understanding the neurobiology of dementias, no treatments are currently available to significantly alter their natural history. An emerging avenue of therapy currently under investigation is deep brain stimulation (DBS), which has demonstrated an ability to engage and regulate dysfunctional neuronal circuits across multiple neural networks. Furthermore, cellular responses that occur after DBS may direct trophic effects to local neural tissue, potentially counteracting chronic degenerative disease processes. In this manuscript, we provide a summary of the current body of
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Nasir Raza Awan, Andres Lozano, and Clement Hamani
, Hamani C, Moro E, Lozano AM, Deep brain stimulation and movement disorder treatment, 369–373, 2009, 65 with permission from Elsevier. Movement Disorders Parkinson Disease The introduction of DBS as a therapeutic tool for advanced PD has revolutionized the clinical management of this condition. Due to its safety profile and efficacy, DBS evolved from a last-resort therapeutic option to a modality that is now routinely offered to patients. Over the years, surgical candidates and the outcome expected with this procedure became well established. In fact, there
Kristian J. Bulluss, Erlick A. Pereira, Carole Joint, and Tipu Z. Aziz
I n the 1990s, publication of the long-term results of pallidotomy for advanced Parkinson's disease (PD) showing significant loss of dyskinesias, rigidity, and tremor led to a second resurgence of stereotactic surgery for PD. 11 However, the relatively high incidence of side effects in some series and the demonstration that bilateral subthalamic nucleus (STN) stimulation was effective and led to a significant reduction in drug requirement, unlike pallidal surgery, resulted in the procedure of choice becoming deep brain stimulation (DBS). With the
Thomas L. Ellis and Andrew Stevens
stimulation may yield up to a 50% reduction in seizure frequency, 2 although most of these patients will not be completely seizure free. Deep brain stimulation is another example of neuromodulation. Given the significant experience and success of DBS for movement disorders 39 combined with its reversibility, programmability, and low risk of complications, there has been a resurgence of interest in using DBS devices for treating medically refractory epilepsy. Deep brain stimulation lead implantation within the ANT, as well as other CNS targets—including the CN
Matthew Moser, Shripadh Chitta, Patrick F. O’Brien, Andrew Caras, and Kathryn L. Holloway
. References 1 Bernstein JE , Kashyap S , Ray K , Ananda A . Infections in deep brain stimulator surgery . Cureus . 2019 ; 11 ( 8 ): e5440 . 31632885 2 Bjerknes S , Skogseid IM , Sæhle T , Dietrichs E , Toft M . Surgical site infections after deep brain stimulation surgery: frequency, characteristics and management in a 10-year period . PLoS One . 2014 ; 9 ( 8 ): e105288 . 10.1371/journal.pone.0105288 3 Jitkritsadakul O , Bhidayasiri R , Kalia SK , Hodaie M , Lozano AM , Fasano A . Systematic review of hardware
Short circuit in deep brain stimulation
Clinical article
Kazuhiro Samura, Yasushi Miyagi, Tsuyoshi Okamoto, Takehito Hayami, Junji Kishimoto, Mitsuo Katano, and Kazufumi Kamikaseda
impulse generators for deep brain stimulation. Clinical article . J Neurosurg 110 : 1274 – 1277 , 2009 2 Arle JE , Mei LZ , Shils JL : Modeling parkinsonian circuitry and the DBS electrode. I. Biophysical background and software . Stereotact Funct Neurosurg 86 : 1 – 15 , 2008 3 Blomstedt P , Hariz MI : Hardware-related complications of deep brain stimulation: a ten year experience . Acta Neurochir (Wien) 147 : 1061 – 1064 , 2005 4 Boviatsis EJ , Stavrinou LC , Themistocleous M , Kouyialis AT , Sakas DE : Surgical and
Andrew I. Yang, Faical Isbaine, Abdulrahman Alwaki, and Robert E. Gross
S urgical resection or ablation remains the cornerstone in the management of patients with drug-resistant epilepsy (DRE). Neuromodulation is an important surgical alternative when a destructive procedure is not feasible or if seizure control continues to be suboptimal. Specifically for deep brain stimulation (DBS), 2 targets have been shown to be effective in double-blinded randomized controlled trials (RCTs)—the anterior nucleus of the thalamus (ANT) and centromedian (CM) nucleus. Results of the Stimulation of the Anterior Nucleus of the Thalamus for
Chikashi Fukaya, Yoichi Katayama, Toshikazu Kano, Takafumi Nagaoka, Kazutaka Kobayashi, Hideki Oshima, and Takamitsu Yamamoto
pallidus internus for control of primary generalized dystonia . Acta Neurochir Suppl 87 : 125 – 128 , 2003 9 Katayama Y , Kano T , Kobayashi K , Oshima H , Fukaya C , Yamamoto T : Difference in surgical strategies between thalamotomy and thalamic deep brain stimulation for tremor control . J Neurol 252 : 4 Suppl 17 – 22 , 2005 10 Krause M , Fogel W , Kloss M , Rasche D , Volkmann J , Tronnier V : Pallidal stimulation for dystonia . Neurosurgery 55 : 1361 – 1368 , 2004 10.1227/01.NEU.0000143331.86101.5E 11 Krauss JK
Jacques Favre, Jamal M. Taha, Timothy Steel, and Kim J. Burchiel
quadripolar deep brain stimulation electrodes (model 3387; Medtronic, Minneapolis, MN) to the calvaria. A curvilinear skin incision is made anterior to the coronal suture, 2.5 cm lateral to the midline. The plate is bent on its longitudinal axis to create a tunnel that is approximately one-half of the diameter of the electrode through which the lead passes. The plate is then placed parallel to the scalp flap and affixed to the skull medially with one 4-mm screw. The hole for the lateral screw is drilled but no screw is inserted. A 3-mm twist-drill hole is created
Alexander C. Whiting, Michael Y. Oh, and Donald M. Whiting
the central nervous system. 30 , 48 This evidence of central nervous system involvement led to the development of a large body of medical literature that evaluates the efficacy of DBS for the treatment of these disorders. Deep Brain Stimulation for Obesity The prevalence of obesity across all age spectrums has greatly increased over the last few decades in both the developed and the developing world. 43 , 44 , 57 Obesity is defined as a body mass index (BMI) greater than or equal to 30, and morbid obesity is defined as a BMI greater than or equal to 40 or greater
