Predictors of Hypomania During Ventral Capsule/Ventral Striatum Deep Brain Stimulation

Widge, Alik S.; Licon, Ernesto; Zorowitz, Samuel; Corse, Andrew K; Arulpragasam, Amanda R.; Camprodon, Joan A.; Cusin, Cristina; Eskandar, Emad N.; Deckersbach, Thilo; Dougherty, Darin D.

doi:10.1176/appi.neuropsych.15040089

Cited by 51 publications

(39 citation statements)

References 30 publications

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“…In DBS of the STN, stimulation of the ventromedial limbic area has been consistently associated with mania (104-107), while stimulation of the dorsolateral motor area instead may lead to resolution of manic symptoms (104)(105)(106). Interestingly, hypomania is associated with right-sided monopolar stimulation of VC/VS, but stimulation of the ventral-most contact in the right VC/VS decreases the risk of hypomania (108). The high prevalence of manic and hypomanic episodes in DBS of VC/VS is believed to result from abundant connections between the nucleus accumbens and the limbic system (101,102).…”

Section: Functional Neurosurgerymentioning

confidence: 99%

Mania secondary to focal brain lesions: implications for understanding the functional neuroanatomy of bipolar disorder

Satzer

Bond

2016

Bipolar Disorders

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Secondary mania should be suspected in patients with neurological deficits, histories atypical for classic bipolar disorder, and first manic episodes after the age of 40 years. Treatment with antimanic medications, along with specific treatment for the underlying neurologic condition, is typically required. Typical lesion locations fit with current models of bipolar disorder, which implicate hyperactivity of left-hemisphere reward-processing brain areas and hypoactivity of bilateral prefrontal emotion-modulating regions. Lesion studies complement these models by suggesting that right-hemisphere limbic-brain hypoactivity, or a left/right imbalance, may be relevant to the pathophysiology of mania.

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Section: Functional Neurosurgerymentioning

confidence: 99%

Mania secondary to focal brain lesions: implications for understanding the functional neuroanatomy of bipolar disorder

Satzer

Bond

2016

Bipolar Disorders

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“…Thus, we hypothesized that dorsal stimulation would be more effective than ventral in this specific task. We did not have a pre-specified hypothesis regarding left vs. right stimulation, but tested hemispheres separately because our past clinical studies of capsular stimulation suggested lateralized effects 67 . We did not test any other stimulation sites for their effects on MSIT performance, because we had a specific hypothesis regarding the internal capsule.…”

Section: Open-loop Capsule Stimulationmentioning

confidence: 99%

Closed loop enhancement and neural decoding of human cognitive control

Basu

Yousefi

Crocker

et al. 2020

Preprint

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Cognitive control is the ability to withhold a default, prepotent response in favor of a more adaptive choice. Control deficits are common across mental disorders, including depression, anxiety, and addiction. Thus, a method for improving cognitive control could be broadly useful in disorders with few effective treatments. Here, we demonstrate closed-loop enhancement of cognitive control by direct brain stimulation in humans. We stimulated internal capsule/striatum in participants undergoing intracranial epilepsy monitoring as they performed a cognitive control task. Stimulation enhanced performance, with the strongest effects from dorsal capsule/striatum stimulation.We then developed a framework to detect control lapses and stimulate in response. This closed-loop approach was more effective than open-loop stimulation. Participants who self-reported difficulties with self-control reported that stimulation made them more able to shift attention away from internal distress. Finally, we decoded cognitive control directly from activity on a small number of electrodes, using features compatible with existing closed-loop brain implants. Our findings suggest a new approach to treating severe mental disorders, by directly remediating underlying cognitive deficits.

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“…In either scenario, there are no physiological measurements or feedback from the brain to verify that the alleged target circuits are being stimulated or changed (Widge & Dougherty, 2015b). This is concerning, given that acute changes in mood do not correlate well to long-term DBS outcomes (Haq et al, 2011; Widge & Dougherty, 2015a; Widge, Licon, et al, 2016). …”

Section: The Need For Closed-loop Systems In Psychiatrymentioning

confidence: 99%

“…Finally, closed-loop systems could prevent “over-treating”. Overly high stimulation dosages can cause adverse side effects such as hypomania and impulsivity (Greenberg et al, 2010; Haq et al, 2010; Widge, Licon, et al, 2016). Patients have expressed a strong interest in closed-loop therapies for exactly these reasons.…”

Section: The Need For Closed-loop Systems In Psychiatrymentioning

confidence: 99%

Closed-loop neuromodulation systems: next-generation treatments for psychiatric illness

Widge

2017

International Review of Psychiatry

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Despite deep brain stimulation’s positive early results in psychiatric disorders, well-designed clinical trials have yielded inconsistent clinical outcomes. One path to more reliable benefit is closed-loop therapy: stimulation that is automatically adjusted by a device or algorithm in response to changes in the patient’s electrical brain activity. These interventions may provide more precise and patient-specific treatments. In this article, we first introduce the available closed-loop neuromodulation platforms, which have shown clinical efficacy in epilepsy and strong early results in movement disorders. We discuss the strengths and limitations of these devices in the context of psychiatric illness. We then describe emerging technologies to address these limitations, including pre-clinical developments such as wireless deep neurostimulation and genetically targeted neuromodulation. Finally, we discuss ongoing challenges and limitations for closed-loop psychiatric brain stimulation development, most notably the difficulty of identifying meaningful biomarkers for titration. We consider this in the recently-released Research Domain Criteria (RDoC) framework and describe how neuromodulation and RDoC are jointly very well suited to address the problem of treatment-resistant illness.

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Predictors of Hypomania During Ventral Capsule/Ventral Striatum Deep Brain Stimulation

Cited by 51 publications

References 30 publications

Mania secondary to focal brain lesions: implications for understanding the functional neuroanatomy of bipolar disorder

Mania secondary to focal brain lesions: implications for understanding the functional neuroanatomy of bipolar disorder

Closed loop enhancement and neural decoding of human cognitive control

Closed-loop neuromodulation systems: next-generation treatments for psychiatric illness

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