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Restorative Neurosurgery From Motion to Emotion Kendall Lee, M.D., Ph.D. Department of Neurosurgery Mayo Clinic. Neuromodulation (Deep Brain Stimulation). Established for: Parkinson’s Disease (STN, GPi) Dystonia (GPi) Tremor (Vim Thalamus) Emerging treatment for: - PowerPoint PPT Presentation
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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)