Neuromodulation: Update on current practice and future developments
Neurotherapeutics,
Год журнала:
2024,
Номер
21(3), С. e00371 - e00371
Опубликована: Апрель 1, 2024
During
the
past
decades,
neuromodulation
has
entered
clinical
practice
exponentially
with
a
variety
of
invasive
and
non-invasive
approaches
(Table
1).
Most
these
treatments
have
shown
not
only
that
their
adoption
results
in
an
improvement
quality
life
(QoL)
but
also
multidisciplinary
approach
is
key
to
successful
implementation.
Clinical
implementation
aside,
advanced
been
used
gain
better
understanding
how
nervous
system
works
normal
pathological
conditions.
Not
surprisingly,
like
deep
brain
stimulation
(DBS)
are
now
adopted
almost
all
countries
worldwide,
steady
growth
numbers
implanted
patients
[1Sarica
C.
Conner
C.R.
Yamamoto
K.
Yang
A.
Germann
J.
Lannon
M.
et
al.Trends
disparities
utilization
United
States:
Nationwide
Inpatient
Sample
analysis
from
1993
2017.Lancet
Reg
Health
Am.
2023;
26
(PMID:
37876670;
PMCID:
PMC10593574)100599https://doi.org/10.1016/j.lana.2023.100599Abstract
Full
Text
PDF
PubMed
Scopus
(2)
Google
Scholar].Table
1The
list
techniques
constantly
expanding.Neuromodulatory
approachesInvasiveNon-invasive•Brain-computer
interface•Cochlear
implant•Deep
stimulation•Dorsal
root
ganglion
stimulation•Gastric/Intestinal
electrical
stimulation•Motor
cortex
stimulation•Peripheral
nerve
stimulation∗•Peripheral
subcutaneous
field
stimulation•Retinal
stimulation•Responsive
neurostimulation•Spinal
cord
stimulation•Vagus
stimulation•Electroconvulsive
therapy•Functional
stimulation•Low-intensity
focused
ultrasound
stimulation∗∗•Non-invasive
vagus
(auricular,
cervical)•Peripheral
stimulation∗•Transcranial
alternating
current
stimulation•Transcranial
direct
stimulation•Transcutaneous
stimulation•Temporal
interference
magnetic
stimulation∗∗Possibly
neuromodulatory
and/or
offered
within
same
program•Intrathecal
drug
delivery
(e.g.
ITB)•Intraventricular
ITB)•Lumboperitoneal
shunt∗∗•Ventriculoperitoneal
shunt∗∗•Intestinal
pump-based
infusion
LICG)•Drug
ketamine)•Subcutaneous
CSAI)Abbreviations:
∗
includes
(invasive
non-invasive)
nerves:
trigeminal,
hypoglossal,
sacral,
pudendal,
occipital,
phrenic
('diaphragm
pacing')
tibial
(usually
percutaneous)'
∗∗
non-electrical
(acoustic
waves,
intracranial
pressure
modulation);
CSAI:
continuous
apomorphine
infusion;
ITB:
intrathecal
baclofen;
LCIG:
levodopa-carbidopa
intestinal
gel.
Open
table
new
tab
Abbreviations:
Such
resulting
expansion
indications
less
conservative
patient
enrollments,
given
high
level
evidence
supporting
early
intervention
translates
greater
sustained
QoL
benefit
[2Schuepbach
W.M.
Rau
Knudsen
Volkmann
Krack
P.
Timmermann
L.
al.Neurostimulation
for
Parkinson's
disease
motor
complications.N
Engl
J
Med.
2013;
368
23406026):
610-622https://doi.org/10.1056/NEJMoa1205158Crossref
(1042)
Scholar].
In
this
special
issue
Neurotherapeutics,
we
present
compilation
excellent
articles
provide
comprehensive
review
both
approved
experimental
therapies.
Davidson
al.
[3Davidson
B.
Bhattacharya
Sarica
Darmani
G.
Raies
N.
Chen
R.
al.Neuromodulation
–
stimulation.Neurotherapeutics.
2024;
3:
xxxGoogle
Scholar]
broad
overview
technologies,
encompassing
methods
transcranial
(TMS),
(tDCS),
(TUS),
surgical
such
as
(DBS),
spinal
(SCS),
(VNS),
which
significantly
treatment
neurological
disorders
by
enabling
precise
modulation
neural
activity.
Techniques
TMS
tDCS
applied
diagnostic
therapeutic
purposes,
leveraging
ability
induce
transient
or
lasting
changes
excitability
address
psychiatric
disorders.
The
authors
emphasize
that,
expands,
ongoing
research
trials
vital
optimizing
technologies
personalized
medicine,
enhancing
efficacy
mechanisms
various
Durham
[4Durham
P.G.
Butnariu
Alghorazi
Pinton
Krishna
V.
Dayton
P.A.
Current
investigations
blood-brain
barrier
disruption:
review.Neurotherapeutics.
(FUS)
technology,
highlighting
its
potential
brain,
could
improve
underscores
efforts
optimize
technique
need
further
test
across
emerging
applications,
Alzheimer's
disease,
(PD),
tumors;
prospect
holds
great
promise
improving
outcomes.
Gouveia
[5Gouveia
F.V.
Warsi
N.M.
Suresh
H.
Matin
Ibrahim
G.M.
Neurostimulatory
epilepsy:
stimulation,
responsive
neurostimulation
discuss
drug-resistant
epilepsy,
specifically
focusing
on
VNS,
DBS,
(RNS).
These
treatments,
include
open-loop
closed-loop
systems,
offer
options
who
do
respond
traditional
candidates
resection.
While
VNS
most
accessible
FDA-approved
children,
DBS
RNS
show
reducing
seizure
frequency
cases,
develop
biomarkers
predicting
response.
Neudorfer
[6Neudorfer
Kultas-Ilinsky
Ilinsky
I.
Paschen
S.
Helmers
A.-K.
Cosgrove
G.R.
al.The
role
thalamus
essential
tremor.Neurotherapeutics.
evolution
state
targeting
tremor
(ET),
controversies
surrounding
optimal
targets
thalamic
ventral
intermediate
nucleus
(Vim)
posterior
subthalamic
area
(PSA).
They
historical
anatomical
basis
selecting
targets,
emphasizing
cerebellothalamic
tract
(CTT)
integration
modern
imaging
electrophysiological
accuracy.
This
suggests
while
Vim
focus
ET
treatment,
technological
advances
indicate
PSA,
particularly
areas
adjacent
involving
CTT,
may
superior
outcomes
suppression,
refined
strategies
enhance
efficacy.
Further
developing
theme,
Silva
[7Silva
N.A.
Barrios-Martinez
Yeh
F.-C.
Hodaie
Roque
D.
Boerwinkle
V.L.
al.Diffusion
functional
MRI
neuromodulation.Neurotherapeutics.
neuromodulation,
mainly
ablation
means
high-intensity
FUS
well
optimization
through
diffusion
(dMRI)
(fMRI).
highlight
shift
toward
conceptualizing
nodes
specific
networks,
rather
than
merely
structures,
paradigm
facilitated
dMRI
fMRI,
improved
precision
programming
Their
modalities
personalizing
conditions,
calling
fully
realize
capabilities
practice.
Martinez-Nunez
therapies
PD,
application,
mechanisms,
[8Martinez-Nunez
A.E.
Justich
M.-B.
Okun
M.S.
Fasano
Emerging
disease.Neurotherapeutics.
details
methods,
including
TMS,
tDCS,
electroconvulsive
therapy
(ECT),
alongside
Temporal
Interference
Stimulation
FUS.
importance
consider
patient's
symptoms,
progression,
genetic
background,
aiming
more
tailored
manage
PD
complex
symptomatology.
[9Davidson
Luka
Milosevic
Kondrataviciute
Kalia
L.V.
S.K.
Neuroscience
fundamentals
relevant
neuromodulation:
neurobiology
in-depth
neurobiological
underpinning
discussing
effects
at
local,
circuit,
neurobiochemical
levels,
(STN)
prime
target.
elaborate
influences
neuronal
activity
axons,
neurotransmitter
release,
impacting
microenvironment.
It
affects
broader
circuits
alters
oscillatory
activities
basal
ganglia.
addresses
debate
whether
exerts
disease-modifying
robust
large-scale
prospective
determine
long-term
impact
progression
conclusively.
Noor
[10Noor
Steina
A.K.
McIntyre
C.M.
Dissecting
evoked
ganglia.Neurotherapeutics.
underlying
DBS-evoked
ganglia,
STN
globus
pallidus
internus
treatment.
recent
discovery
large
amplitude
(EP)
oscillations
opportunities
understand
human
ganglia
network
highlights
DBS-induced
antidromic
activation
externus
(GPe)
critical
driver
oscillations,
suggesting
significant
previously
underappreciated
GPe
outlines
EPs
clinically
useful
confirming
target
engagement.
Wang
[11Bath
J.E.
Unraveling
threads
stability:
neurophysiology
postural
control
challenges
complexities
treating
instability
biomechanical
circuitry
deficits
contribute
condition.
describe
therapies,
feedback-based
wearable
devices,
managing
instability.
implantable
devices
chronic
data
collection
mechanisms.
future
interventions
where
personalized,
circuit-based
symptom
control.
Sammartino
colleagues
[12Sammartino
F.
MacDonnell
North
R.B.
Vibhor
Poree
Disease
applications
stimulation:
nonmalignant
pain.Neurotherapeutics.
SCS
established
cost-effective
neuropathic
pain,
application
conditions
post-laminectomy
syndrome,
peripheral
neuropathy,
regional
pain
syndrome.
case
studies
followed
demonstrates
exhausted
conventional
treatments.
emphasizes
therapy,
loss
over
time,
explores
other
syndromes,
underscoring
evolving
landscape
management.
Saway
[13Saway
B.F.
Palmer
Hughes
Triano
R.E.
Gilmore
stroke:
neuroplasticity
brain-computer
interfaces.Neurotherapeutics.
exciting
development
facilitate
stroke
recovery,
rooted
interfaces
(BCIs).
BCIs,
augment
rehabilitation
efforts.
explore
directions
field,
integrating
artificial
intelligence
personalization
effectiveness
recovery
patients.
Finally,
Ranjan
[14Ranjan
Mahoney
J.J.
Rezai
A.R.
Neurosurgical
indications.Neurotherapeutics.
disorders,
obsessive-compulsive
disorder
(OCD),
depression,
addiction.
OCD,
uses
remain
investigational.
techniques,
testing
safety,
efficacy,
hopes
expanding
future.
With
very
few
exceptions,
centers
offering
nowadays
organized
classic
framework
hospitals'
operations,
whereby
different
departments
(neurology,
neurosurgery,
psychiatry,
etc.)
collaborate
maintaining
distinct
space
personnel
allocation.
existence
multiple
center
centralize
decision
making
process
related
selection
right
candidate
procedure
(e.g.,
ketamine
rTMS
before
ECT
depressed
patient).
Therefore,
any
tertiary
should
be
able
alternative
less-invasive
options.
Furthermore,
existing
rate
complications
reduces
time
individual
[15Sorar
Hanalioglu
Kocer
Eser
M.T.
Comoglu
S.S.
Kertmen
Experience
hardware-related
surgery:
single-center
study
181
operated
six
years.Parkinsons
Dis.
2018;
30140425;
PMC6081564)056018https://doi.org/10.1155/2018/3056018Crossref
(33)
academic
tend
overall
outcome
[16Deng
Yue
J.K.
D.D.
Trends
safety
cost
movement
2002-2014.Br
Neurosurg.
2021;
35
(Epub
2020
Jun
1.
PMID:
32476485):
57-64https://doi.org/10.1080/02688697.2020.1759776Crossref
(9)
fast
pace
requires
dedicated
expertise,
ready
change
similar
well-established
neurosurgeon
there
specialist
expertise
management
treated
treatments;
e.g.,
'functional'
neurologist.
Establishing
subspecialty,
educational
training
curricula
students,
residents,
postgraduate
fellowships
necessary
accreditation
certain
programs,
highlighted
priority
many
experts
field.
was
indeed
goal
Brain
Subspecialty
Summit,
took
place
September
14–15,
2023,
hosted
Brigham
&
Women's
Hospital
Harvard
Faculty
Club,
Boston,
Massachusetts.
meeting
attended
54
physicians
scientists
representing
psychology,
neurology,
partners
neuroscience,
industry,
professional
societies,
bodies.
A
unified
agnostic
advantages.
From
point
view,
some
can
treat
post-traumatic
Tourettism
seizures
whom
centromedian
chosen,
problems
[17Picillo
Rohani
Lozano
A.M.
Two
indications,
one
target:
concomitant
epilepsy
Centromedian/parafascicular
stimulation.Brain
Stimul.
2017;
10
2017
Jan
12.
28117177):
711-713https://doi.org/10.1016/j.brs.2017.01.577Abstract
(4)
standpoint,
inspire
novel
paradigms.
(an
management)
freezing
gait
[18Rohani
Kalsi-Ryan
Spinal
primary
progressive
gait.Mov
Disord.
32
Jul
6.
28681922):
1336-1337https://doi.org/10.1002/mds.27103Crossref
(11)
Another
example
classically
recently
pipeline
PD-related
Interestingly
migraine
potentially
predict
newer
indications.
Lastly,
clearly
interdisciplinarity
success
it
contemporary
medicine
(Fig.
Beyond
neurologists,
psychiatrists
neurosurgeons,
Table
2
offers
partial
contributors
practitioners
whose
adds
value
neuromodulation.Table
2Beyond
professionals
program.ExpertiseRoleBiomedical
engineers,
computational
scientistDiscovery
commercialization
stimulating
algorithmsEthicistDesign
dilemmasGeneticistPrognosis
surgery,
i.e.
'surgicogenomics'
(visanji
al.,
2022)KinesiologistObjective
evaluation
gait,
balance
disturbances.NeuropathologistAnalysis
biopsies
taken
during
surgeryNeurophysiologistNeuronal
recordings
surgery
externalized
wires
LFP
recording.NeuroradiologistAnatomical
DTI-based
targeting,
aggregated
individualized
VTA
heatmaps
assist
neuroimaging-based
DBS).PsychologistAssessment
around
psychosocial
introduced
life-changing
interventions,
e.g.
disordersRehabilitation
physiotherapistsMaximizing
benefits
gained
mobility.Abbreviations:
DBS:
DTI:
tensor
(tractography),
LFP:
local
potential,
VTA:
volume
tissue
activated.
summary,
Neurotherapeutics
ranging
range
reviews
collectively
pivotal
several
advancing
paradigms
modulation,
hope
deemed
intractable.
All
included
response,
applications.
Moreover,
promises
exploration
into
neuromodulation's
capabilities,
especially
revolutionize
care.
aims
serve
cornerstone
space,
inspiring
collaborations
will
push
boundaries
what
possible
neurotherapeutics.
Язык: Английский
Focused Ultrasound
Investigative Radiology,
Год журнала:
2024,
Номер
unknown
Опубликована: Авг. 20, 2024
Invasive
open
surgery
used
to
be
compulsory
access
tumor
mass
perform
excision
or
resection.
Development
of
minimally
invasive
laparoscopic
procedures
followed,
as
well
catheter-based
approaches,
such
stenting,
endovascular
surgery,
chemoembolization,
brachytherapy,
which
minimize
side
effects
and
reduce
the
risks
patients.
Completely
noninvasive
bring
further
benefits
in
terms
reducing
risk,
procedure
time,
recovery
potential
infection,
other
effects.
Focusing
ultrasound
waves
from
outside
body
specifically
at
disease
site
has
proven
a
safe
approach
localized
ablative
hyperthermia,
mechanical
ablation,
targeted
drug
delivery.
Focused
medical
intervention
was
proposed
decades
ago,
but
it
only
became
feasible
plan,
guide,
monitor,
control
treatment
with
advanced
radiological
imaging
capabilities.
The
purpose
this
review
is
describe
capabilities
approaches
these
tasks,
emphasis
on
magnetic
resonance
ultrasound.
Some
already
are
clinical
practice,
more
trial
stage.
Imaging
fully
integrated
workflow
includes
following:
(1)
planning,
definition
target
regions
adjacent
organs
risk;
(2)
real-time
monitoring
via
thermometry
imaging,
cavitation
feedback,
motion
control,
assure
targeting
safety
normal
tissues;
(3)
evaluation
efficacy,
assessment
ablation
physiological
parameters,
blood
supply.
This
also
focuses
sonosensitive
microparticles
nanoparticles,
microbubbles
injected
bloodstream.
They
enable
energy
deposition
down
microvascular
level,
induce
vascular
inflammation
shutdown,
accelerate
clot
dissolution,
delivery
interventions,
including
focal
gene
Especially
exciting
ability
opening
blood-brain
barrier
desired
areas
within
brain.
Overall,
focused
under
image
guidance
rapidly
developing,
become
choice
interventional
radiology
tool
treat
cure
Язык: Английский
The Third Pillar of Precision Medicine — Precision Delivery
MedComm,
Год журнала:
2025,
Номер
6(5)
Опубликована: Апрель 28, 2025
ABSTRACT
Precision
Medicine
is
thought
of
as
having
two
main
pillars:
Diagnosis
and
Therapy.
However,
for
to
reach
its
full
potential,
a
third
pillar
needed
that
we
propose
call
Delivery
.
In
the
laboratory,
many
therapies
show
great
efficacy
when
tested
directly
with
target
cells.
upon
clinical
translation,
they
are
often
given
via
intravenous
or
oral
administration,
resulting
in
their
systemic
distribution.
To
ensure
sites
at
correct
therapeutic
levels,
higher
concentrations.
this
can
be
associated
off‐target
effects,
side‐effects,
unwanted
interactions.
strategies
help
mitigate
by
“spatially
re‐coupling”
vivo
This
review
explains
concept
,
which
three
interconnected,
but
independent,
modules:
targeted
delivery,
microenvironment
modulation,
cellular
While
locoregional
approaches
deliver
into
tissues
through
endovascular,
endoluminal,
percutaneous,
implantation
techniques,
modulation
technologies
facilitate
movement
across
biological
barriers
tissue
matrices,
so
optimized
interact
We
highlight
new
innovations
driving
advances
while
also
discussing
considerations
challenges
faces
it
becomes
increasingly
integrated
treatment
workflows.
Язык: Английский
Single-cell omics: moving towards a new era in ischemic stroke research
European Journal of Pharmacology,
Год журнала:
2025,
Номер
unknown, С. 177725 - 177725
Опубликована: Май 1, 2025
Язык: Английский
Overview of Therapeutic Ultrasound Applications and Safety Considerations: 2024 Update
Journal of Ultrasound in Medicine,
Год журнала:
2024,
Номер
unknown
Опубликована: Ноя. 11, 2024
A
2012
review
of
therapeutic
ultrasound
was
published
to
educate
researchers
and
physicians
on
potential
applications
concerns
for
unintended
bioeffects
(doi:
10.7863/jum.2012.31.4.623).
This
serves
as
an
update
the
parent
article,
highlighting
advances
in
over
past
12
years.
In
addition
general
mechanisms
produced
by
ultrasound,
current
applications,
pre-clinical
clinical
stages
are
outlined.
An
overview
is
provided
image
guidance
methods
monitor
assess
treatment
progress.
Finally,
other
topics
relevant
translation
discussed,
including
computational
modeling,
tissue-mimicking
phantoms,
quality
assurance
protocols.
Язык: Английский
Neuroinflammation in Glioblastoma: Progress and Perspectives
Brain Sciences,
Год журнала:
2024,
Номер
14(7), С. 687 - 687
Опубликована: Июль 9, 2024
Glioblastoma
is
the
most
common
and
malignant
primary
brain
tumor,
with
high
morbidity
mortality.
Despite
an
aggressive,
multimodal
treatment
regimen,
including
surgical
resection
followed
by
chemotherapy
radiotherapy,
prognosis
of
glioblastoma
patients
remains
poor.
One
formidable
challenge
to
advancing
therapy
complexity
tumor
microenvironment.
The
microenvironment
a
highly
dynamic
heterogeneous
system
that
consists
not
only
cancerous
cells
but
also
various
resident
or
infiltrating
inflammatory
cells.
These
provide
unique
environment
for
develop
grow
play
important
roles
in
regulating
aggressiveness
resistance.
Targeting
microenvironment,
especially
neuroinflammation,
has
increasingly
been
recognized
as
novel
therapeutic
approach
glioblastoma.
In
this
review,
we
discuss
components
glioblastoma,
focusing
on
neuroinflammation.
We
interactions
between
different
well
their
functions
pathogenesis
progression.
will
anti-tumor
interventions
can
be
employed
potential
targets.
Язык: Английский