Proceedings of the Eighth Annual Deep Brain Stimulation Think Tank: Advances in Optogenetics, Ethical Issues Affecting DBS Research, Neuromodulatory Approaches for Depression, Adaptive Neurostimulation, and Emerging DBS Technologies

We estimate that 208,000 deep brain stimulation (DBS) devices have been implanted to address neurological and neuropsychiatric disorders worldwide. DBS Think Tank presenters pooled data and determined that DBS expanded in its scope and has been applied to multiple brain disorders in an effort to modulate neural circuitry. The DBS Think Tank was founded in 2012 providing a space where clinicians, engineers, researchers from industry and academia discuss current and emerging DBS technologies and logistical and ethical issues facing the field. The emphasis is on cutting edge research and collaboration aimed to advance the DBS field. The Eighth Annual DBS Think Tank was held virtually on September 1 and 2, 2020 (Zoom Video Communications) due to restrictions related to the COVID-19 pandemic. The meeting focused on advances in: (1) optogenetics as a tool for comprehending neurobiology of diseases and on optogenetically-inspired DBS, (2) cutting edge of emerging DBS technologies, (3) ethical issues affecting DBS research and access to care, (4) neuromodulatory approaches for depression, (5) advancing novel hardware, software and imaging methodologies, (6) use of neurophysiological signals in adaptive neurostimulation, and (7) use of more advanced technologies to improve DBS clinical outcomes. There were 178 attendees who participated in a DBS Think Tank survey, which revealed the expansion of DBS into several indications such as obesity, post-traumatic stress disorder, addiction and Alzheimer’s disease. This proceedings summarizes the advances discussed at the Eighth Annual DBS Think Tank

Embedding Digital Chronotherapy into Bioelectronic Medicines

Biological rhythms permeate all living organisms at a variety of timescales. These rhythms are fundamental to physiological homeostasis, and their disruption is thought to play a key role in the initiation, progression, and expression of disease. In the last two decades, neuromodulation has been established as an effective adjunct therapy for medically refractory neurological disorders. To date, however, due to the limited sensing and algorithm capabilities of neuromodulation devices, exploring the influence of biological rhythms on therapy efficacy has not been feasible. However, with the development of new bioelectronic devices capable of long-term data recording and adaptive stimulation parameter adjustments, clinical neuroscience researchers are now gaining unprecedented insight into patient physiology across a variety of neurological diseases, including longitudinal rhythmic behavior. In this perspective, we propose that future bioelectronic devices 2 should integrate chronobiological considerations in their physiological control structure to maximize the benefits of therapy. We specifically highlight this need for deep brain stimulation (DBS) chronotherapy, where the DBS therapeutic dosage would be titrated based on the time-of-day and synchronized to each patient's individual chronotype/sleep-wake cycle. This is motivated by preliminary longitudinal data recorded from both patients with Parkinson's disease (PD) and epilepsy, which show periodic symptom biomarkers synchronized to sub-daily (ultradian), daily (circadian 1), and longer time scale (infradian) rhythms. In addition, considering side effects, tonic stimulation can undermine diurnal patterns and cause fragmentation of sleep-wake rhythms. Based on these observations, we suggest a control structure for future bioelectronic devices which incorporates anticipatory, time-based adaptation of stimulation control, locked to patient-specific biological rhythms, as an adjunct to classical feedforward and feedback control methods. Initial results from three of our recent case studies using chronotherapy-enabled prototypes will illustrate the concept. The proposed control architecture for a future bioelectronic implant mimics more closely the classical integration of adaptive, feedforward, and feedback control methods found in physiology, and could be useful as a general method for personalized therapy refinement

Proceedings of the Sixth Deep Brain Stimulation Think Tank Modulation of Brain Networks and Application of Advanced Neuroimaging, Neurophysiology, and Optogenetics

© Copyright © 2019 Ramirez-Zamora, Giordano, Boyden, Gradinaru, Gunduz, Starr, Sheth, McIntyre, Fox, Vitek, Vedam-Mai, Akbar, Almeida, Bronte-Stewart, Mayberg, Pouratian, Gittis, Singer, Creed, Lazaro-Munoz, Richardson, Rossi, Cendejas-Zaragoza, D’Haese, Chiong, Gilron, Chizeck, Ko, Baker, Wagenaar, Harel, Deeb, Foote and Okun. The annual deep brain stimulation (DBS) Think Tank aims to create an opportunity for a multidisciplinary discussion in the field of neuromodulation to examine developments, opportunities and challenges in the field. The proceedings of the Sixth Annual Think Tank recapitulate progress in applications of neurotechnology, neurophysiology, and emerging techniques for the treatment of a range of psychiatric and neurological conditions including Parkinson’s disease, essential tremor, Tourette syndrome, epilepsy, cognitive disorders, and addiction. Each section of this overview provides insight about the understanding of neuromodulation for specific disease and discusses current challenges and future directions. This year’s report addresses key issues in implementing advanced neurophysiological techniques, evolving use of novel modulation techniques to deliver DBS, ans improved neuroimaging techniques. The proceedings also offer insights into the new era of brain network neuromodulation and connectomic DBS to define and target dysfunctional brain networks. The proceedings also focused on innovations in applications and understanding of adaptive DBS (closed-loop systems), the use and applications of optogenetics in the field of neurostimulation and the need to develop databases for DBS indications. Finally, updates on neuroethical, legal, social, and policy issues relevant to DBS research are discussed

Proceedings of the 10th annual deep brain stimulation think tank: Advances in cutting edge technologies, artificial intelligence, neuromodulation, neuroethics, interventional psychiatry, and women in neuromodulation

The deep brain stimulation (DBS) Think Tank X was held on August 17-19, 2022 in Orlando FL. The session organizers and moderators were all women with the theme women in neuromodulation. Dr. Helen Mayberg from Mt. Sinai, NY was the keynote speaker. She discussed milestones and her experiences in developing depression DBS. The DBS Think Tank was founded in 2012 and provides an open platform where clinicians, engineers and researchers (from industry and academia) can freely discuss current and emerging DBS technologies as well as the logistical and ethical issues facing the field. The consensus among the DBS Think Tank X speakers was that DBS has continued to expand in scope however several indications have reached the "trough of disillusionment." DBS for depression was considered as "re-emerging" and approaching a slope of enlightenment. DBS for depression will soon re-enter clinical trials. The group estimated that globally more than 244,000 DBS devices have been implanted for neurological and neuropsychiatric disorders. This year's meeting was focused on advances in the following areas: neuromodulation in Europe, Asia, and Australia; cutting-edge technologies, closed loop DBS, DBS tele-health, neuroethics, lesion therapy, interventional psychiatry, and adaptive DBS