The heart side of brain neuromodulation.
Simone RossiEmiliano SantarnecchiGaetano ValenzaMonica UlivelliPublished in: Philosophical transactions. Series A, Mathematical, physical, and engineering sciences (2016)
Neuromodulation refers to invasive, minimally invasive or non-invasive techniques to stimulate discrete cortical or subcortical brain regions with therapeutic purposes in otherwise intractable patients: for example, thousands of advanced Parkinsonian patients, as well as patients with tremor or dystonia, benefited by deep brain stimulation (DBS) procedures (neural targets: basal ganglia nuclei). A new era for DBS is currently opening for patients with drug-resistant depression, obsessive-compulsive disorders, severe epilepsy, migraine and chronic pain (neural targets: basal ganglia and other subcortical nuclei or associative fibres). Vagal nerve stimulation (VNS) has shown clinical benefits in patients with pharmacoresistant epilepsy and depression. Non-invasive brain stimulation neuromodulatory techniques such as repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) are also being increasingly investigated for their therapeutic potential in several neurological and psychiatric disorders. In this review, we first address the most common neural targets of each of the mentioned brain stimulation techniques, and the known mechanisms of their neuromodulatory action on stimulated brain networks. Then, we discuss how DBS, VNS, rTMS and tDCS could impact on the function of brainstem centres controlling vital functions, critically reviewing their acute and long-term effects on brain sympathetic outflow controlling heart function and blood pressure. Finally, as there is clear experimental evidence in animals that brain stimulation can affect autonomic and heart functions, we will try to give a critical perspective on how it may enhance our understanding of the cortical/subcortical mechanisms of autonomic cardiovascular regulation, and also if it might find a place among therapeutic opportunities in patients with otherwise intractable autonomic dysfunctions.
Keyphrases
- deep brain stimulation
- white matter
- resting state
- transcranial magnetic stimulation
- transcranial direct current stimulation
- drug resistant
- obsessive compulsive disorder
- parkinson disease
- chronic pain
- high frequency
- blood pressure
- end stage renal disease
- functional connectivity
- cerebral ischemia
- heart failure
- ejection fraction
- minimally invasive
- chronic kidney disease
- heart rate
- newly diagnosed
- heart rate variability
- multiple sclerosis
- depressive symptoms
- prognostic factors
- multidrug resistant
- acinetobacter baumannii
- type diabetes
- early onset
- pain management
- metabolic syndrome
- patient reported
- liver failure
- blood glucose
- weight loss
- cystic fibrosis
- blood brain barrier
- pseudomonas aeruginosa
- acute respiratory distress syndrome
- insulin resistance