Author: Erwin B. Montgomery Jr. MD

Deep Brain Stimulation is a Screw, Not a Nail

Professor – Abraham Maslow said “When all you have is a hammer, the whole world looks like a nail” Student – What if the world is a screw? Deep Brain Stimulation (DBS) is arguably the most effective treatment for many neurological and psychiatric disorders. In disorders in which DBS has been applied, DBS is better […]


Helpful Hints at the Time of DBS Lead Implantation

It is the little things that usually get you and they are the hardest to anticipate. While I am not a neurosurgeon, it appears to me that Deep Brain Stimulation (DBS) lead implantation surgery has a lot of moving parts, any one of which can go wrong. One of the best descriptions of the surgery […]


Predicting DBS Lead Implantation Success from Microsubthalamotomy

Neurologist 1: “We generally do not use microelectrode recordings for target location in the subthalamic nucleus. We use the patient’s clinical response to DBS test stimulation and adjust the location of the lead if we need to. However, our last patient had a remarkable microsubthalamotomy effect so we could only test whether the patient would […]


The Choice Between What is Right and What is Easy

“Dark times lie ahead of us and there will be a time when we must choose between what is easy and what is right. -Albus Dumbledore” ― J.K. Rowling, Harry Potter and the Goblet of Fire There is a subtle genius in the quote above. Note that the dichotomy is between what is right and […]


Surgical Approaches, Statistics, and What it Takes to not Mislead and not be Misled

“There are three kinds of lies: lies, damned lies and statistics.” Attributed to Disraeli by Mark Twain (Mark Twain’s Own Autobiography: The Chapters from the North American Review) “Everyone is a statistician, the only question is whether a good or bad one.” – Unknown Despite the remarkable benefits from Deep Brain Stimulation (DBS), there are […]


Humanitarian Device Exemptions (HDEs)

“What’s in a name? That which we call a rose by any other name would smell as sweet.” – Romeo and Juliet, Act II, Scene II, Shakespeare Considerable confusion seems to stem from the fact that the US Food and Drug Administration (FDA) has approved Deep Brain Stimulation (DBS) for some conditions under a Humanitarian […]


Microelectrode Arrays versus Single Electrodes

“Well, Jane, it just goes to show you, it’s always something—if it ain’t one thing, it’s another.” – Roseanne Roseannadanna (Gilda Radner) Saturday Night Live, NBC television There is great diversity between surgical approaches for Deep Brain Stimulation (DBS) lead implantation; however, there is no “smoking gun” evidence for one approach over another. However, it […]


Accuracy or Precision – More than a Matter of Semantics

“Consistency [precision] is about engineering, accuracy is about knowledge.” – Anonymous Authors discussing various methods for targeting in Deep Brain Stimulation (DBS) use the term “accuracy” when, in actuality, they mean precision. Precision refers to the repeatability or reproducibility of a method or intervention. The question becomes, how often is the target “hit” on repeated […]


Deep Brain Stimulation Lead Implantation Surgery – Awake or Asleep?

“To sleep, perchance to dream- ay, there’s the rub.” — Hamlet (III, i, 65-68), Shakespeare The great diversity of surgical methods for Deep Brain Stimulation (DBS) lead implantation raises interesting issues. A neurologist looking in from the outside would have to ask the question, are all of the implantation approaches right? To be sure, even […]