The rapid evolution of neuromodulation techniques includes an increasing amount of research into stimulation paradigms that are guided by patients' neurophysiology, to increase efficacy and responder rates. Treatment personalisation and target engagement have shown to be effective in fields such as Parkinson's disease, and closed-loop paradigms have been successfully implemented in cardiac defibrillators. Promising avenues are being explored for physiologically informed neuromodulation in psychiatry. Matching the stimulation frequency to individual brain rhythms has shown some promise in transcranial magnetic stimulation (TMS). Matching the phase of those rhythms may further enhance neuroplasticity, for instance when combining TMS with electroencephalographic (EEG) recordings. Resting-state EEG and event-related potentials may be useful to demonstrate connectivity between stimulation sites and connected areas. These techniques are available today to the psychiatrist to diagnose underlying sleep disorders, epilepsy, or lesions as contributing factors to the cause of depression. These technologies may also be useful in assessing the patient's brain network status prior to deciding on treatment options. Ongoing research using invasive recordings may allow for future identification of mood biomarkers and network structure. A core limitation is that biomarker research may currently be limited by the internal heterogeneity of psychiatric disorders according to the current DSM-based classifications. New approaches are being developed and may soon be validated. Finally, care must be taken when incorporating closed-loop capabilities into neuromodulation systems, by ensuring the safe operation of the system and understanding the physiological dynamics. Neurophysiological tools are rapidly evolving and will likely define the next generation of neuromodulation therapies.
Bibliographical noteFunding Information:
Saydra Wilson has current grant funding to use physiologic markers to optimize neuromodulation supported by the University of Minnesota 's MnDRIVE (Minnesota's Discovery, Research and Innovation Economy) initiative.
Tim Denison and Karen Wendt acknowledge support from the Medical Research Council (project MC_UU_00003/3 ).
ASW acknowledges support from the Minnesota Medical Discovery Team on Addictions, the MnDRIVE Brain Conditions Initiative, and the National Institutes of Health (projects UH3NS100548 , R01MH119384 , R01NS113804 , R01MH123634 , and R01MH124687 ).
- Biomarkers in psychiatry
- Brain-state dependent stimulation
- Deep brain stimulation
- Transcranial magnetic stimulation
- Evoked Potentials
- Transcranial Magnetic Stimulation/methods
PubMed: MeSH publication types
- Journal Article