Intro; Acknowledgment; Introduction; Reference; Contents; Contributors; Part I: The Current Practice of Surgery for PD; 1: Indications for Deep Brain Stimulation Therapy in Parkinson's Disease; Background; Symptoms and Diagnosis; Disease Progression; Pathophysiology; Medical Therapy; Surgical Therapy; Mechanism of Action of DBS; Goals of DBS; Reduction in Motor Symptom Fluctuations; Reduction in Tremor; Reduction in Bradykinesia; Reduction of Dyskinesia; Improvement in Quality of Life; Limitations of DBS; DBS Does Not Reduce Nonmotor Symptoms; DBS Does Not Slow Progression of the Disease
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4: Globus Pallidus Interna Deep Brain Stimulation: Practical Guide to Placement with Microelectrode Recording introduction; Stereotactic Targeting of the GPi; Setting the Electrode Trajectory; Microelectrode Recording and Stimulation to Physiologically Target the GPi; Conclusion; References; 5: Microelectrode Recording-Based Targeting for Parkinson's Disease Surgery; Introduction; History; Advantages of MER; Disadvantages of MER; MER Basics; Neurophysiological Signals Relevant to DBS; Hardware Needed; Personnel Needed; Targets in PD; STN MER; GPi MER; Other Targets in PD
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Future Directions in MER References; 6: MRI-Guided DBS for Parkinson's Disease; Introduction; Patient Selection; MRI System Requirements; Pre-operative Preparation; Procedure; Draping and Initial Trajectory Planning; Opening and Frame Placement; Alignment; Insertion; Closure and MRI Safety; Intra-operative Pitfalls and Complications; Post-operative Management; Outcomes; Conclusion; References; 7: Optimizing Deep Brain Stimulation Programming in Parkinson's Disease; Screening, Expectations, and Assessments; DBS Programming Visits; Basics; Programming; Programming Specifics; Newer DBS Leads
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Indications and Patient Selection diagnosis of PD; Disability; Levodopa Responsiveness; Contraindications and Additional Considerations; Cognitive Impairment; Psychiatric Comorbidity; Medical Comorbidity; Age; Target Selection; Summary; References; 2: Subthalamic Nucleus Deep Brain Stimulation with Microelectrode Recording Using a Frame; Introduction; Patient Selection; Preoperative Evaluation; Imaging; Targeting; Frame Placement; Patient Positioning and Anesthesia; Microelectrode Recording; DBS Electrode Implantation and Testing; Closure and Postoperative Care; Implanting the Pulse Generator
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SUMMARY OR ABSTRACT
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This book is designed to provide practicing neurosurgeons with current knowledge on the practical aspects of surgical treatment of patients with Parkinson's disease. It explains how to identify appropriate surgical candidates and determine the optimal surgery, describes the various surgical techniques that are currently employed, and offers insights into how to optimize deep brain stimulation therapy after implantation. The keys to avoidance of surgical complications are carefully elucidated. In addition, an overview is provided of potential advances on the near-term horizon, including closed-loop deep brain stimulation, gene therapy, optogenetics, and MRI-guided focused ultrasound lesioning. All topics are covered by experienced Parkinson's disease surgeons, in a concise and digestable format.