Neuromodulation

by Elliot S. Krames (Editor), P. Hunter Peckham (Editor), Ali R. Rezai (Editor)

Overview

Neuromodulation will be the first comprehensive and in-depth reference textbook covering all aspects of the rapidly growing field of neuromodulation. This book provides a complete discussion of the fundamental principles of neuromodulation and therapies applied to the brain, spinal cord, peripheral nerves, autonomic nerves and various organs. The textbook is highly structured and organized into overarching sections that cover chronic pain, movement disorders, psychiatric disorders, epilepsy, functional electrical stimulation, cardiac, gastrointestinal, genitourinary and organ neuromodulation. The fundamental principles of electricity and infusion, neural tissue interface, biomedical engineering, neuromodulation devices, basic science, neuroanatomy, neurophysiology, imaging and mechanisms are emphasized. In addition to providing details pertaining to the state-of-the-art current practice, innovative and emerging applications are discussed in specific chapters. Finally, the textbook provides specific chapters focusing on the technical aspects of the various neuromodulation procedures as well as technical specifications of various implantable devices. All of the contributors to Neuromodulation represent leading experts in the field. The editors are internationally renowned in their respective fields of neuromodulation, pain management, functional neurosurgery and biomedical engineering. Neuromodulation will be the first and foremost authoritative text on neuromodulation therapies and will establish the gold standard that defines the field for years to come.Key Features - The first comprehensive reference on the emerging field of Neuromodulation - Editors and authors include all leading figures in the field, and the leaders of the International Neuromodulation Society - Over 90 chapters on topics ranging from a layout of the fundamentals (e.g. neuroanatomy, plasticity, bioelectrical effects, infusion therapies), solutions for the biomedical engineering challenges (e.g. materials, how to preserve normal function etc.), to a rundown of the existing applications and their future promise - Over 1200 pages in splendid full color, richly illustrated - Important areas of application include: control of chronic paindelivery of drugs to the nervous system via implanted devicescontrol of epilepsy, Parkinson, etc.functional restoration, e.g. visual, auditory, restoration after stroke, restoration of motor function after traumatic eventsstimulation of body organs via neural devices (incl. the heart, abdominal organs, genitourinary organs)overview over newly emerging fields - control of obesity, blood pressure, tinnitus, brain injury, neurodegenerative diseases, brain-machine interfaces

Product Details

ISBN-13:	9780080921396
Publisher:	Elsevier Science & Technology Books
Publication date:	05/05/2009
Sold by:	Barnes & Noble
Format:	eBook
Pages:	1088
File size:	19 MB
Note:	This product may take a few minutes to download.

About the Author

Dr. Peckham is the Donnell Institute Professor of Biomedical Engineering and Orthopaedics at Case Western Reserve University and Director, Cleveland Functional Electrical Stimulation Center. The major area of Dr. Peckham's research is in rehabilitation engineering and neuroprostheses. He’s also the Founder for the Institute for Functional Restoration at the Case Western School of Medicine and the Co-Director of MetroHealth Rehabilitation Institute of Ohio. A holder of eight patents, he is a member of multiple councils, Dr. Peckham is also a fellow of the American Institute of Medical and Biological Engineering.
Dr. Rezai is currently executive chair and vice president of neurosciences for WVU Medicine. He also serves as associate dean and the John D. Rockefeller IV tenured professor in neurosciences at the WVU School of Medicine. Dr. Rezai has published over 150 peer reviewed articles, more than 30 book chapters, and serves on the editorial board of five journals. Dr. Rezai is currently the Past President of the Congress of Neurological Surgeons (CNS), the largest neurosurgical societies in the world, as well as the Past President North American Neuromodulation Society (NANS), and the American Society of Stereotactic and Functional Neurosurgery (ASSFN).Dr. Rezai’s research focuses on mechanisms of neurostimulation, and developing neuromodulation devices and novel therapeutic strategies for treatment of neurological disorders.

Read an Excerpt

Neuromodulation

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Academic Press

Copyright © 2009 Elsevier Ltd.
All right reserved.
ISBN: 978-0-08-092139-6

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Chapter One

What Is Neuromodulation?

Elliot S. Krames, P. Hunter Peckham, Ali R. Rezai, and Farag Aboelsaad

OUTLINE

Defining Neuromodulation 3 Other Definitions and Terms 5

The Field of Neuromodulation 5

Neuromodulation for Chronic Pain 5 Brain Neuromodulation 6 Neuromodulation for Spasticity 6 Functional Electrical Stimulation (FES) 6 Neuromodulation and GI Disorders 7 Neuromodulation for Urological Disorders 7 Neuromodulation for Cardiac Disorders 7 References 7

DEFINING NEUROMODULATION

Neuromodulation is among the fastest-growing areas of medicine, involving many diverse specialties and impacting hundreds of thousands of patients with numerous disorders worldwide. In the past decade, neuromodulation has witnessed significant advances with regard to the science, mechanisms, clinical applications, and technology development. These advances have been coupled with the rapid growth of the neuromodulation device industry and improvements in current devices and development of next generation neuromodulation systems (Figure 1.1).

Neuromodulation is "technology impacting on the neural interface." It is the process of inhibition, stimulation, modification, regulation or therapeutic alteration of activity, electrically or chemically, in the central, peripheral or autonomic nervous systems. It is the science of how electrical, chemical, and mechanical interventions can modulate the nervous system function. Neuromodulation is inherently non-destructive, reversible, and adjustable. The INS (the International Neuromodulation Society) (Sakas et al., 2007) defines neuromodulation as a field of science, medicine, and bioengineering that encompasses implantable and non-implantable technologies, electrical or chemical, for the purpose of improving quality of life and functioning of humans. At the present time, neuromodulation implantable devices are either neural stimulators or microinfusion pumps. These devices are being utilized for the management of chronic pain, movement disorders, psychiatric disorders, epilepsy, dismotility disorders, disorders of pacing, spasticity, and others (Figure 1.2). Neuroprostheses such as cochlear implants and sacral root stimulators are also commonly included within the definition of neuromodulation. Jan Holsheimer (2003) suggests that for a therapy to be considered neuromodulation, the therapy must consist of the following:

1. The therapy must be dynamic, ongoing (continuous or intermittent) intervention, and not a short and non-recurring procedure.

2. The activity of specific neural networks is affected by the ongoing electrical stimulation or by ongoing neuropharmacological stimulation.

3. The clinical effect is continuously controllable by varying one or more stimulation parameters to satisfy a patient's need.

Neuromodulation therefore is either electrical or chemical. Electrical neuromodulation is electrical stimulation of the brain, spinal cord, peripheral nerves, plexuses of nerves, the autonomic system, and functional electrical stimulation of the muscles, while chemical neuromodulation uses direct placement of chemical agents to neural tissues through utilization of technology of implantation such as epidural or intrathecal delivery systems.

Other Definitions and Terms

The term neuromodulation can be defined as a technology that impacts upon neural interfaces and is the science of how electrical, chemical, and mechanical interventions can modulate or change central and peripheral nervous system functioning. It is a form of therapy in which neurophysiological signals are initiated or influenced with the intention of achieving therapeutic effects by altering the function and performance of the nervous system. The term neuromodulation, in the opinion of these authors, should replace other terms that are relevant to the field and are being used, including neuroaugmentation, neurostimulation, neuroprosthetics, functional electrical stimulation, assistive technologies, and neural engineering (Sakas et al., 2007). These terms have much overlap and tend to confuse the uninitiated.

Neuroaugmentation is defined by the OnLine Medical Dictionary as the use of electrical stimulation to supplement the activity of the nervous system. Neurostimulation is the process or technology that applies electrical currents, in varying parameters, by means of implanted electrodes to achieve functional activation or inhibition of specific neuronal groups, pathways, or networks. Functional electrical stimulation, also known as FES, is defined as a technique that uses electrical currents to activate nerves innervating extremities affected by paralysis resulting from spinal cord injury (SCI), head injury, stroke, or other neurological disorders, restoring function in people with disabilities (Wikipedia: Functional Electrical Stimulation). FES is electrical stimulation of a muscle to provide normal control in order to produce a functional useful contraction, therefore, electrical stimulation that produces only sensory response generally would not be termed as FES and electrical stimulation that reduces pain is also not FES. Neuroprosthetics "is a discipline related to neuroscience and biomedical engineering concerned with developing neural prostheses, artificial devices to replace or improve the function of an impaired nervous system. The neuroprosthetic that has the most widespread use today is the cochlear implant with approximately 100 000 in worldwide use as of 2006" (Wikipedia: Neuroprosthetics). Neural engineering is an emerging interdisciplinary field of research that uses engineering techniques to investigate the function and manipulate the behavior of the central or peripheral nervous systems. The field draws heavily on the fields of computational neuroscience, experimental neuroscience, clinical neurobiology, electrical engineering and signal processing of living neural tissue, and encompasses elements from robotics, computer engineering, neural tissue engineering, materials science and nanotechnology (Answers.Com.).

THE FIELD OF NEUROMODULATION

Neuromodulation, paraphrasing Jan Holsheimer (2003), should be concerned with long-term treatment of chronic conditions. It is a rapidly evolving multidisciplinary biomedical and technical field and is among the fastest-growing fields of medicine today. Multiple specialties are now utilizing neuromodulatory techniques to benefit their patients. The field of neuromodulation covers a wide and heterogeneous range of conditions that include disorders of cardiac pacing, eyesight, gastric motility, epilepsy, headaches, hearing, limb and organ ischemia, movement disorders, occipital neuralgia, chronic pain, peripheral neuralgias, psychiatric and neurobehavioral disorders, spasticity, stroke, traumatic brain injury, urinary frequency, urinary urgency, urinary and fecal incontinence, and more (see Figure 1.3).

Because the nervous system controls body functions and because disorders of body functions are ubiquitous, many clinical specialists, including anesthesiologists, cardiologists, gastroenterologists, neurologists, neurosurgeons, ophthalmologists, otolaryngologists, pain physicians, psychiatrists, physical medicine and rehabilitation specialists, and urologists use the therapies of neuromodulation.

The goal of this book was to provide a comprehensive review and discussion pertaining to all aspects of the field of neuromodulation. Specific chapters will address the fundamentals of neuromodulation, including mechanisms of neuromodulation, neural networks, neuroscience, basics of device design, impact of technology at the neural interface, computational science, modeling, and others. This essential information benefits all those involved with neuromodulation. In addition to the fundamentals and general background topics, specific clinical applications of neuromodulation for various conditions will be provided with chapters pertaining to the following topics.

NEUROMODULATION FOR CHRONIC PAIN

An extensive and detailed discussion of neuromodulation for pain management will be provided in multiple chapters. Chronic pain is estimated to be the third largest healthcare problem in the world, afflicting around 30% of the worldwide population (Latham and Davis, 1994). Chapters on micro-infusion therapy, spinal cord, peripheral nerve and brain stimulation will review the various methods and approaches used to treat chronic pain conditions. This includes chronic regional pain syndrome (CRPS), headaches, occipital neuralgia, failed back pain, neck pain, extremity pain, degenerative spinal disease pain, central pain, cancer pain, visceral pain, and other pain conditions.

Brain Neuromodulation

Brain neuromodulation involving cortical and sub-cortical neurostimulation has been growing significantly, with a number of emerging applications involving multiple disorders. The most visible among these has been the use of deep brain stimulation (DBS) for treatment of movement disorders (Parkinson's disease, dystonia, essential tremor). The success of DBS for movement disorders in over 55 000 patients worldwide has provided a platform for acceptance of the concept of a brain stimulator or a brain pacemaker. The use of DBS in Parkinson's disease and other movement disorders has ushered in a new ear of brain neuromodulation implants. In this context, the emerging use of brain stimulation for the treatment of neurobehavioral disorders such as obsessive–compulsive disorder and depression as well as epilepsy will be discussed. Additional applications of brain stimulation for eating disorders, addiction, obesity, tinnitus, blood pressure control, and traumatic brain injury will be discussed in the emerging application section. Additional brain neuromodulation chapters pertain to novel uses of brain infusion and neuromodulation approaches for Alzheimer's and other neurodegenerative disorders.

Neuromodulation for Spasticity

The use of intrathecal baclofen infusion pumps has provided significant relief for patients suffering from spasticity secondary to multiple sclerosis, stroke, and other conditions. This is one of the most common and successful uses of neuromodulation infusion devices.

Functional Electrical Stimulation (FES)

FES encompasses the control of movements that are compromised because of impairment. It enhances exercise of paralyzed extremities, and augments activity of afferent neural pathways (Popovic et al., 2002). Applications to improve functional ability of patients include enhancing upper and lower extremity functions as well as increasing range of motion of affected joints. FES devices serve as neuro-orthoses or external controls for motor function. Other benefits of FES include increasing muscle mass, reducing venous pooling, increasing stroke volume and cardiac output, and improvement of cardiovascular fitness, especially for paralyzed patients, as in patients with spinal cord injury. Neuroprosthetics that employ FES are effective in providing functional enhancement in patients with severe neurological impairment as in patients with spinal cord injury or stroke. The goals of these devices are to provide independence of functions of daily living such as standing, walking, breathing, micturition, and defecation (Grill and Kirsch, 2000; Troyk and Donaldson, 2001; Chae et al., 2002).

(Continues...)

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Table of Contents

Prolog (Joseph Pancrazio)SECTION IAN INTRODUCTION TO NEUROMODULATIONIntroductionElliot S. Krames1What Is Neuromodulation?Elliot S. Krames, Ali R. Rezai, P. Hunter Peckham, and Farag Aboelsaad2Neuromodulation: A Historical PerspectivePhilip L. Gildenberg3Neuromodulation Technologies: Whom Do We Serve?Allen R. Dyer and Mary Pat Aardrup4Challenges in Moving Toward Product DevelopmentPaul Meadows5The Birth of an IndustryJames Cavuoto6Beginnings of the SocietiesRoss Davis, Philip L. Gildenberg, Giancarlo Barolat, Elliot Krames, Dejan Popovic, and Paul Meadows7Clinical Study DesignDaniel B. Carr and Anthony Eidelman 8Psychological Issues and Evaluation for Patients Undergoing Implantable TechnologyDaniel M. Doleys9Deep Brain Stimulation: Ethical Issues in Clinical Practice and Neurosurgical ResearchJoseph J. FinsSECTION IIFUNDAMENTALS OF NEUROMODULATIONIntroductionNarendra Bhadra, J. Thomas Mortimer, and Hunter Peckham10Anatomy of the Nervous SystemJoshua M. Rosenow11Fundamentals of Electrical StimulationJ. Thomas Mortimer and Narendra Bhadra12Neuromodulation and Neuronal PlasticityAlon Y. Mogilner13Gene-Based NeuromodulationThais Federici, Jonathan Riley, and Nicholas BoulisSECTION IIA MECHANISMSIntroduction14Principals of Electric Field Generation for Stimulation of the Central Nervous SystemWarren M. Grill15Mechanisms of Action of Deep Brain Stimulation: A ReviewKendall Lee, Charles Blaha, and Jonathan M. Bledsoe16Computational Modeling of Deep Brain StimulationCameron C. McIntyreSECTION IIIBIOMEDICAL ENGINEERING CONSIDERATIONSIntroductionJoseph Pancrazio and Hunter Peckham17Electrodes for the Neural InterfaceDustin J. Tyler and Katharine H. Polasek18Implantable Neural StimulatorsP. Hunter Peckham and D. Michael Ackermann, Jr19Designing a Neural Interface System to Restore MobilityJohn P. Donoghue and Leigh Hochberg20MRI Safety and Neuromodulation SystemsFrank G. ShellockSECTION IVNEUROMODULATION FOR PAINIntroductionElliot S. Krames and Andre Machado21Physiology and Pathophysiology of Chronic PainJoshua M. Rosenow22The Endogenous Neuromodulation SystemAllan I. Basbaum, Joao Braz, Michael H. Ossipov and Frank Porreca23Management Strategies for Chronic PainRollin M. GallagherSection IVAIntrathecal TherapiesIntroduction 24Transcutaneous Electrical Nerve Stimulation (TENS): A ReviewKathleen Sluka, Howard S. Smith and Deirdre M. Walsh25Mechanisms of Spinal Cord Stimulation in Neuropathic and Ischemic Pain SyndromesBengt Linderoth, Robert D. Foreman, Björn A. Meyerson26The Cost-Effectiveness of Spinal Cord StimulationRichard B. North, Jane Shipley and Rod S. Taylor27SCS for Painful NeuropathiesGiancarlo Barolat28Neurostimulation in the Treatment of Complex Regional Pain SyndromeJoshua P. Prager29 Peripheral nerve stimulation (PNS) for Pain Peripheral Neuralgia and CRPSMichael Stanton-Hicks30Occipital Neurostimulation (ONS) for Treatment of Intractable Headache SyndromesRichard L. Weiner and Kenneth M. Alo'31Subcutaneous Targeted StimulationTeodor Goroszeniuk and Sandesha KothariSection IVBNeuromodulation for PainIntroduction 32 Relevant Anatomy for Spinal DeliveryTimothy R Deer, Matthew Ranson and Douglas Stewart33The Rational Use of Intrathecal Opioid AnalgesicsElliot S. Krames and Mouchir Harb34Intrathecal Analgesics, Choice of SystemMarshall D. Bedder35Intrathecal Non-Opioid Analgesics for the Control of PainEnrique Reig, David Abejón, and Elliot S. Krames36Compounding Intrathecal DrugsRichard L. Rauck 37Intracerebroventricular Opioid Administration for Chronic PainKatherine E. Groothuis and Robert M. LevySection IVCIntracranial Procedures for Chronic PainIntroduction 38Deep Brain Stimulation for PainErlick A.C. Pereira, Sarah L.F. Owen, Alexander L. Green and Tipu Z. Aziz39Deep-Brain Stimulation of the Posterior Hypothalamus in Chronic Cluster HeadacheA. Franzini, G. Messina, M. Leone, G. Bussone, C. Marras, G. Tringali and G.

What People are Saying About This

From the Publisher

The first comprehensive reference dedicated to the field Neuromodulation, the technology that provides tools to directly stimulate specific areas of the nervous system electrically or pharmatcologically, written and edited by the pioneering scientists of this emerging field.

Editorial Reviews

"This reference is the product of a varied and exceptionally diverse collection of multidisciplinary, leading experts in the field who have added their significant contributions to the field of neuromodulation." —Elmer "Al" Pinzone, M.D., M.P.H., in Practical Pain Management, October 1, 2009

"Neuromodulation will be the go-to-it reference work for this rapidly expanding and fascinating field. The editors have assembled an all-star group of contributors who comprehensively cover all aspects of neuromodulation in the treatment of human disease and dysfunction." —John D. Loeser, M.D., Departments of Neurological Surgery and Anesthesiology, University of Washington, Seattle, USA

"The greater than 40 year history of scientific inquiry into the interface between neural tissue and therapeutic electrical fields or targeted drug infusion has resulted in a body of rapidly growing evidence for positive effects when these technologies are applied to selected patients who suffer from chronic neurological diseases. The editors of Neuromodulation have organized a definitive knowledge resource for this growing and complex field by assembling many of the world leaders in basic neuroscience, electrical engineering and drug infusion technologies, and clinical investigation. Any new paradigm in medicine, such as neuromodulation, deserves such an outstanding text to help the clinician and researcher to navigate through novel concepts, clinical outcomes and promising new applications." —Richard E. Kuntz, M.D., M.Sc., Sr. Vice President and President, Medtronic Neuromodulation, Minneapolis, USA

"As it has become possible to directly interact with neural tissue, neuromodulation as a new and very promising field of therapeutic approaches has emerged on a very steep path of development. Since the first applications to the treatment of pain with electrical stimulation numerous newly developed methods, including direct electrical stimulation and drug infusion, targeting neural tissue from the cortex to the basal ganglia, spinal cord, and peripheral nerves have made it possible to develop new very powerful therapeutic approaches to serious clinical conditions. Every new branch soon produces its own ramifications and the neuromodulation looks like a very fast-growing tree. This timely publication provides a global and comprehensive review of the current state of the art technology from new and exciting perspectives. This book will be a milestone in the development of neuromodulation." —Alim Louis Benabid, Member Institut Universitaire de France, French Academy of Sciences, French Academy of Medicine, Royal Academy of Medicine of Belgium, Professor Emeritus of Biophysics at the Joseph Fourier University in Grenoble, Scientific Advisor at French Atomic Energy Commission, Grenoble, France

"Neuromodulation therapy has advanced dramatically in recent years and promises to grow into a multi-indication modality that will help millions who suffer from chronic pain and other – neurological diseases.…As, the awareness, acceptance, and use of Neuromodulation technologies grow, the thoughtful publication and updating of reference books like Neuromodulation will play a vital role in the sharing of knowledge and best practices, enabling the modality to reach its full clinical potential.…This book draws from the giants of Neuromodulation who have contributed greatly to the field’s expansion. It broadly captures the wisdom of many talented and caring people and shares it with the world. We will use this book and its future updates as a core resource to further strengthen our educational programs. I thank the editors and authors for their vision and ambitious efforts in making this important book a reality." —Christopher G. Chavez, President, Neuromodulation Division, St. Jude Medical, St. Paul, USA

From the Publisher