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Feng AY, Barbosa DAN, Casey AB, Rijsketic DR, Salgado JS, Huang H, Malenka RC, Hermes D, Miller KJ, Halpern CH, Heifets BD. Cross-species brain-wide mapping reveals a conserved and coordinated network engaged by NAc DBS. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.09.08.611940. [PMID: 39314466 PMCID: PMC11419029 DOI: 10.1101/2024.09.08.611940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/25/2024]
Abstract
Nucleus accumbens (NAc) deep brain stimulation (DBS) has been increasingly explored as a treatment modality for refractory neuropsychiatric disorders. Uncovering the accumbens network that is engaged by DBS is a critical step forward in understanding how modulating this important node impacts the broader mesocorticolimbic circuit. Using whole-brain clearing and unbiased, brain-wide neural activity mapping, we found that NAc DBS increases neural activity in a coordinated mesocorticolimbic network in mice. Simultaneous intracranial electrophysiology recordings from the human NAc and brief stimulation epochs of homologous mesocorticolimbic nodes revealed similar connectivity. Altogether, these results identify specific connectivity conserved across species within the mesocorticolimbic circuit that may underlie mechanisms of NAc DBS.
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Cowan RL, Davis T, Kundu B, Rahimpour S, Rolston JD, Smith EH. More widespread and rigid neuronal representation of reward expectation underlies impulsive choices. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.04.11.588637. [PMID: 38645037 PMCID: PMC11030340 DOI: 10.1101/2024.04.11.588637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/23/2024]
Abstract
Impulsive choices prioritize smaller, more immediate rewards over larger, delayed, or potentially uncertain rewards. Impulsive choices are a critical aspect of substance use disorders and maladaptive decision-making across the lifespan. Here, we sought to understand the neuronal underpinnings of expected reward and risk estimation on a trial-by-trial basis during impulsive choices. To do so, we acquired electrical recordings from the human brain while participants carried out a risky decision-making task designed to measure choice impulsivity. Behaviorally, we found a reward-accuracy tradeoff, whereby more impulsive choosers were more accurate at the task, opting for a more immediate reward while compromising overall task performance. We then examined how neuronal populations across frontal, temporal, and limbic brain regions parametrically encoded reinforcement learning model variables, namely reward and risk expectation and surprise, across trials. We found more widespread representations of reward value expectation and prediction error in more impulsive choosers, whereas less impulsive choosers preferentially represented risk expectation. A regional analysis of reward and risk encoding highlighted the anterior cingulate cortex for value expectation, the anterior insula for risk expectation and surprise, and distinct regional encoding between impulsivity groups. Beyond describing trial-by-trial population neuronal representations of reward and risk variables, these results suggest impaired inhibitory control and model-free learning underpinnings of impulsive choice. These findings shed light on neural processes underlying reinforced learning and decision-making in uncertain environments and how these processes may function in psychiatric disorders.
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Affiliation(s)
- Rhiannon L Cowan
- Department of Neurosurgery, University of Utah, Salt Lake City, UT 84132, USA
| | - Tyler Davis
- Department of Neurosurgery, University of Utah, Salt Lake City, UT 84132, USA
| | - Bornali Kundu
- Department of Neurosurgery, University of Missouri, Columbia, MO 65212, USA
| | - Shervin Rahimpour
- Department of Neurosurgery, University of Utah, Salt Lake City, UT 84132, USA
| | - John D Rolston
- Department of Neurosurgery, Brigham & Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Elliot H Smith
- Department of Neurosurgery, University of Utah, Salt Lake City, UT 84132, USA
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Mendes AJ, Galdo-Álvarez S, Lema A, Carvalho S, Leite J. Transcranial Direct Current Stimulation Decreases P3 Amplitude and Inherent Delta Activity during a Waiting Impulsivity Paradigm: Crossover Study. Brain Sci 2024; 14:168. [PMID: 38391742 PMCID: PMC10887229 DOI: 10.3390/brainsci14020168] [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: 01/05/2024] [Revised: 02/05/2024] [Accepted: 02/06/2024] [Indexed: 02/24/2024] Open
Abstract
The inability to wait for a target before initiating an action (i.e., waiting impulsivity) is one of the main features of addictive behaviors. Current interventions for addiction, such as transcranial Direct Current Stimulation (tDCS), have been suggested to improve this inability. Nonetheless, the effects of tDCS on waiting impulsivity and underlying electrophysiological (EEG) markers are still not clear. Therefore, this study aimed to evaluate the effects of neuromodulation over the right inferior frontal gyrus (rIFG) on the behavior and EEG markers of reward anticipation (i.e., cue and target-P3 and underlying delta/theta power) during a premature responding task. For that, forty healthy subjects participated in two experimental sessions, where they received active and sham tDCS over the rIFG combined with EEG recording during the task. To evaluate transfer effects, participants also performed two control tasks to assess delay discounting and motor inhibition. The active tDCS decreased the cue-P3 and target-P3 amplitudes, as well as delta power during target-P3. While no tDCS effects were found for motor inhibition, active tDCS increased the discounting of future rewards when compared to sham. These findings suggest a tDCS-induced modulation of the P3 component and underlying oscillatory activity during waiting impulsivity and the discounting of future rewards.
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Affiliation(s)
- Augusto J Mendes
- Psychological Neuroscience Laboratory, CIPsi, School of Psychology, University of Minho, Campus de Gualtar, 4704-553 Braga, Portugal
- Laboratory of Neuroimaging of Aging (LANVIE), University of Geneva, 1205 Geneva, Switzerland
- Geneva Memory Center, Department of Rehabilitation and Geriatrics, Geneva University Hospitals, 1205 Geneva, Switzerland
| | - Santiago Galdo-Álvarez
- Laboratorio de Neurociencia Cognitiva, Departamento de Psicoloxía Clínica e Psicobioloxía, Facultade de Psicoloxía, Universidade de Santiago de Compostela, 1205 Galicia, Spain
| | - Alberto Lema
- Psychological Neuroscience Laboratory, CIPsi, School of Psychology, University of Minho, Campus de Gualtar, 4704-553 Braga, Portugal
| | - Sandra Carvalho
- Department of Education and Psychology, William James Center for Research (WJCR), University of Aveiro, Campus Universitário de Santiago, 3810-193 Aveiro, Portugal
- CINTESIS@RISE, Center for Health Technology and Services Research at the Associate Laboratory RISE-Health Research Network, Department of Education and Psychology, University of Aveiro, 3810-193 Aveiro, Portugal
| | - Jorge Leite
- CINTESIS@RISE, CINTESIS.UPT, Portucalense University, 4200-072 Porto, Portugal
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Hounchonou HF, Tang H, Paulat R, Kühn A, Spranger J, van Riesen C, Maurer L. Continuous deep brain stimulation of the nucleus accumbens reduces food intake but does not affect body weight in mice fed a high-fat diet. Sci Rep 2023; 13:18952. [PMID: 37919311 PMCID: PMC10622429 DOI: 10.1038/s41598-023-45511-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 10/20/2023] [Indexed: 11/04/2023] Open
Abstract
Obesity is an enormous health problem, and many patients do not respond to any of the available therapies. Deep brain stimulation (DBS) is currently investigated as a potential treatment for morbid obesity. In this study, we tested the hypothesis that high-frequency DBS targeting the nucleus accumbens (NAc) shell region reduces food intake and weight gain in mice fed a high-fat diet. We implanted male C57BL/6J mice with bilateral electrodes and a head-mounted microstimulator enabling continuous stimulation for up to 5 weeks. In successfully operated animals (n = 9 per group, high-frequency vs. sham stimulation), we investigated immediate and long-term stimulation effects on metabolic and behavioral phenotypes. Here we show that stimulation acutely induced a transient reduction in energy expenditure and locomotor activity but did not significantly affect spontaneous food intake, social interaction, anxiety or exploratory behaviors. In contrast, continuous stimulation over 5 weeks led to a decrease in food intake and thigmotaxis (the tendency to stay near walls in an open lit arena). However, chronic stimulation did not substantially change weight gain in mice fed a high-fat diet. Our results do not support the use of continuous high-frequency NAc shell DBS as a treatment for obesity. However, DBS can alter obesity-related parameters with differing short and long-term effects. Therefore, future research should employ time and context-sensitive experimental designs to assess the potential of DBS for clinical translation in this area.
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Affiliation(s)
- Harold F Hounchonou
- Department of Endocrinology and Metabolism, Charité University Medicine Berlin, Berlin, Germany
- Max Rubner Center for Cardiovascular Metabolic Renal Research, Charité University Medicine Berlin, Berlin, Germany
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
| | - Hui Tang
- Department of Endocrinology and Metabolism, Charité University Medicine Berlin, Berlin, Germany
- Max Rubner Center for Cardiovascular Metabolic Renal Research, Charité University Medicine Berlin, Berlin, Germany
| | - Raik Paulat
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité University Medicine Berlin, Berlin, Germany
| | - Andrea Kühn
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité University Medicine Berlin, Berlin, Germany
| | - Joachim Spranger
- Department of Endocrinology and Metabolism, Charité University Medicine Berlin, Berlin, Germany
- Max Rubner Center for Cardiovascular Metabolic Renal Research, Charité University Medicine Berlin, Berlin, Germany
| | - Christoph van Riesen
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité University Medicine Berlin, Berlin, Germany
- Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
| | - Lukas Maurer
- Department of Endocrinology and Metabolism, Charité University Medicine Berlin, Berlin, Germany.
- Max Rubner Center for Cardiovascular Metabolic Renal Research, Charité University Medicine Berlin, Berlin, Germany.
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Ojeda Valencia G, Gregg NM, Huang H, Lundstrom BN, Brinkmann BH, Pal Attia T, Van Gompel JJ, Bernstein MA, In MH, Huston J, Worrell GA, Miller KJ, Hermes D. Signatures of Electrical Stimulation Driven Network Interactions in the Human Limbic System. J Neurosci 2023; 43:6697-6711. [PMID: 37620159 PMCID: PMC10538586 DOI: 10.1523/jneurosci.2201-22.2023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 08/04/2023] [Accepted: 08/08/2023] [Indexed: 08/26/2023] Open
Abstract
Stimulation-evoked signals are starting to be used as biomarkers to indicate the state and health of brain networks. The human limbic network, often targeted for brain stimulation therapy, is involved in emotion and memory processing. Previous anatomic, neurophysiological, and functional studies suggest distinct subsystems within the limbic network (Rolls, 2015). Studies using intracranial electrical stimulation, however, have emphasized the similarities of the evoked waveforms across the limbic network. We test whether these subsystems have distinct stimulation-driven signatures. In eight patients (four male, four female) with drug-resistant epilepsy, we stimulated the limbic system with single-pulse electrical stimulation. Reliable corticocortical evoked potentials (CCEPs) were measured between hippocampus and the posterior cingulate cortex (PCC) and between the amygdala and the anterior cingulate cortex (ACC). However, the CCEP waveform in the PCC after hippocampal stimulation showed a unique and reliable morphology, which we term the "limbic Hippocampus-Anterior nucleus of the thalamus-Posterior cingulate, HAP-wave." This limbic HAP-wave was visually distinct and separately decoded from the CCEP waveform in ACC after amygdala stimulation. Diffusion MRI data show that the measured end points in the PCC overlap with the end points of the parolfactory cingulum bundle rather than the parahippocampal cingulum, suggesting that the limbic HAP-wave may travel through fornix, mammillary bodies, and the anterior nucleus of the thalamus (ANT). This was further confirmed by stimulating the ANT, which evoked the same limbic HAP-wave but with an earlier latency. Limbic subsystems have unique stimulation-evoked signatures that may be used in the future to help network pathology diagnosis.SIGNIFICANCE STATEMENT The limbic system is often compromised in diverse clinical conditions, such as epilepsy or Alzheimer's disease, and characterizing its typical circuit responses may provide diagnostic insight. Stimulation-evoked waveforms have been used in the motor system to diagnose circuit pathology. We translate this framework to limbic subsystems using human intracranial stereo EEG (sEEG) recordings that measure deeper brain areas. Our sEEG recordings describe a stimulation-evoked waveform characteristic to the memory and spatial subsystem of the limbic network that we term the "limbic HAP-wave." The limbic HAP-wave follows anatomic white matter pathways from hippocampus to thalamus to the posterior cingulum and shows promise as a distinct biomarker of signaling in the human brain memory and spatial limbic network.
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Affiliation(s)
- Gabriela Ojeda Valencia
- Department of Physiology and Biomedical Engineering, Mayo Clinic Rochester, Rochester, Minnesota 55902
| | - Nicholas M Gregg
- Department of Neurology, Mayo Clinic Rochester, Rochester, Minnesota 55902
| | - Harvey Huang
- Mayo Clinic Medical Scientist Training Program, Mayo Clinic Rochester, Rochester, Minnesota 55902
| | - Brian N Lundstrom
- Department of Neurology, Mayo Clinic Rochester, Rochester, Minnesota 55902
| | | | - Tal Pal Attia
- Department of Physiology and Biomedical Engineering, Mayo Clinic Rochester, Rochester, Minnesota 55902
| | - Jamie J Van Gompel
- Department of Neurologic Surgery, Mayo Clinic Rochester, Rochester, Minnesota 55902
| | - Matt A Bernstein
- Department of Radiology, Mayo Clinic Rochester, Rochester, Minnesota 55902
| | - Myung-Ho In
- Department of Radiology, Mayo Clinic Rochester, Rochester, Minnesota 55902
| | - John Huston
- Department of Radiology, Mayo Clinic Rochester, Rochester, Minnesota 55902
| | - Gregory A Worrell
- Department of Physiology and Biomedical Engineering, Mayo Clinic Rochester, Rochester, Minnesota 55902
- Department of Neurology, Mayo Clinic Rochester, Rochester, Minnesota 55902
| | - Kai J Miller
- Department of Physiology and Biomedical Engineering, Mayo Clinic Rochester, Rochester, Minnesota 55902
- Department of Neurologic Surgery, Mayo Clinic Rochester, Rochester, Minnesota 55902
| | - Dora Hermes
- Department of Physiology and Biomedical Engineering, Mayo Clinic Rochester, Rochester, Minnesota 55902
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Rolle CE, Ng GY, Nho YH, Barbosa DAN, Shivacharan RS, Gold JI, Bassett DS, Halpern CH, Buch V. Accumbens connectivity during deep-brain stimulation differentiates loss of control from physiologic behavioral states. Brain Stimul 2023; 16:1384-1391. [PMID: 37734587 PMCID: PMC10811591 DOI: 10.1016/j.brs.2023.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 09/10/2023] [Accepted: 09/11/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND Loss of control (LOC) eating, the subjective sense that one cannot control what or how much one eats, characterizes binge-eating behaviors pervasive in obesity and related eating disorders. Closed-loop deep-brain stimulation (DBS) for binge eating should predict LOC and trigger an appropriately timed intervention. OBJECTIVE/HYPOTHESIS This study aimed to identify a sensitive and specific biomarker to detect LOC onset for DBS. We hypothesized that changes in phase-locking value (PLV) predict the onset of LOC-associated cravings and distinguish them from potential confounding states. METHODS Using DBS data recorded from the nucleus accumbens (NAc) of two patients with binge eating disorder (BED) and severe obesity, we compared PLV between inter- and intra-hemispheric NAc subregions for three behavioral conditions: craving (associated with LOC eating), hunger (not associated with LOC), and sleep. RESULTS In both patients, PLV in the high gamma frequency band was significantly higher for craving compared to sleep and significantly higher for hunger compared to craving. Maximum likelihood classifiers achieved accuracies above 88% when differentiating between the three conditions. CONCLUSIONS High-frequency inter- and intra-hemispheric PLV in the NAc is a promising biomarker for closed-loop DBS that differentiates LOC-associated cravings from physiologic states such as hunger and sleep. Future trials should assess PLV as a LOC biomarker across a larger cohort and a wider patient population transdiagnostically.
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Affiliation(s)
- Camarin E Rolle
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Pennsylvania Hospital, Spruce Building 3rd Floor, 801 Spruce Street, Philadelphia, PA 19107, USA; Department of Surgery, Corporal Michael J. Crescenz Veterans Affairs Medical Center, 3900 Woodland Ave, Philadelphia, PA, USA; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94304, USA
| | - Grace Y Ng
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Pennsylvania Hospital, Spruce Building 3rd Floor, 801 Spruce Street, Philadelphia, PA 19107, USA; Department of Surgery, Corporal Michael J. Crescenz Veterans Affairs Medical Center, 3900 Woodland Ave, Philadelphia, PA, USA; Department of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, 55 Fruit St, Boston, MA 02114, USA
| | - Young-Hoon Nho
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Pennsylvania Hospital, Spruce Building 3rd Floor, 801 Spruce Street, Philadelphia, PA 19107, USA; Department of Surgery, Corporal Michael J. Crescenz Veterans Affairs Medical Center, 3900 Woodland Ave, Philadelphia, PA, USA
| | - Daniel A N Barbosa
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Pennsylvania Hospital, Spruce Building 3rd Floor, 801 Spruce Street, Philadelphia, PA 19107, USA; Department of Surgery, Corporal Michael J. Crescenz Veterans Affairs Medical Center, 3900 Woodland Ave, Philadelphia, PA, USA
| | - Rajat S Shivacharan
- Department of Neurosurgery, Stanford University School of Medicine, 453 Quarry Road Office 245C, Stanford, CA 94304, USA
| | - Joshua I Gold
- Department of Neuroscience, University of Pennsylvania, 3700 Hamilton Walk, Richards D407, Philadelphia, PA 19104, USA
| | - Dani S Bassett
- Departments of Bioengineering, Physics and Astronomy, Electrical and Systems Engineering, Neurology, and Psychiatry, University of Pennsylvania, 210 S. 33rd St, Skirkanich Hall 240, Philadelphia, PA 19104, USA; Santa Fe Institute, 1399 Hyde Park Rd, Santa Fe, NM 87501, USA
| | - Casey H Halpern
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Pennsylvania Hospital, Spruce Building 3rd Floor, 801 Spruce Street, Philadelphia, PA 19107, USA; Department of Surgery, Corporal Michael J. Crescenz Veterans Affairs Medical Center, 3900 Woodland Ave, Philadelphia, PA, USA
| | - Vivek Buch
- Department of Neurosurgery, Stanford University School of Medicine, 453 Quarry Road Office 245C, Stanford, CA 94304, USA.
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Dwiel LL, Henricks AM, Bragg E, Gui J, Doucette WT. Neural oscillations in the ventral striatum reveal differences between the encoding of palatable food and ethanol consumption. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2023; 47:1327-1340. [PMID: 37166071 PMCID: PMC10601443 DOI: 10.1111/acer.15101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 04/24/2023] [Accepted: 05/03/2023] [Indexed: 05/12/2023]
Abstract
BACKGROUND Across multiple levels of investigation, there appear to be convergent neuronal processes underlying substance use and other motivated behaviors (i.e., the pursuit and consumption of rewarding substances). The consumption of alcohol and sweet, high-fat food engages many of the same brain regions, especially, the ventral striatum. In the current study, we hypothesized that ventral striatal local field potentials (LFPs) recorded during self-administration sessions could be used to detect when the consumption of 10% ethanol or sweet-fat food (SF) was occurring compared to all other behaviors, including naturalistic controls (i.e., water or house-chow). METHODS We used an intermittent limited access approach to condition Sprague-Dawley rats to consume either ethanol or SF while we recorded LFPs. We used machine learning and simple logistic regressions to determine whether LFP features could classify when consumption of each substance was occurring, and whether a general model could predict consumption of both substances. We report performance as the average area under the receiver operator characteristic curve (AUROC). RESULTS Consumption of a single substance was differentiable from all other behaviors, as evidenced by the AUROC (ethanol = 0.84 and SF = 0.83, p < 0.01). Models built from the combined dataset (general) did modestly overall (general → general = 0.68, p < 0.05), and did not detect the consumption of the two substances similarly (general → SF = 0.5 and general → ethanol = 0.63, p > 0.05). CONCLUSIONS Models successfully classified ethanol and SF consumption versus all other behavior/naturalistic controls. However, the findings highlight differences in how the ventral striatum represents the consumption of ethanol and SF and show that, although there is potential for finding biomarkers related to substance use, it may be difficult to build a model that performs well detecting multiple substances.
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Affiliation(s)
- Lucas L. Dwiel
- Department of Psychiatry, Geisel School of Medicine at Dartmouth
| | | | - Elise Bragg
- Department of Psychiatry, Geisel School of Medicine at Dartmouth
| | - Jiang Gui
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth
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Satzer D, Wu S, Henry J, Doll E, Issa NP, Warnke PC. Ambulatory Local Field Potential Recordings from the Thalamus in Epilepsy: A Feasibility Study. Stereotact Funct Neurosurg 2023; 101:195-206. [PMID: 37232010 PMCID: PMC11227660 DOI: 10.1159/000529961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 02/24/2023] [Indexed: 05/27/2023]
Abstract
INTRODUCTION Stimulation of the thalamus is gaining favor in the treatment of medically refractory multifocal and generalized epilepsy. Implanted brain stimulators capable of recording ambulatory local field potentials (LFPs) have recently been introduced, but there is little information to guide their use in thalamic stimulation for epilepsy. This study sought to assess the feasibility of chronically recording ambulatory interictal LFP from the thalamus in patients with epilepsy. METHODS In this pilot study, ambulatory LFP was recorded from patients who underwent sensing-enabled deep brain stimulation (DBS, 2 participants) or responsive neurostimulation (RNS, 3 participants) targeting the anterior nucleus of the thalamus (ANT, 2 electrodes), centromedian nucleus (CM, 7 electrodes), or medial pulvinar (PuM, 1 electrode) for multifocal or generalized epilepsy. Time-domain and frequency-domain LFP was investigated for epileptiform discharges, spectral peaks, circadian variation, and peri-ictal patterns. RESULTS Thalamic interictal discharges were visible on ambulatory recordings from both DBS and RNS. At-home interictal frequency-domain data could be extracted from both devices. Spectral peaks were noted at 10-15 Hz in CM, 6-11 Hz in ANT, and 19-24 Hz in PuM but varied in prominence and were not visible in all electrodes. In CM, 10-15 Hz power exhibited circadian variation and was attenuated by eye opening. CONCLUSION Chronic ambulatory recording of thalamic LFP is feasible. Common spectral peaks can be observed but vary between electrodes and across neural states. DBS and RNS devices provide a wealth of complementary data that have the potential to better inform thalamic stimulation for epilepsy.
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Affiliation(s)
- David Satzer
- Department of Neurological Surgery, University of Chicago, Chicago, IL, USA
| | - Shasha Wu
- Department of Neurology, University of Chicago, Chicago, IL, USA
| | - Julia Henry
- Department of Pediatrics, Child Neurology Section, University of Chicago, Chicago, IL, USA
| | - Emily Doll
- Department of Pediatrics, Child Neurology Section, University of Chicago, Chicago, IL, USA
| | - Naoum P. Issa
- Department of Neurology, University of Chicago, Chicago, IL, USA
| | - Peter C. Warnke
- Department of Neurological Surgery, University of Chicago, Chicago, IL, USA
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Basu I, Yousefi A, Crocker B, Zelmann R, Paulk AC, Peled N, Ellard KK, Weisholtz DS, Cosgrove GR, Deckersbach T, Eden UT, Eskandar EN, Dougherty DD, Cash SS, Widge AS. Closed-loop enhancement and neural decoding of cognitive control in humans. Nat Biomed Eng 2023; 7:576-588. [PMID: 34725508 PMCID: PMC9056584 DOI: 10.1038/s41551-021-00804-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 09/02/2021] [Indexed: 12/20/2022]
Abstract
Deficits in cognitive control-that is, in the ability to withhold a default pre-potent response in favour of a more adaptive choice-are common in depression, anxiety, addiction and other mental disorders. Here we report proof-of-concept evidence that, in participants undergoing intracranial epilepsy monitoring, closed-loop direct stimulation of the internal capsule or striatum, especially the dorsal sites, enhances the participants' cognitive control during a conflict task. We also show that closed-loop stimulation upon the detection of lapses in cognitive control produced larger behavioural changes than open-loop stimulation, and that task performance for single trials can be directly decoded from the activity of a small number of electrodes via neural features that are compatible with existing closed-loop brain implants. Closed-loop enhancement of cognitive control might remediate underlying cognitive deficits and aid the treatment of severe mental disorders.
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Affiliation(s)
- Ishita Basu
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Ali Yousefi
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Departments of Computer Science and Neuroscience, Worcester Polytechnic Institute, Worcester, MA, USA
| | - Britni Crocker
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Rina Zelmann
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Angelique C Paulk
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Noam Peled
- Department of Radiology, MGH/HST Martinos Center for Biomedical Imaging and Harvard Medical School, Boston, MA, USA
| | - Kristen K Ellard
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | | | - G Rees Cosgrove
- Department of Neurological Surgery, Brigham & Womens Hospital, Boston, MA, USA
| | - Thilo Deckersbach
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Uri T Eden
- Department of Mathematics and Statistics, Boston University, Boston, MA, USA
| | - Emad N Eskandar
- Department of Neurological Surgery, Massachusetts General Hospital, Boston, MA, USA
- Department of Neurological Surgery, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Darin D Dougherty
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Sydney S Cash
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Alik S Widge
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
- Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA.
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10
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Parker JJ, Rolle CE, Shivacharan RS, Barbosa DAN, Feng A, Huang Y, Kakusa BW, Prieto T, Jaffe RA, Williams NR, Halpern CH. Appetitive Mapping of the Human Nucleus Accumbens. Biol Psychiatry 2023; 93:e15-e19. [PMID: 36509559 DOI: 10.1016/j.biopsych.2022.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 09/09/2022] [Accepted: 09/16/2022] [Indexed: 12/14/2022]
Affiliation(s)
- Jonathon J Parker
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California
| | - Cammie E Rolle
- Department of Neurosurgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Rajat S Shivacharan
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California
| | - Daniel A N Barbosa
- Department of Neurosurgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Austin Feng
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California
| | - Yuhao Huang
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California
| | - Bina W Kakusa
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California
| | - Tom Prieto
- Department of Neurology, Stanford University School of Medicine, Stanford, California
| | - Richard A Jaffe
- Department of Anesthesia, Stanford University School of Medicine, Stanford, California
| | - Nolan R Williams
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | - Casey H Halpern
- Department of Neurosurgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; Department of Surgery, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania.
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Manssuer L, Wang L, Ding Q, Li J, Zhang Y, Zhang C, Hallett M, Li D, Sun B, Voon V. Subthalamic Oscillatory Activity of Reward and Loss Processing Using the Monetary Incentive Delay Task in Parkinson Disease. Neuromodulation 2023; 26:414-423. [PMID: 35570149 PMCID: PMC10385018 DOI: 10.1016/j.neurom.2022.04.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 02/08/2022] [Accepted: 03/08/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND The subthalamic nucleus (STN) is an effective deep brain stimulation target for Parkinson disease (PD) and obsessive-compulsive disorder and has been implicated in reward and motivational processing. In this study, we assessed the STN and prefrontal oscillatory dynamics in the anticipation and receipt of reward and loss using a task commonly used in imaging. MATERIALS AND METHODS We recorded intracranial left subthalamic local field potentials from deep brain stimulation electrodes and prefrontal scalp electroencephalography in 17 patients with PD while they performed a monetary incentive delay task. RESULTS During the expectation phase, enhanced left STN delta-theta activity was observed in both reward and loss vs neutral anticipation, with greater STN delta-theta activity associated with greater motivation specifically to reward. In the consummatory outcome phase, greater left STN delta activity was associated with a rewarding vs neutral outcome, particularly with more ventral contacts along with greater delta-theta coherence with the prefrontal cortex. We highlight a differential activity in the left STN to loss vs reward anticipation, demonstrating a distinct STN high gamma activity. Patients with addiction-like behaviors show lower left STN delta-theta activity to loss vs neutral outcomes, emphasizing impaired sensitivity to negative outcomes. CONCLUSIONS Together, our findings highlight a role for the left STN in reward and loss processing and a potential role in addictive behaviors. These findings emphasize the cognitive-limbic function of the STN and its role as a physiologic target for neuropsychiatric disorders.
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Affiliation(s)
- Luis Manssuer
- Department of Neurosurgery, RuiJin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Linbin Wang
- Neural and Intelligence Engineering Center, Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China
| | - Qiong Ding
- Neural and Intelligence Engineering Center, Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China
| | - Jun Li
- Department of Neurosurgery, RuiJin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yingying Zhang
- Department of Neurosurgery, RuiJin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chencheng Zhang
- Department of Neurosurgery, RuiJin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Mark Hallett
- Human Motor Control Section, Medical Neurology Branch, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
| | - Dianyou Li
- Department of Neurosurgery, RuiJin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bomin Sun
- Department of Neurosurgery, RuiJin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Valerie Voon
- Department of Neurosurgery, RuiJin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Department of Psychiatry, University of Cambridge, Cambridge, UK; Neural and Intelligence Engineering Center, Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China.
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12
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Wong JK, Mayberg HS, Wang DD, Richardson RM, Halpern CH, Krinke L, Arlotti M, Rossi L, Priori A, Marceglia S, Gilron R, Cavanagh JF, Judy JW, Miocinovic S, Devergnas AD, Sillitoe RV, Cernera S, Oehrn CR, Gunduz A, Goodman WK, Petersen EA, Bronte-Stewart H, Raike RS, Malekmohammadi M, Greene D, Heiden P, Tan H, Volkmann J, Voon V, Li L, Sah P, Coyne T, Silburn PA, Kubu CS, Wexler A, Chandler J, Provenza NR, Heilbronner SR, Luciano MS, Rozell CJ, Fox MD, de Hemptinne C, Henderson JM, Sheth SA, Okun MS. Proceedings of the 10th annual deep brain stimulation think tank: Advances in cutting edge technologies, artificial intelligence, neuromodulation, neuroethics, interventional psychiatry, and women in neuromodulation. Front Hum Neurosci 2023; 16:1084782. [PMID: 36819295 PMCID: PMC9933515 DOI: 10.3389/fnhum.2022.1084782] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 12/12/2022] [Indexed: 02/05/2023] Open
Abstract
The deep brain stimulation (DBS) Think Tank X was held on August 17-19, 2022 in Orlando FL. The session organizers and moderators were all women with the theme women in neuromodulation. Dr. Helen Mayberg from Mt. Sinai, NY was the keynote speaker. She discussed milestones and her experiences in developing depression DBS. The DBS Think Tank was founded in 2012 and provides an open platform where clinicians, engineers and researchers (from industry and academia) can freely discuss current and emerging DBS technologies as well as the logistical and ethical issues facing the field. The consensus among the DBS Think Tank X speakers was that DBS has continued to expand in scope however several indications have reached the "trough of disillusionment." DBS for depression was considered as "re-emerging" and approaching a slope of enlightenment. DBS for depression will soon re-enter clinical trials. The group estimated that globally more than 244,000 DBS devices have been implanted for neurological and neuropsychiatric disorders. This year's meeting was focused on advances in the following areas: neuromodulation in Europe, Asia, and Australia; cutting-edge technologies, closed loop DBS, DBS tele-health, neuroethics, lesion therapy, interventional psychiatry, and adaptive DBS.
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Affiliation(s)
- Joshua K. Wong
- Department of Neurology, Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Helen S. Mayberg
- Department of Neurology, Neurosurgery, Psychiatry, and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Doris D. Wang
- Department of Neurological Surgery, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - R. Mark Richardson
- Department of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Casey H. Halpern
- Richards Medical Research Laboratories, Department of Neurosurgery, Perelman School of Medicine, Pennsylvania Hospital, University of Pennsylvania, Philadelphia, PA, United States
| | - Lothar Krinke
- Newronika, Goose Creek, SC, United States
- Department of Neuroscience, West Virginia University, Morgantown, WV, United States
| | | | | | | | | | | | - James F. Cavanagh
- Department of Psychology, University of New Mexico, Albuquerque, NM, United States
| | - Jack W. Judy
- Department of Electrical and Computer Engineering, University of Florida, Gainesville, FL, United States
| | - Svjetlana Miocinovic
- Department of Neurology, School of Medicine, Emory University, Atlanta, GA, United States
| | - Annaelle D. Devergnas
- Department of Neurology, School of Medicine, Emory University, Atlanta, GA, United States
| | - Roy V. Sillitoe
- Department of Neuroscience, Baylor College of Medicine, Houston, TX, United States
| | - Stephanie Cernera
- Department of Neurological Surgery, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Carina R. Oehrn
- Department of Neurological Surgery, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Aysegul Gunduz
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, FL, United States
| | - Wayne K. Goodman
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States
| | - Erika A. Petersen
- Department of Neurosurgery, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Helen Bronte-Stewart
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - Robert S. Raike
- Restorative Therapies Group Implantables, Research, and Core Technology, Medtronic Inc., Minneapolis, MN, United States
| | | | - David Greene
- NeuroPace, Inc., Mountain View, CA, United States
| | - Petra Heiden
- Department of Stereotactic and Functional Neurosurgery, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Huiling Tan
- Medical Research Council Brain Network Dynamics Unit, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Jens Volkmann
- Department of Neurology, University of Würzburg, Würzburg, Germany
| | - Valerie Voon
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Luming Li
- National Engineering Research Center of Neuromodulation, School of Aerospace Engineering, Tsinghua University, Beijing, China
| | - Pankaj Sah
- Queensland Brain Institute, University of Queensland, St Lucia, QLD, Australia
| | - Terry Coyne
- Queensland Brain Institute, University of Queensland, St Lucia, QLD, Australia
| | - Peter A. Silburn
- Queensland Brain Institute, University of Queensland, St Lucia, QLD, Australia
| | - Cynthia S. Kubu
- Department of Neurology, Cleveland Clinic, Cleveland, OH, United States
| | - Anna Wexler
- Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, PA, United States
| | - Jennifer Chandler
- Centre for Health Law, Policy, and Ethics, Faculty of Law, University of Ottawa, Ottawa, ON, Canada
| | - Nicole R. Provenza
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, United States
| | - Sarah R. Heilbronner
- Department of Neuroscience, University of Minnesota, Minneapolis, MN, United States
| | - Marta San Luciano
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Christopher J. Rozell
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA, United States
| | - Michael D. Fox
- Center for Brain Circuit Therapeutics, Department of Neurology, Psychiatry, Radiology, and Neurosurgery, Brigham and Women’s Hospital, Boston, MA, United States
| | - Coralie de Hemptinne
- Department of Neurology, Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Jaimie M. Henderson
- Department of Neurosurgery, Stanford University, Stanford, CA, United States
| | - Sameer A. Sheth
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, United States
| | - Michael S. Okun
- Department of Neurology, Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
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13
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Walsh JJ, Christoffel DJ, Malenka RC. Neural circuits regulating prosocial behaviors. Neuropsychopharmacology 2023; 48:79-89. [PMID: 35701550 PMCID: PMC9700801 DOI: 10.1038/s41386-022-01348-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 05/09/2022] [Accepted: 05/17/2022] [Indexed: 11/09/2022]
Abstract
Positive, prosocial interactions are essential for survival, development, and well-being. These intricate and complex behaviors are mediated by an amalgamation of neural circuit mechanisms working in concert. Impairments in prosocial behaviors, which occur in a large number of neuropsychiatric disorders, result from disruption of the coordinated activity of these neural circuits. In this review, we focus our discussion on recent findings that utilize modern approaches in rodents to map, monitor, and manipulate neural circuits implicated in a variety of prosocial behaviors. We highlight how modulation by oxytocin, serotonin, and dopamine of excitatory and inhibitory synaptic transmission in specific brain regions is critical for regulation of adaptive prosocial interactions. We then describe how recent findings have helped elucidate pathophysiological mechanisms underlying the social deficits that accompany neuropsychiatric disorders. We conclude by discussing approaches for the development of more efficacious and targeted therapeutic interventions to ameliorate aberrant prosocial behaviors.
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Affiliation(s)
- Jessica J Walsh
- Department of Pharmacology, University of North Carolina, Chapel Hill, NC, 27514, USA.
- Carolina Institute for Developmental Disabilities, University of North Carolina, Chapel Hill, NC, USA.
- Neuroscience Center, University of North Carolina, Chapel Hill, NC, 27514, USA.
| | - Daniel J Christoffel
- Neuroscience Center, University of North Carolina, Chapel Hill, NC, 27514, USA
- Department of Psychology and Neuroscience, University of North Carolina, Chapel Hill, NC, 27514, USA
| | - Robert C Malenka
- Nancy Pritzker Laboratory, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, 94305-5453, USA.
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14
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Saalmann YB, Mofakham S, Mikell CB, Djuric PM. Microscale multicircuit brain stimulation: Achieving real-time brain state control for novel applications. CURRENT RESEARCH IN NEUROBIOLOGY 2022; 4:100071. [PMID: 36619175 PMCID: PMC9816916 DOI: 10.1016/j.crneur.2022.100071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 11/30/2022] [Accepted: 12/19/2022] [Indexed: 12/30/2022] Open
Abstract
Neurological and psychiatric disorders typically result from dysfunction across multiple neural circuits. Most of these disorders lack a satisfactory neuromodulation treatment. However, deep brain stimulation (DBS) has been successful in a limited number of disorders; DBS typically targets one or two brain areas with single contacts on relatively large electrodes, allowing for only coarse modulation of circuit function. Because of the dysfunction in distributed neural circuits - each requiring fine, tailored modulation - that characterizes most neuropsychiatric disorders, this approach holds limited promise. To develop the next generation of neuromodulation therapies, we will have to achieve fine-grained, closed-loop control over multiple neural circuits. Recent work has demonstrated spatial and frequency selectivity using microstimulation with many small, closely-spaced contacts, mimicking endogenous neural dynamics. Using custom electrode design and stimulation parameters, it should be possible to achieve bidirectional control over behavioral outcomes, such as increasing or decreasing arousal during central thalamic stimulation. Here, we discuss one possible approach, which we term microscale multicircuit brain stimulation (MMBS). We discuss how machine learning leverages behavioral and neural data to find optimal stimulation parameters across multiple contacts, to drive the brain towards desired states associated with behavioral goals. We expound a mathematical framework for MMBS, where behavioral and neural responses adjust the model in real-time, allowing us to adjust stimulation in real-time. These technologies will be critical to the development of the next generation of neurostimulation therapies, which will allow us to treat problems like disorders of consciousness and cognition.
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Affiliation(s)
- Yuri B. Saalmann
- Department of Psychology, University of Wisconsin-Madison, Madison, WI, USA
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, WI, USA
| | - Sima Mofakham
- Department of Neurological Surgery, Stony Brook University Hospital, Stony Brook, NY, USA
- Department of Electrical and Computer Engineering, Stony Brook University, Stony Brook, NY, USA
| | - Charles B. Mikell
- Department of Neurological Surgery, Stony Brook University Hospital, Stony Brook, NY, USA
| | - Petar M. Djuric
- Department of Electrical and Computer Engineering, Stony Brook University, Stony Brook, NY, USA
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15
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Khodagholy D, Ferrero JJ, Park J, Zhao Z, Gelinas JN. Large-scale, closed-loop interrogation of neural circuits underlying cognition. Trends Neurosci 2022; 45:968-983. [PMID: 36404457 PMCID: PMC10437206 DOI: 10.1016/j.tins.2022.10.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 09/26/2022] [Accepted: 10/03/2022] [Indexed: 11/05/2022]
Abstract
Cognitive functions are increasingly understood to involve coordinated activity patterns between multiple brain regions, and their disruption by neuropsychiatric disorders is similarly complex. Closed-loop neurostimulation can directly modulate neural signals with temporal and spatial precision. How to leverage such an approach to effectively identify and target distributed neural networks implicated in mediating cognition remains unclear. We review current conceptual and technical advances in this area, proposing that devices that enable large-scale acquisition, integrated processing, and multiregion, arbitrary waveform stimulation will be critical for mechanistically driven manipulation of cognitive processes in physiological and pathological brain networks.
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Affiliation(s)
- Dion Khodagholy
- Department of Electrical Engineering, Columbia University, New York, NY 10027, USA.
| | - Jose J Ferrero
- Institute for Genomic Medicine, Columbia University Irving Medical Center, 701 W 168(th) St., New York, NY 10032, USA
| | - Jaehyo Park
- Department of Electrical Engineering, Columbia University, New York, NY 10027, USA
| | - Zifang Zhao
- Department of Electrical Engineering, Columbia University, New York, NY 10027, USA; Institute for Genomic Medicine, Columbia University Irving Medical Center, 701 W 168(th) St., New York, NY 10032, USA
| | - Jennifer N Gelinas
- Institute for Genomic Medicine, Columbia University Irving Medical Center, 701 W 168(th) St., New York, NY 10032, USA; Department of Neurology, Columbia University Medical Center, New York, NY 10032, USA..
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16
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Abstract
Some have argued that the brain is so complex that it cannot be understood using current reductive approaches. Drawing on examples from decision neuroscience, we instead contend that combining new neuroscientific techniques with reductive approaches that consider central brain components in time and space has generated significant progress over the past 2 decades. This progress has allowed researchers to advance from the scientific goals of description and explanation to prediction and control. Resulting knowledge promises to improve human health and well-being. As an alternative to the extremes of reductive versus emergent approaches, however, we propose a middle way of "expansion." This expansionist approach promises to leverage the specific spatial localization, temporal precision, and directed connectivity of central neural components to ultimately link levels of analysis.
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17
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Pilot study of responsive nucleus accumbens deep brain stimulation for loss-of-control eating. Nat Med 2022; 28:1791-1796. [PMID: 36038628 PMCID: PMC9499853 DOI: 10.1038/s41591-022-01941-w] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 07/08/2022] [Indexed: 11/08/2022]
Abstract
Cravings that precede loss of control (LOC) over food consumption present an opportunity for intervention in patients with the binge eating disorder (BED). In this pilot study, we used responsive deep brain stimulation (DBS) to record nucleus accumbens (NAc) electrophysiology during food cravings preceding LOC eating in two patients with BED and severe obesity (trial registration no. NCT03868670). Increased NAc low-frequency oscillations, prominent during food cravings, were used to guide DBS delivery. Over 6 months, we observed improved self-control of food intake and weight loss. These findings provide early support for restoring inhibitory control with electrophysiologically-guided NAc DBS. Further work with increased sample sizes is required to determine the scalability of this approach. Nucleus accumbens, low-frequency, responsive deep brain stimulation improved self-control of food intake and weight loss in two patients with binge eating disorder and severe obesity
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18
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Barbosa DAN, Kuijper FM, Duda J, Wang AR, Cartmell SCD, Saluja S, Cunningham T, Shivacharan RS, Bhati MT, Safer DL, Lock JD, Malenka RC, de Oliveira-Souza R, Williams NR, Grossman M, Gee JC, McNab JA, Bohon C, Halpern CH. Aberrant impulse control circuitry in obesity. Mol Psychiatry 2022; 27:3374-3384. [PMID: 35697760 PMCID: PMC9192250 DOI: 10.1038/s41380-022-01640-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 05/11/2022] [Accepted: 05/18/2022] [Indexed: 01/09/2023]
Abstract
The ventromedial prefrontal cortex (vmPFC) to nucleus accumbens (NAc) circuit has been implicated in impulsive reward-seeking. This disinhibition has been implicated in obesity and often manifests as binge eating, which is associated with worse treatment outcomes and comorbidities. It remains unclear whether the vmPFC-NAc circuit is perturbed in impulsive eaters with obesity. Initially, we analyzed publicly available, high-resolution, normative imaging data to localize where vmPFC structural connections converged within the NAc. These structural connections were found to converge ventromedially in the presumed NAc shell subregion. We then analyzed multimodal clinical and imaging data to test the a priori hypothesis that the vmPFC-NAc shell circuit is linked to obesity in a sample of female participants that regularly engaged in impulsive eating (i.e., binge eating). Functionally, vmPFC-NAc shell resting-state connectivity was inversely related to body mass index (BMI) and decreased in the obese state. Structurally, vmPFC-NAc shell structural connectivity and vmPFC thickness were inversely correlated with BMI; obese binge-prone participants exhibited decreased vmPFC-NAc structural connectivity and vmPFC thickness. Finally, to examine a causal link to binge eating, we directly probed this circuit in one binge-prone obese female using NAc deep brain stimulation in a first-in-human trial. Direct stimulation of the NAc shell subregion guided by local behaviorally relevant electrophysiology was associated with a decrease in number of weekly episodes of uncontrolled eating and decreased BMI. This study unraveled vmPFC-NAc shell circuit aberrations in obesity that can be modulated to restore control over eating behavior in obesity.
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Affiliation(s)
- Daniel A N Barbosa
- Department of Neurosurgery, Pennsylvania Hospital, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Fiene Marie Kuijper
- Department of Neurosurgery, Pennsylvania Hospital, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jeffrey Duda
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Allan R Wang
- Department of Neurosurgery, Pennsylvania Hospital, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Samuel C D Cartmell
- Department of Neurosurgery, Pennsylvania Hospital, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Sabir Saluja
- Department of Neurosurgery, Pennsylvania Hospital, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Tricia Cunningham
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Rajat S Shivacharan
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Mahendra T Bhati
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Debra L Safer
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - James D Lock
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Robert C Malenka
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
- Nancy Pritzker Laboratory, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Ricardo de Oliveira-Souza
- Department of Specialized Medicine, Gaffrée e Guinle University Hospital, The Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Nolan R Williams
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Murray Grossman
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - James C Gee
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jennifer A McNab
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
| | - Cara Bohon
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Casey H Halpern
- Department of Neurosurgery, Pennsylvania Hospital, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA.
- Department of Surgery, Corporal Michael J. Crescenz Veterans Affairs Medical Center, PA, Philadelphia, USA.
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19
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Hoch MJ, Shepherd TM. MRI-Visible Anatomy of the Basal Ganglia and Thalamus. Neuroimaging Clin N Am 2022; 32:529-541. [PMID: 35843660 DOI: 10.1016/j.nic.2022.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Conventional MR imaging does not discriminate basal ganglia and thalamic internal anatomy well. Radiology reports describe anatomic locations but not specific functional structures. Functional neurosurgery uses indirect targeting based on commissural coordinates or atlases that do not fully account for individual variability. We describe innovative MR imaging sequences that improve the visualization of normal anatomy in this complex brain region and may increase our understanding of basal ganglia and thalamic function. Better visualization also may improve treatments for movement disorders and other emerging functional neurosurgery targets. We aim to provide an accessible review of the most clinically-relevant neuroanatomy within the thalamus and basal ganglia.
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Affiliation(s)
- Michael J Hoch
- Department of Radiology, University of Pennsylvania, 3400 Spruce Street, Suite 130, Philadelphia, PA 19104, USA. https://twiter.com/@RVUhound
| | - Timothy M Shepherd
- Department of Radiology, New York University Langone School of Medicine, 660 First Avenue, Room 226, New York, NY 10016, USA.
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20
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Bulik CM, Coleman JRI, Hardaway JA, Breithaupt L, Watson HJ, Bryant CD, Breen G. Genetics and neurobiology of eating disorders. Nat Neurosci 2022; 25:543-554. [PMID: 35524137 PMCID: PMC9744360 DOI: 10.1038/s41593-022-01071-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 04/01/2022] [Indexed: 12/14/2022]
Abstract
Eating disorders (anorexia nervosa, bulimia nervosa and binge-eating disorder) are a heterogeneous class of complex illnesses marked by weight and appetite dysregulation coupled with distinctive behavioral and psychological features. Our understanding of their genetics and neurobiology is evolving thanks to global cooperation on genome-wide association studies, neuroimaging, and animal models. Until now, however, these approaches have advanced the field in parallel, with inadequate cross-talk. This review covers overlapping advances in these key domains and encourages greater integration of hypotheses and findings to create a more unified science of eating disorders. We highlight ongoing and future work designed to identify implicated biological pathways that will inform staging models based on biology as well as targeted prevention and tailored intervention, and will galvanize interest in the development of pharmacologic agents that target the core biology of the illnesses, for which we currently have few effective pharmacotherapeutics.
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Affiliation(s)
- Cynthia M Bulik
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
| | - Jonathan R I Coleman
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- National Institute of Health Research Maudsley Biomedical Research Centre, South London and Maudsley National Health Service Trust, London, UK
| | - J Andrew Hardaway
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Lauren Breithaupt
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA
| | - Hunna J Watson
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- School of Psychology, Curtin University, Perth, Western Australia, Australia
- Division of Paediatrics, School of Medicine, The University of Western Australia, Perth, Western Australia, Australia
| | - Camron D Bryant
- Department of Pharmacology and Experimental Therapeutics and Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Gerome Breen
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- National Institute of Health Research Maudsley Biomedical Research Centre, South London and Maudsley National Health Service Trust, London, UK
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21
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Kochanski RB, Slavin KV. The future perspectives of psychiatric neurosurgery. PROGRESS IN BRAIN RESEARCH 2022; 270:211-228. [PMID: 35396029 DOI: 10.1016/bs.pbr.2022.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The future of psychiatric neurosurgery can be viewed from two separate perspectives: the immediate future and the distant future. Both show promise, but the treatment strategy for mental diseases and the technology utilized during these separate periods will likely differ dramatically. It can be expected that the initial advancements will be built upon progress of neuroimaging and stereotactic targeting while surgical technology becomes adapted to patient-specific symptomatology and structural/functional imaging parameters. This individualized approach has already begun to show significant promise when applied to deep brain stimulation for treatment-resistant depression and obsessive-compulsive disorder. If effectiveness of these strategies is confirmed by well designed, double-blind, placebo-controlled clinical studies, further technological advances will continue into the distant future, and will likely involve precise neuromodulation at the cellular level, perhaps using wireless technology with or without closed-loop design. This approach, being theoretically less invasive and carrying less risk, may ultimately propel psychiatric neurosurgery to the forefront in the treatment algorithm of mental illness. Despite prominent development of non-invasive therapeutic options, such as stereotactic radiosurgery or transcranial magnetic resonance-guided focused ultrasound, chances are there will still be a need in surgical management of patients with most intractable psychiatric conditions.
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Affiliation(s)
- Ryan B Kochanski
- Neurosurgery, Methodist Healthcare System, San Antonio, TX, United States
| | - Konstantin V Slavin
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, United States; Neurology Service, Jesse Brown Veterans Administration Medical Center, Chicago, IL, United States.
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22
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Mahajan UV, Ojukwu DI, Azagury DE, Safer DL, Cunningham T, Halpern CH. Can responsive deep brain stimulation be a cost-effective treatment for severe obesity? Obesity (Silver Spring) 2022; 30:338-346. [PMID: 35088556 DOI: 10.1002/oby.23324] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 09/29/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVE A first-in-human responsive deep brain stimulation (rDBS) trial (NCT03868670) for obesity is under way, which is based on promising preclinical evidence. Given the upfront costs of rDBS, it is prudent to examine the success threshold for cost-effectiveness compared with laparoscopic Roux-en-Y gastric bypass (LRYGB). METHODS Efficacy and safety data on LRYGB and safety data on rDBS were collected for established indications through a literature search. The success threshold was defined as minimum BMI reduction. Treatment costs were calculated via Medicare national reimbursement data. RESULTS LRYGB had a mean BMI reduction of 13.75 kg/m2 . Based on adverse events, LRYGB was a less-preferred health state (overall adverse event utility of 0.96 [0.02]) than rDBS (0.98 [0.01]), but LRYGB ($14,366 [$6,410]) had a significantly lower treatment cost than rDBS ($29,951 [$4,490]; p < 0.0001). Therefore, for rDBS to be cost-effective compared with LRYGB, the multiple models yielded a success threshold range of 13.7 to 15.2 kg/m2 . CONCLUSIONS This study established a preliminary efficacy success threshold for rDBS to be cost-effective for severe obesity, and results from randomized controlled trials are needed. This analysis allows for interpretation of the economic impact of advancing rDBS for obesity in light of ongoing trial results and suggests an attainable threshold is needed for cost-effectiveness.
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Affiliation(s)
- Uma V Mahajan
- Department of Neurosurgery, Stanford University Medical Center, Stanford, California, USA
- School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Disep I Ojukwu
- Department of Neurosurgery, Stanford University Medical Center, Stanford, California, USA
| | - Dan E Azagury
- Section of Minimally Invasive and Bariatric Surgery, Department of General Surgery, Stanford University Medical Center, Stanford, California, USA
| | - Debra L Safer
- Stanford Adult Eating and Weight Disorders Program, Department of Psychiatry, Stanford University Medical Center, Stanford, California, USA
| | - Tricia Cunningham
- Department of Neurosurgery, Stanford University Medical Center, Stanford, California, USA
| | - Casey H Halpern
- Department of Neurosurgery, Stanford University Medical Center, Stanford, California, USA
- Department of Neurosurgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
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23
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Effect of reward and punishment on no-risk decision-making in young men: an EEG study. Brain Res 2022; 1779:147788. [PMID: 35041842 DOI: 10.1016/j.brainres.2022.147788] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 01/10/2022] [Accepted: 01/11/2022] [Indexed: 11/20/2022]
Abstract
Decision-making is a process that allows adapting behavior in response to feedback to achieve a goal. Previous studies have suggested that the cerebral cortex shows different activation patterns in response to feedback. However, the effects of reward and punishment on learning contexts and decision-making are not clear. Thus, this experiment compared the effects of reward and punishment on behavior and the electroencephalographic activity of cortical areas related to decision-making in a no-risk context. Twenty healthy males were asked to perform a decision-making task under two conditions in which the goal was to finish in the shortest time possible. In the reward condition, the more points the participant accumulated the sooner the task ended, while in the punishment condition, the more points accumulated the longer the task lasted. Lower reaction times were found in the reward condition, characterized by a higher absolute power of the slow bands in almost all the cortices recorded. Changes in the interhemispheric correlation were also obtained in the comparison of the two feedback conditions. Results suggest that changes in the type of feedback affect cortical functionality and behavioral execution during decision-making, with the reward being related to a quick emotional response strategy and punishment associated with slower and, likely, more reasoned responses.
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24
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Local accumbens in vivo imaging during deep brain stimulation reveals a strategy-dependent amelioration of hedonic feeding. Proc Natl Acad Sci U S A 2022; 119:2109269118. [PMID: 34921100 PMCID: PMC8740575 DOI: 10.1073/pnas.2109269118] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2021] [Indexed: 11/18/2022] Open
Abstract
Impulsive overeating is a common, disabling feature of eating disorders. Calcium imaging using fiber photometry has emerged as an in vivo methodology to measure neuronal population activity immune to electrical stimulation artifact from deep brain stimulation (DBS). Thus, when used simultaneously, calcium imaging can elucidate poorly understood DBS mechanisms. We show that nucleus accumbens D1 medial spiny calcium signaling increases in preparation of hedonic feeding of high-fat food. Further, responsive, over continuous, DBS strategies effectively disrupt this activity leading to decreased consumption. Implementation of this methodology to better understand mechanisms of these and other forms of neuromodulation for various indications may help advance the field to identify novel therapeutic targets with applications extending beyond obesity. Impulsive overeating is a common, disabling feature of eating disorders. Both continuous deep brain stimulation (DBS) and responsive DBS, which limits current delivery to pathological brain states, have emerged as potential therapies. We used in vivo fiber photometry in wild-type, Drd1-cre, and A2a-cre mice to 1) assay subtype-specific medium spiny neuron (MSN) activity of the nucleus accumbens (NAc) during hedonic feeding of high-fat food, and 2) examine DBS strategy-specific effects on NAc activity. D1, but not D2, NAc GCaMP activity increased immediately prior to high-fat food approach. Responsive DBS triggered a GCaMP surge throughout the stimulation period and durably reduced high-fat intake. However, with continuous DBS, this surge decayed, and high-fat intake reemerged. Our results argue for a stimulation strategy-dependent modulation of D1 MSNs with a more sustained decrease in consumption with responsive DBS. This study illustrates the important role in vivo imaging can play in understanding effects of such novel therapies.
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25
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Neuroimaging and modulation in obesity and diabetes research: 10th anniversary meeting. Int J Obes (Lond) 2022; 46:718-725. [PMID: 34934178 PMCID: PMC8960390 DOI: 10.1038/s41366-021-01025-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 10/29/2021] [Accepted: 11/09/2021] [Indexed: 11/29/2022]
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26
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Martinez MC, Zold CL, Coletti MA, Murer MG, Belluscio MA. Dorsal striatum coding for the timely execution of action sequences. eLife 2022; 11:74929. [PMID: 36426715 PMCID: PMC9699698 DOI: 10.7554/elife.74929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 10/27/2022] [Indexed: 11/27/2022] Open
Abstract
The automatic initiation of actions can be highly functional. But occasionally these actions cannot be withheld and are released at inappropriate times, impulsively. Striatal activity has been shown to participate in the timing of action sequence initiation and it has been linked to impulsivity. Using a self-initiated task, we trained adult male rats to withhold a rewarded action sequence until a waiting time interval has elapsed. By analyzing neuronal activity we show that the striatal response preceding the initiation of the learned sequence is strongly modulated by the time subjects wait before eliciting the sequence. Interestingly, the modulation is steeper in adolescent rats, which show a strong prevalence of impulsive responses compared to adults. We hypothesize this anticipatory striatal activity reflects the animals’ subjective reward expectation, based on the elapsed waiting time, while the steeper waiting modulation in adolescence reflects age-related differences in temporal discounting, internal urgency states, or explore–exploit balance.
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Affiliation(s)
- Maria Cecilia Martinez
- Universidad de Buenos Aires, Facultad de Ciencias Exactas y Naturales, Departamento de Fisiología, Biología Molecular y Celular “Dr. Héctor Maldonado”Buenos AiresArgentina,Universidad de Buenos Aires - CONICET, Instituto de Fisiología y Biofísica “Dr. Bernardo Houssay” (IFIBIO-Houssay), Grupo de Neurociencia de SistemasBuenos AiresArgentina
| | - Camila Lidia Zold
- Universidad de Buenos Aires - CONICET, Instituto de Fisiología y Biofísica “Dr. Bernardo Houssay” (IFIBIO-Houssay), Grupo de Neurociencia de SistemasBuenos AiresArgentina,Universidad de Buenos Aires, Facultad de Ciencias Médicas, Departamento de FisiologíaBuenos AiresArgentina
| | - Marcos Antonio Coletti
- Universidad de Buenos Aires - CONICET, Instituto de Fisiología y Biofísica “Dr. Bernardo Houssay” (IFIBIO-Houssay), Grupo de Neurociencia de SistemasBuenos AiresArgentina,Universidad de Buenos Aires, Facultad de Ciencias Médicas, Departamento de FisiologíaBuenos AiresArgentina
| | - Mario Gustavo Murer
- Universidad de Buenos Aires - CONICET, Instituto de Fisiología y Biofísica “Dr. Bernardo Houssay” (IFIBIO-Houssay), Grupo de Neurociencia de SistemasBuenos AiresArgentina,Universidad de Buenos Aires, Facultad de Ciencias Médicas, Departamento de FisiologíaBuenos AiresArgentina
| | - Mariano Andrés Belluscio
- Universidad de Buenos Aires - CONICET, Instituto de Fisiología y Biofísica “Dr. Bernardo Houssay” (IFIBIO-Houssay), Grupo de Neurociencia de SistemasBuenos AiresArgentina,Universidad de Buenos Aires, Facultad de Ciencias Médicas, Departamento de FisiologíaBuenos AiresArgentina
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27
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Provenza NR, Sheth SA, Dastin-van Rijn EM, Mathura RK, Ding Y, Vogt GS, Avendano-Ortega M, Ramakrishnan N, Peled N, Gelin LFF, Xing D, Jeni LA, Ertugrul IO, Barrios-Anderson A, Matteson E, Wiese AD, Xu J, Viswanathan A, Harrison MT, Bijanki KR, Storch EA, Cohn JF, Goodman WK, Borton DA. Long-term ecological assessment of intracranial electrophysiology synchronized to behavioral markers in obsessive-compulsive disorder. Nat Med 2021; 27:2154-2164. [PMID: 34887577 PMCID: PMC8800455 DOI: 10.1038/s41591-021-01550-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 09/22/2021] [Indexed: 01/02/2023]
Abstract
Detection of neural signatures related to pathological behavioral states could enable adaptive deep brain stimulation (DBS), a potential strategy for improving efficacy of DBS for neurological and psychiatric disorders. This approach requires identifying neural biomarkers of relevant behavioral states, a task best performed in ecologically valid environments. Here, in human participants with obsessive-compulsive disorder (OCD) implanted with recording-capable DBS devices, we synchronized chronic ventral striatum local field potentials with relevant, disease-specific behaviors. We captured over 1,000 h of local field potentials in the clinic and at home during unstructured activity, as well as during DBS and exposure therapy. The wide range of symptom severity over which the data were captured allowed us to identify candidate neural biomarkers of OCD symptom intensity. This work demonstrates the feasibility and utility of capturing chronic intracranial electrophysiology during daily symptom fluctuations to enable neural biomarker identification, a prerequisite for future development of adaptive DBS for OCD and other psychiatric disorders.
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Affiliation(s)
- Nicole R Provenza
- Brown University School of Engineering, Providence, RI, USA
- Charles Stark Draper Laboratory, Cambridge, MA, USA
| | - Sameer A Sheth
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | | | - Raissa K Mathura
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Yaohan Ding
- Intelligent Systems Program, University of Pittsburgh, Pittsburgh, PA, USA
| | - Gregory S Vogt
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Michelle Avendano-Ortega
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Nithya Ramakrishnan
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Noam Peled
- MGH/HST Martinos Center for Biomedical Imaging, Charlestown, MA, USA
- Harvard Medical School, Cambridge, MA, USA
| | | | - David Xing
- Brown University School of Engineering, Providence, RI, USA
| | - Laszlo A Jeni
- Robotics Institute, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Itir Onal Ertugrul
- Department of Cognitive Science and Artificial Intelligence, Tilburg University, Tilburg, the Netherlands
| | | | - Evan Matteson
- Brown University School of Engineering, Providence, RI, USA
| | - Andrew D Wiese
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
- Department of Psychology, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Junqian Xu
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
- Department of Radiology, Baylor College of Medicine, Houston, TX, USA
| | - Ashwin Viswanathan
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | | | - Kelly R Bijanki
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Eric A Storch
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Jeffrey F Cohn
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Wayne K Goodman
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - David A Borton
- Brown University School of Engineering, Providence, RI, USA.
- Carney Institute for Brain Science, Brown University, Providence, RI, USA.
- Center for Neurorestoration and Neurotechnology, Rehabilitation R&D Service, Department of Veterans Affairs, Providence, RI, USA.
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28
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Sareen E, Zahar S, Ville DVD, Gupta A, Griffa A, Amico E. Exploring MEG brain fingerprints: Evaluation, pitfalls, and interpretations. Neuroimage 2021; 240:118331. [PMID: 34237444 DOI: 10.1016/j.neuroimage.2021.118331] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 06/22/2021] [Accepted: 07/01/2021] [Indexed: 12/16/2022] Open
Abstract
Individual characterization of subjects based on their functional connectome (FC), termed "FC fingerprinting", has become a highly sought-after goal in contemporary neuroscience research. Recent functional magnetic resonance imaging (fMRI) studies have demonstrated unique characterization and accurate identification of individuals as an accomplished task. However, FC fingerprinting in magnetoencephalography (MEG) data is still widely unexplored. Here, we study resting-state MEG data from the Human Connectome Project to assess the MEG FC fingerprinting and its relationship with several factors including amplitude- and phase-coupling functional connectivity measures, spatial leakage correction, frequency bands, and behavioral significance. To this end, we first employ two identification scoring methods, differential identifiability and success rate, to provide quantitative fingerprint scores for each FC measurement. Secondly, we explore the edgewise and nodal MEG fingerprinting patterns across the different frequency bands (delta, theta, alpha, beta, and gamma). Finally, we investigate the cross-modality fingerprinting patterns obtained from MEG and fMRI recordings from the same subjects. We assess the behavioral significance of FC across connectivity measures and imaging modalities using partial least square correlation analyses. Our results suggest that fingerprinting performance is heavily dependent on the functional connectivity measure, frequency band, identification scoring method, and spatial leakage correction. We report higher MEG fingerprinting performances in phase-coupling methods, central frequency bands (alpha and beta), and in the visual, frontoparietal, dorsal-attention, and default-mode networks. Furthermore, cross-modality comparisons reveal a certain degree of spatial concordance in fingerprinting patterns between the MEG and fMRI data, especially in the visual system. Finally, the multivariate correlation analyses show that MEG connectomes have strong behavioral significance, which however depends on the considered connectivity measure and temporal scale. This comprehensive, albeit preliminary investigation of MEG connectome test-retest identifiability offers a first characterization of MEG fingerprinting in relation to different methodological and electrophysiological factors and contributes to the understanding of fingerprinting cross-modal relationships. We hope that this first investigation will contribute to setting the grounds for MEG connectome identification.
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Affiliation(s)
- Ekansh Sareen
- Signal Processing and Biomedical Imaging, Dept. of Electronics and Communication Engineering, IIIT-Delhi, New Delhi, India
| | - Sélima Zahar
- Institute of Bioengineering, Center for Neuroprosthetics, École Polytechnique Fédérale De Lausanne (EPFL), Geneva, Switzerland
| | - Dimitri Van De Ville
- Institute of Bioengineering, Center for Neuroprosthetics, École Polytechnique Fédérale De Lausanne (EPFL), Geneva, Switzerland; Department of Radiology and Medical Informatics, University of Geneva (UNIGE), Geneva, Switzerland
| | - Anubha Gupta
- Signal Processing and Biomedical Imaging, Dept. of Electronics and Communication Engineering, IIIT-Delhi, New Delhi, India
| | - Alessandra Griffa
- Institute of Bioengineering, Center for Neuroprosthetics, École Polytechnique Fédérale De Lausanne (EPFL), Geneva, Switzerland; Department of Clinical Neurosciences, Division of Neurology, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Enrico Amico
- Institute of Bioengineering, Center for Neuroprosthetics, École Polytechnique Fédérale De Lausanne (EPFL), Geneva, Switzerland; Department of Radiology and Medical Informatics, University of Geneva (UNIGE), Geneva, Switzerland.
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29
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The insulo-opercular cortex encodes food-specific content under controlled and naturalistic conditions. Nat Commun 2021; 12:3609. [PMID: 34127675 PMCID: PMC8203663 DOI: 10.1038/s41467-021-23885-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 05/13/2021] [Indexed: 12/02/2022] Open
Abstract
The insulo-opercular network functions critically not only in encoding taste, but also in guiding behavior based on anticipated food availability. However, there remains no direct measurement of insulo-opercular activity when humans anticipate taste. Here, we collect direct, intracranial recordings during a food task that elicits anticipatory and consummatory taste responses, and during ad libitum consumption of meals. While cue-specific high-frequency broadband (70–170 Hz) activity predominant in the left posterior insula is selective for taste-neutral cues, sparse cue-specific regions in the anterior insula are selective for palatable cues. Latency analysis reveals this insular activity is preceded by non-discriminatory activity in the frontal operculum. During ad libitum meal consumption, time-locked high-frequency broadband activity at the time of food intake discriminates food types and is associated with cue-specific activity during the task. These findings reveal spatiotemporally-specific activity in the human insulo-opercular cortex that underlies anticipatory evaluation of food across both controlled and naturalistic settings. Animal studies have shown that insulo-opercular network function is critical in gustation and in behaviour based on anticipated food availability. The authors describe activities within the human insulo-opercular cortex which underlie anticipatory food evaluation in both controlled and naturalistic settings.
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30
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Kuijper FM, Mahajan UV, Ku S, Barbosa DAN, Alessi SM, Stein SC, Kampman KM, Bentzley BS, Halpern CH. Deep Brain Stimulation Compared With Contingency Management for the Treatment of Cocaine Use Disorders: A Threshold and Cost-Effectiveness Analysis. Neuromodulation 2021; 25:253-262. [PMID: 34028131 DOI: 10.1111/ner.13410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 03/13/2021] [Accepted: 04/05/2021] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Cocaine is the second most frequently used illicit drug worldwide (after cannabis), and cocaine use disorder (CUD) related deaths increased globally by 80% from 1990 to 2013. There is yet to be a regulatory-approved treatment. Emerging preclinical evidence indicates that deep brain stimulation (DBS) of the nucleus accumbens may be a therapeutic option. Prior to expanding the costly investigation of DBS for treatment of CUD, it is important to ensure societal cost-effectiveness. AIMS We conducted a threshold and cost-effectiveness analysis to determine the success rate at which DBS would be equivalent to contingency management (CM), recently identified as the most efficacious therapy for treatments of CUDs. MATERIALS AND METHODS Quality of life, efficacy, and safety parameters for CM were obtained from previous literature. Costs were calculated from a societal perspective. Our model predicted the utility benefit based on quality-adjusted-life-years (QALYs) and incremental-cost-effectiveness-ratio resulting from two treatments on a one-, two-, and five-year timeline. RESULTS On a one-year timeline, DBS would need to impart a success rate (i.e., cocaine free) of 70% for it to yield the same utility benefit (0.492 QALYs per year) as CM. At no success rate would DBS be more cost-effective (incremental-cost-effectiveness-ratio <$50,000) than CM during the first year. Nevertheless, as DBS costs are front-loaded, DBS would need to achieve success rates of 74% and 51% for its cost-effectiveness to exceed that of CM over a two- and five-year period, respectively. CONCLUSIONS We find DBS would not be cost-effective in the short-term (one year) but may be cost-effective in longer timelines. Since DBS holds promise to potentially be a cost-effective treatment for CUDs, future randomized controlled trials should be performed to assess its efficacy.
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Affiliation(s)
- Fiene Marie Kuijper
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Uma V Mahajan
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Seul Ku
- Department of Medicine, Stanford University, Stanford, CA, USA
| | - Daniel A N Barbosa
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Sherman C Stein
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Kyle M Kampman
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Brandon S Bentzley
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Casey H Halpern
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
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31
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Christoffel DJ, Walsh JJ, Heifets BD, Hoerbelt P, Neuner S, Sun G, Ravikumar VK, Wu H, Halpern CH, Malenka RC. Input-specific modulation of murine nucleus accumbens differentially regulates hedonic feeding. Nat Commun 2021; 12:2135. [PMID: 33837200 PMCID: PMC8035198 DOI: 10.1038/s41467-021-22430-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 03/05/2021] [Indexed: 02/08/2023] Open
Abstract
Hedonic feeding is driven by the "pleasure" derived from consuming palatable food and occurs in the absence of metabolic need. It plays a critical role in the excessive feeding that underlies obesity. Compared to other pathological motivated behaviors, little is known about the neural circuit mechanisms mediating excessive hedonic feeding. Here, we show that modulation of prefrontal cortex (PFC) and anterior paraventricular thalamus (aPVT) excitatory inputs to the nucleus accumbens (NAc), a key node of reward circuitry, has opposing effects on high fat intake in mice. Prolonged high fat intake leads to input- and cell type-specific changes in synaptic strength. Modifying synaptic strength via plasticity protocols, either in an input-specific optogenetic or non-specific electrical manner, causes sustained changes in high fat intake. These results demonstrate that input-specific NAc circuit adaptations occur with repeated exposure to a potent natural reward and suggest that neuromodulatory interventions may be therapeutically useful for individuals with pathologic hedonic feeding.
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Affiliation(s)
- Daniel J Christoffel
- Nancy Pritzker Laboratory, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Jessica J Walsh
- Nancy Pritzker Laboratory, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Boris D Heifets
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Paul Hoerbelt
- Nancy Pritzker Laboratory, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Sophie Neuner
- Nancy Pritzker Laboratory, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Gordon Sun
- Nancy Pritzker Laboratory, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Vinod K Ravikumar
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Hemmings Wu
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Casey H Halpern
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Robert C Malenka
- Nancy Pritzker Laboratory, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA.
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32
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Accumbens coordinated reset stimulation in mice exhibits ameliorating aftereffects on binge alcohol drinking. Brain Stimul 2021; 14:330-334. [PMID: 33524612 DOI: 10.1016/j.brs.2021.01.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 01/09/2021] [Accepted: 01/21/2021] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Alcohol use disorder (AUD) affects nearly 5% of the world's adult population. Despite treatment, AUD often manifests with relapse to binge drinking, which has been associated with corticostriatal hypersynchrony involving the nucleus accumbens (NAc). METHODS A modified "Drinking in the Dark" protocol was used to provoke binge-like alcohol drinking. We implemented Coordinated Reset Stimulation (CRS), a computationally designed, spatio-temporal stimulation algorithm, to desynchronize abnormal neuronal activity via a deep brain stimulation (DBS) electrode in the NAc of mice exhibiting binge-like alcohol drinking. Integral CRS charge injected would be 2.5% of that of conventional high-frequency DBS. RESULTS NAc CRS delivery during only the initial phase of exposure to alcohol and prior to the exposure (but not during) significantly reduced binge-like drinking without interfering with social behavior or locomotor activity. CONCLUSIONS NAc CRS ameliorates binge-like alcohol drinking and preliminarily exhibits sustained aftereffects that are suggestive of an unlearning of hypersynchrony.
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33
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Zhou P, Liu Z, Wu H, Wang Y, Lei Y, Abbaszadeh S. Automatically detecting bregma and lambda points in rodent skull anatomy images. PLoS One 2020; 15:e0244378. [PMID: 33373400 PMCID: PMC7771702 DOI: 10.1371/journal.pone.0244378] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 12/08/2020] [Indexed: 11/24/2022] Open
Abstract
Currently, injection sites of probes, cannula, and optic fibers in stereotactic neurosurgery are typically located manually. This step involves location estimations based on human experiences and thus introduces errors. In order to reduce localization error and improve repeatability of experiments and treatments, we investigate an automated method to locate injection sites. This paper proposes a localization framework, which integrates a region-based convolutional network and a fully convolutional network, to locate specific anatomical points on skulls of rodents. Experiment results show that the proposed localization framework is capable of identifying and locatin bregma and lambda in rodent skull anatomy images with mean errors less than 300 μm. This method is robust to different lighting conditions and mouse orientations, and has the potential to simplify the procedure of locating injection sites.
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Affiliation(s)
- Peng Zhou
- Department of Electrical and Computer Engineering, University of California, Santa Cruz, Santa Cruz, California, United States of America
| | - Zheng Liu
- Department of Nuclear, Plasma, and Radiological Engineering, University of Illinois at Urbana-Champaign, Urbana, Illinois, United States of America
| | - Hemmings Wu
- Department of Neurosurgery, Stanford University, Palo Alto, California, United States of America
| | - Yuli Wang
- Department of Electrical and Computer Engineering, University of California, Santa Cruz, Santa Cruz, California, United States of America
| | - Yong Lei
- State Key Laboratory of Fluid Power and Mechatronic Systems, School of Mechanical Engineering, Zhejiang University, Hangzhou, China
| | - Shiva Abbaszadeh
- Department of Electrical and Computer Engineering, University of California, Santa Cruz, Santa Cruz, California, United States of America
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34
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Yilmaz Balban M, Cafaro E, Saue-Fletcher L, Washington MJ, Bijanzadeh M, Lee AM, Chang EF, Huberman AD. Human Responses to Visually Evoked Threat. Curr Biol 2020; 31:601-612.e3. [PMID: 33242389 DOI: 10.1016/j.cub.2020.11.035] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 10/20/2020] [Accepted: 11/13/2020] [Indexed: 12/12/2022]
Abstract
Vision is the primary sense humans use to evaluate and respond to threats. Understanding the biological underpinnings of the human threat response has been hindered by lack of realistic in-lab threat paradigms. We established an immersive virtual reality (VR) platform to simultaneously measure behavior, physiological state, and neural activity from the human brain using chronically implanted electrodes. Subjects with high anxiety showed increased visual scanning in response to threats as compared to healthy controls. In both healthy and anxious subjects, the amount of scanning behavior correlated with the magnitude of physiological arousal, suggesting that visual scanning behavior is directly linked to internal state. Intracranial electroencephalography (iEEG) recordings from three subjects suggested that high-frequency gamma activity in the insula positively correlates with physiological arousal induced by visual threats and that low-frequency theta activity in the orbitofrontal cortex (OFC) negatively correlates with physiological arousal induced by visual threats. These findings reveal a key role of eye movements and suggest that distinct insula and OFC activation dynamics may be important for detecting and adjusting human stress in response to visually perceived threats.
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Affiliation(s)
- Melis Yilmaz Balban
- Department of Neurobiology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Erin Cafaro
- Department of Neurobiology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Lauren Saue-Fletcher
- Department of Neurobiology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Marlon J Washington
- Department of Neurobiology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Maryam Bijanzadeh
- Department of Neurological Surgery, University of California, San Francisco, 400 Parnassus Avenue, San Francisco, CA 94143, USA
| | - A Moses Lee
- Department of Neurological Surgery, University of California, San Francisco, 400 Parnassus Avenue, San Francisco, CA 94143, USA
| | - Edward F Chang
- Department of Neurological Surgery, University of California, San Francisco, 400 Parnassus Avenue, San Francisco, CA 94143, USA
| | - Andrew D Huberman
- Department of Neurobiology, Stanford University School of Medicine, Stanford, CA 94305, USA; Department of Ophthalmology, Stanford University School of Medicine, Stanford, CA 94305, USA; BioX, Stanford University School of Medicine, Stanford, CA 94305, USA.
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Wu H, Adler S, Azagury DE, Bohon C, Safer DL, Barbosa DAN, Bhati MT, Williams NR, Dunn LB, Tass PA, Knutson BD, Yutsis M, Fraser A, Cunningham T, Richardson K, Skarpaas TL, Tcheng TK, Morrell MJ, Roberts LW, Malenka RC, Lock JD, Halpern CH. Brain-Responsive Neurostimulation for Loss of Control Eating: Early Feasibility Study. Neurosurgery 2020; 87:1277-1288. [PMID: 32717033 PMCID: PMC8599841 DOI: 10.1093/neuros/nyaa300] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 05/02/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Loss of control (LOC) is a pervasive feature of binge eating, which contributes significantly to the growing epidemic of obesity; approximately 80 million US adults are obese. Brain-responsive neurostimulation guided by the delta band was previously found to block binge-eating behavior in mice. Following novel preclinical work and a human case study demonstrating an association between the delta band and reward anticipation, the US Food and Drug Administration approved an Investigational Device Exemption for a first-in-human study. OBJECTIVE To assess feasibility, safety, and nonfutility of brain-responsive neurostimulation for LOC eating in treatment-refractory obesity. METHODS This is a single-site, early feasibility study with a randomized, single-blinded, staggered-onset design. Six subjects will undergo bilateral brain-responsive neurostimulation of the nucleus accumbens for LOC eating using the RNS® System (NeuroPace Inc). Eligible participants must have treatment-refractory obesity with body mass index ≥ 45 kg/m2. Electrophysiological signals of LOC will be characterized using real-time recording capabilities coupled with synchronized video monitoring. Effects on other eating disorder pathology, mood, neuropsychological profile, metabolic syndrome, and nutrition will also be assessed. EXPECTED OUTCOMES Safety/feasibility of brain-responsive neurostimulation of the nucleus accumbens will be examined. The primary success criterion is a decrease of ≥1 LOC eating episode/week based on a 28-d average in ≥50% of subjects after 6 mo of responsive neurostimulation. DISCUSSION This study is the first to use brain-responsive neurostimulation for obesity; this approach represents a paradigm shift for intractable mental health disorders.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Casey H Halpern
- Correspondence: Casey H. Halpern, MD, Department of Neurosurgery, Stanford University School of Medicine, 300 Pasteur Drive (R-227), Stanford, CA 94305-5327, USA.
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36
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Topalovic U, Aghajan ZM, Villaroman D, Hiller S, Christov-Moore L, Wishard TJ, Stangl M, Hasulak NR, Inman CS, Fields TA, Rao VR, Eliashiv D, Fried I, Suthana N. Wireless Programmable Recording and Stimulation of Deep Brain Activity in Freely Moving Humans. Neuron 2020; 108:322-334.e9. [PMID: 32946744 PMCID: PMC7785319 DOI: 10.1016/j.neuron.2020.08.021] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 07/11/2020] [Accepted: 08/20/2020] [Indexed: 12/29/2022]
Abstract
Uncovering the neural mechanisms underlying human natural ambulatory behavior is a major challenge for neuroscience. Current commercially available implantable devices that allow for recording and stimulation of deep brain activity in humans can provide invaluable intrinsic brain signals but are not inherently designed for research and thus lack flexible control and integration with wearable sensors. We developed a mobile deep brain recording and stimulation (Mo-DBRS) platform that enables wireless and programmable intracranial electroencephalographic recording and electrical stimulation integrated and synchronized with virtual reality/augmented reality (VR/AR) and wearables capable of external measurements (e.g., motion capture, heart rate, skin conductance, respiration, eye tracking, and scalp EEG). When used in freely moving humans with implanted neural devices, this platform is adaptable to ecologically valid environments conducive to elucidating the neural mechanisms underlying naturalistic behaviors and to the development of viable therapies for neurologic and psychiatric disorders.
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Affiliation(s)
- Uros Topalovic
- Department of Electrical and Computer Engineering, University of California, Los Angeles, Los Angeles, CA 90095, USA; Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA 90024, USA
| | - Zahra M Aghajan
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA 90024, USA
| | - Diane Villaroman
- Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Sonja Hiller
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA 90024, USA
| | - Leonardo Christov-Moore
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA 90024, USA
| | - Tyler J Wishard
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA 90024, USA
| | - Matthias Stangl
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA 90024, USA
| | | | - Cory S Inman
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA 90024, USA
| | - Tony A Fields
- Department of Neurology, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Vikram R Rao
- Department of Neurology and Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Dawn Eliashiv
- Department of Neurology, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Itzhak Fried
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA 90024, USA; Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA; Tel Aviv Sourasky Medical Center and Sackler Faculty School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Nanthia Suthana
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA 90024, USA; Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA; Department of Bioengineering, University of California, Los Angeles, Los Angeles, CA 90095, USA; Department of Psychology, University of California, Los Angeles, Los Angeles, CA 90095, USA.
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37
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Upadhyayula PS, Rennert RC, Martin JR, Yue JK, Yang J, Gillis-Buck EM, Sidhu N, Cheung CK, Lee AT, Hoshide RR, Ciacci JD. Basal impulses: findings from the last twenty years on impulsivity and reward pathways using deep brain stimulation. J Neurosurg Sci 2020; 64:544-551. [PMID: 32972108 DOI: 10.23736/s0390-5616.20.04906-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Deep brain stimulation (DBS) is an important treatment modality for movement disorders. Its role in tasks and processes of higher cortical function continues to increase in importance and relevance. This systematic review investigates the impact of DBS on measures of impulsivity. EVIDENCE ACQUISITION A total of 45 studies were collated from PubMed (30 prospective, 8 animal, 4 questionnaire-based, and 3 computational models), excluding case reports and review articles. Two areas extensively studied are the subthalamic nucleus (STN) and nucleus accumbens (NAc). EVIDENCE SYNTHESIS While both are part of the basal ganglia, the STN and NAc have extensive connections to the prefrontal cortex, cingulate cortex, and limbic system. Therefore, understanding cause and treatment of impulsivity requires understanding motor pathways, learning, memory, and emotional processing. DBS of the STN and NAc shell can increase objective measures of impulsivity, as measured by reaction times or reward-based learning, independent from patient insight. The ability for DBS to treat impulse control disorders, and also cause and/or worsen impulsivity in Parkinson's disease, may be explained by the affected closely-related neuroanatomical areas with discrete and sometimes opposing functions. CONCLUSIONS As newer, more refined DBS technology emerges, large-scale prospective studies specifically aimed at treatment of impulsivity disorders are needed.
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Affiliation(s)
- Pavan S Upadhyayula
- Department of Neurological Surgery, University of California San Diego, San Diego, CA, USA
| | - Robert C Rennert
- Department of Neurological Surgery, University of California San Diego, San Diego, CA, USA
| | - Joel R Martin
- Department of Neurological Surgery, University of California San Diego, San Diego, CA, USA
| | - John K Yue
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Jason Yang
- Department of Neurological Surgery, University of California San Diego, San Diego, CA, USA
| | - Eva M Gillis-Buck
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Nikki Sidhu
- Department of Neurological Surgery, University of California San Diego, San Diego, CA, USA
| | - Christopher K Cheung
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Anthony T Lee
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Reid R Hoshide
- Department of Neurological Surgery, University of California San Diego, San Diego, CA, USA
| | - Joseph D Ciacci
- Department of Neurological Surgery, University of California San Diego, San Diego, CA, USA -
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Jarosiewicz B, Morrell M. The RNS System: brain-responsive neurostimulation for the treatment of epilepsy. Expert Rev Med Devices 2020; 18:129-138. [PMID: 32936673 DOI: 10.1080/17434440.2019.1683445] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Introduction: Epilepsy affects more than 1% of the US population, and over 30% of adults with epilepsy do not respond to antiseizure medications without life-impacting medication-related side effects. Resection of the seizure focus is not an option for many patients because it would cause unacceptable neurological or cognitive harm. For these patients, neuromodulation has emerged as a nondestructive, effective, and safe alternative. The NeuroPace® RNS® System, the only brain-responsive neurostimulation device, records neural activity from leads placed at one or two seizure foci. When the neurostimulator detects epileptiform activity, as defined for each patient by his or her physician, brief pulses of electrical stimulation are delivered to normalize the activity.Areas covered: This review describes the RNS System, the results of multi-year clinical trials, and the research discoveries enabled by the chronic ambulatory brain data collected by the RNS System.Expert commentary: Brain-responsive neurostimulation could potentially be used to treat any episodic neurological disorder that's accompanied by a neurophysiological biomarker of severity. Combining advanced machine learning approaches with the chronic ambulatory brain data collected by the RNS System could eventually enable automatic fine-tuning of detection and stimulation for each patient, creating a general-purpose neurotechnological platform for precision medicine.
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Affiliation(s)
| | - Martha Morrell
- NeuroPace, Inc, Mountain View, CA, USA.,Neurology & Neurological Sciences, Stanford University, Stanford Neuroscience Health Center, Palo Alto, CA, USA
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39
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Qiao S, Sedillo JI, Brown KA, Ferrentino B, Pesaran B. A Causal Network Analysis of Neuromodulation in the Mood Processing Network. Neuron 2020; 107:972-985.e6. [PMID: 32645299 DOI: 10.1016/j.neuron.2020.06.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 04/21/2020] [Accepted: 06/09/2020] [Indexed: 12/19/2022]
Abstract
Neural decoding and neuromodulation technologies hold great promise for treating mood and other brain disorders in next-generation therapies that manipulate functional brain networks. Here we perform a novel causal network analysis to decode multiregional communication in the primate mood processing network and determine how neuromodulation, short-burst tetanic microstimulation (sbTetMS), alters multiregional network communication. The causal network analysis revealed a mechanism of network excitability that regulates when a sender stimulation site communicates with receiver sites. Decoding network excitability from neural activity at modulator sites predicted sender-receiver communication, whereas sbTetMS neuromodulation temporarily disrupted sender-receiver communication. These results reveal specific network mechanisms of multiregional communication and suggest a new generation of brain therapies that combine neural decoding to predict multiregional communication with neuromodulation to disrupt multiregional communication.
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Affiliation(s)
- Shaoyu Qiao
- Center for Neural Science, New York University, New York, NY 10003, USA
| | - J Isaac Sedillo
- Center for Neural Science, New York University, New York, NY 10003, USA
| | - Kevin A Brown
- Center for Neural Science, New York University, New York, NY 10003, USA
| | | | - Bijan Pesaran
- Center for Neural Science, New York University, New York, NY 10003, USA; Neuroscience Institute, New York University Langone Health, New York, NY 10016, USA; Department of Neurology, New York University Langone Health, New York, NY 10016, USA.
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40
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Smith EE, Schüller T, Huys D, Baldermann JC, Andrade P, Allen JJ, Visser-Vandewalle V, Ullsperger M, Gruendler TOJ, Kuhn J. A brief demonstration of frontostriatal connectivity in OCD patients with intracranial electrodes. Neuroimage 2020; 220:117138. [PMID: 32634597 DOI: 10.1016/j.neuroimage.2020.117138] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 06/19/2020] [Accepted: 07/02/2020] [Indexed: 01/05/2023] Open
Abstract
Closed-loop neuromodulation is presumed to be the logical evolution for improving the effectiveness of deep brain stimulation (DBS) treatment protocols (Widge et al., 2018). Identifying symptom-relevant biomarkers that provide meaningful feedback to stimulator devices is an important initial step in this direction. This report demonstrates a technique for assaying neural circuitry hypothesized to contribute to OCD and DBS treatment outcomes. We computed phase-lag connectivity between LFPs and EEGs in thirteen treatment-refractory OCD patients. Simultaneous recordings from scalp EEG and externalized DBS electrodes in the ventral capsule/ventral striatum (VC/VS) were collected at rest during the perioperative treatment stage. Connectivity strength between midfrontal EEG sensors and VC/VS electrodes correlated with baseline OCD symptoms and 12-month posttreatment OCD symptoms. Results are qualified by a relatively small sample size, and limitations regarding the conclusiveness of VS and mPFC as neural generators given some concerns about volume conduction. Nonetheless, findings are consistent with treatment-relevant tractography findings and theories that link frontostriatal hyperconnectivity to the etiopathogenesis of OCD. Findings support the continued investigation of connectivity-based assays for aiding in determination of optimal stimulation location, and are an initial step towards the identification of biomarkers that can guide closed-loop neuromodulation systems.
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Affiliation(s)
- Ezra E Smith
- Division of Translational Epidemiology, New York State Psychiatric Institute, New York, NY, USA; Department of Psychology, University of Arizona, Tucson, AZ, USA.
| | - Thomas Schüller
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Psychiatry and Psychotherapy, University Hospital Cologne, Cologne, Germany
| | - Daniel Huys
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Psychiatry and Psychotherapy, University Hospital Cologne, Cologne, Germany
| | - Juan Carlos Baldermann
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Psychiatry and Psychotherapy, University Hospital Cologne, Cologne, Germany; University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, University Hospital Cologne, Cologne, Germany
| | - Pablo Andrade
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Stereotactic and Functional Neurosurgery, Cologne, Germany
| | - John Jb Allen
- Department of Psychology, University of Arizona, Tucson, AZ, USA
| | - Veerle Visser-Vandewalle
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Stereotactic and Functional Neurosurgery, Cologne, Germany
| | - Markus Ullsperger
- Otto von Guericke University, Institute of Psychology, Magdeburg, Germany; Center for Behavioral Brain Sciences, Magdeburg, Germany
| | - Theo O J Gruendler
- Center for Military Mental Health, Military Hospital Berlin, Berlin, Germany
| | - Jens Kuhn
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Psychiatry and Psychotherapy, University Hospital Cologne, Cologne, Germany; Department of Psychiatry, Psychotherapy, and Psychosomatics, Johanniter Hospital Oberhausen, Oberhausen, Germany
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41
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Kakusa B, Saluja S, Dadey DYA, Barbosa DAN, Gattas S, Miller KJ, Cowan RP, Kouyoumdjian Z, Pouratian N, Halpern CH. Electrophysiology and Structural Connectivity of the Posterior Hypothalamic Region: Much to Learn From a Rare Indication of Deep Brain Stimulation. Front Hum Neurosci 2020; 14:164. [PMID: 32670034 PMCID: PMC7326144 DOI: 10.3389/fnhum.2020.00164] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 04/15/2020] [Indexed: 12/18/2022] Open
Abstract
Cluster headache (CH) is among the most common and debilitating autonomic cephalalgias. We characterize clinical outcomes of deep brain stimulation (DBS) to the posterior hypothalamic region through a novel analysis of the electrophysiological topography and tractography-based structural connectivity. The left posterior hypothalamus was targeted ipsilateral to the refractory CH symptoms. Intraoperatively, field potentials were captured in 1 mm depth increments. Whole-brain probabilistic tractography was conducted to assess the structural connectivity of the estimated volume of activated tissue (VAT) associated with therapeutic response. Stimulation of the posterior hypothalamic region led to the resolution of CH symptoms, and this benefit has persisted for 1.5-years post-surgically. Active contacts were within the posterior hypothalamus and dorsoposterior border of the ventral anterior thalamus (VAp). Delta- (3 Hz) and alpha-band (8 Hz) powers increased and peaked with proximity to the posterior hypothalamus. In the posterior hypothalamus, the delta-band phase was coupled to beta-band amplitude, the latter of which has been shown to increase during CH attacks. Finally, we identified that the VAT encompassing these regions had a high proportion of streamlines of pain processing regions, including the insula, anterior cingulate gyrus, inferior parietal lobe, precentral gyrus, and the brainstem. Our unique case study of posterior hypothalamic region DBS supports durable efficacy and provides a platform using electrophysiological topography and structural connectivity, to improve mechanistic understanding of CH and this promising therapy.
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Affiliation(s)
- Bina Kakusa
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, United States
| | - Sabir Saluja
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, United States
| | - David Y A Dadey
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, United States
| | - Daniel A N Barbosa
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, United States
| | - Sandra Gattas
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, United States
| | - Kai J Miller
- Department of Neurosurgery, Mayo Clinic, Rochester, MN, United States
| | - Robert P Cowan
- Department of Neurology and Neurosciences, Stanford University School of Medicine, Stanford, CA, United States
| | - Zepure Kouyoumdjian
- Department of Neurology, South Valley Neurology, Morgan Hill, CA, United States
| | - Nader Pouratian
- Department of Neurosurgery, School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Casey H Halpern
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, United States
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42
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Hoang KB, Turner DA. The Emerging Role of Biomarkers in Adaptive Modulation of Clinical Brain Stimulation. Neurosurgery 2020; 85:E430-E439. [PMID: 30957145 DOI: 10.1093/neuros/nyz096] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 03/01/2019] [Indexed: 11/14/2022] Open
Abstract
Therapeutic brain stimulation has proven efficacious for treatment of nervous system diseases, exerting widespread influence via disease-specific neural networks. Activation or suppression of neural networks could theoretically be assessed by either clinical symptom modification (ie, tremor, rigidity, seizures) or development of specific biomarkers linked to treatment of symptomatic disease states. For example, biomarkers indicative of disease state could aid improved intraoperative localization of electrode position, optimize device efficacy or efficiency through dynamic control, and eventually serve to guide automatic adjustment of stimulation settings. Biomarkers to control either extracranial or intracranial stimulation span from continuous physiological brain activity, intermittent pathological activity, and triggered local phenomena or potentials, to wearable devices, blood flow, biochemical or cardiac signals, temperature perturbations, optical or magnetic resonance imaging changes, or optogenetic signals. The goal of this review is to update new approaches to implement control of stimulation through relevant biomarkers. Critical questions include whether adaptive systems adjusted through biomarkers can optimize efficiency and eventually efficacy, serve as inputs for stimulation adjustment, and consequently broaden our fundamental understanding of abnormal neural networks in pathologic states. Neurosurgeons are at the forefront of translating and developing biomarkers embedded within improved brain stimulation systems. Thus, criteria for developing and validating biomarkers for clinical use are important for the adaptation of device approaches into clinical practice.
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Affiliation(s)
- Kimberly B Hoang
- Department of Neurosurgery, MD Anderson Cancer Center, Houston, Texas
| | - Dennis A Turner
- Departments of Neurosurgery, Duke University Medical Center, Durham, North Carolina.,Department of Neurobiology, Duke University Medical Center, Durham, North Carolina.,Department of Biomedical Engineering, Duke University, Durham, North Carolina
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43
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Takeuchi Y, Berényi A. Oscillotherapeutics - Time-targeted interventions in epilepsy and beyond. Neurosci Res 2020; 152:87-107. [PMID: 31954733 DOI: 10.1016/j.neures.2020.01.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 12/18/2019] [Accepted: 12/19/2019] [Indexed: 02/09/2023]
Abstract
Oscillatory brain activities support many physiological functions from motor control to cognition. Disruptions of the normal oscillatory brain activities are commonly observed in neurological and psychiatric disorders including epilepsy, Parkinson's disease, Alzheimer's disease, schizophrenia, anxiety/trauma-related disorders, major depressive disorders, and drug addiction. Therefore, these disorders can be considered as common oscillation defects despite having distinct behavioral manifestations and genetic causes. Recent technical advances of neuronal activity recording and analysis have allowed us to study the pathological oscillations of each disorder as a possible biomarker of symptoms. Furthermore, recent advances in brain stimulation technologies enable time- and space-targeted interventions of the pathological oscillations of both neurological disorders and psychiatric disorders as possible targets for regulating their symptoms.
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Affiliation(s)
- Yuichi Takeuchi
- MTA-SZTE 'Momentum' Oscillatory Neuronal Networks Research Group, Department of Physiology, University of Szeged, Szeged, 6720, Hungary; Department of Neuropharmacology, Graduate School of Pharmaceutical Sciences, Nagoya City University, Nagoya, 467-8603, Japan.
| | - Antal Berényi
- MTA-SZTE 'Momentum' Oscillatory Neuronal Networks Research Group, Department of Physiology, University of Szeged, Szeged, 6720, Hungary; HCEMM-SZTE Magnetotherapeutics Research Group, University of Szeged, Szeged, 6720, Hungary; Neuroscience Institute, New York University, New York, NY 10016, USA.
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44
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Prefrontal delta oscillations during deep brain stimulation predict treatment success in patients with obsessive-compulsive disorder. Brain Stimul 2020; 13:259-261. [DOI: 10.1016/j.brs.2019.09.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 09/21/2019] [Indexed: 12/20/2022] Open
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Bina RW, Langevin JP. Developing New Indications: Strategies and Hurdles to Discovery. Stereotact Funct Neurosurg 2020. [DOI: 10.1007/978-3-030-34906-6_35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Cruz-Cano R, Rangel-Gomez M, Van Wagoner C, Kidanu A, Brinkman M, Clark P. The acceptability of smokeless tobacco products depends on nicotine levels. Addict Behav Rep 2019; 10:100217. [PMID: 31517021 PMCID: PMC6728877 DOI: 10.1016/j.abrep.2019.100217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 08/08/2019] [Accepted: 08/24/2019] [Indexed: 11/18/2022] Open
Abstract
Understanding the role nicotine plays in initiating and sustaining addiction has been of interest for the scientific community and general population, with the idea that low levels of nicotine will reduce abuse liability associated with smokeless tobacco products. Previously, research has relied on subjective assessments to determine consumer acceptability, but these measures cannot provide a characterization of the physiological responses associated with nicotine use. Consumer acceptability arises from psychological and neurophysiological factors, thus establishing the need to use subjective and objective measurements in conjunction. This study provides a comprehensive characterization of the subjective and objective effects of smokeless tobacco product use with varying levels of nicotine. EEG data were recorded before and after the use of four different smokeless tobacco products and one control product over five separate visits, with participants arriving to each visit after 12 h of tobacco abstinence. These products have distinct consumer acceptability levels and patterns of use characteristics ranging from starter products to those used primarily by established users. Subjective results showed that smokeless tobacco products with higher levels of nicotine were more successful in reducing craving and more reinforcing than those with lower levels. These results were concordant with the activity present in the EEG recordings where products with high nicotine levels produced larger changes in the amplitude of the event-related signal than those with low levels. This study is fundamental in understanding the relationship between subjective and objective smokeless tobacco acceptability measurements, as mediated by the different levels of nicotine in each product.
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Affiliation(s)
| | | | | | - A. Kidanu
- University of Maryland, College Park
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Abstract
The mechanisms of appetite disorders, such as refractory obesity and anorexia nervosa, have been vigorously studied over the last century, and these studies have shown that the central nervous system has significant involvement with, and responsibility for, the pathology associated with these diseases. Because deep brain stimulation has been shown to be a safe, efficacious, and adjustable treatment modality for a variety of other neurological disorders, it has also been studied as a possible treatment for appetite disorders. In studies of refractory obesity in animal models, the ventromedial hypothalamus, the lateral hypothalamus, and the nucleus accumbens have all demonstrated elements of success as deep brain stimulation targets. Multiple targets for deep brain stimulation have been proposed for anorexia nervosa, with research predominantly focusing on the subcallosal cingulate, the nucleus accumbens, and the stria terminalis and medial forebrain bundle. Human deep brain stimulation studies that focus specifically on refractory obesity and anorexia nervosa have been performed but with limited numbers of patients. In these studies, the target for refractory obesity has been the lateral hypothalamus, ventromedial hypothalamus, and nucleus accumbens, and the target for anorexia nervosa has been the subcallosal cingulate. These studies have shown promising findings, but further research is needed to elucidate the long-term efficacy of deep brain stimulation for the treatment of appetite disorders.
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Affiliation(s)
- Alexander C Whiting
- 1Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
| | - Michael Y Oh
- 2Department of Neurosurgery, Allegheny Health Network, Pittsburgh, Pennsylvania
| | - Donald M Whiting
- 2Department of Neurosurgery, Allegheny Health Network, Pittsburgh, Pennsylvania
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Cartmell SC, Tian Q, Thio BJ, Leuze C, Ye L, Williams NR, Yang G, Ben-Dor G, Deisseroth K, Grill WM, McNab JA, Halpern CH. Multimodal characterization of the human nucleus accumbens. Neuroimage 2019; 198:137-149. [PMID: 31077843 PMCID: PMC7341972 DOI: 10.1016/j.neuroimage.2019.05.019] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 04/27/2019] [Accepted: 05/07/2019] [Indexed: 01/03/2023] Open
Abstract
Dysregulation of the nucleus accumbens (NAc) is implicated in numerous neuropsychiatric disorders. Treatments targeting this area directly (e.g. deep brain stimulation) demonstrate variable efficacy, perhaps owing to non-specific targeting of a functionally heterogeneous nucleus. Here we provide support for this notion, first observing disparate behavioral effects in response to direct simulation of different locations within the NAc in a human patient. These observations motivate a segmentation of the NAc into subregions, which we produce from a diffusion-tractography based analysis of 245 young, unrelated healthy subjects. We further explore the mechanism of these stimulation-induced behavioral responses by identifying the most probable subset of axons activated using a patient-specific computational model. We validate our diffusion-based segmentation using evidence from several modalities, including MRI-based measures of function and microstructure, human post-mortem immunohistochemical staining, and cross-species comparison of cortical-NAc projections that are known to be conserved. Finally, we visualize the passage of individual axon bundles through one NAc subregion in a post-mortem human sample using CLARITY 3D histology corroborated by 7T tractography. Collectively, these findings extensively characterize human NAc subregions and provide insight into their structural and functional distinctions with implications for stereotactic treatments targeting this region.
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Affiliation(s)
- Samuel Cd Cartmell
- Department of Neurosurgery, Stanford University, Stanford, CA, 94305, USA
| | - Qiyuan Tian
- Department of Radiology, Stanford University, Stanford, CA, 94305, USA; Department of Electrical Engineering, Stanford University, Stanford, CA, 94305, USA
| | - Brandon J Thio
- Department of Biomedical Engineering, Duke University, Stanford University, Stanford, CA, 94305, USA
| | - Christoph Leuze
- Department of Radiology, Stanford University, Stanford, CA, 94305, USA
| | - Li Ye
- Department of Bioengineering, Stanford University, Stanford, CA, 94305, USA
| | - Nolan R Williams
- Department of Psychiatry, Stanford University, Stanford, CA, 94305, USA
| | - Grant Yang
- Department of Radiology, Stanford University, Stanford, CA, 94305, USA; Department of Electrical Engineering, Stanford University, Stanford, CA, 94305, USA
| | - Gabriel Ben-Dor
- Department of Psychiatry, Stanford University, Stanford, CA, 94305, USA
| | - Karl Deisseroth
- Department of Bioengineering, Stanford University, Stanford, CA, 94305, USA; Department of Psychiatry, Stanford University, Stanford, CA, 94305, USA
| | - Warren M Grill
- Department of Biomedical Engineering, Duke University, Stanford University, Stanford, CA, 94305, USA
| | - Jennifer A McNab
- Department of Radiology, Stanford University, Stanford, CA, 94305, USA
| | - Casey H Halpern
- Department of Neurosurgery, Stanford University, Stanford, CA, 94305, USA.
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Tekriwal A, Afshar NM, Santiago-Moreno J, Kuijper FM, Kern DS, Halpern CH, Felsen G, Thompson JA. Neural Circuit and Clinical Insights from Intraoperative Recordings During Deep Brain Stimulation Surgery. Brain Sci 2019; 9:brainsci9070173. [PMID: 31330813 PMCID: PMC6681002 DOI: 10.3390/brainsci9070173] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 07/17/2019] [Accepted: 07/18/2019] [Indexed: 12/15/2022] Open
Abstract
Observations using invasive neural recordings from patient populations undergoing neurosurgical interventions have led to critical breakthroughs in our understanding of human neural circuit function and malfunction. The opportunity to interact with patients during neurophysiological mapping allowed for early insights in functional localization to improve surgical outcomes, but has since expanded into exploring fundamental aspects of human cognition including reward processing, language, the storage and retrieval of memory, decision-making, as well as sensory and motor processing. The increasing use of chronic neuromodulation, via deep brain stimulation, for a spectrum of neurological and psychiatric conditions has in tandem led to increased opportunity for linking theories of cognitive processing and neural circuit function. Our purpose here is to motivate the neuroscience and neurosurgical community to capitalize on the opportunities that this next decade will bring. To this end, we will highlight recent studies that have successfully leveraged invasive recordings during deep brain stimulation surgery to advance our understanding of human cognition with an emphasis on reward processing, improving clinical outcomes, and informing advances in neuromodulatory interventions.
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Affiliation(s)
- Anand Tekriwal
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, CO 80203, USA
- Department of Physiology and Biophysics, University of Colorado School of Medicine, Aurora, CO 80203, USA
- Medical Scientist Training Program, University of Colorado School of Medicine, Aurora, CO 80203, USA
| | - Neema Moin Afshar
- Department of Physiology and Biophysics, University of Colorado School of Medicine, Aurora, CO 80203, USA
| | - Juan Santiago-Moreno
- Medical Scientist Training Program, University of Colorado School of Medicine, Aurora, CO 80203, USA
| | - Fiene Marie Kuijper
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Drew S Kern
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, CO 80203, USA
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO 80203, USA
| | - Casey H Halpern
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Gidon Felsen
- Department of Physiology and Biophysics, University of Colorado School of Medicine, Aurora, CO 80203, USA
| | - John A Thompson
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, CO 80203, USA.
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO 80203, USA.
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Miller KJ, Prieto T, Williams NR, Halpern CH. Case Studies in Neuroscience: The electrophysiology of a human obsession in nucleus accumbens. J Neurophysiol 2019; 121:2336-2340. [PMID: 31017846 PMCID: PMC7327227 DOI: 10.1152/jn.00096.2019] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Microelectrode recordings were performed during awake deep brain stimulation surgery for obsessive-compulsive disorder, revealing robust brain oscillations that were plainly visible throughout the ventral striatum. There was an elegant topological correspondence between each oscillation and the underlying brain anatomy, most prominently a ~35-Hz gamma-oscillation specific to the nucleus accumbens. Direct provocation of the patient's contamination obsession modulated both firing rate and gamma-oscillation amplitude within the nucleus accumbens. NEW & NOTEWORTHY Surgical implantation of deep brain stimulating electrodes (DBS) to treat obsessive-compulsive disorder (OCD) is an option for patients who have not fully responded to medical intervention or cognitive behavioral therapy. We measured the electrophysiology of a collection of deep brain structures during awake DBS surgery for an OCD patient with an obsession about cleanliness and contamination. The anatomic delineation of these deep brain structures was revealed by distinct brain rhythms, most notably a ~35 Hz oscillation specific to the nucleus accumbens. In the first ever measurement of a human obsessive thought, we found that this ~35-Hz biomarker, as well as the local neuronal action potential rate, were modulated by handing the patient a toothbrush to bring to his face and instructing him to "imagine brushing your teeth with this dirty toothbrush."
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Affiliation(s)
- Kai J Miller
- Department of Neurosurgery, Stanford University , Stanford, California.,Department of Neurological Surgery, Mayo Clinic , Rochester, Minnesota
| | - Thomas Prieto
- Department of Neurology, Stanford University , Stanford, California
| | - Nolan R Williams
- Department of Neurosurgery Psychiatry, Stanford University , Stanford, California
| | - Casey H Halpern
- Department of Neurosurgery, Stanford University , Stanford, California
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