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

Widge, Alik S.; Sahay, Amar

doi:10.1038/npp.2015.241

Cited by 12 publications

(18 citation statements)

References 7 publications

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“…The instrumental potential of neural states also underwrites pharmacological intervention in cognitive and mental states, as well as treatments such as DBS. This is the rationale for using DBS in cases of obsessive compulsive disorder, persistent depression, or anorexia nervosa for instance (Klein et al 2016 ; Maslen et al 2015 ; Widge and Sahay 2016 ). It is also key in the development of neurotechnologies, such as neuroprosthetics for speech, which might be seen as likely successors to a neuropharmacological-psychiatric industry (Parastarfeizabadi and Kouzani 2017 ).…”

Section: Neurotechnologies Ai and Modifying Neural Activitymentioning

confidence: 99%

“…All functions of observation, intervention, and treatment may be given over to a closed loop neurotechnology system, especially the algorithms governing its ‘good’ functioning (Widge and Sahay 2016 ). In one sense, the automaticity of the system assumes a 1:1 relation between neural processes and desired mental state, itself the basis for a desirable behavioural outcome.…”

Section: Neurotechnologies Ai and Modifying Neural Activitymentioning

confidence: 99%

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Correcting the Brain? The Convergence of Neuroscience, Neurotechnology, Psychiatry, and Artificial Intelligence

Rainey

Erden

2020

Sci Eng Ethics

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The incorporation of neural-based technologies into psychiatry offers novel means to use neural data in patient assessment and clinical diagnosis. However, an over-optimistic technologisation of neuroscientifically-informed psychiatry risks the conflation of technological and psychological norms. Neurotechnologies promise fast, efficient, broad psychiatric insights not readily available through conventional observation of patients. Recording and processing brain signals provides information from ‘beneath the skull’ that can be interpreted as an account of neural processing and that can provide a basis to evaluate general behaviour and functioning. But it ought not to be forgotten that the use of such technologies is part of a human practice of neuroscience informed psychiatry. This paper notes some challenges in the integration of neural technologies into psychiatry and suggests vigilance particularly in respect to normative challenges. In this way, psychiatry can avoid a drift toward reductive technological approaches, while nonetheless benefitting from promising advances in neuroscience and technology.

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Section: Neurotechnologies Ai and Modifying Neural Activitymentioning

confidence: 99%

Section: Neurotechnologies Ai and Modifying Neural Activitymentioning

confidence: 99%

Correcting the Brain? The Convergence of Neuroscience, Neurotechnology, Psychiatry, and Artificial Intelligence

Rainey

Erden

2020

Sci Eng Ethics

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“…Although the initial work focused on motor disorders, more recently Widge and Sahay also discussed the concept of closed-loop applications in psychiatric disease (Widge and Sahay, 2016 ), with attention to BCIs as a better, dynamic, real-time source of input for psychiatric disease states. While largely theoretical, early work in this area suggests that closed-loop feedback can remap and alter neural network firing patterns as the BCI training proceeds, allowing the device to depict intention, which may be critical for treatment of a fluctuating disease like psychiatric illness (Widge and Sahay, 2016 ).…”

Section: Adaptive and Closed-loop Controlmentioning

confidence: 99%

Biomarkers and Stimulation Algorithms for Adaptive Brain Stimulation

et al. 2017

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The goal of this review is to describe in what ways feedback or adaptive stimulation may be delivered and adjusted based on relevant biomarkers. Specific treatment mechanisms underlying therapeutic brain stimulation remain unclear, in spite of the demonstrated efficacy in a number of nervous system diseases. Brain stimulation appears to exert widespread influence over specific neural networks that are relevant to specific disease entities. In awake patients, activation or suppression of these neural networks can be assessed by either symptom alleviation (i.e., tremor, rigidity, seizures) or physiological criteria, which may be predictive of expected symptomatic treatment. Secondary verification of network activation through specific biomarkers that are linked to symptomatic disease improvement may be useful for several reasons. For example, these biomarkers could aid optimal intraoperative localization, possibly improve efficacy or efficiency (i.e., reduced power needs), and provide long-term adaptive automatic adjustment of stimulation parameters. Possible biomarkers for use in portable or implanted devices span from ongoing physiological brain activity, evoked local field potentials (LFPs), and intermittent pathological activity, to wearable devices, biochemical, blood flow, optical, or magnetic resonance imaging (MRI) changes, temperature changes, or optogenetic signals. First, however, potential biomarkers must be correlated directly with symptom or disease treatment and network activation. Although numerous biomarkers are under consideration for a variety of stimulation indications the feasibility of these approaches has yet to be fully determined. Particularly, there are critical questions whether the use of adaptive systems can improve efficacy over continuous stimulation, facilitate adjustment of stimulation interventions and improve our understanding of the role of abnormal network function in disease mechanisms.

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“…CLDBS systems promise circuit based learning and adaptation, improved system efficacy, increased safety, and reduced risk of tissue damage from prolonged stimulation. OLDBS, however, requires input through a human interface, unadaptable monomorphic stimulation between programming, habituation to stimuli, attenuation of response, and diminished efficacy over time (Santos et al, 2011 ; Richardson, 2012 ; Carron et al, 2013 ; Hosain et al, 2014 ; Hamilton et al, 2015 ; Sharma et al, 2016 ; Widge and Sahay, 2016 ; Widge et al, 2016 , 2017 ).…”

Section: Introductionmentioning

confidence: 99%

“…The ideal biomarker is one that can be followed in real-time and that correlates with symptoms and network activation. Work continues in CLDBS for movement disorder using a wide variety of parameters extracted from peripheral biomarkers of disease to predict tremor (Khobragade et al, 2015 ; Widge and Sahay, 2016 ; Widge et al, 2017 ) and in psychiatric disease through use of invasive monitoring of local field potentials and stimuli in brain regions of interest in epilepsy patients (Widge and Sahay, 2016 ; Widge et al, 2017 ). In this report, we propose the hypothetical application of CLDBS to Post-Traumatic Stress Disorder (PTSD), addiction disorders, and disorders affecting social skills.…”

Section: Introductionmentioning

confidence: 99%

Closed Loop Deep Brain Stimulation for PTSD, Addiction, and Disorders of Affective Facial Interpretation: Review and Discussion of Potential Biomarkers and Stimulation Paradigms

Bina

Langevin

2018

Front. Neurosci.

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The treatment of psychiatric diseases with Deep Brain Stimulation (DBS) is becoming more of a reality as studies proliferate the indications and targets for therapies. Opinions on the initial failures of DBS trials for some psychiatric diseases point to a certain lack of finesse in using an Open Loop DBS (OLDBS) system in these dynamic, cyclical pathologies. OLDBS delivers monomorphic input into dysfunctional brain circuits with modulation of that input via human interface at discrete time points with no interim modulation or adaptation to the changing circuit dynamics. Closed Loop DBS (CLDBS) promises dynamic, intrinsic circuit modulation based on individual physiologic biomarkers of dysfunction. Discussed here are several psychiatric diseases which may be amenable to CLDBS paradigms as the neurophysiologic dysfunction is stochastic and not static. Post-Traumatic Stress Disorder (PTSD) has several peripheral and central physiologic and neurologic changes preceding stereotyped hyper-activation behavioral responses. Biomarkers for CLDBS potentially include skin conductance changes indicating changes in the sympathetic nervous system, changes in serum and central neurotransmitter concentrations, and limbic circuit activation. Chemical dependency and addiction have been demonstrated to be improved with both ablation and DBS of the Nucleus Accumbens and as a serendipitous side effect of movement disorder treatment. Potential peripheral biomarkers are similar to those proposed for PTSD with possible use of environmental and geolocation based cues, peripheral signs of physiologic arousal, and individual changes in central circuit patterns. Non-substance addiction disorders have also been serendipitously treated in patients with OLDBS for movement disorders. As more is learned about these behavioral addictions, DBS targets and effectors will be identified. Finally, discussed is the use of facial recognition software to modulate activation of inappropriate responses for psychiatric diseases in which misinterpretation of social cues feature prominently. These include Autism Spectrum Disorder, PTSD, and Schizophrenia—all of which have a common feature of dysfunctional interpretation of facial affective clues. Technological advances and improvements in circuit-based, individual-specific, real-time adaptable modulation, forecast functional neurosurgery treatments for heretofore treatment-resistant behavioral diseases.

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

Cited by 12 publications

References 7 publications

Correcting the Brain? The Convergence of Neuroscience, Neurotechnology, Psychiatry, and Artificial Intelligence

Correcting the Brain? The Convergence of Neuroscience, Neurotechnology, Psychiatry, and Artificial Intelligence

Biomarkers and Stimulation Algorithms for Adaptive Brain Stimulation

Closed Loop Deep Brain Stimulation for PTSD, Addiction, and Disorders of Affective Facial Interpretation: Review and Discussion of Potential Biomarkers and Stimulation Paradigms

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