Role of functional imaging in the development and refinement of invasive neuromodulation for psychiatric disorders

doi:10.4329/wjr.v6.i10.756

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World Journal of Radiology

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1949-8470

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World J Radiol. Oct 28, 2014; 6(10): 756-778
Published online Oct 28, 2014. doi: 10.4329/wjr.v6.i10.756

Table 1 Advantages and disadvantages of imaging methods

Modality	Advantages	Disadvantages
PET	Unlikely to disrupt implant placement or function Widely available Technically simple to combine with DBS (relative to fMRI) Customized radiotracers to measure binding capacity	Cost, availability and health risks of radiotracers Static data (averaged over set time interval) Poor temporal and spatial resolution (relative to fMRI) Difficult to interpret data (receptor binding vs density)
MRI	Time-locked data High temporal and spatial resolution (relative to PET) Flexible data acquisition, processing and analysis Possible analysis of ON and OFF settings	BOLD signal interpretation (temporal lag, anatomical imprecision) DBS safety considerations (lead migration, secondary lesioning) Possible deactivation of implanted impulse generators Potential DBS-related artifacts on images

PET: Positron emission tomography; DBS: Deep brain stimulation; fMRI: Functional magnetic resonance imaging; BOLD: Blood oxygen level dependent.

Table 2 Obsessive compulsive disorder deep brain stimulation targets: Activation/deactivation of cortical and subcortical targets

	STN_DBS	ALIC_DBS	VCVS_DBS
Frontal cortex		↑Nuttin¹^a
Medial frontal gyrus	↓Le Jeune¹^f
Inferior frontal gyrus		↓Zuo¹^b
Supplementary motor area	↑Min^1b,5	↓Zuo²
Prefrontal cortex			↑ Knight^1d,7
Lateral PFC			↓Figee^1b,2,↓ Knight
Dorsolateral PFC	↑Min^1b,5		↑Sturm, ↑ Knight
Medial PFC	↓Le Jeune²		↓Figee^1a,2 , ↑ Knight
Cingulate			↑Sturm; ↑ Knight^1d,7
Anterior cingulate cortex	↑Min¹^b; ↓Le Jeune¹^f	↓Zuo^1b,2	↑ Knight¹^d; ↑Rauch¹^f
Orbitofrontal cortex	↓Le Jeune²	↓Zuo¹^b; ↓Abelson³	↑Rauch¹^f
Insula	↑Min¹^b		↑ Figee; ↑Knight^1d,6
Striatum		↑ Nuttin¹^a
Caudate	↑Min¹^b	↓Zuo¹^b	↑Figee
Putamen	↑Min¹^b		↑Figee; ↓Sturm;↑Rauch¹^f
Nucleus accumbens			↑Figee¹^c
Temporal cortex	↑ Min^1b,4
Superior temporal gyrus		↓Zuo¹^b ;↑Nuttin¹^a
Medial temporal gyrus		↑Nuttin¹^a
Thalamus	↑ Min^1b,4	↓Zuo¹^b	↑Figee; ↓Knight^1d,6; ↑Rauch¹^f
Pons			↑Nuttin¹^a
Hippocampus/parahippocampus	↑ Min^1b,4		↑ Knight^1d,6
Globus pallidus			↑ Rauch¹^f

¹Statistically significant,

^aP < 0.05,

^bP < 0.001,

^dP < 0.0001,

^fP < 0.005,

^cP = 0.031 vs scans;

²Statistically correlated with treatment response;

³Decreased activity for 2 of 3 patients; ⁴Significant activation to STN vs Gpi; ⁵Significant at 2 V; ⁶As the stimulation voltage increased from 3 V to 5 V, the region of BOLD signal modulation increased; ⁷As the stimulation voltage increased from 3 V to 5 V, the region of BOLD signal modulation area decreased for n = 2 pigs. STN: Subthalamic nucleus; ALIC: Anterior capsulotomy of anterior limb of internal capsules; DBS: Deep brain stimulation; VCVS: Ventral (anterior internal) capsule/ventral striatum; BOLD: Blood oxygen level dependent; PFC: Prefrontal cortex.

Table 3 Treatment-resistant depression deep brain stimulation targets: Activation/deactivation of cortical and subcortical targets

	NAc_DBS	SCG_DBS	DLFPC_ EpCS
Frontal cortex
Ventral superior frontal sulcus	↓Bewernick¹^c
Dorsal superior frontal sulcus	↓Bewernick¹^c
Medial frontal gyrus	↑Schlaepfer; ↓Bewernick¹^c
Superior frontal gyrus	↑Schlaepfer		↓Kopel^l2
Inferior frontal gyrus	↓Schlaepfer¹^a
Prefrontal cortex (PFC)	↑Knight^1d,11
Dorsomedial PFC	↑Schlaepfer¹^a	↓Lozano⁴
Dorsolateral PFC	↑Schlaepfer¹^a	↑Mayberg⁸; ↓ Lozano^4,6f	↑Kopell¹^f;↓Kopell²
Ventral prefrontal
Ventrolateral prefrontal	↓Schlaepfer¹^a; ↑Knight	↑Lozano⁶^f
Ventromedial prefrontal	↓Schlaepfer¹^a	↑Lozano⁴
Medial prefrontal		↓Mayberg⁸
Dorsal frontal pole		↓Lozano⁴
Ventral frontal pole		↓Lozano⁴
Cingulate	↑Schlaepfer¹^a; ↑Knight^1d,11
Posterior cingulate	↓Bewernick¹^c	↑Mayberg⁷^b; ↑Lozano⁵	↓Kopell²
Subgenual cingulate	↓Bewernick^1c,2	↓Mayberg⁷^b; ↑Lozano⁴
Anterior cingulate	↓Schlaepfer¹^a; ↑Knight¹^d	↑Mayberg⁸; ↓Lozano⁶^f
Orbitofrontal cortex	↓Bewernick¹^e	↓Mayberg⁹^b	↑Kopell¹^f
Lateral orbitofrontal		↑Lozano⁴
Medial orbitofrontal		↓Lozano⁶^f
Premotor cortex		↑Mayberg⁷^b; ↑Lozano³
Dorsolateral premotor		↓Lozano³
Striatum
Ventral striatum	↑Schlaepfer¹^a; ↑Knight
Caudate	↓Bewernick¹^c; ↑Schlaepfer¹^c	↑(rostral) ↓(caudal)Lozano⁴
Putamen	↑Schlaepfer
Insula	↓Schlaepfer¹^a; ↑Knight¹^d	↓Mayberg⁷^b; ↑Lozano⁴
Amygdala	↑Schlaepfer¹^a; ↑Bewernick^1c,2
Pons		↓Lozano⁵
Thalamus	↓Bewernick¹^c; ↓Schlaepfer¹^a↓Knight^1d,10
Hypothalamus		↓Mayberg⁷^b
Hippocampus/parahippocampus	↑Schlaepfer; ↑Knight¹^d	↑Lozano⁴⁵

¹Statistically significant,

^bP < 0.001,

^dP < 0.0001,

^aP < 0.05,

^fP < 0.005,

^cP = 0.05,

^eP = 0.038 vs scans;

²Statistically correlated with change in depression scale;

³de/activation at 3 mo only;

⁴de/activation at 3 and 6 mo;

⁵de/activation at 6 mo only;

⁶significant between scans at 6 mo only;

⁷significant between scans at 3 and 6 mo;

⁸statistically correlated at 3 and 6 mo;

⁹significant between scans at 3 mo only; ¹⁰as the stimulation voltage increased from 3 V to 5 V, the region of BOLD signal modulation increased; ¹¹as the stimulation voltage increased from 3 V to 5V, the region of BOLD signal modulation area decreased for n = 2 pigs; NAc: Nucleus accumbens; DBS: Deep brain stimulation; SCG: Subcallosal cingulate gyrus; DLFPC: Dorsolateral prefrontal cortex; EpCS: Epidural cortical stimulation; BOLD: Blood oxygen level dependent.

Table 4 Tourette syndrome deep brain stimulation targets: Activation/deactivation of cortical and subcortical targets

	Gpi_DBS	Thalamic_DBS	Nac-ALIC_DBS	Pf_DBS	CM_DBS
Prefrontal cortex	↓Min⁶		↑Knight^1d,5	↑Kim^7,8b,9,10b	↑Kim^7,8a,9,10a
Dorsolateral prefrontal cortex	↑Min¹^b
Cingulate
Anterior cingulate cortex	↑Min¹^b
Dorsalanterior cingulate cortex			↑Knight⁴	↓Kim⁷⁸¹⁰	↓Kim^7a,8,9,10
Dorsal Posterior cingulate cortex				↓Kim^7,8a,10	↓Kim^7d,8,9,10
Motor cortex
Primary motor cortex	↑Min¹^b			↓Kim^{7,8a ,9,10a}	↓Kim^7,8b,9,10a
Premotor cortex	↑Min¹^b			↓Kim^7,8a,9,10a	↓Kim^{7a,e,f, 8ba,9a,10a}
Primary somatosensory cortex	↑Min¹^b			↓Kim^7,8a,9,10a	↓Kim^7,8,9,10a
Insula	↑Min¹^b		↑Knight^1d,4	↓Kim⁷⁹↑ 8a,10a	↓Kim⁷⁸⁹¹⁰
Temporal lobe
Inferior temporal gyrus		↓Kuhn		↓Kim⁷↑^8a,10	↓Kim⁷⁹↑⁸¹⁰
Striatum
Caudate	↑Min¹^b	↓Kuhn ↓Vernaleken		↓Kim⁸¹⁰	↑Kim⁷↓⁸¹⁰
Putamen		↑Kuhn ↑Vernaleken		↓Kim⁸¹⁰	↑Kim⁷↓⁸¹⁰
Thalamus		↓Kuhn ↓Vernaleken	↓Knight^1d,4
Right thalamus		↑ Kuhn²
Left thalamus		↓Kuhn³
Central thalamic nucleus					↑Kim⁸
Hippocampus				↓Kim⁷⁸¹⁰	↓Kim⁸
Parahippocampal cortex			↑Knight^1d,4	↓Kim⁷⁸¹⁰	↓Kim⁷⁸¹⁰

¹Statistically significant scans;

^bP < 0.001, ^dP < 0.0001, ^aP < 0.05 vs scans, ^eResponse at 130 Hz 3 V was significant vs P_f contact site at P < 0.05, ^fresponse at 60 Hz 3 V was significant vs Pf;

²Patient #3, unilateral had reduction of putamen activity;

³Only in unilateral patient;

⁴As the stimulation voltage increased from 3 V to 5 V, the region of BOLD signal modulation increased; ⁵As the stimulation voltage increased from 3V to 5V, the region of BOLD signal modulation area decreased for n = 2 pigs;

⁶Activation decreased at 2V;

⁷Response @ 130 Hz 3 V;

⁸Response @ 130 Hz 5 V;

⁹Response @ 60 Hz 3 V;

¹⁰Response @ 60 Hz 5 V; Gpi: Globus pallidus interna; DBS: Deep brain stimulation; NAc-ALIC: Nucleus accumbens-anterior limb of internal capsule; CM-Pf: Centromedian-parafascicular nuclei complex; BOLD: Blood oxygen level dependent.

Table 5 Parkinson’s disease deep brain stimulation targets-limbic effects

	STN_DBS
Prefrontal
Dorsolateral prefrontal cortex	↑Hilker¹^b
Lateral prefrontal cortex	↑Stefurak¹^b
Cingulate
Posterior cingulate	↓Stefurak¹^b; ↑Hilker¹^b
Anterior cingulate cortex	↑Stefurak¹^b; ↑Hilker¹^b
Dorsal anterior cingulate cortex	↓Stefurak¹^b
Frontal cortex	↑Stefurak
Medial frontal cortex	↓Stefurak¹^b
Medial superior frontal	↑Stefurak¹^b
Orbitofrontal cortex	↑Hilker¹^b
Parietal Inferior lobule	↑Hilker¹^b
Frontal motor cortex	↑Stefurak¹^b
Premotor cortex	↑Stefurak¹^b
Primary motor cortex	↑Stefurak¹^b
Medial supplementary motor area	↓Stefurak¹^b
Ipsilateral parietal lobe	↓Stefurak¹^b
Insula	↑Stefurak¹^b
Superior temporal gyrus	↑Stefurak¹^b
Middle temporal gyrus	↓Hilker¹^b
Inferior temporal gyrus	↑Stefurak¹^b
Striatum
Caudate	↓Stefurak¹^b
Putamen	↑Stefurak¹^b
Lentiform nucleus	↑Hilker¹^b
Thalamus
Ventrolateral thalamus	↑Stefurak; ↑Hilker¹^a
Ventroanterior thalamus	↑Stefurak¹^b
Dorsomedial nuclei of Thalamus	↑Stefurak¹^b
Pons	↑Stefurak¹^b
Midbrain	↑Stefurak¹^b
Cerebellum	↑Stefurak¹^b
Right Cerebellar posterior lobe	↑Hilker¹^a
Left Cerebellar posterior lobe	↓Hilker¹^b
Parahippocampal cortex	↑Stefurak¹^b
Occipital lobe	↓Stefurak¹^b

¹Statistically significant,

^bP < 0.001,

^aP = 0.002 vs scans. STN: Subthalamic nucleus; DBS: Deep brain stimulation.

Citation: Williams NR, Taylor JJ, Lamb K, Hanlon CA, Short EB, George MS. Role of functional imaging in the development and refinement of invasive neuromodulation for psychiatric disorders. World J Radiol 2014; 6(10): 756-778
URL: https://www.wjgnet.com/1949-8470/full/v6/i10/756.htm
DOI: https://dx.doi.org/10.4329/wjr.v6.i10.756