Technology of deep brain stimulation: current status and future directions

Devices for the electrical stimulation of the olfactory system: A review

The loss of olfactory function has a profound impact on quality of life, affecting not only sensory perception but also memory, emotion, and overall well-being. Despite this, advancements in olfactory prostheses have lagged significantly behind those made for vision and hearing restoration. This review offers a comprehensive analysis of the current state of devices for electrical stimulation of the olfactory system. We begin by providing an overview of the olfactory system's structure and function, emphasizing the neural pathways involved in smell perception. Following this, we explore the key challenges associated with chronic implantation and electrical stimulation, material biocompatibility, inflammation risks, and ensuring long-term functionality and durability. A detailed analysis of existing neural stimulation devices-including ECoG, intracortical, and depth electrodes-is presented, assessing their potential for application in olfactory stimulation. We also discuss the limitations and pitfalls of current approaches and explore new emerging technologies aimed at overcoming these obstacles. A comprehensive literature review about the olfactory system electrical stimulation is reported, and results are analyzed to identify the most promising routes. Finally, the review highlights emerging technologies, ongoing research, and the ethical considerations associated with olfactory implants, along with future directions for developing more effective, safe, and durable solutions to restore the sense of smell for individuals with olfactory disorders.

Microelectrode Recording During Deep Brain Stimulation Does Not Consistently Represent Lead Trajectory

BACKGROUND AND OBJECTIVES

Long-term outcomes in deep brain stimulation (DBS) depend on accuracy of lead placement. Microelectrode recording (MER) is a long-used adjunct to leverage neurophysiological information to confirm satisfactory trajectory of implanted electrodes. The goal of this study was to evaluate the consistency in which electrodes are placed in sampled microelectrode trajectories.

METHODS

This is a retrospective study using intraoperative computed tomography to measure final electrode deviation from MER probe placement during the DBS insertion targeting subthalamic nucleus. Fifteen patients had 29 DBS leads placed using MER assistance. Radial distance between the probe and the lead were measured for each patient using intraoperative imaging. In addition, the preoperative target to final lead error was measured in 14 patients undergoing subthalamic nucleus implants without the use of MER and compared with the 15 patients in which MER was used as an adjunct.

RESULTS

There was no significant difference in the mean radial target error (1.2 vs 1.0 mm, P = .156) when comparing the leads placed with or without MER assistance, respectively. The mean difference in final position of microelectrode compared with DBS lead was 0.9 ± 0.1 (range 0.4-2.0 mm). Of all MER-assisted electrodes placed, 44.8% (13) of electrode final positions radially deviated 1.0 mm or more from the MER probe.

CONCLUSION

Electrode placement may deviate significantly from MER trajectories. Given the concern that physiological data may not be representative of the final electrode trajectory, surgeons should consider using intraoperative imaging or other adjunctive techniques during DBS to confirm accuracy and satisfactory trajectory of DBS leads.

Striatal stimulation enhances cognitive control and evidence processing in rodents and humans

Brain disorders, in particular mental disorders, might be effectively treated by direct electrical brain stimulation, but clinical progress requires understanding of therapeutic mechanisms. Animal models have not helped, because there are no direct animal models of mental illness. Here, we propose a potential path past this roadblock, by leveraging a common ingredient of most mental disorders: impaired cognitive control. We previously showed that deep brain stimulation (DBS) improves cognitive control in humans. We now reverse translate that result using a set-shifting task in rats. DBS-like stimulation of the midstriatum improved reaction times without affecting accuracy, mirroring our human findings. Impulsivity, motivation, locomotor, and learning effects were ruled out through companion tasks and model-based analyses. To identify the specific cognitive processes affected, we applied reinforcement learning drift-diffusion modeling. This approach revealed that DBS-like stimulation enhanced evidence accumulation rates and lowered decision thresholds, improving domain-general cognitive control. Reanalysis of prior human data showed that the same mechanism applies in humans. This reverse/forward translational model could have near-term implications for clinical DBS practice and future trial design.

A Comprehensive Overview of the Current Status and Advancements in Various Treatment Strategies against Epilepsy

Epilepsy affects more than 70 million individuals of all ages worldwide and remains one of the most severe chronic noncommunicable neurological diseases globally. Several neurotransmitters, membrane protein channels, receptors, enzymes, and, more recently noted, various pathways, such as inflammatory and mTORC complexes, play significant roles in the initiation and propagation of seizures. Over the past two decades, significant developments have been made in the diagnosis and treatment of epilepsy. Various pharmacological drugs with diverse mechanisms of action and other treatment options have been developed to control seizures and treat epilepsy. These options include surgical treatment, nanomedicine, gene therapy, natural products, nervous stimulation, a ketogenic diet, gut microbiota, etc., which are in various developmental stages. Despite a plethora of drugs and other treatment options, one-third of affected individuals are resistant to current medications, while the majority of approved drugs have severe side effects, and significant changes can occur, such as pharmacoresistance, effects on cognition, long-term problems, drug interactions, risks of poor adherence, specific effects for certain medications, and psychological complications. Therefore, the development of new drugs and other treatment options that have no or minimal adverse effects is needed to combat this deadly disease. In this Review, we comprehensively summarize and explain all of the treatment options that have been approved or are in developmental stages for epilepsy as well as their status in clinical trials and advancements.

Survey of common deep brain stimulation programming practices by experts in Parkinson's Disease

OBJECTIVE

Identify consensus and variability in deep brain stimulation (DBS) programming practices for Parkinson's disease.

BACKGROUND

DBS programming relies on the personal experience and skills of programmers. Despite consensus statements, there aren't official guidelines for DBS programming, making it likely for protocols to vary among providers.

METHODS

We administered an online survey to the Functional Neurosurgery Working Group of the Parkinson's Study Group to capture those actively programming DBS patients. We performed descriptive statistics and comparisons of responses based on career stage: early (0-10 years) versus later (>10 years).

RESULTS

Boston Scientific (n = 15/31, 48%) and Medtronic (n = 14/35, 40%) are the two DBS systems ranked as most used, with less reported frequency of Abbott devices (n = 4/32, 12.5). Traditional monopolar review ranked as the most common initial programming strategy by 23/29 (79%) respondents, regardless of the device type implanted. Monopolar omnidirectional testing was the most often used approach for contact configuration at initial programming (24/33, 73%).For treating dyskinesia, tremor, bradykinesia, rigidity, speech-related side effects, non-motor adverse effects, or swallowing-related side effects, the most likely optimization strategy selected was to modify amplitude of the active contact. When treating freezing of gait, there was a divergence between first modifying amplitude (n = 11/29, 38%) or frequency (n = 12/33, 36%).

CONCLUSION

Initial programming practices generally align with published recommendations, which can reassure less experienced clinicians in practices with near consensus and allow them to devote more time to areas with wider variety of practice. Our data also highlights aspects of DBS programming with less consensus, demonstrating the need for future evidence.

The research focus and frontiers in surgical treatment of essential tremor

Background

Essential tremor (ET) is one of the most prevalent neurodegenerative disorders, with surgery serving as the principal treatment option. This paper presents a bibliometric analysis of research in the field of ET surgery from 2004 to 2024, aiming to identify current research hotspots and inform future research directions.

Methods

This study employs CiteSpace to analyze publication trends, countries/institutions, authors, keywords, and co-cited references in ET surgery, using the Web of Science core database from 2004 to 2024 to delineate the research pathways.

Results

A total of 1,362 publications were included in this study. The number of publications has shown steady growth over the analyzed period from 2004 to 2024. Research in this field was carried out in 58 countries and by 371 institutions. The United States had the highest volume of publications, with the University of California System identified as the most prolific institution. Dr. Michael S. Okun from the University of Florida was the most prolific author, also based in the United States. This study identified 879 keywords, with significant citation bursts noted in areas such as the caudal zona incerta, ventral intermediate nucleus, location, and MR-guided focused ultrasound. Among the top ten highly cited articles, five pertained to MR-guided focused ultrasound thalamotomy, two addressed localization techniques, and one focused on surgical targets.

Conclusion

This study employs comprehensive bibliometric and visualization analyses to elucidate the evolution of research and identify emerging hotspots. The identified hotspots are as follows: First, deep brain stimulation (DBS), the most advanced technology in ET surgery, has room for improvement, especially in neuromodulation automation. Second, MR-guided focused ultrasound thalamotomy is a new surgical approach that requires further research on efficacy, safety, and side effect management. Third, novel surgical targets have demonstrated some efficacy, yet further research is essential to validate their effectiveness and safety. Lastly, localization techniques are fundamental to ET surgery, with ongoing efforts directed towards achieving more precise, individualized, and intelligent localization.

Imaging-Guided Subthalamic Nucleus Deep Brain Stimulation Programming for Parkinson Disease: A Real-Life Pilot Study

Background and Objectives

Deep brain stimulation (DBS) is a well-established treatment for Parkinson disease (PD), with programming methods continually evolving. This study aimed to compare the efficacy and patient burden between conventional ring-mode programming (CP-RM) and image-guided volume of tissue activated (IG-VTA) programming for subthalamic nucleus (STN) DBS in PD.

Methods

In this retrospective study, patients with PD who underwent STN-DBS between 2011 and 2014 (CP-RM group) and 2019 and 2021 (IG-VTA group) were evaluated. The primary outcome was the improvement in the UPDRS III score from preoperative OFF to postoperative ON state without medication at one-year follow-up. Secondary outcomes included hospital stay duration and programming sessions.

Results

A total of 26 patients were analyzed (IG-VTA: n = 12, CP-RM: n = 14). Both groups showed similar improvements in UPDRS III scores (IG-VTA: 43.62, CP-RM: 41.29). However, the IG-VTA group experienced shorter immediate postoperative hospital stays and fewer hospitalizations after discharge.

Discussion

IG-VTA programming preserved the clinical efficacy of STN-DBS over 1 year and reduced the patient and clinician burden of hospital stay and programming sessions. However, conclusions drawn must consider the limitations of retrospective design, differing time epochs, and evolving clinical practices. Further multicentric and prospective studies are warranted to validate these findings in the evolving field of neurostimulation.

Trial Registration Information

The trial is registered on clinicaltrials.gov (NCT05103072).

Reporting guidelines for randomised controlled trial reports of implantable neurostimulation devices: the CONSORT-iNeurostim extension

Background

The Consolidated Standards of Reporting Trials (CONSORT) statement has improved the quality of reporting of randomised trials. Extensions to the CONSORT statement are often needed to address specific issues of trial reporting, including those relevant to particular types of interventions. Methodological and reporting deficiencies in clinical trials of implantable neurostimulation devices are common. The CONSORT-iNeurostim extension is a new reporting guideline for randomised controlled trials evaluating implantable neurostimulation devices.

Methods

CONSORT-iNeurostim was developed using the EQUATOR methodological framework including a literature review and expert consultation to generate an initial list of candidate items. The candidate items were included in a two-round Delphi survey, discussed at an international consensus meeting (42 stakeholders including healthcare professionals, methodologists, journal editors and industry representatives from the United States, United Kingdom, Netherlands and other countries), and refined through a checklist pilot (18 stakeholders).

Findings

The initial extension item list included 49 candidate items relevant to CONSORT-iNeurostim. We received 132 responses in the first round of the Delphi survey and 99 responses in the second round. Participants suggested an additional 20 candidate items for CONSORT-iNeurostim during the first round of the survey, and those achieving initial consensus were discussed at the consensus meeting. The CONSORT-iNeurostim extension includes 7 new checklist items, including one item for reporting the neurostimulation intervention comprising a separate checklist of 14 items.

Interpretation

The CONSORT-iNeurostim extension will promote increased transparency, clarity, and completeness of trial reports of implantable neurostimulation devices. It will assist journal editors, peer-reviewers, and readers to better interpret the appropriateness and generalisability of the methods used and reported outcomes.

Funding

Abbott, Boston Scientific Corp., Mainstay Medical, Medtronic Ltd, Nevro Corp. and Saluda Medical.

Reporting guidelines for protocols of randomised controlled trials of implantable neurostimulation devices: the SPIRIT-iNeurostim extension

Background

The Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) statement has improved the quality of reporting of randomised trial protocols. Extensions to the SPIRIT statement are needed to address specific issues of trial protocol reporting, including those relevant to particular types of interventions. Methodological and reporting deficiencies in protocols of clinical trials of implantable neurostimulation devices are common. The SPIRIT-iNeurostim extension is a new reporting guideline for randomised controlled trial protocols evaluating implantable neurostimulation devices.

Methods

SPIRIT-iNeurostim was developed using the EQUATOR methodological framework including a literature review and expert consultation to generate an initial list of candidate items. The candidate items were included in a two-round Delphi survey, discussed at an international consensus meeting (42 stakeholders including healthcare professionals, methodologists, journal editors and industry representatives from the United States, United Kingdom, Netherlands and other countries), and refined through a checklist pilot (18 stakeholders).

Findings

The initial extension item list included 42 candidate items relevant to SPIRIT-iNeurostim. We received 132 responses in the first round of the Delphi survey and 99 responses in the second round. Participants suggested an additional 14 candidate items for SPIRIT-iNeurostim during the first round of the survey, and those achieving initial consensus were discussed at the consensus meeting. The SPIRIT-iNeurostim extension includes 5 new checklist items, including one item for reporting the neurostimulation intervention comprising a separate checklist of 14 items.

Interpretation

The SPIRIT-iNeurostim extension will help to promote increased transparency, clarity, and completeness of reporting trial protocols evaluating implantable neurostimulation devices. It will assist journal editors, peer-reviewers, and readers to better interpret the appropriateness and generalisability of the methods used for a planned clinical trial.

Funding

Abbott, Boston Scientific Corp., Mainstay Medical, Medtronic Ltd, Nevro Corp., and Saluda Medical.

Deep brain stimulation and lag synchronization in a memristive two-neuron network

In the pursuit of potential treatments for neurological disorders and the alleviation of patient suffering, deep brain stimulation (DBS) has been utilized to intervene or investigate pathological neural activities. To explore the exact mechanism of how DBS works, a memristive two-neuron network considering DBS is newly proposed in this work. This network is implemented by coupling two-dimensional Morris-Lecar neuron models and using a memristor synaptic synapse to mimic synaptic plasticity. The complex bursting activities and dynamical effects are revealed numerically through dynamical analysis. By examining the synchronous behavior, the desynchronization mechanism of the memristor synapse is uncovered. The study demonstrates that synaptic connections lead to the appearance of time-lagged or asynchrony in completely synchronized firing activities. Additionally, the memristive two-neuron network is implemented in hardware based on FPGA, and experimental results confirm the abundant neuronal electrical activities and chaotic dynamical behaviors. This work offers insights into the potential mechanisms of DBS intervention in neural networks.

Beta Oscillations in the Sensory Thalamus During Severe Facial Neuropathic Pain Using Novel Sensing Deep Brain Stimulation

OBJECTIVE

Advancements in deep brain stimulation (DBS) devices provide a unique opportunity to record local field potentials longitudinally to improve the efficacy of treatment for intractable facial pain. We aimed to identify potential electrophysiological biomarkers of pain in the ventral posteromedial nucleus (VPM) of the thalamus and periaqueductal gray (PAG) using a long-term sensing DBS system.

MATERIALS AND METHODS

We analyzed power spectra of ambulatory pain-related events from one patient implanted with a long-term sensing generator, representing different pain intensities (pain >7, pain >9) and pain qualities (no pain, burning, stabbing, and shocking pain). Power spectra were parametrized to separate oscillatory and aperiodic features and compared across the different pain states.

RESULTS

Overall, 96 events were marked during a 16-month follow-up. Parameterization of spectra revealed a total of 62 oscillatory peaks with most in the VPM (77.4%). The pain-free condition did not show any oscillations. In contrast, β peaks were observed in the VPM during all episodes (100%) associated with pain >9, 56% of episodes with pain >7, and 50% of burning pain events (center frequencies: 28.4 Hz, 17.8 Hz, and 20.7 Hz, respectively). Episodes of pain >9 indicated the highest relative β band power in the VPM and decreased aperiodic exponents (denoting the slope of the power spectra) in both the VPM and PAG.

CONCLUSIONS

For this patient, an increase in β band activity in the sensory thalamus was associated with severe facial pain, opening the possibility for closed-loop DBS in facial pain.

Biomarker discovery using machine learning in the psychosis spectrum

The past decade witnessed substantial discoveries related to the psychosis spectrum. Many of these discoveries resulted from pursuits of objective and quantifiable biomarkers in tandem with the application of analytical tools such as machine learning. These approaches provided exciting new insights that significantly helped improve precision in diagnosis, prognosis, and treatment. This article provides an overview of how machine learning has been employed in recent biomarker discovery research in the psychosis spectrum, which includes schizophrenia, schizoaffective disorders, bipolar disorder with psychosis, first episode psychosis, and clinical high risk for psychosis. It highlights both human and animal model studies and explores a varying range of the most impactful biomarkers including cognition, neuroimaging, electrophysiology, and digital markers. We specifically highlight new applications and opportunities for machine learning to impact noninvasive symptom monitoring, prediction of future diagnosis and treatment outcomes, integration of new methods with traditional clinical research and practice, and personalized medicine approaches.

Closed-loop systems for deep brain stimulation to treat neuropsychiatric disorders

INTRODUCTION

A closed-loop or feedback-control system is a process which considers the system's output in order to automatically adjust the input. Compared to a traditional open-loop system, a closed-loop system allows for a higher degree of accuracy with minimal human intervention. Novel methods of closed loop 'adaptive' deep brain stimulation DBS (aDBS) are being developed.

AREAS COVERED

This review focuses on the current state of aDBS for various neuropsychiatric conditions: common movement disorders such as Parkinson's disease, dystonia, essential tremor, and Tourette syndrome, as well as psychiatric disorders of depression and obsessive-compulsive disorder. Finally, the future directions of closed-loop neuromodulation treatments are also discussed.

EXPERT OPINION

Recently, aDBS has been shown to offer benefits compared to open-loop DBS. Understanding the biomarkers of pathological states across various disorders is, however, crucial to implementation of aDBS, and improved sensing-capable hardware and advances in machine learning are poised to allow its effective implementation.

Thalamocortical Hodology to Personalize Electrical Stimulation for Focal Epilepsy

Targeted electrical stimulation to specific thalamic regions offers a therapeutic approach for patients with refractory focal and generalized epilepsy who are not candidates for resective surgery. However, clinical outcome varies significantly, in particular for focal epilepsy, influenced by several factors, notably the precise anatomical and functional alignment between cortical regions generating epileptic discharges and the targeted thalamic stimulation sites. Here we hypothesized that targeting thalamic nuclei with precise anatomical and functional connections to epileptic cortical areas (an approach that we refer to as hodological matching) could enhance neuromodulatory effects on focal epileptic discharges. To investigate this, we examined three thalamic subnuclei (pulvinar nucleus, anterior nucleus, and ventral intermediate nucleus/ventral oral posterior nuclei) in a retrospective study involving 32 focal epilepsy patients. Specifically, we first identified hodologically organized thalamocortical fibers connecting these nuclei to individual seizure onset zones (SOZs), combining neuroimaging and electrophysiological techniques. Further, analysis of 216 spontaneous seizures revealed the critical role of matched thalamic nuclei in seizure development and termination. Importantly, electrical stimulation of hodologically-matched thalamic nuclei immediately suppressed intracortical interictal epileptiform discharges, contrasting with ineffective outcomes from stimulation of unmatched targets. Finally, we retrospectively evaluated 7 patients with a chronic hodologically-matched neurostimulation system, which led to a clinically relevant reduction in seizure frequency (median reduction 86.5%), that outstands the current clinical practice of unmatched targets (39%). Our results underscore the potential of hodological thalamic targeting to modulate epileptiform activity in specific cortical regions, highlighting the promise of precision medicine in thalamic neuromodulation for focal refractory epilepsy.

Deep brain stimulation of Hippocampus in Treatment-resistant Schizophrenia (DBS-HITS): protocol for a crossover randomized controlled trial

BACKGROUND

Ventral hippocampus (vHipp) in schizophrenia is in a state of hyperactivity and hypermetabolism, where the glutamate/gamma-aminobutyric acid (GABA) imbalance leads to downstream dopamine hyperactivity in the midbrain-limbic system. High-frequency deep brain stimulation (DBS) can disrupt the abnormal synchronization of functional circuits and modulate local brain networks.

METHODS

The DBS-HITS study is a crossover randomized controlled trial. DBS will be applied to bilateral vHipp in six patients. They will be randomly assigned to receive 3-month high-frequency active stimulation and then 3-month sham stimulation, or vice versa. After 6-month crossover trial phase, all participants will undergo personalized active stimulation. Researchers will assess clinical symptoms and neurocognition, collect EEG and PET-CT data during planned follow-ups. Adverse event will be researcher-assessed or participant self-reported throughout the trial.

DISCUSSION

To our knowledge, the DBS-HITS study is the first hippocampal DBS randomized controlled trial for schizophrenia. The goal of the DBS-HITS study is to assess the efficacy and safety of hippocampal DBS in treatment-resistant schizophrenia (TRS) and to investigate its impact on hippocampal activity and glutamate/GABA metabolism. The study is expected to deepen our understanding of the effects and side-effects of neuromodulation in TRS to facilitate individualized DBS treatment.

TRIAL REGISTRATION

NCT05694000 in ClinicalTrial.gov, registered on January 23, 2023.

Low-Frequency Deep Brain Stimulation in Non-Rapid Eye Movement Sleep Modifies Memory Retention in Parkinson's Disease

BACKGROUND AND OBJECTIVE

Memory impairment is a frequent and debilitating symptom in neurodegenerative disorders. The objective of this study was to provide proof-of-principle that deep brain stimulation during sleep can modify memory consolidation in people with Parkinson's disease depending on the stimulation frequency that is applied.

METHODS

Twenty-four patients with Parkinson's disease who were treated with deep brain stimulation of the subthalamic nucleus were included in this single-blind pilot study. Six patients had to be excluded because of insomnia on the night of testing. Patients were randomized (1:1 ratio) to receiving either low frequency deep brain stimulation (4 Hz) or clinically used high frequency deep brain stimulation (130 Hz) during early non-rapid eye movement (NREM) sleep. The main outcome measure was overnight memory retention as measured by a validated declarative memory task.

RESULTS

Patients receiving low frequency deep brain stimulation during early NREM sleep (n = 9, 4 females, mean age 61.1 ± 4.3 years) showed improved overnight memory retention (z = 2.549, P = 0.011). Patients receiving clinically used high frequency deep brain stimulation (n = 9, 2 females, mean age 62.2 ± 7.1) did not show any improvement (z = 1.023, P = 0.306) leading to a significant difference between groups (z = 2.214, P = 0.027). Stronger improvement in memory function was correlated with increased cortical low frequency activity after low frequency deep brain stimulation as measured by electroencephalography (ρ = 0.711, P = 0.037).

CONCLUSION

These results provide proof-of-principle that memory can be modulated by frequency-specific deep brain stimulation during sleep. © 2024 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

Mesoscale neuronal granular trial variability in vivo illustrated by nonlinear recurrent network in silico

Large-scale neural recording with single-neuron resolution has revealed the functional complexity of the neural systems. However, even under well-designed task conditions, the cortex-wide network exhibits highly dynamic trial variability, posing challenges to the conventional trial-averaged analysis. To study mesoscale trial variability, we conducted a comparative study between fluorescence imaging of layer-2/3 neurons in vivo and network simulation in silico. We imaged up to 40,000 cortical neurons' triggered responses by deep brain stimulus (DBS). And we build an in silico network to reproduce the biological phenomena we observed in vivo. We proved the existence of ineluctable trial variability and found it influenced by input amplitude and range. Moreover, we demonstrated that a spatially heterogeneous coding community accounts for more reliable inter-trial coding despite single-unit trial variability. A deeper understanding of trial variability from the perspective of a dynamical system may lead to uncovering intellectual abilities such as parallel coding and creativity.

Subthalamic control of impulsive actions: insights from deep brain stimulation in Parkinson's disease

Control of actions allows adaptive, goal-directed behaviour. The basal ganglia, including the subthalamic nucleus, are thought to play a central role in dynamically controlling actions through recurrent negative feedback loops with the cerebral cortex. Here, we summarize recent translational studies that used deep brain stimulation to record neural activity from and apply electrical stimulation to the subthalamic nucleus in people with Parkinson's disease. These studies have elucidated spatial, spectral and temporal features of the neural mechanisms underlying the controlled delay of actions in cortico-subthalamic networks and demonstrated their causal effects on behaviour in distinct processing windows. While these mechanisms have been conceptualized as control signals for suppressing impulsive response tendencies in conflict tasks and as decision threshold adjustments in value-based and perceptual decisions, we propose a common framework linking decision-making, cognition and movement. Within this framework, subthalamic deep brain stimulation can lead to suboptimal choices by reducing the time that patients take for deliberation before committing to an action. However, clinical studies have consistently shown that the occurrence of impulse control disorders is reduced, not increased, after subthalamic deep brain stimulation surgery. This apparent contradiction can be reconciled when recognizing the multifaceted nature of impulsivity, its underlying mechanisms and modulation by treatment. While subthalamic deep brain stimulation renders patients susceptible to making decisions without proper forethought, this can be disentangled from effects related to dopamine comprising sensitivity to benefits versus costs, reward delay aversion and learning from outcomes. Alterations in these dopamine-mediated mechanisms are thought to underlie the development of impulse control disorders and can be relatively spared with reduced dopaminergic medication after subthalamic deep brain stimulation. Together, results from studies using deep brain stimulation as an experimental tool have improved our understanding of action control in the human brain and have important implications for treatment of patients with neurological disorders.

Synaptic Plasticity in the Injured Brain Depends on the Temporal Pattern of Stimulation

Neurostimulation protocols are increasingly used as therapeutic interventions, including for brain injury. In addition to the direct activation of neurons, these stimulation protocols are also likely to have downstream effects on those neurons' synaptic outputs. It is well known that alterations in the strength of synaptic connections (long-term potentiation, LTP; long-term depression, LTD) are sensitive to the frequency of stimulation used for induction; however, little is known about the contribution of the temporal pattern of stimulation to the downstream synaptic plasticity that may be induced by neurostimulation in the injured brain. We explored interactions of the temporal pattern and frequency of neurostimulation in the normal cerebral cortex and after mild traumatic brain injury (mTBI), to inform therapies to strengthen or weaken neural circuits in injured brains, as well as to better understand the role of these factors in normal brain plasticity. Whole-cell (WC) patch-clamp recordings of evoked postsynaptic potentials in individual neurons, as well as field potential (FP) recordings, were made from layer 2/3 of visual cortex in response to stimulation of layer 4, in acute slices from control (naive), sham operated, and mTBI rats. We compared synaptic plasticity induced by different stimulation protocols, each consisting of a specific frequency (1 Hz, 10 Hz, or 100 Hz), continuity (continuous or discontinuous), and temporal pattern (perfectly regular, slightly irregular, or highly irregular). At the individual neuron level, dramatic differences in plasticity outcome occurred when the highly irregular stimulation protocol was used at 1 Hz or 10 Hz, producing an overall LTD in controls and shams, but a robust overall LTP after mTBI. Consistent with the individual neuron results, the plasticity outcomes for simultaneous FP recordings were similar, indicative of our results generalizing to a larger scale synaptic network than can be sampled by individual WC recordings alone. In addition to the differences in plasticity outcome between control (naive or sham) and injured brains, the dynamics of the changes in synaptic responses that developed during stimulation were predictive of the final plasticity outcome. Our results demonstrate that the temporal pattern of stimulation plays a role in the polarity and magnitude of synaptic plasticity induced in the cerebral cortex while highlighting differences between normal and injured brain responses. Moreover, these results may be useful for optimization of neurostimulation therapies to treat mTBI and other brain disorders, in addition to providing new insights into downstream plasticity signaling mechanisms in the normal brain.

Transcranial Focused Ultrasound: A History of Our Future

The history of focused ultrasound is a parallel history of neuroradiology, functional neurosurgery, and physics and engineering. Multiple pioneers collaborated as ultrasound transitioned from a wartime technology to a therapeutic one, particularly in using it to ablate the brain to treat movement disorders. Several competing technologies ensured that this "ultrasonic neurosurgery" remained in a lull. An algorithm and other advancements that obviated a craniectomy for ultrasonic neurosurgery allowed magnetic resonance-guided focused ultrasound to flourish to its modern phase.

The effects of deep brain stimulation on sleep: a systematic review and meta-analysis

Background

Deep brain stimulation (DBS) is a standard treatment for movement disorders, epilepsy, and others, yet its influence on postprocedural sleep quality remains an under-researched topic.

Study Objectives

We performed a systematic review and meta-analysis of all DBS effects on sleep.

Methods

The use of preferred reporting items for systematic reviews and meta-analyses guidelines (PRISMA) was utilized. We extracted demographic data, disease type/duration, DBS target, stimulation laterality (unilateral vs bilateral), follow-up lengths, and sleep pre/post-op measurements with polysomnography or across four standard sleep scales. The Cochrane methodology for evaluating RCTs was employed using the risk of bias assessments, data synthesis, and statistical methods, including forest plots (risk ratio; M-H random effects; 95% CI).

Results

Sixty-three studies were included in the overall analysis, representing 3022 patients. In a subgroup meta-analysis of subthalamic nucleus (STN) DBS for Parkinson's disease (PD), patients showed significant sleep improvement at three but not 12 months postoperatively with PDSS, at 12 but not 3 months with Epworth sleep scale, and at 6 months with nonmotor symptom scale. Pittsburgh sleep quality index (PSQI) showed no significant improvement in sleep at any time. Bilateral DBS showed significantly more improvement than unilateral DBS in the PSQI at 6 but not 3 months. Polysomnography showed significant sleep improvement at 1 week but not at 3 or 6 months. Most studies showed no significant sleep improvement for globus pallidus internus, centromedian thalamus, and ventral intermediate nucleus DBS.

Conclusions

STN-DBS for PD likely improves sleep; however, significant standardization in sleep scale outcome reporting and follow-up time is needed to effectively determine the target-dependent effects of DBS surgery on sleep.

Quantum Computing in the Realm of Neurosurgery

Quantum computing leverages the principles of quantum mechanics to provide unprecedented computational power by processing data in a fundamentally different way from classical binary computers. Quantum computers use "qubits" which superimpose 0 and 1. Because qubits can exist in multiple states at the same time, quantum computers can perform "quantum parallelism" wherein data are processed simultaneously rather than sequentially. The quantum parallelism is what enables the computer to have exponentially larger processing capabilities and consider all potential outcomes simultaneously to derive solutions. Our study aims to explore aspects of neurosurgery through which quantum computing could improve patient outcomes and enhance quality of care. Quantum computing has the potential for future applications in neuroprosthetics, neurostimulation, surgical precision, diagnosis, and patient privacy and security. It promises improved patient outcomes, enhanced surgical precision, and personalized healthcare delivery. With its inherent sensitivity and precision, quantum computing could advance the understanding of disease processes and development, providing neurosurgeons with deeper insight into patient pathologies. Challenges such as biocompatibility, cost, and ethical considerations remain significant barriers to integrating the technology into neurosurgical practice. Addressing these challenges will be crucial for realizing the transformative potential of quantum computing in advancing neurosurgical care and improving clinical outcomes.

Recent advances in neurotechnology-based biohybrid robots

Biohybrid robots retain the innate biological characteristics and behavioral traits of animals, making them valuable in applications such as disaster relief, exploration of unknown terrains, and medical care. This review aims to comprehensively discuss the evolution of biohybrid robots, their key technologies and applications, and the challenges they face. By analyzing studies conducted on terrestrial, aquatic, and aerial biohybrid robots, we gain a deeper understanding of how these technologies have made significant progress in simulating natural organisms, improving mechanical performance, and intelligent control. Additionally, we address challenges associated with the application of electrical stimulation technology, the precision of neural signal monitoring, and the ethical considerations for biohybrid robots. We highlight the importance of future research focusing on developing more sophisticated and biocompatible control methods while prioritizing animal welfare. We believe that exploring multimodal monitoring and stimulation technologies holds the potential to enhance the performance of biohybrid robots. These efforts are expected to pave the way for biohybrid robotics technology to introduce greater innovation and well-being to human society in the future.

Comparative Efficacy of Neuromodulatory Strategies for Drug-Resistant Epilepsy: A Systematic Review and Meta-Analysis

OBJECTIVE

The study aims to evaluate the efficacy of neuromodulatory strategies for people who have drug-resistant epilepsy (DRE).

METHODS

We searched electronic repositories, including PubMed, Web of Science, Embase, and the Cochrane Library, for randomized controlled trials, their ensuing open-label extension studies, and prospective studies focusing on surgical or neuromodulation interventions for people with DRE. We used seizure frequency reduction as the primary outcome. A single-arm meta-analysis synthesized data across all studies to assess treatment effectiveness at multiple time points. A network meta-analysis evaluated the efficacy of diverse therapies in randomized controlled trials. Grading of Recommendations, Assessment, Development, and Evaluations was applied to evaluate the overall quality of the evidence.

RESULTS

Twenty-eight studies representing 2936 individuals underwent 10 treatments were included. Based on the cumulative ranking in the network meta-analysis, the top 3 neuromodulatory options were deep brain stimulation (DBS) with 27% probability, responsive neurostimulation (RNS) with 22.91%, and transcranial direct current stimulation with 24.31%. In the single-arm meta-analysis, in the short-to-medium term, seizure control is more effective with RNS than with invasive vagus nerve stimulation (inVNS), which in turn is slightly more effective than DBS, though the differences are minimal. However, in the long term, inVNS appears to be less effective than both DBS and RNS. Trigeminal nerve stimulation, transcranial magnetic stimulation, and transcranial alternating current stimulation did not demonstrate significant seizure frequency reduction.

CONCLUSIONS

Regarding long-term efficacy, RNS and DBS outperformed inVNS. While transcranial direct current stimulation and transcutaneous auricular VNS showed promise for treating DRE, further studies are needed to confirm their long-term efficacy.

Bidirectional regulation of motor circuits using magnetogenetic gene therapy

Here, we report a magnetogenetic system, based on a single anti-ferritin nanobody-TRPV1 receptor fusion protein, which regulated neuronal activity when exposed to magnetic fields. Adeno-associated virus (AAV)-mediated delivery of a floxed nanobody-TRPV1 into the striatum of adenosine-2a receptor-Cre drivers resulted in motor freezing when placed in a magnetic resonance imaging machine or adjacent to a transcranial magnetic stimulation device. Functional imaging and fiber photometry confirmed activation in response to magnetic fields. Expression of the same construct in the striatum of wild-type mice along with a second injection of an AAVretro expressing Cre into the globus pallidus led to similar circuit specificity and motor responses. Last, a mutation was generated to gate chloride and inhibit neuronal activity. Expression of this variant in the subthalamic nucleus in PitX2-Cre parkinsonian mice resulted in reduced c-fos expression and motor rotational behavior. These data demonstrate that magnetogenetic constructs can bidirectionally regulate activity of specific neuronal circuits noninvasively in vivo using clinically available devices.

Large-Scale Mechanistic Models of Brain Circuits with Biophysically and Morphologically Detailed Neurons

Understanding the brain requires studying its multiscale interactions from molecules to networks. The increasing availability of large-scale datasets detailing brain circuit composition, connectivity, and activity is transforming neuroscience. However, integrating and interpreting this data remains challenging. Concurrently, advances in supercomputing and sophisticated modeling tools now enable the development of highly detailed, large-scale biophysical circuit models. These mechanistic multiscale models offer a method to systematically integrate experimental data, facilitating investigations into brain structure, function, and disease. This review, based on a Society for Neuroscience 2024 MiniSymposium, aims to disseminate recent advances in large-scale mechanistic modeling to the broader community. It highlights (1) examples of current models for various brain regions developed through experimental data integration; (2) their predictive capabilities regarding cellular and circuit mechanisms underlying experimental recordings (e.g., membrane voltage, spikes, local-field potential, electroencephalography/magnetoencephalography) and brain function; and (3) their use in simulating biomarkers for brain diseases like epilepsy, depression, schizophrenia, and Parkinson's, aiding in understanding their biophysical underpinnings and developing novel treatments. The review showcases state-of-the-art models covering hippocampus, somatosensory, visual, motor, auditory cortical, and thalamic circuits across species. These models predict neural activity at multiple scales and provide insights into the biophysical mechanisms underlying sensation, motor behavior, brain signals, neural coding, disease, pharmacological interventions, and neural stimulation. Collaboration with experimental neuroscientists and clinicians is essential for the development and validation of these models, particularly as datasets grow. Hence, this review aims to foster interest in detailed brain circuit models, leading to cross-disciplinary collaborations that accelerate brain research.

Neural interfaces: Bridging the brain to the world beyond healthcare

Neural interfaces, emerging at the intersection of neurotechnology and urban planning, promise to transform how we interact with our surroundings and communicate. By recording and decoding neural signals, these interfaces facilitate direct connections between the brain and external devices, enabling seamless information exchange and shared experiences. Nevertheless, their development is challenged by complexities in materials science, electrochemistry, and algorithmic design. Electrophysiological crosstalk and the mismatch between electrode rigidity and tissue flexibility further complicate signal fidelity and biocompatibility. Recent closed-loop brain-computer interfaces, while promising for mood regulation and cognitive enhancement, are limited by decoding accuracy and the adaptability of user interfaces. This perspective outlines these challenges and discusses the progress in neural interfaces, contrasting non-invasive and invasive approaches, and explores the dynamics between stimulation and direct interfacing. Emphasis is placed on applications beyond healthcare, highlighting the need for implantable interfaces with high-resolution recording and stimulation capabilities.

Role of Neurosurgical Interventions in the Treatment of Movement Disorders Like Parkinson's Disease, Dystonia, and Tourette Syndrome

This article provides an overview of neurosurgical therapies for movement disorders (MDs), including Tourette syndrome, dystonia, Parkinson's disease (PD), and others. It focuses on the benefits of these treatments and suggests directions for further research. A total of 10 years' worth of English-language PubMed articles were combed through, with an emphasis on studies conducted in North America. To manage MDs like Parkinson's disease and Tourette syndrome, the results suggest that non-invasive neuromodulation techniques, closed-loop deep brain stimulation (DBS), and other advanced therapies may become the treatment of choice in the future. Research on dystonia is being focused on improving treatment methods by investigating new areas of the brain that might be stimulated through neurosurgery and looking at gene therapy. Modern technological developments, such as non-invasive neuromodulation procedures and improved imaging, provide promising substitutes for traditional surgical approaches. This study highlights the need for continuous clinical trials for better outcomes, which is why research and development in this area must continue.

Potentiation of cortico-spinal output via targeted electrical stimulation of the motor thalamus

Cerebral white matter lesions prevent cortico-spinal descending inputs from effectively activating spinal motoneurons, leading to loss of motor control. However, in most cases, the damage to cortico-spinal axons is incomplete offering a potential target for therapies aimed at improving volitional muscle activation. Here we hypothesize that, by engaging direct excitatory connections to cortico-spinal motoneurons, stimulation of the motor thalamus could facilitate activation of surviving cortico-spinal fibers thereby immediately potentiating motor output. To test this hypothesis, we identify optimal thalamic targets and stimulation parameters that enhance upper-limb motor-evoked potentials and grip forces in anesthetized monkeys. This potentiation persists after white matter lesions. We replicate these results in humans during intra-operative testing. We then design a stimulation protocol that immediately improves strength and force control in a patient with a chronic white matter lesion. Our results show that electrical stimulation targeting surviving neural pathways can improve motor control after white matter lesions.

The expanding horizon of neurotechnology: Is multimodal neuromodulation the future?

The clinical applications of neurotechnology are rapidly expanding, and the combination of different approaches could be more effective and precise to treat brain disorders. This Perspective discusses the potential and challenges of "multimodal neuromodulation," which combines modalities such as electrical, magnetic, and ultrasound stimulation.

Current and future applications of local field potential-guided programming for Parkinson's disease with the Percept™ rechargeable neurostimulator

Deep brain stimulation (DBS) has been established as an effective neuromodulatory treatment for Parkinson's disease (PD) with motor complications or refractory tremor. Various DBS devices with unique technology platforms are commercially available and deliver continuous, open-loop stimulation. The Percept™ family of neurostimulators use BrainSense™ technology with five key features to sense local field potentials while stimulating, enabling integration of physiologic data into the routine practice of DBS programming. The newly approved Percept™ rechargeable RC implantable pulse generator offers a smaller, thinner design and reduced recharge time with prolonged recharge interval. In this review, we describe the application of local field potential sensing-based programming in PD and highlight the potential future clinical implementation of closed-loop stimulation using the Percept™ RC implantable pulse generator.

Real-world outcomes of Deep Brain Stimulation for dystonia treatment: Protocol for a prospective, multicenter, international registry

INTRODUCTION

Deep Brain Stimulation (DBS) is an established therapeutic approach for the treatment of dystonia. However, to date, no large-scale or comprehensive DBS dystonia patient registry has been yet undertaken. Here, we describe the protocol for a world-wide registry of clinical outcomes in dystonia patients implanted with DBS.

METHODS AND ANALYSIS

This protocol describes a multicenter, international clinical outcomes registry consisting of up to 200 prospectively enrolled participants at up to 40 different sites to be implanted with a constant-current, multiple independent current controlled (MICC) DBS device (Vercise DBS Systems, Boston Scientific) for treatment of dystonia. Key inclusion criteria for registry candidates include the following: understanding of study requirements and treatment procedures, a signed written informed consent form prior to participation, and meeting all criteria established in the locally applicable Instructions for Use (IFU) for the implanted DBS system. Key clinical endpoints include (but are not limited to) the evaluation of disease state (Burke-Fahn-Marsden Dystonia Rating Scale [BFMDRS], Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS), quality of life (Short Form Health Survey-36, Short Form Health Survey-10), and treatment satisfaction (Clinical Global Impression of Change [CGI-Clinician; CGI-Subject; CGI-Caregiver]) at 6-months, 12-months, 2-years, and 3-years post-lead placement. Adverse events are documented and reported using structured questionnaires.

PERSPECTIVES

Treatment of patients with dystonia using DBS has progressed considering recent technological advances. This international dystonia outcomes registry aims to collect and evaluate real-world clinical data derived from patients who have been implanted with a constant-current, MICC-equipped DBS system (with available directional capabilities), per standard of care.

Targeted deep brain stimulation of the motor thalamus improves speech and swallowing motor functions after cerebral lesions

Speech and swallowing are complex motor acts that depend upon the integrity of input neural signals from motor cortical areas to control muscles of the head and neck. Lesions damaging these neural pathways result in weakness of key muscles causing dysarthria and dysphagia, leading to profound social isolation and risk of aspiration and suffocation. Here we show that Deep Brain Stimulation (DBS) of the motor thalamus improved speech and swallowing functions in two participants with dysarthria and dysphagia. First, we proved that DBS increased excitation of the face motor cortex, augmenting motor evoked potentials, and range and speed of motion of orofacial articulators in n = 10 volunteers with intact neural pathways. Then, we demonstrated that this potentiation led to immediate improvement in swallowing functions in a patient with moderate dysphagia and profound dysarthria as a consequence of a traumatic brain lesion. In this subject and in another with mild dysarthria, we showed that DBS immediately ameliorated impairments of respiratory, phonatory, resonatory, and articulatory control thus resulting in a clinically significant improvement in speech intelligibility. Our data provide first-in-human evidence that DBS can be used to treat dysphagia and dysarthria in people with cerebral lesions.

Negative pressure wound therapy for the management of deep brain stimulation-related surgical site infections: A retrospective case series

The management of deep brain stimulation (DBS)-related surgical site infection (SSI) is challenging. This article aimed to report the efficacy of negative pressure wound therapy (NPWT) in treating DBS-related SSI while preserving all DBS devices. As a retrospective case series in a single center, localized DBS-related SSI was treated with complete debridement and NPWT, with preserving all DBS devices. Successful infection control was defined as no clinical or microbiological evidence of recurrent infection 3 months after NPWT. Five patients (three females, two males, median age: 64 years) received NPWT for their DBS-related SSI. The infection was located in the chest, parietal, and retroauricular areas. Only one patient had the extension wires removed due to the heavy contamination, while no DBS devices were removed in the other patients. All patients showed successful infection control without any remarkable side effects 3 months after debridement and NPWT. These findings suggest that NPWT may effectively promote wound healing with a high probability of preserving all DBS devices in DBS-related SSI.

Mental integrity, autonomy, and fundamental interests

Many technology ethicists hold that the time has come to articulate neurorights: our normative claims vis-à-vis our brains and minds. One such claim is the right to mental integrity ('MI'). I begin by considering some paradigmatic threats to MI (§1) and how the dominant autonomy-based conception ('ABC') of MI attempts to make sense of them (§2). I next consider the objection that the ABC is overbroad in its understanding of what threatens MI and suggest a friendly revision to the ABC that addresses the objection (§3). I then consider a second objection: that the ABC cannot make sense of the MI of the non-autonomous This objection appears fatal even to the revised ABC (§4). On that basis, I develop an alternative conception on which MI is grounded in a plurality of simpler capacities, namely, those for affect, cognition, and volition Each of these more basic capacities grounds a set of fundamental interests, and they are for that reason worthy of protection even when they do not rise to the level of complexity necessary for autonomy (§5). This yields a fully general theory of MI that accounts for its manifestations in both the autonomous and the non-autonomous.

Injectable conductive hydrogel electrodes for minimally invasive neural interfaces

Soft bioelectronic neural interfaces have great potential as mechanically favourable alternatives to implantable metal electrodes. In this pursuit, conductive hydrogels (CHs) are particularly viable, combining tissue compliance with the required electrochemical characteristics. Physically-aggregated CHs offer an additional advantage by their facile synthesis into injectable systems, enabling minimally invasive implantation, though they can be impeded by a lack of control over their particle size and packing. Guided by these principles, an injectable PEDOT:PSS/acetic acid-based hydrogel is presented herein whose mechanical and electrochemical properties are independently tuneable by modifying the relative acetic acid composition. The fabrication process further benefits from employing batch emulsion to decrease particle sizes and facilitate tighter packing. The resulting material is stable and anatomically compact upon injection both in tissue phantom and ex vivo, while retaining favourable electrochemical properties in both contexts. Biphasic current stimulation yielding voltage transients well below the charge injection limit as well as the gel's non-cytotoxicity further underscore its potential for safe and effective neural interfacing applications.

Memory Reconsolidation Updating in Substance Addiction: Applications, Mechanisms, and Future Prospects for Clinical Therapeutics

Persistent and maladaptive drug-related memories represent a key component in drug addiction. Converging evidence from both preclinical and clinical studies has demonstrated the potential efficacy of the memory reconsolidation updating procedure (MRUP), a non-pharmacological strategy intertwining two distinct memory processes: reconsolidation and extinction-alternatively termed "the memory retrieval-extinction procedure". This procedure presents a promising approach to attenuate, if not erase, entrenched drug memories and prevent relapse. The present review delineates the applications, molecular underpinnings, and operational boundaries of MRUP in the context of various forms of substance dependence. Furthermore, we critically examine the methodological limitations of MRUP, postulating potential refinement to optimize its therapeutic efficacy. In addition, we also look at the potential integration of MRUP and neurostimulation treatments in the domain of substance addiction. Overall, existing studies underscore the significant potential of MRUP, suggesting that interventions predicated on it could herald a promising avenue to enhance clinical outcomes in substance addiction therapy.

Non-invasive temporal interference brain stimulation reduces preference on morphine-induced conditioned place preference in rats

Long-term use of opioid drugs such as morphine can induce addiction in the central nervous system through dysregulation of the reward system of the brain. Deep brain stimulation (DBS) is a non-pharmacological technique capable of attenuating behavioral responses associated with opioid drug consumption and possesses the capability to selectively activate and target localized brain regions with a high spatial resolution. However, long-term implantation of electrodes in brain tissue may limit the effectiveness of DBS due to changes in impedance, position, and shape of the tip of the stimulation electrode and the risk of infection of nerve tissue around the implanted electrode. The main objective of the current study is to evaluate the effect of temporal interference (TI) brain stimulation on addictive behaviors of morphine-induced conditioned place preference (CPP) in rats. TI stimulation is a non-invasive technique used transcranially to modulate neural activity within targeted brain regions. It involves applying two high-frequency currents with slightly different frequencies, resulting in interference and targeted stimulation of different brain areas with the desired spatial resolution. The results indicated that TI stimulation with the amplitude ofI 1 = I 2 = 0.5 mA, carrier frequency of 2 kHz, frequency difference of 25 Hz, ON-OFF stimulation frequency of 0.25 Hz, and total duration of 10 min in three consecutive days resulted in a significant reduction of morphine preference in the morphine-stimulation group in comparison with the morphine group (p < 0.001). These findings highlight the potential of TI stimulation as a modulatory intervention in mitigating the addictive properties of morphine and provide valuable insights into the therapeutic implications of this stimulation paradigm for treatment of opioid drugs in human subjects.

Enhancement of Hybrid BCI System Performance Based on Motor Imagery and SSVEP by Transcranial Alternating Current Stimulation

The hybrid brain-computer interface (BCI) is verified to reduce disadvantages of conventional BCI systems. Transcranial electrical stimulation (tES) can also improve the performance and applicability of BCI. However, enhancement in BCI performance attained solely from the perspective of users or solely from the angle of BCI system design is limited. In this study, a hybrid BCI system combining MI and SSVEP was proposed. Furthermore, transcranial alternating current stimulation (tACS) was utilized to enhance the performance of the proposed hybrid BCI system. The stimulation interface presented a depiction of grabbing a ball with both of hands, with left-hand and right-hand flickering at frequencies of 34 Hz and 35 Hz. Subjects watched the interface and imagined grabbing a ball with either left hand or right hand to perform SSVEP and MI task. The MI and SSVEP signals were processed separately using filter bank common spatial patterns (FBCSP) and filter bank canonical correlation analysis (FBCCA) algorithms, respectively. A fusion method was proposed to fuse the features extracted from MI and SSVEP. Twenty healthy subjects took part in the online experiment and underwent tACS sequentially. The fusion accuracy post-tACS reached 90.25% ± 11.40%, which was significantly different from pre-tACS. The fusion accuracy also surpassed MI accuracy and SSVEP accuracy respectively. These results indicated the superior performance of the hybrid BCI system and tACS would improve the performance of the hybrid BCI system.

Acoustic deep brain modulation: Enhancing neuronal activation and neurogenesis

BACKGROUND

Non-invasive deep brain modulation (DBM) stands as a promising therapeutic avenue to treat brain diseases. Acoustic DBM represents an innovative and targeted approach to modulate the deep brain, employing techniques such as focused ultrasound and shock waves. Despite its potential, the optimal mechanistic parameters, the effect in the brain and behavioral outcomes of acoustic DBM remains poorly understood.

OBJECTIVE

To establish a robust protocol for the shock wave DBM by optimizing its mechanistic profile of external stimulation, and to assess its efficacy in preclinical settings.

METHODS

We used shockwaves due to their capacity to leverage a broader spectrum of peak intensity (10-127 W/mm2) in contrast to ultrasound (0.1-5.0 W/mm2), thereby enabling a more extensive range of neuromodulation effects. We established various types of shockwave pressure profiles of DBM and compared neural and behavioral responses. To ascertain the anticipated cause of the heightened neural activity response, numerical analysis was employed to examine the mechanical dynamics within the brain.

RESULTS

An optimized profile led to an enhancement in neuronal activity within the hypothalamus of mouse models. The optimized profile in the hippocampus elicited a marked increase in neurogenesis without neuronal damage. Behavioral analyses uncovered a noteworthy reduction in locomotion without significant effects on spatial memory function.

CONCLUSIONS

The present study provides an optimized shock wave stimulation protocol for non-invasive DBM. Our optimized stimulation profile selectively triggers neural functions in the deep brain. Our protocol paves the way for new non-invasive DBM devices to treat brain diseases.

Historical Perspective of the Cardiac Autonomic Nervous System

The contemporary history of the cardiac autonomic nervous system includes early descriptions of neuroanatomy in the 19th century, followed by an understanding of the physiologic determinants of neurocardiology in the 20th century. Neurology and cardiology preceded the arrival of clinical cardiac electrophysiology, a specialized field in medicine devoted to the diagnosis and treatment of cardiac arrhythmias. The rapid growth in pharmacology, ablation, pacing and defibrillation, associated with significant technological breakthroughs, have resulted in new opportunities for neuromodulation in the 21st century. Small changes in autonomic tone can potentially provide important therapeutic benefits for patients with cardiac and arrhythmia disorders.

The role of neuromodulation in the management of drug-resistant epilepsy

Drug-resistant epilepsy (DRE) poses significant challenges in terms of effective management and seizure control. Neuromodulation techniques have emerged as promising solutions for individuals who are unresponsive to pharmacological treatments, especially for those who are not good surgical candidates for surgical resection or laser interstitial therapy (LiTT). Currently, there are three neuromodulation techniques that are FDA-approved for the management of DRE. These include vagus nerve stimulation (VNS), deep brain stimulation (DBS), and responsive neurostimulation (RNS). Device selection, optimal time, and DBS and RNS target selection can also be challenging. In general, the number and localizability of the epileptic foci, alongside the comorbidities manifested by the patients, substantially influence the selection process. In the past, the general axiom was that DBS and VNS can be used for generalized and localized focal seizures, while RNS is typically reserved for patients with one or two highly localized epileptic foci, especially if they are in eloquent areas of the brain. Nowadays, with the advance in our understanding of thalamic involvement in DRE, RNS is also very effective for general non-focal epilepsy. In this review, we will discuss the underlying mechanisms of action, patient selection criteria, and the evidence supporting the use of each technique. Additionally, we explore emerging technologies and novel approaches in neuromodulation, such as closed-loop systems. Moreover, we examine the challenges and limitations associated with neuromodulation therapies, including adverse effects, complications, and the need for further long-term studies. This comprehensive review aims to provide valuable insights on present and future use of neuromodulation.

Nonlinear analysis of neuronal firing modulated by sinusoidal stimulation at axons in rat hippocampus

Introduction

Electrical stimulation of the brain has shown promising prospects in treating various brain diseases. Although biphasic pulse stimulation remains the predominant clinical approach, there has been increasing interest in exploring alternative stimulation waveforms, such as sinusoidal stimulation, to improve the effectiveness of brain stimulation and to expand its application to a wider range of brain disorders. Despite this growing attention, the effects of sinusoidal stimulation on neurons, especially on their nonlinear firing characteristics, remains unclear.

Methods

To address the question, 50 Hz sinusoidal stimulation was applied on Schaffer collaterals of the rat hippocampal CA1 region in vivo. Single unit activity of both pyramidal cells and interneurons in the downstream CA1 region was recorded and analyzed. Two fractal indexes, namely the Fano factor and Hurst exponent, were used to evaluate changes in the long-range correlations, a manifestation of nonlinear dynamics, in spike sequences of neuronal firing.

Results

The results demonstrate that sinusoidal electrical stimulation increased the firing rates of both pyramidal cells and interneurons, as well as altered their firing to stimulation-related patterns. Importantly, the sinusoidal stimulation increased, rather than decreased the scaling exponents of both Fano factor and Hurst exponent, indicating an increase in the long-range correlations of both pyramidal cells and interneurons.

Discussion

The results firstly reported that periodic sinusoidal stimulation without long-range correlations can increase the long-range correlations of neurons in the downstream post-synaptic area. These results provide new nonlinear mechanisms of brain sinusoidal stimulation and facilitate the development of new stimulation modes.

Research on Tremor Suppression Strategies Under a Constant Current Peripheral Electrical Stimulation Device for Parkinson's Disease

Tremor, a prevalent symptom in Parkinson's patients, is conventionally treated with medications and craniotomy. However, the associated side effects and high surgical costs pose challenges for some individuals. In this study, a lightweight constant current electrical stimulator was developed, which is driven by the FPGA to control the underlying logic and has multiple programmable stimulation parameters. Clinical experiments involving patients with Parkinson's-related resting tremor symptoms were conducted to assess the efficacy of peripheral electrical stimulation. Two Co-contraction Avoidance Stimulation (CAS) strategies targeting nerves and muscles were proposed to reduce tremors. Four Parkinson's disease (PD) patients were recruited to verify the effectiveness of these strategies. Kinematic data recorded by inertial sensors showed that the radial nerve and muscle intervention strategies reduced the average angular velocity amplitude of finger joints during resting tremor by 75.92% and 82.41%, respectively. Notably, under low-frequency pulse stimulation (100 Hz) focused on muscle interference, a low-intensity current of no more than 8 mA maintained a tremor suppression rate of 59.91% even 5 minutes post-stimulation. Based on the experimental results, it is concluded that the constant current electrical stimulator developed in this study can effectively suppress tremor under specific stimulation strategies. These findings have significant implications for the development of lightweight, wearable tremor suppression devices. The stimulator's adaptability, coupled with its precise control parameters, demonstrates promise for advancing non-invasive and cost-effective tremor management in Parkinson's patients.

Soft, Multifunctional MXene-Coated Fiber Microelectrodes for Biointerfacing

Flexible fiber-based microelectrodes allow safe and chronic investigation and modulation of electrically active cells and tissues. Compared to planar electrodes, they enhance targeting precision while minimizing side effects from the device-tissue mechanical mismatch. However, the current manufacturing methods face scalability, reproducibility, and handling challenges, hindering large-scale deployment. Furthermore, only a few designs can record electrical and biochemical signals necessary for understanding and interacting with complex biological systems. In this study, we present a method that utilizes the electrical conductivity and easy processability of MXenes, a diverse family of two-dimensional nanomaterials, to apply a thin layer of MXene coating continuously to commercial nylon filaments (30-300 μm in diameter) at a rapid speed (up to 15 mm/s), achieving a linear resistance below 10 Ω/cm. The MXene-coated filaments are then batch-processed into free-standing fiber microelectrodes with excellent flexibility, durability, and consistent performance even when knotted. We demonstrate the electrochemical properties of these fiber electrodes and their hydrogen peroxide (H2O2) sensing capability and showcase their applications in vivo (rodent) and ex vivo (bladder tissue). This scalable process fabricates high-performance microfiber electrodes that can be easily customized and deployed in diverse bioelectronic monitoring and stimulation studies, contributing to a deeper understanding of health and disease.