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David S. Xu and Francisco A. Ponce

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

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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

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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

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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

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Chikashi Fukaya, Yoichi Katayama, Toshikazu Kano, Takafumi Nagaoka, Kazutaka Kobayashi, Hideki Oshima, and Takamitsu Yamamoto

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 11 Krauss JK , Loher TJ , Pohle T , Weber S , Taub E , Barlocher CB , : Pallidal deep brain stimulation in patients with cervical dystonia and severe cervical dyskinesias with cervical myelopathy . J Neurol

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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

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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

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Derrick A. Dupré, Nestor Tomycz, Michael Y. OH, and Donald Whiting

the coming decades. 62 Because of the consequences of this pandemic for society, investigators have intensified programs geared toward alleviating the burden of this debilitating disease. Thanks to recent advances in molecular genetics and functional neuroimaging, functional neurosurgery is one of the most recently developed tools used to treat morbid obesity. Deep brain stimulation (DBS) in particular has been shown to improve symptoms in neurological disorders such as Parkinson’s disease, essential tremor, and dystonia in both adults and children. 15 , 47

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Yasushi Miyagi, Fumio Shima, and Katsuya Ishido

,649 surgical wounds. Arch Surg 107: 206–210, 1973 3. Favre J , Taha JM , Steel T , et al : Anchoring of deep brain stimulation electrode using a microplate. Technical note. J Neurosurg 85 : 1181 – 1183 , 1996 Favre J, Taha JM, Steel T, et al: Anchoring of deep brain stimulation electrode using a microplate. Technical note. J Neurosurg 85: 1181–1183, 1996 4. Hamilton HW , Hamilton KR , Lone FJ : Preoperative hair removal. Can J Surg 20 : 269 – 275 , 1977 Hamilton HW, Hamilton