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The Neurostimulationist will see you now: prescribing direct electrical stimulation therapies for the human brain in epilepsy and beyond.

作者信息

Hadar Peter N, Zelmann Rina, Salami Pariya, Cash Sydney S, Paulk Angelique C

机构信息

Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States.

Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Boston, MA, United States.

出版信息

Front Hum Neurosci. 2024 Sep 4;18:1439541. doi: 10.3389/fnhum.2024.1439541. eCollection 2024.


DOI:10.3389/fnhum.2024.1439541
PMID:39296917
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11408201/
Abstract

As the pace of research in implantable neurotechnology increases, it is important to take a step back and see if the promise lives up to our intentions. While direct electrical stimulation applied intracranially has been used for the treatment of various neurological disorders, such as Parkinson's, epilepsy, clinical depression, and Obsessive-compulsive disorder, the effectiveness can be highly variable. One perspective is that the inability to consistently treat these neurological disorders in a standardized way is due to multiple, interlaced factors, including stimulation parameters, location, and differences in underlying network connectivity, leading to a trial-and-error stimulation approach in the clinic. An alternate view, based on a growing knowledge from neural data, is that variability in this input (stimulation) and output (brain response) relationship may be more predictable and amenable to standardization, personalization, and, ultimately, therapeutic implementation. In this review, we assert that the future of human brain neurostimulation, via direct electrical stimulation, rests on deploying standardized, constrained models for easier clinical implementation and informed by intracranial data sets, such that diverse, individualized therapeutic parameters can efficiently produce similar, robust, positive outcomes for many patients closer to a prescriptive model. We address the pathway needed to arrive at this future by addressing three questions, namely: (1) why aren't we already at this prescriptive future?; (2) how do we get there?; (3) how far are we from this Neurostimulationist prescriptive future? We first posit that there are limited and predictable ways, constrained by underlying networks, for direct electrical stimulation to induce changes in the brain based on past literature. We then address how identifying underlying individual structural and functional brain connectivity which shape these standard responses enable targeted and personalized neuromodulation, bolstered through large-scale efforts, including machine learning techniques, to map and reverse engineer these input-output relationships to produce a good outcome and better identify underlying mechanisms. This understanding will not only be a major advance in enabling intelligent and informed design of neuromodulatory therapeutic tools for a wide variety of neurological diseases, but a shift in how we can predictably, and therapeutically, prescribe stimulation treatments the human brain.

摘要
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0fcf/11408201/51d42b67dc6c/fnhum-18-1439541-g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0fcf/11408201/472622ef0ee0/fnhum-18-1439541-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0fcf/11408201/7c62182f79c1/fnhum-18-1439541-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0fcf/11408201/ce5f023e5d31/fnhum-18-1439541-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0fcf/11408201/988900e6b4b9/fnhum-18-1439541-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0fcf/11408201/9d4af7536020/fnhum-18-1439541-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0fcf/11408201/51d42b67dc6c/fnhum-18-1439541-g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0fcf/11408201/472622ef0ee0/fnhum-18-1439541-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0fcf/11408201/7c62182f79c1/fnhum-18-1439541-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0fcf/11408201/ce5f023e5d31/fnhum-18-1439541-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0fcf/11408201/988900e6b4b9/fnhum-18-1439541-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0fcf/11408201/9d4af7536020/fnhum-18-1439541-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0fcf/11408201/51d42b67dc6c/fnhum-18-1439541-g006.jpg

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The Neurostimulationist will see you now: prescribing direct electrical stimulation therapies for the human brain in epilepsy and beyond.

Front Hum Neurosci. 2024-9-4

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本文引用的文献

[1]
Centromedian region thalamic responsive neurostimulation mitigates idiopathic generalized and multifocal epilepsy with focal to bilateral tonic-clonic seizures.

Epilepsia. 2024-9

[2]
Case report: Nocturnal low-frequency stimulation of the centromedian thalamic nucleus improves sleep quality and seizure control.

Front Hum Neurosci. 2024-6-5

[3]
Thalamic deep brain stimulation in traumatic brain injury: a phase 1, randomized feasibility study.

Nat Med. 2023-12

[4]
Closed-loop stimulation in periods with less epileptiform activity drives improved epilepsy outcomes.

Brain. 2024-2-1

[5]
Invasive neurophysiology and whole brain connectomics for neural decoding in patients with brain implants.

Res Sq. 2023-9-20

[6]
Cingulate dynamics track depression recovery with deep brain stimulation.

Nature. 2023-10

[7]
Differential cortical network engagement during states of un/consciousness in humans.

Neuron. 2023-11-1

[8]
Sensing with deep brain stimulation device in epilepsy: Aperiodic changes in thalamic local field potential during seizures.

Epilepsia. 2023-11

[9]
Cerebellar deep brain stimulation for chronic post-stroke motor rehabilitation: a phase I trial.

Nat Med. 2023-9

[10]
Functional network dynamics between the anterior thalamus and the cortex in deep brain stimulation for epilepsy.

Brain. 2023-11-2

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