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Acknowledgments This concepts and work presented in this chapter have been supported by the NIH through 3 R01 (1R01-EB006136, 2R01-EB006136, and 9R01-NS095291) grants and performed in close collaboration with the following partnering research institutions: Ohio State University (Dr. Ali Rezai, MD), the VA in Richmond (Dr. Kathryn Holloway, MD), Wake Forest Medical Center (Dr. Stephen Tatter), and Thomas Jefferson University (Dr. Ashwini Sharan, MD). Phase I…
Acknowledgments This work was supported by grants from the National Institutes of Health (R01 NS085188, R01 MH102238). Conflict of Interest Statement C.C.M. authored intellectual property related to the content of this chapter, is a paid consultant for Boston Scientific Neuromodulation, and is a shareholder in the following neuromodulation companies: Surgical Information Sciences, Inc.; Autonomic Technologies, Inc.; Cardionomics, Inc.; Neuros Medical, Inc.; and Enspire DBS, Inc. Deep…
Introduction From the first reported applications in pain ( ), the indications for neuromodulation have broadened over the years to movement disorders, epilepsy, spasticity, and psychiatric disorders ( ). Neurostimulation systems consist of metallic electrode contacts (either paddle or cylindrical electrodes) connected to an implantable pulse generator (IPG) via subcutaneous insulated wires. The IPG is usually implanted in a subcutaneous or subfascial pocket away from the…
Introduction The activation of neurons using electrical stimulation is a well-recognized phenomenon and has multiple clinical applications. However, the use of electrical currents to block the conduction of action potentials in peripheral nerves is a more recent discovery and has been the subject of increased interest in the past decade. Inactivation or downregulation of the nervous system has relied on indirect methods, such as neuromodulation, that…
Introduction The immediate and dramatic improvements seen seconds after deep brain stimulation (DBS) in a patient with essential tremor or Parkinson disease, combined with the rapid return of symptoms following DBS shutoff, suggest that its mechanism of action involves modulation of existing neuronal circuitry as opposed to the formation of new permanent neuronal connections. Thus, the term neuronal plasticity , traditionally referring to changes in neuronal…
Acknowledgments Preparation of this chapter was supported in part by Grants R37 NS040894 and R01 NS050514 from the US National Institutes of Health. Introduction The primary requirement for a stimulation waveform is the ability to excite or activate neurons or nerve fibers. Although necessary, this fundamental requirement is rarely sufficient, and the criteria of risk of potential tissue damage, stimulation selectivity, and energy efficiency of stimulation…
Introduction When considering the safety requirements for electrical stimulation–based neuromodulation, a common misconception is that the US Food and Drug Administration (FDA) or the European Union notified bodies require that an implantable medical device be 100% safe and cause no damage to tissue. Holding device manufacturers to such a strict standard would be disadvantageous to patients for a variety of reasons. Implantation of the cardiac pacemaker/defibrillator,…
In the context of neuromodulation and neuroprosthetics, electrical stimulation is applied to restore function to people who are unable to move, see, or hear or to alter behavior such as seen in a variety of disorders of motor, sensory, and cognitive function. Guidelines have evolved during the past 50 years or so on ways to apply electrical stimulation, so that the neural response does not diminish…
Introduction – The BRAIN Initiative Launched in April , the White House Brain Research through Advancing Innovative Neurotechnologies (BRAIN) Initiative is a “bold new research effort to revolutionize our understanding of the human mind and uncover new ways to treat, prevent, and cure brain disorders like Alzheimer’s, schizophrenia, autism, epilepsy, and traumatic brain injury ( )” (see Fig. 5.1 ). The BRAIN Initiative includes participation from…
Introduction Neuromodulation, defined by the International Neuromodulation Society as “the alteration of nerve activity through targeted delivery of a stimulus, such as electrical stimulation or chemical agents, to specific neurological sites in the body” ( ), has been in use for thousands of years ( ). The pain-relieving effect of stimulation delivered via electric fish was a serendipitous finding, based on anecdotal experience that was passed…
Gross Structures Brain The nervous system is divided into central and peripheral divisions, along with the separate autonomic system. The central nervous system consists of the brain and spinal cord, while the peripheral nervous system consists of the nerves to the trunk and extremities. The brain is composed of the hemispheres, the brainstem, and the cerebellum. The hemispheres are divided into the frontal, temporal, parietal, and…
Introduction The collection of topics in this volume gives evidence that neuromodulation has transcended the treatment of pain. Activity of visceral structures, psychiatric disorders, and movement disorders have emerged as viable therapeutic targets. Advances in technology have led to the questioning of long-held notions such as the importance of patient-perceived concordant paresthesia and the necessity of an implanted power supply. Stimulator leads are being placed in…
Introduction Medical fields, as in other fields of scientific or intellectual endeavor, are advanced from an idea of necessity to reality only after those early adherents to the idea form associations to bring commonality of purpose to their association. As we shall see in this chapter, neuromodulation, 1 1 Neuromodulation is defined by the INS as technology that acts directly upon nerves. It is the alteration—or…
Basic Terminology and Laboratory Procedures 1. What are the two major disciplines in the field of pathology? The two disciplines of pathology are anatomic pathology and clinical pathology. Pathologists commonly use the shorthand “AP” and “CP” to refer to these fields. To become certified by the American Board of Pathology in AP/CP in the United States requires a 4-year residency, whereas standalone AP or CP certifications…
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General Psychiatry 1. When referring to brain dysfunction (neurologic and psychiatric disorders), why are the terms focal and functional preferred over organic and inorganic ? Using the terms organic and inorganic to refer to neurologic and psychiatric disorders, respectively, follows from the dualistic (Cartesian) model—an antiquated model that regards mind and brain as two distinct entities, which somehow are unified. A modern neuroscience-based view is that…