The development of deep brain stimulation for neurological and psychiatric disorders: clinical, societal and ethical issues


Book Description

To date more than eighty thousand patients worldwide have received deep brain stimulation (DBS), mainly in order to alleviate symptoms of treatment-resistant disorders such as tremor associated with Parkinson’s disease, essential tremor, chronic pain, epilepsy, obsessive compulsive disorder, major depression and Tourette syndrome. The number of indications for neurological and psychiatric conditions using this technology is rapidly increasing, raising important societal and ethical issues that cannot be dealt with by scientists and clinicians on their own, but need discussions among all possible stakeholders on questions such as: what are the comprehensive risks and benefits of this technology? what is the real impact on patients’ life, in terms of health, quality of life and personal identity? This Research Topic provides an overview of potentials and limitations of deep brain stimulation as used to treat neurological and psychiatric conditions, bringing together Mini Reviews, Perspectives and Opinion papers from key stakeholders interested in the development and social impact of this technology. It is also a continuation of the debate that started among scientists, clinicians, patients, sociologists, journalists, philosophers and other experts during the “brains in dialogue on deep brain stimulation” workshop that was organized in September 2010 in Warsaw, Poland, by the FP7 project bid – brains in dialogue (www.neuromedia.eu) coordinated by the Interdisciplinary Laboratory of SISSA (Trieste, Italy).




Brain Stimulation


Book Description

The consideration of ethical and social issues related to current uses of deep brain stimulation (DBS) as well as investigational uses should now be an integral part of contemporary DBS practice. Scholarship, interdisciplinary work groups, and peer processes have helped articulate standards that need to be respected and implemented in current DBS practice. Integrating new knowledge and interdisciplinary ethical perspectives could be considered a sign of the maturity and rigor of a DBS program. Still, investigational uses of DBS carry tremendous hope but also touch on sensitive and thorny ethical questions. These questions can benefit from the ethical wisdom generated for standard uses of DBS but also challenge current practices and professional conduct. Realizing this, interdisciplinary expert groups have been convened to identify and flesh out ethical guideposts for cutting-edge research in DBS. By implementing these ethical frameworks, DBS is an opportunity to develop promising treatments for a set of vulnerable and sometimes underserved patients while keeping their best interests in sight.




Fundamentals and Clinics of Deep Brain Stimulation


Book Description

This book provides a state-of-the-art overview of our current understanding of deep brain stimulation (DBS) for the treatment of neurological and psychiatric disorders. With a broad multidisciplinary scope, it presents contributions from leading experts in the field from Europe and America, who share not only their knowledge, but their experience as well. The book focuses both on basic and theoretical aspects of DBS, as well as clinical and practical aspects. It follows an evidence-based approach, and where possible offers clinical recommendations based on published guidelines. It starts with a general section, which discusses basic principles and general considerations. This is followed a sections dedicated to neurological disorders, and psychiatric disorders, in which only accepted indications are discussed. All experimental indications are discussed in the final chapter. The text is supplemented with numerous illustrations. Intended for medical specialists and residents involved in the treatment of patients with DBS, it also appeals to other professionals working with DBS patients, such as psychologists, nurses, physiotherapists, as well as basic and clinical neuroscientists.




Deep Brain Stimulation


Book Description

This book examines present developments and the future possibilities of deep brain stimulation therapy for patients with therapy-refractory psychiatric disorders. Presents clinical applications and animal research, and offers a chapter on ethical issues.




Deep Brain Stimulation


Book Description

The one-stop resource on deep brain stimulation for functional neurosurgeons! Deep brain stimulation (DBS) is used to modulate dysfunctional circuits in the brain with stimulation pulses applied to specific target areas of the brain. Globally, DBS procedures have been most commonly performed for Parkinson's disease and essential tremor, but there are now new and growing research efforts studying DBS for psychiatric disorders and epilepsy. Deep Brain Stimulation: Techniques and Practices written by the Society for Innovative Neuroscience in Neurosurgery along with Dr. William S. Anderson and distinguished experts presents the latest DBS approaches. The book begins with a history of DBS, general frame-based techniques, patient selection primarily for movement disorders, multidisciplinary collaboration, and ethical considerations. Subsequent chapters detail diverse technologies and disease-specific treatment for Parkinson's disease, essential tremor, dystonia, OCD, epilepsy, major depression, Tourette syndrome, emerging psychiatric indications, and pediatric applications. Key highlights Lead placement techniques utilizing currently available customized platforms and robotics Microelectrode recording and image-based direct targeting with MRI and CT to enhance lead placement Lesioning methods including radiofrequency, and MR-guided focused ultrasound Discussion of recent innovations in tractography to delineate white matter tracts in the brain and closed loop stimulation DBS has helped thousands of patients with intractable conditions, allowing for a programmable therapy with durable treatment effect. This remarkable guide provides the essentials for functional neurosurgeons to pursue intraoperative research opportunities in this growing subspecialty and incorporate DBS into clinical practice.




Deep Brain Stimulation


Book Description

The one-stop resource on deep brain stimulation for functional neurosurgeons! Deep brain stimulation (DBS) is used to modulate dysfunctional circuits in the brain with stimulation pulses applied to specific target areas of the brain. Globally, DBS procedures have been most commonly performed for Parkinson's disease and essential tremor, but there are now new and growing research efforts studying DBS for psychiatric disorders and epilepsy. Deep Brain Stimulation: Techniques and Practices written by the Society for Innovative Neuroscience in Neurosurgery along with Dr. William S. Anderson and distinguished experts presents the latest DBS approaches. The book begins with a history of DBS, general frame-based techniques, patient selection primarily for movement disorders, multidisciplinary collaboration, and ethical considerations. Subsequent chapters detail diverse technologies and disease-specific treatment for Parkinson's disease, essential tremor, dystonia, OCD, epilepsy, major depression, Tourette syndrome, emerging psychiatric indications, and pediatric applications. Key highlights Lead placement techniques utilizing currently available customized platforms and robotics Microelectrode recording and image-based direct targeting with MRI and CT to enhance lead placement Lesioning methods including radiofrequency, and MR-guided focused ultrasound Discussion of recent innovations in tractography to delineate white matter tracts in the brain and closed loop stimulation DBS has helped thousands of patients with intractable conditions, allowing for a programmable therapy with durable treatment effect. This remarkable guide provides the essentials for functional neurosurgeons to pursue intraoperative research opportunities in this growing subspecialty and incorporate DBS into clinical practice.




Deep Brain Stimulation for Neurological Disorders


Book Description

Chronic electrical stimulation of the brain has demonstrated excellent outcomes in patients with Parkinson’s disease and has recently also been applied to various other neurological diseases. This comprehensive, up-to-date textbook will meet the needs of all who wish to learn more about the application of deep brain stimulation and will provide a sound basis for safe and accurate surgery. The book comprises two main parts, the first of which presents relevant anatomical and functional background information on the basal ganglia, thalamus and other brain structures as well as on the mechanism of brain stimulation. The second part describes clinical studies on deep brain stimulation, covering results in a range of movement disorders and psychiatric diseases and also important aspects of instrumentation and technique. The authors are outstanding scientists and experts in the field from across the world.




The Pleasure Shock


Book Description

The electrifying, forgotten history of Robert Heath's brain pacemaker, investigating the origins and ethics of one of today's most promising medical breakthroughs: deep brain stimulation The technology invented by psychiatrist Robert G. Heath in the 1950s and '60s has been described as among the most controversial experiments in US history. His work was alleged at the time to be part of MKUltra, the CIA's notorious "mind control" project. His research subjects included incarcerated convicts and gay men who wished to be "cured" of their sexual preference. Yet his cutting-edge research and legacy were quickly buried deep in Tulane University's archives. Investigative science journalist Lone Frank now tells the complete sage of this passionate, determined doctor and his groundbreaking neuroscience. More than fifty years after Heath's experiments, this very same treatment is becoming mainstream practice in modern psychiatry for everything from schizophrenia, anorexia, and compulsive behavior to depression, Parkinson's, and even substance addiction. Lone Frank uncovered lost documents and accounts of Heath's trailblazing work. She tracked down surviving colleagues and patients, and she delved into the current support for deep brain stimulation by scientists and patients alike. What has changed? Why do we today unquestioningly embrace this technology as a cure? How do we decide what is a disease of the brain to be cured and what should be allowed to remain unrobed and unprodded? And how do we weigh the decades of criticism against the promise of treatment that could be offered to millions of patients? Elegantly written and deeply fascinating, The Pleasure Shock weaves together biography, scientific history, and medical ethics. It is an adventure into our ever-shifting views of the mind and the fateful power we wield when we tinker with the self.




Deep Brain Stimulation Management


Book Description

Deep brain stimulation (DBS) is now a firmly established treatment for movement disorders, and an increasing body of evidence supports DBS in the treatment of other neurological and psychiatric disorders. This essential reference guide outlines a practical approach to the use of this paradigm-shifting therapy and covers key aspects of DBS practice. Chapters describe how to implement a DBS program and select appropriate patients, device programming to achieve optimal symptom control, and long-term management of patients. Thoroughly revised, this third edition includes additional chapters on managing patients with emerging applications of DBS. An entire chapter is dedicated to troubleshooting common problems with the therapy as many 'failures' are preventable and addressable. With contributions from experts in the field, this is a must-have reference guide for any clinician working with DBS patients.




Grt & Desperate Cures


Book Description