Brain Stimulation For Psychiatric Disorders Research Articles

Closed-Loop Deep Brain Stimulation for Psychiatric Disorders.

Deep brain stimulation (DBS) is a well-established approach to treating medication-refractory neurological disorders and holds promise for treating psychiatric disorders. Despite strong open-label results in extremely refractory patients, DBS has struggled to meet endpoints in randomized controlled trials. A major challenge is stimulation "dosing"-DBS systems have many adjustable parameters, and clinicians receive little feedback on whether they have chosen the correct parameters for an individual patient. Multiple groups have proposed closed loop technologies as a solution. These systems sense electrical activity, identify markers of an (un)desired state, then automatically deliver or adjust stimulation to alter that electrical state. Closed loop DBS has been successfully deployed in movement disorders and epilepsy. The availability of that technology, as well as advances in opportunities for invasive research with neurosurgical patients, has yielded multiple pilot demonstrations in psychiatric illness. Those demonstrations split into two schools of thought, one rooted in well-established diagnoses and symptom scales, the other in the more experimental Research Domain Criteria (RDoC) framework. Both are promising, and both are limited by the boundaries of current stimulation technology. They are in turn driving advances in implantable recording hardware, signal processing, and stimulation paradigms. The combination of these advances is likely to change both our understanding of psychiatric neurobiology and our treatment toolbox, though the timeframe may be limited by the realities of implantable device development.

Closed Loop Deep Brain Stimulation for Psychiatric Disorders: Are We Ready?

Closed Loop Deep Brain Stimulation for Psychiatric Disorders: Are We Ready?

Electrophysiology-guided brain stimulation for psychiatric disorders

Electrophysiology-guided brain stimulation for psychiatric disorders

Deep brain stimulation for psychiatric disorders and behavioral/cognitive-related indications: Review of the literature and implications for treatment

While pharmacological and/or behavioral treatments are effective in managing symptoms for many patients with psychiatric diagnoses and disorders with behavioral/cognitive manifestations, a subset of individuals are treatment-refractory, unable to achieve appreciable benefit or symptom relief from traditional methods. In recent years, neuromodulation has gained momentum as an adjunctive treatment for improving outcomes in patients who are treatment-refractory. One form of neuromodulation, deep brain stimulation (DBS), has been investigated for the treatment of various psychiatric disorders and behavioral/cognitive symptoms. The following article provides a review of DBS investigations for several psychiatric and behavioral-related disorders, including depression, obsessive-compulsive disorder, substance use disorder, Alzheimer's disease, anorexia, obesity, schizophrenia, and posttraumatic stress disorder. PubMed, PsycINFO, Scopus, Ovid MEDLINE, and Web of Science were used to identify published articles, and Clinicaltrials.gov was used to identify currently ongoing or planned studies. Findings revealed the potential utility of DBS in improving outcomes for various psychiatric and behavioral/cognitive-related disorders. While promising, there are several limitations present in the available literature, and further well-designed clinical trials are necessary before conclusive decisions regarding the utility of DBS for the treatment of these psychiatric/behavioral/cognitive-related disorders can be made. Regardless, the studies included in this review demonstrate positive preliminary findings for the potential benefit of DBS for treatment of a variety of psychiatric disorders, and further research is warranted to better determine the potential utility of DBS for those who are treatment-refractory and unable to achieve symptom relief with standard care.

Concurrent Intracranial and Extracranial Electrophysiological Recordings in Humans: relevance for deep brain stimulation in psychiatric disorders

Concurrent Intracranial and Extracranial Electrophysiological Recordings in Humans: relevance for deep brain stimulation in psychiatric disorders

Deep brain stimulation for psychiatric disorders: A review

Deep brain stimulation for psychiatric disorders: A review

Deep brain stimulation for psychiatric disorders: role of imaging in identifying/confirming DBS targets, predicting, and optimizing outcome and unravelling mechanisms of action.

Following the established application of deep brain stimulation (DBS) in the treatment of movement disorders, new non-neurological indications have emerged, such as for obsessive-compulsive disorders, major depressive disorder, dementia, Gilles de la Tourette Syndrome, anorexia nervosa, and addictions. As DBS is a network modulation surgical treatment, the development of DBS for both neurological and psychiatric disorders has been partly driven by advances in neuroimaging, which has helped explain the brain networks implicated. Advances in magnetic resonance imaging connectivity and electrophysiology have led to the development of the concept of modulating widely distributed, complex brain networks. Moreover, the increasing number of targets for treating psychiatric disorders have indicated that there may be a convergence of the effect of stimulating different targets for the same disorder, and the effect of stimulating the same target for different disorders. The aim of this paper is to review the imaging studies of DBS for psychiatric disorders. Imaging, and particularly connectivity analysis, offers exceptional opportunities to better understand and even predict the clinical outcomes of DBS, especially where there is a lack of objective biomarkers that are essential to properly guide DBS pre- and post-operatively. In future, imaging might also prove useful to individualize DBS treatment. Finally, one of the most important aspects of imaging in DBS is that it allows us to better understand the brain through observing the changes of the functional connectome under neuromodulation, which may in turn help explain the mechanisms of action of DBS that remain elusive.

Brain stimulation for psychiatric disorders: Insight from animal models

In this symposium, we will tackle several examples of studies conducted in animal models to unravel the mode of action of different methods of non-invasive brain stimulation used to treat psychiatric disorders in human. First, Sylvie Gory-Faure will highlight the essential role of neural survival for short- and long-term efficacy of electroconvulsive stimulation in an animal model of depression (MAP6 KO mouse). Then, Vincent Van Waes will present behavioral and neurobiological data on the beneficial impact of repeated anodal transcranial direct stimulation on cognition, depression- and addiction-related behaviors in mice. Robrecht Dockx will describe a new accelerated high frequency (aHF) repetitive transcranial magnetic stimulation protocol tested in dogs. Finally, Dimitri De Bundel will talk about the effects of transcranial direct current stimulation to modulate fear extinction in a mouse model based on auditory fear conditioning. To conclude, the necessity to carry out translational studies to accelerate the development of brain stimulation techniques that have a strong therapeutic potential in human will be discussed.

Is Molecular Inflammatory Profiling a Useful Tool for Personalized Brain Stimulation in Psychiatric Disorders?

Is Molecular Inflammatory Profiling a Useful Tool for Personalized Brain Stimulation in Psychiatric Disorders?

Recent advances in deep brain stimulation in psychiatric disorders.

Deep brain stimulation (DBS) has been offered to patients suffering of severe and resistant neuropsychiatric disorders like Obsessive Compulsive Disorder (OCD), Gilles de la Tourette Syndrome (TS) and Major Depression (MDD). Modulation of several targets within the cortico-striato-thalamo-cortical circuits can lead to a decrease of symptom severity in those patients. This review focuses on the recent clinical outcomes in DBS in psychiatric disorders. Studies on OCD and TS are now focusing on the long-term effects of DBS, with encouraging results regarding not only the decrease of symptoms, but also quality of life. They also highlighted efficient adjuvant techniques, like cognitive and behavioural therapy and support programs, to enhance an often-partial response to DBS. The application of DBS for MDD is more recent and, despite encouraging initial open-label studies, two large randomised studies have failed to demonstrate an efficacy of DBS in MDD according to evidence-based medicine criteria. Last years, DBS was also tested in other resistant psychiatric disorders, as anorexia nervosa and addiction, with encouraging preliminary results. However, today, no target – whatever the disease – can meet the criteria for clinical efficacy as recently defined by an international committee for neurosurgery for psychiatric disorders. Consequently, DBS in psychiatric disorders still needs to proceed within the frame of clinical trials.

The Habenula's Role in Adaptive Behaviors: Contributions From Neuroimaging.

The Habenula's Role in Adaptive Behaviors: Contributions From Neuroimaging.

Deep brain stimulation for psychiatric disorders: Is there an impact on social functioning?

Background:Deep brain stimulation (DBS) for refractory psychiatric disorders shows promising effects on symptom-reduction, however, little is known regarding the effects of DBS on social outcome.Methods:A PubMed search based on original studies of DBS for psychiatric disorders [treatment resistant depression (TRD), Gilles de la Tourette's syndrome (GTS), and obsessive compulsive disorder (OCD)] was conducted. Data on social outcome following surgery were extracted and analyzed.Results:Social functioning was not a primary outcome measure in the reviewed article. The literature is incomplete and inconclusive on this variable, however from the reported data, there is some evidence that DBS has the potential to improve social functioning.Conclusions:More systematic and detailed data gathering and reporting on social outcome with longer follow-ups are needed to evaluate more exhaustively the role of DBS in refractory psychiatric disorders.

Neuromodulation Is Gaining Momentum

This issue of Psychiatric Annals, guest edited by Dr. Khurshid A. Khurshid, focuses on which neuromodulation models can be used effectively to treat an array of mental disorders. As defined in this issue, the techniques used to administer some of the newer neuromodulation treatments are less invasive, which may increase patient satisfaction and remission. The first article, “Overview of the Current Use of Deep Brain Stimulation in Psychiatric Disorders,” by Drs. Daniel P. Witter and Herbert E. Ward reviews the history of deep brain stimulation, which started as a treatment for refractory mood disorders. The second article, “Update on Transcranial Magnetic Stimulation for Depression and Other Neuropsychiatric Illnesses,” by Drs. Jonathan E. Becker, Christopher Maley, Elizabeth Shultz, and Warren D. Taylor overviews transcranial magnetic stimulation and its use in clinical practice for the treatment of depression and other disorders. Next, transcranial direct current stimulation (tDCS) is discussed by Sarah M. Szymkowicz, Molly E. McLaren, and Drs. Uma Suryadevara and Adam J. Woods in the article “Transcranial Direct Current Stimulation Use in the Treatment of Neuropsychiatric Disorders: A Brief Review.” The authors review the efficacy of tDCS in depression, while proposing that more in-depth studies are warranted to understand the benefits of this treatment model, as well as other neuromodulation techniques that seek to alleviate the symptoms of psychiatric disorders. The final article, “Charting the Course of Electroconvulsive Therapy: Where Have We Been and Where Are We Headed?,” by Drs. Peter B. Rosenquist, W. Vaughn McCall, and Nagy Youssef details electroconvulsive therapy (ECT) and what methods are used to select patients who are a best fit for this treatment modality. A recent finding suggests that the medication pramipexole may be an alternative when ECT fails for patients with treatment-refractory depression.1 Although neuromodulation systems are emerging in the psychiatry field, there’s still lots of work necessary to balance medication-based therapies with psychotherapeutic methods; the long-term goal is the implementation of more effective holistic treatment modalities for all patients regardless of their disorder.

Overview of the Current Use of Deep Brain Stimulation in Psychiatric Disorders

Stemming from its use in movement disorders, deep brain stimulation (DBS) has emerged as an experimental therapy for treatment-resistant cases of major depressive disorder, obsessive-compulsive disorder, and Tourette's syndrome. Early, positive results from case studies have led to controlled trials evaluating the use of DBS in each of these conditions. Results have been varied but suggest moderate benefit in many cases and remain encouraging. As the relative safety and potential efficacy of DBS has become more widely accepted, its use has expanded to include the treatment of other psychiatric disorders and symptoms including anorexia nervosa, substance use disorder, aggression, and Alzheimer's disease. Case studies using DBS for each of these have reported benefits. [ Psychiatr Ann . 2016;46(11):631–636.]

Mavridis’ Area Targeting for Deep Brain Stimulation in Psychiatric Disorders: Stereotactic Microanatomy and Technical Aspects

Context: The human Nucleus Accumbens (NA) constitutes nowadays a target of deep brain stimulation (DBS) for selected patients mainly suffering from some psychiatric disorders. Mavridis’ Area (MA) of the human brain is the most reliable stereotactically standard part of the NA, regardless of side or gender. Primary purpose of this review article was to discuss the MA as a stereotactic microanatomic target for NA DBS application, emphasizing on technical aspects of targeting the MA. Evidence Acquisition: A detailed search of the current literature regarding MA was applied. The critically reviewed literature was then used to discuss the MA as a stereotactic microanatomic target for NA DBS application, emphasizing on technical aspects of targeting the MA. The suggestion of future research directions was also aimed. Results: Following the currently used trajectory through the anterior limb of the internal capsule (ALIC) in combination with the principles of the ‘port model’, a DBS electrode placement within the NA, targeting the MA, is feasible. MA could be the target area of one, only, of the electrode contacts, preferably contact 1 or 2. It could be also the target area for contact 0 in ALIC DBS and even the target for a combined NA-ALIC DBS. MA is the first and most representative example of the evolution of stereotactic anatomy into stereotactic microanatomy, in order to serve the development of the field of stereotactic microneurosurgery. Conclusions: MA is nowadays the most accurate stereotactic anatomic guide for targeting the human NA. It is a representative example of how stereotactic microanatomy could serve the development of stereotactic microneurosurgery. Following the currently used trajectory through the ALIC, a DBS electrode placement within the NA, targeting the MA, is feasible, allowing either NA or ALIC stimulation. Simultaneous stimulation of the NA and ALIC is also possible with this application.

Deep Brain Stimulation of the internal globus pallidus in refractory Tourette Syndrome

ObjectiveDeep Brain Stimulation in psychiatric disorders is becoming an increasingly performed surgery. At present, seven different targets have been stimulated in Tourette Syndrome, including the internal globus pallidus. We describe the effects on tics and comorbid behavioral disorders of Deep Brain Stimulation of the anterior internal globus pallidus in five patients with refractory Tourette Syndrome. MethodsThis study was performed as an open label study with follow-up assessment between 12 and 38 months. Patients were evaluated twice, one month before surgery and at long-term follow-up. Primary outcome was tic severity, assessed by several scales. Secondary outcomes were comorbid behavioral disorders, mood and cognition. The final position of the active contacts of the implanted electrodes was investigated and side effects were reported. ResultsThree males and two females were included with a mean age of 41.6 years (SD 9.7). The total post-operative score on the Yale Global Tic Severity Scale was significantly lower than the pre-operative score (42.2±4.8 versus 12.8±3.8, P=0.043). There was also a significant reduction on the modified Rush Video-Based Tic Rating Scale (13.0±2.0 versus 7.0±1.6, P=0.041) and in the total number of video-rated tics (259.6±107.3 versus 49.6±24.8, P=0.043). No significant difference on the secondary outcomes was found, however, there was an improvement on an individual level for obsessive-compulsive behavior. The final position of the active contacts was variable in our sample and no relationship between position and stimulation effects could be established. ConclusionOur study suggests that Deep Brain Stimulation of the anterior internal globus pallidus is effective in reducing tic severity, and possibly also obsessive–compulsive behavior, in refractory Tourette patients without serious adverse events or side-effects.

Closing the Loop in Deep Brain Stimulation for Psychiatric Disorders: Lessons from Motor Neural Prosthetics

Closing the Loop in Deep Brain Stimulation for Psychiatric Disorders: Lessons from Motor Neural Prosthetics

Deep brain stimulation for psychiatric disorders: where we are now

Fossil records showing trephination in the Stone Age provide evidence that humans have sought to influence the mind through physical means since before the historical record. Attempts to treat psychiatric disease via neurosurgical means in the 20th century provided some intriguing initial results. However, the indiscriminate application of these treatments, lack of rigorous evaluation of the results, and the side effects of ablative, irreversible procedures resulted in a backlash against brain surgery for psychiatric disorders that continues to this day. With the advent of psychotropic medications, interest in invasive procedures for organic brain disease waned. Diagnosis and classification of psychiatric diseases has improved, due to a better understanding of psychiatric patho-physiology and the development of disease and treatment biomarkers. Meanwhile, a significant percentage of patients remain refractory to multiple modes of treatment, and psychiatric disease remains the number one cause of disability in the world. These data, along with the safe and efficacious application of deep brain stimulation (DBS) for movement disorders, in principle a reversible process, is rekindling interest in the surgical treatment of psychiatric disorders with stimulation of deep brain sites involved in emotional and behavioral circuitry. This review presents a brief history of psychosurgery and summarizes the development of DBS for psychiatric disease, reviewing the available evidence for the current application of DBS for disorders of the mind.

Deep brain stimulation for psychiatric disorders: Are nucleus accumbens and medial forebrain bundle two branches of the same tree?

Purpose of this commentary is to discuss the relation of the nucleus accumbens (NA) with the medial forebrain bundle (MFB) and compare them as deep brain stimulation (DBS) targets in psychiatric disorders. Could a “bundle” be a more effective target than a “nucleus”? Or, more correctly, could an important “modulator” be a more effective target than a highly significant “pleasure center”? The answer hides in the fact that NA is a key component of the MFB. Thus NA dysfunction is synonym to MFB dysfunction. The NA is a “hot-spot” in the neurocircuitry of psychiatric disorders and further experimental investigation is needed for the MFB as a target for neuromodulation in depression, as well as to optimize benefit of psychiatric patients from neuromodulation treatment efforts. Are the NA and MFB two branches of the same tree? They definitely could be, particularly if the “tree” is the brain's “motivation super-system”.

O24: An EEG and fMRI investigation into the therapeutic mechanism of deep brain stimulation in psychiatric disorders

O24: An EEG and fMRI investigation into the therapeutic mechanism of deep brain stimulation in psychiatric disorders