Thus, the concept of using neuromodulation to target distributed brain networks is not new. Anderson, 2019).Some of the earliest studies of DBS adopted this same motivation, seeking to modulate the network of brain regions connected to the stimulation site ( Montgomery and Gale, 2008). Knight began lesioning white matter tracts below the caudate (subcaudate tractotomy) to disrupt the connection between orbitofrontal and limbic regions ( W.S. For instance, Talairach and Leksell began lesioning the anterior limb of the internal capsule in patients with psychiatric disease with the goal of disrupting limbic input tothe prefrontal cortex ( Feldman and Goodrich, 2001). Neurosurgical lesioning was performed as early as 1890, often with the goalof disrupting information flow between connected brain regions or brain networks ( Gabriel and Nashold, 1998). The idea that brain connectivity may be important for understanding DBS and neuromodulation more generally is an old concept. Finally, DBS has shown some promise in Tourette’s Syndrome ( Ackermans et al., 2011), Huntington’s Disease ( Gruber et al., 2014), Major Depression ( Mayberg et al., 2005), alcohol addiction ( Müller et al., 2009), and other emerging indications ( Fox et al.,2014 Lozano et al., 2019). ![]() DBS leads to significant improvements of motor symptoms and quality of life inpatients with Parkinson’s Disease, Dystonia and Essential tial Tremor( Deuschl et al., 2006 Kupsch etal., 2006 Vitek et al., 2020).DBS is also FDA approved for the treatment of medication-refractory epilepsy ( Salanova et al., 2015) and obsessive compulsive disorder (OCD, via humanitarian device exemption ( Anderson and Ahmed, 2003 Baldermann et al., 2019b Franzini et al., 2010 Nuttin et al.,2003)). In this review, we will touch on all forms of neuromodulation, but will focus on DBS as it is one of the most widely used clinical neuromodulation technologies with well-established therapeutic benefits. transcranial electrical current stimulation). Other technologies exist but have not been FDA approved for clinical neuromodulation of the brain (e.g. Various lesioning devices have been previously approved by the FDA for ablation of neural tissue (radiofrequency thermoablation, laser interstitial thermal therapy, sterotactic radiosurgery) with applications including thalamotomy for tremor, pallidotomy for Parkinson’s or dystonia, and cingulotomy for pain. List on the left shows recent device approvals issued by the U.S. ![]() Methods used for clinical neuromodulation of the brain. We outline future perspectives and provide testable hypotheses for future work. We focus on deep brain stimulation, but show that the same principles can be applied to other forms of neuromodulation, such as transcranial magnetic stimulation and MRI-guided focused ultrasound. In this article, we review studies combining neuromodulation and brain connectomics, highlighting opportunities where this approach may prove particularly valuable. ![]() Brain connectivity information derived from advanced magnetic resonance imaging data can be used to identify these connections and better understand clinical and behavioral effectsof neuromodulation. Instead of focusing on the local impact at the stimulation site itself, we are considering the remote impact on brainregions connected to the stimulation site. However, our understanding of how neuromodulation impacts the brain is evolving. Deep brain stimulation in particular has provided clinical benefit to over 150,000 patients. The process of altering neural activity – neuromodulation – has long been used to treat patients with brain disorders and answer scientific questions.
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