101
|
Narita Z, Noda T, Setoyama S, Sueyoshi K, Inagawa T, Sumiyoshi T. The effect of transcranial direct current stimulation on psychotic symptoms of schizophrenia is associated with oxy-hemoglobin concentrations in the brain as measured by near-infrared spectroscopy: A pilot study. J Psychiatr Res 2018; 103:5-9. [PMID: 29754106 DOI: 10.1016/j.jpsychires.2018.05.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 03/29/2018] [Accepted: 05/05/2018] [Indexed: 11/20/2022]
Abstract
Transcranial direct current stimulation (tDCS) has been shown to be effective in treating some of the symptoms of schizophrenia. In the current study, we sought to determine whether oxy-hemoglobin ([oxy-Hb]), measured by near-infrared spectroscopy (NIRS), is associated with effects of transcranial direct current stimulation (tDCS) on psychotic symptoms of schizophrenia. Twenty-six patients underwent tDCS (2 mA × 20 min) two times per day for five consecutive days. The anodal electrode was placed over the left dorsolateral prefrontal cortex while the cathodal electrode was placed over the right supraorbital region. One month after the last administration of tDCS, positive, but not negative symptoms, evaluated by the Positive and Negative Syndrome Scale (PANSS), were significantly improved. At baseline, regional [oxy-Hb] concentrations in the brain were measured by a 52-channel NIRS instrument. Significant negative correlation was demonstrated between [oxy-Hb] concentrations of left temporoparietal regions throughout verbal fluency tasks vs. changes of PANSS Positive and Negative subscale scores. This is the first study to demonstrate the correlation between the response of neural activity to cognitive tasks at baseline and the ability of tDCS to improve positive and negative psychotic symptoms. Our observations suggest that NIRS provides a marker to predict the response to treatment with tDCS in schizophrenia.
Collapse
Affiliation(s)
- Zui Narita
- Department of Psychiatry, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan.
| | - Takamasa Noda
- Department of Psychiatry, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - Shiori Setoyama
- Department of Psychiatry, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - Kazuki Sueyoshi
- Department of Clinical Epidemiology, Translational Medical Center, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - Takuma Inagawa
- Department of Psychiatry, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - Tomiki Sumiyoshi
- Department of Clinical Epidemiology, Translational Medical Center, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| |
Collapse
|
102
|
Baeken C, Dedoncker J, Remue J, Wu GR, Vanderhasselt MA, De Witte S, Poppa T, Hooley JM, De Raedt R. One MRI-compatible tDCS session attenuates ventromedial cortical perfusion when exposed to verbal criticism: The role of perceived criticism. Hum Brain Mapp 2018; 39:4462-4470. [PMID: 29956424 DOI: 10.1002/hbm.24285] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 05/16/2018] [Accepted: 06/03/2018] [Indexed: 12/30/2022] Open
Abstract
Transcranial direct current stimulation (tDCS) is a potential treatment strategy for mood and anxiety disorders, but how this application may influence emotional processes, and whether this is related to individual characteristics, is not well understood. It has been proposed that perceived criticism (PC) may represent a vulnerability factor for the development of such mental illnesses. To decipher whether neural mechanisms of action of tDCS potentially differ depending on PC status (low vs. high), we evaluated mood and brain perfusion before and after applying MRI-compatible tDCS, and after participants were exposed to verbal criticism in the scanner. Experimental design 30 healthy nondepressed females were included in a sham-controlled crossover MRI-compatible tDCS study. Brain perfusion was measured by means of arterial spin labeling (ASL) before and after tDCS applied to the left dorsolateral prefrontal cortex (DLPFC), and after hearing criticism. Before the experiment, all participants provided a rating of PC in their closest environment. Principal observations at the behavioral level, criticism made participants angrier. This was unrelated to the active or sham stimulation. After being criticized, females scoring high on PC had significantly decreased brain perfusion in the pregenual anterior cingulate cortex (pgACC) and medioprefrontal cortex (mPFC), after active tDCS but not sham. The decrease in pgACC/mPFC perfusion points to a significant impact of tDCS in brain areas related to stress responses and self-referential processes, especially in females scoring high on PC, which has been shown to be related to vulnerability for mood and anxiety disorders.
Collapse
Affiliation(s)
- Chris Baeken
- Department of Psychiatry and Medical Psychology, Ghent University Hospital, Ghent University, Ghent, Belgium.,Department of Psychiatry, University Hospital UZBrussel, Brussels, Belgium.,Ghent Experimental Psychiatry (GHEP) Lab, Ghent, Belgium
| | - Josefien Dedoncker
- Department of Psychiatry and Medical Psychology, Ghent University Hospital, Ghent University, Ghent, Belgium.,Ghent Experimental Psychiatry (GHEP) Lab, Ghent, Belgium
| | - Jonathan Remue
- Department of Psychiatry and Medical Psychology, Ghent University Hospital, Ghent University, Ghent, Belgium.,Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Guo-Rong Wu
- Key Laboratory of Cognition and Personality, Faculty of Psychology, Southwest University, Chongqing, China
| | - Marie-Anne Vanderhasselt
- Department of Psychiatry and Medical Psychology, Ghent University Hospital, Ghent University, Ghent, Belgium.,Ghent Experimental Psychiatry (GHEP) Lab, Ghent, Belgium.,Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Sara De Witte
- Department of Psychiatry and Medical Psychology, Ghent University Hospital, Ghent University, Ghent, Belgium.,Ghent Experimental Psychiatry (GHEP) Lab, Ghent, Belgium
| | - Tasha Poppa
- Department of Psychology, University of Southern California, Los Angeles, California
| | - Jill M Hooley
- Department of Psychology, Harvard University, Cambridge, Massachusetts
| | - Rudi De Raedt
- Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
| |
Collapse
|
103
|
Cancel LM, Arias K, Bikson M, Tarbell JM. Direct current stimulation of endothelial monolayers induces a transient and reversible increase in transport due to the electroosmotic effect. Sci Rep 2018; 8:9265. [PMID: 29915178 PMCID: PMC6006334 DOI: 10.1038/s41598-018-27524-9] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 05/29/2018] [Indexed: 12/25/2022] Open
Abstract
We investigated the effects of direct current stimulation (DCS) on fluid and solute transport across endothelial cell (EC) monolayers in vitro. Our motivation was transcranial direct current stimulation (tDCS) that has been investigated for treatment of neuropsychiatric disorders, to enhance neurorehabilitation, and to change cognition in healthy subjects. The mechanisms underlying this diversity of applications remain under investigation. To address the possible role of blood-brain barrier (BBB) changes during tDCS, we applied direct current to cultured EC monolayers in a specially designed chamber that generated spatially uniform direct current. DCS induced fluid and solute movement across EC layers that persisted only for the duration of the stimulation suggesting an electroosmosis mechanism. The direction of induced transport reversed with DCS polarity - a hallmark of the electroosmotic effect. The magnitude of DCS-induced flow was linearly correlated to the magnitude of the applied current. A mathematical model based on a two-pore description of the endothelial transport barrier and a Helmholtz model of the electrical double layer describes the experimental data accurately and predicts enhanced significance of this mechanism in less permeable monolayers. This study demonstrates that DCS transiently alters the transport function of the BBB suggesting a new adjunct mechanism of tDCS.
Collapse
Affiliation(s)
- Limary M Cancel
- Department of Biomedical Engineering, The City College of New York, New York, USA
| | - Katherin Arias
- Department of Biomedical Engineering, The City College of New York, New York, USA
| | - Marom Bikson
- Department of Biomedical Engineering, The City College of New York, New York, USA
| | - John M Tarbell
- Department of Biomedical Engineering, The City College of New York, New York, USA.
| |
Collapse
|
104
|
Gomes-Osman J, Indahlastari A, Fried PJ, Cabral DLF, Rice J, Nissim NR, Aksu S, McLaren ME, Woods AJ. Non-invasive Brain Stimulation: Probing Intracortical Circuits and Improving Cognition in the Aging Brain. Front Aging Neurosci 2018; 10:177. [PMID: 29950986 PMCID: PMC6008650 DOI: 10.3389/fnagi.2018.00177] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 05/22/2018] [Indexed: 12/14/2022] Open
Abstract
The impact of cognitive aging on brain function and structure is complex, and the relationship between aging-related structural changes and cognitive function are not fully understood. Physiological and pathological changes to the aging brain are highly variable, making it difficult to estimate a cognitive trajectory with which to monitor the conversion to cognitive decline. Beyond the information on the structural and functional consequences of cognitive aging gained from brain imaging and neuropsychological studies, non-invasive brain stimulation techniques such as transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS) can enable stimulation of the human brain in vivo, offering useful insights into the functional integrity of intracortical circuits using electrophysiology and neuromodulation. TMS measurements can be used to identify and monitor changes in cortical reactivity, the integrity of inhibitory and excitatory intracortical circuits, the mechanisms of long-term potentiation (LTP)/depression-like plasticity and central cholinergic function. Repetitive TMS and tDCS can be used to modulate neuronal excitability and enhance cortical function, and thus offer a potential means to slow or reverse cognitive decline. This review will summarize and critically appraise relevant literature regarding the use of TMS and tDCS to probe cortical areas affected by the aging brain, and as potential therapeutic tools to improve cognitive function in the aging population. Challenges arising from intra-individual differences, limited reproducibility, and methodological differences will be discussed.
Collapse
Affiliation(s)
- Joyce Gomes-Osman
- Department of Physical Therapy, University of Miami Miller School of Medicine, Miami, FL, United States
- Evelyn F. McKnight Brain Institute, University of Miami Miller School of Medicine, Miami, FL, United States
- Berenson-Allen Center for Noninvasive Brain Stimulation, Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Aprinda Indahlastari
- Department of Clinical and Health Psychology, Department of Neuroscience, Center for Cognitive Aging and Memory, McKnight Brain Institute, University of Florida, Gainesville, FL, United States
| | - Peter J. Fried
- Berenson-Allen Center for Noninvasive Brain Stimulation, Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Danylo L. F. Cabral
- Department of Physical Therapy, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Jordyn Rice
- Department of Physical Therapy, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Nicole R. Nissim
- Department of Clinical and Health Psychology, Department of Neuroscience, Center for Cognitive Aging and Memory, McKnight Brain Institute, University of Florida, Gainesville, FL, United States
| | - Serkan Aksu
- Department of Clinical and Health Psychology, Department of Neuroscience, Center for Cognitive Aging and Memory, McKnight Brain Institute, University of Florida, Gainesville, FL, United States
| | - Molly E. McLaren
- Department of Clinical and Health Psychology, Department of Neuroscience, Center for Cognitive Aging and Memory, McKnight Brain Institute, University of Florida, Gainesville, FL, United States
| | - Adam J. Woods
- Department of Clinical and Health Psychology, Department of Neuroscience, Center for Cognitive Aging and Memory, McKnight Brain Institute, University of Florida, Gainesville, FL, United States
| |
Collapse
|
105
|
Ong WY, Stohler CS, Herr DR. Role of the Prefrontal Cortex in Pain Processing. Mol Neurobiol 2018; 56:1137-1166. [PMID: 29876878 PMCID: PMC6400876 DOI: 10.1007/s12035-018-1130-9] [Citation(s) in RCA: 347] [Impact Index Per Article: 57.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 05/14/2018] [Indexed: 12/16/2022]
Abstract
The prefrontal cortex (PFC) is not only important in executive functions, but also pain processing. The latter is dependent on its connections to other areas of the cerebral neocortex, hippocampus, periaqueductal gray (PAG), thalamus, amygdala, and basal nuclei. Changes in neurotransmitters, gene expression, glial cells, and neuroinflammation occur in the PFC during acute and chronic pain, that result in alterations to its structure, activity, and connectivity. The medial PFC (mPFC) could serve dual, opposing roles in pain: (1) it mediates antinociceptive effects, due to its connections with other cortical areas, and as the main source of cortical afferents to the PAG for modulation of pain. This is a ‘loop’ where, on one side, a sensory stimulus is transformed into a perceptual signal through high brain processing activity, and perceptual activity is then utilized to control the flow of afferent sensory stimuli at their entrance (dorsal horn) to the CNS. (2) It could induce pain chronification via its corticostriatal projection, possibly depending on the level of dopamine receptor activation (or lack of) in the ventral tegmental area-nucleus accumbens reward pathway. The PFC is involved in biopsychosocial pain management. This includes repetitive transcranial magnetic stimulation, transcranial direct current stimulation, antidepressants, acupuncture, cognitive behavioral therapy, mindfulness, music, exercise, partner support, empathy, meditation, and prayer. Studies demonstrate the role of the PFC during placebo analgesia, and in establishing links between pain and depression, anxiety, and loss of cognition. In particular, losses in PFC grey matter are often reversible after successful treatment of chronic pain.
Collapse
Affiliation(s)
- Wei-Yi Ong
- Department of Anatomy, National University of Singapore, Singapore, 119260, Singapore.
- Neurobiology and Ageing Research Programme, National University of Singapore, Singapore, 119260, Singapore.
| | | | - Deron R Herr
- Department of Pharmacology, National University of Singapore, Singapore, 119260, Singapore.
| |
Collapse
|
106
|
Riggs A, Patel V, Paneri B, Portenoy RK, Bikson M, Knotkova H. At-Home Transcranial Direct Current Stimulation (tDCS) With Telehealth Support for Symptom Control in Chronically-Ill Patients With Multiple Symptoms. Front Behav Neurosci 2018; 12:93. [PMID: 29872381 PMCID: PMC5972211 DOI: 10.3389/fnbeh.2018.00093] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 04/23/2018] [Indexed: 11/13/2022] Open
Abstract
Transcranial direct current stimulation (tDCS) delivered in multiple sessions can reduce symptom burden, but access of chronically ill patients to tDCS studies is constrained by the burden of office-based tDCS administration. Expanded access to this therapy can be accomplished through the development of interventions that allow at-home tDCS applications. Objective: We describe the development and initial feasibility assessment of a novel intervention for the chronically ill that combines at-home tDCS with telehealth support. Methods: In the developmental phase, the tDCS procedure was adjusted for easy application by patients or their informal caregivers at home, and a tDCS protocol with specific elements for enhanced safety and remote adherence monitoring was created. Lay language instructional materials were written and revised based on expert feedback. The materials were loaded onto a tablet allowing for secure video-conferencing. The telehealth tablet was paired with an at-home tDCS device that allowed for remote dose control via electronic codes dispensed to patients prior to each session. tDCS was delivered in two phases: once daily on 10 consecutive days, followed by an as needed regimen for 20 days. Initial feasibility of this tDCS-telehealth system was evaluated in four patients with advanced chronic illness and multiple symptoms. Change in symptom burden and patient satisfaction were assessed with the Condensed Memorial Symptom Assessment Scale (CMSAS) and a tDCS user survey. Results: The telehealth-tDCS protocol includes one home visit and has seven patient-tailored elements and six elements enhancing safety monitoring. Replicable electrode placement at home without 10–20 EEG measurement is achieved via a headband that holds electrodes in a pre-determined position. There were no difficulties with patients’ training, protocol adherence, or tolerability. A total of 60 tDCS sessions were applied. No session required discontinuation, and there were no adverse events. Data collection was feasible and there were no missing data. Satisfaction with the tDCS-telehealth procedure was high and the patients were comfortable using the system. Conclusion: At-home tDCS with telehealth support appears to be a feasible approach for the management of symptom burden in patients with chronic illness. Further studies to evaluate and optimize the protocol effectiveness for symptom-control outcomes are warranted.
Collapse
Affiliation(s)
- Alexa Riggs
- MJHS Institute for Innovation in Palliative Care, New York, NY, United States
| | - Vaishali Patel
- MJHS Institute for Innovation in Palliative Care, New York, NY, United States
| | - Bhaskar Paneri
- Department of Biomedical Engineering, Grove School of Engineering, The City College of New York, New York, NY, United States
| | - Russell K Portenoy
- MJHS Institute for Innovation in Palliative Care, New York, NY, United States.,MJHS Hospice and Palliative Care, New York, NY, United States.,Department of Family and Social Medicine, Albert Einstein College of Medicine, New York, NY, United States.,The Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, New York, NY, United States
| | - Marom Bikson
- Department of Biomedical Engineering, Grove School of Engineering, The City College of New York, New York, NY, United States
| | - Helena Knotkova
- MJHS Institute for Innovation in Palliative Care, New York, NY, United States.,Department of Family and Social Medicine, Albert Einstein College of Medicine, New York, NY, United States
| |
Collapse
|
107
|
Varoli E, Pisoni A, Mattavelli GC, Vergallito A, Gallucci A, Mauro LD, Rosanova M, Bolognini N, Vallar G, Romero Lauro LJ. Tracking the Effect of Cathodal Transcranial Direct Current Stimulation on Cortical Excitability and Connectivity by Means of TMS-EEG. Front Neurosci 2018; 12:319. [PMID: 29867330 PMCID: PMC5962888 DOI: 10.3389/fnins.2018.00319] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 04/24/2018] [Indexed: 12/23/2022] Open
Abstract
Transcranial direct current stimulation (tDCS) is increasingly used in both research and therapeutic settings, but its precise mechanisms remain largely unknown. At a neuronal level, tDCS modulates cortical excitability by shifting the resting membrane potential in a polarity-dependent way: anodal stimulation increases the spontaneous firing rate, while cathodal decreases it. However, the neurophysiological underpinnings of anodal/cathodal tDCS seem to be different, as well as their behavioral effect, in particular when high order areas are involved, compared to when motor or sensory brain areas are targeted. Previously, we investigated the effect of anodal tDCS on cortical excitability, by means of a combination of Transcranial Magnetic Stimulation (TMS) and Electroencephalography (EEG). Results showed a diffuse rise of cortical excitability in a bilateral fronto-parietal network. In the present study, we tested, with the same paradigm, the effect of cathodal tDCS. Single pulse TMS was delivered over the left posterior parietal cortex (PPC), before, during, and after 10 min of cathodal or sham tDCS over the right PPC, while recording HD-EEG. Indexes of global and local cortical excitability were obtained both at sensors and cortical sources level. At sensors, global and local mean field power (GMFP and LMFP) were computed for three temporal windows (0-50, 50-100, and 100-150 ms), on all channels (GMFP), and in four different clusters of electrodes (LMFP, left and right, in frontal and parietal regions). After source reconstruction, Significant Current Density was computed at the global level, and for four Broadmann's areas (left/right BA 6 and 7). Both sensors and cortical sources results converge in showing no differences during and after cathodal tDCS compared to pre-stimulation sessions, both at global and local level. The same holds for sham tDCS. These data highlight an asymmetric impact of anodal and cathodal stimulation on cortical excitability, with a diffuse effect of anodal and no effect of cathodal tDCS over the parietal cortex. These results are consistent with the current literature: while anodal-excitatory and cathodal-inhibitory effects are well-established in the sensory and motor domains, both at physiological and behavioral levels, results for cathodal stimulation are more controversial for modulation of exitability of higher order areas.
Collapse
Affiliation(s)
- Erica Varoli
- Ph.D. Program in Neuroscience, Department of Medicine and Surgery, University Milano-Bicocca, Monza, Italy.,NeuroMi - Milan Center of Neuroscience, Milan, Italy
| | - Alberto Pisoni
- NeuroMi - Milan Center of Neuroscience, Milan, Italy.,Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | - Giulia C Mattavelli
- NeuroMi - Milan Center of Neuroscience, Milan, Italy.,Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | - Alessandra Vergallito
- NeuroMi - Milan Center of Neuroscience, Milan, Italy.,Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | - Alessia Gallucci
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | - Lilia D Mauro
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | - Mario Rosanova
- Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy.,Fondazione Europea per la Ricerca Biomedica Onlus, Milan, Italy
| | - Nadia Bolognini
- NeuroMi - Milan Center of Neuroscience, Milan, Italy.,Department of Psychology, University of Milano-Bicocca, Milan, Italy.,Laboratory of Neuropsychology, IRCCS Istituto Auxologico, Milan, Italy
| | - Giuseppe Vallar
- NeuroMi - Milan Center of Neuroscience, Milan, Italy.,Department of Psychology, University of Milano-Bicocca, Milan, Italy.,Laboratory of Neuropsychology, IRCCS Istituto Auxologico, Milan, Italy
| | - Leonor J Romero Lauro
- NeuroMi - Milan Center of Neuroscience, Milan, Italy.,Department of Psychology, University of Milano-Bicocca, Milan, Italy
| |
Collapse
|
108
|
Bikson M, Brunoni AR, Charvet LE, Clark VP, Cohen LG, Deng ZD, Dmochowski J, Edwards DJ, Frohlich F, Kappenman ES, Lim KO, Loo C, Mantovani A, McMullen DP, Parra LC, Pearson M, Richardson JD, Rumsey JM, Sehatpour P, Sommers D, Unal G, Wassermann EM, Woods AJ, Lisanby SH. Rigor and reproducibility in research with transcranial electrical stimulation: An NIMH-sponsored workshop. Brain Stimul 2018; 11:465-480. [PMID: 29398575 PMCID: PMC5997279 DOI: 10.1016/j.brs.2017.12.008] [Citation(s) in RCA: 123] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 12/01/2017] [Accepted: 12/21/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Neuropsychiatric disorders are a leading source of disability and require novel treatments that target mechanisms of disease. As such disorders are thought to result from aberrant neuronal circuit activity, neuromodulation approaches are of increasing interest given their potential for manipulating circuits directly. Low intensity transcranial electrical stimulation (tES) with direct currents (transcranial direct current stimulation, tDCS) or alternating currents (transcranial alternating current stimulation, tACS) represent novel, safe, well-tolerated, and relatively inexpensive putative treatment modalities. OBJECTIVE This report seeks to promote the science, technology and effective clinical applications of these modalities, identify research challenges, and suggest approaches for addressing these needs in order to achieve rigorous, reproducible findings that can advance clinical treatment. METHODS The National Institute of Mental Health (NIMH) convened a workshop in September 2016 that brought together experts in basic and human neuroscience, electrical stimulation biophysics and devices, and clinical trial methods to examine the physiological mechanisms underlying tDCS/tACS, technologies and technical strategies for optimizing stimulation protocols, and the state of the science with respect to therapeutic applications and trial designs. RESULTS Advances in understanding mechanisms, methodological and technological improvements (e.g., electronics, computational models to facilitate proper dosing), and improved clinical trial designs are poised to advance rigorous, reproducible therapeutic applications of these techniques. A number of challenges were identified and meeting participants made recommendations made to address them. CONCLUSIONS These recommendations align with requirements in NIMH funding opportunity announcements to, among other needs, define dosimetry, demonstrate dose/response relationships, implement rigorous blinded trial designs, employ computational modeling, and demonstrate target engagement when testing stimulation-based interventions for the treatment of mental disorders.
Collapse
Affiliation(s)
- Marom Bikson
- Department of Biomedical Engineering, The City College of the City University of New York, United States
| | - Andre R Brunoni
- Laboratory of Neurosciences (LIM-27), Department and Institute of Psychiatry, University of Sao Paulo, Sao Paulo, Brazil
| | - Leigh E Charvet
- Department of Neurology, New York University School of Medicine, New York, NY, United States
| | - Vincent P Clark
- Department of Psychology, University of New Mexico, Albuquerque, NM, United States
| | - Leonardo G Cohen
- Human Cortical Physiology and Neurorehabilitation Section, National Institute of Neurological Disorders and Stroke, Bethesda, MD, United States
| | - Zhi-De Deng
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, Bethesda, MD, United States
| | - Jacek Dmochowski
- Department of Biomedical Engineering, The City College of the City University of New York, United States
| | - Dylan J Edwards
- Non-invasive Brain Stimulation and Human Motor Control Laboratory, Burke Rehabilitation and Research, Burke-Cornell Medical Research Facility, White Plains, New York and School of Medicine and Health Sciences, Edith Cowan University, Perth, Australia
| | - Flavio Frohlich
- Department of Psychiatry, Cell Biology and Physiology, Biomedical Engineering, and Neurology, Carolina Center for Neurostimulation, University of North Carolina School of Medicine, Chapel Hill, NC, United States
| | - Emily S Kappenman
- Department of Psychology, San Diego State University, San Diego, CA, United States
| | - Kelvin O Lim
- Department of Psychiatry, University of Minnesota, Minneapolis Veterans Administration Health Care System, and Defense Veterans Brain Injury Center, Minneapolis, MN, United States
| | - Colleen Loo
- School of Psychiatry and Black Dog Institute, University of New South Wales, Sydney, Australia
| | - Antonio Mantovani
- Department of Physiology, Pharmacology and Neuroscience, City College of the City University of New York, New York, NY, United States
| | - David P McMullen
- Division of Translational Research, National Institute of Mental Health, Bethesda, MD, United States
| | - Lucas C Parra
- Department of Biomedical Engineering, The City College of the City University of New York, United States
| | - Michele Pearson
- Division of Translational Research, National Institute of Mental Health, Bethesda, MD, United States
| | - Jessica D Richardson
- Department of Speech and Hearing Sciences, University of New Mexico, Albuquerque, NM, United States
| | - Judith M Rumsey
- Division of Translational Research, National Institute of Mental Health, Bethesda, MD, United States.
| | - Pejman Sehatpour
- Department of Psychiatry, Columbia University, New York, NY, United States
| | - David Sommers
- Scientific Review Branch, National Institute of Mental Health, Bethesda, MD, United States
| | - Gozde Unal
- Department of Biomedical Engineering, The City College of the City University of New York, United States
| | - Eric M Wassermann
- Behavioral Neurology Unit, National Institute of Neurological Disorders and Stroke, Bethesda, MD, United States
| | - Adam J Woods
- Department of Clinical and Health Psychology, Center for Cognitive Aging and Memory, McKnight Brain Institute, University of Florida, Gainesville, FL, United States
| | - Sarah H Lisanby
- Division of Translational Research, National Institute of Mental Health, Bethesda, MD, United States
| |
Collapse
|
109
|
Imburgio MJ, Orr JM. Effects of prefrontal tDCS on executive function: Methodological considerations revealed by meta-analysis. Neuropsychologia 2018; 117:156-166. [PMID: 29727626 DOI: 10.1016/j.neuropsychologia.2018.04.022] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 04/17/2018] [Accepted: 04/20/2018] [Indexed: 02/04/2023]
Abstract
A meta-analysis of studies using single-session transcranial direct current stimulation (tDCS) to target the dorsolateral prefrontal cortex (DLPFC) was undertaken to examine the effect of stimulation on executive function (EF) in healthy samples. 27 studies were included in analyses, yielding 71 effect sizes. The most relevant measure for each task was determined a priori and used to calculate Hedge's g. Methodological characteristics of each study were examined individually as potential moderators of effect size. Stimulation effects on three domains of EF (inhibition of prepotent responses, mental set shifting, and information updating and monitoring) were analyzed separately. In line with previous work, the current study found no significant effect of anodal unilateral tDCS, cathodal unilateral tDCS, or bilateral tDCS on EF. Further moderator and subgroup analyses were only carried out for anodal unilateral montages due to the small number of studies using other montages. Subgroup analyses revealed a significant effect of anodal unilateral tDCS on updating tasks, but not on inhibition or set-shifting tasks. Cathode location significantly moderated the effect of anodal unilateral tDCS. Extracranial cathodes yielded a significant effect on EF while cranial cathodes yielded no effect. Anode size also significantly moderated effect of anodal unilateral tDCS, with smaller anodes being more effective than larger anodes. In summary, anodal DLPFC stimulation is more effective at improving updating ability than inhibition and set-shifting ability, but anodal stimulation can significantly improve general executive function when extracranial cathodes or small anodes are used. Future meta-analyses may examine how stimulation's effects on specific behavioral tasks, rather than broader domains, might be affected by methodological moderators.
Collapse
Affiliation(s)
- Michael J Imburgio
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, TX, USA.
| | - Joseph M Orr
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, TX, USA; Texas A&M Institute for Neuroscience, Texas A&M University, College Station, TX, USA.
| |
Collapse
|
110
|
Martin AK, Dzafic I, Ramdave S, Meinzer M. Causal evidence for task-specific involvement of the dorsomedial prefrontal cortex in human social cognition. Soc Cogn Affect Neurosci 2018; 12:1209-1218. [PMID: 28444345 PMCID: PMC5597860 DOI: 10.1093/scan/nsx063] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 04/17/2017] [Indexed: 01/17/2023] Open
Abstract
The dorsomedial prefrontal cortex (dmPFC) is a key hub of the 'social brain', but little is known about specific processes supported by this region. Using focal high-definition transcranial direct current stimulation (HD-tDCS) and a social cognitive battery with differing demands on self-other processing, we demonstrate specific involvement of the dmPFC in tasks placing high demands on self-other processing. Specifically, excitatory (anodal) HD-tDCS enhanced the integration of external information into the self for explicit higher-order socio-cognitive tasks across cognitive domains; i.e. visual perspective taking (VPT) and episodic memory. These effects were task specific, as no stimulation effects were found for attributing mental states from the eyes or implicit VPT. Inhibitory (cathodal) HD-tDCS had weaker effects in the opposite direction towards reduced integration of external information into the self. We thus demonstrate for the first time a specific and causal role of the dmPFC in integrating higher-order information from others/external source into that of the self across cognitive domains.
Collapse
Affiliation(s)
- Andrew K Martin
- Centre for Clinical Research, University of Queensland, Brisbane, QLD 4029, Australia
| | - Ilvana Dzafic
- Queensland Brain Institute, University of Queensland, Brisbane, QLD 4067, Australia
| | - Swathi Ramdave
- Centre for Clinical Research, University of Queensland, Brisbane, QLD 4029, Australia
| | - Marcus Meinzer
- Centre for Clinical Research, University of Queensland, Brisbane, QLD 4029, Australia
| |
Collapse
|
111
|
To WT, De Ridder D, Hart J, Vanneste S. Changing Brain Networks Through Non-invasive Neuromodulation. Front Hum Neurosci 2018; 12:128. [PMID: 29706876 PMCID: PMC5908883 DOI: 10.3389/fnhum.2018.00128] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 03/19/2018] [Indexed: 01/10/2023] Open
Abstract
Background/Objective: Non-invasive neuromodulation techniques, such as repetitive Transcranial Magnetic Stimulation (rTMS) and transcranial Direct Current Stimulation (tDCS), have increasingly been investigated for their potential as treatments for neurological and psychiatric disorders. Despite widespread dissemination of these techniques, the underlying therapeutic mechanisms and the ideal stimulation site for a given disorder remain unknown. Increasing evidence support the possibility of non-invasive neuromodulation affecting a brain network rather than just the local stimulation target. In this article, we present evidence in a clinical setting to support the idea that non-invasive neuromodulation changes brain networks. Method: This article addresses the idea that non-invasive neuromodulation modulates brain networks, rather than just the local stimulation target, using neuromodulation studies in tinnitus and major depression as examples. We present studies that support this hypothesis from different perspectives. Main Results/Conclusion: Studies stimulating the same brain region, such as the dorsolateral prefrontal cortex (DLPFC), have shown to be effective for several disorders and studies using different stimulation sites for the same disorder have shown similar results. These findings, as well as results from studies investigating brain network connectivity on both macro and micro levels, suggest that non-invasive neuromodulation affects a brain network rather than just the local stimulation site targeted. We propose that non-invasive neuromodulation should be approached from a network perspective and emphasize the therapeutic potential of this approach through the modulation of targeted brain networks.
Collapse
Affiliation(s)
- Wing Ting To
- School of Behavioral and Brain Sciences, The University of Texas at Dallas, Richardson, TX, United States
| | - Dirk De Ridder
- Department of Surgical Sciences, Section of Neurosurgery, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - John Hart
- School of Behavioral and Brain Sciences, The University of Texas at Dallas, Richardson, TX, United States
| | - Sven Vanneste
- School of Behavioral and Brain Sciences, The University of Texas at Dallas, Richardson, TX, United States
| |
Collapse
|
112
|
Mineo L, Fetterman A, Concerto C, Warren M, Infortuna C, Freedberg D, Chusid E, Aguglia E, Battaglia F. Motor facilitation during observation of implied motion: Evidence for a role of the left dorsolateral prefrontal cortex. Int J Psychophysiol 2018; 128:47-51. [PMID: 29627584 DOI: 10.1016/j.ijpsycho.2018.04.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 04/02/2018] [Accepted: 04/04/2018] [Indexed: 10/17/2022]
Abstract
The phenomenon of motor resonance (the increase in motor cortex excitability during observation of actions) has been previously described. Transcranial magnetic stimulation (TMS) studies have demonstrated a similar effect during perception of implied motion (IM). The left dorsolateral prefrontal cortex (DLPFC) seems to be activated during action observation. Furthermore, the role of this brain area in motor resonance to IM is yet to be investigated. Fourteen healthy volunteers were enrolled into the study. We used transcranial direct current stimulation (tDCS) to stimulate DLPFC aiming to investigate whether stimulation with different polarities would affect the amplitude of motor evoked potential collected during observation of images with and without IM. The results of our experiment indicated that Cathodal tDCS over the left DLPFC prevented motor resonance during observation of IM. On the contrary, anodal and sham tDCS did not significantly modulate motor resonance to IM. The current study expands the understanding of the neural circuits engaged during observation of IM. Our results are consistent with the hypothesis that action understanding requires the interaction of large networks and that the left DLPFC plays a crucial role in generating motor resonance to IM.
Collapse
Affiliation(s)
- Ludovico Mineo
- Department of Interprofessional Health Sciences & Health Administration, School of Health and Medical Sciences, Seton Hall University, NJ, USA
| | - Alexander Fetterman
- Pre-clinical Sciences, New York College of Podiatric Medicine, New York, USA
| | - Carmen Concerto
- Department of Interprofessional Health Sciences & Health Administration, School of Health and Medical Sciences, Seton Hall University, NJ, USA
| | - Michael Warren
- Pre-clinical Sciences, New York College of Podiatric Medicine, New York, USA
| | | | - David Freedberg
- Department of Art History Columbia University, and Italian Academy for Advanced Studies, Columbia University, New York, USA
| | - Eileen Chusid
- Pre-clinical Sciences, New York College of Podiatric Medicine, New York, USA
| | - Eugenio Aguglia
- Department of Clinical and Experimental Medicine, Psychiatry Unit, University of Catania, Italy
| | - Fortunato Battaglia
- Department of Interprofessional Health Sciences & Health Administration, School of Health and Medical Sciences, Seton Hall University, NJ, USA.
| |
Collapse
|
113
|
Jacoby N, Lavidor M. Null tDCS Effects in a Sustained Attention Task: The Modulating Role of Learning. Front Psychol 2018; 9:476. [PMID: 29681876 PMCID: PMC5897507 DOI: 10.3389/fpsyg.2018.00476] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 03/21/2018] [Indexed: 12/15/2022] Open
Abstract
The purpose of this study was to investigate sustained attention through modulation of the fronto-cerebral network with transcranial direct current stimulation (tDCS) in adults with attention-deficit/hyperactivity disorder (ADHD) and control participants. Thirty-seven participants (21 with ADHD) underwent three separate sessions (baseline, active tDCS, and sham) and performed the MOXO Continuous Performance Test (CPT). We applied double anodal stimulation of 1.8 mA tDCS for 20 min over the left and right dorsolateral prefrontal cortex (DLPFC), with the cathode over the cerebellum. Baseline session revealed significant differences between ADHD and control participants in the MOXO-CPT attention and hyperactivity scores, validating the MOXO as a diagnostic tool. However, there were no tDCS effects in most MOXO-CPT measures, except hyperactivity, due to a significant learning effect. We conclude that learning and repetition effects in cognitive tasks need to be considered when designing within-subjects tDCS experiments, as there are natural improvements between sessions that conceal potential stimulation effects.
Collapse
Affiliation(s)
- Noa Jacoby
- Cognitive Neuroscience Laboratory, Department of Psychology, Gonda Brain Science Center, Bar-Ilan University, Ramat Gan, Israel
| | - Michal Lavidor
- Cognitive Neuroscience Laboratory, Department of Psychology, Gonda Brain Science Center, Bar-Ilan University, Ramat Gan, Israel
| |
Collapse
|
114
|
Westwood SJ, Romani C. Null Effects on Working Memory and Verbal Fluency Tasks When Applying Anodal tDCS to the Inferior Frontal Gyrus of Healthy Participants. Front Neurosci 2018; 12:166. [PMID: 29615855 PMCID: PMC5867342 DOI: 10.3389/fnins.2018.00166] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 03/01/2018] [Indexed: 01/22/2023] Open
Abstract
Transcranial direct current stimulation (tDCS) is a technique used to modify cognition by modulating underlying cortical excitability via weak electric current applied through the scalp. Although many studies have reported positive effects with tDCS, a number of recent studies highlight that tDCS effects can be small and difficult to reproduce. This is especially the case when attempting to modulate performance using single applications of tDCS in healthy participants. Possible reasons may be that optimal stimulation parameters have yet to be identified, and that individual variation in cortical activity and/or level of ability confound outcomes. To address these points, we carried out a series of experiments in which we attempted to modulate performance in fluency and working memory probe tasks using stimulation parameters which have been associated with positive outcomes: we targeted the left inferior frontal gyrus (LIFG) and compared performance when applying a 1.5 mA anodal current for 25 min and with sham stimulation. There is evidence that LIFG plays a role in these tasks and previous studies have found positive effects of stimulation. We also compared our experimental group (N = 19–20) with a control group receiving no stimulation (n = 24). More importantly, we also considered effects on subgroups subdivided according to memory span as well as to more direct measures of executive function abilities and motivational levels. We found no systematic effect of stimulation. Our findings are in line with a growing body of evidence that tDCS produces unreliable effects. We acknowledge that our findings speak to the conditions we investigated, and that alternative protocols (e.g., multiple sessions, clinical samples, and different stimulation polarities) may be more effective. We encourage further research to explore optimal conditions for tDCS efficacy, given the potential benefits that this technique poses for understanding and enhancing cognition.
Collapse
Affiliation(s)
- Samuel J Westwood
- School of Life & Health Sciences, Aston University, Birmingham, United Kingdom
| | - Cristina Romani
- School of Life & Health Sciences, Aston University, Birmingham, United Kingdom
| |
Collapse
|
115
|
Bogdanov M, Ruff CC, Schwabe L. Transcranial Stimulation Over the Dorsolateral Prefrontal Cortex Increases the Impact of Past Expenses on Decision-Making. Cereb Cortex 2018; 27:1094-1102. [PMID: 26656728 DOI: 10.1093/cercor/bhv298] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Goal-directed choices should be guided by the expected value of the available options. However, people are often influenced by past costs in their decisions, thus succumbing to a bias known as the "sunk-cost effect." Recent functional magnetic resonance imaging data show that the sunk-cost effect is associated with increased activity in dorsolateral prefrontal cortex (dlPFC) and altered crosstalk of the dlPFC with other prefrontal areas. Are these correlated neural processes causally involved in the sunk-cost effect? Here, we employed transcranial direct current stimulation (tDCS) to examine the role of the dlPFC for biasing choices in line with the cost of past expenses. Specifically, we applied different types of tDCS over the right dlPFC while participants performed an investment task designed to assess the impact of past investments on current choices. Our results show a pronounced sunk-cost effect that was significantly increased by anodal tDCS, but left unaltered by cathodal or sham stimulation. Importantly, choices were not affected by stimulation when no prior investments had been made, underlining the specificity of the obtained effect. Our findings suggest a critical role of the dlPFC in the sunk-cost effect and thus elucidate neural mechanisms by which past investments may influence current decision-making.
Collapse
Affiliation(s)
- Mario Bogdanov
- Department of Cognitive Psychology, Institute for Psychology, University of Hamburg, Hamburg, Germany
| | - Christian C Ruff
- Laboratory for Social and Neural Systems Research (SNS-Lab), Department of Economics, University of Zurich, Zurich, Switzerland
| | - Lars Schwabe
- Department of Cognitive Psychology, Institute for Psychology, University of Hamburg, Hamburg, Germany
| |
Collapse
|
116
|
Chai Y, Sheng J, Bandettini PA, Gao JH. Frequency-dependent tACS modulation of BOLD signal during rhythmic visual stimulation. Hum Brain Mapp 2018; 39:2111-2120. [PMID: 29389051 DOI: 10.1002/hbm.23990] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 01/10/2018] [Accepted: 01/23/2018] [Indexed: 01/05/2023] Open
Abstract
Transcranial alternating current stimulation (tACS) has emerged as a promising tool for modulating cortical oscillations. In previous electroencephalogram (EEG) studies, tACS has been found to modulate brain oscillatory activity in a frequency-specific manner. However, the spatial distribution and hemodynamic response for this modulation remains poorly understood. Functional magnetic resonance imaging (fMRI) has the advantage of measuring neuronal activity in regions not only below the tACS electrodes but also across the whole brain with high spatial resolution. Here, we measured fMRI signal while applying tACS to modulate rhythmic visual activity. During fMRI acquisition, tACS at different frequencies (4, 8, 16, and 32 Hz) was applied along with visual flicker stimulation at 8 and 16 Hz. We analyzed the blood-oxygen-level-dependent (BOLD) signal difference between tACS-ON vs tACS-OFF, and different frequency combinations (e.g., 4 Hz tACS, 8 Hz flicker vs 8 Hz tACS, 8 Hz flicker). We observed significant tACS modulation effects on BOLD responses when the tACS frequency matched the visual flicker frequency or the second harmonic frequency. The main effects were predominantly seen in regions that were activated by the visual task and targeted by the tACS current distribution. These findings bridge different scientific domains of tACS research and demonstrate that fMRI could localize the tACS effect on stimulus-induced brain rhythms, which could lead to a new approach for understanding the high-level cognitive process shaped by the ongoing oscillatory signal.
Collapse
Affiliation(s)
- Yuhui Chai
- Section on Functional Imaging Methods, Laboratory of Brain and Cognition, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland.,Center for MRI Research, Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, China.,Beijing City Key Lab for Medical Physics and Engineering, Institution of Heavy Ion Physics, School of Physics, Peking University, Beijing, China
| | - Jingwei Sheng
- Section on Functional Imaging Methods, Laboratory of Brain and Cognition, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland.,Beijing City Key Lab for Medical Physics and Engineering, Institution of Heavy Ion Physics, School of Physics, Peking University, Beijing, China
| | - Peter A Bandettini
- Section on Functional Imaging Methods, Laboratory of Brain and Cognition, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland
| | - Jia-Hong Gao
- Center for MRI Research, Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, China.,Beijing City Key Lab for Medical Physics and Engineering, Institution of Heavy Ion Physics, School of Physics, Peking University, Beijing, China.,McGovern Institute for Brain Research, Peking University, Beijing, China.,Shenzhen Institute of Neuroscience, Shenzhen, China
| |
Collapse
|
117
|
Woods AJ, Cohen R, Marsiske M, Alexander GE, Czaja SJ, Wu S. Augmenting cognitive training in older adults (The ACT Study): Design and Methods of a Phase III tDCS and cognitive training trial. Contemp Clin Trials 2018; 65:19-32. [PMID: 29313802 PMCID: PMC5803439 DOI: 10.1016/j.cct.2017.11.017] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 11/27/2017] [Accepted: 11/29/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND Adults over age 65 represent the fastest growing population in the US. Decline in cognitive abilities is a hallmark of advanced age and is associated with loss of independence and dementia risk. There is a pressing need to develop effective interventions for slowing or reversing the cognitive aging process. While certain forms of cognitive training have shown promise in this area, effects only sometimes transfer to neuropsychological tests within or outside the trained domain. This paper describes a NIA-funded Phase III adaptive multisite randomized clinical trial, examining whether transcranial direct current stimulation (tDCS) of frontal cortices enhances neurocognitive outcomes achieved from cognitive training in older adults experiencing age-related cognitive decline: the Augmenting Cognitive Training in Older Adults study (ACT). METHODS ACT will enroll 360 participants aged 65 to 89 with age-related cognitive decline, but not dementia. Participants will undergo cognitive training intervention or education training-control combined with tDCS or sham tDCS control. Cognitive training employs a suite of eight adaptive training tasks focused on attention/speed of processing and working memory from Posit Science BrainHQ. Training control involves exposure to educational nature/history videos and related content questions of the same interval/duration as the cognitive training. Participants are assessed at baseline, after training (12weeks), and 12-month follow-up on our primary outcome measure, NIH Toolbox Fluid Cognition Composite Score, as well as a comprehensive neurocognitive, functional, clinical and multimodal neuroimaging battery. SIGNIFICANCE The findings from this study have the potential to significantly enhance efforts to ameliorate cognitive aging and slow dementia.
Collapse
Affiliation(s)
- Adam J Woods
- Center for Cognitive Aging and Memory, Cognitive Aging and Memory Clinical Translational Research Program, Department of Clinical and Health Psychology, McKnight Brain Institute, University of Florida, United States.
| | - Ronald Cohen
- Center for Cognitive Aging and Memory, Cognitive Aging and Memory Clinical Translational Research Program, Department of Clinical and Health Psychology, McKnight Brain Institute, University of Florida, United States
| | - Michael Marsiske
- Center for Cognitive Aging and Memory, Cognitive Aging and Memory Clinical Translational Research Program, Department of Clinical and Health Psychology, McKnight Brain Institute, University of Florida, United States
| | - Gene E Alexander
- Departments of Psychology and Psychiatry, Neuroscience and Physiological Sciences Graduate Interdisciplinary Programs, BIO5 Institute, and McKnight Brain Institute, University of Arizona, Tucson, AZ, United States
| | - Sara J Czaja
- Center on Aging, Department of Psychiatry and Behavioral Sciences, McKnight Brain Institute, Miller School of Medicine, University of Miami, United States
| | - Samuel Wu
- Department of Biostatistics, University of Florida, United States
| |
Collapse
|
118
|
Koo H, Kim MS, Han SW, Paulus W, Nitche MA, Kim YH, Kim HI, Ko SH, Shin YI. After-effects of anodal transcranial direct current stimulation on the excitability of the motor cortex in rats. Restor Neurol Neurosci 2018; 34:859-68. [PMID: 27567759 DOI: 10.3233/rnn-160664] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE Transcranial direct current stimulation (tDCS) is increasingly seen as a useful tool for noninvasive cortical neuromodulation. A number of studies in humans have shown that when tDCS is applied to the motor cortex it can modulate cortical excitability. It is especially interesting to note that when applied with sufficient duration and intensity, tDCS can enable long-lasting neuroplastic effects. However, the mechanism by which tDCS exerts its effects on the cortex is not fully understood. We investigated the effects of anodal tDCS under urethane anesthesia on field potentials in in vivo rats. METHODS These were measured on the skull over the right motor cortex of rats immediately after stimulating the left corpus callosum. RESULTS Evoked field potentials in the motor cortex were gradually increased for more than one hour after anodal tDCS. To induce these long-lasting effects, a sufficient duration of stimulation (20 minutes or more) was found to may be required rather than high stimulation intensity. CONCLUSION We propose that anodal tDCS with a sufficient duration of stimulation may modulate transcallosal plasticity.
Collapse
Affiliation(s)
- Ho Koo
- Department of Physiology, Wonkwang University College of Medicine, Iksan, South Korea
| | - Min Sun Kim
- Department of Physiology, Wonkwang University College of Medicine, Iksan, South Korea
| | - Sang Who Han
- Department of Physiology, Wonkwang University College of Medicine, Iksan, South Korea
| | - Walter Paulus
- University Medical Center, Department Clinical Neurophysiology, Georg-August-University, Goettingen, Germany
| | - Michael A Nitche
- University Medical Center, Department Clinical Neurophysiology, Georg-August-University, Goettingen, Germany; Leibniz Research Center for Working Environment and Human Factors, Dortmund, Germany; Department of Neurology, BG University Hospital Bergmannsheil, Ruhr-University Bochum, Germany
| | - Yun-Hee Kim
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hyoung-Ihl Kim
- Department of Medical System Engineering & Department of Mechatronics, Gwangju Institute of Science and Technology, Gwangju, South Korea
| | - Sung-Hwa Ko
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Yong-Il Shin
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, South Korea
| |
Collapse
|
119
|
Zheng X, Dai W, Alsop DC, Schlaug G. Modulating transcallosal and intra-hemispheric brain connectivity with tDCS: Implications for interventions in Aphasia. Restor Neurol Neurosci 2018; 34:519-30. [PMID: 27472845 DOI: 10.3233/rnn-150625] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND/OBJECTIVE Transcranial direct current stimulation (tDCS) can enhance or diminish cortical excitability levels depending on the polarity of the stimulation. One application of non-invasive brain-stimulation has been to modulate a possible inter-hemispheric disinhibition after a stroke. This disinhibition model has been developed mainly for the upper extremity motor system, but it is not known whether the language/speech-motor system shows a similar inter-hemispheric interaction. We aimed to examine physiological evidence of inter- and intra-hemispheric connectivity changes induced by tDCS of the right inferior frontal gyrus (IFG) using arterial-spin labeling (ASL) MRI. METHODS Using an MR-compatible DC-Stimulator, we applied anodal stimulation to the right IFG region of nine healthy adults while undergoing non-invasive cerebral blood flow imaging with arterial-spin labeling (ASL) before, during, and after the stimulation. All ASL images were then normalized and timecourses were extracted in regions of interest (ROIs), which were the left and right IFG regions, and the right supramarginal gyrus (SMG) in the inferior parietal lobule. Two additional ROIs (the right occipital lobe and the left fronto-orbital region) were taken as control regions. RESULTS Using regional correlation coefficients as a surrogate marker of connectivity, we could show that inter-hemispheric connectivity (right IFG with left IFG) decreased significantly (p < 0.05; r-scores from 0.67 to 0.53) between baseline and post-stimulation, while the intra-hemispheric connectivity (right IFG with right SMG) increased significantly (p < 0.05;r-scores from 0.74 to 0.81). A 2 × 2 ANOVA found a significant main effect of HEMISPHERE (F(8) = 6.83, p < 0.01) and a significant HEMISPHERE-by-TIME interaction (F(8) = 4.24, p < 0.05) in connectivity changes. The correlation scores did not change significantly in the control region pairs (right IFG with right occipital and right IFG with left fronto-orbital) over time. CONCLUSION Using an MR-compatible DC stimulator we showed that ASL-MRI can detect tDCS-induced modulation of brain connectivity within and between hemispheres. These findings might affect trial designs focusing on modulating the non-dominant hemisphere to enhance language/speech-motor functions.
Collapse
Affiliation(s)
- Xin Zheng
- Department of Neurology, Neuroimaging and Stroke Recovery Laboratory, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Weiying Dai
- Division of MR Research, Department of Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - David C Alsop
- Division of MR Research, Department of Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Gottfried Schlaug
- Department of Neurology, Neuroimaging and Stroke Recovery Laboratory, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| |
Collapse
|
120
|
Esmaeilpour Z, Marangolo P, Hampstead BM, Bestmann S, Galletta E, Knotkova H, Bikson M. Incomplete evidence that increasing current intensity of tDCS boosts outcomes. Brain Stimul 2017; 11:310-321. [PMID: 29258808 DOI: 10.1016/j.brs.2017.12.002] [Citation(s) in RCA: 124] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 12/06/2017] [Accepted: 12/08/2017] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Transcranial direct current stimulation (tDCS) is investigated to modulate neuronal function by applying a fixed low-intensity direct current to scalp. OBJECTIVES We critically discuss evidence for a monotonic response in effect size with increasing current intensity, with a specific focus on a question if increasing applied current enhance the efficacy of tDCS. METHODS We analyzed tDCS intensity does-response from different perspectives including biophysical modeling, animal modeling, human neurophysiology, neuroimaging and behavioral/clinical measures. Further, we discuss approaches to design dose-response trials. RESULTS Physical models predict electric field in the brain increases with applied tDCS intensity. Data from animal studies are lacking since a range of relevant low-intensities is rarely tested. Results from imaging studies are ambiguous while human neurophysiology, including using transcranial magnetic stimulation (TMS) as a probe, suggests a complex state-dependent non-monotonic dose response. The diffusivity of brain current flow produced by conventional tDCS montages complicates this analysis, with relatively few studies on focal High Definition (HD)-tDCS. In behavioral and clinical trials, only a limited range of intensities (1-2 mA), and typically just one intensity, are conventionally tested; moreover, outcomes are subject brain-state dependent. Measurements and models of current flow show that for the same applied current, substantial differences in brain current occur across individuals. Trials are thus subject to inter-individual differences that complicate consideration of population-level dose response. CONCLUSION The presence or absence of simple dose response does not impact how efficacious a given tDCS dose is for a given indication. Understanding dose-response in human applications of tDCS is needed for protocol optimization including individualized dose to reduce outcome variability, which requires intelligent design of dose-response studies.
Collapse
Affiliation(s)
- Zeinab Esmaeilpour
- Department of Biomedical Engineering, The City College of New York of CUNY, New York, NY 10031, USA; Biomedical Engineering Department, Amirkabir University of Technology, Tehran, Iran.
| | - Paola Marangolo
- Dipartimento di Studi Umanistici, University Federico II, Naples and IRCCS Fondazione Santa Lucia, Rome Italy
| | - Benjamin M Hampstead
- VA Ann Arbor Healthcare System, Ann Arbor, MI 48105, USA; Department of Psychiatry, University of Michigan, Ann Arbor, MI 48105, USA
| | - Sven Bestmann
- Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, University College London, UK
| | - Elisabeth Galletta
- Rusk Rehabilitation Medicine, New York University Langone Medical Center, USA
| | - Helena Knotkova
- MJHS Institute for Innovation in Palliative Care, New York, NY, USA; Department of Family and Social Medicine, Albert Einstein College of Medicine, The Bronx, NY, USA
| | - Marom Bikson
- Department of Biomedical Engineering, The City College of New York of CUNY, New York, NY 10031, USA
| |
Collapse
|
121
|
Sex Mediates the Effects of High-Definition Transcranial Direct Current Stimulation on “Mind-Reading”. Neuroscience 2017; 366:84-94. [DOI: 10.1016/j.neuroscience.2017.10.005] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 09/23/2017] [Accepted: 10/04/2017] [Indexed: 01/30/2023]
|
122
|
Increased left prefrontal brain perfusion after MRI compatible tDCS attenuates momentary ruminative self-referential thoughts. Brain Stimul 2017; 10:1088-1095. [DOI: 10.1016/j.brs.2017.09.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 07/05/2017] [Accepted: 09/04/2017] [Indexed: 02/08/2023] Open
|
123
|
Westwood SJ, Olson A, Miall RC, Romani C. tDCS modulation of naming in healthy participants: Negative results and still no explanation – A response to a commentary by Gauvin et al. (2017). Cortex 2017; 96:143-147. [DOI: 10.1016/j.cortex.2017.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 08/07/2017] [Indexed: 11/30/2022]
|
124
|
Safety of repeated sessions of transcranial direct current stimulation: A systematic review. Brain Stimul 2017; 11:278-288. [PMID: 29169814 DOI: 10.1016/j.brs.2017.10.020] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Revised: 10/26/2017] [Accepted: 10/30/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Repeated sessions of transcranial direct current stimulation (tDCS) are increasingly used for therapeutic applications. However, adverse events (AEs) associated with repeated sessions have not been comprehensively evaluated. OBJECTIVE The aim of this study was therefore to evaluate the safety of repeated sessions of tDCS, examining AE risk relative to tDCS exposure. Further, to identify whether certain participant populations are particularly at risk from tDCS. METHODS A systematic review and meta-analysis included sham-controlled studies (up to June 2017) involving two or more tDCS sessions, spaced not more than a day apart. Data was extracted on AEs reported, total tDCS exposure (cumulative charge), and diagnostic groups (Healthy, Pain Disorder, Stroke, Neurocognitive Disorder, Neuropsychiatric Disorder, and Other). Univariate simple linear meta-regression analyses examined AE likelihood, comparing active and sham tDCS, with increasing exposure. Rates of AEs were compared for diagnostic groups. RESULTS 158 studies (total 4130 participants) met inclusion criteria and were included for quantitative analyses. The incidence of AEs (examined per session, by proportion of participants, and by the number of studies reporting AEs) did not increase with higher levels of tDCS exposure. Furthermore, AE rates were not found to be greater for any diagnostic group. CONCLUSIONS Little evidence was found to suggest that repeated sessions of active tDCS pose increased risk to participants compared to sham tDCS within the limits of parameters used to date. Increased risks associated with greater levels of exposure to tDCS, or rare and under-reported AEs, however, cannot be ruled out.
Collapse
|
125
|
|
126
|
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: 658] [Impact Index Per Article: 94.0] [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.
Collapse
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
| |
Collapse
|
127
|
Hong X, Lu ZK, Teh I, Nasrallah FA, Teo WP, Ang KK, Phua KS, Guan C, Chew E, Chuang KH. Brain plasticity following MI-BCI training combined with tDCS in a randomized trial in chronic subcortical stroke subjects: a preliminary study. Sci Rep 2017; 7:9222. [PMID: 28835651 PMCID: PMC5569072 DOI: 10.1038/s41598-017-08928-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 05/24/2017] [Indexed: 12/17/2022] Open
Abstract
Brain-computer interface-assisted motor imagery (MI-BCI) or transcranial direct current stimulation (tDCS) has been used in stroke rehabilitation, though their combinatory effect is unknown. We investigated brain plasticity following a combined MI-BCI and tDCS intervention in chronic subcortical stroke patients with unilateral upper limb disability. Nineteen patients were randomized into tDCS and sham-tDCS groups. Diffusion and perfusion MRI, and transcranial magnetic stimulation were used to study structural connectivity, cerebral blood flow (CBF), and corticospinal excitability, respectively, before and 4 weeks after the 2-week intervention. After quality control, thirteen subjects were included in the CBF analysis. Eleven healthy controls underwent 2 sessions of MRI for reproducibility study. Whereas motor performance showed comparable improvement, long-lasting neuroplasticity can only be detected in the tDCS group, where white matter integrity in the ipsilesional corticospinal tract and bilateral corpus callosum was increased but sensorimotor CBF was decreased, particularly in the ipsilesional side. CBF change in the bilateral parietal cortices also correlated with motor function improvement, consistent with the increased white matter integrity in the corpus callosum connecting these regions, suggesting an involvement of interhemispheric interaction. The preliminary results indicate that tDCS may facilitate neuroplasticity and suggest the potential for refining rehabilitation strategies for stroke patients.
Collapse
Affiliation(s)
- Xin Hong
- Singapore Bioimaging Consortium, Agency for Science Technology and Research, 11 Biopolis Way, #02-02 Helios, Singapore, 138667, Singapore
| | - Zhong Kang Lu
- Institute for Infocomm Research, Agency for Science Technology and Research, 1 Fusionopolis Way, #21-01 Connexis (South Tower), Singapore, 138632, Singapore
| | - Irvin Teh
- Clinical Imaging Research Center, Agency for Science Technology and Research, Centre for Translational Medicine (MD6), 14 Medical Drive, #B1-01, Singapore, 117599, Singapore
- Wellcome Trust Centre for Human Genetics, Roosevelt Drive, Oxford, OX3 7BN, UK
| | - Fatima Ali Nasrallah
- Singapore Bioimaging Consortium, Agency for Science Technology and Research, 11 Biopolis Way, #02-02 Helios, Singapore, 138667, Singapore
- Queensland Brain Institute, The University of Queensland, Brisbane, Queensland, 4072, Australia
| | - Wei Peng Teo
- Division of Neurology, National University Hospital System, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Burwood, VIC 3125, Australia
| | - Kai Keng Ang
- Institute for Infocomm Research, Agency for Science Technology and Research, 1 Fusionopolis Way, #21-01 Connexis (South Tower), Singapore, 138632, Singapore
| | - Kok Soon Phua
- Institute for Infocomm Research, Agency for Science Technology and Research, 1 Fusionopolis Way, #21-01 Connexis (South Tower), Singapore, 138632, Singapore
| | - Cuntai Guan
- Institute for Infocomm Research, Agency for Science Technology and Research, 1 Fusionopolis Way, #21-01 Connexis (South Tower), Singapore, 138632, Singapore
- School of Computer Science and Engineering, Nanynag Technological University, 50 Nanyang Avenue, Singapore, 639798, Singapore
| | - Effie Chew
- Division of Neurology, National University Hospital System, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore.
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, Level 11, 1E Kent Ridge Road, Singapore, 119228, Singapore.
| | - Kai-Hsiang Chuang
- Singapore Bioimaging Consortium, Agency for Science Technology and Research, 11 Biopolis Way, #02-02 Helios, Singapore, 138667, Singapore.
- Clinical Imaging Research Center, Agency for Science Technology and Research, Centre for Translational Medicine (MD6), 14 Medical Drive, #B1-01, Singapore, 117599, Singapore.
- Queensland Brain Institute and Centre for Advanced Imaging, The University of Queensland, Brisbane, Queensland, 4072, Australia.
| |
Collapse
|
128
|
Brain Network Mechanisms Underlying Motor Enhancement by Transcranial Entrainment of Gamma Oscillations. J Neurosci 2017; 36:12053-12065. [PMID: 27881788 DOI: 10.1523/jneurosci.2044-16.2016] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 09/30/2016] [Accepted: 10/05/2016] [Indexed: 11/21/2022] Open
Abstract
Gamma and beta oscillations are routinely observed in motor-related brain circuits during movement preparation and execution. Entrainment of gamma or beta oscillations via transcranial alternating current stimulation (tACS) over primary motor cortex (M1) has opposite effects on motor performance, suggesting a causal role of these brain rhythms for motor control. However, it is largely unknown which brain mechanisms characterize these changes in motor performance brought about by tACS. In particular, it is unclear whether these effects result from brain activity changes only in the targeted areas or within functionally connected brain circuits. Here we investigated this issue by applying gamma-band and beta-band tACS over M1 in healthy humans during a visuomotor task and concurrent functional magnetic resonance imaging (fMRI). Gamma tACS indeed improved both the velocity and acceleration of visually triggered movements, compared with both beta tACS and sham stimulation. Beta tACS induced a numerical decrease in velocity compared with sham stimulation, but this was not statistically significant. Crucially, gamma tACS induced motor performance enhancements correlated with changed BOLD activity in the stimulated M1. Moreover, we found frequency- and task-specific neural compensatory activity modulations in the dorsomedial prefrontal cortex (dmPFC), suggesting a key regulatory role of this region in motor performance. Connectivity analyses revealed that the dmPFC interacted functionally with M1 and with regions within the executive motor system. These results suggest a role of the dmPFC for motor control and show that tACS-induced behavioral changes not only result from activity modulations underneath the stimulation electrode but also reflect compensatory modulation within connected and functionally related brain networks. More generally, our results illustrate how combined tACS-fMRI can be used to resolve the causal link between cortical rhythms, brain systems, and behavior. SIGNIFICANCE STATEMENT Recent research has suggested a causal role for gamma oscillations during movement preparation and execution. Here we combine transcranial alternating current stimulation (tACS) with functional magnetic resonance imaging (fMRI) to identify the neural mechanisms that accompany motor performance enhancements triggered by gamma tACS over the primary motor cortex. We show that the tACS-induced motor performance enhancements correlate with changed neural activity in the stimulated area and modulate, in a frequency- and task-specific manner, the neural activity in the dorsomedial prefrontal cortex. This suggests a regulatory role of this region for motor control. More generally, we show that combined tACS-fMRI can elucidate the causal link between brain oscillations, neural systems, and behavior.
Collapse
|
129
|
van Steenburgh JJ, Varvaris M, Schretlen DJ, Vannorsdall TD, Gordon B. Balanced bifrontal transcranial direct current stimulation enhances working memory in adults with high-functioning autism: a sham-controlled crossover study. Mol Autism 2017; 8:40. [PMID: 28775825 PMCID: PMC5534041 DOI: 10.1186/s13229-017-0152-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 06/16/2017] [Indexed: 11/20/2022] Open
Abstract
Background Working memory (WM) often is impaired in autism spectrum disorder (ASD). Such impairment may underlie core deficits in cognition and social functioning. Transcranial direct current stimulation (tDCS) has been shown to enhance WM in both healthy adults and clinical populations, but its efficacy in ASD is unknown. We predicted that bifrontal tDCS would improve WM performances of adults with high-functioning autism during active stimulation compared to sham stimulation and that such enhancement would generalize to an untrained task. Methods Twelve adults with high-functioning ASD engaged in a battery of WM tasks that included backward spatial span, backward digit span, spatial n-back and letter n-back. While engaged, 40 min of 1.5 mA bifrontal stimulation was applied over the left and the right dorsolateral prefrontal cortices (DLPFC). Using a single-blind crossover design, each participant received left anodal/right cathodal stimulation, right anodal/left cathodal stimulation, or sham stimulation, in randomized counterbalanced order on three separate days. Following tDCS, participants again engaged in letter and spatial n-back tasks before taking the Brief Test of Attention (BTA). We used repeated-measures ANOVA to compare overall performance on the WM battery as measured by a composite of z-scores for all five measures. Post hoc ANOVAs, t tests, Friedman’s tests, and Wilcoxon signed-rank tests were used to measure the online and offline effects of tDCS and to assess performances on individual measures. Results Compared to sham stimulation, both left DLPFC anodal stimulation (t11 = 5.4, p = 0.0002) and right DLPFC anodal stimulation (t11 = 3.57, p = 0.004) improved overall WM performance. Left anodal stimulation (t11 = 3.9, p = 0.003) and right anodal stimulation (t11 = 2.7, p = 0.019) enhanced performances during stimulation. Enhancement transferred to an untrained task 50 min after right anodal stimulation (z11 = 2.263, p = 0.024). The tasks that showed the largest effects of active stimulation were spatial span backward (z11 = 2.39, p = 0.017) and BTA (z11 = 2.263, p = 0.024). Conclusions In adults with high-functioning ASD, active bifrontal tDCS given during WM tasks appears to improve performance. TDCS benefits also transferred to an untrained task completed shortly after stimulation. These results suggest that tDCS can improve WM task performance and could reduce some core deficits of autism. Trial registration NCT01602263
Collapse
Affiliation(s)
- J Jason van Steenburgh
- Department of Neurology, The Johns Hopkins University School of Medicine, 1629 Thames Street, Suite 350, Baltimore, MD 21231 USA
| | - Mark Varvaris
- Department of Neurology, The Johns Hopkins University School of Medicine, 1629 Thames Street, Suite 350, Baltimore, MD 21231 USA
| | - David J Schretlen
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, MD 21287 USA.,Division of MR Research, Russell H. Morgan Department of Radiology and Radiological Science, 600 N. Wolfe Street, Baltimore, MD 21287 USA
| | - Tracy D Vannorsdall
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, MD 21287 USA.,Department of Neurology, The Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, MD 21287 USA
| | - Barry Gordon
- Department of Neurology, The Johns Hopkins University School of Medicine, 1629 Thames Street, Suite 350, Baltimore, MD 21231 USA
| |
Collapse
|
130
|
Muthalib M, Besson P, Rothwell J, Perrey S. Focal Hemodynamic Responses in the Stimulated Hemisphere During High-Definition Transcranial Direct Current Stimulation. Neuromodulation 2017; 21:348-354. [PMID: 28714545 DOI: 10.1111/ner.12632] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 05/01/2017] [Accepted: 05/25/2017] [Indexed: 12/01/2022]
Abstract
OBJECTIVE High-definition transcranial direct current stimulation (HD-tDCS) using a 4 × 1 electrode montage has been previously shown using modeling and physiological studies to constrain the electric field within the spatial extent of the electrodes. The aim of this proof-of-concept study was to determine if functional near-infrared spectroscopy (fNIRS) neuroimaging can be used to determine a hemodynamic correlate of this 4 × 1 HD-tDCS electric field on the brain. MATERIALS AND METHODS In a three session cross-over study design, 13 healthy males received one sham (2 mA, 30 sec) and two real (HD-tDCS-1 and HD-tDCS-2, 2 mA, 10 min) anodal HD-tDCS targeting the left M1 via a 4 × 1 electrode montage (anode on C3 and 4 return electrodes 3.5 cm from anode). The two real HD-tDCS sessions afforded a within-subject replication of the findings. fNIRS was used to measure changes in brain hemodynamics (oxygenated hemoglobin integral-O2 Hbint ) during each 10 min session from two regions of interest (ROIs) in the stimulated left hemisphere that corresponded to "within" (Lin ) and "outside" (Lout ) the spatial extent of the 4 × 1 electrode montage, and two corresponding ROIs (Rin and Rout ) in the right hemisphere. RESULTS The ANOVA showed that both real anodal HD-tDCS compared to sham induced a significantly greater O2 Hbint in the Lin than Lout ROIs of the stimulated left hemisphere; while there were no significant differences between the real and sham sessions for the right hemisphere ROIs. Intra-class correlation coefficients showed "fair-to-good" reproducibility for the left stimulated hemisphere ROIs. CONCLUSIONS The greater O2 Hbint "within" than "outside" the spatial extent of the 4 × 1 electrode montage represents a hemodynamic correlate of the electrical field distribution, and thus provides a prospective reliable method to determine the dose of stimulation that is necessary to optimize HD-tDCS parameters in various applications.
Collapse
Affiliation(s)
| | - Pierre Besson
- EuroMov, University of Montpellier, Montpellier, France
| | - John Rothwell
- Institute of Neurology, University College London, London, UK
| | | |
Collapse
|
131
|
Eddy CM, Shapiro K, Clouter A, Hansen PC, Rickards HE. Transcranial direct current stimulation can enhance working memory in Huntington's disease. Prog Neuropsychopharmacol Biol Psychiatry 2017; 77:75-82. [PMID: 28390970 DOI: 10.1016/j.pnpbp.2017.04.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 04/03/2017] [Accepted: 04/03/2017] [Indexed: 11/28/2022]
Abstract
UNLABELLED Transcranial direct current stimulation (tDCS) combined with a cognitive task can enhance targeted aspects of cognitive functioning in clinical populations. The movement disorder Huntington's disease (HD) is associated with progressive cognitive impairment. Deficits in working memory (WM) can be apparent early in the disease and impact functional capacity. We investigated whether tDCS combined with cognitive training could improve WM in patients with HD, and if baseline clinical or cognitive measures may predict efficacy. Twenty participants with HD completed this crossover trial, undergoing 1.5mA anodal tDCS over left dorsolateral prefrontal cortex and sham stimulation on separate visits. Participants and assessor were blinded to condition order, which was randomised across participants. All participants completed baseline clinical and cognitive assessments. Pre- and post-stimulation tasks included digit reordering, computerised n-back tests and a Stroop task. During 15min of tDCS/sham stimulation, participants practiced 1- and 2-back WM tasks. Participants exhibited an increase in WM span on the digit re-ordering span task from pre- to post-stimulation after tDCS, but not after sham stimulation. Gains in WM were positively related to motor symptom ratings and negatively associated with verbal fluency scores. Patients with more severe motor symptoms showed greatest improvement, suggesting that motor symptom ratings may help identify patients who are most likely to benefit from tDCS. CONCLUSIONS Dorsolateral prefrontal tDCS appears well tolerated in HD and enhances WM span compared to sham stimulation. Our findings strongly encourage further investigation of the extent to which tDCS combined with cognitive training could enhance everyday function in HD. ClinicalTrials.gov; NCT02216474 Brain stimulation in Movement Disorders; https://clinicaltrials.gov/ct2/show/NCT02216474.
Collapse
Affiliation(s)
- Clare M Eddy
- National Centre for Mental Health, BSMHFT, Birmingham and College of Medical and Dental Sciences, University of Birmingham, UK.
| | - Kimron Shapiro
- School of Psychology, College of Life and Environmental Sciences, University of Birmingham, UK
| | - Andrew Clouter
- School of Psychology, College of Life and Environmental Sciences, University of Birmingham, UK
| | - Peter C Hansen
- School of Psychology, College of Life and Environmental Sciences, University of Birmingham, UK
| | - Hugh E Rickards
- National Centre for Mental Health, BSMHFT, Birmingham and College of Medical and Dental Sciences, University of Birmingham, UK
| |
Collapse
|
132
|
Norise C, Sacchetti D, Hamilton R. Transcranial Direct Current Stimulation in Post-stroke Chronic Aphasia: The Impact of Baseline Severity and Task Specificity in a Pilot Sample. Front Hum Neurosci 2017; 11:260. [PMID: 28611609 PMCID: PMC5447043 DOI: 10.3389/fnhum.2017.00260] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 05/02/2017] [Indexed: 11/13/2022] Open
Abstract
Emerging evidence suggests that transcranial direct current stimulation (tDCS) can improve aspects of language production in persons with chronic non-fluent aphasia due to left hemisphere stroke. However, to date, studies exploring factors that predict response to tDCS in this or any patient population remain sparse, as are studies that investigate the specific aspects of language performance that are most responsive to stimulation. The current study explored factors that could predict recovery of language fluency and which aspects of language fluency could be expected to improve with the identified factor(s). We report nine patients who demonstrated deficits in fluency as assessed using the Cookie Theft picture description task of the Boston Diagnostic Aphasia Examination. In the treatment condition, subjects received a 2.0 mA current through 5 cm × 5 cm electrodes for 20 min at a site previously shown to elicit a patient-dependent optimal response to tDCS. They were then tested 2-weeks and 2-months after treatment. In the sham condition, a subset of these subjects were tested on the same protocol with sham instead of real tDCS. The current study assessed language fluency improvements in measures of production at the word-level and sentence level, grammatical accuracy, and lexical selection as a function of baseline aphasia severity. A more severe baseline language profile was associated with larger improvements in fluency at the word-level after real tDCS but not sham stimulation. These improvements were maintained at the 2-week follow-up. The results suggest that for at least some outcome measures, baseline severity may be an important factor in predicting the response to tDCS in patients with chronic non-fluent aphasia. Moving forward, the ability to identify patient factors that can predict response could help refine strategies for the administration of therapeutic tDCS, focusing attention on those patients most likely to benefit from stimulation.
Collapse
Affiliation(s)
- Catherine Norise
- Laboratory for Cognition and Neural Stimulation, Department of Neurology, University of PennsylvaniaPhiladelphia, PA, United States
| | - Daniela Sacchetti
- Laboratory for Cognition and Neural Stimulation, Department of Neurology, University of PennsylvaniaPhiladelphia, PA, United States
| | - Roy Hamilton
- Laboratory for Cognition and Neural Stimulation, Department of Neurology, University of PennsylvaniaPhiladelphia, PA, United States
| |
Collapse
|
133
|
Frontoparietal neurostimulation modulates working memory training benefits and oscillatory synchronization. Brain Res 2017; 1667:28-40. [PMID: 28502585 DOI: 10.1016/j.brainres.2017.05.005] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 05/01/2017] [Accepted: 05/03/2017] [Indexed: 11/24/2022]
Abstract
There is considerable interest in maintaining working memory (WM) because it is essential to accomplish most cognitive tasks, and it is correlated with fluid intelligence and ecologically valid measures of daily living. Toward this end, WM training protocols aim to improve WM capacity and extend improvements to unpracticed domains, yet success is limited. One emerging approach is to couple WM training with transcranial direct current stimulation (tDCS). This pairing of WM training with tDCS in longitudinal designs promotes behavioral improvement and evidence of transfer of performance gains to untrained WM tasks. However, the mechanism(s) underlying tDCS-linked training benefits remain unclear. Our goal was to gain purchase on this question by recording high-density EEG before and after a weeklong WM training+tDCS study. Participants completed four sessions of frontoparietal tDCS (active anodal or sham) during which they performed a visuospatial WM change detection task. Participants who received active anodal tDCS demonstrated significant improvement on the WM task, unlike those who received sham stimulation. Importantly, this pattern was mirrored by neural correlates in spectral and phase synchrony analyses of the HD-EEG data. Notably, the behavioral interaction was echoed by interactions in frontal-posterior alpha band power, and theta and low alpha oscillations. These findings indicate that one mechanism by which paired tDCS+WM training operates is to enhance cortical efficiency and connectivity in task-relevant networks.
Collapse
|
134
|
The Role of the Orbitofrontal and Dorsolateral Prefrontal Cortices in Aesthetic Preference for Art. Behav Sci (Basel) 2017; 7:bs7020031. [PMID: 28492478 PMCID: PMC5485461 DOI: 10.3390/bs7020031] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 05/08/2017] [Accepted: 05/09/2017] [Indexed: 11/17/2022] Open
Abstract
The search for the underlying neural activation that occurs during subjective aesthetic experiences of artwork has been enhanced through neuroimaging techniques. Recently, the dorsolateral prefrontal cortex, alongside the orbitofrontal cortex, have been implicated in aesthetic appreciation, and this is the focus of the present paper. Here, the validity of this conclusion is examined through the discussion of its neuroanatomical connections and functional properties. It is proposed that the experimental evidence challenges the view that this area could hold a privileged position in a brain network involved in aesthetic preference.
Collapse
|
135
|
Green AE, Spiegel KA, Giangrande EJ, Weinberger AB, Gallagher NM, Turkeltaub PE. Thinking Cap Plus Thinking Zap: tDCS of Frontopolar Cortex Improves Creative Analogical Reasoning and Facilitates Conscious Augmentation of State Creativity in Verb Generation. Cereb Cortex 2017; 27:2628-2639. [PMID: 27075035 DOI: 10.1093/cercor/bhw080] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Recent neuroimaging evidence indicates neural mechanisms that support transient improvements in creative performance (augmented state creativity) in response to cognitive interventions (creativity cueing). Separately, neural interventions via tDCS show encouraging potential for modulating neuronal function during creative performance. If cognitive and neural interventions are separately effective, can they be combined? Does state creativity augmentation represent "real" creativity, or do interventions simply yield divergence by diminishing meaningfulness/appropriateness? Can augmenting state creativity bolster creative reasoning that supports innovation, particularly analogical reasoning? To address these questions, we combined tDCS with creativity cueing. Testing a regionally specific hypothesis from neuroimaging, high-definition tDCS-targeted frontopolar cortex activity recently shown to predict state creativity augmentation. In a novel analogy finding task, participants under tDCS formulated substantially more creative analogical connections in a large matrix search space (creativity indexed via latent semantic analysis). Critically, increased analogical creativity was not due to diminished accuracy in discerning valid analogies, indicating "real" creativity rather than inappropriate divergence. A simpler relational creativity paradigm (modified verb generation) revealed a tDCS-by-cue interaction; tDCS further enhanced creativity cue-related increases in semantic distance. Findings point to the potential of noninvasive neuromodulation to enhance creative relational cognition, including augmentation of the deliberate effort to formulate connections between distant concepts.
Collapse
Affiliation(s)
- Adam E Green
- Department of Psychology, Georgetown University, Washington, DC, USA
| | | | - Evan J Giangrande
- Clinical and Translational Neuroscience Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - Adam B Weinberger
- Department of Psychology, Georgetown University, Washington, DC, USA
| | | | - Peter E Turkeltaub
- Department of Neurology, Georgetown University Medical Center, Washington, DC, USA.,Research Division, MedStar National Rehabilitation Hospital, Washington, DC, USA
| |
Collapse
|
136
|
Sankarasubramanian V, Cunningham DA, Potter-Baker KA, Beall EB, Roelle SM, Varnerin NM, Machado AG, Jones SE, Lowe MJ, Plow EB. Transcranial Direct Current Stimulation Targeting Primary Motor Versus Dorsolateral Prefrontal Cortices: Proof-of-Concept Study Investigating Functional Connectivity of Thalamocortical Networks Specific to Sensory-Affective Information Processing. Brain Connect 2017; 7:182-196. [PMID: 28142257 DOI: 10.1089/brain.2016.0440] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The pain matrix is comprised of an extensive network of brain structures involved in sensory and/or affective information processing. The thalamus is a key structure constituting the pain matrix. The thalamus serves as a relay center receiving information from multiple ascending pathways and relating information to and from multiple cortical areas. However, it is unknown how thalamocortical networks specific to sensory-affective information processing are functionally integrated. Here, in a proof-of-concept study in healthy humans, we aimed to understand this connectivity using transcranial direct current stimulation (tDCS) targeting primary motor (M1) or dorsolateral prefrontal cortices (DLPFC). We compared changes in functional connectivity (FC) with DLPFC tDCS to changes in FC with M1 tDCS. FC changes were also compared to further investigate its relation with individual's baseline experience of pain. We hypothesized that resting-state FC would change based on tDCS location and would represent known thalamocortical networks. Ten right-handed individuals received a single application of anodal tDCS (1 mA, 20 min) to right M1 and DLPFC in a single-blind, sham-controlled crossover study. FC changes were studied between ventroposterolateral (VPL), the sensory nucleus of thalamus, and cortical areas involved in sensory information processing and between medial dorsal (MD), the affective nucleus, and cortical areas involved in affective information processing. Individual's perception of pain at baseline was assessed using cutaneous heat pain stimuli. We found that anodal M1 tDCS and anodal DLPFC tDCS both increased FC between VPL and sensorimotor cortices, although FC effects were greater with M1 tDCS. Similarly, anodal M1 tDCS and anodal DLPFC tDCS both increased FC between MD and motor cortices, but only DLPFC tDCS modulated FC between MD and affective cortices, like DLPFC. Our findings suggest that M1 stimulation primarily modulates FC of sensory networks, whereas DLPFC stimulation modulates FC of both sensory and affective networks. Our findings when replicated in a larger group of individuals could provide useful evidence that may inform future studies on pain to differentiate between effects of M1 and DLPFC stimulation. Notably, our finding that individuals with high baseline pain thresholds experience greater FC changes with DLPFC tDCS implies the role of DLPFC in pain modulation, particularly pain tolerance.
Collapse
Affiliation(s)
| | - David A Cunningham
- 1 Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic Foundation , Cleveland, Ohio.,2 School of Biomedical Sciences, Department of Neuroscience, Kent State University , Kent, Ohio
| | - Kelsey A Potter-Baker
- 1 Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic Foundation , Cleveland, Ohio
| | - Erik B Beall
- 3 Department of Diagnostic Radiology, Imaging Institute, Cleveland Clinic Foundation , Cleveland, Ohio
| | - Sarah M Roelle
- 1 Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic Foundation , Cleveland, Ohio
| | - Nicole M Varnerin
- 1 Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic Foundation , Cleveland, Ohio
| | - Andre G Machado
- 4 Center for Neurological Restoration, Neurosurgery, Neurological Institute, Cleveland Clinic Foundation , Cleveland, Ohio
| | - Stephen E Jones
- 3 Department of Diagnostic Radiology, Imaging Institute, Cleveland Clinic Foundation , Cleveland, Ohio
| | - Mark J Lowe
- 3 Department of Diagnostic Radiology, Imaging Institute, Cleveland Clinic Foundation , Cleveland, Ohio
| | - Ela B Plow
- 1 Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic Foundation , Cleveland, Ohio.,4 Center for Neurological Restoration, Neurosurgery, Neurological Institute, Cleveland Clinic Foundation , Cleveland, Ohio.,5 Department of Physical Medicine and Rehabilitation, Neurological Institute, Cleveland Clinic Foundation , Cleveland, Ohio
| |
Collapse
|
137
|
Rahman A, Lafon B, Parra LC, Bikson M. Direct current stimulation boosts synaptic gain and cooperativity in vitro. J Physiol 2017; 595:3535-3547. [PMID: 28436038 DOI: 10.1113/jp273005] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Accepted: 02/13/2017] [Indexed: 12/12/2022] Open
Abstract
KEY POINTS Direct current stimulation (DCS) polarity specifically modulates synaptic efficacy during a continuous train of presynaptic inputs, despite synaptic depression. DCS polarizes afferent axons and postsynaptic neurons, boosting cooperativity between synaptic inputs. Polarization of afferent neurons in upstream brain regions may modulate activity in the target brain region during transcranial DCS (tDCS). A statistical theory of coincident activity predicts that the diffuse and weak profile of current flow can be advantageous in enhancing connectivity between co-active brain regions. ABSTRACT Transcranial direct current stimulation (tDCS) produces sustained and diffuse current flow in the brain with effects that are state dependent and outlast stimulation. A mechanistic explanation for tDCS should capture these spatiotemporal features. It remains unclear how sustained DCS affects ongoing synaptic dynamics and how modulation of afferent inputs by diffuse stimulation changes synaptic activity at the target brain region. We tested the effect of acute DCS (10-20 V m-1 for 3-5 s) on synaptic dynamics with constant rate (5-40 Hz) and Poisson-distributed (4 Hz mean) trains of presynaptic inputs. Across tested frequencies, sustained synaptic activity was modulated by DCS with polarity-specific effects. Synaptic depression attenuates the sensitivity to DCS from 1.1% per V m-1 to 0.55%. DCS applied during synaptic activity facilitates cumulative neuromodulation, potentially reversing endogenous synaptic depression. We establish these effects are mediated by both postsynaptic membrane polarization and afferent axon fibre polarization, which boosts cooperativity between synaptic inputs. This potentially extends the locus of neuromodulation from the nominal target to afferent brain regions. Based on these results we hypothesized the polarization of afferent neurons in upstream brain regions may modulate activity in the target brain region during tDCS. A multiscale model of transcranial electrical stimulation including a finite element model of brain current flow, numerical simulations of neuronal activity, and a statistical theory of coincident activity predicts that the diffuse and weak profile of current flow can be advantageous. Thus, we propose that specifically because tDCS is diffuse, weak and sustained it can boost connectivity between co-active brain regions.
Collapse
Affiliation(s)
- Asif Rahman
- Department of Biomedical Engineering, The City College of The City University of New York, Steinman Hall, 160 Convent Ave, New York, NY, 10031, USA
| | - Belen Lafon
- Department of Biomedical Engineering, The City College of The City University of New York, Steinman Hall, 160 Convent Ave, New York, NY, 10031, USA
| | - Lucas C Parra
- Department of Biomedical Engineering, The City College of The City University of New York, Steinman Hall, 160 Convent Ave, New York, NY, 10031, USA
| | - Marom Bikson
- Department of Biomedical Engineering, The City College of The City University of New York, Steinman Hall, 160 Convent Ave, New York, NY, 10031, USA
| |
Collapse
|
138
|
Talsma LJ, Kroese HA, Slagter HA. Boosting Cognition: Effects of Multiple-Session Transcranial Direct Current Stimulation on Working Memory. J Cogn Neurosci 2017; 29:755-768. [DOI: 10.1162/jocn_a_01077] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Abstract
Transcranial direct current stimulation (tDCS) is a promising tool for neurocognitive enhancement. Several studies have shown that just a single session of tDCS over the left dorsolateral pFC (lDLPFC) can improve the core cognitive function of working memory (WM) in healthy adults. Yet, recent studies combining multiple sessions of anodal tDCS over lDLPFC with verbal WM training did not observe additional benefits of tDCS in subsequent stimulation sessions nor transfer of benefits to novel WM tasks posttraining. Using an enhanced stimulation protocol as well as a design that included a baseline measure each day, the current study aimed to further investigate the effects of multiple sessions of tDCS on WM. Specifically, we investigated the effects of three subsequent days of stimulation with anodal (20 min, 1 mA) versus sham tDCS (1 min, 1 mA) over lDLPFC (with a right supraorbital reference) paired with a challenging verbal WM task. WM performance was measured with a verbal WM updating task (the letter n-back) in the stimulation sessions and several WM transfer tasks (different letter set n-back, spatial n-back, operation span) before and 2 days after stimulation. Anodal tDCS over lDLPFC enhanced WM performance in the first stimulation session, an effect that remained visible 24 hr later. However, no further gains of anodal tDCS were observed in the second and third stimulation sessions, nor did benefits transfer to other WM tasks at the group level. Yet, interestingly, post hoc individual difference analyses revealed that in the anodal stimulation group the extent of change in WM performance on the first day of stimulation predicted pre to post changes on both the verbal and the spatial transfer task. Notably, this relationship was not observed in the sham group. Performance of two individuals worsened during anodal stimulation and on the transfer tasks. Together, these findings suggest that repeated anodal tDCS over lDLPFC combined with a challenging WM task may be an effective method to enhance domain-independent WM functioning in some individuals, but not others, or can even impair WM. They thus call for a thorough investigation into individual differences in tDCS respondence as well as further research into the design of multisession tDCS protocols that may be optimal for boosting cognition across a wide range of individuals.
Collapse
|
139
|
Concerto C, Babayev J, Mahmoud R, Rafiq B, Chusid E, Aguglia E, Coira D, Battaglia F. Modulation of prefrontal cortex with anodal tDCS prevents post-exercise facilitation interference during dual task. Somatosens Mot Res 2017; 34:80-84. [DOI: 10.1080/08990220.2017.1292238] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Carmen Concerto
- Department of Interprofessional Health Sciences & Health Administration, Seton Hall University, South Orange, NJ, USA
| | - Jacqueline Babayev
- Pre-clinical Sciences, New York College of Podiatric Medicine, New York, USA
| | - Rowan Mahmoud
- Pre-clinical Sciences, New York College of Podiatric Medicine, New York, USA
| | - Basil Rafiq
- Pre-clinical Sciences, New York College of Podiatric Medicine, New York, USA
| | - Eileen Chusid
- Pre-clinical Sciences, New York College of Podiatric Medicine, New York, USA
| | - Eugenio Aguglia
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Diego Coira
- Department of Psychiatry and Behavioral Medicine, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Fortunato Battaglia
- Department of Interprofessional Health Sciences & Health Administration, Seton Hall University, South Orange, NJ, USA
| |
Collapse
|
140
|
Sotnikova A, Soff C, Tagliazucchi E, Becker K, Siniatchkin M. Transcranial Direct Current Stimulation Modulates Neuronal Networks in Attention Deficit Hyperactivity Disorder. Brain Topogr 2017; 30:656-672. [DOI: 10.1007/s10548-017-0552-4] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Accepted: 01/27/2017] [Indexed: 12/19/2022]
|
141
|
Lefebvre S, Liew SL. Anatomical Parameters of tDCS to Modulate the Motor System after Stroke: A Review. Front Neurol 2017; 8:29. [PMID: 28232816 PMCID: PMC5298973 DOI: 10.3389/fneur.2017.00029] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Accepted: 01/23/2017] [Indexed: 01/19/2023] Open
Abstract
Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation method to modulate the local field potential in neural tissue and consequently, cortical excitability. As tDCS is relatively portable, affordable, and accessible, the applications of tDCS to probe brain-behavior connections have rapidly increased in the last 10 years. One of the most promising applications is the use of tDCS to modulate excitability in the motor cortex after stroke and promote motor recovery. However, the results of clinical studies implementing tDCS to modulate motor excitability have been highly variable, with some studies demonstrating that as many as 50% or more of patients fail to show a response to stimulation. Much effort has therefore been dedicated to understand the sources of variability affecting tDCS efficacy. Possible suspects include the placement of the electrodes, task parameters during stimulation, dosing (current amplitude, duration of stimulation, frequency of stimulation), individual states (e.g., anxiety, motivation, attention), and more. In this review, we first briefly review potential sources of variability specific to stroke motor recovery following tDCS. We then examine how the anatomical variability in tDCS placement [e.g., neural target(s) and montages employed] may alter the neuromodulatory effects that tDCS exerts on the post-stroke motor system.
Collapse
Affiliation(s)
- Stephanie Lefebvre
- Neural Plasticity and Neurorehabilitation Laboratory, Chan Division of Occupational Science and Occupational Therapy, Division of Biokinesiology and Physical Therapy, Department of Neurology, Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles, CA, USA
| | - Sook-Lei Liew
- Neural Plasticity and Neurorehabilitation Laboratory, Chan Division of Occupational Science and Occupational Therapy, Division of Biokinesiology and Physical Therapy, Department of Neurology, Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles, CA, USA
| |
Collapse
|
142
|
Giordano J, Bikson M, Kappenman ES, Clark VP, Coslett HB, Hamblin MR, Hamilton R, Jankord R, Kozumbo WJ, McKinley RA, Nitsche MA, Reilly JP, Richardson J, Wurzman R, Calabrese E. Mechanisms and Effects of Transcranial Direct Current Stimulation. Dose Response 2017; 15:1559325816685467. [PMID: 28210202 PMCID: PMC5302097 DOI: 10.1177/1559325816685467] [Citation(s) in RCA: 127] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The US Air Force Office of Scientific Research convened a meeting of researchers in the fields of neuroscience, psychology, engineering, and medicine to discuss most pressing issues facing ongoing research in the field of transcranial direct current stimulation (tDCS) and related techniques. In this study, we present opinions prepared by participants of the meeting, focusing on the most promising areas of research, immediate and future goals for the field, and the potential for hormesis theory to inform tDCS research. Scientific, medical, and ethical considerations support the ongoing testing of tDCS in healthy and clinical populations, provided best protocols are used to maximize safety. Notwithstanding the need for ongoing research, promising applications include enhancing vigilance/attention in healthy volunteers, which can accelerate training and support learning. Commonly, tDCS is used as an adjunct to training/rehabilitation tasks with the goal of leftward shift in the learning/treatment effect curves. Although trials are encouraging, elucidating the basic mechanisms of tDCS will accelerate validation and adoption. To this end, biomarkers (eg, clinical neuroimaging and findings from animal models) can support hypotheses linking neurobiological mechanisms and behavioral effects. Dosage can be optimized using computational models of current flow and understanding dose–response. Both biomarkers and dosimetry should guide individualized interventions with the goal of reducing variability. Insights from other applied energy domains, including ionizing radiation, transcranial magnetic stimulation, and low-level laser (light) therapy, can be prudently leveraged.
Collapse
Affiliation(s)
- James Giordano
- Department of Neurology and Biochemistry, Neuroethics Studies Program, Pellegrino Center for Clinical Bioethics, Georgetown University Medical Center, Washington, DC, USA
| | - Marom Bikson
- Biomedical Engineering, City College of New York, CUNY, New York, NY, USA
| | - Emily S Kappenman
- San Diego State University, Department of Psychology, San Diego, CA, USA
| | - Vincent P Clark
- Psychology Clinical Neuroscience Center, Department of Psychology, University of New Mexico, Albuquerque, NM, USA
| | - H Branch Coslett
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Michael R Hamblin
- Wellman Center for Photomedicine, Massachusetts General Hospital and Department of Dermatology, Harvard Medical School, Boston, MA, USA
| | - Roy Hamilton
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ryan Jankord
- United States Air Force Research Laboratory, Wright-Patterson Air Force Base, OH, USA
| | | | - R Andrew McKinley
- United States Air Force Research Laboratory, Wright-Patterson Air Force Base, OH, USA
| | - Michael A Nitsche
- Department Psychology and Neurosciences, Leibniz Research Center for Working Environmental and Human Factors, Dortmund, Germany
| | | | - Jessica Richardson
- Department of Speech and Hearing Sciences, University of New Mexico, Albuquerque, NM, USA
| | - Rachel Wurzman
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Edward Calabrese
- Environmental Health Sciences, University of Massachusetts, Amherst, MA, USA
| |
Collapse
|
143
|
Lin RL, Douaud G, Filippini N, Okell TW, Stagg CJ, Tracey I. Structural Connectivity Variances Underlie Functional and Behavioral Changes During Pain Relief Induced by Neuromodulation. Sci Rep 2017; 7:41603. [PMID: 28148969 PMCID: PMC5288647 DOI: 10.1038/srep41603] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 12/23/2016] [Indexed: 12/31/2022] Open
Abstract
An increased understanding of the relationship between structural connections and functional and behavioral outcomes is an essential but under-explored topic in neuroscience. During transcranial direct current stimulation (tDCS)-induced analgesia, neuromodulation occurs through a top-down process that depends on inter-regional connections. To investigate whether variation in anatomical connectivity explains functional and behavorial outcomes during neuromodulation, we first combined tDCS and a tonic pain model with concurrent arterial spin labelling that measures cerebral perfusion related to ongoing neural activity. Left dorsolateral prefrontal cortex (L-DLPFC) tDCS induced an analgesic effect, which was explained by reduced perfusion to posterior insula and thalamus. Second, we used diffusion imaging to assess white matter structural integrity between L-DLPFC and thalamus, two key components of the neuromodulatory network. Fractional anisotropy of this tract correlated positively with functional and behavioral modulations. This suggests structural dependence by the neuromodulatory process to induce analgesia with potential relevance for patient stratification.
Collapse
Affiliation(s)
- Richard L. Lin
- Oxford Centre for Functional Magnetic Resonance Imaging of the Brain (FMRIB Centre), University of Oxford, Oxford OX1 3UH, United Kingdom
- Nuffield Division of Anaesthetics, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford OX1 3UH, United Kingdom
| | - Gwenaëlle Douaud
- Oxford Centre for Functional Magnetic Resonance Imaging of the Brain (FMRIB Centre), University of Oxford, Oxford OX1 3UH, United Kingdom
| | - Nicola Filippini
- Oxford Centre for Functional Magnetic Resonance Imaging of the Brain (FMRIB Centre), University of Oxford, Oxford OX1 3UH, United Kingdom
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford OX1 3UH, United Kingdom
| | - Thomas W. Okell
- Oxford Centre for Functional Magnetic Resonance Imaging of the Brain (FMRIB Centre), University of Oxford, Oxford OX1 3UH, United Kingdom
| | - Charlotte J. Stagg
- Oxford Centre for Functional Magnetic Resonance Imaging of the Brain (FMRIB Centre), University of Oxford, Oxford OX1 3UH, United Kingdom
- Oxford Centre for Human Brain Activity, Department of Psychiatry, University of Oxford, Oxford OX1 3UH, United Kingdom
| | - Irene Tracey
- Oxford Centre for Functional Magnetic Resonance Imaging of the Brain (FMRIB Centre), University of Oxford, Oxford OX1 3UH, United Kingdom
- Nuffield Division of Anaesthetics, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford OX1 3UH, United Kingdom
| |
Collapse
|
144
|
Bai Y, Xia X, Kang J, Yang Y, He J, Li X. TDCS modulates cortical excitability in patients with disorders of consciousness. NEUROIMAGE-CLINICAL 2017; 15:702-709. [PMID: 28702347 PMCID: PMC5487253 DOI: 10.1016/j.nicl.2017.01.025] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Revised: 12/27/2016] [Accepted: 01/23/2017] [Indexed: 12/16/2022]
Abstract
Transcranial direct current stimulation (tDCS)1 has been reported to be a promising technique for consciousness improvement for patients with disorders of consciousness (DOC).2 However, there has been no direct electrophysiological evidence to demonstrate the efficacy of tDCS on patients with DOC. Therefore, we aim to measure the cortical excitability changes induced by tDCS in patients with DOC, to find electrophysiological evidence supporting the therapeutic efficacy of tDCS on patients with DOC. In this study, we enrolled sixteen patients with DOC, including nine vegetative state (VS)3 and seven minimally conscious state (MCS)4 (six females and ten males). TMS-EEG was applied to assess cortical excitability changes after twenty minutes of anodal tDCS of the left dorsolateral prefrontal cortex. Global cerebral excitability were calculated to quantify cortical excitability in the temporal domain: four time intervals (0–100, 100–200, 200–300, 300-400 ms). Then local cerebral excitability in the significantly altered time windows were investigated (frontal, left/right hemispheres, central, and posterior). Compared to baseline and sham stimulation, we found that global cerebral excitability increased in early time windows (0–100 and 100-200 ms) for patients with MCS; for the patients with VS, global cerebral excitability increased in the 0-100 ms interval but decreased in the 300-400 ms interval. The local cerebral excitability was significantly different between MCS and VS. The results indicated that tDCS can effectively modulate the cortical excitability of patients with DOC; and the changes in excitability in temporal and spatial domains are different between patients with MCS and those with VS. TDCS was used to alter cerebral excitability in patients of DOC. TMS-EEG was used to evaluate cortical excitability changes in patients of DOC. TDCS could induce significant cortical excitability changes in patients of DOC. TDCS induced different temporal-spatial excitability changes between MCS and VS.
Collapse
Affiliation(s)
- Yang Bai
- Institute of Electrical Engineering, Yanshan University, Qinhuangdao 066004, China
| | - Xiaoyu Xia
- Department of Neurosurgery, PLA Army General Hospital, Beijing 100700, China; Department of Biomedical Engineering, Medical school, Tsinghua University, China
| | - Jiannan Kang
- Institute of Electronic Information Engineering, Hebei University, Baoding 071002, China
| | - Yi Yang
- Department of Neurosurgery, PLA Army General Hospital, Beijing 100700, China
| | - Jianghong He
- Department of Neurosurgery, PLA Army General Hospital, Beijing 100700, China.
| | - Xiaoli Li
- State Key Laboratory of Cognitive Neuroscience and Learning & IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing 100875, China; Center for Collaboration and Innovation in Brain and Learning Sciences, Beijing Normal University, Beijing 100875, China.
| |
Collapse
|
145
|
Narita Z, Inagawa T, Maruo K, Sueyoshi K, Sumiyoshi T. Effect of Transcranial Direct Current Stimulation on Functional Capacity in Schizophrenia: A Study Protocol for a Randomized Controlled Trial. Front Psychiatry 2017; 8:233. [PMID: 29180969 PMCID: PMC5694143 DOI: 10.3389/fpsyt.2017.00233] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Accepted: 10/31/2017] [Indexed: 12/13/2022] Open
Abstract
UNLABELLED Schizophrenia patients elicit a wide range of psychopathology, including psychotic symptoms, mood symptoms, and cognitive impairment. Functional capacity is defined as the ability to perform everyday living skills, which is linked to cognition and real-world functional outcome. In a previous open trial, we demonstrated that transcranial direct current stimulation (tDCS), one of the neuromodulation methods, improved cognition and functional capacity in 28 patients with schizophrenia. However, since it was a pilot study, a controlled trial is needed. Therefore, we present a study protocol for a randomized controlled trial designed to evaluate the effect of tDCS on functional capacity in patients with schizophrenia. This is a two-arm, parallel-design, randomized controlled trial, in which patients and assessors will be blinded. Patients meeting DSM-5 criteria for schizophrenia will be enrolled and randomized to receive either active or sham stimulation (with 10 sessions in five consecutive days). Functional capacity will be evaluated by the UCSD Performance-based Skills Assessment-Brief as primary outcome. Cognition, as measured by the Brief Assessment of Cognition in Schizophrenia, and psychotic symptoms, as measured by the Positive and Negative Syndrome Scale, will also be evaluated. Data will be collected at baseline, immediately after the last stimulation, and 1 and 2 months thereafter. If active stimulation elicits greater effects compared with those of sham stimulation, it may add to the efforts to improve functional outcomes by neuromodulation in patients with schizophrenia. TRIAL REGISTRATION UMIN000028224; https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000032305.
Collapse
Affiliation(s)
- Zui Narita
- Department of Psychiatry, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Takuma Inagawa
- Department of Psychiatry, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Kazushi Maruo
- Department of Clinical Epidemiology, Translational Medical Center, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Kazuki Sueyoshi
- Department of Clinical Epidemiology, Translational Medical Center, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Tomiki Sumiyoshi
- Department of Clinical Epidemiology, Translational Medical Center, National Center of Neurology and Psychiatry, Tokyo, Japan
| |
Collapse
|
146
|
Narita Z, Inagawa T, Sueyoshi K, Lin C, Sumiyoshi T. Possible Facilitative Effects of Repeated Anodal Transcranial Direct Current Stimulation on Functional Outcome 1 Month Later in Schizophrenia: An Open Trial. Front Psychiatry 2017; 8:184. [PMID: 29033856 PMCID: PMC5626815 DOI: 10.3389/fpsyt.2017.00184] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 09/11/2017] [Indexed: 11/13/2022] Open
Abstract
UNLABELLED Recent research on neuromodulation techniques, such as transcranial direct current stimulation (tDCS), for the treatment of schizophrenia has mainly focused on psychotic symptoms. We aimed to determine whether repetitive tDCS is efficacious in improving determinants of outcome, such as cognitive function, daily living skills, and depressive mood in patients with schizophrenia. Twenty-eight patients underwent tDCS (2 mA × 20 min) two times per day for 5 consecutive days. The anodal electrode was placed over the left dorsolateral prefrontal cortex while the cathodal electrode was placed over the right supraorbital region. One month after the last stimulation, there was a significant improvement on cognitive function, measured by the brief assessment of cognition in schizophrenia (d = 0.49). Significant effects were also shown on daily living skills (functional capacity), measured by the UCSD performance-based skills assessment-brief (d = 0.70). Depressive symptoms, measured by the Calgary depression rating scale, as well as psychotic symptoms measured by on the positive and negative syndrome scale positive and general psychopathology subscales also responded to the treatment (d = 0.38, d = 0.48, and d = 0.50, respectively). This is the first study to suggest that tDCS with the anodal electrode on the left prefrontal cortex improves functional capacity and depressive symptoms in patients with schizophrenia. These results may add to the concept that tDCS provides a strategy to enhance functional outcomes in patients with schizophrenia. TRIAL REGISTRATION https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000018556, UMIN000015953.
Collapse
Affiliation(s)
- Zui Narita
- Department of Psychiatry, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Takuma Inagawa
- Department of Psychiatry, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Kazuki Sueyoshi
- Department of Clinical Epidemiology, Translational Medical Center, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Crystal Lin
- Department of Clinical Epidemiology, Translational Medical Center, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Tomiki Sumiyoshi
- Department of Clinical Epidemiology, Translational Medical Center, National Center of Neurology and Psychiatry, Tokyo, Japan
| |
Collapse
|
147
|
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]
|
148
|
Rosen DS, Erickson B, Kim YE, Mirman D, Hamilton RH, Kounios J. Anodal tDCS to Right Dorsolateral Prefrontal Cortex Facilitates Performance for Novice Jazz Improvisers but Hinders Experts. Front Hum Neurosci 2016; 10:579. [PMID: 27899889 PMCID: PMC5110534 DOI: 10.3389/fnhum.2016.00579] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 11/01/2016] [Indexed: 11/29/2022] Open
Abstract
Research on creative cognition reveals a fundamental disagreement about the nature of creative thought, specifically, whether it is primarily based on automatic, associative (Type-1) or executive, controlled (Type-2) processes. We hypothesized that Type-1 and Type-2 processes make differential contributions to creative production that depend on domain expertise. We tested this hypothesis with jazz pianists whose expertise was indexed by the number of public performances given. Previous fMRI studies of musical improvisation have reported that domain expertise is characterized by deactivation of the right-dorsolateral prefrontal cortex (r-DLPFC), a brain area associated with Type-2 executive processing. We used anodal, cathodal, and sham transcranial direct current stimulation (tDCS) applied over r-DLPFC with the reference electrode on the contralateral mastoid (1.5 mA for 15 min, except for sham) to modulate the quality of the pianists' performances while they improvised over chords with drum and bass accompaniment. Jazz experts rated each improvisation for creativity, esthetic appeal, and technical proficiency. There was no main effect of anodal or cathodal stimulation on ratings compared to sham; however, a significant interaction between anodal tDCS and expertise emerged such that stimulation benefitted musicians with less experience but hindered those with more experience. We interpret these results as evidence for a dual-process model of creativity in which novices and experts differentially engage Type-1 and Type-2 processes during creative production.
Collapse
Affiliation(s)
- David S Rosen
- Creativity Research Laboratory, Department of Psychology, Drexel University Philadelphia, PA, USA
| | - Brian Erickson
- Creativity Research Laboratory, Department of Psychology, Drexel University Philadelphia, PA, USA
| | - Youngmoo E Kim
- Music and Entertainment Technology Laboratory, Department of Electrical and Computer Engineering, Drexel University Philadelphia, PA, USA
| | - Daniel Mirman
- Language and Cognitive Dynamics Laboratory, Department of Psychology, University of Alabama at Birmingham Birmingham, AL, USA
| | - Roy H Hamilton
- Laboratory for Cognition and Neural Stimulation, Perelman School of Medicine, University of Pennsylvania Philadelphia, PA, USA
| | - John Kounios
- Creativity Research Laboratory, Department of Psychology, Drexel University Philadelphia, PA, USA
| |
Collapse
|
149
|
Increased contextual cue utilization with tDCS over the prefrontal cortex during a recognition task. Brain Res 2016; 1655:1-9. [PMID: 27845032 DOI: 10.1016/j.brainres.2016.11.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 10/07/2016] [Accepted: 11/08/2016] [Indexed: 11/22/2022]
Abstract
The precise role of the prefrontal and posterior parietal cortices in recognition performance remains controversial, with questions about whether these regions contribute to recognition via the availability of mnemonic evidence or via decision biases and retrieval orientation. Here we used an explicit memory cueing paradigm, whereby external cues probabilistically predict upcoming memoranda as old or new, in our case with 75% validity, and these cues affect recognition decision biases in the direction of the cue. The present study applied bilateral transcranial direct current stimulation (tDCS) over prefrontal or posterior parietal cortex, or sham tDCS, to test the causal role of these regions in recognition accuracy or decision biasing. Participants who received tDCS over prefrontal cortex showed increased cue utilization compared to tDCS over posterior parietal cortex and sham tDCS, suggesting that the prefrontal cortex is involved in processes that contribute to decision biases in memory.
Collapse
|
150
|
Effects of HD-tDCS on memory and metamemory for general knowledge questions that vary by difficulty. Brain Stimul 2016; 10:231-241. [PMID: 27876306 DOI: 10.1016/j.brs.2016.10.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 10/24/2016] [Accepted: 10/28/2016] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND The ability to monitor one's own memory is an important feature of normal memory and is an aspect of 'metamemory'. Lesion studies have shown dissociations between memory and metamemory, but only single dissociations have been shown using transcranial direct current stimulation (tDCS). One potential reason that only single dissociations have been shown is that tDCS effects may be moderated by task difficulty. OBJECTIVE/HYPOTHESIS We used high definition (HD) tDCS to test for dissociable roles of the dorsolateral prefrontal cortex (DLPFC) and anterior temporal lobe (ATL) in semantic long-term memory and metamemory tasks. We also tested whether general knowledge question difficulty moderated the effects of HD-tDCS. METHODS Across 3 sessions, participants received active HD-tDCS over the left DLPFC or left ATL, or sham HD-tDCS during general knowledge recall and recognition tests, and a 'feeling-of-knowing' metamemory task. General knowledge questions were blocked by difficulty. Repeated measures ANOVAs were used to examine the effects of HD-tDCS on memory and metamemory tasks by memory question difficulty. RESULTS HD-tDCS over the ATL led to improved recall compared to DLPFC and sham HD-tDCS, and this occurred only for medium difficulty questions. In contrast, for non-recalled questions, HD-tDCS over the DLPFC led to improved recognition accuracy and improved feeling-of-knowing accuracy compared to ATL and sham HD-tDCS, and this was not moderated by memory question difficulty. CONCLUSION (S) HD-tDCS can be used to dissociate the roles of the ATL and DLPFC in different memory and 'metamemory' tasks. The effects of HD-tDCS on task may be moderated by task difficulty, depending on the nature of the task and site of stimulation.
Collapse
|