Arle / Shils Essential Neuromodulation

1. Auflage 2011
ISBN: 978-0-12-381410-4
Verlag: Elsevier Science & Techn.
Format: EPUB
Kopierschutz: 6 - ePub Watermark

E-Book, Englisch, 504 Seiten

Neuromodulation is an emerging field that explores the use of electrical, chemical, and mechanical interventions to heal neurological deficits. Such neurostimulation has already shown great promise with disorders and diseases such as chronic pain, epilepsy, and Parkinson's disease. This is the first concise reference covering all of the basic principles of neuromodulation in a single affordable volume for neuro-residents, fellows, and basic clinical practitioners, edited by two prominent clinical experts in the field. This volume emphasizes essential observations from all of the important clinical phases involved in any neuromodulation: targeting, intraoperative assessment, programming, complications, and complication avoidance. There are commonalities to all neuromodulation procedures that must be brought to the forefront to form a cohesive presentation of neuromodulation, and such emphasis will give readers a more solid grounding in the fundamentals needed to embrace this field as a cohesive clinical entity. - Chapters offer point-counterpoint commentary for varied perspectives - Appendix distills current guidelines in easy, accessible format - Chapters follow story of patient care, effectively emphasizing general principles with supporting examples - Offers outstanding scholarship, with over 20% of chapters involving international contributors

Autoren/Hrsg.

Arle, Jeffrey

Shils, D. Abnm

Inhaltsverzeichnis

1;Cover;2
2;Front matter;2
3;Essential Neuromodulation;2
4;Copyright;5
5;Contents;6
6;Contributors;10
7;Introduction;12
8;Part I - The Neuromodulation Approach;14
8.1;Chapter 1 - The Neuromodulation Approach;16
8.1.1;Introduction;16
8.1.2;History;17
8.1.3;Applications;21
8.1.4;Ethics;22
8.1.5;Cost;24
8.1.6;References;27
9;Part II - Regions of Application;30
9.1;Chapter 2 - Cerebral – Surface;32
9.1.1;History;33
9.1.2;Anatomical constraints on targeting;34
9.1.3;Can cortical stimulation be optimized through modeling?;37
9.1.4;MI as a paradigm of cortical stimulation;42
9.1.5;Mechanism of action and parameters considerations;44
9.1.6;Comparing techniques of cortical stimulation;49
9.1.7;References;52
9.2;Chapter 3 - Cerebral – Deep;60
9.2.1;Introduction;60
9.2.2;The thalamus;60
9.2.3;Globus pallidus pars internus (GPi);66
9.2.4;Subthalamic nucleus (STN);69
9.2.5;PedunculoponTine nucleus (PPN);70
9.2.6;Deep cerebral targets for psychiatric illness;71
9.2.7;Hypothalamus;73
9.2.8;Conclusion;74
9.2.9;References;75
9.2.10;Commentary on Cerebral – Deep;82
9.2.11;References;84
9.3;Chapter 4 - Spinal – Extradural;86
9.3.1;Introduction;86
9.3.2;Epidural spinal cord stimulation: the procedure;88
9.3.3;Epidural stimulation to target specific disease states;92
9.3.4;Contraindications to SCS;97
9.3.5;Programming the epidural leads;99
9.3.6;Conclusion;101
9.3.7;References;101
9.3.8;Commentary on Spinal – Extradural;105
9.3.9;Mechanisms;105
9.3.10;Practice structure contribution;106
9.3.11;References;107
9.4;Chapter 5 - Peripheral Nerve;108
9.4.1;Introduction;108
9.4.2;General principles of PNS;108
9.4.3;Specific PNS applications;111
9.4.4;Vagal nerve stimulation;113
9.4.5;Conclusion;114
9.4.6;References;114
9.4.7;Commentary on Peripheral Nerve;118
10;Part III - The Neuromodulation Therapy Interface;120
10.1;Chapter 6 - The Electrode – Materials and Configurations;122
10.1.1;Physical basis of the electrode/electrolyte interface;122
10.1.2;Charge injection across the electrode–electrolyte interface during electrical stimulation;127
10.1.3;Charge injection for extracellular stimulation of excitable tissue;133
10.1.4;Mechanisms of damage;135
10.1.5;Design compromises for efficacious and safe electrical stimulation;138
10.1.6;Materials used as electrodes for charge injection and reversible charge storage capacity;142
10.1.7;Size and shape considerations;150
10.1.8;References;152
10.1.9;Commentary on The Electrode – Materials and Configurations;160
10.1.10;Delivery of electrical energy;160
10.1.11;Optimizing neural atitivation;162
10.1.12;Injury produced by electrical stimulatiation;163
10.2;Chapter 7 - The Electrode – Principles of the Neural Interface: Axons and Cell Bodies;166
10.2.1;Introduction;166
10.2.2;Electrode–brain interface;166
10.2.3;Electric field;167
10.2.4;Stimulated neural elements;169
10.2.5;Cable equation and activating function;169
10.2.6;Direct neural activation;170
10.2.7;Indirect synaptic modulation;171
10.2.8;Stimulation-induced network activity;172
10.2.9;References;173
10.2.10;Considerations for Quantitative Modeling of Excitation and Modulation of CNS neurons;175
10.2.11;Introduction;175
10.2.12;Part one: generation of potentials in tissue;176
10.2.13;Part two: effects of extracellular potential on neurons;177
10.2.14;Part three: network effects of CNS stimulation;179
10.2.15;References;180
10.3;Chapter 8 - The Electrode – Principles of the Neural Interface: Circuits;182
10.3.1;Evidence in support of a DBS systems effect hypothesis;183
10.3.2;Evidence related to DBS systems versus local effects hypotheses;188
10.3.3;Regarding evidence for the DBS local effect ­hypothesis;190
10.3.4;Evidence for the DBS systems effect hypothesis;190
10.3.5;Implications of DBS for the physiology and pathophysiology of the BG–TH–CTX system;198
10.3.6;Intellectual antecedents to the DBS local effect;199
10.3.7;Implications of the DBS systems effect hypothesis on future surgical therapies;200
10.3.8;Final note;200
10.3.9;References;201
10.3.10;Commentary on The Electrode - Principles of the Neural Interface: Circuits ;204
10.4;Chapter ­ 9 Device ­Materials, ­Handling, and ­Upgradability;206
10.4.1;Introduction;206
10.4.2;Neurostimulator form factor and materials;206
10.4.3;Lead system configuration and materials;211
10.4.4;Safety considerations;215
10.4.5;Conclusions;219
10.4.6;References;219
10.4.7;Commentary on Device Materials Handling, and Upgradability;222
10.4.8;References;223
10.5;Chapter 10 - Electronics;226
10.5.1;The history of SCS devices;226
10.5.2;The first implanted dorsal column stimulators;227
10.5.3;Electronics for spinal cord stimulation;231
10.5.4;Future;251
10.5.5;References;253
10.5.6;Commentary on Electronics;257
10.5.7;Basic definitions in pulse delivery;257
10.5.8;Current, charge density and dissipated energy in the example of spatial targeting of axon fibers;258
10.5.9;Spatial selectivity engineering by multielectrode grids;258
10.5.10;Temporal selectivity engineering based on interleaving;259
10.5.11;Constant current and voltage stimulation;260
10.5.12;Engineering aspects of the electronic circuits;262
10.5.13;Concluding remarks;264
10.5.14;References;264
10.6;Chapter 11 - Power;266
10.6.1;Overview;266
10.6.2;Power requirements;266
10.6.3;System power requirements;268
10.6.4;Patient compliance and cost considerations;272
10.6.5;Power source options;272
10.6.6;References;277
10.6.7;Commentary on The Electrode – Power;279
11;Part IV - Placing Neuromodulation in the Human Body;282
11.1;Chapter 12 - Surgical Techniques;284
11.1.1;Introduction;284
11.1.2;Emphasizing the physiological target;284
11.1.3;Being attuned to nuances (tissue, physiology, and the patient);286
11.1.4;Assuring that intraoperative resources are adequate for decision making;291
11.1.5;Conclusions;292
11.1.6;References;293
11.1.7;Commentary on Surgical Techniques;294
11.1.8;Reference;294
11.2;Chapter 13 - Trials and Their Applicability;296
11.2.1;Introduction;296
11.2.2;Intrathecal infusion trials;296
11.2.3;Needle placement for intrathecal pump placement;299
11.2.4;Spinal cord stimulation trials;302
11.2.5;Selected reading;307
11.2.6;Commentary on Trials and Their Applicability;308
11.2.7;Neuroaxial opioids;308
11.2.8;Neurostimulation;309
11.2.9;References;311
11.3;Chapter ­ 14 Limiting ­Morbidity;314
11.3.1;Infection;315
11.3.2;Hemorrhage;317
11.3.3;Injury of nervous tissue;319
11.3.4;Cerebrospinal fluid leak;322
11.3.5;Placing the device into the wrong compartment;324
11.3.6;Hardware migration;325
11.3.7;Hardware erosion;327
11.3.8;Hardware malfunction/fracture/disconnection;328
11.3.9;Granuloma formation;329
11.3.10;Other issues;331
11.3.11;References;331
11.3.12;Commentaryon LimitingMorbidity;334
11.3.13;Infection/erosion;334
11.3.14;CSF leak following intrathecal catheter placement;335
11.3.15;Complicatiations following SCS paddle lead implantatiantation;336
11.3.16;Lead fracture;336
12;Part V - Troubleshooting and Repair;338
12.1;Chapter ­ 15 Intraoperative Evaluation;340
12.1.1;Introduction;340
12.1.2;Principles of assessment;341
12.1.3;Non-invasive testing;347
12.1.4;Intraoperative testing;353
12.1.5;Testing methodology;354
12.1.6;Examples;355
12.1.7;Conclusion;357
12.1.8;References;358
13;Part VI - Postoperative Management;362
13.1;Chapter 16 - Programming – DBS Programming;364
13.1.1;Introduction;364
13.1.2;Overview;364
13.1.3;Process;366
13.1.4;Initial programming session;369
13.1.5;Follow up;374
13.1.6;Maintenance;379
13.1.7;Alternative programming methods;380
13.1.8;Patient control;381
13.1.9;Conclusion;382
13.1.10;References;382
13.1.11;Commentary on Programming – DBS Programming;385
13.2;Chapter 17 - Programming – SCS;388
13.2.1;Introduction;388
13.2.2;Anatomical considerations in spinal cord stimulation;388
13.2.3;Programmable aspects of stimulation;392
13.2.4;Intraoperative programming;398
13.2.5;Postoperative programming;400
13.2.6;Conclusions;405
13.2.7;References;406
13.2.8;Commentary on Programming – SCS;408
13.2.9;References;409
13.3;Chapter ­ 18 Safety ­Concerns and ­Limitations;410
13.3.1;Patient activity and environmental concerns;410
13.3.2;Medical imaging;415
13.3.3;Medical and surgical interventions;418
13.3.4;Conclusions;421
13.3.5;References;421
13.3.6;Commentaryon Safety Concerns and Limitations;424
14;Part VII - The End User;426
14.1;Chapter 19 - Expectations and Outcomes;428
14.1.1;Expectations and outcomes;428
14.1.2;Deep brain stimulation for movement disorders;428
14.1.3;Spinal cord stimulation for pain;433
14.1.4;Motor cortex stimulation for neuropathic pain;434
14.1.5;Vagal nerve stimulation for epilepsy;435
14.1.6;Expectations of the patient;436
14.1.7;Considerations from a patient´s perspective: psychology of pill burden;437
14.1.8;Conclusions;438
14.1.9;References;438
14.1.10;Commentaryon Expectations and Outcomes;442
14.2;Chapter 20 - Neuromodulation Perspectives;448
14.2.1;Introduction;448
14.2.2;Should we say DBS-HF or simply ­DBS?;449
14.2.3;Targeting;449
14.2.4;Anesthesia;452
14.2.5;How to choose best practice?;453
14.2.6;Suicide and cognitive effects;456
14.2.7;Mechanism of action;457
14.2.8;Should we go back to lesioning and unilateral implantation?;458
14.2.9;Costs;460
14.2.10;Evidence-based medicine (­EBM) and clinical trials;460
14.2.11;Alternative methods and conclusion;463
14.2.12;Commentaryon Neuromodulation Perspectives;464
14.2.13;History as the future;464
14.2.14;The DBS frequency story;467
14.2.15;The surgical procedure, including anesthesia, from the neurophysiologist/neurologist perspective;470
14.2.16;The art, and hopefully, the science of choosing the best practice ;471
14.2.17;Reflecting prospectively;473
14.2.18;References;475
15;Appendix;478
16;Index;496