Proceedings of the Ninth Annual Deep Brain Stimulation Think Tank: Advances in Cutting Edge Technologies, Artificial Intelligence, Neuromodulation, Neuroethics, Pain, Interventional Psychiatry, Epilepsy, and Traumatic Brain Injury – ScienceOpen
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      Proceedings of the Ninth Annual Deep Brain Stimulation Think Tank: Advances in Cutting Edge Technologies, Artificial Intelligence, Neuromodulation, Neuroethics, Pain, Interventional Psychiatry, Epilepsy, and Traumatic Brain Injury

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      1 , * , , 2 , 2 , 3 , 4 , 4 , 5 , 6 , 6 , 6 , 6 , 6 , 7 , 7 , 7 , 7 , 8 , 9 , 10 , 11 , 12 , 1 , 13 , 14 , 1 , 15 , 16 , 17 , 18 , 18 , 18 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 24 , 24 , 24 , 24 , 25 , 26 , 6 , 27 , 28 , 28 , 29 , 30 , 31 , 1
      Frontiers in Human Neuroscience
      Frontiers Media S.A.
      deep brain stimulation, artificial intelligence, neuroethics, pain, interventional psychiatry, adaptive DBS, epilepsy, traumatic brain injury

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          Abstract

          DBS Think Tank IX was held on August 25–27, 2021 in Orlando FL with US based participants largely in person and overseas participants joining by video conferencing technology. The DBS Think Tank was founded in 2012 and provides an open platform where clinicians, engineers and researchers (from industry and academia) can freely discuss current and emerging deep brain stimulation (DBS) technologies as well as the logistical and ethical issues facing the field. The consensus among the DBS Think Tank IX speakers was that DBS expanded in its scope and has been applied to multiple brain disorders in an effort to modulate neural circuitry. After collectively sharing our experiences, it was estimated that globally more than 230,000 DBS devices have been implanted for neurological and neuropsychiatric disorders. As such, this year’s meeting was focused on advances in the following areas: neuromodulation in Europe, Asia and Australia; cutting-edge technologies, neuroethics, interventional psychiatry, adaptive DBS, neuromodulation for pain, network neuromodulation for epilepsy and neuromodulation for traumatic brain injury.

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          A theory of human motivation.

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            Behavioural improvements with thalamic stimulation after severe traumatic brain injury.

            Widespread loss of cerebral connectivity is assumed to underlie the failure of brain mechanisms that support communication and goal-directed behaviour following severe traumatic brain injury. Disorders of consciousness that persist for longer than 12 months after severe traumatic brain injury are generally considered to be immutable; no treatment has been shown to accelerate recovery or improve functional outcome in such cases. Recent studies have shown unexpected preservation of large-scale cerebral networks in patients in the minimally conscious state (MCS), a condition that is characterized by intermittent evidence of awareness of self or the environment. These findings indicate that there might be residual functional capacity in some patients that could be supported by therapeutic interventions. We hypothesize that further recovery in some patients in the MCS is limited by chronic underactivation of potentially recruitable large-scale networks. Here, in a 6-month double-blind alternating crossover study, we show that bilateral deep brain electrical stimulation (DBS) of the central thalamus modulates behavioural responsiveness in a patient who remained in MCS for 6 yr following traumatic brain injury before the intervention. The frequency of specific cognitively mediated behaviours (primary outcome measures) and functional limb control and oral feeding (secondary outcome measures) increased during periods in which DBS was on as compared with periods in which it was off. Logistic regression modelling shows a statistical linkage between the observed functional improvements and recent stimulation history. We interpret the DBS effects as compensating for a loss of arousal regulation that is normally controlled by the frontal lobe in the intact brain. These findings provide evidence that DBS can promote significant late functional recovery from severe traumatic brain injury. Our observations, years after the injury occurred, challenge the existing practice of early treatment discontinuation for patients with only inconsistent interactive behaviours and motivate further research to develop therapeutic interventions.
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              Adaptive Deep Brain Stimulation In Advanced Parkinson Disease

              Objective: Brain–computer interfaces (BCIs) could potentially be used to interact with pathological brain signals to intervene and ameliorate their effects in disease states. Here, we provide proof-of-principle of this approach by using a BCI to interpret pathological brain activity in patients with advanced Parkinson disease (PD) and to use this feedback to control when therapeutic deep brain stimulation (DBS) is delivered. Our goal was to demonstrate that by personalizing and optimizing stimulation in real time, we could improve on both the efficacy and efficiency of conventional continuous DBS. Methods: We tested BCI-controlled adaptive DBS (aDBS) of the subthalamic nucleus in 8 PD patients. Feedback was provided by processing of the local field potentials recorded directly from the stimulation electrodes. The results were compared to no stimulation, conventional continuous stimulation (cDBS), and random intermittent stimulation. Both unblinded and blinded clinical assessments of motor effect were performed using the Unified Parkinson's Disease Rating Scale. Results: Motor scores improved by 66% (unblinded) and 50% (blinded) during aDBS, which were 29% (p = 0.03) and 27% (p = 0.005) better than cDBS, respectively. These improvements were achieved with a 56% reduction in stimulation time compared to cDBS, and a corresponding reduction in energy requirements (p < 0.001). aDBS was also more effective than no stimulation and random intermittent stimulation. Interpretation BCI-controlled DBS is tractable and can be more efficient and efficacious than conventional continuous neuromodulation for PD. Ann Neurol 2013;74:449–457
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                Author and article information

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                Journal
                Front Hum Neurosci
                Front Hum Neurosci
                Front. Hum. Neurosci.
                Frontiers in Human Neuroscience
                Frontiers Media S.A.
                1662-5161
                04 March 2022
                2022
                : 16
                : 813387
                Affiliations
                [1] 1Department of Neurology, Fixel Institute for Neurological Diseases, University of Florida , Gainesville, FL, United States
                [2] 2Department of Neurology, Christian-Albrechts-University , Kiel, Germany
                [3] 3Department of Medical Neurobiology (Physiology), Institute of Medical Research Israel-Canada, Hebrew University of Jerusalem , Jerusalem, Israel
                [4] 4Biomedical Statistics and Multimodal Signal Processing Unit, Section of Movement Disorders and Neurostimulation, Focus Program Translational Neuroscience, Department of Neurology, University Medical Center of the Johannes Gutenberg-University Mainz , Mainz, Germany
                [5] 5Department of Neurological Surgery, Baylor College of Medicine , Houston, TX, United States
                [6] 6The Human Motor Control and Neuromodulation Laboratory, Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford University , Stanford, CA, United States
                [7] 7Department of Neurological Surgery, Kavli Institute for Fundamental Neuroscience, University of California, San Francisco , San Francisco, CA, United States
                [8] 8Department of Anesthesia, University of California, San Francisco , San Francisco, CA, United States
                [9] 9Department of Neurology, Wilder Center for Epilepsy Research, University of Florida , Gainesville, FL, United States
                [10] 10Department of Neurology, Mayo Clinic , Rochester, NY, United States
                [11] 11Department of Neurosurgery, Mayo Clinic , Rochester, NY, United States
                [12] 12Department of Neurology, Weill Cornell Brain and Spine Institute, Weill Cornell Medicine , New York, NY, United States
                [13] 13Department of Neurosurgery, Stanford University , Stanford, CA, United States
                [14] 14Department of Electrical and Computer Engineering, University of Florida , Gainesville, FL, United States
                [15] 15Department of Neurosurgery, Fixel Institute for Neurological Diseases, University of Florida , Gainesville, FL, United States
                [16] 16Queensland Brain Institute, University of Queensland and Saint Andrews War Memorial Hospital , Brisbane, QLD, Australia
                [17] 17National Engineering Laboratory for Neuromodulation, School of Aerospace Engineering, Tsinghua University , Beijing, China
                [18] 18Department of Neurology, Faculty of Medicine, Juntendo University , Tokyo, Japan
                [19] 19Neuroethics Studies Program, Department of Neurology, Georgetown University Medical Center , Washington, DC, United States
                [20] 20US Department of Defense Fort Lesley J. McNair, National Defense University , Washington, DC, United States
                [21] 21Department of Philosophy and Science Education, University of Buffalo , Buffalo, NY, United States
                [22] 22Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School , Boston, MA, United States
                [23] 23Department of Psychiatry, University of Minnesota , Minneapolis, MN, United States
                [24] 24Department of Neurology and Neurosurgery, Icahn School of Medicine at Mount Sinai , New York, NY, United States
                [25] 25Department of Neurology, Emory University , Atlanta, GA, United States
                [26] 26Department of Psychology, Columbia University , New York, NY, United States
                [27] 27Department of Anesthesiology (Pain Management) and Neurology, University of California, San Francisco , San Francisco, CA, United States
                [28] 28School of Electrical and Computer Engineering, Georgia Institute of Technology , Atlanta, GA, United States
                [29] 29Restorative Therapies Group Implantables, Research and Core Technology, Medtronic Inc. , Minneapolis, MN, United States
                [30] 30Boston Scientific Neuromodulation Corporation , Valencia, CA, United States
                [31] 31NeuroPace, Inc. , Mountain View, CA, United States
                Author notes

                Edited by: Karsten Mueller, Max Planck Institute for Human Cognitive and Brain Sciences, Germany

                Reviewed by: Josef Vymazal, Na Homolce Hospital, Czechia

                *Correspondence: Joshua K. Wong, joshua.wong@ 123456neurology.ufl.edu

                This article was submitted to Brain Imaging and Stimulation, a section of the journal Frontiers in Human Neuroscience

                Article
                10.3389/fnhum.2022.813387
                8931265
                35308605
                a9b75fb3-515d-4ed0-a1ab-3b2aa63af87e
                Copyright © 2022 Wong, Deuschl, Wolke, Bergman, Muthuraman, Groppa, Sheth, Bronte-Stewart, Wilkins, Petrucci, Lambert, Kehnemouyi, Starr, Little, Anso, Gilron, Poree, Kalamangalam, Worrell, Miller, Schiff, Butson, Henderson, Judy, Ramirez-Zamora, Foote, Silburn, Li, Oyama, Kamo, Sekimoto, Hattori, Giordano, DiEuliis, Shook, Doughtery, Widge, Mayberg, Cha, Choi, Heisig, Obatusin, Opri, Kaufman, Shirvalkar, Rozell, Alagapan, Raike, Bokil, Green and Okun.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 11 November 2021
                : 11 January 2022
                Page count
                Figures: 12, Tables: 0, Equations: 0, References: 105, Pages: 21, Words: 14630
                Categories
                Neuroscience
                Perspective

                Neurosciences
                deep brain stimulation,artificial intelligence,neuroethics,pain,interventional psychiatry,adaptive dbs,epilepsy,traumatic brain injury

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