Center for Brain Circuit Therapeutics
Mission: To develop and administer treatments for patients with brain disorders by directly targeting the brain circuits responsible for neurological and psychiatric symptoms.
Rationale: Patients with brain disorders often have symptoms that are refractory to medication. Some of these symptoms can be improved by directly targeting brain circuits. Recent advances in brain imaging allow us to determine which brain circuit is responsible for which symptom. Neuromodulation therapies such as deep brain stimulation (DBS), transcranial magnetic stimulation (TMS), and MRI-guided focused ultrasound (MRIg-FUS) allow us to directly target brain circuits and improve symptoms in ways not possible with medication.
Structure: The Center for Brain Circuit Therapeutics is a joint initiative across the Departments of Neurology, Psychiatry, Neurosurgery, and Neuroradiology, all located within the Hale Building for Transformative Medicine at Brigham and Women’s Hospital Neurosciences Center. The Center is multi-disciplinary because symptoms of brain disease cross traditional boundaries as does the expertise needed to develop and administer brain circuit therapies. The Center offers multiple different forms of therapeutic neuromodulation because the same brain circuit can potentially be targeted in different ways. The Center combines research and clinical care as one inherently informs the other and accelerates development of new treatments.
Who do we treat? We treat patients with medication-refractory symptoms from brain disorders including depression, Parkinson’s disease, essential tremor, dystonia, epilepsy, bipolar disorder, obsessive-compulsive disorder, and several other diagnoses. We also offer treatment as part research trials designed to test the efficacy of new neuromodulation treatments for brain disorders.
What services do we provide? Clinical services include deep brain stimulation, MRI-guided focused ultrasound, and transcranial magnetic stimulation. A second-opinion service is available for patients who previously received these treatments but were not satisfied with their outcome. Additional neuromodulation technologies may be available as part research trials.
The Center for Brain Circuit Therapeutics offers the full range of neuromodulation treatments in a unique multi-disciplinary environment. Services include deep brain stimulation, MRI-guided focused ultrasound, and transcranial magnetic stimulation.
Patients are first evaluated by an expert in brain stimulation therapies matched to their specific symptom or diagnosis. This evaluation can occur in person or via a video appointment. Often, patients see multiple experts across multiple departments, which are organized into a single day at a single location to maximize patient convenience. For example, a patient undergoing DBS evaluation for Parkinson’s disease may see a neurosurgeon, neurologist, neuropsychologist, social worker, and get an MRI, all in back-to back appointments in the same building on the same day.
For patients that have previously received neuromodulation treatment at another institution but were not satisfied with their outcome, we offer a second opinion service. We will evaluate your diagnosis, symptoms, treatment, and response and determine whether changes can be made to improve your therapeutic outcome. This service includes advanced analysis of the location of your neuromodulation treatment, so please send MRI scans (on disk) and records prior to your appointment.
Traditionally, clinical care and neuromodulation treatments are organized by clinical department. However, patients with brain disease can have symptoms that cross departmental boundaries and treating these symptoms requires multi-disciplinary expertise. In the Center for Brian Circuit Therapeutics, we treat both neurological and psychiatric symptoms as brain circuit problems. We use a variety of neuromodulation therapies to target these brain circuits for symptom relief. This unique approach fosters innovation, collaboration, and new perspectives on delivering better treatments for patients with brain disorders. Specific examples of what makes us different include:
- All the brain experts, all in one place. The departments of neurology, neurosurgery, psychiatry, and neuroradiology have come together in the Hale Building for Transformative Medicine, a structure that makes trans-departmental initiatives such as the Center for Brain Circuit Therapeutics possible.
- All neuromodulation treatments, all in one place. We are one of the few centers in the world to offer the full range of neuromodulation treatments including DBS, TMS, and MRI-guided focused ultrasound. Bringing these treatments together helps ensure the right patient gets the right treatment and facilitates the development of new treatments.
- Linking clinical care and research. Our mission is to treat patients with existing neuromodulation therapies, but also to develop new and improved neuromodulation therapies. All clinical patients have the opportunity to participate in research and help with these new therapies.
- Advanced on-site neuroimaging for mapping brain circuits and guiding neuromodulation therapies. There are four on-site MRI scanners in the Hale Building for Transformative Medicine, including a high-powered 7 Tesla MRI scanner.
- Advanced facilities for administering neuromodulation treatment including:
- The AMIGO operating suite, which allows for asleep DBS and implantation of DBS electrodes within an MRI scanner
- One of the first MRI-guided focused ultrasound suites, which allows for neurosurgical lesions to be placed without a skin incision or risk of infection. Brigham and Women’s hospital was the first hospital in the United States to treat 100 patients using this technology
- Two TMS suites within the Hale Building, including robot administered TMS, which allows for more accurate and consistent TMS delivery
- A focus on safety during COVID19. All clinical services have been optimized for safety and social distancing during COVID19, including video appointments for neuromodulation evaluations, video-guided DBS programming, robot administered TMS, and video conferencing equipment in each TMS room for remote check-ins and treatment monitoring.