Brain Stimulation

Visual Snow Syndrome (VSS) is a neurological condition characterized by continuous visual disturbances resembling television static across the visual field. Despite its significant impact on quality of life, objective assessment methods remain limited, with diagnosis relying primarily on subjective patient reports. Current understanding of VSS pathophysiology suggests cortical hyperexcitability, but precise mechanisms remain unclear. Here we developed an integrated protocol combining transcrania...

BackgroundTheta-band oscillation is integral to fronto-parietal connectivity in the executive control network and its top-down regulation on subcortical areas. External frontoparietal synchronization using theta-frequency transcranial alternating current (tACS) is a technology to potentially engage this network. In this pre-registered, triple-blind, sham-controlled trial (NCT03907644), we tested this intervention targeting the right frontoparietal network in people with opioid use disorder (OUD)...

IntroductionSleep spindles are electroencephalographic elements characteristic of non-rapid eye movement sleep generated by thalamo-cortical interactions. Spindles have been linked to some of the cognitive benefits afforded by sleep and high spindle activity is associated with increased arousal threshold (deeper sleep). Here, we demonstrate that targeting the thalamus with Transcranial Electrical Stimulation with Temporal Interference (TES-TI) can enhance spindle activity. Methods24 participant...

Despite decades of clinical implementation of medications for opioid use disorder (OUD), overdose mortality rates remain high, underscoring a critical gap in treatments that target brain mechanisms driving addiction. Mindfulness-Oriented Recovery Enhancement (MORE) has demonstrated efficacy in reducing opioid use and craving, hypothetically by restructuring the salience of drug and natural rewards. Yet, to date, MOREs neurobiological mechanisms remain unclear. In this first functional magnetic r...

The neural signature of rhythm and tempo remains difficult to study in both humans and non-human primates. Here we recorded from the motor cortex of human participants implanted with intracortical microelectrode arrays while they performed a series of rhythmic tapping tasks. We found that rhythmic tapping elicited low-dimensional rotational neural dynamics whose radii varied in a tempo-dependent manner and axes related to kinematic properties. Moreover, we observed a spectrum of kinematic and ne...

BackgroundDeep brain stimulation has emerged as an effective investigational treatment for select cases of severe Gilles de la Tourette Syndrome. Defining the optimal stimulation sites within different targets and the specific tic improvement network across targets will be important to guide neuromodulation therapies. MethodsThis retrospective multi-center cohort study analyzed stimulation locations in patients who received bilateral deep brain stimulation for Gilles de la Tourette Syndrome acr...

BackgroundOscillations underpin a large spectrum of brain function. Brain oscillations are altered by neuromodulation approaches including deep brain stimulation (DBS), but a mechanistic understanding of the brain oscillation - DBS interaction is missing. DBS is predominantly used in the treatment of Parkinsons disease. DBS can induce or alter pre-existing narrow frequency band gamma oscillations at half the stimulation frequency. Such half-harmonic responses have been interpreted as entrainmen...

Sensory organization at the spinal segment level is commonly inferred from dermatomal maps that assume a fixed correspondence between cutaneous regions and spinal segments. However, based on the complexities of spinal neuroanatomy and neurophysiology, the distribution of sensory signals within the cord may be broader and less segment-specific than dermatomal maps suggest, leaving the segment-level localization of sensory-evoked activity in humans uncertain. Spinal cord functional magnetic resona...

About half of patients who undergo epilepsy surgery for drug-resistant epilepsy have seizure recurrence, supporting the need for approaches that more accurately identify the epileptogenic zone, defined as the brain areas whose removal causes cessation of seizures. Altered network connectivity has emerged as a candidate biomarker of the epileptogenic zone, but how connectivity is altered in the epileptogenic zone remains uncertain, with prior studies reporting inconsistent results. We hypothesize...

BackgroundEpilepsy affects approximately 50 million individuals worldwide, with nearly one-third developing drug-resistant epilepsy (DRE). The centromedian nucleus of the thalamus (CM) and the brainstem are integral components of seizure-modulating networks and represent promising targets for neuromodulation. This study aimed to map structural connectivity between CM and specific brainstem nuclei using probabilistic tractography and to evaluate whether connectivity patterns correlate with seizur...

Gait impairment (GI) and freezing of gait (FOG) affect 80% of patients with advanced Parkinsons disease. Continuous deep brain stimulation (cDBS) provides limited adaptability to address the episodic nature of FOG due to fixed parameters. Neural biomarkers for adaptive DBS are limited by signal artifacts and poor FOG classification. Wearable inertial measurement units (IMUs) offer a promising alternative by directly measuring signatures of GI&FOG. We developed Kinematic adaptive DBS (KaDBS), the...

ObjectiveWe developed and validated a detection-guided artifact removal framework for clinical electroencephalography (EEG). It corrects only the contaminated segments and preserves artifact-free data. ApproachThe framework employs convolutional neural network (CNN) detectors trained on the Temple University Hospital (TUH) Artifact Corpus of 150 recordings from 105 patients. For eye movement artifacts (20 second windows), it uses independent component analysis (ICA) and canonical correlation an...

Effective connectivity of the human insula, mainly assessed at rest using cortico-cortical evoked potentials (CCEPs), is not yet fully characterized at high-resolution. Here, we significantly extend prior CCEP studies of the insula by leveraging an extensive multicenter CCEP database and fine-grained anatomical atlases of the insula. We analyzed CCEP datasets from 897 patients with refractory focal epilepsy (459 females, age: 26{+/-}14 years) explored by stereo electroencephalography and with a...

BackgroundMotor threshold (MT) estimation is fundamental to transcranial magnetic stimulation (TMS), guiding individualized stimulation intensity in research and therapy. Conventional methods such as the 5-out-of-10 rule require many stimuli, while adaptive approaches like Parameter Estimation by Sequential Testing (PEST) improve efficiency but can exhibit poor convergence under certain conditions. ObjectiveThis study introduces the Bayesian Uncertainty Dynamic Algorithm for Parameter Estimatio...

Restoring communication for people with dysarthria secondary to pontine stroke remains a critical challenge. Intracortical brain-computer interfaces (iBCIs) have demonstrated great potential for speech restoration in people with amyotrophic lateral sclerosis (ALS), with 1-24% word error rates (WERs) on a 125,000-word vocabulary. In pontine stroke, electrocorticography (ECoG) BCIs achieved 25.5% WERs with a smaller 1,024-word vocabulary. Whether intracortical BCI performance improvements extend t...

BackgroundPersons with epilepsy are at increased risk of depression/anxiety. Older antiseizure medications (ASMs) had drug-drug interactions that complicated pharmacotherapy of depression/anxiety; newer ASMs lack this drawback but can have psychiatric side effects. Anxiety/depression are increasingly recognized and treated pharmacologically. We hypothesized that the likelihood of treatment with selective serotonin uptake inhibitors (SSRI) would have increased in adult-onset epilepsy when prescri...

Type 1 narcolepsy (NT1), a disorder caused by the loss of hypocretin/orexin transmission, is characterized by daytime sleepiness and symptoms where Rapid Eye Movement (REM) sleep, a state normally occurring from middle to late in the night, can intermingle with wakefulness. This results in cataplexy and sleep paralysis, episodes of muscle paralysis when awake, or in the generation of dream-like hallucinations and vivid dreaming, periods of visual imagery or sensory experiences that occur while a...

BackgroundSubstance use disorders (SUD) are associated with a high global burden of disease, with 5.4% of all disability-adjusted life years lost due to alcohol and illicit drugs. Highly prevalent multimorbidity includes polysubstance use, mental health conditions, and other non-communicable and infectious diseases. Where traditional treatments are insufficient alone, music therapy (MT) is highly engaging and improves motivation and reduces craving; however, its long-term effects are unknown. Th...

ImportanceTracking and predicting seizure frequency in patients with epilepsy is important for prognostication and therapy management. Interictal spikes have been proposed as a biomarker of seizure burden, but their association with seizure frequency has not been well quantified across epilepsy subtypes. ObjectiveTo measure the association between spike rate and seizure frequency and how this varies by epilepsy subtype. Design, Setting and ParticipantsWe studied 3,614 consecutive routine outpa...

Study ObjectivesNarcolepsy type 1 (NT1) is characterized by excessive daytime sleepiness and cataplexy. Previous studies have implicated the amygdala, thalamus, brainstem and hippocampus in the pathophysiology of NT1. We here aimed to examine more detailed subregional case-control differences in MRI-based segmentations of these brain regions to gain deeper insights. MethodsWe obtained 3T MRI brain scans from 54 NT1 patients (39 females, mean age 21.8 {+/-} 11.0 years, 51 with confirmed hypocret...