Closed-loop neuromodulation systems: next-generation treatments for psychiatric illness
Meng Chen Lo, Alik S. Widge
Despite deep brain stimulation's positive early results in psychiatric disorders, well-designed clinical trials have yielded inconsistent clinical outcomes. One path to more reliable benefit is closed-loop therapy: stimulation that is automatically adjusted by a device or algorithm in response to changes in the patient's electrical brain activity. These interventions may provide more precise and patient-specific treatments. This article first introduces the available closed-loop neuromodulation platforms, which have shown clinical efficacy in epilepsy and strong early results in movement disorders. It discusses the strengths and limitations of these devices in the context of psychiatric illness. It then describes emerging technologies to address these limitations, including pre-clinical developments such as wireless deep neurostimulation and genetically targeted neuromodulation. Finally, ongoing challenges and limitations for closed-loop psychiatric brain stimulation development, most notably the difficulty of identifying meaningful biomarkers for titration, are discussed. This is considered in the recently-released Research Domain Criteria (RDoC) framework, and how neuromodulation and RDoC are jointly very well suited to address the problem of treatment-resistant illness is described.
International Review of Psychiatry
Preparation of this work was supported in part by grants from the Brain & Behavior Research Foundation, Harvard Brain Initiative, Defense Advanced Research Projects Agency (cooperative agreement W911NF-14-2-0045, issued by the Army Research Office contracting office in support of DARPA?s SUBNETS program), and National Institute of Mental Health (MH109722-01).
© 2017 Institute of Psychiatry and Johns Hopkins University.
transdiagnostic
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Lo, M. C., & Widge, A. S. (2017). Closed-loop neuromodulation systems: next-generation treatments for psychiatric illness. International Review of Psychiatry, 29(2), 191-204. https://doi.org/10.1080/09540261.2017.1282438
Closed-loop neuromodulation systems : next-generation treatments for psychiatric illness. / Lo, Meng Chen; Widge, Alik S.
In: International Review of Psychiatry, Vol. 29, No. 2, 04.03.2017, p. 191-204.
Lo, MC & Widge, AS 2017, 'Closed-loop neuromodulation systems: next-generation treatments for psychiatric illness', International Review of Psychiatry, vol. 29, no. 2, pp. 191-204. https://doi.org/10.1080/09540261.2017.1282438
Lo MC, Widge AS. Closed-loop neuromodulation systems: next-generation treatments for psychiatric illness. International Review of Psychiatry. 2017 Mar 4;29(2):191-204. doi: 10.1080/09540261.2017.1282438
Lo, Meng Chen ; Widge, Alik S. / Closed-loop neuromodulation systems : next-generation treatments for psychiatric illness. In: International Review of Psychiatry. 2017 ; Vol. 29, No. 2. pp. 191-204.
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title = "Closed-loop neuromodulation systems: next-generation treatments for psychiatric illness",
abstract = "Despite deep brain stimulation{\textquoteright}s positive early results in psychiatric disorders, well-designed clinical trials have yielded inconsistent clinical outcomes. One path to more reliable benefit is closed-loop therapy: stimulation that is automatically adjusted by a device or algorithm in response to changes in the patient{\textquoteright}s electrical brain activity. These interventions may provide more precise and patient-specific treatments. This article first introduces the available closed-loop neuromodulation platforms, which have shown clinical efficacy in epilepsy and strong early results in movement disorders. It discusses the strengths and limitations of these devices in the context of psychiatric illness. It then describes emerging technologies to address these limitations, including pre-clinical developments such as wireless deep neurostimulation and genetically targeted neuromodulation. Finally, ongoing challenges and limitations for closed-loop psychiatric brain stimulation development, most notably the difficulty of identifying meaningful biomarkers for titration, are discussed. This is considered in the recently-released Research Domain Criteria (RDoC) framework, and how neuromodulation and RDoC are jointly very well suited to address the problem of treatment-resistant illness is described.",
keywords = "Deep brain stimulation, bioengineering, biomarker, electrophysiology, neuromodulation, transdiagnostic",
author = "Lo, {Meng Chen} and Widge, {Alik S.}",
note = "Funding Information: Preparation of this work was supported in part by grants from the Brain & Behavior Research Foundation, Harvard Brain Initiative, Defense Advanced Research Projects Agency (cooperative agreement W911NF-14-2-0045, issued by the Army Research Office contracting office in support of DARPA?s SUBNETS program), and National Institute of Mental Health (MH109722-01). Publisher Copyright: {\textcopyright} 2017 Institute of Psychiatry and Johns Hopkins University.",
journal = "International Review of Psychiatry",
T1 - Closed-loop neuromodulation systems
T2 - next-generation treatments for psychiatric illness
AU - Lo, Meng Chen
AU - Widge, Alik S.
N1 - Funding Information: Preparation of this work was supported in part by grants from the Brain & Behavior Research Foundation, Harvard Brain Initiative, Defense Advanced Research Projects Agency (cooperative agreement W911NF-14-2-0045, issued by the Army Research Office contracting office in support of DARPA?s SUBNETS program), and National Institute of Mental Health (MH109722-01). Publisher Copyright: © 2017 Institute of Psychiatry and Johns Hopkins University.
N2 - Despite deep brain stimulation's positive early results in psychiatric disorders, well-designed clinical trials have yielded inconsistent clinical outcomes. One path to more reliable benefit is closed-loop therapy: stimulation that is automatically adjusted by a device or algorithm in response to changes in the patient's electrical brain activity. These interventions may provide more precise and patient-specific treatments. This article first introduces the available closed-loop neuromodulation platforms, which have shown clinical efficacy in epilepsy and strong early results in movement disorders. It discusses the strengths and limitations of these devices in the context of psychiatric illness. It then describes emerging technologies to address these limitations, including pre-clinical developments such as wireless deep neurostimulation and genetically targeted neuromodulation. Finally, ongoing challenges and limitations for closed-loop psychiatric brain stimulation development, most notably the difficulty of identifying meaningful biomarkers for titration, are discussed. This is considered in the recently-released Research Domain Criteria (RDoC) framework, and how neuromodulation and RDoC are jointly very well suited to address the problem of treatment-resistant illness is described.
AB - Despite deep brain stimulation's positive early results in psychiatric disorders, well-designed clinical trials have yielded inconsistent clinical outcomes. One path to more reliable benefit is closed-loop therapy: stimulation that is automatically adjusted by a device or algorithm in response to changes in the patient's electrical brain activity. These interventions may provide more precise and patient-specific treatments. This article first introduces the available closed-loop neuromodulation platforms, which have shown clinical efficacy in epilepsy and strong early results in movement disorders. It discusses the strengths and limitations of these devices in the context of psychiatric illness. It then describes emerging technologies to address these limitations, including pre-clinical developments such as wireless deep neurostimulation and genetically targeted neuromodulation. Finally, ongoing challenges and limitations for closed-loop psychiatric brain stimulation development, most notably the difficulty of identifying meaningful biomarkers for titration, are discussed. This is considered in the recently-released Research Domain Criteria (RDoC) framework, and how neuromodulation and RDoC are jointly very well suited to address the problem of treatment-resistant illness is described.
KW - Deep brain stimulation
KW - bioengineering
KW - biomarker
KW - electrophysiology
KW - neuromodulation
KW - transdiagnostic
JO - International Review of Psychiatry
JF - International Review of Psychiatry