Deep Brain Stimulation: Current Indications and Future ... · Deep Brain Stimulation: Current...
Transcript of Deep Brain Stimulation: Current Indications and Future ... · Deep Brain Stimulation: Current...
P A C I F I C N E U R O . O R G
Deep Brain Stimulation: Current Indications and Future Directions
Jean-Philippe Langevin, MDDirector, Restorative Neurosurgery
Pacific Neuroscience Institute
Objectives
• Deep Brain Stimulation (DBS)
• Current and emerging indications for DBS
• Closed-loop DBS (epilepsy)
• Surgical technique and frameless DBS
Electrical stimulation of a specific region of the brain
St-Jude medical
Medtronic DBS Implant
St. Jude Medical DBS implant
Directional Stimulation
Future of Current Steering
Dijk KJ et al. J Neural Eng 2015;12 (4)
Neurology
• Parkinson’s Disease• Essential Tremor• Dystonia• Epilepsy (Neuropace)
Psychiatry
• Obsessive-Compulsive Disorder (HDE)
• Depression • Addiction • PTSD
Current and Emerging Indications
Quality of life improvement
Pre-operative
Post-operative
DBS works by disrupting signals
Grill WM, Snyder AN, Miocinovic S. Neuroreport. 2004;15:1137-1140.
A B
DBS Center of Excellence
• Patient Selection
• Electrode placement precision
• Post-operative care
Four additional hours/day
EarlyStim Trial
Quality of Life Improvement
DBS FOR ESSENTIAL TREMOR
Tremor reduction
DBS Off DBS On
EPILEPSY: CLOSING THE LOOP
Closed Loop System
Condition Biomarker
Implanted Computer
Target Response
Self-Programming
Chronic Monitoring
Closed-loop Neuromodulation
Benefits of RNS for Epilepsy
• Median reduction overall: 1 year 44 %; 2 years 53%
• Responder rate: 1 year 44 %; 2 years 55%
Heck CN et al. Epilepsia 2014; 55(3): 432-441.
DBS FOR OCD
Activated PET in OCD patients
Rauch SL, Jenike MA, Alpert NM, Baer L, Breiter HC, Savage CR, Fischman AJ. Arch Gen Psychiatry. 1994 Jan;51(1):62-70.
Benefits: 35% Reduction in Severity
Greenberg B, Malon D, Friehs G, Rezai A, Kubu C, Malloy P, Salloway S, Okun M, Goodman W, Rasmussen S et al. Neuropsychopharmacology 2006; 31:2384-2393.
ADVANCE IN SURGICAL TECHNIQUE
Frameless DBS
Frame-based vs Frameless
3D Printed Custom Mini-Frame
Computerized Targeting
Accuracy and Complications
• Dislodged fiducial (s): 0.1 % (3)• Infection: 0004% (1)• Starfix not fitting: 0.004% (1)• Accuracy: 1.24-1.99 mm
Konrad P, Neimat JS, Yu H, Kao CC, Remple MS, D’Haese, DawantBM. Stereotact Funct Neurosurg 2011;89:34-41.
D’Haese PF, Pallavaram S, Konrad PE, Neimat J, Fitzpatrick JM, Dawant B. Stereotact Funct Neurosurg 2010;88:81-87.
Conclusion