Neuroimaging and Neurostimulation: Going inside the black box
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1 Neuroimaging and Neurostimulation: Going inside the black box Benzi M. Kluger M.D., M.S. Director, Movement Disorders Center Associate Professor of Neurology & Psychiatry University of Colorado
2 OUTLINE I. What is neuroimaging and neurostimulation? II. Brief history of neuroimaging and neurostimulation in Parkinson s? III. Why is this important? IV. What s in the research pipeline? V. What else is happening at the University of Colorado?
3 The Black Box
4
5
6
7 I. What is neuroimaging and neurostimulation?
8 Neuroimaging includes the use of various techniques to either directly or indirectly image the structure, function/pharmacology of the nervous system.
9 Neuroimaging What can we see inside the head? Structure Molecules Blood Flow Metabolic/Chemicals Activity Electrical Activity
10 Neuroimaging Computed Tomography (CT) Scan Positron Emission Tomography (PET) and Single photon emission computed tomography (SPECT) Scans (e.g. DAT Scan) Magnetic resonance imaging (MRI) Megnetoencephalography (MEG) and electroencephalography (EEG) Near Infrared spectroscopy (NIRS)
11 CT, PET and SPECT
12 DAT Scan
13 MRI
14 MEG/EEG
15 NIRS
16 Neurostimulation is a therapeutic activation of part of the nervous system using various techniques.
17
18 Neurostimulation Deep Brain Stimulation (DBS) Transcranial Magnetic Stimulation (TMS) Transcranial direct current stimulation (tdcs) Gene Therapy Cell Transplantation/Stem Cells (Ultrasound)
19 DBS
20 TMS
21 tdcs
22 Gene Therapy
23 Stem Cells
24 IIa. Brief History of Neuroimaging
25 History of Neuroimaging
26 Neuroimaging and Parkinson s There is no brain scan that can diagnose PD There is nothing that can be seen on an MRI DAT scan can assist in detecting a loss of dopamine neurons PET scans have found patterns of brain activity associated with both motor and nonmotor symptoms MRI scans have found changes in both grey matter and white matter
27 IIb. Brief History of Neurostimulation
28 History of Neurostimulation
29 History of Neurostimulation & PD Surgery in PD has a long history First use of DBS for tremor was in 1987 DBS rapidly became the surgical treatment of choice with targets in STN, GPI and thalamus PD is most widely used indication for DBS with over 100,000 implanted patients
30 III. Why is this important?
31 Neuroimaging: Mechanism
32 Neuroimaging: Biomarker A biomarker, or biological marker, generally refers to a measurable indicator of some biological state or condition Diagnostic Predictive Monitor Disease progression
33 IV. What s in the research pipeline?
34 Optogenetics
35 Biomarkers Imaging alpha-synuclein Connectivity Structural Functional
36 7 Tesla MRI
37 Deep Brain Stimulation Paramedian Pontine Nucleus (PPN) Stimulation for depression and dementia Neuroprotection? Smarter stimulators
38 Gene Therapy and Stem Cells All trials have been negative to date Dopamine replacement Neurotransmitter replacement Growth factors
39 Transcranial Magnetic Stimulation
40 Transcranial Direct Current Stimulation
41 V. Research at the University of Colorado
42 Getting Patients Involved Parkinson s Advocates in Research (PAIR) Grant Patient Centered Outcomes Research Institute (PCORI)
43 Marijuana Used by 5-10% of our patients Most helpful for non-motor symptoms New Grant from state of Colorado on CBD for tremor Also looking at memory and driving
44 Complementary and Alternative Medicine Acupuncture Massage Yoga Meditation
45 Exercise Different forms of exercise have different benefits SPARX study is looking into the question of what is the right dose Neuroprotective?
46 Neuroimaging fmri and PD phenotypes MEG and cognitive symptoms MRS and cognitive symptoms MEG and the benefits of rhythm on movement
47 Nonmotor Symptoms Palliative Care Fatigue Cognitive Impairment TMS treatment
48 Genetics PROGENI study More on the way
49 Neuroprotection Curt Freed and phenylbutyrate Margaret Schenkman and Exercise Katherine James and pesticides CoQ10 Creatine
50 Medications Long acting amantadine Botox for drooling Low dose azilect/mirapex
51
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