Deep brain stimulation: current challenges and future directions

Lozano, Andrés M.; Lipsman, Nir; Bergman, Hagai; Brown, Peter; Chabardès, Stéphan; Chang, Jin Woo; Matthews, Keith; McIntyre, Cameron C.; Schläepfer, Thomas E.; Schulder, Michael; Temel, Yasin; Volkmann, Jens; Krauss, Joachim K.

doi:10.1038/s41582-018-0128-2

Cited by 900 publications

(727 citation statements)

References 143 publications

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“…There is widespread and growing interest in using brain stimulation for various research, clinical, and practical purposes [Borchers et al, 2012, Ezzyat and Rizzuto, 2018]. In many cases, the stimulation parameters that are chosen for a given task are modeled after the ones used in other protocols or in other subjects [Lozano et al, 2019]. Our work supports a tailored approach to choosing stimulation parameters, by customizing the parameters for each person based on how different types of stimulation affects their own ongoing brain signals as well as the electrophysiological pattern of interest.…”

Section: Discussionmentioning

confidence: 99%

The effects of direct brain stimulation in humans depend on frequency, amplitude, and white-matter proximity

Mohan

Watrous

Miller

et al. 2019

Preprint

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Researchers have used direct electrical brain stimulation to treat a range of neurological and psychiatric disorders. However, for brain stimulation to be maximally effective, clinicians and researchers should optimize stimulation parameters according to desired outcomes. To examine how different kinds of stimulation affect human brain activity, we compared the changes in neuronal activity that resulted from stimulation at a range of frequencies, amplitudes, and locations with direct human brain recordings. We recorded human brain activity directly with electrodes that were implanted in widespread regions across 106 neurosurgical epilepsy patients while systematically stimulating across a range of parameters and locations. Overall, stimulation most often had an inhibitory effect on neuronal activity, consistent with earlier work. When stimulation excited neuronal activity, it most often occurred from high-frequency stimulation. These effects were modulated by the location of the stimulating electrode, with stimulation sites near white matter more likely to cause excitation and sites near gray matter more likely to inhibit neuronal activity. By characterizing how different stimulation parameters produced specific neuronal activity patterns on a large scale, our results help guide clinicians and researchers when designing stimulation protocols to cause precisely targeted changes in human brain activity.43 Maurice et al., 2003, Windels et al., 2000, Johnson et al., 2008. There is evidence that the location 44 of a stimulation electrode also has an important role in dictating the outcome of stimulation, with 45 white-and gray-matter stimulation sites causing different effects [Histed et al., 2009, 2013 3 and Bullier, 1998a,b]. Further, Logothetis et al. [2010] show evidence in monkeys that specific pat-47 terns of stimulation can simultaneously induce inhibitory both excitatory effects in different affected 48 regions. These findings, which illustrate the diverse range of electrophysiological effects that result 49 from brain stimulation, demonstrate the challenge in designing brain stimulation protocols to alter 50 brain activity in targeted ways that achieve desired behavioral outcomes. 51 The goal of our study was to comprehensively evaluate the effects of different types of stimula-52 tion on neuronal activity across the human brain. To examine changes in neuronal activity due to 53 stimulation, we collected and analyzed direct brain recordings from 106 neurosurgical patients who 54 underwent an extensive stimulation "parameter search" paradigm involving a range of stimulation 55 frequencies and amplitudes at different cortical surface and depth locations. We then measured how 56 different stimulation parameters correlated with the directional changes in neuronal activity that re-57 sulted from stimulation. Because we sought to understand the effects of stimulation on the mean 58 activity across neuronal populations, we measured high-frequency broadband power, which provides 59 an estimate of the mean rate...

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Section: Discussionmentioning

confidence: 99%

The effects of direct brain stimulation in humans depend on frequency, amplitude, and white-matter proximity

Mohan

Watrous

Miller

et al. 2019

Preprint

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“…Indeed, chronic deep brain stimulation in this area improves chronic dysphoric conditions (Mayberg et al, 2005). However, with evidence accumulating that the most effective electrodes in deep brain stimulation are situated in or nearby white matter fiber tracts, rather than in grey matter proper, recent deep brain stimulation approaches are explicitly targeting white matter fiber structures (Baldermann et al, 2019;Lozano et al, 2019). Considering the effective electrical stimulation of area 25 (Johansen-Berg et al, 2008), this region is innervated and visited by the nearby AmF, suggesting the hypothesis that the physiological effects may be primarily ascribed to the AmF pathway and the regions it interconnects.…”

Section: Discussionmentioning

confidence: 99%

Two fiber pathways connecting amygdala and prefrontal cortex in humans and monkeys

Folloni

Sallet

Khrapitchev

et al. 2019

Preprint

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The interactions between amygdala and prefrontal cortex are pivotal to many neural processes involved in learning, decision-making, emotion, and social regulation. The broad functional role of amygdala-prefrontal interplay may reflect the diversity of its anatomical connections. Little, however, is known of the structural wiring linking amygdala and prefrontal cortex in humans. Using diffusion imaging techniques, we reconstructed connections between amygdala, anterior temporal and prefrontal cortex in human and macaque brains. First, by studying macaques we were able to assess which aspects of connectivity known from tracer studies could be identified with diffusion imaging. Second, by comparing diffusion imaging results in humans and macaques we were able to estimate amygdala-prefrontal connection patterns in humans and compare them with those in the monkey. We observed a prominent and well-preserved bifurcation of connections between amygdala and frontal lobe into two fiber networksan amygdalofugal path and an uncinate fascicle pathin both species.There has recently been a particular focus on understanding amygdala-prefrontal pathways in health and disease. These neural circuits have been implicated with reward-based learning and decision-making (De Martino et al.

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“…In the first study examining deep brain stimulation (DBS) at 10 kHz frequencies (10 kHz‐DBS; also called ultra‐high frequency DBS), we reported that acute 10 kHz‐DBS appears safe and may be effective in improving motor symptoms in patients with movement disorders . Furthermore, 10 kHz‐DBS stimulation may have the potential to reduce stimulation‐induced adverse effects, such as transient paresthesia and impaired speech, which are often encountered with DBS at conventional frequencies . Selecting the optimal stimulation frequency for DBS can be challenging.…”

Section: Introductionmentioning

confidence: 99%

Bio-Heat Model of Kilohertz-Frequency Deep Brain Stimulation Increases Brain Tissue Temperature

Khadka

Harmsen

Lozano

et al. 2020

Neuromodulation: Technology at the Neural Interface

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Deep brain stimulation: current challenges and future directions

Cited by 900 publications

References 143 publications

The effects of direct brain stimulation in humans depend on frequency, amplitude, and white-matter proximity

The effects of direct brain stimulation in humans depend on frequency, amplitude, and white-matter proximity

Two fiber pathways connecting amygdala and prefrontal cortex in humans and monkeys

Bio-Heat Model of Kilohertz-Frequency Deep Brain Stimulation Increases Brain Tissue Temperature

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