Treating refractory mental illness with closed-loop brain stimulation: Progress towards a patient-specific transdiagnostic approach

Alik S. Widge, Kristen K. Ellard, Angelique C. Paulk, Ishita Basu, Ali Yousefi, Samuel Zorowitz, Anna Gilmour, Afsana Afzal, Thilo Deckersbach, Sydney S. Cash, Mark A. Kramer, Uri T. Eden, Darin D. Dougherty, Emad N. Eskandar

Research output: Contribution to journalReview article

38 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)461-472
Number of pages12
JournalExperimental Neurology
Volume287
DOIs
StatePublished - Jan 1 2017
Externally publishedYes

Fingerprint

Deep Brain Stimulation
Amygdala
Brain
Functional Neuroimaging
Electrophysiology
Gyrus Cinguli
Negotiating
Statistical Models
Neurosciences
Prefrontal Cortex
Mental Disorders
Psychiatry
Emotions
Clinical Trials
Morbidity
Equipment and Supplies
Mortality
Therapeutics
Population

Keywords

  • Anxiety disorders
  • Deep brain stimulation
  • Electrophysiology
  • Functional imaging
  • Local field potential
  • Modeling
  • Mood disorders
  • Psychiatric diagnosis
  • Psychiatric illness

ASJC Scopus subject areas

  • Neurology
  • Developmental Neuroscience

Cite this

Treating refractory mental illness with closed-loop brain stimulation : Progress towards a patient-specific transdiagnostic approach. / 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.

In: Experimental Neurology, Vol. 287, 01.01.2017, p. 461-472.

Research output: Contribution to journalReview article

Widge, AS, Ellard, KK, Paulk, AC, Basu, I, Yousefi, A, Zorowitz, S, Gilmour, A, Afzal, A, Deckersbach, T, Cash, SS, Kramer, MA, Eden, UT, Dougherty, DD & Eskandar, EN 2017, 'Treating refractory mental illness with closed-loop brain stimulation: Progress towards a patient-specific transdiagnostic approach', Experimental Neurology, vol. 287, pp. 461-472. https://doi.org/10.1016/j.expneurol.2016.07.021
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. / Treating refractory mental illness with closed-loop brain stimulation : Progress towards a patient-specific transdiagnostic approach. In: Experimental Neurology. 2017 ; Vol. 287. pp. 461-472.
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AU - Yousefi, Ali

AU - Zorowitz, Samuel

AU - Gilmour, Anna

AU - Afzal, Afsana

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