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Neuroprostheses for Restoring Sensation

Introduction One of the most beautiful words is touch; it exquisitely represents our need to prove ourselves that we are not in a dream! Mehmet Murat Ildan Feelings aroused by the touch of someone’s hand… work on both the unconscious and the conscious aspects of the self, and they have physiological consequences, as well. Bernie Siegel When an individual loses a limb, they lose touch with…

Neuromodulation for Treatment of Dry Eye

Acknowledgments Writing and editorial assistance was provided to the authors by Andrew Fitton, PhD, and Kakuri M. Omari, PhD, of Evidence Scientific Solutions, Philadelphia, PA, USA, and was funded by Allergan plc. Overview of Dry Eye Disease Signs, Symptoms, and Diagnosis of Dry Eye Dry eye, also known as keratoconjunctivitis sicca, is a multifactorial disease of the tears and ocular surface that is caused by reduced…

The Development of Visual Prosthetic Devices to Restore Vision to the Blind

Aged related macular degeneration (AMD) and retinitis pigmentosa (RP) are two degenerative diseases that affect mainly the photoreceptors layer, rendering the retina unable to translate light into biological signals and causing blindness in patients. In the United States, 700,000 new AMD patients are diagnosed every year and 1 in 4000 live births are afflicted with RP. In these conditions, inner retinal neurons (bipolar cells and ganglion…

Stimulation for the Return of Hearing

Acknowledgments This chapter is an update of the chapter with the same title in the first edition of this book. Parts of the update were drawn from several recent publications, including and . Author BSW is a consultant for MED EL GmbH and author MFD is a consultant for Advanced Bionics LLC. However, none of the statements in this chapter favors either of those companies or…

A Brief History of the Cochlear Implant and Related Treatments

Acknowledgments Parts of this chapter were drawn or adapted from several publications by the authors, including , and . Author BSW is a consultant for MED EL GmbH and author MFD is a consultant for Advanced Bionics LLC. However, none of the statements in this chapter favors either of those companies or any other company. Introduction Cochlear implants (CIs) have been described as one of the…

Neuromodulation of the Spinal Cord for Movement Restoration

Historical Perspective Over a century of elegant experiments have culminated in demonstrating that mammalian spinal networks have sophisticated neural networks which intrinsically contain the necessary information to generate locomotion, and these central pattern-generating networks are viable targets for recovery after spinal cord injury ( ). Coordinated locomotor activity in mammals launched six decades of detailing how these interneuronal systems function, and their interactions with sensory information…

Lower Extremity Motor System Neuroprostheses

Neuroprosthetic Options for Restoring or Improving Ambulation Improving truncal stability is ranked as one of the highest priorities for functional improvement by individuals with paraplegia and tetraplegia alike ( ), and within 10 years of thoraco-lumbar-level spinal cord injuries, individuals would prefer to walk again over eliminating pain or improving other bodily functions ( ). Similarly, improving walking and upper body/trunk strength are identified as very…

Stimulation for Return of Upper-Extremity Function

Historical Perspective The first modern practical application of neuroprostheses to move paralyzed limbs was to correct foot drop in hemiplegic subjects ( ). Based on the success of the Lubjliana foot-drop system, became the first to apply electrical stimulation in spinal cord injury (SCI) for functional purposes. Long and Masciarelli used a splint that passively held the fingers closed and achieved finger opening by electrical activation…

Invasive Neurostimulation for Poststroke Motor Recovery

Introduction Approximately 795,000 people suffer a new or recurrent stroke annually in the United States, with 87% of strokes caused by cerebral ischemia ( ). Ischemic stroke (IS) is a leading cause of disability worldwide, and indirect costs resulting from lost productivity due to stroke are projected to increase from $25 billion in 2010 to $44 billion in 2030 in the United States alone ( ).…

Functional Electrical Stimulation for Return of Function After Stroke

Acknowledgments The preparation of this chapter was supported in part by grants R01HD068588 and R01HD075542 from the National Institute of Child Health and Human Development, and KL2TR000440 from the National Center for Advancing Translational Sciences. Introduction Stroke is the leading cause of disability or activity limitation among older adults in the United States. Approximately 800,000 strokes occur each year, with a prevalence of approximately 6.6 million…

Cortical Stimulation for Depression

Introduction The economic and societal burden of treatment-resistant depression, which is suffered by 12%–20% of all depressed patients, remains a significant challenge to the psychiatric and neurosurgical communities ( ). In the United States alone its overall societal cost is estimated to be $106–$118 billion per year in lost productivity and healthcare costs ( ). Unfortunately, adequate medical treatment options for refractory depression remain scarce and…

Subgenual Cingulate Deep Brain Stimulation for Treatment-Resistant Depression

Introduction Overview of MDD Major depressive disorder (MDD) is a common psychiatric complaint with a lifetime prevalence of 17% ( ), affecting some 5% of the world’s population at any given time ( ). It is characterized by one or more prolonged episodes of severe sadness and/or melancholia with a tendency to relapse over time ( ), and is associated with significant morbidity and mortality (including…

Surgical Treatment for Refractory Drug Addiction

Overview Drug addiction is characterized by repetitive substance abuse associated with symptoms of behavioral, cognitive, and physiological dependence, and is categorized in the Diagnostic and Statistical Manual of Mental Disorders V (DSM-V) as “substance use disorder.” Dependence is indicated by a persistent desire to use the addictive substance, continuous reckless and uncontrollable usage, and the prioritization of drug abuse over other activities and obligations ( ).…

Deep Brain Stimulation for Alcoholism

Introduction and Background Substance-related addictions, including alcohol addiction, constitute the most frequently occurring psychiatric disease category ( ). Half of the world’s population consumes alcohol, and many of these people meet the World Health Organization criteria for high-risk consumption ( ). The 12-month prevalence of alcohol use disorder is 8.5% among adults in the United States, with higher rates among men (12.4%) compared to women (4.9%),…

Neuromodulation in Anorexia Nervosa

Introduction Anorexia nervosa (AN) is a chronic and debilitating illness with a prevalence of 0.3%–0.9% in the general population ( ). The disorder is 10 times more common in women, being typically diagnosed in adolescents ( ) between the ages of 15 and 21. Patients identified during adulthood are usually those who have suffered from the disease for many years prior to diagnosis ( ). Clinical…

Deep Brain Stimulation for Highly Refractory Depression

Introduction “Depression” connotes a group of conditions imposing a serious public health burden ( ). The lifetime prevalence of unipolar major depressive disorder (MDD) has been estimated at 10%–20%, with rates significantly higher for women than for men ( ). Most (50%–85%) patients have recurrent depressive episodes. Depression can cause profound disability in addition to marked distress. Impairment in marital, parental, social, vocational, and academic functioning…

High-Intensity Focused Ultrasound Surgery for the Treatment of Obsessive–Compulsive Disorder

Introduction Obsessive–compulsive disorder (OCD) is a common and disabling neuropsychiatric disorder that affects 2%–3% of the global population at some point in their life; additionally, it is known that 6%–8% of the general population has subclinical symptoms ( ). OCD is characterized by recurrent obsessions (intrusive anxious thoughts, desires, or images) and/or compulsions (repetitive ritualized behaviors used to prevent or reduce distress) ( ). In most…

Deep Brain Stimulation for Obsessive–Compulsive Disorder

List of Abbreviations ACC Anterior cingulate cortex ALIC Anterior limb of internal capsule BDI Beck depression inventory CSTC Cortico-striato-thalamic-cortical DBS Deep brain stimulation fMRI Functional magnetic resonance imaging Gpi Globus pallidus internus ITP Inferior thalamic peduncle NAcc Nucleus accumbens OCD Obsessive–compulsive disorder OFC Orbitofrontal cortex PET Positron emission tomography slMFB Superolateral branch of the medial forebrain bundle SMA Supplementary motor area STN Subthalamic nucleus TRD Treatment…

Closed-Loop Responsive Stimulation for Epilepsy

Introduction The Burden of Epilepsy Epilepsy affects approximately 1% of the world’s population, with between 30% and 40% of these patients suffering from drug-resistant disease. Epilepsy surgery historically has been one of the best options for such refractory disease, and on average results in 62% of all patients becoming seizure free ( ). Resective surgery is not without risks, however, and is sometimes impossible due to…