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Koek RJ, Avecillas-Chasin J, Krahl SE, Chen JW, Sultzer DL, Kulick AD, Mandelkern MA, Malpetti M, Gordon HL, Landry HN, Einstein EH, Langevin JP. Deep brain stimulation of the amygdala for treatment-resistant combat post-traumatic stress disorder: Long-term results. J Psychiatr Res 2024; 175:131-139. [PMID: 38733927 DOI: 10.1016/j.jpsychires.2024.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 04/23/2024] [Accepted: 05/02/2024] [Indexed: 05/13/2024]
Abstract
Deep brain stimulation (DBS) holds promise for neuropsychiatric conditions where imbalance in network activity contributes to symptoms. Treatment-resistant Combat post-traumatic stress disorder (TR-PTSD) is a highly morbid condition and 50% of PTSD sufferers fail to recover despite psychotherapy or pharmacotherapy. Reminder-triggered symptoms may arise from inadequate top-down ventromedial prefrontal cortex (vmPFC) control of amygdala reactivity. Here, we report long-term data on two TR-PTSD participants from an investigation utilizing high-frequency amygdala DBS. The two combat veterans were implanted bilaterally with quadripolar electrodes targeting the basolateral amygdala. Following a randomized staggered onset, patients received stimulation with adjustments based on PTSD symptom severity for four years while psychiatric and neuropsychiatric symptoms, neuropsychological performance, and electroencephalography were systematically monitored. Evaluation of vmPFC-Amygdala network engagement was assessed with 18FDG positron emission tomography (PET). CAPS-IV scores varied over time, but improved 55% from 119 at baseline to 53 at 4-year study endpoint in participant 1; and 44%, from 68 to 38 in participant 2. Thereafter, during 5 and 1.5 years of subsequent clinical care respectively, long-term bilateral amygdala DBS was associated with additional, clinically significant symptomatic and functional improvement. There were no serious stimulation-related adverse psychiatric, neuropsychiatric, neuropsychological, neurological, or neurosurgical effects. In one subject, symptomatic improvement was associated with an intensity-dependent reduction in amygdala theta frequency power. In our two participants, FDG-PET findings were inconclusive regarding the hypothesized mechanism of suppression of amygdala hyperactivity. Our findings encourage further research to confirm and extend our preliminary observations.
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Affiliation(s)
- Ralph J Koek
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at University of California, Los Angeles, 760 Westwood Blvd., Room 58-229, Los Angeles, CA, USA, 90095-1759; Psychiatry Service, Mental Health and Behavioral Sciences, Sepulveda Ambulatory Care Center, VAGLAHS, 16111 Plummer St. (116A-11), North Hills, CA, USA, 91343.
| | - Josue Avecillas-Chasin
- Department of Neurosurgery University of Nebraska Medical Center College of Medicine, 42nd and Emile, Omaha, Nebraska USA, 68198.
| | - Scott E Krahl
- Department of Neurosurgery, University of California at Los Angeles (UCLA), 300 Stein Plaza Driveway Suite 420, Los Angeles, CA, 90095, USA; Research Service, VAGLAHS (Clinical Neurophysiology), 16111 Plummer St., Building 1, North Hills, CA, USA, 91343.
| | - James Wy Chen
- Department of Neurology, UCLA, 710 Westwood Plaza, Los Angeles, CA, 90095, USA; Neurology Service (Epilepsy Center of Excellence), VAGLAHS, 11301 Wilshire Blvd, Los Angeles, CA, USA, 90073.
| | - David L Sultzer
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at University of California, Los Angeles, 760 Westwood Blvd., Room 58-229, Los Angeles, CA, USA, 90095-1759; Department of Psychiatry and Human Behavior, School of Medicine, University of California, Irvine Institute for Memory Impairments and Neurological Disorders, 3214 Biological Sciences III, Irvine, CA, USA, 92697-4545.
| | - Alexis D Kulick
- Psychology Service (Neuropsychology), Mental Health and Behavioral Sciences, VAGLAHS, 16111 Plummer St. (116A-11) North Hills, CA, USA, 91343.
| | - Mark A Mandelkern
- Imaging Department, VAGLAHS, 11301 Wilshire Blvd, Los Angeles, CA, USA, 90073.
| | - Maura Malpetti
- Department of Clinical Neurosciences, Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge, UK.
| | - Hailey L Gordon
- STEM Pathways at Boston University, 610 Commonwealth Avenue, Room 402, Boston, MA, 02215, USA.
| | | | - Evan H Einstein
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at University of California, Los Angeles, 760 Westwood Blvd., Room 58-229, Los Angeles, CA, USA, 90095-1759
| | - Jean-Philippe Langevin
- Department of Neurosurgery, UCLA, 300 Stein Plaza Driveway Suite 420, Los Angeles, CA, 90095, USA; Southwest VA Epilepsy Center of Excellence, 11301 Wilshire Blvd, Bldg 500 (10H2), Los Angeles, CA, USA, 90073.
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Sivakumar W, Guan J, Langevin JP, Barkhoudarian G, Kelly DF, Martin N. Enhanced recovery after brain tumor surgery: pilot protocol implementation in a large healthcare system. Neurosurg Focus 2023; 55:E5. [PMID: 38039543 DOI: 10.3171/2023.9.focus23563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 09/28/2023] [Indexed: 12/03/2023]
Abstract
OBJECTIVE Enhanced recovery after surgery (ERAS) protocols have been used in numerous specialties to improve the safety, efficiency, and cost of surgical interventions. Despite these successes, implementation of ERAS in cranial neurosurgery remains limited. In this study, a comprehensive ERAS protocol was implemented at two pilot sites within the Providence Health & Services system, and groundwork was laid for systemwide adoption. METHODS An enhanced recovery protocol was developed and implemented through an interdisciplinary team of clinicians, executive leadership, and clinical informatics professionals across preoperative, intraoperative, and postoperative domains. Outcomes including length of stay, discharge destination, and cost were collected through systemwide databases and compared with nonprotocolized sites. RESULTS During the study period, both pilot sites became top performers across the regional system in all evaluated metrics. The median length of stay for elective craniotomy at site 1 was reduced to 1.25 days, with a home discharge rate of > 90%. The cost per case at the pilot sites was nearly $7000 less on average than that of the nonprotocolized sites. CONCLUSIONS Implementation of enhanced recovery protocols for brain tumor surgery is feasible and effective, resulting in marked improvements in healthcare efficiency. Future studies, including implementation of the current protocol across the entire Providence system, are needed to maximize the potential benefits of enhanced recovery programs.
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Affiliation(s)
- Walavan Sivakumar
- 1Department of Neurosurgery, Pacific Neuroscience Institute, Santa Monica, California; and
- 2Department of Neurosurgery and Neuroscience, Saint John's Cancer Institute, Santa Monica, California
| | - Jian Guan
- 1Department of Neurosurgery, Pacific Neuroscience Institute, Santa Monica, California; and
- 2Department of Neurosurgery and Neuroscience, Saint John's Cancer Institute, Santa Monica, California
| | - Jean-Philippe Langevin
- 1Department of Neurosurgery, Pacific Neuroscience Institute, Santa Monica, California; and
| | - Garni Barkhoudarian
- 1Department of Neurosurgery, Pacific Neuroscience Institute, Santa Monica, California; and
- 2Department of Neurosurgery and Neuroscience, Saint John's Cancer Institute, Santa Monica, California
| | - Daniel F Kelly
- 1Department of Neurosurgery, Pacific Neuroscience Institute, Santa Monica, California; and
- 2Department of Neurosurgery and Neuroscience, Saint John's Cancer Institute, Santa Monica, California
| | - Neil Martin
- 1Department of Neurosurgery, Pacific Neuroscience Institute, Santa Monica, California; and
- 2Department of Neurosurgery and Neuroscience, Saint John's Cancer Institute, Santa Monica, California
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Maoz SLL, Stangl M, Topalovic U, Batista D, Hiller S, Aghajan ZM, Knowlton B, Stern J, Langevin JP, Fried I, Eliashiv D, Suthana N. Dynamic neural representations of memory and space during human ambulatory navigation. Nat Commun 2023; 14:6643. [PMID: 37863929 PMCID: PMC10589239 DOI: 10.1038/s41467-023-42231-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 10/03/2023] [Indexed: 10/22/2023] Open
Abstract
Our ability to recall memories of personal experiences is an essential part of daily life. These episodic memories often involve movement through space and thus require continuous encoding of one's position relative to the surrounding environment. The medial temporal lobe (MTL) is thought to be critically involved, based on studies in freely moving rodents and stationary humans. However, it remains unclear if and how the MTL represents both space and memory especially during physical navigation, given challenges associated with deep brain recordings in humans during movement. We recorded intracranial electroencephalographic (iEEG) activity while participants completed an ambulatory spatial memory task within an immersive virtual reality environment. MTL theta activity was modulated by successful memory retrieval or spatial positions within the environment, depending on dynamically changing behavioral goals. Altogether, these results demonstrate how human MTL oscillations can represent both memory and space in a temporally flexible manner during freely moving navigation.
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Affiliation(s)
- Sabrina L L Maoz
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, CA, 90095, USA
- Medical Scientist Training Program, University of California, Los Angeles, Los Angeles, CA, 90095, USA
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, 90024, USA
| | - Matthias Stangl
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, 90024, USA
| | - Uros Topalovic
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, 90024, USA
| | - Daniel Batista
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, 90024, USA
| | - Sonja Hiller
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, 90024, USA
| | - Zahra M Aghajan
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, 90024, USA
| | - Barbara Knowlton
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - John Stern
- Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Jean-Philippe Langevin
- Neurosurgery Service, Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, 90073, USA
- Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Itzhak Fried
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, 90024, USA
- Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, 90095, USA
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, 69978, Israel
| | - Dawn Eliashiv
- Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Nanthia Suthana
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, CA, 90095, USA.
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, 90024, USA.
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, 90095, USA.
- Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, 90095, USA.
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Gill JL, Schneiders JA, Stangl M, Aghajan ZM, Vallejo M, Hiller S, Topalovic U, Inman CS, Villaroman D, Bari A, Adhikari A, Rao VR, Fanselow MS, Craske MG, Krahl SE, Chen JWY, Vick M, Hasulak NR, Kao JC, Koek RJ, Suthana N, Langevin JP. A pilot study of closed-loop neuromodulation for treatment-resistant post-traumatic stress disorder. Nat Commun 2023; 14:2997. [PMID: 37225710 PMCID: PMC10209131 DOI: 10.1038/s41467-023-38712-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 05/12/2023] [Indexed: 05/26/2023] Open
Abstract
The neurophysiological mechanisms in the human amygdala that underlie post-traumatic stress disorder (PTSD) remain poorly understood. In a first-of-its-kind pilot study, we recorded intracranial electroencephalographic data longitudinally (over one year) in two male individuals with amygdala electrodes implanted for the management of treatment-resistant PTSD (TR-PTSD) under clinical trial NCT04152993. To determine electrophysiological signatures related to emotionally aversive and clinically relevant states (trial primary endpoint), we characterized neural activity during unpleasant portions of three separate paradigms (negative emotional image viewing, listening to recordings of participant-specific trauma-related memories, and at-home-periods of symptom exacerbation). We found selective increases in amygdala theta (5-9 Hz) bandpower across all three negative experiences. Subsequent use of elevations in low-frequency amygdala bandpower as a trigger for closed-loop neuromodulation led to significant reductions in TR-PTSD symptoms (trial secondary endpoint) following one year of treatment as well as reductions in aversive-related amygdala theta activity. Altogether, our findings provide early evidence that elevated amygdala theta activity across a range of negative-related behavioral states may be a promising target for future closed-loop neuromodulation therapies in PTSD.
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Affiliation(s)
- Jay L Gill
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
- Medical Scientist Training Program, University of California, Los Angeles, CA, USA
| | - Julia A Schneiders
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
- Research and Development Service; Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Matthias Stangl
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Zahra M Aghajan
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
- Department of Neurosurgery, University of California, Los Angeles, CA, USA
| | - Mauricio Vallejo
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Sonja Hiller
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Uros Topalovic
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
- Department of Electrical and Computer Engineering, University of California, Los Angeles, CA, USA
| | - Cory S Inman
- Department of Psychology, University of Utah, Salt Lake City, UT, USA
| | - Diane Villaroman
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Ausaf Bari
- Department of Neurosurgery, University of California, Los Angeles, CA, USA
| | - Avishek Adhikari
- Department of Psychology, University of California, Los Angeles, CA, USA
| | - Vikram R Rao
- Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Michael S Fanselow
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
- Department of Psychology, University of California, Los Angeles, CA, USA
| | - Michelle G Craske
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
- Department of Psychology, University of California, Los Angeles, CA, USA
| | - Scott E Krahl
- Research and Development Service; Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- Department of Neurosurgery, University of California, Los Angeles, CA, USA
| | - James W Y Chen
- Neurology Service; Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- Department of Neurology, University of California, Los Angeles, CA, USA
| | | | - Nicholas R Hasulak
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
- Phoenix Research Consulting LLC, Gilbert, AZ, USA
| | - Jonathan C Kao
- Department of Electrical and Computer Engineering, University of California, Los Angeles, CA, USA
| | - Ralph J Koek
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
- Psychiatry and Mental Health Service; Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Nanthia Suthana
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA.
- Department of Neurosurgery, University of California, Los Angeles, CA, USA.
- Department of Psychology, University of California, Los Angeles, CA, USA.
- Department of Bioengineering, University of California, Los Angeles, CA, USA.
| | - Jean-Philippe Langevin
- Department of Neurosurgery, University of California, Los Angeles, CA, USA.
- Neurosurgery Service; Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
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Avecillas-Chasin JM, Levinson S, Kuhn T, Omidbeigi M, Langevin JP, Pouratian N, Bari A. Author Correction: Connectivity-based parcellation of the amygdala and identification of its main white matter connections. Sci Rep 2023; 13:5495. [PMID: 37015960 PMCID: PMC10073221 DOI: 10.1038/s41598-023-32200-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2023] Open
Affiliation(s)
- Josue M Avecillas-Chasin
- Department of Neurosurgery, University of Nebraska Medical Center, 988437 Nebraska Medical Center, Omaha, NE, 68198-8437, USA.
- Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
| | - Simon Levinson
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Taylor Kuhn
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA, USA
| | - Mahmoud Omidbeigi
- Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Jean-Philippe Langevin
- Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Neurosurgery Service, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Nader Pouratian
- Department of Neurological Surgery, UT Southwestern Medical Center, Dallas, TX, USA
| | - Ausaf Bari
- Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
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Avecillas-Chasin JM, Levinson S, Kuhn T, Omidbeigi M, Langevin JP, Pouratian N, Bari A. Connectivity-based parcellation of the amygdala and identification of its main white matter connections. Sci Rep 2023; 13:1305. [PMID: 36693904 PMCID: PMC9873600 DOI: 10.1038/s41598-023-28100-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 01/12/2023] [Indexed: 01/25/2023] Open
Abstract
The amygdala plays a role in emotion, learning, and memory and has been implicated in behavioral disorders. Better understanding of the amygdala circuitry is crucial to develop new therapies for these disorders. We used data from 200 healthy-subjects from the human connectome project. Using probabilistic tractography, we created population statistical maps of amygdala connectivity to brain regions involved in limbic, associative, memory, and reward circuits. Based on the amygdala connectivity with these regions, we applied k-means clustering to parcellate the amygdala into three clusters. The resultant clusters were averaged across all subjects and the main white-matter pathways of the amygdala from each averaged cluster were generated. Amygdala parcellation into three clusters showed a medial-to-lateral pattern. The medial cluster corresponded with the centromedial and cortical nuclei, the basal cluster with the basal nuclei and the lateral cluster with the lateral nuclei. The connectivity analysis revealed different white-matter pathways consistent with the anatomy of the amygdala circuit. This in vivo connectivity-based parcellation of the amygdala delineates three clusters of the amygdala in a mediolateral pattern based on its connectivity with brain areas involved in cognition, memory, emotion, and reward. The human amygdala circuit presented in this work provides the first step for personalized amygdala circuit mapping for patients with behavioral disorders.
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Affiliation(s)
- Josue M Avecillas-Chasin
- Department of Neurosurgery, University of Nebraska Medical Center, 988437 Nebraska Medical Center, Omaha, NE, 68198-8437, USA. .,Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
| | - Simon Levinson
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Taylor Kuhn
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA, USA
| | - Mahmoud Omidbeigi
- Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Jean-Philippe Langevin
- Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.,Neurosurgery Service, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Nader Pouratian
- Department of Neurological Surgery, UT Southwestern Medical Center, Dallas, TX, USA
| | - Ausaf Bari
- Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
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Chasin JA, Levinson S, Khun T, Omidbeigi M, Pouratian N, Langevin JP, Bari A. ID:16202 Tractography-Based Parcellation of the Amygdala. Neuromodulation 2022. [DOI: 10.1016/j.neurom.2022.02.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Vedam-Mai V, Deisseroth K, Giordano J, Lazaro-Munoz G, Chiong W, Suthana N, Langevin JP, Gill J, Goodman W, Provenza NR, Halpern CH, Shivacharan RS, Cunningham TN, Sheth SA, Pouratian N, Scangos KW, Mayberg HS, Horn A, Johnson KA, Butson CR, Gilron R, de Hemptinne C, Wilt R, Yaroshinsky M, Little S, Starr P, Worrell G, Shirvalkar P, Chang E, Volkmann J, Muthuraman M, Groppa S, Kühn AA, Li L, Johnson M, Otto KJ, Raike R, Goetz S, Wu C, Silburn P, Cheeran B, Pathak YJ, Malekmohammadi M, Gunduz A, Wong JK, Cernera S, Hu W, Wagle Shukla A, Ramirez-Zamora A, Deeb W, Patterson A, Foote KD, Okun MS. Corrigendum: Proceedings of the Eighth Annual Deep Brain Stimulation Think Tank: Advances in Optogenetics, Ethical Issues Affecting DBS Research, Neuromodulatory Approaches for Depression, Adaptive Neurostimulation, and Emerging DBS Technologies. Front Hum Neurosci 2021; 15:765150. [PMID: 34658825 PMCID: PMC8517517 DOI: 10.3389/fnhum.2021.765150] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 09/03/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Vinata Vedam-Mai
- Norman Fixel Institute for Neurological Diseases and the Program for Movement Disorders and Neurorestoration, Department of Neurology, University of Florida, Gainesville, FL, United States
| | - Karl Deisseroth
- Department of Bioengineering, Stanford University, Stanford, CA, United States.,Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, United States
| | - James Giordano
- Department of Neurology and Neuroethics Studies Program, Georgetown University Medical Center, Washington, DC, United States
| | - Gabriel Lazaro-Munoz
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, United States
| | - Winston Chiong
- Weill Institute for Neurosciences, Memory and Aging Center, University of California, San Francisco, San Francisco, CA, United States
| | - Nanthia Suthana
- Department of Neurosurgery, David Geffen School of Medicine and Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, United States.,Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, United States.,Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States.,Department of Bioengineering, University of California, Los Angeles, Los Angeles, CA, United States
| | - Jean-Philippe Langevin
- Department of Neurosurgery, David Geffen School of Medicine and Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, United States.,Neurosurgery Service, Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, United States
| | - Jay Gill
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, United States
| | - Wayne Goodman
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States
| | - Nicole R Provenza
- School of Engineering, Brown University, Providence, RI, United States
| | - Casey H Halpern
- Department of Neurosurgery, Stanford University Medical Center, Stanford, CA, United States
| | - Rajat S Shivacharan
- Department of Neurosurgery, Stanford University Medical Center, Stanford, CA, United States
| | - Tricia N Cunningham
- Department of Neurosurgery, Stanford University Medical Center, Stanford, CA, United States
| | - Sameer A Sheth
- Department of Neurological Surgery, Baylor College of Medicine, Houston, TX, United States
| | - Nader Pouratian
- Department of Neurosurgery, David Geffen School of Medicine and Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, United States
| | - Katherine W Scangos
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, United States
| | - Helen S Mayberg
- Department of Neurology and Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Andreas Horn
- Movement Disorders & Neuromodulation Unit, Department for Neurology, Charité - University Medicine Berlin, Berlin, Germany
| | - Kara A Johnson
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, United States.,Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT, United States
| | - Christopher R Butson
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, United States.,Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT, United States
| | - Ro'ee Gilron
- Department of Neurological Surgery, Kavli Institute for Fundamental Neuroscience, University of California, San Francisco, San Francisco, CA, United States
| | - Coralie de Hemptinne
- Norman Fixel Institute for Neurological Diseases and the Program for Movement Disorders and Neurorestoration, Department of Neurology, University of Florida, Gainesville, FL, United States.,Department of Neurological Surgery, Kavli Institute for Fundamental Neuroscience, University of California, San Francisco, San Francisco, CA, United States
| | - Robert Wilt
- Department of Neurological Surgery, Kavli Institute for Fundamental Neuroscience, University of California, San Francisco, San Francisco, CA, United States
| | - Maria Yaroshinsky
- Department of Neurological Surgery, Kavli Institute for Fundamental Neuroscience, University of California, San Francisco, San Francisco, CA, United States
| | - Simon Little
- Department of Neurological Surgery, Kavli Institute for Fundamental Neuroscience, University of California, San Francisco, San Francisco, CA, United States
| | - Philip Starr
- Department of Neurological Surgery, Kavli Institute for Fundamental Neuroscience, University of California, San Francisco, San Francisco, CA, United States
| | - Greg Worrell
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | - Prasad Shirvalkar
- Department of Neurological Surgery, Kavli Institute for Fundamental Neuroscience, University of California, San Francisco, San Francisco, CA, United States.,Department of Anesthesiology (Pain Management) and Neurology, University of California, San Francisco, San Francisco, CA, United States
| | - Edward Chang
- Department of Neurological Surgery, Kavli Institute for Fundamental Neuroscience, University of California, San Francisco, San Francisco, CA, United States
| | - Jens Volkmann
- Neurologischen Klinik Universitätsklinikum Würzburg, Würzburg, Germany
| | - Muthuraman Muthuraman
- Section of Movement Disorders and Neurostimulation, Biomedical Statistics and Multimodal Signal Processing Unit, Department of Neurology, Focus Program Translational Neuroscience, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Sergiu Groppa
- Section of Movement Disorders and Neurostimulation, Biomedical Statistics and Multimodal Signal Processing Unit, Department of Neurology, Focus Program Translational Neuroscience, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Andrea A Kühn
- Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Luming Li
- National Engineering Laboratory for Neuromodulation, School of Aerospace Engineering, Tsinghua University, Beijing, China
| | - Matthew Johnson
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN, United States
| | - Kevin J Otto
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, FL, United States
| | - Robert Raike
- Restorative Therapies Group Implantables, Research and Core Technology, Medtronic, Minneapolis, MN, United States
| | - Steve Goetz
- Restorative Therapies Group Implantables, Research and Core Technology, Medtronic, Minneapolis, MN, United States
| | - Chengyuan Wu
- Department of Neurological Surgery, Thomas Jefferson University Hospitals, Philadelphia, PA, United States
| | - Peter Silburn
- Asia Pacific Centre for Neuromodulation, Queensland Brain Institute, The University of Queensland, Brisbane, QLD, Australia
| | - Binith Cheeran
- Neuromodulation Division, Abbott, Plano, TX, United States
| | - Yagna J Pathak
- Neuromodulation Division, Abbott, Plano, TX, United States
| | | | - Aysegul Gunduz
- Norman Fixel Institute for Neurological Diseases and the Program for Movement Disorders and Neurorestoration, Department of Neurology, University of Florida, Gainesville, FL, United States.,J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, FL, United States
| | - Joshua K Wong
- Norman Fixel Institute for Neurological Diseases and the Program for Movement Disorders and Neurorestoration, Department of Neurology, University of Florida, Gainesville, FL, United States
| | - Stephanie Cernera
- Norman Fixel Institute for Neurological Diseases and the Program for Movement Disorders and Neurorestoration, Department of Neurology, University of Florida, Gainesville, FL, United States.,J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, FL, United States
| | - Wei Hu
- Norman Fixel Institute for Neurological Diseases and the Program for Movement Disorders and Neurorestoration, Department of Neurology, University of Florida, Gainesville, FL, United States
| | - Aparna Wagle Shukla
- Norman Fixel Institute for Neurological Diseases and the Program for Movement Disorders and Neurorestoration, Department of Neurology, University of Florida, Gainesville, FL, United States
| | - Adolfo Ramirez-Zamora
- Norman Fixel Institute for Neurological Diseases and the Program for Movement Disorders and Neurorestoration, Department of Neurology, University of Florida, Gainesville, FL, United States
| | - Wissam Deeb
- Department of Neurology, University of Massachusetts, Worchester, MA, United States
| | - Addie Patterson
- Norman Fixel Institute for Neurological Diseases and the Program for Movement Disorders and Neurorestoration, Department of Neurology, University of Florida, Gainesville, FL, United States
| | - Kelly D Foote
- Norman Fixel Institute for Neurological Diseases and the Program for Movement Disorders and Neurorestoration, Department of Neurology, University of Florida, Gainesville, FL, United States
| | - Michael S Okun
- Norman Fixel Institute for Neurological Diseases and the Program for Movement Disorders and Neurorestoration, Department of Neurology, University of Florida, Gainesville, FL, United States
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9
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Vedam-Mai V, Deisseroth K, Giordano J, Lazaro-Munoz G, Chiong W, Suthana N, Langevin JP, Gill J, Goodman W, Provenza NR, Halpern CH, Shivacharan RS, Cunningham TN, Sheth SA, Pouratian N, Scangos KW, Mayberg HS, Horn A, Johnson KA, Butson CR, Gilron R, de Hemptinne C, Wilt R, Yaroshinsky M, Little S, Starr P, Worrell G, Shirvalkar P, Chang E, Volkmann J, Muthuraman M, Groppa S, Kühn AA, Li L, Johnson M, Otto KJ, Raike R, Goetz S, Wu C, Silburn P, Cheeran B, Pathak YJ, Malekmohammadi M, Gunduz A, Wong JK, Cernera S, Wagle Shukla A, Ramirez-Zamora A, Deeb W, Patterson A, Foote KD, Okun MS. Proceedings of the Eighth Annual Deep Brain Stimulation Think Tank: Advances in Optogenetics, Ethical Issues Affecting DBS Research, Neuromodulatory Approaches for Depression, Adaptive Neurostimulation, and Emerging DBS Technologies. Front Hum Neurosci 2021; 15:644593. [PMID: 33953663 PMCID: PMC8092047 DOI: 10.3389/fnhum.2021.644593] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 03/10/2021] [Indexed: 12/20/2022] Open
Abstract
We estimate that 208,000 deep brain stimulation (DBS) devices have been implanted to address neurological and neuropsychiatric disorders worldwide. DBS Think Tank presenters pooled data and determined that DBS expanded in its scope and has been applied to multiple brain disorders in an effort to modulate neural circuitry. The DBS Think Tank was founded in 2012 providing a space where clinicians, engineers, researchers from industry and academia discuss current and emerging DBS technologies and logistical and ethical issues facing the field. The emphasis is on cutting edge research and collaboration aimed to advance the DBS field. The Eighth Annual DBS Think Tank was held virtually on September 1 and 2, 2020 (Zoom Video Communications) due to restrictions related to the COVID-19 pandemic. The meeting focused on advances in: (1) optogenetics as a tool for comprehending neurobiology of diseases and on optogenetically-inspired DBS, (2) cutting edge of emerging DBS technologies, (3) ethical issues affecting DBS research and access to care, (4) neuromodulatory approaches for depression, (5) advancing novel hardware, software and imaging methodologies, (6) use of neurophysiological signals in adaptive neurostimulation, and (7) use of more advanced technologies to improve DBS clinical outcomes. There were 178 attendees who participated in a DBS Think Tank survey, which revealed the expansion of DBS into several indications such as obesity, post-traumatic stress disorder, addiction and Alzheimer’s disease. This proceedings summarizes the advances discussed at the Eighth Annual DBS Think Tank.
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Affiliation(s)
- Vinata Vedam-Mai
- Norman Fixel Institute for Neurological Diseases and the Program for Movement Disorders and Neurorestoration, Department of Neurology, University of Florida, Gainesville, FL, United States
| | - Karl Deisseroth
- Department of Bioengineering, Stanford University, Stanford, CA, United States.,Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, United States
| | - James Giordano
- Department of Neurology and Neuroethics Studies Program, Georgetown University Medical Center, Washington, DC, United States
| | - Gabriel Lazaro-Munoz
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, United States
| | - Winston Chiong
- Weill Institute for Neurosciences, Memory and Aging Center, University of California, San Francisco, San Francisco, CA, United States
| | - Nanthia Suthana
- Department of Neurosurgery, David Geffen School of Medicine and Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, United States.,Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, United States.,Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States.,Department of Bioengineering, University of California, Los Angeles, Los Angeles, CA, United States
| | - Jean-Philippe Langevin
- Department of Neurosurgery, David Geffen School of Medicine and Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, United States.,Neurosurgery Service, Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, United States
| | - Jay Gill
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, United States
| | - Wayne Goodman
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States
| | - Nicole R Provenza
- School of Engineering, Brown University, Providence, RI, United States
| | - Casey H Halpern
- Department of Neurosurgery, Stanford University Medical Center, Stanford, CA, United States
| | - Rajat S Shivacharan
- Department of Neurosurgery, Stanford University Medical Center, Stanford, CA, United States
| | - Tricia N Cunningham
- Department of Neurosurgery, Stanford University Medical Center, Stanford, CA, United States
| | - Sameer A Sheth
- Department of Neurological Surgery, Baylor College of Medicine, Houston, TX, United States
| | - Nader Pouratian
- Department of Neurosurgery, David Geffen School of Medicine and Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, United States
| | - Katherine W Scangos
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, United States
| | - Helen S Mayberg
- Department of Neurology and Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Andreas Horn
- Movement Disorders & Neuromodulation Unit, Department for Neurology, Charité - University Medicine Berlin, Berlin, Germany
| | - Kara A Johnson
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, United States.,Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT, United States
| | - Christopher R Butson
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, United States.,Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT, United States
| | - Ro'ee Gilron
- Department of Neurological Surgery, Kavli Institute for Fundamental Neuroscience, University of California, San Francisco, San Francisco, CA, United States
| | - Coralie de Hemptinne
- Norman Fixel Institute for Neurological Diseases and the Program for Movement Disorders and Neurorestoration, Department of Neurology, University of Florida, Gainesville, FL, United States.,Department of Neurological Surgery, Kavli Institute for Fundamental Neuroscience, University of California, San Francisco, San Francisco, CA, United States
| | - Robert Wilt
- Department of Neurological Surgery, Kavli Institute for Fundamental Neuroscience, University of California, San Francisco, San Francisco, CA, United States
| | - Maria Yaroshinsky
- Department of Neurological Surgery, Kavli Institute for Fundamental Neuroscience, University of California, San Francisco, San Francisco, CA, United States
| | - Simon Little
- Department of Neurological Surgery, Kavli Institute for Fundamental Neuroscience, University of California, San Francisco, San Francisco, CA, United States
| | - Philip Starr
- Department of Neurological Surgery, Kavli Institute for Fundamental Neuroscience, University of California, San Francisco, San Francisco, CA, United States
| | - Greg Worrell
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | - Prasad Shirvalkar
- Department of Neurological Surgery, Kavli Institute for Fundamental Neuroscience, University of California, San Francisco, San Francisco, CA, United States.,Department of Anesthesiology (Pain Management) and Neurology, University of California, San Francisco, San Francisco, CA, United States
| | - Edward Chang
- Department of Neurological Surgery, Kavli Institute for Fundamental Neuroscience, University of California, San Francisco, San Francisco, CA, United States
| | - Jens Volkmann
- Neurologischen Klinik Universitätsklinikum Würzburg, Würzburg, Germany
| | - Muthuraman Muthuraman
- Section of Movement Disorders and Neurostimulation, Biomedical Statistics and Multimodal Signal Processing Unit, Department of Neurology, Focus Program Translational Neuroscience, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Sergiu Groppa
- Section of Movement Disorders and Neurostimulation, Biomedical Statistics and Multimodal Signal Processing Unit, Department of Neurology, Focus Program Translational Neuroscience, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Andrea A Kühn
- Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Luming Li
- National Engineering Laboratory for Neuromodulation, School of Aerospace Engineering, Tsinghua University, Beijing, China
| | - Matthew Johnson
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN, United States
| | - Kevin J Otto
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, FL, United States
| | - Robert Raike
- Restorative Therapies Group Implantables, Research and Core Technology, Medtronic, Minneapolis, MN, United States
| | - Steve Goetz
- Restorative Therapies Group Implantables, Research and Core Technology, Medtronic, Minneapolis, MN, United States
| | - Chengyuan Wu
- Department of Neurological Surgery, Thomas Jefferson University Hospitals, Philadelphia, PA, United States
| | - Peter Silburn
- Asia Pacific Centre for Neuromodulation, Queensland Brain Institute, The University of Queensland, Brisbane, QLD, Australia
| | - Binith Cheeran
- Neuromodulation Division, Abbott, Plano, TX, United States
| | - Yagna J Pathak
- Neuromodulation Division, Abbott, Plano, TX, United States
| | | | - Aysegul Gunduz
- Norman Fixel Institute for Neurological Diseases and the Program for Movement Disorders and Neurorestoration, Department of Neurology, University of Florida, Gainesville, FL, United States.,J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, FL, United States
| | - Joshua K Wong
- Norman Fixel Institute for Neurological Diseases and the Program for Movement Disorders and Neurorestoration, Department of Neurology, University of Florida, Gainesville, FL, United States
| | - Stephanie Cernera
- Norman Fixel Institute for Neurological Diseases and the Program for Movement Disorders and Neurorestoration, Department of Neurology, University of Florida, Gainesville, FL, United States.,J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, FL, United States
| | - Aparna Wagle Shukla
- Norman Fixel Institute for Neurological Diseases and the Program for Movement Disorders and Neurorestoration, Department of Neurology, University of Florida, Gainesville, FL, United States
| | - Adolfo Ramirez-Zamora
- Norman Fixel Institute for Neurological Diseases and the Program for Movement Disorders and Neurorestoration, Department of Neurology, University of Florida, Gainesville, FL, United States
| | - Wissam Deeb
- Department of Neurology, University of Massachusetts, Worchester, MA, United States
| | - Addie Patterson
- Norman Fixel Institute for Neurological Diseases and the Program for Movement Disorders and Neurorestoration, Department of Neurology, University of Florida, Gainesville, FL, United States
| | - Kelly D Foote
- Norman Fixel Institute for Neurological Diseases and the Program for Movement Disorders and Neurorestoration, Department of Neurology, University of Florida, Gainesville, FL, United States
| | - Michael S Okun
- Norman Fixel Institute for Neurological Diseases and the Program for Movement Disorders and Neurorestoration, Department of Neurology, University of Florida, Gainesville, FL, United States
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10
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Bari AA, Sparks H, Levinson S, Wilson B, London ED, Langevin JP, Pouratian N. Amygdala Structural Connectivity Is Associated With Impulsive Choice and Difficulty Quitting Smoking. Front Behav Neurosci 2020; 14:117. [PMID: 32714164 PMCID: PMC7351509 DOI: 10.3389/fnbeh.2020.00117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 06/11/2020] [Indexed: 11/24/2022] Open
Abstract
Introduction: The amygdala is known to play a role in mediating emotion and possibly addiction. We used probabilistic tractography (PT) to evaluate whether structural connectivity of the amygdala to the brain reward network is associated with impulsive choice and tobacco smoking. Methods: Diffusion and structural MRI scans were obtained from 197 healthy subjects (45 with a history of tobacco smoking) randomly sampled from the Human Connectome database. PT was performed to assess amygdala connectivity with several brain regions. Seed masks were generated, and statistical maps of amygdala connectivity were derived. Connectivity results were correlated with a subject performance both on a delayed discounting task and whether they met specified criteria for difficulty quitting smoking. Results: Amygdala connectivity was spatially segregated, with the strongest connectivity to the hippocampus, orbitofrontal cortex (OFC), and brainstem. Connectivity with the hippocampus was associated with preference for larger delayed rewards, whereas connectivity with the OFC, rostral anterior cingulate cortex (rACC), and insula were associated with preference for smaller immediate rewards. Greater nicotine dependence with difficulty quitting was associated with less hippocampal and greater brainstem connectivity. Scores on the Fagerstrom Test for Nicotine Dependence (FTND) correlated with rACC connectivity. Discussion: These findings highlight the importance of the amygdala-hippocampal-ACC network in the valuation of future rewards and substance dependence. These results will help to identify potential targets for neuromodulatory therapies for addiction and related disorders.
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Affiliation(s)
- Ausaf A Bari
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, CA, United States
| | - Hiro Sparks
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, CA, United States
| | - Simon Levinson
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, CA, United States
| | - Bayard Wilson
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, CA, United States
| | - Edythe D London
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine and Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, United States
| | - Jean-Philippe Langevin
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, CA, United States
| | - Nader Pouratian
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, CA, United States
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11
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Lai G, Langevin JP, Koek RJ, Krahl SE, Bari AA, Chen JWY. Acute Effects and the Dreamy State Evoked by Deep Brain Electrical Stimulation of the Amygdala: Associations of the Amygdala in Human Dreaming, Consciousness, Emotions, and Creativity. Front Hum Neurosci 2020; 14:61. [PMID: 32158384 PMCID: PMC7052301 DOI: 10.3389/fnhum.2020.00061] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 02/10/2020] [Indexed: 01/06/2023] Open
Abstract
Accurate localization of complex human experiences such as emotions, dreaming, creativity, and consciousness to specific cerebral structures or neural networks has remained elusive despite technological advances. We report the use of acute deep brain stimulation (DBS) to evoke behavioral and emotional effects by applying electrical stimulation (ES) at various voltage strengths to the basolateral and central subnuclei of the amygdala in addition to the head of hippocampus (HC) for two subjects with medically refractory post-traumatic stress disorder (PTSD). Our results suggest that the amygdala could be a node in a neural network responsible for the generation of complex vivid mental imagery and integrated sensory experiences similar to John Hughlings Jackson's "dreamy state" and "double consciousness," which have been classically associated with temporal lobe epilepsy during uncinate seizures. That we were able to elicit similar vivid, dynamic, complex, bizarre, and original mental imagery with ES in non-epileptic subjects suggests that Jackson's seizure related "dreamy state" and "double consciousness" may arise from heightened innate brain mechanisms with the amygdala acting as a node in the neural network responsible for physiologic dreaming and creative functions. Furthermore, our subjects experienced different emotions with different stimulation strengths at various electrode contacts. Our results suggest that higher voltage stimulation of the amygdala and HC at 4-5 V leads to predominantly negative responses and 2-4 V stimulation showed inversely coupled positive and negative responses of the amygdala in either hemisphere which may imply hemispheric dominance of emotional valences without relation to handedness. Due to the unique and complex responses dependent on location and strength of stimulation, we advise that all patients receiving DBS of the amygdala undergo acute stimulation mapping in a monitored setting before selecting therapeutic parameters for chronic stimulation.
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Affiliation(s)
- George Lai
- Neurology Service, VA Greater Los Angeles Healthcare System, Los Angeles, CA, United States.,Department of Neurology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Jean-Philippe Langevin
- Neurosurgery Service, VA Greater Los Angeles Healthcare System, Los Angeles, CA, United States.,Department of Neurosurgery, University of California, Los Angeles, Los Angeles, CA, United States
| | - Ralph J Koek
- Psychiatry and Mental Health Service, VA Greater Los Angeles Healthcare System, Los Angeles, CA, United States.,Department of Psychiatry and Behavior Sciences, University of California, Los Angeles, Los Angeles, CA, United States
| | - Scott E Krahl
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, CA, United States.,Research and Development, VA Greater Los Angeles Healthcare System, Los Angeles, CA, United States
| | - Ausaf A Bari
- Neurosurgery Service, VA Greater Los Angeles Healthcare System, Los Angeles, CA, United States.,Department of Neurosurgery, University of California, Los Angeles, Los Angeles, CA, United States
| | - James W Y Chen
- Neurology Service, VA Greater Los Angeles Healthcare System, Los Angeles, CA, United States.,Department of Neurology, University of California, Los Angeles, Los Angeles, CA, United States
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12
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Bina RW, Langevin JP. Developing New Indications: Strategies and Hurdles to Discovery. Stereotact Funct Neurosurg 2020. [DOI: 10.1007/978-3-030-34906-6_35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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13
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Avecillas-Chasin JM, Justo M, Levinson S, Koek R, Krahl SE, Chen JW, Lee SJ, Langevin JP, Bari A. Structural correlates of emotional response to electrical stimulation of the amygdala in subjects with PTSD. Brain Stimul 2019; 13:424-426. [PMID: 31884187 DOI: 10.1016/j.brs.2019.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Accepted: 12/09/2019] [Indexed: 11/28/2022] Open
Affiliation(s)
| | - Monica Justo
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Simon Levinson
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Ralph Koek
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA; Psychiatry Service VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Scott E Krahl
- Research Service, VA Greater Los Angeles Healthcare System. Department of Neurosurgery David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - James Wy Chen
- Department of Neurology David Geffen School of Medicine, University of California Los Angeles. Neurological Service, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Seung Jin Lee
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Jean-Philippe Langevin
- Department of Neurosurgery David Geffen School of Medicine, University of California Los Angeles. Neurosurgery Service, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Ausaf Bari
- Department of Neurosurgery David Geffen School of Medicine, University of California Los Angeles. Neurosurgery Service, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
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14
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Tucker A, Wallbom A, Darling M, Nguyen D, Everson R, Terterov S, Nastasi A, Langevin JP. Electrodiagnostic findings in postoperative C5 palsy after cervical laminectomy and fusion. Interdisciplinary Neurosurgery 2018. [DOI: 10.1016/j.inat.2018.05.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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15
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Bari AA, Mikell CB, Abosch A, Ben-Haim S, Buchanan RJ, Burton AW, Carcieri S, Cosgrove GR, D'Haese PF, Daskalakis ZJ, Eskandar EN, Gerrard JL, Goodman WK, Greenberg BD, Gross RE, Hamani C, Kiss ZHT, Konrad P, Kopell BH, Krinke L, Langevin JP, Lozano AM, Malone D, Mayberg HS, Miller JP, Patil PG, Peichel D, Petersen EA, Rezai AR, Richardson RM, Riva-Posse P, Sankar T, Schwalb JM, Simpson HB, Slavin K, Stypulkowski PH, Tosteson T, Warnke P, Willie JT, Zaghloul KA, Neimat JS, Pouratian N, Sheth SA. Charting the road forward in psychiatric neurosurgery: proceedings of the 2016 American Society for Stereotactic and Functional Neurosurgery workshop on neuromodulation for psychiatric disorders. J Neurol Neurosurg Psychiatry 2018; 89:886-896. [PMID: 29371415 PMCID: PMC7340367 DOI: 10.1136/jnnp-2017-317082] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 11/28/2017] [Accepted: 12/19/2017] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Refractory psychiatric disease is a major cause of morbidity and mortality worldwide, and there is a great need for new treatments. In the last decade, investigators piloted novel deep brain stimulation (DBS)-based therapies for depression and obsessive-compulsive disorder (OCD). Results from recent pivotal trials of these therapies, however, did not demonstrate the degree of efficacy expected from previous smaller trials. To discuss next steps, neurosurgeons, neurologists, psychiatrists and representatives from industry convened a workshop sponsored by the American Society for Stereotactic and Functional Neurosurgery in Chicago, Illinois, in June of 2016. DESIGN Here we summarise the proceedings of the workshop. Participants discussed a number of issues of importance to the community. First, we discussed how to interpret results from the recent pivotal trials of DBS for OCD and depression. We then reviewed what can be learnt from lesions and closed-loop neurostimulation. Subsequently, representatives from the National Institutes of Health, the Food and Drug Administration and industry discussed their views on neuromodulation for psychiatric disorders. In particular, these third parties discussed their criteria for moving forward with new trials. Finally, we discussed the best way of confirming safety and efficacy of these therapies, including registries and clinical trial design. We close by discussing next steps in the journey to new neuromodulatory therapies for these devastating illnesses. CONCLUSION Interest and motivation remain strong for deep brain stimulation for psychiatric disease. Progress will require coordinated efforts by all stakeholders.
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Affiliation(s)
- Ausaf A Bari
- Department of Neurosurgery, University of California Los Angeles Medical Center, Los Angeles, California, USA
| | - Charles B Mikell
- Department of Neurosurgery, Stony Brook University Hospital, Stony Brook, New York, USA
| | - Aviva Abosch
- Department of Neurosurgery, School of Medicine, University of Colorado, Aurora, Colorado, USA
| | - Sharona Ben-Haim
- Department of Neurosurgery, University of California San Diego Health, La Jolla, California, USA
| | - Robert J Buchanan
- Department of Neurosurgery, Seton Brain and Spine Institute, Austin, Texas, USA
| | - Allen W Burton
- Neuromodulation, Movement Disorders, and Pain, St. Jude-Abbott, Plano, Texas, USA
| | - Stephen Carcieri
- Neuromodulation, Boston Scientific Corp, Marlborough, Massachusetts, USA
| | - G Rees Cosgrove
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | | | - Emad N Eskandar
- Department of Neurosurgery, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Jason L Gerrard
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Wayne K Goodman
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
| | | | - Robert E Gross
- Department of Neurosurgery, Emory University, Atlanta, Georgia, USA
| | - Clement Hamani
- Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
| | - Zelma H T Kiss
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Peter Konrad
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Brian H Kopell
- Department of Neurosurgery, The Mount Sinai Hospital, New York City, New York, USA
| | - Lothar Krinke
- Medtronic Neuromodulation, Minneapolis, Minnesota, USA
| | - Jean-Philippe Langevin
- Department of Neurosurgery, University of California Los Angeles Medical Center, Los Angeles, California, USA
| | - Andres M Lozano
- Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
| | - Donald Malone
- Department of Psychiatry and Psychology, Center for Neurological Restoration, Cleveland Clinic, Cleveland, Ohio, USA
| | - Helen S Mayberg
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Jonathan P Miller
- Department of Neurological Surgery, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Parag G Patil
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA
| | - DeLea Peichel
- Neuromodulation, Movement Disorders, and Pain, St. Jude-Abbott, Plano, Texas, USA
| | - Erika A Petersen
- Department of Neurosurgery, University of Arkansas for Medical Science, Little Rock, Arkansas, USA
| | - Ali R Rezai
- Neurological Institute, Ohio State University, Columbus, Ohio, USA
| | - R Mark Richardson
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Patricio Riva-Posse
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Tejas Sankar
- Division of Neurosurgery, University of Alberta, Edmonton, Alberta, Canada
| | - Jason M Schwalb
- Department of Neurosurgery, Henry Ford Health System, Detroit, Michigan, USA
| | - Helen Blair Simpson
- Department of Psychiatry, Columbia University, NY State Psychiatric Institute, New York, NY
| | - Konstantin Slavin
- Department of Neurosurgery, University of Illinois College of Medicine, Chicago, Illinois, USA
| | | | - Tor Tosteson
- Departmentof Biomedical Data Science, Geisel School of Medicine, Dartmouth University, Hanover, New Hampshire, USA
| | - Peter Warnke
- Section of Neurosurgery, Department of Surgery, University of Chicago, Chicago, Illinois, USA
| | - Jon T Willie
- Department of Neurosurgery, Emory University, Atlanta, Georgia, USA
| | - Kareem A Zaghloul
- Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, Bethesda, Maryland, USA
| | - Joseph S Neimat
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky, USA
| | - Nader Pouratian
- Department of Neurosurgery, University of California Los Angeles Medical Center, Los Angeles, California, USA
| | - Sameer A Sheth
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
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Lundberg J, Langevin JP. Lumbar Microlaminectomy vs Traditional Laminectomy. Fed Pract 2017; 34:32-35. [PMID: 30766247 PMCID: PMC6370467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Lumbar microlaminectomy is associated with shorter hospitalization and lower cost within the VA system.
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Affiliation(s)
- Jaclyn Lundberg
- is a medical student at Creighton University School of Medicine in Omaha, Nebraska. is a physician at Greater Los Angeles VA Healthcare System in California
| | - Jean-Philippe Langevin
- is a medical student at Creighton University School of Medicine in Omaha, Nebraska. is a physician at Greater Los Angeles VA Healthcare System in California
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Langevin JP, Koek RJ, Schwartz HN, Chen JWY, Sultzer DL, Mandelkern MA, Kulick AD, Krahl SE. Neuromodulation for Treatment-Refractory PTSD. Fed Pract 2017; 34:20S-33S. [PMID: 30766304 PMCID: PMC6375501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Deep brain stimulation has been successful in treating Parkinson disease and essential tremor and is now reducing PTSD symptoms in the first patient enrolled in an early-phase safety trial.
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Affiliation(s)
- Jean-Philippe Langevin
- is a neurosurgeon, is a neurologist, is a radiologist, and is a neurophysiologist in the research and development service; and are mental/behavioral health physicians, is a psychologist, and is a mental/behavioral health physician in the psychiatry and mental health service; all at the VA Greater Los Angeles Healthcare System in California. Dr. Langevin, Dr. Koek, Dr. Chen, Dr. Sultzer, Dr. Mandelkern, and Dr. Krahl are professors at David Geffen School of Medicine at the University of California Los Angeles
| | - Ralph J Koek
- is a neurosurgeon, is a neurologist, is a radiologist, and is a neurophysiologist in the research and development service; and are mental/behavioral health physicians, is a psychologist, and is a mental/behavioral health physician in the psychiatry and mental health service; all at the VA Greater Los Angeles Healthcare System in California. Dr. Langevin, Dr. Koek, Dr. Chen, Dr. Sultzer, Dr. Mandelkern, and Dr. Krahl are professors at David Geffen School of Medicine at the University of California Los Angeles
| | - Holly N Schwartz
- is a neurosurgeon, is a neurologist, is a radiologist, and is a neurophysiologist in the research and development service; and are mental/behavioral health physicians, is a psychologist, and is a mental/behavioral health physician in the psychiatry and mental health service; all at the VA Greater Los Angeles Healthcare System in California. Dr. Langevin, Dr. Koek, Dr. Chen, Dr. Sultzer, Dr. Mandelkern, and Dr. Krahl are professors at David Geffen School of Medicine at the University of California Los Angeles
| | - James W Y Chen
- is a neurosurgeon, is a neurologist, is a radiologist, and is a neurophysiologist in the research and development service; and are mental/behavioral health physicians, is a psychologist, and is a mental/behavioral health physician in the psychiatry and mental health service; all at the VA Greater Los Angeles Healthcare System in California. Dr. Langevin, Dr. Koek, Dr. Chen, Dr. Sultzer, Dr. Mandelkern, and Dr. Krahl are professors at David Geffen School of Medicine at the University of California Los Angeles
| | - David L Sultzer
- is a neurosurgeon, is a neurologist, is a radiologist, and is a neurophysiologist in the research and development service; and are mental/behavioral health physicians, is a psychologist, and is a mental/behavioral health physician in the psychiatry and mental health service; all at the VA Greater Los Angeles Healthcare System in California. Dr. Langevin, Dr. Koek, Dr. Chen, Dr. Sultzer, Dr. Mandelkern, and Dr. Krahl are professors at David Geffen School of Medicine at the University of California Los Angeles
| | - Mark A Mandelkern
- is a neurosurgeon, is a neurologist, is a radiologist, and is a neurophysiologist in the research and development service; and are mental/behavioral health physicians, is a psychologist, and is a mental/behavioral health physician in the psychiatry and mental health service; all at the VA Greater Los Angeles Healthcare System in California. Dr. Langevin, Dr. Koek, Dr. Chen, Dr. Sultzer, Dr. Mandelkern, and Dr. Krahl are professors at David Geffen School of Medicine at the University of California Los Angeles
| | - Alexis D Kulick
- is a neurosurgeon, is a neurologist, is a radiologist, and is a neurophysiologist in the research and development service; and are mental/behavioral health physicians, is a psychologist, and is a mental/behavioral health physician in the psychiatry and mental health service; all at the VA Greater Los Angeles Healthcare System in California. Dr. Langevin, Dr. Koek, Dr. Chen, Dr. Sultzer, Dr. Mandelkern, and Dr. Krahl are professors at David Geffen School of Medicine at the University of California Los Angeles
| | - Scott E Krahl
- is a neurosurgeon, is a neurologist, is a radiologist, and is a neurophysiologist in the research and development service; and are mental/behavioral health physicians, is a psychologist, and is a mental/behavioral health physician in the psychiatry and mental health service; all at the VA Greater Los Angeles Healthcare System in California. Dr. Langevin, Dr. Koek, Dr. Chen, Dr. Sultzer, Dr. Mandelkern, and Dr. Krahl are professors at David Geffen School of Medicine at the University of California Los Angeles
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18
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Deeb W, Giordano JJ, Rossi PJ, Mogilner AY, Gunduz A, Judy JW, Klassen BT, Butson CR, Van Horne C, Deny D, Dougherty DD, Rowell D, Gerhardt GA, Smith GS, Ponce FA, Walker HC, Bronte-Stewart HM, Mayberg HS, Chizeck HJ, Langevin JP, Volkmann J, Ostrem JL, Shute JB, Jimenez-Shahed J, Foote KD, Wagle Shukla A, Rossi MA, Oh M, Pourfar M, Rosenberg PB, Silburn PA, de Hemptine C, Starr PA, Denison T, Akbar U, Grill WM, Okun MS. Proceedings of the Fourth Annual Deep Brain Stimulation Think Tank: A Review of Emerging Issues and Technologies. Front Integr Neurosci 2016; 10:38. [PMID: 27920671 PMCID: PMC5119052 DOI: 10.3389/fnint.2016.00038] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 11/01/2016] [Indexed: 02/02/2023] Open
Abstract
This paper provides an overview of current progress in the technological advances and the use of deep brain stimulation (DBS) to treat neurological and neuropsychiatric disorders, as presented by participants of the Fourth Annual DBS Think Tank, which was convened in March 2016 in conjunction with the Center for Movement Disorders and Neurorestoration at the University of Florida, Gainesveille FL, USA. The Think Tank discussions first focused on policy and advocacy in DBS research and clinical practice, formation of registries, and issues involving the use of DBS in the treatment of Tourette Syndrome. Next, advances in the use of neuroimaging and electrochemical markers to enhance DBS specificity were addressed. Updates on ongoing use and developments of DBS for the treatment of Parkinson's disease, essential tremor, Alzheimer's disease, depression, post-traumatic stress disorder, obesity, addiction were presented, and progress toward innovation(s) in closed-loop applications were discussed. Each section of these proceedings provides updates and highlights of new information as presented at this year's international Think Tank, with a view toward current and near future advancement of the field.
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Affiliation(s)
- Wissam Deeb
- Department of Neurology, Center for Movement Disorders and Neurorestoration, University of Florida Gainesville, FL, USA
| | - James J Giordano
- Department of Neurology, and Neuroethics Studies Program, Pellegrino Center for Clinical Bioethics, Georgetown University Medical Center Washington, DC, USA
| | - Peter J Rossi
- Department of Neurology, Center for Movement Disorders and Neurorestoration, University of Florida Gainesville, FL, USA
| | - Alon Y Mogilner
- Department of Neurosurgery, Center for Neuromodulation, New York University Langone Medical Center New York, NY, USA
| | - Aysegul Gunduz
- Department of Neurology, Center for Movement Disorders and Neurorestoration, University of FloridaGainesville, FL, USA; J. Crayton Pruitt Family Department of Biomedical Engineering, University of FloridaGainesville, FL, USA
| | - Jack W Judy
- Department of Neurology, Center for Movement Disorders and Neurorestoration, University of FloridaGainesville, FL, USA; J. Crayton Pruitt Family Department of Biomedical Engineering, University of FloridaGainesville, FL, USA
| | | | - Christopher R Butson
- Department of Bioengineering, Scientific Computing and Imaging Institute, University of Utah Salt Lake City, UT, USA
| | - Craig Van Horne
- Department of Neurosurgery, University of Kentucky Chandler Medical Center Lexington, KY, USA
| | - Damiaan Deny
- Department of Psychiatry, Academic Medical Center, University of Amsterdam Amsterdam, Netherlands
| | - Darin D Dougherty
- Department of Psychiatry, Massachusetts General Hospital Boston, MA, USA
| | - David Rowell
- Asia Pacific Centre for Neuromodulation, Queensland Brain Institute, The University of Queensland Brisbane, QLD, Australia
| | - Greg A Gerhardt
- Department of Anatomy and Neurobiology, University of Kentucky Chandler Medical Center Lexington, KY, USA
| | - Gwenn S Smith
- Departments of Psychiatry and Behavioral Sciences and Radiology and Radiological Sciences, Johns Hopkins University School of Medicine Baltimore, MD, USA
| | - Francisco A Ponce
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center Phoenix Arizona, AZ, USA
| | - Harrison C Walker
- Department of Neurology and Department of Biomedical Engineering, University of Alabama at Birmingham Birmingham, AL, USA
| | - Helen M Bronte-Stewart
- Departments of Neurology and Neurological Sciences and Neurosurgery, Stanford University Stanford, CA, USA
| | - Helen S Mayberg
- Department of Psychiatry, Emory University School of Medicine Atlanta, GA, USA
| | - Howard J Chizeck
- Electrical Engineering Department, University of WashingtonSeattle, WA, USA; NSF Engineering Research Center for Sensorimotor Neural EngineeringSeattle, WA, USA
| | - Jean-Philippe Langevin
- Department of Neurosurgery, VA Greater Los Angeles Healthcare System Los Angeles, CA, USA
| | - Jens Volkmann
- Department of Neurology, University Clinic of Würzburg Würzburg, Germany
| | - Jill L Ostrem
- Department of Neurology, University of California San Francisco San Francisco, CA, USA
| | - Jonathan B Shute
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida Gainesville, FL, USA
| | | | - Kelly D Foote
- Department of Neurology, Center for Movement Disorders and Neurorestoration, University of FloridaGainesville, FL, USA; Department of Neurological Sciences, University of FloridaGainesville, FL, USA
| | - Aparna Wagle Shukla
- Department of Neurology, Center for Movement Disorders and Neurorestoration, University of Florida Gainesville, FL, USA
| | - Marvin A Rossi
- Departments of Neurological Sciences, Diagnostic Radiology, and Nuclear Medicine, Rush University Medical Center Chicago, IL, USA
| | - Michael Oh
- Division of Functional Neurosurgery, Department of Neurosurgery, Allegheny General Hospital Pittsburgh, PA, USA
| | - Michael Pourfar
- Department of Neurology, New York University Langone Medical Center New York, NY, USA
| | - Paul B Rosenberg
- Psychiatry and Behavioral Sciences, Johns Hopkins Bayview Medical Center, Johns Hopkins School of Medicine Baltimore, MD, USA
| | - Peter A Silburn
- Asia Pacific Centre for Neuromodulation, Queensland Brain Institute, The University of Queensland Brisbane, QLD, Australia
| | - Coralie de Hemptine
- Graduate Program in Neuroscience, Department of Neurological Surgery, Kavli Institute for Fundamental Neuroscience, University of California, San Francisco San Francisco, CA, USA
| | - Philip A Starr
- Graduate Program in Neuroscience, Department of Neurological Surgery, Kavli Institute for Fundamental Neuroscience, University of California, San Francisco San Francisco, CA, USA
| | | | - Umer Akbar
- Movement Disorders Program, Department of Neurology, Alpert Medical School, Rhode Island Hospital, Brown University Providence, RI, USA
| | - Warren M Grill
- Department of Biomedical Engineering, Duke University Durham, NC, USA
| | - Michael S Okun
- Department of Neurology, Center for Movement Disorders and Neurorestoration, University of Florida Gainesville, FL, USA
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Langevin JP, Skoch JM, Sherman SJ. Deep brain stimulation of a patient with psychogenic movement disorder. Surg Neurol Int 2016; 7:S824-S826. [PMID: 27990313 PMCID: PMC5134113 DOI: 10.4103/2152-7806.194063] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 07/02/2016] [Indexed: 11/16/2022] Open
Abstract
Background: The long-term safety of deep brain stimulation (DBS) is an important issue because new applications are being investigated for a variety of disorders. Studying instances where DBS was inadvertently implanted in patients without a movement disorder may provide information about the safety of the therapy. We report the case of a patient with a psychogenic movement disorder treated with deep brain stimulation (DBS). Case Description: The patient presented at our clinic after 5 years of chronic DBS of the subthalamic nucleus (STN) for presumed Parkinson's disease. A dopamine transporter (DAT) scan (DaTscan) showed normal DAT distribution in the striatum. A positron emission tomography (PET) scan showed no abnormal metabolic patterns. Further psychiatric and neurological evaluations revealed that the patient was suffering from a psychogenic movement disorder. The patient displayed no sign or symptom from the stimulation, and DBS did not lead to any benefits or side effects for this patient. Conclusion: We argue that the absence of side effects, the normal DaTscan, and PET scan after 5 years of chronic stimulation illustrate the safety of DBS on neural tissue.
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Affiliation(s)
- Jean-Philippe Langevin
- Neurosurgery, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA; Department of Neurosurgery, University of California Los Angeles, Los Angeles, California, USA
| | - Jesse M Skoch
- Division of Neurosurgery, University of Arizona, Tucson, Arizona, USA
| | - Scott J Sherman
- Department of Neurology, University of Arizona, Tucson, Arizona, USA
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Langevin JP, Koek RJ, Schwartz HN, Chen JWY, Sultzer DL, Mandelkern MA, Kulick AD, Krahl SE. Deep Brain Stimulation of the Basolateral Amygdala for Treatment-Refractory Posttraumatic Stress Disorder. Biol Psychiatry 2016; 79:e82-e84. [PMID: 26475671 DOI: 10.1016/j.biopsych.2015.09.003] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 09/02/2015] [Accepted: 09/02/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Jean-Philippe Langevin
- Neurosurgery Service, Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California; David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California.
| | - Ralph J Koek
- Psychiatry and Mental Health Service, Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California; David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
| | - Holly N Schwartz
- Psychiatry and Mental Health Service, Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California
| | - James W Y Chen
- Neurology Service, Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California; David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
| | - David L Sultzer
- Psychiatry and Mental Health Service, Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California; David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
| | - Mark A Mandelkern
- Radiology Service, Nuclear Medicine, Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California; David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
| | - Alexis D Kulick
- Psychiatry and Mental Health Service, Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California
| | - Scott E Krahl
- Research and Development Service, Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California; David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
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Rossi PJ, Gunduz A, Judy J, Wilson L, Machado A, Giordano JJ, Elias WJ, Rossi MA, Butson CL, Fox MD, McIntyre CC, Pouratian N, Swann NC, de Hemptinne C, Gross RE, Chizeck HJ, Tagliati M, Lozano AM, Goodman W, Langevin JP, Alterman RL, Akbar U, Gerhardt GA, Grill WM, Hallett M, Herrington T, Herron J, van Horne C, Kopell BH, Lang AE, Lungu C, Martinez-Ramirez D, Mogilner AY, Molina R, Opri E, Otto KJ, Oweiss KG, Pathak Y, Shukla A, Shute J, Sheth SA, Shih LC, Steinke GK, Tröster AI, Vanegas N, Zaghloul KA, Cendejas-Zaragoza L, Verhagen L, Foote KD, Okun MS. Proceedings of the Third Annual Deep Brain Stimulation Think Tank: A Review of Emerging Issues and Technologies. Front Neurosci 2016; 10:119. [PMID: 27092042 PMCID: PMC4821860 DOI: 10.3389/fnins.2016.00119] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 03/11/2016] [Indexed: 11/25/2022] Open
Abstract
The proceedings of the 3rd Annual Deep Brain Stimulation Think Tank summarize the most contemporary clinical, electrophysiological, imaging, and computational work on DBS for the treatment of neurological and neuropsychiatric disease. Significant innovations of the past year are emphasized. The Think Tank's contributors represent a unique multidisciplinary ensemble of expert neurologists, neurosurgeons, neuropsychologists, psychiatrists, scientists, engineers, and members of industry. Presentations and discussions covered a broad range of topics, including policy and advocacy considerations for the future of DBS, connectomic approaches to DBS targeting, developments in electrophysiology and related strides toward responsive DBS systems, and recent developments in sensor and device technologies.
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Affiliation(s)
- P Justin Rossi
- Department of Neuroscience, Center for Movement Disorders and Neurorestoration, University of Florida Gainesville, FL, USA
| | - Aysegul Gunduz
- Department of Neuroscience, Center for Movement Disorders and Neurorestoration, University of Florida Gainesville, FL, USA
| | - Jack Judy
- Department of Neuroscience, Center for Movement Disorders and Neurorestoration, University of Florida Gainesville, FL, USA
| | - Linda Wilson
- Formerly affiliated with the International Technology Roadmap for Semiconductors (ITRS) Washington, USA
| | - Andre Machado
- Neurological Institute Cleveland Clinic Cleveland, OH, USA
| | - James J Giordano
- Neuroethics Studies Program, Department of Neurology, Georgetown University Medical Center Washington, DC, USA
| | - W Jeff Elias
- Neurological Surgery and Neurology, Stereotactic and Functional Neurosurgery, Department of Neurosurgery, University of Virginia Health Science Center Charlottesville, VA, USA
| | - Marvin A Rossi
- Department of Neurology, Rush University Medical Center Chicago, IL, USA
| | - Christopher L Butson
- Scientific Computing and Imaging Institute, University of Utah Salt Lake City, UT, USA
| | - Michael D Fox
- Beth Israel Deaconess Medical Center, Harvard Medical School Boston, MA, USA
| | - Cameron C McIntyre
- Department of Biomedical Engineering, School of Medicine, Case Western Reserve University Cleveland, OH, USA
| | - Nader Pouratian
- Department of Neurosurgery, University of California, Los Angeles Los Angeles, CA, USA
| | - Nicole C Swann
- University of California, San Francisco San Francisco, CA, USA
| | | | | | - Howard J Chizeck
- Department of Electrical Engineering, University of Washington Seattle, WA, USA
| | - Michele Tagliati
- Movement Disorders Program, Department of Neurology, Cedars-Sinai Medical Center Los Angeles, CA, USA
| | - Andres M Lozano
- Department of Neurosurgery, University of Toronto Toronto, ON, Canada
| | - Wayne Goodman
- The Icahn School of Medicine at Mount Sinai New York, NY, USA
| | | | - Ron L Alterman
- Beth Israel Deaconess Medical Center, Harvard Medical School Boston, MA, USA
| | - Umer Akbar
- Department of Neurology, Alpert Medical School, Brown University Providence, RI, USA
| | | | - Warren M Grill
- Department of Biomedical Engineering, Duke University Durham, NC, USA
| | - Mark Hallett
- National Institute of Neurological Disorders and Stroke, National Institutes of Health Bethesda, MD, USA
| | - Todd Herrington
- Massachusetts General Hospital, Harvard Medical School Boston, MA, USA
| | - Jeffrey Herron
- Department of Electrical Engineering, University of Washington Seattle, WA, USA
| | | | - Brian H Kopell
- The Icahn School of Medicine at Mount Sinai New York, NY, USA
| | - Anthony E Lang
- Department of Neurosurgery, University of Toronto Toronto, ON, Canada
| | - Codrin Lungu
- National Institute of Neurological Disorders and Stroke, National Institutes of Health Bethesda, MD, USA
| | - Daniel Martinez-Ramirez
- Department of Neuroscience, Center for Movement Disorders and Neurorestoration, University of Florida Gainesville, FL, USA
| | - Alon Y Mogilner
- Department of Neurosurgery-Center for Neuromodulation, NYU Langone Medical Center New York, NY, USA
| | - Rene Molina
- Department of Neuroscience, Center for Movement Disorders and Neurorestoration, University of Florida Gainesville, FL, USA
| | - Enrico Opri
- Department of Neuroscience, Center for Movement Disorders and Neurorestoration, University of Florida Gainesville, FL, USA
| | - Kevin J Otto
- Department of Neuroscience, Center for Movement Disorders and Neurorestoration, University of Florida Gainesville, FL, USA
| | - Karim G Oweiss
- Department of Neuroscience, Center for Movement Disorders and Neurorestoration, University of Florida Gainesville, FL, USA
| | - Yagna Pathak
- Neurological Institute, Columbia University Medical Center New York, NY, USA
| | - Aparna Shukla
- Department of Neuroscience, Center for Movement Disorders and Neurorestoration, University of Florida Gainesville, FL, USA
| | - Jonathan Shute
- Department of Neuroscience, Center for Movement Disorders and Neurorestoration, University of Florida Gainesville, FL, USA
| | - Sameer A Sheth
- Neurological Institute, Columbia University Medical Center New York, NY, USA
| | - Ludy C Shih
- Beth Israel Deaconess Medical Center, Harvard Medical School Boston, MA, USA
| | | | - Alexander I Tröster
- Department of Clinical Neuropsychology, Barrow Neurological Institute Phoenix, AZ, USA
| | - Nora Vanegas
- Neurological Institute, Columbia University Medical Center New York, NY, USA
| | - Kareem A Zaghloul
- National Institute of Neurological Disorders and Stroke, National Institutes of Health Bethesda, MD, USA
| | | | - Leonard Verhagen
- Department of Neurology, Rush University Medical Center Chicago, IL, USA
| | - Kelly D Foote
- Department of Neuroscience, Center for Movement Disorders and Neurorestoration, University of Florida Gainesville, FL, USA
| | - Michael S Okun
- Department of Neuroscience, Center for Movement Disorders and Neurorestoration, University of Florida Gainesville, FL, USA
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Koek RJ, Langevin JP, Krahl SE, Kosoyan HJ, Schwartz HN, Chen JWY, Melrose R, Mandelkern MJ, Sultzer D. Deep brain stimulation of the basolateral amygdala for treatment-refractory combat post-traumatic stress disorder (PTSD): study protocol for a pilot randomized controlled trial with blinded, staggered onset of stimulation. Trials 2014; 15:356. [PMID: 25208824 PMCID: PMC4168122 DOI: 10.1186/1745-6215-15-356] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Accepted: 08/21/2014] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Combat post-traumatic stress disorder (PTSD) involves significant suffering, impairments in social and occupational functioning, substance use and medical comorbidity, and increased mortality from suicide and other causes. Many veterans continue to suffer despite current treatments. Deep brain stimulation (DBS) has shown promise in refractory movement disorders, depression and obsessive-compulsive disorder, with deep brain targets chosen by integration of clinical and neuroimaging literature. The basolateral amygdala (BLn) is an optimal target for high-frequency DBS in PTSD based on neurocircuitry findings from a variety of perspectives. DBS of the BLn was validated in a rat model of PTSD by our group, and limited data from humans support the potential safety and effectiveness of BLn DBS. METHODS/DESIGN We describe the protocol design for a first-ever Phase I pilot study of bilateral BLn high-frequency DBS for six severely ill, functionally impaired combat veterans with PTSD refractory to conventional treatments. After implantation, patients are monitored for a month with stimulators off. An electroencephalographic (EEG) telemetry session will test safety of stimulation before randomization to staggered-onset, double-blind sham versus active stimulation for two months. Thereafter, patients will undergo an open-label stimulation for a total of 24 months. Primary efficacy outcome is a 30% decrease in the Clinician Administered PTSD Scale (CAPS) total score. Safety outcomes include extensive assessments of psychiatric and neurologic symptoms, psychosocial function, amygdala-specific and general neuropsychological functions, and EEG changes. The protocol requires the veteran to have a cohabiting significant other who is willing to assist in monitoring safety and effect on social functioning. At baseline and after approximately one year of stimulation, trauma script-provoked 18FDG PET metabolic changes in limbic circuitry will also be evaluated. DISCUSSION While the rationale for studying DBS for PTSD is ethically and scientifically justified, the importance of the amygdaloid complex and its connections for a myriad of emotional, perceptual, behavioral, and vegetative functions requires a complex trial design in terms of outcome measures. Knowledge generated from this pilot trial can be used to design future studies to determine the potential of DBS to benefit both veterans and nonveterans suffering from treatment-refractory PTSD. TRIAL REGISTRATION PCC121657, 19 March 2014.
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Affiliation(s)
- Ralph J Koek
- />Psychiatry Service, VA Greater Los Angeles Healthcare System (VAGLAHS), 11301 Wilshire Blvd, Los Angeles, CA 90073 USA
- />David Geffen School of Medicine at UCLA, Los Angeles, USA
- />16111 Plummer St. (116A-11), North Hills, CA 91343 USA
| | - Jean-Philippe Langevin
- />David Geffen School of Medicine at UCLA, Los Angeles, USA
- />Neurosurgery Service, VAGLAHS, 11301 Wilshire Blvd, Los Angeles, C 90073 USA
| | - Scott E Krahl
- />David Geffen School of Medicine at UCLA, Los Angeles, USA
- />Research and Development Service, VAGLAHS, 11301 Wilshire Blvd, Los Angeles, CA 90073 USA
| | - Hovsep J Kosoyan
- />David Geffen School of Medicine at UCLA, Los Angeles, USA
- />Research and Development Service, VAGLAHS, 11301 Wilshire Blvd, Los Angeles, CA 90073 USA
| | - Holly N Schwartz
- />Psychiatry Service, VA Greater Los Angeles Healthcare System (VAGLAHS), 11301 Wilshire Blvd, Los Angeles, CA 90073 USA
- />David Geffen School of Medicine at UCLA, Los Angeles, USA
| | - James WY Chen
- />David Geffen School of Medicine at UCLA, Los Angeles, USA
- />Neurology Service, VAGLAHS, 11301 Wilshire Blvd, Los Angeles, CA 90073 USA
| | - Rebecca Melrose
- />David Geffen School of Medicine at UCLA, Los Angeles, USA
- />Brain, Behavior, and Aging Research Center, VAGLAHS, 11301 Wilshire Blvd, Los Angeles, CA 90073 USA
| | - Mark J Mandelkern
- />David Geffen School of Medicine at UCLA, Los Angeles, USA
- />Imaging Department, Radiology Service, VAGLAHS, 11301 Wilshire Blvd, Los Angeles, CA 90073 USA
- />Physics Department, UC Irvine, Irvine, CA 92697 USA
| | - David Sultzer
- />Psychiatry Service, VA Greater Los Angeles Healthcare System (VAGLAHS), 11301 Wilshire Blvd, Los Angeles, CA 90073 USA
- />David Geffen School of Medicine at UCLA, Los Angeles, USA
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Langevin JP, Srikandarajah N, Krahl SE, Gorgulho A, Behnke E, Malkasian D, DeSalles AAF. Eyelid apraxia associated with deep brain stimulation of the periaqueductal gray area. J Clin Neurosci 2014; 21:1652-3. [PMID: 24726237 DOI: 10.1016/j.jocn.2014.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Accepted: 03/02/2014] [Indexed: 10/25/2022]
Abstract
We report a patient with eyelid apraxia following deep brain stimulation of the periaqueductal gray area. Based on the position of our electrode, we argue that the phenomenon is linked to inhibition of the nearby central caudal nucleus of the oculomotor nucleus by high frequency stimulation.
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Affiliation(s)
- Jean-Philippe Langevin
- Department of Neurosurgery, University of California Los Angeles, Los Angeles, CA, USA; Service of Neurosurgery, Greater Los Angeles VA Healthcare System, 11301 Wilshire Boulevard 10H2, Los Angeles, CA 90073, USA.
| | | | - Scott E Krahl
- Department of Neurosurgery, University of California Los Angeles, Los Angeles, CA, USA; Service of Neurosurgery, Greater Los Angeles VA Healthcare System, 11301 Wilshire Boulevard 10H2, Los Angeles, CA 90073, USA
| | - Alessandra Gorgulho
- Department of Neurosurgery, University of California Los Angeles, Los Angeles, CA, USA
| | - Eric Behnke
- Department of Neurosurgery, University of California Los Angeles, Los Angeles, CA, USA
| | - Dennis Malkasian
- Department of Neurosurgery, University of California Los Angeles, Los Angeles, CA, USA
| | - Antonio A F DeSalles
- Department of Neurosurgery, University of California Los Angeles, Los Angeles, CA, USA
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24
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Stidd DA, Vogelsang K, Krahl SE, Langevin JP, Fellous JM. Amygdala Deep Brain Stimulation Is Superior to Paroxetine Treatment in a Rat Model of Posttraumatic Stress Disorder. Brain Stimul 2013; 6:837-44. [DOI: 10.1016/j.brs.2013.05.008] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2012] [Revised: 05/21/2013] [Accepted: 05/30/2013] [Indexed: 11/16/2022] Open
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Abstract
Deep brain stimulation, a technique whereby electrodes are implanted into specific brain regions to modulate their activity, has been mainly used to treat movement disorders. More recently this technique has been proposed for the treatment of drug addiction, posttraumatic stress disorder (PTSD), and dementia. The nucleus accumbens, amygdala, and hippocampus, central nuclei within the limbic system, have been studied as potential targets for neuromodulation for the treatment of drug addiction, PTSD, and dementia, respectively. As the scope of neuromodulation grows to include disorders of mood and thought, new ethical and philosophic challenges that require multidisciplinary discussion and cooperation are emerging.
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Affiliation(s)
- Ausaf Bari
- Department of Neurosurgery, Geffen School of Medicine, University of California, Los Angeles, Room 18-228 NPI, Box 957039, Los Angeles, CA 90095, USA.
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Abstract
The amygdala was a popular target during the era of psychosurgery, specifically for the treatment of intractable aggression. This mesiotemporal structure was thought to primarily mediate fear and anger. However, recent evidence suggests that the amygdala is part of a complex network that mediates the formation of a larger repertoire of positive and negative emotions. Dysfunctions within the network or the amygdala itself can lead to various mental illnesses. In those cases, deep brain stimulation (DBS) applied focally may treat the symptoms. This review presents data supporting the potential therapeutic role of DBS of the amygdala in the treatment of anxiety disorders, addiction, and mood disorders. The success of DBS for psychiatric conditions will likely depend on our ability to precisely determine the optimal target for a specific case.
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27
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Langevin JP, De Salles AAF, Kosoyan HP, Krahl SE. Deep brain stimulation of the amygdala alleviates post-traumatic stress disorder symptoms in a rat model. J Psychiatr Res 2010; 44:1241-5. [PMID: 20537659 DOI: 10.1016/j.jpsychires.2010.04.022] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2010] [Revised: 04/16/2010] [Accepted: 04/20/2010] [Indexed: 10/19/2022]
Abstract
Post-traumatic stress disorder (PTSD) is an anxiety disorder triggered by a life-threatening event causing intense fear. Recently, functional neuroimaging studies have suggested that amygdala hyperactivity is responsible for the symptoms of PTSD. Deep brain stimulation (DBS) can functionally reduce the activity of a cerebral target by delivering an electrical signal through an electrode. We tested whether DBS of the amygdala could be used to treat PTSD symptoms. Rats traumatized by inescapable shocks, in the presence of an unfamiliar object, develop the tendency to bury the object when re-exposed to it several days later. This behavior mimics the symptoms of PTSD. 10 Sprague-Dawley rats underwent the placement of an electrode in the right basolateral nucleus of the amygdala (BLn). The rats were then subjected to a session of inescapable shocks while being exposed to a conspicuous object (a ball). Five rats received DBS treatment while the other 5 rats did not. After 7 days of treatment, the rats were re-exposed to the ball and the time spent burying it under the bedding was recorded. Rats treated with BLn DBS spent on average 13 times less time burying the ball than the sham control rats. The treated rats also spent 18 times more time exploring the ball than the sham control rats. In conclusion, the behavior of treated rats in this PTSD model was nearly normalized. We argue that these results have direct implications for patients suffering from treatment-resistant PTSD by offering a new therapeutic strategy.
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Affiliation(s)
- Jean-Philippe Langevin
- Division of Neurosurgery, University of Arizona, PO Box 245070, 1501 N Campbell Avenue, Room 4310, Tucson, AZ 85724-5070, USA.
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28
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Langevin JP, Dang T, Kon D, Sapo M, Batzdorf U, Martin N. Curriculum-Based Neurosurgery Digital Library. Neurosurgery 2010; 67:1426-30; discussion 1430. [DOI: 10.1227/neu.0b013e3181f07c7e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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29
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Langevin JP, Bergsneider M, Yashar P, Makary RF. Waldenström's macroglobulinemia and large B-cell central nervous system lymphoma: a case report. ACTA ACUST UNITED AC 2008; 69:407-10. [DOI: 10.1016/j.surneu.2007.05.053] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2007] [Accepted: 05/18/2007] [Indexed: 11/29/2022]
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30
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Grizenko N, Zappitelli M, Langevin JP, Hrychko S, el-Messidi A, Kaminester D, Pawliuk N, Ter Stepanian M. Effectiveness of a social skills training program using self/other perspective-taking: a nine-month follow-up. Am J Orthopsychiatry 2000; 70:501-9. [PMID: 11086528 DOI: 10.1037/h0087662] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Using a pre/posttest design, with a nine-month follow-up, a new, "modified" social skills training program, which incorporates the concept of self/other perspective-taking, was evaluated and compared to a traditional social skills program in a sample of 36 children. Students in the modified group showed more short- and long-term improvement in behavior than did those in the traditional social skills training group. Implications for practice and research are discussed.
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31
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Abstract
The aim of this study was to examine a possible relation between the speed of information processing, as measured by simple and choice visual RT, and problem-solving, as measured by the Tower of Hanoi test. For 20 normal teenagers, performing all tests, significant correlations were found between choice RT and both measures of performance on the Tower of Hanoi, number of disk moves, and time taken to complete the task. Simple RT was correlated with Completion time but not with the number of moves, while the reverse pattern was discerned for decision time. Choice movement time was also associated with both measures, but simple movement time was not. These results are consistent with the hypothesis of a common neurobiological basis to information-processing speed and executive functions.
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Affiliation(s)
- A Bestawros
- Behavioral Neurology, Neurobiology and Neuropsychology Research Unit, University of Montréal, Canada
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