importance of Monopolar Surveys Detection of a Response is Critical Programming for Optimal Benefit in the Absence of Adverse Effects Programming to Prevent Adverse Effects Exiting the DBS Programming Session Chapter 10. Clinical Assessments Clinical Assessments by Disease Clinical Assessment of Corticospinal and Corticobulbar Stimulation Clinical Assessment of Speech, Language and Swallowing Hints to Clinical Evaluations Chapter 11. Approach to Subthalamic Nucleus Regional Anatomy of the Subthalamic Nucleus Adverse Effects Created by the Position of the DBS Lead Relative to the STN Approach to STN DBS for Parkinson's Disease Chapter 12. Approach to Globus Pallidus Internal Regional Anatomy of the Globus Pallidus Internal (GPi) Segment Adverse Effects Resulting from the Position of the DBS Lead Relative to the GPi Approaches to GPi DBS for Parkinson's Disease Treating Dystonia with DBS of the Globus Pallidus Interna Treating Hyperkinetic Disorders Chapter 13. Approach to Thalamic DBS Regional Anatomy of the Ventral Intermediate Thalamus Adverse Effects Resulting from the Position of the DBS Lead Relative to the Ventral Effects of DBS on Speech and Swallowing An Approach to Thalamic DBS for Tremor Chapter 14. Algorithm for Selecting Electrode Configurations and Stimulation Parameters Chapter 15. Helpful Programming Hints Use of Constant-Voltage DBS (to be discouraged) Conduct a Monopolar Survey Always Increase the Voltage to Clarify Any Side Effects Check Therapeutic Impedances on Commercial IPGs Confirm that the Parameters under Patient Control are within Safe Limits Systematically Document all Clinical Responses to all DBS Stimulation Parameters and Electrode Configurations Always Reset Counters and Trouble-Shoot Inconsistent Responses Advise Patents, Family Members and Caregivers to Take Their DBS Controlling Devices with Them to Emergency Rooms or Doctor's Visits Be Patient and Persistent! When in Doubt, Turn the Pulse Generator Off and Wait Trouble Shooting Chapter 16. Oscillator Basics Chapter 17. Discrete Neural Oscillators Importance of Neural Oscillators in Nervous System Function Continuous harmonic oscillators Discrete Oscillators Single Reentrant Discrete Oscillator Interactions Among Discrete Oscillators Discrete Neural Oscillators Oscillators with multiple realistic neurons The Systems (Discrete) Oscillators Theory Appendix of Supplemental Material Glossary References