Closing the loop in psychiatric deep brain stimulation: physiology, psychometrics, and plasticity

Widge, Alik S.

doi:10.1038/s41386-023-01643-y

Cited by 14 publications

(7 citation statements)

References 187 publications

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“…Cutting‐edge neural‐device research—concerning, for instance, thought control of a robotic arm, 1 deep brain stimulation for psychiatric conditions, 2 and brain‐computer interfaces for communication 3 —holds great promise for improving health and well‐being. Along the way to achieving this promise, neural‐device research involves human beings who put their brains and health in the hands of multidisciplinary teams, sometimes for the hope of clinical benefit, sometimes to advance science or help others.…”

Section: Neuroscience and Societymentioning

confidence: 99%

Brain Pioneers and Moral Entanglement: An Argument for Post‐trial Responsibilities in Neural‐Device Trials

Goering,

Brown,

Klein

2024

Hastings Center Report

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We argue that in implanted neurotechnology research, participants and researchers experience what Henry Richardson has called “moral entanglement.” Participants partially entrust researchers with access to their brains and thus to information that would otherwise be private, leading to created intimacies and special obligations of beneficence for researchers and research funding agencies. One of these obligations, we argue, is about continued access to beneficial technology once a trial ends. We make the case for moral entanglement in this context through exploration of participants’ vulnerability, uncompensated risks and burdens, depth of relationship with the research team, and dependence on researchers in implanted neurotechnology trials.

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Section: Neuroscience and Societymentioning

confidence: 99%

Brain Pioneers and Moral Entanglement: An Argument for Post‐trial Responsibilities in Neural‐Device Trials

Goering,

Brown,

Klein

2024

Hastings Center Report

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“…At present, there is no biomarker which unequivocally corresponds to the individual's experience of his/her acute mood state. There are other approaches, which probe multiple sites of the subcortical networks with multiple depth electrodes, in order to isolate the ideal hub region as well as to extract readings of mood and its fluctuations [85][86][87] in depressed patients (see Widge [88] for a recent parallel perspective). However, stereo EEG is invasive and a potential scalability of such an approach is likely improvable.…”

Section: Considerations Regarding Cl-dbs Approaches In Psychiatric Di...mentioning

confidence: 99%

Perspectives of Implementation of Closed-Loop Deep Brain Stimulation: From Neurological to Psychiatric Disorders

Groppa,

Gonzalez-Escamilla,

Tinkhauser

et al. 2023

Stereotact Funct Neurosurg

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Background: Deep brain stimulation (DBS) is a highly efficient, evidence-based therapy to alleviate symptoms and improve quality of life in movement disorders such as Parkinson’s disease, essential tremor, and dystonia, which is also being applied in several psychiatric disorders, such as obsessive-compulsive disorder and depression, when they are otherwise resistant to therapy. Summary: At present, DBS is clinically applied in the so-called open-loop approach, with fixed stimulation parameters, irrespective of the patients’ clinical state(s). This approach ignores the brain states or feedback from the central nervous system or peripheral recordings, thus potentially limiting its efficacy and inducing side effects by stimulation of the targeted networks below or above the therapeutic level. Key Messages: The currently emerging closed-loop (CL) approaches are designed to adapt stimulation parameters to the electrophysiological surrogates of disease symptoms and states. CL-DBS paves the way for adaptive personalized DBS protocols. This review elaborates on the perspectives of the CL technology and discusses its opportunities as well as its potential pitfalls for both clinical and research use in neuropsychiatric disorders.

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“…DBS is highly successful in movement disorders (1) and is being actively investigated for treatment of psychiatric disorders, including treatment-refractory obsessive-compulsive disorder (OCD) (2), Tourette syndrome (3), and major depressive disorder (MDD) (4). In all these disorders, DBS' mechanism of action remains unclear (1, 5,6). The lack of mechanistic understanding leads to difficulties in programming stimulation to individual patients' needs, which contributes to clinical trial failures (5,6).…”

Section: Main Text: Introductionmentioning

confidence: 99%

“…In all these disorders, DBS' mechanism of action remains unclear (1, 5,6). The lack of mechanistic understanding leads to difficulties in programming stimulation to individual patients' needs, which contributes to clinical trial failures (5,6). Human neurophysiology studies offer hope for better stimulator programming (6)(7)(8)(9) but are similarly limited by the internal heterogeneity of psychiatric diagnoses (6,10,11).…”

Section: Main Text: Introductionmentioning

confidence: 99%

“…The lack of mechanistic understanding leads to difficulties in programming stimulation to individual patients' needs, which contributes to clinical trial failures (5,6). Human neurophysiology studies offer hope for better stimulator programming (6)(7)(8)(9) but are similarly limited by the internal heterogeneity of psychiatric diagnoses (6,10,11). In movement disorders, mechanistic understanding arose from animal models (12), and those models are testbeds for new treatment paradigms (13,14).…”

Section: Main Text: Introductionmentioning

confidence: 99%

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Cross-species modeling and enhancement of cognitive control with striatal brain stimulation

Reimer,

Dastin-van Rijn,

Kim

et al. 2024

Preprint

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Brain disorders, particularly mental disorders, might be effectively treated by direct electrical brain stimulation, but clinical progress requires understanding of therapeutic mechanisms. Animal models have not helped, because there are no direct animal models of mental illness. We show a path past this roadblock, by leveraging a common ingredient of most mental disorders: impaired cognitive control. We previously showed that deep brain stimulation (DBS) improves cognitive control in humans. We now reverse translate that result, showing that DBS-like stimulation of the mid-striatum improves cognitive control in rats. Using this model, we identify a mechanism, improvement in domain-general cognitive control, and rule out competing hypotheses such as impulsivity. The rat findings explain prior human results and have immediate implications for clinical practice and future trial design.One Sentence Summary:Developing a reliable animal model of a human brain stimulation therapy reveals that this therapy works by enhancing the brain’s ability to process conflicting pieces of evidence.

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Closing the loop in psychiatric deep brain stimulation: physiology, psychometrics, and plasticity

Cited by 14 publications

References 187 publications

Brain Pioneers and Moral Entanglement: An Argument for Post‐trial Responsibilities in Neural‐Device Trials

Brain Pioneers and Moral Entanglement: An Argument for Post‐trial Responsibilities in Neural‐Device Trials

Perspectives of Implementation of Closed-Loop Deep Brain Stimulation: From Neurological to Psychiatric Disorders

Cross-species modeling and enhancement of cognitive control with striatal brain stimulation

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