Neuromodulation

Copyright Page......Page 1
List of Contributors......Page 2
Foreword......Page 10
Preface......Page 11
Defining neuromodulation......Page 12
Neuromodulation for Urogenital Disorders......Page 0
Neuromodulation for chronic pain......Page 14
Functional Electrical Stimulation (FES)......Page 15
References......Page 16
Neuromodulation: A Historical Perspective......Page 18
References......Page 26
Introduction......Page 30
Pain and dependency......Page 32
Ethical and economic considerations: whom do we not serve?......Page 33
The healer’s art......Page 35
References......Page 36
Introduction......Page 37
Patient population......Page 38
Available technology......Page 39
Proposed technology – intellectual property......Page 40
Planning phase......Page 41
Product definition......Page 42
Process validation......Page 43
A modern day success story – advanced bionics and alfred e. mann......Page 44
The spinal cord stimulation market in 2000......Page 45
The design approach taken by advanced bionics corp.......Page 46
References......Page 48
Early neuromodulation devices......Page 49
The 21st century neuromodulation industry......Page 50
2002......Page 51
2004......Page 52
2006......Page 53
Competitive landscape......Page 54
References......Page 55
A: history of the societies of stereotactic and functional neurosurgery......Page 56
B: history of the international neuromodulation society......Page 59
Formation of international chapters......Page 60
Mission statement of the INS......Page 61
C: history of the international functional electrical stimulation society......Page 62
FES history......Page 63
Advances in external control of humans extremities (ECHE) meetings......Page 64
The development of IFESS......Page 65
References......Page 67
Hierarchy of clinical study design......Page 68
Clinical objective......Page 69
Study population, intervention, and setting......Page 70
Analysis of results......Page 71
Future clinical trials of neuromodulation......Page 72
Conclusion......Page 73
References......Page 74
Background......Page 76
Brief review of psychological variables......Page 77
When are psychological factors most likely to influence outcomes?......Page 78
Relevant psychological factors......Page 80
Psychological test(s) and the evaluation process......Page 81
How to make what works work better......Page 83
References......Page 84
Regulation: from research to therapy......Page 88
In the setting of decisional capacity......Page 90
In the setting of decisional incapacity......Page 91
Conflicts of interest: disclosure and justification......Page 93
Neurosurgical antecedents......Page 94
Psychosurgery......Page 95
References......Page 96
Introduction......Page 99
Brain......Page 101
Autonomic nervous system......Page 104
References......Page 112
A brief historical note......Page 114
Some basic concepts......Page 115
Voltage-gated Ion channels......Page 116
Electrically generating action potentials......Page 117
Choosing the duration of the stimulus......Page 119
Electrochemistry of stimulating electrodes......Page 120
Electrode behavior under pulsed conditions......Page 122
Monophasic pulses......Page 123
How stimulus waveform choices impact tissues......Page 124
References......Page 126
Topographic organization of the central nervous system – historical overview......Page 127
Chronic pain......Page 129
Neurostimulation and neuronal plasticity......Page 131
References......Page 133
Gene-based neuromodulation: an unmet need......Page 135
In vivo gene therapy – background......Page 136
Strategies for regulation for transgene expression......Page 137
Direct Delivery......Page 138
Ex vivo gene therapy......Page 139
Parkinson’s disease (PD)......Page 140
Epilepsy......Page 141
Chronic pain......Page 142
Spasticity......Page 143
References......Page 144
Introduction......Page 146
Potentials generated by a point source electrode......Page 147
Anisotropic electrical conductivity......Page 148
Inhomogeneous electrical conductivity......Page 150
Bipolar electrodes......Page 151
Electrode–tissue interface......Page 152
Regulated voltage and regulated current stimulation......Page 153
Current density on electrode vs. current density in the tissue......Page 154
References......Page 155
Introduction......Page 157
Depolarization block hypothesis......Page 158
Synaptic modulation hypothesis......Page 159
Neural jamming/modulation hypothesis......Page 161
Synaptic facilitation hypothesis......Page 162
Conclusions......Page 165
References......Page 166
Deep brain stimulation......Page 170
Modeling neurostimulation......Page 171
Modeling deep brain stimulation......Page 172
Clinical application of DBS models......Page 174
References......Page 176
Introduction......Page 178
Electrodes for the Neural Interface......Page 179
Major divisions of the nervous system......Page 180
Structure and organization – pns......Page 182
Organization of the autonomic nervous system......Page 183
Organization of the cns......Page 185
Organization of the spinal cord......Page 186
Pns vasculature......Page 187
Cns vasculature......Page 188
Tissue electrical impedance......Page 189
Tissue mechanical properties......Page 190
Neural behavior in response to applied electric fields......Page 191
Proximity to the neurons......Page 192
Complexity of function required from the electrode......Page 193
Stimulation......Page 194
Recording......Page 195
Tissue response......Page 196
Design principles for neural interface electrode......Page 197
Surface electrodes......Page 198
Cochlear......Page 199
Extraneural......Page 200
Interfascicular......Page 202
Intrafascicular......Page 203
Superficial and distal cns interfaces......Page 204
Deeper cns structures......Page 205
Deep brain stimulation (dbs)......Page 206
References......Page 207
Introduction......Page 212
Physical design and materials for the stimulator......Page 213
The neural interface: electrodes and leads......Page 215
Stimulating and processing circuitry......Page 216
The power system......Page 218
Device communication and telemetry......Page 220
Sensors for device command and closed-loop control......Page 221
Future directions in implantable neurostimulator technology......Page 222
References......Page 223
Neural interface systems for persons with impaired mobility......Page 226
Terminology......Page 228
System demands......Page 229
Field potentials as ni signals......Page 230
Sources of movement signals......Page 231
Sensors......Page 233
Decoding......Page 235
Shortcomings of decoding......Page 236
Extending ni to muscle control......Page 237
References......Page 238
MRI Safety and Neuromodulation Systems......Page 240
Bioeffects of Static Magnetic Fields......Page 241
Acoustic Noise......Page 242
Thermophysiologic Responses to MRI Procedure-Related Heating......Page 243
Pre-MRI Procedure Screening for Patients......Page 244
Pregnant Patients and MRI Procedures......Page 245
Evaluation of Implants and Devices for Safety in the MRI Environment......Page 247
MRI-Related Heating......Page 248
Terminology......Page 250
MRI Procedures and Neuromodulation Systems......Page 251
Programmable Infusion Pumps......Page 252
Bion Microstimulator......Page 256
Vagus Nerve Stimulation (VNS) System, VNS Therapy System......Page 259
Neurostimulation Systems for Deep Brain Stimulation......Page 260
Activa Tremor Control System......Page 261
Libra DBS System......Page 267
DBS Neuromodulation Systems: Emphasis on MRI Safety Issues......Page 269
Spinal Cord Stimulation Systems......Page 270
Itrel 3: 7425; Restore: 37711; Synergy: 7427; SynergyPlus: 7479; Synergy Versitrel: 7427V; Mattrix: 3272, 3271; and SynergyCompact: 7479B Spinal Cord Stimulation Systems......Page 271
Enterra Therapy, Gastric Electrical Stimulation System......Page 275
References......Page 276
Introduction......Page 279
References......Page 281
Physiology/anatomy of nociception......Page 282
Peripheral sensitization......Page 286
Central sensitization......Page 287
Antinociception......Page 290
Supraspinal and descending systems......Page 291
References......Page 293
Introduction......Page 298
The history of electrical brain stimulation for the relief of pain......Page 299
ON and OFF cells: contrasting inhibitory and facilitatory descending controls......Page 300
Endogenous pain control mechanisms: relevance to clinical pain......Page 301
Pharmacological insights into descending control: well beyond opioids......Page 302
Conclusion......Page 304
References......Page 305
Introduction......Page 308
The evaluation, treatment planning, and treatment of chronic pain......Page 311
Clinical evaluation and treatment planning in pain management......Page 312
Formulating an integrated treatment plan......Page 313
Pharmacotherapy......Page 315
The pain diary for evaluation and management of pain......Page 317
Physical therapy and occupational therapy......Page 320
Psychotherapies and behavioral therapies......Page 321
Record keeping......Page 322
Conclusion and looking to the future......Page 323
References......Page 324
Introduction......Page 327
General principles of application of tens......Page 328
High frequency (50–100hz) tens......Page 330
Translation of mechanisms of tens analgesia to the clinic......Page 332
The clinical efficacy of tens......Page 333
References......Page 334
Background......Page 337
Animal models of neuropathic pain......Page 338
Dorsal horn and spinal circuitry......Page 339
Possible transmitter mechanisms involved in SCS......Page 340
Clinical pain states associated with dysautonomia......Page 341
Ischemic pain......Page 342
Conclusions......Page 343
References......Page 344
The Cost-effectiveness of Spinal Cord Stimulation......Page 347
General considerations about spinal cord stimulation (scs) cost studies......Page 348
The first scs cost study......Page 349
More early indications that scs is cost-effective......Page 350
Problems with patient selection, techniques, and equipment cast doubt on the cost and effectiveness conclusions of an rct in patients with PVD
......Page 351
Reduction of hospitalizations in angina patients treated with scs reduces costs......Page 352
A randomized comparison of scs plus physical therapy vs. physical therapy alone......Page 353
Immediate cost savings with scs vs. bypass surgery......Page 354
A long-term prospective multi-site cost-effectiveness analysis......Page 355
The first review of scs cost literature......Page 356
A national effort to link scs reimbursement with continuous quality improvement......Page 357
Another look at crps......Page 358
Three-way analysis of long-term cost–utility and cost-effectiveness from a crossover rct of scs vs. reoperation for fbss......Page 359
6-Month rct comparison of scs vs. medical management healthcare costs, health resources use, and quality of life in fbss: predictable results, interesting problems......Page 363
Appropriate patient selection......Page 364
The cost impact of conducting a screening trial......Page 365
References......Page 366
Introduction......Page 369
Mechanisms of action of neurostimulation on peripheral neuropathic pain......Page 370
General clinical series......Page 371
Diabetic neuropathy......Page 372
Post-herpetic neuralgia (PHN)......Page 374
References......Page 375
Introduction......Page 377
The efficacy of spinal cord stimulation in treating CRPS......Page 378
The benefits and risks of spinal cord stimulation......Page 380
The role of SCS in the comprehensive interdisciplinary treatment model of CRPS......Page 382
Conducting a screening trial......Page 383
Patient management......Page 384
Conclusions......Page 385
References......Page 386
Historical perspective......Page 388
Pertinent anatomy, physiology, and disease pathophysiology......Page 389
Blood supply of peripheral nerves......Page 390
Peripheral nerve stimulation (pns) – indications......Page 391
Surgical technique......Page 393
Review of most recent literature......Page 394
Assessment and cost-effectiveness......Page 395
References......Page 397
Introduction......Page 399
Literature review......Page 400
Surgical technique......Page 401
Pulse generator implantation......Page 402
Stimulation usage......Page 403
Conclusions......Page 404
References......Page 405
Historical perspective......Page 407
Rationale for selection......Page 410
Implantation procedure......Page 411
Outcomes......Page 412
Complications and contraindications......Page 414
References......Page 415
Delivery systems for pharmaceutical agents......Page 418
Positioning the patient......Page 419
Overview......Page 420
Ligaments of the spine......Page 421
Blood supply to the spinal cord......Page 422
The vacuum effect......Page 423
Anatomical detail of the epidural space......Page 424
Distribution of intrathecal agents in the spinal fluid......Page 425
References......Page 427
Indications for IT therapy......Page 428
Trials for IT delivery......Page 430
Morphine......Page 431
Hydromorphone......Page 433
Sufentanil......Page 434
Methadone......Page 435
Meperidine......Page 436
An algorithmic approach to intrathecal therapy......Page 437
Conclusion......Page 439
References......Page 440
Current implantable systems......Page 443
Medtronic synchromed pumps......Page 444
Advanced neuromodulation systems (st. jude medical) accurx pump......Page 445
Cost efficacy......Page 446
Intrathecal baclofen for spasticity......Page 447
Complications......Page 448
General complications of intrathecal drug delivery systems......Page 449
Choice of system......Page 450
References......Page 451
Introduction......Page 453
Local anesthetics......Page 454
Bupivacaine......Page 455
Ropivacaine......Page 456
Clonidine......Page 457
Ziconotide......Page 458
Baclofen......Page 460
Gabapentin......Page 462
Conclusions......Page 463
References......Page 464
What is compounding?......Page 468
Important issues for intrathecal drug compounding......Page 469
The united states pharmacopoeia......Page 470
Regulations......Page 471
Legal side of compounding......Page 472
Considerations for compounded formulations for intraspinal pumps......Page 473
Polyanalgesic consensus guidelines......Page 474
References......Page 475
Introduction......Page 476
General indications and preoperative evaluation......Page 477
Surgical and drug administration techniques......Page 478
Side effects and complications......Page 479
References......Page 480
Introduction......Page 482
Patient assessment and selection......Page 483
Fundamentals of the stimulation technique......Page 484
Future prospects......Page 486
References......Page 488
Patients......Page 491
Microelectrode recording......Page 492
Results......Page 493
References......Page 494
Introduction......Page 496
Preoperative localization of the motor cortex......Page 497
Intraoperative electrophysiology......Page 498
Stimulation parameters......Page 500
Peripheral pain......Page 501
Complications......Page 502
Conclusions......Page 505
References......Page 506
Historical events in the development of functional neurosurgery for movement disorders......Page 508
Physiology of parkinson’s disease......Page 509
Deep brain stimulation: mechanism of action......Page 510
Rate model......Page 512
Thalamocortical dysrhythmia......Page 513
Vim thalamus/parkinsonian and essential tremor (ET)......Page 514
References......Page 515
History of surgical intervention for PD......Page 518
Preoperative screening evaluation......Page 519
Preoperative preparation and frame placement......Page 520
Coordinate systems and target selection......Page 521
Microelectrode recording......Page 522
IPG/Lead extenders......Page 523
Choosing the stimulation target: STN vs. GPi......Page 524
Complications......Page 525
References......Page 526
Historical perspective......Page 528
Pertinent anatomy, physiology, and disease pathophysiology......Page 529
Rationale for neuromodulation, target selection, and approach......Page 532
Implant procedure details......Page 533
Outcomes (review of most recent literature)......Page 534
Complications and avoidance......Page 535
References......Page 536
Introduction......Page 539
Oral baclofen......Page 540
Pump implantation and programming......Page 541
Risks......Page 542
Perspective on parkinson’s disease......Page 543
Preliminary studies......Page 544
Current state of therapy......Page 545
References......Page 546
Diagnosis and classification of dystonia......Page 549
Deep brain stimulation: surgical technique......Page 550
Macroelectrode stimulation......Page 551
Clinical results......Page 553
Conclusions......Page 554
References......Page 555
Clinical characteristics and prevalence of TS......Page 557
History of neurosurgical treatment of TS......Page 558
Targets......Page 559
Neuroanatomic basis for deep brain stimulation in TS......Page 560
Patient selection......Page 561
Programming......Page 562
References......Page 563
Hemifacial spasm......Page 565
Neurodiagnostic evaluation of hfs......Page 566
Operative procedures/patient positioning......Page 567
Decompression of the offending vessel......Page 568
Operative results and clinical outcome......Page 569
Meige syndrome......Page 570
Outcome and complications......Page 571
References......Page 573
Introduction......Page 576
Anatomy of the CM–Pf complex......Page 577
Afferent connection fibers of the cm......Page 578
Afferent and efferent connection of the Pf......Page 579
The CM–Pf complex and movement disorders......Page 580
Data interpretations......Page 581
Surgical planning and 3D stereotactic anatomy......Page 582
Patient evaluation......Page 585
Results......Page 586
Discussion......Page 588
Summary and perspectives......Page 589
References......Page 590
Introduction......Page 593
Pathophysiology......Page 594
References......Page 596
NCP device components......Page 598
Theoretical basis of VNS......Page 600
Clinical utility of VNS......Page 602
Alternative uses of VNS......Page 604
Operative procedure: general considerations......Page 605
Operative procedure: relevant anatomy......Page 606
Operative procedure in detail......Page 607
Surgical complication avoidance and management......Page 608
References......Page 609
Introduction......Page 611
Targeting and surgical procedure......Page 612
Pilot studies......Page 615
Complications......Page 616
Cerebellum......Page 617
Open- versus closed-loop systems......Page 618
References......Page 619
Cerebellar organization......Page 622
Research leading to cerebellar stimulation for epilepsy......Page 623
Clinical experience......Page 624
References......Page 625
Introduction......Page 628
Ecog storage......Page 629
Technique of neurostimulator system implantation......Page 630
Conclusions......Page 632
References......Page 633
Introduction......Page 634
References......Page 635
Introduction......Page 636
Electroconvulsive therapy (ECT)......Page 637
Transcranial magnetic stimulation (TMS)......Page 638
Vagus nerve stimulation (VNS)......Page 641
References......Page 644
Electrical Brain Stimulation in Treatment-Resistant Obsessive–Compulsive Disorder: Parcellation, and Cyto- and Chemoarchitecture of the Bed Nucleus of the Stria Terminalis – a Review......Page 648
Cytoarchitecture of the bst......Page 649
Somatostatin......Page 651
Pituitary adenylate cyclase activating polypeptide......Page 652
The granin family......Page 653
The catecholaminergic system......Page 654
Sexual dimorphism......Page 655
References......Page 656
Introduction......Page 659
Treatment of refractory patients......Page 660
History......Page 661
Dbs for obsessive–compulsive disorder......Page 663
Stimulation technique......Page 664
Stimulation targets for depression......Page 665
Issues independent of dbs target......Page 666
Mechanism(s) of action of dbs......Page 667
Adverse effects......Page 668
Research protocols for investigational treatment with dbs......Page 669
References......Page 670
Introduction......Page 672
Rationale for nucleus accumbens as the target of surgery......Page 673
Surgical procedure......Page 674
Perioperative patient management......Page 675
Programming and other points of consideration......Page 676
Conclusion......Page 677
References......Page 678
Introduction......Page 679
Introduction......Page 680
Electrical stimulation of the auditory nerve......Page 681
Components of cochlear implant systems......Page 683
Transformation of a microphone input into stimuli for the implant......Page 684
Performance with present-day unilateral implants......Page 685
Recent advances......Page 686
Possibilities for the future......Page 687
References......Page 688
Introduction......Page 690
Various approaches to treat neural forms of blindness......Page 692
Development of a visual prosthesis to restore vision to the blind......Page 694
The approach of the boston retinal implant project......Page 695
Microfabrication of thin-film, flexible circuits......Page 697
Considerations for encapsulation of implanted microelectronic components......Page 698
Titanium case and feedthrough technology......Page 699
Design and fabrication of the stimulating electrode array......Page 700
Iridium oxide electrodes......Page 701
Methods of surgical implantation......Page 702
Human test results to date......Page 703
Significant long-term problems......Page 706
References......Page 707
Introduction......Page 710
Upper limb applications......Page 711
Surface nmes......Page 712
Intramuscular nmes......Page 713
Upper limb applications......Page 714
Lower limb applications......Page 715
Acknowledgments......Page 716
References......Page 717
Introduction......Page 719
Animal studies......Page 720
Human studies......Page 722
Discussion......Page 730
References......Page 731
Historical perspective......Page 733
Rationale for neuromodulation target selection and approach......Page 734
Programming and other points of consideration......Page 735
Implanted upper extremity neuroprostheses......Page 736
Lower extremity neuroprostheses......Page 738
What the future holds......Page 739
References......Page 740
Introduction......Page 743
Control of airway patency through tongue muscles......Page 744
Prosthetic design for OSA......Page 746
Single electrode closed loop prosthesis design for OSA......Page 747
OSA prosthesis with selective stimulation......Page 748
Conclusion......Page 750
References......Page 751
Introduction......Page 753
References......Page 755
History of the basic discovery or technology......Page 756
Current state of basic science or technical knowledge......Page 757
Use of knowledge or technology in clinical applications......Page 759
What is needed to fill these gaps/deficits......Page 760
References......Page 761
Basic elements of a pacemaker system......Page 763
Basic terminology, programming, and timing cycles......Page 764
Additional programming and features......Page 766
Cardiac resynchronization therapy (CRT)......Page 767
References......Page 768
Historical perspective......Page 769
Stimulation......Page 771
Cardiac “electrical” anatomy......Page 772
Pacing for atrioventricular block......Page 773
Pacing for heart failure......Page 774
Pacemaker-related complications......Page 775
References......Page 776
Historical perspective......Page 779
Implant procedure details......Page 780
Function, programming, and other points of consideration......Page 781
Indications and patient selection criteria......Page 782
References......Page 783
Introduction......Page 784
History of stimulation for PAD......Page 785
Indications and patient selection criteria......Page 786
Implant procedure details and programming......Page 787
Outcomes......Page 788
References......Page 789
Angina pectoris......Page 791
Therapy-refractory angina......Page 792
Neural hierarchy in cardiac control......Page 794
Electrical neuromodulation......Page 795
Implant procedure......Page 796
Programming and other points for consideration......Page 797
Outcomes review of most recent literature......Page 798
Complications and avoidance......Page 799
Conclusions......Page 800
References......Page 801
Introduction......Page 804
Autonomous nervous system: anatomy and normal physiology......Page 805
The baroreflex......Page 806
Pharmacologic neuromodulation......Page 807
Carotid sinus experiments involving animal models......Page 808
Role of the aortic arch......Page 809
Ongoing trials......Page 810
Future prospects......Page 811
References......Page 812
Introduction......Page 814
Neurostimulation for acute heart failure......Page 815
Sympathetic Neuromodulation for Arrhythmia......Page 817
Parasympathetic Neuromodulation for Arrhythmias......Page 818
References......Page 819
Background......Page 822
Current state of basic science......Page 823
Gaps in knowledge for clinical applications......Page 825
References......Page 826
Model of pain transmission in the abdomen......Page 829
Dorsal column pathways in visceral nociception......Page 830
SCS in visceral pain: animal data......Page 831
SCS in visceral pain: human data......Page 832
Conclusions......Page 834
References......Page 835
Gastric stimulation to activate gastric transit......Page 836
Stomach anatomy and mechanisms of gastric propulsion......Page 837
Rationale for neuromodulation target and approach......Page 838
Implant procedure details......Page 839
Programming and stimulation parameters......Page 840
Mechanisms activated by electrical stimulation of the stomach......Page 841
What the future holds......Page 842
References......Page 843
Introduction......Page 845
Small intestinal myoelectrical activity......Page 846
Dual pulses......Page 848
Effects on intestinal slow waves......Page 849
Effects and mechanisms on intestinal motility......Page 850
Effects and mechanisms on intestinal transit and absorption......Page 851
Potential applications of ies......Page 852
Discussion and conclusions......Page 853
References......Page 854
Introduction......Page 857
Anatomy......Page 859
Parasympathetic pathways......Page 861
Neural modulatory mechanisms......Page 863
Afferent pathways......Page 864
Urothelial-afferent interactions......Page 865
Reflex mechanisms controlling the lower urinary tract......Page 866
Anatomy of central nervous pathways controlling the lower urinary tract......Page 867
Pathways in the spinal cord......Page 868
Somatic pathways to the urethral sphincter......Page 869
Voiding reflexes......Page 870
Excitatory neurotransmitters......Page 871
Spinal injury......Page 872
Sympathetic pathways......Page 874
Peripheral mechanisms......Page 875
Glandular secretion......Page 876
Central reflex pathways......Page 877
References......Page 878
Nomenclature and epidemiology......Page 883
Etiology, pathophysiology, and research evidence......Page 884
Clinical features and diagnosis......Page 885
Historic overview......Page 886
Indications and contraindications for sacral nerve root stimulation......Page 887
Pelvic neuroanatomy......Page 888
The retrograde (cephalocaudal) approach......Page 889
Laparoscopic implantation of neuroprosthesis (the LION procedure)......Page 891
Pudendal nerve stimulation using the bion......Page 892
Intrathecal drug delivery......Page 893
References......Page 894
Introduction......Page 897
History......Page 898
Patient selection......Page 899
Multiple sclerosis (MS)......Page 900
Surgical technique......Page 901
Outcomes......Page 903
Dorsal genital nerve......Page 904
Electrical stimulation directly to the bladder and spinal cord......Page 905
Conclusions......Page 906
References......Page 907
Introduction......Page 909
Classification and epidemiology......Page 911
Treatment......Page 912
Hypothalamic anatomy and physiology......Page 913
Animal studies of hypothalamic stimulation......Page 914
Human studies of hypothalamic lesioning and stimulation......Page 915
References......Page 916
Clinical outcomes......Page 919
Conclusions......Page 921
References......Page 922
Physiology......Page 923
Conventional treatment......Page 924
Neuromodulation for tinnitus......Page 925
Conclusion......Page 926
References......Page 927
Introduction......Page 928
Scientific background for CNS drug delivery......Page 929
History of direct CNS drug therapy......Page 931
Other drug products, routes of administration, and commercial environment......Page 932
References......Page 933
Deep Brain Stimulation for Cognitive Neuromodulation......Page 935
Summary Points......Page 937
References......Page 938
Introduction......Page 939
References......Page 940
Introduction......Page 942
Introduction......Page 943
Preoperative imaging......Page 944
Target localization......Page 945
Microelectrode recordings......Page 947
Electrode implantation and fixation......Page 948
Complications......Page 949
References......Page 950
Introduction......Page 952
Surgical technique......Page 953
Local anesthesia......Page 954
Emg/ssep during SCS implant surgery......Page 955
Laminotomy-placed leads under spinal anesthesia: the results......Page 956
References......Page 957
Surgical technique for median and ulnar nerves......Page 959
Surgical technique for sciatic nerve......Page 960
Surgical technique for common peroneal nerve......Page 961
Trialing......Page 962
Techniques for Subcutaneous Peripheral Nerve Field Stimulation for Intractable Pain......Page 963
Trial stimulation......Page 966
Permanent implant – percutaneous wire electrodes......Page 967
Permanent implant – paddle electrode......Page 970
References......Page 971
Surgical planning/preoperative considerations......Page 972
Positioning and surgical preparation......Page 973
Catheter insertion......Page 974
Pump preparation and insertion......Page 975
Postoperative considerations......Page 976
References......Page 977
Surgical anatomy......Page 978
Operative technique......Page 980
Complications of surgery......Page 984
References......Page 985
Advanced Neuromodulation Systems (ANS) IPG
 Specifications......Page 986
Medtronic IPG Specifications......Page 987
Boston Scientific Neuromodulation IPG  Specifications
......Page 989
A......Page 990
C......Page 991
D......Page 993
E......Page 995
G......Page 996
H......Page 997
I......Page 998
L......Page 999
M......Page 1000
N......Page 1001
O......Page 1002
P......Page 1003
S......Page 1004
T......Page 1006
V......Page 1007
Z......Page 1008