Neuromodulation: present and emerging methods

Effects of home-based neurostimulation on outcomes after stroke: a systematic review and meta-analysis

BACKGROUND

Home-based rehabilitation is a cost-effective means of making services available for patients. The aim of this study is to determine the evidence in the literature on the effects of home-based neurostimulation in patients with stroke.

METHOD

We searched PubMED, Embase, Web of Science, Scopus, and CENTRAL for randomized controlled trials on the subject matter using keywords such as stroke, electrical stimulation and transcranial direct current stimulation. Information on participants' characteristics and mean scores on the outcomes of interest were extracted. Risks of bias and methodological quality of the included studies were assessed using Cochrane Risks of bias tool and PEDro scale respectively. The data was analyzed using both narrative and quantitative syntheses. In the quantitative synthesis, meta-analysis was carried out using random effect model analysis.

RESULT

The results showed that, home-based neurostimulation is superior to the control at improving upper limb muscle strength (SMD = 0.72, 95% CI = 0.08 to 1.32, p = 0.03), functional mobility (SMD = -0.39, 95% CI = -0.65 to 0.14, p = 0.003) and walking endurance (SMD = 0.33, 95% CI = 0.08 to 0.59, p = 0.01) post intervention; and upper limb motor function (SMD = 0.9, 95% CI = 0.10 to 1.70, p = 0.03), functional mobility (SMD = -0.30, 95% CI = -0.56 to -0.05, p = 0.02) and walking endurance (SMD = 0.33, 95% CI = 0.08 to 0.59, p = 0.01) at follow-up.

CONCLUSIONS

Home-based neurostimulation can be used to improve upper and lower limb function after stroke.

Therapeutic ultrasound: an innovative approach for targeting neurological disorders affecting the basal ganglia

The basal ganglia are involved in motor control and action selection, and their impairment manifests in movement disorders such as Parkinson's disease (PD) and dystonia, among others. The complex neuronal circuitry of the basal ganglia is located deep inside the brain and presents significant treatment challenges. Conventional treatment strategies, such as invasive surgeries and medications, may have limited effectiveness and may result in considerable side effects. Non-invasive ultrasound (US) treatment approaches are becoming increasingly recognized for their therapeutic potential for reversibly permeabilizing the blood-brain barrier (BBB), targeting therapeutic delivery deep into the brain, and neuromodulation. Studies conducted on animals and early clinical trials using ultrasound as a therapeutic modality have demonstrated promising outcomes for controlling symptom severity while preserving neural tissue. These results could improve the quality of life for patients living with basal ganglia impairments. This review article explores the therapeutic frontiers of ultrasound technology, describing the brain mechanisms that are triggered and engaged by ultrasound. We demonstrate that this cutting-edge method could transform the way neurological disorders associated with the basal ganglia are managed, opening the door to less invasive and more effective treatments.

Engineering 3D Scaffold-Free Nanoparticle-Laden Stem Cell Constructs for Piezoelectric Enhancement of Human Neural Tissue Formation and Function

Electrical stimulation (ES) of cellular systems can be utilized for biotechnological applications and electroceuticals (bioelectric medicine). Neural cell stimulation especially has a long history in neuroscience research and is increasingly applied for clinical therapies. Application of ES via conventional electrodes requires external connectors and power sources, hindering scientific and therapeutic applications. Here engineering novel 3D scaffold-free human neural stem cell constructs with integrated piezoelectric nanoparticles for enhanced neural tissue induction and function is described. Tetragonal barium titanate (BaTi03) nanoparticles are employed as piezoelectric stimulators prepared as cytocompatible dispersions, incorporated into 3D self-organizing neural spheroids, and activated wirelessly by ultrasound. Ultrasound delivery (low frequency; 40 kHz) is optimized for cell survival, and nanoparticle activation enabled ES throughout the spheroids during differentiation, tissue formation, and maturation. The resultant human neural tissues represent the first example of direct tissue loading with piezoelectric particles for ensuing 3D ultrasound-mediated piezoelectric enhancement of human neuronal induction from stem cells, including augmented neuritogenesis and synaptogenesis. It is anticipated that the platform described will facilitate advanced tissue engineering and in vitro modeling of human neural (and potentially non-neural) tissues, with modeling including tissue development and pathology, and applicable to preclinical testing and prototyping of both electroceuticals and pharmaceuticals.

Neurobiological Insights Into Cerebral Palsy: A Review of the Mechanisms and Therapeutic Strategies

BACKGROUND

Cerebral palsy (CP) is a common neurodevelopmental disorder characterized by impaired mobility and posture caused by brain injury or abnormal development. CP relates to a variety of neurological mechanisms and pathways that impact the type and severity of motor disability, as well as comorbidities. The heterogeneity in clinical phenotype, pathogenesis, and etiology poses significant challenges for effective therapeutic intervention.

OBJECTIVES

The review aims to provide a comprehensive analysis of the neurobiological mechanisms underlying CP and evaluate current and prospective therapeutic strategies, highlighting the necessity for targeted interventions to address the disorder's multifaceted nature.

METHODS

A thorough literature review was conducted, focusing on studies published in peer-reviewed journals that explore the pathophysiological mechanisms, clinical interventions, and therapeutic strategies for CP.

RESULTS

The pathogenesis of CP involves a complex interplay of genetic, environmental, and perinatal factors leading to brain injury. Inflammatory processes, oxidative stress, and excitotoxicity are critical in CP development. Current therapeutic approaches primarily focus on symptom management through physical and occupational therapy, as well as pharmacological interventions. Emerging therapies, including anti-inflammatory agents, antioxidants, and neuroprotective and neurotrophic agents, show potential but require further validation. Notably, although steroids provide anti-inflammatory benefits, their use in pediatric patients raises concerns regarding long-term adverse effects such as osteoporosis.

CONCLUSION

Despite advances in understanding CP's neurobiological underpinnings, effective therapeutic targets remain elusive. A comprehensive approach addressing CP's heterogeneity is essential. Future research should emphasize in-depth evaluations of the efficacy and safety of therapeutic agents, particularly in pediatric populations, to develop targeted and effective treatments for CP.

Topological Quantum Switching Enabled Neuroelectronic Synaptic Modulators for Brain Computer Interface

Aging and genetic-related disorders in the human brain lead to impairment of daily cognitive functions. Due to their neural synaptic complexity and the current limits of knowledge, reversing these disorders remains a substantial challenge for brain-computer interfaces (BCI). In this work, a solution is provided to potentially override aging and neurological disorder-related cognitive function loss in the human brain through the application of the authors' quantum synaptic device. To illustrate this point, a quantum topological insulator (QTI) Bi2Se2Te-based synaptic neuroelectronic device, where the electric field-induced tunable topological surface edge states and quantum switching properties make them a premier option for establishing artificial synaptic neuromodulation approaches, is designed and developed. Leveraging these unique quantum synaptic properties, the developed synaptic device provides the capability to neuromodulate distorted neural signals, leading to the reversal of age-related disorders via BCI. With the synaptic neuroelectronic characteristics of this device, excellent efficacy in treating cognitive neural dysfunctions through modulated neuromorphic stimuli is demonstrated. As a proof of concept, real-time neuromodulation of electroencephalogram (EEG) deduced distorted event-related potentials (ERP) is demonstrated by modulation of the synaptic device array.

Micro/nanomotors for neuromodulation

Micro-nanomotors (MNMs) are micro/nanoscale intelligent devices with vast potential in the fields of drug delivery, precision medicine, biosensing, and environmental remediation. Their primary advantage lies in their ability to convert various forms of external energy (such as magnetic, ultrasonic, and light energy) into their own propulsive force. Additionally, MNMs offer high controllability and modifiability, enabling them to navigate in the microscopic world. Importantly, recent research has harnessed the unique advantages of MNMs to synergize their capabilities in neuromodulation. This mini-review presents the significant progress and pioneering achievements in the use of MNMs for neuromodulation, with the aim of inspiring readers to explore the broader biomedical applications of these MNMs. Through continuous innovation and diligent exploration, MNMs show promise to have a profound impact on the field of biomedicine.

A Closed Formalism for Anatomy-Independent Projection and Optimization of Magnetic Stimulation Coils on Arbitrarily Shaped Surfaces

INTRODUCTION

Transcranial magnetic stimulation (TMS) is a popular method for the noninvasive stimulation of neurons in the brain. It has become a standard instrument in experimental brain research and has been approved for a range of diagnostic and therapeutic applications. These applications require appropriately shaped coils. Various applications have been established or approved for specific coil designs with their corresponding spatial electric field distributions. However, the specific coil implementation may no longer be appropriate from the perspective of available material and manufacturing opportunities or considering the latest understanding of how to achieve induced electric fields in the head most efficiently. Furthermore, in some cases, field measurements of coils with unknown winding or a user-defined field are available and require an actual implementation. Similar applications exist for magnetic resonance imaging coils.

OBJECTIVE

This work aims at introducing a complete formalism free from heuristics, iterative optimization, and ad-hoc or manual steps to form practical stimulation coils with individual turns to either equivalently match an existing coil or produce a given field. The target coil can reside on practically any sufficiently large or closed surface adjacent to or around the head.

METHODS

The method derives an equivalent field through vector projection exploiting the well-known Huygens' and Love's equivalence principle. In contrast to other coil design or optimization approaches recently presented, the procedure is an explicit forward Hilbert-space vector projection or basis change. For demonstration, we map a commercial figure-of-eight coil as one of the most widely used devices and a more intricate coil recently approved clinically for addiction treatment (H4) onto a bent surface close to the head for highest efficiency and lowest field energy.

RESULTS

The resulting projections are within ≤4% of the target field and reduce the necessary pulse energy by more than 40%.

Miniaturized therapeutic systems for ultrasound-modulated drug delivery to the central and peripheral nervous system

Ultrasound is a promising technology to address challenges in drug delivery, including limited drug penetration across physiological barriers and ineffective targeting. Here we provide an overview of the significant advances made in recent years in overcoming technical and pharmacological barriers using ultrasound-assisted drug delivery to the central and peripheral nervous system. We commence by exploring the fundamental principles of ultrasound physics and its interaction with tissue. The mechanisms of ultrasonic-enhanced drug delivery are examined, as well as the relevant tissue barriers. We highlight drug transport through such tissue barriers utilizing insonation alone, in combination with ultrasound contrast agents (e.g., microbubbles), and through innovative particulate drug delivery systems. Furthermore, we review advances in systems and devices for providing therapeutic ultrasound, as their practicality and accessibility are crucial for clinical application.

Insular cortex stimulation alleviates neuropathic pain through changes in the expression of collapsin response mediator protein 2 involved in synaptic plasticity

In recent studies, brain stimulation has shown promising potential to alleviate chronic pain. Although studies have shown that stimulation of pain-related brain regions can induce pain-relieving effects, few studies have elucidated the mechanisms of brain stimulation in the insular cortex (IC). The present study was conducted to explore the changes in characteristic molecules involved in pain modulation mechanisms and to identify the changes in synaptic plasticity after IC stimulation (ICS). Following ICS, pain-relieving behaviors and changes in proteomics were explored. Neuronal activity in the IC after ICS was observed by optical imaging. Western blotting was used to validate the proteomics data and identify the changes in the expression of glutamatergic receptors associated with synaptic plasticity. Experimental results showed that ICS effectively relieved mechanical allodynia, and proteomics identified specific changes in collapsin response mediator protein 2 (CRMP2). Neuronal activity in the neuropathic rats was significantly decreased after ICS. Neuropathic rats showed increased expression levels of phosphorylated CRMP2, alpha amino-3-hydroxy-5-methylisoxazole-4-propionic acid receptor (AMPAR), and N-methyl-d-aspartate receptor (NMDAR) subunit 2B (NR2B), which were inhibited by ICS. These results indicate that ICS regulates the synaptic plasticity of ICS through pCRMP2, together with AMPAR and NR2B, to induce pain relief.

Accessibility and Ease of Use in Neuromodulation Devices

BACKGROUND

The utilization of neuromodulation therapy continues to grow as therapeutic indications expand. These conditions often present with comorbid physical, visual, and auditory impairments. Patients with disabilities in these categories may have difficulty operating their devices. Thus, reviewing the accessibility and inclusive design of neuromodulation devices is imperative to ensure equal access for patients of all ability levels. To date, the literature provides little insight into this topic.

MATERIALS AND METHODS

Manufacturers of Food and Drug Administration-approved neuromodulation devices in the United States completed our electronic survey to assess neuromodulation device features, universal/inclusive design guidelines, and methods used to make the device accessible to patients with disabilities.

RESULTS

We assessed 11 devices from seven manufacturers. Of those, there were six spinal cord, two peripheral nerve, and three deep brain stimulators. Of all respondents, 91% used universal inclusive design guidelines. Of the studied devices, 91% have an interface that uses visual feedback, and 82% have an interface that uses auditory feedback. All surveyed devices were reported to have an interface that requires physical handling.

DISCUSSION

Our study found that most devices incorporate auditory signals, buttons with raised indentations, speech commands, or other useful features to assist those with visual disabilities. Visual interfaces may be sufficient for a patient with hearing impairment to use all the surveyed devices. However, dual sensory impairment presents a significant limitation in all devices surveyed. Furthermore, the biggest barrier to using neuromodulation devices was physical impairment because all surveyed devices require physical handling.

CONCLUSIONS

Manufacturers have awareness of universal inclusive design principles. However, our study was unable to find a device that is accessible to all users regardless of ability. As such, it is critical to involve universal design principles to ensure that inclusive devices are available to improve patient adherence, treatment efficacy, and outcomes.

Biophysical modulation and robustness of itinerant complexity in neuronal networks

Transient synchronization of bursting activity in neuronal networks, which occurs in patterns of metastable itinerant phase relationships between neurons, is a notable feature of network dynamics observed in vivo. However, the mechanisms that contribute to this dynamical complexity in neuronal circuits are not well understood. Local circuits in cortical regions consist of populations of neurons with diverse intrinsic oscillatory features. In this study, we numerically show that the phenomenon of transient synchronization, also referred to as metastability, can emerge in an inhibitory neuronal population when the neurons' intrinsic fast-spiking dynamics are appropriately modulated by slower inputs from an excitatory neuronal population. Using a compact model of a mesoscopic-scale network consisting of excitatory pyramidal and inhibitory fast-spiking neurons, our work demonstrates a relationship between the frequency of pyramidal population oscillations and the features of emergent metastability in the inhibitory population. In addition, we introduce a method to characterize collective transitions in metastable networks. Finally, we discuss potential applications of this study in mechanistically understanding cortical network dynamics.

Preservation versus dissection of the intercostobrachial nerve for breast cancer surgeries: a systematic review and meta-analysis

Introduction

This meta-analysis aimed to compare the efficacy of preservation of the intercostobrachial nerve (ICBN) versus its dissection for patients who underwent breast surgery.

Methods

The authors searched Web of Science, PubMed, Cochrane CENTRAL, and Scopus from inception until March 2023. Records were screened for eligible studies, and all relevant outcomes were pooled as an odds ratio (OR) with the corresponding 95% CI in the meta-analysis models using RevMan version 5.4.

Results

These results from 11 studies (1021 patients) favored preservation of the ICBN over its dissection in terms of anaesthesia and hypaesthesia [OR 0.50, (95% CI, 0.31-0.82); P = 0.006] and [OR 0.33, (95% CI, 0.16-0.68); P = 0.003], respectively. Whereas the overall effect favored ICBN dissection over preservation in the case of hyperaesthesia [OR 4.34, (95% CI, 1.43-13.15); P = 0.01]. Conversely, no significant variance was detected between the two groups in terms of pain [OR 0.68, (95% CI, 0.28-1.61) P = 0.38], paraesthesia [OR 0.88, (95% CI, 0.49-1.60); P = 0.68], and analgesia [OR 1.46, (95% CI, 0.05-45.69); P = 0.83].

Conclusion

This meta-analysis revealed that the preservation of the ICBN has a significant effect on the disturbance of sensory parameters of hypaesthesia and anaesthesia when compared to its dissection. Further studies with larger sample sizes are recommended to precisely compare both techniques on a wider range of parameters.

Visual Neuroprosthesis - Stimulation of Visual Cortical Centers in The Brain. Design of Non-Invasive Transcranial Stimulation of Functional Neurons

PURPOSE

The purpose of the article is to present the history and current status of visual cortical neuroprostheses, and to present a new method of stimulating intact visual cortex cells.

METHODS

This paper contains an overview of the history and current status of visual cortex stimulation in severe visual impairment, but also highlights its shortcomings. These include mainly the stimulation of currently damaged cortical cells over a small area and, from a morphological point of view, possible damage to the stimulated neurons by the electrodes and their encapsulation by gliotic tissue.

RESULTS

The paper also presents a proposal for a new technology of image processing and its transformation into a form of non-invasive transcranial stimulation of undamaged parts of the brain, which is protected by a national and international patent.

CONCLUSION

The paper presents a comprehensive review of the current options for compensating for lost vision at the level of the cerebral cortex and a proposal for a new non-invasive method of stimulating the functional neurons of the visual cortex.

Wireless deep-brain neuromodulation using photovoltaics in the second near-infrared spectrum

Conventional electrical neuromodulation techniques are constrained by the need for invasive implants in neural tissues, whereas methods using optogenetic are subjected to genetic alterations and hampered by the poor tissue penetration of visible light. Photovoltaic neuromodulation using light from the second near-infrared (NIR-II) spectrum, which minimizes scattering and enhances tissue penetration, shows promise as an alternative to existing neuromodulation technologies. NIR-II light has been used in deep-tissue imaging and in deep-brain photothermal neuromodulation via nanotransducers. This Perspective will provide an overview for the underpinning mechanisms of photovoltaic neuromodulation and identify avenues for future research in materials science and bioengineering that can further advance NIR-II photovoltaic neuromodulation methods.

In vivo neuromodulation of animal behavior with organic semiconducting oligomers

Modulating neural activity with electrical or chemical stimulus can be used for fundamental and applied research. Typically, neuronal stimulation is performed with intracellular and extracellular electrodes that deliver brief electrical pulses to neurons. However, alternative wireless methodologies based on functional materials may allow clinical translation of technologies to modulate neuronal function. Here, we show that the organic semiconducting oligomer 4-[2-{2,5-bis(2,3-dihydrothieno[3,4-b][1,4]dioxin-5-yl)thiophen-3-yl}ethoxy]butane-1-sulfonate (ETE-S) induces precise behaviors in the small invertebrate Hydra, which were dissected through pharmacological and electrophysiological approaches. ETE-S-induced behavioral response relies on the presence of head neurons and calcium ions and is prevented by drugs targeting ionotropic channels and muscle contraction. Moreover, ETE-S affects Hydra's electrical activity enhancing the contraction burst frequency. The unexpected neuromodulatory function played by this conjugated oligomer on a simple nerve net opens intriguing research possibilities on fundamental chemical and physical phenomena behind organic bioelectronic interfaces for neuromodulation and on alternative methods that could catalyze a wide expansion of this rising technology for clinical applications.

Thermal neuromodulation using pulsed and continuous infrared illumination in a penicillin-induced acute epilepsy model

Infrared neuromodulation (INM) is a promising neuromodulation tool that utilizes pulsed or continuous-wave near-infrared (NIR) laser light to produce an elevation of the background temperature of the neural tissue. The INM-based cortical heating has been proven as an effective modality to induce changes in neuronal activities. In this paper, we investigate the effect of INM-based cortical heating on the characteristics of interictal epileptiform discharges (IEDs) induced by penicillin in anesthetized rats. Cortical heating was conducted using a NIR laser light guided through a needle-like silicon-based waveguide probe. We detected penicillin-induced cortical IEDs from preprocessed micro-electrocorticography ([Formula: see text]ECoG) recordings, then we assessed changes in various temporal and spectral features of IEDs due to INM. Our findings show that the fast cortical heating phase obtained with continuous-wave NIR light is highly associated with a reduction of IED amplitudes, small but significant changes in the negative amplitude of IEDs compared with the baseline, and a proportional increase in the power of frequency bands related to delta/theta (2-8 Hz) and gamma (28-80 Hz) oscillations. Furthermore, a low rate of cortical heating with pulsed NIR illumination has a more inhibitory impact on the sharp negative polarity of IEDs. Our findings do not indicate a clear reduction in the frequency of IEDs in anesthetized rodents. In contrast, 2-4 min of continuous laser illumination leads to a notable increase in IED frequency. This effect of INM could potentially restrict its use in therapeutic applications related to epilepsy. However, the thermal effect of INM on cortical neurons induces changes in other characteristics of IEDs, which could prove beneficial for future applications.

Computational modeling and minimization of unintended neuronal excitation in a LIFU stimulation

The neuromodulation effect of low-intensity focused ultrasound (LIFU) is highly target-specific. Unintended off-target neuronal excitation can be elicited when the beam focusing accuracy and resolution are limited, whereas the resulted side effect has not been evaluated quantitatively. There is also a lack of methods addressing the minimization of such side effects. Therefore, this work introduces a computational model of unintended neuronal excitation during LIFU neuromodulation, which evaluates the off-target activation area (OTAA) by integrating an ultrasound field model with the neuronal spiking model. In addition, a phased array beam focusing scheme called constrained optimal resolution beamforming (CORB) is proposed to minimize the off-target neuronal excitation area while ensuring effective stimulation in the target brain region. A lower bound of the OTAA is analytically approximated in a simplified homogeneous medium, which could guide the selection of transducer parameters such as aperture size and operating frequency. Simulations in a human head model using three transducer setups show that CORB markedly reduces the OTAA compared with two benchmark beam focusing methods. The high neuromodulation resolution demonstrates the capability of LIFU to effectively limit the side effects during neuromodulation, allowing future clinical applications such as treatment of neuropsychiatric disorders.

A phased array ultrasound system with a robotic arm for neuromodulation

BACKGROUND

Ultrasonic neuromodulation (UNMOD) provides a non-invasive brain stimulation. However, the high-resolution region-specificity of UNMOD with a single element transducer combined with a mechanical positioning system could have limits due to the intrinsic positioning error from mechanical systems.

OBJECTIVE/HYPOTHESIS

A phased array system could lead to highly selective neuromodulation with electronic control.

METHODS

A specialized phased-array system with a robotic arm is implemented for a rhesus monkey model. Various primary motor cortex areas related to tail, hand, and mouth were stimulated with a 200 μm step size. The ultrasonic parameters were ISPTA of 840 mW/cm2, pulse repetition frequency of 100 Hz, and a 5% duty factor at 600 kHz. The induced movement were recorded and analyzed.

RESULTS

Separate digits, mouth, and tongue motions were successfully induced by electronically controlling the focus. The identical body part movement could be induced when the focus was moved back to the identical primary motor cortex with electronic control. Accordingly, the reproducibility of UNMOD could be partially validated with rhesus monkey model.

CONCLUSION

A phased-array system appears to have a potential for the non-invasive and region-selective neuromodulation method.

Optimized monophasic pulses with equivalent electric field for rapid-rate transcranial magnetic stimulation

Objective.Transcranial magnetic stimulation (TMS) with monophasic pulses achieves greater changes in neuronal excitability but requires higher energy and generates more coil heating than TMS with biphasic pulses, and this limits the use of monophasic pulses in rapid-rate protocols. We sought to design a stimulation waveform that retains the characteristics of monophasic TMS but significantly reduces coil heating, thereby enabling higher pulse rates and increased neuromodulation effectiveness.Approach.A two-step optimization method was developed that uses the temporal relationship between the electric field (E-field) and coil current waveforms. The model-free optimization step reduced the ohmic losses of the coil current and constrained the error of the E-field waveform compared to a template monophasic pulse, with pulse duration as a second constraint. The second, amplitude adjustment step scaled the candidate waveforms based on simulated neural activation to account for differences in stimulation thresholds. The optimized waveforms were implemented to validate the changes in coil heating.Main results.Depending on the pulse duration and E-field matching constraints, the optimized waveforms produced 12%-75% less heating than the original monophasic pulse. The reduction in coil heating was robust across a range of neural models. The changes in the measured ohmic losses of the optimized pulses compared to the original pulse agreed with numeric predictions.Significance.The first step of the optimization approach was independent of any potentially inaccurate or incorrect model and exhibited robust performance by avoiding the highly nonlinear behavior of neural responses, whereas neural simulations were only run once for amplitude scaling in the second step. This significantly reduced computational cost compared to iterative methods using large populations of candidate solutions and more importantly reduced the sensitivity to the choice of neural model. The reduced coil heating and power losses of the optimized pulses can enable rapid-rate monophasic TMS protocols.

Improving the quality of ultrasound images acquired using a therapeutic transducer

To enhance the effectiveness and safety of focused ultrasound (FUS) therapy, ultrasound image-based guidance and treatment monitoring are crucial. However, the use of FUS transducers for both therapy and imaging is impractical due to their low spatial resolution, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR). To address this issue, we propose a new method that significantly improve the quality of images obtained by a FUS transducer. The proposed method employs coded excitation to enhance SNR and Wiener deconvolution to solve the problem of low axial resolution resulting from the narrow spectral bandwidth of FUS transducers. Specifically, the method eliminates the impulse response of a FUS transducer from received ultrasound signals using Wiener deconvolution, and pulse compression is performed using a mismatched filter. Simulation and commercial phantom experiments confirmed that the proposed method significantly improves the quality of images acquired by the FUS transducer. The -6 dB axial resolution was improved 1.27 mm to 0.37 mm that was similar to the resolution achieved by the imaging transducer, i.e., 0.33 mm. SNR and CNR also increased from 16.5 dB and 0.69 to 29.1 dB and 3.03, respectively, that were also similar to those by the imaging transducer (27.8 dB and 3.16). Based on the results, we believe that the proposed method has great potential to enhance the clinical utility of FUS transducers in ultrasound image-guided therapy.

Low-intensity ultrasound stimulation modulates time-frequency patterns of cerebral blood oxygenation and neurovascular coupling of mouse under peripheral sensory stimulation state

Previous studies have demonstrated that transcranial ultrasound stimulation (TUS) not only modulates cerebral hemodynamics, neural activity, and neurovascular coupling characteristics in resting samples but also exerts a significant inhibitory effect on the neural activity in task samples. However, the effect of TUS on cerebral blood oxygenation and neurovascular coupling in task samples remains to be elucidated. To answer this question, we first used forepaw electrical stimulation of the mice to elicit the corresponding cortical excitation, and then stimulated this cortical region using different modes of TUS, and simultaneously recorded the local field potential using electrophysiological acquisition and hemodynamics using optical intrinsic signal imaging. The results indicate that for the mice under peripheral sensory stimulation state, TUS with a duty cycle of 50% can (1) enhance the amplitude of cerebral blood oxygenation signal, (2) reduce the time-frequency characteristics of evoked potential, (3) reduce the strength of neurovascular coupling in time domain, (4) enhance the strength of neurovascular coupling in frequency domain, and (5) reduce the time-frequency cross-coupling of neurovasculature. The results of this study indicate that TUS can modulate the cerebral blood oxygenation and neurovascular coupling in peripheral sensory stimulation state mice under specific parameters. This study opens up a new area of investigation for potential applicability of TUS in brain diseases related to cerebral blood oxygenation and neurovascular coupling.

Charge Injection Enhancement Comparisons of Iridium Oxide Microelectrodes In Vitro and In Vivo Using a Portable Neurostimulator

Microelectrodes are desired to deliver more charges to neural tissues while under electrochemical safety limits. Applying anodic bias potential during neurostimulation is a known technique for charge enhancement. Here, we investigated the levels of charge enhancement with anodic bias potential in vitro and in vivo using a custom-designed portable neurostimulator. We immersed our custom microelectrode probe in saline and measured voltage transients in response to constant current stimulation with and without a 500 mV anodic bias potential. We then inserted the same microelectrode probe into the primary motor cortex of the rat brain and measured voltage transients with the same electronics. Results showed that the charge injection capacity of the activated iridium oxide microelectrode site (with 2000 μm2 geometric surface areas (GSAs)) increased by the use of the anodic bias potentials in both in vitro and in vivo: from 10 nC/phase to 32 nC/phase for 200 μs pulse widths, and from 2 nC/phase to 8 nC/phase, respectively. Thus, the order of charge injection capacities of the four cases tested in this study is as follows (from the lowest to the highest): in vivo without anodic bias, in vivo with anodic bias, in vitro without anodic bias, and in vitro with anodic bias. This work also validated in vivo use of our new portable neurostimulator which received stimulation waveforms wirelessly.

Active fault tolerant deep brain stimulator for epilepsy using deep neural network

Millions of people around the world are affected by different kinds of epileptic seizures. A deep brain stimulator is now claimed to be one of the most promising tools to control severe epileptic seizures. The present study proposes Hodgkin-Huxley (HH) model-based Active Fault Tolerant Deep Brain Stimulator (AFTDBS) for brain neurons to suppress epileptic seizures against ion channel conductance variations using a Deep Neural Network (DNN). The AFTDBS contains the following three modules: (i) Detection of epileptic seizures using black box classifiers such as Support Vector Machine (SVM) and K-Nearest Neighbor (KNN), (ii) Prediction of ion channels conductance variations using Long Short-Term Memory (LSTM), and (iii) Development of Reconfigurable Deep Brain Stimulator (RDBS) to control epileptic spikes using Proportional Integral (PI) Controller and Model Predictive Controller (MPC). Initially, the synthetic data were collected from the HH model by varying ion channel conductance. Then, the seizure was classified into four groups namely, normal and epileptic due to variations in sodium ion-channel conductance, potassium ion-channel conductance, and both sodium and potassium ion-channel conductance. In the present work, current controlled deep brain stimulators were designed for epileptic suppression. Finally, the closed-loop performances and stability of the proposed control schemes were analyzed. The simulation results demonstrated the efficacy of the proposed DNN-based AFTDBS.

Modulation effect of mouse hippocampal neural oscillations by closed-loop transcranial ultrasound stimulation

Objective. Closed-loop transcranial ultrasound stimulation (TUS) can be applied at a specific time according to the state of neural activity to achieve timely and precise neuromodulation and improve the modulation effect. In a previous study, we found that closed-loop TUS at the peaks and troughs of the theta rhythm in the mouse hippocampus was able to increase the absolute power and decrease the relative power of the theta rhythm of local field potentials (LFPs) independent of the peaks and troughs of the stimulus. However, it remained unclear whether the modulation effect of this closed-loop TUS-induced mouse hippocampal neural oscillation depended on the peaks and troughs of the theta rhythm.Approach. In this study, we used ultrasound with different stimulation modes and durations to stimulate the peaks (peak stimulation) and troughs (trough stimulation) of the hippocampal theta rhythm. The LFPs in the area of ultrasound stimulation were recorded and the amplitudes and power spectra of the theta rhythm before and after ultrasound stimulation were analyzed.Main results. The results showed that (a) the relative change in amplitude of theta rhythm decreases as the number of stimulation trials under peak stimulation increases; (b) the relative change in the absolute power of the theta rhythm decreases as the number of stimulation trials under peak stimulation increases; (c) the relative change in amplitude of the theta rhythm increases nonlinearly with the stimulation duration (SD) under peak stimulation, and; (d) the relative change in absolute power exhibits a nonlinear increase with SD under peak stimulation.Significance. These results suggest that the modulation effect of closed-loop TUS on theta rhythm is dependent on the stimulation mode and duration under peak stimulation. TUS has the potential to precisely modulate theta rhythm-related neural activity.

Tibial nerve stimulation increases vaginal blood perfusion and bone mineral density and yield load in ovariectomized rat menopause model

INTRODUCTION AND HYPOTHESIS

Human menopause transition and post-menopausal syndrome, driven by reduced ovarian activity and estrogen levels, are associated with an increased risk for symptoms including but not limited to sexual dysfunction, metabolic disease, and osteoporosis. Current treatments are limited in efficacy and may have adverse consequences, so investigation for additional treatment options is necessary. Previous studies have demonstrated that percutaneous tibial nerve stimulation (PTNS) and electro-acupuncture near the tibial nerve are minimally invasive treatments that increase vaginal blood perfusion or serum estrogen in the rat model. We hypothesized that PTNS would protect against harmful reproductive and systemic changes associated with menopause.

METHODS

We examined the effects of twice-weekly PTNS (0.2 ms pulse width, 20 Hz, 2× motor threshold) under ketamine-xylazine anesthesia in ovariectomized (OVX) female Sprague-Dawley rats on menopause-associated physiological parameters including serum estradiol, body weight, blood glucose, bone health, and vaginal blood perfusion. Rats were split into three groups (n = 10 per group): (1) intact control (no stimulation), (2) OVX control (no stimulation), and (3) OVX stimulation (treatment group).

RESULTS

PTNS did not affect serum estradiol levels, body weight, or blood glucose. PTNS transiently increased vaginal blood perfusion during stimulation for up to 5 weeks after OVX and increased areal bone mineral density and yield load of the right femur (side of stimulation) compared to the unstimulated OVX control.

CONCLUSIONS

PTNS may ameliorate some symptoms associated with menopause. Additional studies to elucidate the full potential of PTNS on menopause-associated symptoms under different experimental conditions are warranted.

A revised calcium-dependent model of transcranial magnetic theta-burst stimulation

OBJECTIVE

Calcium dependency is presently an essential assumption in modelling the neuromodulatory effects of transcranial magnetic stimulation. Y.Z.Huang et al.developed the first neuromodulation model to explain the bidirectional effects of theta-burst stimulation (TBS) based on the postsynaptic intracellular calcium concentration elevation. However, we discover that the published computer code is not consistent with the model formulation, neither do the parameters and derived plots consequently match the formulations. Here we intend to fix the computer code and re-calibrate the model.

METHODS

We corrected the affected difference equations and re-calibrated the revised model with experimental data using non-convex optimisation based on a L² penalty.

RESULTS

The revised model outperforms the initial model in characterising the relative motor-evoked potential levels of TBS-induced after-effects in various conditions.

CONCLUSIONS

We corrected the inconsistencies in the previous model and computer code and provided a complete calibration to support the research that is based on it.

SIGNIFICANCE

This work improves the accuracy and secures the scope of the model, which is necessary to retain a rich body of research resulting from the model. Furthermore, this model provides both a quantitative model for several parameters of TBS and a basic model foundation for future refinement.

Modular pulse synthesizer for transcranial magnetic stimulation with fully adjustable pulse shape and sequence

The temporal shape of a pulse in transcranial magnetic stimulation (TMS) influences which neuron populations are activated preferentially as well as the strength and even direction of neuromodulation effects. Furthermore, various pulse shapes differ in their efficiency, coil heating, sensory perception, and clicking sound. However, the available TMS pulse shape repertoire is still very limited to a few biphasic, monophasic, and polyphasic pulses with sinusoidal or near-rectangular shapes. Monophasic pulses, though found to be more selective and stronger in neuromodulation, are generated inefficiently and therefore only available in simple low-frequency repetitive protocols. Despite a strong interest to exploit the temporal effects of TMS pulse shapes and pulse sequences, waveform control is relatively inflexible and only possible parametrically within certain limits. Previously proposed approaches for flexible pulse shape control, such as through power electronic inverters, have significant limitations: The semiconductor switches can fail under the immense electrical stress associated with free pulse shaping, and most conventional power inverter topologies are incapable of generating smooth electric fields or existing pulse shapes. Leveraging intensive preliminary work on modular power electronics, we present a modular pulse synthesizer (MPS) technology that can, for the first time, flexibly generate high-power TMS pulses (one-side peak ∼4000 V, ∼8000 A) with user-defined electric field shape as well as rapid sequences of pulses with high output quality. The circuit topology breaks the problem of simultaneous high power and switching speed into smaller, manageable portions, distributed across several identical modules. In consequence, the MPS TMS techology can use semiconductor devices with voltage and current ratings lower than the overall pulse voltage and distribute the overall switching of several hundred kilohertz among multiple transistors. MPS TMS can synthesize practically any pulse shape, including conventional ones, with fine quantization of the induced electric field (⩽17% granularity without modulation and ∼300 kHz bandwidth). Moreover, the technology allows optional symmetric differential coil driving so that the average electric potential of the coil, in contrast to conventional TMS devices, stays constant to prevent capacitive artifacts in sensitive recording amplifiers, such as electroencephalography. MPS TMS can enable the optimization of stimulation paradigms for more sophisticated probing of brain function as well as stronger and more selective neuromodulation, further expanding the parameter space available to users.

Thermal effects on neurons during stimulation of the brain

All electric and magnetic stimulation of the brain deposits thermal energy in the brain. This occurs through either Joule heating of the conductors carrying current through electrodes and magnetic coils, or through dissipation of energy in the conductive brain.Objective.Although electrical interaction with brain tissue is inseparable from thermal effects when electrodes are used, magnetic induction enables us to separate Joule heating from induction effects by contrasting AC and DC driving of magnetic coils using the same energy deposition within the conductors. Since mammalian cortical neurons have no known sensitivity to static magnetic fields, and if there is no evidence of effect on spike timing to oscillating magnetic fields, we can presume that the induced electrical currents within the brain are below the molecular shot noise where any interaction with tissue is purely thermal.Approach.In this study, we examined a range of frequencies produced from micromagnetic coils operating below the molecular shot noise threshold for electrical interaction with single neurons.Main results.We found that small temperature increases and decreases of 1∘C caused consistent transient suppression and excitation of neurons during temperature change. Numerical modeling of the biophysics demonstrated that the Na-K pump, and to a lesser extent the Nernst potential, could account for these transient effects. Such effects are dependent upon compartmental ion fluxes and the rate of temperature change.Significance.A new bifurcation is described in the model dynamics that accounts for the transient suppression and excitation; in addition, we note the remarkable similarity of this bifurcation's rate dependency with other thermal rate-dependent tipping points in planetary warming dynamics. These experimental and theoretical findings demonstrate that stimulation of the brain must take into account small thermal effects that are ubiquitously present in electrical and magnetic stimulation. More sophisticated models of electrical current interaction with neurons combined with thermal effects will lead to more accurate modulation of neuronal activity.

Visual neuroprosthesis: present and possible perspectives

The purpose of this study is to provide an overview of the replacements used in lost vision in the form of the bionic eye, to show their deficiencies and outline other possibilities for non-invasive stimulation of functional areas of the visual cortex. The review highlights the damage not only to the primary altered cellular structures, but also to all other horizontally and vertically localised structures. Based on the results of a large number of functional magnetic resonance imaging and electrophysiological methods, the authors focus on the pathology of the entire visual pathway in pigmentary retinopathy (PR) and age-related macular degeneration (AMD). This study provides a recent overview of the possible systems used to replace lost vision. These range from stimulation with intraocular implants, through stimulation of the optic nerve and lateral geniculate nucleus to the visual cortex. The second part deals with the design of image processing technology and its transformation into the form of transcranial stimulation of undamaged parts of the brain, which is protected by a patent. This is comprehensive overview of the current possibilities of replacement of lost vision and a proposal for a new non-invasive methods of stimulation of functional neurons of the visual cortex.

Emerging Trends in Neuromodulation for Treatment of Drug-Resistant Epilepsy

Epilepsy is a neurological disorder that affects more than 70 million people globally. A considerable proportion of epilepsy is resistant to anti-epileptic drugs (AED). For patients with drug-resistant epilepsy (DRE), who are not eligible for resective or ablative surgery, neuromodulation has been a palliative option. Since the approval of vagus nerve stimulation (VNS) in 1997, expansion to include other modalities, such as deep brain stimulation (DBS) and responsive neurostimulation (RNS), has led to improved seizure control in this population. In this article, we discuss the current updates and emerging trends on neuromodulation for epilepsy.

Adaptive polymer fiber neural device for drug delivery and enlarged illumination angle for neuromodulation

OBJECTIVE

Optical fiber devices constitute significant tools for the modulation and interrogation of neuronal circuitry in the mid and deep brain regions. The illuminated brain area during neuromodulation has a direct impact on the spatio-temporal properties of the brain activity and depends solely on the material and geometrical characteristics of the optical fibers. In the present work, we developed two different flexible polymer optical fibers (POFs) with integrated microfluidic channels (MFCs) and an ultra-high numerical aperture (UHNA) for enlarging the illumination angle to achieve efficient neuromodulation.

APPROACH

Three distinct thermoplastic polymers: polysulfone (PSU), polycarbonate (PC), and fluorinated ethylene propylene (FEP) were used to fabricate two step-index UHNA POF neural devices using a scalable thermal drawing process. The POFs were characterized in terms of their illumination map as well as their fluid delivery capability in phantom and adult rat brain slices.

MAIN RESULTS

A 100-fold reduced bending stiffness of the proposed fiber devices compared to their commercially available counterparts has been found. The integrated MFCs can controllably deliver dye (trypan blue) on-demand over a wide range of injection rates spanning from 10 nL/min to 1000 nL/min. Compared with commercial silica fibers, the proposed UHNA POFs exhibited an increased illumination area by 17% and 21% under 470 and 650 nm wavelength, respectively. In addition, a fluorescent light recording experiment has been conducted to demonstrate the ability of our UHNA POFs to be used as optical waveguides in fiber photometry.

SIGNIFICANCE

Our results overcome the current technological limitations of fiber implants that have limited illumination area and we suggest that soft neural fiber devices can be developed using different custom designs for illumination, collection, and photometry applications. We anticipate our work to pave the way towards the development of next-generation functional optical fibers for neuroscience.

The Potential Role of Neuromodulation in Subarachnoid Hemorrhage

OBJECTIVES

Aneurysmal subarachnoid hemorrhage (SAH) continues to be a difficult cerebrovascular disease with limited pharmacologic treatment options. Cerebral vasospasm (CV) and delayed cerebral ischemia (DCI) are leading causes of morbidity and mortality after SAH. Despite the advances in the understanding of its pathophysiology and tremendous efforts to date, nimodipine is currently the sole Food and Drug Administration-approved treatment for patients with SAH, with benefits that are marginal at best. The neuromodulation therapies are promising, especially those that target CV and DCI to improve functional outcomes. The aim of this review is therefore to summarize the available evidence for each type of neuromodulation for CV and DCI, with a special focus on its pathophysiological mechanisms, in addition to their clinical utility and drawbacks, which we hope will lead to future translational therapy options after SAH.

MATERIALS AND METHODS

We conducted a comprehensive review of preclinical and clinical studies demonstrating the use of neuromodulation for SAH. The literature search was performed using PubMed, Embase, and ClinicalTrials.gov. A total of 21 articles published from 1992 to 2021 and eight clinical trials were chosen.

RESULTS

The studies reviewed provide a compelling demonstration that neuromodulation is a potentially useful strategy to target multiple mechanisms of DCI and thus to potentially improve functional outcomes from SAH. There are several types of neuromodulation that have been tested to treat CV and DCI, including the trigeminal/vagus/facial nerve stimulation, sphenopalatine ganglion and spinal cord stimulation, transcranial direct electrical stimulation, transcutaneous electrical neurostimulation, and electroacupuncture. Most of them are in the preclinical or early phases of clinical application; however, they show promising results.

CONCLUSIONS

DCI has a complex pathogenesis, making the unique anatomical distribution and pleiotropic capabilities of various types of neuromodulation a promising field of study. We may be at the cusp of a breakthrough in the use of these techniques for the treatment of this stubbornly difficult disease.

Neurosensory Prosthetics: An Integral Neuromodulation Part of Bioelectronic Device

Bioelectronic medicines (BEMs) constitute a branch of bioelectronic devices (BEDs), which are a class of therapeutics that combine neuroscience with molecular biology, immunology, and engineering technologies. Thus, BEMs are the culmination of thought processes of scientists of varied fields and herald a new era in the treatment of chronic diseases. BEMs work on the principle of neuromodulation of nerve stimulation. Examples of BEMs based on neuromodulation are those that modify neural circuits through deep brain stimulation, vagal nerve stimulation, spinal nerve stimulation, and retinal and auditory implants. BEDs may also serve as diagnostic tools by mimicking human sensory systems. Two examples of in vitro BEDs used as diagnostic agents in biomedical applications based on in vivo neurosensory circuits are the bioelectronic nose and bioelectronic tongue. The review discusses the ever-growing application of BEDs to a wide variety of health conditions and practices to improve the quality of life.

Translating node of Ranvier currents to extraneural electrical fields: a flexible FEM modeling approach

Simulations of electroneurogram recording could help find the optimal set of electrodes and algorithms for selective neural recording. However, no flexible methods are established for selective neural recording as for neural stimulation. This paper proposes a method to couple a compartmental and a FEM nerve model, implemented in NEURON and COMSOL, respectively, to translate Node of Ranvier currents into extraneural electric fields. The study simulate ex-vivo experimental conditions, and the method allows flexibility in electrode geometries and nerve topologies. This model has been made available in a public repository⁴. So far, the model behavior complies with available experimental results and expectations from literature. There is good agreement in terms of signal amplitude and waveform, and computational times are acceptable, leaving room for flexible simulation studies complementary to animal tests.

Bioluminescent Multi-Characteristic Opsin for Simultaneous Optical Stimulation and Continuous Monitoring of Cortical Activities

Stimulation and continuous monitoring of neural activities at cellular resolution are required for the understanding of the sensory processing of stimuli and development of effective neuromodulation therapies. We present bioluminescence multi-characteristic opsin (bMCOII), a hybrid optogenetic actuator, and a bioluminescence Ca2+ sensor for excitation-free, continuous monitoring of neural activities in the visual cortex, with high spatiotemporal resolution. An exceptionally low intensity (10 μW/mm2) of light could elicit neural activation that could be detected by Ca2+ bioluminescence imaging. An uninterrupted (>14 h) recording of visually evoked neural activities in the cortex of mice enabled the determination of strength of sensory activation. Furthermore, an artificial intelligence-based neural activation parameter transformed Ca2+ bioluminescence signals to network activity patterns. During continuous Ca2+-bioluminescence recordings, visual cortical activity peaked at the seventh to eighth hour of anesthesia, coinciding with circadian rhythm. For both direct optogenetic stimulation in cortical slices and visually evoked activities in the visual cortex, we observed secondary delayed Ca2+-bioluminescence responses, suggesting the involvement of neuron-astrocyte-neuron pathway. Our approach will enable the development of a modular and scalable interface system capable of serving a multiplicity of applications to modulate and monitor large-scale activities in the brain.

Neuromodulation in the Treatment of Alzheimer's Disease: Current and Emerging Approaches

Neuromodulation as a treatment strategy for psychiatric and neurological diseases has grown in popularity in recent years, with the approval of repetitive transcranial magnetic stimulation (rTMS) for the treatment of depression being one such example. These approaches offer new hope in the treatment of diseases that have proven largely intractable to traditional pharmacological approaches. For this reason, neuromodulation is increasingly being explored for the treatment of Alzheimer's disease. However, such approaches have variable, and, in many cases, very limited evidence for safety and efficacy, with most human evidence obtained in small clinical trials. Here we review work in animal models and humans with Alzheimer's disease exploring emerging neuromodulation modalities. Approaches reviewed include deep brain stimulation, transcranial magnetic stimulation, transcranial electrical stimulation, ultrasound stimulation, photobiomodulation, and visual or auditory stimulation. In doing so, we clarify the current evidence for these approaches in treating Alzheimer's disease and identify specific areas where additional work is needed to facilitate their clinical translation.

Infrared neurostimulation inex-vivorat sciatic nerve using 1470 nm wavelength

Objective.To design and implement a setup forex-vivooptical stimulation for exploring the effect of several key parameters (optical power and pulse duration), activation features (threshold, spatial selectivity) and recovery characteristics (repeated stimuli) in peripheral nerves.Approach.A nerve chamber allowing ex-vivo electrical and optical stimulation was designed and built. A 1470 nm light source was chosen to stimulate the nerve. A photodiode module was implemented for synchronization of the electrical and optical channels.Main results. Compound neural action potentials (CNAPs) were successfully generated with infrared light pulses of 200-2000µs duration and power in the range of 3-10 W. These parameters determine a radiant exposure for stimulation in the range 1.59-4.78 J cm^-2. Recruitment curves were obtained by increasing durations at a constant power level. Neural activation threshold is reached at a mean radiant exposure of 3.16 ± 0.68 J cm^-2and mean pulse energy of 3.79 ± 0.72 mJ. Repetition rates of 2-10 Hz have been explored. In eight out of ten sciatic nerves (SNs), repeated light stimuli induced a sensitization effect in that the CNAP amplitude progressively grows, representing an increasing number of recruited fibres. In two out of ten SNs, CNAPs were composed of a succession of peaks corresponding to different conduction velocities.Significance.The reported sensitization effect could shed light on the mechanism underlying infrared neurostimulation. Our results suggest that, in sharp contrast with electrical stimuli, optical pulses could recruit slow fibres early on. This more physiological order of recruitment opens the perspective for specific neuromodulation of fibre population who remained poorly accessible until now. Short high-power light pulses at wavelengths below 1.5µm offer interesting perspectives for neurostimulation.

Three-dimensional, multifunctional neural interfaces for cortical spheroids and engineered assembloids

Three-dimensional (3D), submillimeter-scale constructs of neural cells, known as cortical spheroids, are of rapidly growing importance in biological research because these systems reproduce complex features of the brain in vitro. Despite their great potential for studies of neurodevelopment and neurological disease modeling, 3D living objects cannot be studied easily using conventional approaches to neuromodulation, sensing, and manipulation. Here, we introduce classes of microfabricated 3D frameworks as compliant, multifunctional neural interfaces to spheroids and to assembloids. Electrical, optical, chemical, and thermal interfaces to cortical spheroids demonstrate some of the capabilities. Complex architectures and high-resolution features highlight the design versatility. Detailed studies of the spreading of coordinated bursting events across the surface of an isolated cortical spheroid and of the cascade of processes associated with formation and regrowth of bridging tissues across a pair of such spheroids represent two of the many opportunities in basic neuroscience research enabled by these platforms.

Fiber-Based Clock Synchronization Method for Medical Ultrasound System

Brain ultrasound has attracted great attention recently due to its noninvasive treatment function for brain diseases. However, ultrasound is still difficult to pass through an intact skull. Phase correction is recognized as an effective method for skull compensation. Half-wavelength pitch transducer is important for the phase correction and, hence, thousands of elements array is required to cover large area human tissue. The clock synchronization between elements is crucial for the phase correction; however, the traditional clock scheme which is designed for 128- or 256-element system is not suitable for thousands of elements. In addition, the clock scheme needs to be magnetic resonance imaging (MRI) compatible since MRI-guided intervention is becoming a routine operation for the brain ultrasound. This study is the first to propose an optical fiber-based clock synchronization method for MRI-guided ultrasound array system. The optical fiber not only distributes the clock but also sets up a link to transmit the data for ultrasound beamformer. The link is full-duplex so both the clock and the data can be transmitted and received simultaneously. The precision of clock synchronization is less than 557 ps when using 50 MHz clock, and the period jitter of the clock is less than 10 ps (rms). Multiple 128- or 256-channel ultrasonic systems can be synchronized, and the error between the channels can be less than 10 ns when using 1-MHz ultrasound transducer. The system can work in an MRI scanning room and communicate with a console via only one fiber. In vivo primate animal study has been achieved, and it has been proven that the proposed clock scheme is suitable for MRI-guided large-scale ultrasound array system.

Novel Extranasal Tear Stimulation: Pivotal Study Results

Purpose

To evaluate the efficacy and safety of iTEAR, a novel, portable, sonic external neuromodulation device, for the treatment of dry eye disease (DED).

Methods

This was a multicenter, open-label, single-arm clinical trial that included adult patients with DED with a Schirmer score of ≤10 mm in at least one eye. Enrolled subjects were instructed to apply the study device at least twice per day for 30 seconds bilaterally to the external nasal nerve. After the initial baseline visit, patients were followed up at days 3, 14, 30, 90, and 180. The primary efficacy endpoint was the Schirmer index (change from unstimulated to stimulated tear production as measured by the Schirmer test) at day 30. The major secondary endpoint was the change in symptoms of DED at day 30 evaluated using the Ocular Surface Disease Index (OSDI).

Results

A total of 101 subjects evaluated at day 30 had a mean Schirmer index of 9.4 mm (95% confidence interval [CI], 7.4–11.3), and the baseline OSDI improved by an average of 14.4 (95% CI, 11.1–17.7). Both endpoints were highly statistically and clinically significant at all time points. There were two mild unanticipated adverse events definitely related to the device.

Conclusions

The safety and efficacy of the iTEAR device observed in this study support its indication for treating DED.

Translational Relevance

Neurostimulation has the potential to improve signs and symptoms of DED.

Infrared neuromodulation:a neuroengineering perspective

Infrared neuromodulation (INM) is a branch of photobiomodulation that offers direct or indirect control of cellular activity through elevation of temperature in a spatially confined region of the target tissue. Research on INM started about 15 ago and is gradually attracting the attention of the neuroscience community, as numerous experimental studies have provided firm evidence on the safe and reproducible excitation and inhibition of neuronal firing in both in vitro and in vivo conditions. However, its biophysical mechanism is not fully understood and several engineered interfaces have been created to investigate infrared stimulation in both the peripheral and central nervous system. In this review, recent applications and present knowledge on the effects of INM on cellular activity are summarized, and an overview of the technical approaches to deliver infrared light to cells and to interrogate the optically evoked response is provided. The micro- and nanoengineered interfaces used to investigate the influence of INM are described in detail.

Neural implant for the treatment of multiple sclerosis

The methods used to treat various neurological diseases are evolving. The facilities provided by the technology have led to creation of new treatment opportunities. Neuromodulation is one of these important methods. By definition, the neuromodulation is a change in neural activity which occurs by stimulating a specific area of nervous system. The mentioned stimulation can be electrical, magnetic, or chemical. This method is used in various diseases, such as stroke, Parkinson's, Alzheimer's, and amyotrophic lateral sclerosis (ALS). Multiple sclerosis (MS) is no exception in this regard and methods including the neurofeedback and transcranial magnetic stimulation (TMS) are used to treat various complications of the MS. One aspect of neuromodulation is the use of neural implant, which is applied nowadays, especially in the Parkinson's disease, and the use of microchips and prostheses to treat various symptoms in different neurological diseases has received significant attention. Although neural implant has been exploited to improve the symptoms of MS, they appear to have much greater potential to improve the condition of patients with MS. It seems that more attention to the symptoms of MS, on the one hand, and a new approach to the pathogenesis of this disease and considering it as a connectomopathy, on the other hand, can provide new opportunities for application of this method in the treatment of MS.

Effectiveness of transcutaneous electrical stimulation combined with artificial tears for the treatment of dry eye: A randomized controlled trial

There is currently no available cure or universally effective treatment for dry eye (DE). The aim of the present study was to investigate the clinical efficacy of transcutaneous electrical stimulation (TES) combined with artificial tears in treating DE. Patients diagnosed with DE were referred for therapy with TES combined with sodium hyaluronate (SH)-containing artificial tears. A total of 52 patients (104 eyes) with DE were enrolled in this randomized controlled trial. The patients were randomized 1:1 to the TES + SH or SH group. The patients in the TES + SH group were treated with 20 sessions (5 sessions per week for 4 weeks), and each session lasted for 20 min. The treatment was continued for 4 weeks in all cases. The Ocular Surface Disease Index (OSDI), tear film breakup time (BUT), Schirmer's I test and corneal fluorescein scores were used to assess treatment efficacy. A total of 90 eyes of 45 patients completed all aspects of the study: 22 patients (44 eyes) in the TES + SH group and 23 patients (46 eyes) in the SH group. There was no statistically significant difference in sex, age or course between the two groups. The mean OSDI scores, BUT, Schirmer's I test and corneal fluorescein scores exhibited a significant improvement in the TES + SH group compared with the SH group after treatment. No serious adverse events were recorded during TES treatment. In conclusion, TES combined with artificial tears appeared to be an effective treatment for DE. Therefore, TES may represent a new therapeutic option with promising potential applications.

Neuromodulation in Psychiatric disorders: Experimental and Clinical evidence for reward and motivation network Deep Brain Stimulation: Focus on the medial forebrain bundle

Deep brain stimulation (DBS) in psychiatric illnesses has been clinically tested over the past 20 years. The clinical application of DBS to the superolateral branch of the medial forebrain bundle in treatment-resistant depressed patients-one of several targets under investigation-has shown to be promising in a number of uncontrolled open label trials. However, there are remain numerous questions that need to be investigated to understand and optimize the clinical use of DBS in depression, including, for example, the relationship between the symptoms, the biological substrates/projections and the stimulation itself. In the context of precision and customized medicine, the current paper focuses on clinical and experimental research of medial forebrain bundle DBS in depression or in animal models of depression, demonstrating how clinical and scientific progress can work in tandem to test the therapeutic value and investigate the mechanisms of this experimental treatment. As one of the hypotheses is that depression engenders changes in the reward and motivational networks, the review looks at how stimulation of the medial forebrain bundle impacts the dopaminergic system.