Physiologically informed neuromodulation.
Physiologically informed neuromodulation.
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DOI：
10.1016/j.jns.2021.120121
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发表时间：
2022-03-15
影响因子：
4.4
通讯作者：
Widge AS
中科院分区：
文献类型：
--
作者：
Wendt K;Denison T;Foster G;Krinke L;Thomson A;Wilson S;Widge AS
神经调节技术的快速发展包括越来越多的对以患者神经生理学为指导的刺激范例的研究，以提高疗效和反应率。治疗个性化和目标参与已被证明在帕金森病等领域是有效的，并且闭环范例已在心脏除颤器中成功实施。人们正在探索精神病学中生理学神经调节的有希望的途径。将刺激频率与个体大脑节律相匹配在经颅磁刺激 (TMS) 中已显示出一些前景。匹配这些节律的相位可能会进一步增强神经可塑性，例如将 TMS 与脑电图 (EEG) 记录相结合时。静息态脑电图和事件相关电位可能有助于证明刺激部位和连接区域之间的连接性。如今，精神科医生可以使用这些技术来诊断潜在的睡眠障碍、癫痫或导致抑郁症的病变。这些技术也可能有助于在决定治疗方案之前评估患者的大脑网络状态。正在进行的使用侵入性录音的研究可能有助于未来识别情绪生物标志物和网络结构。一个核心限制是，根据当前基于 DSM 的分类，生物标志物研究目前可能受到精神疾病内部异质性的限制。新方法正在开发中，可能很快就会得到验证。最后，在将闭环功能纳入神经调节系统时必须小心，确保系统的安全运行并了解生理动力学。神经生理学工具正在迅速发展，很可能定义下一代神经调节疗法。生理学神经调节有望提高治疗效果。针对多种神经系统疾病存在有效方法的例子。对精神病学应用实施的研究正在迅速推进。在将它们用于临床实践之前，需要进一步的研究和验证。
The rapid evolution of neuromodulation techniques includes an increasing amount of research into stimulation paradigms that are guided by patients' neurophysiology, to increase efficacy and responder rates. Treatment personalisation and target engagement have shown to be effective in fields such as Parkinson's disease, and closed-loop paradigms have been successfully implemented in cardiac defibrillators. Promising avenues are being explored for physiologically informed neuromodulation in psychiatry. Matching the stimulation frequency to individual brain rhythms has shown some promise in transcranial magnetic stimulation (TMS). Matching the phase of those rhythms may further enhance neuroplasticity, for instance when combining TMS with electroencephalographic (EEG) recordings. Resting-state EEG and event-related potentials may be useful to demonstrate connectivity between stimulation sites and connected areas. These techniques are available today to the psychiatrist to diagnose underlying sleep disorders, epilepsy, or lesions as contributing factors to the cause of depression. These technologies may also be useful in assessing the patient's brain network status prior to deciding on treatment options. Ongoing research using invasive recordings may allow for future identification of mood biomarkers and network structure. A core limitation is that biomarker research may currently be limited by the internal heterogeneity of psychiatric disorders according to the current DSM-based classifications. New approaches are being developed and may soon be validated. Finally, care must be taken when incorporating closed-loop capabilities into neuromodulation systems, by ensuring the safe operation of the system and understanding the physiological dynamics. Neurophysiological tools are rapidly evolving and will likely define the next generation of neuromodulation therapies. Physiologically informed neuromodulation is promising to improve therapy efficacy. Examples of effective approaches exist for several neurological diseases. Research into implementations for psychiatric applications is advancing rapidly. Further research and validation are needed before using these in clinical practice.
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影响因子：
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