The Deep Brain Stimulation (DBS) surgery program led by Dr. Albert Fenoy focuses on delivering optimal treatment to patients suffering from movement disorders such as Parkinson’s disease, tremor, and dystonia, as well as refining treatments for patients with refractory psychiatric disease states, such as treatment resistant depression. In the majority of these surgeries, we record from the subcortical structures of the awake patient in an effort to better understand the disease process, refine the targeting, and together with new brain imaging techniques provide exemplar outcomes. Thus, the operating room is our chief laboratory space, to both learn from each patient and optimize treatment strategies. Examples include identifying subcortical tracts to avoid in order to prevent speech decline in DBS for Parkinson’s disease, as well as the role of the subthalamic nucleus in reward expectation.
Simultaneously with learning intraoperatively from human research subjects, animal models of disease enable us to understand the biochemical mediators of such pathological cortical states and how the intervention of deep brain stimulation improves aberrant subcortical firing to improve symptomatology.
Albert J. Fenoy, M.D. is Associate Professor and Director of Deep Brain Stimulation at the University of Texas Health Science Center at Houston. He completed his residency in neurosurgery at the University of Iowa and completed a fellowship in functional neurosurgery at the Centre Hospitalier Universitaire de Grenoble, France.
Deep Brain Stimulation for Treatment Resistant Depression: Clinical Trial
Performed in conjunction with the UT Center of Excellence on Mood Disorders, led by chairman Jair C. Soares, M.D., Ph.D, this is an FDA-approved clinical trial for patients suffering from treatment resistant depression. This study is aimed to determine feasibility, safety and efficacy of DBS applied to the supero-lateral branch of the medial forebrain bundle (slMFB). UT is the only site in the US to perform such surgery at this target, and the second in the world.
For more information, please refer to here.
Houston Chronicle write up here.
Deep Brain Stimulation for Treatment Resistant Depression: Animal models
Performed in collaboration with the UT Translational Psychiatry Program at the Behavioral and Biomedical Sciences Building (BBSB), led by Joao Quevedo, M.D., Ph. D., this project aims to evaluate the mechanisms by which MFB DBS improves depression. In the rodent, once a depression model is created using chronic unpredictable stress, MFB DBS is applied to observe behavioral improvement. Afterward, histological analysis is performed on subcortical/cortical structures investigating the involvement or modulation of the dopamine-reward pathway, which is hypothesized to be a key factor in how MFB DBS can incur a reversal of anhedonia.
Diffusion Tensor Brain Imaging in Deep Brain Stimulation
Many of the disease states treated by DBS involve placement of an electrode into to an anatomical area of the brain that has historically been seen to be part of a neuronal circuit subserving some function, such as the motor system. These anatomical nodes within this network are visible on standard imaging, but the circuits connecting them are not. Use of diffusion tensor imaging to identify tracts linking subcortical/cortical structures has elucidated novel and more refined targeting protocols for certain disease states, such as tremor. Evolution of imaging acquisitioning, stereotactic analysis and targeting schemes is underway to optimize outcomes.
Reward expectation in the subthalamic nucleus
Intraoperative microelectrode recording of cells within the subthalamic nucleus (STN), which occurs routinely in many patients during DBS surgery for Parkinson’s disease, has revealed that the STN predicts reward and encodes its anticipation. We are analyzing the STN responses to a reward delivered intraoperatively during such cell recording; the catch trials where no reward is delivered after cue results in an interesting firing pattern.
Albert Fenoy, M.D., Assistant Professor
Joao Quevedo, MD, Ph.D., Professor
Jonathan Flynn, B.S., Ph.D. candidate
Animal Protocol Team:
Manoj Dandekar, PhD, post-doc fellow
Vija Giriharan, PhD, post-doc fellow
Dustin Luse, B.S., Medical Student
Carson Hoffmann, B.S., Medical Student
Travis Peery, B.S., Medical Student
Christian Ruiz, B.S., Medical Student
Shalini Jayawickrama B.S., Medical Student
Caroline Hussey B.S., Medical Student
Judy Chen B.S., Medical Student
Matthew Meece B.S., Medical Student
Anuj Shah B.S., Medical Student
Agata Migut B.S., Medical Student
Jenny Shin B.S., Medical Student
Department of Neurosurgery
The University of Texas Medical School-Houston
Fenoy AJ, Simpson RK Jr. Risks of common complications in deep brain stimulation surgery: management and avoidance. J Neurosurg, 120(1):132-9, 2014.
Fenoy AJ, Goetz L, Chabardès S, Xia Y. Deep Brain Stimulation: Are Astrocytes a Key Driver Behind the Scene? CNS Neurosci Ther 20(3):191-201, 2014
Fenoy AJ, Schulz P, Selvaraj S, Burrows C, Spiker D, Cao B, Zunta-Soares G, Gajwani P, Quevedo J, Soares J. Deep brain stimulation of the medial forebrain bundle: Distinctive responses in resistant depression. J Affect Disord. 203:143- 151, 2016
Fenoy AJ, McHenry MA, Schiess MC. Speech changes induced by deep brain stimulation of the subthalamic nucleus in Parkinson disease: involvement of the dentatorubrothalamic tract. J Neurosurg. 2016 Sep 9:1-11.
Fenoy AJ, Schiess MC. Deep Brain Stimulation of the Dentato-Rubro-Thalamic tract: Outcomes of Direct Targeting for Tremor. Neuromodulation. 2017. DOI: 10.1111/ner.12585.
Dandekar MP, Luse D, Hoffmann C, Cotton P, Peery T, Ruiz C, Hussey C, Giridharan VV, Soares JC, Quevedo J, Fenoy AJ. Increased dopamine receptor expression and anti-depressant response following deep brain stimulation of the medial forebrain bundle. J Affect Disord. 2017 Apr 5;217:80-88. DOI: 10.1016/j.jad.2017.03.074.