Y P O C Mechanisms of T Transcranial Current Stimulation O N - - PowerPoint PPT Presentation

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Y P O C Mechanisms of T Transcranial Current Stimulation O N - - PowerPoint PPT Presentation

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Y P O C Mechanisms of T Transcranial Current Stimulation O N O D Flavio Frohlich University of North Carolina - Chapel Hill E Department of Psychiatry S Department of Cell Biology and Physiology Department of Biomedical Engineering

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Mechanisms of Transcranial Current Stimulation

Flavio Frohlich

University of North Carolina - Chapel Hill

Department of Psychiatry Department of Cell Biology and Physiology Department of Biomedical Engineering Department of Neurology Neuroscience Center

www.networkneuroscientist.org

www.facebook.com/FrohlichLabUNC

P L E A S E D O N O T C O P Y

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  • UNC owns IP related with FF as the lead inventor.
  • UNC has determined the absence of a conflict of

interest (COI) for the majority of work presented here and has determined a “COI with administrative considerations” for the clinical trials in the Frohlich Lab.

  • FF is the founder, chief scientific officer, and

majority owner of Pulvinar Neuro LLC.

  • Received industry funding from Tal Medical (travel +

research)

  • I frequently travel and give presentations. I typically

receive reimbursement and a stipend.

  • My preferred brain stimulation modality is doppio

espresso.

Conflicts of Interest – You Decide

P L E A S E D O N O T C O P Y

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Neurons, Synapses, and Circuits. Measuring, Perturbing, and Analyzing Brain Networks Cortical Oscillations Network Disorders Toolboxes

P L E A S E D O N O T C O P Y

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Standing on the Shoulders of Giants

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NEUROTECHNOLOGY

Synergies with other treatments. Adaptive, individualized therapies. Mobile, on-demand diagnosis and treatment.

P L E A S E D O N O T C O P Y

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P L E A S E D O N O T C O P Y

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Frohlich et al. 2015 Brunelin et al. 2012

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Sellers et al. 2015

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Lesson #1 Do not skip measuring brain activity (EEG, fMRI, etc.). #BeDifferent

P L E A S E D O N O T C O P Y

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VERTICAL INTEGRATION

Patients Model Systems

COMPLEXITY TRACTABILITY Clinical Trials Brain Stimulation, Human Neurophysiology In vivo (Animal) Electrophysiology In vitro (Animal) Electrophysiology Computer Simulations

P L E A S E D O N O T C O P Y

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Lesson #2 Leverage the tools of (network) neuroscience. #Collaboration

P L E A S E D O N O T C O P Y

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TRANSCRANIAL CURRENT STIMULATION STUDY DESIGN

Behavioral Target Network Target Target Engagement

P L E A S E D O N O T C O P Y

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Lesson #3

Make sure you know your target and have a plan how to engage it. #RationalDesign

P L E A S E D O N O T C O P Y

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TARGET ENGAGEMENT

How do we best engage a network target? We need to understand what the effect of stimulation is on the brain in terms of neurophysiology.

P L E A S E D O N O T C O P Y

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OUTLINE

  • 1. Cellular Effects
  • 2. Spatial Targeting
  • 3. Targeting Network Dynamics

P L E A S E D O N O T C O P Y

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ELECTRIC FIELDS

How do electric fields change electric signaling in neurons?

P L E A S E D O N O T C O P Y

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“Anodal” Depolarized Soma Hyperpolarized Dendrite “Cathodal” Hyperpolarized Soma Depolarized Dendrite

P L E A S E D O N O T C O P Y

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CABLE EQUATION

Frohlich and McCormick. 2010

P L E A S E D O N O T C O P Y

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NEURONAL MORPHOLOGY AND STATE

Change in somatic membrane voltage:

  • Increases with cable length.
  • Decreases with membrane conductance.
  • Increases with cable diameter.

A B vs.

Radmann et al. 2009

P L E A S E D O N O T C O P Y

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Change in somatic membrane voltage can be modeled as a sub- threshold somatic current injection.

Frohlich and McCormick. 2010

P L E A S E D O N O T C O P Y

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Lesson #4

tDCS/tACS cause small changes in neuronal membrane voltage. #synergy #EndogenousBrainActivity

P L E A S E D O N O T C O P Y

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SPATIAL TARGETING

Tissue Resistivity [Ohm cm] Copper 2e-6 CSF 64 Cortex 350 White Matter 650 Bone 8,000-16,000

P L E A S E D O N O T C O P Y

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IMPLEMENTATION

  • MR Scan
  • Tissue segmentation
  • Numerical solution (e.g. finite elements).
  • 1. Develop you own code
  • 2. Collaborate
  • 3. Buy tool / use free tool

P L E A S E D O N O T C O P Y

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P L E A S E D O N O T C O P Y

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P L E A S E D O N O T C O P Y

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Modeling performed by Angel Peterchev Sellers et al 2015

P L E A S E D O N O T C O P Y

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P L E A S E D O N O T C O P Y

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Lesson #5

MR scan + Segmentation + EF modeling = Spatial Targeting #KnowYour3D #HowGoodisHD

P L E A S E D O N O T C O P Y

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STRUCTURE DYNAMICS BEHAVIOR

P L E A S E D O N O T C O P Y

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MODELING DYNAMICS

Frohlich 2014

P L E A S E D O N O T C O P Y

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OSCILLATIONS

Caution: Most tACS literature refers to the peak-to-peak amplitude as amplitude.

P L E A S E D O N O T C O P Y

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NETWORK DYNAMICS

  • 1. Raw trace.
  • 2. Spectrum: Power as a

function of frequency.

  • 3. Spectrogram: Spectrum as

a function of time.

  • 4. Coherence: Interaction

between two sites as a function of frequency.

Raw Trace Spectrum

P L E A S E D O N O T C O P Y

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  • 1. Raw trace.
  • 2. Spectrum: Power as a function of frequency.
  • 3. Spectrogram: Spectrum as a function of time.

Raw Trace Spectrogram

P L E A S E D O N O T C O P Y

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  • 1. Raw trace.
  • 2. Spectrum: Power as a function of frequency.
  • 3. Spectrogram: Spectrum as a function of time.
  • 4. Coherence: Interaction between two sites as a function
  • f frequency.

P L E A S E D O N O T C O P Y

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Lesson #6

Brain rhythms effectively targeted by rhythmic brain stimulation #MiddleSchoolMath

P L E A S E D O N O T C O P Y

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TARGETING BRAIN NETWORK DYNAMICS

Write / Input tACS Transcranial Alternating Current Stimulation (tACS)

Neuroconn

Read / Output EEG

Berger 1929

P L E A S E D O N O T C O P Y

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NATURALISTIC ELECTRIC FIELDS

Frohlich and McCormick. 2010

P L E A S E D O N O T C O P Y

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ARNOLD TONGUE

Frohlich 2014

P L E A S E D O N O T C O P Y

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SPIKING NEURAL MODEL (NETWORK)

Ali et al. 2013

P L E A S E D O N O T C O P Y

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SPATIO-TEMPORAL DYNAMICS

Ali et al. 2013

P L E A S E D O N O T C O P Y

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Ali et al. 2013

P L E A S E D O N O T C O P Y

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STIMULATION PHASE

Ali et al. 2013

P L E A S E D O N O T C O P Y

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HOTSPOTS

Ali et al. 2013

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NETWORK-LEVEL MECHANISM

Ali et al. 2013

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CELLULAR-LEVEL MECHANISM

Ali et al. 2013

P L E A S E D O N O T C O P Y

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TARGETING A SUBPOPULATION

Ali et al. 2013

P L E A S E D O N O T C O P Y

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NETWORK RESONANCE

Ali et al. 2013

P L E A S E D O N O T C O P Y

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PHASE SLIPPING

Ali et al. 2013

P L E A S E D O N O T C O P Y

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INTERACTING NETWORKS

Kutchko and Frohlich 2013

P L E A S E D O N O T C O P Y

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MULTISTABILITY

“Rapid Fire” “Slow Propagating” “Spiral Waves”

Kutchko and Frohlich 2013

P L E A S E D O N O T C O P Y

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STATE SWITCHING BY tACS

Kutchko and Frohlich 2013

P L E A S E D O N O T C O P Y

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Lesson #7

Complexity of brain dynamics requires computer simulations to understand target engagement.

#MultiStability #NerdForPresident

P L E A S E D O N O T C O P Y

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TARGET: ALPHA OSCILLATIONS

  • Neurofeedback, rTMS (10 Hz), tACS,
  • thers…
  • “Offline” state, long-range

functional connectivity, gating.

P L E A S E D O N O T C O P Y

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COGNITIVE ENHANCEMENT

High Creative Ideation Low Creative Ideation

“increased alpha power during creative ideation is among the most consistent findings in neuroscientific research on creativity” (Fink and Benedek, 2010)

Lustenberger et al. (2015)

P L E A S E D O N O T C O P Y

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ENHANCING CREATIVITY

  • Blinding was successful (p > 0.2).
  • 10 Hz tACS significantly enhances creativity as measured by the Torrance

Test of Creative Thinking (7.45 % ± 3.11 % S.E.M.; F1,16 = 5.14, p = 0.036).

  • No enhancement with 40Hz-tACS..

Lustenberger et al. (2015)

P L E A S E D O N O T C O P Y

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OSCILLATION ENHANCEMENT

P L E A S E D O N O T C O P Y

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FEEDBACK tACS TO MODULATE SLEEP SPINDLES

Lustenberger et al. (2015)

P L E A S E D O N O T C O P Y

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IMPROVING MEMORY CONSOLIDATION

Lustenberger et al. (2015)

P L E A S E D O N O T C O P Y

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TARGET ENGAGEMENT

P L E A S E D O N O T C O P Y

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Lesson #8

Individualize with feedback stimulation to enhance target engagement. #OMGWasThatASpindle

P L E A S E D O N O T C O P Y

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SUMMARY: TARGETING NETWORK DYNAMICS

  • Oscillations represent fundamental activity structure.
  • tACS ideal to target cortical oscillations.
  • Endogenous network dynamics represent oscillator to

be modulated by weak periodic perturbations.

  • Arnold Tongue: Necessity of individualizing

stimulation frequency?

  • Multistable dynamics: State-dependent stimulation

effects.

P L E A S E D O N O T C O P Y

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Charles Zhou Caroline Lustenberger Sankar Alagapan Yuhui Li Guoshi Li Ehsan Negahbani Juliann Mellin Courtney Lugo Morgan Alexander Philipp Lustenberger Iain Stitt Supritha Dugyala Toheed Khan Quique Toloza Nadia Mishal Mia DeMarco Matt Mattoni Jhana Parikh Hemanth Ambala Carolyn Rapp Franz Hamilton Jessica Page Maadhurya Duvvuri

Alumni Lab Members

Mohsin Ali Kristin Sellers Katrina Kutchko Stephen Schmidt Chunxiu Yu Carrington Merritt Collaborators

ECOG: Dr. Haewon Shin Sleep Spindles: Dr. Bradley Vaughn Modeling ECOG: Dr. Jeremy Lefebvre Electric Field Spatial Targeting: Dr. Angel Peterchev SCZ Clinical Trial: Dr. Fred Jarskog, Dr. John Gilmore Mood Disorders Clinical Trials: Dr. David Rubinow

Funding

NIMH BRAINS R01 MH101547, NIMH R21MH105557, NIMH R21MH105574, Human Frontier Science Program, UNC School of Medicine, Department of Psychiatry, NCTraCS (CTSA #1UL1TR001111), Foundation of Hope, UNC SOM TTSA, NARSAD, Tal Medical, Patient Donations.

P L E A S E D O N O T C O P Y

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Thank you for your attention. flavio_frohlich@med.unc.edu www.networkneuroscientist.org @FrohlichLab

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