Table of Contents

1. OVERVIEW OF NEUROLOGICAL DISORDERS…………………………………. 1-1
1.1 Alzheimer’s Disease……………………………………………………………….. 1-1
1.2 Amyotrophic Lateral Sclerosis ………………………………………………….. 1-3
1.3 Arteriovenous Malformation……………………………………………………… 1-4
1.4 Bipolar Disorder……………………………………………………………………… 1-5
1.5 Depression ……………………………………………………………………………. 1-6
1.6 Epilepsy………………………………………………………………………………… 1-6
1.7 Huntington’s Disease………………………………………………………………. 1-7
1.8 Hydrocephalus……………………………………………………………………….. 1-8
1.9 Multiple Sclerosis……………………………………………………………………. 1-9
1.10 Parkinson’s Disease……………………………………………………………… 1-10
1.11 Schizophrenia………………………………………………………………………. 1-11
1.12 Stroke…………………………………………………………………………………. 1-12
Exhibit 1-1: Germany, Neurosurgery, Procedure Volumes Forecast, by Type, 2010-2016………………………………………………………………… 1-2
Exhibit 1-2: Germany, Neurological Diseases/Disorders, Incidence and Prevalence ……………………………………………………… 1-14
2. NEUROLOGICAL AND PSYCHIATRIC DISORDERS………………………….. 2-1
2.1 Alzheimer’s Disease and Dementia…………………………………………… 2-1
2.1.1 Etiology…………………………………………………………………… 2-1
2.1.2 Epidemiology…………………………………………………………… 2-2
2.2 Amyotrophic Lateral Sclerosis ………………………………………………….. 2-3
2.2.1 Etiology…………………………………………………………………… 2-3
2.2.2 Epidemiology…………………………………………………………… 2-7
2.3 Bipolar Disorder……………………………………………………………………… 2-8
2.3.1 Etiology…………………………………………………………………… 2-8
2.3.2 Epidemiology…………………………………………………………. 2-10
2.4 Cerebrovascular Disorders…………………………………………………….. 2-11
2.4.1 Arteriovenous Malformation……………………………………… 2-11
2.4.1.1 Etiology ………………………………………………….. 2-13
2.4.1.2 Epidemiology…………………………………………… 2-13
2.4.2 Stroke…………………………………………………………………… 2-14
2.4.2.1 Etiology ………………………………………………….. 2-14
2.4.2.2 Epidemiology…………………………………………… 2-17
2.5 Depression ………………………………………………………………………….. 2-19
2.5.1 Etiology…………………………………………………………………. 2-19
2.5.2 Epidemiology…………………………………………………………. 2-20
2.6 Epilepsy………………………………………………………………………………. 2-21
2.6.1 Etiology…………………………………………………………………. 2-23
2.6.2 Epidemiology…………………………………………………………. 2-24
2.7 Huntington’s Disease…………………………………………………………….. 2-25
2.7.1 Etiology…………………………………………………………………. 2-25
2.7.2 Epidemiology…………………………………………………………. 2-27
2.8 Hydrocephalus……………………………………………………………………… 2-27
2.8.1 Etiology…………………………………………………………………. 2-29
2.8.2 Epidemiology…………………………………………………………. 2-29
2.9 Multiple Sclerosis………………………………………………………………….. 2-30
2.9.1 Etiology…………………………………………………………………. 2-33
2.9.2 Epidemiology…………………………………………………………. 2-34
2.10 Myasthenia Gravis………………………………………………………………… 2-37
2.10.1 Etiology…………………………………………………………………. 2-37
2.10.2 Epidemiology…………………………………………………………. 2-38
2.11 Parkinson’s Disease……………………………………………………………… 2-38
2.11.1 Etiology…………………………………………………………………. 2-41
2.11.2 Epidemiology…………………………………………………………. 2-42
2.12 Schizophrenia………………………………………………………………………. 2-42
2.12.1 Etiology…………………………………………………………………. 2-44
2.12.2 Epidemiology…………………………………………………………. 2-45
Exhibit 2-1: 2010, Europe, Diagnosed and Undiagnosed Dementia,
Incidence Rates, by Age and Gender………………………………………… 2-4
Exhibit 2-2: 2010, Europe, Diagnosed and Undiagnosed Dementia,
Prevalence Rates, by Age and Gender ……………………………………… 2-5
Exhibit 2-3: 2010, Germany and Europe, Alzheimer’s Disease, Comparative Incidence and Prevalence…………………………………….. 2-6
Exhibit 2-4: 2010, Germany and Europe, Amyotrophic Lateral Sclerosis,
Comparative Incidence and Prevalence…………………………………….. 2-9
Exhibit 2-5: 2010, Germany and Europe, Bipolar Disorder,
Comparative Incidence and Prevalence…………………………………… 2-12
Exhibit 2-6: 2010, Germany and Europe, Arteriovenous Malformation,
Comparative Incidence and Prevalence…………………………………… 2-15
Exhibit 2-7: 2010, Germany and Europe, Stroke,
Comparative Incidence and Prevalence…………………………………… 2-18
Exhibit 2-8: 2010, Germany and Europe, Depression,
Comparative Prevalence ……………………………………………………….. 2-22
Exhibit 2-9: 2010, Germany and Europe, Epilepsy,
Comparative Incidence and Prevalence…………………………………… 2-26
Exhibit 2-10: 2010, Germany and Europe, Huntington’s Disease,
Comparative Incidence and Prevalence…………………………………… 2-28
Exhibit 2-11: 2010, Germany and Europe, Hydrocephalus,
Comparative Incidence and Prevalence…………………………………… 2-31
Exhibit 2-12: 2010, Germany and Europe, Multiple Sclerosis,
Comparative Incidence and Prevalence…………………………………… 2-36
Exhibit 2-13: 2010, Germany and Europe, Myasthenia Gravis,
Comparative Incidence and Prevalence…………………………………… 2-39
Exhibit 2-14: 2010, Germany and Europe, Parkinson’s Disease,
Comparative Incidence and Prevalence…………………………………… 2-43
Exhibit 2-15: 2010, Germany and Europe, Schizophrenia,
Comparative Incidence and Prevalence…………………………………… 2-46
3. NEUROSURGICAL PROCEDURES ………………………………………………….. 3-1
3.1 The Brain………………………………………………………………………………. 3-1
3.1.1 The Cerebrum …………………………………………………………. 3-1
3.1.2 The Cerebellum……………………………………………………….. 3-2
3.1.3 The Brainstem …………………………………………………………. 3-2
3.1.4 The Meninges………………………………………………………….. 3-4
3.1.5 The Ventricular System …………………………………………….. 3-4
3.1.6 Cerebrospinal Fluid ………………………………………………….. 3-6
3.1.7 The Hypothalamus …………………………………………………… 3-6
3.1.8 The Pineal Gland……………………………………………………… 3-6
3.1.9 The Pituitary Gland…………………………………………………… 3-8
3.2 Selected Diseases/Disorders of the Central Nervous System and the Peripheral Nervous System………………………………………….. 3-8
3.2.1 Hydrocephalus ………………………………………………………… 3-8
3.2.2 Movement, Seizure, and Tremor Disorders………………… 3-10
3.2.2.1 Alzheimer’s Disease…………………………………. 3-10
3.2.2.2 Epilepsy………………………………………………….. 3-12
3.2.2.3 Multiple Sclerosis …………………………………….. 3-14
3.2.2.4 Parkinson’s Disease…………………………………. 3-15
3.2.2.5 Deep Brain Stimulation……………………………… 3-16
3.2.2.6 Stereotactic Radiosurgery …………………………. 3-18
3.2.3 Traumatic Brain Injury …………………………………………….. 3-19
3.3 The Cerebrovascular System and Selected Diseases/Disorders …. 3-22
3.3.1 The Arterial System………………………………………………… 3-22
3.3.2 The Venous System ……………………………………………….. 3-25
3.3.3 Aneurysm ……………………………………………………………… 3-25
3.3.4 Arteriovenous Malformation……………………………………… 3-27
3.3.5 Stroke…………………………………………………………………… 3-30
Exhibit 3-1: Structural Relationship between the Cerebrum, Cerebellum, and Brainstem ……………………………………………………………………….. 3-3
Exhibit 3-2: Structure of the Meninges ……………………………………………………….. 3-5
Exhibit 3-3: Ventricles of the Brain …………………………………………………………….. 3-7
Exhibit 3-4: Germany, Ventricular Shunting and Ventriculostomy,
Procedure Volumes Forecast, 2010-2016 ………………………………… 3-11
Exhibit 3-5: Germany, Deep Brain Stimulation and Stereotactic Radiosurgery,
Procedure Volumes Forecast, 2010-2016 ………………………………… 3-20
Exhibit 3-6: Germany, Evacuation of Subdural Hematoma,
Procedure Volumes Forecast, 2010-2016 ………………………………… 3-23
Exhibit 3-7: Germany, Cerebral Aneurysm Clipping,
Procedure Volumes Forecast, 2010-2016 ………………………………… 3-28
Exhibit 3-8: Germany, Arteriovenous Malformation Embolization,
Procedure Volumes Forecast, 2010-2016 ………………………………… 3-31
Exhibit 3-9: Germany, Carotid Endarterectomy and Carotid Artery Stenting,
Procedure Volumes Forecast, 2010-2016 ………………………………… 3-35