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Surendrakumar S, Rabelo TK, Campos ACP, Mollica A, Abrahao A, Lipsman N, Burke MJ, Hamani C. Neuromodulation Therapies in Pre-Clinical Models of Traumatic Brain Injury: Systematic Review and Translational Applications. J Neurotrauma 2023; 40:435-448. [PMID: 35983592 DOI: 10.1089/neu.2022.0286] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Traumatic brain injury (TBI) has been associated with several lasting impairments that affect quality of life. Pre-clinical models of TBI have been studied to further our understanding of the underlying short-term and long-term symptomatology. Neuromodulation techniques have become of great interest in recent years as potential rehabilitative therapies after injury because of their capacity to alter neuronal activity and neural circuits in targeted brain regions. This systematic review aims to provide an overlook of the behavioral and neurochemical effects of transcranial direct current stimulation (tDCS), transcranial magnetic stimulation (TMS), deep brain stimulation (DBS), and vagus nerve stimulation (VNS) in pre-clinical TBI models. After screening 629 abstracts, 30 articles were pooled for review. These studies showed that tDCS, TMS, DBS, or VNS delivered to rodents restored TBI-induced deficits in coordination, balance, locomotor activity and improved cognitive impairments in memory, learning, and impulsivity. Potential mechanisms for these effects included neuroprotection, a decrease in apoptosis, neuroplasticity, and the restoration of neural circuit abnormalities. The translational value, potential applicability, and the interpretation of these findings in light of outcome data from clinical trials in patients with TBI are discussed.
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Affiliation(s)
- Shanan Surendrakumar
- Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Thallita Kelly Rabelo
- Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Ana Carolina P Campos
- Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Adriano Mollica
- Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Neuropsychiatry Program, Department of Psychiatry, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Agessandro Abrahao
- Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Hurvitz Brain Sciences Centre, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Nir Lipsman
- Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Hurvitz Brain Sciences Centre, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Matthew J Burke
- Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Hurvitz Brain Sciences Centre, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Neuropsychiatry Program, Department of Psychiatry, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Clement Hamani
- Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Hurvitz Brain Sciences Centre, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
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2
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Rasmussen SA, Goodman WK. The prefrontal cortex and neurosurgical treatment for intractable OCD. Neuropsychopharmacology 2022; 47:349-360. [PMID: 34433915 PMCID: PMC8616947 DOI: 10.1038/s41386-021-01149-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 07/14/2021] [Accepted: 07/29/2021] [Indexed: 01/03/2023]
Abstract
Over the past two decades, circuit-based neurosurgical procedures have gained increasing acceptance as a safe and efficacious approach to the treatment of the intractable obsessive-compulsive disorder (OCD). Lesions and deep brain stimulation (DBS) of the longitudinal corticofugal white matter tracts connecting the prefrontal cortex with the striatum, thalamus, subthalamic nucleus (STN), and brainstem implicate orbitofrontal, medial prefrontal, frontopolar, and ventrolateral cortical networks in the symptoms underlying OCD. The highly parallel distributed nature of these networks may explain the relative lack of adverse effects observed following surgery. Additional pre-post studies of cognitive tasks in more surgical patients are needed to confirm the role of these networks in OCD and to define therapeutic responses to surgical intervention.
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Affiliation(s)
- Steven A. Rasmussen
- grid.40263.330000 0004 1936 9094Department of Psychiatry and Human Behavior, Alpert School of Medicine, Brown University, Providence, RI USA ,grid.40263.330000 0004 1936 9094Carney Brain Science Institute, Brown University, Providence, RI USA
| | - Wayne K. Goodman
- grid.39382.330000 0001 2160 926XMenninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX USA
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Maraone A, Tarsitani L, Pinucci I, Pasquini M. Antiglutamatergic agents for obsessive-compulsive disorder: Where are we now and what are possible future prospects? World J Psychiatry 2021; 11:568-580. [PMID: 34631461 PMCID: PMC8474998 DOI: 10.5498/wjp.v11.i9.568] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 07/25/2021] [Accepted: 08/06/2021] [Indexed: 02/06/2023] Open
Abstract
Recent data suggest that obsessive-compulsive disorder (OCD) is driven by an imbalance among the habit learning system and the goal-directed system. The frontostriatal loop termed cortico-striatal-thalamo-cortical (CSTC) circuitry loop is involved in habits and their dysfunction plays an important role in OCD. Glutamatergic neurotransmission is the principal neurotransmitter implicated in the CSTC model of OCD. Hyperactivity in the CSTC loop implies a high level of glutamate in the cortical-striatal pathways as well as a dysregulation of GABAergic transmission, and could represent the pathophysiology of OCD. Moreover, the dysregulation of glutamate levels can lead to neurotoxicity, acting as a neuronal excitotoxin. The hypothesis of a role of neurotoxicity in the pathophysiology of OCD clinically correlates to the importance of an early intervention for patients. Indeed, some studies have shown that a reduction of duration of untreated illness is related to an earlier onset of remission. Although robust data supporting a progression of such brain changes are not available so far, an early intervention could help interrupt damage from neurotoxicity. Moreover, agents targeting glutamate neurotransmission may represent promising therapeutical option in OCD patients.
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Affiliation(s)
- Annalisa Maraone
- Department of Human Neurosciences, Sapienza University of Rome, Rome 00185, Lazio, Italy
| | - Lorenzo Tarsitani
- Department of Human Neurosciences, Sapienza University of Rome, Rome 00185, Lazio, Italy
| | - Irene Pinucci
- Department of Human Neurosciences, Sapienza University of Rome, Rome 00185, Lazio, Italy
| | - Massimo Pasquini
- Department of Human Neurosciences, Sapienza University of Rome, Rome 00185, Lazio, Italy
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4
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Guang J, Baker H, Ben-Yishay Nizri O, Firman S, Werner-Reiss U, Kapuller V, Israel Z, Bergman H. Toward asleep DBS: cortico-basal ganglia spectral and coherence activity during interleaved propofol/ketamine sedation mimics NREM/REM sleep activity. NPJ PARKINSONS DISEASE 2021; 7:67. [PMID: 34341348 PMCID: PMC8329235 DOI: 10.1038/s41531-021-00211-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 07/09/2021] [Indexed: 12/20/2022]
Abstract
Deep brain stimulation (DBS) is currently a standard procedure for advanced Parkinson's disease. Many centers employ awake physiological navigation and stimulation assessment to optimize DBS localization and outcome. To enable DBS under sedation, asleep DBS, we characterized the cortico-basal ganglia neuronal network of two nonhuman primates under propofol, ketamine, and interleaved propofol-ketamine (IPK) sedation. Further, we compared these sedation states in the healthy and Parkinsonian condition to those of healthy sleep. Ketamine increases high-frequency power and synchronization while propofol increases low-frequency power and synchronization in polysomnography and neuronal activity recordings. Thus, ketamine does not mask the low-frequency oscillations used for physiological navigation toward the basal ganglia DBS targets. The brain spectral state under ketamine and propofol mimicked rapid eye movement (REM) and Non-REM (NREM) sleep activity, respectively, and the IPK protocol resembles the NREM-REM sleep cycle. These promising results are a meaningful step toward asleep DBS with nondistorted physiological navigation.
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Affiliation(s)
- Jing Guang
- Edmond and Lily Safra Center for Brain Sciences, The Hebrew University of Jerusalem, Jerusalem, Israel.
| | - Halen Baker
- Department of Medical Neurobiology, The Hebrew University of Jerusalem, Jerusalem, Israel
| | | | - Shimon Firman
- Department of Anesthesiology, Critical Care Medicine, and Pain Management, Hadassah Medical Center, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Uri Werner-Reiss
- Edmond and Lily Safra Center for Brain Sciences, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Vadim Kapuller
- Department of Pediatric Surgery, Hadassah Medical Center, The Hebrew University of Jerusalem, Jerusalem, Israel.,Asuta-Ashdod University Medical Center, Ashdod, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Zvi Israel
- Department of Neurosurgery, Hadassah Medical Center, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Hagai Bergman
- Edmond and Lily Safra Center for Brain Sciences, The Hebrew University of Jerusalem, Jerusalem, Israel.,Department of Medical Neurobiology, The Hebrew University of Jerusalem, Jerusalem, Israel.,Department of Neurosurgery, Hadassah Medical Center, The Hebrew University of Jerusalem, Jerusalem, Israel
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Abstract
Although rodent research provides important insights into neural correlates of human psychology, new cortical areas, connections, and cognitive abilities emerged during primate evolution, including human evolution. Comparison of human brains with those of nonhuman primates reveals two aspects of human brain evolution particularly relevant to emotional disorders: expansion of homotypical association areas and expansion of the hippocampus. Two uniquely human cognitive capacities link these phylogenetic developments with emotion: a subjective sense of participating in and reexperiencing remembered events and a limitless capacity to imagine details of future events. These abilities provided evolving humans with selective advantages, but they also created proclivities for emotional problems. The first capacity evokes the "reliving" of past events in the "here-and-now," accompanied by emotional responses that occurred during memory encoding. It contributes to risk for stress-related syndromes, such as posttraumatic stress disorder. The second capacity, an ability to imagine future events without temporal limitations, facilitates flexible, goal-related behavior by drawing on and creating a uniquely rich array of mental representations. It promotes goal achievement and reduces errors, but the mental construction of future events also contributes to developmental aspects of anxiety and mood disorders. With maturation of homotypical association areas, the concrete concerns of childhood expand to encompass the abstract apprehensions of adolescence and adulthood. These cognitive capacities and their dysfunction are amenable to a research agenda that melds experimental therapeutic interventions, cognitive neuropsychology, and developmental psychology in both humans and nonhuman primates.
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Affiliation(s)
- Daniel S. Pine
- Section on Development and Affective Neuroscience, Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD 20892
| | - Steven P. Wise
- Olschefskie Institute for the Neurobiology of Knowledge, Bethesda, MD 20814
| | - Elisabeth A. Murray
- Section on the Neurobiology of Learning and Memory, Laboratory of Neuropsychology, National Institute of Mental Health, Bethesda, MD 20892
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Cagle JN, Eisinger RS, Holland MT, Foote KD, Okun MS, Gunduz A. A novel local field potential-based functional approach for targeting the centromedian-parafascicular complex for deep brain stimulation. Neuroimage Clin 2021; 30:102644. [PMID: 33845353 PMCID: PMC8064020 DOI: 10.1016/j.nicl.2021.102644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 02/18/2021] [Accepted: 03/22/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND The centromedian-parafascicular (Cm-Pf) complex of the thalamus is a common deep brain stimulation (DBS) target for treatment of Tourette syndrome (TS). Currently, there are no standardized functional intraoperative neurosurgical targeting approaches. Collectively, these issues have led to variability in DBS lead placement. Therefore, more defined methods are needed to improve targeting accuracy. OBJECTIVE The objective of this observational study was to develop and to verify a functional mapping task capable of differentiating the Cm-Pf region from the nearby ventral intermediate (Vim) nucleus region of the thalamus. The overarching goal was to improve the reproducibility of DBS targeting in the Cm-Pf region. METHODS Seven TS patients completed a modified Go/NoGo task (five in the post-operative setting and two in the intra-operative setting). Post-operative neural signals from Cm-Pf region were collected using sensing-enabled implanted neural stimulators, and intraoperative neural signals from the Cm-Pf region were collected using an external amplifier. Event-related potential (ERP) features were identified by using the grand-average of stimulus onset signals derived from the postoperative participants. These features were correlated with anatomical locations for the specific electrode recordings. The same features were extracted from the intraoperative patients in order to verify electrode positions in the operating room environment. RESULTS Two features - a positive and a negative deflection - were identified in the average ERP from the post-operative participants. The peak amplitudes of both features were significantly correlated with the electrode depth position (p = 0.025 for positive deflection and p = 0.039 for negative deflection). The same result was reproduced intra-operatively in the two most recent patients, where more ventral electrode contacts revealed stronger peak amplitudes in comparison to the dorsal electrode contacts. CONCLUSION This process was used to physiologically confirm accurate lead placement in the operating room setting. The modified Go/NoGo task elicited robust neural responses in the Cm-Pf region however the signal was not present in the Vim nucleus region of thalamus along the DBS electrode trajectory. We conclude that the differences in ERP responses may be a potentially novel LFP based functional approach for future targeting of the Cm-Pf complex for TS DBS.
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Affiliation(s)
- Jackson N Cagle
- J. Crayton Pruitt Department of Biomedical Engineering, University of Florida, Gainesville FL, United States
| | - Robert S Eisinger
- Department of Neuroscience, University of Florida, Gainesville, FL, United States
| | - Marshall T Holland
- Department of Neurosurgery, University of Florida Norman Fixel Institute for Neurological Diseases, Gainesville, FL, United States; Department of Neurosurgery, University of Iowa, Iowa City, IA, United States
| | - Kelly D Foote
- Department of Neurosurgery, University of Florida Norman Fixel Institute for Neurological Diseases, Gainesville, FL, United States
| | - Michael S Okun
- Department of Neuroscience, University of Florida, Gainesville, FL, United States; Department of Neurology, University of Florida Norman Fixel Institute for Neurological Diseases, Gainesville, FL, United States
| | - Aysegul Gunduz
- J. Crayton Pruitt Department of Biomedical Engineering, University of Florida, Gainesville FL, United States
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Abstract
Obsessive-compulsive disorder (OCD) is a common, chronic, and oftentimes disabling disorder. The only established first-line treatments for OCD are exposure and response prevention, and serotonin reuptake inhibitor medications (SRIs). However, a subset of patients fails to respond to either modality, and few experience complete remission. Beyond SRI monotherapy, antipsychotic augmentation is the only medication approach for OCD with substantial empirical support. Our incomplete understanding of the neurobiology of OCD has hampered efforts to develop new treatments or enhance extant interventions. This review focuses on several promising areas of research that may help elucidate the pathophysiology of OCD and advance treatment. Multiple studies support a significant genetic contribution to OCD, but pinpointing the specific genetic determinants requires additional investigation. The preferential efficacy of SRIs in OCD has neither led to discovery of serotonergic abnormalities in OCD nor to development of new serotonergic medications for OCD. Several lines of preclinical and clinical evidence suggest dysfunction of the glutamatergic system in OCD, prompting testing of several promising glutamate modulating agents. Functional imaging studies in OCD show consistent evidence for increased activity in brain regions that form a cortico-striato-thalamo-cortical (CSTC) loop. Neuromodulation treatments with either noninvasive devices (e.g., transcranial magnetic stimulation) or invasive procedures (e.g., deep brain stimulation) provide further support for the CSTC model of OCD. A common substrate for various interventions (whether drug, behavioral, or device) may be modulation (at different nodes or connections) of the CSTC circuit that mediates the symptoms of OCD.
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Affiliation(s)
- Wayne K. Goodman
- Menninger Department of Psychiatry and Behavioral Sciences (all authors) and Department of Neurosurgery (Sheth), Baylor College of Medicine, Houston
| | - Eric A. Storch
- Menninger Department of Psychiatry and Behavioral Sciences (all authors) and Department of Neurosurgery (Sheth), Baylor College of Medicine, Houston
| | - Sameer A. Sheth
- Menninger Department of Psychiatry and Behavioral Sciences (all authors) and Department of Neurosurgery (Sheth), Baylor College of Medicine, Houston
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Holland MT, Trapp NT, McCormick LM, Jareczek FJ, Zanaty M, Close LN, Beeghly J, Greenlee JDW. Deep Brain Stimulation for Obsessive-Compulsive Disorder: A Long Term Naturalistic Follow Up Study in a Single Institution. Front Psychiatry 2020; 11:55. [PMID: 32184741 PMCID: PMC7058594 DOI: 10.3389/fpsyt.2020.00055] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 01/22/2020] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Deep brain stimulation (DBS) is a proven, effective tool in the treatment of movement disorders. Expansion of indications for DBS into the realm of neuropsychiatric disorders, especially obsessive-compulsive disorder (OCD), has gained fervent interest, although data on appropriate clinical utilization remains limited. METHODS A retrospective, naturalistic study followed nine severely affected OCD patients (average YBOCs score before implantation 34.2 ± 2.5) treated with DBS of ventral capsule/ventral striatum, with average follow up of 54.8 months. RESULTS With chronic stimulation (years), a majority of the patients achieved significant benefits in obsessive-compulsive and depressive symptoms. Six patients experienced periods of OCD remission following implantation. Four of the six responders required more than 12 months to achieve response. Relief of major depressive symptoms occurred in four out of six patients with documented co-morbid depression. Settings required to achieve efficacy were higher than those typically utilized for movement disorders, necessitating increased impulse generator (IPG) battery demand. We found patients benefited from conversion to a rechargeable IPG to prevent serial operations for IPG replacement. For patients with rechargeable IPGs, the repetitive habit of recharging did not appear to aggravate or trigger new obsessive-compulsive behaviors or anxiety symptoms. CONCLUSIONS Our study supports and builds upon other research suggesting that DBS for OCD in a real-world setting can be implemented successfully and provide long-term benefit for severely affected OCD patients. Optimal patient selection and DBS programming criteria are discussed. The use of rechargeable IPGs appears to be both cost effective and well-tolerated in this population.
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Affiliation(s)
- Marshall T Holland
- Department of Neurosurgery, University of Iowa, Iowa City, IA, United States
| | - Nicholas T Trapp
- Department of Psychiatry, University of Iowa, Iowa City, IA, United States
| | - Laurie M McCormick
- Department of Psychiatry, University of Iowa, Iowa City, IA, United States.,Rein Center: Emotional Health and Well-Being, Iowa City, IA, United States
| | | | - Mario Zanaty
- Department of Neurosurgery, University of Iowa, Iowa City, IA, United States
| | - Liesl N Close
- Department of Neurosurgery, University of Iowa, Iowa City, IA, United States
| | - James Beeghly
- Department of Psychiatry, University of Iowa, Iowa City, IA, United States
| | - Jeremy D W Greenlee
- Department of Neurosurgery, University of Iowa, Iowa City, IA, United States
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From bed to bench side: Reverse translation to optimize neuromodulation for mood disorders. Proc Natl Acad Sci U S A 2019; 116:26288-26296. [PMID: 31871143 DOI: 10.1073/pnas.1902287116] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
The advent of neuroimaging has provided foundational insights into the neural basis of psychiatric conditions, such as major depression. Across countless studies, dysfunction has been localized to distinct parts of the limbic system. Specific knowledge about affected locations has led to the development of circuit modulation therapies to correct dysfunction, notably deep brain stimulation (DBS). This and other emerging neuromodulation approaches have shown great promise, but their refinement has been slow and fundamental questions about their mechanisms of action remain. Here, we argue that their continued development requires reverse translation to animal models with close homology to humans, namely, nonhuman primates. With a particular focus on DBS approaches for depression, we highlight the parts of the brain that have been targeted by neuromodulation in humans, their efficacy, and why nonhuman primates are the most suitable model in which to conduct their refinement. We finish by highlighting key gaps in our knowledge that need to be filled to allow more rapid progress toward effective therapies in patients for whom all other treatment attempts have failed.
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Fellous JM, Sapiro G, Rossi A, Mayberg H, Ferrante M. Explainable Artificial Intelligence for Neuroscience: Behavioral Neurostimulation. Front Neurosci 2019; 13:1346. [PMID: 31920509 PMCID: PMC6923732 DOI: 10.3389/fnins.2019.01346] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Accepted: 11/29/2019] [Indexed: 01/08/2023] Open
Abstract
The use of Artificial Intelligence and machine learning in basic research and clinical neuroscience is increasing. AI methods enable the interpretation of large multimodal datasets that can provide unbiased insights into the fundamental principles of brain function, potentially paving the way for earlier and more accurate detection of brain disorders and better informed intervention protocols. Despite AI's ability to create accurate predictions and classifications, in most cases it lacks the ability to provide a mechanistic understanding of how inputs and outputs relate to each other. Explainable Artificial Intelligence (XAI) is a new set of techniques that attempts to provide such an understanding, here we report on some of these practical approaches. We discuss the potential value of XAI to the field of neurostimulation for both basic scientific inquiry and therapeutic purposes, as well as, outstanding questions and obstacles to the success of the XAI approach.
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Affiliation(s)
- Jean-Marc Fellous
- Theoretical and Computational Neuroscience Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, United States
- Department of Psychology and Biomedical Engineering, University of Arizona, Tucson, AZ, United States
| | - Guillermo Sapiro
- Department of Electrical and Computer Engineering, Duke University, Durham, NC, United States
| | - Andrew Rossi
- Executive Functions and Reward Systems Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, United States
| | - Helen Mayberg
- Center for Advanced Circuit Therapeutics, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Michele Ferrante
- Theoretical and Computational Neuroscience Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, United States
- Computational Psychiatry Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, United States
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Bus S, Pal G, Ouyang B, van den Munckhof P, Bot M, Sani S, Verhagen Metman L. Accuracy of Microelectrode Trajectory Adjustments during DBS Assessed by Intraoperative CT. Stereotact Funct Neurosurg 2018; 96:231-238. [PMID: 30145596 DOI: 10.1159/000489945] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 05/09/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS Microelectrode recording (MER)-guided deep brain stimulation (DBS) aims to place the DBS lead in the optimal electrophysiological target. When single-track MER or test stimulation yields suboptimal results, trajectory adjustments are made. The accuracy of these trajectory adjustments is unknown. Intraoperative computed tomography can visualize the microelectrode (ME) and verify ME adjustments. We aimed to determine the accuracy of ME movements in patients undergoing MER-guided DBS. METHODS Coordinates following three methods of adjustment were compared: (1) those within the default "+" configuration of the ME holder; (2) those involving rotation of the default "+" to the "x" configuration; and (3) those involving head stage adjustments. Radial error and absolute differences between coordinates were determined. RESULTS 87 ME movements in 59 patients were analyzed. Median (IQR) radial error was 0.59 (0.64) mm. Median (IQR) absolute x and y coordinate errors were 0.29 (0.52) and 0.38 (0.44) mm, respectively. Errors were largest after rotating the multielectrode holder to its "x"-shaped setup. CONCLUSION ME trajectory adjustments can be made accurately. In a considerable number of cases, errors exceeding 1 mm were found. Adjustments from the "+" setup to the "x" setup are most prone to inaccuracies.
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Affiliation(s)
- Sander Bus
- Department of Neurology, Amsterdam UMC, Amsterdam, the Netherlands
| | - Gian Pal
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Bichun Ouyang
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | | | - Maarten Bot
- Department of Neurosurgery, Amsterdam UMC, Amsterdam, the Netherlands
| | - Sepehr Sani
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Leo Verhagen Metman
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
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12
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Chen X, Zhang C, Li Y, Huang P, Lv Q, Yu W, Chen S, Sun B, Wang Z. Functional Connectivity-Based Modelling Simulates Subject-Specific Network Spreading Effects of Focal Brain Stimulation. Neurosci Bull 2018; 34:921-938. [PMID: 30043099 PMCID: PMC6246850 DOI: 10.1007/s12264-018-0256-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 05/16/2018] [Indexed: 12/23/2022] Open
Abstract
Neurostimulation remarkably alleviates the symptoms in a variety of brain disorders by modulating the brain-wide network. However, how brain-wide effects on the direct and indirect pathways evoked by focal neurostimulation elicit therapeutic effects in an individual patient is unknown. Understanding this remains crucial for advancing neural circuit-based guidance to optimize candidate patient screening, pre-surgical target selection, and post-surgical parameter tuning. To address this issue, we propose a functional brain connectome-based modeling approach that simulates the spreading effects of stimulating different brain regions and quantifies the rectification of abnormal network topology in silico. We validated these analyses by pinpointing nuclei in the basal ganglia circuits as top-ranked targets for 43 local patients with Parkinson’s disease and 90 patients from a public database. Individual connectome-based analysis demonstrated that the globus pallidus was the best choice for 21.1% and the subthalamic nucleus for 19.5% of patients. Down-regulation of functional connectivity (up to 12%) at these prioritized targets optimally maximized the therapeutic effects. Notably, the priority rank of the subthalamic nucleus significantly correlated with motor symptom severity (Unified Parkinson’s Disease Rating Scale III) in the local cohort. These findings underscore the potential of neural network modeling for advancing personalized brain stimulation therapy, and warrant future experimental investigation to validate its clinical utility.
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Affiliation(s)
- Xiaoyu Chen
- Institute of Neuroscience, State Key Laboratory of Neuroscience, Chinese Academy of Sciences Center for Excellence in Brain Science and Intelligence Technology, Shanghai Institute for Biological Sciences, Chinese Academy of Sciences, Shanghai, 200031, China.,University of Chinese Academy of Sciences, Beijing, 100049, China
| | - Chencheng Zhang
- Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Yuxin Li
- Institute of Neuroscience, State Key Laboratory of Neuroscience, Chinese Academy of Sciences Center for Excellence in Brain Science and Intelligence Technology, Shanghai Institute for Biological Sciences, Chinese Academy of Sciences, Shanghai, 200031, China.,Department of Radiology, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Pei Huang
- Department of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Qian Lv
- Institute of Neuroscience, State Key Laboratory of Neuroscience, Chinese Academy of Sciences Center for Excellence in Brain Science and Intelligence Technology, Shanghai Institute for Biological Sciences, Chinese Academy of Sciences, Shanghai, 200031, China.,University of Chinese Academy of Sciences, Beijing, 100049, China
| | - Wenwen Yu
- Institute of Neuroscience, State Key Laboratory of Neuroscience, Chinese Academy of Sciences Center for Excellence in Brain Science and Intelligence Technology, Shanghai Institute for Biological Sciences, Chinese Academy of Sciences, Shanghai, 200031, China
| | - Shengdi Chen
- Department of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Bomin Sun
- University of Chinese Academy of Sciences, Beijing, 100049, China.
| | - Zheng Wang
- Institute of Neuroscience, State Key Laboratory of Neuroscience, Chinese Academy of Sciences Center for Excellence in Brain Science and Intelligence Technology, Shanghai Institute for Biological Sciences, Chinese Academy of Sciences, Shanghai, 200031, China.
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Brahimaj B, Kochanski RB, Sani S. Microelectrode accuracy in deep brain stimulation surgery. J Clin Neurosci 2018; 50:58-61. [DOI: 10.1016/j.jocn.2018.01.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 01/08/2018] [Indexed: 10/18/2022]
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14
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15
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Sharma M, Reeves K, Deogaonkar M, Rezai AR. Deep Brain Stimulation for Obsessive–Compulsive Disorder. Neuromodulation 2018. [DOI: 10.1016/b978-0-12-805353-9.00085-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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16
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Zhang C, Huang Y, Zheng F, Zeljic K, Pan J, Sun B. Death From Opioid Overdose After Deep Brain Stimulation: A Case Report. Biol Psychiatry 2018; 83:e9-e10. [PMID: 28882316 DOI: 10.1016/j.biopsych.2017.07.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Revised: 07/25/2017] [Accepted: 07/25/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Chencheng Zhang
- Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Yuhua Huang
- Department of Psychiatry, Hainan Danzhou People's Hospital, Danzhou, Hainan, China
| | - Fangchen Zheng
- Department of Psychology, University of Arizona, Tucson, Arizona
| | | | - Jun Pan
- Department of Neurosurgery, Hainan Danzhou People's Hospital, Danzhou, Hainan, China
| | - Bomin Sun
- Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Zhang C, Li D, Jin H, Zeljic K, Sun B. Target-specific deep brain stimulation of the ventral capsule/ventral striatum for the treatment of neuropsychiatric disease. ANNALS OF TRANSLATIONAL MEDICINE 2017; 5:402. [PMID: 29152502 DOI: 10.21037/atm.2017.07.13] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Deep brain stimulation (DBS) is a well-established therapy for Parkinson's disease and other movement disorders. An accumulating body of evidence supports the extension of DBS application for the treatment of refractory psychiatric disorders. The ventral capsule/ventral striatum (VC/VS) is the most common anatomical target for obsessive-compulsive disorder (OCD), addiction, and depression. However, no specific electrode is available for the clinical targeting of these areas for DBS. According to the anatomical features of the VC/VS, a novel electrode was developed for simultaneous and independently programmed stimulation of the nucleus accumbens (NAc) and the anterior limb of the internal capsule (ALIC). This VC/VS-specific electrode has the potential to enhance stimulus intensity, provide independent and flexible target stimulation.
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Affiliation(s)
- Chencheng Zhang
- Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Dianyou Li
- Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Haiyan Jin
- Department of Psychiatry, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Kristina Zeljic
- Institute of Neuroscience, Shanghai Institute for Biological Sciences, Chinese Academy of Sciences, Shanghai 200031, China
| | - Bomin Sun
- Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
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Deep brain stimulation of the medial forebrain bundle elevates striatal dopamine concentration without affecting spontaneous or reward-induced phasic release. Neuroscience 2017; 364:82-92. [PMID: 28918253 DOI: 10.1016/j.neuroscience.2017.09.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 09/01/2017] [Accepted: 09/06/2017] [Indexed: 12/24/2022]
Abstract
Deep brain stimulation (DBS) of the medial forebrain bundle (MFB) induces rapid improvement of depressive symptoms in patients suffering from treatment-refractory major depressive disorder (MDD). It has been hypothesized that activation of the dopamine (DA) system contributes to this effect. To investigate whether DBS in the MFB affects DA release in the striatum, we combined DBS with fast-scan cyclic voltammetry (FSCV) in freely moving rats. Animals were implanted with a stimulating electrode at the border of the MFB and the ventral tegmental area, and a FSCV microelectrode in the ventromedial striatum to monitor extracellular DA during the acute onset of DBS and subsequent continued stimulation. DBS onset induced a significant increase in extracellular DA concentration in the ventromedial striatum that was sustained for at least 40s. However, continued DBS did not affect amplitude or frequency of so-called spontaneous phasic DA transients, nor phasic DA release in response to the delivery of unexpected food pellets. These findings suggest that effects of DBS in the MFB are mediated by an acute change in extracellular DA concentration, but more research is needed to further explore the potentially sustained duration of this effect. Together, our results provide both support and refinement of the hypothesis that MFB DBS activates the DA system: DBS induces an increase in overall ambient concentration of DA, but spontaneous or reward-associated more rapid, phasic DA dynamics are not enhanced. This knowledge improves our understanding of how DBS affects brain function and may help improve future therapies for depressive symptoms.
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Improving the accuracy of microelectrode recording in deep brain stimulation surgery with intraoperative CT. J Clin Neurosci 2017; 40:130-135. [PMID: 28262405 DOI: 10.1016/j.jocn.2017.02.037] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 02/11/2017] [Indexed: 11/21/2022]
Abstract
Microelectrode recording (MER) is used to confirm electrophysiological signals within intended anatomic targets during deep brain stimulation (DBS) surgery. We describe a novel technique called intraoperative CT-guided extrapolation (iCTE) to predict the intended microelectrode trajectory and, if necessary, make corrections in real-time before dural opening. Prior to dural opening, a guide tube was inserted through the headstage and rested on dura. Intraoperative CT (iCT) was obtained, and a trajectory was extrapolated along the path of the guide tube to target depth using targeting software. The coordinates were recorded and compared to initial plan coordinates. If needed, adjustments were made using the headstage to correct for error. The guide tube was then inserted and MER ensued. At target, iCT was performed and microelectrode tip coordinates were compared with planned/adjusted track coordinates. Radial error between MER track and planned/adjusted track was calculated. For comparison, MER track error prior to the iCTE technique was assessed retrospectively in patients who underwent MER using iCT, whereby iCT was performed following completion of the first MER track. Forty-seven MER tracks were analyzed prior to iCTE (pre-iCTE), and 90 tracks were performed using the iCTE technique. There was no difference between radial error of pre-iCTE MER track and planned trajectory (2.1±0.12mm) compared to iCTE predicted trajectory and planned trajectory (1.76±0.13mm, p>0.05). iCTE was used to make trajectory adjustments which reduced radial error between the newly corrected and final microelectrode tip coordinates to 0.84±0.08mm (p<0.001). Inter-rater reliability was also tested using a second blinded measurement reviewer which showed no difference between predicted and planned MER track error (p=0.53). iCTE can predict and reduce trajectory error for microelectrode placement compared with the traditional use of iCT post MER.
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20
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Van Den Berge N, Albaugh DL, Salzwedel A, Vanhove C, Van Holen R, Gao W, Stuber GD, Shih YYI. Functional circuit mapping of striatal output nuclei using simultaneous deep brain stimulation and fMRI. Neuroimage 2017; 146:1050-1061. [PMID: 27825979 PMCID: PMC5322177 DOI: 10.1016/j.neuroimage.2016.10.049] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 09/08/2016] [Accepted: 10/31/2016] [Indexed: 01/11/2023] Open
Abstract
The substantia nigra pars reticulata (SNr) and external globus pallidus (GPe) constitute the two major output targets of the rodent striatum. Both the SNr and GPe converge upon thalamic relay nuclei (directly or indirectly, respectively), and are traditionally modeled as functionally antagonistic relay inputs. However, recent anatomical and functional studies have identified unanticipated circuit connectivity in both the SNr and GPe, demonstrating their potential as far more than relay nuclei. In the present study, we employed simultaneous deep brain stimulation and functional magnetic resonance imaging (DBS-fMRI) with cerebral blood volume (CBV) measurements to functionally and unbiasedly map the circuit- and network level connectivity of the SNr and GPe. Sprague-Dawley rats were implanted with a custom-made MR-compatible stimulating electrode in the right SNr (n=6) or GPe (n=7). SNr- and GPe-DBS, conducted across a wide range of stimulation frequencies, revealed a number of surprising evoked responses, including unexpected CBV decreases within the striatum during DBS at either target, as well as GPe-DBS-evoked positive modulation of frontal cortex. Functional connectivity MRI revealed global modulation of neural networks during DBS at either target, sensitive to stimulation frequency and readily reversed following cessation of stimulation. This work thus contributes to a growing literature demonstrating extensive and unanticipated functional connectivity among basal ganglia nuclei.
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Affiliation(s)
- Nathalie Van Den Berge
- Department of Neurology, University of North Carolina, Chapel Hill, NC, USA; Biomedical Research Imaging Center, University of North Carolina, Chapel Hill, NC, USA; Medical Image and Signal Processing Group, Ghent University, Ghent, Belgium
| | - Daniel L Albaugh
- Department of Neurology, University of North Carolina, Chapel Hill, NC, USA; Biomedical Research Imaging Center, University of North Carolina, Chapel Hill, NC, USA; Curriculum in Neurobiology, University of North Carolina, Chapel Hill, NC, USA
| | - Andrew Salzwedel
- Biomedical Imaging Research Institute, Department of Biomedical Sciences and Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Christian Vanhove
- Medical Image and Signal Processing Group, Ghent University, Ghent, Belgium
| | - Roel Van Holen
- Medical Image and Signal Processing Group, Ghent University, Ghent, Belgium
| | - Wei Gao
- Biomedical Imaging Research Institute, Department of Biomedical Sciences and Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Garret D Stuber
- Curriculum in Neurobiology, University of North Carolina, Chapel Hill, NC, USA; Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA
| | - Yen-Yu Ian Shih
- Department of Neurology, University of North Carolina, Chapel Hill, NC, USA; Biomedical Research Imaging Center, University of North Carolina, Chapel Hill, NC, USA; Curriculum in Neurobiology, University of North Carolina, Chapel Hill, NC, USA; Department of Biomedical Engineering, University of North Carolina, Chapel Hill, NC, USA.
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21
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Siegel AM, Barrett MS, Bhati MT. Deep Brain Stimulation for Alzheimer’s Disease: Ethical Challenges for Clinical Research. J Alzheimers Dis 2017; 56:429-439. [DOI: 10.3233/jad-160356] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Andrew M. Siegel
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Marna S. Barrett
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Mahendra T. Bhati
- Departments of Psychiatry and Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
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22
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Use of intraoperative CT to predict the accuracy of microelectrode recording during deep brain stimulation surgery. A proof of concept study. Clin Neurol Neurosurg 2016; 150:164-168. [DOI: 10.1016/j.clineuro.2016.09.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 08/26/2016] [Accepted: 09/23/2016] [Indexed: 11/20/2022]
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23
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Albaugh DL, Salzwedel A, Van Den Berge N, Gao W, Stuber GD, Shih YYI. Functional Magnetic Resonance Imaging of Electrical and Optogenetic Deep Brain Stimulation at the Rat Nucleus Accumbens. Sci Rep 2016; 6:31613. [PMID: 27601003 PMCID: PMC5013271 DOI: 10.1038/srep31613] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 07/25/2016] [Indexed: 01/16/2023] Open
Abstract
Deep brain stimulation of the nucleus accumbens (NAc-DBS) is an emerging therapy for diverse, refractory neuropsychiatric diseases. Although DBS therapy is broadly hypothesized to work through large-scale neural modulation, little is known regarding the neural circuits and networks affected by NAc-DBS. Using a healthy, sedated rat model of NAc-DBS, we employed both evoked- and functional connectivity (fc) MRI to examine the functional circuit and network changes achieved by electrical NAc stimulation. Optogenetic-fMRI experiments were also undertaken to evaluate the circuit modulation profile achieved by selective stimulation of NAc neurons. NAc-DBS directly modulated neural activity within prefrontal cortex and a large number of subcortical limbic areas (e.g., amygdala, lateral hypothalamus), and influenced functional connectivity among sensorimotor, executive, and limbic networks. The pattern and extent of circuit modulation measured by evoked-fMRI was relatively insensitive to DBS frequency. Optogenetic stimulation of NAc cell bodies induced a positive fMRI signal in the NAc, but no other detectable downstream responses, indicating that therapeutic NAc-DBS might exert its effect through antidromic stimulation. Our study provides a comprehensive mapping of circuit and network-level neuromodulation by NAc-DBS, which should facilitate our developing understanding of its therapeutic mechanisms of action.
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Affiliation(s)
- Daniel L. Albaugh
- Department of Neurology, University of North Carolina, Chapel Hill, NC, 27599, USA
- Biomedical Research Imaging Center, University of North Carolina, Chapel Hill, NC, 27599, USA
- Curriculum in Neurobiology, University of North Carolina, Chapel Hill, NC, 27599, USA
| | - Andrew Salzwedel
- Biomedical Research Imaging Center, University of North Carolina, Chapel Hill, NC, 27599, USA
- Department of Radiology, University of North Carolina, Chapel Hill, NC, 27599, USA
- Biomedical Imaging Research Institute, Department of Biomedical Sciences and Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA
| | - Nathalie Van Den Berge
- Department of Neurology, University of North Carolina, Chapel Hill, NC, 27599, USA
- Biomedical Research Imaging Center, University of North Carolina, Chapel Hill, NC, 27599, USA
- Medical Image and Signal Processing Group, Ghent University, Ghent, 9000, Belgium
| | - Wei Gao
- Biomedical Research Imaging Center, University of North Carolina, Chapel Hill, NC, 27599, USA
- Department of Radiology, University of North Carolina, Chapel Hill, NC, 27599, USA
- Biomedical Imaging Research Institute, Department of Biomedical Sciences and Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA
| | - Garret D. Stuber
- Curriculum in Neurobiology, University of North Carolina, Chapel Hill, NC, 27599, USA
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, 27599, USA
| | - Yen-Yu Ian Shih
- Department of Neurology, University of North Carolina, Chapel Hill, NC, 27599, USA
- Biomedical Research Imaging Center, University of North Carolina, Chapel Hill, NC, 27599, USA
- Curriculum in Neurobiology, University of North Carolina, Chapel Hill, NC, 27599, USA
- Department of Biomedical Engineering, University of North Carolina, Chapel Hill, NC, 27599, USA
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24
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Hardenacke K, Hashemiyoon R, Visser-Vandewalle V, Zapf A, Freund HJ, Sturm V, Hellmich M, Kuhn J. Deep Brain Stimulation of the Nucleus Basalis of Meynert in Alzheimer's Dementia: Potential Predictors of Cognitive Change and Results of a Long-Term Follow-Up in Eight Patients. Brain Stimul 2016; 9:799-800. [PMID: 27522168 DOI: 10.1016/j.brs.2016.05.013] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 05/30/2016] [Indexed: 12/28/2022] Open
Affiliation(s)
- K Hardenacke
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
| | - R Hashemiyoon
- Department of Functional Neurosurgery and Stereotaxy, University of Cologne, Cologne, Germany
| | - V Visser-Vandewalle
- Department of Functional Neurosurgery and Stereotaxy, University of Cologne, Cologne, Germany
| | - A Zapf
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
| | - H J Freund
- Research Centre Juelich, Institute of Neuroscience and Medicine (INM-1), Juelich, Germany
| | - V Sturm
- Department of Neurosurgery, University Clinic of Würzburg, Würzburg, Germany
| | - M Hellmich
- Institute of Medical Statistics, Informatics and Epidemiology, University of Cologne, Cologne, Germany
| | - J Kuhn
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany.
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26
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Sun L, Hinrichs H. Moving average template subtraction to remove stimulation artefacts in EEGs and LFPs recorded during deep brain stimulation. J Neurosci Methods 2016; 266:126-36. [PMID: 27039973 DOI: 10.1016/j.jneumeth.2016.03.020] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 03/29/2016] [Accepted: 03/30/2016] [Indexed: 12/23/2022]
Abstract
BACKGROUND Deep brain stimulation (DBS) is a well established therapy to treat movement disorders such as Parkinson's disease. More recently it has also been discussed as a therapy for certain psychiatric diseases. However, during active DBS the recordings of local field potentials (LFP) and the electroencephalogram (EEG) can be corrupted by substantial spike-type artefacts which need to be removed before any analysis. NEW METHOD Here, we present a new method that we term ' Moving Average Subtraction' (MAS) that removes DBS artefacts by subtracting adaptive DBS artefact templates from the artefact contaminated data. In particular we have developed a resampling technique which is more efficient than upsampling for a precise reconstruction of the artefact shape without the need to oversample the EEGs. RESULTS By applying this method we can derive undistorted signals even in case of the low sampling frequencies that are usual in clinical recordings. We applied the new technique to 12 data sets recorded at the surface and in various brain structures [subthalamic nucleus (STN), pedunculo pontine nucleus (PPN), Globus pallidus internus (GPi)] with 7 patients. Our results demonstrate the suppression of artefact related activity at the basic and harmonic frequencies of DBS. COMPARISON WITH EXISTING METHOD(S) The new technique outperforms the non-adaptive template subtraction technique for the removal of high frequency artefact residuals without producing the spectral dips that occur with notch filter approaches. CONCLUSIONS The new technique facilitates the analysis of higher frequency bands (Gamma activity) in LFPs and EEGs recorded during active DBS.
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Affiliation(s)
- Limin Sun
- Division of Newborn Medicine, Boston Children's Hospital, Harvard Medical School, 02115 Boston, MA, USA; Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 02129 Cambridge, MA, USA
| | - Hermann Hinrichs
- Department of Neurology, Otto-von-Guericke University, Leipziger Straße 44, 39120 Magdeburg, Germany; Leibniz Institute for Neurobiology (LIN), Brenneckestr. 6, 39118 Magdeburg, Germany; Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Leipziger Straße 44, 39120 Magdeburg, Germany; Forschungscampus STIMULATE, Sandtorstraße 23, 39106 Magdeburg, Germany; Center for Behavioural Brain Sciences (CBBS), Leipziger Straße 44, 39120 Magdeburg, Germany.
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27
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Fisher RS. Stimulation of the medial septum should benefit patients with temporal lobe epilepsy. Med Hypotheses 2015; 84:543-50. [DOI: 10.1016/j.mehy.2015.02.016] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Revised: 02/03/2015] [Accepted: 02/25/2015] [Indexed: 11/16/2022]
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28
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Abstract
Recent advances in imaging technology and in the understanding of neural circuits relevant to emotion, motivation, and depression have boosted interest and experimental work in neuromodulation for affective disorders. Real-time functional magnetic resonance imaging (fMRI) can be used to train patients in the self regulation of these circuits, and thus complement existing neurofeedback technologies based on electroencephalography (EEG). EEG neurofeedback for depression has mainly been based on models of altered hemispheric asymmetry. fMRI-based neurofeedback (fMRI-NF) can utilize functional localizer scans that allow the dynamic adjustment of the target areas or networks for self-regulation training to individual patterns of emotion processing. An initial application of fMRI-NF in depression has produced promising clinical results, and further clinical trials are under way. Challenges lie in the design of appropriate control conditions for rigorous clinical trials, and in the transfer of neurofeedback protocols from the laboratory to mobile devices to enhance the sustainability of any clinical benefits.
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Affiliation(s)
- David E J Linden
- MRC Centre for Neuropsychiatric Genetics and Genomics, Neuroscience and Mental Health Research Institute, National Centre for Mental Health, Cardiff University, Cardiff, UK
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29
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Rossi E, Rosa M, Rossi L, Priori A, Marceglia S. WebBioBank: A new platform for integrating clinical forms and shared neurosignal analyses to support multi-centre studies in Parkinson’s Disease. J Biomed Inform 2014; 52:92-104. [DOI: 10.1016/j.jbi.2014.08.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Revised: 07/07/2014] [Accepted: 08/28/2014] [Indexed: 11/27/2022]
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30
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Neumann WJ, Huebl J, Brücke C, Gabriëls L, Bajbouj M, Merkl A, Schneider GH, Nuttin B, Brown P, Kühn AA. Different patterns of local field potentials from limbic DBS targets in patients with major depressive and obsessive compulsive disorder. Mol Psychiatry 2014; 19:1186-92. [PMID: 24514569 PMCID: PMC4813757 DOI: 10.1038/mp.2014.2] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Revised: 12/15/2013] [Accepted: 01/06/2014] [Indexed: 12/11/2022]
Abstract
The role of distinct limbic areas in emotion regulation has been largely inferred from neuroimaging studies. Recently, the opportunity for intracranial recordings from limbic areas has arisen in patients undergoing deep brain stimulation (DBS) for neuropsychiatric disorders including major depressive disorder (MDD) and obsessive compulsive disorder (OCD). Here we test the hypothesis that distinct temporal patterns of local field potential (LFP) activity in the human limbic system reflect disease state and symptom severity in MDD and OCD patients. To this end, we recorded LFPs via implanted DBS electrodes from the bed nucleus of stria terminalis (BNST area) in 12 patients (5 OCD, 7 MDD) and from the subgenual cingulate cortex in 7 MDD patients (CG25 area). We found a distinct pattern of oscillatory activity with significantly higher α-power in MDD compared with OCD in the BNST area (broad α-band 8-14 Hz; P<0.01) and a similar level of α-activity in the CG25 area as in the BNST area in MDD patients. The mean α-power correlated with severity of depressive symptoms as assessed by the Beck depression inventory in MDD (n=14, r=0.55, P=0.042) but not with severity of obsessive compulsive symptoms in OCD. Here we show larger α-band activity in MDD patients compared with OCD recorded from intracranial DBS targets. Our results suggest that α-activity in the limbic system may be a signature of symptom severity in MDD and may serve as a potential state biomarker for closed loop DBS in MDD.
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Affiliation(s)
- W-J Neumann
- Department of Neurology, Charité–University Medicine Berlin, Berlin, Germany
| | - J Huebl
- Department of Neurology, Charité–University Medicine Berlin, Berlin, Germany
| | - C Brücke
- Department of Neurology, Charité–University Medicine Berlin, Berlin, Germany
| | - L Gabriëls
- Department of Psychiatry, University Hospital Leuven, Leuven, Belgium
| | - M Bajbouj
- Department of Psychiatry and Psychotherapy, Charité–University Medicine Berlin, Berlin, Germany
| | - A Merkl
- Department of Neurology, Charité–University Medicine Berlin, Berlin, Germany
,Department of Psychiatry and Psychotherapy, Charité–University Medicine Berlin, Berlin, Germany
| | - G-H Schneider
- Department of Neurosurgery, Charité–University Medicine Berlin, Berlin, Germany
| | - B Nuttin
- Department of Neurosurgery, University Hospital Leuven, Leuven, Belgium
| | - P Brown
- Nuffield Department of Clinical Neurosciences, University of Oxford, and National Institute of Health Related Research Oxford Biomedical Research Centre, Oxford, UK
| | - AA Kühn
- Department of Neurology, Charité–University Medicine Berlin, Berlin, Germany
,Berlin School of Mind and Brain, Charité–University Medicine Berlin, Berlin, Germany
,NeuroCure, Charité–University Medicine Berlin, Berlin, Germany
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31
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Abstract
A 19-year-old man is brought to his primary physician by his father, who explains that his son washes his hands a hundred times a day, will not touch anything that has been touched by someone else without scrubbing it first, and has a fear of germs that has left him isolated in his bedroom, unable to eat, and wishing he were dead. Although the father reports that his son has always been finicky, this problem started approximately 2 years ago and has gradually become completely disabling. How should this patient be evaluated and treated?
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32
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Lapidus KAB, Stern ER, Berlin HA, Goodman WK. Neuromodulation for obsessive-compulsive disorder. Neurotherapeutics 2014; 11:485-95. [PMID: 24981434 PMCID: PMC4121444 DOI: 10.1007/s13311-014-0287-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Neuromodulation shows increasing promise in the treatment of psychiatric disorders, particularly obsessive-compulsive disorder (OCD). Development of tools and techniques including deep brain stimulation, transcranial magnetic stimulation, and electroconvulsive therapy may yield additional options for patients who fail to respond to standard treatments. This article reviews the motivation for and use of these treatments in OCD. We begin with a brief description of the illness followed by discussion of the circuit models thought to underlie the disorder. These circuits provide targets for intervention. Basal ganglia and talamocortical pathophysiology, including cortico-striato-thalamo-cortical loops is a focus of this discussion. Neuroimaging findings and historical treatments that led to the use of neuromodulation for OCD are presented. We then present evidence from neuromodulation studies using deep brain stimulation, electroconvulsive therapy, and transcranial magnetic stimulation, with targets including nucleus accumbens, subthalamic nucleus inferior thalamic peduncle, dorsolateral prefrontal cortex, supplementary motor area, and orbitofrontal cortex. Finally, we explore potential future neuromodulation approaches that may further refine and improve treatment.
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Affiliation(s)
- Kyle A B Lapidus
- Departments of Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA,
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Abstract
Tourette's syndrome (TS) is a childhood neuropsychiatric disorder characterized by multiple involuntary motor and vocal tics. It is commonly associated with other behavioral disorders including attention-deficit/hyperactivity disorder, obsessive-compulsive disorder, anxiety, depression, and self-injurious behaviors. Tourette's syndrome can be effectively managed with psychobehavioral and pharmacological treatments, and many patients experience an improvement in tics in adulthood. However, symptoms may persist and cause severe impairment in a small subset of patients despite available therapies. In recent years, deep brain stimulation (DBS) has been shown to be a promising treatment option for such patients. Since the advent of its use in 1999, multiple targets have been identified in DBS for TS, including the medial thalamus, globus pallidus internus, globus pallidus externus, anterior limb of the internal capsule/nucleus accumbens, and subthalamic nucleus. While the medial thalamus is the most commonly reported trajectory, the optimal surgical target for TS is still a topic of much debate. This paper provides a review of the available literature regarding the use of DBS for TS.
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Affiliation(s)
- Janine Rotsides
- Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
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Abstract
Neuroethics Now welcomes papers addressing the ethical application of neuroscience in research and patient care, as well as its impact on society.
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Lai HY, Albaugh DL, Kao YCJ, Younce JR, Shih YYI. Robust deep brain stimulation functional MRI procedures in rats and mice using an MR-compatible tungsten microwire electrode. Magn Reson Med 2014; 73:1246-51. [DOI: 10.1002/mrm.25239] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 02/14/2014] [Accepted: 03/11/2014] [Indexed: 11/08/2022]
Affiliation(s)
- Hsin-Yi Lai
- Department of Neurology; University of North Carolina; Chapel Hill North Carolina USA
- Biomedical Research Imaging Center; University of North Carolina; Chapel Hill North Carolina USA
| | - Daniel L. Albaugh
- Department of Neurology; University of North Carolina; Chapel Hill North Carolina USA
- Biomedical Research Imaging Center; University of North Carolina; Chapel Hill North Carolina USA
- Curriculum in Neurobiology; University of North Carolina; Chapel Hill North Carolina USA
| | - Yu-Chieh Jill Kao
- Department of Neurology; University of North Carolina; Chapel Hill North Carolina USA
- Biomedical Research Imaging Center; University of North Carolina; Chapel Hill North Carolina USA
| | - John R. Younce
- Department of Neurology; University of North Carolina; Chapel Hill North Carolina USA
- Biomedical Research Imaging Center; University of North Carolina; Chapel Hill North Carolina USA
- School of Medicine; University of North Carolina; Chapel Hill North Carolina USA
| | - Yen-Yu Ian Shih
- Department of Neurology; University of North Carolina; Chapel Hill North Carolina USA
- Biomedical Research Imaging Center; University of North Carolina; Chapel Hill North Carolina USA
- Curriculum in Neurobiology; University of North Carolina; Chapel Hill North Carolina USA
- Department of Biomedical Engineering; University of North Carolina; Chapel Hill North Carolina USA
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Akil M, Etkin A. Transforming neuroscience education in psychiatry. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2014; 38:116-120. [PMID: 24567033 DOI: 10.1007/s40596-014-0065-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Accepted: 01/31/2014] [Indexed: 06/03/2023]
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Younce JR, Albaugh DL, Shih YYI. Deep brain stimulation with simultaneous FMRI in rodents. J Vis Exp 2014:e51271. [PMID: 24561922 DOI: 10.3791/51271] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
In order to visualize the global and downstream neuronal responses to deep brain stimulation (DBS) at various targets, we have developed a protocol for using blood oxygen level dependent (BOLD) functional magnetic resonance imaging (fMRI) to image rodents with simultaneous DBS. DBS fMRI presents a number of technical challenges, including accuracy of electrode implantation, MR artifacts created by the electrode, choice of anesthesia and paralytic to minimize any neuronal effects while simultaneously eliminating animal motion, and maintenance of physiological parameters, deviation from which can confound the BOLD signal. Our laboratory has developed a set of procedures that are capable of overcoming most of these possible issues. For electrical stimulation, a homemade tungsten bipolar microelectrode is used, inserted stereotactically at the stimulation site in the anesthetized subject. In preparation for imaging, rodents are fixed on a plastic headpiece and transferred to the magnet bore. For sedation and paralysis during scanning, a cocktail of dexmedetomidine and pancuronium is continuously infused, along with a minimal dose of isoflurane; this preparation minimizes the BOLD ceiling effect of volatile anesthetics. In this example experiment, stimulation of the subthalamic nucleus (STN) produces BOLD responses which are observed primarily in ipsilateral cortical regions, centered in motor cortex. Simultaneous DBS and fMRI allows the unambiguous modulation of neural circuits dependent on stimulation location and stimulation parameters, and permits observation of neuronal modulations free of regional bias. This technique may be used to explore the downstream effects of modulating neural circuitry at nearly any brain region, with implications for both experimental and clinical DBS.
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Affiliation(s)
- John Robert Younce
- Department of Neurology, University of North Carolina; Biomedical Research Imaging Center, University of North Carolina; School of Medicine, University of North Carolina
| | - Daniel L Albaugh
- Department of Neurology, University of North Carolina; Biomedical Research Imaging Center, University of North Carolina; Curriculum in Neurobiology, University of North Carolina
| | - Yen-Yu Ian Shih
- Department of Neurology, University of North Carolina; Biomedical Research Imaging Center, University of North Carolina; Department of Biomedical Engineering, University of North Carolina; Curriculum in Neurobiology, University of North Carolina;
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Circuit dynamics of adaptive and maladaptive behaviour. Nature 2014; 505:309-17. [PMID: 24429629 DOI: 10.1038/nature12982] [Citation(s) in RCA: 137] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Accepted: 11/08/2013] [Indexed: 02/08/2023]
Abstract
The recent development of technologies for investigating specific components of intact biological systems has allowed elucidation of the neural circuitry underlying adaptive and maladaptive behaviours. Investigators are now able to observe and control, with high spatio-temporal resolution, structurally defined intact pathways along which electrical activity flows during and after the performance of complex behaviours. These investigations have revealed that control of projection-specific dynamics is well suited to modulating behavioural patterns that are relevant to a broad range of psychiatric diseases. Structural dynamics principles have emerged to provide diverse, unexpected and causal insights into the operation of intact and diseased nervous systems, linking form and function in the brain.
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A Short History of Neurosurgical Localization. World Neurosurg 2013; 80:479-81. [DOI: 10.1016/j.wneu.2012.06.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Accepted: 06/12/2012] [Indexed: 11/22/2022]
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O’Rawe JA, Fang H, Rynearson S, Robison R, Kiruluta ES, Higgins G, Eilbeck K, Reese MG, Lyon GJ. Integrating precision medicine in the study and clinical treatment of a severely mentally ill person. PeerJ 2013; 1:e177. [PMID: 24109560 PMCID: PMC3792182 DOI: 10.7717/peerj.177] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Accepted: 09/16/2013] [Indexed: 01/02/2023] Open
Abstract
Background. In recent years, there has been an explosion in the number of technical and medical diagnostic platforms being developed. This has greatly improved our ability to more accurately, and more comprehensively, explore and characterize human biological systems on the individual level. Large quantities of biomedical data are now being generated and archived in many separate research and clinical activities, but there exists a paucity of studies that integrate the areas of clinical neuropsychiatry, personal genomics and brain-machine interfaces. Methods. A single person with severe mental illness was implanted with the Medtronic Reclaim(®) Deep Brain Stimulation (DBS) Therapy device for Obsessive Compulsive Disorder (OCD), targeting his nucleus accumbens/anterior limb of the internal capsule. Programming of the device and psychiatric assessments occurred in an outpatient setting for over two years. His genome was sequenced and variants were detected in the Illumina Whole Genome Sequencing Clinical Laboratory Improvement Amendments (CLIA)-certified laboratory. Results. We report here the detailed phenotypic characterization, clinical-grade whole genome sequencing (WGS), and two-year outcome of a man with severe OCD treated with DBS. Since implantation, this man has reported steady improvement, highlighted by a steady decline in his Yale-Brown Obsessive Compulsive Scale (YBOCS) score from ∼38 to a score of ∼25. A rechargeable Activa RC neurostimulator battery has been of major benefit in terms of facilitating a degree of stability and control over the stimulation. His psychiatric symptoms reliably worsen within hours of the battery becoming depleted, thus providing confirmatory evidence for the efficacy of DBS for OCD in this person. WGS revealed that he is a heterozygote for the p.Val66Met variant in BDNF, encoding a member of the nerve growth factor family, and which has been found to predispose carriers to various psychiatric illnesses. He carries the p.Glu429Ala allele in methylenetetrahydrofolate reductase (MTHFR) and the p.Asp7Asn allele in ChAT, encoding choline O-acetyltransferase, with both alleles having been shown to confer an elevated susceptibility to psychoses. We have found thousands of other variants in his genome, including pharmacogenetic and copy number variants. This information has been archived and offered to this person alongside the clinical sequencing data, so that he and others can re-analyze his genome for years to come. Conclusions. To our knowledge, this is the first study in the clinical neurosciences that integrates detailed neuropsychiatric phenotyping, deep brain stimulation for OCD and clinical-grade WGS with management of genetic results in the medical treatment of one person with severe mental illness. We offer this as an example of precision medicine in neuropsychiatry including brain-implantable devices and genomics-guided preventive health care.
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Affiliation(s)
- Jason A. O’Rawe
- Stanley Institute for Cognitive Genomics, Cold Spring Harbor Laboratory, NY, USA
- Stony Brook University, Stony Brook, NY, USA
| | - Han Fang
- Stanley Institute for Cognitive Genomics, Cold Spring Harbor Laboratory, NY, USA
- Stony Brook University, Stony Brook, NY, USA
| | - Shawn Rynearson
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, USA
| | - Reid Robison
- Utah Foundation for Biomedical Research, Salt Lake City, UT, USA
| | | | | | - Karen Eilbeck
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, USA
| | | | - Gholson J. Lyon
- Stanley Institute for Cognitive Genomics, Cold Spring Harbor Laboratory, NY, USA
- Stony Brook University, Stony Brook, NY, USA
- Utah Foundation for Biomedical Research, Salt Lake City, UT, USA
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History of Psychosurgery: A Psychiatrist's Perspective. World Neurosurg 2013; 80:S27.e1-16. [DOI: 10.1016/j.wneu.2013.02.053] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2012] [Revised: 02/03/2013] [Accepted: 02/11/2013] [Indexed: 01/13/2023]
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Buzsáki G, Watson BO. Brain rhythms and neural syntax: implications for efficient coding of cognitive content and neuropsychiatric disease. DIALOGUES IN CLINICAL NEUROSCIENCE 2013. [PMID: 23393413 PMCID: PMC3553572 DOI: 10.31887/dcns.2012.14.4/gbuzsaki] [Citation(s) in RCA: 304] [Impact Index Per Article: 27.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The perpetual activity of the cerebral cortex is largely supported by the variety of oscillations the brain generates, spanning a number of frequencies and anatomical locations, as well as behavioral correlates. First, we review findings from animal studies showing that most forms of brain rhythms are inhibition-based, producing rhythmic volleys of inhibitory inputs to principal cell populations, thereby providing alternating temporal windows of relatively reduced and enhanced excitability in neuronal networks. These inhibition-based mechanisms offer natural temporal frames to group or "chunk" neuronal activity into cell assemblies and sequences of assemblies, with more complex multi-oscillation interactions creating syntactical rules for the effective exchange of information among cortical networks. We then review recent studies in human psychiatric patients demonstrating a variety alterations in neural oscillations across all major psychiatric diseases, and suggest possible future research directions and treatment approaches based on the fundamental properties of brain rhythms.
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Affiliation(s)
- György Buzsáki
- NYU Neuroscience Institute, School of Medicine, New York University, New York, NY 10016, USA.
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Abstract
Using brain surgery, specific areas in the brain can be stimulated with electrical impulses to reversibly change their activity and alleviate symptoms related to mental illnesses. This so-called deep brain stimulation and other methodological advances that even more selectively activate specific groups of neurons can give us clues as to what neural circuitry is involved in a particular mental disorder and whether therapeutic activation of these brain areas and neurons may be effective. In "Bedside to Bench", Eric Nestler discusses two trials of individuals with anorexia nervosa in which deep brain stimulation of different brain areas resulted in improvement of behavioral domains associated with the syndrome. The results and potential of this technique in animals and humans may bring us closer to understanding the neurobiology of anorexia nervosa, which still remains a mystery and poses a challenge for treatment. In "Bench to Bedside", Jennifer Warner-Schmidt peruses recent findings that uncover the functional connectivity of brain regions involved in depression and how activation of cortical regions can result in antidepressant effects that can compensate for the malfunction of other brain circuits that results in depression.
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Lipsman N, Kaping D, Westendorff S, Sankar T, Lozano AM, Womelsdorf T. Beta coherence within human ventromedial prefrontal cortex precedes affective value choices. Neuroimage 2013; 85 Pt 2:769-78. [PMID: 23732884 DOI: 10.1016/j.neuroimage.2013.05.104] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Revised: 04/30/2013] [Accepted: 05/21/2013] [Indexed: 12/24/2022] Open
Abstract
Ventromedial prefrontal cortex (vmPFC) forms a core region of larger brain circuits that assign value to sensory inputs and interfaces motivational and cognitive dominated brain processes. This network function of the vmPFC could be realized by synchronizing local activity at time scales that are shared by connected brain areas, but it is unknown whether vmPFC circuitry engages in functionally specific synchronization. Here, we recorded in human subcallosal vmPFC while subjects engaged in an emotion tracking task that required the assignment of positive or negative affective value to ambiguous (happy-sad) facial expressions. We found that vmPFC engages in low beta-band (15-20 Hz) coherent activation just before subjects subjectively judged ambiguous facial expressions as conveying negative valence ('sad') information, but not before positive valence ('happy') judgments. The predictive beta coherence emerged particularly for conflicting rather than pure emotional facial cues and dissipated slowly after the choice was made. These results suggest that 15-20 Hz coherent activity within vmPFC marks a functional signature of a valuation process that informs categorical affective choices. We hypothesize that coherent beta band activation signifies functional interactions to anatomical vmPFC projection targets, raising the possibility that dysfunctional biases in affective valuation and an enhanced decision conflict in clinical depression could be indexed by alterations of beta coherent network activation.
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Affiliation(s)
- Nir Lipsman
- Division of Neurosurgery, Krembil Neuroscience Centre and Toronto Western Research Institute, University Health Network, Department of Surgery, University of Toronto, 399 Bathurst, Toronto, Ontario M5T 2S8, Canada
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Zariffa J, Hitzig SL, Popovic MR. Neuromodulation of emotion using functional electrical stimulation applied to facial muscles. Neuromodulation 2013; 17:85-92; discussion 92. [PMID: 23551502 DOI: 10.1111/ner.12056] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Revised: 02/13/2013] [Accepted: 02/26/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVE Major depressive disorder (MDD) is a common condition for which available pharmaceutical treatments are not always effective and can have side-effects. Therefore, alternative and/or complementary MDD treatments are needed. Research on facial expressions has shown that facial movements can induce the corresponding emotions, particularly when specific attention is paid to voluntarily activating muscles that are typically only activated involuntarily while expressing emotions. We hypothesized that functional electrical stimulation (FES) applied to facial muscles may enhance this effect due to its ability to modulate central nervous system plasticity. Thus, applying FES to the facial muscles associated with smiling (including the "Duchenne marker") may increase the activity of subcortical nuclei related to positive emotions and counteract symptoms of depression. METHODS Twelve able-bodied subjects received FES and were compared with a group of 12 control subjects. Both groups underwent the same experimental procedures involving a cognitive task, and a deception was used such that subjects were unaware that the objective was to modulate mood. Assessments with the Positive and Negative Affect Schedule-Expanded Form (PANAS-X) were administered before and after the experiment. RESULTS No significant between-group differences were found in the change scores for our primary outcomes, the PANAS-X item "happy," and aggregate scores "Joviality" and "Positive Affect." Significant differences were, however, detected for secondary outcomes "determined," "daring," "scared," and "concentrating." CONCLUSIONS These results suggest that modulating emotion using FES may be possible, but is difficult to target accurately. Further work is warranted to explore FES applications to MDD.
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Affiliation(s)
- José Zariffa
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada; Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON, Canada
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Electrical stimulation of the insular region attenuates nicotine-taking and nicotine-seeking behaviors. Neuropsychopharmacology 2013; 38:690-8. [PMID: 23249816 PMCID: PMC3572467 DOI: 10.1038/npp.2012.235] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Pharmacological inactivation of the granular insular cortex is able to block nicotine-taking and -seeking behaviors in rats. In this study, we explored the potential of modulating activity in the insular region using electrical stimulation. Animals were trained to self-administer nicotine (0.03 mg/kg per infusion) under a fixed ratio-5 (FR-5) schedule of reinforcement followed by a progressive ratio (PR) schedule. Evaluation of the effect of stimulation in the insular region was performed on nicotine self-administration under FR-5 and PR schedules, as well on reinstatement of nicotine-seeking behavior induced by nicotine-associated cues or nicotine-priming injections. The effect of stimulation was also examined in brain slices containing insular neurons. Stimulation significantly attenuated nicotine-taking, under both schedules of reinforcement, as well as nicotine-seeking behavior induced by cues and priming. These effects appear to be specific to nicotine-associated behaviors, as stimulation did not have any effect on food-taking behavior. They appear to be anatomically specific, as stimulation surrounding the insular region had no effect on behavior. Stimulation of brain slices containing the insular region was found to inactivate insular neurons. Our results suggest that deep brain stimulation to modulate insular activity should be further explored.
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Taira T, Goto S. Validation and perspectives of neuromodulation in Japan. Neurol Med Chir (Tokyo) 2012; 52:457-62. [PMID: 22850492 DOI: 10.2176/nmc.52.457] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Neuromodulation in functional neurosurgery is closely related to the development and availability of devices such as implantable electric stimulators and pumps. All such devices used in Japan are developed and made in foreign countries, and no made-in-Japan device exists. Introduction and approval by the government took many years for most devices, during which time many patients had to continue to live in our medically conservative country. The history of neuromodulation is summarized in Japan and the problems surrounding neuromodulation pointed out. Everyone has to aware of such circumstances and make every effort to improve the internationally unusual situation of neuromodulation in Japan. Otherwise, Japan will become a medically isolated country in the near future.
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Affiliation(s)
- Takaomi Taira
- Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan.
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Lipsman N, Meyerson BA, Lozano AM. A Narrative History of the International Society for Psychiatric Surgery: 19701983. Stereotact Funct Neurosurg 2012; 90:347-55. [DOI: 10.1159/000341082] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2012] [Accepted: 06/10/2012] [Indexed: 11/19/2022]
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Rosa M, Giannicola G, Marceglia S, Fumagalli M, Barbieri S, Priori A. Neurophysiology of Deep Brain Stimulation. EMERGING HORIZONS IN NEUROMODULATION - NEW FRONTIERS IN BRAIN AND SPINE STIMULATION 2012. [DOI: 10.1016/b978-0-12-404706-8.00004-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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