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Polosan M, Figee M. Electrical deep neuromodulation in psychiatry. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2021; 159:89-110. [PMID: 34446252 DOI: 10.1016/bs.irn.2021.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Addressing treatment refractoriness in psychiatric diseases is an essential public health objective. The last two decades have seen an increasing interest for deep brain stimulation (DBS) of several brain targets. In this chapter, we have reviewed the main DBS clinical trials in psychiatric diseases, mainly obsessive compulsive disorders (OCD) and depression, but also emerging research in other psychiatric disorders. While its efficacy and safety are confirmed, DBS is still not considered as standard therapy in psychiatry. However, advances in neuroimaging research combined to behavioral and electrophysiological data uniquely provided by DBS studies improve knowledge on physiopathology in these brain diseases. This will help define the optimal brain targets according to specific phenotype dimensions. Revealing the mechanisms of action and effects of DBS will support that its impact goes beyond a loco-regional brain stimulation and confirms that electrical neuromodulation influences brain networks. Added to the progress in neuromodulation technology, these insights will hopefully facilitate a more widespread application of this promising treatment. Future development of a personalized multimodal assessment of underlying dysfunctional brain networks will open new circuit-specific treatment perspectives that may facilitate better patient outcomes.
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Affiliation(s)
- Mircea Polosan
- Univ. Grenoble Alpes, Inserm, U1216, CHU Grenoble Alpes, Grenoble Institut Neurosciences, Grenoble, France.
| | - Martijn Figee
- Center for Advanced Circuit Therapeutics, Mount Sinai West, Icahn School of Medicine at Mount Sinai, New York, United States
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Arumugham SS, Srinivas D, Narayanaswamy JC, Jaisoorya TS, Kashyap H, Domenech P, Palfi S, Mallet L, Venkatasubramanian G, Reddy YJ. Identification of biomarkers that predict response to subthalamic nucleus deep brain stimulation in resistant obsessive-compulsive disorder: protocol for an open-label follow-up study. BMJ Open 2021; 11:e047492. [PMID: 34158304 PMCID: PMC8220486 DOI: 10.1136/bmjopen-2020-047492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 05/26/2021] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Deep brain stimulation (DBS) of bilateral anteromedial subthalamic nucleus (amSTN) has been found to be helpful in a subset of patients with severe, chronic and treatment-refractory obsessive-compulsive disorder (OCD). Biomarkers may aid in patient selection and optimisation of this invasive treatment. In this trial, we intend to evaluate neurocognitive function related to STN and related biosignatures as potential biomarkers for STN DBS in OCD. METHODS AND ANALYSIS Twenty-four subjects with treatment-refractory OCD will undergo open-label STN DBS. Structural/functional imaging, electrophysiological recording and neurocognitive assessment would be performed at baseline. The subjects would undergo a structured clinical assessment for 12 months postsurgery. A group of 24 healthy volunteers and 24 subjects with treatment-refractory OCD who receive treatment as usual would be recruited for comparison of biomarkers and treatment response, respectively. Baseline biomarkers would be evaluated as predictors of clinical response. Neuroadaptive changes would be studied through a reassessment of neurocognitive functioning, imaging and electrophysiological activity post DBS. ETHICS AND DISSEMINATION The protocol has been approved by the National Institute of Mental Health and Neurosciences Ethics Committee. The study findings will be disseminated through peer-reviewed scientific journals and scientific meetings.
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Affiliation(s)
- Shyam Sundar Arumugham
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Dwarakanath Srinivas
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Janardhanan C Narayanaswamy
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - T S Jaisoorya
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Himani Kashyap
- Department of Clinical Psychology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Philippe Domenech
- Univ Paris-Est Créteil, DMU CARE - Département Médical-Universitaire de Chirurgie et Anesthésie réanimation, DMU IMPACT, Département Médical-Universitaire de Psychiatrie et d'Addictologie, Hôpitaux Universitaires Henri Mondor, Creteil, France
- Univ of Paris 12 UPEC, Faculté de médecine, INSERM U955, Creteil, France
| | - Stéphane Palfi
- Univ Paris-Est Créteil, DMU CARE - Département Médical-Universitaire de Chirurgie et Anesthésie réanimation, DMU IMPACT, Département Médical-Universitaire de Psychiatrie et d'Addictologie, Hôpitaux Universitaires Henri Mondor, Creteil, France
- Univ of Paris 12 UPEC, Faculté de médecine, INSERM U955, Creteil, France
| | - Luc Mallet
- Institut du Cerveau, ICM, Inserm U 1127, CNRS UMR 7225, Sorbonne Université, Paris, France
- Department of Mental Health and Psychiatry, University of Geneva, Geneva, Switzerland
| | - Ganesan Venkatasubramanian
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Yc Janardhan Reddy
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
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Lee TY, Jung WH, Kwak YB, Yoon YB, Lee J, Kim M, Kim E, Kwon JS. Distinct neural networks associated with obsession and delusion: a connectome-wide association study. Psychol Med 2021; 51:1320-1328. [PMID: 31997729 DOI: 10.1017/s0033291720000057] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Obsession and delusion are theoretically distinct from each other in terms of reality testing. Despite such phenomenological distinction, no extant studies have examined the identification of common and distinct neural correlates of obsession and delusion by employing biologically grounded methods. Here, we investigated dimensional effects of obsession and delusion spanning across the traditional diagnostic boundaries reflected upon the resting-state functional connectivity (RSFC) using connectome-wide association studies (CWAS). METHODS Our study sample comprised of 96 patients with obsessive-compulsive disorder, 75 patients with schizophrenia, and 65 healthy controls. A connectome-wide analysis was conducted to examine the relationship between obsession and delusion severity and RFSC using multivariate distance-based matrix regression. RESULTS Obsession was associated with the supplementary motor area, precentral gyrus, and superior parietal lobule, while delusion was associated with the precuneus. Follow-up seed-based RSFC and modularity analyses revealed that obsession was related to aberrant inter-network connectivity strength. Additional inter-network analyses demonstrated the association between obsession severity and inter-network connectivity between the frontoparietal control network and the dorsal attention network. CONCLUSIONS Our CWAS study based on the Research Domain Criteria (RDoC) provides novel evidence for the circuit-level functional dysconnectivity associated with obsession and delusion severity across diagnostic boundaries. Further refinement and accumulation of biomarkers from studies embedded within the RDoC framework would provide useful information in treating individuals who have some obsession or delusion symptoms but cannot be identified by the category of clinical symptoms alone.
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Affiliation(s)
- Tae Young Lee
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Wi Hoon Jung
- Department of Psychology, Daegu University, Gyeongsan, Republic of Korea
| | - Yoo Bin Kwak
- Department of Brain and Cognitive Science, Seoul National University College of Natural Science, Seoul, Republic of Korea
| | - Youngwoo B Yoon
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, USA
| | - Junhee Lee
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Minah Kim
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Euitae Kim
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jun Soo Kwon
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Brain and Cognitive Science, Seoul National University College of Natural Science, Seoul, Republic of Korea
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Lopez-Sosa F, Reneses B, Sanmartino F, Galarza-Vallejo A, Garcia-Albea J, Cruz-Gomez AJ, Yebra M, Oliviero A, Barcia JA, Strange BA, Gonzalez-Rosa JJ. Nucleus Accumbens Stimulation Modulates Inhibitory Control by Right Prefrontal Cortex Activation in Obsessive-Compulsive Disorder. Cereb Cortex 2021; 31:2742-2758. [PMID: 33406245 DOI: 10.1093/cercor/bhaa397] [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: 08/20/2020] [Revised: 12/03/2020] [Accepted: 12/11/2020] [Indexed: 11/14/2022] Open
Abstract
Inhibitory control is considered a compromised cognitive function in obsessive-compulsive (OCD) patients and likely linked to corticostriatal circuitry disturbances. Here, 9 refractory OCD patients treated with deep brain stimulation (DBS) were evaluated to address the dynamic modulations of large-scale cortical network activity involved in inhibitory control after nucleus accumbens (NAc) stimulation and their relationship with cortical thickness. A comparison of DBS "On/Off" states showed that patients committed fewer errors and exhibited increased intraindividual reaction time variability, resulting in improved goal maintenance abilities and proactive inhibitory control. Visual P3 event-related potentials showed increased amplitudes during Go/NoGo performance. Go and NoGo responses increased cortical activation mainly over the right inferior frontal gyrus and medial frontal gyrus, respectively. Moreover, increased cortical activation in these areas was equally associated with a higher cortical thickness within the prefrontal cortex. These results highlight the critical role of NAc DBS for preferentially modulating the neuronal activity underlying sustained speed responses and inhibitory control in OCD patients and show that it is triggered by reorganizing brain functions to the right prefrontal regions, which may depend on the underlying cortical thinning. Our findings provide updated structural and functional evidence that supports critical dopaminergic-mediated frontal-striatal network interactions in OCD.
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Affiliation(s)
- Fernando Lopez-Sosa
- Psychophysiology and Neuroimaging Group, Institute of Biomedical Research Cadiz (INiBICA), 11009 Cádiz, Spain.,Laboratory for Clinical Neuroscience, Centre for Biomedical Technology (CTB), Technical University of Madrid (UPM), 28040 Madrid, Spain
| | - Blanca Reneses
- Department of Psychiatry, Health Research Institute of Hospital Clinico San Carlos (IdISSC), Complutense University of Madrid (UCM), 28040 Madrid, Spain
| | | | - Ana Galarza-Vallejo
- Laboratory for Clinical Neuroscience, Centre for Biomedical Technology (CTB), Technical University of Madrid (UPM), 28040 Madrid, Spain
| | - Julia Garcia-Albea
- Department of Psychiatry, Health Research Institute of Hospital Clinico San Carlos (IdISSC), Complutense University of Madrid (UCM), 28040 Madrid, Spain
| | - Alvaro J Cruz-Gomez
- Psychophysiology and Neuroimaging Group, Institute of Biomedical Research Cadiz (INiBICA), 11009 Cádiz, Spain
| | - Mar Yebra
- Laboratory for Clinical Neuroscience, Centre for Biomedical Technology (CTB), Technical University of Madrid (UPM), 28040 Madrid, Spain.,Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Antonio Oliviero
- FENNSI Group, Hospital Nacional de Parapléjicos, SESCAM, 45004 Toledo, Spain
| | - Juan A Barcia
- Department of Neurosurgery, Health Research Institute of Hospital Clinico San Carlos (IdISSC), Complutense University of Madrid (UCM), 28040 Madrid, Spain
| | - Bryan A Strange
- Laboratory for Clinical Neuroscience, Centre for Biomedical Technology (CTB), Technical University of Madrid (UPM), 28040 Madrid, Spain.,Department of Neuroimaging, Alzheimer's Disease Research Centre, Reina Sofia-CIEN Foundation, 28013 Madrid, Spain
| | - Javier J Gonzalez-Rosa
- Psychophysiology and Neuroimaging Group, Institute of Biomedical Research Cadiz (INiBICA), 11009 Cádiz, Spain.,Laboratory for Clinical Neuroscience, Centre for Biomedical Technology (CTB), Technical University of Madrid (UPM), 28040 Madrid, Spain.,Department of Psychology, University of Cadiz. 11003 Cádiz, Spain
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Habelt B, Arvaneh M, Bernhardt N, Minev I. Biomarkers and neuromodulation techniques in substance use disorders. Bioelectron Med 2020; 6:4. [PMID: 32232112 PMCID: PMC7098236 DOI: 10.1186/s42234-020-0040-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 01/29/2020] [Indexed: 01/10/2023] Open
Abstract
Addictive disorders are a severe health concern. Conventional therapies have just moderate success and the probability of relapse after treatment remains high. Brain stimulation techniques, such as transcranial Direct Current Stimulation (tDCS) and Deep Brain Stimulation (DBS), have been shown to be effective in reducing subjectively rated substance craving. However, there are few objective and measurable parameters that reflect neural mechanisms of addictive disorders and relapse. Key electrophysiological features that characterize substance related changes in neural processing are Event-Related Potentials (ERP). These high temporal resolution measurements of brain activity are able to identify neurocognitive correlates of addictive behaviours. Moreover, ERP have shown utility as biomarkers to predict treatment outcome and relapse probability. A future direction for the treatment of addiction might include neural interfaces able to detect addiction-related neurophysiological parameters and deploy neuromodulation adapted to the identified pathological features in a closed-loop fashion. Such systems may go beyond electrical recording and stimulation to employ sensing and neuromodulation in the pharmacological domain as well as advanced signal analysis and machine learning algorithms. In this review, we describe the state-of-the-art in the treatment of addictive disorders with electrical brain stimulation and its effect on addiction-related neurophysiological markers. We discuss advanced signal processing approaches and multi-modal neural interfaces as building blocks in future bioelectronics systems for treatment of addictive disorders.
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Affiliation(s)
- Bettina Habelt
- Department of Psychiatry and Psychotherapy, Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Mahnaz Arvaneh
- Department of Automatic Control and Systems Engineering, University of Sheffield, Sheffield, UK
| | - Nadine Bernhardt
- Department of Psychiatry and Psychotherapy, Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Ivan Minev
- Department of Automatic Control and Systems Engineering, University of Sheffield, Sheffield, UK
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Electroencephalographic read-outs of the modulation of cortical network activity by deep brain stimulation. Bioelectron Med 2018; 4:2. [PMID: 32232078 PMCID: PMC7098231 DOI: 10.1186/s42234-018-0003-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 02/15/2018] [Indexed: 12/24/2022] Open
Abstract
Deep brain stimulation (DBS), a reversible and adjustable treatment for neurological and psychiatric refractory disorders, consists in delivering electrical currents to neuronal populations located in subcortical structures. The targets of DBS are spatially restricted, but connect to many parts of the brain, including the cortex, which might explain the observed clinical benefits in terms of symptomatology. The DBS mechanisms of action at a large scale are however poorly understood, which has motivated several groups to recently conduct many research programs to monitor cortical responses to DBS. Here we review the knowledge gathered from the use of electroencephalography (EEG) in patients treated by DBS. We first focus on the methodology to record and process EEG signals concurrently to DBS. In the second part of the review, we address the clinical and scientific benefits brought by EEG/DBS studies so far.
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Jahanshahi M, Rothwell JC. Inhibitory dysfunction contributes to some of the motor and non-motor symptoms of movement disorders and psychiatric disorders. Philos Trans R Soc Lond B Biol Sci 2017; 372:rstb.2016.0198. [PMID: 28242732 DOI: 10.1098/rstb.2016.0198] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2016] [Indexed: 12/13/2022] Open
Abstract
Recently, it has been proposed that similar to goal-directed and habitual action mediated by the fronto-striatal circuits, the fronto-striato-subthalamic-pallidal-thalamo-cortical network may also mediate goal-directed and habitual (automatic) inhibition in both the motor and non-motor domains. Within this framework, some of the clinical manifestations of Parkinson's disease, dystonia, Tourette syndrome and obsessive-compulsive disorder can be considered to represent an imbalance between goal-directed and habitual action and inhibition. It is possible that surgical interventions targeting the basal ganglia nuclei, such as deep brain stimulation of the subthalamic nucleus or the internal segment of the globus pallidus, improve these disorders by restoring a functional balance between facilitation and inhibition in the fronto-striatal networks. These proposals require investigation in future studies.This article is part of the themed issue 'Movement suppression: brain mechanisms for stopping and stillness'.
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Affiliation(s)
- Marjan Jahanshahi
- Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, 33 Queen Square, London WC1N 3BG, UK
| | - John C Rothwell
- Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, 33 Queen Square, London WC1N 3BG, UK
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