Widge Alik S, Ellard Kristen K, Paulk Angelique C, Basu Ishita, Yousefi Ali, Zorowitz Samuel, Gilmour Anna, Afzal Afsana, Deckersbach Thilo, Cash Sydney S, Kramer Mark A, Eden Uri T, Dougherty Darin D, Eskandar Emad N
Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, United States; Picower Institute for Learning & Memory, Massachusetts Institute of Technology, Cambridge, MA, United Sates.
Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, United States.
Exp Neurol. 2017 Jan;287(Pt 4):461-472. doi: 10.1016/j.expneurol.2016.07.021. Epub 2016 Jul 30.
Mental disorders are a leading cause of disability, morbidity, and mortality among civilian and military populations. Most available treatments have limited efficacy, particularly in disorders where symptoms vary over relatively short time scales. Targeted modulation of neural circuits, particularly through open-loop deep brain stimulation (DBS), showed initial promise but has failed in blinded clinical trials. We propose a new approach, based on targeting neural circuits linked to functional domains that cut across diagnoses. Through that framework, which includes measurement of patients using six psychophysical tasks, we seek to develop a closed-loop DBS system that corrects dysfunctional activity in brain circuits underlying those domains. We present convergent preliminary evidence from functional neuroimaging, invasive human electrophysiology, and human brain stimulation experiments suggesting that this approach is feasible. Using the Emotional Conflict Resolution (ECR) task as an example, we show that emotion-related networks can be identified and modulated in individual patients. Invasive and non-invasive methodologies both identify a network between prefrontal cortex, cingulate cortex, insula, and amygdala. Further, stimulation in cingulate and amygdala changes patients' performance in ways that are linked to the task's emotional content. We present preliminary statistical models that predict this change and allow us to track it at a single-trial level. As these diagnostic and modeling strategies are refined and embodied in an implantable device, they offer the prospect of a new approach to psychiatric treatment and its accompanying neuroscience.
精神障碍是导致平民和军人残疾、发病和死亡的主要原因。大多数现有的治疗方法疗效有限,尤其是在症状在相对较短的时间尺度上变化的疾病中。对神经回路的靶向调节,特别是通过开环深部脑刺激(DBS),最初显示出了前景,但在盲法临床试验中失败了。我们提出了一种新方法,该方法基于靶向与跨越诊断的功能域相关的神经回路。通过这个框架,包括使用六项心理物理学任务对患者进行测量,我们试图开发一种闭环DBS系统,以纠正这些域背后的脑回路中的功能失调活动。我们提供了来自功能神经影像学、侵入性人体电生理学和人脑刺激实验的一致初步证据,表明这种方法是可行的。以情绪冲突解决(ECR)任务为例,我们表明可以在个体患者中识别和调节与情绪相关的网络。侵入性和非侵入性方法都识别出前额叶皮层、扣带回皮层、脑岛和杏仁核之间的一个网络。此外,对扣带回和杏仁核的刺激会以与任务的情绪内容相关的方式改变患者的表现。我们提出了初步的统计模型,这些模型可以预测这种变化,并使我们能够在单次试验水平上对其进行跟踪。随着这些诊断和建模策略的完善并体现在可植入设备中,它们为精神疾病治疗及其相关神经科学提供了一种新方法的前景。