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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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2
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Özek MM, Bozkurt B. Surgical Approach to Thalamic Tumors. Adv Tech Stand Neurosurg 2022; 45:177-198. [PMID: 35976450 DOI: 10.1007/978-3-030-99166-1_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Thalamic tumors are deep-seated lesions. Recent improvements in therapeutic approaches and surgical techniques have allowed a more accurate approach to these lesions and a reduction in morbidity and mortality. In this article, the various surgical approaches for the resection of thalamic tumors are described. Each of these approaches has its own indications and risk of complications. Resection of thalamic tumors needs specific anatomical knowledge, especially the vascular anatomy of the region and the thalamic peduncles.
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Affiliation(s)
- M Memet Özek
- Department of Neurosurgery, Division of Pediatric Neurosurgery, Acıbadem University, School of Medicine, Istanbul, Turkey.
| | - Baran Bozkurt
- Neuroanatomy Laboratory at Department of Neurosurgery, Acıbadem University, School of Medicine, Istanbul, Turkey
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3
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Amiri S, Arbabi M, Kazemi K, Parvaresh-Rizi M, Mirbagheri MM. Characterization of brain functional connectivity in treatment-resistant depression. Prog Neuropsychopharmacol Biol Psychiatry 2021; 111:110346. [PMID: 33961964 DOI: 10.1016/j.pnpbp.2021.110346] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 04/13/2021] [Accepted: 05/02/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To characterize the functional connectivity (FC) of target brain regions for deep brain stimulation (DBS) in patients with treatment-resistant depression (TRD), and to evaluate its gender and brain lateralization dependence. METHODS Thirty-one TRD patients and twenty-nine healthy control (HC) subjects participated. FC of subcallosal cingulate gyrus (SCG), ventral caudate (VCa), nucleus accumbens (NAc), lateral habenula (LHb), and inferior thalamic peduncle (ITP) were evaluated using resting-state fMRI. FC was characterized by calculating the nodal 'degree', a major feature of the graph theory. RESULTS The degree measures of the left and right VCa, the left LHb, and the left ITP were significantly greater in the TRD than in the HC group. The degree was greater in females with TRD in all these regions except the right LHb. Finally, the left hemisphere was generally more affected by depression and presented significant degrees in LHb and ITP regions of the patients. CONCLUSION Our findings demonstrate the ability of degree to characterize brain FC and identify the regions with abnormal activities in TRD patients. This implies that the degree may have the potential to be used as an important graph-theoretical feature to further investigate the mechanisms underlying TRD, and consequently along with other diagnostic markers, to assist in the determination of the appropriate target region for DBS treatment in TRD patients.
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Affiliation(s)
- Saba Amiri
- Medical Physics and Biomedical Engineering Department, Faculty of Medicine, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Mohammad Arbabi
- Psychiatry, Psychosomatic Medicine Research Center Department, Tehran University of Medical Sciences, Tehran, Iran
| | - Kamran Kazemi
- Electrical and Electronics Engineering Department, Shiraz University of Technology, Shiraz, Iran.
| | | | - Mehdi M Mirbagheri
- Medical Physics and Biomedical Engineering Department, Faculty of Medicine, Tehran University of Medical Sciences (TUMS), Tehran, Iran; Physical Medicine and Rehabilitation Department, Northwestern University, USA.
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Guo Y, Zhang L, Zhang J, Lv SX, Du CX, Wang T, Wang HS, Xie W, Liu J. Activation and Blockade of Serotonin-4 Receptors in the Lateral Habenula Produce Antidepressant Effects in the Hemiparkinsonian Rat. Neuropsychobiology 2021; 80:52-63. [PMID: 32663830 DOI: 10.1159/000508680] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 05/05/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND The 5-hydroxytryptamine (5-HT) neurotransmitter system and lateral habenula (LHb) are involved in the regulation of depression, while the mechanisms remain to be clarified. OBJECTIVES The effects and possible mecha-nism underlying activation or blockade of 5-HT4 receptors (5-HT4Rs) in the LHb in depression were investigated by behavioral and neurochemical methods based on a Parkinson's disease (PD) rat model. METHOD 6-Hydroxydopamine (6-OHDA) was injected unilaterally into the substantia nigra pars compacta to establish the PD rat model. The depressive-like behaviors were measured by the forced swimming test (FST) and sucrose preference test (SPT). The concentrations of dopamine (DA), noradrenaline (NA) and 5-HT in the related brain regions were measured by a neurochemical method. RESULTS The 6-OHDA lesions increased the immobility time in the FST and decreased the sucrose consumption in the SPT, suggesting the induction of depressive-like behaviors. Intra-LHb injection of BIMU-8 (5-HT4R agonist) or GR113808 (5-HT4R antagonist) produced antidepressant effects in the lesioned rats. Intra-LHb injection of BIMU-8 significantly increased the DA levels in the medial prefrontal cortex (mPFC) and ventral hippocampus (vHip), increased the 5-HT level in the mPFC and decreased the NA level in the vHip only in the lesioned rats, while intra-LHb injection of GR113808 changed DA, NA and 5-HT levels in the mPFC, LHb and vHip in both sham and the lesioned rats. CONCLUSIONS All these results suggest that activation or blockade of the LHb 5-HT4Rs produce antidepressant effects in the 6-OHDA-lesioned rats, which are related to the changes of monoamines in the limbic and limbic-related regions.
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Affiliation(s)
- Yuan Guo
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Li Zhang
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Jin Zhang
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Shu-Xuan Lv
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Cheng-Xue Du
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Tao Wang
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Hui-Sheng Wang
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Wen Xie
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Jian Liu
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Xi'an Jiaotong University Health Science Center, Xi'an, China,
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Dandekar MP, Diaz AP, Rahman Z, Silva RH, Nahas Z, Aaronson S, Selvaraj S, Fenoy AJ, Sanches M, Soares JC, Riva-Posse P, Quevedo J. A narrative review on invasive brain stimulation for treatment-resistant depression. ACTA ACUST UNITED AC 2021; 44:317-330. [PMID: 34468549 PMCID: PMC9169472 DOI: 10.1590/1516-4446-2021-1874] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 04/22/2021] [Indexed: 12/20/2022]
Abstract
While most patients with depression respond to pharmacotherapy and psychotherapy, about one-third will present treatment resistance to these interventions. For patients with treatment-resistant depression (TRD), invasive neurostimulation therapies such as vagus nerve stimulation, deep brain stimulation, and epidural cortical stimulation may be considered. We performed a narrative review of the published literature to identify papers discussing clinical studies with invasive neurostimulation therapies for TRD. After a database search and title and abstract screening, relevant English-language articles were analyzed. Vagus nerve stimulation, approved by the U.S. Food and Drug Administration as a TRD treatment, may take several months to show therapeutic benefits, and the average response rate varies from 15.2-83%. Deep brain stimulation studies have shown encouraging results, including rapid response rates (> 30%), despite conflicting findings from randomized controlled trials. Several brain regions, such as the subcallosal-cingulate gyrus, nucleus accumbens, ventral capsule/ventral striatum, anterior limb of the internal capsule, medial-forebrain bundle, lateral habenula, inferior-thalamic peduncle, and the bed-nucleus of the stria terminalis have been identified as key targets for TRD management. Epidural cortical stimulation, an invasive intervention with few reported cases, showed positive results (40-60% response), although more extensive trials are needed to confirm its potential in patients with TRD.
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Affiliation(s)
- Manoj P Dandekar
- Department of Pharmacology & Toxicology, National Institute of Pharmaceutical Education and Research, Hyderabad, Telangana, India
| | - Alexandre P Diaz
- Center of Excellence on Mood Disorders, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Ziaur Rahman
- Department of Pharmacology & Toxicology, National Institute of Pharmaceutical Education and Research, Hyderabad, Telangana, India
| | - Ritele H Silva
- Laboratório de Psiquiatria Translacional, Programa de Pós-Graduação em Ciências da Saúde, Universidade do Extremo Sul Catarinense (UNESC), Criciúma, SC, Brazil
| | - Ziad Nahas
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, USA
| | - Scott Aaronson
- Clinical Research Programs, Sheppard Pratt Health System, Baltimore, MD, USA
| | - Sudhakar Selvaraj
- Center of Excellence on Mood Disorders, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Albert J Fenoy
- Center of Excellence on Mood Disorders, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA.,Deep Brain Stimulation Program, Department of Neurosurgery, McGovern Medical School, UTHealth, Houston, TX, USA
| | - Marsal Sanches
- Center of Excellence on Mood Disorders, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Jair C Soares
- Center of Excellence on Mood Disorders, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA.,Neuroscience Graduate Program, The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX, USA
| | - Patricio Riva-Posse
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA, USA
| | - Joao Quevedo
- Center of Excellence on Mood Disorders, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA.,Laboratório de Psiquiatria Translacional, Programa de Pós-Graduação em Ciências da Saúde, Universidade do Extremo Sul Catarinense (UNESC), Criciúma, SC, Brazil.,Neuroscience Graduate Program, The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX, USA.,Translational Psychiatry Program, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, UTHealth, Houston, TX, USA
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6
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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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7
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Papp M, Cubala WJ, Swiecicki L, Newman-Tancredi A, Willner P. Perspectives for therapy of treatment-resistant depression. Br J Pharmacol 2021; 179:4181-4200. [PMID: 34128229 DOI: 10.1111/bph.15596] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 04/11/2021] [Accepted: 06/02/2021] [Indexed: 12/12/2022] Open
Abstract
A high proportion of depressed patients fail to respond to antidepressant drug treatment. Treatment-resistant depression (TRD) is a major challenge for the psychopharmacology of mood disorders. Only in the past decade have novel treatments, including deep brain stimulation (DBS) and ketamine, been discovered that provide rapid and sometimes prolonged relief to a high proportion of TRD sufferers. In this review, we consider the current status of TRD from four perspectives: the challenge of developing an appropriate regulatory framework for novel rapidly acting antidepressants; the efficacy of non-pharmacological somatic therapies; the development of an animal model of TRD and its use to understand the neural basis of antidepressant non-response; and the potential for rapid antidepressant action from targets (such as 5-HT1A receptors) beyond the glutamate receptor.
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Affiliation(s)
- Mariusz Papp
- Maj Institute of Pharmacology, Polish Academy of Sciences, Kraków, Poland
| | - Wiesław Jerzy Cubala
- Department of Psychiatry, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Lukasz Swiecicki
- Second Department of Psychiatry, Institute of Psychiatry and Neurology, Warsaw, Poland
| | | | - Paul Willner
- Department of Psychology, Swansea University, Swansea, UK
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8
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Zhang Y, Burock MA. Diffusion Tensor Imaging in Parkinson's Disease and Parkinsonian Syndrome: A Systematic Review. Front Neurol 2020; 11:531993. [PMID: 33101169 PMCID: PMC7546271 DOI: 10.3389/fneur.2020.531993] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 08/18/2020] [Indexed: 12/21/2022] Open
Abstract
Diffusion tensor imaging (DTI) allows measuring fractional anisotropy and similar microstructural indices of the brain white matter. Lower than normal fractional anisotropy as well as higher than normal diffusivity is associated with loss of microstructural integrity and neurodegeneration. Previous DTI studies in Parkinson's disease (PD) have demonstrated abnormal fractional anisotropy in multiple white matter regions, particularly in the dopaminergic nuclei and dopaminergic pathways. However, DTI is not considered a diagnostic marker for the earliest Parkinson's disease since anisotropic alterations present a temporally divergent pattern during the earliest Parkinson's course. This article reviews a majority of clinically employed DTI studies in PD, and it aims to prove the utilities of DTI as a marker of diagnosing PD, correlating clinical symptomatology, tracking disease progression, and treatment effects. To address the challenge of DTI being a diagnostic marker for early PD, this article also provides a comparison of the results from a longitudinal, early stage, multicenter clinical cohort of Parkinson's research with previous publications. This review provides evidences of DTI as a promising marker for monitoring PD progression and classifying atypical PD types, and it also interprets the possible pathophysiologic processes under the complex pattern of fractional anisotropic changes in the first few years of PD. Recent technical advantages, limitations, and further research strategies of clinical DTI in PD are additionally discussed.
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Affiliation(s)
- Yu Zhang
- Department of Psychiatry, War Related Illness and Injury Study Center, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, United States
| | - Marc A Burock
- Department of Psychiatry, Mainline Health, Bryn Mawr Hospital, Bryn Mawr, PA, United States
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9
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Sanguinetti JL, Hameroff S, Smith EE, Sato T, Daft CMW, Tyler WJ, Allen JJB. Transcranial Focused Ultrasound to the Right Prefrontal Cortex Improves Mood and Alters Functional Connectivity in Humans. Front Hum Neurosci 2020; 14:52. [PMID: 32184714 PMCID: PMC7058635 DOI: 10.3389/fnhum.2020.00052] [Citation(s) in RCA: 82] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 02/04/2020] [Indexed: 01/21/2023] Open
Abstract
Transcranial focused ultrasound (tFUS) is an emerging method for non-invasive neuromodulation akin to transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS). tFUS offers several advantages over electromagnetic methods including high spatial resolution and the ability to reach deep brain targets. Here we describe two experiments assessing whether tFUS could modulate mood in healthy human volunteers by targeting the right inferior frontal gyrus (rIFG), an area implicated in mood and emotional regulation. In a randomized, placebo-controlled, double-blind study, participants received 30 s of 500 kHz tFUS or a placebo control. Visual Analog Mood Scales (VAMS) assessed mood four times within an hour (baseline and three times after tFUS). Participants who received tFUS reported an overall increase in Global Affect (GA), an aggregate score from the VAMS scale, indicating a positive shift in mood. Experiment 2 examined resting-state functional (FC) connectivity using functional magnetic resonance imaging (fMRI) following 2 min of 500 kHz tFUS at the rIFG. As in Experiment 1, tFUS enhanced self-reported mood states and also decreased FC in resting state networks related to emotion and mood regulation. These results suggest that tFUS can be used to modulate mood and emotional regulation networks in the prefrontal cortex.
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Affiliation(s)
- Joseph L Sanguinetti
- Department of Psychology, University of Arizona, Tucson, AZ, United States.,Center for Consciousness Studies, University of Arizona, Tucson, AZ, United States.,Department of Psychology, The University of New Mexico, Albuquerque, NM, United States
| | - Stuart Hameroff
- Department of Psychology, University of Arizona, Tucson, AZ, United States.,Center for Consciousness Studies, University of Arizona, Tucson, AZ, United States.,Department of Anesthesiology, University of Arizona, Tucson, AZ, United States
| | - Ezra E Smith
- Department of Psychology, University of Arizona, Tucson, AZ, United States.,New York State Psychiatric Institute, New York, NY, United States
| | - Tomokazu Sato
- The Division of Biology and Biological Engineering, California Institute of Technology, Pasadena, CA, United States
| | - Chris M W Daft
- River Sonic Solutions LLC, San Francisco, CA, United States
| | - William J Tyler
- School of Biological and Health Systems Engineering, Arizona State University, Tempe, AZ, United States
| | - John J B Allen
- Department of Psychology, University of Arizona, Tucson, AZ, United States
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10
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He N, Sethi SK, Zhang C, Li Y, Chen Y, Sun B, Yan F, Haacke EM. Visualizing the lateral habenula using susceptibility weighted imaging and quantitative susceptibility mapping. Magn Reson Imaging 2019; 65:55-61. [PMID: 31655137 DOI: 10.1016/j.mri.2019.09.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 09/03/2019] [Accepted: 09/15/2019] [Indexed: 12/22/2022]
Abstract
The habenulae consist of a pair of small nuclei which bridge the limbic forebrain and midbrain monoaminergic centers. They are implicated in major depressive disorders due to abnormal phasic response when provoked by a conditioned stimulus. The lateral habenula (Lhb) is believed to be involved in dopamine metabolism and is now a target for deep brain stimulation, a treatment which has shown promising anti-depression effects. We imaged the habenulae with susceptibility weighted imaging (SWI) and quantitative susceptibility mapping (QSM) in order to localize the lateral habenula. Fifty-six healthy controls were recruited for this study. For the quantitative assessment, we traced the structure to compute volume from magnitude images and mean susceptibility bilaterally for the habenula on QSM. Thresholding methods were used to delineate the Lhb habenula on QSM. SWI, true SWI (tSWI), and QSM data were subjectively reviewed for increased Lhb contrast. SWI, QSM, and tSWI showed bilateral signal changes in the posterior location of the habenulae relative to the anterior location, which may indicate increased putative iron content within the Lhb. This signal behavior was shown in 41/44 (93%) subjects. In summary, it is possible to localize the lateral component of the habenula using SWI and QSM at 3 T.
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Affiliation(s)
- Naying He
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Sean K Sethi
- Magnetic Resonance Innovations, Inc., Bingham Farms, MI, USA; The MRI Institute for Biomedical Research, Bingham Farms, MI, USA; Department of Radiology, Wayne State University, Detroit, MI, USA
| | - Chencheng Zhang
- Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yan Li
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yongsheng Chen
- Department of Neurology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Bomin Sun
- Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fuhua Yan
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - E Mark Haacke
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Magnetic Resonance Innovations, Inc., Bingham Farms, MI, USA; The MRI Institute for Biomedical Research, Bingham Farms, MI, USA; Department of Radiology, Wayne State University, Detroit, MI, USA
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11
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Miguel EC, Lopes AC, McLaughlin NCR, Norén G, Gentil AF, Hamani C, Shavitt RG, Batistuzzo MC, Vattimo EFQ, Canteras M, De Salles A, Gorgulho A, Salvajoli JV, Fonoff ET, Paddick I, Hoexter MQ, Lindquist C, Haber SN, Greenberg BD, Sheth SA. Evolution of gamma knife capsulotomy for intractable obsessive-compulsive disorder. Mol Psychiatry 2019; 24:218-240. [PMID: 29743581 PMCID: PMC6698394 DOI: 10.1038/s41380-018-0054-0] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 02/26/2018] [Accepted: 03/06/2018] [Indexed: 11/08/2022]
Abstract
For more than half a century, stereotactic neurosurgical procedures have been available to treat patients with severe, debilitating symptoms of obsessive-compulsive disorder (OCD) that have proven refractory to extensive, appropriate pharmacological, and psychological treatment. Although reliable predictors of outcome remain elusive, the establishment of narrower selection criteria for neurosurgical candidacy, together with a better understanding of the functional neuroanatomy implicated in OCD, has resulted in improved clinical efficacy for an array of ablative and non-ablative intervention techniques targeting the cingulum, internal capsule, and other limbic regions. It was against this backdrop that gamma knife capsulotomy (GKC) for OCD was developed. In this paper, we review the history of this stereotactic radiosurgical procedure, from its inception to recent advances. We perform a systematic review of the existing literature and also provide a narrative account of the evolution of the procedure, detailing how the procedure has changed over time, and has been shaped by forces of evidence and innovation. As the procedure has evolved and adverse events have decreased considerably, favorable response rates have remained attainable for approximately one-half to two-thirds of individuals treated at experienced centers. A reduction in obsessive-compulsive symptom severity may result not only from direct modulation of OCD neural pathways but also from enhanced efficacy of pharmacological and psychological therapies working in a synergistic fashion with GKC. Possible complications include frontal lobe edema and even the rare formation of delayed radionecrotic cysts. These adverse events have become much less common with new radiation dose and targeting strategies. Detailed neuropsychological assessments from recent studies suggest that cognitive function is not impaired, and in some domains may even improve following treatment. We conclude this review with discussions covering topics essential for further progress of this therapy, including suggestions for future trial design given the unique features of GKC therapy, considerations for optimizing stereotactic targeting and dose planning using biophysical models, and the use of advanced imaging techniques to understand circuitry and predict response. GKC, and in particular its modern variant, gamma ventral capsulotomy, continues to be a reliable treatment option for selected cases of otherwise highly refractory OCD.
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Affiliation(s)
- Euripedes C Miguel
- Department and Institute of Psychiatry, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brazil.
| | - Antonio C Lopes
- Department and Institute of Psychiatry, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brazil
| | - Nicole C R McLaughlin
- Departments of Psychiatry and Human Behavior and Neurosurgery, Warren Alpert Medical School of Brown University and Veterans Affairs Medical Center of Providence, Providence, RI, USA
| | - Georg Norén
- Departments of Psychiatry and Human Behavior and Neurosurgery, Warren Alpert Medical School of Brown University and Veterans Affairs Medical Center of Providence, Providence, RI, USA
| | - André F Gentil
- Department and Institute of Psychiatry, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brazil
| | - Clement Hamani
- Division of Neurosurgery, Sunnybrook Health Sciences Centre, Harquail Centre for Neuromodulation, University of Toronto, Toronto, Ontario, Canada
| | - Roseli G Shavitt
- Department and Institute of Psychiatry, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brazil
| | - Marcelo C Batistuzzo
- Department and Institute of Psychiatry, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brazil
| | - Edoardo F Q Vattimo
- Department and Institute of Psychiatry, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brazil
| | - Miguel Canteras
- Discipline of Neurosurgery, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | | | | | | | - Erich Talamoni Fonoff
- Department of Neurology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brazil
| | - Ian Paddick
- National Hospital for Neurology and Neurosurgery, London, UK
| | - Marcelo Q Hoexter
- Department and Institute of Psychiatry, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brazil
| | | | - Suzanne N Haber
- University of Rochester School of Medicine, Rochester, New York, USA
- McLean Hospital, Harvard University, Boston, USA
| | - Benjamin D Greenberg
- Departments of Psychiatry and Human Behavior and Neurosurgery, Warren Alpert Medical School of Brown University and Veterans Affairs Medical Center of Providence, Providence, RI, USA
| | - Sameer A Sheth
- Discipline of Neurosurgery, Universidade Federal de São Paulo, São Paulo, SP, Brazil
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12
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How Deep Brain Stimulation of the Nucleus Accumbens Affects the Cingulate Gyrus and Vice Versa. Brain Sci 2019; 9:brainsci9010005. [PMID: 30621216 PMCID: PMC6356752 DOI: 10.3390/brainsci9010005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Accepted: 12/30/2018] [Indexed: 12/20/2022] Open
Abstract
The nucleus accumbens (NA) and the cingulate gyrus (CG) are two vital limbic brain structures. They have attracted attention as deep brain stimulation (DBS) targets in the treatment of common refractory psychiatric illness. The primary purpose of this article was to review the current knowledge regarding the way that NA DBS affects the CG and vice versa. Methodologically, a thorough literature review was performed. According to the current literature, NA DBS modulates the function of several brain areas including the CG cortex. It specifically causes activation in the ipsilateral CG cortex and voltage-dependent reduction of its blood oxygenation. It also reverses anterior mid-CG cortex dysfunction and decreases metabolism in the subgenual CG. Moreover, NA DBS that induces mirth inhibits the function of the anterior CG cortex and enhances effective connectivity from anterior CG to the ventral striatum. On the other hand, although it is highly probable that CG DBS affects the NA, the exact nature of its effects remains unclear. Despite the increasing interest in psychiatric DBS, the available data on how NA DBS affects the CG and vice versa are restricted. This conclusion probably reflects the high complexity of the limbic circuits and necessitates further research.
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13
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Focal stimulation of the sheep motor cortex with a chronically implanted minimally invasive electrode array mounted on an endovascular stent. Nat Biomed Eng 2018; 2:907-914. [DOI: 10.1038/s41551-018-0321-z] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 10/22/2018] [Indexed: 12/29/2022]
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14
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Aydın S, Canaz H, Topcular B, Benackova Z. Major Depression and Obsessive-compulsive Disorder Treated with Deep Brain Stimulation of Bilateral Nucleus Accumbens: The First Case of Turkey. Asian J Neurosurg 2018; 13:842-844. [PMID: 30283561 PMCID: PMC6159045 DOI: 10.4103/ajns.ajns_319_16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Deep brain stimulation (DBS) is a new alternative treatment for treatment-resistant major depression (MD) and obsessive-compulsive disorder (OCD). Various DBS targets were defined for MD and OCD. Nucleus accumbens (NAcc) comes out among the other targets in patients with MD and comorbid OCD when physiopathology and limited side effects are taken into account. We report a 27-year-old male with MD and OCD who was treated by bilateral NAcc-DBS. The aim of this study is to discuss NAcc as a DBS target in patients with MD and OCD and to report the first case of a psychiatric disorder treated with DBS in Turkey.
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Affiliation(s)
- Sabri Aydın
- Department of Neurosurgery, Istanbul Bilim University, Istanbul, Turkey
| | - Huseyin Canaz
- Department of Neurosurgery, Istanbul Bilim University, Istanbul, Turkey
| | - Barıs Topcular
- Department of Neurology, Istanbul Bilim University, Istanbul, Turkey
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15
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Gorgulho AA, Fernandes F, Damiani LP, Barbosa DAN, Cury A, Lasagno CM, Bueno PRT, Santos BFO, Santos RHN, Berwanger O, Cavalcanti AB, Teixeira MJ, Moreno RA, De Salles AAF. Double Blinded Randomized Trial of Subcutaneous Trigeminal Nerve Stimulation as Adjuvant Treatment for Major Unipolar Depressive Disorder. Neurosurgery 2018; 85:717-728. [DOI: 10.1093/neuros/nyy420] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 08/07/2018] [Indexed: 12/28/2022] Open
Abstract
Abstract
BACKGROUND
More than 30% of major depressive disorder patients fail to respond to adequate trials of medications and psychotherapy. While modern neuromodulation approaches (ie, vagal nerve stimulation, deep brain stimulation) are yet to prove their efficacy for such cases in large randomized controlled trials, trigeminal nerve stimulation (TNS) has emerged as an alternative with promising effects on mood disorders.
OBJECTIVE
To assess efficacy, safety, tolerability, and placebo effect duration of continuous subcutaneous TNS (sTNS) in treatment-resistant depression (TRD).
METHODS
The TREND study is a single-center, double-blind, randomized, controlled, phase II clinical trial. Twenty unipolar TRD patients will receive V1 sTNS as adjuvant to medical therapy and randomized to active vs sham stimulation throughout a 24-wk period. An additional 24-wk open-label phase will follow. Data concerning efficacy, placebo response, relapse, and side effects related to surgery or electrical stimulation will be recorded. We will use the HDRS-17, BDI-SR, IDS_SR30, and UKU scales.
EXPECTED OUTCOMES
The main outcome measure is improvement in depression scores using HAM-17 under continuous sTNS as adjuvant to antidepressants. Active stimulation is expected to significantly impact response and remission rates. Minor side effects are expected due to the surgical procedure and electrical stimulation. The open-label phase should further confirm efficacy and tolerability.
DISCUSSION
This study protocol is designed to define efficacy of a novel adjuvant therapy for TRD. We must strive to develop safe, reproducible, predictable, and well-tolerated neuromodulation approaches for TRD patients impaired to manage their lives and contribute with society.
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Affiliation(s)
| | - Fernando Fernandes
- Mood Disorders Unit (GRUDA), Department of Psychiatry, Faculty of Medicine, University of São Paulo (USP), São Paulo, São Paulo, Brazil
| | - Lucas P Damiani
- Research Institute (IP), Heart Hospital (HCor), São Paulo, São Paulo, Brazil
| | - Daniel A N Barbosa
- HCor Neuroscience Institute, Heart Hos-pital (HCor), São Paulo, São Paulo, Brazil
| | - Abrão Cury
- Internal Medicine Department, Federal University of São Paulo (UNIFESP), São Paulo, São Paulo, Brazil
| | - Camila M Lasagno
- Research Institute (IP), Heart Hospital (HCor), São Paulo, São Paulo, Brazil
| | - Priscila R T Bueno
- Research Institute (IP), Heart Hospital (HCor), São Paulo, São Paulo, Brazil
| | - Bruno F O Santos
- HCor Neuroscience Institute, Heart Hos-pital (HCor), São Paulo, São Paulo, Brazil
| | - Renato H N Santos
- Research Institute (IP), Heart Hospital (HCor), São Paulo, São Paulo, Brazil
| | - Otávio Berwanger
- Research Institute (IP), Heart Hospital (HCor), São Paulo, São Paulo, Brazil
| | | | - Manoel J Teixeira
- HCor Neuroscience Institute, Heart Hos-pital (HCor), São Paulo, São Paulo, Brazil
- Neurosurgery Discipline, Neurology Department, Faculty of Medicine, University of São Paulo (USP), São Paulo, São Paulo, Brazil
| | - Ricardo A Moreno
- Mood Disorders Unit (GRUDA), Department of Psychiatry, Faculty of Medicine, University of São Paulo (USP), São Paulo, São Paulo, Brazil
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16
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Holland MT, Zanaty M, Li L, Thomsen T, Beeghly JH, Greenlee JD, Reddy CG. Successful deep brain stimulation for central post-stroke pain and dystonia in a single operation. J Clin Neurosci 2018; 50:190-193. [DOI: 10.1016/j.jocn.2018.01.036] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 01/08/2018] [Indexed: 11/26/2022]
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17
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A little rein on addiction. Semin Cell Dev Biol 2017; 78:120-129. [PMID: 28986065 DOI: 10.1016/j.semcdb.2017.09.030] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 09/18/2017] [Accepted: 09/20/2017] [Indexed: 10/18/2022]
Abstract
Rewarding and aversive experiences influence emotions, motivate specific behaviors, and modify future action in animals. Multiple conserved vertebrate neural circuits have been discovered that act in a species-specific manner to reinforce behaviors that are rewarding, while attenuating those with an adverse outcome. A growing body of research now suggests that malfunction of the same circuits is an underlying cause for many human disorders and mental ailments. The habenula (Latin for "little rein") complex, an epithalamic structure that regulates midbrain monoaminergic activity has emerged in recent years as one such region in the vertebrate brain that modulates behavior. Its dysfunction, on the other hand, is implicated in a spectrum of psychiatric disorders in humans such as schizophrenia, depression and addiction. Here, I review the progress in identification of potential mechanisms involving the habenula in addiction.
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18
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Hollingworth M, Sims-Williams HP, Pickering AE, Barua N, Patel NK. Single Electrode Deep Brain Stimulation with Dual Targeting at Dual Frequency for the Treatment of Chronic Pain: A Case Series and Review of the Literature. Brain Sci 2017; 7:brainsci7010009. [PMID: 28098766 PMCID: PMC5297298 DOI: 10.3390/brainsci7010009] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 01/04/2017] [Accepted: 01/09/2017] [Indexed: 01/02/2023] Open
Abstract
Deep Brain Stimulation (DBS) has been used to target many deep brain structures for the treatment of chronic pain. The periaqueductal grey and periventricular grey (PAG/PVG) is an effective target but results are variable, sometimes short-lived or subject to tolerance. The centromedian intra-laminar parafascicular complex (CMPf) modulates medial pain pathways and CMPf DBS may address the affective aspects of pain perception. Stimulation of multiple deep brain targets may offer a strategy to optimize management of patients with complex pain symptomatology. However, previous attempts to stimulate multiple targets requires multiple trajectories and considerable expense. Using a single electrode to stimulate multiple targets would help overcome these challenges. A pre-requisite of such a technique is the ability to use different stimulation parameters at different contacts simultaneously on the same electrode. We describe a novel technique in 3 patients with chronic pain syndromes for whom conventional medical and/or neuromodulation therapy had failed using a single electrode technique to stimulate PVG/PAG and CMPf at dual frequencies.
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Affiliation(s)
- Milo Hollingworth
- Department of Neurosurgery, North Bristol Trust, Bristol BS10 5NB, UK.
| | | | - Anthony E Pickering
- School of Physiology, Pharmacology & Neuroscience, University of Bristol, Bristol BS8 1TD, UK.
| | - Neil Barua
- Department of Neurosurgery, North Bristol Trust, Bristol BS10 5NB, UK.
| | - Nikunj K Patel
- Department of Neurosurgery, North Bristol Trust, Bristol BS10 5NB, UK.
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19
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Meidahl AC, Orlowski D, Sørensen JCH, Bjarkam CR. The Retrograde Connections and Anatomical Segregation of the Göttingen Minipig Nucleus Accumbens. Front Neuroanat 2016; 10:117. [PMID: 27994542 PMCID: PMC5136552 DOI: 10.3389/fnana.2016.00117] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 11/21/2016] [Indexed: 12/12/2022] Open
Abstract
Nucleus accumbens (NAcc) has been implicated in several psychiatric disorders such as treatment resistant depression (TRD), and obsessive-compulsive disorder (OCD), and has been an ongoing experimental target for deep brain stimulation (DBS) in both rats and humans. In order to translate basic scientific results from rodents to the human setting a large animal model is needed to thoroughly study the effect of such therapeutic interventions. The aim of the study was, accordingly, to describe the basic anatomy of the Göttingen minipig NAcc and its retrograde connections. Tracing was carried out by MRI-guided stereotactic unilateral fluorogold injections in the NAcc of Göttingen minipigs. After 2 weeks the brains were sectioned and subsequently stained with Nissl-, autometallographic (AMG) development of myelin, and DARPP-32 and calbindin immunohistochemistry. The minipig NAcc was divided in a central core and an outer medial, ventral and lateral shell. We confirmed the NAcc to be a large and well-segregated structure toward its medial, ventral and lateral borders. The fluorogold tracing revealed inputs to NAcc from the medial parts of the prefrontal cortex, BA 25 (subgenual cortex), insula bilaterally, amygdala, the CA1-region of hippocampus, entorhinal cortex, subiculum, paraventricular and anterior parts of thalamus, dorsomedial parts of hypothalamus, substantia nigra, ventral tegmental area (VTA), the retrorubral field and the dorsal and median raphe nuclei. In conclusion the Göttingen minipig NAcc is a large ventral striatal structure that can be divided into a core and shell with prominent afferent connections from several subrhinal and infra-/prelimbic brain areas.
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Affiliation(s)
- Anders C Meidahl
- Department of Neurosurgery, Department of Clinical Medicine, Faculty of Health, Center for Experimental Neuroscience, Aarhus University Hospital, Aarhus University Aarhus, Denmark
| | - Dariusz Orlowski
- Department of Neurosurgery, Department of Clinical Medicine, Faculty of Health, Center for Experimental Neuroscience, Aarhus University Hospital, Aarhus University Aarhus, Denmark
| | - Jens C H Sørensen
- Department of Neurosurgery, Department of Clinical Medicine, Faculty of Health, Center for Experimental Neuroscience, Aarhus University Hospital, Aarhus University Aarhus, Denmark
| | - Carsten R Bjarkam
- Department of Neurosurgery, Institute of Clinical Medicine, Aalborg University Hospital Aalborg, Denmark
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20
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Schizophrenia and neurosurgery: A dark past with hope of a brighter future. J Clin Neurosci 2016; 34:53-58. [DOI: 10.1016/j.jocn.2016.08.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Revised: 07/05/2016] [Accepted: 08/10/2016] [Indexed: 12/11/2022]
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21
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Leaver AM, Espinoza R, Joshi SH, Vasavada M, Njau S, Woods RP, Narr KL. Desynchronization and Plasticity of Striato-frontal Connectivity in Major Depressive Disorder. Cereb Cortex 2016; 26:4337-4346. [PMID: 26400916 PMCID: PMC5066823 DOI: 10.1093/cercor/bhv207] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Major depressive disorder (MDD) is associated with dysfunctional corticolimbic networks, making functional connectivity studies integral for understanding the mechanisms underlying MDD pathophysiology and treatment. Resting-state functional connectivity (RSFC) studies analyze patterns of temporally coherent intrinsic brain activity in "resting-state networks" (RSNs). The default-mode network (DMN) has been of particular interest to depression research; however, a single RSN is unlikely to capture MDD pathophysiology in its entirety, and the DMN itself can be characterized by multiple RSNs. This, coupled with conflicting previous results, underscores the need for further research. Here, we measured RSFC in MDD by targeting RSNs overlapping with corticolimbic regions and further determined whether altered patterns of RSFC were restored with electroconvulsive therapy (ECT). MDD patients exhibited hyperconnectivity between ventral striatum (VS) and the ventral default-mode network (vDMN), while simultaneously demonstrating hypoconnectivity with the anterior DMN (aDMN). ECT influenced this pattern: VS-vDMN hyperconnectivity was significantly reduced while VS-aDMN hypoconnectivity only modestly improved. RSFC between the salience RSN and dorsomedial prefrontal cortex was also reduced in MDD, but was not affected by ECT. Taken together, our results support a model of ventral/dorsal imbalance in MDD and further suggest that the VS is a key structure contributing to this desynchronization.
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Affiliation(s)
- Amber M. Leaver
- Ahmanson-Lovelace Brain Mapping Center, Department of Neurology
| | - Randall Espinoza
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA 90095, USA
| | | | - Megha Vasavada
- Ahmanson-Lovelace Brain Mapping Center, Department of Neurology
| | - Stephanie Njau
- Ahmanson-Lovelace Brain Mapping Center, Department of Neurology
| | - Roger P. Woods
- Ahmanson-Lovelace Brain Mapping Center, Department of Neurology
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Katherine L. Narr
- Ahmanson-Lovelace Brain Mapping Center, Department of Neurology
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA 90095, USA
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22
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Dupré DA, Tomycz N, Oh MY, Whiting D. Deep brain stimulation for obesity: past, present, and future targets. Neurosurg Focus 2016; 38:E7. [PMID: 26030707 DOI: 10.3171/2015.3.focus1542] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The authors review the history of deep brain stimulation (DBS) in patients for treating obesity, describe current DBS targets in the brain, and discuss potential DBS targets and nontraditional stimulation parameters that may improve the effectiveness of DBS for ameliorating obesity. Deep brain stimulation for treating obesity has been performed both in animals and in humans with intriguing preliminary results. The brain is an attractive target for addressing obesity because modulating brain activity may permit influencing both sides of the energy equation--caloric intake and energy expenditure.
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Affiliation(s)
- Derrick A Dupré
- Department of Neurosurgery, Allegheny General Hospital, Pittsburgh, Pennsylvania
| | - Nestor Tomycz
- Department of Neurosurgery, Allegheny General Hospital, Pittsburgh, Pennsylvania
| | - Michael Y Oh
- Department of Neurosurgery, Allegheny General Hospital, Pittsburgh, Pennsylvania
| | - Donald Whiting
- Department of Neurosurgery, Allegheny General Hospital, Pittsburgh, Pennsylvania
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23
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Akhtar H, Bukhari F, Nazir M, Anwar MN, Shahzad A. Therapeutic Efficacy of Neurostimulation for Depression: Techniques, Current Modalities, and Future Challenges. Neurosci Bull 2016; 32:115-26. [PMID: 26781880 PMCID: PMC5563754 DOI: 10.1007/s12264-015-0009-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 10/20/2015] [Indexed: 01/30/2023] Open
Abstract
Depression is the most prevalent debilitating mental illness; it is characterized as a disorder of mood, cognitive function, and neurovegetative function. About one in ten individuals experience depression at some stage of their lives. Antidepressant drugs are used to reduce the symptoms but relapse occurs in ~20% of patients. However, alternate therapies like brain stimulation techniques have shown promising results in this regard. This review covers the brain stimulation techniques electroconvulsive therapy, transcranial direct current stimulation, repetitive transcranial magnetic stimulation, vagus nerve stimulation, and deep brain stimulation, which are used as alternatives to antidepressant drugs, and elucidates their research and clinical outcomes.
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Affiliation(s)
- Hafsah Akhtar
- Human Systems Lab, Department of Biomedical Engineering and Sciences, School of Mechanical and Manufacturing Engineering, National University of Sciences and Technology (NUST), Sector H-12, Islamabad, 44000, Pakistan
| | - Faiza Bukhari
- Human Systems Lab, Department of Biomedical Engineering and Sciences, School of Mechanical and Manufacturing Engineering, National University of Sciences and Technology (NUST), Sector H-12, Islamabad, 44000, Pakistan
| | - Misbah Nazir
- Human Systems Lab, Department of Biomedical Engineering and Sciences, School of Mechanical and Manufacturing Engineering, National University of Sciences and Technology (NUST), Sector H-12, Islamabad, 44000, Pakistan
| | - Muhammad Nabeel Anwar
- Human Systems Lab, Department of Biomedical Engineering and Sciences, School of Mechanical and Manufacturing Engineering, National University of Sciences and Technology (NUST), Sector H-12, Islamabad, 44000, Pakistan.
| | - Adeeb Shahzad
- Human Systems Lab, Department of Biomedical Engineering and Sciences, School of Mechanical and Manufacturing Engineering, National University of Sciences and Technology (NUST), Sector H-12, Islamabad, 44000, Pakistan
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24
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Woo YS, Seo HJ, McIntyre RS, Bahk WM. Obesity and Its Potential Effects on Antidepressant Treatment Outcomes in Patients with Depressive Disorders: A Literature Review. Int J Mol Sci 2016; 17:ijms17010080. [PMID: 26771598 PMCID: PMC4730324 DOI: 10.3390/ijms17010080] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 01/04/2016] [Indexed: 02/07/2023] Open
Abstract
Accumulating evidence regarding clinical, neurobiological, genetic, and environmental factors suggests a bidirectional link between obesity and depressive disorders. Although a few studies have investigated the link between obesity/excess body weight and the response to antidepressants in depressive disorders, the effect of weight on treatment response remains poorly understood. In this review, we summarized recent data regarding the relationship between the response to antidepressants and obesity/excess body weight in clinical studies of patients with depressive disorders. Although several studies indicated an association between obesity/excess body weight and poor antidepressant responses, it is difficult to draw definitive conclusions due to the variability of subject composition and methodological differences among studies. Especially, differences in sex, age and menopausal status, depressive symptom subtypes, and antidepressants administered may have caused inconsistencies in the results among studies. The relationship between obesity/excess body weight and antidepressant responses should be investigated further in high-powered studies addressing the differential effects on subject characteristics and treatment. Moreover, future research should focus on the roles of mediating factors, such as inflammatory markers and neurocognitive performance, which may alter the antidepressant treatment outcome in patients with comorbid obesity and depressive disorder.
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Affiliation(s)
- Young Sup Woo
- Department of Psychiatry, College of Medicine, the Catholic University of Korea, Seoul 07345, Korea.
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON M5T 2S8, Canada.
| | - Hye-Jin Seo
- Department of Psychiatry, College of Medicine, the Catholic University of Korea, Seoul 07345, Korea.
| | - Roger S McIntyre
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON M5T 2S8, Canada.
- Department of Psychiatry, University of Toronto, Toronto, ON M5T 2S8, Canada.
| | - Won-Myong Bahk
- Department of Psychiatry, College of Medicine, the Catholic University of Korea, Seoul 07345, Korea.
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25
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Ali R, Shebak SS. Deep Brain Stimulation in the Globus Pallidus Internus in a Woman With Parkinson's Disease Treats Depression but Does Not Improve Parkinsonian Symptoms: A Case Report. Prim Care Companion CNS Disord 2015; 17:14l01750. [PMID: 26693031 DOI: 10.4088/pcc.14l01750] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
| | - Shady S Shebak
- Department of Psychiatry, Virginia Tech Carilion School of Medicine, Roanoke
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The medial forebrain bundle as a deep brain stimulation target for treatment resistant depression: A review of published data. Prog Neuropsychopharmacol Biol Psychiatry 2015; 58:59-70. [PMID: 25530019 DOI: 10.1016/j.pnpbp.2014.12.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Revised: 12/08/2014] [Accepted: 12/09/2014] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Despite a wide variety of therapeutic interventions for major depressive disorder (MDD), treatment resistant depression (TRD) remains to be prevalent and troublesome in clinical practice. In recent years, deep brain stimulation (DBS) has emerged as an alternative for individuals suffering from TRD not responding to combining antidepressants, multiple adjunctive strategies and electroconvulsive therapy (ECT). Although the best site for TRD-DBS is still unclear, pilot data suggests that the medial forebrain bundle (MFB) might be a key target to accomplish therapeutic efficacy in TRD patients. OBJECTIVE To explore the anatomic, electrophysiologic, neurocognitive and treatment data supporting the MFB as a target for TRD-DBS. RESULTS The MFB connects multiple targets involved in motivated behavior, mood regulation and antidepressant response. Specific phenomenology associated with TRD can be linked specifically to the superolateral branch (sl) of the MFB (slMFB). TRD patients who received DBS-slMFB reported high response/remission rates with an improvement in functioning and no significant adverse outcomes in their physical health or neurocognitive performance. DISCUSSION The slMFB is an essential component of a network of structural and functional pathways connecting different areas possibly involved in the pathogenesis of mood disorders. Therefore, the slMFB should be considered as an exciting therapeutic target for DBS therapy to achieve a sustained relief in TRD patients. CONCLUSION There is an urgent need for clinical trials exploring DBS-slMFB in TRD. Further efforts should pursue measuring baseline pro-inflammatory cytokines, oxidative stress, and cognition as possible biomarkers of DBS-slMFB response in order to aid clinicians in better patient selection.
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Inan SY, Soner BC, Sahin AS. Infralimbic cortex Rho-kinase inhibition causes antidepressant-like activity in rats. Prog Neuropsychopharmacol Biol Psychiatry 2015; 57:36-43. [PMID: 25445474 DOI: 10.1016/j.pnpbp.2014.10.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Revised: 10/13/2014] [Accepted: 10/20/2014] [Indexed: 01/31/2023]
Abstract
Depression is one of the most common psychiatric disorders in the world; however, its mechanisms remain unclear. Recently, a new signal-transduction pathway, namely Rho/Rho-kinase signalling, has been suggested to be involved in diverse cellular events in the central nervous system; such as epilepsy, anxiety-related behaviors, regulation of dendritic and axonal morphology, antinociception, subarachnoid haemorrhage, spinal cord injury and amyotrophic lateral sclerosis. However there is no evidence showing the involvement of Rho-kinase pathway in depression. In addition, the infralimbic cortex, rodent equivalent to subgenual cingulate cortex has been shown to be responsible for emotional responses. Thus, in the present study, intracranial guide cannulae were stereotaxically implanted bilaterally into the infralimbic cortex, and the effects of repeated microinjections of a Rho-kinase (ROCK) inhibitor Y-27632 (10 nmol) were investigated in rats. Y-27632 significantly decreased immobility time and increased swimming and climbing behaviors when compared to fluoxetine (10 μg) and saline groups in the forced swim test. In addition, Y-27632 treatment did not affect spontaneous locomotor activity and forelimb use in the open-field and cylinder tests respectively; but it enhanced limb placing accuracy in the ladder rung walking test. Our results suggest that Y-27632 could be a potentially active antidepressant agent.
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Affiliation(s)
- Salim Yalcin Inan
- Department of Pharmacology, Meram Faculty of Medicine, University of Konya-NE, Konya, Turkey.
| | - Burak Cem Soner
- Department of Pharmacology, Meram Faculty of Medicine, University of Konya-NE, Konya, Turkey
| | - Ayse Saide Sahin
- Department of Pharmacology, Meram Faculty of Medicine, University of Konya-NE, Konya, Turkey
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Da Cunha C, Boschen SL, Gómez-A A, Ross EK, Gibson WSJ, Min HK, Lee KH, Blaha CD. Toward sophisticated basal ganglia neuromodulation: Review on basal ganglia deep brain stimulation. Neurosci Biobehav Rev 2015; 58:186-210. [PMID: 25684727 DOI: 10.1016/j.neubiorev.2015.02.003] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Revised: 02/01/2015] [Accepted: 02/05/2015] [Indexed: 12/11/2022]
Abstract
This review presents state-of-the-art knowledge about the roles of the basal ganglia (BG) in action-selection, cognition, and motivation, and how this knowledge has been used to improve deep brain stimulation (DBS) treatment of neurological and psychiatric disorders. Such pathological conditions include Parkinson's disease, Huntington's disease, Tourette syndrome, depression, and obsessive-compulsive disorder. The first section presents evidence supporting current hypotheses of how the cortico-BG circuitry works to select motor and emotional actions, and how defects in this circuitry can cause symptoms of the BG diseases. Emphasis is given to the role of striatal dopamine on motor performance, motivated behaviors and learning of procedural memories. Next, the use of cutting-edge electrochemical techniques in animal and human studies of BG functioning under normal and disease conditions is discussed. Finally, functional neuroimaging studies are reviewed; these works have shown the relationship between cortico-BG structures activated during DBS and improvement of disease symptoms.
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Affiliation(s)
- Claudio Da Cunha
- Departamento de Farmacologia, Universidade Federal do Paraná, Curitiba, PR, Brazil
| | - Suelen L Boschen
- Departamento de Farmacologia, Universidade Federal do Paraná, Curitiba, PR, Brazil
| | - Alexander Gómez-A
- Departamento de Farmacologia, Universidade Federal do Paraná, Curitiba, PR, Brazil
| | - Erika K Ross
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - Hoon-Ki Min
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA; Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA
| | - Kendall H Lee
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA; Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA
| | - Charles D Blaha
- Department of Psychology, The University of Memphis, Memphis, TN, USA.
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Lee SW, Fried SI. Suppression of subthalamic nucleus activity by micromagnetic stimulation. IEEE Trans Neural Syst Rehabil Eng 2015; 23:116-27. [PMID: 25163063 PMCID: PMC4467829 DOI: 10.1109/tnsre.2014.2348415] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Magnetic stimulation delivered via 0.5-mm diameter coils was recently shown to activate retinal neurons; the small coil size raises the possibility that micromagnetic stimulation ( μMS) could underlie a new generation of implanted neural prosthetics. Such an approach has several inherent advantages over conventional electric stimulation, including the potential for selective activation of neuronal targets as well as less susceptibility to inflammatory responses. The viability of μMS for some applications, e.g., deep brain stimulation (DBS), may require suppression (rather than creation) of neuronal activity, however, and therefore we explore here whether (μMS) could, in fact, suppress activity. While single pulses elicited weak and inconsistent spiking in neurons of the mouse subthalamic nucleus (in vitro), repetitive stimulation effectively suppressed activity in ∼ 70% of targeted neurons. This is the same percentage suppressed by conventional electric stimulation; with both modalities, suppression occurred only after an initial increase in spiking. The latency to the onset of suppression was inversely correlated to the energy of the stimulus waveform: larger amplitudes and lower frequencies had the fastest onset of suppression. These findings continue to support the viability of μMS as a next-generation implantable neural prosthetic.
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Affiliation(s)
- Seung Woo Lee
- Massachusetts General Hospital, Department of Neuro-surgery, Harvard Medical School, Boston, MA 02114 USA ()
| | - Shelley I. Fried
- Boston Veterans Administration Healthcare System, Rehabilitation, Research and Development, Boston, MA 01230 USA and also with Massachusetts General Hospital, Department of Neurosurgery, Harvard Medical School, Boston, MA 02114 USA ()
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Cahill CM, Taylor AMW, Cook C, Ong E, Morón JA, Evans CJ. Does the kappa opioid receptor system contribute to pain aversion? Front Pharmacol 2014; 5:253. [PMID: 25452729 PMCID: PMC4233910 DOI: 10.3389/fphar.2014.00253] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Accepted: 10/30/2014] [Indexed: 01/18/2023] Open
Abstract
The kappa opioid receptor (KOR) and the endogenous peptide-ligand dynorphin have received significant attention due the involvement in mediating a variety of behavioral and neurophysiological responses, including opposing the rewarding properties of drugs of abuse including opioids. Accumulating evidence indicates this system is involved in regulating states of motivation and emotion. Acute activation of the KOR produces an increase in motivational behavior to escape a threat, however, KOR activation associated with chronic stress leads to the expression of symptoms indicative of mood disorders. It is well accepted that KOR can produce analgesia and is engaged in chronic pain states including neuropathic pain. Spinal studies have revealed KOR-induced analgesia in reversing pain hypersensitivities associated with peripheral nerve injury. While systemic administration of KOR agonists attenuates nociceptive sensory transmission, this effect appears to be a stress-induced effect as anxiolytic agents, including delta opioid receptor agonists, mitigate KOR agonist-induced analgesia. Additionally, while the role of KOR and dynorphin in driving the dysphoric and aversive components of stress and drug withdrawal has been well characterized, how this system mediates the negative emotional states associated with chronic pain is relatively unexplored. This review provides evidence that dynorphin and the KOR system contribute to the negative affective component of pain and that this receptor system likely contributes to the high comorbidity of mood disorders associated with chronic neuropathic pain.
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Affiliation(s)
- Catherine M Cahill
- Department of Anesthesiology and Perioperative Care, University of California Irvine Irvine, CA, USA ; Department of Pharmacology, University of California Irvine Irvine, CA, USA ; Department of Biomedical and Molecular Sciences, Queen's University Kingston, ON, Canada
| | - Anna M W Taylor
- Department of Anesthesiology and Perioperative Care, University of California Irvine Irvine, CA, USA ; Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles Los Angeles, CA, USA
| | - Christopher Cook
- Department of Anesthesiology and Perioperative Care, University of California Irvine Irvine, CA, USA ; Department of Pharmacology, University of California Irvine Irvine, CA, USA
| | - Edmund Ong
- Department of Anesthesiology and Perioperative Care, University of California Irvine Irvine, CA, USA ; Department of Biomedical and Molecular Sciences, Queen's University Kingston, ON, Canada
| | - Jose A Morón
- Department of Anesthesiology, Columbia University Medical Center, New York, NY USA
| | - Christopher J Evans
- Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles Los Angeles, CA, USA
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Zhao H, Zhang BL, Yang SJ, Rusak B. The role of lateral habenula-dorsal raphe nucleus circuits in higher brain functions and psychiatric illness. Behav Brain Res 2014; 277:89-98. [PMID: 25234226 DOI: 10.1016/j.bbr.2014.09.016] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Revised: 09/06/2014] [Accepted: 09/08/2014] [Indexed: 11/25/2022]
Abstract
Serotonergic neurons in the dorsal raphe nucleus (DRN) play an important role in regulation of many physiological functions. The lateral nucleus of the habenular complex (LHb) is closely connected to the DRN both morphologically and functionally. The LHb is a key regulator of the activity of DRN serotonergic neurons, and it also receives reciprocal input from the DRN. The LHb is also a major way-station that receives limbic system input via the stria medullaris and provides output to the DRN and thereby indirectly connects a number of other brain regions to the DRN. The complex interactions of the LHb and DRN contribute to the regulation of numerous important behavioral and physiological mechanisms, including those regulating cognition, reward, pain sensitivity and patterns of sleep and waking. Disruption of these functions is characteristic of major psychiatric illnesses, so there has been a great deal of interest in how disturbed LHb-DRN interactions may contribute to the symptoms of these illnesses. This review summarizes recent research related to the roles of the LHb-DRN system in regulation of higher brain functions and the possible role of disturbed LHb-DRN function in the pathogenesis of psychiatric disorders, especially depression.
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Affiliation(s)
- Hua Zhao
- Department of Physiology, College of Basic Medical Sciences, Jilin University, Changchun 130021, PR China.
| | - Bei-Lin Zhang
- Department of Physiology, College of Basic Medical Sciences, Jilin University, Changchun 130021, PR China
| | - Shao-Jun Yang
- Department of Physiology, College of Basic Medical Sciences, Jilin University, Changchun 130021, PR China
| | - Benjamin Rusak
- Departments of Psychiatry and Psychology & Neuroscience, Dalhousie University, Halifax, Nova Scotia, B3H 2E2, Canada
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Neuromodulation for depression: invasive and noninvasive (deep brain stimulation, transcranial magnetic stimulation, trigeminal nerve stimulation). Neurosurg Clin N Am 2014; 25:103-16. [PMID: 24262903 DOI: 10.1016/j.nec.2013.10.002] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Major depressive disorder is among the most disabling illnesses and, despite best practices with medication and psychotherapy, many patients remain ill even after several treatment trials. For many of these patients with treatment-resistant or pharmacoresistant depression, treatment with neuromodulation offers an alternative. Options range from systems that are implanted to others that are entirely noninvasive. This review surveys recent literature to update readers on 3 particular interventions: deep brain stimulation, transcranial magnetic stimulation, and trigeminal nerve stimulation. Additional comparative research is needed to delineate the relative advantages of these treatments, and how best to match individual patients to neuromodulation intervention.
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Abstract
Deep brain stimulation (DBS) is a commonly used neurosurgical form of therapeutic brain stimulation that has been demonstrated to be safe, well tolerated, and effective for the treatment of essential tremor, Parkinson's disease, and primary dystonia. These particular uses have been approved by the U.S. Food and Drug Administration (FDA). Investigational studies using DBS have been conducted for refractory epilepsy, obesity, chronic pain, tardive dyskinesia, Tourette syndrome, and other movement disorders, but none of these studies has led to FDA approval for these indications. Although the use of DBS has been approved by the FDA under a Humanitarian Device Exemption for the treatment of treatment-resistant obsessive-compulsive disorder, studies systematically investigating the potential use of DBS for various severe chronic psychiatric disorders are in their earliest stages, and further studies are warranted.
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Teplitzky BA, Connolly AT, Bajwa JA, Johnson MD. Computational modeling of an endovascular approach to deep brain stimulation. J Neural Eng 2014; 11:026011. [PMID: 24608363 DOI: 10.1088/1741-2560/11/2/026011] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Deep brain stimulation (DBS) therapy currently relies on a transcranial neurosurgical technique to implant one or more electrode leads into the brain parenchyma. In this study, we used computational modeling to investigate the feasibility of using an endovascular approach to target DBS therapy. APPROACH Image-based anatomical reconstructions of the human brain and vasculature were used to identify 17 established and hypothesized anatomical targets of DBS, of which five were found adjacent to a vein or artery with intraluminal diameter ≥1 mm. Two of these targets, the fornix and subgenual cingulate white matter (SgCwm) tracts, were further investigated using a computational modeling framework that combined segmented volumes of the vascularized brain, finite element models of the tissue voltage during DBS, and multi-compartment axon models to predict the direct electrophysiological effects of endovascular DBS. MAIN RESULTS The models showed that: (1) a ring-electrode conforming to the vessel wall was more efficient at neural activation than a guidewire design, (2) increasing the length of a ring-electrode had minimal effect on neural activation thresholds, (3) large variability in neural activation occurred with suboptimal placement of a ring-electrode along the targeted vessel, and (4) activation thresholds for the fornix and SgCwm tracts were comparable for endovascular and stereotactic DBS, though endovascular DBS was able to produce significantly larger contralateral activation for a unilateral implantation. SIGNIFICANCE Together, these results suggest that endovascular DBS can serve as a complementary approach to stereotactic DBS in select cases.
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Affiliation(s)
- Benjamin A Teplitzky
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN 55455, USA
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Schneider TM, Beynon C, Sartorius A, Unterberg AW, Kiening KL. Deep brain stimulation of the lateral habenular complex in treatment-resistant depression: traps and pitfalls of trajectory choice. Neurosurgery 2013; 72:ons184-93; discussion ons193. [PMID: 23147781 DOI: 10.1227/neu.0b013e318277a5aa] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Deep brain stimulation (DBS) has recently been discussed as a promising treatment option for severe cases of major depression. Experimental data have suggested that the lateral habenular complex (LHb-c) is a central region of depression-related neuronal circuits. Because of its location close to the midline, stereotactic targeting of the LHb-c presents surgeons with distinct challenges. OBJECTIVE To define the obstacles of DBS surgery for stimulation of the LHb-c and thus to establish safe trajectories. METHODS Stereotactic magnetic resonance imaging data sets of 54 hemispheres originating from 27 DBS patients were taken for analysis on a stereotactic planning workstation. After alignment of images according to the anterior commissure--posterior commissure definition, analyses focused on vessels and enlarged ventricles interfering with trajectories. RESULTS As major trajectory obstacles, enlarged ventricles and an interfering superior thalamic vein were found. A standard frontal trajectory (angle > 40° relative to the anterior commissure--posterior commissure in sagittal images) for bilateral stimulation was safely applicable in 48% of patients, whereas a steeper frontal trajectory (angle <40 relative to the anterior commissure--posterior commissure in sagittal images) for bilateral stimulation was possible in 96%. Taken together, safe bilateral targeting of the LHb-c was possible in 98% of all patients. CONCLUSION Targeting LHb-c is a feasible and safe technique in the majority of patients undergoing surgery for DBS. However, meticulous individual planning to avoid interference with ventricles and thalamus-related veins is mandatory because an alternative steep frontal entry point has to be considered in about half of the patients.
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Affiliation(s)
- Till M Schneider
- Division of Stereotactic Neurosurgery, Department of Neurosurgery, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 400, Heidelberg, Germany
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Yadid G, Gispan I, Lax E. Lateral habenula deep brain stimulation for personalized treatment of drug addiction. Front Hum Neurosci 2013; 7:806. [PMID: 24376408 PMCID: PMC3860270 DOI: 10.3389/fnhum.2013.00806] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 11/06/2013] [Indexed: 01/11/2023] Open
Affiliation(s)
- Gal Yadid
- The Neuropsychopharmacology Lab, The Mina and Everard Goodman Faculty of Life Sciences, Bar-Ilan University Ramat-Gan, Israel ; The Leslie and Susan Gonda (Goldschmied) Multidisciplinary Brain Research Center, Bar-Ilan University Ramat-Gan, Israel
| | - Iris Gispan
- The Neuropsychopharmacology Lab, The Mina and Everard Goodman Faculty of Life Sciences, Bar-Ilan University Ramat-Gan, Israel ; The Leslie and Susan Gonda (Goldschmied) Multidisciplinary Brain Research Center, Bar-Ilan University Ramat-Gan, Israel
| | - Elad Lax
- The Neuropsychopharmacology Lab, The Mina and Everard Goodman Faculty of Life Sciences, Bar-Ilan University Ramat-Gan, Israel ; The Leslie and Susan Gonda (Goldschmied) Multidisciplinary Brain Research Center, Bar-Ilan University Ramat-Gan, Israel
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Aizawa H, Cui W, Tanaka K, Okamoto H. Hyperactivation of the habenula as a link between depression and sleep disturbance. Front Hum Neurosci 2013; 7:826. [PMID: 24339810 PMCID: PMC3857532 DOI: 10.3389/fnhum.2013.00826] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Accepted: 11/16/2013] [Indexed: 12/13/2022] Open
Abstract
Depression occurs frequently with sleep disturbance such as insomnia. Sleep in depression is associated with disinhibition of the rapid eye movement (REM) sleep. Despite the coincidence of the depression and sleep disturbance, neural substrate for depressive behaviors and sleep regulation remains unknown. Habenula is an epithalamic structure regulating the activities of monoaminergic neurons in the brain stem. Since the imaging studies showed blood flow increase in the habenula of depressive patients, hyperactivation of the habenula has been implicated in the pathophysiology of the depression. Recent electrophysiological studies reported a novel role of the habenular structure in regulation of REM sleep. In this article, we propose possible cellular mechanisms which could elicit the hyperactivation of the habenular neurons and a hypothesis that dysfunction in the habenular circuit causes the behavioral and sleep disturbance in depression. Analysis of the animals with hyperactivated habenula would open the door to understand roles of the habenula in the heterogeneous symptoms such as reduced motor behavior and altered REM sleep in depression.
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Affiliation(s)
- Hidenori Aizawa
- Department of Molecular Neuroscience, Medical Research Institute, Tokyo Medical and Dental University Bunkyo-ku, Tokyo, Japan
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Abstract
Deep brain stimulation an effective treatment of many neurologic conditions such as Parkinson disease, essential tremor, dystonia, and obsessive-compulsive disorder. Structural and functional neuroimaging studies provide the opportunity to visualize the dysfunctional nodes and networks underlying neurologic and psychiatric disease, and to thereby realize new targets for neuromodulation as well as personalize current therapy. This article reviews contemporary advances in neuroimaging in the basic sciences and how they can be applied to redirect and propel functional neurosurgery toward a goal of functional localization of targets with individualized maps and identification of novel targets for other neuropsychiatric diseases.
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Mallory GW, Abulseoud O, Hwang SC, Gorman DA, Stead SM, Klassen BT, Sandroni P, Watson JC, Lee KH. The nucleus accumbens as a potential target for central poststroke pain. Mayo Clin Proc 2012; 87:1025-31. [PMID: 22980165 PMCID: PMC3498057 DOI: 10.1016/j.mayocp.2012.02.029] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2012] [Accepted: 02/09/2012] [Indexed: 12/21/2022]
Abstract
Although deep brain stimulation (DBS) has been found to be efficacious for some chronic pain syndromes, its usefulness in patients with central poststroke pain (CPSP) has been disappointing. The most common DBS targets for pain are the periventricular gray region (PVG) and the ventralis caudalis of the thalamus. Despite the limited success of DBS for CPSP, few alternative targets have been explored. The nucleus accumbens (NAC), a limbic structure within the ventral striatum that is involved in reward and pain processing, has emerged as an effective target for psychiatric disease. There is also evidence that it may be an effective target for pain. We describe a 72-year-old woman with a large right hemisphere infarct who subsequently experienced refractory left hemibody pain. She underwent placement of 3 electrodes in the right PVG, ventralis caudalis of the thalamus, and NAC. Individual stimulation of the NAC and PVG provided substantial improvement in pain rating. The patient underwent implantation of permanent electrodes in both targets, and combined stimulation has provided sustained pain relief at nearly 1 year after the procedure. These results suggest that the NAC may be an effective DBS target for CPSP.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Kendall H. Lee
- Department of Neurosurgery, Mayo Clinic, Rochester, MN
- Correspondence: Address to Kendall H. Lee, MD, PhD, Department of Neurosurgery, Mayo Clinic, 200 First St SW, Rochester, MN 55901
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Cusin C, Dougherty DD. Somatic therapies for treatment-resistant depression: ECT, TMS, VNS, DBS. BIOLOGY OF MOOD & ANXIETY DISORDERS 2012; 2:14. [PMID: 22901565 PMCID: PMC3514332 DOI: 10.1186/2045-5380-2-14] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Accepted: 07/24/2012] [Indexed: 01/11/2023]
Abstract
The field of non-pharmacological therapies for treatment resistant depression (TRD) is rapidly evolving and new somatic therapies are valuable options for patients who have failed numerous other treatments. A major challenge for clinicians (and patients alike) is how to integrate the results from published clinical trials in the clinical decision-making process. We reviewed the literature for articles reporting results for clinical trials in particular efficacy data, contraindications and side effects of somatic therapies including electroconvulsive therapy (ECT), transcranial magnetic stimulation (TMS), vagal nerve stimulation (VNS) and deep brain stimulation (DBS). Each of these devices has an indication for patients with different level of treatment resistance, based on acuteness of illness, likelihood of response, costs and associated risks. ECT is widely available and its effects are relatively rapid in severe TRD, but its cognitive adverse effects may be cumbersome. TMS is safe and well tolerated, and it has been approved by FDA for adults who have failed to respond to one antidepressant, but its use in TRD is still controversial as it is not supported by rigorous double-blind randomized clinical trials. The options requiring surgical approach are VNS and DBS. VNS has been FDA-approved for TRD, however it is not indicated for management of acute illness. DBS for TRD is still an experimental area of investigation and double-blind clinical trials are underway.
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Affiliation(s)
- Cristina Cusin
- Division of Neurotherapeutics, Department of Psychiatry, Massachusetts General Hospital, 149 13th Street, Rm 2612, Charlestown, MA 02129, USA.
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Anderson RJ, Frye MA, Abulseoud OA, Lee KH, McGillivray JA, Berk M, Tye SJ. Deep brain stimulation for treatment-resistant depression: efficacy, safety and mechanisms of action. Neurosci Biobehav Rev 2012; 36:1920-33. [PMID: 22721950 DOI: 10.1016/j.neubiorev.2012.06.001] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2012] [Revised: 06/06/2012] [Accepted: 06/10/2012] [Indexed: 12/22/2022]
Abstract
Deep brain stimulation (DBS), a neuromodulation therapy that has been used successfully in the treatment of symptoms associated with movement disorders, has recently undergone clinical trials for individuals suffering from treatment-resistant depression (TRD). Although the small patient numbers and open label study design limit our ability to identify optimum targets and make definitive conclusions about treatment efficacy, a review of the published research demonstrates significant reductions in depressive symptomatology and high rates of remission in a severely treatment-resistant patient group. Despite these encouraging results, an incomplete understanding of the mechanisms of action underlying the therapeutic effects of DBS for TRD is highlighted, paralleling the incomplete understanding of the neuroanatomy of mood regulation and treatment resistance. Proposed mechanisms of action include short and long-term local effects of stimulation at the neuronal level, to modulation of neural network activity.
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Shen X, Ruan X, Zhao H. Stimulation of midbrain dopaminergic structures modifies firing rates of rat lateral habenula neurons. PLoS One 2012; 7:e34323. [PMID: 22485164 PMCID: PMC3317773 DOI: 10.1371/journal.pone.0034323] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2011] [Accepted: 02/28/2012] [Indexed: 11/18/2022] Open
Abstract
Ventral tegmental area (VTA) and substantia nigra pars compacta (SNpc) are midbrain structures known to be involved in mediating reward in rodents. Lateral habenula (LHb) is considered as a negative reward source and it is reported that stimulation of the LHb rapidly induces inhibition of firing in midbrain dopamine neurons. Interestingly, the phasic fall in LHb neuronal activity may follow the excitation of dopamine neurons in response to reward-predicting stimuli. The VTA and SNpc give rise to dopaminergic projections that innervate the LHb, which is also known to be involved in processing painful stimuli. But it's unclear what physiological effects these inputs have on habenular function. In this study we distinguished the LHb pain-activated neurons of the Wistar rats and assessed their electrophysiological responsiveness to the stimulation of the VTA and SNpc with either single-pulse stimulation (300 µA, 0.5 Hz) or tetanic stimulation (80 µA, 25 Hz). Single-pulse stimulation that was delivered to either midbrain structure triggered transient inhibition of firing of ∼90% of the LHb pain-activated neurons. However, tetanic stimulation of the VTA tended to evoke an elevation in neuronal firing rate. We conclude that LHb pain-activated neurons can receive diverse reward-related signals originating from midbrain dopaminergic structures, and thus participate in the regulation of the brain reward system via both positive and negative feedback mechanisms.
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Affiliation(s)
| | | | - Hua Zhao
- Department of Physiology, Norman Bethune College of Medicine, Jilin University, Changchun, Jilin, China
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Hypothalamic deep brain stimulation reduces weight gain in an obesity-animal model. PLoS One 2012; 7:e30672. [PMID: 22295102 PMCID: PMC3266267 DOI: 10.1371/journal.pone.0030672] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Accepted: 12/20/2011] [Indexed: 11/19/2022] Open
Abstract
Prior studies of appetite regulatory networks, primarily in rodents, have established that targeted electrical stimulation of ventromedial hypothalamus (VMH) can alter food intake patterns and metabolic homeostasis. Consideration of this method for weight modulation in humans with severe overeating disorders and morbid obesity can be further advanced by modeling procedures and assessing endpoints that can provide preclinical data on efficacy and safety. In this study we adapted human deep brain stimulation (DBS) stereotactic methods and instrumentation to demonstrate in a large animal model the modulation of weight gain with VMH-DBS. Female Göttingen minipigs were used because of their dietary habits, physiologic characteristics, and brain structures that resemble those of primates. Further, these animals become obese on extra-feeding regimens. DBS electrodes were first bilaterally implanted into the VMH of the animals (n = 8) which were then maintained on a restricted food regimen for 1 mo following the surgery. The daily amount of food was then doubled for the next 2 mo in all animals to produce obesity associated with extra calorie intake, with half of the animals (n = 4) concurrently receiving continuous low frequency (50 Hz) VMH-DBS. Adverse motoric or behavioral effects were not observed subsequent to the surgical procedure or during the DBS period. Throughout this 2 mo DBS period, all animals consumed the doubled amount of daily food. However, the animals that had received VMH-DBS showed a cumulative weight gain (6.1±0.4 kg; mean ± SEM) that was lower than the nonstimulated VMH-DBS animals (9.4±1.3 kg; p<0.05), suggestive of a DBS-associated increase in metabolic rate. These results in a porcine obesity model demonstrate the efficacy and behavioral safety of a low frequency VMH-DBS application as a potential clinical strategy for modulation of body weight.
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Rosa MA, Lisanby SH. Somatic treatments for mood disorders. Neuropsychopharmacology 2012; 37:102-16. [PMID: 21976043 PMCID: PMC3238088 DOI: 10.1038/npp.2011.225] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2011] [Revised: 08/18/2011] [Accepted: 08/18/2011] [Indexed: 12/22/2022]
Abstract
Somatic treatments for mood disorders represent a class of interventions available either as a stand-alone option, or in combination with psychopharmacology and/or psychotherapy. Here, we review the currently available techniques, including those already in clinical use and those still under research. Techniques are grouped into the following categories: (1) seizure therapies, including electroconvulsive therapy and magnetic seizure therapy, (2) noninvasive techniques, including repetitive transcranial magnetic stimulation, transcranial direct current stimulation, and cranial electric stimulation, (3) surgical approaches, including vagus nerve stimulation, epidural electrical stimulation, and deep brain stimulation, and (4) technologies on the horizon. Additionally, we discuss novel approaches to the optimization of each treatment, and new techniques that are under active investigation.
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Affiliation(s)
- Moacyr A Rosa
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Sarah H Lisanby
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
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Mohr P, Rodriguez M, Slavíčková A, Hanka J. The application of vagus nerve stimulation and deep brain stimulation in depression. Neuropsychobiology 2011; 64:170-81. [PMID: 21811087 DOI: 10.1159/000325225] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2010] [Accepted: 01/23/2011] [Indexed: 01/24/2023]
Abstract
Despite the progress in the pharmacotherapy of depression, there is a substantial proportion of treatment-resistant patients. Recently, reversible invasive stimulation methods, i.e. vagus nerve stimulation (VNS) and deep brain stimulation (DBS), have been introduced into the management of treatment-resistant depression (TRD). VNS has already received regulatory approval for TRD. This paper reviews the available clinical evidence and neurobiology of VNS and DBS in TRD. The principle of VNS is a stimulation of the left cervical vagus nerve with a programmable neurostimulator. VNS was examined in 4 clinical trials with 355 patients. VNS demonstrated steadily increasing improvement with full benefit after 6-12 months, sustained up to 2 years. Patients who responded best had a low-to-moderate antidepressant resistance. However, the primary results of the only controlled trial were negative. DBS involves stereotactical implantation of electrodes powered by a pulse generator into the specific brain regions. For depression, the targeted areas are the subthalamic nucleus, internal globus pallidus, ventral internal capsule/ventral striatum, the subgenual cingulated region, and the nucleus accumbens. Antidepressant effects of DBS were examined in case series with a total number of 50 TRD patients. Stimulation of different brain regions resulted in a reduction of depressive symptoms. The clinical data on the use of VNS and DBS in TRD are encouraging. The major contribution of the methods is a novel approach that allows for precise targeting of the specific brain areas, nuclei and circuits implicated in the etiopathogenesis of neuropsychiatric disorders. For clinical practice, it is necessary to identify patients who may best benefit from VNS or DBS.
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Affiliation(s)
- Pavel Mohr
- Prague Psychiatric Center, Charles University Prague, Prague, Czech Republic.
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The habenula: from stress evasion to value-based decision-making. Nat Rev Neurosci 2011; 11:503-13. [PMID: 20559337 DOI: 10.1038/nrn2866] [Citation(s) in RCA: 663] [Impact Index Per Article: 51.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Surviving in a world with hidden rewards and dangers requires choosing the appropriate behaviours. Recent discoveries indicate that the habenula plays a prominent part in such behavioural choice through its effects on neuromodulator systems, in particular the dopamine and serotonin systems. By inhibiting dopamine-releasing neurons, habenula activation leads to the suppression of motor behaviour when an animal fails to obtain a reward or anticipates an aversive outcome. Moreover, the habenula is involved in behavioural responses to pain, stress, anxiety, sleep and reward, and its dysfunction is associated with depression, schizophrenia and drug-induced psychosis. As a highly conserved structure in the brain, the habenula provides a fundamental mechanism for both survival and decision-making.
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Shah RS, Chang SY, Min HK, Cho ZH, Blaha CD, Lee KH. Deep brain stimulation: technology at the cutting edge. J Clin Neurol 2010; 6:167-82. [PMID: 21264197 PMCID: PMC3024521 DOI: 10.3988/jcn.2010.6.4.167] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2010] [Revised: 09/16/2010] [Accepted: 09/16/2010] [Indexed: 01/15/2023] Open
Abstract
Deep brain stimulation (DBS) surgery has been performed in over 75,000 people worldwide, and has been shown to be an effective treatment for Parkinson's disease, tremor, dystonia, epilepsy, depression, Tourette's syndrome, and obsessive compulsive disorder. We review current and emerging evidence for the role of DBS in the management of a range of neurological and psychiatric conditions, and discuss the technical and practical aspects of performing DBS surgery. In the future, evolution of DBS technology may depend on several key areas, including better scientific understanding of its underlying mechanism of action, advances in high-spatial resolution imaging and development of novel electrophysiological and neurotransmitter microsensor systems. Such developments could form the basis of an intelligent closed-loop DBS system with feedback-guided neuromodulation to optimize both electrode placement and therapeutic efficacy.
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Affiliation(s)
- Rahul S Shah
- Department of Neurological Surgery, Mayo Clinic, Rochester, MN, USA
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Hauptman JS. From the bench to the bedside: Breaking down the blood-brain barrier, decoding the habenula, understanding hand choice, and the role of ketone bodies in epilepsy. Surg Neurol Int 2010; 1:86. [PMID: 21206538 PMCID: PMC3011105 DOI: 10.4103/2152-7806.74143] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2010] [Accepted: 11/01/2010] [Indexed: 11/08/2022] Open
Affiliation(s)
- Jason S Hauptman
- Intellectual and Developmental Disabilities Center and Department of Neurosurgery, Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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Griessenauer CJ, Chang SY, Tye SJ, Kimble CJ, Bennet KE, Garris PA, Lee KH. Wireless Instantaneous Neurotransmitter Concentration System: electrochemical monitoring of serotonin using fast-scan cyclic voltammetry--a proof-of-principle study. J Neurosurg 2010; 113:656-65. [PMID: 20415521 DOI: 10.3171/2010.3.jns091627] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECT The authors previously reported the development of the Wireless Instantaneous Neurotransmitter Concentration System (WINCS) for measuring dopamine and suggested that this technology may be useful for evaluating deep brain stimulation-related neuromodulatory effects on neurotransmitter systems. The WINCS supports fast-scan cyclic voltammetry (FSCV) at a carbon-fiber microelectrode (CFM) for real-time, spatially resolved neurotransmitter measurements. The FSCV parameters used to establish WINCS dopamine measurements are not suitable for serotonin, a neurotransmitter implicated in depression, because they lead to CFM fouling and a loss of sensitivity. Here, the authors incorporate into WINCS a previously described N-shaped waveform applied at a high scan rate to establish wireless serotonin monitoring. METHODS Optimized for the detection of serotonin, FSCV consisted of an N-shaped waveform scanned linearly from a resting potential of +0.2 to +1.0 V, then to -0.1 V and back to +0.2 V, at a rate of 1000 V/second. Proof-of-principle tests included flow injection analysis and electrically evoked serotonin release in the dorsal raphe nucleus of rat brain slices. RESULTS Flow cell injection analysis demonstrated that the N waveform, applied at a scan rate of 1000 V/second, significantly reduced serotonin fouling of the CFM, relative to that observed with FSCV parameters for dopamine. In brain slices, WINCS reliably detected subsecond serotonin release in the dorsal raphe nucleus evoked by local high-frequency stimulation. CONCLUSIONS The authors found that WINCS supported high-fidelity wireless serotonin monitoring by FSCV at a CFM. In the future such measurements of serotonin in large animal models and in humans may help to establish the mechanism of deep brain stimulation for psychiatric disease.
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Abstract
Depressive disorders are highly prevalent and are a leading cause of disability, morbidity, and mortality worldwide; however, they often remain undertreated or untreated. This article provides a broad overview of the many strategies for treating depression. More than 24 antidepressant medications and depression-focused psychotherapies are available as first-choice options for treating depression. When patients have not had a satisfactory treatment response, the 2 main strategies are switching to an alternative antidepressant therapy or adding a second antidepressant therapy. A large number of medication combinations have been reported in the literature, and some have been shown to be effective in controlled studies. Nonstandard alternatives to conventional antidepressant treatments include exercise, light therapy, sleep deprivation, and various complementary and alternative therapies. For more chronic and refractory forms of depression, various neuromodulation therapies are available or are being investigated. Because depressive disorders are common in primary care and other medical settings, medical practitioners should be aware of the therapeutic armamentarium available for treating depression.
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Affiliation(s)
- Robert H Howland
- University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, Pittsburgh, PA 15213, USA.
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