Chronic deep brain stimulation (DBS) has been a rapidly evolving area of neurotherapeutics since its initial introduction for the treatment of Parkinson’s disease and essential tremor in the 1990s. For these conditions, DBS is now considered accepted therapy for patients failing to adequately respond to m- ical treatment. Since the 1990s, new clinical indications, anatomic targets, and technologies have contributed to an expanding role for DBS in the treatment of other movement disorders such as dystonia and Tourette syndrome as well as for other neurologic disorders such as epilepsy and cluster headache. Early experience has also been reported for psychiatric syndromes, such as obs- sive–compulsive disorder and depression. Experience with DBS in psychiatric disorders is very limited but is reviewed in this volume as neuropsychiatric indications are expected to grow in coming years. Because of the rapidly increasing application of DBS for neurologic and psychiatric indications and the recruitment of increasing numbers of neu- logic, neurosurgical, and psychiatric clinicians to the field, it is appropriate to provide a resource that updates the underlying scientific background, describes methodologies and standards of treatment, and provides information on new technologies essential for clinical success and to advance the field. Deep Brain Stimulation in Neurological and Psychiatric Disorders begins with reviews of the functional anatomy and physiology of motor and nonmotor aspects of the basal ganglia and their connections, which underlie the application of DBS to neurological and psychiatric disorders.
Written by renowned authorities in the field, Deep Brain Stimulation in Neurological and Psychiatric Disorders discusses today’s most current and cutting-edge applications of DBS. Initially used to treat Parkinson’s disease and essential tremor, DBS now has new clinical indications, new anatomic targets, and new technologies that enable an expanded role for DBS in the treatment of other movement disorders such as dystonia, and for other neurologic disorders such as epilepsy, Tourette syndrome and cluster headache. Early experience has also been reported for psychiatric syndromes, such as obsessive-compulsive disorder and depression. This important book begins with reviews of the functional anatomy and physiology of motor and nonmotor aspects of the basal ganglia and their connections which underlie the application of DBS to neurological and psychiatric disorders. This is followed by proposed mechanisms of action of DBS based on functional neuroimaging and neurophysiologic studies in animals and man. Discussions of patient selection, preoperative assessment, operative complications and brain targeting are followed by chapters concerning the demands of microelectrode mapping as well as new and emerging brain imaging approaches for target localization inside the operating room. Postoperative management and outcomes are reviewed in a series of chapters concerning immediate and delayed complications. Particularly important chapters on programming, DBS safety with regard to MRI and other electronic devices, neuropsychological sequelae, and quality of life are also included. Finally, new areas of DBS application are addressed by experts with experience in Tourette syndrome, epilepsy, obsessive-compulsive disorder, depression, and cluster headache. Comprehensive and state-of-the-art, Deep Brain Stimulation in Neurological and Psychiatric Disorders provides a balanced and level-headed approach to the use of DBS with emphasis on proper andobjective assessment of outcomes, particularly in regard to the new and emerging applications -- all with the main goal of providing patients with some measure of relief from their difficult conditions.
