Neuromodulation
Original Editor - Sehriban Ozmen
Top Contributors - Sehriban Ozmen and Kim Jackson Edit Source
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Introduction
Neuromodulation refers to invasive or noninvasive therapeutic options to treat neurological disorders, eliminating their symptoms. The underlying mechanism is to change neuronal activity in a specific brain region or circuit through stimulation, regulating neuroplasticity.
Invasive and Non-Invasive Neuromodulation Techniques
Invasive Neuromodulation Techniques
- Brain-computer interface
- Cochlear implant
- Deep brain stimulation
- Dorsal root ganglion stimulation
- Gastric/Intestinal electrical stimulation
- Motor cortex stimulation
- Peripheral nerve stimulation; includes (invasive and/or non-invasive) stimulation of the nerves: trigeminal, hypoglossal, sacral, pudendal, occipital, phrenic (‘diaphragm pacing’) and tibial (usually percutaneous)
- Peripheral subcutaneous field stimulation
- Retinal stimulation
- Responsive neurostimulation
- Spinal cord stimulation
- Vagus nerve stimulation [1]
Non-Invasive Neuromodulation Techniques
- Electroconvulsive therapy
- Functional electrical stimulation
- Low-intensity focused ultrasound stimulation; non-electrical (acoustic waves, intracranial pressure modulation)
- Non-invasive vagus nerve stimulation (auricular, cervical)
- Peripheral nerve stimulation; includes (invasive and/or non-invasive) stimulation of the nerves: trigeminal, hypoglossal, sacral, pudendal, occipital, phrenic (‘diaphragm pacing’) and tibial (usually percutaneous)
- Transcranial alternating current stimulation
- Transcranial direct current stimulation
- Transcutaneous electrical nerve stimulation
- Temporal interference stimulation
- Transcranial magnetic stimulation
- Transcranial ultrasound stimulation; non-electrical (acoustic waves, intracranial pressure modulation) [1]
Deep Brain Stimulation
Deep brain stimulation (DBS) is a system that was originally borrowed from cardiac pacemakers [2] and composed of leads, electrodes, extension cables and an implantable pulse generator. There is also a recharger for the rechargeable devices. [3]
The system allows the clinicians to modulate brain circuits (which align with the established targets) by electrical stimulation and adjusting the parameters (amplitude, pulse with, and rate) to improve the symptoms of Parkinson's Disease, essential tremor, distonia, and some of the psychiatric disorders (such as treatment-resistant depression [4]). [3]
The indications of DBS approved by the Food and Drug Administration (FDA) include:[5]
- Tremor in Parkinson's disease; DBS of subthalamic nucleus
- Focal onset seizures; DBS of anterior nucleus thalamus
- Obsessive-compulsive disorder (OCD)
Spinal Cord Stimulation
Spinal cord stimulation (SCS)...
It has been proven to be beneficial for managing pain associated with complex regional pain syndrome, diabetic neuropathy, phantom limb pain, and neuropathic pain secondary to tumours. Additionally, SCS can be used for non-pain-related conditions such as Parkinson’s disease and other movement disorders, spasticity and spinal cord injuries.[6] It's important to note that pain is the FDA-approved indication among them.[5]
Vagus Nerve Stimulation
Vagus Nerve Stimulation (VNS) is a neuromodulation technique introduced by a neurologist, Corning, more than a century ago, in which electrical stimulation is delivered to the vagus nerve. The technique can be separated into invasive or non-invasive (transcutaneus cervical, transcutaneus auricular) VNS. [7]
In the invasive approach, the electrode is implanted in the left vagus nerve by surgery and connected to a pulse generator implanted in the left pectoral region. [7] The approved indications of invasive cervical VNS include: [8]
- Depression
- Epilepsy
- Obesity
- Stroke-rehabilitation
Among the most commonly used non-invasive VNS devices, 'gammaCore' is FDA-approved for the treatment of headaches, and the auricular branch of the vagus nerve stimulating 'NEMOS' has been approved for treating resistant epilepsy. [7]
Transcranial Magnetic Stimulation
Transcranial Magnetic Stimulation (TMS)... The approved indication of TMS includes depression. [5]
Transcranial Direct Current Stimulation
Transcranial Direct Current Stimulation (tDCS)...
Multidisciplinary Approach
Resources
References
- ↑ 1.0 1.1 Krishna V, Fasano A. Neuromodulation: Update on current practice and future developments. Neurotherapeutics. 2024 Apr 1;21(3).
- ↑ Krauss JK, Lipsman N, Aziz T, Boutet A, Brown P, Chang JW, Davidson B, Grill WM, Hariz MI, Horn A, Schulder M. Technology of deep brain stimulation: current status and future directions. Nature Reviews Neurology. 2021 Feb;17(2):75-87.
- ↑ 3.0 3.1 Değirmenci Y. Current DBS programming. Deep Brain Stimulation. 2024 Jun 1;4:29-31.
- ↑ Figee M, Riva-Posse P, Choi KS, Bederson L, Mayberg HS, Kopell BH. Deep brain stimulation for depression. Neurotherapeutics. 2022 Jul 1;19(4):1229-45.
- ↑ 5.0 5.1 5.2 Denison T, Morrell MJ. Neuromodulation in 2035: the neurology future forecasting series. Neurology. 2022 Jan 11;98(2):65-72.
- ↑ Pérez JT. Spinal cord stimulation: beyond pain management. Neurología (English Edition). 2022 Sep 1;37(7):586-95.
- ↑ 7.0 7.1 7.2 Andalib S, Divani AA, Ayata C, Baig S, Arsava EM, Topcuoglu MA, Cáceres EL, Parikh V, Desai MJ, Majid A, Girolami S. Vagus nerve stimulation in ischemic stroke. Current neurology and neuroscience reports. 2023 Dec;23(12):947-62.
- ↑ Hilz MJ. Transcutaneous vagus nerve stimulation-a brief introduction and overview. Autonomic Neuroscience. 2022 Dec 1;243:103038.