Personalizing brain simulation targets based on clinical features

Abstract

Abstract Most efforts to personalize brain simulation have focused on individualized neurophysiological measurements, such as functional connectivity and electrophysiology. For instance, the most effective TMS targets for depression are functionally anti-correlated to the subgenual cingulate. However, these approaches assume that we are treating a unitary clinical entity. In reality, patients with mental illness often have complex symptoms constellations with multiple comorbidities. It may be more appropriate to identify distinct target circuits for specific symptom clusters rather than targeting the subgenual circuit in all patients with depression. Here, we will review our work on expanding circuit-based neuromodulation beyond depression alone. First, targets may be personalized based on specific symptoms; for instance, different circuits can be targeted to modulate “dysphoric” versus “anxiosomatic” symptoms of depression. Second, targets may be personalized based on comorbidities; for instance, different circuits are involved in PTSD, OCD, and addiction. We will also describe a new framework for identifying better TMS targets for any given symptom cluster based on the locations of lesions or DBS sites that modulate the same symptom cluster. Keywords: TMS, Transdiagnostic, Personalized, fMRI