Restorative Neurosurgery From Motion to Emotion Kendall Lee, M.D., Ph.D

Restorative NeurosurgeryRestorative NeurosurgeryFrom Motion to EmotionFrom Motion to Emotion

Kendall Lee, M.D., Ph.D.Kendall Lee, M.D., Ph.D.

Department of NeurosurgeryDepartment of NeurosurgeryMayo ClinicMayo Clinic

Established for:• Parkinson’s Disease (STN, GPi)• Dystonia (GPi)• Tremor (Vim Thalamus)

Emerging treatment for:• Epilepsy (Anterior Thalamus) • Tourette’s Syndrome (CM Thalamus)• Obsessive compulsive disorder• Depression (Area 25)• Chronic Pain (PAG/PVG, Thalamus)• Chronic Pain (Motor cortex)

Neuromodulation Neuromodulation (Deep Brain Stimulation)(Deep Brain Stimulation)Neuromodulation Neuromodulation (Deep Brain Stimulation)(Deep Brain Stimulation)

NeuromodulationNeuromodulationNeuromodulationNeuromodulation >60 thousand DBS implants>60 thousand DBS implants

Stimulation 24 hrs a day - 7 days a Stimulation 24 hrs a day - 7 days a weekweek

Immediate reduction in tremorsImmediate reduction in tremors

However,However,

Time consuming surgery without Time consuming surgery without feedbackfeedback

Difficulty programming without Difficulty programming without feedbackfeedback

Unknown mechanism of actionUnknown mechanism of action

Need a Closed-Loop Feedback Need a Closed-Loop Feedback SystemSystem

Better targeting of electrodeBetter targeting of electrode of implant of implant

HOW TO GET THERE?HOW TO GET THERE?

1.1. Neuroelectrical monitoringNeuroelectrical monitoring2.2. Neurochemical monitoringNeurochemical monitoring

Neuroelectrical monitoring Neuroelectrical monitoring Neuroelectrical monitoring Neuroelectrical monitoring

Real-Time Neurochemical RecordingsReal-Time Neurochemical RecordingsReal-Time Neurochemical RecordingsReal-Time Neurochemical Recordings

ElectrochemistryFast-Scan Cyclic Voltammetry

(FSCV)

8

Fast-Scan Cyclic VoltammetryFast-Scan Cyclic VoltammetryFast-Scan Cyclic VoltammetryFast-Scan Cyclic Voltammetry

1.0-0.4 -0.4Voltage

Real-Time Neurochemical RecordingsReal-Time Neurochemical RecordingsReal-Time Neurochemical RecordingsReal-Time Neurochemical Recordings

-0.4V

1.0V

Applied Potential (V)

Pseudo colorplot

DAoxidation reduction

Background subtracted cyclic voltammogram

DA

DAMeasured Current (uA)

Pseudo colorplot

Universal Electrochemistry Instruments systemUniversal Electrochemistry Instruments system: the University of North Carolina : the University of North Carolina Universal Electrochemistry Instruments systemUniversal Electrochemistry Instruments system: the University of North Carolina : the University of North Carolina

Hardware Software

Dopamine Adenosine Serotonin

Mayo Clinic

Wireless Instantaneous Neurotransmitter Concentration Wireless Instantaneous Neurotransmitter Concentration Sensor System (WINCS)Sensor System (WINCS)Wireless Instantaneous Neurotransmitter Concentration Wireless Instantaneous Neurotransmitter Concentration Sensor System (WINCS)Sensor System (WINCS)

Wireless Instantaneous Neurotransmitter Wireless Instantaneous Neurotransmitter Concentration Sensor System (WINCS): Concentration Sensor System (WINCS): Mayo ClinicMayo Clinic

Wireless Instantaneous Neurotransmitter Wireless Instantaneous Neurotransmitter Concentration Sensor System (WINCS): Concentration Sensor System (WINCS): Mayo ClinicMayo Clinic

A. B.

C.

SENSOR

WINCS

HOMEBASE

(implanted)

(external)

(remote)

Concept - Intraoperative Neurochemical Monitoring Concept - Intraoperative Neurochemical Monitoring during Deep Brain Stimulation Surgeryduring Deep Brain Stimulation SurgeryConcept - Intraoperative Neurochemical Monitoring Concept - Intraoperative Neurochemical Monitoring during Deep Brain Stimulation Surgeryduring Deep Brain Stimulation Surgery

Human WINCS Recording StudiesHuman WINCS Recording StudiesHuman WINCS Recording StudiesHuman WINCS Recording StudiesPart IPart I

(Dr. Lee’s work)(Dr. Lee’s work)

Human WINCS Recording StudiesHuman WINCS Recording StudiesHuman WINCS Recording StudiesHuman WINCS Recording StudiesPart IPart I

(Dr. Lee’s work)(Dr. Lee’s work)