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Essential Neuromodulation This Page Intentionally Left Blank Essential Neuromodulation Essential Neuromodulation This page intentionally left blank Essential Neuromodulation Jeffrey E. Arle Director, Functional Neurosurgery and Research, Department of Neurosurgery Lahey Clinic Burlington, MA Associate Professor of Neurosurgery Tufts University School of Medicine, Boston, MA Jay L. Shils Director of Intraoperative Monitoring, Dept of Neurosurgery Lahey Clinic Burlington, MA AMSTERDAM • BOSTON • HEIDELBERG • LONDON NEW YORK • OXFORD • PARIS • SAN DIEGO SAN FRANCISCO • SINGAPORE • SYDNEY • TOKYO Academic Press is an Imprint of Elsevier Academic Press is an imprint of Elsevier 32 Jamestown Road, London NW1 7BY, UK 30 Corporate Drive, Suite 400, Burlington, MA 01803, USA 525 B Street, Suite 1800, San Diego, CA 92101-4495, USA First edition 2011 Copyright © 2011 Elsevier Inc. All rights reserved No part of this publication may be reproduced, stored in a retrieval system or transmitted in any form or by any means electronic, mechanical, photocopying, recording or otherwise without the prior written permission of the publisher Permissions may be sought directly from Elsevier's Science & Technology Rights Department in Oxford, UK: phone ( + 44) (0) 1865 843830; fax ( +44) (0) 1865 853333; email: [email protected]. Alternatively, visit the Science and Technology Books website at www.elsevierdirect.com/rights for further information Notice No responsibility is assumed by the publisher for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions or ideas contained in the material herein. Because of rapid advances in the medical sciences, in particular, independent verification of diagnoses and drug dosages should be made British Library Cataloguing-in-Publication Data A catalogue record for this book is available from the British Library Library of Congress Cataloging-in-Publication Data A catalog record for this book is available from the Library of Congress ISBN : 978-0-12-381409-8 For information on all Academic Press publications visit our website at elsevierdirect.com Typeset by Thomson Digital, B-10-11-12, Noida Special Economic Zone, Noida-201 305, India, Website: www.thomsondigital.com. Printed and bound in China 10 11 12 13 14 15 10 9 8 7 6 5 4 3 2 1 Contents Contributors ix Introduction xi Andres Lozano and Francisco Ponce Part I The Neuromodulation Approach 1. The Neuromodulation Approach 3 Jeffrey E. Arle, MD, PhD Part II Regions of Application 2. Cerebral – Surface 19 Sergio Canavero, MD (US FMGEMS) Commentary on Cerebral – Surface 43 Beatrice Cioni, MD 3. Cerebral – Deep 47 Yakov Gologorsky, MD and Ron Alterman, MD Commentary on Cerebral – Deep 69 Joachim K. Krauss, MD 4. Spinal – Extradural 73 Timothy R. Deer, MD and Mathew Shocket, MD Commentary on Spinal – Extradural 92 Jeffrey E. Arle, MD, PhD 5. Peripheral Nerve 95 Konstantin V. Slavin, MD Commentary on Peripheral Nerve 107 Jeffrey E. Arle, MD, PhD v vi Contents Part III The Neuromodulation Therapy Interface 6. The Electrode – Materials and Configurations 109 Daniel R. Merrill, PhD Commentary on The Electrode – Materials and Configurations 147 Mark Stecker, PhD, MD 7. The Electrode – Principles of the Neural Interface: Axons and Cell Bodies 153 Cameron C. McIntyre, PhD Commentary: Considerations for Quantitative Modeling of Excitation and Modulation of CNS neurons 162 Warren M. Grill, PhD 8. The Electrode – Principles of the Neural Interface: Circuits 169 Erwin B. Montgomery Jr, MD Commentary on The Electrode – Principles of the Neural Interface: Circuits 191 Mark Stecker, PhD, MD 9. Device Materials, Handling, and Upgradability 193 John Kast, BSME, Gabi Molnar, MS and Mark Lent, BSME, MSMOT Commentary on Device Materials, Handling, and Upgradability 209 Jay L. Shils, PhD 10. Electronics 213 Emarit Ranu, MSEE, MSBS, EMT-B Commentary on Electronics 244 Henricus Louis Journee, MD, PhD 11. Power 253 Tracy Cameron, PhD, Ben Tranchina, MSEE and John Erickson, BSEE Commentary on Power 266 Jay L. Shils, PhD Part IV Placing Neuromodulation in the Human Body 12. Surgical Techniques 271 Jeffrey E. Arle, MD, PhD Commentary on Surgical Techniques 281 Phillip Starr, MD, PhD Contents vii 13. Trials and Their Applicability 283 Louis J. Raso, MD Commentary on Trials and Their Applicability 295 Y. Eugene Mironer, MD 14. Limiting Morbidity 301 Konstantin V. Slavin, MD Commentary on Limiting Morbidity 321 Alon Y. Mogilner, MD, PhD Part V Troubleshooting and Repair 15. Intraoperative Evaluation 327 Jay L. Shils, PhD and Jeffrey E. Arle, MD, PhD Commentary on Intraoperative Evaluation 346 Jeffrey E. Arle, MD, PhD Part VI Postoperative Management 16. Programming – DBS Programming 351 Jay L. Shils, PhD Commentary on Programming – DBS Programming 372 Jeffrey E. Arle, MD, PhD 17. Programming – SCS 375 Gabi Molnar, MS, Lisa Johanek, PhD, Steve Goetz, MS and John Heitman, BS Commentary on Programming – SCS 395 Richard B. North, MD 18. Safety Concerns and Limitations 397 Paul S. Larson, MD and Alastair J. Martin, PhD Commentary on Safety Concerns and Limitations 411 Ali Rezai and Jeffrey E. Arle, MD, PhD Part VII The End User 19. Expectations and Outcomes 415 Guillermo A. Monsalve, MD, Chad W. Farley, MD and George T. Mandybur, MD Commentary on Expectations and Outcomes 429 Chris Hart, BA viii Contents 20. Neuromodulation Perspectives 435 Alim Louis Benabid, MD, PhD Commentary on Neuromodulation Perspectives 451 Erwin B. Montgomery Jr., MD Appendix 465 Index 483 Contributors Ron Alterman, MD, Department of Neurosurgery, Mount Sinai School of Medicine, New York, USA Jeffrey E. Arle, MD, PhD, Director, Functional Neurosurgery, and Research, Department of Neurosurgery, Lahey Clinic, Burlington MA Associate Professor of Neurosurgery, Tufts, University School of Medicine, Boston, MA, USA Alim Louis Benabid, MD, PhD, CEA Clinatec, Clinatec, CEA Grenoble, Grenoble, France Tracy Cameron, St Jude Medical Neuromodulation Division, Plano, Texas, USA Sergio Canavero, MD (US FMGEMS), Turin Advanced Neuromodulation Group (TANG), Turin, Italy Beatrice Cioni, MD, Department of Functional and Spinal Neurosurgery, Catholic University, Rome, Italy Timothy R. Deer, MD, President and CEO, The Center for Pain Relief, Inc., Charleston, WV, Clinical Professor of Anesthesiology West Viriginia University, Charleston, WV, USA John Erickson, BSEE, St Jude Medical Neuromodutation Division, Plano, Texas, USA Chad W. Farley, MD, Department of Neurosurgery, University of Cincinnati (UC) Neuroscience Institute and UC College of Medicine, and Mayfield Clinic, Cincinnati, OH, USA Steve Goetz, MS, Medtronic Neuromodulation, Minneapolis, MN, USA Yakov Gologorsky, MD, Department of Neurosurgery, Mount Sinai School of Medicine, New York, USA Warren M. Grill, PhD, Department of Biomedical Engineering, Duke University, Durham, NC, USA Chris Hart, BA, Director of Urban and Transit Projects, Institute for Human centered Design, Boston, massachusetts, USA John Heitman, Medtronic Neuromodulation, Cincinnati, OH, USA Lisa Johanek, PhD, Medtronic Neuromodulation, Minneapolis, USA Henricus Louis Journee, MD, PhD, Department of Neurosurgery, University Medical Center Groningen, Groningen, The Netherlands John Kast, BSME, Medtronic Neuromodulation, Minneapolis, MN, USA Joachim K. Krauss, MD, Medical University of Hannover/Neurosurgery, Hanover, Germany ix x Contributors Paul S. Larson, MD, Associate Professor, Department of Neurological Surgery, University of California, San Francisco, CA, USA Chief, Neurosurgery, San Francisco VA Medical Center, San Francisco, CA, USA Mark Lent, BSME, MSMOT, Medtronic Neuromodulation, Minneapolis, MN, USA Andres Lozano, Division of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada George T. Mandybur, MD, Department of Neurosurgery, University of Cincinnati (UC) Neuroscience Institute and UC College of Medicine, and Mayfield Clinic, Cincinnati, OH, USA Alastair J. Martin, PhD, Adjunct Professor, Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA Cameron C. McIntyre, PhD, Cleveland Clinic Foundation, Department of Biomedical Engineering, Cleveland, OH, USA Daniel R. Merrill, PhD, Vice President, Technical Affairs, Alfred Mann Foundation, Santa Clara, CA, USA Y. Eugene Mironer, MD, 220 Roper Mountain Road Ext., Greenville, SC Alon Y. Mogilner, MD, PhD, Assitant Professor of Neurosurgery, Chief, Section of Function and Restorative Neurosurgery, Hofstra–North shorf LIJ School of Madicine, President, AANS/CNS Joint section on Pain, Great Neck, NY, USA Gabi Molnar, MS, Medtronic Neuromodulation Minneapolis, MN, USA Guillermo A. Monsalve, MD, Department of Neurosurgery, University of Cincinnati (UC) Neuroscience Institute and UC College of Medicine, and Mayfield Clinic, Cincinnati, OH, USA Erwin B. Montgomery Jr, MD, Dr Sigmund Rosen Scholar in Neurology, Professor of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA Richard B. North, MD, The Sandra, Malcolm Berman Brain & Spine Institute, Baltimore, MD Professor of Neurosurgery, Anesthesiology, Critical Care Medicine (ret.), Johns Hopkins University School of Medicine, Baltimore, MD Francisco Ponce Division of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada Emarit Ranu, MSEE, MSBS, EMT-B, Boston Scientific Neuromodulation, Fort Collins, CO, USA Louis J. Raso, MD, CEO, Jupiter Intervention Pain Management Corp, Jupiter, FL, US Ali Rezai, Ohio State University, Department of Neurosurgery, Columbus, OH, USA S. Matthew Schocket, MD,
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