A Novel Framework for Network-Targeted Neuropsychiatric Deep Brain Stimulation

Anusha Allawala, Kelly R. Bijanki, Wayne Goodman, Jeffrey F. Cohn, Ashwin Viswanathan, Daniel Yoshor, David A. Borton, Nader Pouratian, Sameer A. Sheth

Research output: Contribution to journalArticlepeer-review

Abstract

Deep brain stimulation (DBS) has emerged as a promising therapy for neuropsychiatric illnesses, including depression and obsessive-compulsive disorder, but has shown inconsistent results in prior clinical trials. We propose a shift away from the empirical paradigm for developing new DBS applications, traditionally based on testing brain targets with conventional stimulation paradigms. Instead, we propose a multimodal approach centered on an individualized intracranial investigation adapted from the epilepsy monitoring experience, which integrates comprehensive behavioral assessment, such as the Research Domain Criteria proposed by the National Institutes of Mental Health. In this paradigm-shifting approach, we combine readouts obtained from neurophysiology, behavioral assessments, and self-report during broad exploration of stimulation parameters and behavioral tasks to inform the selection of ideal DBS parameters. Such an approach not only provides a foundational understanding of dysfunctional circuits underlying symptom domains in neuropsychiatric conditions but also aims to identify generalizable principles that can ultimately enable individualization and optimization of therapy without intracranial monitoring.

Original languageEnglish (US)
Pages (from-to)E116-E120
JournalNeurosurgery
Volume89
Issue number2
DOIs
StatePublished - Aug 1 2021

Keywords

  • deep brain stimulation
  • depression
  • neuromodulation
  • neuropsychiatry
  • stereoelectroencephalography

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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