Deep brain stimulation of the ventral internal capsule/ventral striatum for obsessive-compulsive disorder: worldwide experience.

Psychiatric neurosurgery teams in the United States and Europe have studied deep brain stimulation (DBS) of the ventral anterior limb of the internal capsule and adjacent ventral striatum (VC/VS) for severe and highly treatment-resistant obsessive-compulsive disorder. Four groups have collaborated most closely, in small-scale studies, over the past 8 years. First to begin was Leuven/Antwerp, followed by Butler Hospital/Brown Medical School, the Cleveland Clinic and most recently the University of Florida. These centers used comparable patient selection criteria and surgical targeting. Targeting, but not selection, evolved during this period. Here, we present combined long-term results of those studies, which reveal clinically significant symptom reductions and functional improvement in about two-thirds of patients. DBS was well tolerated overall and adverse effects were overwhelmingly transient. Results generally improved for patients implanted more recently, suggesting a 'learning curve' both within and across centers. This is well known from the development of DBS for movement disorders. The main factor accounting for these gains appears to be the refinement of the implantation site. Initially, an anterior-posterior location based on anterior capsulotomy lesions was used. In an attempt to improve results, more posterior sites were investigated resulting in the current target, at the junction of the anterior capsule, anterior commissure and posterior ventral striatum. Clinical results suggest that neural networks relevant to therapeutic improvement might be modulated more effectively at a more posterior target. Taken together, these data show that the procedure can be successfully implemented by dedicated interdisciplinary teams, and support its therapeutic promise.

Instrumentation for neuromodulation.

The explosion in understanding how the central nervous system (CNS) works affords new opportunities to interact with the nervous system to compensate for dysfunction due to disease or injury. Neuromodulation is a term that describes methods that carry out that interaction based on principles of nerve cell physiology. There currently are two neuromodulation techniques used that require implantable devices-neurostimulation and implantable, chronic drug delivery. This article describes the devices used for neuromodulation, the motivation for the different feature sets of the devices, and the physiological and technological principles underpinning their use.

Clinical use of biocompatible ultrasonic bladder volume sensor.

A biocompatible ultrasonic bladder volume sensor has been developed and successfully employed to sense bladder fullness in healthy volunteers. It is anticipated that it will be of practical use in patients with diabetic autonomic neuropathy as well as in patients employing self-intermittent catheterization.