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805 Northern Blvd, Suite 100, Great Neck NY 11021
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Research Laboratory
DBS Surgery Program
The Deep Brain Stimulation (DBS) surgery program focuses on delivering optimal treatment to patients suffering from movement disorders such as Parkinson’s disease, tremor, and dystonia, as well as refining treatments for patients with refractory psychiatric disease states, such as treatment resistant depression. In the majority of these surgeries, we record from the subcortical structures of the awake patient in an effort to better understand the disease process, refine the targeting, and together with new brain imaging techniques provide exemplar outcomes. Thus, the operating room is our chief laboratory space, to both learn from each patient and optimize treatment strategies. During DBS surgery, we use subdural electrodes to record from nodes implicated in the particular disease process as we test stimulate at the subcortical target to better understand the electrophysiology of the network, such as those affected by the dentato-rubro-thalamic tract (DRTt) in tremor or the medial forebrain bundle in depression. See example below.
Illustration of the dentato-rubro-thalamic tract (DRTt)
Outside the operating room, the use of imaging to illustrate both the structural and functional connectivity of the networks involved in various pathophysiologies treated by deep brain stimulation can improve our understanding of the disease process and potentially lead to more strategic treatment paradigms.
Both of our NIH funded clinical trials utilize imaging to explore the functional connectivity of specific networks modulated by DBS. Serial resting state functional MRIs (rsfMRIs) can elucidate functional connectivity changes over time secondary to DBS and give us clues about specific cortical/subcortical structures and their relevance in producing the clinical effects observed. In our NINDS R01 funded trial, we are exploring the structural and functional connectivity changes of the dentato-rubro-thalamic tract (DRTt) in essential tremor patients after DBS. In our NIMH R01 funded trial, we are investigating reward network modulation in treatment resistant depression patients after DBS to the medial forebrain bundle (MFB). Please see above for the tabs for each study.
Simultaneously with learning intraoperatively from human research subjects, animal models of disease enable us to understand the biochemical mediators of such pathological cortical states and how the intervention of deep brain stimulation improves aberrant subcortical firing to improve symptomatology.
Illustration of the superolateral branch of the medial forebrain bundle (MFB)
Published Work
Complete List of Published Work in MyBibliography
Boscutti A, Asir B, Moura I, Fenoy A, Quevedo J, Soares JC. Deep brain stimulation of the medial forebrain bundle: Effects on anhedonia and behavioral activation in treatment-resistant depression. Brain Stimul. 2024 Dec 12;18(1):61-63. doi: 10.1016/j.brs.2024.12.1186. [Epub ahead of print] PubMed PMID: 39672230.
Fenoy AJ, Chu ZD, Ritter RJ 3rd, Conner CR, Kralik SF. Evaluating functional connectivity differences between DBS ON/OFF states in essential tremor. Neurotherapeutics. 2024 Jul;21(4):e00375. doi: 10.1016/j.neurot.2024.e00375. Epub 2024 May 31. PubMed PMID: 38824101; PubMed Central PMCID: PMC11301224.
Mishra A, Begley SL, Shah HA, Santhumayor BA, Ramdhani RA, Fenoy AJ, Schulder M. Why are clinical trials of deep brain stimulation terminated? An analysis of clinicaltrials.gov. World Neurosurg X. 2024 Jul;23:100378. doi: 10.1016/j.wnsx.2024.100378. eCollection 2024 Jul. PubMed PMID: 38595675; PubMed Central PMCID: PMC11002890.
Unadkat P, Vo A, Ma Y, Peng S, Nguyen N, Niethammer M, Tang CC, Dhawan V, Ramdhani R, Fenoy A, Caminiti SP, Perani D, Eidelberg D. Deep brain stimulation of the subthalamic nucleus for Parkinson's disease: A network imaging marker of the treatment response. Res Sq. 2024 May 7;. doi: 10.21203/rs.3.rs-4178280/v1. PubMed PMID: 38766007; PubMed Central PMCID: PMC11100869.
Conner CR, Forseth KJ, Lozano AM, Ritter R 3rd, Fenoy AJ. Thalamo-cortical evoked potentials during stimulation of the dentato-rubro-thalamic tract demonstrate synaptic filtering. Neurotherapeutics. 2024 Jan;21(1):e00295. doi: 10.1016/j.neurot.2023.10.005. Epub 2023 Dec 19. PubMed PMID: 38237402; PubMed Central PMCID: PMC10903089.
Hussain M, Norgeot B, Zaafran A, Stark J, Caridi J, Fenoy A, Pivalizza E. Virtual transitional pain service delivered via telehealth is effective in preventing new and persistent opioid use amongst post-surgical spine patients. medRxiv. 2023 Aug 20;. doi: 10.1101/2023.08.18.23294272. PubMed PMID: 37645940; PubMed Central PMCID: PMC10462235.
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