Neurosurgery clinics of North America
-
Chronic neuropathic pain affects 8.2% of adults, extrapolated to roughly 18 million people every year in the United States. Patients who have pain that cannot be controlled with pharmacologic management or less invasive techniques can be considered for deep brain stimulation or motor cortex stimulation. These techniques are not currently approved by the Food and Drug Administration for chronic pain and are, thus, considered off-label use of medical devices for this patient population. Conclusive effectiveness studies are still needed to demonstrate the best targets as well as the reliability of the results with these approaches.
-
Current DBS therapy delivers a train of electrical pulses at set stimulation parameters. This open-loop design is effective for movement disorders, but therapy may be further optimized by a closed loop design. ⋯ Neuronal oscillations may represent or facilitate the cooperative functioning of brain ensembles, and may provide critical information to customize neuromodulation therapy. This review addresses advances to date, not of the technology per se, but of the strategies to apply neuronal signals to trigger or modulate stimulation systems.
-
Advances in deep brain stimulation (DBS) surgery have been achieved through the use of stereotactic targeting of key tracks in patients undergoing awake surgery. Intraoperative detection of track location has been useful in interpreting physiologic results, has limited the number of brain penetrations, and has decreased the incidence of reoperations. Alternatively, some centers are gaining experience with placement of the lead under general anesthesia using a purely anatomic approach, for which both computed tomography and magnetic resonance imaging have proved useful. In this article, the use of image guidance with both the anatomic and physiologic approaches is described.
-
Neurosurg. Clin. N. Am. · Jan 2014
ReviewLimbic neuromodulation: implications for addiction, posttraumatic stress disorder, and memory.
Deep brain stimulation, a technique whereby electrodes are implanted into specific brain regions to modulate their activity, has been mainly used to treat movement disorders. More recently this technique has been proposed for the treatment of drug addiction, posttraumatic stress disorder (PTSD), and dementia. The nucleus accumbens, amygdala, and hippocampus, central nuclei within the limbic system, have been studied as potential targets for neuromodulation for the treatment of drug addiction, PTSD, and dementia, respectively. As the scope of neuromodulation grows to include disorders of mood and thought, new ethical and philosophic challenges that require multidisciplinary discussion and cooperation are emerging.
-
Neurosurg. Clin. N. Am. · Jan 2014
ReviewNeuromodulation for depression: invasive and noninvasive (deep brain stimulation, transcranial magnetic stimulation, trigeminal nerve stimulation).
Major depressive disorder is among the most disabling illnesses and, despite best practices with medication and psychotherapy, many patients remain ill even after several treatment trials. For many of these patients with treatment-resistant or pharmacoresistant depression, treatment with neuromodulation offers an alternative. ⋯ This review surveys recent literature to update readers on 3 particular interventions: deep brain stimulation, transcranial magnetic stimulation, and trigeminal nerve stimulation. Additional comparative research is needed to delineate the relative advantages of these treatments, and how best to match individual patients to neuromodulation intervention.