Obsessive-compulsive disorder

Advances in deep brain stimulation (DBS) for Parkinson disease could lead to treatments for conditions such as obsessive-compulsive disorder (OCD); Gilles de la Tourette syndrome and depression. The authors of the paper, from the Geneva University Hospitals (HUG), argue that bi-directional electrodes which can both stimulate and record from deep brain structures – known as closed-loop DBS could have applications beyond Parkinson disease.

Processing of neuronal activity

Other bi-directional brain-computer interfaces (BCIs) have in development in recent years; notably for the real-time signal processing of neuronal activity to allow control of a robotic arm; directly from the brain in people with paralysis. “Interestingly the fields of brain-computer interfaces for movement restoration and deep brain stimulation for Parkinson disease have developed largely independently.
Deep brain stimulation researchers tend to neurologists or neurosurgeons while brain-computer interface researchers are often neuroscientists, roboticists and engineers. By working together and sharing information we can learn from each other and potentially expand the reach of this technology; so that it can help more people.” DBS is typically using to relieve the shaking and rigidity with Parkinson disease.
Although it has tried in more than 40 other brain targets; very few other disease indications for the treatment have established. The latest closed-loop DBS systems sense changes in the brain following stimulation and automatically adapt the level of the next stimulating pulse accordingly. This adjustment in the way that stimulation is delivered allows for tailored, accurate treatment that may prove suitable for other disorders.

Tics and psychiatric symptoms

Other areas that might benefit from closed-loop DBS include OCD although early trials indicate that there may a time delay before improvements are seen, Gilles de la Tourette syndrome for the treatment of both movement tics and psychiatric symptoms, and depression although early trials indicate that the exact position of the electrodes and stimulation parameters are critical.

The authors warn against the use of DBS for purposes beyond disease and call for strong ethical standards; that require both artificial intelligence and neural interfaces to respect and preserve people’s privacy, identity, agency and equality. Neurostimulators with sensing capabilities are still in their infancy. They have still only used in research settings and so closed-loop DBS is not yet a long-term treatment solution for Parkinson disease or any other disorder.

These new systems will however soon become commercially available and when they do they will bring with them new treatment possibilities and new hope. These questions will discuss at OptoDBS2019; the third edition of an international meeting held at Campus Biotech, Geneva later this year.