51
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Meers J, Ferri R, Bruni O, Alfano CA. Sleep spindle density is associated with worry in children with generalized anxiety disorder and healthy controls. J Affect Disord 2020; 260:418-425. [PMID: 31539675 PMCID: PMC6880871 DOI: 10.1016/j.jad.2019.09.065] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 09/06/2019] [Accepted: 09/13/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Childhood generalized anxiety disorder (GAD), characterized by uncontrollable worry, is associated with long-term psychopathology risk, yet understanding of developmental trajectories is limited. Despite common complaints about sleep, 'macro' sleep abnormalities have not been identified. Emerging findings suggest micro-architectural features of sleep, including sleep spindles, differentiate various psychiatric populations. The current study investigated sleep spindle density during non-rapid eye movement (NREM) sleep among youth with GAD and healthy controls, including relationships with anxiety, worry, global functioning, and subjective sleep quality. METHODS 58 pre-pubertal children, n = 26 with GAD and n = 32 matched healthy controls, aged 7-11 years (M = 8.86, SD=1.47), completed diagnostic assessments and a week of actigraphy monitoring prior to a night of polysomnography (PSG) either at home or in a sleep laboratory. NREM spindle activity was detected in frontal and central regions. RESULTS Sleep spindle activity did not differ based on diagnostic group or sex. Sleep spindles were unassociated with anxiety and sleep quality but showed a significant positive association with worry in all youth. Among youth with GAD, global functioning was negatively associated with spindle density in frontal regions during NREM stage 3. Spindle density was significantly greater during in-lab compared to at-home PSG. LIMITATIONS The small sample size and reliance on only one night of PSG necessitate additional studies. CONCLUSIONS The identified link between spindle activity and worry in pre-pubertal children highlights a need for investigations on transdiagnostic features of child psychopathology rather than specific disorders. Longitudinal studies are needed to explore spindle characteristics and affective risk across development.
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Affiliation(s)
| | | | - Oliviero Bruni
- Sapienza University of Rome, Department of Developmental and Social Psychology
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53
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Distinct Montages of Slow Oscillatory Transcranial Direct Current Stimulation (so-tDCS) Constitute Different Mechanisms during Quiet Wakefulness. Brain Sci 2019; 9:brainsci9110324. [PMID: 31739576 PMCID: PMC6896026 DOI: 10.3390/brainsci9110324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 11/06/2019] [Accepted: 11/11/2019] [Indexed: 12/13/2022] Open
Abstract
Slow oscillatory- (so-) tDCS has been applied in many sleep studies aimed to modulate brain rhythms of slow wave sleep and memory consolidation. Yet, so-tDCS may also modify coupled oscillatory networks. Efficacy of weak electric brain stimulation is however variable and dependent upon the brain state at the time of stimulation (subject and/or task-related) as well as on stimulation parameters (e.g., electrode placement and applied current. Anodal so-tDCS was applied during wakefulness with eyes-closed to examine efficacy when deviating from the dominant brain rhythm. Additionally, montages of different electrodes size and applied current strength were used. During a period of quiet wakefulness bilateral frontolateral stimulation (F3, F4; return electrodes at ipsilateral mastoids) was applied to two groups: ‘Group small’ (n = 16, f:8; small electrodes: 0.50 cm2; maximal current per electrode pair: 0.26 mA) and ‘Group Large’ (n = 16, f:8; 35 cm2; 0.35 mA). Anodal so-tDCS (0.75 Hz) was applied in five blocks of 5 min epochs with 1 min stimulation-free epochs between the blocks. A finger sequence tapping task (FSTT) was used to induce comparable cortical activity across sessions and subject groups. So-tDCS resulted in a suppression of alpha power over the parietal cortex. Interestingly, in Group Small alpha suppression occurred over the standard band (8–12 Hz), whereas for Group Large power of individual alpha frequency was suppressed. Group Small also revealed a decrease in FSTT performance at retest after stimulation. It is essential to include concordant measures of behavioral and brain activity to help understand variability and poor reproducibility in oscillatory-tDCS studies.
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54
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Early Life Trauma Has Lifelong Consequences for Sleep And Behavior. Sci Rep 2019; 9:16701. [PMID: 31723235 PMCID: PMC6853921 DOI: 10.1038/s41598-019-53241-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 10/30/2019] [Indexed: 12/13/2022] Open
Abstract
Sleep quality varies widely across individuals, especially during normal aging, with impaired sleep contributing to deficits in cognition and emotional regulation. Sleep can also be impacted by a variety of adverse events, including childhood adversity. Here we examined how early life adverse events impacted later life sleep structure and physiology using an animal model to test the relationship between early life adversity and sleep quality across the life span. Rat pups were exposed to an Adversity-Scarcity model from postnatal day 8–12, where insufficient bedding for nest building induces maternal maltreatment of pups. Polysomnography and sleep physiology were assessed in weaning, early adult and older adults. Early life adversity induced age-dependent disruptions in sleep and behavior, including lifelong spindle decreases and later life NREM sleep fragmentation. Given the importance of sleep in cognitive and emotional functions, these results highlight an important factor driving variation in sleep, cognition and emotion throughout the lifespan that suggest age-appropriate and trauma informed treatment of sleep problems.
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55
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Scarpelli S, Gorgoni M, D'Atri A, Reda F, De Gennaro L. Advances in Understanding the Relationship between Sleep and Attention Deficit-Hyperactivity Disorder (ADHD). J Clin Med 2019; 8:E1737. [PMID: 31635095 PMCID: PMC6832299 DOI: 10.3390/jcm8101737] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 10/09/2019] [Accepted: 10/17/2019] [Indexed: 02/05/2023] Open
Abstract
Starting from the consolidated relationship between sleep and cognition, we reviewed the available literature on the association between Attention Deficit-Hyperactivity Disorder (ADHD) and sleep. This review analyzes the macrostructural and microstructural sleep features, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria (PRISMA). We included the polysomnographic studies published in the last 15 years. The results of macrostructural parameters are mixed. Almost half of the 18 selected investigations did not find differences between sleep architecture of children with ADHD and controls. Five studies observed that children with ADHD show a longer Rapid Eye Movement (REM) sleep duration than controls. Eight studies included microstructural measures. Remarkable alterations in sleep microstructure of ADHD are related to slow wave activity (SWA) and theta oscillations, respectively, during Non-REM (NREM) and REM sleep. Specifically, some studies found higher SWA in the ADHD group than controls. Similarly, higher theta activity appears to be detrimental for memory performance and inhibitory control in ADHD. These patterns could be interpreted as a maturational delay in ADHD. Also, the increased amount of these activities would be consistent with the hypothesis that the poor sleep could imply a chronic sleep deprivation in children with ADHD, which in turn could affect their cognitive functioning.
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Affiliation(s)
- Serena Scarpelli
- Department of Psychology, University of Rome "Sapienza", Rome 00185, Italy.
| | - Maurizio Gorgoni
- Department of Psychology, University of Rome "Sapienza", Rome 00185, Italy.
| | - Aurora D'Atri
- Department of Psychology, University of Rome "Sapienza", Rome 00185, Italy.
| | - Flaminia Reda
- Department of Psychology, University of Rome "Sapienza", Rome 00185, Italy.
| | - Luigi De Gennaro
- Department of Psychology, University of Rome "Sapienza", Rome 00185, Italy.
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56
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Miano S, Amato N, Garbazza C, Abbafati M, Foderaro G, Pezzoli V, Ramelli GP, Manconi M. Shooting a high-density electroencephalographic picture on sleep in children with attention-deficit/hyperactivity disorder. Sleep 2019; 42:5540162. [DOI: 10.1093/sleep/zsz167] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 05/28/2019] [Indexed: 02/04/2023] Open
Abstract
Abstract
Study Objectives
Sleep-related slow-wave activity (SWA) has been recognized as a marker of synaptic plasticity. In children affected by attention deficit hyperactivity disorder (ADHD), SWA is mainly located in the central rather than frontal regions, reflecting a maturational delay. A detailed subjective and objective sleep investigation, including a full night video-polysomnography (PSG-HD-EEG), was performed on 30 consecutive drug naïve outpatients with a diagnosis of ADHD. They received a diagnosis of sleep disorders in 29/30 cases, and most of them had a past history of sleep problems. They had a higher apnea–hypopnea index at PSG, and slept less than 9 hr at actigraphy. We aimed to describe the SWA behavior in the same group of children with ADHD.
Materials and Methods
The full-night PSG-HD EEG of children with ADHD was compared with the one of the 25 healthy controls. The scalp SWA mapping, the decrease of SWA during the night, and the EEG source of SWA were analyzed.
Results
At scalp topography, the focus of SWA was observed over the centro–parietal–occipital regions in participants with ADHD (p < 0.01), which remained significant in the subgroups divided between subgroups according to the sleep diagnosis (p < 0.01). The physiological decrease in SWA was more evident in control participants. The source analysis revealed a greater delta power over the posterior cingulate in participants with ADHD (p < 0.01).
Conclusions
Our results confirm static and dynamic changes in SWA behavior in children with ADHD, which may reflect a maturational delay occurring at a vulnerable age, as a consequence of chronic sleep deprivation.
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Affiliation(s)
- Silvia Miano
- Sleep Center, Neurocenter of Southern Switzerland, Civic Hospital of Lugano (EOC), Lugano, Switzerland
| | - Ninfa Amato
- Sleep Center, Neurocenter of Southern Switzerland, Civic Hospital of Lugano (EOC), Lugano, Switzerland
| | - Corrado Garbazza
- Sleep Center, Neurocenter of Southern Switzerland, Civic Hospital of Lugano (EOC), Lugano, Switzerland
| | - Manuel Abbafati
- Sleep Center, Neurocenter of Southern Switzerland, Civic Hospital of Lugano (EOC), Lugano, Switzerland
| | - Giuseppe Foderaro
- Department of Pediatrics, Civic Hospital of Lugano, Lugano, Switzerland
| | - Valdo Pezzoli
- Department of Pediatrics, Civic Hospital of Lugano, Lugano, Switzerland
| | - Gian Paolo Ramelli
- Department of Pediatrics, San Giovanni Hospital, Bellinzona, Switzerland
| | - Mauro Manconi
- Sleep Center, Neurocenter of Southern Switzerland, Civic Hospital of Lugano (EOC), Lugano, Switzerland
- Department of Neurology, University Hospital, Inselspital, Bern, Switzerland
- Faculty of Biomedical Sciences, University of Southern Switzerland, Lugano, Switzerland
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57
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Bueno-Lopez A, Eggert T, Dorn H, Danker-Hopfe H. Slow oscillatory transcranial direct current stimulation (so-tDCS) during slow wave sleep has no effects on declarative memory in healthy young subjects. Brain Stimul 2019; 12:948-958. [DOI: 10.1016/j.brs.2019.02.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 02/13/2019] [Accepted: 02/15/2019] [Indexed: 12/14/2022] Open
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58
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Cordone S, Annarumma L, Rossini PM, De Gennaro L. Sleep and β-Amyloid Deposition in Alzheimer Disease: Insights on Mechanisms and Possible Innovative Treatments. Front Pharmacol 2019; 10:695. [PMID: 31281257 PMCID: PMC6595048 DOI: 10.3389/fphar.2019.00695] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 05/28/2019] [Indexed: 02/05/2023] Open
Abstract
The growing interest in the preclinical stage of Alzheimer's disease (AD) led investigators to identify modifiable risk and predictive factors useful to design early intervention strategies. The preclinical stage of AD is characterized by β-amyloid (Aβ) aggregation into amyloid plaques and tau phosphorylation and aggregation into neurofibrillary tangles. There is a consensus on the importance of sleep within this context: the bidirectional relationship between sleep and AD pathology is supported by growing evidence that proved that the occurrence of sleep changes starting from the preclinical stage of AD, many years before the onset of cognitive decline. Hence, we review the most recent studies on sleep disturbances related to Aβ and the effects of sleep deprivation on Aβ accumulation in animal and human models. We also discuss evidence on the role of sleep in clearing the brain of toxic metabolic by-products, with original findings of the clearance activity of the glymphatic system stimulated by sleep. Furthermore, starting from new recent advances about the relationship between slow-wave sleep (SWS) and Aβ burden, we review the results of recent electroencephalographic (EEG) studies in order to clarify the possible role of SWS component disruption as a novel mechanistic pathway through which Aβ pathology may contribute to cognitive decline and, conversely, the eventual useful role of SWS in facilitating Aβ clearance. Finally, we discuss some promising innovative, effective, low-risk, non-invasive interventions, although empirical evidence on the efficacy of sleep interventions in improving the course of AD is at the very beginning.
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Affiliation(s)
- Susanna Cordone
- Department of Psychology, University of Rome "Sapienza," Rome, Italy
| | | | - Paolo Maria Rossini
- Department of Neurological, Motor and Sensory Sciences, IRCCS San Raffaele Pisana, Rome, Italy.,Institute of Neurology, Catholic University of The Sacred Heart, Rome, Italy
| | - Luigi De Gennaro
- Department of Psychology, University of Rome "Sapienza," Rome, Italy
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59
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Sreeraj VS, Shivakumar V, Sowmya S, Bose A, Nawani H, Narayanaswamy JC, Venkatasubramanian G. Online Theta Frequency Transcranial Alternating Current Stimulation for Cognitive Remediation in Schizophrenia: A Case Report and Review of Literature. J ECT 2019; 35:139-143. [PMID: 30024457 DOI: 10.1097/yct.0000000000000523] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Transcranial alternating current stimulation (tACS), a noninvasive brain stimulation technique that uses low-intensity alternating current, has been postulated to be a potential therapeutic option in treating the cognitive deficits in schizophrenia. Transcranial alternating current stimulation synchronizes the neural oscillations to the applied stimulation frequency in the stimulated cortical regions. In this report, we have reviewed the literature pertinent to the clinical application of tACS in psychiatric disorders; in addition, we have described the clinical use of online theta tACS in a schizophrenia patient with cognitive deficits. Online theta tACS led to improvement in working memory, attention, processing speed, and emotional processing. The beneficial effect of tACS persisted during reassessment of the patient after 50 days. Transcranial alternating current stimulation, given its noninvasiveness, safety, and ease of administration, has the potential to ameliorate cognitive deficits in neuropsychiatric disorders like schizophrenia.
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Affiliation(s)
- Vanteemar S Sreeraj
- From the WISER Program, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India
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60
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Cellini N, Shimizu RE, Connolly PM, Armstrong DM, Hernandez LT, Polakiewicz AG, Estrada R, Aguilar-Simon M, Weisend MP, Mednick SC, Simons SB. Short Duration Repetitive Transcranial Electrical Stimulation During Sleep Enhances Declarative Memory of Facts. Front Hum Neurosci 2019; 13:123. [PMID: 31031612 PMCID: PMC6474382 DOI: 10.3389/fnhum.2019.00123] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 03/22/2019] [Indexed: 11/13/2022] Open
Abstract
Transcranial electrical stimulation (tES) during sleep has been shown to successfully modulate memory consolidation. Here, we tested the effect of short duration repetitive tES (SDR-tES) during a daytime nap on the consolidation of declarative memory of facts in healthy individuals. We use a previously described approach to deliver the stimulation at regular intervals during non-rapid eye movement (NREM) sleep, specifically stage NREM2 and NREM3. Similar to previous studies using tES, we find enhanced memory performance compared to sham both after sleep and 48 h later. We also observed an increase in the proportion of time spent in NREM3 sleep and SDR-tES boosted the overall rate of slow oscillations (SOs) during NREM2/NREM3 sleep. Retrospective investigation of brain activity immediately preceding stimulation suggests that increases in the SO rate are more likely when stimulation is delivered during quiescent and asynchronous periods of activity in contrast to other closed-loop approaches which target phasic stimulation during ongoing SOs.
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Affiliation(s)
- Nicola Cellini
- Department of General Psychology, University of Padova, Padova, Italy
- Department of Cognitive Science, University of California, Irvine, Irvine, CA, United States
| | | | | | | | - Lexus T. Hernandez
- Department of Cognitive Science, University of California, Irvine, Irvine, CA, United States
| | | | | | | | | | - Sara C. Mednick
- Department of Cognitive Science, University of California, Irvine, Irvine, CA, United States
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61
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Salehinejad MA, Wischnewski M, Nejati V, Vicario CM, Nitsche MA. Transcranial direct current stimulation in attention-deficit hyperactivity disorder: A meta-analysis of neuropsychological deficits. PLoS One 2019; 14:e0215095. [PMID: 30978259 PMCID: PMC6461252 DOI: 10.1371/journal.pone.0215095] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 03/26/2019] [Indexed: 02/02/2023] Open
Abstract
Transcranial direct current stimulation (tDCS) is a promising method for altering cortical excitability with clinical implications in neuropsychiatric diseases. Its application in neurodevelopmental disorders especially attention-deficit hyperactivity disorder (ADHD), is in early stage and promising but its effectiveness has not been systematically examined yet. We conducted a meta-analysis on the effectiveness of tDCS on the most studied neuropsychological symptoms of ADHD, which is the first reported meta-analysis of tDCS studies on ADHD. Data from 10 randomized controlled studies (including 11 separate experiments) targeting inhibitory control, and/or working memory (WM) in ADHD were included. Results show that overall tDCS significantly improved inhibitory control. Sub-analyses further show that dorsolateral prefrontal cortex (dlPFC) (but not right inferior frontal gyrus) tDCS and anodal (but not cathodal) tDCS significantly improved inhibitory control with a small effect size. Anodal dlPFC-tDCS had the largest significant effect on inhibitory control with a small-to-medium effect size. Additionally, a significant improving effect of tDCS on inhibitory control accuracy (but not response time) and WM speed (but not accuracy) were found. Overall, this meta-analysis supports a beneficial effect of tDCS on inhibitory control and WM in ADHD with a small-to-medium effect size. TDCS seems to be a promising method for improving neuropsychological and cognitive deficits in ADHD. However, there might be a dissociation between neuropsychological deficits and clinical symptoms of ADHD and therefore, the significance of this meta-analysis for clinical purposes is limited. Future studies should systematically evaluate the role of inter-individual factors (i.e., ADHD subtype, types of the deficit) and stimulation parameters (i.e., site, polarity, intensity, duration, repetition rate) on tDCS efficacy in ADHD population and examine whether benefits are long-term.
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Affiliation(s)
- Mohammad Ali Salehinejad
- Ruhr-University Bochum, International Graduate School of Neuroscience, Bochum, Germany
- Leibniz Research Centre for Working Environment and Human Factors, Department of Psychology and Neurosciences, Dortmund, Germany
- * E-mail:
| | - Miles Wischnewski
- Donders Institute for Brain, Cognition, and Behaviour, Radboud University Nijmegen, The Netherlands
| | - Vahid Nejati
- Department of Psychology, Shahid Beheshti University, Tehran, Iran
- Department of Psychology, University of Regensburg, Regensburg, Germany
| | - Carmelo M. Vicario
- Leibniz Research Centre for Working Environment and Human Factors, Department of Psychology and Neurosciences, Dortmund, Germany
- University of Messina, Department of Scienze Cognitive della Formazione e degli Studi Culturali, Messina, Italy
| | - Michael A. Nitsche
- Leibniz Research Centre for Working Environment and Human Factors, Department of Psychology and Neurosciences, Dortmund, Germany
- University Medical Hospital Bergmannsheil, Department of Neurology, Bochum, Germany
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62
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Finisguerra A, Borgatti R, Urgesi C. Non-invasive Brain Stimulation for the Rehabilitation of Children and Adolescents With Neurodevelopmental Disorders: A Systematic Review. Front Psychol 2019; 10:135. [PMID: 30787895 PMCID: PMC6373438 DOI: 10.3389/fpsyg.2019.00135] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 01/15/2019] [Indexed: 12/18/2022] Open
Abstract
In the last years, there has been a growing interest in the application of different non-invasive brain stimulation techniques to induce neuroplasticity and to modulate cognition and behavior in adults. Very recently, different attempts have been made to induce functional plastic changes also in pediatric populations. Importantly, not only sensorimotor processing, but also higher-level functions have been addressed, with the aim to boost rehabilitation in different neurodevelopmental disorders. However, efficacy and safety of using these techniques in pediatric population is still debated. The current article aims to review the non-invasive brain stimulation studies conducted in pediatric populations using Transcranial Magnetic Stimulation or transcranial Direct Current Stimulation. Specifically, the available proofs concerning the efficacy and safety of these techniques on Autism Spectrum Disorder, Attention-deficit/hyperactivity disorder, Dyslexia, Tourette syndrome, and tic disorders are systematically reviewed and discussed. The article also aims to provide an overview about other possible applications of these and other stimulation techniques for rehabilitative purposes in children and adolescents.
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Affiliation(s)
| | - Renato Borgatti
- Child Neuropsychiatry and Neurorehabilitation Unit, Scientific Institute, IRCCS E. Medea, Bosisio Parini, Italy
| | - Cosimo Urgesi
- Scientific Institute, IRCCS E. Medea, Pasian di Prato, Udine, Italy.,Child Neuropsychiatry and Neurorehabilitation Unit, Scientific Institute, IRCCS E. Medea, Bosisio Parini, Italy.,Laboratory of Cognitive Neuroscience, Department of Languages, Literatures, Communication, Education and Society, University of Udine, Udine, Italy
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63
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Sierawska A, Prehn-Kristensen A, Moliadze V, Krauel K, Nowak R, Freitag CM, Siniatchkin M, Buyx A. Unmet Needs in Children With Attention Deficit Hyperactivity Disorder-Can Transcranial Direct Current Stimulation Fill the Gap? Promises and Ethical Challenges. Front Psychiatry 2019; 10:334. [PMID: 31156480 PMCID: PMC6531921 DOI: 10.3389/fpsyt.2019.00334] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 04/29/2019] [Indexed: 12/21/2022] Open
Abstract
Attention deficit hyperactivity disorder (ADHD) is a disorder most frequently diagnosed in children and adolescents. Although ADHD can be effectively treated with psychostimulants, a significant proportion of patients discontinue treatment because of adverse events or insufficient improvement of symptoms. In addition, cognitive abilities that are frequently impaired in ADHD are not directly targeted by medication. Therefore, additional treatment options, especially to improve cognitive abilities, are needed. Because of its relatively easy application, well-established safety, and low cost, transcranial direct current stimulation (tDCS) is a promising additional treatment option. Further research is needed to establish efficacy and to integrate this treatment into the clinical routine. In particular, limited evidence regarding the use of tDCS in children, lack of clear translational guidelines, and general challenges in conducting research with vulnerable populations pose a number of practical and ethical challenges to tDCS intervention studies. In this paper, we identify and discuss ethical issues related to research on tDCS and its potential therapeutic use for ADHD in children and adolescents. Relevant ethical issues in the tDCS research for pediatric ADHD center on safety, risk/benefit ratio, information and consent, labeling problems, and nonmedical use. Following an analysis of these issues, we developed a list of recommendations that can guide clinicians and researchers in conducting ethically sound research on tDCS in pediatric ADHD.
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Affiliation(s)
- Anna Sierawska
- Division of Biomedical Ethics, Institute of Experimental Medicine, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Alexander Prehn-Kristensen
- Department of Child and Adolescent Psychiatry and Psychotherapy, Centre for Integrative Psychiatry, School of Medicine, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Vera Moliadze
- Institute of Medical Psychology and Medical Sociology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Kerstin Krauel
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Magdeburg, Magdeburg, Germany
| | | | - Christine M Freitag
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Michael Siniatchkin
- Institute of Medical Psychology and Medical Sociology, Christian-Albrechts-University of Kiel, Kiel, Germany.,Clinic for Child and Adolescent Psychiatry and Psychotherapy, Medical Center Bethel, Bielefeld, Germany
| | - Alena Buyx
- Institute for History and Ethics in Medicine Medical School, Technical University of Munich, Munich, Germany
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64
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Lee JC, Kenney-Jung DL, Blacker CJ, Doruk Camsari D, Lewis CP. Transcranial Direct Current Stimulation in Child and Adolescent Psychiatric Disorders. Child Adolesc Psychiatr Clin N Am 2019; 28:61-78. [PMID: 30389077 DOI: 10.1016/j.chc.2018.07.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Research involving transcranial direct current stimulation (tDCS) in child and adolescent psychiatry is limited. Early, short-term studies have found tDCS to be safe and well-tolerated in youth with neurodevelopmental disorders (attention-deficit hyperactivity disorder, autism, learning disorders). Preliminary data suggest potential utility in symptom reduction and improving cognitive function. Further careful research considering implications for the developing brain is necessary.
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Affiliation(s)
- Jonathan C Lee
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, 1001 Queen Street W, Toronto, ON M6J 1H4, Canada; Department of Psychiatry, Faculty of Medicine, University of Toronto, 250 College Street, Toronto, ON M5T 1R8, Canada
| | - Daniel L Kenney-Jung
- Department of Neurology, University of Minnesota, 420 Delaware Street SE, MMC 295, Minneapolis, MN 55455, USA
| | - Caren J Blacker
- Department of Psychiatry and Psychology, Division of Child and Adolescent Psychiatry, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Deniz Doruk Camsari
- Department of Psychiatry and Psychology, Division of Child and Adolescent Psychiatry, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Charles P Lewis
- Department of Psychiatry and Psychology, Division of Child and Adolescent Psychiatry, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
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65
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Sleep Impact on Perception, Memory, and Emotion in Adults and the Effects of Early-Life Experience. HANDBOOK OF SLEEP RESEARCH 2019. [DOI: 10.1016/b978-0-12-813743-7.00039-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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66
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Cellini N, Mednick SC. Stimulating the sleeping brain: Current approaches to modulating memory-related sleep physiology. J Neurosci Methods 2018; 316:125-136. [PMID: 30452977 DOI: 10.1016/j.jneumeth.2018.11.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 10/25/2018] [Accepted: 11/14/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND One of the most audacious proposals throughout the history of psychology was the potential ability to learn while we sleep. The idea penetrated culture via sci-fi movies and inspired the invention of devices that claimed to teach foreign languages, facts, and even quit smoking by simply listening to audiocassettes or other devices during sleep. However, the promises from this endeavor didn't stand up to experimental scrutiny, and the dream was shunned from the scientific community. Despite the historic evidence that the sleeping brain cannot learn new complex information (i.e., words, images, facts), a new wave of current interventions are demonstrating that sleep can be manipulated to strengthen recent memories. NEW METHOD Several recent approaches have been developed that play with the sleeping brain in order to modify ongoing memory processing. Here, we provide an overview of the available techniques to non-invasively modulate memory-related sleep physiology, including sensory, vestibular and electrical stimulation, as well as pharmacological approaches. RESULTS N/A. COMPARISON WITH EXISTING METHODS N/A. CONCLUSIONS Although the results are encouraging, suggesting that in general the sleeping brain may be optimized for better memory performance, the road to bring these techniques in free-living conditions is paved with unanswered questions and technical challenges that need to be carefully addressed.
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Affiliation(s)
- Nicola Cellini
- Department of General Psychology, University of Padova, Padova, Italy.
| | - Sara C Mednick
- Department of Cognitive Sciences, University of California, Irvine, United States
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Röhner F, Breitling C, Rufener KS, Heinze HJ, Hinrichs H, Krauel K, Sweeney-Reed CM. Modulation of Working Memory Using Transcranial Electrical Stimulation: A Direct Comparison Between TACS and TDCS. Front Neurosci 2018; 12:761. [PMID: 30405341 PMCID: PMC6206050 DOI: 10.3389/fnins.2018.00761] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Accepted: 10/03/2018] [Indexed: 01/05/2023] Open
Abstract
Transcranial electrical stimulation (TES) has been considered a promising tool for improving working memory (WM) performance. Recent studies have demonstrated modulation of networks underpinning WM processing through application of transcranial alternating current (TACS) as well as direct current (TDCS) stimulation. Differences between study designs have limited direct comparison of the efficacy of these approaches, however. Here we directly compared the effects of theta TACS (6 Hz) and anodal TDCS on WM, applying TACS to the frontal-parietal loop and TDCS to the dorsolateral prefrontal cortex (DLPFC). WM was evaluated using a visual 2-back WM task. A within-subject, crossover design was applied (N = 30) in three separate sessions. TACS, TDCS, and sham stimulation were administered in a counterbalanced order, and the WM task was performed before, during, and after stimulation. Neither reaction times for hits (RT-hit) nor accuracy differed according to stimulation type with this study design. A marked practice effect was noted, however, with improvement in RT-hit irrespective of stimulation type, which peaked at the end of the second session. Pre-stimulation RT-hits in session three returned to the level observed pre-stimulation in session two, irrespective of stimulation type. The participants who received sham stimulation in session one and had therefore improved their performance due to practice alone, had thus reached a plateau by session two, enabling us to pool RT-hits from sessions two and three for these participants. The pooling allowed implementation of a within-subject crossover study design, with a direct comparison of the effects of TACS and TDCS in a subgroup of participants (N = 10), each of whom received both stimulation types, in a counterbalanced order, with pre-stimulation performance the same for both sessions. TACS resulted in a greater improvement in RT-hits than TDCS (F(2,18) = 4.31 p = 0.03). Our findings suggest that future work optimizing the application of TACS has the potential to facilitate WM performance.
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Affiliation(s)
- Franziska Röhner
- Neurocybernetics and Rehabilitation, Department of Neurology and Stereotactic Neurosurgery, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Carolin Breitling
- Department of Child and Adolescent Psychiatry and Psychotherapy, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Katharina S Rufener
- Department of Neurology, Otto von Guericke University Magdeburg, Magdeburg, Germany.,Center for Behavioral Brain Sciences (CBBS), Magdeburg, Germany
| | - Hans-Jochen Heinze
- Department of Neurology, Otto von Guericke University Magdeburg, Magdeburg, Germany.,Center for Behavioral Brain Sciences (CBBS), Magdeburg, Germany.,Department of Behavioral Neurology, Leibniz Institute for Neurobiology, Magdeburg, Germany.,German Center for Neurodegenerative Diseases, Magdeburg, Germany
| | - Hermann Hinrichs
- Department of Neurology, Otto von Guericke University Magdeburg, Magdeburg, Germany.,Center for Behavioral Brain Sciences (CBBS), Magdeburg, Germany.,Department of Behavioral Neurology, Leibniz Institute for Neurobiology, Magdeburg, Germany.,German Center for Neurodegenerative Diseases, Magdeburg, Germany
| | - Kerstin Krauel
- Department of Child and Adolescent Psychiatry and Psychotherapy, Otto von Guericke University Magdeburg, Magdeburg, Germany.,Center for Behavioral Brain Sciences (CBBS), Magdeburg, Germany
| | - Catherine M Sweeney-Reed
- Neurocybernetics and Rehabilitation, Department of Neurology and Stereotactic Neurosurgery, Otto von Guericke University Magdeburg, Magdeburg, Germany
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68
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Léger D, Debellemaniere E, Rabat A, Bayon V, Benchenane K, Chennaoui M. Slow-wave sleep: From the cell to the clinic. Sleep Med Rev 2018; 41:113-132. [DOI: 10.1016/j.smrv.2018.01.008] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 01/02/2018] [Accepted: 01/22/2018] [Indexed: 10/18/2022]
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69
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Doruk Camsari D, Kirkovski M, Croarkin PE. Therapeutic Applications of Noninvasive Neuromodulation in Children and Adolescents. Psychiatr Clin North Am 2018; 41:465-477. [PMID: 30098658 PMCID: PMC6413505 DOI: 10.1016/j.psc.2018.05.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Recent advances and growing evidence supporting the safety and efficacy of noninvasive neuromodulatory techniques in adults have facilitated the study of neuromodulation applications in children and adolescents. Noninvasive brain stimulation methods such as transcranial direct current stimulation and transcranial magnetic stimulation have been considered in children with depression, autism spectrum disorder, attention-deficit hyperactivity disorder, and other neuropsychiatric disorders. However, current clinical applications of neuromodulation techniques in children and adolescents are nascent. There is a great need for developmentally informed, large, double-blinded, randomized, controlled clinical trials to demonstrate efficacy and safety of noninvasive brain stimulation in children and adolescents.
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Affiliation(s)
- Deniz Doruk Camsari
- Department of Psychiatry and Psychology, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Melissa Kirkovski
- Deakin Child Study Centre, School of Psychology, Deakin University, Geelong, VIC 3220, Australia
| | - Paul E Croarkin
- Department of Psychiatry and Psychology, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.
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70
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Prehn-Kristensen A, Göder R. [Sleep and cognition in children and adolescents]. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2018; 46:405-422. [PMID: 30141742 DOI: 10.1024/1422-4917/a000614] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Sleep and cognition in children and adolescents Abstract. In this review, one of the most important functions of sleep was described: Its role in promoting cognitive processes in children and adolescents. Particularly, studies of older children and adolescents revealed that sleep interacts in a complex manner with cognitive performance. Moreover, it was shown that sleep supports long-term memory even in young children. This is true for many different long-term memory systems such as memory of factual information (declarative memory), language acquisition, and for reward-related learning, but less so for learning motor skills. Clinical implications arise from observing the consequences of sleep deficits in children and adolescents due to early school hours or due to clinical conditions like attention deficits hyperactive disorder (ADHD), sleep apnea syndrome or other sleep disturbances. Current research has only partially shown that the treatment of sleep problems also benefits cognitive and memory performance. Filling this gap remains an opportunity for further research.
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Affiliation(s)
- Alexander Prehn-Kristensen
- 1 Klinik für Kinder- und Jugendpsychiatrie und -psychotherapie, Zentrum für Integrative Psychiatrie, Universitätsklinikum Schleswig-Holstein, UKSH, Campus Kiel
| | - Robert Göder
- 2 Klinik für Psychiatrie und Psychotherapie, Zentrum für Integrative Psychiatrie, Universitätsklinikum Schleswig-Holstein, UKSH, Campus Kiel
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71
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Ketz N, Jones AP, Bryant NB, Clark VP, Pilly PK. Closed-Loop Slow-Wave tACS Improves Sleep-Dependent Long-Term Memory Generalization by Modulating Endogenous Oscillations. J Neurosci 2018; 38:7314-7326. [PMID: 30037830 PMCID: PMC6596034 DOI: 10.1523/jneurosci.0273-18.2018] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 05/31/2018] [Accepted: 06/13/2018] [Indexed: 01/10/2023] Open
Abstract
Benefits in long-term memory retention and generalization have been shown to be related to sleep-dependent processes, which correlate with neural oscillations as measured by changes in electric potential. The specificity and causal role of these oscillations, however, are still poorly understood. Here, we investigated the potential for augmenting endogenous slow-wave (SW) oscillations in humans with closed-loop transcranial alternating current stimulation (tACS) with an aim toward enhancing the consolidation of recent experiences into long-term memory. Sixteen (three female) participants were trained presleep on a target detection task identifying targets hidden in complex visual scenes. During post-training sleep, closed-loop SW detection and stimulation were used to deliver tACS matching the phase and frequency of the dominant oscillation in the range of 0.5-1.2 Hz. Changes in performance were assessed the following day using test images that were identical to the training ("repeated"), and images generated from training scenes but with novel viewpoints ("generalized"). Results showed that active SW tACS during sleep enhanced the postsleep versus presleep target detection accuracy for the generalized images compared with sham nights, while no significant change was found for repeated images. Using a frequency-agnostic clustering approach sensitive to stimulation-induced spectral power changes in scalp EEG, this behavioral enhancement significantly correlated with both a poststimulation increase and a subsequent decrease in measured spectral power within the SW band, which in turn showed increased coupling with spindle amplitude. These results suggest that augmenting endogenous SW oscillations can enhance consolidation by specifically improving generalization over recognition or cued recall.SIGNIFICANCE STATEMENT This human study demonstrates the use of a closed-loop noninvasive brain stimulation method to enhance endogenous neural oscillations during sleep with the effect of improving consolidation of recent experiences into long-term memory. Here we show that transient slow oscillatory transcranial alternating current stimulation (tACS) triggered by endogenous slow oscillations and matching their frequency and phase can increase slow-wave power and coupling with spindles. Further, this increase correlates with overnight improvements in generalization of recent training to facilitate performance in a target detection task. We also provide novel evidence for a tACS-induced refractory period following the tACS-induced increase. Here slow-wave power is temporarily reduced relative to sham stimulation, which nonetheless maintains a positive relationship with behavioral improvements.
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Affiliation(s)
- Nicholas Ketz
- Information and Systems Sciences Laboratory, Center for Human Machine Collaboration, HRL Laboratories, Malibu, California 90265 and
| | - Aaron P Jones
- Psychology Clinical Neuroscience Center, Department of Psychology, University of New Mexico, Albuquerque, New Mexico 87131
| | - Natalie B Bryant
- Psychology Clinical Neuroscience Center, Department of Psychology, University of New Mexico, Albuquerque, New Mexico 87131
| | - Vincent P Clark
- Psychology Clinical Neuroscience Center, Department of Psychology, University of New Mexico, Albuquerque, New Mexico 87131
| | - Praveen K Pilly
- Information and Systems Sciences Laboratory, Center for Human Machine Collaboration, HRL Laboratories, Malibu, California 90265 and
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72
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The Efficacy of Transcranial Current Stimulation Techniques to Modulate Resting-State EEG, to Affect Vigilance and to Promote Sleepiness. Brain Sci 2018; 8:brainsci8070137. [PMID: 30037023 PMCID: PMC6071002 DOI: 10.3390/brainsci8070137] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 07/09/2018] [Accepted: 07/17/2018] [Indexed: 02/05/2023] Open
Abstract
Transcranial Current Stimulations (tCSs) are non-invasive brain stimulation techniques which modulate cortical excitability and spontaneous brain activity by the application of weak electric currents through the scalp, in a safe, economic, and well-tolerated manner. The direction of the cortical effects mainly depend on the polarity and the waveform of the applied current. The aim of the present work is to provide a broad overview of recent studies in which tCS has been applied to modulate sleepiness, sleep, and vigilance, evaluating the efficacy of different stimulation techniques and protocols. In recent years, there has been renewed interest in these stimulations and their ability to affect arousal and sleep dynamics. Furthermore, we critically review works that, by means of stimulating sleep/vigilance patterns, in the sense of enhancing or disrupting them, intended to ameliorate several clinical conditions. The examined literature shows the efficacy of tCSs in modulating sleep and arousal pattern, likely acting on the top-down pathway of sleep regulation. Finally, we discuss the potential application in clinical settings of this neuromodulatory technique as a therapeutic tool for pathological conditions characterized by alterations in sleep and arousal domains and for sleep disorders per se.
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73
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Shelton KT, Qu J, Bilotta F, Brown EN, Cudemus G, D’Alessandro DA, Deng H, DiBiasio A, Gitlin JA, Hahm EY, Hobbs LE, Houle TT, Ibala R, Loggia M, Pavone KJ, Shaefi S, Tolis G, Westover MB, Akeju O. Minimizing ICU Neurological Dysfunction with Dexmedetomidine-induced Sleep (MINDDS): protocol for a randomised, double-blind, parallel-arm, placebo-controlled trial. BMJ Open 2018; 8:e020316. [PMID: 29678977 PMCID: PMC5914725 DOI: 10.1136/bmjopen-2017-020316] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Delirium, which is prevalent in postcardiac surgical patients, is an acute brain dysfunction characterised by disturbances in attention, awareness and cognition not explained by a pre-existing neurocognitive disorder. The pathophysiology of delirium remains poorly understood. However, basic science and clinical studies suggest that sleep disturbance may be a modifiable risk factor for the development of delirium. Dexmedetomidine is a α-2A adrenergic receptor agonist medication that patterns the activity of various arousal nuclei similar to sleep. A single night-time loading dose of dexmedetomidine promotes non-rapid eye movement sleep stages N2 and N3 sleep. This trial hypothesises dexmedetomidine-induced sleep as pre-emptive therapy for postoperative delirium. METHODS AND ANALYSIS The MINDDS (Minimizing ICU Neurological Dysfunction with Dexmedetomidine-induced Sleep) trial is a 370-patient block-randomised, placebo-controlled, double-blinded, single-site, parallel-arm superiority trial. Patients over 60 years old, undergoing cardiac surgery with planned cardiopulmonary bypass, will be randomised to receive a sleep-inducing dose of dexmedetomidine or placebo. The primary outcome is the incidence of delirium on postoperative day 1, assessed with the Confusion Assessment Method by staff blinded to the treatment assignment. To ensure that the study is appropriately powered for the primary outcome measure, patients will be recruited and randomised into the study until 370 patients receive the study intervention on postoperative day 0. Secondary outcomes will be evaluated by in-person assessments and medical record review for in-hospital end points, and by telephone interview for 30-day, 90-day and 180-day end points. All trial outcomes will be evaluated using an intention-to-treat analysis plan. Hypothesis testing will be performed using a two-sided significance level (type I error) of α=0.05. Sensitivity analyses using the actual treatment received will be performed and compared with the intention-to-treat analysis results. Additional sensitivity analyses will assess the potential impact of missing data due to loss of follow-up. ETHICS AND DISSEMINATION The Partners Human Research Committee approved the MINDDS trial. Recruitment began in March 2017. Dissemination plans include presentations at scientific conferences, scientific publications and popular media. TRIAL REGISTRATION NUMBER NCT02856594.
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Affiliation(s)
- Kenneth T Shelton
- Department of Anesthesiology, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jason Qu
- Department of Anesthesiology, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Federico Bilotta
- Department of Anaesthesia and Critical Care Medicine, Sapienza University of Rome, Rome, Italy
| | - Emery N Brown
- Department of Anesthesiology, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Institute for Medical Engineering and Sciences, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Gaston Cudemus
- Department of Anesthesiology, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - David A D’Alessandro
- Department of Surgery, Division of Cardiac Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Hao Deng
- Department of Anesthesiology, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Alan DiBiasio
- Department of Pharmacy, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jacob A Gitlin
- Department of Anesthesiology, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Eunice Y Hahm
- Department of Anesthesiology, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Lauren E Hobbs
- Department of Anesthesiology, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Timothy T Houle
- Department of Anesthesiology, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Reine Ibala
- Department of Anesthesiology, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Marco Loggia
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kara J Pavone
- Department of Anesthesiology, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Shahzad Shaefi
- Department of Anesthesia and Critical Care, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - George Tolis
- Department of Surgery, Division of Cardiac Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - M. Brandon Westover
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Oluwaseun Akeju
- Department of Anesthesiology, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
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Rubia K. Cognitive Neuroscience of Attention Deficit Hyperactivity Disorder (ADHD) and Its Clinical Translation. Front Hum Neurosci 2018; 12:100. [PMID: 29651240 PMCID: PMC5884954 DOI: 10.3389/fnhum.2018.00100] [Citation(s) in RCA: 181] [Impact Index Per Article: 30.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 03/05/2018] [Indexed: 01/01/2023] Open
Abstract
This review focuses on the cognitive neuroscience of Attention Deficit Hyperactivity Disorder (ADHD) based on functional magnetic resonance imaging (fMRI) studies and on recent clinically relevant applications such as fMRI-based diagnostic classification or neuromodulation therapies targeting fMRI deficits with neurofeedback (NF) or brain stimulation. Meta-analyses of fMRI studies of executive functions (EFs) show that ADHD patients have cognitive-domain dissociated complex multisystem impairments in several right and left hemispheric dorsal, ventral and medial fronto-cingulo-striato-thalamic and fronto-parieto-cerebellar networks that mediate cognitive control, attention, timing and working memory (WM). There is furthermore emerging evidence for abnormalities in orbital and ventromedial prefrontal and limbic areas that mediate motivation and emotion control. In addition, poor deactivation of the default mode network (DMN) suggests an abnormal interrelationship between hypo-engaged task-positive and poorly "switched off" hyper-engaged task-negative networks, both of which are related to impaired cognition. Translational cognitive neuroscience in ADHD is still in its infancy. Pattern recognition analyses have attempted to provide diagnostic classification of ADHD using fMRI data with respectable classification accuracies of over 80%. Necessary replication studies, however, are still outstanding. Brain stimulation has been tested in heterogeneously designed, small numbered proof of concept studies targeting key frontal functional impairments in ADHD. Transcranial direct current stimulation (tDCS) appears to be promising to improve ADHD symptoms and cognitive functions based on some studies, but larger clinical trials of repeated stimulation with and without cognitive training are needed to test clinical efficacy and potential costs on non-targeted functions. Only three studies have piloted NF of fMRI-based frontal dysfunctions in ADHD using fMRI or near-infrared spectroscopy, with the two larger ones finding some improvements in cognition and symptoms, which, however, were not superior to the active control conditions, suggesting potential placebo effects. Neurotherapeutics seems attractive for ADHD due to their safety and potential longer-term neuroplastic effects, which drugs cannot offer. However, they need to be thoroughly tested for short- and longer-term clinical and cognitive efficacy and their potential for individualized treatment.
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Affiliation(s)
- Katya Rubia
- Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King’s College London, London, United Kingdom
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75
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Koo PC, Mölle M, Marshall L. Efficacy of slow oscillatory‐transcranial direct current stimulation on
EEG
and memory – contribution of an inter‐individual factor. Eur J Neurosci 2018; 47:812-823. [DOI: 10.1111/ejn.13877] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 02/08/2018] [Accepted: 02/16/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Ping Chai Koo
- Institute of Experimental and Clinical Pharmacology and Toxicology University of Lübeck Ratzeburger Allee 160, Bldg 66 23562 Lübeck Germany
- Center of Brain, Behavior and Metabolism University of Lübeck Lübeck Germany
- Department of Psychiatry and Psychotherapy Rostock University Medical Centre Rostock Germany
| | - Matthias Mölle
- Center of Brain, Behavior and Metabolism University of Lübeck Lübeck Germany
| | - Lisa Marshall
- Institute of Experimental and Clinical Pharmacology and Toxicology University of Lübeck Ratzeburger Allee 160, Bldg 66 23562 Lübeck Germany
- Center of Brain, Behavior and Metabolism University of Lübeck Lübeck Germany
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Lafon B, Henin S, Huang Y, Friedman D, Melloni L, Thesen T, Doyle W, Buzsáki G, Devinsky O, Parra LC, A Liu A. Low frequency transcranial electrical stimulation does not entrain sleep rhythms measured by human intracranial recordings. Nat Commun 2017; 8:1199. [PMID: 29084960 PMCID: PMC5662600 DOI: 10.1038/s41467-017-01045-x] [Citation(s) in RCA: 125] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Accepted: 08/15/2017] [Indexed: 01/20/2023] Open
Abstract
Transcranial electrical stimulation has widespread clinical and research applications, yet its effect on ongoing neural activity in humans is not well established. Previous reports argue that transcranial alternating current stimulation (tACS) can entrain and enhance neural rhythms related to memory, but the evidence from non-invasive recordings has remained inconclusive. Here, we measure endogenous spindle and theta activity intracranially in humans during low-frequency tACS and find no stable entrainment of spindle power during non-REM sleep, nor of theta power during resting wakefulness. As positive controls, we find robust entrainment of spindle activity to endogenous slow-wave activity in 66% of electrodes as well as entrainment to rhythmic noise-burst acoustic stimulation in 14% of electrodes. We conclude that low-frequency tACS at common stimulation intensities neither acutely modulates spindle activity during sleep nor theta activity during waking rest, likely because of the attenuated electrical fields reaching the cortical surface.
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Affiliation(s)
- Belen Lafon
- Department of Biomedical Engineering, City College of New York, 160 Convent Ave, New York, NY, 10031, USA
| | - Simon Henin
- New York University Comprehensive Epilepsy Center, 223 East 34th Street, New York, NY, 10016, USA
- Department of Neurology, New York University School of Medicine, 240 East 38th St, 20th Floor, New York, NY, 10016, USA
| | - Yu Huang
- Department of Biomedical Engineering, City College of New York, 160 Convent Ave, New York, NY, 10031, USA
| | - Daniel Friedman
- New York University Comprehensive Epilepsy Center, 223 East 34th Street, New York, NY, 10016, USA
- Department of Neurology, New York University School of Medicine, 240 East 38th St, 20th Floor, New York, NY, 10016, USA
| | - Lucia Melloni
- New York University Comprehensive Epilepsy Center, 223 East 34th Street, New York, NY, 10016, USA
- Department of Neurology, New York University School of Medicine, 240 East 38th St, 20th Floor, New York, NY, 10016, USA
- Department of Neuroscience, Max Planck Institute for Empirical Aesthetics, Gruneburgweg 14, 60322, Frankfurt am Main, Germany
| | - Thomas Thesen
- Department of Neurology, New York University School of Medicine, 240 East 38th St, 20th Floor, New York, NY, 10016, USA
- Department of Physiology and Neuroscience, St. George's University, St. George's, Grenada
| | - Werner Doyle
- New York University Comprehensive Epilepsy Center, 223 East 34th Street, New York, NY, 10016, USA
- Department of Neurosurgery NYU School of Medicine, 530 1st Avenue, Suite 7W, New York, NY, 10016, USA
| | - György Buzsáki
- Department of Neurology, New York University School of Medicine, 240 East 38th St, 20th Floor, New York, NY, 10016, USA
- New York University Neuroscience Institute, 450 East 29th St, New York, NY, 10016, USA
| | - Orrin Devinsky
- New York University Comprehensive Epilepsy Center, 223 East 34th Street, New York, NY, 10016, USA
- Department of Neurology, New York University School of Medicine, 240 East 38th St, 20th Floor, New York, NY, 10016, USA
| | - Lucas C Parra
- Department of Biomedical Engineering, City College of New York, 160 Convent Ave, New York, NY, 10031, USA
| | - Anli A Liu
- New York University Comprehensive Epilepsy Center, 223 East 34th Street, New York, NY, 10016, USA.
- Department of Neurology, New York University School of Medicine, 240 East 38th St, 20th Floor, New York, NY, 10016, USA.
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Akeju O, Hobbs LE, Gao L, Burns SM, Pavone KJ, Plummer GS, Walsh EC, Houle TT, Kim SE, Bianchi MT, Ellenbogen JM, Brown EN. Dexmedetomidine promotes biomimetic non-rapid eye movement stage 3 sleep in humans: A pilot study. Clin Neurophysiol 2017; 129:69-78. [PMID: 29154132 DOI: 10.1016/j.clinph.2017.10.005] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 09/26/2017] [Accepted: 10/11/2017] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Sleep, which comprises of rapid eye movement (REM) and non-REM stages 1-3 (N1-N3), is a natural occurring state of decreased arousal that is crucial for normal cardiovascular, immune and cognitive function. The principal sedative drugs produce electroencephalogram beta oscillations, which have been associated with neurocognitive dysfunction. Pharmacological induction of altered arousal states that neurophysiologically approximate natural sleep, termed biomimetic sleep, may eliminate drug-induced neurocognitive dysfunction. METHODS We performed a prospective, single-site, three-arm, randomized-controlled, crossover polysomnography pilot study (n = 10) comparing natural, intravenous dexmedetomidine- (1-μg/kg over 10 min [n = 7] or 0.5-μg/kg over 10 min [n = 3]), and zolpidem-induced sleep in healthy volunteers. Sleep quality and psychomotor performance were assessed with polysomnography and the psychomotor vigilance test, respectively. Sleep quality questionnaires were also administered. RESULTS We found that dexmedetomidine promoted N3 sleep in a dose dependent manner, and did not impair performance on the psychomotor vigilance test. In contrast, zolpidem extended release was associated with decreased theta (∼5-8 Hz; N2 and N3) and increased beta oscillations (∼13-25 Hz; N2 and REM). Zolpidem extended release was also associated with increased lapses on the psychomotor vigilance test. No serious adverse events occurred. CONCLUSIONS Pharmacological induction of biomimetic N3 sleep with psychomotor sparing benefits is feasible. SIGNIFICANCE These results suggest that α2a adrenergic agonists may be developed as a new class of sleep enhancing medications with neurocognitive sparing benefits.
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Affiliation(s)
- Oluwaseun Akeju
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - Lauren E Hobbs
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Lei Gao
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Sara M Burns
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Kara J Pavone
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - George S Plummer
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Elisa C Walsh
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Tim T Houle
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Seong-Eun Kim
- Department of Brain and Cognitive Science, Massachusetts Institute of Technology, Cambridge, MA, USA; Department of Electronics and Control Engineering, Hanbat National University, Daejon, Republic of Korea
| | - Matt T Bianchi
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Emery N Brown
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Brain and Cognitive Science, Massachusetts Institute of Technology, Cambridge, MA, USA
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Brandejsky L, Micoulaud Franchi JA, Lopez R, Bioulac S, Da Fonseca D, Daudet C, Boyer L, Richieri R, Lançon C. Stimulation cérébrale non invasive dans le traitement du trouble déficit de l’attention avec ou sans hyperactivité : une revue de la littérature. Encephale 2017; 43:457-463. [DOI: 10.1016/j.encep.2016.08.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 08/09/2016] [Accepted: 08/10/2016] [Indexed: 11/26/2022]
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Antal A, Alekseichuk I, Bikson M, Brockmöller J, Brunoni AR, Chen R, Cohen LG, Dowthwaite G, Ellrich J, Flöel A, Fregni F, George MS, Hamilton R, Haueisen J, Herrmann CS, Hummel FC, Lefaucheur JP, Liebetanz D, Loo CK, McCaig CD, Miniussi C, Miranda PC, Moliadze V, Nitsche MA, Nowak R, Padberg F, Pascual-Leone A, Poppendieck W, Priori A, Rossi S, Rossini PM, Rothwell J, Rueger MA, Ruffini G, Schellhorn K, Siebner HR, Ugawa Y, Wexler A, Ziemann U, Hallett M, Paulus W. Low intensity transcranial electric stimulation: Safety, ethical, legal regulatory and application guidelines. Clin Neurophysiol 2017; 128:1774-1809. [PMID: 28709880 PMCID: PMC5985830 DOI: 10.1016/j.clinph.2017.06.001] [Citation(s) in RCA: 670] [Impact Index Per Article: 95.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 05/29/2017] [Accepted: 06/06/2017] [Indexed: 12/11/2022]
Abstract
Low intensity transcranial electrical stimulation (TES) in humans, encompassing transcranial direct current (tDCS), transcutaneous spinal Direct Current Stimulation (tsDCS), transcranial alternating current (tACS), and transcranial random noise (tRNS) stimulation or their combinations, appears to be safe. No serious adverse events (SAEs) have been reported so far in over 18,000 sessions administered to healthy subjects, neurological and psychiatric patients, as summarized here. Moderate adverse events (AEs), as defined by the necessity to intervene, are rare, and include skin burns with tDCS due to suboptimal electrode-skin contact. Very rarely mania or hypomania was induced in patients with depression (11 documented cases), yet a causal relationship is difficult to prove because of the low incidence rate and limited numbers of subjects in controlled trials. Mild AEs (MAEs) include headache and fatigue following stimulation as well as prickling and burning sensations occurring during tDCS at peak-to-baseline intensities of 1-2mA and during tACS at higher peak-to-peak intensities above 2mA. The prevalence of published AEs is different in studies specifically assessing AEs vs. those not assessing them, being higher in the former. AEs are frequently reported by individuals receiving placebo stimulation. The profile of AEs in terms of frequency, magnitude and type is comparable in healthy and clinical populations, and this is also the case for more vulnerable populations, such as children, elderly persons, or pregnant women. Combined interventions (e.g., co-application of drugs, electrophysiological measurements, neuroimaging) were not associated with further safety issues. Safety is established for low-intensity 'conventional' TES defined as <4mA, up to 60min duration per day. Animal studies and modeling evidence indicate that brain injury could occur at predicted current densities in the brain of 6.3-13A/m2 that are over an order of magnitude above those produced by tDCS in humans. Using AC stimulation fewer AEs were reported compared to DC. In specific paradigms with amplitudes of up to 10mA, frequencies in the kHz range appear to be safe. In this paper we provide structured interviews and recommend their use in future controlled studies, in particular when trying to extend the parameters applied. We also discuss recent regulatory issues, reporting practices and ethical issues. These recommendations achieved consensus in a meeting, which took place in Göttingen, Germany, on September 6-7, 2016 and were refined thereafter by email correspondence.
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Affiliation(s)
- A Antal
- Department of Clinical Neurophysiology, University Medical Center Göttingen, Georg August University, Göttingen, Germany.
| | - I Alekseichuk
- Department of Clinical Neurophysiology, University Medical Center Göttingen, Georg August University, Göttingen, Germany
| | - M Bikson
- Department of Biomedical Engineering, The City College of New York, New York, USA
| | - J Brockmöller
- Department of Clinical Pharmacology, University Medical Center Goettingen, Germany
| | - A R Brunoni
- Service of Interdisciplinary Neuromodulation, Department and Institute of Psychiatry, Laboratory of Neurosciences (LIM-27) and Interdisciplinary Center for Applied Neuromodulation University Hospital, University of São Paulo, São Paulo, Brazil
| | - R Chen
- Division of Neurology, Department of Medicine, University of Toronto and Krembil Research Institute, Toronto, Ontario, Canada
| | - L G Cohen
- Human Cortical Physiology and Neurorehabilitation Section, National Institute of Neurological Disorders and Stroke NIH, Bethesda, USA
| | | | - J Ellrich
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark; Institute of Physiology and Pathophysiology, University of Erlangen-Nürnberg, Erlangen, Germany; EBS Technologies GmbH, Europarc Dreilinden, Germany
| | - A Flöel
- Universitätsmedizin Greifswald, Klinik und Poliklinik für Neurologie, Greifswald, Germany
| | - F Fregni
- Spaulding Neuromodulation Center, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA
| | - M S George
- Brain Stimulation Division, Medical University of South Carolina, and Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, USA
| | - R Hamilton
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA
| | - J Haueisen
- Institute of Biomedical Engineering and Informatics, Technische Universität Ilmenau, Germany
| | - C S Herrmann
- Experimental Psychology Lab, Department of Psychology, European Medical School, Carl von Ossietzky Universität, Oldenburg, Germany
| | - F C Hummel
- Defitech Chair of Clinical Neuroengineering, Centre of Neuroprosthetics (CNP) and Brain Mind Institute, Swiss Federal Institute of Technology (EPFL), Geneva, Switzerland; Defitech Chair of Clinical Neuroengineering, Clinique Romande de Réadaptation, Swiss Federal Institute of Technology (EPFL Valais), Sion, Switzerland
| | - J P Lefaucheur
- Department of Physiology, Henri Mondor Hospital, Assistance Publique - Hôpitaux de Paris, and EA 4391, Nerve Excitability and Therapeutic Team (ENT), Faculty of Medicine, Paris Est Créteil University, Créteil, France
| | - D Liebetanz
- Department of Clinical Neurophysiology, University Medical Center Göttingen, Georg August University, Göttingen, Germany
| | - C K Loo
- School of Psychiatry & Black Dog Institute, University of New South Wales, Sydney, Australia
| | - C D McCaig
- Institute of Medical Sciences, University of Aberdeen, Aberdeen, Scotland, UK
| | - C Miniussi
- Center for Mind/Brain Sciences CIMeC, University of Trento, Rovereto, Italy; Cognitive Neuroscience Section, IRCCS Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - P C Miranda
- Institute of Biophysics and Biomedical Engineering, Faculdade de Ciências, Universidade de Lisboa, Lisboa, Portugal
| | - V Moliadze
- Institute of Medical Psychology and Medical Sociology, University Hospital of Schleswig-Holstein (UKSH), Campus Kiel, Christian-Albrechts-University, Kiel, Germany
| | - M A Nitsche
- Department of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany; Department of Neurology, University Hospital Bergmannsheil, Bochum, Germany
| | - R Nowak
- Neuroelectrics, Barcelona, Spain
| | - F Padberg
- Department of Psychiatry and Psychotherapy, Munich Center for Brain Stimulation, Ludwig-Maximilian University Munich, Germany
| | - A Pascual-Leone
- Division of Cognitive Neurology, Harvard Medical Center and Berenson-Allen Center for Noninvasive Brain Stimulation at Beth Israel Deaconess Medical Center, Boston, USA
| | - W Poppendieck
- Department of Information Technology, Mannheim University of Applied Sciences, Mannheim, Germany
| | - A Priori
- Center for Neurotechnology and Experimental Brain Therapeutich, Department of Health Sciences, University of Milan Italy; Deparment of Clinical Neurology, University Hospital Asst Santi Paolo E Carlo, Milan, Italy
| | - S Rossi
- Department of Medicine, Surgery and Neuroscience, Human Physiology Section and Neurology and Clinical Neurophysiology Section, Brain Investigation & Neuromodulation Lab, University of Siena, Italy
| | - P M Rossini
- Area of Neuroscience, Institute of Neurology, University Clinic A. Gemelli, Catholic University, Rome, Italy
| | | | - M A Rueger
- Department of Neurology, University Hospital of Cologne, Germany
| | | | | | - H R Siebner
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark; Department of Neurology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
| | - Y Ugawa
- Department of Neurology, Fukushima Medical University, Fukushima, Japan; Fukushima Global Medical Science Center, Advanced Clinical Research Center, Fukushima Medical University, Japan
| | - A Wexler
- Department of Science, Technology & Society, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - U Ziemann
- Department of Neurology & Stroke, and Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - M Hallett
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD, USA
| | - W Paulus
- Department of Clinical Neurophysiology, University Medical Center Göttingen, Georg August University, Göttingen, Germany
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Promoting Sleep Oscillations and Their Functional Coupling by Transcranial Stimulation Enhances Memory Consolidation in Mild Cognitive Impairment. J Neurosci 2017. [PMID: 28637840 DOI: 10.1523/jneurosci.0260-17.2017] [Citation(s) in RCA: 148] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Alzheimer's disease (AD) not only involves loss of memory functions, but also prominent deterioration of sleep physiology, which is already evident at the stage of mild cognitive impairment (MCI). Cortical slow oscillations (SO; 0.5-1 Hz) and thalamocortical spindle activity (12-15 Hz) during sleep, and their temporal coordination, are considered critical for memory formation. We investigated the potential of slow oscillatory transcranial direct current stimulation (so-tDCS), applied during a daytime nap in a sleep-state-dependent manner, to modulate these activity patterns and sleep-related memory consolidation in nine male and seven female human patients with MCI. Stimulation significantly increased overall SO and spindle power, amplified spindle power during SO up-phases, and led to stronger synchronization between SO and spindle power fluctuations in EEG recordings. Moreover, visual declarative memory was improved by so-tDCS compared with sham stimulation and was associated with stronger synchronization. These findings indicate a well-tolerated therapeutic approach for disordered sleep physiology and memory deficits in MCI patients and advance our understanding of offline memory consolidation.SIGNIFICANCE STATEMENT In the light of increasing evidence that sleep disruption is crucially involved in the progression of Alzheimer's disease (AD), sleep appears as a promising treatment target in this pathology, particularly to counteract memory decline. This study demonstrates the potential of a noninvasive brain stimulation method during sleep in patients with mild cognitive impairment (MCI), a precursor of AD, and advances our understanding of its mechanism. We provide first time evidence that slow oscillatory transcranial stimulation amplifies the functional cross-frequency coupling between memory-relevant brain oscillations and improves visual memory consolidation in patients with MCI.
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Wilhelm I, Groch S, Preiss A, Walitza S, Huber R. Widespread reduction in sleep spindle activity in socially anxious children and adolescents. J Psychiatr Res 2017; 88:47-55. [PMID: 28086128 DOI: 10.1016/j.jpsychires.2016.12.018] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 12/21/2016] [Accepted: 12/22/2016] [Indexed: 11/19/2022]
Abstract
Social anxiety disorder (SAD) is one of the most prevalent psychiatric diseases typically emerging during childhood and adolescence. Biological vulnerabilities such as a protracted maturation of prefrontal cortex functioning together with heightened reactivity of the limbic system leading to increased emotional reactivity are discussed as factors contributing to the emergence and maintenance of SAD. Sleep slow wave activity (SWA, 0.75-4.5 Hz) and sleep spindle activity (9-16 Hz) reflect processes of brain maturation and emotion regulation. We used high-density electroencephalography to characterize sleep SWA and spindle activity and their relationship to emotional reactivity in children and adolescents suffering from SAD and healthy controls (HC). Subjectively rated arousal was assessed using an emotional picture-word association task. SWA did not differ between socially anxious and healthy participants. We found a widespread reduction in fast spindle activity (13-16 Hz) in SAD patients compared to HC. SAD patients rated negative stimuli to be more arousing and these arousal ratings were negatively correlated with fast spindle activity. These results suggest electrophysiological alterations that are evident at an early stage of psychopathology and that are closely linked to one core symptom of anxiety disorders such as increased emotional reactivity. The role of disturbed GABAergic neurotransmission is discussed as an underlying factor.
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Affiliation(s)
- Ines Wilhelm
- University Children's Hospital Zürich, Switzerland; Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zürich, Switzerland; Department of Experimental Psychopathology and Psychotherapy, University of Zürich, Switzerland
| | - Sabine Groch
- University Children's Hospital Zürich, Switzerland
| | - Andrea Preiss
- Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric Hospital, University of Zürich, Switzerland
| | - Susanne Walitza
- Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric Hospital, University of Zürich, Switzerland
| | - Reto Huber
- University Children's Hospital Zürich, Switzerland; Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric Hospital, University of Zürich, Switzerland.
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Saletin JM, Coon WG, Carskadon MA. Stage 2 Sleep EEG Sigma Activity and Motor Learning in Childhood ADHD: A Pilot Study. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2017; 46:188-197. [PMID: 27267670 PMCID: PMC5802965 DOI: 10.1080/15374416.2016.1157756] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Attention deficit hyperactivity disorder (ADHD) is associated with deficits in motor learning and sleep. In healthy adults, overnight improvements in motor skills are associated with sleep spindle activity in the sleep electroencephalogram (EEG). This association is poorly characterized in children, particularly in pediatric ADHD. Polysomnographic sleep was monitored in 7 children with ADHD and 14 typically developing controls. All children were trained on a validated motor sequence task (MST) in the evening with retesting the following morning. Analyses focused on MST precision (speed-accuracy trade-off). NREM Stage 2 sleep EEG power spectral analyses focused on spindle-frequency EEG activity in the sigma (12-15 Hz) band. The ADHD group demonstrated a selective decrease in power within the sigma band. Evening MST precision was lower in ADHD, yet no difference in performance was observed following sleep. Moreover, ADHD status moderated the association between slow sleep spindle activity (12-13.5 Hz) and overnight improvement; spindle-frequency EEG activity was positively associated with performance improvements in children with ADHD but not in controls. These data highlight the importance of sleep in supporting next-day behavior in ADHD while indicating that differences in sleep neurophysiology may contribute to deficits in this population.
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Affiliation(s)
- Jared M Saletin
- a Department of Psychiatry and Human Behavior , Alpert Medical School of Brown University
- b Sleep for Science Research Laboratory , E.P. Bradley Hospital
| | - William G Coon
- b Sleep for Science Research Laboratory , E.P. Bradley Hospital
- c National Center for Adaptive Neurotechnologies , New York State Department of Health
| | - Mary A Carskadon
- a Department of Psychiatry and Human Behavior , Alpert Medical School of Brown University
- b Sleep for Science Research Laboratory , E.P. Bradley Hospital
- d Centre for Sleep Research , University of South Australia
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Wiesner CD, Molzow I, Prehn-Kristensen A, Baving L. Sleep-Dependent Consolidation of Rewarded Behavior Is Diminished in Children with Attention Deficit Hyperactivity Disorder and a Comorbid Disorder of Social Behavior. Front Psychol 2017; 8:167. [PMID: 28228742 PMCID: PMC5296295 DOI: 10.3389/fpsyg.2017.00167] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 01/25/2017] [Indexed: 01/13/2023] Open
Abstract
Children suffering from attention-deficit hyperactivity disorder (ADHD) often also display impaired learning and memory. Previous research has documented aberrant reward processing in ADHD as well as impaired sleep-dependent consolidation of declarative memory. We investigated whether sleep also fosters the consolidation of behavior learned by probabilistic reward and whether ADHD patients with a comorbid disorder of social behavior show deficits in this memory domain, too. A group of 17 ADHD patients with comorbid disorders of social behavior aged 8–12 years and healthy controls matched for age, IQ, and handedness took part in the experiment. During the encoding task, children worked on a probabilistic learning task acquiring behavioral preferences for stimuli rewarded most often. After a 12-hr retention interval of either sleep at night or wakefulness during the day, a reversal task was presented where the contingencies were reversed. Consolidation of rewarded behavior is indicated by greater resistance to reversal learning. We found that healthy children consolidate rewarded behavior better during a night of sleep than during a day awake and that the sleep-dependent consolidation of rewarded behavior by trend correlates with non-REM sleep but not with REM sleep. In contrast, children with ADHD and comorbid disorders of social behavior do not show sleep-dependent consolidation of rewarded behavior. Moreover, their consolidation of rewarded behavior does not correlate with sleep. The results indicate that dysfunctional sleep in children suffering from ADHD and disorders of social behavior might be a crucial factor in the consolidation of behavior learned by reward.
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Affiliation(s)
- Christian D Wiesner
- Department of Child and Adolescent Psychiatry and Psychotherapy, School of Medicine, Christian Albrecht University Kiel, Germany
| | - Ina Molzow
- Department of Child and Adolescent Psychiatry and Psychotherapy, School of Medicine, Christian Albrecht University Kiel, Germany
| | - Alexander Prehn-Kristensen
- Department of Child and Adolescent Psychiatry and Psychotherapy, School of Medicine, Christian Albrecht University Kiel, Germany
| | - Lioba Baving
- Department of Child and Adolescent Psychiatry and Psychotherapy, School of Medicine, Christian Albrecht University Kiel, Germany
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Lee JC, Lewis CP, Daskalakis ZJ, Croarkin PE. Transcranial Direct Current Stimulation: Considerations for Research in Adolescent Depression. Front Psychiatry 2017; 8:91. [PMID: 28638351 PMCID: PMC5461263 DOI: 10.3389/fpsyt.2017.00091] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Adolescent depression is a prevalent disorder with substantial morbidity and mortality. Current treatment interventions do not target relevant pathophysiology and are frequently ineffective, thereby leading to a substantial burden for individuals, families, and society. During adolescence, the prefrontal cortex undergoes extensive structural and functional changes. Recent work suggests that frontolimbic development in depressed adolescents is delayed or aberrant. The judicious application of non-invasive brain stimulation techniques to the prefrontal cortex may present a promising opportunity for durable interventions in adolescent depression. Transcranial direct current stimulation (tDCS) applies a low-intensity, continuous current that alters cortical excitability. While this modality does not elicit action potentials, it is thought to manipulate neuronal activity and neuroplasticity. Specifically, tDCS may modulate N-methyl-d-aspartate receptors and L-type voltage-gated calcium channels and effect changes through long-term potentiation or long-term depression-like mechanisms. This mini-review considers the neurobiological rationale for developing tDCS protocols in adolescent depression, reviews existing work in adult mood disorders, surveys the existing tDCS literature in adolescent populations, reviews safety studies, and discusses distinct ethical considerations in work with adolescents.
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Affiliation(s)
- Jonathan C Lee
- Temerty Centre for Therapeutic Brain Intervention, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Faculty of Medicine, Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Charles P Lewis
- Mayo Clinic Depression Center, Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
| | - Zafiris J Daskalakis
- Temerty Centre for Therapeutic Brain Intervention, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Faculty of Medicine, Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Paul E Croarkin
- Mayo Clinic Depression Center, Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
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Campos-Beltrán D, Marshall L. Electric Stimulation to Improve Memory Consolidation During Sleep. COGNITIVE NEUROSCIENCE OF MEMORY CONSOLIDATION 2017. [DOI: 10.1007/978-3-319-45066-7_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Memory consolidation of socially relevant stimuli during sleep in healthy children and children with attention-deficit/hyperactivity disorder and oppositional defiant disorder: What you can see in their eyes. Biol Psychol 2016; 123:196-204. [PMID: 28049026 DOI: 10.1016/j.biopsycho.2016.12.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 11/08/2016] [Accepted: 12/29/2016] [Indexed: 11/22/2022]
Abstract
Children with attention-deficit/hyperactivity disorder (ADHD) display deficits in sleep-dependent memory consolidation, and being comorbid with oppositional defiant disorder (ODD), results in deficits in face processing. The aim of the present study was to investigate the role of sleep in recognizing faces in children with ADHD+ODD. Sixteen healthy children and 16 children diagnosed with ADHD+ODD participated in a sleep and a wake condition. During encoding (sleep condition at 8p.m.; wake condition at 8a.m.) pictures of faces were rated according to their emotional content; the retrieval session (12h after encoding session) contained a recognition task including pupillometry. Pupillometry and behavioral data revealed that healthy children benefited from sleep compared to wake with respect to face picture recognition; in contrast recognition performance in patients with ADHD+ODD was not improved after sleep compared to wake. It is discussed whether in patients with ADHD+ODD social stimuli are preferentially consolidated during daytime.
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Lunsford-Avery JR, Krystal AD, Kollins SH. Sleep disturbances in adolescents with ADHD: A systematic review and framework for future research. Clin Psychol Rev 2016; 50:159-174. [PMID: 27969004 DOI: 10.1016/j.cpr.2016.10.004] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 09/15/2016] [Accepted: 10/21/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND Biological mechanisms underlying symptom and prognostic heterogeneity in Attention-Deficit/Hyperactivity Disorder (ADHD) are unclear. Sleep impacts neurocognition and daytime functioning and is disrupted in ADHD, yet little is known about sleep in ADHD during adolescence, a period characterized by alterations in sleep, brain structure, and environmental demands as well as diverging ADHD trajectories. METHODS A systematic review identified studies published prior to August 2016 assessing sleep in adolescents (aged 10-19years) with ADHD or participating in population-based studies measuring ADHD symptoms. RESULTS Twenty-five studies were identified (19 subjective report, 6 using actigraphy/polysomnography). Findings are mixed but overall suggest associations between sleep disturbances and 1) ADHD symptoms in the population and 2) poorer clinical, neurocognitive, and functional outcomes among adolescents with ADHD. Common limitations of studies included small or non-representative samples, non-standardized sleep measures, and cross-sectional methodology. CONCLUSIONS Current data on sleep in adolescent ADHD are sparse and limited by methodological concerns. Future studies are critical for clarifying a potential role of sleep in contributing to heterogeneity of ADHD presentation and prognosis. Potential mechanisms by which sleep disturbances during adolescence may contribute to worsened symptom severity and persistence of ADHD into adulthood and an agenda to guide future research are discussed.
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Affiliation(s)
- Jessica R Lunsford-Avery
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, 2608 Erwin Road Suite 300, Durham, NC 27705, United States.
| | - Andrew D Krystal
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, 2608 Erwin Road Suite 300, Durham, NC 27705, United States; Departments of Psychiatry and Neurology, University of California San Francisco School of Medicine, 401 Parnassus Avenue, San Francisco, CA 94143, United States
| | - Scott H Kollins
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, 2608 Erwin Road Suite 300, Durham, NC 27705, United States
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Imaging transcranial direct current stimulation (tDCS) of the prefrontal cortex—correlation or causality in stimulation-mediated effects? Neurosci Biobehav Rev 2016; 69:333-56. [DOI: 10.1016/j.neubiorev.2016.08.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 06/30/2016] [Accepted: 08/01/2016] [Indexed: 02/03/2023]
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90
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Muszkat D, Polanczyk GV, Dias TGC, Brunoni AR. Transcranial Direct Current Stimulation in Child and Adolescent Psychiatry. J Child Adolesc Psychopharmacol 2016; 26:590-7. [PMID: 27027666 DOI: 10.1089/cap.2015.0172] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Transcranial direct current stimulation (tDCS) is a noninvasive brain stimulation technique that consists of applying a weak electric current over the scalp to modulate cortical excitability. tDCS has been extensively investigated in adults with psychiatric disorders. The aim of this study was to review the current literature regarding the use of tDCS in children and adolescents with psychiatric disorders. METHODS We searched MEDLINE and EMBASE databases for studies evaluating the safety and efficacy of tDCS in children and adolescents from age 0 to 18 years with psychiatric disorders. RESULTS We found six studies that evaluated patients with different psychiatric disorders, with diverse study designs and stimulation parameters, including three small randomized clinical trials (RCTs), one evaluating childhood-onset schizophrenia, one RCT with patients with autism spectrum disorders (ASD), and one study in attention-deficit/hyperactivity disorder (ADHD); three open-label studies, two evaluating patients with ASD, and one study of feasibility of the technique in children and adolescents with language disorders and diverse psychiatric disorders, including ASD, intellectual disability, and ADHD. We also found three studies of dosage considerations in the general pediatric population. The technique was well tolerated, with no reports of serious side effects. CONCLUSION Preliminary research suggests that tDCS may be well tolerated and safe for children and adolescents with psychiatric and neurodevelopmental disorders. Nevertheless, because the literature regarding tDCS in child and adolescent psychiatry is scarce and there exist limited numbers of randomized controlled trials, it is not possible to draw definite conclusions. Future studies should investigate the technique with regard to specific psychiatric conditions in comparison with standard treatments. In addition, long-term efficacy and safety should be monitored.
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Affiliation(s)
- Débora Muszkat
- 1 Department and Institute of Psychiatry, University of São Paulo , São Paulo, Brazil
| | - Guilherme Vanoni Polanczyk
- 1 Department and Institute of Psychiatry, University of São Paulo , São Paulo, Brazil .,2 National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq) , São Paulo, Brazil.,3 Research Center on Neurodevelopment and Mental Health, University of São Paulo , São Paulo, Brazil
| | - Taciana G Costa Dias
- 1 Department and Institute of Psychiatry, University of São Paulo , São Paulo, Brazil .,2 National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq) , São Paulo, Brazil.,3 Research Center on Neurodevelopment and Mental Health, University of São Paulo , São Paulo, Brazil
| | - André Russowsky Brunoni
- 1 Department and Institute of Psychiatry, University of São Paulo , São Paulo, Brazil .,4 Service of Interdisciplinary Neuromodulation, Laboratory of Neurosciences (LIM-27), University of São Paulo , São Paulo, Brazil
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91
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Mander BA, Winer JR, Jagust WJ, Walker MP. Sleep: A Novel Mechanistic Pathway, Biomarker, and Treatment Target in the Pathology of Alzheimer's Disease? Trends Neurosci 2016; 39:552-566. [PMID: 27325209 PMCID: PMC4967375 DOI: 10.1016/j.tins.2016.05.002] [Citation(s) in RCA: 290] [Impact Index Per Article: 36.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 04/13/2016] [Accepted: 05/10/2016] [Indexed: 12/16/2022]
Abstract
Sleep disruption appears to be a core component of Alzheimer's disease (AD) and its pathophysiology. Signature abnormalities of sleep emerge before clinical onset of AD. Moreover, insufficient sleep facilitates accumulation of amyloid-β (Aβ), potentially triggering earlier cognitive decline and conversion to AD. Building on such findings, this review has four goals: evaluating (i) associations and plausible mechanisms linking non-rapid-eye-movement (NREM) sleep disruption, Aβ, and AD; (ii) a role for NREM sleep disruption as a novel factor linking cortical Aβ to impaired hippocampus-dependent memory consolidation; (iii) the potential diagnostic utility of NREM sleep disruption as a new biomarker of AD; and (iv) the possibility of sleep as a new treatment target in aging, affording preventative and therapeutic benefits.
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Affiliation(s)
- Bryce A Mander
- Sleep and Neuroimaging Laboratory University of California, Berkeley, CA 94720-1650, USA.
| | - Joseph R Winer
- Sleep and Neuroimaging Laboratory University of California, Berkeley, CA 94720-1650, USA
| | - William J Jagust
- Helen Wills Neuroscience Institute, University of California, Berkeley, CA 94720-1650, USA; Molecular Biophysics and Bioimaging Division, Lawrence Berkeley National Laboratory, Berkeley, CA 94720, USA
| | - Matthew P Walker
- Sleep and Neuroimaging Laboratory University of California, Berkeley, CA 94720-1650, USA; Helen Wills Neuroscience Institute, University of California, Berkeley, CA 94720-1650, USA.
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92
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Ladenbauer J, Külzow N, Passmann S, Antonenko D, Grittner U, Tamm S, Flöel A. Brain stimulation during an afternoon nap boosts slow oscillatory activity and memory consolidation in older adults. Neuroimage 2016; 142:311-323. [PMID: 27381076 DOI: 10.1016/j.neuroimage.2016.06.057] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 05/28/2016] [Accepted: 06/30/2016] [Indexed: 10/21/2022] Open
Abstract
Sleep-related consolidation of declarative memories, as well as associated neurophysiological events such as slow oscillatory and spindle activity, deteriorate in the course of aging. This process is accelerated in neurodegenerative disease. Transcranial slow oscillatory stimulation (so-tDCS) during sleep has been shown to enhance slow oscillatory brain activity and thereby improve memory consolidation in young subjects. Here, we investigated whether so-tDCS applied to older adults during an afternoon nap exerts similar effects. Eighteen older human subjects were assessed using visuo-spatial (picture memory, primary, and location memory) and verbal memory tasks before and after a 90-min nap either comprising weak so-tDCS at 0.75Hz over fronto-central location or sham (no) stimulation in a within-subject design. Electroencephalographic activity was recorded throughout the naps and immediate effects of stimulation on brain activity were evaluated. Here, spectral power within three frequency bands of interest were computed, i.e., slow oscillatory activity, slow spindle and fast spindle activity; in 1-min stimulation-free intervals following 5 stimulation blocks. So-tDCS significantly increased frontal slow oscillatory activity as well as fast spindle activity, and significantly improved picture memory retention after sleep. Retention in the location memory subtask and in the verbal memory task was not affected. These findings may indicate a novel strategy to counteract cognitive decline in aging in a convenient manner during brief daytime naps.
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Affiliation(s)
- Julia Ladenbauer
- Department of Neurology, Charité Universitätsmedizin Berlin, 10117 Berlin, Germany; NeuroCure Cluster of Excellence, Charité Universitätsmedizin Berlin, 10117 Berlin, Germany.
| | - Nadine Külzow
- Department of Neurology, Charité Universitätsmedizin Berlin, 10117 Berlin, Germany; NeuroCure Cluster of Excellence, Charité Universitätsmedizin Berlin, 10117 Berlin, Germany.
| | - Sven Passmann
- Department of Neurology, Charité Universitätsmedizin Berlin, 10117 Berlin, Germany; NeuroCure Cluster of Excellence, Charité Universitätsmedizin Berlin, 10117 Berlin, Germany.
| | - Daria Antonenko
- Department of Neurology, Charité Universitätsmedizin Berlin, 10117 Berlin, Germany; NeuroCure Cluster of Excellence, Charité Universitätsmedizin Berlin, 10117 Berlin, Germany.
| | - Ulrike Grittner
- Biostatistics and Clinical Epidemiology, Charité Universitätsmedizin Berlin, 10117 Berlin, Germany.
| | - Sascha Tamm
- Department of Psychology, Freie Universität Berlin, 14195 Berlin, Germany.
| | - Agnes Flöel
- Department of Neurology, Charité Universitätsmedizin Berlin, 10117 Berlin, Germany; NeuroCure Cluster of Excellence, Charité Universitätsmedizin Berlin, 10117 Berlin, Germany.
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93
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Palm U, Segmiller FM, Epple AN, Freisleder FJ, Koutsouleris N, Schulte-Körne G, Padberg F. Transcranial direct current stimulation in children and adolescents: a comprehensive review. J Neural Transm (Vienna) 2016; 123:1219-34. [PMID: 27173384 DOI: 10.1007/s00702-016-1572-z] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 05/06/2016] [Indexed: 12/23/2022]
Abstract
Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation method that has shown promising results in various neuropsychiatric disorders in adults. This review addresses the therapeutic use of tDCS in children and adolescents including safety, ethical, and legal considerations. There are several studies addressing the dosage of tDCS in children and adolescents by computational modeling of electric fields in the pediatric brain. Results suggest halving the amperage used in adults to obtain the same peak electric fields, however, there are some studies reporting on the safe application of tDCS with standard adult parameters in children (2 mA; 20-30 min). There are several randomized placebo controlled trials suggesting beneficial effects of tDCS for the treatment of cerebral palsy. For dystonia there are mixed data. Some studies suggest efficacy of tDCS for the treatment of refractory epilepsy, and for the improvement of attention deficit/hyperactivity disorder and autism. Interestingly, there is a lack of data for the treatment of childhood and adolescent psychiatric disorders, i.e., childhood onset schizophrenia and affective disorders. Overall, tDCS seems to be safe in pediatric population. More studies are needed to confirm the preliminary encouraging results; however, ethical deliberation has to be weighed carefully for every single case.
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Affiliation(s)
- Ulrich Palm
- Department of Psychiatry and Psychotherapy, Klinikum der Universität München, Nußbaumstr. 7, 80336, Munich, Germany.
| | - Felix M Segmiller
- Department of Psychiatry and Psychotherapy, Klinikum der Universität München, Nußbaumstr. 7, 80336, Munich, Germany
| | | | | | - Nikolaos Koutsouleris
- Department of Psychiatry and Psychotherapy, Klinikum der Universität München, Nußbaumstr. 7, 80336, Munich, Germany
| | - Gerd Schulte-Körne
- Department of Childhood and Adolescent Psychiatry, Klinikum der Universität München, Munich, Germany
| | - Frank Padberg
- Department of Psychiatry and Psychotherapy, Klinikum der Universität München, Nußbaumstr. 7, 80336, Munich, Germany
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94
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Rubio B, Boes AD, Laganiere S, Rotenberg A, Jeurissen D, Pascual-Leone A. Noninvasive Brain Stimulation in Pediatric Attention-Deficit Hyperactivity Disorder (ADHD): A Review. J Child Neurol 2016; 31:784-96. [PMID: 26661481 PMCID: PMC4833526 DOI: 10.1177/0883073815615672] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 07/10/2015] [Indexed: 01/08/2023]
Abstract
Attention-deficit hyperactivity disorder (ADHD) is one of the most prevalent neurodevelopmental disorders in the pediatric population. The clinical management of ADHD is currently limited by a lack of reliable diagnostic biomarkers and inadequate therapy for a minority of patients who do not respond to standard pharmacotherapy. There is optimism that noninvasive brain stimulation may help to address these limitations. Transcranial magnetic stimulation and transcranial direct current stimulation are 2 methods of noninvasive brain stimulation that modulate cortical excitability and brain network activity. Transcranial magnetic stimulation can be used diagnostically to probe cortical neurophysiology, whereas daily use of repetitive transcranial magnetic stimulation or transcranial direct current stimulation can induce long-lasting and potentially therapeutic changes in targeted networks. In this review, we highlight research showing the potential diagnostic and therapeutic applications of transcranial magnetic stimulation and transcranial direct current stimulation in pediatric ADHD. We also discuss the safety and ethics of using these tools in the pediatric population.
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Affiliation(s)
- Belen Rubio
- Child and Adolescent Psychiatry Department, Hospital Universitario de Canarias, La Laguna, Tenerife, Spain Both are co-primary authors
| | - Aaron D Boes
- Berenson-Allen Center for Noninvasive Brain Stimulation, Division of Cognitive Neurology, Department of Neurology, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, MA, USA Harvard Medical School, Department of Pediatric Neurology, Massachusetts General Hospital, Boston, MA, USA Both are co-primary authors.
| | - Simon Laganiere
- Berenson-Allen Center for Noninvasive Brain Stimulation, Division of Cognitive Neurology, Department of Neurology, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Alexander Rotenberg
- Berenson-Allen Center for Noninvasive Brain Stimulation, Division of Cognitive Neurology, Department of Neurology, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, MA, USA Pediatric Neuromodulation Program, Division of Epilepsy and Neurophysiology, Department of Neurology, Children's Hospital Boston, Harvard Medical School, Boston, MA, USA
| | - Danique Jeurissen
- Berenson-Allen Center for Noninvasive Brain Stimulation, Division of Cognitive Neurology, Department of Neurology, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, MA, USA Department of Vision and Cognition, Netherlands Institute for Neuroscience, Royal Netherlands Academy of Arts and Sciences, Amsterdam, The Netherlands
| | - Alvaro Pascual-Leone
- Berenson-Allen Center for Noninvasive Brain Stimulation, Division of Cognitive Neurology, Department of Neurology, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, MA, USA
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95
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Um YH, Jeong JH, Hong SC, Kim TW, Lim HK, Seo HJ, Han JH. Association between sleep parameters and cognitive function in drug-naïve children with attention-deficit hyperactivity disorder: a polysomnographic study. Sleep Med 2016; 21:165-70. [DOI: 10.1016/j.sleep.2015.11.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 10/19/2015] [Accepted: 11/14/2015] [Indexed: 12/01/2022]
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96
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Breitling C, Zaehle T, Dannhauer M, Bonath B, Tegelbeckers J, Flechtner HH, Krauel K. Improving Interference Control in ADHD Patients with Transcranial Direct Current Stimulation (tDCS). Front Cell Neurosci 2016; 10:72. [PMID: 27147964 PMCID: PMC4834583 DOI: 10.3389/fncel.2016.00072] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 03/07/2016] [Indexed: 12/21/2022] Open
Abstract
The use of transcranial direct current stimulation (tDCS) in patients with attention deficit hyperactivity disorder (ADHD) has been suggested as a promising alternative to psychopharmacological treatment approaches due to its local and network effects on brain activation. In the current study, we investigated the impact of tDCS over the right inferior frontal gyrus (rIFG) on interference control in 21 male adolescents with ADHD and 21 age matched healthy controls aged 13–17 years, who underwent three separate sessions of tDCS (anodal, cathodal, and sham) while completing a Flanker task. Even though anodal stimulation appeared to diminish commission errors in the ADHD group, the overall analysis revealed no significant effect of tDCS. Since participants showed a considerable learning effect from the first to the second session, performance in the first session was separately analyzed. ADHD patients receiving sham stimulation in the first session showed impaired interference control compared to healthy control participants whereas ADHD patients who were exposed to anodal stimulation, showed comparable performance levels (commission errors, reaction time variability) to the control group. These results suggest that anodal tDCS of the right inferior frontal gyrus could improve interference control in patients with ADHD.
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Affiliation(s)
- Carolin Breitling
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Magdeburg Magdeburg, Germany
| | - Tino Zaehle
- Department of Neurology, University of Magdeburg Magdeburg, Germany
| | - Moritz Dannhauer
- Scientific Computing and Imaging Institute, Center for Integrated Biomedical Computing, University of Utah Salt Lake City, UT, USA
| | - Björn Bonath
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Magdeburg Magdeburg, Germany
| | - Jana Tegelbeckers
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Magdeburg Magdeburg, Germany
| | - Hans-Henning Flechtner
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Magdeburg Magdeburg, Germany
| | - Kerstin Krauel
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of MagdeburgMagdeburg, Germany; Center for Behavioral Brain Sciences, University of MagdeburgMagdeburg, Germany
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97
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Mouthon AL, van Hedel HJA, Meyer-Heim A, Kurth S, Ringli M, Pugin F, Huber R. High-density electroencephalographic recordings during sleep in children with disorders of consciousness. NEUROIMAGE-CLINICAL 2016; 11:468-475. [PMID: 27104141 PMCID: PMC4827803 DOI: 10.1016/j.nicl.2016.03.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 02/17/2016] [Accepted: 03/17/2016] [Indexed: 11/20/2022]
Abstract
Introduction A large number of studies have investigated neural correlates of consciousness in adults. However, knowledge about brain function in children with disorders of consciousness (DOC) is very limited. We suggest that EEG recordings during sleep are a promising approach. In healthy adults as well as in children, it has been shown that the activity of sleep slow waves (EEG spectral power 1–4.5 Hz), the primary characteristic of deep sleep, is dependent on use during previous wakefulness. Thus the regulation of slow wave activity (SWA) provides indirect insights into brain function during wakefulness. Methods In the present study, we investigated high-density EEG recordings during sleep in ten healthy children and in ten children with acquired brain injury, including five children with DOC and five children with acquired brain injury without DOC. We used the build-up of SWA to quantify SWA regulation. Results Children with DOC showed a global reduction in the SWA build-up when compared to both, healthy children and children with acquired brain injury without DOC. This reduction was most pronounced over parietal brain areas. Comparisons within the group of children with DOC revealed that the parietal SWA build-up was the lowest in patients showing poor outcome. Longitudinal measurements during the recovery period showed an increase in parietal SWA build-up from the first to the second sleep recording. Conclusions Our results suggest that the reduced parietal SWA regulation may represent a characteristic topographical marker for brain network dysfunction in children with DOC. In the future, the regulation of SWA might be used as a complementary assessment in adult and paediatric patients with DOC. Longitudinal high-density EEG recording in children with disorders of consciousness Sleep electrophysiology provides a marker for brain network dysfunction. The sleep EEG might be used as a complementary assessment in paediatric patients.
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Affiliation(s)
- Anne-Laure Mouthon
- Child Development Centre and Paediatric Sleep Disorders Centre, University Children's Hospital Zurich, Switzerland; Rehabilitation Centre Affoltern am Albis, University Children's Hospital Zurich, Switzerland; Children's Research Centre, University Children's Hospital Zurich, Switzerland
| | - Hubertus J A van Hedel
- Rehabilitation Centre Affoltern am Albis, University Children's Hospital Zurich, Switzerland; Children's Research Centre, University Children's Hospital Zurich, Switzerland
| | - Andreas Meyer-Heim
- Rehabilitation Centre Affoltern am Albis, University Children's Hospital Zurich, Switzerland; Children's Research Centre, University Children's Hospital Zurich, Switzerland
| | - Salome Kurth
- Child Development Centre and Paediatric Sleep Disorders Centre, University Children's Hospital Zurich, Switzerland; Children's Research Centre, University Children's Hospital Zurich, Switzerland; Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO, USA
| | - Maya Ringli
- Child Development Centre and Paediatric Sleep Disorders Centre, University Children's Hospital Zurich, Switzerland; Children's Research Centre, University Children's Hospital Zurich, Switzerland
| | - Fiona Pugin
- Child Development Centre and Paediatric Sleep Disorders Centre, University Children's Hospital Zurich, Switzerland; Children's Research Centre, University Children's Hospital Zurich, Switzerland
| | - Reto Huber
- Child Development Centre and Paediatric Sleep Disorders Centre, University Children's Hospital Zurich, Switzerland; Children's Research Centre, University Children's Hospital Zurich, Switzerland; University Clinics for Child and Adolescent Psychiatry, University of Zurich, Switzerland.
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98
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Abstract
PURPOSE OF REVIEW Sleep disorders in individuals with developmental difficulties continue to be a significant challenge for families, carers, and therapists with a major impact on individuals and carers alike. This review is designed to update the reader on recent developments in this area. RECENT FINDINGS A systematic search identified a variety of studies illustrating advances in the regulation of circadian rhythm and sleep disturbance in neurodevelopmental disorders. Specific advances are likely to lead in some disorders to targeted therapies. There is strong evidence that behavioural and sleep hygiene measures should be first line therapy; however, studies are still limited in this area. Nonpharmacological measures such as exercise, sensory interventions, and behavioural are reported. Behavioural regulation and sleep hygiene demonstrate the best evidence for improved sleep parameters in individuals with neurodisability. SUMMARY Although the mainstay of management of children with sleep problems and neurodevelopmental disability is similar to that of typically developing children, there is emerging evidence of behavioural strategies being successful in large-scale trials and the promise of more targeted therapies for more specific resistant disorders.
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99
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Barham MP, Enticott PG, Conduit R, Lum JAG. Transcranial electrical stimulation during sleep enhances declarative (but not procedural) memory consolidation: Evidence from a meta-analysis. Neurosci Biobehav Rev 2016; 63:65-77. [PMID: 26828569 DOI: 10.1016/j.neubiorev.2016.01.009] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 01/21/2016] [Accepted: 01/26/2016] [Indexed: 11/16/2022]
Abstract
This meta-analysis summarizes research examining whether transcranial electrical stimulation (transcranial direct current stimulation with oscillating and constant currents; transcranial alternating current stimulation), administered during sleep, can modulate declarative and procedural memory consolidation. Included in the meta-analysis were 13 experiments that represented data from 179 participants. Study findings were summarized using standardized mean difference (SMD) which is an effect size that summarizes differences in standard deviation units. Results showed electrical stimulation during sleep could enhance (SMD=0.447; p=.003) or disrupt (SMD=-0.476, p=.030) declarative memory consolidation. However, transcranial electric stimulation does not appear to be able to enhance (SMD=0.154, p=.279) or disrupt (SMD=0.076, p=.675) procedural memory consolidation. This meta-analysis provides strong evidence that TES is able to modulate some consolidation processes. Additional research is required to determine the mechanisms by which transcranial electrical stimulation is able to influence declarative memory consolidation. Finally, it is yet to be determined whether transcranial electrical stimulation can modulate procedural memory consolidation.
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Affiliation(s)
- Michael P Barham
- Cognitive Neuroscience Unit, School of Psychology, Deakin University, Australia
| | - Peter G Enticott
- Cognitive Neuroscience Unit, School of Psychology, Deakin University, Australia
| | - Russell Conduit
- School of Health and Biomedical Sciences, Royal Melbourne Institute of Technology, Australia
| | - Jarrad A G Lum
- Cognitive Neuroscience Unit, School of Psychology, Deakin University, Australia.
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100
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Pérez C, Leite J, Carvalho S, Fregni F. Transcranial Electrical Stimulation (tES) for the Treatment of Neuropsychiatric Disorders Across Lifespan. EUROPEAN PSYCHOLOGIST 2016. [DOI: 10.1027/1016-9040/a000252] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Abstract. Transcranial electrical stimulation (tES) is a safe, painless, and inexpensive noninvasive brain stimulation (NIBS) technique. tES has been shown to reduce symptoms in a variety of neuropsychiatric conditions such as depression, schizophrenia, anxiety, autism, and craving. There are many factors that can influence the effects of tES, such as current intensity, duration, baseline level of activity, gender, and age. Age is a critical variable, since the human brain undergoes several anatomic and functional changes across the lifespan. Therefore, tES-induced effects may not be the same across the lifespan. In this review we summarize the effects of tES, including tDCS, tACS, and tRNS, on clinical outcomes in several neuropsychiatric conditions, using a framework in which studies are organized according to the age of subjects. The use of tES in neuropsychiatric disorders has yielded promising results with mild, if any, adverse effects. Most of the published studies with tES have been conducted with tDCS in adult population. Future studies should focus on interventions guided by surrogate outcomes of neuroplasticity. A better understanding of neuroplasticity across the lifespan will help optimize current tES stimulation parameters, especially for use with children and elderly populations.
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Affiliation(s)
- Carolina Pérez
- Spaulding Neuromodulation Center, Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jorge Leite
- Spaulding Neuromodulation Center, Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Neuropsychophysiology Laboratory, CIPsi, School of Psychology (EPsi), University of Minho, Braga, Portugal
| | - Sandra Carvalho
- Spaulding Neuromodulation Center, Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Neuropsychophysiology Laboratory, CIPsi, School of Psychology (EPsi), University of Minho, Braga, Portugal
| | - Felipe Fregni
- Spaulding Neuromodulation Center, Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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