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Yalcinbas EA, Ajanaku B, Nelson ED, Garcia-Flores R, Eagles NJ, Montgomery KD, Stolz JM, Wu J, Divecha HR, Chandra A, Bharadwaj RA, Bach S, Rajpurohit A, Tao R, Pertea G, Shin JH, Kleinman JE, Hyde TM, Weinberger DR, Huuki-Myers LA, Collado-Torres L, Maynard KR. Transcriptomic analysis of the human habenula in schizophrenia. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.02.26.582081. [PMID: 38463979 PMCID: PMC10925152 DOI: 10.1101/2024.02.26.582081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
Pathophysiology of many neuropsychiatric disorders, including schizophrenia (SCZD), is linked to habenula (Hb) function. While pharmacotherapies and deep brain stimulation targeting the Hb are emerging as promising therapeutic treatments, little is known about the cell type-specific transcriptomic organization of the human Hb or how it is altered in SCZD. Here we define the molecular neuroanatomy of the human Hb and identify transcriptomic changes in individuals with SCZD compared to neurotypical controls. Utilizing Hb-enriched postmortem human brain tissue, we performed single nucleus RNA-sequencing (snRNA-seq; n=7 neurotypical donors) and identified 17 molecularly defined Hb cell types across 16,437 nuclei, including 3 medial and 7 lateral Hb populations, several of which were conserved between rodents and humans. Single molecule fluorescent in situ hybridization (smFISH; n=3 neurotypical donors) validated snRNA-seq Hb cell types and mapped their spatial locations. Bulk RNA-sequencing and cell type deconvolution in Hb-enriched tissue from 35 individuals with SCZD and 33 neurotypical controls yielded 45 SCZD-associated differentially expressed genes (DEGs, FDR < 0.05), with 32 (71%) unique to Hb-enriched tissue. eQTL analysis identified 717 independent SNP-gene pairs (FDR < 0.05), where either the SNP is a SCZD risk variant (16 pairs) or the gene is a SCZD DEG (7 pairs). eQTL and SCZD risk colocalization analysis identified 16 colocalized genes. These results identify topographically organized cell types with distinct molecular signatures in the human Hb and demonstrate unique genetic changes associated with SCZD, thereby providing novel molecular insights into the role of Hb in neuropsychiatric disorders. One Sentence Summary Transcriptomic analysis of the human habenula and identification of molecular changes associated with schizophrenia risk and illness state.
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Ranjan M, Mahoney JJ, Rezai AR. Neurosurgical neuromodulation therapy for psychiatric disorders. Neurotherapeutics 2024; 21:e00366. [PMID: 38688105 PMCID: PMC11070709 DOI: 10.1016/j.neurot.2024.e00366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 04/09/2024] [Accepted: 04/16/2024] [Indexed: 05/02/2024] Open
Abstract
Psychiatric disorders are among the leading contributors to global disease burden and disability. A significant portion of patients with psychiatric disorders remain treatment-refractory to best available therapy. With insights from the neurocircuitry of psychiatric disorders and extensive experience of neuromodulation with deep brain stimulation (DBS) in movement disorders, DBS is increasingly being considered to modulate the neural network in psychiatric disorders. Currently, obsessive-compulsive disorder (OCD) is the only U.S. FDA (United States Food and Drug Administration) approved DBS indication for psychiatric disorders. Medically refractory depression, addiction, and other psychiatric disorders are being explored for DBS neuromodulation. Studies evaluating DBS for psychiatric disorders are promising but lack larger, controlled studies. This paper presents a brief review and the current state of DBS and other neurosurgical neuromodulation therapies for OCD and other psychiatric disorders. We also present a brief review of MR-guided Focused Ultrasound (MRgFUS), a novel form of neurosurgical neuromodulation, which can target deep subcortical structures similar to DBS, but in a noninvasive fashion. Early experiences of neurosurgical neuromodulation therapies, including MRgFUS neuromodulation are encouraging in psychiatric disorders; however, they remain investigational. Currently, DBS and VNS are the only FDA approved neurosurgical neuromodulation options in properly selected cases of OCD and depression, respectively.
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Affiliation(s)
- Manish Ranjan
- Department of Neurosurgery, WVU Rockefeller Neuroscience Institute, Morgantown, WV, USA.
| | - James J Mahoney
- Department of Behavioral Medicine and Psychiatry, WVU Rockefeller Neuroscience Institute, Morgantown, WV, USA; Department of Neuroscience, WVU Rockefeller Neuroscience Institute, Morgantown, WV, USA
| | - Ali R Rezai
- Department of Neurosurgery, WVU Rockefeller Neuroscience Institute, Morgantown, WV, USA; Department of Neuroscience, WVU Rockefeller Neuroscience Institute, Morgantown, WV, USA
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Wang F, Dai L, Pan Y, Huang P, Zhang C, Sun B, Li D. Unilateral anterior capsulotomy combined with deep brain stimulation for Parkinson's disease psychosis and motor dysfunctions. Prog Neuropsychopharmacol Biol Psychiatry 2024; 128:110865. [PMID: 37739157 DOI: 10.1016/j.pnpbp.2023.110865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 09/07/2023] [Accepted: 09/19/2023] [Indexed: 09/24/2023]
Abstract
Psychosis is a frequent and debilitating non-motor symptom of Parkinson's disease (PD). This study aimed to evaluate the availability of unilateral anterior capsulotomy combined with subthalamic nucleus deep brain stimulation (STN-DBS) in managing advanced PD patients comorbid with psychosis. Five advanced PD patients with psychosis who had been treated with unilateral anterior capsulotomy combined with bilateral STN-DBS were assessed. The positive subscore of the Positive and Negative Syndrome Scale (PANSS) and the Unified Parkinson's Disease Rating Scale III (UPDRS-III) were used to assess the efficacy parameter of psychosis and the improved motor symptoms, respectively. The quality of life (QoL) was accessed by an 8-item Parkinson's disease Questionnaire (PDQ-8). Clinical outcome assessments were performed at baseline and follow-ups after one or two years. Significant improvement was observed in PD patients during follow-up after the combined treatment. The positive subscore of PANSS improved by 13.4 (5.7) (mean (SD), p = 0.006). Item P1 (delusions) and Item P3 (hallucinations) of the PANSS improved by 5.0 (0.71) (p < 0.0001) and 3.6 (0.89) (p = 0.0008), respectively. Furthermore, the motor symptoms improved by 32.4 (5.7) (UPDRS-III, p = 0.0002), and the QoL improved by 6.4 (3.8) (PDQ-8, p = 0.021). No significant side effects or complications occurred during the study. For advanced PD patients with refractory psychosis, unilateral anterior capsulotomy combined with bilateral STN-DBS improved PD psychosis and motor dysfunction, providing an effective therapeutic option for such patients.
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Affiliation(s)
- Fang Wang
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lulin Dai
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Department of Psychiatry, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yixin Pan
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Peng Huang
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chencheng Zhang
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bomin Sun
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Dianyou Li
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Aibar-Durán JÁ, Corripio Collado I, Roldán Bejarano A, Sánchez Nevado R, Aracil Bolanos I, García-Cornet J, Alonso-Solís A, Grasa Bello EM, de Quintana Schmidt C, Muñoz Hernández F, Molet Teixidó J, Rodríguez RR. Long-term outcomes of deep brain stimulation for treatment-resistant schizophrenia: Exploring potential targets. J Psychiatr Res 2023; 163:296-304. [PMID: 37245316 DOI: 10.1016/j.jpsychires.2023.05.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 05/03/2023] [Accepted: 05/15/2023] [Indexed: 05/30/2023]
Abstract
BACKGROUND Schizophrenia is a complex and disabling disorder. Around 30% of patients have treatment-resistant schizophrenia (TRS). OBJECTIVE This study summarizes the outcomes after three years follow-up of the first series of patients with TRS treated with deep brain stimulation (DBS) and discuss surgical, clinical and imaging analysis. METHODS Eight patients with TRS treated with DBS in the nucleus accumbens (NAcc) or the subgenual cingulate gyrus (SCG) were included. Symptoms were rated with the PANSS scale and normalized using the illness density index (IDI). A reduction in IDI-PANSS of ≥25% compared to baseline was the criterion of good response. The volume of activated tissue was calculated to perform a connectomic analysis for each patient. An estimation of the tracts and cortical areas modulated was generated. RESULTS Five women and three men were analyzed. After 3 years' follow-up, positive symptoms improved in 50% of the SCG group and 75% of the NAcc group (p = 0.06), and general symptoms improved in 25% and 50% respectively (p = 0.06). The SCG group showed activation of the cingulate bundle and modulation of orbitofrontal and frontomesial regions; in contrast, the NAcc group showed activation of the ventral tegmental area projections pathway and modulation of regions associated with the "default mode network" (precuneus) and Brodmann areas 19 and 20. CONCLUSIONS These results showed a trend toward improvement for positive and general symptoms in patients with TRS treated with DBS. The connectomic analysis will help us understand the interaction of this treatment with the disease to pursue future trial designs.
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Affiliation(s)
- Juan Ángel Aibar-Durán
- Department of Neurosurgery, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau (IIB-Sant Pau), Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Iluminada Corripio Collado
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau (IIB-Sant Pau), Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain
| | - Alexandra Roldán Bejarano
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau (IIB-Sant Pau), Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain.
| | - Raquel Sánchez Nevado
- Department of Neurosurgery, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau (IIB-Sant Pau), Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Ignacio Aracil Bolanos
- Deparment of Neurology, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau (IIB-Sant Pau), Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Julia García-Cornet
- Ingeniering imaging and Signaling, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau (IIB-Sant Pau), Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Anna Alonso-Solís
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau (IIB-Sant Pau), Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain
| | - Eva Ma Grasa Bello
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau (IIB-Sant Pau), Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain
| | - Cristian de Quintana Schmidt
- Department of Neurosurgery, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau (IIB-Sant Pau), Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Fernando Muñoz Hernández
- Department of Neurosurgery, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau (IIB-Sant Pau), Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Joan Molet Teixidó
- Department of Neurosurgery, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau (IIB-Sant Pau), Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Rodrigo Rodríguez Rodríguez
- Department of Neurosurgery, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau (IIB-Sant Pau), Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
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Carrillo-Ruiz JD, Carrillo-Márquez JR, Beltrán JQ, Jiménez-Ponce F, García-Muñoz L, Navarro-Olvera JL, Márquez-Franco R, Velasco F. Innovative perspectives in limbic surgery using deep brain stimulation. Front Neurosci 2023; 17:1167244. [PMID: 37274213 PMCID: PMC10233042 DOI: 10.3389/fnins.2023.1167244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 04/24/2023] [Indexed: 06/06/2023] Open
Abstract
Limbic surgery is one of the most attractive and retaken fields of functional neurosurgery in the last two decades. Psychiatric surgery emerged from the incipient work of Moniz and Lima lesioning the prefrontal cortex in agitated patients. Since the onset of stereotactic and functional neurosurgery with Spiegel and Wycis, the treatment of mental diseases gave attention to refractory illnesses mainly with the use of thalamotomies. Neurosis and some psychotic symptoms were treated by them. Several indications when lesioning the brain were included: obsessive-compulsive disorder, depression, and aggressiveness among others with a diversity of targets. The indiscriminately use of anatomical sites without enough scientific evidence, and uncertainly defined criteria for selecting patients merged with a deficiency in ethical aspects, brought a lack of procedures for a long time: only select clinics allowed this surgery around the world from 1950 to the 1990s. In 1999, Nuttin et al. began a new chapter in limbic surgery with the use of Deep Brain Stimulation, based on the experience of pain, Parkinson's disease, and epilepsy. The efforts were focused on different targets to treat depression and obsessive-compulsive disorders. Nevertheless, other diseases were added to use neuromodulation. The goal of this article is to show the new opportunities to treat neuropsychiatric diseases.
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Affiliation(s)
- José Damián Carrillo-Ruiz
- Stereotactic, Functional & Radiosurgery Unit of Neurosurgery Service, Mexico General Hospital, Mexico City, Mexico
- Research Direction, Mexico General Hospital, Mexico City, Mexico
- Neuroscience Coordination, Psychology Faculty, Anahuac University, Mexico City, Mexico
| | - José Rodrigo Carrillo-Márquez
- Faculty of Health Sciences, Anahuac University, Mexico City, Mexico
- Alpha Health Sciences Leadership Program, Anahuac University, Mexico City, Mexico
| | - Jesús Quetzalcóatl Beltrán
- Stereotactic, Functional & Radiosurgery Unit of Neurosurgery Service, Mexico General Hospital, Mexico City, Mexico
| | - Fiacro Jiménez-Ponce
- Stereotactic, Functional & Radiosurgery Unit of Neurosurgery Service, Mexico General Hospital, Mexico City, Mexico
| | - Luis García-Muñoz
- Stereotactic, Functional & Radiosurgery Unit of Neurosurgery Service, Mexico General Hospital, Mexico City, Mexico
| | - José Luis Navarro-Olvera
- Stereotactic, Functional & Radiosurgery Unit of Neurosurgery Service, Mexico General Hospital, Mexico City, Mexico
| | - René Márquez-Franco
- Stereotactic, Functional & Radiosurgery Unit of Neurosurgery Service, Mexico General Hospital, Mexico City, Mexico
| | - Francisco Velasco
- Stereotactic, Functional & Radiosurgery Unit of Neurosurgery Service, Mexico General Hospital, Mexico City, Mexico
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Investigating Deep Brain Stimulation of the Habenula: A Review of Clinical Studies. Neuromodulation 2023; 26:292-301. [PMID: 35840520 DOI: 10.1016/j.neurom.2022.05.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 05/19/2022] [Indexed: 02/07/2023]
Abstract
OBJECTIVES The aim of this study was to examine the current scientific literature on deep brain stimulation (DBS) targeting the habenula for the treatment of neuropsychiatric disorders including schizophrenia, major depressive disorder, and obsessive-compulsive disorder (OCD). MATERIALS AND METHODS Two authors performed independent data base searches using the PubMed, Cochrane, PsycINFO, and Web of Science search engines. The data bases were searched for the query ("deep brain stimulation" and "habenula"). The inclusion criteria involved screening for human clinical trials written in English and published from 2007 to 2020. From the eligible studies, data were collected on the mean age, sex, number of patients included, and disorder treated. Patient outcomes of each study were summarized. RESULTS The search yielded six studies, which included 11 patients in the final analysis. Treated conditions included refractory depression, bipolar disorder, OCD, schizophrenia, and major depressive disorder. Patients with bipolar disorder unmedicated for at least two months had smaller habenula volumes than healthy controls. High-frequency stimulation of the lateral habenula attenuated the rise of serotonin in the dorsal raphe nucleus for treating depression. Bilateral habenula DBS and patient OCD symptoms were reduced and maintained at one-year follow up. Low- and high-frequency stimulation DBS can simulate input paths to the lateral habenula to treat addiction, including cocaine addiction. More data are needed to draw conclusions as to the impact of DBS for schizophrenia and obesity. CONCLUSIONS The habenula is a novel target that could aid in reducing neuropsychiatric symptoms and should be considered in circuit-specific investigation of neuromodulation for psychiatric disorders. More information needs to be gathered and assessed before this treatment is fully approved for treatment of neuropsychiatric conditions.
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Gault JM, Hosokawa P, Kramer D, Saks ER, Appelbaum PS, Thompson JA, Olincy A, Cascella N, Sawa A, Goodman W, Moukaddam N, Sheth SA, Anderson WS, Davis RA. Postsurgical morbidity and mortality favorably informs deep brain stimulation for new indications including schizophrenia and schizoaffective disorder. Front Surg 2023; 10:958452. [PMID: 37066004 PMCID: PMC10098000 DOI: 10.3389/fsurg.2023.958452] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 03/07/2023] [Indexed: 04/18/2023] Open
Abstract
Background Deep brain stimulation (DBS) shows promise for new indications like treatment-refractory schizophrenia in early clinical trials. In the first DBS clinical trial for treatment refractory schizophrenia, despite promising results in treating psychosis, one of the eight subjects experienced both a symptomatic hemorrhage and an infection requiring device removal. Now, ethical concerns about higher surgical risk in schizophrenia/schizoaffective disorder (SZ/SAD) are impacting clinical trial progress. However, insufficient cases preclude conclusions regarding DBS risk in SZ/SAD. Therefore, we directly compare adverse surgical outcomes for all surgical procedures between SZ/SAD and Parkinson's disease (PD) cases to infer relative surgical risk relevant to gauging DBS risks in subjects with SZ/SAD. Design In the primary analysis, we used browser-based statistical analysis software, TriNetX Live (trinetx.com TriNetX LLC, Cambridge, MA), for Measures of Association using the Z-test. Postsurgical morbidity and mortality after matching for ethnicity, over 39 risk factors, and 19 CPT 1003143 coded surgical procedures from over 35,000 electronic medical records, over 19 years, from 48 United States health care organizations (HCOs) through the TriNetX Research Network™. TriNetXis a global, federated, web-based health research network providing access and statistical analysis of aggregate counts of deidentified EMR data. Diagnoses were based on ICD-10 codes. In the final analysis, logistic regression was used to determine relative frequencies of outcomes among 21 diagnostic groups/cohorts being treated with or considered for DBS and 3 control cohorts. Results Postsurgical mortality was 1.01-4.11% lower in SZ/SAD compared to the matched PD cohort at 1 month and 1 year after any surgery, while morbidity was 1.91-2.73% higher and associated with postsurgical noncompliance with medical treatment. Hemorrhages and infections were not increased. Across the 21 cohorts compared, PD and SZ/SAD were among eight cohorts with fewer surgeries, nine cohorts with higher postsurgical morbidity, and fifteen cohorts within the control-group range for 1-month postsurgical mortality. Conclusions Given that the subjects with SZ or SAD, along with most other diagnostic groups examined, had lower postsurgical mortality than PD subjects, it is reasonable to apply existing ethical and clinical guidelines to identify appropriate surgical candidates for inclusion of these patient populations in DBS clinical trials.
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Affiliation(s)
- Judith M. Gault
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
- Correspondence: Judith M. Gault
| | - Patrick Hosokawa
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Daniel Kramer
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Elyn R. Saks
- The Law School, University of Southern California, Los Angeles, CA, United States
| | - Paul S. Appelbaum
- Department of Psychiatry, Columbia University, New York, Ny, United States Of America
| | - John A. Thompson
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Ann Olincy
- VA Eastern Colorado Medical Center, Aurora, CO, United States
| | - Nicola Cascella
- Department of Psychiatry, Johns Hopkins University, Baltimore, MD, United States
| | - Akira Sawa
- Department of Psychiatry, Johns Hopkins University, Baltimore, MD, United States
| | - Wayne Goodman
- Department of Psychiatry, Baylor College of Medicine, Houston, TX, United States
| | - Nidal Moukaddam
- Department of Psychiatry, Baylor College of Medicine, Houston, TX, United States
| | - Sameer A. Sheth
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, United States
| | - William S. Anderson
- Department of Neurosurgery, Johns Hopkins University, Baltimore, MD, United States
| | - Rachel A. Davis
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
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Circuits regulating pleasure and happiness - focus on potential biomarkers for circuitry including the habenuloid complex. Acta Neuropsychiatr 2022; 34:229-239. [PMID: 35587050 DOI: 10.1017/neu.2022.15] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
INTRODUCTION The multiplicity and complexity of the neuronal connections in the central nervous system make it difficult to disentangle circuits that play an essential role in the development or treatment of (neuro)psychiatric disorders. By choosing the evolutionary development of the forebrain as a starting point, a certain order in the connections can be created. The dorsal diencephalic connection (DDC) system can be applied for the development of biomarkers that can predict treatment response. MATERIALS AND METHODS After providing a brief introduction to the theory, we examined neuroanatomical publications on the connectivity of the DDC system. We then searched for neurochemical components that are specific for the habenula. RESULTS AND DISCUSSION The best strategy to find biomarkers that reflect the function of the habenular connection is to use genetic variants of receptors, transporters or enzymes specific to this complex. By activating these with probes and measuring the response in people with different functional genotypes, the usefulness of biomarkers can be assessed. CONCLUSIONS The most promising biomarkers in this respect are those linked to activation or inhibition of the nicotine receptor, dopamine D4 receptor, μ-opioid receptor and also those of the functioning of habenular glia cells (astrocytes and microglia).
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Lu C, Feng Y, Li H, Gao Z, Zhu X, Hu J. A preclinical study of deep brain stimulation in the ventral tegmental area for alleviating positive psychotic-like behaviors in mice. Front Hum Neurosci 2022; 16:945912. [PMID: 36034113 PMCID: PMC9399924 DOI: 10.3389/fnhum.2022.945912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 06/14/2022] [Indexed: 11/13/2022] Open
Abstract
Deep brain stimulation (DBS) is a clinical intervention for the treatment of movement disorders. It has also been applied to the treatment of psychiatric disorders such as depression, anorexia nervosa, obsessive-compulsive disorder, and schizophrenia. Psychiatric disorders including schizophrenia, bipolar disorder, and major depression can lead to psychosis, which can cause patients to lose touch with reality. The ventral tegmental area (VTA), located near the midline of the midbrain, is an important region involved in psychosis. However, the clinical application of electrical stimulation of the VTA to treat psychotic diseases has been limited, and related mechanisms have not been thoroughly studied. In the present study, hyperlocomotion and stereotyped behaviors of the mice were employed to mimic and evaluate the positive-psychotic-like behaviors. We attempted to treat positive psychotic-like behaviors by electrically stimulating the VTA in mice and exploring the neural mechanisms behind behavioral effects. Local field potential recording and in vivo fiber photometry to observe the behavioral effects and changes in neural activities caused by DBS in the VTA of mice. Optogenetic techniques were used to verify the neural mechanisms underlying the behavioral effects induced by DBS. Our results showed that electrical stimulation of the VTA activates local gamma-aminobutyric acid (GABA) neurons, and dopamine (DA) neurons, reduces hyperlocomotion, and relieves stereotyped behaviors induced by MK-801 (dizocilpine) injection. The results of optogenetic manipulation showed that the activation of the VTA GABA neurons, but not DA neurons, is involved in the alleviation of hyperlocomotion and stereotyped behaviors. We visualized changes in the activity of specific types in specific brain areas induced by DBS, and explored the neural mechanism of DBS in alleviating positive psychotic-like behaviors. This preclinical study not only proposes new technical means of exploring the mechanism of DBS, but also provides experimental justification for the clinical treatment of psychotic diseases by electrical stimulation of the VTA.
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Affiliation(s)
- Chen Lu
- School of Life Science and Technology, Shanghai Tech University, Shanghai, China
- Institute of Neuroscience, State Key Laboratory of Neuroscience, CAS Center for Excellence in Brain Science and Intelligence Technology, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai, China
- University of Chinese Academy of Sciences, Beijing, China
| | - Yifan Feng
- School of Life Science and Technology, Shanghai Tech University, Shanghai, China
| | - Hongxia Li
- Department of Neurology and Institute of Neurology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zilong Gao
- School of Life Sciences, Westlake University, Hangzhou, China
| | - Xiaona Zhu
- School of Life Science and Technology, Shanghai Tech University, Shanghai, China
- *Correspondence: Ji Hu Xiaona Zhu
| | - Ji Hu
- School of Life Science and Technology, Shanghai Tech University, Shanghai, China
- *Correspondence: Ji Hu Xiaona Zhu
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Chen S, Sun X, Zhang Y, Mu Y, Su D. Habenula bibliometrics: Thematic development and research fronts of a resurgent field. Front Integr Neurosci 2022; 16:949162. [PMID: 35990593 PMCID: PMC9382245 DOI: 10.3389/fnint.2022.949162] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 07/12/2022] [Indexed: 11/19/2022] Open
Abstract
The habenula (Hb) is a small structure of the posterior diencephalon that is highly conserved across vertebrates but nonetheless has attracted relatively little research attention until the past two decades. The resurgent interest is motivated by neurobehavioral studies demonstrating critical functions in a broad spectrum of motivational and cognitive processes, including functions relevant to psychiatric diseases. The Hb is widely conceived as an “anti-reward” center that acts by regulating brain monoaminergic systems. However, there is still no general conceptual framework for habenula research, and no study has focused on uncovering potentially significant but overlooked topics that may advance our understanding of physiological functions or suggest potential clinical applications of Hb-targeted interventions. Using science mapping tools, we quantitatively and qualitatively analyzed the relevant publications retrieved from the Web of Science Core Collection (WoSCC) database from 2002 to 2021. Herein we present an overview of habenula-related publications, reveal primary research trends, and prioritize some key research fronts by complementary bibliometric analysis. High-priority research fronts include Ventral Pallidum, Nucleus Accumbens, Nicotine and MHb, GLT-1, Zebrafish, and GCaMP, Ketamine, Deep Brain Stimulation, and GPR139. The high intrinsic heterogeneity of the Hb, extensive connectivity with both hindbrain and forebrain structures, and emerging associations with all three dimensions of mental disorders (internalizing, externalizing, and psychosis) suggest that the Hb may be the neuronal substrate for a common psychopathology factor shared by all mental illnesses termed the p factor. A future challenge is to explore the therapeutic potential of habenular modulation at circuit, cellular, and molecular levels.
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Affiliation(s)
- Sifan Chen
- Department of Anesthesiology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaoyu Sun
- Department of Anesthesiology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yizhe Zhang
- Department of Anesthesiology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yu Mu
- State Key Laboratory of Neuroscience, Center for Excellence in Brain Science and Intelligence Technology, Institute of Neuroscience, Chinese Academy of Sciences, Shanghai, China
| | - Diansan Su
- Department of Anesthesiology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- *Correspondence: Diansan Su,
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11
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Wada M, Noda Y, Iwata Y, Tsugawa S, Yoshida K, Tani H, Hirano Y, Koike S, Sasabayashi D, Katayama H, Plitman E, Ohi K, Ueno F, Caravaggio F, Koizumi T, Gerretsen P, Suzuki T, Uchida H, Müller DJ, Mimura M, Remington G, Grace AA, Graff-Guerrero A, Nakajima S. Dopaminergic dysfunction and excitatory/inhibitory imbalance in treatment-resistant schizophrenia and novel neuromodulatory treatment. Mol Psychiatry 2022; 27:2950-2967. [PMID: 35444257 DOI: 10.1038/s41380-022-01572-0] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 03/31/2022] [Accepted: 04/07/2022] [Indexed: 12/13/2022]
Abstract
Antipsychotic drugs are the mainstay in the treatment of schizophrenia. However, one-third of patients do not show adequate improvement in positive symptoms with non-clozapine antipsychotics. Additionally, approximately half of them show poor response to clozapine, electroconvulsive therapy, or other augmentation strategies. However, the development of novel treatment for these conditions is difficult due to the complex and heterogenous pathophysiology of treatment-resistant schizophrenia (TRS). Therefore, this review provides key findings, potential treatments, and a roadmap for future research in this area. First, we review the neurobiological pathophysiology of TRS, particularly the dopaminergic, glutamatergic, and GABAergic pathways. Next, the limitations of existing and promising treatments are presented. Specifically, this article focuses on the therapeutic potential of neuromodulation, including electroconvulsive therapy, repetitive transcranial magnetic stimulation, transcranial direct current stimulation, and deep brain stimulation. Finally, we propose multivariate analyses that integrate various perspectives of the pathogenesis, such as dopaminergic dysfunction and excitatory/inhibitory imbalance, thereby elucidating the heterogeneity of TRS that could not be obtained by conventional statistics. These analyses can in turn lead to a precision medicine approach with closed-loop neuromodulation targeting the detected pathophysiology of TRS.
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Affiliation(s)
- Masataka Wada
- Department of Neuropsychiatry, Keio University, School of Medicine, Tokyo, Japan
| | - Yoshihiro Noda
- Department of Neuropsychiatry, Keio University, School of Medicine, Tokyo, Japan
| | - Yusuke Iwata
- Department of Neuropsychiatry, University of Yamanashi Faculty of Medicine, Yamanashi, Japan
| | - Sakiko Tsugawa
- Department of Neuropsychiatry, Keio University, School of Medicine, Tokyo, Japan
| | - Kazunari Yoshida
- Department of Neuropsychiatry, Keio University, School of Medicine, Tokyo, Japan.,Tanenbaum Centre for Pharmacogenetics, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Hideaki Tani
- Department of Neuropsychiatry, Keio University, School of Medicine, Tokyo, Japan
| | - Yoji Hirano
- Department of Neuropsychiatry, Kyushu University, Fukuoka, Japan.,Neural Dynamics Laboratory, Research Service, VA Boston Healthcare System, and Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Shinsuke Koike
- Center for Evolutionary Cognitive Sciences, Graduate School of Art and Sciences, The University of Tokyo, Tokyo, Japan
| | - Daiki Sasabayashi
- Department of Neuropsychiatry, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan.,Research Center for Idling Brain Science, University of Toyama, Toyama, Japan
| | - Haruyuki Katayama
- Department of Neuropsychiatry, Keio University, School of Medicine, Tokyo, Japan
| | - Eric Plitman
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Kazutaka Ohi
- Department of Psychiatry, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Fumihiko Ueno
- Department of Neuropsychiatry, Keio University, School of Medicine, Tokyo, Japan.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Brain Health Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Fernando Caravaggio
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Brain Health Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Teruki Koizumi
- Department of Neuropsychiatry, Keio University, School of Medicine, Tokyo, Japan.,Department of Psychiatry, National Hospital Organization Shimofusa Psychiatric Medical Center, Chiba, Japan
| | - Philip Gerretsen
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Brain Health Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Takefumi Suzuki
- Department of Neuropsychiatry, University of Yamanashi Faculty of Medicine, Yamanashi, Japan
| | - Hiroyuki Uchida
- Department of Neuropsychiatry, Keio University, School of Medicine, Tokyo, Japan
| | - Daniel J Müller
- Tanenbaum Centre for Pharmacogenetics, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Masaru Mimura
- Department of Neuropsychiatry, Keio University, School of Medicine, Tokyo, Japan
| | - Gary Remington
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Anthony A Grace
- Departments of Neuroscience, Psychiatry and Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ariel Graff-Guerrero
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Brain Health Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Shinichiro Nakajima
- Department of Neuropsychiatry, Keio University, School of Medicine, Tokyo, Japan. .,Brain Health Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada.
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12
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Gouveia FV, Baker PM, Mameli M, Germann J. Editorial: The Habenula and Its Role in Neuropsychiatric Symptoms. Front Behav Neurosci 2022; 16:929507. [PMID: 35685273 PMCID: PMC9172991 DOI: 10.3389/fnbeh.2022.929507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 05/02/2022] [Indexed: 11/30/2022] Open
Affiliation(s)
- Flavia Venetucci Gouveia
- Neuroscience and Mental Health, The Hospital for Sick Children Research Institute, Toronto, ON, Canada
- *Correspondence: Flavia Venetucci Gouveia
| | | | - Manuel Mameli
- The Department of Fundamental Neuroscience, The University of Lausanne, Lausanne, Switzerland
- INSERM, UMR-S 839, Paris, France
| | - Jurgen Germann
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, ON, Canada
- Jurgen Germann
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13
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Messina G, Vetrano IG, Bonomo G, Broggi G. Role of deep brain stimulation in management of psychiatric disorders. PROGRESS IN BRAIN RESEARCH 2022; 270:61-96. [PMID: 35396031 DOI: 10.1016/bs.pbr.2022.01.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Nowadays, most of patients affected by psychiatric disorders are successfully treated with conservative therapies. Still, a variable percentage of them demonstrate resistance to conventional treatments, and alternative methods can then be considered. During the last 20 years, there is a progressive interest in use of deep brain stimulation (DBS) in mental illnesses. It has become clear nowadays, that this modality may be effectively applied under specific indications in some patients with major depressive disorder, obsessive-compulsive disorder, anorexia nervosa and other eating disorders, Tourette syndrome, schizophrenia, substance use disorder, and even pathologically aggressive behavior. Despite the fact that the efficacy of neuromodulation with DBS, as well as of various lesional interventions, in cases of mental illnesses is still not fully established, there are several premises for wider applications of such "unclassical" psychiatric treatments in the future. Novel technologies of DBS, developments in non-invasive lesioning using stereotactic radiosurgery and transcranial magnetic resonance-guided focused ultrasound, and advances of neurophysiological and neuroimaging modalities may bolster further clinical applications of psychiatric neurosurgery, improve its results, and allow for individually selected treatment strategies tailored to specific needs of the patient.
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Affiliation(s)
- Giuseppe Messina
- Functional Neurosurgery Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.
| | - Ignazio G Vetrano
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Giulio Bonomo
- Functional Neurosurgery Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Giovanni Broggi
- Functional Neurosurgery Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; Department of Neurosurgery, M Cecilia Hospital-GVM, Ravenna, Italy
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14
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De Salles A, Lucena L, Paranhos T, Ferragut MA, de Oliveira-Souza R, Gorgulho A. Modern neurosurgical techniques for psychiatric disorders. PROGRESS IN BRAIN RESEARCH 2022; 270:33-59. [PMID: 35396030 DOI: 10.1016/bs.pbr.2022.01.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Psychosurgery refers to an ensemble of more or less invasive techniques designed to reduce the burden caused by psychiatric diseases in patients who have failed to respond to conventional therapy. While most surgeries are designed to correct apparent anatomical abnormalities, no discrete cerebral anatomical lesion is evident in most psychiatric diseases amenable to invasive interventions. Finding the optimal surgical targets in mental illness is troublesome. In general, contemporary psychosurgical procedures can be classified into one of two primary modalities: lesioning and stimulation procedures. The first group is divided into (a) thermocoagulation and (b) stereotactic radiosurgery or recently introduced transcranial magnetic resonance-guided focused ultrasound, whereas stimulation techniques mainly include deep brain stimulation (DBS), cortical stimulation, and the vagus nerve stimulation. The most studied psychiatric diseases amenable to psychosurgical interventions are severe treatment-resistant major depressive disorder, obsessive-compulsive disorder, Tourette syndrome, anorexia nervosa, schizophrenia, and substance use disorder. Furthermore, modern neuroimaging techniques spurred the interest of clinicians to identify cerebral regions amenable to be manipulated to control psychiatric symptoms. On this way, the concept of a multi-nodal network need to be embraced, enticing the collaboration of psychiatrists, psychologists, neurologists and neurosurgeons participating in multidisciplinary groups, conducting well-designed clinical trials.
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Affiliation(s)
- Antonio De Salles
- University of California Los Angeles (UCLA), Los Angeles, CA, United States; NeuroSapiens®, Brazil; Hospital Rede D'Or, São Luiz, SP, Brazil.
| | - Luan Lucena
- NeuroSapiens®, Brazil; Hospital Rede D'Or, São Luiz, SP, Brazil
| | - Thiago Paranhos
- Hospital Rede D'Or, São Luiz, SP, Brazil; Federal University of Rio De Janeiro (UFRJ), Rio de Janeiro, Brazil
| | | | - Ricardo de Oliveira-Souza
- D'Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil; Federal University of the State of Rio De Janeiro (UNIRIO), Rio de Janeiro, Brazil
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15
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Tang WK, Wang L, Tsoi KKF, Yasuno F, Kim JS. Apathy after subarachnoid haemorrhage: A systematic review. J Psychosom Res 2022; 155:110742. [PMID: 35168165 DOI: 10.1016/j.jpsychores.2022.110742] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 01/18/2022] [Accepted: 01/22/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Apathy is a common and debilitating symptom accompanying many neurological disorders including non-traumatic subarachnoid hemorrhage (SAH). OBJECTIVES The aim of this systematic review was to identify and critically appraise all published studies that have reported the prevalence, severity, and time course of apathy after SAH, the factors associated with its development, and the impact of apathy on patients' quality of life after SAH. METHODS The PubMed, EMBASE, PsycINFO, and Ovid Nursing databases were searched for studies published in English that recruited at least 10 patients (>18 years old) after SAH who were also diagnosed with apathy. RESULTS Altogether 10 studies covering 595 patients met the study's inclusion criteria. The prevalence of apathy ranged from 15 to 68%, with a weighted proportion of 38%. The time course of apathy was unknown. Comorbid cognitive impairment increases the risk of apathy. Blood in lateral ventricles and hydrocephalus may also be related to apathy. Apathy reduces participation in leisure and sexual activities. There were several methodological shortcomings in the included studies, namely, heterogeneity in study design and timing of apathy assessment, hospitalized /clinic-based and biased sampling, small sample sizes and some had high attrition rates, and uncertain validity of the measures of apathy. CONCLUSIONS Apathy is common after SAH. Further research is needed to clarify its time course and identify the neurochemical factors and brain circuits associated with the development of post-SAH apathy. Randomized controlled treatment trials targeting SAH-related apathy are warranted.
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Affiliation(s)
- Wai Kwong Tang
- Department of Psychiatry, Chinese University of Hong Kong, Hong Kong, SAR, China.
| | - Lisha Wang
- Department of Psychiatry, Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Kelvin K F Tsoi
- Jockey Club School of Public Health and Primary Care, Chinese University of Hong Kong, Hong Kong SAR, China; Stanley Ho Big Data Decision Analytics Research Centre, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Fumihiko Yasuno
- Department of Psychiatry, National Center for Geriatrics and Gerontology, Aichi, Japan
| | - Jong S Kim
- Department of Neurology, Asan Medical Center, University of Ulsan, Seoul, Korea
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16
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Mahoney JJ, Koch-Gallup N, Scarisbrick DM, Berry JH, Rezai AR. Deep brain stimulation for psychiatric disorders and behavioral/cognitive-related indications: Review of the literature and implications for treatment. J Neurol Sci 2022; 437:120253. [DOI: 10.1016/j.jns.2022.120253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 02/23/2022] [Accepted: 04/03/2022] [Indexed: 11/15/2022]
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17
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Hollunder B, Rajamani N, Siddiqi SH, Finke C, Kühn AA, Mayberg HS, Fox MD, Neudorfer C, Horn A. Toward personalized medicine in connectomic deep brain stimulation. Prog Neurobiol 2022; 210:102211. [PMID: 34958874 DOI: 10.1016/j.pneurobio.2021.102211] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 12/15/2021] [Accepted: 12/22/2021] [Indexed: 02/08/2023]
Abstract
At the group-level, deep brain stimulation leads to significant therapeutic benefit in a multitude of neurological and neuropsychiatric disorders. At the single-patient level, however, symptoms may sometimes persist despite "optimal" electrode placement at established treatment coordinates. This may be partly explained by limitations of disease-centric strategies that are unable to account for heterogeneous phenotypes and comorbidities observed in clinical practice. Instead, tailoring electrode placement and programming to individual patients' symptom profiles may increase the fraction of top-responding patients. Here, we propose a three-step, circuit-based framework with the aim of developing patient-specific treatment targets that address the unique symptom constellation prevalent in each patient. First, we describe how a symptom network target library could be established by mapping beneficial or undesirable DBS effects to distinct circuits based on (retrospective) group-level data. Second, we suggest ways of matching the resulting symptom networks to circuits defined in the individual patient (template matching). Third, we introduce network blending as a strategy to calculate optimal stimulation targets and parameters by selecting and weighting a set of symptom-specific networks based on the symptom profile and subjective priorities of the individual patient. We integrate the approach with published literature and conclude by discussing limitations and future challenges.
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Affiliation(s)
- Barbara Hollunder
- Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany; Einstein Center for Neurosciences Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany; Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany.
| | - Nanditha Rajamani
- Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Shan H Siddiqi
- Center for Brain Circuit Therapeutics, Brigham & Women's Hospital, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Carsten Finke
- Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany; Einstein Center for Neurosciences Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany; Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Andrea A Kühn
- Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany; Einstein Center for Neurosciences Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany; Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany; NeuroCure Cluster of Excellence, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Helen S Mayberg
- Nash Family Center for Advanced Circuit Therapeutics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Michael D Fox
- Center for Brain Circuit Therapeutics, Brigham & Women's Hospital, Boston, MA, USA
| | - Clemens Neudorfer
- Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany; Center for Brain Circuit Therapeutics, Brigham & Women's Hospital, Boston, MA, USA; Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Andreas Horn
- Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany; Einstein Center for Neurosciences Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany; Center for Brain Circuit Therapeutics, Brigham & Women's Hospital, Boston, MA, USA; Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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18
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Sonkusare S, Ding Q, Zhang Y, Wang L, Gong H, Mandali A, Manssuer L, Zhao YJ, Pan Y, Zhang C, Li D, Sun B, Voon V. Power signatures of habenular neuronal signals in patients with bipolar or unipolar depressive disorders correlate with their disease severity. Transl Psychiatry 2022; 12:72. [PMID: 35194027 PMCID: PMC8863838 DOI: 10.1038/s41398-022-01830-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 01/17/2022] [Accepted: 01/28/2022] [Indexed: 01/03/2023] Open
Abstract
The habenula is an epithalamic structure implicated in negative reward mechanisms and plays a downstream modulatory role in regulation of dopaminergic and serotonergic functions. Human and animal studies show its hyperactivity in depression which is curtailed by the antidepressant response of ketamine. Deep brain stimulation of habenula (DBS) for major depression have also shown promising results. However, direct neuronal activity of habenula in human studies have rarely been reported. Here, in a cross-sectional design, we acquired both spontaneous resting state and emotional task-induced neuronal recordings from habenula from treatment resistant depressed patients undergoing DBS surgery. We first characterise the aperiodic component (1/f slope) of the power spectrum, interpreted to signify excitation-inhibition balance, in resting and task state. This aperiodicity for left habenula correlated between rest and task and which was significantly positively correlated with depression severity. Time-frequency responses to the emotional picture viewing task show condition differences in beta and gamma frequencies for left habenula and alpha for right habenula. Notably, alpha activity for right habenula was negatively correlated with depression severity. Overall, from direct habenular recordings, we thus show findings convergent with depression models of aberrant excitatory glutamatergic output of the habenula driving inhibition of monoaminergic systems.
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Affiliation(s)
- Saurabh Sonkusare
- grid.5335.00000000121885934Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom ,grid.16821.3c0000 0004 0368 8293Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China ,grid.8547.e0000 0001 0125 2443Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China
| | - Qiong Ding
- grid.16821.3c0000 0004 0368 8293Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yingying Zhang
- grid.16821.3c0000 0004 0368 8293Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Linbin Wang
- grid.16821.3c0000 0004 0368 8293Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hengfen Gong
- grid.24516.340000000123704535Shanghai Pudong New Area Mental Health Center, Tongji University School of Medicine, Shanghai, China
| | - Alekhya Mandali
- grid.5335.00000000121885934Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Luis Manssuer
- grid.5335.00000000121885934Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom ,grid.16821.3c0000 0004 0368 8293Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China ,grid.8547.e0000 0001 0125 2443Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China
| | - Yi-Jie Zhao
- grid.8547.e0000 0001 0125 2443Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China ,grid.8547.e0000 0001 0125 2443Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence, Fudan University, Ministry of Education, Shanghai, China
| | - Yixin Pan
- grid.16821.3c0000 0004 0368 8293Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chencheng Zhang
- grid.16821.3c0000 0004 0368 8293Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dianyou Li
- grid.16821.3c0000 0004 0368 8293Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bomin Sun
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Valerie Voon
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom. .,Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. .,Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China.
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19
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He W, Shao L, Wang H, Huang H, Zhang S, Li C, Zhang C, Yi W. Bilateral Anterior Capsulotomy for the Treatment of Refractory Somatic Symptom Disorder: A Case Report. Front Integr Neurosci 2022; 15:721833. [PMID: 35115912 PMCID: PMC8805728 DOI: 10.3389/fnint.2021.721833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 12/10/2021] [Indexed: 11/13/2022] Open
Abstract
Somatic symptom disorder (SSD) is a form of mental illness that causes one or more distressing somatic symptoms leading to a significant disruption to everyday life, characterized by excessive thoughts, feelings, or behaviors related to these symptoms. While SSD is characterized by significant discomfort in some parts of the body, these symptoms are not related to any known medical condition and therefore it cannot be diagnosed using any medical instrument examination. Currently available treatments for SSD, including drug therapy and psychotherapy (such as cognitive behavioral therapy), usually improve psychiatric symptoms, but the results are often disappointing. Furthermore, SSD is often comorbid with anxiety and depression (75.1 and 65.7%, respectively). Importantly, interventions targeting the anterior limb of the internal capsule (ALIC; e.g., deep brain stimulation and thermal ablation) can effectively treat various mental disorders, such as refractory obsessive-compulsive disorder, depression, and eating disorders, suggesting that it may also be effective for treating the depressive symptoms associated with SSD comorbidity. In this report, a 65-year-old woman diagnosed with SSD accompanied with depression and anxiety underwent bilateral anterior capsulotomy. The patient complained of nausea and vomiting, swelling of the hilum of the liver for 14 years, weakness of the limbs for 13 years, and burning pain in the esophagus for 1 year. Psychiatric and neuropsychological assessments were conducted to record the severity of the patients' symptoms and the progression of postoperative symptoms. The patient's somatization, depression, and anxiety symptoms as well as quality of life improved significantly and steadily; thus, anti-depressive and anti-anxiety medication were stopped. However, the patient developed new somatization symptoms, including dizziness, headache, and sternal pain, 10 months after the operation. Therefore, the patient resumed taking flupentixol and melitracen in order to control the new symptoms. This study shows that bilateral anterior capsulotomy appears to be a complementary treatment for refractory SSD with depressive and anxiety symptoms. Furthermore, postoperative use of anxiolytic and antidepressant medications may be useful for controlling future somatization symptoms.
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Affiliation(s)
- Weibin He
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Lingmin Shao
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Huiling Wang
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
| | - Huan Huang
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
| | - Shudi Zhang
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Chenhui Li
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Chencheng Zhang
- Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Research Center for Brain Science and Brain-Inspired Intelligence, Shanghai, China
- *Correspondence: Wei Yi
| | - Wei Yi
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, China
- Chencheng Zhang
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20
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Corripio I, Roldán A, McKenna P, Sarró S, Alonso-Solís A, Salgado L, Álvarez E, Molet J, Pomarol-Clotet E, Portella M. Target selection for deep brain stimulation in treatment resistant schizophrenia. Prog Neuropsychopharmacol Biol Psychiatry 2022; 112:110436. [PMID: 34517055 DOI: 10.1016/j.pnpbp.2021.110436] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 08/28/2021] [Accepted: 09/07/2021] [Indexed: 11/19/2022]
Abstract
The use of deep brain stimulation (DBS) in treatment resistant patients with schizophrenia is of considerable current interest, but where to site the electrodes is challenging. This article reviews rationales for electrode placement in schizophrenia based on evidence for localized brain abnormality in the disorder and the targets that have been proposed and employed to date. The nucleus accumbens and the subgenual anterior cingulate cortex are of interest on the grounds that they are sites of potential pathologically increased brain activity in schizophrenia and so susceptible to the local inhibitory effects of DBS; both sites have been employed in trials of DBS in schizophrenia. Based on other lines of reasoning, the ventral tegmental area, the substantia nigra pars reticulata and the habenula have also been proposed and in some cases employed. The dorsolateral prefrontal cortex has not been suggested, probably reflecting evidence that it is underactive rather than overactive in schizophrenia. The hippocampus is also of theoretical interest but there is no clear functional imaging evidence that it shows overactivity in schizophrenia. On current evidence, the nucleus accumbens may represent the strongest candidate for DBS electrode placement in schizophrenia, with the substantia nigra pars reticulata also showing promise in a single case report; the ventral tegmental area is also of potential interest, though it remains untried.
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Affiliation(s)
- Iluminada Corripio
- Psychiatry Department, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB-Sant Pau), Universitat Autònoma de Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain
| | - Alexandra Roldán
- Psychiatry Department, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB-Sant Pau), Universitat Autònoma de Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain
| | - Peter McKenna
- FIDMAG Germanes Hospitalàries, Sant Boi de Llobregat, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain.
| | - Salvador Sarró
- FIDMAG Germanes Hospitalàries, Sant Boi de Llobregat, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain
| | - Anna Alonso-Solís
- Psychiatry Department, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB-Sant Pau), Universitat Autònoma de Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain
| | - Laura Salgado
- Neurosurgery Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Spain
| | - Enric Álvarez
- Psychiatry Department, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB-Sant Pau), Universitat Autònoma de Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain
| | - Joan Molet
- Neurosurgery Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Spain
| | - Edith Pomarol-Clotet
- FIDMAG Germanes Hospitalàries, Sant Boi de Llobregat, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain
| | - Maria Portella
- Psychiatry Department, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB-Sant Pau), Universitat Autònoma de Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain
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21
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Gouveia FV, Ibrahim GM. Habenula as a Neural Substrate for Aggressive Behavior. Front Psychiatry 2022; 13:817302. [PMID: 35250669 PMCID: PMC8891498 DOI: 10.3389/fpsyt.2022.817302] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 01/25/2022] [Indexed: 11/17/2022] Open
Abstract
Over the past decades, an ever growing body of literature has explored the anatomy, connections, and functions of the habenula (Hb). It has been postulated that the Hb plays a central role in the control of the monoaminergic system, thus influencing a wide range of behavioral responses, and participating in the pathophysiology of a number of psychiatric disorders and neuropsychiatric symptoms, such as aggressive behaviors. Aggressive behaviors are frequently accompanied by restlessness and agitation, and are commonly observed in patients with psychiatric disorders, intellectual disabilities, and neurodegenerative diseases of aging. Recently, the Hb has been explored as a new target for neuromodulation therapies, such as deep brain stimulation, with promising results. Here we review the anatomical organization of the habenula and discuss several distinct mechanisms by which the Hb is involved in the modulation of aggressive behaviors, and propose new investigations for the development of novel treatments targeting the habenula to reduce aggressive behaviors.
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Affiliation(s)
- Flavia Venetucci Gouveia
- Neuroscience and Mental Health, Hospital for Sick Children Research Institute, Toronto, ON, Canada
| | - George M Ibrahim
- Neuroscience and Mental Health, Hospital for Sick Children Research Institute, Toronto, ON, Canada.,Division of Neurosurgery, The Hospital for Sick Children, Toronto, ON, Canada.,Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.,Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada
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22
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Cascella N, Butala AA, Mills K, Kim MJ, Salimpour Y, Wojtasievicz T, Hwang B, Cullen B, Figee M, Moran L, Lenz F, Sawa A, Schretlen DJ, Anderson W. Deep Brain Stimulation of the Substantia Nigra Pars Reticulata for Treatment-Resistant Schizophrenia: A Case Report. Biol Psychiatry 2021; 90:e57-e59. [PMID: 33906736 DOI: 10.1016/j.biopsych.2021.03.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 03/02/2021] [Indexed: 12/26/2022]
Affiliation(s)
- Nicola Cascella
- Johns Hopkins Schizophrenia Center, Johns Hopkins Hospital, the Johns Hopkins University School of Medicine and Bloomberg School of Public Health, Baltimore, Maryland; Department of Psychiatry, Johns Hopkins Hospital, the Johns Hopkins University School of Medicine and Bloomberg School of Public Health, Baltimore, Maryland.
| | - Ankur A Butala
- Department of Psychiatry, Johns Hopkins Hospital, the Johns Hopkins University School of Medicine and Bloomberg School of Public Health, Baltimore, Maryland; Department of Neurology, Johns Hopkins Hospital, the Johns Hopkins University School of Medicine and Bloomberg School of Public Health, Baltimore, Maryland
| | - Kelly Mills
- Department of Neurology, Johns Hopkins Hospital, the Johns Hopkins University School of Medicine and Bloomberg School of Public Health, Baltimore, Maryland
| | - Min Jae Kim
- Department of Neurology, Johns Hopkins Hospital, the Johns Hopkins University School of Medicine and Bloomberg School of Public Health, Baltimore, Maryland
| | - Yousef Salimpour
- Department of Neurology, Johns Hopkins Hospital, the Johns Hopkins University School of Medicine and Bloomberg School of Public Health, Baltimore, Maryland
| | - Teresa Wojtasievicz
- Department of Neurosurgery, Johns Hopkins Hospital, the Johns Hopkins University School of Medicine and Bloomberg School of Public Health, Baltimore, Maryland
| | - Brian Hwang
- Department of Neurosurgery, Johns Hopkins Hospital, the Johns Hopkins University School of Medicine and Bloomberg School of Public Health, Baltimore, Maryland
| | - Bernadette Cullen
- Department of Psychiatry, Johns Hopkins Hospital, the Johns Hopkins University School of Medicine and Bloomberg School of Public Health, Baltimore, Maryland
| | - Martijn Figee
- Nash Family Center for Advanced Circuit Therapeutics, Icahn School of Medicine, New York, New York
| | - Lauren Moran
- Division of Psychotic Disorders, McLean Hospital, Belmont, Massachusetts
| | - Fred Lenz
- Department of Neurosurgery, Johns Hopkins Hospital, the Johns Hopkins University School of Medicine and Bloomberg School of Public Health, Baltimore, Maryland
| | - Akira Sawa
- Johns Hopkins Schizophrenia Center, Johns Hopkins Hospital, the Johns Hopkins University School of Medicine and Bloomberg School of Public Health, Baltimore, Maryland; Department of Psychiatry, Johns Hopkins Hospital, the Johns Hopkins University School of Medicine and Bloomberg School of Public Health, Baltimore, Maryland; Department of Neuroscience, Johns Hopkins Hospital, the Johns Hopkins University School of Medicine and Bloomberg School of Public Health, Baltimore, Maryland; Department of Biomedical Engineering, Johns Hopkins Hospital, the Johns Hopkins University School of Medicine and Bloomberg School of Public Health, Baltimore, Maryland; Department of Mental Health, Johns Hopkins Hospital, the Johns Hopkins University School of Medicine and Bloomberg School of Public Health, Baltimore, Maryland
| | - David J Schretlen
- Department of Psychiatry, Johns Hopkins Hospital, the Johns Hopkins University School of Medicine and Bloomberg School of Public Health, Baltimore, Maryland
| | - William Anderson
- Department of Neurosurgery, Johns Hopkins Hospital, the Johns Hopkins University School of Medicine and Bloomberg School of Public Health, Baltimore, Maryland
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23
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Keuken MC, Alkemade A, Stevenson N, Innes RJ, Forstmann BU. Structure-function similarities in deep brain stimulation targets cross-species. Neurosci Biobehav Rev 2021; 131:1127-1135. [PMID: 34715147 DOI: 10.1016/j.neubiorev.2021.10.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 10/22/2021] [Accepted: 10/24/2021] [Indexed: 11/24/2022]
Abstract
Deep Brain Stimulation (DBS) is an effective neurosurgical treatment to alleviate motor symptoms of advanced Parkinson's disease. Due to its potential, DBS usage is rapidly expanding to target a large number of brain regions to treat a wide range of diseases and neuropsychiatric disorders. The identification and validation of new target regions heavily rely on the insights gained from rodent and primate models. Here we present a large-scale automatic meta-analysis in which the structure-function associations within and between species are compared for 21 DBS targets in humans. The results indicate that the structure-function association for the majority of the 21 included subcortical areas were conserved cross-species. A subset of structures showed overlapping functional association. This can potentially be attributed to shared brain networks and might explain why multiple brain areas are targeted for the same disease or neuropsychiatric disorder.
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Affiliation(s)
- Max C Keuken
- Integrative Model-based Cognitive Neuroscience Research Unit, University of Amsterdam, Nieuwe Achtergracht 129B, Postbus 15926, 1001 NK, Amsterdam, The Netherlands.
| | - Anneke Alkemade
- Integrative Model-based Cognitive Neuroscience Research Unit, University of Amsterdam, Nieuwe Achtergracht 129B, Postbus 15926, 1001 NK, Amsterdam, The Netherlands
| | - Niek Stevenson
- Integrative Model-based Cognitive Neuroscience Research Unit, University of Amsterdam, Nieuwe Achtergracht 129B, Postbus 15926, 1001 NK, Amsterdam, The Netherlands
| | - Reilly J Innes
- Integrative Model-based Cognitive Neuroscience Research Unit, University of Amsterdam, Nieuwe Achtergracht 129B, Postbus 15926, 1001 NK, Amsterdam, The Netherlands; Newcastle Cognition Lab, University of Newcastle, Callaghan, NSW, Australia
| | - Birte U Forstmann
- Integrative Model-based Cognitive Neuroscience Research Unit, University of Amsterdam, Nieuwe Achtergracht 129B, Postbus 15926, 1001 NK, Amsterdam, The Netherlands
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24
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Georgiev D, Akram H, Jahanshahi M. Deep brain stimulation for psychiatric disorders: role of imaging in identifying/confirming DBS targets, predicting, and optimizing outcome and unravelling mechanisms of action. PSYCHORADIOLOGY 2021; 1:118-151. [PMID: 38665808 PMCID: PMC10917192 DOI: 10.1093/psyrad/kkab012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 08/31/2021] [Accepted: 09/08/2021] [Indexed: 04/28/2024]
Abstract
Following the established application of deep brain stimulation (DBS) in the treatment of movement disorders, new non-neurological indications have emerged, such as for obsessive-compulsive disorders, major depressive disorder, dementia, Gilles de la Tourette Syndrome, anorexia nervosa, and addictions. As DBS is a network modulation surgical treatment, the development of DBS for both neurological and psychiatric disorders has been partly driven by advances in neuroimaging, which has helped explain the brain networks implicated. Advances in magnetic resonance imaging connectivity and electrophysiology have led to the development of the concept of modulating widely distributed, complex brain networks. Moreover, the increasing number of targets for treating psychiatric disorders have indicated that there may be a convergence of the effect of stimulating different targets for the same disorder, and the effect of stimulating the same target for different disorders. The aim of this paper is to review the imaging studies of DBS for psychiatric disorders. Imaging, and particularly connectivity analysis, offers exceptional opportunities to better understand and even predict the clinical outcomes of DBS, especially where there is a lack of objective biomarkers that are essential to properly guide DBS pre- and post-operatively. In future, imaging might also prove useful to individualize DBS treatment. Finally, one of the most important aspects of imaging in DBS is that it allows us to better understand the brain through observing the changes of the functional connectome under neuromodulation, which may in turn help explain the mechanisms of action of DBS that remain elusive.
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Affiliation(s)
- Dejan Georgiev
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, Queen Square, London, WC1N 3BG, UK
- Department of Neurology, University Medical Centre Ljubljana, Zaloška cesta 2, 1000 Ljubljana, Slovenia
- Artificial Intelligence Laboratory, Faculty of Computer and Information Science, University of Ljubljana, Večna pot 113, 1000 Ljubljana, Slovenia
| | - Harith Akram
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - Marjan Jahanshahi
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, Queen Square, London, WC1N 3BG, UK
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Laboratory for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, 611731, China
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25
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Sevigny JP, Bryant EN, Encarnacion É, Smith DF, Acosta R, Baker PM. Lateral Habenula Inactivation Alters Willingness to Exert Physical Effort Using a Maze Task in Rats. Front Behav Neurosci 2021; 15:652793. [PMID: 34447300 PMCID: PMC8382800 DOI: 10.3389/fnbeh.2021.652793] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 07/14/2021] [Indexed: 11/23/2022] Open
Abstract
An impairment in willingness to exert physical effort in daily activities is a noted aspect of several psychiatric conditions. Previous studies have supported an important role for the lateral habenula (LHb) in dynamic decision-making, including decisions associated with discounting costly high value rewards. It is unknown whether a willingness to exert physical effort to obtain higher rewards is also mediated by the LHb. It also remains unclear whether the LHb is critical to monitoring the task contingencies generally as they change, or whether it also mediates choices in otherwise static reward environments. The present study indicates that the LHb might have an integrative role in effort-based decision-making even when no alterations in choice contingencies occur. Specifically, pharmacological inactivation of the LHb showed differences in motivational behavior by reducing choices for the high effort (30cm barrier) high reward (2 pellets) choice versus the low effort (0 cm) low reward (1 pellet) choice. In sessions where the barrier was removed, rats demonstrated a similar preference for the high reward arm under both control and LHb inactivation. Further, no differences were observed when accounting for sex as a biological variable. These results support that effort to receive a high-value reward is considered on a trial-by-trial basis and the LHb is part of the circuit responsible for integrating this information during decision-making. Therefore, it is likely that previously observed changes in the LHb may be a key contributor to changes in a willingness to exert effort in psychiatric conditions.
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Affiliation(s)
- Joshua P Sevigny
- Department of Psychology, Seattle Pacific University, Seattle, WA, United States
| | - Emily N Bryant
- Department of Psychology, Seattle Pacific University, Seattle, WA, United States
| | - Érica Encarnacion
- Department of Psychology, Seattle Pacific University, Seattle, WA, United States
| | - Dylan F Smith
- Department of Psychology, Seattle Pacific University, Seattle, WA, United States
| | - Rudith Acosta
- Department of Psychology, Seattle Pacific University, Seattle, WA, United States
| | - Phillip M Baker
- Department of Psychology, Seattle Pacific University, Seattle, WA, United States
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26
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Germann J, Mameli M, Elias GJB, Loh A, Taha A, Gouveia FV, Boutet A, Lozano AM. Deep Brain Stimulation of the Habenula: Systematic Review of the Literature and Clinical Trial Registries. Front Psychiatry 2021; 12:730931. [PMID: 34484011 PMCID: PMC8415908 DOI: 10.3389/fpsyt.2021.730931] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 07/21/2021] [Indexed: 11/13/2022] Open
Abstract
The habenula is a small bilateral epithalamic structure that plays a key role in the regulation of the main monoaminergic systems. It is implicated in many aspects of behavior such as reward processing, motivational behavior, behavioral adaptation, and sensory integration. A role of the habenula has been indicated in the pathophysiology of a number of neuropsychiatric disorders such as depression, addiction, obsessive-compulsive disorder, and bipolar disorder. Neuromodulation of the habenula using deep brain stimulation (DBS) as potential treatment has been proposed and a first successful case of habenula DBS was reported a decade ago. To provide an overview of the current state of habenula DBS in human subjects for the treatment of neuropsychiatric disorders we conducted a systematic review of both the published literature using PUBMED and current and past registered clinical trials using ClinicalTrials.gov as well as the International Clinical Trials Registry Platform. Using PRISMA guidelines five articles and five registered clinical trials were identified. The published articles detailed the results of habenula DBS for the treatment of schizophrenia, depression, obsessive-compulsive disorder, and bipolar disorder. Four are single case studies; one reports findings in two patients and positive clinical outcome is described in five of the six patients. Of the five registered clinical trials identified, four investigate habenula DBS for the treatment of depression and one for obsessive-compulsive disorder. One trial is listed as terminated, one is recruiting, two are not yet recruiting and the status of the fifth is unknown. The planned enrollment varies between 2 to 13 subjects and four of the five are open label trials. While the published studies suggest a potential role of habenula DBS for a number of indications, future trials and studies are necessary. The outcomes of the ongoing clinical trials will provide further valuable insights. Establishing habenula DBS, however, will depend on successful randomized clinical trials to confirm application and clinical benefit of this promising intervention.
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Affiliation(s)
- Jürgen Germann
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Manuel Mameli
- The Department of Fundamental Neuroscience, The University of Lausanne, Lausanne, Switzerland
- INSERM, UMR-S 839, Paris, France
| | - Gavin J. B. Elias
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Aaron Loh
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Alaa Taha
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Flavia Venetucci Gouveia
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Alexandre Boutet
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, ON, Canada
- Joint Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Andres M. Lozano
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, ON, Canada
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27
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Huang Y, Sun B, Debarros J, Zhang C, Zhan S, Li D, Zhang C, Wang T, Huang P, Lai Y, Brown P, Cao C, Tan H. Increased theta/alpha synchrony in the habenula-prefrontal network with negative emotional stimuli in human patients. eLife 2021; 10:e65444. [PMID: 34251338 PMCID: PMC8275130 DOI: 10.7554/elife.65444] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 06/28/2021] [Indexed: 11/13/2022] Open
Abstract
Lateral habenula is believed to encode negative motivational stimuli and plays key roles in the pathophysiology of psychiatric disorders. However, how habenula activities are modulated during the processing of emotional information is still poorly understood. We recorded local field potentials from bilateral habenula areas with simultaneous cortical magnetoencephalography in nine patients with psychiatric disorders during an emotional picture-viewing task. Transient activity in the theta/alpha band (5-10 Hz) within the habenula and prefrontal cortical regions, as well as the coupling between these structures, is increased during the perception and processing of negative emotional stimuli compared to positive emotional stimuli. The increase in theta/alpha band synchronization in the frontal cortex-habenula network correlated with the emotional valence but not the arousal score of the stimuli. These results provide direct evidence for increased theta/alpha synchrony within the habenula area and prefrontal cortex-habenula network in the perception of negative emotion in human participants.
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Affiliation(s)
- Yongzhi Huang
- Academy of Medical Engineering and Translational Medicine, Tianjin UniversityTianjinChina
- Nuffield Department of Surgical Sciences, University of OxfordOxfordUnited Kingdom
| | - Bomin Sun
- Department of Neurosurgery, Affiliated Ruijin Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Jean Debarros
- Medical Research Council (MRC) Brain Network Dynamics Unit at the University of Oxford, Nuffield Department of Clinical Neurosciences, University of OxfordOxfordUnited Kingdom
| | - Chao Zhang
- Department of Neurosurgery, Affiliated Ruijin Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Shikun Zhan
- Department of Neurosurgery, Affiliated Ruijin Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Dianyou Li
- Department of Neurosurgery, Affiliated Ruijin Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Chencheng Zhang
- Department of Neurosurgery, Affiliated Ruijin Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Tao Wang
- Department of Neurosurgery, Affiliated Ruijin Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Peng Huang
- Department of Neurosurgery, Affiliated Ruijin Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Yijie Lai
- Department of Neurosurgery, Affiliated Ruijin Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Peter Brown
- Medical Research Council (MRC) Brain Network Dynamics Unit at the University of Oxford, Nuffield Department of Clinical Neurosciences, University of OxfordOxfordUnited Kingdom
| | - Chunyan Cao
- Department of Neurosurgery, Affiliated Ruijin Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Huiling Tan
- Medical Research Council (MRC) Brain Network Dynamics Unit at the University of Oxford, Nuffield Department of Clinical Neurosciences, University of OxfordOxfordUnited Kingdom
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28
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Zhang C, Lai Y, Zhang Y, Xu X, Sun B, Li D. Deep Brain Stimulation-Induced Transient Effects in the Habenula. Front Psychiatry 2021; 12:674962. [PMID: 34248713 PMCID: PMC8260931 DOI: 10.3389/fpsyt.2021.674962] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 05/17/2021] [Indexed: 11/24/2022] Open
Abstract
The habenula, located in the epithalamus, has been implicated in various psychiatric disorders including mood disorders and schizophrenia. This study explored the transient effects of deep brain stimulation in the habenula. Each of the four patients (two with bipolar disorder and two with schizophrenia) was tested with eight deep brain stimulation contacts. Patients were examined via transient electrical stimulation 1 month after deep brain stimulation surgery. The pulse width was 60 μs and the voltage ranged from 0 V to a maximum of 10 V, increasing in increments of 1 V. Each patient received stimulation at two frequencies, 60 and 135 Hz. A total of 221 out of 385 active trials elicited stimulation-induced effects. The three most common transient effects were numbness, heart rate changes, and pain. The incidence of numbness, heart rate changes, pain, and involuntary movements increased with the increase in stimulation voltage. Through contralateral stimulation, numbness was triggered in all parts of the body except the scalp. The obtained stimulus-response maps suggested a possible somatosensory organization of the habenula.
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Affiliation(s)
- Chencheng Zhang
- Clinical Neuroscience Center, Ruijin Hospital Luwan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yijie Lai
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yingying Zhang
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xinmeng Xu
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bomin Sun
- Clinical Neuroscience Center, Ruijin Hospital Luwan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dianyou Li
- Clinical Neuroscience Center, Ruijin Hospital Luwan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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29
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Idris Z, Zakaria Z, Fitzrol DN, Ang SY, Yee SV, Ghani ARI, Abdullah JM. Commentary: Tractography-Guided Anterior Capsulotomy for Major Depression and Obsessive-Compulsive Disorder: Targeting the Emotion Network. Oper Neurosurg (Hagerstown) 2021; 20:E281-E283. [PMID: 33475706 DOI: 10.1093/ons/opaa473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 11/20/2020] [Indexed: 11/12/2022] Open
Affiliation(s)
- Zamzuri Idris
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, 16150, Kota Bharu, Kelantan, Malaysia.,Department of Neurosciences, Hospital Universiti Sains Malaysia, Universiti Sains Malaysia, Health Campus, Jalan Raja Perempuan Zainab 2, 16150, Kota Bharu, Kelantan, Malaysia.,Brain and Behaviour Cluster, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, 16150, Kota Bharu, Kelantan, Malaysia
| | - Zaitun Zakaria
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, 16150, Kota Bharu, Kelantan, Malaysia.,Department of Neurosciences, Hospital Universiti Sains Malaysia, Universiti Sains Malaysia, Health Campus, Jalan Raja Perempuan Zainab 2, 16150, Kota Bharu, Kelantan, Malaysia.,Brain and Behaviour Cluster, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, 16150, Kota Bharu, Kelantan, Malaysia
| | - Diana Noma Fitzrol
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, 16150, Kota Bharu, Kelantan, Malaysia.,Department of Neurosciences, Hospital Universiti Sains Malaysia, Universiti Sains Malaysia, Health Campus, Jalan Raja Perempuan Zainab 2, 16150, Kota Bharu, Kelantan, Malaysia.,Brain and Behaviour Cluster, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, 16150, Kota Bharu, Kelantan, Malaysia
| | - Song Yee Ang
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, 16150, Kota Bharu, Kelantan, Malaysia.,Department of Neurosciences, Hospital Universiti Sains Malaysia, Universiti Sains Malaysia, Health Campus, Jalan Raja Perempuan Zainab 2, 16150, Kota Bharu, Kelantan, Malaysia.,Brain and Behaviour Cluster, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, 16150, Kota Bharu, Kelantan, Malaysia
| | - Sze-Voon Yee
- Department of Neurosurgery, Institut Kaji Saraf Tunku Abdul Rahman (IKTAR), Hospital Kuala Lumpur, Jalan Pahang, 50586, Kuala Lumpur, Malaysia
| | - Abdul Rahman Izaini Ghani
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, 16150, Kota Bharu, Kelantan, Malaysia.,Department of Neurosciences, Hospital Universiti Sains Malaysia, Universiti Sains Malaysia, Health Campus, Jalan Raja Perempuan Zainab 2, 16150, Kota Bharu, Kelantan, Malaysia.,Brain and Behaviour Cluster, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, 16150, Kota Bharu, Kelantan, Malaysia
| | - Jafri Malin Abdullah
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, 16150, Kota Bharu, Kelantan, Malaysia.,Department of Neurosciences, Hospital Universiti Sains Malaysia, Universiti Sains Malaysia, Health Campus, Jalan Raja Perempuan Zainab 2, 16150, Kota Bharu, Kelantan, Malaysia.,Brain and Behaviour Cluster, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, 16150, Kota Bharu, Kelantan, Malaysia
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30
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Aryutova K, Paunova R, Kandilarova S, Todeva-Radneva A, Stoyanov D. Implications from translational cross-validation of clinical assessment tools for diagnosis and treatment in psychiatry. World J Psychiatry 2021; 11:169-180. [PMID: 34046313 PMCID: PMC8134869 DOI: 10.5498/wjp.v11.i5.169] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 03/17/2021] [Accepted: 03/31/2021] [Indexed: 02/06/2023] Open
Abstract
Traditional therapeutic methods in psychiatry, such as psychopharmacology and psychotherapy help many people suffering from mental disorders, but in the long-term prove to be effective in a relatively small proportion of those affected. Therapeutically, resistant forms of mental disorders such as schizophrenia, major depressive disorder, and bipolar disorder lead to persistent distress and dysfunction in personal, social, and professional aspects. In an effort to address these problems, the translational approach in neuroscience has initiated the inclusion of novel or modified unconventional diagnostic and therapeutic techniques with promising results. For instance, neuroimaging data sets from multiple modalities provide insight into the nature of pathophysiological mechanisms such as disruptions of connectivity, integration, and segregation of neural networks, focusing on the treatment of mental disorders through instrumental biomedical methods such as electro-convulsive therapy (ECT), transcranial magnetic stimulation (TMS), transcranial direct current stimulation (tDCS) and deep brain stimulation (DBS). These methodologies have yielded promising results that have yet to be understood and improved to enhance the prognosis of the severe and persistent psychotic and affective disorders. The current review is focused on the translational approach in the management of schizophrenia and mood disorders, as well as the adaptation of new transdisciplinary diagnostic tools such as neuroimaging with concurrently administered psychopathological questionnaires and integration of the results into the therapeutic framework using various advanced instrumental biomedical tools such as ECT, TMS, tDCS and DBS.
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Affiliation(s)
- Katrin Aryutova
- Department of Psychiatry and Medical Psychology, Scientific Research Institute, Medical University of Plovdiv, Plovdiv 4002, Bulgaria
| | - Rositsa Paunova
- Department of Psychiatry and Medical Psychology, Scientific Research Institute, Medical University of Plovdiv, Plovdiv 4002, Bulgaria
| | - Sevdalina Kandilarova
- Department of Psychiatry and Medical Psychology, Scientific Research Institute, Medical University of Plovdiv, Plovdiv 4002, Bulgaria
| | - Anna Todeva-Radneva
- Department of Psychiatry and Medical Psychology, Scientific Research Institute, Medical University of Plovdiv, Plovdiv 4002, Bulgaria
| | - Drozdstoy Stoyanov
- Department of Psychiatry and Medical Psychology, Scientific Research Institute, Medical University of Plovdiv, Plovdiv 4002, Bulgaria
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Edemann-Callesen H, Winter C, Hadar R. Using cortical non-invasive neuromodulation as a potential preventive treatment in schizophrenia - A review. Brain Stimul 2021; 14:643-651. [PMID: 33819680 DOI: 10.1016/j.brs.2021.03.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 02/11/2021] [Accepted: 03/23/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Evidence suggests that schizophrenia constitutes a neurodevelopmental disorder, characterized by a gradual emergence of behavioral and neurobiological abnormalities over time. Therefore, applying early interventions to prevent later manifestation of symptoms is appealing. OBJECTIVE This review focuses on the use of cortical neuromodulation in schizophrenia and its potential as a preventive treatment approach. We present clinical and preclinical findings investigating the use of neuromodulation in schizophrenia, including the current research focusing on cortical non-invasive stimulation and its possibility as a future preventive treatment. METHODS We performed a search in Medline (PubMed) in September 2020 using a combination of relevant medical subject headings (MeSH) and text words. The search included human and preclinical trials as well as existing systematic reviews and meta-analysis. There were no restrictions on language or the date of publication. RESULTS Neurodevelopmental animal models may be used to investigate how the disease progresses and thus which brain areas ideally should be targeted at a given time point. Here, abnormalities of the prefrontal cortex have been often identified as an early and persistent impairment in schizophrenia. Currently there is insufficient evidence to either support or refute the use of neuromodulation to the cortex in adult patients with already manifested symptoms. However, preclinical results show that early non-invasive neuromodulation to the prefrontal cortex of adolescent animals, sufficiently prevents later psychosis-relevant abnormalities in adulthood. This points to the promising potential of cortical non-invasive neuromodulation as a preventive treatment when applied early in the course of the disease. CONCLUSION Preclinical translational-oriented findings indicate, that neuromodulation to cortical areas offers the possibility of targeting early neuropathology and through this diminish the progression of a later schizophrenic profile. Further studies are needed to investigate whether such early cortical stimulation may serve as a future preventive treatment in schizophrenia.
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Affiliation(s)
- Henriette Edemann-Callesen
- Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Charité -Universitätsmedizin, Berlin, Germany
| | - Christine Winter
- Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Charité -Universitätsmedizin, Berlin, Germany
| | - Ravit Hadar
- Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Charité -Universitätsmedizin, Berlin, Germany.
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Alternatives to Pharmacological and Psychotherapeutic Treatments in Psychiatric Disorders. PSYCHIATRY INTERNATIONAL 2021. [DOI: 10.3390/psychiatryint2010001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Nowadays, most of the patients affected by psychiatric disorders are successfully treated with psychotherapy and pharmacotherapy. Nevertheless, according to the disease, a variable percentage of patients results resistant to such modalities, and alternative methods can then be considered. The purpose of this review is to summarize the techniques and results of invasive modalities for several treatment-resistant psychiatric diseases. A literature search was performed to provide an up-to-date review of advantages, disadvantages, efficacy, and complications of Deep-Brain Stimulation, Magnetic Resonance-guided Focused-Ultrasound, radiofrequency, and radiotherapy lesioning for depression, obsessive-compulsive disorder, schizophrenia, addiction, anorexia nervosa, and Tourette’s syndrome. The literature search did not strictly follow the criteria for a systematic review: due to the large differences in methodologies and patients’ cohort, we tried to identify the highest quality of available evidence for each technique. We present the data as a comprehensive, narrative review about the role, indication, safety, and results of the contemporary instrumental techniques that opened new therapeutic fields for selected patients unresponsive to psychotherapy and pharmacotherapy.
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