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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
Role of functional imaging in the development and refinement of invasive neuromodulation for psychiatric disorders
Nolan R Williams, Joseph J Taylor, Kayla Lamb, Colleen A Hanlon, E Baron Short, Mark S George
Nolan R Williams, Joseph J Taylor, Kayla Lamb, Colleen A Hanlon, E Baron Short, Mark S George, Brain Stimulation Laboratory, Medical University of South Carolina, Charleston, SC 29425, United States
Joseph J Taylor, Colleen A Hanlon, Mark S George, Ralph H Johnson VA Medical Center, Charleston, SC 29401, United States
Joseph J Taylor, Colleen A Hanlon, Mark S George, Center for Biomedical Imaging, Medical University of South Carolina, Charleston, SC 29425, United States
Author contributions: Williams NR was the primary author; Taylor JJ and Hanlon CA wrote critical sections of the imaging physics; Williams NR and Lamb K designed and created the tables; George MS and Short EB edited as senior authors.
Supported by NIDA R25
Correspondence to: Nolan R Williams, MD, Brain Stimulation Laboratory, Medical University of South Carolina, 67 President Street, Charleston, SC 29425, United States. willianr@musc.edu
Telephone: +1-843-7920333 Fax: +1-843-7923187
Received: March 3, 2014
Revised: July 4, 2014
Accepted: August 27, 2014
Published online: October 28, 2014
Abstract

Deep brain stimulation (DBS) is emerging as a powerful tool for the alleviation of targeted symptoms in treatment-resistant neuropsychiatric disorders. Despite the expanding use of neuropsychiatric DBS, the mechanisms responsible for its effects are only starting to be elucidated. Several modalities such as quantitative electroencephalography as well a intraoperative recordings have been utilized to attempt to understand the underpinnings of this new treatment modality, but functional imaging appears to offer several unique advantages. Functional imaging techniques like positron emission tomography, single photon emission computed tomography and functional magnetic resonance imaging have been used to examine the effects of focal DBS on activity in a distributed neural network. These investigations are critical for advancing the field of invasive neuromodulation in a safe and effective manner, particularly in terms of defining the neuroanatomical targets and refining the stimulation protocols. The purpose of this review is to summarize the current functional neuroimaging findings from neuropsychiatric DBS implantation for three disorders: treatment-resistant depression, obsessive-compulsive disorder, and Tourette syndrome. All of the major targets will be discussed (Nucleus accumbens, anterior limb of internal capsule, subcallosal cingulate, Subthalamic nucleus, Centromedial nucleus of the thalamus-Parafasicular complex, frontal pole, and dorsolateral prefrontal cortex). We will also address some apparent inconsistencies within this literature, and suggest potential future directions for this promising area.

Keywords: Deep brain stimulation, Functional neuroimaging, Functional magnetic resonance imaging, Functional magnetic resonance imaging, Cortical stimulation, Nuclear imaging

Core tip: Deep brain stimulation (DBS) is emerging as a powerful tool for the alleviation of targeted symptoms in treatment-resistant neuropsychiatric disorders. Most recently, functional magnetic resonance imaging has been used to examine the effects of focal DBS on activity in a distributed neural network. The purpose of this review is to summarize the current functional neuroimaging findings from neuropsychiatric DBS implantation and to discuss some apparent inconsistencies within this literature, and to suggest potential future directions for this promising area.