MAR 13, 2019 9:30 AM PDT

Deep Brain Stimulation: Opportunities and Ethical Dilemmas

Presented at: Neuroscience 2019
C.E. Credits: P.A.C.E. CE Florida CE
Speaker
  • Biography
      Dr. Rowshanak Hashemiyoon is a scientific and executive consultant. She was the founder and head of the Human Brain and Behavior Laboratory in the Department of Stereotactic and Functional Neurosurgery at the University Hospital of Cologne in Germany. Her academic work unites scientific research with clinical care. It focuses on identifying the altered network dynamics underlying the dysfunctional brain states of neuropsychiatric and neurologic disorders as well as fosters the development of novel treatments which alleviate the symptoms of these disorders. She has been involved in the study and development of time- and structure-adapted neuromodulation for disease-tailored treatment. A computational neuroscientist by training, she received her PhD with John Chapin from Hahnemann University in Philadelphia while studying the nonlinear dynamics of oscillatory behavior in the subcortical visual system. After a post-doctoral fellowship with David McCormick at the Yale University School of Medicine where she then studied the dynamics of thalamocortical activity in the somatosensory system during normal and epileptic states, she moved to the Center for Complex Systems in Florida to investigate large-scale human brain dynamics during dyadic interaction. While at the University of Miami, she reported the first longitudinal study in humans of the effects of DBS on the underlying neuropathophysiology in a psychiatric disorder. Her work described the dynamics of neuronal activation in correlation with the symptomatology observed in Tourette syndrome, offering important insights into tic genesis and expression. She has now expanded her work to studying the neuropathomechanisms of whole network dysfunction in a range of psychiatric and movement disorders in humans, including OCD, addiction and Parkinson's disease.

    Abstract

    Neurological disorders present a worldwide multi-factorial burden. They affect as many as one billion people globally - and that number is predicted to increase in the next decades. The wide-range effects of this problem are both pervasive and staggering. As such, we are ethically compelled to carefully consider and address this crisis. Unfortunately, the biological basis of dysfunction for these disorders is largely unknown; furthermore, the diagnosis for psychiatric disorders remains subjective.

    The development of new neurotechnologies can offer both therapeutic relief and the opportunity to better understand the underlying pathomechanisms of dysfunction. Deep brain stimulation (DBS) is a relatively new therapy which has enjoyed successful application and approval for several neurological disorders.  It is suggested that DBS substantially reduces refractory symptoms in these disorders via the modulation of dysregulated networks. This theory is supported by the reports of correlation between improved symptomatology and the observed changes in synchronization of oscillatory rhythms. Although these data consequently suggest an important role for oscillatory rhythms, the scope of these rhythms in the pathological network and the mechanism(s) which exact their modification in the improved disease state has not been elucidated. Such information would bear directly on the important issues, including that of target selection and the quest for biomarkers. Therefore, DBS serves as a powerful tool to better understand the neurodynamics of systems level dysfunction subserving neuropsychiatric disorders.

    While DBS can provide therapeutic benefit in otherwise treatment-refractory cases, it is not without risk and must be a carefully considered option. Several ethical issues must be deliberated, including risk v. benefit, age, post-surgical follow-up, and patient profile.

    This presentation will address both the opportunities that DBS offers as well as the ethical challenges that are inherent in the determination of candidacy for and application of DBS. Gilles de la Tourette syndrome will be the model used to express such variables.

     


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