Neuromodulation (TWG)

Mission statement/aims
Neuromodulation techniques, especially repetitive TMS (rTMS), have long been investigated in the treatment of various neuropsychiatric disorders, mainly depression. Developed as an investigational tool, rTMS has been approved by the Food and Drug Administration (FDA) for treatment-resistant depression, and its clinical efficacy is currently under investigation in other treatment-resistant disorders such as obsessive-compulsive and related disorders, autism spectrum disorders and attention deficit/hyperactivity disorder (ADHD). One of the most advantageous features of neuromodulation techniques in the possibility to personalise treatment: the accurate identification of the most suitable brain region/s to be targeted, as well as of the combination of parameters (i.e. frequency, intensity, number of pulses) in a rTMS protocol, offers the opportunity to develop a tailored treatment towards a specific dimension, symptom and, consequently, brain network involved, for the specific person. This is consistent with the recently developed Research Domain Criteria (RDoC) project launched by the US National Institute of Mental Health (NIMH) that offers a framework integrating the most recent contributions in neuroscience and genomics to guide future classification schemes.
Given the high rates of non-response to treatment of psychiatric disorders, there is a compelling need to develop alternative treatments to target residual symptoms: neuromodulation techniques allow a network pathway-oriented treatment, advantageous for their focality and ability to target specific networks and to also reach distant key nodes, grounding upon our the paradigm of brain connectivity and the increasing evidence of the brain circuitries underlying specific behavioral domains. Also, neuromodulation techniques may be employed as a tool to investigate and broaden out knowledge regarding neuroplasticity and inflammatory phenomena in psychiatric disorders.
However, whereas the employ of neuromodulation is rapidly spreading in clinical settings, research on its mechanisms of action and its interactions with pharmacotherapy and psychotherapy is still scarce and requires further developments.

The main objectives of this Thematic Working Group (TWG) are:

• investigating the neurofunctional and neuropharmacological impact of neuromodulation techniques, both invasive and non-invasive (rTMS, tDCS, DBS).
• broadening the knowledge on the clinical efficacy of neuromodulation techniques in neuropsychiatric disorders by investigating the underlying neurobiological mechanisms of the therapeutic effects.
• refining treatment protocols and implementation in neuropsychiatric disorders, consistent with a precision medicine approach grounding on a connectivity-based framework, derived from the Research Domain Criteria (RDoC) project.