Deep Brain Stimulation Programming: Principles and Practice

by Erwin B. Montgomery Jr.

Deep Brain Stimulation (DBS) is a remarkable therapy for an expanding range of neurological and psychiatric disorders. In many cases it is better than best medical therapy and succeeds even when brain transplants fail. Yet despite the remarkable benefits, many physicians and healthcare professionals seem hesitant to embrace this therapy. Post-operative programming of the DBS systems seems unfamiliar, even mysterious, and is viewed as difficult and time consuming. However, DBS programming is rational and can be efficient and effective if one understands the basing underlying concepts of electronics, electrophysiology, and the relevant regional anatomy. Even these principles can be relatively easy to grasp.

The book helps the reader to obtain an intuitive understanding of the basic principles of electronics, electrophysiology and the relevant regional anatomy through the use of readily understood metaphors and numerous illustrations. In addition a number of tools are provided including algorithms to ensure efficient and thorough programming. Forms are provided to help with documentation.

In addition, DBS related research provides a remarkable tool to understand how the brain works and what happens in diseases such as Parkinson's disease. Already long cherished theories of the pathophysiology of Parkinson's disease must be abandoned. Indeed, these DBS derived insights suggest fundamental revisions of theories of brain function are in order. The book provides an introduction to where some of the new theories may lead particularly with the growing awareness of the importance of oscillations in the brain's activities. The brain has more in common with electrical devices, such as computers, than it does to a stew of chemicals. DBS operates at the electrical level in the brain, which is fundamental to how the brain creates, manipulates and conveys information and may indeed be fundamental to the misinformation the results in the dysfunction related to disorders of the brain.

For downloadable forms and other relevant material, please

208 pages, Hardcover

First published March 16, 2010

Reviews

[Efren Silva · Rating 4 out of 5]

I found this book to be a refreshing and modern approach to learning Deep Brain Stimulation as a therapy and as a corrective input for an electronic device, the brain. Montogmery describes Parkinson's disease as an electrical transmission problem. Hence, Parkinson's is not a chemical problem. Dopamine is the physical means by which the messenger travels but it is not the message; the message is the pattern of action potentials. After reading this book, I view Parkinson's disease in a whole new light and understand that previous mechanisms for the disease are outdated and based on pharmacology. Previous mechanisms postulate the prokinetic activity from an underactive Gpi's input to the thalamic-cortical pathway, which results in involuntary movements. The System's Oscillatory Theory, as well as the pallidotomy, have largely debunked the Gpi Rate Theory.
The Chapter on Principles of Electrophysiology was my absolute favorite. Montgomery speaks to the conductive nature of monopolar, bipolar, interleaving, and their associated electric fields. Describing bipolar programming as a sink and drain was brilliant. Additionally, he briefly describes the current waveform utilized in DBS, cathodal leading, biphasic-symmetrical waveform. The cathodal and anodal components are clearly defined. I would have appreciated more images regarding this critical waveform. Montgomery's book, Intraoperative Physiological Monitoring, provides more details regarding the waveform and the biophysics of stimulation.
This book also had some rich details regarding anatomy and side effects of stimulation. I was surprised to learn that the brachium conjevictum is located medial and slightly posterior to the STN. This could explain side effects such as ataxia or imbalance in a patient with STN targeting. Additionally, when targeting VIM, I always think a too-ventral lead may potentially hit the brachium conjevictum or the zona incerta. Hence, the book points to the internal capsule as a possibility. I always think of the internal capsule as simply lateral to VIM.
This book served as an introduction to Oscillators. It makes you think of brain physiology in terms of neural oscillators as opposed to simply neurotransmitters going from one synapse to the other or lack thereof. The author uses the Fourier Transform to comprehend the harmonics of the nested oscillators involved in the misinformation that the lower motor neurons receive. Hence, a movement disorder results. I found the race car example brilliant and helped me understand oscillators. Montgomery points out that DBS would not work on a healthy brain. In other words, a basal ganglia thalamic cortical network with no misinformation being produced from its underlying oscillators. Hence, there appears to be some resonating effect with DBS and the underlying oscillator(s) creating a therapeutic effect, similar to how AM transmissions work with Antennas.
Montgomery did a great job introducing circuit physics to the reader. I have an engineering degree, so it was easy enough to follow. Although, I was not a big fan of several of the illustrations made throughout the book. Additionally, the font size that describes all the figures is too small.
I will certainly be looking to read the second edition of this book.