Targeted neuromodulation to improve neuropsychiatric function
Systems and methods are provided for targeting neuromodulation. A first image, representing a structure of the brain, is acquired from a first imaging system and a second image, representing a connectivity of the brain, is acquired from either the first imaging system or a second imaging system. A first utility value associated with directly modulating tissue within a region of interest is determined for each of a plurality of voxels within the region of interest from the first image. A second utility value associated with indirectly modulating tissue outside of the region of interest by modulating tissue within the region of interest is determined for each of the plurality of voxels from the second image. An overall utility value for each of the plurality of voxels is determined from the first utility value and the second utility value, and an optimal location is determined from the overall utility values.
1 . A method for targeting neuromodulation in a brain of a patient for one of improving, diagnosing, and managing a neuropsychiatric function, the method comprising:
acquiring a first image, representing a structure of the brain, from a first imaging system;
acquiring a second image, representing a connectivity of the brain, from one of the first imaging system and a second imaging system;
determining a first utility value associated with directly modulating tissue within a region of interest for each of a plurality of voxels within the region of interest from the first image;
determining a second utility value associated with indirectly modulating tissue outside of the region of interest by modulating tissue within the region of interest for each of the plurality of voxels from the second image, wherein determining the second utility value for each of the plurality of voxels comprises:
determining, for a given voxel of the plurality of voxels, a set of locations outside of the region of interest that are indirectly modulated when the given voxel is modulated from the second image, each of the set of locations having an associated indirect utility value;
determining respective strengths of a connection between the given voxel and each of the set of locations from the second image, the strength between each of the set of locations and the given voxel being represented as a connection weight; and
determining the second utility value for the given voxel as a sum of the products of the indirect utility value and connection weight for each of the set of locations;
determining an overall utility value for each of the plurality of voxels from at least the first utility value and the second utility value, each of first utility value, the second utility value, and the overall utility value representing a degree to which application of energy to the tissue represented by the voxel is desirable as one of a cost approach, in which positive values are assigned to regions for which application of energy is undesired and a utility approach in which positive values are assigned to regions for which application of energy is desirable; and
determining an optimal location for neuromodulation from the overall utility value for each of the plurality of voxels; and
applying neuromodulation at the optimal location.
2 . The method of claim 1 , further comprising:
acquiring a third image, representing activity of the brain, from one of the first imaging system, the second imaging system, and a third imaging system at a first time; after applying the neuromodulation at the optimal location, the
neuromodulation having a volume of influence representing an intensity profile associated with energy delivered during the neuromodulation for a given center point associated with the optimal location;
acquiring a fourth image, representing activity of the brain, from the one of the first imaging system, the second imaging system, and a third imaging system after applying the neuromodulation at the optimal location a second time; and
revising the connection weight for each of the set of locations for the given voxel according to the third image and the fourth image.
3 . The method of claim 1 , wherein determining the first utility value for each of the plurality of voxels comprises registering a portion of the first image representing the region of interest to a histology-based atlas having assigned values for the first utility value for each of a plurality of locations within the histology-based atlas.
4 . The method of claim 3 , wherein the assigned values within the histology-based atlas represented expected concentrations of excitatory neurons within the region of interest.
5 . The method of claim 3 , wherein the assigned values within the histology-based atlas represented expected concentrations of inhibitory neurons within the region of interest.
6 . The method of claim 3 , further comprising:
acquiring a third image, representing activity of the brain, from one of the first imaging system, the second imaging system, and a third imaging system after applying the neuromodulation at the optimal location,
the applied neuromodulation having a volume of influence representing an intensity profile associated with energy delivered during neuromodulation for a given center point associated with the optimal location;
acquiring a fourth image, representing activity of the brain, from the one of the first imaging system, the second imaging system, and a third imaging system after applying the neuromodulation at the optimal location; and
revising at least one of the assigned values for the first utility value for the plurality of locations within the histology-based atlas according to the third image and the fourth image.
7 . The method of claim 1 , further comprising:
acquiring a third image, representing activity of the brain, from one of the first imaging system, the second imaging system, and a third imaging system after applying the neuromodulation at the optimal location,
the applied neuromodulation having a volume of influence, representing an intensity profile associated with energy delivered during neuromodulation for a given center point, associated with the optimal location;
acquiring a fourth image, representing activity of the brain, from the one of the first imaging system, the second imaging system, and a third imaging system after applying the neuromodulation at the optimal location; and
revising the first utility value for at least one voxel within the volume of influence according to the third image and the fourth image.
8 . The method of claim 1 , wherein determining the optimal location for neuromodulation from the overall utility value for each of the plurality of voxels comprises determining the optimal location and an optimal shape for a volume of influence, representing an intensity profile associated with energy delivered during neuromodulation for a given center point, associated with the optimal location for neuromodulation from the overall utility value for each of the plurality of voxels.
9 . The method of claim 1 , further comprising:
measuring feedback comprising one of a physiological parameter, a cognitive parameter, a psychosocial parameter, a behavioral parameter of the patient;
determining an effectiveness of the neuromodulation according to the measured feedback; and
selecting a new location within the region of interest from the overall utility value for each of the plurality of voxels if the effectiveness of the neuromodulation fails to meet a threshold value.
10 . The method of claim 1 , further comprising:
applying neuromodulation at the optimal location having a volume of influence representing an intensity profile associated with energy delivered during neuromodulation for a given center point;
measuring feedback comprising one of a physiological parameter, a cognitive parameter, a psychosocial parameter, a behavioral parameter of the patient;
determining an effectiveness of the neuromodulation according to the measured feedback; and
revising the first utility value for at least one voxel within the volume of influence according to the determined effectiveness of the neuromodulation.
11 . The method of claim 1 , wherein the region of interest comprises at least a portion of the nucleus accumbens and the ventral internal capsule, and wherein determining the optimal location for neuromodulation from the overall utility value for each of the plurality of voxels comprises determining the optimal location such that a volume of influence, representing an intensity profile associated with energy delivered during neuromodulation for a given center point, associated with the optimal location has a center point that is between seven millimeters (mm) to twelve mm lateral from midline on the right and left sides of the brain, between one mm to six mm anterior to the anterior commissure (AC), and between two mm above to two mm below the AC.
12 . A system comprising:
an imagining interface that receives a first image, representing a structure of the brain, from a first imaging system and a second image, representing a connectivity of the brain, from one of the first imaging system and a second imaging system;
a targeting component that determines a first utility value associated with directly modulating tissue within a region of interest for each of a plurality of voxels within the region of interest from the first image, determines a second utility value associated with indirectly modulating tissue outside of the region of interest by modulating tissue within the region of interest for each of the plurality of voxels from the second image, determines an overall utility value for each of the plurality of voxels from at least the first utility value and the second utility value, and determines an optimal location for neuromodulation from the overall utility value for each of the plurality of voxels, each of the first utility value, the second utility value, and the overall utility value representing a degree to which application of energy to the tissue represented by the voxel is desirable as one of a cost approach, in which positive values are assigned to regions for which application of energy is undesired and a utility approach in which positive values are assigned to regions for which application of energy is desirable, and the targeting component selecting a target location of the nucleus accumbens and the ventral internal capsule such that a volume of influence, representing an intensity profile associated with energy delivered during neuromodulation for a given center point, associated with the optimal location has a center point that is between seven millimeters (mm) to twelve mm lateral from midline on the right and left sides of the brain, between one mm to six mm anterior to the anterior commissure (AC), and between two mm above to two mm below the AC; and
a neuromodulation system that delivers neuromodulation to the optimal location.
13 . The system of claim 12 , wherein the neuromodulation system is a deep brain stimulation system, the targeting component further determining at least one electrode to activate based on the overall utility value for each of the plurality of voxels.
14 . The system of claim 12 , wherein the neuromodulation system is a focused neuromodulation system, the targeting component further determining a number and orientation of focal points to use for excitation based on the overall utility value for each of the plurality of voxels.
15 . The system of claim 12 , further comprising a feedback component that measures one of a physiological parameter, a cognitive parameter, a psychosocial parameter, a behavioral parameter of the patient and determines an effectiveness of the neuromodulation according to the measured feedback, the targeting component selecting a new location within the region of interest from the overall utility value for each of the plurality of voxels if the effectiveness of the neuromodulation fails to meet a threshold value.
16 . The system of claim 12 , further comprising a feedback component that measures one of a physiological parameter, a cognitive parameter, a psychosocial parameter, a behavioral parameter of the patient and determines an effectiveness of the neuromodulation according to the measured feedback, the targeting component revising the first utility value for at least one voxel within the volume of influence according to the determined effectiveness of the neuromodulation.
17 . The system of claim 12 , the targeting component selecting the target location of the nucleus accumbens and the ventral internal capsule such that the volume of influence, representing an intensity profile associated with energy delivered during neuromodulation for a given center point, associated with the optimal location has a center point that is between seven millimeters (mm) to twelve mm lateral from midline on the right and left sides of the brain, between one mm to six mm anterior to the anterior commissure (AC), and between two mm above to two mm below the AC.
18 . A method of improving neuropsychiatric function in a patient comprising:
acquiring a first image, representing a structure of a brain of the patient, from a first imaging system;
acquiring a second image, representing a connectivity of the brain, from one of the first imaging system and a second imaging system;
determining a first utility value associated with directly modulating tissue within a region of interest for each of a plurality of voxels within the region of interest from the first image;
determining a second utility value associated with indirectly modulating tissue outside of the region of interest by modulating tissue within the region of interest for each of the plurality of voxels from the second image;
determining an overall utility value for each of the plurality of voxels from at least the first utility value and the second utility value, each of first utility value, the second utility value, and the overall utility value representing a degree to which application of energy to the tissue represented by the voxel is desirable as one of a cost approach, in which positive values are assigned to regions for which application of energy is undesired and a utility approach in which positive values are assigned to regions for which application of energy is desirable; and
selecting a volume of influence, representing an intensity profile associated with energy delivered during neuromodulation for a given center point, having a center point within a target region comprising the nucleus accumbens and the ventral internal capsule that is between seven millimeters (mm) to twelve mm lateral from midline on the right and left sides of the brain, between one mm to six mm anterior to the anterior commissure (AC), and between two mm above to two mm below the AC according to the overall utility value for each of the plurality of voxels; and
delivering neuromodulation to the selected volume of influence.
19 . The method of claim 18 , wherein delivering neuromodulation to the selected volume of influence comprises delivering focused ultrasound to the selected volume of influence.
20 . The method of claim 18 , further comprising:
measuring feedback comprising one of a physiological parameter, a cognitive parameter, a psychosocial parameter, a behavioral parameter of the patient;
determining an effectiveness of the neuromodulation according to the measured feedback; and
selecting a volume of influence having a center point within the target region if the effectiveness of the neuromodulation fails to meet a threshold value.
21 . A method for targeting neuromodulation in a brain of a patient for one of improving, diagnosing, and managing a neuropsychiatric function, the method comprising:
acquiring a first image, representing a structure of the brain, from a first imaging system;
acquiring a second image, representing a connectivity of the brain, from one of the first imaging system and a second imaging system;
determining a first utility value associated with directly modulating tissue within a region of interest for each of a plurality of voxels within the region of interest from the first image;
determining a second utility value associated with indirectly modulating tissue outside of the region of interest by modulating tissue within the region of interest for each of the plurality of voxels from the second image;
determining an overall utility value for each of the plurality of voxels from at least the first utility value and the second utility value, each of first utility value, the second utility value, and the overall utility value representing a degree to which application of energy to the tissue represented by the voxel is desirable as one of a cost approach, in which positive values are assigned to regions for which application of energy is undesired and a utility approach in which positive values are assigned to regions for which application of energy is desirable;
determining an optimal location for neuromodulation from the overall utility value for each of the plurality of voxels
acquiring a third image, representing activity of the brain, from one of the first imaging system, the second imaging system, and a third imaging system after applying the neuromodulation at the optimal location,
applied neuromodulation having a volume of influence associated with the optimal location;
acquiring a fourth image, representing activity of the brain, from the one of the first imaging system, the second imaging system, and a third imaging system after applying the neuromodulation at the optimal location; and
revising at least one of the assigned values for the first utility value for the plurality of locations within the histology-based atlas according to the third image and the fourth image.