The Neural Crossroads of Psychiatric Illness: An Emerging Target for Brain Stimulation

Jonathan Downar; Daniel M Blumberger; Zafiris J Daskalakis

doi:10.1016/j.tics.2015.10.007

The Neural Crossroads of Psychiatric Illness: An Emerging Target for Brain Stimulation

Trends Cogn Sci. 2016 Feb;20(2):107-120. doi: 10.1016/j.tics.2015.10.007. Epub 2015 Dec 3.

Authors

Jonathan Downar¹, Daniel M Blumberger², Zafiris J Daskalakis²

Affiliations

¹ Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada; Krembil Research Institute, University Health Network, Toronto, ON, Canada; MRI-Guided rTMS Clinic, University Health Network, Toronto, ON, Canada. Electronic address: jonathan.downar@uhn.ca.
² Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada; Temerty Centre for Therapeutic Brain Intervention and Campbell Family Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.

PMID: 26655436
DOI: 10.1016/j.tics.2015.10.007

Abstract

Recent meta-analyses of structural and functional neuroimaging studies are converging on a collective core of brain regions affected across most psychiatric disorders, centered on the dorsal anterior cingulate cortex (dACC) and anterior insula. These nodes correspond well to an anterior cingulo-insular (aCIN) or 'salience' network, and stand at a crossroads within the functional architecture of the brain, acting as a switch to deploy other major functional networks according to motivational demands and environmental constraints. Therefore, disruption of these 'linchpin' areas may be disproportionately disabling, even when other networks remain intact. These regions may represent promising targets for a new generation of anatomically directed brain stimulation treatments. Here, we review the potential of the psychiatric core areas as targets for therapeutic brain stimulation in psychiatric disease.

Keywords: DBS; VBM; cingulate; insula; neuroimaging; psychiatry; rTMS; resting-state; salience; tDCS.

Publication types

Research Support, Non-U.S. Gov't
Review

MeSH terms

Brain / physiopathology*
Deep Brain Stimulation / methods*
Humans
Mental Disorders / physiopathology*
Mental Disorders / therapy*
Neural Pathways / physiopathology
Transcranial Direct Current Stimulation / methods*
Transcranial Magnetic Stimulation / methods*

Grants and funding

Canadian Institutes of Health Research/Canada