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Wang S, Zhang Y, Wang M, Meng F, Liu Y, Zhang J. Deep brain stimulation for Tourette's syndrome. Cochrane Database Syst Rev 2024; 8:CD015924. [PMID: 39136257 PMCID: PMC11320656 DOI: 10.1002/14651858.cd015924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/16/2024]
Abstract
OBJECTIVES This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the efficacy and harm of deep brain stimulation for motor symptoms, with psychiatric and behavioural comorbidities, either individually or in combination, in adults and adolescents with Tourette's syndrome compared to placebo, sham intervention, or the best available behavioural and pharmacological treatment.
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Affiliation(s)
- Shu Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Yuan Zhang
- Neonatal Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Minzhong Wang
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong Province, China
| | - Fangang Meng
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
- Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing 100070, China
- Beijing Key Laboratory of Neurostimulation, Beijing 100070, China
| | - Yali Liu
- Center for Clinical Epidemiology and Evidence-based Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Jianguo Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
- Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing 100070, China
- Beijing Key Laboratory of Neurostimulation, Beijing 100070, China
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Lenka A, Jankovic J. An update on the pharmacological management of Tourette syndrome and emerging treatment paradigms. Expert Rev Neurother 2024:1-9. [PMID: 39034647 DOI: 10.1080/14737175.2024.2382463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 07/16/2024] [Indexed: 07/23/2024]
Abstract
INTRODUCTION Tourette syndrome (TS) is a childhood-onset neurobehavioral disorder characterized by tics. Pharmacotherapy is advised for patients whose symptoms affect their quality of life. AREAS COVERED The authors review the tic phenomenology and TS diagnostic criteria. The bulk of this article focuses on pharmacotherapeutic options for treating tics. They also highlight pharmacotherapies in the research pipeline. EXPERT OPINION Tic treatment must be tailored to individual needs. Behavioral therapy is the first line of treatment. Most with bothersome tics need pharmacotherapy and rarely, for medication-refractory cases, surgical therapy is indicated. Alpha-2 agonists are considered in patients with mild tics, especially in those with attention deficit with or without hyperactivity. Second-generation antipsychotics like aripiprazole and tiapride may be considered for severe tics. However, prescribers should be mindful of potential side effects, especially drug-induced movement disorders. Botulinum toxin injections may be considered for focal motor tics. Topiramate can be considered when other treatments are ineffective, and its benefits outweigh the risks. The same holds true for vesicular monoamine transporter-2 inhibitors, as they are deemed to be safe and effective in real-world use and open-label trials despite not meeting primary endpoints in placebo-controlled trials. Cannabinoids may be considered in adults if the approaches above do not control tics.
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Affiliation(s)
- Abhishek Lenka
- Department of Neurology, Parkinson's Disease Center and Movement Disorders Clinic, Baylor College of Medicine, Houston, TX, USA
| | - Joseph Jankovic
- Department of Neurology, Parkinson's Disease Center and Movement Disorders Clinic, Baylor College of Medicine, Houston, TX, USA
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Okun MS, Cagle J, Gomez J, Bowers D, Wong J, Foote KD, Gunduz A. Responsive deep brain stimulation for the treatment of Tourette syndrome. Sci Rep 2024; 14:6467. [PMID: 38499664 PMCID: PMC10948908 DOI: 10.1038/s41598-024-57071-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 03/14/2024] [Indexed: 03/20/2024] Open
Abstract
To report the results of 'responsive' deep brain stimulation (DBS) for Tourette syndrome (TS) in a National Institutes of Health funded experimental cohort. The use of 'brain derived physiology' as a method to trigger DBS devices to deliver trains of electrical stimulation is a proposed approach to address the paroxysmal motor and vocal tic symptoms which appear as part of TS. Ten subjects underwent bilateral staged DBS surgery and each was implanted with bilateral centromedian thalamic (CM) region DBS leads and bilateral M1 region cortical strips. A series of identical experiments and data collections were conducted on three groups of consecutively recruited subjects. Group 1 (n = 2) underwent acute responsive DBS using deep and superficial leads. Group 2 (n = 4) underwent chronic responsive DBS using deep and superficial leads. Group 3 (n = 4) underwent responsive DBS using only the deep leads. The primary outcome measure for each of the 8 subjects with chronic responsive DBS was calculated as the pre-operative baseline Yale Global Tic Severity Scale (YGTSS) motor subscore compared to the 6 month embedded responsive DBS setting. A responder for the study was defined as any subject manifesting a ≥ 30 points improvement on the YGTSS motor subscale. The videotaped Modified Rush Tic Rating Scale (MRVTRS) was a secondary outcome. Outcomes were collected at 6 months across three different device states: no stimulation, conventional open-loop stimulation, and embedded responsive stimulation. The experience programming each of the groups and the methods applied for programming were captured. There were 10 medication refractory TS subjects enrolled in the study (5 male and 5 female) and 4/8 (50%) in the chronic responsive eligible cohort met the primary outcome manifesting a reduction of the YGTSS motor scale of ≥ 30% when on responsive DBS settings. Proof of concept for the use of responsive stimulation was observed in all three groups (acute responsive, cortically triggered and deep DBS leads only). The responsive approach was safe and well tolerated. TS power spectral changes associated with tics occurred consistently in the low frequency 2-10 Hz delta-theta-low alpha oscillation range. The study highlighted the variety of programming strategies which were employed to achieve responsive DBS and those used to overcome stimulation induced artifacts. Proof of concept was also established for a single DBS lead triggering bi-hemispheric delivery of therapeutic stimulation. Responsive DBS was applied to treat TS related motor and vocal tics through the application of three different experimental paradigms. The approach was safe and effective in a subset of individuals. The use of different devices in this study was not aimed at making between device comparisons, but rather, the study was adapted to the current state of the art in technology. Overall, four of the chronic responsive eligible subjects met the primary outcome variable for clinical effectiveness. Cortical physiology was used to trigger responsive DBS when therapy was limited by stimulation induced artifacts.
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Affiliation(s)
- Michael S Okun
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, 3011 SW Williston Rd, Gainesville, FL, 32608, USA.
- Department of Neurosurgery, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA.
| | - Jackson Cagle
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, 3011 SW Williston Rd, Gainesville, FL, 32608, USA
| | - Julieth Gomez
- Department of Biomedical Engineering, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Dawn Bowers
- Department of Clinical and Health Psychology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Joshua Wong
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, 3011 SW Williston Rd, Gainesville, FL, 32608, USA
| | - Kelly D Foote
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, 3011 SW Williston Rd, Gainesville, FL, 32608, USA
- Department of Neurosurgery, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Aysegul Gunduz
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, 3011 SW Williston Rd, Gainesville, FL, 32608, USA
- Department of Clinical and Health Psychology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
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Johnson KA, Dosenbach NUF, Gordon EM, Welle CG, Wilkins KB, Bronte-Stewart HM, Voon V, Morishita T, Sakai Y, Merner AR, Lázaro-Muñoz G, Williamson T, Horn A, Gilron R, O'Keeffe J, Gittis AH, Neumann WJ, Little S, Provenza NR, Sheth SA, Fasano A, Holt-Becker AB, Raike RS, Moore L, Pathak YJ, Greene D, Marceglia S, Krinke L, Tan H, Bergman H, Pötter-Nerger M, Sun B, Cabrera LY, McIntyre CC, Harel N, Mayberg HS, Krystal AD, Pouratian N, Starr PA, Foote KD, Okun MS, Wong JK. Proceedings of the 11th Annual Deep Brain Stimulation Think Tank: pushing the forefront of neuromodulation with functional network mapping, biomarkers for adaptive DBS, bioethical dilemmas, AI-guided neuromodulation, and translational advancements. Front Hum Neurosci 2024; 18:1320806. [PMID: 38450221 PMCID: PMC10915873 DOI: 10.3389/fnhum.2024.1320806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 02/05/2024] [Indexed: 03/08/2024] Open
Abstract
The Deep Brain Stimulation (DBS) Think Tank XI was held on August 9-11, 2023 in Gainesville, Florida with the theme of "Pushing the Forefront of Neuromodulation". The keynote speaker was Dr. Nico Dosenbach from Washington University in St. Louis, Missouri. He presented his research recently published in Nature inn a collaboration with Dr. Evan Gordon to identify and characterize the somato-cognitive action network (SCAN), which has redefined the motor homunculus and has led to new hypotheses about the integrative networks underpinning therapeutic DBS. The DBS Think Tank was founded in 2012 and provides an open platform where clinicians, engineers, and researchers (from industry and academia) can freely discuss current and emerging DBS technologies, as well as logistical and ethical issues facing the field. The group estimated that globally more than 263,000 DBS devices have been implanted for neurological and neuropsychiatric disorders. This year's meeting was focused on advances in the following areas: cutting-edge translational neuromodulation, cutting-edge physiology, advances in neuromodulation from Europe and Asia, neuroethical dilemmas, artificial intelligence and computational modeling, time scales in DBS for mood disorders, and advances in future neuromodulation devices.
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Affiliation(s)
- Kara A. Johnson
- Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
- Department of Neurology, University of Florida, Gainesville, FL, United States
| | - Nico U. F. Dosenbach
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, United States
| | - Evan M. Gordon
- Department of Radiology, Washington University School of Medicine, St. Louis, MO, United States
| | - Cristin G. Welle
- Department of Physiology and Biophysics, University of Colorado School of Medicine, Aurora, CO, United States
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, CO, United States
| | - Kevin B. Wilkins
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - Helen M. Bronte-Stewart
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - Valerie Voon
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Takashi Morishita
- Department of Neurosurgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Yuki Sakai
- ATR Brain Information Communication Research Laboratory Group, Kyoto, Japan
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Amanda R. Merner
- Center for Bioethics, Harvard Medical School, Boston, MA, United States
| | - Gabriel Lázaro-Muñoz
- Center for Bioethics, Harvard Medical School, Boston, MA, United States
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Theresa Williamson
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, United States
| | - Andreas Horn
- Department of Neurology, Center for Brain Circuit Therapeutics, Harvard Medical School, Brigham & Women's Hospital, Boston, MA, United States
- MGH Neurosurgery and Center for Neurotechnology and Neurorecovery (CNTR) at MGH Neurology Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Berlin, Germany
| | | | | | - Aryn H. Gittis
- Biological Sciences and Center for Neural Basis of Cognition, Carnegie Mellon University, Pittsburgh, PA, United States
| | - Wolf-Julian Neumann
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Berlin, Germany
| | - Simon Little
- Department of Neurological Surgery, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Nicole R. Provenza
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, United States
| | - Sameer A. Sheth
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, United States
| | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson's Disease, Division of Neurology, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network (UHN), University of Toronto, Toronto, ON, Canada
- Krembil Brain Institute, Toronto, ON, Canada
| | - Abbey B. Holt-Becker
- Restorative Therapies Group Implantables, Research, and Core Technology, Medtronic Inc., Minneapolis, MN, United States
| | - Robert S. Raike
- Restorative Therapies Group Implantables, Research, and Core Technology, Medtronic Inc., Minneapolis, MN, United States
| | - Lisa Moore
- Boston Scientific Neuromodulation Corporation, Valencia, CA, United States
| | | | - David Greene
- NeuroPace, Inc., Mountain View, CA, United States
| | - Sara Marceglia
- Department of Engineering and Architecture, University of Trieste, Trieste, Italy
| | - Lothar Krinke
- Newronika SPA, Milan, Italy
- Department of Neuroscience, West Virginia University, Morgantown, WV, United States
| | - Huiling Tan
- Medical Research Council Brain Network Dynamics Unit, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Hagai Bergman
- Edmond and Lily Safar Center (ELSC) for Brain Research and Department of Medical Neurobiology (Physiology), Institute of Medical Research Israel-Canada, Hebrew University of Jerusalem, Jerusalem, Israel
- Department of Neurosurgery, Hadassah Medical Center, Jerusalem, Israel
| | - Monika Pötter-Nerger
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Bomin Sun
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Laura Y. Cabrera
- Neuroethics, Department of Engineering Science and Mechanics, Philosophy, and Bioethics, and the Rock Ethics Institute, Pennsylvania State University, State College, PA, United States
| | - Cameron C. McIntyre
- Department of Biomedical Engineering, Duke University, Durham, NC, United States
- Department of Neurosurgery, Duke University, Durham, NC, United States
| | - Noam Harel
- Department of Radiology, Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, MN, United States
| | - Helen S. Mayberg
- Department of Neurology, Neurosurgery, Psychiatry, and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Andrew D. Krystal
- Departments of Psychiatry and Behavioral Science and Neurology, University of California, San Francisco, San Francisco, CA, United States
| | - Nader Pouratian
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Philip A. Starr
- Department of Neurological Surgery, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Kelly D. Foote
- Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
- Department of Neurosurgery, University of Florida, Gainesville, FL, United States
| | - Michael S. Okun
- Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
- Department of Neurology, University of Florida, Gainesville, FL, United States
| | - Joshua K. Wong
- Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
- Department of Neurology, University of Florida, Gainesville, FL, United States
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Anderson DN, Charlebois CM, Smith EH, Davis TS, Peters AY, Newman BJ, Arain AM, Wilcox KS, Butson CR, Rolston JD. Closed-loop stimulation in periods with less epileptiform activity drives improved epilepsy outcomes. Brain 2024; 147:521-531. [PMID: 37796038 PMCID: PMC10834245 DOI: 10.1093/brain/awad343] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 07/17/2023] [Accepted: 08/28/2023] [Indexed: 10/06/2023] Open
Abstract
In patients with drug-resistant epilepsy, electrical stimulation of the brain in response to epileptiform activity can make seizures less frequent and debilitating. This therapy, known as closed-loop responsive neurostimulation (RNS), aims to directly halt seizure activity via targeted stimulation of a burgeoning seizure. Rather than immediately stopping seizures as they start, many RNS implants produce slower, long-lasting changes in brain dynamics that better predict clinical outcomes. Here we hypothesize that stimulation during brain states with less epileptiform activity drives long-term changes that restore healthy brain networks. To test this, we quantified stimulation episodes during low- and high-risk brain states-that is, stimulation during periods with a lower or higher risk of generating epileptiform activity-in a cohort of 40 patients treated with RNS. More frequent stimulation in tonic low-risk states and out of rhythmic high-risk states predicted seizure reduction. Additionally, stimulation events were more likely to be phase-locked to prolonged episodes of abnormal activity for intermediate and poor responders when compared to super-responders, consistent with the hypothesis that improved outcomes are driven by stimulation during low-risk states. These results support the hypothesis that stimulation during low-risk periods might underlie the mechanisms of RNS, suggesting a relationship between temporal patterns of neuromodulation and plasticity that facilitates long-term seizure reduction.
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Affiliation(s)
- Daria Nesterovich Anderson
- Department of Neurosurgery, University of Utah, Salt Lake City, UT 84132, USA
- Department of Pharmacology and Toxicology, University of Utah, Salt Lake City, UT 84112, USA
- School of Biomedical Engineering, Faculty of Engineering, The University of Sydney, Darlington, NSW 2008, Australia
| | - Chantel M Charlebois
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT 84112, USA
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT 84112, USA
| | - Elliot H Smith
- Department of Neurosurgery, University of Utah, Salt Lake City, UT 84132, USA
| | - Tyler S Davis
- Department of Neurosurgery, University of Utah, Salt Lake City, UT 84132, USA
| | - Angela Y Peters
- Department of Neurology, University of Utah, Salt Lake City, UT 84132, USA
| | - Blake J Newman
- Department of Neurology, University of Utah, Salt Lake City, UT 84132, USA
| | - Amir M Arain
- Department of Neurology, University of Utah, Salt Lake City, UT 84132, USA
| | - Karen S Wilcox
- Department of Pharmacology and Toxicology, University of Utah, Salt Lake City, UT 84112, USA
| | - Christopher R Butson
- Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL 32608, USA
- Department of Neurology, University of Florida, Gainesville, FL 32611, USA
- Department of Neurosurgery, University of Florida, Gainesville, FL 32608, USA
- Department of Biomedical Engineering, University of Florida, Gainesville, FL 32611, USA
| | - John D Rolston
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT 84112, USA
- Department of Neurosurgery, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA 02115, USA
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Sellers KK, Cohen JL, Khambhati AN, Fan JM, Lee AM, Chang EF, Krystal AD. Closed-loop neurostimulation for the treatment of psychiatric disorders. Neuropsychopharmacology 2024; 49:163-178. [PMID: 37369777 PMCID: PMC10700557 DOI: 10.1038/s41386-023-01631-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 05/31/2023] [Accepted: 06/02/2023] [Indexed: 06/29/2023]
Abstract
Despite increasing prevalence and huge personal and societal burden, psychiatric diseases still lack treatments which can control symptoms for a large fraction of patients. Increasing insight into the neurobiology underlying these diseases has demonstrated wide-ranging aberrant activity and functioning in multiple brain circuits and networks. Together with varied presentation and symptoms, this makes one-size-fits-all treatment a challenge. There has been a resurgence of interest in the use of neurostimulation as a treatment for psychiatric diseases. Initial studies using continuous open-loop stimulation, in which clinicians adjusted stimulation parameters during patient visits, showed promise but also mixed results. Given the periodic nature and fluctuations of symptoms often observed in psychiatric illnesses, the use of device-driven closed-loop stimulation may provide more effective therapy. The use of a biomarker, which is correlated with specific symptoms, to deliver stimulation only during symptomatic periods allows for the personalized therapy needed for such heterogeneous disorders. Here, we provide the reader with background motivating the use of closed-loop neurostimulation for the treatment of psychiatric disorders. We review foundational studies of open- and closed-loop neurostimulation for neuropsychiatric indications, focusing on deep brain stimulation, and discuss key considerations when designing and implementing closed-loop neurostimulation.
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Affiliation(s)
- Kristin K Sellers
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
- Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Joshua L Cohen
- Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA
| | - Ankit N Khambhati
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
- Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Joline M Fan
- Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
- Department of Neurology, University of California, San Francisco, CA, USA
| | - A Moses Lee
- Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA
| | - Edward F Chang
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
- Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Andrew D Krystal
- Weill Institute for Neurosciences, University of California, San Francisco, CA, USA.
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA.
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Sandoval-Pistorius SS, Hacker ML, Waters AC, Wang J, Provenza NR, de Hemptinne C, Johnson KA, Morrison MA, Cernera S. Advances in Deep Brain Stimulation: From Mechanisms to Applications. J Neurosci 2023; 43:7575-7586. [PMID: 37940596 PMCID: PMC10634582 DOI: 10.1523/jneurosci.1427-23.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 08/14/2023] [Accepted: 08/15/2023] [Indexed: 11/10/2023] Open
Abstract
Deep brain stimulation (DBS) is an effective therapy for various neurologic and neuropsychiatric disorders, involving chronic implantation of electrodes into target brain regions for electrical stimulation delivery. Despite its safety and efficacy, DBS remains an underutilized therapy. Advances in the field of DBS, including in technology, mechanistic understanding, and applications have the potential to expand access and use of DBS, while also improving clinical outcomes. Developments in DBS technology, such as MRI compatibility and bidirectional DBS systems capable of sensing neural activity while providing therapeutic stimulation, have enabled advances in our understanding of DBS mechanisms and its application. In this review, we summarize recent work exploring DBS modulation of target networks. We also cover current work focusing on improved programming and the development of novel stimulation paradigms that go beyond current standards of DBS, many of which are enabled by sensing-enabled DBS systems and have the potential to expand access to DBS.
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Affiliation(s)
| | - Mallory L Hacker
- Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee 37232
| | - Allison C Waters
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York 10029
- Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, New York 10029
| | - Jing Wang
- Department of Neurology, University of Minnesota, Minneapolis, Minnesota 55455
| | - Nicole R Provenza
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas 77030
| | - Coralie de Hemptinne
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, Florida 32608
| | - Kara A Johnson
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, Florida 32608
| | - Melanie A Morrison
- Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, California 94143
| | - Stephanie Cernera
- Department of Neurological Surgery, University of California-San Francisco, San Francisco, California 94143
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8
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Gunduz A, Ganos C. Motor awareness, volition, and the cortical neurophysiology of simple motor tics. Clin Neurophysiol 2023; 151:130-131. [PMID: 37210248 DOI: 10.1016/j.clinph.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 04/21/2023] [Indexed: 05/22/2023]
Affiliation(s)
- Aysegul Gunduz
- Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL 32608, USA
| | - Christos Ganos
- Department of Neurology, Charité University Medicine, Berlin, Germany.
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Najera RA, Mahavadi AK, Khan AU, Boddeti U, Del Bene VA, Walker HC, Bentley JN. Alternative patterns of deep brain stimulation in neurologic and neuropsychiatric disorders. Front Neuroinform 2023; 17:1156818. [PMID: 37415779 PMCID: PMC10320008 DOI: 10.3389/fninf.2023.1156818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 06/06/2023] [Indexed: 07/08/2023] Open
Abstract
Deep brain stimulation (DBS) is a widely used clinical therapy that modulates neuronal firing in subcortical structures, eliciting downstream network effects. Its effectiveness is determined by electrode geometry and location as well as adjustable stimulation parameters including pulse width, interstimulus interval, frequency, and amplitude. These parameters are often determined empirically during clinical or intraoperative programming and can be altered to an almost unlimited number of combinations. Conventional high-frequency stimulation uses a continuous high-frequency square-wave pulse (typically 130-160 Hz), but other stimulation patterns may prove efficacious, such as continuous or bursting theta-frequencies, variable frequencies, and coordinated reset stimulation. Here we summarize the current landscape and potential clinical applications for novel stimulation patterns.
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Affiliation(s)
- Ricardo A. Najera
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Anil K. Mahavadi
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Anas U. Khan
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Ujwal Boddeti
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Victor A. Del Bene
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Harrison C. Walker
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - J. Nicole Bentley
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, United States
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Wong JK, Mayberg HS, Wang DD, Richardson RM, Halpern CH, Krinke L, Arlotti M, Rossi L, Priori A, Marceglia S, Gilron R, Cavanagh JF, Judy JW, Miocinovic S, Devergnas AD, Sillitoe RV, Cernera S, Oehrn CR, Gunduz A, Goodman WK, Petersen EA, Bronte-Stewart H, Raike RS, Malekmohammadi M, Greene D, Heiden P, Tan H, Volkmann J, Voon V, Li L, Sah P, Coyne T, Silburn PA, Kubu CS, Wexler A, Chandler J, Provenza NR, Heilbronner SR, Luciano MS, Rozell CJ, Fox MD, de Hemptinne C, Henderson JM, Sheth SA, Okun MS. Proceedings of the 10th annual deep brain stimulation think tank: Advances in cutting edge technologies, artificial intelligence, neuromodulation, neuroethics, interventional psychiatry, and women in neuromodulation. Front Hum Neurosci 2023; 16:1084782. [PMID: 36819295 PMCID: PMC9933515 DOI: 10.3389/fnhum.2022.1084782] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 12/12/2022] [Indexed: 02/05/2023] Open
Abstract
The deep brain stimulation (DBS) Think Tank X was held on August 17-19, 2022 in Orlando FL. The session organizers and moderators were all women with the theme women in neuromodulation. Dr. Helen Mayberg from Mt. Sinai, NY was the keynote speaker. She discussed milestones and her experiences in developing depression DBS. The DBS Think Tank was founded in 2012 and provides an open platform where clinicians, engineers and researchers (from industry and academia) can freely discuss current and emerging DBS technologies as well as the logistical and ethical issues facing the field. The consensus among the DBS Think Tank X speakers was that DBS has continued to expand in scope however several indications have reached the "trough of disillusionment." DBS for depression was considered as "re-emerging" and approaching a slope of enlightenment. DBS for depression will soon re-enter clinical trials. The group estimated that globally more than 244,000 DBS devices have been implanted for neurological and neuropsychiatric disorders. This year's meeting was focused on advances in the following areas: neuromodulation in Europe, Asia, and Australia; cutting-edge technologies, closed loop DBS, DBS tele-health, neuroethics, lesion therapy, interventional psychiatry, and adaptive DBS.
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Affiliation(s)
- Joshua K. Wong
- Department of Neurology, Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Helen S. Mayberg
- Department of Neurology, Neurosurgery, Psychiatry, and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Doris D. Wang
- Department of Neurological Surgery, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - R. Mark Richardson
- Department of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Casey H. Halpern
- Richards Medical Research Laboratories, Department of Neurosurgery, Perelman School of Medicine, Pennsylvania Hospital, University of Pennsylvania, Philadelphia, PA, United States
| | - Lothar Krinke
- Newronika, Goose Creek, SC, United States
- Department of Neuroscience, West Virginia University, Morgantown, WV, United States
| | | | | | | | | | | | - James F. Cavanagh
- Department of Psychology, University of New Mexico, Albuquerque, NM, United States
| | - Jack W. Judy
- Department of Electrical and Computer Engineering, University of Florida, Gainesville, FL, United States
| | - Svjetlana Miocinovic
- Department of Neurology, School of Medicine, Emory University, Atlanta, GA, United States
| | - Annaelle D. Devergnas
- Department of Neurology, School of Medicine, Emory University, Atlanta, GA, United States
| | - Roy V. Sillitoe
- Department of Neuroscience, Baylor College of Medicine, Houston, TX, United States
| | - Stephanie Cernera
- Department of Neurological Surgery, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Carina R. Oehrn
- Department of Neurological Surgery, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Aysegul Gunduz
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, FL, United States
| | - Wayne K. Goodman
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States
| | - Erika A. Petersen
- Department of Neurosurgery, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Helen Bronte-Stewart
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - Robert S. Raike
- Restorative Therapies Group Implantables, Research, and Core Technology, Medtronic Inc., Minneapolis, MN, United States
| | | | - David Greene
- NeuroPace, Inc., Mountain View, CA, United States
| | - Petra Heiden
- Department of Stereotactic and Functional Neurosurgery, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Huiling Tan
- Medical Research Council Brain Network Dynamics Unit, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Jens Volkmann
- Department of Neurology, University of Würzburg, Würzburg, Germany
| | - Valerie Voon
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Luming Li
- National Engineering Research Center of Neuromodulation, School of Aerospace Engineering, Tsinghua University, Beijing, China
| | - Pankaj Sah
- Queensland Brain Institute, University of Queensland, St Lucia, QLD, Australia
| | - Terry Coyne
- Queensland Brain Institute, University of Queensland, St Lucia, QLD, Australia
| | - Peter A. Silburn
- Queensland Brain Institute, University of Queensland, St Lucia, QLD, Australia
| | - Cynthia S. Kubu
- Department of Neurology, Cleveland Clinic, Cleveland, OH, United States
| | - Anna Wexler
- Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, PA, United States
| | - Jennifer Chandler
- Centre for Health Law, Policy, and Ethics, Faculty of Law, University of Ottawa, Ottawa, ON, Canada
| | - Nicole R. Provenza
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, United States
| | - Sarah R. Heilbronner
- Department of Neuroscience, University of Minnesota, Minneapolis, MN, United States
| | - Marta San Luciano
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Christopher J. Rozell
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA, United States
| | - Michael D. Fox
- Center for Brain Circuit Therapeutics, Department of Neurology, Psychiatry, Radiology, and Neurosurgery, Brigham and Women’s Hospital, Boston, MA, United States
| | - Coralie de Hemptinne
- Department of Neurology, Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Jaimie M. Henderson
- Department of Neurosurgery, Stanford University, Stanford, CA, United States
| | - Sameer A. Sheth
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, United States
| | - Michael S. Okun
- Department of Neurology, Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
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