Neurosurgery Blog: Connecting Invasive and Noninvasive Brain Stimulation (S52.002)

Connecting Invasive and Noninvasive Brain Stimulation (S52.002)

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OBJECTIVE: To identify brain diseases in which both invasive and noninvasive brain stimulation have shown evidence of efficacy and determine whether the stimulation sites are different nodes within the same brain network.BACKGROUND: Invasive deep brain stimulation (DBS) and noninvasive transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS) are increasingly being applied to treat a variety of brain diseases. Although generally considered separate in terms of mechanism and clinical indication, invasive and noninvasive approaches share the ability to modify brain activity at the stimulated site, impact regions remote from the site of stimulation, and the challenge of knowing where to stimulate to optimize therapeutic effect. Here we determine whether these two forms of stimulation are linked through brain networks.DESIGN/METHODS: Diseases with evidence of efficacy for both invasive and noninvasive brain stimulation were identified using a pubmed search. For each disease, resting state functional connectivity with the most effective DBS site was assessed using a previously collected MRI dataset from 1000 normal subjects. Connectivity to noninvasive brain stimulation sites was compared to that expected by chance.RESULTS: Thirteen brain diseases were identified with reports of efficacy for both invasive and noninvasive brain stimulation including Parkinson's, dystonia, epilepsy, Alzheimer's, and disorders of consciousness. Across diseases, DBS sites were functionally connected to noninvasive brain stimulation sites at a level much greater than chance (p < 0.005).CONCLUSIONS: Resting state functional connectivity links invasive and noninvasive brain stimulation sites across diseases. This suggests that these two types of brain stimulation may exert their therapeutic effect by modulating different nodes in the same brain network. Identifying such networks may prove valuable in determining the optimal targets for brain stimulation and represents a potential therapeutic application of the human connectome.Study Supported by: National Institutes of Health (K23NS083741), the AAN / American Brain Foundation, and the National Center for Research Resources: Harvard Clinical and Translational Science Center (UL1 RR025758).

Disclosure: Dr. Buckner has nothing to disclose. Dr. Lozano has received personal compensation for activities with Medtronic Inc., Boston Scientific Corp., Johnson & Johnson, and St Jude Medical. Dr. Lozano has received personal compensation in an editorial capacity for Brain Stimulation. Dr. Pascual-Leone has received personal compensation for activities with Nexstim, Neuronix, Starlab Neuroscience, Neuroelectrics, Neosync, and Novavision. Dr. Pascual-Leone has received personal compensation in an editorial capacity for the European Journal of Neurology. Dr. Pascual-Leone has received research support from Nexstim and Neuronix.

Original Article: http://www.neurology.org/cgi/content/short/82/10_Supplement/S52.002?rss=1