1
|
Winker M, Hoffmann S, Laborde S, Javelle F. The acute effects of motor cortex transcranial direct current stimulation on athletic performance in healthy adults: A systematic review and meta-analysis. Eur J Neurosci 2024; 60:5086-5110. [PMID: 39120435 DOI: 10.1111/ejn.16488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 07/02/2024] [Accepted: 07/13/2024] [Indexed: 08/10/2024]
Abstract
This systematic review and meta-analysis assesses independently the acute effects of anodal and cathodal motor cortex transcranial direct current stimulation (tDCS) on athletic performance in healthy adults. Besides, it evaluates the unique and conjoint effects of potential moderators (i.e., stimulation parameters, exercise type, subjects' training status and risk of bias). Online database search was performed from inception until March 18th 2024 (PROSPERO: CRD42023355461). Forty-three controlled trials were included in the systematic review, 40 in the anodal tDCS meta-analysis (68 effects), and 9 (11 effects) in the cathodal tDCS meta-analysis. Performance enhancement between pre- and post-stimulation was the main outcome measure considered. The anodal tDCS effects on physical performance were small to moderate (g = .29, 95%CI [.18, .40], PI = -.64 to 1.23, I2 = 64.0%). Exercise type, training status and use of commercial tDCS were significant moderators of the results. The cathodal tDCS effects were null (g = .04, 95%CI [-.05, .12], PI = -.14 to .23, I2 = 0%), with a small to moderate heterogeneity entirely due to sampling error, thus impairing further moderator analysis. These findings hold significant implications for the field of brain stimulation and physical performance, as they not only demonstrate a small to moderate effect of acute tDCS but also identify specific categories of individuals, devices and activities that are more susceptible to improvements. By addressing the multidimensional factors influencing the mechanisms of tDCS, we also provide suggestions for future research.
Collapse
Affiliation(s)
- Matteo Winker
- University of Cologne, Cologne, Germany
- Institute for Sport and Sport Science, Performance and Health (Sports Medicine), TU Dortmund University, Dortmund, Germany
- Department for Molecular and Cellular Sports Medicine, Institute of Cardiovascular Research and Sports Medicine, German Sport University Cologne, Cologne, Germany
| | - Sven Hoffmann
- Psychological Methods and Evaluation, Institute of Psychology, University of Hagen, Hagen, Germany
| | - Sylvain Laborde
- Department of Performance Psychology, Institute of Psychology, German Sport University Cologne, Cologne, Germany
| | - Florian Javelle
- NeuroPsychoImmunology research unit, Department for Molecular and Cellular Sports Medicine, Institute for Cardiovascular Research and Sports Medicine, German Sport University Cologne, Cologne, Germany
| |
Collapse
|
2
|
Prabhu NM, Lehmann N, Kaminski E, Müller N, Taubert M. Online stimulation of the prefrontal cortex during practice increases motor variability and modulates later cognitive transfer: a randomized, double-blinded and sham-controlled tDCS study. Sci Rep 2024; 14:20162. [PMID: 39215020 PMCID: PMC11364672 DOI: 10.1038/s41598-024-70857-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 08/21/2024] [Indexed: 09/04/2024] Open
Abstract
The benefits of learning a motor skill extend to improved task-specific cognitive abilities. The mechanistic underpinnings of this motor-cognition relationship potentially rely on overlapping neural resources involved in both processes, an assumption lacking causal evidence. We hypothesize that interfering with prefrontal networks would inhibit concurrent motor skill performance, long-term learning and associated cognitive functions dependent on similar networks (transfer). We conducted a randomised, double-blinded, sham-controlled brain stimulation study using transcranial direct current stimulation (tDCS) in young adults spanning over three weeks to assess the role of the prefrontal regions in learning a complex balance task and long-term cognitive performance. Balance training combined with active tDCS led to higher performance variability in the trained task as compared to the sham group, impacting the process of learning a complex task without affecting the learning rate. Furthermore, active tDCS also positively influenced performance in untrained motor and cognitive tasks. The findings of this study help ascertaining the networks directly involved in learning a complex motor task and its implications on cognitive function. Hence, opening up the possibility of harnessing the observed frontal networks involved in resource mobilization in instances of aging, brain lesion/injury or dysfunction.
Collapse
Affiliation(s)
- Nisha Maria Prabhu
- Faculty of Human Sciences, Department of Sport Science, Institute III, Otto von Guericke University, Zschokkestraße 32, 39104, Magdeburg, Germany.
| | - Nico Lehmann
- Faculty of Human Sciences, Department of Sport Science, Institute III, Otto von Guericke University, Zschokkestraße 32, 39104, Magdeburg, Germany
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Stephanstraße 1a, 04103, Leipzig, Germany
| | - Elisabeth Kaminski
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Stephanstraße 1a, 04103, Leipzig, Germany
- Department of Movement Neuroscience, Faculty of Sport Science, Leipzig University, Leipzig, Germany
| | - Notger Müller
- Center for Behavioral and Brain Science (CBBS), Otto von Guericke University, Universitätsplatz 2, 39106, Magdeburg, Germany
- Research Group Degenerative and Chronic Diseases, Movement, Faculty of Health Sciences Brandenburg, University of Potsdam, Am Mühlenberg 9, 14476, Potsdam, Germany
- Neuroprotection Lab, German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany
| | - Marco Taubert
- Faculty of Human Sciences, Department of Sport Science, Institute III, Otto von Guericke University, Zschokkestraße 32, 39104, Magdeburg, Germany.
- Center for Behavioral and Brain Science (CBBS), Otto von Guericke University, Universitätsplatz 2, 39106, Magdeburg, Germany.
| |
Collapse
|
3
|
Shahbazi N, Heirani A, Amiri E, da Silva Machado DG. Effects of repeated unihemispheric concurrent dual-site tDCS and virtual reality games on motor coordination of sedentary adolescent girls. BEHAVIORAL AND BRAIN FUNCTIONS : BBF 2024; 20:20. [PMID: 39174998 PMCID: PMC11342668 DOI: 10.1186/s12993-024-00247-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Accepted: 08/14/2024] [Indexed: 08/24/2024]
Abstract
BACKGROUND This study investigated the effects of repetitive unihemispheric concurrent dual-site anodal transcranial direct current stimulation (a-tDCSUHCDS) associated with the use of virtual reality games (VR) on the motor coordination of sedentary adolescent girls. METHODS Thirty-six inactive adolescent girls were randomly assigned into 3 groups (n = 12 per group): (1) VR + a-tDCSUHCDS, (2) VR + sham-tDCSUHCDS, and (3) Control. The VR + a-tDCSUHCDS and VR + s-tDCSUHCDS groups received the intervention three times a week for four weeks. In each experimental session, participants first received either 20 min of a-tDCSUHCDS (2 mA at each anodal electrode) targeting the primary motor cortex (M1) and the left dorsolateral prefrontal cortex (DLPFC) or sham and then performed VR for 1 h. The control group received no intervention. Eye-hand coordination (EHC) and bimanual coordination (BC) were measured at baseline, post-intervention, and two weeks later (retention test) using the automatic scoring mirror tracer and continuous two-arm coordination test, respectively. RESULTS Results showed that the EHC was significantly higher in the VR + a-tDCS and VR + s-tDCS groups at post-intervention (all ps< 0.001) and the retention test (all ps< 0.001) compared to the control group. Moreover, the EHC was significantly higher in the VR + a-tDCS group compared to the VR + s-tDCS group (p = 0.024) at the retention. Similarly, VR + a-tDCS and VR + s-tDCS improved BC compared to the control group at post-intervention (all ps< 0.001) and retention test (all ps< 0.001). In addition, higher BC was observed in the VR + a-tDCS group compared to the VR + s-tDCS group (p< 0.001) at the retention test. CONCLUSIONS Our results suggest that adding a-tDCSUHCDS to VR over 12 sessions may have an additional effect on VR training for improving and retaining motor coordination in sedentary adolescent girls.
Collapse
Affiliation(s)
- Nasrin Shahbazi
- Department of Motor Behavior and Corrective Exercises, Faculty of Sport Sciences, Razi University, Kermanshah, Iran
| | - Ali Heirani
- Department of Motor Behavior and Corrective Exercises, Faculty of Sport Sciences, Razi University, Kermanshah, Iran.
| | - Ehsan Amiri
- Exercise Metabolism and Performance Lab (EMPL), Department of Exercise Physiology, Faculty of Sport Sciences, Razi University, Kermanshah, Iran
| | - Daniel Gomes da Silva Machado
- Research Group in Neuroscience of Human Movement (NeuroMove), Department of Physical Education, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| |
Collapse
|
4
|
Riemann S, van Lück J, Rodríguez-Fornells A, Flöel A, Meinzer M. The role of frontal cortex in novel-word learning and consolidation: Evidence from focal transcranial direct current stimulation. Cortex 2024; 177:15-27. [PMID: 38824804 DOI: 10.1016/j.cortex.2024.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 02/28/2024] [Accepted: 05/13/2024] [Indexed: 06/04/2024]
Abstract
Previous studies have demonstrated that conventional transcranial direct current stimulation (tDCS) can enhance novel-word learning. However, because of the widespread current that is induced by these setups and lack of appropriate control conditions, little is known about the underlying neural mechanisms. In the present double-blinded and sham-tDCS controlled study, we investigated for the first time if regionally precise focal tDCS targeting two key nodes of the novel-word learning network at different time points would result in regionally and temporally distinct effects. 156 participants completed a contextual novel-word-learning paradigm and learning success was probed immediately after the acquisition period and 30-min later. Participants were randomly assigned to six stimulation conditions: Active tDCS (1.5 mA) was administered to left inferior frontal (IFG) or middle temporal gyrus (MTG), either during acquisition or delayed recall. Control groups received sham-tDCS either during acquisition or delayed recall (50% IFG/MTG). Data were analyzed with a generalized linear mixed model with a binomial link function in a Bayesian framework. Our results showed that frontal tDCS selectively increased accuracy gains from immediate to delayed recall, irrespective of timing of the stimulation. There was no evidence for beneficial effects of middle temporal gyrus tDCS. Our findings confirm that IFG tDCS can enhance novel-word learning in a regionally, but not timing specific way. Tentatively, this may be explained by enhancement of semantic selection processes resulting in more effective consolidation and/or retrieval. Future studies using longer time intervals between assessments are required to clarify the potential contribution of neurophysiological after-effects of IFG tDCS administered during acquisition to enhanced consolidation.
Collapse
Affiliation(s)
- Steffen Riemann
- Department of Neurology, University Medicine Greifswald, Germany.
| | - Jil van Lück
- Department of Neurology, University Medicine Greifswald, Germany
| | - Antoni Rodríguez-Fornells
- Catalan Institution for Research and Advanced Studies, ICREA, Barcelona, Spain; Department of Cognition, Development and Educational Psychology, University of Barcelona - IDIBELL, Barcelona, Spain
| | - Agnes Flöel
- Department of Neurology, University Medicine Greifswald, Germany; German Center for Neurodegenerative Diseases (DZNE), Rostock, Greifswald, Germany
| | - Marcus Meinzer
- Department of Neurology, University Medicine Greifswald, Germany
| |
Collapse
|
5
|
Ciricugno A, Oldrati V, Cattaneo Z, Leggio M, Urgesi C, Olivito G. Cerebellar Neurostimulation for Boosting Social and Affective Functions: Implications for the Rehabilitation of Hereditary Ataxia Patients. CEREBELLUM (LONDON, ENGLAND) 2024; 23:1651-1677. [PMID: 38270782 PMCID: PMC11269351 DOI: 10.1007/s12311-023-01652-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/15/2023] [Indexed: 01/26/2024]
Abstract
Beyond motor deficits, spinocerebellar ataxia (SCA) patients also suffer cognitive decline and show socio-affective difficulties, negatively impacting on their social functioning. The possibility to modulate cerebello-cerebral networks involved in social cognition through cerebellar neurostimulation has opened up potential therapeutic applications for ameliorating social and affective difficulties. The present review offers an overview of the research on cerebellar neurostimulation for the modulation of socio-affective functions in both healthy individuals and different clinical populations, published in the time period 2000-2022. A total of 25 records reporting either transcranial magnetic stimulation (TMS) or transcranial direct current stimulation (tDCS) studies were found. The investigated clinical populations comprised different pathological conditions, including but not limited to SCA syndromes. The reviewed evidence supports that cerebellar neurostimulation is effective in improving social abilities in healthy individuals and reducing social and affective symptoms in different neurological and psychiatric populations associated with cerebellar damage or with impairments in functions that involve the cerebellum. These findings encourage to further explore the rehabilitative effects of cerebellar neurostimulation on socio-affective deficits experienced by patients with cerebellar abnormalities, as SCA patients. Nevertheless, conclusions remain tentative at this stage due to the heterogeneity characterizing stimulation protocols, study methodologies and patients' samples.
Collapse
Affiliation(s)
- Andrea Ciricugno
- IRCCS Mondino Foundation, 27100, Pavia, Italy.
- Department of Brain and Behavioral Science, University of Pavia, 27100, Pavia, Italy.
| | - Viola Oldrati
- Scientific Institute, IRCCS Eugenio Medea, 23842, Bosisio Parini, Italy
| | - Zaira Cattaneo
- IRCCS Mondino Foundation, 27100, Pavia, Italy
- Department of Human and Social Sciences, University of Bergamo, 24129, Bergamo, Italy
| | - Maria Leggio
- Department of Psychology, Sapienza University of Rome, 00185, Rome, Italy
- Ataxia Laboratory, Fondazione Santa Lucia IRCCS, 00179, Rome, Italy
| | - Cosimo Urgesi
- Scientific Institute, IRCCS Eugenio Medea, 23842, Bosisio Parini, Italy
- Laboratory of Cognitive Neuroscience, Department of Languages and Literatures, Communication, Education and Society, University of Udine, 33100, Udine, Italy
| | - Giusy Olivito
- Department of Psychology, Sapienza University of Rome, 00185, Rome, Italy
- Ataxia Laboratory, Fondazione Santa Lucia IRCCS, 00179, Rome, Italy
| |
Collapse
|
6
|
Duffy MJ, Feltman KA, Kelley AM, Mackie R. Limitations associated with transcranial direct current stimulation for enhancement: considerations of performance tradeoffs in active-duty Soldiers. Front Hum Neurosci 2024; 18:1444450. [PMID: 39132676 PMCID: PMC11310018 DOI: 10.3389/fnhum.2024.1444450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Accepted: 07/03/2024] [Indexed: 08/13/2024] Open
Abstract
Introduction Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation method, popular due to its low cost, ease-of-application, and portability. As such, it has gained traction in examining its potential for cognitive enhancement in a diverse range of populations, including active-duty military. However, current literature presents mixed results regarding its efficacy and limited evaluations of possible undesirable side-effects (such as degradation to cognitive processes). Methods To further examine its potential for enhancing cognition, a double-blind, randomized, sham-controlled, within-subjects design, was used to evaluate both online active-anodal and -cathodal on several cognitive tasks administered. Potential undesirable side effects related to mood, sleepiness, and cognitive performance, were also assessed. Active tDCS was applied for 30 min, using 2 mA, to the left dorsolateral prefrontal cortex with an extracephalic reference placed on the contralateral arm of 27 (14 males) active-duty Soldiers. Results We report mixed results. Specifically, we found improvements in sustained attention (active-anodal) for males in reaction time (p = 0.024, ηp 2 = 0.16) and for sensitivity index in females (p = 0.013, ηp 2 = 0.18). In addition, we found faster reaction time (p = 0.034, ηp 2 = 0.15) and increased accuracy (p = 0.029, ηp 2 = 0.16) associated with executive function (active-anodal and -cathodal), and worsened working memory performance (active-cathodal; p = 0.008, ηp 2 = 0.18). Additionally, we found increased risk-taking with active-anodal (p = 0.001, ηp 2 = 0.33). Discussion tDCS may hold promise as a method for cognitive enhancement, as evidenced by our findings related to sustained attention and executive function. However, we caution that further study is required to better understand additional parameters and limitations that may explain results, as our study only focused on anode vs. cathode stimulation. Risk-taking was examined secondary to our main interests which warrants further experimental investigation isolating potential tradeoffs that may be associated with tDCS simulation.
Collapse
Affiliation(s)
- Michelle J. Duffy
- U.S. Army Aeromedical Research Laboratory, Fort Novosel, AL, United States
- Oak Ridge Institute for Science and Education, Oak Ridge, TN, United States
| | - Kathryn A. Feltman
- U.S. Army Aeromedical Research Laboratory, Fort Novosel, AL, United States
| | - Amanda M. Kelley
- U.S. Army Aeromedical Research Laboratory, Fort Novosel, AL, United States
| | - Ryan Mackie
- U.S. Army Aeromedical Research Laboratory, Fort Novosel, AL, United States
- Oak Ridge Institute for Science and Education, Oak Ridge, TN, United States
| |
Collapse
|
7
|
Lee TW, Tramontano G. Neural consequences of 5-Hz transcranial alternating current stimulation over right hemisphere: An eLORETA EEG study. Neurosci Lett 2024; 835:137849. [PMID: 38825146 DOI: 10.1016/j.neulet.2024.137849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 05/06/2024] [Accepted: 05/30/2024] [Indexed: 06/04/2024]
Abstract
INTRODUCTION Transcranial alternating current stimulation (tACS) at 5-Hz to the right hemisphere can effectively alleviate anxiety symptoms. This study aimed to explore the neural mechanisms that drive the therapeutic benefits. METHODS We collected electroencephalography (EEG) data from 24 participants with anxiety disorders before and after a tACS treatment session. tACS was applied over the right hemisphere, with 1.0 mA at F4, 1.0 mA at P4, and 2.0 mA at T8 (10-10 EEG convention). With eLORETA, we transformed the scalp signals into the current source density in the cortex. We then assessed the differences between post- and pre-treatment brain maps across multiple spectra (delta to low gamma) with non-parametric statistics. RESULTS We observed a trend of heightened power in alpha and reduced power in mid-to-high beta and low gamma, in accord with the EEG markers of anxiolytic effects reported in previous studies. Additionally, we observed a consistent trend of de-synchronization at the stimulating sites across spectra. CONCLUSION tACS 5-Hz over the right hemisphere demonstrated EEG markers of anxiety reduction. The after-effects of tACS on the brain are intricate and cannot be explained solely by the widely circulated entrainment theory. Rather, our results support the involvement of plasticity mechanisms in the offline effects of tACS.
Collapse
Affiliation(s)
- Tien-Wen Lee
- The NeuroCognitive Institute (NCI) Clinical Research Foundation, NJ 07856, USA
| | - Gerald Tramontano
- The NeuroCognitive Institute (NCI) Clinical Research Foundation, NJ 07856, USA.
| |
Collapse
|
8
|
Li Z, Schoonjans E, Allaert J, De Smet S, Kappen M, Houfflyn J, Ottaviani C, De Raedt R, Pulopulos MM, Vanderhasselt MA. Unraveling the temporal interplay of slow-paced breathing and prefrontal transcranial direct current stimulation on cardiac indices of autonomic activity. Psychophysiology 2024:e14650. [PMID: 38997945 DOI: 10.1111/psyp.14650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 06/09/2024] [Accepted: 06/28/2024] [Indexed: 07/14/2024]
Abstract
The neurovisceral integration model proposes that information flows bidirectionally between the brain and the heart via the vagus nerve, indexed by vagally mediated heart rate variability (vmHRV). Voluntary reduction in breathing rate (slow-paced breathing, SPB, 5.5 Breathing Per Minute (BPM)) can enhance vmHRV. Additionally, prefrontal transcranial direct current stimulation (tDCS) can modulate the excitability of the prefrontal region and influence the vagus nerve. However, research on the combination of SPB and prefrontal tDCS to increase vmHRV and other cardiac (heart rate (HR) and blood pressure) and peripheral (skin conductance) indices is scarce. We hypothesized that the combination of 20 min of SPB and prefrontal tDCS would have a greater effect than each intervention in isolation. Hence, 200 participants were divided into four groups: active tDCS with SPB, active tDCS with 15 BPM breathing, sham tDCS with SPB, and sham tDCS with 15 BPM breathing. Regardless of the tDCS condition, the 5.5 BPM group showed a significant increase in vmHRV over 20 minutes and significant decreases in HR at the first and second 5-min epochs of the intervention. Regardless of breathing condition, the active tDCS group exhibited higher HR at the fourth 5-min epoch of the intervention than the sham tDCS group. No other effects were observed. Overall, SPB is a robust technique for increasing vmHRV, whereas prefrontal tDCS may produce effects that counteract those of SPB. More research is necessary to test whether and how SPB and neuromodulation approaches can be combined to improve cardiac vagal tone.
Collapse
Affiliation(s)
- Zefeng Li
- Department of Head and Skin, Ghent Experimental Psychiatry Lab, Ghent University, Ghent, Belgium
| | - Emmanuelle Schoonjans
- Department of Head and Skin, Ghent Experimental Psychiatry Lab, Ghent University, Ghent, Belgium
| | - Jens Allaert
- Department of Head and Skin, Ghent Experimental Psychiatry Lab, Ghent University, Ghent, Belgium
- Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Stefanie De Smet
- Department of Head and Skin, Ghent Experimental Psychiatry Lab, Ghent University, Ghent, Belgium
| | - Mitchel Kappen
- Department of Head and Skin, Ghent Experimental Psychiatry Lab, Ghent University, Ghent, Belgium
| | - Joni Houfflyn
- Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | | | - Rudi De Raedt
- Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Matias M Pulopulos
- Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Marie-Anne Vanderhasselt
- Department of Head and Skin, Ghent Experimental Psychiatry Lab, Ghent University, Ghent, Belgium
| |
Collapse
|
9
|
Hejazi HS, Khanmohammadi R, Olyaei G, Qanbari S. The effects of combining sensorimotor training with transcranial direct current stimulation on the anticipatory and compensatory postural adjustments in patients with chronic low back pain. Disabil Rehabil 2024:1-13. [PMID: 38982892 DOI: 10.1080/09638288.2024.2375756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 06/24/2024] [Indexed: 07/11/2024]
Abstract
PURPOSE To investigate the effects of concurrent sensorimotor training (SMT) and transcranial direct current stimulation (tDCS) on the anticipatory and compensatory postural adjustments (APAs and CPAs) in patients with chronic low back pain (CLBP). METHOD The interventions included (1) SMT plus tDCS and (2) SMT plus sham tDCS. Outcome measures were the normalized integrals of electromyography activity (NIEMG) during the phases of anticipatory and compensatory, and muscle onset latency. The investigated muscles were ipsilateral and contralateral multifidus (MF), transversus abdominus/internal oblique (TrA/IO), and gluteus medius (GM). RESULTS Between-group comparisons demonstrated that ipsilateral TrA/IO NIEMG during CPA1 (p = 0.010) and ipsilateral GM NIEMG during CPA1 (p = 0.002) and CPA2 (p = 0.025) were significantly lower in the SMT combined with tDCS than in the control group. Furthermore, this group had greater NIEMG for contralateral GM during APA1 than the control group (p = 0.032). Moreover, the onset latency of contralateral TrA/IO was significantly earlier after SMT combined with tDCS (p = 0.011). CONCLUSIONS Both groups that received SMT showed positive effects, but anodal tDCS had an added value over sham stimulation for improving postural control strategies in patients with CLBP. Indeed, SMT combined with tDCS leads to stronger APA and less demand for CPA. RCT REGISTRATION NUMBER IRCT20220228054149N1. REGISTRATION DATE 2022-04-04.
Collapse
Affiliation(s)
- Hanie Sadat Hejazi
- Physical Therapy Department, Tehran University of Medical Sciences, Tehran, Iran
| | - Roya Khanmohammadi
- Physical Therapy Department, Tehran University of Medical Sciences, Tehran, Iran
| | - Gholamreza Olyaei
- Physical Therapy Department, Tehran University of Medical Sciences, Tehran, Iran
| | - Soheila Qanbari
- Physical Therapy Department, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
10
|
Şahintürk S, Yıldırım E. Effects of tDCS on emotion recognition and brain oscillations. J Clin Exp Neuropsychol 2024; 46:504-521. [PMID: 38855946 DOI: 10.1080/13803395.2024.2364403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 05/30/2024] [Indexed: 06/11/2024]
Abstract
INTRODUCTION Emotion recognition, the ability to interpret the emotional state of individuals by looking at their facial expressions, is essential for healthy social interactions and communication. There is limited research on the effects of tDCS on emotion recognition in the literature. This study aimed to investigate the effects of anodal stimulation of the ventromedial prefrontal cortex (vmPFC), a key region for emotion recognition from facial expressions, on emotion recognition and brain oscillations. METHOD A single-blind randomized-controlled study was conducted with 54 healthy participants. Before and after brain stimulation emotion recognition tasks were administered and resting-state EEG were recorded. The changes in task performances and brain oscillations were analyzed using repeated-measures two-way ANOVA analysis. RESULTS There was no significant difference in the emotion recognition tasks between groups in pre-post measurements. The changes in delta, theta, alpha, beta and gamma frequency bands in the frontal, temporal, and posterio-occipital regions, which were determined as regions of interest in resting state EEG data before and after tDCS, were compared between groups. The results showed that there was a significant difference between groups only in delta frequency before and after tDCS in the frontal and temporal regions. While an increase in delta activity was observed in the experimental group in the frontal and temporal regions, a decrease was observed in the control group. CONCLUSIONS The tDCS may not have improved emotion recognition because it may not have had the desired effect on the vmPFC, which is in the lower part of the prefrontal lobe. The changes in EEG frequencies observed section tDCS may be similar to those seen in some pathological processes, which could explain the lack of improvement in emotion recognition. Future studies to be carried out for better understand this effect are important.
Collapse
Affiliation(s)
- Saliha Şahintürk
- The Research Institute for Health Sciences and Technologies (SABITA) fiNCAN Laboratory, Istanbul Medipol University, İstanbul, Türkiye
| | - Erol Yıldırım
- The Research Institute for Health Sciences and Technologies (SABITA) fiNCAN Laboratory, Istanbul Medipol University, İstanbul, Türkiye
- Department of Psychology, Istanbul Medipol University, İstanbul, Türkiye
| |
Collapse
|
11
|
Alizadehgoradel J, Razavi SD, Shirani Z, Barati M, Taherifard M, Nejati V, Nitsche MA. Targeting the left DLPFC and right VLPFC in unmarried romantic relationship breakup (love trauma syndrome) with intensified electrical stimulation: A randomized, single-blind, parallel-group, sham-controlled study. J Psychiatr Res 2024; 175:170-182. [PMID: 38735262 DOI: 10.1016/j.jpsychires.2024.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 04/29/2024] [Accepted: 05/08/2024] [Indexed: 05/14/2024]
Abstract
BACKGROUND Ending a romantic relationship is one of the most painful losses an adult experience. Neuroimaging studies suggest that there is a neuropsychological link between breakup experiences and bereaved individuals, and that specific prefrontal regions are involved. The aim of this study was to determine whether enhancement of left DLPFC and right VLPFC activity with a novel intensified anodal transcranial direct current stimulation protocol reduces core symptoms of love trauma syndrome (LTS) and improves treatment-related variables. METHODS In this randomized, sham-controlled, single-blind parallel trial, we assessed the efficacy of an intensified anodal stimulation protocol (20 min, twice-daily sessions with 20 min intervals, 5 consecutive days) with two montages (left DLPFC vs right VLPFC) to reduce love trauma symptoms. 36 participants with love trauma syndrome were randomized in three tDCS condition (left DLPFC, right VLPFC, sham stimulation). LTS symptoms, treatment-related outcome variables (depressive state, anxiety, emotion regulation, positive and negative affect), and cognitive functions were assessed before, right after, and one month after intervention. RESULTS Both DLPFC and VLPFC protocols significantly reduced LTS symptoms, and improved depressive state and anxiety after the intervention, as compared to the sham group. The improving effect of the DLPFC protocol on love trauma syndrome was significantly larger than that of the VLPFC protocol. For emotion regulation and positive and negative affect, improved regulation of emotions and positive affect and reduced negative affect were revealed after intervention in the two real stimulation conditions compared to the sham. For cognitive functions, no significant difference was observed between the groups, but again a positive effect of intervention within groups in the real stimulation conditions (DLPFC and VLPFC) was found for most components of the cognitive tasks. CONCLUSIONS Enhancement of left DLPFC and right VLPFC activity with intensified stimulation improves LTS symptoms and treatment-related variables. For LTS symptoms, DLPFC stimulation was more efficient than VLPFC stimulation., For the other variables, no significant difference was observed between these two stimulation groups. These promising results require replication in larger trials.
Collapse
Affiliation(s)
- Jaber Alizadehgoradel
- Department of Psychology, Faculty of Humanities, University of Zanjan, Zanjan, Iran.
| | | | - Zahra Shirani
- Department of Psychology, Faculty of Humanities, University of Zanjan, Zanjan, Iran
| | - Mobina Barati
- Department of Psychology, Faculty of Humanities, University of Zanjan, Zanjan, Iran
| | - Mina Taherifard
- Department of Psychology, Mohaghegh-Ardabili University, Ardabil, Iran
| | - Vahid Nejati
- Department of Psychology, Shahid Beheshti University, Tehran, Iran
| | - Michael A Nitsche
- Department of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany; Bielefeld University, University Hospital OWL, Protestant Hospital of Bethel Foundation, University Clinic of Psychiatry and Psychotherapy and University Clinic of Child and Adolescent Psychiatry and Psychotherapy, Germany; German Centre for Mental Health (DZPG), Germany
| |
Collapse
|
12
|
Sveva V, Cruciani A, Mancuso M, Santoro F, Latorre A, Monticone M, Rocchi L. Cerebellar Non-Invasive Brain Stimulation: A Frontier in Chronic Pain Therapy. J Pers Med 2024; 14:675. [PMID: 39063929 PMCID: PMC11277881 DOI: 10.3390/jpm14070675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Revised: 06/07/2024] [Accepted: 06/20/2024] [Indexed: 07/28/2024] Open
Abstract
Chronic pain poses a widespread and distressing challenge; it can be resistant to conventional therapies, often having significant side effects. Non-invasive brain stimulation (NIBS) techniques offer promising avenues for the safe and swift modulation of brain excitability. NIBS approaches for chronic pain management targeting the primary motor area have yielded variable outcomes. Recently, the cerebellum has emerged as a pivotal hub in human pain processing; however, the clinical application of cerebellar NIBS in chronic pain treatment remains limited. This review delineates the cerebellum's role in pain modulation, recent advancements in NIBS for cerebellar activity modulation, and novel biomarkers for assessing cerebellar function in humans. Despite notable progress in NIBS techniques and cerebellar activity assessment, studies targeting cerebellar NIBS for chronic pain treatment are limited in number. Nevertheless, positive outcomes in pain alleviation have been reported with cerebellar anodal transcranial direct current stimulation. Our review underscores the potential for further integration between cerebellar NIBS and non-invasive assessments of cerebellar function to advance chronic pain treatment strategies.
Collapse
Affiliation(s)
- Valerio Sveva
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, University of Rome “Sapienza”, Piazzale Aldo Moro 5, 00185 Rome, Italy;
| | - Alessandro Cruciani
- Unit of Neurology, Neurophysiology, Neurobiology and Psychiatry, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128 Rome, Italy; (A.C.); (F.S.)
- Department of Medicine and Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128 Rome, Italy
| | - Marco Mancuso
- Department of Human Neuroscience, University of Rome “Sapienza”, Viale dell’Università 30, 00185 Rome, Italy;
| | - Francesca Santoro
- Unit of Neurology, Neurophysiology, Neurobiology and Psychiatry, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128 Rome, Italy; (A.C.); (F.S.)
- Department of Medicine and Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128 Rome, Italy
| | - Anna Latorre
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London WC1N 3BG, UK;
| | - Marco Monticone
- Department of Surgical Sciences, University of Cagliari, 09124 Cagliari, Italy;
| | - Lorenzo Rocchi
- Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy
| |
Collapse
|
13
|
Meinzer M, Shahbabaie A, Antonenko D, Blankenburg F, Fischer R, Hartwigsen G, Nitsche MA, Li SC, Thielscher A, Timmann D, Waltemath D, Abdelmotaleb M, Kocataş H, Caisachana Guevara LM, Batsikadze G, Grundei M, Cunha T, Hayek D, Turker S, Schlitt F, Shi Y, Khan A, Burke M, Riemann S, Niemann F, Flöel A. Investigating the neural mechanisms of transcranial direct current stimulation effects on human cognition: current issues and potential solutions. Front Neurosci 2024; 18:1389651. [PMID: 38957187 PMCID: PMC11218740 DOI: 10.3389/fnins.2024.1389651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 05/15/2024] [Indexed: 07/04/2024] Open
Abstract
Transcranial direct current stimulation (tDCS) has been studied extensively for its potential to enhance human cognitive functions in healthy individuals and to treat cognitive impairment in various clinical populations. However, little is known about how tDCS modulates the neural networks supporting cognition and the complex interplay with mediating factors that may explain the frequently observed variability of stimulation effects within and between studies. Moreover, research in this field has been characterized by substantial methodological variability, frequent lack of rigorous experimental control and small sample sizes, thereby limiting the generalizability of findings and translational potential of tDCS. The present manuscript aims to delineate how these important issues can be addressed within a neuroimaging context, to reveal the neural underpinnings, predictors and mediators of tDCS-induced behavioral modulation. We will focus on functional magnetic resonance imaging (fMRI), because it allows the investigation of tDCS effects with excellent spatial precision and sufficient temporal resolution across the entire brain. Moreover, high resolution structural imaging data can be acquired for precise localization of stimulation effects, verification of electrode positions on the scalp and realistic current modeling based on individual head and brain anatomy. However, the general principles outlined in this review will also be applicable to other imaging modalities. Following an introduction to the overall state-of-the-art in this field, we will discuss in more detail the underlying causes of variability in previous tDCS studies. Moreover, we will elaborate on design considerations for tDCS-fMRI studies, optimization of tDCS and imaging protocols and how to assure high-level experimental control. Two additional sections address the pressing need for more systematic investigation of tDCS effects across the healthy human lifespan and implications for tDCS studies in age-associated disease, and potential benefits of establishing large-scale, multidisciplinary consortia for more coordinated tDCS research in the future. We hope that this review will contribute to more coordinated, methodologically sound, transparent and reproducible research in this field. Ultimately, our aim is to facilitate a better understanding of the underlying mechanisms by which tDCS modulates human cognitive functions and more effective and individually tailored translational and clinical applications of this technique in the future.
Collapse
Affiliation(s)
- Marcus Meinzer
- Department of Neurology, University Medicine Greifswald, Greifswald, Germany
| | - Alireza Shahbabaie
- Department of Neurology, University Medicine Greifswald, Greifswald, Germany
| | - Daria Antonenko
- Department of Neurology, University Medicine Greifswald, Greifswald, Germany
| | - Felix Blankenburg
- Neurocomputation and Neuroimaging Unit, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Rico Fischer
- Department of Psychology, University of Greifswald, Greifswald, Germany
| | - Gesa Hartwigsen
- Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
- Wilhelm Wundt Institute for Psychology, Leipzig University, Leipzig, Germany
| | - Michael A. Nitsche
- Department of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors at TU Dortmund, Dortmund, Germany
- German Center for Mental Health (DZPG), Bochum, Germany
- Bielefeld University, University Hospital OWL, Protestant Hospital of Bethel Foundation, University Clinic of Psychiatry and Psychotherapy, Bielefeld, Germany
| | - Shu-Chen Li
- Chair of Lifespan Developmental Neuroscience, Faculty of Psychology, Technische Universität Dresden, Dresden, Germany
| | - Axel Thielscher
- Section for Magnetic Resonance, Department of Health Technology, Technical University of Denmark, Kongens Lyngby, Denmark
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Amager and Hvidovre, Copenhagen, Denmark
| | - Dagmar Timmann
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), Essen University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Dagmar Waltemath
- Core Unit Data Integration Center, University Medicine Greifswald, Greifswald, Germany
| | | | - Harun Kocataş
- Department of Neurology, University Medicine Greifswald, Greifswald, Germany
| | | | - Giorgi Batsikadze
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), Essen University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Miro Grundei
- Neurocomputation and Neuroimaging Unit, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Teresa Cunha
- Section for Magnetic Resonance, Department of Health Technology, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Dayana Hayek
- Department of Neurology, University Medicine Greifswald, Greifswald, Germany
| | - Sabrina Turker
- Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
- Wilhelm Wundt Institute for Psychology, Leipzig University, Leipzig, Germany
| | - Frederik Schlitt
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), Essen University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Yiquan Shi
- Chair of Lifespan Developmental Neuroscience, Faculty of Psychology, Technische Universität Dresden, Dresden, Germany
| | - Asad Khan
- Department of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors at TU Dortmund, Dortmund, Germany
| | - Michael Burke
- Department of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors at TU Dortmund, Dortmund, Germany
| | - Steffen Riemann
- Department of Neurology, University Medicine Greifswald, Greifswald, Germany
| | - Filip Niemann
- Department of Neurology, University Medicine Greifswald, Greifswald, Germany
| | - Agnes Flöel
- Department of Neurology, University Medicine Greifswald, Greifswald, Germany
- German Center for Neurodegenerative Diseases (DZNE Site Greifswald), Greifswald, Germany
| |
Collapse
|
14
|
Firouzan F, Sadeghi-Firoozabadi V, Nejati V, Fathabadi J, Firouzan A. A Comparison between the Effectiveness of computerized Cognitive Rehabilitation Training and transcranial Direct Current Stimulation on Dialysis Patients' Executive Functions. Health Psychol Res 2024; 12:118447. [PMID: 38903127 PMCID: PMC11188767 DOI: 10.52965/001c.118447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 02/05/2024] [Indexed: 06/22/2024] Open
Abstract
Purpose Executive function impairments are among the most common dialysis side effects. The present study aims to compare the efficiency of transcranial Direct Current Stimulation (tDCS) with computerized Cognitive Rehabilitation Training (cCRT) on dialysis patients' executive functions. Research method The present study, a quasi-experimental effort, adopted a pre-test/post-test method that included a control (sham) group. Design The study sample consisted of 30 participants, selected through the convenience sampling method, and categorized into three groups of cCRT, tDCS, and sham participants. The cCRT participants were asked to complete 8 tasks in Captain's Log MindPower Builder software. The tDCS participants were treated with a 0.06 mA/cm2 current with the anodal electrode on F3 and the cathodal electrode on Fp2. For the sham participants, the electrodes were put on the same regions but there was no current stimulation. The treatment lasted for 10 sessions carried out every other day. Results The results of MANCOVA showed no significant difference between the sham group and the cCRT group in any of the executive function items. . However, between the sham group and the tDCS group was detected a significant difference in spatial working memory (p \< 0.05) and a marginally significant in cognitive flexibility (p = 0.091). No significant difference was reported between cCRT and tDCS groups in any item. Conclusion According to the findings of the study, given the efficacy of tDCS on spatial working memory and cognitive flexibility for dialysis patients, it can be used to improve these skills.
Collapse
Affiliation(s)
- Fatemeh Firouzan
- Department of Psychology, Faculty of Education and Psychology, Shahid Beheshti University, Tehran, Iran
| | - Vahid Sadeghi-Firoozabadi
- Assistant Professor, Department of Psychology, Faculty of Education and Psychology, Shahid Beheshti University, Tehran, Iran
| | - Vahid Nejati
- Professor, Department of Psychology, Faculty of Education and Psychology, Shahid Beheshti University, Tehran, Iran
| | - Jalil Fathabadi
- Associate Professor, Department of Psychology, Faculty of Education and Psychology, Shahid Beheshti University, Tehran, Iran
| | - Ahmad Firouzan
- Associate Professor, Chronic Kidney Disease Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| |
Collapse
|
15
|
Wyss AM, Baumgartner T, Guizar Rosales E, Soutschek A, Knoch D. Cathodal HD-tDCS above the left dorsolateral prefrontal cortex increases environmentally sustainable decision-making. Front Hum Neurosci 2024; 18:1395426. [PMID: 38946792 PMCID: PMC11212476 DOI: 10.3389/fnhum.2024.1395426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Accepted: 05/27/2024] [Indexed: 07/02/2024] Open
Abstract
Environmental sustainability is characterized by a conflict between short-term self-interest and longer-term collective interests. Self-control capacity has been proposed to be a crucial determinant of people's ability to overcome this conflict. Yet, causal evidence is lacking, and previous research is dominated by the use of self-report measures. Here, we modulated self-control capacity by applying inhibitory high-definition transcranial current stimulation (HD-tDCS) above the left dorsolateral prefrontal cortex (dlPFC) while participants engaged in an environmentally consequential decision-making task. The task includes conflicting and low conflicting trade-offs between short-term personal interests and long-term environmental benefits. Contrary to our preregistered expectation, inhibitory HD-tDCS above the left dlPFC, presumably by reducing self-control capacity, led to more, and not less, pro-environmental behavior in conflicting decisions. We speculate that in our exceptionally environmentally friendly sample, deviating from an environmentally sustainable default required self-control capacity, and that inhibiting the left dlPFC might have reduced participants' ability to do so.
Collapse
Affiliation(s)
- Annika M. Wyss
- Department of Social Neuroscience and Social Psychology, University of Bern, Bern, Switzerland
| | - Thomas Baumgartner
- Department of Social Neuroscience and Social Psychology, University of Bern, Bern, Switzerland
| | - Emmanuel Guizar Rosales
- Department of Social Neuroscience and Social Psychology, University of Bern, Bern, Switzerland
| | - Alexander Soutschek
- Department of Psychology, Ludwig Maximilian University Munich, Munich, Germany
| | - Daria Knoch
- Department of Social Neuroscience and Social Psychology, University of Bern, Bern, Switzerland
| |
Collapse
|
16
|
Niemann F, Riemann S, Hubert AK, Antonenko D, Thielscher A, Martin AK, Unger N, Flöel A, Meinzer M. Electrode positioning errors reduce current dose for focal tDCS set-ups: Evidence from individualized electric field mapping. Clin Neurophysiol 2024; 162:201-209. [PMID: 38643613 DOI: 10.1016/j.clinph.2024.03.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 01/29/2024] [Accepted: 03/26/2024] [Indexed: 04/23/2024]
Abstract
OBJECTIVE Electrode positioning errors contribute to variability of transcranial direct current stimulation (tDCS) effects. We investigated the impact of electrode positioning errors on current flow for tDCS set-ups with different focality. METHODS Deviations from planned electrode positions were determined using data acquired in an experimental study (N = 240 datasets) that administered conventional and focal tDCS during magnetic resonance imaging (MRI). Comparison of individualized electric field modeling for planned and empirically derived "actual" electrode positions was conducted to quantify the impact of positioning errors on the electric field dose in target regions for tDCS. RESULTS Planned electrode positions resulted in higher current dose in the target regions for focal compared to conventional montages (7-12%). Deviations from planned positions significantly reduced current flow in the target regions, selectively for focal set-ups (26-30%). Dose reductions were significantly larger for focal compared to conventional set-ups (29-43%). CONCLUSIONS Precise positioning is crucial when using focal tDCS set-ups to avoid significant reductions of current dose in the intended target regions. SIGNIFICANCE Our results highlight the urgent need to routinely implement methods for improving electrode positioning, minimization of electrode drift, verification of electrode positions before and/or after tDCS and also to consider positioning errors when investigating dose-response relationships, especially for focal set-ups.
Collapse
Affiliation(s)
- Filip Niemann
- University Medicine Greifswald, Department of Neurology, Greifswald, Germany
| | - Steffen Riemann
- University Medicine Greifswald, Department of Neurology, Greifswald, Germany
| | - Ann-Kathrin Hubert
- University Medicine Greifswald, Department of Neurology, Greifswald, Germany
| | - Daria Antonenko
- University Medicine Greifswald, Department of Neurology, Greifswald, Germany
| | - Axel Thielscher
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark; Technical University of Denmark, Department of Health Technology, Kongens Lyngby, Denmark
| | - Andrew K Martin
- Kent University, School of Psychology, Canterbury, United Kingdom
| | - Nina Unger
- University Medicine Greifswald, Department of Neurology, Greifswald, Germany
| | - Agnes Flöel
- University Medicine Greifswald, Department of Neurology, Greifswald, Germany; German Center for Neurodegenerative Diseases (DZNE Site Greifswald), Greifswald, Germany
| | - Marcus Meinzer
- University Medicine Greifswald, Department of Neurology, Greifswald, Germany.
| |
Collapse
|
17
|
Damercheli S, Morrenhof K, Ahmed K, Ortiz-Catalan M. Performance in myoelectric pattern recognition improves with transcranial direct current stimulation. Sci Rep 2024; 14:11744. [PMID: 38778042 PMCID: PMC11111686 DOI: 10.1038/s41598-024-62185-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 05/14/2024] [Indexed: 05/25/2024] Open
Abstract
Sensorimotor impairments, resulting from conditions like stroke and amputations, can profoundly impact an individual's functional abilities and overall quality of life. Assistive and rehabilitation devices such as prostheses, exo-skeletons, and serious gaming in virtual environments can help to restore some degree of function and alleviate pain after sensorimotor impairments. Myoelectric pattern recognition (MPR) has gained popularity in the past decades as it provides superior control over said devices, and therefore efforts to facilitate and improve performance in MPR can result in better rehabilitation outcomes. One possibility to enhance MPR is to employ transcranial direct current stimulation (tDCS) to facilitate motor learning. Twelve healthy able-bodied individuals participated in this crossover study to determine the effect of tDCS on MPR performance. Baseline training was followed by two sessions of either sham or anodal tDCS using the dominant and non-dominant arms. Assignments were randomized, and the MPR task consisted of 11 different hand/wrist movements, including rest or no movement. Surface electrodes were used to record EMG and the MPR open-source platform, BioPatRec, was used for decoding motor volition in real-time. The motion test was used to evaluate performance. We hypothesized that using anodal tDCS to increase the excitability of the primary motor cortex associated with non-dominant side in able-bodied individuals, will improve motor learning and thus MPR performance. Overall, we found that tDCS enhanced MPR performance, particularly in the non-dominant side. We were able to reject the null hypothesis and improvements in the motion test's completion rate during tDCS (28% change, p-value: 0.023) indicate its potential as an adjunctive tool to enhance MPR and motor learning. tDCS appears promising as a tool to enhance the learning phase of using assistive devices using MPR, such as myoelectric prostheses.
Collapse
Affiliation(s)
- Shahrzad Damercheli
- Center for Bionics and Pain Research, Mölndal, Sweden
- Department of Electrical Engineering, Chalmers University of Technology, Gothenburg, Sweden
| | - Kelly Morrenhof
- Center for Bionics and Pain Research, Mölndal, Sweden
- Department of Electrical Engineering, Chalmers University of Technology, Gothenburg, Sweden
| | - Kirstin Ahmed
- Center for Bionics and Pain Research, Mölndal, Sweden
- Department of Electrical Engineering, Chalmers University of Technology, Gothenburg, Sweden
| | - Max Ortiz-Catalan
- Center for Bionics and Pain Research, Mölndal, Sweden.
- Department of Electrical Engineering, Chalmers University of Technology, Gothenburg, Sweden.
- Bionics Institute, Melbourne, Australia.
- Medical Bionics Department, University of Melbourne, Melbourne, Australia.
- NeuroBioniX, Melbourne, Australia.
- Prometei Pain Rehabilitation Center, Vinnytsia, Ukraine.
| |
Collapse
|
18
|
Caravati E, Barbeni F, Chiarion G, Raggi M, Mesin L. Closed-Loop Transcranial Electrical Neurostimulation for Sustained Attention Enhancement: A Pilot Study towards Personalized Intervention Strategies. Bioengineering (Basel) 2024; 11:467. [PMID: 38790334 PMCID: PMC11118513 DOI: 10.3390/bioengineering11050467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Revised: 05/03/2024] [Accepted: 05/06/2024] [Indexed: 05/26/2024] Open
Abstract
Sustained attention is pivotal for tasks like studying and working for which focus and low distractions are necessary for peak productivity. This study explores the effectiveness of adaptive transcranial direct current stimulation (tDCS) in either the frontal or parietal region to enhance sustained attention. The research involved ten healthy university students performing the Continuous Performance Task-AX (AX-CPT) while receiving either frontal or parietal tDCS. The study comprised three phases. First, we acquired the electroencephalography (EEG) signal to identify the most suitable metrics related to attention states. Among different spectral and complexity metrics computed on 3 s epochs of EEG, the Fuzzy Entropy and Multiscale Sample Entropy Index of frontal channels were selected. Secondly, we assessed how tDCS at a fixed 1.0 mA current affects attentional performance. Finally, a real-time experiment involving continuous metric monitoring allowed personalized dynamic optimization of the current amplitude and stimulation site (frontal or parietal). The findings reveal statistically significant improvements in mean accuracy (94.04 vs. 90.82%) and reaction times (262.93 vs. 302.03 ms) with the adaptive tDCS compared to a non-stimulation condition. Average reaction times were statistically shorter during adaptive stimulation compared to a fixed current amplitude condition (262.93 vs. 283.56 ms), while mean accuracy stayed similar (94.04 vs. 93.36%, improvement not statistically significant). Despite the limited number of subjects, this work points out the promising potential of adaptive tDCS as a tailored treatment for enhancing sustained attention.
Collapse
Affiliation(s)
| | | | | | | | - Luca Mesin
- Mathematical Biology and Physiology, Department Electronics and Telecommunications, Politecnico di Torino, 10129 Turin, Italy; (E.C.); (F.B.); (G.C.); (M.R.)
| |
Collapse
|
19
|
Hafezi S, Doustan M, Saemi E. The Effect of Brain Anodal and Cathodal Transcranial Direct Current Stimulation on Psychological Refractory Period at Different Stimulus-Onset Asynchrony in Non-Fatigue and Mental Fatigue Conditions. Brain Sci 2024; 14:477. [PMID: 38790455 PMCID: PMC11118837 DOI: 10.3390/brainsci14050477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 05/04/2024] [Accepted: 05/07/2024] [Indexed: 05/26/2024] Open
Abstract
The psychological refractory period (PRP) effect occurs when two stimuli that require separate responses are presented sequentially, particularly with a short and variable time interval between them. Fatigue is a suboptimal psycho-physiological state that leads to changes in strategies. In recent years, numerous studies have investigated the effects of transcranial direct current stimulation (tDCS) on motor control. The present study aimed to investigate the effects of two tDCS methods, anodal and cathodal, on PRP in ten different conditions of stimulus-onset asynchronies (SOAs) under non-fatigue and mental fatigue conditions. The participants involved 39 male university students aged 19 to 25 years. In the pre-test, they were assessed using the PRP measurement tool under both non-fatigue and mental fatigue conditions. The mental fatigue was induced by a 30-min Stroop task. The test consisted of two stimuli with different SOAs (50, 75, 100, 150, 300, 400, 600, 900, 1200, and 1500 ms). The first was a visual stimulus with three choices (letters A, B, and C). After a random SOA, the second stimulus, a visual stimulus with three choices (colors red, yellow, and blue), was presented. Subsequently, participants were randomly assigned to the anodal, cathodal, and sham stimulation groups and underwent four consecutive sessions of tDCS stimulation. In the anodal and cathodal stimulation groups, 20 min of tDCS stimulation were applied to the PLPFC area in each session, while in the sham group, the stimulation was artificially applied. All participants were assessed using the same measurement tools as in the pre-test phase, in a post-test phase one day after the last stimulation session, and in a follow-up phase four days after that. Inferential statistics include mixed ANOVA, one-way ANOVA, independent, and dependent t-tests. The findings indicated that the response time to the second stimulus was longer at lower SOAs. However, there was no significant difference between the groups in this regard. Additionally, there was no significant difference in response time to the second stimulus between the fatigue and non-fatigue conditions, or between the groups. Therefore, tDCS had no significant effect. There was a significant difference between mental fatigue and non-fatigue conditions in the psychological refractory period. Moreover, at lower SOAs, the PRP was longer than at higher SOAs. In conditions of fatigue, the active stimulation groups (anodal and cathodal) performed better than the sham stimulation group at higher SOAs. Considering the difference in response to both stimuli at different SOAs, some central aspects of the response can be simultaneously parallel. Fatigue also affects parallel processing. This study supports the response integration phenomenon in PRP, which predicts that there will be an increase in response time to the first stimulus as the interval between the presentation of the two stimuli increases. This finding contradicts the bottleneck model. In this study, the effectiveness of cathodal and anodal tDCS on response time to the second stimulus and PRP was found to be very small.
Collapse
Affiliation(s)
| | - Mohammadreza Doustan
- Department of Motor Behavior and Sport Psychology, Faculty of Sport Sciences, Shahid Chamran University of Ahvaz, Ahvaz 6135783151, Iran; (S.H.); (E.S.)
| | | |
Collapse
|
20
|
Wang Y, Monai H. Transcranial direct current stimulation alters cerebrospinal fluid-interstitial fluid exchange in mouse brain. Brain Stimul 2024; 17:620-632. [PMID: 38688399 DOI: 10.1016/j.brs.2024.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 03/28/2024] [Accepted: 04/15/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation technique that has gained prominence recently. Clinical studies have explored tDCS as an adjunct to neurologic disease rehabilitation, with evidence suggesting its potential in modulating brain clearance mechanisms. The glymphatic system, a proposed brain waste clearance system, posits that cerebrospinal fluid-interstitial fluid (CSF-ISF) exchange aids in efficient metabolic waste removal. While some studies have linked tDCS to astrocytic inositol trisphosphate (IP3)/Ca2+ signaling, the impact of tDCS on CSF-ISF exchange dynamics remains unclear. HYPOTHESIS tDCS influences the dynamics of CSF-ISF exchange through astrocytic IP3/Ca2+ signaling. METHODS In this study, we administered tDCS (0.1 mA for 10 min) to C57BL/6N mice anesthetized with ketamine-xylazine (KX). The anode was positioned on the cranial bone above the cortex, and the cathode was inserted into the neck. Following tDCS, we directly assessed brain fluid dynamics by injecting biotinylated dextran amine (BDA) as a CSF tracer into the cisterna magna (CM). The brain was then extracted after either 30 or 60 min and fixed. After 24 h, the sectioned brain slices were stained with Alexa 594-conjugated streptavidin (SA) to visualize BDA using immunohistochemistry. We conducted Electroencephalography (EEG) recordings and aquaporin 4 (AQP4)/CD31 immunostaining to investigate the underlying mechanisms of tDCS. Additionally, we monitored the efflux of Evans blue, injected into the cisterna magna, using cervical lymph node imaging. Some experiments were subsequently repeated with inositol trisphosphate receptor type 2 (IP3R2) knockout (KO) mice. RESULTS Post-tDCS, we observed an increased CSF tracer influx, indicating a modulation of CSF-ISF exchange by tDCS. Additionally, tDCS appeared to enhance the brain's metabolic waste efflux. EEG recordings showed an increase in delta wave post-tDCS. But no significant change in AQP4 expression was detected 30 min post-tDCS. Besides, we found no alteration in CSF-ISF exchange and delta wave activity in IP3R2 KO mice after tDCS. CONCLUSION Our findings suggest that tDCS augments the glymphatic system's influx and efflux. Through astrocytic IP3/Ca2+ signaling, tDCS was found to modify the delta wave, which correlates positively with brain clearance. This study underscores the potential of tDCS in modulating brain metabolic waste clearance.
Collapse
Affiliation(s)
- Yan Wang
- Graduate School of Humanities and Sciences, Ochanomizu University, Ohtsuka, Bunkyo-ku, Tokyo, 112-8610, Japan
| | - Hiromu Monai
- Graduate School of Humanities and Sciences, Ochanomizu University, Ohtsuka, Bunkyo-ku, Tokyo, 112-8610, Japan.
| |
Collapse
|
21
|
Delicado-Miralles M, Flix-Diez L, Gurdiel-Álvarez F, Velasco E, Galán-Calle M, Lerma Lara S. Temporal Dynamics of Adverse Effects across Five Sessions of Transcranial Direct Current Stimulation. Brain Sci 2024; 14:457. [PMID: 38790436 PMCID: PMC11118034 DOI: 10.3390/brainsci14050457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 04/26/2024] [Accepted: 04/29/2024] [Indexed: 05/26/2024] Open
Abstract
(1) Background: Transcranial direct current stimulation (tDCS) is a safe intervention, only producing mild and transient adverse effects (AEs). However, there is no detailed analysis of the pattern of adverse effects in an application transferable to the clinic. Therefore, our objective is to describe the AEs produced by tDCS and its temporal evolution. (2) Methods: A total of 33 young volunteers were randomized into a tDCS or sham group. Participants performed a hand dexterity task while receiving the tDCS or sham intervention (20 min and 1 mA), for five consecutive days. AEs were assessed daily after each intervention and classified as somatosensory, pain, or other effects. (3) Results: The number of AEs was generally increased by tDCS intervention. Specifically, tDCS led to more frequent somatosensory discomfort, characterized by sensations like itching and tingling, alongside painful sensations such as burning, compared to the sham intervention. Additionally, certain adverse events, including neck and arm pain, as well as dizziness and blurry vision, were exclusive to the tDCS group. Interestingly, tDCS produced similar AEs across the days; meanwhile, the somatosensory AEs in the sham group showed a trend to decrease. (4) Conclusions: tDCS produces mild and temporary somatosensory and pain AEs during and across sessions. The different evolution of the AEs between the tDCS and sham protocol could unmask the blinding protocol most used in tDCS studies. Potential solutions for improving blinding protocols for future studies are discussed.
Collapse
Affiliation(s)
- Miguel Delicado-Miralles
- Department of Pathology and Surgery, Center for Translational Research in Physiotherapy, Miguel Hernández University, Sant Joan d’Alacant, 03550 Alicante, Spain;
| | - Laura Flix-Diez
- Physiotherapy Faculty, Universidad de Valencia (UV), 46010 Valencia, Spain;
| | - Francisco Gurdiel-Álvarez
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine University of Rey Juan Carlos, 28922 Alcorcón, Spain;
| | - Enrique Velasco
- Laboratory of Ion Channel Research, Department of Cellular and Molecular Medicine, KU Leuven, VIB-KU Leuven Center for Brain & Disease Research, 3001 Leuven, Belgium;
| | - María Galán-Calle
- Health Sciences Faculty, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, 28023 Madrid, Spain;
| | - Sergio Lerma Lara
- Health Sciences Faculty, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, 28023 Madrid, Spain;
- Motion in Brains Research Group, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, 28023 Madrid, Spain
| |
Collapse
|
22
|
Hooyman A, Haikalis NK, Wang P, Schambra HM, Lohse KR, Schaefer SY. Evidence and sources of placebo effects in transcranial direct current stimulation during a single session of visuospatial working memory practice. Sci Rep 2024; 14:9094. [PMID: 38643299 PMCID: PMC11032394 DOI: 10.1038/s41598-024-59927-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 04/16/2024] [Indexed: 04/22/2024] Open
Abstract
Transcranial direct current stimulation (tDCS) can be used to non-invasively augment cognitive training. However, the benefits of tDCS may be due in part to placebo effects, which have not been well-characterized. The purpose of this study was to determine whether tDCS can have a measurable placebo effect on cognitive training and to identify potential sources of this effect. Eighty-three right-handed adults were randomly assigned to one of three groups: control (no exposure to tDCS), sham tDCS, or active tDCS. The sham and active tDCS groups were double-blinded. Each group performed 20 min of an adapted Corsi Block Tapping Task (CBTT), a visuospatial working memory task. Anodal or sham tDCS was applied during CBTT training in a right parietal-left supraorbital montage. After training, active and sham tDCS groups were surveyed on expectations about tDCS efficacy. Linear mixed effects models showed that the tDCS groups (active and sham combined) improved more on the CBTT with training than the control group, suggesting a placebo effect of tDCS. Participants' tDCS expectations were significantly related to the placebo effect, as was the belief of receiving active stimulation. This placebo effect shows that the benefits of tDCS on cognitive training can occur even in absence of active stimulation. Future tDCS studies should consider how treatment expectations may be a source of the placebo effect in tDCS research, and identify ways to potentially leverage them to maximize treatment benefit.
Collapse
Affiliation(s)
- Andrew Hooyman
- School of Biological and Health Systems Engineering, Arizona State University, 501 E. Tyler Mall, MC 9709, Tempe, AZ, 85287, USA
| | - Nicole K Haikalis
- School of Biological and Health Systems Engineering, Arizona State University, 501 E. Tyler Mall, MC 9709, Tempe, AZ, 85287, USA
| | - Peiyuan Wang
- School of Biological and Health Systems Engineering, Arizona State University, 501 E. Tyler Mall, MC 9709, Tempe, AZ, 85287, USA
| | - Heidi M Schambra
- Department of Neurology and Department of Physical Medicine and Rehabilitation, Grossman School of Medicine, New York University, New York, NY, USA
| | - Keith R Lohse
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO, USA
| | - Sydney Y Schaefer
- School of Biological and Health Systems Engineering, Arizona State University, 501 E. Tyler Mall, MC 9709, Tempe, AZ, 85287, USA.
| |
Collapse
|
23
|
Muller CO, Metais A, Boublay N, Breuil C, Deligault S, Di Rienzo F, Guillot A, Collet C, Krolak-Salmon P, Saimpont A. Anodal transcranial direct current stimulation does not enhance the effects of motor imagery training of a sequential finger-tapping task in young adults. J Sports Sci 2024:1-12. [PMID: 38574326 DOI: 10.1080/02640414.2024.2328418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 03/01/2024] [Indexed: 04/06/2024]
Abstract
When applied over the primary motor cortex (M1), anodal transcranial direct current stimulation (a-tDCS) could enhance the effects of a single motor imagery training (MIt) session on the learning of a sequential finger-tapping task (SFTT). This study aimed to investigate the effect of a-tDCS on the learning of an SFTT during multiple MIt sessions. Two groups of 16 healthy young adults participated in three consecutive MIt sessions over 3 days, followed by a retention test 1 week later. They received active or sham a-tDCS during a MIt session in which they mentally rehearsed an eight-item complex finger sequence with their left hand. Before and after each session, and during the retention test, they physically repeated the sequence as quickly and accurately as possible. Both groups (i) improved their performance during the first two sessions, showing online learning; (ii) stabilised the level they reached during all training sessions, reflecting offline consolidation; and (iii) maintained their performance level one week later, showing retention. However, no significant difference was found between the groups, regardless of the MSL stage. These results emphasise the importance of performing several MIt sessions to maximise performance gains, but they do not support the additional effects of a-tDCS.
Collapse
Affiliation(s)
- Camille O Muller
- Universite Claude Bernard Lyon 1, LIBM, Inter-university Laboratory of Human Movement Sciences, UR 7424, F-69622 Villeurbanne, France
- EuroMov Digital Health in Motion, Univ Montpellier, IMT Mines Alès, Montpellier, France
| | - Angèle Metais
- Universite Claude Bernard Lyon 1, LIBM, Inter-university Laboratory of Human Movement Sciences, UR 7424, F-69622 Villeurbanne, France
| | - Nawale Boublay
- Centre de Recherche Clinique Vieillissement Cerveau - Fragilité, Hospices Civils de Lyon, Lyon, France
| | - Caroline Breuil
- Universite Claude Bernard Lyon 1, LIBM, Inter-university Laboratory of Human Movement Sciences, UR 7424, F-69622 Villeurbanne, France
| | - Sébastien Deligault
- Centre d'Etude et de Recherche Multimodal et Pluridisciplinaire en Imagerie du Vivant (CERMEP), Département de MagnétoEncéphalographie, Bron, France
| | - Franck Di Rienzo
- Universite Claude Bernard Lyon 1, LIBM, Inter-university Laboratory of Human Movement Sciences, UR 7424, F-69622 Villeurbanne, France
| | - Aymeric Guillot
- Universite Claude Bernard Lyon 1, LIBM, Inter-university Laboratory of Human Movement Sciences, UR 7424, F-69622 Villeurbanne, France
| | - Christian Collet
- Universite Claude Bernard Lyon 1, LIBM, Inter-university Laboratory of Human Movement Sciences, UR 7424, F-69622 Villeurbanne, France
| | - Pierre Krolak-Salmon
- Centre de Recherche Clinique Vieillissement Cerveau - Fragilité, Hospices Civils de Lyon, Lyon, France
| | - Arnaud Saimpont
- Universite Claude Bernard Lyon 1, LIBM, Inter-university Laboratory of Human Movement Sciences, UR 7424, F-69622 Villeurbanne, France
| |
Collapse
|
24
|
Zolezzi DM, Larsen DB, McPhee M, Graven-Nielsen T. Effects of pain on cortical homeostatic plasticity in humans: a systematic review. Pain Rep 2024; 9:e1141. [PMID: 38444774 PMCID: PMC10914232 DOI: 10.1097/pr9.0000000000001141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 12/09/2023] [Accepted: 12/28/2023] [Indexed: 03/07/2024] Open
Abstract
Homeostatic plasticity (HP) is a negative feedback mechanism that prevents excessive facilitation or depression of cortical excitability (CE). Cortical HP responses in humans have been investigated by using 2 blocks of noninvasive brain stimulation with a no-stimulation block in between. A healthy HP response is characterized by reduced CE after 2 excitatory stimulation blocks and increased CE when using inhibitory stimulation. Conversely, impaired HP responses have been demonstrated in experimental and chronic pain conditions. Therefore, this systematic review aimed to provide an overview of the effect of pain on cortical HP in humans. Scopus, Embase, and PubMed were searched from inception until November 20, 2023. The included studies (1) compared experimental or clinical pain conditions with healthy controls, (2) induced HP using 2 blocks of stimulation with a no-stimulation interval, and (3) evaluated CE measures such as motor-evoked potentials. Four studies were included, consisting of 5 experiments and 146 participants, of whom 63 were patients with chronic pain and 48 were subjected to an experimental pain model. This systematic review found support for an HP impairment in pain compared with that in pain-free states, reflected by a lack of CE reduction after excitatory-excitatory HP induction over the primary motor cortex. Inhibitory-inhibitory HP induction did not produce a consistent HP response across studies, independent of pain or pain-free states. Standardization of HP induction protocols and outcome calculations is needed to ensure reproducibility and study comparison. Future HP studies may consider investigating sensory domains including nociception, which would further our understanding of abnormal HP regulation in pain conditions.
Collapse
Affiliation(s)
- Daniela M. Zolezzi
- Center for Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Dennis B. Larsen
- Center for Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Megan McPhee
- Center for Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Thomas Graven-Nielsen
- Center for Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| |
Collapse
|
25
|
Wang CC, Hu TM, Lin YJ, Chen CL, Hsu YC, Kao CL. Use of noninvasive brain stimulation and neurorehabilitation devices to enhance poststroke recovery: review of the current evidence and pitfalls. J Int Med Res 2024; 52:3000605241238066. [PMID: 38603599 PMCID: PMC11010770 DOI: 10.1177/03000605241238066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 02/22/2024] [Indexed: 04/13/2024] Open
Abstract
Neurorehabilitation devices and technologies are crucial for enhancing stroke recovery. These include noninvasive brain stimulation devices that provide repetitive transcranial magnetic stimulation or transcranial direct current stimulation, which can remodulate an injured brain. Technologies such as robotics, virtual reality, and telerehabilitation are suitable add-ons or complements to physical therapy. However, the appropriate application of these devices and technologies, which target specific deficits and stages, for stroke therapy must be clarified. Accordingly, a literature review was conducted to evaluate the theoretical and practical evidence on the use of neurorehabilitation devices and technologies for stroke therapy. This narrative review provides a practical guide for the use of neurorehabilitation devices and describes the implications of use and potential integration of these devices into healthcare.
Collapse
Affiliation(s)
- Chien-Chih Wang
- Department of Physical Medicine and Rehabilitation, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
- Department of Physical Medicine and Rehabilitation, School of Medicine, National Yang Ming Chao Tung University, Taipei, Taiwan, ROC
- Intelligent Long Term Medical Care Research Center, Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan, ROC
| | - Tsung-Ming Hu
- Department of Future Studies and LOHAS Industry, Fo Guang University, Yilan, Taiwan, ROC
- Department of Psychiatry, Taipei Veterans General Hospital Yuli Branch, Hualien, Taiwan, ROC
| | - Yung-Jie Lin
- Department of Family Medicine, Taipei Veterans General Hospital Yuli Branch, Hualien, Taiwan, ROC
| | - Chien-Lung Chen
- Taipei Hospital, Ministry of Health and Welfare, Taipei, Taiwan, ROC
- National Yang Ming Chao Tung University, Institute of Hospital and Health Care Administration, Taipei Taiwan, ROC
| | - Yu-Chuan Hsu
- Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Chung-Lan Kao
- Department of Physical Medicine and Rehabilitation, School of Medicine, National Yang Ming Chao Tung University, Taipei, Taiwan, ROC
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Institute of Clinical Medicine, National Yang Ming Chao Tung University, Taipei, Taiwan, ROC
- Center For Intelligent Drug Systems and Smart Bio-devices (IDS2B), National Chiao Tung University, Hsinchu, Taiwan, ROC
| |
Collapse
|
26
|
Toth J, Kurtin DL, Brosnan M, Arvaneh M. Opportunities and obstacles in non-invasive brain stimulation. Front Hum Neurosci 2024; 18:1385427. [PMID: 38562225 PMCID: PMC10982339 DOI: 10.3389/fnhum.2024.1385427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 03/05/2024] [Indexed: 04/04/2024] Open
Abstract
Non-invasive brain stimulation (NIBS) is a complex and multifaceted approach to modulating brain activity and holds the potential for broad accessibility. This work discusses the mechanisms of the four distinct approaches to modulating brain activity non-invasively: electrical currents, magnetic fields, light, and ultrasound. We examine the dual stochastic and deterministic nature of brain activity and its implications for NIBS, highlighting the challenges posed by inter-individual variability, nebulous dose-response relationships, potential biases and neuroanatomical heterogeneity. Looking forward, we propose five areas of opportunity for future research: closed-loop stimulation, consistent stimulation of the intended target region, reducing bias, multimodal approaches, and strategies to address low sample sizes.
Collapse
Affiliation(s)
- Jake Toth
- Automatic Control and Systems Engineering, Neuroscience Institute, Insigneo Institute, University of Sheffield, Sheffield, United Kingdom
| | | | - Méadhbh Brosnan
- School of Psychology, University College Dublin, Dublin, Ireland
- Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom
- Oxford Centre for Human Brain Activity, Wellcome Centre for Integrative Neuroimaging, Department of Psychiatry, University of Oxford, Oxford, United Kingdom
- Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Melbourne, VIC, Australia
| | - Mahnaz Arvaneh
- Automatic Control and Systems Engineering, Neuroscience Institute, Insigneo Institute, University of Sheffield, Sheffield, United Kingdom
| |
Collapse
|
27
|
Jiang S, Jones M, von Bastian CC. TDCS over PPC or DLPFC does not improve visual working memory capacity. COMMUNICATIONS PSYCHOLOGY 2024; 2:20. [PMID: 39242793 DOI: 10.1038/s44271-024-00067-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 02/13/2024] [Indexed: 09/09/2024]
Abstract
Non-invasive brain stimulation has been highlighted as a possible intervention to induce cognitive benefits, including on visual working memory (VWM). However, findings are inconsistent, possibly due to methodological issues. A recent high-profile study by Wang et al.1 reported that anodal transcranial direct current stimulation (tDCS) over posterior parietal cortex (PPC), but not over dorsolateral prefrontal cortex (DLPFC), selectively improved VWM capacity but not precision, especially at a high VWM load. Thus, in the current pre-registered conceptual replication study, we accounted for the key potential methodological issues in the original study and tested an adequate number of participants required to demonstrate the previously reported effects (n = 48 compared to n = 20). Participants underwent counterbalanced PPC, DLPFC and sham stimulation before completing 360 trials of a continuous orientation-reproduction task with a slight variation of task stimuli and setup. We found no evidence for the selective effect of PPC stimulation. Instead, our results showed that tDCS effects were absent regardless of stimulation region and VWM load, which was largely supported by substantial to strong Bayesian evidence. Therefore, our results challenge previously reported benefits of single-session anodal PPC-tDCS on VWM.
Collapse
Affiliation(s)
- Shuangke Jiang
- Department of Psychology and Neuroscience Institute, University of Sheffield, Sheffield, UK.
| | - Myles Jones
- Department of Psychology and Neuroscience Institute, University of Sheffield, Sheffield, UK
| | - Claudia C von Bastian
- Department of Psychology and Neuroscience Institute, University of Sheffield, Sheffield, UK.
| |
Collapse
|
28
|
Konrad K, Gerloff C, Kohl SH, Mehler DMA, Mehlem L, Volbert EL, Komorek M, Henn AT, Boecker M, Weiss E, Reindl V. Interpersonal neural synchrony and mental disorders: unlocking potential pathways for clinical interventions. Front Neurosci 2024; 18:1286130. [PMID: 38529267 PMCID: PMC10962391 DOI: 10.3389/fnins.2024.1286130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 01/30/2024] [Indexed: 03/27/2024] Open
Abstract
Introduction Interpersonal synchronization involves the alignment of behavioral, affective, physiological, and brain states during social interactions. It facilitates empathy, emotion regulation, and prosocial commitment. Mental disorders characterized by social interaction dysfunction, such as Autism Spectrum Disorder (ASD), Reactive Attachment Disorder (RAD), and Social Anxiety Disorder (SAD), often exhibit atypical synchronization with others across multiple levels. With the introduction of the "second-person" neuroscience perspective, our understanding of interpersonal neural synchronization (INS) has improved, however, so far, it has hardly impacted the development of novel therapeutic interventions. Methods To evaluate the potential of INS-based treatments for mental disorders, we performed two systematic literature searches identifying studies that directly target INS through neurofeedback (12 publications; 9 independent studies) or brain stimulation techniques (7 studies), following PRISMA guidelines. In addition, we narratively review indirect INS manipulations through behavioral, biofeedback, or hormonal interventions. We discuss the potential of such treatments for ASD, RAD, and SAD and using a systematic database search assess the acceptability of neurofeedback (4 studies) and neurostimulation (4 studies) in patients with social dysfunction. Results Although behavioral approaches, such as engaging in eye contact or cooperative actions, have been shown to be associated with increased INS, little is known about potential long-term consequences of such interventions. Few proof-of-concept studies have utilized brain stimulation techniques, like transcranial direct current stimulation or INS-based neurofeedback, showing feasibility and preliminary evidence that such interventions can boost behavioral synchrony and social connectedness. Yet, optimal brain stimulation protocols and neurofeedback parameters are still undefined. For ASD, RAD, or SAD, so far no randomized controlled trial has proven the efficacy of direct INS-based intervention techniques, although in general brain stimulation and neurofeedback methods seem to be well accepted in these patient groups. Discussion Significant work remains to translate INS-based manipulations into effective treatments for social interaction disorders. Future research should focus on mechanistic insights into INS, technological advancements, and rigorous design standards. Furthermore, it will be key to compare interventions directly targeting INS to those targeting other modalities of synchrony as well as to define optimal target dyads and target synchrony states in clinical interventions.
Collapse
Affiliation(s)
- Kerstin Konrad
- Child Neuropsychology Section, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital RWTH, Aachen, Germany
- JARA Brain Institute II, Molecular Neuroscience and Neuroimaging (INM-11), Jülich Research Centre, Jülich, Germany
| | - Christian Gerloff
- Child Neuropsychology Section, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital RWTH, Aachen, Germany
- JARA Brain Institute II, Molecular Neuroscience and Neuroimaging (INM-11), Jülich Research Centre, Jülich, Germany
- Department of Applied Mathematics and Theoretical Physics, Cambridge Centre for Data-Driven Discovery, University of Cambridge, Cambridge, United Kingdom
| | - Simon H. Kohl
- Child Neuropsychology Section, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital RWTH, Aachen, Germany
- JARA Brain Institute II, Molecular Neuroscience and Neuroimaging (INM-11), Jülich Research Centre, Jülich, Germany
| | - David M. A. Mehler
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical School, RWTH Aachen University, Aachen, Germany
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
- School of Psychology, Cardiff University Brain Research Imaging Center (CUBRIC), Cardiff University, Cardiff, United Kingdom
| | - Lena Mehlem
- Child Neuropsychology Section, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital RWTH, Aachen, Germany
| | - Emily L. Volbert
- Child Neuropsychology Section, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital RWTH, Aachen, Germany
| | - Maike Komorek
- Child Neuropsychology Section, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital RWTH, Aachen, Germany
| | - Alina T. Henn
- Child Neuropsychology Section, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital RWTH, Aachen, Germany
| | - Maren Boecker
- Child Neuropsychology Section, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital RWTH, Aachen, Germany
- Institute of Medical Psychology and Medical Sociology, University Hospital RWTH, Aachen, Germany
| | - Eileen Weiss
- Child Neuropsychology Section, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital RWTH, Aachen, Germany
- Institute of Medical Psychology and Medical Sociology, University Hospital RWTH, Aachen, Germany
| | - Vanessa Reindl
- Child Neuropsychology Section, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital RWTH, Aachen, Germany
- Department of Psychology, School of Social Sciences, Nanyang Technological University, Singapore, Singapore
| |
Collapse
|
29
|
Li S, Tang Y, Zhou Y, Ni Y. Effects of Transcranial Direct Current Stimulation on Cognitive Function in Older Adults with and without Mild Cognitive Impairment: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Gerontology 2024; 70:544-560. [PMID: 38452749 DOI: 10.1159/000537848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 02/12/2024] [Indexed: 03/09/2024] Open
Abstract
INTRODUCTION Noninvasive brain stimulation (NIBS) has shown benefits for cognitive function in older adults. However, the effects of transcranial direct current stimulation (tDCS) on cognitive function in older adults are inconsistent across studies, and the evidence for tDCS has limitations. We aim to explore whether tDCS can improve cognitive function and different cognitive domains (i.e., learning and memory and executive function) in adults aged 65 years and older with and without mild cognitive impairment and to further analyze the influencing factors of tDCS. METHODS Five English databases (PubMed, Cochrane Library, EMBASE, Web of Science, the cumulative Index to Nursing and Allied Health Literature [CINAHL]) and four Chinese databases were searched from inception to October 14, 2023. Literature screening, data extraction, and quality assessment were completed independently by two reviewers. All statistical analyses were conducted using RevMan software (version 5.3). Standardized mean difference (SMD) along with a 95% confidence interval (CI) was used to express the effect size of the outcomes, and a random-effect model was also used. RESULTS A total of 10 RCTs and 1,761 participants were included in the meta-analysis, and the risk of bias in those studies was relatively low. A significant effect favoring tDCS on immediate postintervention cognitive function (SMD = 0.16, Z = 2.36, p = 0.02) was found. However, the effects on immediate postintervention learning and memory (SMD = 0.20, Z = 2.00, p = 0.05) and executive function (SMD = 0.10, Z = 1.22, p = 0.22), and 1-month postintervention cognitive function (SMD = 0.12, Z = 1.50, p = 0.13), learning and memory (SMD = 0.17, Z = 1.39, p = 0.16), and executive function (SMD = 0.08, Z = 0.67, p = 0.51) were not statistically significant. CONCLUSION tDCS can significantly improve the immediate postintervention cognitive function of healthy older adults and MCI elderly individuals. Additional longitudinal extensive sample studies are required to clarify the specific effects of tDCS on different cognitive domains, and the optimal tDCS parameters need to be explored to guide clinical practice.
Collapse
Affiliation(s)
- Sijia Li
- Department of Cardiology, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China,
- School of Nursing, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China,
| | - Ying Tang
- Department of Cardiology, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - You Zhou
- School of Nursing, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yunxia Ni
- Department of Cardiology, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| |
Collapse
|
30
|
Galaz Prieto F, Samavaki M, Pursiainen S. Lattice layout and optimizer effect analysis for generating optimal transcranial electrical stimulation (tES) montages through the metaheuristic L1L1 method. Front Hum Neurosci 2024; 18:1201574. [PMID: 38487104 PMCID: PMC10937538 DOI: 10.3389/fnhum.2024.1201574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 02/16/2024] [Indexed: 03/17/2024] Open
Abstract
Introduction This study focuses on broadening the applicability of the metaheuristic L1-norm fitted and penalized (L1L1) optimization method in finding a current pattern for multichannel transcranial electrical stimulation (tES). The metaheuristic L1L1 optimization framework defines the tES montage via linear programming by maximizing or minimizing an objective function with respect to a pair of hyperparameters. Methods In this study, we explore the computational performance and reliability of different optimization packages, algorithms, and search methods in combination with the L1L1 method. The solvers from Matlab R2020b, MOSEK 9.0, Gurobi Optimizer, CVX's SeDuMi 1.3.5, and SDPT3 4.0 were employed to produce feasible results through different linear programming techniques, including Interior-Point (IP), Primal-Simplex (PS), and Dual-Simplex (DS) methods. To solve the metaheuristic optimization task of L1L1, we implement an exhaustive and recursive search along with a well-known heuristic direct search as a reference algorithm. Results Based on our results, and the given optimization task, Gurobi's IP was, overall, the preferable choice among Interior-Point while MOSEK's PS and DS packages were in the case of Simplex methods. These methods provided substantial computational time efficiency for solving the L1L1 method regardless of the applied search method. Discussion While the best-performing solvers show that the L1L1 method is suitable for maximizing either focality and intensity, a few of these solvers could not find a bipolar configuration. Part of the discrepancies between these methods can be explained by a different sensitivity with respect to parameter variation or the resolution of the lattice provided.
Collapse
Affiliation(s)
- Fernando Galaz Prieto
- Computing Sciences, Faculty of Information Technology, Tampere University, Tampere, Finland
| | | | | |
Collapse
|
31
|
Calderone A, Cardile D, Gangemi A, De Luca R, Quartarone A, Corallo F, Calabrò RS. Traumatic Brain Injury and Neuromodulation Techniques in Rehabilitation: A Scoping Review. Biomedicines 2024; 12:438. [PMID: 38398040 PMCID: PMC10886871 DOI: 10.3390/biomedicines12020438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 02/08/2024] [Accepted: 02/13/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Traumatic Brain Injury (TBI) is a condition in which an external force, usually a violent blow to the head, causes functional impairment in the brain. Neuromodulation techniques are thought to restore altered function in the brain, resulting in improved function and reduced symptoms. Brain stimulation can alter the firing of neurons, boost synaptic strength, alter neurotransmitters and excitotoxicity, and modify the connections in their neural networks. All these are potential effects on brain activity. Accordingly, this is a promising therapy for TBI. These techniques are flexible because they can target different brain areas and vary in frequency and amplitude. This review aims to investigate the recent literature about neuromodulation techniques used in the rehabilitation of TBI patients. MATERIALS AND METHODS The identification of studies was made possible by conducting online searches on PubMed, Web of Science, Cochrane, Embase, and Scopus databases. Studies published between 2013 and 2023 were selected. This review has been registered on OSF (JEP3S). RESULTS We have found that neuromodulation techniques can improve the rehabilitation process for TBI patients in several ways. Transcranial Magnetic Stimulation (TMS) can improve cognitive functions such as recall ability, neural substrates, and overall improved performance on neuropsychological tests. Repetitive TMS has the potential to increase neural connections in many TBI patients but not in all patients, such as those with chronic diffuse axonal damage. CONCLUSIONS This review has demonstrated that neuromodulation techniques are promising instruments in the rehabilitation field, including those affected by TBI. The efficacy of neuromodulation can have a significant impact on their lives and improve functional outcomes for TBI patients.
Collapse
Affiliation(s)
| | - Davide Cardile
- IRCCS Centro Neurolesi Bonino-Pulejo, S.S. 113 Via Palermo, C. da Casazza; 98124 Messina, Italy; (A.C.); (A.G.); (R.D.L.); (A.Q.); (F.C.); (R.S.C.)
| | | | | | | | | | | |
Collapse
|
32
|
Lee YK, Gold MS, Blum K, Thanos PK, Hanna C, Fuehrlein BS. Opioid use disorder: current trends and potential treatments. Front Public Health 2024; 11:1274719. [PMID: 38332941 PMCID: PMC10850316 DOI: 10.3389/fpubh.2023.1274719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 12/29/2023] [Indexed: 02/10/2024] Open
Abstract
Opioid use disorder (OUD) is a major public health threat, contributing to morbidity and mortality from addiction, overdose, and related medical conditions. Despite our increasing knowledge about the pathophysiology and existing medical treatments of OUD, it has remained a relapsing and remitting disorder for decades, with rising deaths from overdoses, rather than declining. The COVID-19 pandemic has accelerated the increase in overall substance use and interrupted access to treatment. If increased naloxone access, more buprenorphine prescribers, greater access to treatment, enhanced reimbursement, less stigma and various harm reduction strategies were effective for OUD, overdose deaths would not be at an all-time high. Different prevention and treatment approaches are needed to reverse the concerning trend in OUD. This article will review the recent trends and limitations on existing medications for OUD and briefly review novel approaches to treatment that have the potential to be more durable and effective than existing medications. The focus will be on promising interventional treatments, psychedelics, neuroimmune, neutraceutical, and electromagnetic therapies. At different phases of investigation and FDA approval, these novel approaches have the potential to not just reduce overdoses and deaths, but attenuate OUD, as well as address existing comorbid disorders.
Collapse
Affiliation(s)
- Yu Kyung Lee
- Department of Psychiatry, Brigham and Women’s Hospital, Boston, MA, United States
| | - Mark S. Gold
- Department of Psychiatry, Washington University in St. Louis Euclid Ave, St. Louis, MO, United States
| | - Kenneth Blum
- Division of Addiction Research and Education, Center for Sports, Exercise, and Mental Health, Western University Health Sciences, Pomona, CA, United States
| | - Panayotis K. Thanos
- Behavioral Neuropharmacology and Neuroimaging Laboratory on Addictions, Department of Pharmacology and Toxicology, Jacobs School of Medicine and Biosciences, Clinical Research Institute on Addictions, State University of New York at Buffalo, Buffalo, NY, United States
| | - Colin Hanna
- Behavioral Neuropharmacology and Neuroimaging Laboratory on Addictions, Department of Pharmacology and Toxicology, Jacobs School of Medicine and Biosciences, Clinical Research Institute on Addictions, State University of New York at Buffalo, Buffalo, NY, United States
| | | |
Collapse
|
33
|
Reffat N, Pusec C, Price S, Gupta M, Mavrocordatos P, Abd-Elsayed A. Neuromodulation Techniques for Headache Management. Life (Basel) 2024; 14:173. [PMID: 38398683 PMCID: PMC10890676 DOI: 10.3390/life14020173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 01/09/2024] [Accepted: 01/19/2024] [Indexed: 02/25/2024] Open
Abstract
This narrative review aims to summarize evidence regarding the current utilization and future applications of neuromodulation in patients with headaches, with special attention paid to migraine and chronic cluster headache. A search was conducted in PubMed in August of 2023 to survey the current literature on neuromodulation for the treatment of headache. In total, the search yielded 1989 results, which were further filtered to include only systematic reviews published between 2022 to 2023 to capture the most up-to-date and comprehensive research on this topic. The citation lists of these articles were reviewed to find additional research on neuromodulation and supplement the results presented in this paper with primary literature. Research on the use of neuromodulation for the treatment of headache has predominantly focused on four neuromodulation techniques: peripheral nerve stimulation (PNS), transcranial magnetic stimulation (TMS), deep brain stimulation (DBS), and spinal cord stimulation (SCS). Outcome measures reported in this article include impact on migraine and headache frequency and/or pain intensity, adverse effects of the neuromodulation technique, and associated costs, when available. We found that neuromodulation has developed utility as an alternative treatment for both chronic cluster headaches and migraines, with a reduction in frequency and intensity of headache most elucidated from the articles mentioned in this review.
Collapse
Affiliation(s)
- Noora Reffat
- School of Medicine and Public Health, University of Wisconsin, Madison, WI 53705, USA; (N.R.)
| | - Carolina Pusec
- Department of Neurology, University of Wisconsin Health, Madison, WI 53705, USA
| | - Scott Price
- School of Medicine and Public Health, University of Wisconsin, Madison, WI 53705, USA; (N.R.)
| | - Mayank Gupta
- Kansas Pain Management & Neuroscience Research Center, Kansas City, KS 66214, USA
| | | | - Alaa Abd-Elsayed
- Department of Anesthesiology, University of Wisconsin Health, Madison, WI 53705, USA
| |
Collapse
|
34
|
Su YJ, Yi PL, Chang FC. Transcranial Direct Current Stimulation (tDCS) Ameliorates Stress-Induced Sleep Disruption via Activating Infralimbic-Ventrolateral Preoptic Projections. Brain Sci 2024; 14:105. [PMID: 38275525 PMCID: PMC10813929 DOI: 10.3390/brainsci14010105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 01/15/2024] [Accepted: 01/18/2024] [Indexed: 01/27/2024] Open
Abstract
Transcranial direct current stimulation (tDCS) is acknowledged for its non-invasive modulation of neuronal activity in psychiatric disorders. However, its application in insomnia research yields varied outcomes depending on different tDCS types and patient conditions. Our primary objective is to elucidate its efficiency and uncover the underlying mechanisms in insomnia treatment. We hypothesized that anodal prefrontal cortex stimulation activates glutamatergic projections from the infralimbic cortex (IL) to the ventrolateral preoptic area (VLPO) to promote sleep. After administering 0.06 mA of electrical currents for 8 min, our results indicate significant non-rapid eye movement (NREM) enhancement in naïve mice within the initial 3 h post-stimulation, persisting up to 16-24 h. In the insomnia group, tDCS enhanced NREM sleep bout numbers during acute stress response and improved NREM and REM sleep duration in subsequent acute insomnia. Sleep quality, assessed through NREM delta powers, remains unaffected. Interference of the IL-VLPO pathway, utilizing designer receptors exclusively activated by designer drugs (DREADDs) with the cre-DIO system, partially blocked tDCS's sleep improvement in stress-induced insomnia. This study elucidated that the activation of the IL-VLPO pathway mediates tDCS's effect on stress-induced insomnia. These findings support the understanding of tDCS effects on sleep disturbances, providing valuable insights for future research and clinical applications in sleep therapy.
Collapse
Affiliation(s)
- Yu-Jie Su
- Department of Veterinary Medicine, School of Veterinary Medicine, National Taiwan University, Taipei 106216, Taiwan;
| | - Pei-Lu Yi
- Department of Sport Management, College of Tourism, Leisure and Sports, Aletheia University, Taipei 251306, Taiwan
| | - Fang-Chia Chang
- Department of Veterinary Medicine, School of Veterinary Medicine, National Taiwan University, Taipei 106216, Taiwan;
- Neurobiology and Cognitive Science Center, National Taiwan University, Taipei 106216, Taiwan
- Graduate Institute of Acupuncture Science, College of Chinese Medicine, China Medical University, Taichung City 404328, Taiwan
- Department of Medicine, College of Medicine, China Medical University, Taichung City 404328, Taiwan
- Graduate Institute of Brain and Mind Sciences, College of Medicine, National Taiwan University, Taipei 106216, Taiwan
| |
Collapse
|
35
|
Kim EH, Lee WS, Lee JH, Kwon DR. Microcurrent therapy as the nonpharmacological new protocol against Alzheimer's disease. Front Aging Neurosci 2024; 16:1344072. [PMID: 38304741 PMCID: PMC10833500 DOI: 10.3389/fnagi.2024.1344072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 01/09/2024] [Indexed: 02/03/2024] Open
Abstract
Introduction Alzheimer's disease (AD) poses an increasing global health challenge and is marked by gradual cognitive deterioration, memory impairment, and neuroinflammation. Innovative therapeutic approaches as non-pharmacological protocol are urgently needed with side effect risk of drugs. Microcurrent therapy, a non-invasive modality involving low-level electrical currents, has emerged as a potential solution to address AD's complex pathogenesis. This study investigates the optimal application of microcurrent therapy as a clinical protocol for AD, utilizing a comprehensive approach that integrates behavioral assessments and neuroinflammation evaluation in a mouse model of dementia. Methods and results The results reveal that microcurrent therapy holds promise in ameliorating memory impairment and reducing neuroinflammation in AD. Behavioral assessments, including the Novel Object Recognition Test (NOR) and Radial Arm Maze Test (RAM), demonstrated improved cognitive function following microcurrent therapy. Furthermore, microcurrent therapy inhibited expression of neuroinflammatory proteins, including ionized calcium binding adaptor molecule 1 (Iba1), and glial fibrillary acidic protein (GFAP) in current-treated group. Mechanistic insights suggest that microcurrent therapy may modulate neuroinflammation through the regulation of MAPK signaling pathways. Conclusion This study emphasizes the prospect of microcurrent therapy as a safe and efficacious non-pharmacological strategy for Alzheimer's disease (AD), providing optimism to the countless individuals impacted by this debilitating ailment. These results contribute to the developments of an innovative clinical protocol for AD and recovery from neurological injury, underscoring the significance of investigating unconventional therapeutic approaches for addressing this complex condition.
Collapse
Affiliation(s)
- Eun Ho Kim
- Department of Biochemistry, School of Medicine, Daegu Catholic University, Daegu, Republic of Korea
| | - Won Seok Lee
- Department of Biochemistry, School of Medicine, Daegu Catholic University, Daegu, Republic of Korea
| | - Jae Hee Lee
- Department of Rehabilitation Medicine, School of Medicine, Daegu Catholic University, Daegu, Republic of Korea
| | - Dong Rak Kwon
- Department of Rehabilitation Medicine, School of Medicine, Daegu Catholic University, Daegu, Republic of Korea
| |
Collapse
|
36
|
Sparling T, Iyer L, Pasquina P, Petrus E. Cortical Reorganization after Limb Loss: Bridging the Gap between Basic Science and Clinical Recovery. J Neurosci 2024; 44:e1051232024. [PMID: 38171645 PMCID: PMC10851691 DOI: 10.1523/jneurosci.1051-23.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 08/28/2023] [Accepted: 09/29/2023] [Indexed: 01/05/2024] Open
Abstract
Despite the increasing incidence and prevalence of amputation across the globe, individuals with acquired limb loss continue to struggle with functional recovery and chronic pain. A more complete understanding of the motor and sensory remodeling of the peripheral and central nervous system that occurs postamputation may help advance clinical interventions to improve the quality of life for individuals with acquired limb loss. The purpose of this article is to first provide background clinical context on individuals with acquired limb loss and then to provide a comprehensive review of the known motor and sensory neural adaptations from both animal models and human clinical trials. Finally, the article bridges the gap between basic science researchers and clinicians that treat individuals with limb loss by explaining how current clinical treatments may restore function and modulate phantom limb pain using the underlying neural adaptations described above. This review should encourage the further development of novel treatments with known neurological targets to improve the recovery of individuals postamputation.Significance Statement In the United States, 1.6 million people live with limb loss; this number is expected to more than double by 2050. Improved surgical procedures enhance recovery, and new prosthetics and neural interfaces can replace missing limbs with those that communicate bidirectionally with the brain. These advances have been fairly successful, but still most patients experience persistent problems like phantom limb pain, and others discontinue prostheses instead of learning to use them daily. These problematic patient outcomes may be due in part to the lack of consensus among basic and clinical researchers regarding the plasticity mechanisms that occur in the brain after amputation injuries. Here we review results from clinical and animal model studies to bridge this clinical-basic science gap.
Collapse
Affiliation(s)
- Tawnee Sparling
- Department of Physical Medicine and Rehabilitation, Uniformed Services University of the Health Sciences, Bethesda, Maryland 20814
| | - Laxmi Iyer
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland 20817
| | - Paul Pasquina
- Department of Physical Medicine and Rehabilitation, Uniformed Services University of the Health Sciences, Bethesda, Maryland 20814
| | - Emily Petrus
- Department of Anatomy, Physiology and Genetics, Uniformed Services University, Bethesda, Maryland 20814
| |
Collapse
|
37
|
Toth AJ, Harvey C, Gullane H, Kelly N, Bruton A, Campbell MJ. The effect of bipolar bihemispheric tDCS on executive function and working memory abilities. Front Psychol 2024; 14:1275878. [PMID: 38235279 PMCID: PMC10791995 DOI: 10.3389/fpsyg.2023.1275878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 12/04/2023] [Indexed: 01/19/2024] Open
Abstract
Introduction Cognitive functioning is central to the ability to learn, problem solve, remember, and use information in a rapid and accurate manner and cognitive abilities are fundamental for communication, autonomy, and quality of life. Transcranial electric stimulation (tES) is a very promising tool shown to improve various motor and cognitive functions. When applied as a direct current stimulus (transcranial direct current stimulation; tDCS) over the dorsolateral pre-frontal cortex (DLPFC), this form of neurostimulation has mixed results regarding its ability to slow cognitive deterioration and potentially enhance cognitive functioning, requiring further investigation. This study set out to comprehensively investigate the effect that anodal and cathodal bipolar bihemispheric tDCS have on executive function and working memory abilities. Methods 72 healthy young adults were recruited, and each participant was randomly allocated to either a control group (CON), a placebo group (SHAM) or one of two neurostimulation groups (Anodal; A-STIM and Cathodal; C-STIM). All participants undertook cognitive tests (Stroop & N Back) before and after a 30-minute stimulation/ sham/ control protocol. Results Overall, our results add further evidence that tDCS may not be as efficacious for enhancing cognitive functioning as it has been shown to be for enhancing motor learning when applied over M1. We also provide evidence that the effect of neurostimulation on cognitive functioning may be moderated by sex, with males demonstrating a benefit from both anodal and cathodal stimulation when considering performance on simple attention trial types within the Stroop task. Discussion Considering this finding, we propose a new avenue for tDCS research, that the potential that sex may moderate the efficacy of neurostimulation on cognitive functioning.
Collapse
Affiliation(s)
- Adam J. Toth
- Department of Physical Education and Sport Sciences, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
- Lero Institute, University of Limerick, Limerick, Ireland
| | - Cliodhna Harvey
- Department of Physical Education and Sport Sciences, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - Hannah Gullane
- Department of Physical Education and Sport Sciences, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - Niall Kelly
- Department of Physical Education and Sport Sciences, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - Adam Bruton
- Department of Life Sciences, Brunel University London, Uxbridge, United Kingdom
- School of Life and Health Sciences, University of Roehampton, London, United Kingdom
| | - Mark J. Campbell
- Department of Physical Education and Sport Sciences, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
- The Science Foundation Ireland Center for Software Research, Lero Institute, University of Limerick, Limerick, Ireland
| |
Collapse
|
38
|
Vimolratana O, Aneksan B, Siripornpanich V, Hiengkaew V, Prathum T, Jeungprasopsuk W, Khaokhiew T, Vachalathiti R, Klomjai W. Effects of anodal tDCS on resting state eeg power and motor function in acute stroke: a randomized controlled trial. J Neuroeng Rehabil 2024; 21:6. [PMID: 38172973 PMCID: PMC10765911 DOI: 10.1186/s12984-023-01300-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 12/21/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Anodal transcranial direct current stimulation (tDCS) is a beneficial adjunctive tool in stroke rehabilitation. However, only a few studies have investigated its effects on acute stroke and recruited only individuals with mild motor deficits. This study investigated the effect of five consecutive sessions of anodal tDCS and conventional physical therapy on brain activity and motor outcomes in individuals with acute stroke, with low and high motor impairments. METHODS Thirty participants were recruited and randomly allocated to either the anodal or sham tDCS group. Five consecutive sessions of tDCS (1.5 mA anodal or sham tDCS for 20 min) were administered, followed by conventional physical therapy. Electroencephalography (EEG), Fugl-Meyer Motor Assessment (FMA), and Wolf Motor Function Test (WMFT) were performed at pre-, post-intervention (day 5), and 1-month follow-up. Sub-analyses were performed on participants with low and high motor impairments. The relationship between EEG power and changes in motor functions was assessed. RESULTS Linear regression showed a significant positive correlation between beta bands and the FMA score in the anodal group. Elevated high frequency bands (alpha and beta) were observed at post-intervention and follow-up in all areas of both hemispheres in the anodal group, while only in the posterior area of the non-lesioned hemisphere in the sham group; however, such elevation induced by tDCS was not greater than sham. Lower limb function assessed by FMA was improved in the anodal group compared with the sham group at post-intervention and follow-up only in those with low motor impairment. For the upper limb outcomes, no difference between groups was found. CONCLUSIONS Five consecutive days of anodal tDCS and physical therapy in acute stroke did not result in a superior improvement of beta bands that commonly related to stroke recovery over sham, but improved lower extremity functions with a post-effect at 1-month follow-up in low motor impairment participants. The increase of beta bands in the lesioned brain in the anodal group was associated with improvement in lower limb function. TRIAL REGISTRATION NCT04578080, date of first registration 10/01/2020.
Collapse
Affiliation(s)
- O Vimolratana
- Faculty of Physical Therapy, Mahidol University, 999 Phuttamonthon 4 Road, Salaya, Nakhon Pathom, 73170, Thailand
- Neuro Electrical Stimulation Laboratory, Faculty of Physical Therapy, Mahidol University, Nakhon Pathom, 73170, Thailand
- School of Integrative Medicine, Mae Fah Luang University, Chiang Rai, 57100, Thailand
| | - B Aneksan
- Faculty of Physical Therapy, Mahidol University, 999 Phuttamonthon 4 Road, Salaya, Nakhon Pathom, 73170, Thailand
- Neuro Electrical Stimulation Laboratory, Faculty of Physical Therapy, Mahidol University, Nakhon Pathom, 73170, Thailand
| | - V Siripornpanich
- Institute of Molecular Biosciences, Mahidol University, Nakhon Pathom, 73170, Thailand
| | - V Hiengkaew
- Faculty of Physical Therapy, Mahidol University, 999 Phuttamonthon 4 Road, Salaya, Nakhon Pathom, 73170, Thailand
| | - T Prathum
- Faculty of Physical Therapy, Mahidol University, 999 Phuttamonthon 4 Road, Salaya, Nakhon Pathom, 73170, Thailand
- Neuro Electrical Stimulation Laboratory, Faculty of Physical Therapy, Mahidol University, Nakhon Pathom, 73170, Thailand
| | - W Jeungprasopsuk
- Faculty of Medical Technology, Mahidol University, Nakhon Pathom, 73170, Thailand
| | - T Khaokhiew
- Faculty of Medical Technology, Mahidol University, Nakhon Pathom, 73170, Thailand
| | - R Vachalathiti
- Faculty of Physical Therapy, Mahidol University, 999 Phuttamonthon 4 Road, Salaya, Nakhon Pathom, 73170, Thailand
| | - W Klomjai
- Faculty of Physical Therapy, Mahidol University, 999 Phuttamonthon 4 Road, Salaya, Nakhon Pathom, 73170, Thailand.
- Neuro Electrical Stimulation Laboratory, Faculty of Physical Therapy, Mahidol University, Nakhon Pathom, 73170, Thailand.
| |
Collapse
|
39
|
Corrêa FI, Kunitake AI, Segheto W, Duarte de Oliveira M, Fregni F, Ferrari Corrêa JC. The effect of transcranial direct current stimulation associated with video game training on the postural balance of older women in the community: A blind, randomized, clinical trial. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2024; 29:e2046. [PMID: 37608641 DOI: 10.1002/pri.2046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 07/03/2023] [Accepted: 08/07/2023] [Indexed: 08/24/2023]
Abstract
BACKGROUND Falls are frequent in older adults and can cause trauma, injury, and death. Fall prevention with virtual reality presents good results in improving postural control. Transcranial Direct Current Stimulation (tDCS) has been used with the same aim; however, the combination of the two techniques has still been little studied. PURPOSE To assess whether tDCS can enhance the effect of video game training (VGT) on improving the postural balance of healthy older women. METHOD A blinded, randomized, controlled clinical trial was conducted with 57 older women who were randomized to three balance training groups: Control Group (VGT), Anodal Group (VGT combined with anodic tDCS-atDCS), and Sham Group (VGT combined with sham tDCS-stDCS). Balance training was performed twice a week for four weeks, totalizing eight 20-min sessions using VGT associated with tDCS. Postural balance was assessed pre-and post-training and 30 days after the end of the eight sessions using the Mini-Balance Evaluation Systems Test. RESULTS Compared to pre-intervention the Mini BEST test increased similarly in the three groups in post-intervention (control: pre 23.7 ± 2.8 to post 27.0 ± 2.2; anodal: pre 24.4 ± 1 to post 27.7 ± 0.8 and sham: pre 24.2 ± 1.9 to post 26.5 ± 1.6; p < 0.001) and follow-up (control: pre 23.7 ± 2.8 to follow-up 26.8 ± 2.3; anodal: pre 24.4 ± 1 to follow-up 27.3 ± 1.4 and sham: pre 24.2 ± 1.9 to follow-up 26.8 ± 1.5; p < 0.001). CONCLUSION There was an improvement in the postural balance of the three training groups that were independent of tDCS. DISCUSSION Some studies have shown the positive tDCS effects associated with other tasks to improve balance. However, these results convey the effects of only anodic-tDCS compared to sham-tDCS. Possibly, the effect of VGT surpassed the tDCS effects, promoting a ceiling effect from the combination of these two therapies. However, studies with other therapies combined with tDCS for older adults deserve to be investigated, as well as in frail older people.
Collapse
Affiliation(s)
- Fernanda Ishida Corrêa
- Doctoral and Master's Programs in Rehabilitation Sciences, Nove de Julho University, São Paulo, Brazil
| | - Andre Issao Kunitake
- Doctoral and Master's Programs in Rehabilitation Sciences, Nove de Julho University, São Paulo, Brazil
| | - Wellington Segheto
- Doctoral and Master's Programs in Rehabilitation Sciences, Nove de Julho University, São Paulo, Brazil
| | - Max Duarte de Oliveira
- Doctoral and Master's Programs in Rehabilitation Sciences, Nove de Julho University, São Paulo, Brazil
| | - Felipe Fregni
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | |
Collapse
|
40
|
Yan J, Zha F, Zhou J, Zhou J, Zhao J, Zhang Q, Long J, Hou D, Song Z, Wang Y. Combining HD-tDCS with music stimulation for patients with prolonged disorders of consciousness: Study protocol for an RCT trial. NeuroRehabilitation 2024; 54:495-504. [PMID: 38457160 PMCID: PMC11091638 DOI: 10.3233/nre-230282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 01/27/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND Patients with prolonged disorders of consciousness (pDOC) pose significant challenges to healthcare workers due to their severe motor impairments and limited interaction with the environment. Non-invasive brain stimulation such as high-definition transcranial direct current stimulation (HD-tDCS) and music stimulation show promise in awakening this population. OBJECTIVE In this study, we present a protocol aiming at investigating the efficacy of combined HD-tDCS and music stimulation in awakening patients with pDOC through a single-blind, randomized controlled trial. METHODS Ninety patients with pDOC will be randomly divided into three groups: active HD-tDCS with music stimulation, active HD-tDCS, and sham HD-tDCS. All participants will receive 20 treatment sessions over a period of 10 days and the Coma Recovery Scale-Revised, Glasgow Outcome Scale and electroencephalogram will be used as assessment measures to evaluate their level of consciousness throughout the study. Adverse events and complications will be recorded during treatment. Within-group pre-post comparisons and between-group efficacy comparisons will be conducted to identify the most effective intervention approach. Statistical analysis will be performed using SPSS software with a significance level set at P < 0.05. CONCLUSION The pursuit of awakening therapy for patients with pDOC remains a clinical research challenge. This study protocol is designed with the aim of introducing an innovative non-pharmacological approach which combined HD-tDCS and music stimulation to facilitate the reinstatement of consciousness in patients with pDOC.
Collapse
Affiliation(s)
- Jie Yan
- Department of Rehabilitation, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People’s Hospital, Shenzhen, China
- Department of Rehabilitation Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Fubing Zha
- Department of Rehabilitation, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People’s Hospital, Shenzhen, China
| | - Juan Zhou
- Department of Rehabilitation, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People’s Hospital, Shenzhen, China
| | - Jing Zhou
- Department of Rehabilitation, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People’s Hospital, Shenzhen, China
| | - Jingpu Zhao
- Department of Rehabilitation, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People’s Hospital, Shenzhen, China
| | - Qingfang Zhang
- Department of Rehabilitation, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People’s Hospital, Shenzhen, China
- Department of Rehabilitation Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Jianjun Long
- Department of Rehabilitation, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People’s Hospital, Shenzhen, China
| | - Dianrui Hou
- Department of Rehabilitation, Nan’ao People’s Hospital of Shenzhen, Dapeng New District, Shenzhen, China
| | - Zhenhua Song
- Department of Rehabilitation Medicine, Haikou Hospital Affiliated to Xiangya Medical College of Central South University, Haikou, China
| | - Yulong Wang
- Department of Rehabilitation, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People’s Hospital, Shenzhen, China
| |
Collapse
|
41
|
Oberman LM, Francis SM, Lisanby SH. The use of noninvasive brain stimulation techniques in autism spectrum disorder. Autism Res 2024; 17:17-26. [PMID: 37873560 PMCID: PMC10841888 DOI: 10.1002/aur.3041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 09/15/2023] [Indexed: 10/25/2023]
Abstract
Noninvasive brain stimulation (NIBS) techniques, including repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS), have recently emerged as alternative, nonpharmacological interventions for a variety of psychiatric, neurological, and neurodevelopmental conditions. NIBS is beginning to be applied in both research and clinical settings for the treatment of core and associated symptoms of autism spectrum disorder (ASD) including social communication deficits, restricted and repetitive behaviors, irritability, hyperactivity, depression and impairments in executive functioning and sensorimotor integration. Though there is much promise for these targeted device-based interventions, in other disorders (including adult major depressive disorder (MDD) and obsessive compulsive disorder (OCD) where rTMS is FDA cleared), data on the safety and efficacy of these interventions in individuals with ASD is limited especially in younger children when neurodevelopmental interventions typically begin. Most studies are open-label, small scale, and/or focused on a restricted subgroup of individuals with ASD. There is a need for larger, randomized controlled trials that incorporate neuroimaging in order to develop predictive biomarkers of treatment response and optimize treatment parameters. We contend that until such studies are conducted, we do not have adequate estimates of the safety and efficacy of NIBS interventions in children across the spectrum. Thus, broad off-label use of these techniques in this population is not supported by currently available evidence. Here we discuss the existing data on the use of NIBS to treat symptoms related to ASD and discuss future directions for the field.
Collapse
Affiliation(s)
- Lindsay M Oberman
- Noninvasive Neuromodulation Unit, Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, USA
| | - Sunday M Francis
- Noninvasive Neuromodulation Unit, Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, USA
| | - Sarah H Lisanby
- Noninvasive Neuromodulation Unit, Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, USA
| |
Collapse
|
42
|
LoBue C, McClintock SM, Chiang HS, Helphrey J, Thakkar VJ, Hart J. A Critical Review of Noninvasive Brain Stimulation Technologies in Alzheimer's Dementia and Primary Progressive Aphasia. J Alzheimers Dis 2024; 100:743-760. [PMID: 38905047 DOI: 10.3233/jad-240230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/23/2024]
Abstract
Multiple pharmacologic agents now have been approved in the United States and other countries as treatment to slow disease and clinical progression for Alzheimer's disease. Given these treatments have not been proven to lessen the cognitive deficits already manifested in the Alzheimer's Clinical Syndrome (ACS), and none are aimed for another debilitating dementia syndrome identified as primary progressive aphasia (PPA), there is an urgent need for new, safe, tolerable, and efficacious treatments to mitigate the cognitive deficits experienced in ACS and PPA. Noninvasive brain stimulation has shown promise for enhancing cognitive functioning, and there has been interest in its potential therapeutic value in ACS and PPA. This review critically examines the evidence of five technologies in ACS and PPA: transcranial direct current stimulation (tDCS), transcranial alternating current stimulation (tACS), transcranial random noise stimulation (tRNS), repetitive transcranial magnetic stimulation (rTMS), and noninvasive vagus nerve stimulation (nVNS). Many randomized controlled trials of tDCS and rTMS report positive treatment effects on cognition in ACS and PPA that persist out to at least 8 weeks, whereas there are few trials for tACS and none for tRNS and nVNS. However, most positive trials did not identify clinically meaningful changes, underscoring that clinical efficacy has yet to be established in ACS and PPA. Much is still to be learned about noninvasive brain stimulation in ACS and PPA, and shifting the focus to prioritize clinical significance in addition to statistical significance in trials could yield greater success in understanding its potential cognitive effects and optimal parameters.
Collapse
Affiliation(s)
- Christian LoBue
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Shawn M McClintock
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Hsueh-Sheng Chiang
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA
- School of Behavioral and Brain Sciences, University of Texas at Dallas, Dallas, TX, USA
| | - Jessica Helphrey
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Vishal J Thakkar
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - John Hart
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA
- School of Behavioral and Brain Sciences, University of Texas at Dallas, Dallas, TX, USA
| |
Collapse
|
43
|
Chan YH, Chang HM, Lu ML, Goh KK. Targeting cravings in substance addiction with transcranial direct current stimulation: insights from a meta-analysis of sham-controlled trials. Psychiatry Res 2024; 331:115621. [PMID: 38043411 DOI: 10.1016/j.psychres.2023.115621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 10/06/2023] [Accepted: 11/19/2023] [Indexed: 12/05/2023]
Abstract
Addiction is a substantial health concern; craving-the core symptom of addiction-is strongly associated with relapse. Transcranial direct current stimulation (tDCS) is a noninvasive brain stimulation technique that reduces cravings by altering cortical excitability and connectivity in brain regions. This systematic review and meta-analysis was conducted (following the PRISMA guidelines) to evaluate the efficacy of tDCS in reducing cravings for substances. Our analysis included 43 randomized, sham-controlled trials involving 1,095 and 913 participants receiving tDCS and sham stimulation, respectively. We analyzed the changes in craving scores and found that tDCS led to a moderate reduction in cravings compared with the sham effects. This effect was particularly pronounced when bilateral stimulation was used, the anodal electrode was placed on the right dorsolateral prefrontal cortex, current intensities ranged from 1.5 to 2 mA, stimulation sessions lasted 20 minutes, and the electrodes size was ≥35 cm². Notably, tDCS effectively reduced cravings for opioids, methamphetamine, cocaine, and tobacco but not for alcohol or cannabis. Our findings indicate tDCS as a promising, noninvasive, and low-risk intervention for reducing cravings for opioids, methamphetamine, cocaine, and tobacco. Additional studies are warranted to refine stimulation parameters and evaluate the long-term efficacy of tDCS in managing substance cravings.
Collapse
Affiliation(s)
- Yi-Hsun Chan
- Department of Psychiatry, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Hu-Ming Chang
- Department of Addiction Sciences, Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan; Psychiatric Research Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Mong-Liang Lu
- Department of Psychiatry, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Psychiatric Research Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Kah Kheng Goh
- Department of Psychiatry, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Psychiatric Research Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei, Taiwan; The Innovative and Translational Research Center for Brain Consciousness, Taipei Medical University, Taipei, Taiwan.
| |
Collapse
|
44
|
Feltman KA, Kelley AM. Transcranial Direct Current Stimulation and Aviator Performance During Simulated Flight. Aerosp Med Hum Perform 2024; 95:5-15. [PMID: 38158568 DOI: 10.3357/amhp.6243.2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
INTRODUCTION: Transcranial direct current stimulation (tDCS) is a promising method for maintaining cognitive performance. Anticipated changes in rotary-wing aircraft are expected to alter aviator performance.METHODS: A single-blind, randomized, sham-controlled study evaluated effects of 2-mA anodal tDCS to the right posterior parietal cortex on aviator performance within a Black Hawk simulator. A mixed design with one between-subjects factor was assessed: stimulation prior to flight (20 constant min) and during flight (two timepoints for 10 min each). The within-subjects factor included active vs. sham stimulation. Randomly assigned to each stimulation group were 22 aviators. Aircraft state metrics derived from the simulator were used to evaluate performance. Subjects completed two flights (active stimulation and sham stimulation) with an in-flight emergency introduced at the end to assess whether the timing of tDCS application (prior or during flight) affected the ability to maintain attention and respond to an unexpected event.RESULTS: Results found active stimulation during flight produced statistically significant improvements in performance during the approach following the in-flight emergency. Subjects maintained a more precise approach path with glideslope values closer to zero (M = 0.05) compared to the prior-to-flight group (M = 0.15). The same was found for localizer values (during flight, M = 0.07; prior to flight, M = 0.17). There were no statistically significant differences between groups on secondary outcome measures.DISCUSSION: These findings suggest stimulation during flight may assist in maintaining cognitive resources necessary to respond to an unexpected in-flight emergency. Moreover, blinding efficacy was supported with 32% of subjects correctly guessing when active stimulation was being delivered (52% correctly guessed the sham condition).Feltman KA, Kelley AM. Transcranial direct current stimulation and aviator performance during simulated flight. Aerosp Med Hum Perform. 2024; 95(1):5-15.
Collapse
|
45
|
Estiasari R, Tiksnadi A, Tunjungsari D, Maharani K, Aninditha T, Sofyan HR, Savitri I, Pangeran D, Jeremia I, Widhani A, Ariane A. Effectiveness of transcranial direct current stimulation (tDCS) as adjunctive treatment for chronic headache in adults with clinically stable systemic lupus erythematosus (SHADE): a randomised double-blind multiarm sham controlled clinical trial. BMJ Open 2023; 13:e076713. [PMID: 38101851 PMCID: PMC10729133 DOI: 10.1136/bmjopen-2023-076713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 11/30/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Chronic headache is a 'silent' neuropsychiatric systemic lupus erythematosus symptom with heterogeneous prevalence, potentially reaching 54.4%. It may reduce quality of life by increasing the likelihood of depression and sleep disturbance. While pharmacotherapy remains the first-line treatment, the current management is still challenging and needs other non-invasive modalities. An effective, tolerable and disease-specific treatment modality including transcranial direct current stimulation (tDCS) is considered to reduce the frequency of chronic headaches, including in SLE. Until recently, there was no standard protocol for tDCS in treating headaches. METHODS AND ANALYSIS SHADE is a single-centre randomised double-blind multiarm sham-controlled trial for adults with clinically stable SLE, chronic headaches and without history of traumatic brain injury, brain infection, stroke or brain tumour. Random allocation is conducted to 88 subjects into 3 treatment groups (administration at primary motor, primary sensory and dorsolateral prefrontal cortex) and control group in 1:1:1:1 ratio. The primary endpoint is reduced number of headache days after adjunctive tDCS. The secondary endpoints are reduced headache intensity, increased quality of life, increased sleep quality, decreased depression and reduced analgesics use. The outcome is measured monthly until 3-month postintervention using headache diary, 36-Item Short Form Survey, Chronic Headache Quality of Life Questionnaire, Pittsburgh Sleep Quality Index and Mini International Neuropsychiatry Interview version 10 (MINI ICD 10). Intention-to-treat analysis will be performed to determine the best tDCS electrode placement. ETHICS AND DISSEMINATION Ethical approval had been obtained from the local Institutional Review Board of Faculty of Medicine Universitas Indonesia. Results will be published through scientific relevant peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT05613582.
Collapse
Affiliation(s)
- Riwanti Estiasari
- Department of Neurology, Cipto Mangunkusumo National General Hospital, DKI Jakarta, Indonesia
- Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Amanda Tiksnadi
- Department of Neurology, Cipto Mangunkusumo National General Hospital, DKI Jakarta, Indonesia
- Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Dyah Tunjungsari
- Department of Neurology, Cipto Mangunkusumo National General Hospital, DKI Jakarta, Indonesia
- Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Kartika Maharani
- Department of Neurology, Cipto Mangunkusumo National General Hospital, DKI Jakarta, Indonesia
- Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Tiara Aninditha
- Department of Neurology, Cipto Mangunkusumo National General Hospital, DKI Jakarta, Indonesia
- Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Henry Riyanto Sofyan
- Department of Neurology, Cipto Mangunkusumo National General Hospital, DKI Jakarta, Indonesia
- Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Irma Savitri
- Department of Neurology, Cipto Mangunkusumo National General Hospital, DKI Jakarta, Indonesia
- Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - David Pangeran
- Department of Neurology, Cipto Mangunkusumo National General Hospital, DKI Jakarta, Indonesia
- Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Ivan Jeremia
- Department of Neurology, Cipto Mangunkusumo National General Hospital, DKI Jakarta, Indonesia
| | - Alvina Widhani
- Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
- Departement of Internal Medicine Allergy Immunology Division, Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Anna Ariane
- Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
- Department of Internal Medicine Rheumatology Division, Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| |
Collapse
|
46
|
Benster LL, Weissman CR, Stolz LA, Daskalakis ZJ, Appelbaum LG. Pre-clinical indications of brain stimulation treatments for non-affective psychiatric disorders, a status update. Transl Psychiatry 2023; 13:390. [PMID: 38097566 PMCID: PMC10721798 DOI: 10.1038/s41398-023-02673-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 11/14/2023] [Accepted: 11/17/2023] [Indexed: 12/17/2023] Open
Abstract
Over the past two decades noninvasive brain stimulation (NIBS) techniques have emerged as powerful therapeutic options for a range of psychiatric and neurological disorders. NIBS are hypothesized to rebalance pathological brain networks thus reducing symptoms and improving functioning. This development has been fueled by controlled studies with increasing size and rigor aiming to characterize how treatments induce clinically effective change. Clinical trials of NIBS for specific indications have resulted in federal approval for unipolar depression, bipolar depression, smoking cessation, and obsessive-compulsive disorder in the United States, and several other indications worldwide. As a rapidly emerging field, there are numerous pre-clinical indications currently in development using a variety of electrical and magnetic, non-convulsive, and convulsive approaches. This review discusses the state-of-the-science surrounding promising avenues of NIBS currently in pre-approval stages for non-affective psychiatric disorders. We consider emerging therapies for psychosis, anxiety disorders, obsessive-compulsive disorder, and borderline personality disorder, utilizing transcranial magnetic stimulation (TMS), transcranial direct current stimulation (tDCS), and magnetic seizure therapy (MST), with an additional brief section for early-stage techniques including transcranial focused ultrasound stimulation (tFUS) and transcranial alternating current stimulation (tACS). As revealed in this review, there is considerable promise across all four psychiatric indications with different NIBS approaches. Positive findings are notable for the treatment of psychosis using tDCS, MST, and rTMS. While rTMS is already FDA approved for the treatment of obsessive-compulsive disorder, methodologies such as tDCS also demonstrate potential in this condition. Emerging techniques show promise for treating non-affective disorders likely leading to future regulatory approvals.
Collapse
Affiliation(s)
- Lindsay L Benster
- Joint Doctoral Program in Clinical Psychology, SDSU/UC San Diego, San Diego, CA, USA.
| | - Cory R Weissman
- Department of Psychiatry, UC San Diego School of Medicine, San Diego, CA, USA
| | - Louise A Stolz
- Department of Psychiatry, UC San Diego School of Medicine, San Diego, CA, USA
| | - Zafiris J Daskalakis
- Joint Doctoral Program in Clinical Psychology, SDSU/UC San Diego, San Diego, CA, USA
- Department of Psychiatry, UC San Diego School of Medicine, San Diego, CA, USA
| | - Lawrence G Appelbaum
- Joint Doctoral Program in Clinical Psychology, SDSU/UC San Diego, San Diego, CA, USA
- Department of Psychiatry, UC San Diego School of Medicine, San Diego, CA, USA
| |
Collapse
|
47
|
Picciuca C, Assogna M, Esposito R, D’Acunto A, Ferraresi M, Picazio S, Borghi I, Martino Cinnera A, Bonnì S, Chiurazzi P, Koch G. Transcranial direct current stimulation combined with speech therapy in Fragile X syndrome patients: a pilot study. Front Neurol 2023; 14:1268165. [PMID: 38116107 PMCID: PMC10729003 DOI: 10.3389/fneur.2023.1268165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 10/16/2023] [Indexed: 12/21/2023] Open
Abstract
Background Fragile X syndrome (FXS) is the leading cause of genetic intellectual disability. Among the neurobehavioral dysfunctions in FXS individuals, language development and literacy are compromised. Recent evidence hypothesized that the disruption of excitatory glutamatergic and GABAergic inhibitory neurotransmission balance might be responsible for impairment in cognitive function. In this study, we evaluated for the first time, the safety, tolerability, and efficacy of anodal prefrontal transcranial direct current stimulation (tDCS) combined with standard speech therapy to enhance language function in FXS patients. Methods In total, 16 adult FXS patients were enrolled. Participants underwent 45 min of anodic tDCS combined with speech therapy for 5 weeks (3 times per week). Language function was evaluated using the Test for Reception of Grammar-Version 2 (TROG-2) and subtests of the Italian Language Examination (Esame del Linguaggio - II, EDL-II). Right and left dorsolateral prefrontal cortex transcranial magnetic stimulation and concurrent electroencephalography (TMS-EEG) recordings were collected at baseline and after the treatment to evaluate cortical reactivity and connectivity changes. Results After 5 weeks of combined therapy, we observed a significant improvement in the writing (7.5%), reading (20.3%), repetition (13.3%), and TROG-2 (10.2%) tests. Parallelly with clinical change, TMS-EEG results showed a significant difference in TMS-evoked potential amplitude over the left frontal cortex after treatment (-0.73 ± 0.87 μV) compared to baseline (0.18 ± 0.84 μV). Conclusion Our study provides novel evidence that left anodal prefrontal tDCS combined with standard speech therapy could be effective in enhancing language function in FXS patients, mainly by inducing a rebalance of the dysfunctional prefrontal cortical excitability.
Collapse
Affiliation(s)
- Chiara Picciuca
- Department of Behavioral and Clinical Neurology, Santa Lucia Foundation IRCCS, Rome, Italy
| | - Martina Assogna
- Department of Behavioral and Clinical Neurology, Santa Lucia Foundation IRCCS, Rome, Italy
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Romina Esposito
- Department of Behavioral and Clinical Neurology, Santa Lucia Foundation IRCCS, Rome, Italy
- Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Alessia D’Acunto
- Department of Behavioral and Clinical Neurology, Santa Lucia Foundation IRCCS, Rome, Italy
| | - Matteo Ferraresi
- Department of Behavioral and Clinical Neurology, Santa Lucia Foundation IRCCS, Rome, Italy
| | - Silvia Picazio
- Department of Behavioral and Clinical Neurology, Santa Lucia Foundation IRCCS, Rome, Italy
| | - Ilaria Borghi
- Department of Behavioral and Clinical Neurology, Santa Lucia Foundation IRCCS, Rome, Italy
- Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Alex Martino Cinnera
- Department of Behavioral and Clinical Neurology, Santa Lucia Foundation IRCCS, Rome, Italy
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy
| | - Sonia Bonnì
- Department of Behavioral and Clinical Neurology, Santa Lucia Foundation IRCCS, Rome, Italy
| | - Pietro Chiurazzi
- Sezione di Medicina genomica, Dipartimento di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
- UOC Genetica Medica, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Giacomo Koch
- Department of Behavioral and Clinical Neurology, Santa Lucia Foundation IRCCS, Rome, Italy
- Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| |
Collapse
|
48
|
Rahimi F, Sadeghisani M, Karimzadeh A. Efficacy of transcranial direct current stimulation in patients with knee osteoarthritis: A systematic review. Neurophysiol Clin 2023; 53:102918. [PMID: 37944293 DOI: 10.1016/j.neucli.2023.102918] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 10/18/2023] [Accepted: 10/21/2023] [Indexed: 11/12/2023] Open
Abstract
OBJECTIVE Transcranial direct current stimulation (tDCS) has demonstrated its efficacy in alleviating pain among individuals with musculoskeletal disorders. This review focuses on the application of tDCS as a therapeutic intervention for managing knee osteoarthritis (OA), a prevalent musculoskeletal condition. The primary objective is to assess the effectiveness of tDCS(add-on tDCS and /or stand-alone tDCS), whether as an add-on to existing treatments or as a standalone therapy, in reducing pain and enhancing functional capacity in patients with knee OA. METHODS A comprehensive search was conducted across multiple databases, including PubMed, Science Direct, OVID, MEDLINE, CINAHL, EMBASE, ProQuest, and Google Scholar, and Web of Science. The search terms employed were "Transcranial direct current stimulation" or "tDCS" in combination with "Osteoarthritis" or "OA" and "knee." After eliminating duplicates and studies that did not meet the inclusion criteria, a total of 14 relevant articles were identified for review. RESULTS Among the included studies, twelve reported statistically significant improvements in pain levels when comparing the active tDCS group to the sham tDCS group. Only two studies reported no significant difference in pain intensity between the active tDCS and sham tDCS groups. Findings regarding functional abilities were diverse, with some studies demonstrating a significant enhancement in functional outcomes in the active tDCS group, while others observed no statistically significant differences. CONCLUSION The results of this review suggest that tDCS holds promise as a pain management intervention for individuals with knee OA. Notably, anodal tDCS applied over the primary motor cortex (M1) appears to be particularly effective in alleviating pain in patients with knee OA. However, the impact of tDCS on functional performance appears to be limited.
Collapse
Affiliation(s)
- Fatemeh Rahimi
- Department of Physiotherapy, School of Allied Medical Sciences, Social Determinants of Health Research Center, Shahrekord University of Medical Sciences, Shahrekord, Iran.
| | - Meissam Sadeghisani
- Department of Physiotherapy, School of Allied Medical Sciences, Social Determinants of Health Research Center, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Atefeh Karimzadeh
- Department of Physiotherapy, School of Allied Medical Sciences, Social Determinants of Health Research Center, Shahrekord University of Medical Sciences, Shahrekord, Iran; Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
49
|
Kho SK, Keeble D, Wong HK, Estudillo AJ. Null effect of anodal and cathodal transcranial direct current stimulation (tDCS) on own- and other-race face recognition. Soc Neurosci 2023; 18:393-406. [PMID: 37840302 DOI: 10.1080/17470919.2023.2263924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Indexed: 10/17/2023]
Abstract
Successful face recognition is important for social interactions and public security. Although some preliminary evidence suggests that anodal and cathodal transcranial direct current stimulation (tDCS) might modulate own- and other-race face identification, respectively, the findings are largely inconsistent. Hence, we examined the effect of both anodal and cathodal tDCS on the recognition of own- and other-race faces. Ninety participants first completed own- and other-race Cambridge Face Memory Test (CFMT) as baseline measurements. Next, they received either anodal tDCS, cathodal tDCS or sham stimulation and finally they completed alternative versions of the own- and other-race CFMT. No difference in performance, in terms of accuracy and reaction time, for own- and other-race face recognition between anodal tDCS, cathodal tDCS and sham stimulation was found. Our findings cast doubt upon the efficacy of tDCS to modulate performance in face identification tasks.
Collapse
Affiliation(s)
- Siew Kei Kho
- Department of Psychology, Bournemouth University, Poole, United Kingdom
- School of Psychology, University of Nottingham Malaysia, Semenyih, Malaysia
| | - David Keeble
- Department of Psychology, Bournemouth University, Poole, United Kingdom
| | - Hoo Keat Wong
- Department of Psychology, Bournemouth University, Poole, United Kingdom
| | | |
Collapse
|
50
|
Al Mohaddesin FR, Moghimi A, Fadardi JS. Disgust-reduction evaluative conditioning (DREC) and brain stimulation in patients with contamination-based obsessive-compulsive disorder: a protocol for a randomized control trial. Trials 2023; 24:750. [PMID: 38001473 PMCID: PMC10675853 DOI: 10.1186/s13063-023-07791-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 11/08/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND The negative emotional valence of a stimulus can be altered if paired with a pleasant stimulus, a phenomenon referred to as evaluative conditioning. Disgust, as a central emotion in obsessive-compulsive disorder (OCD), particularly in the contamination subtype, may be an appropriate target for such a method. We know that disgust processing and OCD pathophysiology share in some brain areas, including the orbitofrontal cortex, as the neuromodulation techniques targeted in this area have been able to decrease OCD symptoms. We aim to conduct a randomized clinical trial to investigate the evaluative conditioning effect on disgust reduction in patients with contamination-based OCD when administered with or without neuromodulation targeted orbitofrontal cortex. METHOD In a single-blind randomized control trial (RCT), 55 patients with contamination-based OCD will be randomly assigned to four arms. In a factorial design, they will receive 10 sessions of evaluative conditioning training (either sham or real) plus cathodal transcranial direct current stimulation (tDCS) over the orbitofrontal cortex (either sham or real). The intensity of disgust experience and clinical symptoms will be investigated as primary outcomes and quantitative electroencephalogram and cognitive functions as secondary outcomes. The data will be collected at three assessment levels: baseline, after completing intervention sessions, and 2-month follow-up. DISCUSSION The present RCT is the first study that applies evaluative conditioning training in the OCD clinical sample. It will clarify the effect of the evaluative conditioning method alone and with tDCS on disgust reduction in patients with contamination-based OCD. It will provide initial evidence for such an emotion modulation method in the OCD population. The effect of this emotion-focused protocol on cognitive functions and electroencephalogram components is also of interest. TRIAL REGISTRATION ClinicalTrials.gov, NCT05907369. Registered on 16 June 2023. Retrospectively registered.
Collapse
Affiliation(s)
| | - Ali Moghimi
- Rayan Research Center for Neuroscience and Behavior, Department of Biology, Faculty of Science, Ferdowsi University of Mashhad, Mashhad, Iran.
| | - Javad Salehi Fadardi
- School of Community and Global Health, Claremont Graduate University, Claremont, USA
- Department of Psychology, Faculty of Education and Psychology, Ferdowsi University of Mashhad, Mashhad, Iran
| |
Collapse
|