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

Area of Science:

• Neuroscience
• Psychiatry
• Biomedical Engineering

Background:

• Mental disorders represent a significant global health burden, with existing treatments offering limited efficacy, especially for conditions with rapidly fluctuating symptoms.
• Previous attempts using open-loop deep brain stimulation (DBS) to modulate neural circuits have not succeeded in blinded clinical trials.
• Current therapeutic strategies often lack precision in targeting the complex neural underpinnings of psychiatric conditions.

Purpose of the Study:

• To propose and provide preliminary evidence for a novel closed-loop deep brain stimulation (DBS) system.
• To target neural circuits associated with functional domains that transcend specific diagnostic categories.
• To develop a system capable of real-time correction of dysfunctional brain activity underlying these domains.

Main Methods:

• Development of a framework involving measurement of patients using six psychophysical tasks.
• Utilizing functional neuroimaging, invasive human electrophysiology, and human brain stimulation experiments.
• Employing the Emotional Conflict Resolution (ECR) task to identify and modulate emotion-related brain networks in individual patients.

Main Results:

• Convergent preliminary evidence suggests the feasibility of the proposed closed-loop DBS approach.
• Identification of a specific brain network (prefrontal cortex, cingulate cortex, insula, amygdala) involved in emotional processing.
• Demonstration that stimulation within the cingulate cortex and amygdala alters patient performance on the ECR task, correlating with emotional content.

Conclusions:

• The study presents a promising new strategy for psychiatric treatment by targeting cross-diagnostic functional domains.
• Preliminary data support the identification and modulation of specific neural networks using both invasive and non-invasive methods.
• The development of diagnostic and modeling strategies for an implantable closed-loop DBS device offers a potential advancement in psychiatric neuroscience and treatment.