Deep brain stimulation

Precisely-timed outpatient recordings of subcortical local field potentials from wireless streaming-capable deep-brain stimulators: a method and toolbox

BACKGROUND

Investigations of the electrophysiological mechanisms of the human subcortex have relied on recording local field potentials (LFPs) during deep-brain stimulation (DBS) neurosurgery. However, the neurosurgical setting severely restricts the research use of these recordings. Recently developed sensing-capable DBS devices wirelessly stream subcortical LFPs in outpatient settings. These recordings have tremendous potential for research. However, synchronizing them with other behavior or neural recordings is challenging, as the clinical devices do not accept digital timing information.

NEW METHOD

Switching the DBS device on introduces transient yet consistent artifacts in both the LFP and simultaneous scalp-EEG recordings. We use these artifacts as a reference to align these recordings (N = 20). We tested whether the alignment was precise enough to match a ground truth state (large artifacts produced by transcranial magnetic stimulation, TMS), yielded trial-averaged event-locked LFPs, and phase consistency across trials. We further evaluated the consistency of task-related LFPs across outpatient and perisurgical recordings.

RESULTS AND COMPARISON WITH EXISTING METHOD(S)

Previous alignment methods were limited because they relied on inconsistent on/offset features of DBS artifacts caused by ongoing stimulation. Moreover, they only provided limited validation. Our highly precise alignment method showed a maximum deviation of only 8 ms - clearly superior to prior techniques. Furthermore, event-related activity patterns were comparable across outpatient and perisurgical LFP recordings.

CONCLUSIONS

We present a method and a MATLAB toolbox that inserts the most precise digital timing information into wirelessly-streamed DBS-LFP recordings to date. By enabling event-related research with high-temporal precision, this method greatly enhances the utility of these recordings.

Dysfunction of subthalamic dopaminergic circuitry contributes to anxiety- and depression-like behaviors in 6-OHDA lesion-induced hemiparkinsonian mice

Anxiety and depression are common non-motor symptoms severely affecting the quality of life in patients with Parkinson's disease, but the underlying pathophysiological mechanisms remain elusive. As dopaminergic (DA) system and the subthalamic nucleus (STN) are involved in motor control and emotional processing, we herein investigated the role of DA circuitry in the STN in regulating depression in parkinsonian mice. A hemi-parkinsonian mouse model was established by injection of 6-OHDA into the right medial forebrain bundle (MFB), desipramine (20 mg/kg, i.p.) was injected 30 min before the intracranial injection. Motor function was monitored in open field test and apomorphine-induced contra-lesional rotation and rotarod tests; anxiety- and depression-like behaviors were assessed with the open field test, elevated plus maze, tail suspension test and forced swim test. We found that the hemi-parkinsonian mice displayed motor dysfunction and depression-like behaviors at different time points. Fiber photometry recording revealed that STN neurons were hypersensitive to anxiety- and depression-like stimulation; chemogenetic inhibition of STN neurons mitigated anxiety- and depression-like behaviors. While dopamine release was significantly reduced in the STN of the parkinsonian mice in response to anxiety- and depression-like stimulation, the expression of D1- and D2-like dopamine receptors was time-dependently changed. Intracranial injection of either D1- or D2-like dopamine receptor agonist into the STN mitigated anxiety- and depression-like behaviors in the parkinsonian mice. We conclude that STN DA circuitry may be promising targets to treat anxiety and depression in PD.

Atypical Applications of Neuromodulation for Non-Painful Conditions

PURPOSE OF REVIEW

This narrative review explores the expanding applications of neuromodulation beyond pain management, focusing on its use in treating non-painful conditions such as heart failure, renal failure, spinal cord injuries, overactive bladder syndrome, and cognitive impairment in neurodegenerative diseases.

RECENT FINDINGS

Neuromodulation techniques, including dorsal root ganglion stimulation, sacral neurostimulation, and deep brain stimulation, have shown promising results in various non-painful medical conditions: Heart and Renal Failure: Dorsal root ganglion stimulation induces diuresis in diuretic-resistant patients, offering a novel approach to managing fluid overload. Spinal Cord Injuries: Epidural spinal cord stimulation and brain-spine interfaces have demonstrated the potential to restore motor function, enhancing mobility and quality of life for paralyzed individuals. Overactive Bladder Syndrome: Sacral neurostimulation and tibial nerve stimulation have proven effective in improving urinary continence and reducing symptoms in patients unresponsive to conventional treatments. Cognitive Impairment in Neurodegenerative Diseases: Techniques such as deep brain stimulation and transcranial magnetic stimulation are being investigated for their ability to enhance cognitive and motor functions in conditions like Parkinson's and Alzheimer's disease. The review highlights the transformative potential of neuromodulation in non-painful conditions, demonstrating its ability to address complex medical issues beyond its traditional scope. Continued research and optimization of these techniques may lead to broader therapeutic applications and improved patient outcomes.

Deep brain stimulation (DBS) in movement disorders management: exploring therapeutic efficacy, neurobiological mechanisms, and clinical implications

Introduction

Deep brain stimulation (DBS) has emerged as a promising therapeutic approach, offering targeted neuromodulation for movement disorders refractory to medical management or stereotactic surgery. However, assessing its benefits against potential risks is essential. This meta-analysis aims to evaluate the efficacy and safety of DBS in movement disorders, shedding light on its role as an alternative therapeutic option.

Methods

A comprehensive search of databases after systemic review yielded studies published in English from 2000 to the present. Data selection, screening, extraction, and risk of bias assessment were performed meticulously. Statistical analysis was conducted using RevMan 2.0, with significant heterogeneity addressed through appropriate methods.

Results

Our meta-analysis included 40 studies assessing the Unified Parkinson's Disease Rating Scale Part III, revealing a significant improvement in motor symptoms (mean difference [MD]: -18.05, 95% confidence interval [CI] [-20.17, -15.93], P < 0.00001). Hoehn and Yahr Stage analysis demonstrated a reduction in disease severity (MD: -0.58, 95% CI [-1.05, -0.12], P = 0.01). Tremor severity (MD: -8.22, 95% CI [-12.30, -4.15], P < 0.0001), overall tremor (MD: -2.68, 95% CI [-4.59, -0.77], P = 0.006), gait velocity (MD: 0.13, 95% CI [0.08, 0.18], P < 0.00001), and Yale Global Tic Severity Scale score (MD: -9.75, 95% CI [-14.55, -4.96], P < 0.0001) also showed significant improvements with DBS.

Conclusion

DBS demonstrates efficacy in improving motor symptoms, disease severity, tremor, gait, and tic severity in movement disorders. However, further research is needed to elucidate long-term efficacy and safety outcomes.

Inkjet-printed transparent electrodes: Design, characterization, and initial in vivo evaluation for brain stimulation

Electrical stimulation is a powerful tool for investigating and modulating brain activity, as well as for treating neurological disorders. However, understanding the precise effects of electrical stimulation on neural activity has been hindered by limitations in recording neuronal responses near the stimulating electrode, such as stimulation artifacts in electrophysiology or obstruction of the field of view in imaging. In this study, we introduce a novel stimulation device fabricated from conductive polymers that is transparent and therefore compatible with optical imaging techniques. The device is manufactured using a combination of microfabrication and inkjet printing techniques and is flexible, allowing better adherence to the brain's natural curvature. We characterized the electrical and optical properties of the electrodes, focusing on the trade-off between the maximum current that can be delivered and optical transmittance. We found that a 1 mm diameter, 350 nm thick PEDOT:PSS electrode could be used to apply a maximum current of 130 μA while maintaining 84% transmittance (approximately 50% under 2-photon imaging conditions). We then evaluated the electrode performance in the brain of an anesthetized mouse by measuring the electric field with a nearby recording electrode and found values up to 30 V/m. Finally, we combined experimental data with a finite-element model of the in vivo experimental setup to estimate the distribution of the electric field underneath the electrode in the mouse brain. Our findings indicate that the device can generate an electric field as high as 300 V/m directly beneath the electrode, demonstrating its potential for studying and manipulating neural activity using a range of electrical stimulation techniques relevant to human applications. Overall, this work presents a promising approach for developing versatile new tools to apply and study electrical brain stimulation.

Pallidothalamic Circuit-Selective Manipulation Ameliorates Motor Symptoms in a Rat Model of Parkinsonian

Deep brain stimulation (DBS) effectively treats motor symptoms of advanced Parkinson's disease (PD), with the globus pallidus interna (GPi) commonly targeted. However, its therapeutic mechanisms remain unclear. We employed optogenetic stimulation in the entopeduncular nucleus (EP), the rat homolog of GPi, in a unilateral 6-hydroxydopamine lesioned female Sprague Dawley rat model of PD. We quantified behavioral effects of optogenetic EP DBS on motor symptoms and conducted single-unit recordings in EP and ventral lateral motor thalamus (VL) to examine changes in neural activity. High-frequency optogenetic EP DBS (75, 100, 130 Hz) reduced ipsilateral turning and corrected forelimb stepping, while low-frequency stimulation (5 and 20 Hz) had no effect. EP and VL neurons exhibited mixed response during stimulation, with both increased and decreased firing. The average firing rate of all recorded neurons in the EP and VL significantly increased at 130 Hz but not at other frequencies. Beta-band oscillatory activity was reduced in most EP neurons across high frequencies (75, 100, 130 Hz), while reductions in beta-band oscillations in VL occurred only at 130 Hz. These findings suggest that the neural firing rates within EP and VL circuits were differentially modulated by EP DBS; they may not fully explain the frequency-dependent behavioral effect. Instead, high-frequency optogenetic EP DBS at 130 Hz may ameliorate parkinsonian motor symptoms by reducing abnormal oscillatory activity in the EP-VL circuits. This study underscores the therapeutic potential of circuit-specific modulation in the pallidothalamic pathway using optogenetic EP DBS to alleviate motor deficits in a PD rat model.

Deep brain stimulation for obsessive compulsive disorder leads to symptom changes of comorbid irritable bowel syndrome

Introduction

Irritable bowel syndrome (IBS) is a common condition characterized by abdominal pain and altered bowel habits, affecting around 11% of individuals globally. It is linked to dysregulation of the brain-gut axis, with altered activity and connectivity in various brain regions. IBS patients often have psychiatric comorbidities like anxiety, or obsessive-compulsive disorder (OCD). Deep brain stimulation (DBS) is an established treatment option for severe, therapy-refractory OCD. It has been suggested that DBS for OCD could also have a beneficial effect on accompanying IBS-symptoms.

Methods and patients

Nine patients with treatment-refractory OCD who underwent DBS in the bed nucleus striae terminalis (BNST) have been included in this study (4 males, 5 females, mean age: 39.1 ± 11.5 years). Patients were examined with the Gastrointestinal Symptom Rating Scale for Irritable Bowel Syndrome (GSRS-IBS) as well as the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) both before the beginning of DBS as well as throughout several follow-up visits for 12 months following the start of DBS.

Results

Three patients displayed clinically relevant levels of IBS-symptoms at baseline (GSRS-IBS scores at or beyond 32). All of those three patients showed a reduction of the GSRS-IBS score at the last follow-up (12-40%). For the other 6 patients, 5 of them showed also a reduction of the GSRS-IBS compared to the score at baseline. The mean score for all patients showed a descriptive trend toward score reduction throughout the study period and until the last follow up visit after 12 months. The mean Y-BOCS decreased from 31.11 at baseline to 16.50 at the last follow-up. Out of the 9 patients, 7 (78%) were considered responders with Y-BOCS scores decreasing between 37% to 74%. Moderate-to-large correlations between both scales could be observed at both the 9-month and the 12-month follow-up visit. However, none of these associations was statistically significant.

Conclusion

In this study, we found alleviation of IBS symptoms after DBS of the BNST, along with improvement in OCD symptoms. Future research using larger sample sizes should address whether the reductions are tied to the improvement of OCD symptoms or if DBS exerts positive effects on IBS independently of OCD symptoms.

Implantable Soft Neural Electrodes of Liquid Metals for Deep Brain Stimulation

Stimulating large volumes of neural networks using macroelectrodes can modulate disorder-associated brain circuits effectively. However, conventional solid-metal electrodes often cause unwanted brain damage due to their high mechanical stiffness. In contrast, low-modulus liquid metals provide tissue-like stiffness while maintaining macroscale electrode dimensions. Here, we present implantable soft macroelectrodes made from biocompatible liquid metals for brain stimulation. These probes can be easily fabricated by simply filling polymeric tubes with a liquid metal, offering a straightforward method for creating brain stimulation devices. They can be customized in various lengths and diameters and also serve as recording microelectrodes. The electrode tips are enhanced with platinum nanoclusters, resulting in low impedance and effective charge injection while preventing liquid metal leakage into brain tissue. In vivo experiments in neuropathic pain rat models demonstrate the stability and effectiveness of these probes for simultaneous neural stimulation and recording, demonstrating their potential for pain alleviation and behavioral control.

Knowledge and practice of deep brain stimulation among pediatric neurology residents in Saudi Arabia

Deep brain stimulation (DBS) is an established neurosurgical intervention for movement disorders, yet awareness among Saudi pediatric neurology residents remains limited. This study assessed the knowledge, attitudes, and perceived barriers to DBS among Saudi pediatric neurology trainees. A cross-sectional survey was conducted among pediatric neurology residents in Saudi Arabia. Participants completed a structured questionnaire assessing their familiarity with DBS indications, procedural knowledge, and training exposure. Descriptive and inferential statistics were applied. A total of 40 pediatric neurology residents participated, with a majority (87.5%) aged 26-30 years and 57.5% being women. While 65% recognized DBS as FDA-approved for adults, only 50% were aware of its pediatric approval. Knowledge of DBS targets was moderate (65%), but awareness of side effects (45%) and genetic factors influencing DBS outcomes (32.5%) was limited. Exposure to DBS-related activities was minimal, with 95% never attending a family discussion, 100% never witnessing a DBS surgery, and 80% never attending a DBS lecture. Higher residency years correlated with better DBS knowledge (P = 0.001), and prior patient referral was associated with higher scores (P = 0.028). Awareness and training in DBS among Saudi pediatric neurology residents are suboptimal. Integrating DBS education into residency curricula may improve competency and clinical decision-making.

Gerstmann Syndrome: What is the Possible Role of Deep Brain Stimulation?

Gerstmann syndrome, characterized by a tetrad of symptoms, which are agraphia, acalculia, left-right disorientation, and finger agnosia, presents challenges in both understanding its pathophysiology and establishing effective treatment modalities. Neuroanatomical studies have highlighted the involvement of the dominant parietal lobe, particularly the inferior parietal lobule, in the development of Gerstmann syndrome. Although current treatment options are largely supportive, recent research suggests a potential role for deep brain stimulation (DBS) in managing this condition. DBS, known for its efficacy in various neurological disorders, has been hypothesized to modulate neuronal pathways associated with Gerstmann syndrome. However, clinical evidence supporting DBS in Gerstmann syndrome remains scarce, posing challenges in patient selection and ethical considerations. Future research should prioritize investigating the efficacy and safety of DBS in Gerstmann syndrome to improve patient outcomes and quality of life.

Electrophysiological approaches to informing therapeutic interventions with deep brain stimulation

Neuromodulation therapy comprises a range of non-destructive and adjustable methods for modulating neural activity using electrical stimulations, chemical agents, or mechanical interventions. Here, we discuss how electrophysiological brain recording and imaging at multiple scales, from cells to large-scale brain networks, contribute to defining the target location and stimulation parameters of neuromodulation, with an emphasis on deep brain stimulation (DBS).

Expansion of stereotactic work envelope using transformation matrices and geometric algebra for neurosurgery

Stereotactic systems have traditionally used Cartesian coordinate combined with linear algebraic mathematical models to navigate the brain. Previously, the development of a novel stereotactic system allowed for improved patient comfort, reduced size, and carried through a simplified interface for surgeons. The system was designed with a work envelope and trajectory range optimized for deep brain stimulation applications only. However, it could be applied in multiple realms of neurosurgery by spanning the entire brain. To this end, a system of translational and rotational adapters was developed to allow total brain navigation capabilities. Adapters were designed to fit onto a Skull Anchor Key of a stereotactic frame system to allow for rotation and translation of the work envelope. Mathematical formulas for the rotations and translations associated with each adapter were developed. Mechanical and image-guided accuracies were examined using a ground truth imaging phantom. The system's clinical workflow and its ability to reliably and accurately be used in a surgical scenario were investigated using a cadaver head and computed tomography guidance. Eight adapters designed and 3D-printed allowed the work envelope to be expanded to the entire head. The mechanical error was 1.75 ± 0.09 mm (n = 20 targets), and the cadaver surgical targeting error was 1.18 ± 0.28 mm (n = 10 implantations). The novel application of conventional and geometric algebra in conjunction with hardware modifications significantly expands the work envelope of the stereotactic system to the entire cranial cavity. This approach greatly extends the clinical applications by the system.

Non-pharmacologic interventions in disorders of consciousness

Severely brain-injured patients with disorders of consciousness pose significant challenges in terms of management, particularly due to the limited therapeutic options available. Despite the potential for some patients to benefit from interventions even years after the injury, clinicians often lack clear and reliable treatment strategies to promote patient recovery. In response to this clinical need, the field of neuromodulation has emerged as a promising alternative to traditional pharmacologic therapies. Both invasive and noninvasive brain stimulation techniques offer diverse possibilities for restoring physiologic neural activity and enhancing functional network integrity in these complex neurological disorders. This chapter offers a comprehensive overview of current neuromodulation techniques, exploring their potential applications and analyzing the existing evidence for their efficacy. Specifically, we describe transcranial electrical stimulation, transcranial magnetic stimulation, deep brain stimulation, low-intensity focused ultrasound, vagal nerve stimulation (including transcutaneous methods), spinal cord stimulation, and median nerve stimulation. While certain approaches show promise for patients with disorders of consciousness, there remains a pressing need for large-scale interventional clinical trials that will play an essential role for elucidating the underlying mechanisms of recovery and for refining stimulation parameters. This, together with the development of tailored individual interventions will move the field forward and optimize therapeutic outcomes.

Neuroprotective Efficacy and Complementary Treatment with Medicinal Herbs: A Comprehensive Review of Recent Therapeutic Approaches in Epilepsy Management

Central Nervous System (CNS) disorders affect millions of people worldwide, with a significant proportion experiencing drug-resistant forms where conventional medications fail to provide adequate seizure control. This abstract delves into recent advancements and innovative therapies aimed at addressing the complex challenge of CNS-related drug-resistant epilepsy (DRE) management. The idea of precision medicine has opened up new avenues for epilepsy treatment. Herbs such as curcumin, ginkgo biloba, panax ginseng, bacopa monnieri, ashwagandha, and rhodiola rosea influence the BDNF pathway through various mechanisms. These include the activation of CREB, inhibition of NF-κB, modulation of neurotransmitters, reduction of oxidative stress, and anti- inflammatory effects. By promoting BDNF expression and activity, these herbs support neuroplasticity, cognitive function, and overall neuronal health. Novel antiepileptic drugs (AEDs) with distinct mechanisms of action demonstrate efficacy in refractory cases where traditional medications falter. Additionally, repurposing existing drugs for antiepileptic purposes presents a cost-effective strategy to broaden therapeutic choices. Cannabidiol (CBD), derived from cannabis herbs, has garnered attention for its anticonvulsant properties, offering a potential adjunctive therapy for refractory seizures. In conclusion, recent advances and innovative therapies represent a multifaceted approach to managing drug-resistant epilepsy. Leveraging precision medicine, neurostimulation technologies, novel pharmaceuticals, and complementary therapies, clinicians can optimize treatment outcomes and improve the life expectancy of patients living with refractory seizures. Genetic testing and biomarker identification now allow for personalized therapeutic approaches tailored to individual patient profiles. Utilizing next-generation sequencing techniques, researchers have elucidated genetic mutations.

An MRI-guided stereotactic neurosurgical robotic system for semi-enclosed head coils

Magnetic resonance imaging (MRI) offers high-quality soft tissue imaging without radiation exposure, which allows stereotactic techniques to significantly improve outcomes in cranial surgeries, particularly in deep brain stimulation (DBS) procedures. However, conventional stereotactic neurosurgeries often rely on mechanical stereotactic head frames and preoperative imaging, leading to suboptimal results due to the invisibility and the contact with patient's head, which may cause additional harm. This paper presents a frameless, MRI-guided stereotactic neurosurgical robotic system. The robot features a seven-degree-of-freedom (7-DOF) remote center of motion, with five DOFs for preoperative trajectory alignment to the target lesion and two DOFs for defining the depth and twisting motion of the needle during insertion, thus to minimize tissue damage. The system employs interactive MRI guidance for real-time visualization of the puncture process, showing great potential in reducing surgery time, enhancing targeting accuracy, and improving safety. Experiments were conducted on the proposed system to evaluate signal-to-noise ratio (SNR) and geometric distortion. During the simultaneous operation and imaging, the system demonstrated less than 10.02% SNR attenuation and less than 0.1% geometric distortion, ensuring image usability. The free-space positioning accuracy of the system was evaluated using a laser tracker, revealing a tip position repeatability error within 0.3 ± 0.1 mm.

Remotely induced electrical modulation of deep brain circuits in non-human primates

Introduction

The combination of magnetic and focused ultrasonic fields generates focused electric fields at depth entirely noninvasively. This noninvasive method may find particularly important applications in targeted treatments of the deep brain circuits involved in mental and neurological disorders. Due to the novelty of this method, it is nonetheless unknown which parameters modulate neural activity effectively.

Methods

We have investigated this issue by applying the combination of magnetic and focused ultrasonic fields to deep brain visual circuits in two non-human primates, quantifying the electroencephalographic gamma activity evoked in the visual cortex. We hypothesized that the pulse repetition frequency of the ultrasonic stimulation should be a key factor in modulating the responses, predicting that lower frequencies should elicit inhibitory effects and higher frequencies excitatory effects.

Results

We replicated the results of a previous study, finding an inhibition of the evoked gamma responses by a strong magnetic field. This inhibition was only observed for the lowest frequency tested (5 Hz), and not for the higher frequencies (10 kHz and 50 kHz). These neuromodulatory effects were transient and no safety issues were noted.

Discussion

We conclude that this new method can be used to transiently inhibit evoked neural activity in deep brain regions of primates, and that delivering the ultrasonic pulses at low pulse repetition frequencies maximizes the effect.

Patterned electrical brain stimulation by a wireless network of implantable microdevices

Transmitting meaningful information into brain circuits by electronic means is a challenge facing brain-computer interfaces. A key goal is to find an approach to inject spatially structured local current stimuli across swaths of sensory areas of the cortex. Here, we introduce a wireless approach to multipoint patterned electrical microstimulation by a spatially distributed epicortically implanted network of silicon microchips to target specific areas of the cortex. Each sub-millimeter-sized microchip harvests energy from an external radio-frequency source and converts this into biphasic current injected focally into tissue by a pair of integrated microwires. The amplitude, period, and repetition rate of injected current from each chip are controlled across the implant network by implementing a pre-scheduled, collision-free bitmap wireless communication protocol featuring sub-millisecond latency. As a proof-of-concept technology demonstration, a network of 30 wireless stimulators was chronically implanted into motor and sensory areas of the cortex in a freely moving rat for three months. We explored the effects of patterned intracortical electrical stimulation on trained animal behavior at average RF powers well below regulatory safety limits.

Endocisternal interfaces for minimally invasive neural stimulation and recording of the brain and spinal cord

Minimally invasive neural interfaces can be used to diagnose, manage and treat many disorders, with reduced risks of surgical complications. However, endovascular probes lack access to key cortical, subcortical and spinal targets, and are not typically explantable after endothelialization. Here we report the development and testing, in sheep, of endocisternal neural interfaces that approach brain and spinal cord targets through inner and outer spaces filled with cerebrospinal fluid. Thus, the interfaces gain access to the entire brain convexity, to deep brain structures within the ventricles and to the spinal cord from the spinal subarachnoid space. We combined an endocisternal neural interface with wireless miniature magnetoelectrically powered bioelectronics so that it can be freely navigated percutaneously from the spinal space to the cranial subarachnoid space, and from the cranial subarachnoid space to the ventricles. In sheep, we show recording and stimulation functions, as well as repositioning of the flexible electrodes and explantation of the interface after chronic implantation. Minimally invasive endocisternal bioelectronics may enable chronic and transient therapies, particularly for stroke rehabilitation and epilepsy monitoring.

Functional brain controllability in Parkinson's disease and its association with motor outcomes after deep brain stimulation

Introduction

Considering the high economic burden and risks of deep brain stimulation (DBS) surgical failure, predicting the motor outcomes of DBS in Parkinson's disease (PD) is of significant importance in clinical decision-making. Functional controllability provides a rationale for combining the abnormal connections of the cortico-striato-thalamic-cortical (CSTC) motor loops and dynamic changes after medication in DBS outcome prediction.

Methods

In this study, we analyzed the association between preoperative delta functional controllability after medication within CSTC loops and motor outcomes of subthalamic nucleus DBS (STN-DBS) and globus pallidus interna DBS (GPi-DBS) and predicted motor outcomes in a Support Vector Regression (SVR) model using the delta controllability of focal regions.

Results

While the STN-DBS motor outcomes were associated with the delta functional controllability of the thalamus, the GPi-DBS motor outcomes were related to the delta functional controllability of the caudate nucleus and postcentral gyrus. In the SVR model, the predicted and actual motor outcomes were positively correlated, with p = 0.020 and R = 0.514 in the STN-DBS group, and p = 0.011 and R = 0.705 in the GPi- DBS group.

Discussion

Our findings indicate that different focal regions within the CSTC motor loops are involved in STN-DBS and GPi-DBS and support the feasibility of functional controllability in predicting DBS motor outcomes for PD in clinical decision-making.

Multifunctional Neural Probes Enable Bidirectional Electrical, Optical, and Chemical Recording and Stimulation In Vivo

Recording and modulation of neuronal activity enables the study of brain function in health and disease. While translational neuroscience relies on electrical recording and modulation techniques, mechanistic studies in rodent models leverage genetic precision of optical methods, such as optogenetics and fluorescent indicator imaging. In addition to electrical signal transduction, neurons produce and receive diverse chemical signals which motivate tools to probe and modulate neurochemistry. Although the past decade has delivered a wealth of technologies for electrophysiology, optogenetics, chemical sensing, and optical recording, combining these modalities within a single platform remains challenging. This work leverages materials selection and convergence fiber drawing to permit neural recording, electrical stimulation, optogenetics, fiber photometry, drug and gene delivery, and voltammetric recording of neurotransmitters within individual fibers. Composed of polymers and non-magnetic carbon-based conductors, these fibers are compatible with magnetic resonance imaging, enabling concurrent stimulation and whole-brain monitoring. Their utility is demonstrated in studies of the mesolimbic reward pathway by interfacing with the ventral tegmental area and nucleus accumbens in mice and characterizing the neurophysiological effects of a stimulant drug. This study highlights the potential of these fibers to probe electrical, optical, and chemical signaling across multiple brain regions in both mechanistic and translational studies.

Human TRPV4 engineering yields an ultrasound-sensitive actuator for sonogenetics

Sonogenetics offers non-invasive and cell-type specific modulation of cells genetically engineered to express ultrasound-sensitive actuators. Finding an ion channel to serve as sonogenetic actuator it critical for advancing this promising technique. Here, we show that ultrasound can activate human TRP channel hTRPV4. By screening different hTRPV4 variants, we identify a mutation F617L that increases mechano-sensitivity of this channel to ultrasound, while reduces its sensitivity to hypo-osmolarity, elevated temperature, and agonist. This altered sensitivity profile correlates with structural differences in hTRPV4-F617L compared to wild-type channels revealed by our cryo-electron microscopy analysis. We also show that hTRPV4-F617L can serve as a sonogenetic actuator for neuromodulation in freely moving mice. Our findings demonstrate the use of structure-guided mutagenesis to engineer ion channels with tailored properties of ideal sonogenetic actuators.

Neural stimulation and modulation with sub-cellular precision by optomechanical bio-dart

Neural stimulation and modulation at high spatial resolution are crucial for mediating neuronal signaling and plasticity, aiding in a better understanding of neuronal dysfunction and neurodegenerative diseases. However, developing a biocompatible and precisely controllable technique for accurate and effective stimulation and modulation of neurons at the subcellular level is highly challenging. Here, we report an optomechanical method for neural stimulation and modulation with subcellular precision using optically controlled bio-darts. The bio-dart is obtained from the tip of sunflower pollen grain and can generate transient pressure on the cell membrane with submicrometer spatial resolution when propelled by optical scattering force controlled with an optical fiber probe, which results in precision neural stimulation via precisely activation of membrane mechanosensitive ion channel. Importantly, controllable modulation of a single neuronal cell, even down to subcellular neuronal structures such as dendrites, axons, and soma, can be achieved. This bio-dart can also serve as a drug delivery tool for multifunctional neural stimulation and modulation. Remarkably, our optomechanical bio-darts can also be used for in vivo neural stimulation in larval zebrafish. This strategy provides a novel approach for neural stimulation and modulation with sub-cellular precision, paving the way for high-precision neuronal plasticity and neuromodulation.

E-Suture: Mixed-Conducting Suture for Medical Devices

Modern implantable bioelectronics demand soft, biocompatible components that make robust, low-impedance connections with the body and circuit elements. Concurrently, such technologies must demonstrate high efficiency, with the ability to interface between the body's ionic and external electronic charge carriers. Here, a mixed-conducting suture, the e-suture, is presented. Composed of silk, the conducting polymer poly(3,4-ethylenedioxythiophene) polystyrene sulfonate (PEDOT:PSS), and insulating jacketing polymers,the resulting e-suture has mixed-conducting properties at the interface with biological tissue as well as effective insulation along its length. The e-suture can be mechanically integrated into electronics, enabling the acquisition of biopotentials such as electrocardiograms, electromyograms, and local field potentials (LFP). Chronic, in vivo acquisition of LFP with e-sutures remains stable for months with robust brain activity patterns. Furthermore, e-sutures can establish electrophoretic-based local drug delivery, potentially offering enhanced anatomical targeting and decreased side effects associated with systemic administration, while maintaining an electrically conducting interface for biopotential monitoring. E-sutures expand on the conventional role of sutures and wires by providing a soft, biocompatible, and mechanically sound structure that additionally has multifunctional capacity for sensing, stimulation, and drug delivery.

Controlling action potentials with magnetoelectric nanoparticles

Non-invasive or minutely invasive and wireless brain stimulation that can target any region of the brain is an open problem in engineering and neuroscience with serious implications for the treatment of numerous neurological diseases. Despite significant recent progress in advancing new methods of neuromodulation, none has successfully replicated the efficacy of traditional wired stimulation and improved on its downsides without introducing new complications. Due to the capability to convert magnetic fields into local electric fields, MagnetoElectric NanoParticle (MENP) neuromodulation is a recently proposed framework based on new materials that can locally sensitize neurons to specific, low-strength alternating current (AC) magnetic fields (50Hz 1.7 kOe field). However, the current research into this neuromodulation concept is at a very early stage, and the theoretically feasible game-changing advantages remain to be proven experimentally. To break this stalemate phase, this study leveraged understanding of the non-linear properties of MENPs and the nanoparticles' field interaction with the cellular microenvironment. Particularly, the applied magnetic field's strength and frequency were tailored to the M - H hysteresis loop of the nanoparticles. Furthermore, rectangular prisms instead of the more traditional "spherical" nanoparticle shapes were used to: (i) maximize the magnetoelectric effect and (ii) improve the nanoparticle-cell-membrane surface interface. Neuromodulation performance was evaluated in a series of exploratory in vitro experiments on 2446 rat hippocampus neurons. Linear mixed effect models were used to ensure the independence of samples by accounting for fixed adjacency effects in synchronized firing. Neural activity was measured over repeated 4-min segments, containing 90 s of baseline measurements, 90 s of stimulation measurements, and 60 s of post stimulation measurements. 87.5 % of stimulation attempts produced statistically significant (P < 0.05) changes in neural activity, with 58.3 % producing large changes (P < 0.01). In negative controls using either zero or 1.7 kOe-strength field without nanoparticles, no experiments produced significant changes in neural activity (P > 0.05 and P > 0.15 respectively). Furthermore, an exploratory analysis of a direct current (DC) magnetic field indicated that the DC field could be used with MENPs to inhibit neuron activity (P < 0.01). These experiments demonstrated the potential for magnetoelectric neuromodulation to offer a near one-to-one functionality match with conventional electrode stimulation without requiring surgical intervention or genetic modification to achieve success, instead relying on physical properties of these nanoparticles as "On/Off" control mechanisms. ONE-SENTENCE SUMMARY: This in vitro neural cell culture study explores how to exploit the non-linear and anisotropic properties of magnetoelectric nanoparticles for wireless neuromodulation, the importance of magnetic field strength and frequency matching for optimization, and demonstrates, for the first time, that magnetoelectric neuromodulation can inhibit neural responses.

Circuit-Specific Deep Brain Stimulation Provides Insights into Movement Control

Deep brain stimulation (DBS), a method in which electrical stimulation is delivered to specific areas of the brain, is an effective treatment for managing symptoms of a number of neurological and neuropsychiatric disorders. Clinical access to neural circuits during DBS provides an opportunity to study the functional link between neural circuits and behavior. This review discusses how the use of DBS in Parkinson's disease and dystonia has provided insights into the brain networks and physiological mechanisms that underlie motor control. In parallel, insights from basic science about how patterns of electrical stimulation impact plasticity and communication within neural circuits are transforming DBS from a therapy for treating symptoms to a therapy for treating circuits, with the goal of training the brain out of its diseased state.

Computational study of associations between the synaptic conductance of STN and GPe and the development of Parkinson's disease

There is evidence that the subthalamic nucleus (STN) and globus pallidus pars externa (GPe) involve in the development of Parkinson's disease, a neurodegenerative disorder characterized by motor and non-motor symptoms and loss of dopaminergic neurons in which the error index (EI) in firing patterns is widely used to address the related issues. Whether and how this interaction mechanism of STN and GPe affects EI in Parkinson's disease is uncertain. To account for this, we propose a kind of basal ganglia-thalamic network model associated with Parkinson's disease coupled with neurons, and investigate the effect of synaptic conductance of STN and GPe on EI in this network, as well as their internal relationship under EI as an index. The results show a relationship like a piecewise function between the error index and the slope of the state transition function of synaptic conductance from STN to GPe ( g snge ) and from GPe to STN ( g gesn ). And there is an approximate negative correlation between EI and g gesn . Increasing g snge and decreasing g gesn can improve the fidelity of thalamus information transmission and alleviate Parkinson's disease effectively. These obtained results can give some theoretical evidence that the abnormal synaptic releases of STN and GPe may be the symptoms of the development of Parkinson's disease, and further enrich the understanding of the pathogenesis and treatment mechanism of Parkinson's disease.

Combined Pimavanserin and Maintenance Electroconvulsive Therapy: A Novel Approach to Parkinson's Disease Psychosis

Parkinson's disease (PD) is among the most common neurodegenerative diseases. Parkinson's disease psychosis (PDP) is a potential psychiatric manifestation of PD that is associated with increased morbidity and mortality. The treatment of PD with concomitant PDP is challenging as standard-of-care medication to improve motor symptoms can cause or exacerbate PDP. In this case report, we present an atypical presentation of a 70-year-old female who developed PDP only four years after her initial PD diagnosis, much earlier than the established average. Treatment was particularly complex as her PDP symptoms were refractory to PD medication reduction and oral antipsychotics, yet her PD motor symptoms were well controlled with a deep brain stimulator (DBS). We discuss a combination of pimavanserin and maintenance electroconvulsive therapy (ECT) as a safe and efficacious treatment modality which has led to remission of her PDP while DBS continues to provide adequate management of her PD symptoms. This case improves upon the early recognition of PDP and outlines a unique treatment modality not well described in the literature. This is the only case that demonstrates the efficacy of combining pimavanserin and ECT for refractory PDP in a patient with a DBS.

Computational models advance deep brain stimulation for Parkinson's disease

Deep brain stimulation(DBS) has become an effective intervention for advanced Parkinson's disease(PD), but the exact mechanism of DBS is still unclear. In this review, we discuss the history of DBS, the anatomy and internal architecture of the basal ganglia (BG), the abnormal pathological changes of the BG in PD, and how computational models can help understand and advance DBS. We also describe two types of models: mathematical theoretical models and clinical predictive models. Mathematical theoretical models simulate neurons or neural networks of BG to shed light on the mechanistic principle underlying DBS, while clinical predictive models focus more on patients' outcomes, helping to adapt treatment plans for each patient and advance novel electrode designs. Finally, we provide insights and an outlook on future technologies.

Fiber-based Probes for Electrophysiology, Photometry, Optical and Electrical Stimulation, Drug Delivery, and Fast-Scan Cyclic Voltammetry In Vivo

Recording and modulation of neuronal activity enables the study of brain function in health and disease. While translational neuroscience relies on electrical recording and modulation techniques, mechanistic studies in rodent models leverage genetic precision of optical methods, such as optogenetics and imaging of fluorescent indicators. In addition to electrical signal transduction, neurons produce and receive diverse chemical signals which motivate tools to probe and modulate neurochemistry. Although the past decade has delivered a wealth of technologies for electrophysiology, optogenetics, chemical sensing, and optical recording, combining these modalities within a single platform remains challenging. This work leverages materials selection and convergence fiber drawing to permit neural recording, electrical stimulation, optogenetics, fiber photometry, drug and gene delivery, and voltammetric recording of neurotransmitters within individual fibers. Composed of polymers and non-magnetic carbon-based conductors, these fibers are compatible with magnetic resonance imaging, enabling concurrent stimulation and whole-brain monitoring. Their utility is demonstrated in studies of the mesolimbic reward pathway by simultaneously interfacing with the ventral tegmental area and nucleus accumbens in mice and characterizing the neurophysiological effects of a stimulant drug. This study highlights the potential of these fibers to probe electrical, optical, and chemical signaling across multiple brain regions in both mechanistic and translational studies.

Clinical neuromodulatory effects of deep brain stimulation in disorder of consciousness: A literature review

BACKGROUND

The management of patients with disorders of consciousness (DOC) presents substantial challenges in clinical practice. Deep brain stimulation (DBS) has emerged as a potential therapeutic approach, but the lack of standardized regulatory parameters for DBS in DOC hinders definitive conclusions.

OBJECTIVE

This comprehensive review aims to provide a detailed summary of the current issues concerning patient selection, target setting, and modulation parameters in clinical studies investigating the application of DBS for DOC patients.

METHODS

A meticulous systematic analysis of the literatures was conducted, encompassing articles published from 1968 to April 2023, retrieved from reputable databases (PubMed, Embase, Medline, and Web of Science).

RESULTS

The systematic analysis of 21 eligible articles, involving 146 patients with DOC resulting from acquired brain injury or other disorders, revealed significant insights. The most frequently targeted regions were the Centromedian-parafascicular complex (CM-pf) nuclei and central thalamus (CT), both recognized for their role in regulating consciousness. However, other targets have also been explored in different studies. The stimulation frequency was predominantly set at 25 or 100 Hz, with pulse width of 120 μs, and voltages ranged from 0 to 4 V. These parameters were customized based on individual patient responses and evaluations. The overall clinical efficacy rate in all included studies was 39.7%, indicating a positive effect of DBS in a subset of DOC patients. Nonetheless, the assessment methods, follow-up durations, and outcome measures varied across studies, potentially contributing to the variability in reported efficacy rates.

CONCLUSION

Despite the challenges arising from the lack of standardized parameters, DBS shows promising potential as a therapeutic option for patients with DOC. However, there still remains the need for standardized protocols and assessment methods, which are crucial to deepen the understanding and optimizing the therapeutic potential of DBS in this specific patient population.

Temporal interference stimulation disrupts spike timing in the primate brain

Electrical stimulation can regulate brain activity, producing clear clinical benefits, but focal and effective neuromodulation often requires surgically implanted electrodes. Recent studies argue that temporal interference (TI) stimulation may provide similar outcomes non-invasively. During TI, scalp electrodes generate multiple electrical fields in the brain, modulating neural activity only at their intersection. Despite considerable enthusiasm for this approach, little empirical evidence demonstrates its effectiveness, especially under conditions suitable for human use. Here, using single-neuron recordings in non-human primates, we establish that TI reliably alters the timing, but not the rate, of spiking activity. However, we show that TI requires strategies-high carrier frequencies, multiple electrodes, and amplitude-modulated waveforms-that also limit its effectiveness. Combined, these factors make TI 80 % weaker than other forms of non-invasive brain stimulation. Although unlikely to cause widespread neuronal entrainment, TI may be ideal for disrupting pathological oscillatory activity, a hallmark of many neurological disorders.

NAc-DBS corrects depression-like behaviors in CUMS mouse model via disinhibition of DA neurons in the VTA

Major depressive disorder (MDD) is characterized by diverse debilitating symptoms that include loss of motivation and anhedonia. If multiple medications, psychotherapy, and electroconvulsive therapy fail in some patients with MDD, their condition is then termed treatment-resistant depression (TRD). MDD can be associated with abnormalities in the reward-system-dopaminergic mesolimbic pathway, in which the nucleus accumbens (NAc) and ventral tegmental area (VTA) play major roles. Deep brain stimulation (DBS) applied to the NAc alleviates the depressive symptoms of MDD. However, the mechanism underlying the effects of this DBS has remained elusive. In this study, using the chronic unpredictable mild stress (CUMS) mouse model, we investigated the behavioral and neurobiological effects of NAc-DBS on the multidimensional depression-like phenotypes induced by CUMS by integrating behavioral, in vivo microdialysis coupled with high-performance liquid chromatography-electrochemical detector (HPLC-ECD), calcium imaging, pharmacological, and genetic manipulation methods in freely moving mice. We found that long-term and repeated, but not single, NAc-DBS induced robust antidepressant responses in CUMS mice. Moreover, even a single trial NAc-DBS led to the elevation of the γ-aminobutyric acid (GABA) neurotransmitter, accompanied by the increase in dopamine (DA) neuron activity in the VTA. Both the inhibition of the GABAA receptor activity and knockdown of the GABAA-α1 gene in VTA-GABA neurons blocked the antidepressant effect of NAc-DBS in CUMS mice. Our results showed that NAc-DBS could disinhibit VTA-DA neurons by regulating the level of GABA and the activity of VTA-GABA in the VTA and could finally correct the depression-like behaviors in the CUMS mouse model.

Human brain tissue identification using coherent anti-Stokes Raman scattering spectroscopy and diffuse reflectance spectroscopy for deep brain stimulation surgery

Significance

We assess the feasibility of using diffuse reflectance spectroscopy (DRS) and coherent anti-Stokes Raman scattering spectroscopy (CARS) as optical tools for human brain tissue identification during deep brain stimulation (DBS) lead insertion, thereby providing a promising avenue for additional real-time neurosurgical guidance.

Aim

We developed a system that can acquire CARS and DRS spectra during the DBS surgery procedure to identify the tissue composition along the lead trajectory.

Approach

DRS and CARS spectra were acquired using a custom-built optical probe integrated in a commercial DBS lead. The lead was inserted to target three specific regions in each of the brain hemispheres of a human cadaver. Spectra were acquired during the lead insertion at constant position increments. Spectra were analyzed to classify each spectrum as being from white matter (WM) or gray matter (GM). The results were compared with tissue classification performed on histological brain sections.

Results

DRS and CARS spectra obtained using the optical probe can identify WM and GM during DBS lead insertion. The tissue composition along the trajectory toward a specific target is unique and can be differentiated by the optical probe. Moreover, the results obtained with principal component analysis suggest that DRS might be able to detect the presence of blood due to the strong optical absorption of hemoglobin.

Conclusions

It is possible to use optical measurements from the DBS lead during surgery to identify WM and GM and possibly the presence of blood in human brain tissue. The proposed optical tool could inform the surgeon during the lead placement if the lead has reached the target as planned. Our tool could eventually replace microelectrode recordings, which would streamline the process and reduce surgery time. Further developments are required to fully integrate these tools into standard clinical procedures.

Neuromodulation techniques in poststroke motor impairment recovery: Efficacy, challenges, and future directions

Cerebrovascular accidents, also known as strokes, represent a major global public health challenge and contribute to substantial mortality, disability, and socioeconomic burden. Multidisciplinary approaches for poststroke therapies are crucial for recovering lost functions and adapting to new limitations. This review discusses the potential of neuromodulation techniques, repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation, spinal cord stimulation (SCS), vagus nerve stimulation (VNS), and deep brain stimulation (DBS), as innovative strategies for facilitating poststroke recovery. Neuromodulation is an emerging adjunct to conventional therapies that target neural plasticity to restore lost function and compensate for damaged brain areas. The techniques discussed in this review have different efficacies in enhancing neural plasticity, optimizing motor recovery, and mitigating poststroke impairments. Specifically, rTMS has shown significant promise in enhancing motor function, whereas SCS has shown potential in improving limb movement and reducing disability. Similarly, VNS, typically used to treat epilepsy, has shown promise in enhancing poststroke motor recovery, while DBS may be used to improve poststroke motor recovery and symptom mitigation. Further studies with standardized protocols are warranted to elucidate the efficacy of these methods and integrate them into mainstream clinical practice to optimize poststroke care.

Janus microparticles-based targeted and spatially-controlled piezoelectric neural stimulation via low-intensity focused ultrasound

Electrical stimulation is a fundamental tool in studying neural circuits, treating neurological diseases, and advancing regenerative medicine. Injectable, free-standing piezoelectric particle systems have emerged as non-genetic and wireless alternatives for electrode-based tethered stimulation systems. However, achieving cell-specific and high-frequency piezoelectric neural stimulation remains challenging due to high-intensity thresholds, non-specific diffusion, and internalization of particles. Here, we develop cell-sized 20 μm-diameter silica-based piezoelectric magnetic Janus microparticles (PEMPs), enabling clinically-relevant high-frequency neural stimulation of primary neurons under low-intensity focused ultrasound. Owing to its functionally anisotropic design, half of the PEMP acts as a piezoelectric electrode via conjugated barium titanate nanoparticles to induce electrical stimulation, while the nickel-gold nanofilm-coated magnetic half provides spatial and orientational control on neural stimulation via external uniform rotating magnetic fields. Furthermore, surface functionalization with targeting antibodies enables cell-specific binding/targeting and stimulation of dopaminergic neurons. Taking advantage of such functionalities, the PEMP design offers unique features towards wireless neural stimulation for minimally invasive treatment of neurological diseases.

3D spatiotemporally scalable in vivo neural probes based on fluorinated elastomers

Electronic devices for recording neural activity in the nervous system need to be scalable across large spatial and temporal scales while also providing millisecond and single-cell spatiotemporal resolution. However, existing high-resolution neural recording devices cannot achieve simultaneous scalability on both spatial and temporal levels due to a trade-off between sensor density and mechanical flexibility. Here we introduce a three-dimensional (3D) stacking implantable electronic platform, based on perfluorinated dielectric elastomers and tissue-level soft multilayer electrodes, that enables spatiotemporally scalable single-cell neural electrophysiology in the nervous system. Our elastomers exhibit stable dielectric performance for over a year in physiological solutions and are 10,000 times softer than conventional plastic dielectrics. By leveraging these unique characteristics we develop the packaging of lithographed nanometre-thick electrode arrays in a 3D configuration with a cross-sectional density of 7.6 electrodes per 100 µm2. The resulting 3D integrated multilayer soft electrode array retains tissue-level flexibility, reducing chronic immune responses in mouse neural tissues, and demonstrates the ability to reliably track electrical activity in the mouse brain or spinal cord over months without disrupting animal behaviour.

Fabrication and validation of flexible neural electrodes based on polyimide tape and gold sheet

This research was conducted to apply polyimide tape, which has the advantages of low price ans strong adhesive strength, to the neural electrode process. In addition, to maximize the low-cost characteristics, a fabrication process based on UV laser patterning rather than a photolithography process was introduced. The fabrication process started by attaching the gold sheet on the conductive double-sided tape without being torn or crushed. Then, the gold sheet and the double-sided tape were patterned together using UV laser. The patterned layer was transferred to the single-side polyimide tape. For insulation layer, electrode site opened single-sided polyimide tape was prepared. Polydimethylsiloxane was used as an adhesion layer, and alignment between electrode sites and opening sites was processed manually. The minimum line width achieved through the proposed fabrication process was approximately 100 μ m, and the sheet resistance of the conductive layer was 0.635 Ω /sq. Measured cathodal charge storage capacity was 0.72 mC/cm2 and impedance at 1 kHz was 4.07 kΩ /cm2. Validation of fabricated electrode was confirmed by conducting 30 days accelerated soak test, flexibility test, adhesion test and ex vivo stimulation test. The novel flexible neural electrodes based on single-sided polyimide tape and UV laser patterned gold sheet was fabricated successfully. Conventional neural electrode fabrication processes based on polyimide substrate has a disadvantages such as long fabrication time, expensive costs, and probability of delamination between layers. However, the novel fabrication process which we introduced can overcome many shortcomings of existing processes, and offers great advantages such as simplicity of fabrication, inexpensiveness, flexibility and long-term reliability.

A systematic review and meta-analysis of neuromodulation therapies for substance use disorders

While pharmacological, behavioral and psychosocial treatments are available for substance use disorders (SUDs), they are not always effective or well-tolerated. Neuromodulation (NM) methods, including repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation (tDCS) and deep brain stimulation (DBS) may address SUDs by targeting addiction neurocircuitry. We evaluated the efficacy of NM to improve behavioral outcomes in SUDs. A systematic literature search was performed on MEDLINE, PsychINFO, and PubMed databases and a list of search terms for four key concepts (SUD, rTMS, tDCS, DBS) was applied. Ninety-four studies were identified that examined the effects of rTMS, tDCS, and DBS on substance use outcomes (e.g., craving, consumption, and relapse) amongst individuals with SUDs including alcohol, tobacco, cannabis, stimulants, and opioids. Meta-analyses were performed for alcohol and tobacco studies using rTMS and tDCS. We found that rTMS reduced substance use and craving, as indicated by medium to large effect sizes (Hedge's g > 0.5). Results were most encouraging when multiple stimulation sessions were applied, and the left dorsolateral prefrontal cortex (DLPFC) was targeted. tDCS also produced medium effect sizes for drug use and craving, though they were highly variable and less robust than rTMS; right anodal DLPFC stimulation appeared to be most efficacious. DBS studies were typically small, uncontrolled studies, but showed promise in reducing misuse of multiple substances. NM may be promising for the treatment of SUDs. Future studies should determine underlying neural mechanisms of NM, and further evaluate extended treatment durations, accelerated administration protocols and long-term outcomes with biochemical verification of substance use.

Noninvasive modulation of essential tremor with focused ultrasonic waves

Objective: Transcranial focused low-intensity ultrasound has the potential to noninvasively modulate confined regions deep inside the human brain, which could provide a new tool for causal interrogation of circuit function in humans. However, it has been unclear whether the approach is potent enough to modulate behavior.Approach: To test this, we applied low-intensity ultrasound to a deep brain thalamic target, the ventral intermediate nucleus, in three patients with essential tremor.Main results: Brief, 15 s stimulations of the target at 10% duty cycle with low-intensity ultrasound, repeated less than 30 times over a period of 90 min, nearly abolished tremor (98% and 97% tremor amplitude reduction) in 2 out of 3 patients. The effect was observed within seconds of the stimulation onset and increased with ultrasound exposure time. The effect gradually vanished following the stimulation, suggesting that the stimulation was safe with no harmful long-term consequences detected.Significance: This result demonstrates that low-intensity focused ultrasound can robustly modulate deep brain regions in humans with notable effects on overt motor behavior.

Overlapping stimulation of subthalamic nucleus and dentato-rubro-thalamic tract in Parkinson's disease after deep brain stimulation

BACKGROUND

Deep brain stimulation (DBS) of the subthalamic nucleus (STN) reduces tremor, rigidity, and akinesia. According to the literature, the dentato-rubro-thalamic tract (DRTt) is verified target for DBS in essential tremor; however, its role in the treatment of Parkinson's disease is only vaguely described. The aim of our study was to identify the relationship between symptom alleviation in PD patients and the distance of the DBS electrode electric field (EF) to the DRTt.

METHODS

A single-center retrospective analysis of patients (N = 30) with idiopathic Parkinson's disease (PD) who underwent DBS between November 2018 and January 2020 was performed. DRTt and STN were visualized using diffusion-weighted imaging (DWI) and tractography protocol of magnetic resonance (MR). The EF was calculated and compared with STN and course of DRTt. Evaluation of patients before and after surgery was performed with use of UPDRS-III scale. The association between distance from EF to DRTt and clinical outcomes was examined. To confirm the anatomical variation between DRTt and STN observed in tractography, white matter dissection was performed with the Klingler technique on ten human brains.

RESULTS

Patients with EF overlapping STN and DRTt benefited from significant motor symptoms improvement. Anatomical findings confirmed the presence of population differences in variability of the DRTt course and were consistent with the DRTt visualized by MR.

CONCLUSIONS

DRTt proximity to STN, the main target in PD DBS surgery, confirmed by DWI with tractography protocol of MR combined with proper predefined stimulation parameters may improve efficacy of DBS-STN.

Thalamo-cortical evoked potentials during stimulation of the dentato-rubro-thalamic tract demonstrate synaptic filtering

Essential tremor DBS targeting the ventral intermediate nucleus (Vim) of the thalamus and its input, the dentato-rubro-thalamic tract (DRTt), has proven to be an effective treatment strategy. We examined thalamo-cortical evoked potentials (TCEPs) and cortical dynamics during stimulation of the DRTt. We recorded TCEPs in primary motor cortex during clinical and supra-clinical stimulation of the DRTt in ten essential tremor patients. Stimulation was varied over pulse amplitude (2-10 ​mA) and pulse width (30-250 ​μs) to allow for strength-duration testing. Testing at clinical levels (3 ​mA, 60 ​μs) for stimulation frequencies of 1-160 ​Hz was performed and phase amplitude coupling (PAC) of beta phase and gamma power was calculated. Primary motor cortex TCEPs displayed two responses: early and all-or-none (<20 ​ms) or delayed and charge-dependent (>50 ​ms). Strength-duration curve approximation indicates that the chronaxie of the neural elements related to the TCEPs is <200 ​μs. At the range of clinical stimulation (amplitude 2-5 ​mA, pulse width 30-60 ​μs), TCEPs were not noted over primary motor cortex. Decreased pathophysiological phase-amplitude coupling was seen above 70 ​Hz stimulation without changes in power spectra and below the threshold of TCEPs. Our findings demonstrate that DRTt stimulation within normal clinical bounds does not excite fibers directly connected with primary motor cortex but that supra-clinical stimulation can excite a direct axonal tract. Both clinical efficacy and phase-amplitude coupling were frequency-dependent, favoring a synaptic filtering model as a possible mechanism of action.

Day one postoperative MRI findings following electrode placement for deep brain stimulation: analysis of a large case series

Objective

This study sought to characterize postoperative day one MRI findings in deep brain stimulation (DBS) patients.

Methods

DBS patients were identified by CPT and had their reviewed by a trained neuroradiologist and neurosurgeon blinded to MR sequence and patient information. The radiographic abnormalities of interest were track microhemorrhage, pneumocephalus, hematomas, and edema, and the occurrence of these findings in compare the detection of these complications between T1/T2 gradient-echo (GRE) and T1/T2 fluid-attenuated inversion recovery (FLAIR) magnetic resonance (MR) sequences was compared. The presence, size, and association of susceptibility artifact with other radiographic abnormalities was also described. Lastly, the association of multiple microelectrode cannula passes with each radiographic finding was evaluated. Ad-hoc investigation evaluated hemisphere-specific associations. Multiple logistic regression with Bonferroni correction (corrected p = 0.006) was used for all analysis.

Results

Out of 198 DBS patients reviewed, 115 (58%) patients showed entry microhemorrhage; 77 (39%) track microhemorrhage; 44 (22%) edema; 69 (35%) pneumocephalus; and 12 (6%) intracranial hematoma. T2 GRE was better for detecting microhemorrhage (OR = 14.82, p < 0.0001 for entry site and OR = 4.03, p < 0.0001 for track) and pneumocephalus (OR = 11.86, p < 0.0001), while T2 FLAIR was better at detecting edema (OR = 123.6, p < 0.0001). The relatively common findings of microhemorrhage and edema were best visualized by T2 GRE and T2 FLAIR sequences, respectively. More passes intraoperatively was associated with detection of ipsilateral track microhemorrhage (OR = 7.151, p < 0.0001 left; OR = 8.953, p < 0.0001 right). Susceptibility artifact surrounding electrodes possibly interfered with further detection of ipsilateral edema (OR = 4.323, p = 0.0025 left hemisphere only).

Discussion

Day one postoperative magnetic resonance imaging (MRI) for DBS patients can be used to detect numerous radiographic abnormalities not identifiable on a computed tomographic (CT) scan. For this cohort, multiple stimulating cannula passes intraoperatively was associated with increased microhemorrhage along the electrode track. Further studies should be performed to evaluate the clinical relevance of these observations.

Interfacing neural cells with typical microelectronics materials for future manufacturing

The biocompatibility of materials used in electronic devices is critical for the development of implantable devices like pacemakers and neuroprosthetics, as well as in future biomanufacturing. Biocompatibility refers to the ability of these materials to interact with living cells and tissues without causing an adverse response. Therefore, it is essential to evaluate the biocompatibility of metals and semiconductor materials used in electronic devices to ensure their safe use in medical applications. Here, we evaluated the biocompatibility of a collection of diced silicon chips coated with a variety of metal thin films, interfacing them with different cell types, including murine mastocytoma cells in suspension culture, adherent NIH 3T3 fibroblasts, and human induced pluripotent stem cell (iPSC)-derived neural progenitor cells (NPCs). All materials tested were biocompatible and showed the potential to support neural differentiation of iPSC-NPCs, creating an opportunity to use these materials in a scalable production of a range of biohybrid devices such as electronic devices to study neural behaviors and neuropathies.

Does Impaired Plantar Cutaneous Vibration Perception Contribute to Axial Motor Symptoms in Parkinson's Disease? Effects of Medication and Subthalamic Nucleus Deep Brain Stimulation

OBJECTIVE

To investigate whether impaired plantar cutaneous vibration perception contributes to axial motor symptoms in Parkinson's disease (PD) and whether anti-parkinsonian medication and subthalamic nucleus deep brain stimulation (STN-DBS) show different effects.

METHODS

Three groups were evaluated: PD patients in the medication "on" state (PD-MED), PD patients in the medication "on" state and additionally "on" STN-DBS (PD-MED-DBS), as well as healthy subjects (HS) as reference. Motor performance was analyzed using a pressure distribution platform. Plantar cutaneous vibration perception thresholds (VPT) were investigated using a customized vibration exciter at 30 Hz.

RESULTS

Motor performance of PD-MED and PD-MED-DBS was characterized by greater postural sway, smaller limits of stability ranges, and slower gait due to shorter strides, fewer steps per minute, and broader stride widths compared to HS. Comparing patient groups, PD-MED-DBS showed better overall motor performance than PD-MED, particularly for the functional limits of stability and gait. VPTs were significantly higher for PD-MED compared to those of HS, which suggests impaired plantar cutaneous vibration perception in PD. However, PD-MED-DBS showed less impaired cutaneous vibration perception than PD-MED.

CONCLUSIONS

PD patients suffer from poor motor performance compared to healthy subjects. Anti-parkinsonian medication in tandem with STN-DBS seems to be superior for normalizing axial motor symptoms compared to medication alone. Plantar cutaneous vibration perception is impaired in PD patients, whereas anti-parkinsonian medication together with STN-DBS is superior for normalizing tactile cutaneous perception compared to medication alone. Consequently, based on our results and the findings of the literature, impaired plantar cutaneous vibration perception might contribute to axial motor symptoms in PD.

PEDOT:PSS-coated platinum electrodes for neural stimulation

Safe and long-term electrical stimulation of neurons requires charge injection without damaging the electrode and tissue. A common strategy to diminish adverse effects includes the modification of electrodes with materials that increases the charge injection capacity. Due to its high capacitance, the conducting polymer PEDOT:PSS is a promising coating material; however, the neural stimulation performance in terms of stability and safety remains largely unexplored. Here, PEDOT:PSS-coated platinum (Pt-PEDOT:PSS) microelectrodes are examined for neural stimulation and compared to bare platinum (Pt) electrodes. Microelectrodes in a bipolar configuration are used to deliver current-controlled, biphasic pulses with charge densities ranging from 64 to 255 μC cm-2. Stimulation for 2 h deteriorates bare Pt electrodes through corrosion, whereas the PEDOT:PSS coating prevents dissolution of Pt and shows no degradation. Acute stimulation of primary cortical cells cultured as neurospheres shows similar dependency on charge density for Pt and Pt-PEDOT:PSS electrodes with a threshold of 127 μC cm-2 and increased calcium response for higher charge densities. Continuous stimulation for 2 h results in higher levels of cell survival for Pt-PEDOT:PSS electrodes. Reduced cell survival on Pt electrodes is most profound for neurospheres in proximity of the electrodes. Extending the stimulation duration to 6 h increases cell death for both types of electrodes; however, neurospheres on Pt-PEDOT:PSS devices still show significant viability whereas stimulation is fatal for nearly all cells close to the Pt electrodes. This work demonstrates the protective properties of PEDOT:PSS that can be used as a promising approach to extend electrode lifetime and reduce cell damage for safe and long-term neural stimulation.

Neuronal and synaptic adaptations underlying the benefits of deep brain stimulation for Parkinson's disease

Deep brain stimulation (DBS) is a well-established and effective treatment for patients with advanced Parkinson's disease (PD), yet its underlying mechanisms remain enigmatic. Optogenetics, primarily conducted in animal models, provides a unique approach that allows cell type- and projection-specific modulation that mirrors the frequency-dependent stimulus effects of DBS. Opto-DBS research in animal models plays a pivotal role in unraveling the neuronal and synaptic adaptations that contribute to the efficacy of DBS in PD treatment. DBS-induced neuronal responses rely on a complex interplay between the distributions of presynaptic inputs, frequency-dependent synaptic depression, and the intrinsic excitability of postsynaptic neurons. This orchestration leads to conversion of firing patterns, enabling both antidromic and orthodromic modulation of neural circuits. Understanding these mechanisms is vital for decoding position- and programming-dependent effects of DBS. Furthermore, patterned stimulation is emerging as a promising strategy yielding long-lasting therapeutic benefits. Research on the neuronal and synaptic adaptations to DBS may pave the way for the development of more enduring and precise modulation patterns. Advanced technologies, such as adaptive DBS or directional electrodes, can also be integrated for circuit-specific neuromodulation. These insights hold the potential to greatly improve the effectiveness of DBS and advance PD treatment to new levels.

Hypothalamic Supramammillary Control of Cognition and Motivation

The supramammillary nucleus (SuM) is a small region in the ventromedial posterior hypothalamus. The SuM has been relatively understudied with much of the prior focus being on its connection with septo-hippocampal circuitry. Thus, most studies conducted until the 21st century examined its role in hippocampal processes, such as theta rhythm and learning/memory. In recent years, the SuM has been "rediscovered" as a crucial hub for several behavioral and cognitive processes, including reward-seeking, exploration, and social memory. Additionally, it has been shown to play significant roles in hippocampal plasticity and adult neurogenesis. This review highlights findings from recent studies using cutting-edge systems neuroscience tools that have shed light on these fascinating roles for the SuM.

Advances in Deep Brain Stimulation: From Mechanisms to Applications

Deep brain stimulation (DBS) is an effective therapy for various neurologic and neuropsychiatric disorders, involving chronic implantation of electrodes into target brain regions for electrical stimulation delivery. Despite its safety and efficacy, DBS remains an underutilized therapy. Advances in the field of DBS, including in technology, mechanistic understanding, and applications have the potential to expand access and use of DBS, while also improving clinical outcomes. Developments in DBS technology, such as MRI compatibility and bidirectional DBS systems capable of sensing neural activity while providing therapeutic stimulation, have enabled advances in our understanding of DBS mechanisms and its application. In this review, we summarize recent work exploring DBS modulation of target networks. We also cover current work focusing on improved programming and the development of novel stimulation paradigms that go beyond current standards of DBS, many of which are enabled by sensing-enabled DBS systems and have the potential to expand access to DBS.

Automated calibration of somatosensory stimulation using reinforcement learning

BACKGROUND

The identification of the electrical stimulation parameters for neuromodulation is a subject-specific and time-consuming procedure that presently mostly relies on the expertise of the user (e.g., clinician, experimenter, bioengineer). Since the parameters of stimulation change over time (due to displacement of electrodes, skin status, etc.), patients undergo recurrent, long calibration sessions, along with visits to the clinics, which are inefficient and expensive. To address this issue, we developed an automatized calibration system based on reinforcement learning (RL) allowing for accurate and efficient identification of the peripheral nerve stimulation parameters for somatosensory neuroprostheses.

METHODS

We developed an RL algorithm to automatically select neurostimulation parameters for restoring sensory feedback with transcutaneous electrical nerve stimulation (TENS). First, the algorithm was trained offline on a dataset comprising 49 subjects. Then, the neurostimulation was then integrated with a graphical user interface (GUI) to create an intuitive AI-based mapping platform enabling the user to autonomously perform the sensation characterization procedure. We assessed the algorithm against the performance of both experienced and naïve and of a brute force algorithm (BFA), on 15 nerves from five subjects. Then, we validated the AI-based platform on six neuropathic nerves affected by distal sensory loss.

RESULTS

Our automatized approach demonstrated the ability to find the optimal values of neurostimulation achieving reliable and comfortable elicited sensations. When compared to alternatives, RL outperformed the naïve and BFA, significantly decreasing the time for mapping and the number of delivered stimulation trains, while improving the overall quality. Furthermore, the RL algorithm showed performance comparable to trained experimenters. Finally, we exploited it successfully for eliciting sensory feedback in neuropathic patients.

CONCLUSIONS

Our findings demonstrated that the AI-based platform based on a RL algorithm can automatically and efficiently calibrate parameters for somatosensory nerve stimulation. This holds promise to avoid experts' employment in similar scenarios, thanks to the merging between AI and neurotech. Our RL algorithm has the potential to be used in other neuromodulation fields requiring a mapping process of the stimulation parameters.

TRIAL REGISTRATION

ClinicalTrial.gov (Identifier: NCT04217005).

Deep brain stimulation for treatment resistant obsessive compulsive disorder; an observational study with ten patients under real-life conditions

Introduction

Obsessive-compulsive disorder (OCD) affects 2-3% of the global population, causing distress in many functioning levels. Standard treatments only lead to a partial recovery, and about 10% of the patients remain treatment-resistant. Deep brain stimulation offers a treatment option for severe, therapy-refractory OCD, with a reported response of about 60%. We report a comprehensive clinical, demographic, and treatment data for patients who were treated with DBS in our institution.

Methods

We offered DBS to patients with severe chronic treatment resistant OCD. Severity was defined as marked impairment in functioning and treatment resistance was defined as non-response to adequate trials of medications and psychotherapy. Between 2020 and 2022, 11 patients were implanted bilaterally in the bed nucleus of stria terminalis (BNST). Patients were evaluated with YBOCS, MADRS, GAF, CGI, and WHOQOL-BREF. We performed the ratings at baseline (before surgery), after implantation before the start of the stimulation, after reaching satisfactory stimulation parameters, and at follow-up visits 3, 6, 9, and 12 months after optimized stimulation.

Results

One patient has retracted his consent to publish the results of his treatment, thus we are reporting the results of 10 patients (5 males, 5 females, mean age: 37 years). Out of our 10 patients, 6 have shown a clear response indicated by a YBOCS-reduction between 42 and 100 percent at last follow-up. One further patient experienced a subjectively dramatic effect on OCD symptoms, but opted afterwards to stop the stimulation. The other 3 patients showed a slight, non-significant improvement of YBOCS between 8.8 and 21.9%. The overall mean YBOCS decreased from 28.3 at baseline to 13.3 (53% reduction) at the last follow-up. The improvement of the OCD symptoms was also accompanied by an improvement of depressive symptoms, global functioning, and quality of life.

Conclusion

Our results suggest that BNST-DBS can be effective for treatment-resistant OCD patients, as indicated by a reduction in symptoms and an overall improvement in functioning. Despite the need for additional research to define the patients' selection criteria, the most appropriate anatomical target, and the most effective stimulation parameters, improved patient access for this therapy should be established.