Brain Stimulation Methodologies and Interventions

Brain stimulation technologies are both tools to probe brain function and to provide therapeutic options for patients with neuropsychiatric disease where pharmacological options are not viable. Although the field has been in existence for over seventy years, research interest in brain stimulation has been on the rise particularly in the last two decades.

Brain Stimulation: Methodologies and Interventions is an introduction to the field of brain stimulation technology and its applications. The book explores how brainstimulating technologies work in the context of brain pathways that mediate normal and abnormal brain function. Chapters cover neuroanatomy and activity dependent changes in neuronal function triggered by brain stimulation, as well as applications of brain stimulation technologies themselves, including noninvasive procedures that rely on convulsive or seizure therapeutics, and non-convulsive therapies such as magnetic and electrical brain stimulation.

Authored by an international group of leaders in the field, Brain Stimulation is a valuable resource for both neuroscience researchers and clinicians.

Contributors xi

1 Introduction to Brain Stimulation 1
Irving M. Reti and Andrew D. Chang

Introduction 1

A Historical Perspective 2

Focal Activation 3

Connectivity 5

Development of Invasive Brain Stimulation 7

Ethical Issues 9

References 9

PART A BRAIN CIRCUITRY AND PLASTICITY 13

2 A Balanced Mind: A Network Perspective on Mood and Motivation Brain Pathways 15
Morten L. Kringelbach

Introduction 15

Dysregulation of Emotion and Mood 18

Potential for Intervention 21

Conclusion 23

References 24

3 Motor Pathways, Basal Ganglia Physiology, and Pathophysiology 29
Hagai Bergman, Shiran Katabi, Maya Slovik, Marc Deffains, David Arkadir, Zvi Israel, and Renana Eitan

Introduction 29

The Classic Models of Basal Ganglia Anatomy 30

Basal Ganglia Physiology 33

The Pathophysiology of Hypo- and HyperDopaminergic States 35

From Physiology to Understanding and Therapy—the Computational Models of the Basal Ganglia 37

References 41

4 Viewing Brain Stimulation from a Plasticity Perspective 45
Jay M. Baraban

Long-Term Potentiation: A Primer 45

AMPA Versus NMDA Receptors 46

Distinct Mechanisms of LTP Induction and Expression 48

Synapse Specificity of LTP 48

Relevance of LTP Mechanisms to Mode of Action of tDCS 49

Long-Term Depression 51

Metaplasticity and Monoamines 52

Clues to rTMS Mode of Action 52

Future Directions 54

Summary 55

References 55

PART B TECHNOLOGY 57

(1) Non-Invasive Brain Stimulation Modalities 59

(a) Convulsive 59

5 Introduction to Convulsive Therapy 61
Richard D. Weiner

Introduction 61

The History of Convulsive Therapy 62

Electroconvulsive Therapy: Basic Principles 64

Electroconvulsive Therapy: Clinical Role 67

Magnetic Seizure Therapy (MST) 76

Focal Electrically Administered Seizure Therapy (FEAST) 77

Future of Convulsive Therapy 77

References 78

6 Improving ECT Efficacy and Decreasing Cognitive Side Effects 83
Keith G. Rasmussen

Introduction 83

ECT Outcome Assessment: Therapeutic Efficacy and Cognitive Side Effects 83

ECT Treatment Technique: Basic Concepts 84

Electrode Placement 86

Stimulus Dosage 88

Stimulus Parameter Configuration 89

Treatment Frequency 93

Concomitant Psychotropic Drugs 94

Choice of Anesthetic Drug 96

References 100

7 How Does Electroconvulsive Therapy Work? 107
Irving M. Reti

Introduction 107

What Can We Learn from ECT’s Action as an Antidepressant? 107

What Can We Learn from ECT’s Action in Treating Catatonia? 112

How Do Stimulus Parameters that Trigger the Seizure Influence How It Works? 113

Conclusions and Implications for ECT Treatment 116

References 117

8 Magnetic Seizure Therapy for the Treatment of Depression 123
Sarah H. Lisanby and Zhi-De Deng

Introduction 123

Definitions 123

Rationale for MST 124

History of MST: A Translational Developmental Trajectory 125

MST Technique 127

E-field Distribution with MST 133

Neurophysiological Effects of MST 135

Safety 139

Antidepressant Efficacy 140

Future Directions for MST Development 142

Conclusions 144

References 144

(b) Non-Convulsive 149

9 Introduction to Nonconvulsive Brain Stimulation: Focus on Transcranial Magnetic Stimulation 151
Masashi Hamada and John C. Rothwell

History of Nonconvulsive Transcranial Brain Stimulation Technique in Humans 151

Basics of Transcranial Magnetic Stimulation 152

New Techniques: Static Magnets and Pulsed Ultrasound 160

References 160

10 Advances in Transcranial Magnetic Stimulation Technology 165
Angel V. Peterchev, Zhi-De Deng and Stefan M. Goetz

Introduction 165

Pulse Source Technology and Waveforms 165

Coils 171

Technical Aspects of Concurrent TMS and Neuroimaging 179

Conclusion and Future Directions 182

References 183

11 Applications of TMS to Study Brain Connectivity 191
Gabriela Cantarero and Pablo Celnik

Introduction 191

Probing Connectivity using Bifocal TMS 192

Connectivity Studies Using TMS Plus fMRI, PET or EEG 204

Conclusions 206

References 206

12 Therapeutic Applications of rTMS for Psychiatric and Neurological Conditions 213
Mark S. George, E. Baron Short, Suzanne E. Kerns, Xingbao Li, Colleen Hanlon, Christopher Pelic, Joseph J. Taylor, Bashar W. Badran, Jeffrey J. Borckardt, Nolan Williams, and James Fox

Introduction 213

The Depressions 213

The Anxiety Disorders 220

The Schizophrenias 221

Pain Syndromes 222

Movement Disorders 222

Repairing the Damaged Brain 223

Other Conditions 223

Summary and Conclusions 225

References 225

13 Transcranial Direct Current Stimulation: Modulation of Brain Pathways and Potential Clinical Applications 233
Michael A. Nitsche, Rafael Polania, and Min-Fang Kuo

Introduction 233

Physiological Basis of tDCS 233

Impact of tDCS on Cognition 242

Application of tDCS in Neuropsychiatric Diseases 244

Concluding Remarks 247

References 248

(2) Invasive Brain Stimulation Modalities 255

14 Epidural Cortical Stimulation 257
Ziad Nahas

Introduction 257

Options for Treatment Resistant Depression 257

Epidural Cortical Stimulation 259

Disrupted Emotion Regulation in Depression and EpCS 263

Deficits in Mentalization in Depression and EpCS 263

Comparison Across Brain Stimulation Therapies 265

Summary 266

References 266

15 Neurological Indications for Deep Brain Stimulation 271
Jennifer J. Cheng, William S. Anderson, and Frederick A. Lenz

Introduction 271

Current Indications for Deep Brain Stimulation 271

Safety of Deep Brain Stimulation 274

Fundamentals of Stimulation 275

Lead Placement 277

Conclusion 282

References 283

16 Psychiatric Indications for Deep Brain Stimulation 289
Reinier Prosée and Damiaan Denys

Introduction 289

Deep Brain Stimulation and Obsessive Compulsive Disorder 289

Deep Brain Stimulation and Major Depressive Disorder 293

Deep Brain Stimulation and Drug Addiction 296

Potential New Indications for Deep Brain Stimulation 298

References 300

17 Vagus Nerve Stimulation for Epilepsy and Depression 305
Charles R. Conway, Mark A. Colijn, and Steven C. Schachter

Introduction 306

The VNS Therapy Device 306

Vagus Nerve Anatomy 308

Mechanisms of Action of VNS 311

Epilepsy 317

Depression 322

General Safety Considerations 326

Future Directions 326

Summary 327

References 328

Index 337