Proceedings of the Sixth Deep Brain Stimulation Think Tank Modulation of Brain Networks and Application of Advanced Neuroimaging, Neurophysiology, and Optogenetics

Abstract

The annual deep brain stimulation (DBS) Think Tank aims to create an opportunity for a multidisciplinary discussion in the field of neuromodulation to examine developments, opportunities and challenges in the field. The proceedings of the Sixth Annual Think Tank recapitulate progress in applications of neurotechnology, neurophysiology, and emerging techniques for the treatment of a range of psychiatric and neurological conditions including Parkinson’s disease, essential tremor, Tourette syndrome, epilepsy, cognitive disorders, and addiction. Each section of this overview provides insight about the understanding of neuromodulation for specific disease and discusses current challenges and future directions. This year’s report addresses key issues in implementing advanced neurophysiological techniques, evolving use of novel modulation techniques to deliver DBS, ans improved neuroimaging techniques. The proceedings also offer insights into the new era of brain network neuromodulation and connectomic DBS to define and target dysfunctional brain networks. The proceedings also focused on innovations in applications and understanding of adaptive DBS (closed-loop systems), the use and applications of optogenetics in the field of neurostimulation and the need to develop databases for DBS indications. Finally, updates on neuroethical, legal, social, and policy issues relevant to DBS research are discussed.

Deep brain stimulation for psychiatric disorders: From focal brain targets to cognitive networks

“…Continuing the theme that DBS may be more effective if it is titrated based on an objective marker, these physiologic changes are promising targets for a rational approach to psychiatric DBS. Multiple such strategies have found early clinical success in tremor-related disorders ( Ramirez-Zamora et al 2019 , 2020 ), and there are prototypes of algorithms designed to control mood-related biomarkers ( Sani et al, 2018 ; Yang et al, 2018 ). An even more advanced approach might be to link stimulation not to the presence or synchrony of LFP oscillations, but to the phase of individual oscillatory waves.…”

International Legal Approaches to Neurosurgery for Psychiatric Disorders

“…Regulatory reporting requirements offer a useful way to ensure that adequately detailed information is collected about what remains an infrequent and exceptional form of intervention, and it also offers a means of retrospective oversight. It is worth noting that experts in the field have argued for more data collection and sharing, viewing it as “crucial to realizing the potential of a number of neurotechnologies and their use in clinical practice” (Ramirez-Zamora et al, 2019 ). The 1977 US National Commission report recommended that a mechanism be created to collect data about: the nature, extent and outcomes of psychosurgical procedures performed in the USA, the indications for the procedures, and the populations on which they are performed.…”

Closed-loop DBS triggered by real-time movement and tremor decoding based on thalamic LFPs for essential tremor

“…In these circumstances, an increased stimulation intensity is usually required in order to maintain the therapy effect, which may be associated with side effects including unpleasant sensations, slurred speech and unsteadiness walking [5]. Closed-loop or adaptive DBS, aiming to only deliver stimulation when necessary and thus reduce side effects and prolong clinical efficacy, is seen to be a promising innovative DBS treatment of ET [6]. Some existing studies have used wearable inertial sensors [7], surface electromyography (EMG) [8], or electrocorticography (ECoG) recorded from a strip of intracranial electrodes implanted over the surface of the motor cortex [9] to provide feedback for the control of the stimulator in closed-loop DBS systems.…”