Yasin Temel - Fundamentals and Clinics of Deep Brain Stimulation: An Interdisciplinary Approach

This Springer imprint is published by the registered company Springer Nature Switzerland AG

The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland

Deep brain stimulation mechanisms. (a) Neurotransmitters (inset) are released in response to stimulation, leading to calcium waves and subsequent release of gliotransmitters. This release influences synaptic plasticity, leading to arteriole dilation and increased regional blood flow. (b) Deep brain stimulation (DBS)-induced changes in local field potentials within the subthalamic nucleus. Activity in the beta band is rapidly reduced with DBS at 3 V and then resumes with stimulation off. Adopted with permission from Lozano et al., Nature Reviews Neurology, 15, pages 148160 (2019)

The interest in deep brain stimulation (DBS) as a treatment option for neurological and psychiatric disorders is rapidly growing. The first application of modern DBS started in the late 1980s with a patient suffering from tremor-dominant Parkinsons disease. The history of using electrical current to suppress symptoms of disease in an experimental setting has since gone far beyond this milestone. DBS has become an accepted therapy for patients with a number of neurological and psychiatric disorders that are refractory to more conservative pharmacological and/or psychotherapeutic treatments. These include essential tremor, dystonia, epilepsy and obsessivecompulsive disorder. These, as well as other, new, indications for which DBS is being evaluated, are discussed in this book.

Two developments have contributed to increased popularity of DBS. The first one is the increased understanding of disease mechanisms that lead to symptoms. We have learned that neurological or psychiatric disorders lead to disrupted activity in a specific brain region or a specific brain pathway, resulting in specific symptoms. A good example is altered activity in the subthalamic nucleus being responsible for key symptoms of Parkinsons disease. DBS of the subthalamic nucleus suppresses this altered activity and relieves these motor symptoms. Another example is tremor, which is linked to tremor cells that can be found in the motor part of the thalamus. When DBS is applied in this region, the tremor can be stopped. Similar mechanisms play a role in obsessivecompulsive disorder. DBS of limbic parts of the basal ganglia improves severe obsessions and compulsions. The second reason for the increased interest in DBS is the limited progress in new drug development for neurological and psychiatric diseases. The limited accessibility of the brain due to the bloodbrain barrier and the non-selective nature of most drugs are major challenges for drug development.

Authors from different disciplines, from many different countries, have contributed their expertise and personal experience to this book. This book provides the latest insights in disease mechanisms, brain anatomy and function, and clinical symptomatology of neurological and psychiatric disorders that are considered indications for DBS. In addition, specific patient management skills and DBS treatment strategies are outlined. Basic and advanced concepts of stimulation protocols, necessary knowledge regarding hardware and software are included as well. The composition of the editors, neurologists, neurosurgeons and psychiatrist reflects the multidisciplinary nature of the field. The editors hold that a well-integrated and dedicated multidisciplinary team, with up-to-date knowledge of the possibilities of DBS treatment, is an essential requirement for successful therapy.