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

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.

“Nothing to Lose, Absolutely Everything to Gain”: Patient and Caregiver Expectations and Subjective Outcomes of Deep Brain Stimulation for Treatment-Resistant Depression

“…The current findings hold a number of implications for informing and consenting participants to clinical DBS research. There have been calls from both neuroethics and scientific communities for the long-term risks and consequences of participation in psychiatric DBS trials to be robustly outlined for potential participants ( Hendriks et al, 2019 ; Goering et al, 2021 ; Vedam-Mai et al, 2021 ). This would include thoroughly addressing the burden associated with participation (regular travel to research center, clinical tests), information on the day-to-day impact of DBS (e.g., recharging, stimulation side-effects, psychosocial adjustment), and providing clear guidance on post-trial continuity of care (given DBS can be a life-long intervention that is dependent on specialist care and requires maintenance) ( Thomson and Carter, 2020 ).…”

Lead-OR: A Multimodal Platform for Deep Brain Stimulation Surgery

“…While these book resources have been and still are invaluable to the field, they lack the possibility to be deformed into native patient space and to be digitally represented in direct synopsis with patient imaging and electrophysiology. Instead, whole-brain resources will grow in number, resolution, and quality in the foreseeable future (Horn, 2019;Krauss et al, 2021;Sui et al, 2021;Vedam-Mai et al, 2021). Similarly to anatomical atlas resources, optimal target definitions ("sweet spots") or even connectomic/tract-based target definitions could one day be integrated to guide DBS surgery -after proper and prospective validation of such datasets and applied methods (Dembek et al, 2019;Boutet et al, 2021;Elias et al, 2020).…”

Past, Present, and Future of Deep Brain Stimulation: Hardware, Software, Imaging, Physiology and Novel Approaches

“…The Medtronic Percept PC received FDA approval in 2020 and is currently the only DBS IPG system capable of sensing chronic in vivo brain activity ( 36 ). Local field potentials (LFPs) from deep brain nuclei can be recorded in a natural setting and help understand the underlying neurophysiology of the disease and the mechanisms of deep brain stimulation by identifying physiologic biomarkers of neural dysfunction ( 36 , 193 , 194 ). Further, if LFPs reliably correspond to particular clinical symptoms, then closed-loop technologies can be developed to fine-tune stimulation parameters in real time ( 26 ).…”