20 things to know about deep brain stimulation PDF
Preview 20 things to know about deep brain stimulation
20 Things to Know about Deep Brain Stimulation 20 Things to Know about Deep Brain Stimulation ERWIN B. MONTGOMERY, JR., MD MEDICAL DIRECTOR GREENVILLE NEUROMODULATION CENTER THE GREENVILLE NEUROMODULATION SCHOLAR IN NEUROSCIENCE AND PHILOSOPHY THIEL COLLEGE GREENVILLE, PA 1 1 Oxford University Press is a department of the University of Oxford. It furthers the University’s objective of excellence in research, scholarship, and education by publishing worldwide. Oxford New York Auckland Cape Town Dar es Salaam Hong Kong Karachi Kuala Lumpur Madrid Melbourne Mexico City Nairobi New Delhi Shanghai Taipei Toronto With offices in Argentina Austria Brazil Chile Czech Republic France Greece Guatemala Hungary Italy Japan Poland Portugal Singapore South Korea Switzerland Thailand Turkey Ukraine Vietnam Oxford is a registered trademark of Oxford University Press in the UK and certain other countries. Published in the United States of America by Oxford University Press 198 Madison Avenue, New York, NY 10016 © Oxford University Press 2015 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, without the prior permission in writing of Oxford University Press, or as expressly permitted by law, by license, or under terms agreed with the appropriate reproduction rights organization. Inquiries concerning reproduction outside the scope of the above should be sent to the Rights Department, Oxford University Press, at the address above. You must not circulate this work in any other form and you must impose this same condition on any acquirer. Library of Congress Cataloging-in-Publication Data Montgomery, Erwin B., Jr., author. 20 things to know about deep brain stimulation / Erwin B. Montgomery, Jr. p. ; cm. Includes bibliographical references. ISBN 978–0–19–933882–5 (alk. paper) I. Title. [DNLM: 1. Deep Brain Stimulation—methods. 2. Mental Disorders—therapy. 3. Movement Disorders—therapy. WL 368] RC347 616.8—dc23 2014029318 The science of medicine is a rapidly changing field. As new research and clinical experience broaden our knowledge, changes in treatment and drug therapy occur. The author and publisher of this work have checked with sources believed to be reliable in their efforts to provide information that is accurate and complete and in accordance with the standards accepted at the time of publication. However, in light of the possibility of human error or changes in the practice of medicine, neither the author, nor the publisher, nor any other party who has been involved in the preparation or publication of this work warrants that the information contained herein is in every respect accurate or complete. Readers are encouraged to confirm the information contained herein with other reliable sources and are strongly advised to check the product information sheet provided by the pharmaceutical company for each drug they plan to administer. 9 8 7 6 5 4 3 2 1 Printed in the United States of America on acid-free paper To Lyn Turkstra, whose unfailing support made every house a home, and to Michael, David, and Pat, whose love was always a source of comfort when needed most. CONTENTS Preface ix 1. What Is Deep Brain Stimulation? 1 2. Why Deep Brain Stimulation? 14 3. Deep Brain Stimulation Is Effective for Patients with Parkinson’s Disease 22 4. Identifying the Least Acceptable Deep Brain Stimulation Candidates Among Patients with Parkinson’s Disease 37 5. Postoperative Management of Patients with Parkinson’s Disease 56 6. Deep Brain Stimulation Is Safe and Effective for Essential Tremor 66 7. Identifying the Least Acceptable Deep Brain Stimulation Candidates Among Patients with Essential Tremor 74 8. Postoperative Care for Essential Tremor 87 9. Deep Brain Stimulation Is Safe and Effective for Patients with Dystonia 94 10. Identifying the Least Acceptable Deep Brain Stimulation Candidates Among Patients with Dystonia 101 11. Postoperative Management of Patients with Dystonia 115 12. Deep Brain Stimulation Is Safe and Effective for Tourette’s Syndrome 122 13. Identifying the Least Acceptable Deep Brain Stimulation Candidates Among Patients with Tourette’s Syndrome 130 14. Deep Brain Stimulation for Cerebellar Outflow Tremor 145 15. Deep Brain Stimulation for Hyperkinetic Disorders 156 16. Deep Brain Stimulation Is Safe and Effective for Obsessive-Compulsive Disorder 171 17. Could Deep Brain Stimulation Be Effective in the Treatment of Posttraumatic Stress Disorder? 186 18. Deep Brain Stimulation and Insights to Pathophysiology and Physiology 216 19. Ethical Issues of Deep Brain Stimulation 226 20. The Future of Deep Brain Stimulation 247 Index 261 PREFACE TWO PLEAS The First Plea In 1998, a 26-year-old woman laid on an operating room table with a set of elec- trodes implanted in the ventral intermediate nucleus of the thalamus of her brain. After the stimulation was turned on, her severe tremor due to her multiple sclerosis went away. She then said, “Now I can hold my baby.” She had given birth three months before. In 2000, a father with young children suffered from Parkinson’s disease. After deep brain stimulation (DBS), much to the consternation and relief of his children, he could beat them in basketball. Whether by fate, providence, or self-organizing physical universe, humankind was given a gift. Since DBS, as currently practiced, was reported in 1979 for psychiatric disor- ders (Dieckmann 1979) and in 1980 for movement disorders (Cooper et al. 1980), much or little has changed, depending on one’s perspective. The technical prow- ess of modern science generated many observations of how the brain reacts to DBS, but it is no further in understanding why DBS creates what even the most jaded would have to admit are nearly miraculous changes in patients’ lives. In many disorders, DBS has demonstrated its superiority over every other treatment option. Indeed, in many ways DBS is revolutionary and, in the field of Parkinson’s disease, a breakthrough on par with the discovery of levodopa. One would think that such a breakthrough would be enthusiastically embraced for the potential insights into pathophysiology and physiology of the brain and for the benefit phy- sicians and healthcare professionals now can provide to their patients. If only that were the case. At the American Academy of Neurology annual meeting in 2014, there was not a single presentation on DBS, only a short course on DBS programming. Since 1997, I cannot think of a single neurology resident who actively sought to participate in the DBS clinic to the point of having knowledge and skills in DBS even close to proficiency. Interestingly, no mention of “Deep Brain Stimulation” or DBS is made in the Certification Examination in Neurology 2013 Content Blueprint published by the American Board of Neurology and Psychiatry (2012).
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