Magnetic Resonance Imaging In Deep Brain Stimulation

This book describes the roles magnetic resonance imaging (MRI) can play in deep brain stimulation (DBS). DBS therapeutically modulates aberrant neural circuits implicated in a broad range of neurological disorders. Following surgical insertion, an electrode placed into the desired brain target generates constant electricity, analogous to a cardiac pacemaker. Most commonly employed in movement disorders such as Parkinson’s disease, dystonia, and tremor, DBS is also being investigated for use in psychiatric and cognitive disorders, including depression and Alzheimer’s disease. It is estimated that more than 230,000 patients have undergone DBS surgery worldwide. Imaging techniques, specifically MRI, have played key roles in the preoperative and postoperative aspects of DBS. This book focuses on the established as well as the innovative roles of MRI in DBS. MRI and DBS are first introduced from an historical perspective and a review of the clinical aspects of DBS is performed. Then, the preoperative and postoperative applications of MRI in DBS are covered. The crucial aspect of MRI safety in these patients is also discussed. Finally, possible upcoming MRI applications for patients with DBS are discussed in a future directions chapter. Chapters are written by experts from the University of Toronto, a world leader in the field of DBS, alongside international co-authors to ensure a thorough review of the topics. This is an ideal guide for both clinicians (neurosurgeons, neurologists, psychiatrists, and neuroradiologists) and researchers as well as trainees interested in neuroimaging for DBS.

Magnetic resonance imaging (MRI) has become the standard of care for the evaluation of different neurological disorders of the brain and spinal cord due to its multiplanar capabilities and excellent soft tissue resolution. With the large and increasing population of patients with implanted deep brain stimulation (DBS) devices, a significant proportion of these patients with chronic neurological diseases require evaluation of their primary neurological disease processes by MRI. The presence of an implanted DBS device in a magnetic resonance environment presents potential hazards. These include the potential for induction of electrical currents or heating in DBS devices, which can result in neurological tissue injury, magnetic field-induced device migration, or disruption of the operational aspects of the devices. In this chapter, we review the basic physics of potential interactions of the MRI environment with implanted DBS devices, summarize results from phantom studies and clinical series, and discuss present recommendations for safe MRI in patients with implanted DBS devices.

Considered the largest breakthrough in the treatment of Parkinson's disease in the past 40 years, Deep Brain Stimulation (DBS) is a pioneering procedure of neurology and functional neurosurgery, forging enormous change and growth within the field. The first comprehensive text devoted to this surgical therapy, Deep Brain Stimulation for Parkinson's

Stereotactic techniques for placement of deep brain stimulation (DBS) electrodes have undergone continuous refinement since the introduction of human stereotaxis in the 1940s. Volumetric imaging techniques, including magnetic resonance imaging and computed tomography, have replaced ventriculography, and increasingly sophisticated computer systems now allow highly refined targeting of subcortical structures. This chapter reviews the underlying principles of stereotactic surgery, including imaging, targeting, and registration, and describes the surgical approach to DBS placement using both framed and frameless techniques.

The use of functional brain imaging techniques, including positron emission tomography (PET), single-photon emission computed tomography (SPECT), and functional magnetic resonance imaging (fMRI), has allowed for monitoring neuronal and neurochemical activities in the living human brain and identifying abnormal changes in various neurological and psychiatric diseases. Combining these methods with techniques such as deep brain stimulation (DBS) and transcranial magnetic stimulation (TMS) has greatly advanced our understanding of the effects of such treatment on brain activity at targeted regions as well as specific disease-related networks. Indeed, recent network-level analysis focusing on inter-regional covarying activities in data interpretation has unveiled several key mechanisms underlying the therapeutic effects of brain stimulation. However, non-negligible discrepancies have been reported in the literature, attributable in part to the heterogeneity of both imaging and brain stimulation techniques. This chapter summarizes recent studies that combine brain imaging and brain stimulation, and includes discussion of future direction in these lines of research.

Essential reference guide for clinicians working with DBS patients, fully revised throughout with new chapters on epilepsy and psychiatric disorders.

Deep brain stimulation for the treatment of patients with Parkinson’s disease was introduced in the 1990s. Initially performed only at academic centers, over the past decade it has become a widespread surgical procedure. A variety of surgical techniques are employed and innovations are introduced frequently. This book is an ideal source of information for the many practicing neurosurgeons who did not learn this surgery during their training but would now like to add it to their practice, as well as an excellent update on exciting new developments in surgery for Parkinson’s disease. This book is designed to provide practicing neurosurgeons with current knowledge on the practical aspects of surgical treatment of patients with Parkinson’s disease. It explains how to identify surgical candidates and determine the optimal surgery, describes the various surgical techniques that are currently employed, and offers insights into how to optimize deep brain stimulation therapy after implantation. The keys to avoidance of surgical complications are carefully elucidated. In addition, an overview is provided of potential advances on the near-term horizon, including closed-loop deep brain stimulation, gene therapy, and optogenetics. All topics are covered by experienced Parkinson’s disease surgeons, in a concise and digestable format. The book will be an ideal source of information for the many practicing neurosurgeons who would like to add deep brain stimulation to their practice, as well as an excellent update on new developments in surgery for Parkinson’s disease.

This is the second part in a two-volume work on neuromodulation. It describes the techniques and procedures applied by direct contact with the central nervous system or cranial nerves (in order to modulate the function of neural networks) or in deeply located structures inside the nervous system (in order to alter the function on specific networks).