Future directions in psychiatric neurosurgery: Proceedings of the 2022 American Society for Stereotactic and Functional Neurosurgery meeting on surgical neuromodulation for psychiatric disorders

Frederick L Hitti; Alik S Widge; Patricio Riva-Posse; Donald A Malone Jr; Michael S Okun; Maryam M Shanechi; Kelly D Foote; Sarah H Lisanby; Elizabeth Ankudowich; Srinivas Chivukula; Edward F Chang; Aysegul Gunduz; Clement Hamani; Ashley Feinsinger; Cynthia S Kubu; Winston Chiong; Jennifer A Chandler; Rafael Carbunaru; Binith Cheeran; Robert S Raike; Rachel A Davis; Casey H Halpern; Nora Vanegas-Arroyave; Dejan Markovic; Sarah K Bick; Cameron C McIntyre; R Mark Richardson; Darin D Dougherty; Brian H Kopell; Jennifer A Sweet; Wayne K Goodman; Sameer A Sheth; Nader Pouratian

doi:10.1016/j.brs.2023.05.011

Future directions in psychiatric neurosurgery: Proceedings of the 2022 American Society for Stereotactic and Functional Neurosurgery meeting on surgical neuromodulation for psychiatric disorders

Brain Stimul. 2023 May-Jun;16(3):867-878. doi: 10.1016/j.brs.2023.05.011. Epub 2023 May 20.

Authors

Frederick L Hitti¹, Alik S Widge², Patricio Riva-Posse³, Donald A Malone Jr⁴, Michael S Okun⁵, Maryam M Shanechi⁶, Kelly D Foote⁷, Sarah H Lisanby⁸, Elizabeth Ankudowich⁹, Srinivas Chivukula¹⁰, Edward F Chang¹¹, Aysegul Gunduz¹², Clement Hamani¹³, Ashley Feinsinger¹⁴, Cynthia S Kubu¹⁵, Winston Chiong¹⁶, Jennifer A Chandler¹⁷, Rafael Carbunaru¹⁸, Binith Cheeran¹⁹, Robert S Raike²⁰, Rachel A Davis²¹, Casey H Halpern²², Nora Vanegas-Arroyave²³, Dejan Markovic²⁴, Sarah K Bick²⁵, Cameron C McIntyre²⁶, R Mark Richardson²⁷, Darin D Dougherty²⁸, Brian H Kopell²⁹, Jennifer A Sweet³⁰, Wayne K Goodman³¹, Sameer A Sheth³², Nader Pouratian¹⁰

Affiliations

¹ Department of Neurosurgery, University of Texas Southwestern Medical Center, Dallas, TX, USA; Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA. Electronic address: Frederick.Hitti@utsouthwestern.edu.
² Department of Psychiatry and Behavioral Sciences, University of Minnesota-Twin Cities, Minneapolis, MN, USA.
³ Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA.
⁴ Department of Psychiatry, Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA.
⁵ Department of Neurology, Norman Fixel Institute for Neurological Diseases, Gainesville, FL, USA.
⁶ Departments of Electrical and Computer Engineering and Biomedical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, CA, USA.
⁷ Department of Neurosurgery, Norman Fixel Institute for Neurological Diseases, Gainesville, FL, USA.
⁸ Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, Bethesda, MD, USA.
⁹ Division of Translational Research, National Institute of Mental Health, Bethesda, MD, USA.
¹⁰ Department of Neurosurgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.
¹¹ Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA.
¹² Department of Biomedical Engineering and Fixel Institute for Neurological Disorders, University of Florida, Gainesville, FL, USA.
¹³ Sunnybrook Research Institute, Hurvitz Brain Sciences Centre, Harquail Centre for Neuromodulation, Division of Neurosurgery, University of Toronto, Toronto, Canada.
¹⁴ Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.
¹⁵ Department of Neurology, Cleveland Clinic and Case Western Reserve University, School of Medicine, Cleveland, OH, USA.
¹⁶ Department of Neurology, University of California San Francisco, San Francisco, CA, USA.
¹⁷ Faculty of Law, University of Ottawa, Ottawa, ON, USA; Affiliate Investigator, Bruyère Research Institute, Ottawa, ON, USA.
¹⁸ Neuromodulation Division, Boston Scientific, Valencia, CA, USA.
¹⁹ Neuromodulation Division, Abbott, Austin, TX, USA.
²⁰ Global Research Organization, Medtronic Inc. Neuromodulation, Minneapolis, MN, USA.
²¹ Departments of Psychiatry and Neurosurgery, University of Colorado Anschutz, Aurora, CO, USA.
²² Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; The Cpl Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA.
²³ Department of Neurology, Baylor College of Medicine, Houston, TX, USA.
²⁴ Department of Electrical Engineering, University of California Los Angeles, Los Angeles, CA, USA.
²⁵ Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
²⁶ Departments of Biomedical Engineering and Neurosurgery, Duke University, Durham, NC, USA.
²⁷ Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, USA.
²⁸ Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.
²⁹ Department of Neurosurgery, Center for Neuromodulation, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
³⁰ Department of Neurosurgery, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
³¹ Department of Psychiatry and Behavior Sciences, Baylor College of Medicine, Houston, TX, USA.
³² Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA.

Abstract

Objective: Despite advances in the treatment of psychiatric diseases, currently available therapies do not provide sufficient and durable relief for as many as 30-40% of patients. Neuromodulation, including deep brain stimulation (DBS), has emerged as a potential therapy for persistent disabling disease, however it has not yet gained widespread adoption. In 2016, the American Society for Stereotactic and Functional Neurosurgery (ASSFN) convened a meeting with leaders in the field to discuss a roadmap for the path forward. A follow-up meeting in 2022 aimed to review the current state of the field and to identify critical barriers and milestones for progress.

Design: The ASSFN convened a meeting on June 3, 2022 in Atlanta, Georgia and included leaders from the fields of neurology, neurosurgery, and psychiatry along with colleagues from industry, government, ethics, and law. The goal was to review the current state of the field, assess for advances or setbacks in the interim six years, and suggest a future path forward. The participants focused on five areas of interest: interdisciplinary engagement, regulatory pathways and trial design, disease biomarkers, ethics of psychiatric surgery, and resource allocation/prioritization. The proceedings are summarized here.

Conclusion: The field of surgical psychiatry has made significant progress since our last expert meeting. Although weakness and threats to the development of novel surgical therapies exist, the identified strengths and opportunities promise to move the field through methodically rigorous and biologically-based approaches. The experts agree that ethics, law, patient engagement, and multidisciplinary teams will be critical to any potential growth in this area.

Keywords: Deep brain stimulation (DBS); Neuromodulation; Obsessive compulsive disorder; Tourette syndrome; Treatment resistant depression.

MeSH terms

Deep Brain Stimulation*
Humans
Mental Disorders* / surgery
Neurosurgery*
Neurosurgical Procedures
Psychosurgery*
United States

Abstract

MeSH terms

Grants and funding