The Neuromodulation Network

Neuromodulation, a set of techniques and technologies that directly modify activity in the brain, is an increasingly established area of research and practice in the treatment of mental and neurological disorders. However, while significant progress in the field has been made during recent decades, these approaches have the potential to achieve far more to advance our scientific and clinical knowledge.

The Neuromodulation Network is a focussed, problem-solving collaboration of leading research teams worldwide working on understanding and treating mental disorders using neuromodulation techniques. Initiated by the Clinical Brain Networks Group at QIMR Berghofer in Brisbane, Australia, the group includes teams from Australia, the United States, China, Hong Kong, Singapore, Taiwan, Canada and the Netherlands.

 

The 1st Neuromodulation Network Virtual Symposium 2023

Tuesday 5, Wednesday 6 and Thursday 7 September 2023

8:00PM (AEST / UTC + 10)

Our first Virtual Symposium will be taking place this September to launch the Neuromodulation Network, identify potential opportunities for collaboration among our members and work together to overcome barriers to progress in Neuromodulation.

We will aim to identify the most important obstacles holding back researchers in this field from taking forward new knowledge and developing new treatments. We will also aim to share ideas for where collaboration could blend the strengths and assets of each group to overcome these obstacles.

Links to access each Virtual Symposium Session are available below:

• Tuesday 5 September – 8:00PM              Session 1 link
• Wednesday 6 September – 8:00PM        Session 2 link
• Thursday 7 September – 8:00PM            Session 3 Link

You can DOWNLOAD A COPY OF THE FULL AGENDA HERE.

You can find abstracts provided by our members for each of their ‘national group’ presentations below.

 

Tuesday 5 September 2023

BRISBANE GROUP – 8:30PM

Associate Professor Luca Cocchi¹, Dr Philip Mosley¹, Dr Bjorn Burgher^1
1QIMR Berghofer Medical Research Institute

Strengths and Assets:

The Clinical Brain Networks Group at QIMR has access to a fully equipped not-for-profit community clinic offering neuronavigated Transcranial Magnetic Stimulation for patients with treatment-resistant major depressive disorder. This clinic generates a TMS Databank recording clinical, fMRI and EEG data for each patient with ethics approval to provide that data to other research teams under appropriate data transfer agreements. The Group is establishing a focused ultrasound stimulation research facility and has expertise in deep brain stimulation. The group is working on neuromodulation (TMS, TUS, & DBS) for MDD and OCD, and has delivered a number of advances in knowledge across these conditions.

Wishlist:

• A new TMS trial targeting the orbitofrontal cortex in OCD. This trial should capitalise on the results from a recent trial conducted by the group (Cocchi et al. Nature Mental Health, 2023). Issues: Funding and capacity to accommodate this trial.    
• Develop new safe and reliable brain stimulation (TMS/FUS/DBS) sequences able to suppress or enhance brain activity. Issues: limited expertise in electrophysiology and no access to labs undertaking preclinical work in this space.
• Define new translatable predictors of TMS response for depression. Issues: Need large datasets.
• Develop new technology to personalise brain stimulation, integrating this with complementary interventions, including neurofeedback.

Barriers to Progress:

• Need expertise in electrophysiology and direct neural recordings. Can we add collaborators to the network?
• Acquisition of large TMS-imaging clinical datasets. The network should play a key role in facilitating this.
• Multidisciplinary team to develop new personalised approaches and integrate these with complementary forms of therapy maximising brain and behavioural changes.  
• Attract interest from industry (e.g., development of devices, coils, sequences, etc.).

 

SINGAPORE GROUP – 9:30PM

Tor Phern Chern¹, Thomas Yeo^2
1Institute of Mental Health, Singapore
²National University of Singapore

Strengths & Assets:

The group has 2 main strengths. a) Internationally renowned brain scientists with access to world class fMRI facilities and analytics facilities. b) A single, central tertiary psychiatry facility for 5.5 million urban citizens, high volume of patient referrals, representative of entire population.

Wishlist:

• Neurostimulation research in newer treatment modalities (tDCS, VNS, TNS)
  • Funding and infrastructure to support patients in the community
• Neurosurgical (NS) research in psychiatric conditions
  • Change in laws restricting NS in psychiatric conditions
  • Integration with national neuroscience institute
• Neurostimulation in community sites rather than institution
  • Treatment facilities in polyclinics
• Focused Ultrasound
• More basic scientists working on neuromodulation
• Co-located imaging and treatment facilities
• Integration of clinical and research imaging facilities

Barriers to Progress:

• Lack of funding / insurance coverage for TMS / Neurostimulation.
• Lack of awareness by professionals and public in NS for psychiatric conditions.
• Lack of data sharing.

 

HONG KONG GROUP – 10:15PM

Assistant Professor Georg Kranz^1
1Department of Rehabilitation Sciences, The Hong Kong Polytechnic University

Strengths & Assets:

We are currently a group of 11 people, including 5 PhD students, 5 research associates/assistants and the PI, Georg Kranz, located at the Hong Kong Polytechnic University. Our background is neuroscience, psychology, biology, physiotherapy, occupational therapy. We collaborate locally with psychiatrists from hospitals and psychiatric departments from other universities in Hong Kong, and internationally with people from Germany (Frank Padberg) and Brazil (Andre Brunoni), among others. Our focus is on depressive disorders and patients with depressive symptoms (not only MDD) and we recruit participants via collaborating hospitals and via the local community. We currently use the following equipment that is available on site: fNIRS (3 systems: Hitachi, NIRX, ISS), MRI (3T Siemens PRISMA), TMS (2 systems from MagVenture), TPS (Stortz medical). We investigate NIBS as treatment, as well as for prognosis (using concurrent TMS/fNIRS).

Wishlist:

We would need people with expertise in TMS/fMRI (we recently bought the TMS compatible MRcoil array from MagVenture). Ppl with TMS/EEG, TEP- experience also needed, as we have a TMS-compatible EEG on site and would like to use it. We aim to move from summary scores to single-item analyses but our data pool is only growing very slowly. Therefore, we would like to explore/test our ideas through pooling itemized data (HDRS, MADRS, IDS etc) from others.

Barriers to Progress:

We would welcome ideas/input on:

• Individualized node targeting; is it really worth it?
• Are there any experimental tasks that are susceptible to single-session TMS/TBS?

 

Wednesday 6 September 2023

TAIWAN GROUP – 8:00PM

Cheng-Ta Li, M.D., Ph.D. ^1
1 School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan

Strengths and Assets:

• I am in charge of Taiwan’s neuromodulation working group in the largest specialty society, including Taiwanese Society of Psychiatry (TSP) and Taiwanese Society of Biological Psychiatry and Neuropsychopharmacology (TSBPN).
• I am connecting a network, sharing data with other hospitals and hospital in other countries (e.g., Japan).
• In our site (Taipei Veterans General Hospital), we have a prediction depression intervention center (PreDIC), which is the largest depression treatment center in Taiwan and is based in a medical center. For example, we have 6 rTMS machines for clinical and research purposes.
• Our main populations: depression is our major target now, but we are working on anxiety, OCD, schizophrenia, pain, and cognitive impairment.

Wishlist:

• Infrastructures: we need cloud resources for data secure and federated learning.
• Collecting data together for large clinical trials and also data learning.

Barriers to Progress:

• It is hard to get large grants for rTMS matters now.

 

Theta burst stimulation in youth with autism spectrum disorder

Hsing-Chang Ni¹, Hsiang-Yuan Lin^2
1Department of Psychiatry, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
²Centre for Addiction and Mental Health, Toronto, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada

Strengths and Assets:

Despite promising results from some pilot trials, there has been no definite evidence suggesting that repetitive transcranial magnetic stimulation (rTMS)/theta burst stimulation (TBS) could be an efficacious intervention for autistic people. As such, our internationally collaborative team, co-led by Dr. Ni (Taiwan; in charge of the conceptualization, recruitment, implementation of the neuromodulation, and data management/analysis) and Dr. Lin (Canada; contributing to conceptualization, analysis/interpretation, and intellectual supervision) have completed three randomized sham-controlled trials, which used TBS over the bilateral posterior superior temporal sulci, left dorsolateral prefrontal cortex, and right inferior frontal gyrus, respectively, in autistic youth. We are currently conducting other two RCTs and investigating the feasibility of resting-state fMRI-navigated cerebellar stimulation in autistic people. We are also collaborating with Dr. Cocchi and his team at QIMR, Australia, to investigate changes in brain dynamics following TBS in autistic people.

Wishlist:

Using the rigorous design with sufficiently powered samples, our completed trials do not support the efficacy of TBS in autistic children and youth. We wish there could be other teams conducting clinical trials of comparable protocols for autism to either replicate or refute our findings. We also welcome insight and suggestions to facilitate alternative analyses of our data.

Barriers to Progress:

The present null results may be driven by wider systemic issues, including heterogeneity in autism, disputable target behaviour/symptom outcome, elusive mechanism of TBS, and inconclusive protocols (involving stimulation sites, stimulation frequency, cumulative intensity, etc). More empirical data, scientific insight, and collaboration are needed to tackle these obstacles.   

 

UNITED STATES GROUP – 10:00PM

Professor Andreas Horn¹
Jordy Tasserie, PhD^1
1Harvard Medical School

The Network Stimulation Laboratory (NetStim) is directed by Prof. Andreas Horn in the Center for Brain Circuit Therapeutics at Brigham & Women’s Hospital and the Department of Neurosurgery at Massachusetts General Hospital within Harvard Medical School, as well as in the Movement Disorders and Neuromodulation Section at Charité, University Medicine Berlin.

Our research group focus on neuroimaging (structural and functional Magnetic Resonance Imaging, electrohysiology, and Computed Tomography) and  both invasive (Deep Brain Stimulation, DBS), and non-invasive stimulation techniques (Transcranial Magnetic Stimulation, transcranial Direct Current Stimulation). Leveraging productive collaborations, we have gathered comprehensive DBS datasets from esteemed institutions worldwide, covering a broad spectrum of diseases ranging from movement disorders spectrum (Parkinson’s Disease, Dystonia, Essential Tremor) along with neuropsychiatric conditions (Tourette’s Syndrome, Alzheimer’s Disease) as well as psychiatric disorders (Obsessive-Compulsive Disorder and Depression). Our core objective revolves around deciphering the intricate interplay between DBS electrode placement and the resultant effects it induces to understand the neurostimulation principles and the underlying mechanisms on distributed cerebral network  that span across the human brain. To facilitate these inquiries, our primary tool is the ‘connectomic DBS’ approach, (connectivity measures)  embedded in the Lead-DBS toolbox we developed.

The overarching goal of our research is to identify and target brain circuitry to improve treatments, toward a connectomic neurostimulation framework. While our current analyses heavily depend on cutting-edge neuroimaging technologies, challenges persist with regards to the quality of acquired images and accessing patient data. Therefore, a need exists for the refinement of medical imaging protocols and the establishment of more collaborative endeavors.

 

Thursday 7 September 2023

MELBOURNE GROUP – 8:00PM

Andrew Zalesky, PhD¹ 
Robin Cash, PhD^1 
1University of Melbourne 

Strengths and Assets:

Expertise in TMS, neuroimaging and personalised targeting. Assets include Magventure TMS, Localite neuronavigation, 7T-MRI, PET.  

Wishlist:

We are looking at how to expand our team (students and a psychiatrist) and seeking further funding to develop capacity and infrastructure for clinical research and translation. Meanwhile, we are looking to initiate local collaborations and a small clinical study.  

Barriers to Progress:

The main barriers are personnel and funding. Our funding applications are being knocked back in part based on a non-competitive track record of clinical trials experience.  

 

CANADA GROUP – 8:45PM

Sara Tremblay, PhD¹
Lauri Tuominen, MD, PhD^1
1Royal’s Institute of Mental Health Research, affiliated with the University of Ottawa

Strengths and Assets:

We will present on current work that focuses on the use of neuroimaging methods such as TMS-EEG, resting state fMRI and FDG-PET to better understand the mechanisms of neurostimulation, with a focus on theta burst stimulation, and to optimize therapeutic response in depression. We will describe our respective expertise, as well as our current access to technology such as a PET-MR system in a tertiary mental health hospital in Ottawa (Canada), dedicated access to three rTMS units within the hospital, a TMS-compatible EEG system, and access to robotic-neuronavigation and controllable pulse TMS at the University campus.

Wishlist:

We will present our new research directions and challenges that we face in their implementation, including:

• The use of connectivity-based targets for theta burst stimulation in treating depression.
• The combination of theta burst stimulation with novel PET tracers, such as [¹⁸F]SynVest-2 that binds to the synaptic vesicle glycoprotein 2A (SV2A) as a marker of synaptic density.

Barriers to Progress:

We will describe current barriers to progress, with a focus on conducting single-site clinical trials and conducting PET research with a clinical population (e.g., cost, development of tracers, etc.).