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MAR 11, 2020 10:30 AM PDT

PANEL: Deep Brain Stimulation for Depression Using Directional Current Steering and Individualized Network Targeting

Presented at: Neuroscience 2020
C.E. Credits: P.A.C.E. CE Florida CE
Speakers
  • D.C and Irene Ellwood Professor and Chair of the Menninger Department of Psychiatry and Behavioral Sciences at Baylor College of Medicine
    Biography
      Wayne Goodman, MD, D.C and Irene Ellwood Professor and Chair of the Menninger Department of Psychiatry and Behavioral Sciences at Baylor College of Medicine, specializes in Obsessive-Compulsive Disorder (OCD) and Deep Brain Stimulation (DBS) for intractable psychiatric illnesses. He is the principal developer of the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), the gold standard for assessing OCD, and co-founder of the International OCD Foundation, the major advocacy group for patients with OCD. Prior to joining Baylor, he held senior administrative positions at Mount Sinai Hospital in New York, NIMH and the University of Florida. He graduated from Columbia University with a degree in Electrical Engineering, received his medical degree from Boston University School of Medicine and completed his internship, residency, and research fellowship at Yale School of Medicine where he remained on faculty for 7 years. He is currently a Principal Investigator on three grants from NIH's BRAIN initiative including one on developing Adaptive DBS for OCD.
    • Professor of Neurosurgery and Radiation Oncology and affiliated faculty in Bioengineering and Neuroscience, UCLA Medical Center & UCLA Brain Research Institute
      Biography
        Dr Pouratian is a Professor of Neurosurgery and Radiation Oncology and affiliated faculty in Bioengineering and Neuroscience. He has broad yet in depth training in both functional neurosurgery and the acquisition and comprehensive analysis of multiple brain mapping modalities and has published extensively in the field of human brain mapping, comparing human brain mapping signals from multiple modalities, including functional MRI, optical imaging, evoked potentials, electrocortical stimulation mapping, electrocorticography, local field potentials, and single unit recordings. As a neurosurgeon, neuroscientist, and bioengineer, he has the unique perspective and training to integrate these fields and take advantages of the unparalleled opportunities presented by neurosurgery to study human brain function and design novel neurotechnologies. His current focus is understanding the network basis of disease and neuromodulatory therapies and designing novel network-based interventions to address neurological and psychiatric disease.
      • Associate Professor, Vice-Chair of Clinical Research, Neurosurgery, Baylor College of Medicine
        Biography
          Sameer Sheth, MD, PhD is Associate Professor of Neurosurgery, Vice-Chair of Clinical Research, and Director of Psychiatric Neurosurgery in the Department of Neurosurgery, Baylor College of Medicine. Clinically, Dr. Sheth specializes in stereotactic/functional neurosurgery, including the surgical treatment of movement disorders, epilepsy, and psychiatric disorders. Dr. Sheth's research focuses on both the study of cognitive neurophysiology,as well as the development of neuromodulatory treatments for neurological and psychiatric disorders.

        Abstract

        The public health burden of Treatment Resistant Depression (TRD) has prompted clinical trials of deep brain stimulation (DBS) that have, unfortunately, produced inconsistent outcomes. Potential gaps and opportunities include a need: (1) to better understand the neurocircuitry of the disease; (2) for precision DBS devices that can target brain networks in a clinically and physiologically validated manner; and (3) for greater insight into stimulation dose-response relationships. These needs are based on our overarching hypothesis that network-guided neuromodulation is critical for the efficacy of DBS in TRD. This project aims to address the unmet need of TRD patients by identifying brain networks critical for treating depression and to use next generation precision DBS with steering capability to engage these targeted networks and develop a new therapy for TRD. We use the Boston Scientific (BS) Vercise DBS system, which offers a segmented steerable lead with multiple independent current sources that allows true directional steering. Moreover, this system integrates stimulation field modeling (SFM) with MR tractography to predict network engagement. We use an innovative approach of targeting both subgenual cingulate (SGC) and ventral capsule/ventral striatum (VC/VS), which we term corticomesolimbic DBS. These targets are hubs in distinct yet partially overlapping depression networks and emerging basic science literature implicates them in bidirectional modulation of depression circuits. We also apply a paradigm-shifting approach using intracranial stereo-EEG (sEEG) subacutely after DBS implant to evaluate the clinical reliability of steering, SFMs, and tractography and to define and then target the networks mediating symptoms of depression. The impact of this proposal includes physiological validation of current “steering” DBS technology to target specific networks, insights into effects of stimulation parameters on network physiology, an improved understanding of the pathophysiology of depression, and, perhaps most importantly, a novel approach for treating TRD. This research will also pioneer a novel and high-yield test bed for DBS therapy development consistent with BRAIN priorities.


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