Deep Brain Stimulation in Neurological and Psychiatric Disorders Current Clinical Neurology Daniel Tarsy, md, Series Editor Deep Brain Stimulation in Neurological and Psychiatric Disorders, edited by Daniel Tarsy, Jerrold L. Vitek, Philip A. Starr, and Michael S. Okun, 2008 Stroke Recovery with Cellular Therapies, edited by Sean I. Savitz and Daniel M. Rosenbaum, 2008 Practicing Neurology: What You Need to Know, What You Need to Do, Second Edition, by Rahman Pourmand, 2007 Sleep Disorders in Women: From Menarche Through Pregnancy to Menopause, edited by Hrayr P. Attarian, 2006 Diagnostic Criteria in Neurology, edited by Alan J. Lerner, 2006 Psychiatry for Neurologists, edited by Dilip V. Jeste and Joseph H. Friedman, 2006 Status Epilepticus: A Clinical Perspective, edited by Frank W. Drislane, 2005 Thrombolytic Therapy for Acute Stroke, Second Edition, edited by Patrick D. Lyden, 2005 Parkinson’s Disease and Nonmotor Dysfunction, edited by Ronald F. 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Daffner, 2000 Sexual and Reproductive Neurorehabilitation, edited by Mindy Aisen, 1997 Deep Brain Stimulation in Neurological and Psychiatric Disorders Edited by Daniel Tarsy, MD Parkinson’s Disease and Movement Disorders Center, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA Jerrold L. Vitek, MD, PhD Neuromodulation Research Center, Lerner Research Institute, The Cleveland Clinic Foundation, Cleveland, OH Philip A. Starr, MD, PhD Department of Neurosurgery, University of California, San Francisco, CA Michael S. Okun, MD Departments of Neurology and Neurosurgery, McKnight Brain Institute, University of Florida, Gainesville, FL Editors Daniel Tarsy Jerrold L. Vitek Beth Israel Deaconess Medical Center The Cleveland Clinic Foundation Harvard Medical School Cleveland, OH Boston, MA Philip A. Starr Michael S. Okun University of California University of Florida San Francisco, CA Gainesville, FL Series Editor Daniel Tarsy ISBN: 978-1-58829-952-9 e-ISBN: 978-1-59745-360-8 DOI: 10.1008/978-1-59745-360-8 Library of Congress Control Number: 2007941161 © 2008 Humana Press, a part of Springer Science+Business Media, LLC All rights reserved. This work may not be translated or copied in whole or in part without the written permission of the publisher (Humana Press, 999 Riverview Drive, Suite 208, Totowa, NJ 07512 USA), except for brief excerpts in connection with reviews or scholarly analysis. Use in connec- tion with any form of information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed is forbidden. The use in this publication of trade names, trademarks, service marks, and similar terms, even if they are not identifi ed as such, is not to be taken as an expression of opinion as to whether or not they are subject to proprietary rights. While the advice and information in this book are believed to be true and accurate at the date of g oing to press, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein. Cover illustration: Photo courtesy of Jeffrey T. Joseph, MD, PhD, Division of Neuropathology, Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA. Printed on acid-free paper 9 8 7 6 5 4 3 2 1 springer.com Preface Chronic deep brain stimulation (DBS) has been a rapidly evolving area of neurotherapeutics since its initial introduction for the treatment of Parkinson’s disease and essential tremor in the 1990s. For these conditions, DBS is now considered accepted therapy for patients failing to adequately respond to med- ical treatment. Since the 1990s, new clinical indications, anatomic targets, and technologies have contributed to an expanding role for DBS in the treatment of other movement disorders such as dystonia and Tourette syndrome as well as for other neurologic disorders such as epilepsy and cluster headache. Early experience has also been reported for psychiatric syndromes, such as obses- sive–compulsive disorder and depression. Experience with DBS in psychiatric disorders is very limited but is reviewed in this volume as neuropsychiatric indications are expected to grow in coming years. Because of the rapidly increasing application of DBS for neurologic and psychiatric indications and the recruitment of increasing numbers of neuro- logic, neurosurgical, and psychiatric clinicians to the field, it is appropriate to provide a resource that updates the underlying scientific background, describes methodologies and standards of treatment, and provides information on new technologies essential for clinical success and to advance the field. Deep Brain Stimulation in Neurological and Psychiatric Disorders begins with reviews of the functional anatomy and physiology of motor and nonmotor aspects of the basal ganglia and their connections, which underlie the application of DBS to neurological and psychiatric disorders. This is followed by proposed mechanisms of action of DBS based on functional neuroimaging, molecular, modeling, and neurophysiologic studies in animals and man. Discussions of patient selection, preoperative assessment, operative complications, and brain targeting are followed by chapters concerning microelectrode mapping as well as new and emerging brain imaging alternatives for target localization inside the operating room. DBS for movement disorders, which remains the most common indication, is reviewed in chapters on essential and other tremors, Parkinson’s disease, atypical parkinsonism, dystonia, and Tourette syndrome. Postoperative man- agement and treatment outcomes are reviewed in a series of chapters which address immediate and delayed complications, a particularly important chapter on programming. We have also included a discussion of DBS safety with v vi Preface regard to MRI and other electronic devices, neuropsychological sequelae, and quality of life. Finally, interesting new areas of DBS applications are addressed by experts with experience in epilepsy, obsessive–compulsive disorder, depression, and cluster headache. We have gathered a group of experienced and recognized authors to review the current state of DBS in neurologic and psychiatric disorders. We thank them for providing a conservative and level-headed approach to the use of DBS with emphasis on objective assessment of clinical outcomes, particularly in the new and emerging applications. We greatly appreciate the efforts of Richard Lansing and Michele Seugling at Humana Press, who have helped to make this work a reality. We also wish to thank our understanding families, without whose love and support this book would not have been possible. Finally, we dedicate this book to our patients and their families, whose continued courage and cooperation in the face of great personal adversity have allowed this work to progress toward providing some measure of relief for their difficult conditions. Daniel Tarsy, MD Jerrold L. Vitek, MD, PhD Philip A. Starr, MD, PhD Michael S. Okun, MD Contents Preface ...................................................................................................... v Contributors ............................................................................................. xi List of Color Plates .................................................................................. xv Part I. Overview of Deep Brain Stimulation 1. Functional Anatomy and Physiology of the Basal Ganglia: Motor Functions .............................................................................. 3 Yoland Smith and Thomas Wichmann 2. Functional Anatomy and Physiology of the Basal Ganglia: Non-motor Functions ........................................................................ 33 Suzanne N. Haber 3. History of the Therapeutic Use of Electricity on the Brain and the Development of Deep Brain Stimulation ............................. 63 Matthew A. Butler, Joshua M. Rosenow, and Michael S. Okun 4. Deep Brain Stimulation: Patient Selection in Parkinson’s Disease, Other Movement Disorders, and Neuropsychiatric Disorders. ........ 83 Mustafa Saad Siddiqui, Thomas Ellis, Stephen S. Tatter, Kelly D. Foote, and Michael S. Okun 5. Technical Alternatives in Performing Deep Brain Stimulator Implantation .................................................................... 99 Paul S. Larson 6. Intra-operative Microrecording and Stimulation .............................. 111 Frank Steigerwald and Jens Volkmann 7. Complication Avoidance and Management in Deep Brain Stimulation Surgery ................................................... 135 Philip A. Starr and Karl Sillay vii viii Contents 8. Mechanisms of Deep Brain Stimulation ......................................... 151 Svjetlana Miocinovic, Cameron C. McIntyre, Marc Savasta, and Jerrold L. Vitek 9. Functional Imaging of Deep Brain Stimulation: fMRI, SPECT, and PET ................................................................... 179 Robert Jech Part II. Deep Brain Stimulation in Movement Disorders 10. Thalamic Deep Brain Stimulation and Essential Tremor .............. 205 Kelly E. Lyons and Rajesh Pahwa 11. Thalamic Deep Brain Stimulation for Other Tremors .................... 215 Erwin B. Montgomery, Jr. 12. Thalamic Deep Brain Stimulation for Parkinson’s Disease Tremor .............................................................................. 229 Daniel Tarsy, Efstathios Papavassiliou, Kelly E. Lyons, and Rajesh Pahwa 13. Globus Pallidus Deep Brain Stimulation for Parkinson’s Disease ................................................................... 243 Frances Weaver, Kenneth Follett, and Matthew Stern 14. Deep Brain Stimulation of the Subthalamic Nucleus for the Treatment of Parkinson’s Disease ...................................... 253 Marcelo Merello 15. Deep Brain Stimulation of the Globus Pallidus Pars Interna and Subthalamic Nucleus in Parkinson’s Disease: Pros and Cons ................................................................. 277 Jorge Guridi, Maria C. Rodriguez-Oroz, and Jose A. Obeso 16. Deep Brain Stimulation in Atypical Parkinsonism ......................... 291 Ludy Shih and Daniel Tarsy 17. Deep Brain Stimulation in Dystonia ............................................... 305 Marie Vidailhet, David Grabli, and Emmanuel Roze 18. Deep Brain Stimulation in Tourette’s Syndrome ............................ 321 Linda Ackermans, Yasin Temel, and Veerle Visser-Vandewalle 19. The Role of Deep Brain Stimulation (DBS) in the Treatment of Postural Instability and Gait Disorders of Parkinson’s Disease .................................................... 333 Helen Bronte-Stewart Contents ix Part III. Postoperative Management in Patients Undergoing Deep Brain Stimulation 20. Deep Brain Stimulation Programming for Movement Disorders ................................................................. 361 Ioannis U. Isaias and Michele Tagliati 21. Neuropsychological Issues in Deep Brain Stimulation of Neurological and Psychiatric Disorders ..................................... 399 Alexander I. Tröster, April B. McTaggart, and Ines A. Heber 22. Deep Brain Stimulation Safety: MRI and Other Electromagnetic Interactions .......................................................... 453 Kenneth B. Baker and Michael D. Phillips 23. Deep Brain Stimulation Fault Testing ............................................ 473 Jay L. Shils, Ron L. Alterman, and Jeffrey E. Arle 24. Quality of Life and Cost Effectiveness of Deep Brain Stimulation in Movement Disorders .............................................. 495 Alan Diamond and Joseph Jankovic Part IV. Deep Brain Stimulation in Other Indications 25. Deep Brain Stimulation in Depression: Background, Progress, and Key Issues ........................................... 511 Benjamin D. Greenberg 26. Deep Brain Stimulation in Obsessive–Compulsive Disorder ......... 531 Loes Gabriëls, Kris van Kuyck, Marleen Welkenhuyzen, Paul Cosyns, and Bart Nuttin 27. Deep Brain Stimulation for Medically Intractable Cluster Headache ........................................................................... 547 Philip A. Starr and Andrew Ahn 28. Deep Brain Stimulation in Epilepsy ............................................... 561 William J. Marks, Jr. 29. The Future of Deep Brain Stimulation ............................................ 571 Julie G. Pilitsis and Roy A.E. Bakay Index ........................................................................................................ 593 Contributors Linda Ackermans, MD, Department of Neurosurgery, University Hospital Maastricht, Maastricht, The Netherlands Andrew Ahn, MD, PhD, Department of Neurology, University of California, San Francisco, San Francisco, CA Ron L. Alterman, MD, Department of Neurosurgery, Mount Sinai School of Medicine, New York, NY Jeffrey E. Arle, MD, PhD, Lahey Clinic, Neurosurgery, Tufts University School of Medicine, Boston, MA Roy A.E. Bakay, MD, Department of Neurosurgery, Rush University, Chicago, IL Kenneth B. Baker, PhD, Department of Neurosciences, The Cleveland Clinic, Cleveland, OH Helen Bronte-Stewart, MD, MSE, Departments of Neurology and Neuro- sciences and Neurosurgery, Stanford Movement Disorders Center, Stanford University, Stanford, CA Matthew A. Butler, MD, Movement Disorders Center, University of Florida, Department of Neurology, McKnight Brain Institute, Gainesville, FL Paul Cosyns, MD, PhD, Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp, Department of Psychiatry, University Hospital Antwerp, Antwerp, Belgium Alan Diamond, DO, Colorado Neurological Institute, Englewood, CO Thomas Ellis, MD, Departments of Neurology and Neurosurgery, Movement Disorders Program, Wake Forest University School of Medicine, Winston- Salem, NC Kenneth Follett, MD, PhD, FACS, Department of Neurosurgery, University of Nebraska Medical Center, Omaha, NE Kelly D. Foote, MD, Departments of Neurology and Neurosurgery, Movement Disorders Center, McKnight Brain Institute, University of Florida, Gainesville, FL xi