We are in critical need of targeted and individualized treatments for mental health disorders, which affect nearly 50% of Americans during our lifetimes. Brain stimulation treatments, including repetitive transcranial magnetic stimulation (rTMS), represent the front-line of innovative approaches to correct dysfunctional brain networks for patients suffering from mental illness. rTMS is FDA-approved for depression and obsessive- compulsive disorder (OCD) with clinical trials underway for post-traumatic stress disorder (PTSD) and substance use, among others. However, as currently administered, rTMS lacks a biomarker to individually optimize treatment and thus suffers from a poor clinical response rate (<50%). Without personalization of rTMS, we risk a one-size-fits-all treatment for all psychiatric disorders, not dissimilar to how antidepressants are administered. In this talk, I provide an overview of the noninvasive brain stimulation field and outline the steps needed to improve the precision and efficacy of our treatments. Specifically, I first discuss how intracranial brain recordings paired with invasive and noninvasive stimulation can help us tease out the underlying neural mechanisms of stimulation-induced neural plasticity. I think move to noninvasive approaches, where we combine TMS with EEG to 1) develop and refine a brain biomarker related to depression, 2) start to explore the relationship between this biomarker and the multidimensional nature of stimulation parameters, and finally 3) outline pathways towards real-time monitoring and closed-loop adaptive brain stimulation.

Learning Objectives:

1. Discuss the challenges associated with noninvasive closed-loop brain stimulation technologies.

2. Discuss how electrophysiology can help guide and personalize these approaches.