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Providence VA Medical Center, Rhode Island

 

Focus Area 2

Focus Area 1

Focus Area 3






Restoring Affective and Cognitive Health

Director
Noah Philip, MD

Core Investigators
Benjamin Greenberg, MD, PhD
M.Tracie Shea, PhD
Mascha van 't Wout-Frank, PhD

Led by Dr. Philip, FA-2 uses noninvasive neurotechnologies to understand and change abnormal brain circuit functioning in a group of neurobehavioral disorders that impose health and functional burdens on Veterans. These include post-traumatic stress disorder (PTSD), depression, suicide, chronic pain, and obsessive-compulsive disorder (OCD). The interventional technologies deliver brain stimulation through devices placed on the scalp to affect the underlying brain. Specifically, we use transcranial magnetic stimulation (TMS) and transcranial electrical stimulation (using direct or alternating current; tDCS or tACS, respectively). To map brain circuit function in these conditions we use advanced MRI and electroencephalography methods in collaboration with Cores A and B, with implementation guided by Core C.

Examples of FA-2 research include:
 
PTSD. CfNN-supported research demonstrated that tDCS, combined with virtual reality exposure, can improve PTSD (van ‘t Wout-Frank et al., 2019); these results led to a Merit-funded study (I01 RX002450) to test this intervention more broadly. FA-2 has also conducted the first randomized controlled study of a novel TMS paradigm (intermittent theta burst) in Veterans with PTSD (Philip et al., 2018). Recent awards of VA equipment grants (IS1 BX004779) will permit the first-in-human testing of low intensity focused ultrasound in PTSD.

Depression. CfNN’s ongoing work on therapeutic TMS suggests that the antidepressant response to TMS can be predicted by specific patterns in brain connectivity before treatment (Philip et al., 2018; further funded by I01 RX003152). Furthermore, FA-2 research demonstrated that data-driven, machine learning approaches can identify patients most likely to respond to TMS (Zandvakili et al., 2019), and identified risks associated with the use of tDCS for depression (Berlow et al., 2019).

Suicide. FA-2 investigators recently identified neural circuits underlying suicide in PTSD (Barredo et al, 2018), and ongoing work is identifying how neuroimaging can identify those at risk for suicide (IK2 CX001824). FA-2 is also about to launch the first study to combine brain stimulation and psychotherapy to reduce suicide in high-risk Veterans (I01 HX002572).

Pain. This line of CfNN research evaluates the emotional (affective) component of chronic pain, a clinical feature which magnifies pain-related disability; FA-2 research demonstrated that tDCS can improve pain tolerance (Mariano et al., 2015). Other FA-2 research focused on the use of tACS to modulate pain-related somatosensory perception (Sliva et al., 2018).

OCD. CfNN investigators completed 12-month data collection in a multicenter NIH-supported trial of deep brain stimulation for individuals suffering with intractable illness (Greenberg, PI). Data analysis in collaboration with Dr. Richard Jones is underway. Ongoing work also indicates the use of tDCS to modulate brain regions implicated in OCD.

Director Dr. Philip demonstrates transcranial magnetic stimulation 
Figure 1. Director Dr. Philip demonstrates transcranial magnetic stimulation
 
 Combined tDCS plus Virtual Reality for PTSD
Figure 2. Combined tDCS plus Virtual Reality for PTSD
 
 Functional neuroimaging to identify brain circuits involved in PTSD and treatment
Figure 3. Functional neuroimaging to identify brain circuits involved in PTSD and treatment
 

 Machine-learning approaches to identify patients most likely to respond to brain stimulation

Figure 4. Machine-learning approaches to identify patients most likely to respond to brain stimulation



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