In Reply: A Novel Framework for Network-Targeted Neuropsychiatric Deep Brain Stimulation

To the Editor:

We thank the authors¹ for their thoughtful comments and agree that there is immense potential for implementing neuromodulation techniques such as deep brain stimulation (DBS) for neurological and neuropsychiatric disorders while taking into account its limitations and ethical considerations.

As stated in our article² and as mentioned in the commentary from Rahman et al,¹ DBS is being increasingly used for various neurological disorders and has made a large impact in the field of motor disorders. We agree that the neural underpinnings of psychiatric disorders have been elusive, in comparison with the strides made in the field of movement disorders. This lack of understanding of network physiology underlying mental health disorders and its response to DBS is a driving force behind our proposal of adapting the epilepsy monitoring experience for refractory psychiatric and neurological disorders.

Although the adaptation of such a neurophysiological monitoring unit has immense potential to help uncover dysfunctional networks, we agree that extreme care should be taken when offering these surgical therapies. It is critical that these innovative approaches be delivered by multidisciplinary teams with expertise across psychiatry, psychology, neurology, neuropsychiatry, and neurosurgery. It is of course important that this care is overseen within the confines of rigorous ethical standards as we have done in our existing clinical trial and as stated in our original article. We once again thank Rahman et al¹ for their interest in this article.

Funding

This work was supported by NIH Award numbers 1UH3NS103549-01 and 1F99NS124181-01.

Disclosures

The authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this article. Dr Sheth is a consultant for Boston Scientific, Zimmer Biomet, Neuropace, and Abbott.