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 I heard was from Dr. Kathryn Holloway who described it as “fussy.” As ...
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 have adverse effects....
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 what is easy, not between what is right or wrong or by extension, between what is go...
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 still significant ...
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 Device Exemption (HDE). The confusion is further ...
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.”
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 targe...
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 in medicine, there ...