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.
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