Table of Contents
1. OVERVIEW OF NEUROLOGICAL DISEASES/DISORDERS………………… 1-1
1.1 Alzheimer’s Disease……………………………………………………………….. 1-1
1.2 Amyotrophic Lateral Sclerosis ………………………………………………….. 1-3
1.3 Bipolar Disorder……………………………………………………………………… 1-3
1.4 Depression ……………………………………………………………………………. 1-4
1.5 Epilepsy………………………………………………………………………………… 1-5
1.6 Multiple Sclerosis……………………………………………………………………. 1-6
1.7 Parkinson’s Disease……………………………………………………………….. 1-7
1.8 Schizophrenia………………………………………………………………………… 1-7
1.9 Stroke…………………………………………………………………………………… 1-8
Exhibit 1-1: Neurosurgery, Procedure Volumes Forecast, by Type, 2011-2017… 1-2
Exhibit 1-2: Neurological Diseases/Disorders, Hospital Discharges
and Prevalence…………………………………………………………………….. 1-10
2. NEUROLOGICAL AND PSYCHIATRIC DISEASES/DISORDERS…………. 2-1
2.1 Alzheimer’s Disease……………………………………………………………….. 2-1
2.1.1 Etiology…………………………………………………………………… 2-3
2.1.2 Epidemiology…………………………………………………………… 2-4
2.2 Amyotrophic Lateral Sclerosis ………………………………………………….. 2-5
2.2.1 Etiology…………………………………………………………………… 2-6
2.2.2 Epidemiology…………………………………………………………… 2-8
2.3 Cerebrovascular Diseases/Disorders ………………………………………… 2-8
2.3.1 Arteriovenous Malformation……………………………………….. 2-8
2.3.1.1 Etiology ………………………………………………….. 2-10
2.3.1.2 Epidemiology…………………………………………… 2-10
2.3.2 Cerebral Aneurysm ………………………………………………… 2-10
2.3.2.1 Etiology ………………………………………………….. 2-12
2.3.2.2 Epidemiology…………………………………………… 2-12
2.3.3 Stroke…………………………………………………………………… 2-13
2.3.3.1 Etiology ………………………………………………….. 2-14
2.3.3.2 Epidemiology…………………………………………… 2-18
2.4 Epilepsy………………………………………………………………………………. 2-18
2.4.1 Etiology…………………………………………………………………. 2-19
2.4.2 Epidemiology…………………………………………………………. 2-21
2.5 Huntington’s Disease…………………………………………………………….. 2-22
2.5.1 Etiology…………………………………………………………………. 2-24
2.5.2 Epidemiology…………………………………………………………. 2-25
2.6 Hydrocephalus……………………………………………………………………… 2-25
2.6.1 Etiology…………………………………………………………………. 2-25
2.6.2 Epidemiology…………………………………………………………. 2-27
2.7 Multiple Sclerosis………………………………………………………………….. 2-27
2.7.1 Etiology…………………………………………………………………. 2-28
2.7.2 Epidemiology…………………………………………………………. 2-32
2.8 Myasthenia Gravis………………………………………………………………… 2-32
2.8.1 Etiology…………………………………………………………………. 2-34
2.8.2 Epidemiology…………………………………………………………. 2-35
2.9 Parkinson’s Disease……………………………………………………………… 2-35
2.9.1 Etiology…………………………………………………………………. 2-37
2.9.2 Epidemiology…………………………………………………………. 2-39
2.10 Psychiatric Disorders…………………………………………………………….. 2-40
2.10.1 Attention Deficient Hyperactivity Disorder ………………….. 2-40
2.10.1.1 Etiology ………………………………………………….. 2-42
2.10.1.2 Epidemiology…………………………………………… 2-44
2.10.2 Bipolar Disorder……………………………………………………… 2-46
2.10.2.1 Etiology ………………………………………………….. 2-46
2.10.2.2 Epidemiology…………………………………………… 2-49
2.10.3 Depression ……………………………………………………………. 2-50
2.10.3.1 Etiology ………………………………………………….. 2-50
2.10.3.2 Epidemiology…………………………………………… 2-54
2.10.4 Schizophrenia………………………………………………………… 2-55
2.10.4.1 Etiology ………………………………………………….. 2-56
2.10.4.2 Epidemiology…………………………………………… 2-58
Exhibit 2-1: Alzheimer’s Disease, Facts and Figures, 1999-2009, and 2010 and 2011…………………………………………………………………. 2-2
Exhibit 2-2: Amyotrophic Lateral Sclerosis, Facts and Figures, 1999-2009, and 2011 ……………………………………………………………… 2-7
Exhibit 2-3: Arteriovenous Malformation, Facts and Figures, 1999-2009, and 2011 ………………………………………………………………………………. 2-9
Exhibit 2-4: Cerebral Aneurysm, Facts and Figures, 1999-2009, and 2011 ……. 2-11
Exhibit 2-5: Stroke, Facts and Figures, 1999-2009, and 2010 and 2011………… 2-15
Exhibit 2-6: Epilepsy, Facts and Figures, 1999-2009, and 2011 …………………… 2-20
Exhibit 2-7: Huntington’s Disease, Facts and Figures …………………………………. 2-23
Exhibit 2-8: Hydrocephalus, Facts and Figures, 1999-2009, and 2011………….. 2-26
Exhibit 2-9: Multiple Sclerosis, Facts and Figures, 1999-2009, and 2011 ………. 2-29
Exhibit 2-10: Myasthenia Gravis, Facts and Figures, 1999-2009, and 2011 …….. 2-33
Exhibit 2-11: Parkinson’s Disease, Facts and Figures, 1999-2009, and 2011 ….. 2-36
Exhibit 2-12: Percentage of Adults Experiencing Serious
Psychological Distress, by Age and Gender……………………………… 2-41
Exhibit 2-13: Attention Deficit Hyperactivity Disorder, Facts and Figures,
1999-2009, and 2011 ……………………………………………………………. 2-43
Exhibit 2-14: Bipolar Disorder, Facts and Figures, 1999-2009, and 2011 ………… 2-47
Exhibit 2-15: Depression, Facts and Figures, 1999-2009, and 2011……………….. 2-51
Exhibit 2-16: Schizophrenia, Facts and Figures, 1999-2009, and 2011 …………… 2-57
3. NEUROSURGICAL PROCEDURES ………………………………………………….. 3-1
3.1 Stroke…………………………………………………………………………………… 3-1
3.1.1 Hemorrhagic Stroke………………………………………………….. 3-1
3.1.2 Ischemic Stroke……………………………………………………….. 3-3
3.2 Cerebral Aneurysm…………………………………………………………………. 3-5
3.3 Arteriovenous Malformations……………………………………………………. 3-6
3.4 Tumors of the Brain and Central Nervous System ………………………. 3-7
3.5 Traumatic Brain Injury …………………………………………………………….. 3-9
3.6 Hydrocephalus and Increased Intracranial Pressure………………….. 3-10
3.7 Neurosurgical Procedures ……………………………………………………… 3-12
3.7.1 Cerebrospinal Fluid Shunting and Drainage……………….. 3-12
3.7.1.1 Procedure Volumes………………………………….. 3-14
3.7.2 Carotid Endarterectomy…………………………………………… 3-14
3.7.2.1 Procedure Volumes………………………………….. 3-16
3.7.3 Cerebral Aneurysm and Arteriovenous Malformation Surgical Clipping…………………………………. 3-16
3.7.3.1 Procedure Volumes………………………………….. 3-19
3.7.4 Cerebral Aneurysm and Arteriovenous Malformation Embolization ………………………………………. 3-20
3.7.4.1 Procedure Volumes………………………………….. 3-22
3.7.5 Carotid Artery Stenting ……………………………………………. 3-22
3.7.5.1 Carotid Revascularization Endarterectomy versus Stenting Trial Results……………………… 3-24
3.7.5.2 Procedure Volumes………………………………….. 3-26
3.7.6 Intracranial Stenting………………………………………………… 3-28
3.7.6.1 Procedure Volumes………………………………….. 3-29
Exhibit 3-1: Cerebrospinal Fluid Shunting, Procedure Volumes Forecast, 2011-2017 …………………………………………………………………………… 3-15
Exhibit 3-2: Carotid Endarterectomy, Procedure Volumes Forecast, 2011-2017 …………………………………………………………………………… 3-17
Exhibit 3-3: Cerebral Aneurysm and Arteriovenous Malformation Surgical Clipping, Procedure Volumes Forecast, 2011-2017 ………. 3-21
Exhibit 3-4: Cerebral Aneurysm and Arteriovenous Malformation
Embolization, Procedure Volumes Forecast, 2011-2017…………….. 3-23
Exhibit 3-5: Distally Protected Carotid Artery Stenting, Procedure Volumes Forecast, 2011-2017 ………………………………… 3-27
Exhibit 3-6: Intracranial Stenting, Procedure Volumes Forecast, 2011-2017 ….. 3-31

Figure: Neurosurgery, Procedure Volumes Forecast, by Type, 2011-2017