Deep Brain Stimulation

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Zox Pro Training Summary


4.7 stars out of 12 votes

Contents: Training System
Author: Richard Welsh and Shannon Panzo
Price: $197.00

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Highly Recommended

All of the information that the author discovered has been compiled into a downloadable ebook so that purchasers of Zox Pro Training can begin putting the methods it teaches to use as soon as possible.

As a whole, this book contains everything you need to know about this subject. I would recommend it as a guide for beginners as well as experts and everyone in between.

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Electrical Brain Stimulation

Following the success of treatment for movement disorders, deep brain stimulation (DBS) is under active investigation as a non-pharmacological therapeutic modality for patients with medically intractable epilepsy who are not eligible for resective surgical procedures 66 . A variety of anatomical structures may be targeted, including deep brain structures 67, 68 . Interest in the stimulation of subcortical structures stems from the recognition of widespread non-specific anterior and intralaminar nuclear connections to many other parts of brain and the progressive recruitment of substantia nigra, subthalamic nucleus and midline thalamic nuclei in animal models of epilepsy 66 . Furthermore, automated seizure detection can be incorporated into an electrical brain stimulator to form a closed-loop system so that electrical stimulation is delivered to the epileptogenic zone when onset of ictal activity is detected 69, 70 . Recent understanding in seizure dynamics also helps decipher the...

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.

Future directions in epilepsy therapy

Chronic electrical stimulation of the cerebellum was attempted over 40 years ago as a treatment for epilepsy. More recently, chronic deep brain stimulation of the anterior nucleus of the thalamus and the subthalamic nucleus has been used in both focal and generalized forms of epilepsy. Most methods have involved continuous or intermittent stimulation, regardless of the presence or absence of ictal activity (open-loop systems). Research is currently focused on the development of an intelligent, closed-loop device that can detect seizure onset and then deliver counter-shock discharges. Preliminary studies have shown that such a device is feasible and potentially beneficial 89 . The NeuroPace Responsive Neurostimulator system is one such closed-loop neurostimulator 90, 91 . The device demonstrated excellent safety and tolerability in a recent feasibility trial, and there was preliminary evidence of efficacy 91 . A randomized, double-blinded, multicentre clinical trial was recently...

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),...

What can experimental researchers learn from the clinical data

The evidence for a delayed or progressive anticonvulsant effect of VNS is intriguing, though not conclusive, and merits further research at the bench to elucidate the possible underlying mechanisms and in the clinic to find surrogate markers and determine ways to accelerate improvements in seizure frequency and severity for patients treated with VNS. Published mechanistic studies provide a starting point. It will also be interesting to determine if similar temporal patterns of efficacy are seen with other forms of electrical brain stimulation that are currently under development for the treatment of epilepsy or being planned.

Other Functional Surgical Procedures

Both stereotactic ablation and deep-brain stimulation have been used, in small numbers of patients, in an attempt to control or modify seizures since the 1930s. Targets have included the amygdala, various thalamic nuclei, the fields of Forel, the anterior commissure, the fornix, and the posterior limb of the internal capsule. The results of these operations in the past were generally poor, and this type of functional surgery had until recently been largely abandoned. There has been a recent resurgence of interest in deep brain stimulation (DBS), encouraged by both the improved anatomical precision of stereotaxy made possible by MRI, better surgical instrumentation and stimulation technology, and also by the success of these procedures in other conditions such as Parkinson disease and in pain. Targets that are most favoured include the caudate nucleus, the centro-median nucleus of the thalamus, the anterior thalamic nucleus, the mamillary bodies and the subthalamic nucleus. Direct...

The biological significance of phenomenological similarities between PD and epilepsy

It is well established that fear may be provoked by activity in medial temporal structures. It is the most common experiential phenomenon produced by depth electrode brain stimulation in antero-medial temporal regions (Halgren et al., 1978). Hence there is evidence that abnormal electrical activity, both epileptiform and experimental, leads to a subjective experience of intense fear of sudden onset a cardinal feature of panic.

Peripheral mechanisms

Finally, we would like to allude to some theoretical difficulties associated with the fact that the vagus is more part of a 'system' than two 'one-way routes' VNS has an impact on the entire vagal brain-periphery feedback loop and electrical stimulation affects signalling in both directions. A vagus under VNS may make the brain 'think' that peripheral functions have changed - even if they actually have not, that is, even if no objective changes can be revealed by psychophysiological measurements. Such a mechanism could be described as virtually peripheral. Conversely, VNS may distort or suggest commands coming from the brain which are to be transmitted to the periphery by the vagus. This virtually cerebral mechanism results in peripheral effects, as for example hoarseness. Studies on the alterations of neural transmission within the vagus as induced by VNS would be required. So far, the artificial stimulation of the vagal system by VNS - with its unphysiological duty cycles, output...

Modeling to Test New Therapies

Alternative treatments for epilepsy also benefit from animal research. Vagus nerve stimulation (VNS), for instance, was first investigated with acute seizures in dogs and then with chronic epilepsy in monkeys before it was tried in humans (Schachter and Wheless, 2002). Animal research is also playing an important role in developing the techniques of deep brain stimulation as a treatment for epilepsy. Epilepsy surgery, gamma knife surgery, and the ketogenic diet (KD) have been used effectively in patients without preliminary studies in animals. However, animal research continues to be of value in our efforts to understand how these therapeutic interventions work, what might be done to improve them, and which patients are most likely to benefit from their use. Identifying appropriate animal models for testing therapeutic interventions is a prime concern. For example, because KD is principally used in children, understanding and improving KD-based approaches require comparable immature...

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

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Brain Blaster

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