Speaker Profile

Executive Summary：
Dr. Kalia is a staff neurosurgeon-scientist and the R.R. Tasker Chair in Stereotactic and Functional Neurosurgery at the University of Toronto. He is currently appointed as an Associate Professor in the Division of Neurosurgery and a Senior Scientist at the Krembil Brain Institute and KITE. His clinical practice at the Toronto Western Hospital focuses on the neurosurgical management of movement disorders, epilepsy, and pain using neuromodulation and neuroablative approaches. He currently co-leads the LITT program and the Neuromodulation Suite as part of the Center for Advancing Neurotechnological Innovation to Application (CRANIA). He has led or co-led several national and international firsts in the treatment of patients with advanced therapies, including DBS, stem cells, spinal cord stimulation (SCS), and focused ultrasound (FUS). His research laboratory (kalialabs.org) has a unique focus on understanding molecular mechanisms of protein homeostasis in Parkinson’s disease (PD) and establishing model systems to develop new applications of neuromodulation to treat PD.

Lecture Abstract：
This presentation will explore the use of Deep Brain Stimulation (DBS) as a therapeutic approach for dystonia, focusing on current indications, techniques, and emerging innovations. The discussion will begin with an overview of the established indications for DBS in treating various forms of dystonia, including primary and secondary cases, along with criteria for patient selection. Next it will delve into contemporary DBS techniques, highlighting advancements in electrode placement, programming strategies, and clinical outcomes. Particular attention is given to the precise targeting of the globus pallidus internus (GPi) and other relevant brain regions to optimize symptom management and improve patient quality of life. The presentation will also address emerging innovations, such as adaptive DBS systems that utilize real-time neural feedback to refine stimulation parameters. Additionally we will discuss the current status of focused ultrasound as a treatment option for dystonia including limitations of this approach. The presentation aims to provide a deeper understanding of the evolving landscape of DBS for dystonia and the potential future directions in the field.

Learning Objectives
1. Understand how DBS is currently used to treat primary and secondary dystonia
2. Review contemporary DBS surgery and emerging technology for maximizing post-operative therapeutic benefit
3. Understand the role and limitations of lesioning procedures in the treatment of dystonia

Executive Summary：
Dr. Lee joined the staff at the Mayo Clinic in 2006 and holds the academic rank of Professor of Neurosurgery and Biomedical Engineering. He also founded the Neural Engineering Laboratories and is currently a Director at the Mayo Clinic.
Dr. Lee earned his B.A. in Biology with a minor in Philosophy (Summa Cum Laude) from the University of Colorado at Denver. He attended Yale University Graduate School, where he received his Master of Philosophy, M.D. (Cum Laude), and Ph.D. in Neurobiology. He completed his residency in Neurology at Harvard Medical School and further trained at Dartmouth Hitchcock Medical Center, where he completed an internship in General Surgery, as well as a residency and chief residency in Neurosurgery.
In his clinical practice, Dr. Lee is an expert in neurological disorders, treating patients with Parkinson’s disease, Tourette’s syndrome, dystonia, and other neurodegenerative diseases. His research focuses on developing deep brain stimulation for the treatment of Parkinson's disease, tremor, depression, obsessive-compulsive disorder, and epilepsy. Dr. Lee entered this field after visualizing a surprising surge of dopamine in a rat brain, which inspired decades of study on human brain signals, including dopamine.
Dr. Lee is passionate about the potential to combine sophisticated electrophysiological and electrochemical recordings with miniaturized analytical elements (microprocessors) to augment or repair disrupted brain function. His team was awarded the Mayo Clinic Distinguished Team Science Award in 2015.

Lecture Abstract：
Deep brain stimulation (DBS) is a well-established therapeutic intervention for various neurological disorders, yet its precise mechanisms of action remain incompletely understood. Our team has developed advanced electrophysiologic and electrochemical recording techniques to investigate the neural dynamics underlying DBS, with a particular focus on neurotransmitters like dopamine. By analyzing real-time brain signals and neurotransmitter fluctuations, we aim to uncover the cellular and molecular pathways influenced by DBS. Our findings provide critical insights into how DBS modulates neural circuits, offering potential avenues for optimizing treatment strategies for conditions such as Parkinson’s disease, essential tremor, and psychiatric disorders.

Executive Summary：
Dr. Po-Yu Fong graduated from the School of Medicine at Chung Shan Medical University and completed his neurological residency training at Chang Gung Memorial Hospital (CGMH) in the Linkou branch, Taipei. He also earned his PhD from the UCL Queen Square Institute of Neurology, University College London, UK. His PhD research focused on cortical physiology using the co-registration of transcranial magnetic stimulation (TMS) and electroencephalography (EEG).
Dr. Fong is currently a consultant neurologist in the Department of Neurology at Chang Gung Memorial Hospital (CGMH) in Linkou. His main academic interests include electrophysiology and the application of TMS in movement disorders.

Lecture Abstract：
TMS and EEG co-registration (TMS-EEG) is a recently developed technique for recording the post-synaptic potentials in the cortex evoked by TMS. Compared to the conventional motor-evoked potential (MEP), which records muscle contractions using surface EMG applied to peripheral muscles, TMS-EEG provides more detailed information on cortical physiology. As a result, TMS-EEG broadens the applications of TMS in clinical research exploring cortical pathophysiology. Recent studies on movement disorders have used TMS-EEG to evaluate both motor and non-motor cortical functions.
In studies involving Parkinson's Disease (PD), the TMS-evoked potential (TEP), representing the time-domain response in TMS-EEG, recorded from the primary motor cortex (M1) of patients revealed decreased motor cortical excitability during the 'off' state and reversed cortical excitability during the 'on' state. These findings reflect the abnormal basal ganglia-thalamocortical activity characteristic of the disease. Furthermore, TEP analysis in PD patients showed changes before and after the occurrence of re-emerging tremor, with TEP amplitude during re-emerging tremor resembling that of rest tremor at the end.
In non-motor cortices, such as the dorsolateral prefrontal cortex (DLPFC) and pre-supplementary motor area (pre-SMA) in PD patients, a decreased early phase deflection in the DLPFC and increased hyperexcitability in the pre-SMA were observed compared to healthy controls. These findings indicate abnormal cortical function and disrupted cortico-subcortical connectivity. In other movement disorders, such as Huntington’s disease, reduced phasic synchronisation evoked by TMS targeting the M1 region was reported, which may correlate with impaired motor performance.
TMS-EEG has also been used to investigate cortical pathophysiology in patients with myoclonus (Unverricht-Lundborg disease, EPM1 gene). TEPs in these patients revealed increased motor cortical excitability and disinhibition. Frequency analysis also showed reduced power across multiple frequency bands and decreased phasic synchronisation, indicating compromised motor cortical function. These studies demonstrate the feasibility of using TMS-EEG in movement disorder research and highlight its advantages over conventional TMS-MEP studies.