Restorative Neurosurgery From Motion to Emotion Kendall Lee

Restorative Neurosurgery From Motion to Emotion Kendall Lee, M. D. , Ph. D. Department of Neurosurgery Mayo Clinic

Neuromodulation (Deep Brain Stimulation) Established for: • Parkinson’s Disease (STN, GPi) • Dystonia (GPi) • Tremor (Vim Thalamus) Emerging treatment for: • Epilepsy (Anterior Thalamus) • Tourette’s Syndrome (CM Thalamus) • Obsessive compulsive disorder • Depression (Area 25) • Chronic Pain (PAG/PVG, Thalamus) • Chronic Pain (Motor cortex)

Neuromodulation n >60 thousand DBS implants n Stimulation 24 hrs a day - 7 days a week n Immediate reduction in tremors However, n Time consuming surgery without feedback n Difficulty programming without feedback n Unknown mechanism of action Need a Closed-Loop Feedback System n Better targeting of electrode of implant HOW TO GET THERE? 1. Neuroelectrical monitoring 2. Neurochemical monitoring

Neuroelectrical monitoring

Real-Time Neurochemical Recordings Electrochemistry Fast-Scan Cyclic Voltammetry (FSCV) 8

Fast-Scan Cyclic Voltammetry -0. 4 1. 0 Voltage -0. 4

Real-Time Neurochemical Recordings 1. 0 V -0. 4 V Applied Potential (V) DA DA Measured Current (u. A) DA oxidation reduction Background subtracted cyclic voltammogram Pseudo colorplot

Pseudo colorplot

Universal Electrochemistry Instruments system : the University of North Carolina

Wireless Instantaneous Neurotransmitter Concentration Sensor System (WINCS) Hardware Dopamine Software Adenosine Mayo Clinic Serotonin

Wireless Instantaneous Neurotransmitter Concentration Sensor System (WINCS): Mayo Clinic B. A. SENSOR (implanted) WINCS (external) HOMEBASE (remote) C.

Concept - Intraoperative Neurochemical Monitoring during Deep Brain Stimulation Surgery

Human WINCS Recording Studies Part I (Dr. Lee’s work)

Human WINCS Recording Studies Part I (Dr. Lee’s work)