Deep Brain Stimulation

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Focal High Frequency Electrical Brain Stimulation

Progressive Spastic Ataxia

19 The principal author of this chapter, B. N., would like to thank Prof. Paul Cosyns, Dr. Loes Gabriels, Dr. Kris van Kuyck, Mr. John Das, Mrs. Marleen Welkenhuysen, Dr. Herwig Neefs, Prof. Jan Gybels, the members of the international the members of the commission for neurosurgery for psychiatric disorders, the patients, their families and their psychiatrists for their collaboration. neously on the cranium itself. Interaction with the stimulator becomes feasible through an external device which communicates with the implanted stimulator by means of a wireless connection. Thereby it is possible to vary different stimulation parameters (frequency, amplitude, pulse width etc.), to change the separate electrical contacts into anode, cathode or neutral and to obtain the history of the stimulation and the battery life. Radio-frequency systems, which obviate the need to replace the stimulator once the battery is empty, also exist, but are no longer frequently used because with this system...

Comments on the Published Guidelines on Electrical Brain Stimulation for Psychiatric Disorders

In order to try to prevent DBS from being used as a routine treatment at this moment without the necessary further research, the DBS-OCD collaborative group has decided to publish guidelines on Electrical brain stimulation for psychiatric disorders. At this moment these are the only published guidelines and these will be explained in the following paragraphs. If somebody were to disagree with those guidelines, the logical step would be for that person to publish a new set of guidelines, so that these could be compared with the existing ones. It is also clear that guidelines may change over time with progress and experience.

Changes In Serum Prolactin With Brain Stimulation

Subsequent to the ECT reports, investigators studied the effects of other methods of brain stimulation on PRL secretion. Parra (14) demonstrated a transient elevation of serum PRL with the direct stimulation of the amygdala in humans, but a subsequent study (15) of limbic and extralimbic structures showed that elevations of serum PRL occur only when stimulation evokes high-frequency, widespread limbic discharges. Thus, it appears that stimulation within physiologic ranges control prolactin release via subcortical structures other than the amygdala. Gallagher (16) confirmed that the stimulation of the amygdala and hippocampus causes elevations of serum prolactin and ACTH, but not growth hormone, only when stimuli are sufficient to produce seizures or after-discharges that last 10 seconds or more.

The Experience Gap Argument

Nineteenth-century materialists were inclined to identify thinking, and mental events generally, with processes in the central nervous system or brain. In order to refute such views I shall suggest your trying an experiment. Heat a piece of iron red-hot, then put your hand on it, and note carefully what you feel. You will have no difficulty in observing that it is quite different from anything which a physiologist could observe, when he considered your . . . brain processes. The throb of pain experienced will not be . . . like anything described in textbooks of physiology as happening in the nervous system or brain. I do not say that it does not happen in the brain, but it is quite distinct from anything that other people could observe if they looked into your brain. . . . We know by experience

Survey of Current Experimental Human Applications of Restorative Neurosurgery

In addition to cellular therapies in PD, phase I studies are currently also being performed with AAV vector-mediated gene transfer, based on a series of successful studies with in vivo and ex vivo AAV and LV vector-mediated gene transfer in PD animal models (Raymon et al. 1997 Freese 1999 Kor-dower et al. 2000 Shen et al. 2000 Le and Frim 2002). One trial tries to mimic the results of deep brain stimulation (DBS) in the subthalamic nucleus (STN) of the brain. DBS is shown to be an effective method to treat many PD patients in the late stages of the disease when L-dopa medication starts to fail. The application of AAV-GAD vectors (containing the gene for glutamic acid decarboxylase GAD , the enzyme synthesising the major inhibitory neurotransmitter gamma amino butyric acid GABA and upon overexpression causing a chronic release of GABA) in the animal STN results in similar result as electrical stimulation (During et al. 1998 2001). According to the interim clinical findings (Feigin et...

Barbara Jobst MD Peter Williamson MD

Penfield, at the Montreal Neurologic Institute, did further pioneering work using direct brain stimulation in patients undergoing electrocorticography under local anesthesia (6). With the help of intraoperative EEG recordings, he was able to localize clinical manifestations to cortical regions. If the patient remained seizure free after surgery, this gave further proof that some of the ictal behavior probably originated in the resected area. Similar experiments were performed by Bancaud and Talairach (Figure 2.1). After initial pioneering work, intracranial EEG recordings were also used outside the operating room during long-term EEG-moni-toring. Multiple centers around the world are now using larger numbers of grid and strip electrodes to localize ictal behavior. Cortical electrical brain mapping gained increasing value to localize ictal behavior and cortical functions. Newer technologies like structural and functional MRI, ictal single photon emission computed tomography (SPECT),...

The Mental Enhancement of Detainees in Prison

Having studied these new methods in psychopharmacology, neurotransplantation, gene transfer, neural prosthetics and electrical brain stimulation, the authors of this book acknowledge and endorse their potential to benefit the individual, as well as society, by yielding innovative therapeutic applications. Of course, since these interventions operate directly on the brain, it is obligatory to handle them with appropriate caution, even if they are used for treatment purposes only.

Concerns about the Integrity of Persons

Those who consider even therapeutic applications of new techniques for intervening in the brain ethically dubious usually do not base their arguments solely on the possibility of mental side effects as such. Rather, new treatment options in this field are typically challenged on the grounds that they may transform patients in more radical or profound ways than more established techniques of intervention. The most common way to express these concerns is to argue that new interventions in the brain may threaten personal identity. The suggestion that such interventions are equivalent to turning someone into someone else by messing with his brain could mobilise public opinion against promising areas of research and frustrate the development of new, and urgently required, treatments. Furthermore, the vague fear that due to the treatment they may no longer be the one I used to be could prevent individual patients from undergoing such medical procedures. In this study, therefore, we took...

Effectors Making Animals Move

A fascinating array of adaptations enable animals to move. Consider the act of jumping. When you jump, neuronal signals from the motor cortex of your brain are routed through spinal circuits that tell specific leg muscles to contract, extending your legs. Highly skilled and trained athletes can actually outleap their own body height.

Interpretation And Implications For Addiction Biology

There are, therefore, multiple potential connections between LH ORX HCRT systems and drug-regulated neural circuitry. ORX HCRT-OxR pathways modulate the activity of VTA and NAc neurons, potentially altering both ends of the mesolimbic reward pathway, while also playing a role in LC neuron excitability that may influence components of opiate withdrawal. These molecular connections provide a potential link between the classical substrates of brain stimulation reward and the well-studied neural and molecular circuitry of drug reward. Future studies are needed to better define the relevant neural circuits by which ORX HCRT modulates morphine dependence and withdrawal.

Current Limitations Possible Solutions and Enhancement Technologies

In the meantime, clinical applications of electrical brain stimulation have gained world-wide acceptance in the treatment of movement disorders. Indications have been extended and Medtronic Inc., the major manufacturer of such implants, uses its products in clinical tests to pulse the thalamus for the treatment of epilepsy another region of the deep brain to treat migraines, depression, and obsessive-compulsive disorder the hypoglossal nerve in the neck to treat sleep apnea the sacral nerve to treat bowel disorders and the stomach to treat obesity. Parallel to the efforts of modelling and duplicating neural networks, efforts are underway to establish improved connections between electrodes and neurons.

Transcranial Magnetic Stimulation

In transcranial magnetic stimulation (TMS) magnetic pulses are applied to a certain region of the head by a handheld stimulating coil. This coil is connected to a stimulator, which generates those pulses. The magnetic field, which changes in time, induces an electrical current in the skin, the deeper tissue and, most interestingly of all, in different brain structures. As opposed to electrical brain stimulation described above, this technique is non-invasive. It is possible to deliver single, paired or repetitive magnetic pulses. In the latter case, one uses the term repetitive transcranial magnetic stimulation (rTMS). As an example of an effect induced by TMS, we can state that muscle contractions can be obtained above the motor cortex. Most studies have looked at effects of TMS on superficially lying brain structures. Both electrical brain stimulation and TMS were developed in the clinic itself and only later on were basic neurobiological data obtained in order to understand some of...

The Philosophical Story I

Philosophers and scientists began to speculate intelligently about a wide range of psychological processes, and many of their ideas turned out to be remarkably farsighted. Much of this early imaginative and empirical work was forgotten through the centuries, slowly stumbled on, and rediscovered time and again through careful or serendipitous efforts. In the seventeenth century, John Locke described a clinical procedure for overcoming unusual fears the procedure he set forth is similar to the systematic desensitization method developed this past century by Joseph Wolpe. Similarly, Gustav Fech-ner, founder of psychophysics in the mid-nineteenth century, recognized that the human brain was divided into two parallel hemispheres that were linked by a thin band of connecting fibers, what we now term the corpus collosum. According to his speculations, if the brain was subdivided, it would create two independent realms of consciousness, a speculation confirmed and elaborated in...

Manganese Enhanced MRI

The other nonhemodynamic technique, pioneered in the laboratory of Dr. Alan Koretsky, is the injection of paramagnetic manganese (after opening the blood-brain barrier with mannitol) to detect brain activity 107 . This technique relies upon the ability of manganese to substitute for calcium, and thus, cells which have increased uptake of calcium during brain stimulation will selectively accumulate manganese. This, in turn, leads to a decrease in Tj that is readily detectable using conventional Tj-weighted imaging. In principle, this technique has high sensitivity and exquisite spatial resolution.

Side Effects and Complications

Technical problems due to the limited life of batteries. The most important problem the Leuven-Antwerp team was confronted with initially was the battery power source of the stimulation devices. It needed to be replaced surgically every four to twelve months. This kind of surgery can be undertaken as outpatient treatment and under local anaesthetic, but puts the patient at risk of infections and can damage the extension cables. In patients 7, 9 and 10 the amplitudes employed approached the level of amplitudes used for the electrical brain stimulation in movement disorders and chronic pain. However, it is too early to state that the battery problem has been solved. On the other hand, Medtronic Inc. has built a stimulator with a rechargeable battery, which is being tested in patients with chronic neuropathic pain, and which could be recharged by wearing a belt now and then for a period of

General Introduction

The term neural prosthetics may generally also be applied to forms of electrical brain stimulation which are the subject of Chapter 4. This chapter focuses principally on deep brain stimulation (DBS) in which an electrical current is administered through electrodes implanted in the brain. This technique of directly interfering with endogenous neural activity can be described as neuromodulation. It is currently used mainly on patients with otherwise untreatable central motor disturbances (e.g. pharmacologically refractory Parkinson's disease), but is also increasingly being applied to patients with mental or psychiatric disorders such as obsessive compulsive disorder or major depression. In addition to DBS, transcranial magnetic stimulation (TMS) and vagal nerve stimulation (VNS) also seem to hold new promise for the treatment of such psychiatric disorders. The potential ramifications of DBS will be discussed in Chapter 4, whilst VNS will be dealt with in Chapter 3.

Stone Tool Culture

Yet despite this uncertainty, language and the carrying of carefully constructed tools remain the undisputed characteristics of humans. There is an obvious lack of evidence for the former, but detailed studies of the mouth region of fossil skulls have recently shown that Neanderthal man did indeed possess speech. Similar studies will probably reveal much more in the future. For the moment, however, and leaving aside brain research, the only way to understand the mental development of ancient hominids is to study their tools. And since most early tools soon perished, being made from bones, horn, teeth, wood, and skin, it is mainly via the remains of the stone axe culture that man the toolmaker can be identified in the early fossil record.

List of Contributors

Brain Research Institute, Melbourne, Victoria, Australia Regula S. Briellmann, M.D. Brain Research Institute and University of Melbourne, Melbourne, Victoria, Australia Steven W. Fleming, B.Eng. (Elec.) Brain Research Institute, Melbourne, Victoria, Australia Gaby S. Pell, Ph.D. Brain Research Institute, Melbourne, Victoria, Australia Anthony B. Waites, Ph.D. Brain Research Institute, Melbourne, Victoria, Australia R. Mark Wellard, Ph.D. Brain Research Institute, Melbourne, Victoria, Australia

List of Authors

Gerard Boer, M.Sc. degree in biochemistry at the University of Amsterdam in 1970. Thereafter working at the Netherlands Central Institute for Brain Research in Amsterdam on a project investigating the role of the glial cells of the neural lobe in the hormone release process of the hypothalamo-neurohypophyseal neurosecretory system, which resulted in a Ph.D. degree in medicine at the University of Amsterdam in 1976. From 1976 onwards, the main basic research topics, first as investigator later as head of a research group, at the reorganised Netherlands Institute for Brain Research of the Royal Netherlands Academy of Arts and Science, were the neuropeptidergic and monoaminergic influences in perinatal rat brain development and the late lasting functional impairments of the brain following drug exposure in the perinatal and postnatal period (functional neuro teratology), neurotransplantation and circadian rhythm studies in rat and approaches to restore injury of the rat central and...

Chapter Fortysix

But is being conscious of the black dog simply a result of the fact that all of these neurons are firing at the same time Your brain is simultaneously processing many other sensory inputs, but you are not necessarily conscious of those inputs. What makes you conscious of the black dog and associated memories and not of other information the brain is processing at the same time

Interpretation

Movement Cortex Human

The story of how the brain integrates information from two eyes begins with the paths of the optic nerves. If you look at the underside of the brain, the optic nerves from the two eyes appear to join together just under the hypothalamus and then separate again. The place where they join is called the optic chiasm (Figure 46.12). Axons from the half of each retina closest to your nose cross in the optic chiasm and go to the opposite side of your brain. The axons from the other half of each retina go to the same side of the brain. The result of this division of axons in the optic chiasm is that all visual information from your left visual field (everything left of straight ahead) goes to the right side of your brain, as shown in red in Figure 46.12. All visual information from your right visual field goes to the left side of your brain, as indicated in green in the figure. Both eyes transmit information about a specific spot in your right visual field, for example, to the same place in...

Conclusions

Brain research is validating and extending clinical and experimental observations of hypnotic phenomena. It is demonstrating that 'There is good evidence for the age-old belief that the brain has something to do with mind' (Miller, Galanter & Pribram, 1960, p. 196). This knowledge will help us communicate to the medical and psychological communities, as well as the patient and family, why and how hypnosis is such an important therapeutic technique in behavioral medicine and psychotherapy.

Preliminaries

It was mentioned in the introduction that one of the major types of concerns related to new methods of intervening in the brain is expressed in the question whether the identity of those persons they are applied to is put at risk. Worries of this kind have already been voiced in the past with respect to traditional intervention techniques used in neurosurgery, psychopharmacol-ogy, and even (non-invasive) psychotherapy. However, the availability of new techniques like neural grafting, neuroprosthetics and electrical brain stimulation endows those old concerns with new socio-political vigour.22 In this preliminary section we will attempt to disambiguate the fears of those who would regard certain techniques for intervening in the brain as a potential threat to personal identity. In doing so, it will turn out that, while some particular worries falling within this category need not be dealt with at great length, others require a clarification of the concepts of identity in general, of...

Brain Blaster

Brain Blaster

Have you ever been envious of people who seem to have no end of clever ideas, who are able to think quickly in any situation, or who seem to have flawless memories? Could it be that they're just born smarter or quicker than the rest of us? Or are there some secrets that they might know that we don't?

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