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Dopamine-dependent changes of cortical excitability induced by transcranial static magnetic field stimulation in Parkinson's disease. Sci Rep 2017; 7:4329. [PMID: 28659614 PMCID: PMC5489478 DOI: 10.1038/s41598-017-04254-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 05/11/2017] [Indexed: 12/02/2022] Open
Abstract
Transcranial static magnetic field stimulation (tSMS) is a recent low-cost non-invasive brain stimulation technique that decreases cortical excitability in healthy subjects. The objective of the present study was to test the ability of tSMS to modulate cortical excitability in patients with Parkinson’s disease. We performed a randomized double-blind sham-controlled cross-over study to assess cortical excitability before and immediately after tSMS (or sham) applied for 10 min to the more affected motor cortex of patients with Parkinson’s disease. Cortical excitability was quantified by the amplitude of motor evoked potentials (MEPs) elicited by single-pulse transcranial magnetic stimulation (TMS). tSMS significantly decreased MEP amplitudes in patients OFF medication (after overnight withdrawal of dopaminergic drugs), but not ON medication (after an acute dose of levodopa). The between-patients variability of tSMS-induced changes was significantly greater ON medication. The variability ON medication could be partly explained by disease progression, i.e. the more advanced the patient, the more likely it was to observe a switch from inhibitory tSMS plasticity OFF medication to paradoxical facilitatory plasticity ON medication. These results suggest that tSMS induces dopamine-dependent changes of cortical excitability in patients with Parkinson’s disease.
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152
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Cosentino G, Valentino F, Todisco M, Alfonsi E, Davì R, Savettieri G, Fierro B, D'Amelio M, Brighina F. Effects of More-Affected vs. Less-Affected Motor Cortex tDCS in Parkinson's Disease. Front Hum Neurosci 2017; 11:309. [PMID: 28659778 PMCID: PMC5466958 DOI: 10.3389/fnhum.2017.00309] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 05/29/2017] [Indexed: 12/19/2022] Open
Abstract
Objective: To evaluate therapeutic potential of different montages of transcranial direct current stimulation (tDCS) in Parkinson’s Disease (PD) patients with asymmetric motor symptoms. Materials and Methods: Fourteen patients with asymmetric PD underwent, while on treatment, seven separate sessions including electrophysiological and clinical evaluation at baseline and after anodal, cathodal and sham tDCS of the primary motor cortex (M1) of the two hemispheres. Changes in motor cortical excitability were evaluated by transcranial magnetic stimulation (TMS). Effects on motor symptoms were assessed by testing finger tapping (FT) and upper limb bradykinesia, and by using the Italian validated Movement Disorder Society revision of the Unified PD Rating Scale (MDS-UPDRS). Results: Only anodal tDCS of the more-affected M1 (contralateral to the more-affected body side) and cathodal tDCS of the less-affected M1 (contralateral to the less-affected body side) were able to induce significant changes in cortical excitability, i.e., facilitation and inhibition of the motor evoked potentials respectively. The motor performances of both hands significantly improved after anodal tDCS of the more-affected M1, as well as after cathodal tDCS of the less-affected one. Conclusion: Our findings support the potential usefulness of tDCS as add-on treatment for asymmetric PD, also providing interesting clues on the possible pathophysiological role played by an asymmetric activation of homologous motor cortical areas in PD.
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Affiliation(s)
- Giuseppe Cosentino
- Department of Experimental Biomedicine and Clinical Neurosciences (BioNeC), University of PalermoPalermo, Italy
| | - Francesca Valentino
- Department of Experimental Biomedicine and Clinical Neurosciences (BioNeC), University of PalermoPalermo, Italy
| | - Massimiliano Todisco
- Department of Neurophysiopathology, C. Mondino National Institute of Neurology Foundation, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS)Pavia, Italy
| | - Enrico Alfonsi
- Department of Neurophysiopathology, C. Mondino National Institute of Neurology Foundation, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS)Pavia, Italy
| | - Rosaria Davì
- Department of Experimental Biomedicine and Clinical Neurosciences (BioNeC), University of PalermoPalermo, Italy
| | - Giovanni Savettieri
- Department of Experimental Biomedicine and Clinical Neurosciences (BioNeC), University of PalermoPalermo, Italy
| | - Brigida Fierro
- Department of Experimental Biomedicine and Clinical Neurosciences (BioNeC), University of PalermoPalermo, Italy
| | - Marco D'Amelio
- Department of Experimental Biomedicine and Clinical Neurosciences (BioNeC), University of PalermoPalermo, Italy
| | - Filippo Brighina
- Department of Experimental Biomedicine and Clinical Neurosciences (BioNeC), University of PalermoPalermo, Italy
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153
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ALHarbi MF, Armijo-Olivo S, Kim ES. Transcranial direct current stimulation (tDCS) to improve naming ability in post-stroke aphasia: A critical review. Behav Brain Res 2017; 332:7-15. [PMID: 28572057 DOI: 10.1016/j.bbr.2017.05.050] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 05/18/2017] [Accepted: 05/22/2017] [Indexed: 12/20/2022]
Abstract
PURPOSE Transcranial Direct Current Stimulation (tDCS) is a non-invasive neuromodulation tool that can be used to influence cortical brain activity to induce measurable behavioral changes. Although there is growing evidence that tDCS combined with behavioural language therapy could boost language recovery in patients with post-stroke aphasia, there is great variability in patient characteristics, treatment protocols, and outcome measures in these studies that poses challenges for analyzing the evidence. The purpose of this study is to critically analyze the methodological rigor of the evidence regarding the use of tDCS for post-stroke anomia. METHOD This critical review was conducted by searching four databases (MEDLINE, EMBase, PsycINFO, and CINAHL). Nineteen studies fully met the inclusion criteria. Three critical appraisal tools and Robey and Schultz's (1998) five- phase model for conducting clinical outcome research were adopted to evaluate and analyze the current level of evidence. Methodological issues of the studies were also identified. RESULTS The current level of evidence for using tDCS for anomia is at the pre-efficacy level with emerging evidence at the efficacy level. Lack of proper evaluation of carry-over effects in cross-over studies, lack of or unclear randomization, allocation concealment, and incomplete data handling were the main methodological issues that could threaten the validity of the tDCS for anomia studies. CONCLUSIONS Several methodological issues have been identified in pre-efficacy studies that pose challenges in determining whether tDCS is a beneficial adjunct to behavioral aphasia therapy. Future studies need to improve the quality of the methods used to investigate the effect of tDCS for anomia.
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Affiliation(s)
- Mohammed F ALHarbi
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada; Department of Speech-language pathology and Audiology, College of Medical Rehabilitation Sciences, Taibah University, Madinah, Saudi Arabia.
| | - Susan Armijo-Olivo
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada; Rehabilitation Research Center, University of Alberta, Edmonton, AB, Canada
| | - Esther S Kim
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada; Dept. of Communication Sciences and Disorders, University of Alberta, Edmonton, AB, Canada
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154
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Zhao H, Qiao L, Fan D, Zhang S, Turel O, Li Y, Li J, Xue G, Chen A, He Q. Modulation of Brain Activity with Noninvasive Transcranial Direct Current Stimulation (tDCS): Clinical Applications and Safety Concerns. Front Psychol 2017; 8:685. [PMID: 28539894 PMCID: PMC5423956 DOI: 10.3389/fpsyg.2017.00685] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Accepted: 04/19/2017] [Indexed: 11/13/2022] Open
Abstract
Transcranial direct current stimulation (tDCS) is a widely-used tool to induce neuroplasticity and modulate cortical function by applying weak direct current over the scalp. In this review, we first introduce the underlying mechanism of action, the brief history from discovery to clinical scientific research, electrode positioning and montages, and parameter setup of tDCS. Then, we review tDCS application in clinical samples including people with drug addiction, major depression disorder, Alzheimer's disease, as well as in children. This review covers the typical characteristics and the underlying neural mechanisms of tDCS treatment in such studies. This is followed by a discussion of safety, especially when the current intensity is increased or the stimulation duration is prolonged. Given such concerns, we provide detailed suggestions regarding safety procedures for tDCS operation. Lastly, future research directions are discussed. They include foci on the development of multi-tech combination with tDCS such as with TMS and fMRI; long-term behavioral and morphological changes; possible applications in other research domains, and more animal research to deepen the understanding of the biological and physiological mechanisms of tDCS stimulation.
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Affiliation(s)
- Haichao Zhao
- Faculty of Psychology, Southwest UniversityChongqing, China
| | - Lei Qiao
- Faculty of Psychology, Southwest UniversityChongqing, China
| | - Dongqiong Fan
- Faculty of Psychology, Southwest UniversityChongqing, China
| | - Shuyue Zhang
- School of Education, Guangxi UniversityNanning, China
| | - Ofir Turel
- Department of Information systems and Decision Sciences, College of Business and Economics, California State University, FullertonFullerton, CA, USA
| | - Yonghui Li
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of SciencesBeijing, China
| | - Jun Li
- National Key Laboratory of Cognitive Neuroscience and Learning, IDG/McGovern Institute for Brain Research, Beijing Normal UniversityBeijing, China
| | - Gui Xue
- National Key Laboratory of Cognitive Neuroscience and Learning, IDG/McGovern Institute for Brain Research, Beijing Normal UniversityBeijing, China
| | - Antao Chen
- Faculty of Psychology, Southwest UniversityChongqing, China
| | - Qinghua He
- Faculty of Psychology, Southwest UniversityChongqing, China.,Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of SciencesBeijing, China.,Southwest University Branch, Collaborative Innovation Center of Assessment toward Basic Education Quality at Beijing Normal UniversityChongqing, China
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155
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Angulo-Sherman IN, Rodríguez-Ugarte M, Sciacca N, Iáñez E, Azorín JM. Effect of tDCS stimulation of motor cortex and cerebellum on EEG classification of motor imagery and sensorimotor band power. J Neuroeng Rehabil 2017; 14:31. [PMID: 28420382 PMCID: PMC5395900 DOI: 10.1186/s12984-017-0242-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 04/08/2017] [Indexed: 12/12/2022] Open
Abstract
Background Transcranial direct current stimulation (tDCS) is a technique for brain modulation that has potential to be used in motor neurorehabilitation. Considering that the cerebellum and motor cortex exert influence on the motor network, their stimulation could enhance motor functions, such as motor imagery, and be utilized for brain-computer interfaces (BCIs) during motor neurorehabilitation. Methods A new tDCS montage that influences cerebellum and either right-hand or feet motor area is proposed and validated with a simulation of electric field. The effect of current density (0, 0.02, 0.04 or 0.06 mA/cm2) on electroencephalographic (EEG) classification into rest or right-hand/feet motor imagery was evaluated on 5 healthy volunteers for different stimulation modalities: 1) 10-minutes anodal tDCS before EEG acquisition over right-hand or 2) feet motor cortical area, and 3) 4-seconds anodal tDCS during EEG acquisition either on right-hand or feet cortical areas before each time right-hand or feet motor imagery is performed. For each subject and tDCS modality, analysis of variance and Tukey-Kramer multiple comparisons tests (p <0.001) are used to detect significant differences between classification accuracies that are obtained with different current densities. For tDCS modalities that improved accuracy, t-tests (p <0.05) are used to compare μ and β band power when a specific current density is provided against the case of supplying no stimulation. Results The proposed montage improved the classification of right-hand motor imagery for 4 out of 5 subjects when the highest current was applied for 10 minutes over the right-hand motor area. Although EEG band power changes could not be related directly to classification improvement, tDCS appears to affect variably different motor areas on μ and/or β band. Conclusions The proposed montage seems capable of enhancing right-hand motor imagery detection when the right-hand motor area is stimulated. Future research should be focused on applying higher currents over the feet motor cortex, which is deeper in the brain compared to the hand motor cortex, since it may allow observation of effects due to tDCS. Also, strategies for improving analysis of EEG respect to accuracy changes should be implemented.
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Affiliation(s)
- Irma N Angulo-Sherman
- Center for Research and Advanced Studies (Cinvestav), Parque de Investigación e Innovación Tecnológica km 9.5 de la Autopista Nueva al Aeropuerto, 201, Monterrey, 66600, NL, Mexico
| | - Marisol Rodríguez-Ugarte
- Brain-Machine Interface Systems Lab, Universidad Miguel Hernández de Elche, Av. de la Universidad S/N, Elche, 03202, Spain
| | - Nadia Sciacca
- Brain-Machine Interface Systems Lab, Universidad Miguel Hernández de Elche, Av. de la Universidad S/N, Elche, 03202, Spain
| | - Eduardo Iáñez
- Brain-Machine Interface Systems Lab, Universidad Miguel Hernández de Elche, Av. de la Universidad S/N, Elche, 03202, Spain.
| | - José M Azorín
- Brain-Machine Interface Systems Lab, Universidad Miguel Hernández de Elche, Av. de la Universidad S/N, Elche, 03202, Spain
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156
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Costa-Ribeiro A, Maux A, Bosford T, Aoki Y, Castro R, Baltar A, Shirahige L, Moura Filho A, Nitsche MA, Monte-Silva K. Transcranial direct current stimulation associated with gait training in Parkinson's disease: A pilot randomized clinical trial. Dev Neurorehabil 2017; 20:121-128. [PMID: 26864140 DOI: 10.3109/17518423.2015.1131755] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVE The aim of this study is to investigate the effects of transcranial direct current stimulation (tDCS) combined with cueing gait training (CGT) on functional mobility in patients with Parkinson´s disease (PD). METHODS A pilot double-blind controlled, randomized clinical trial was conducted with 22 patients with PD assigned to the experimental (anodal tDCS plus CGT) and control group (sham tDCS plus CGT). The primary outcome (functional mobility) was assessed by 10-m walk test, cadence, stride length, and Timed Up and Go test. Motor impairment, bradykinesia, balance, and quality of life were analyzed as secondary outcomes. Minimal clinically important differences (MCIDs) were observed when assessing outcome data. RESULTS Both groups demonstrated similar gains in all outcome measures, except for the stride length. The number of participants who showed MCID was similar between groups. CONCLUSION The CGT provided many benefits to functional mobility, motor impairment, bradykinesia, balance, and quality of life. However, these effect magnitudes were not influenced by stimulation, but tDCS seems to prolong the effects of cueing therapy on functional mobility.
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Affiliation(s)
- Adriana Costa-Ribeiro
- a Department of Physical Therapy, Applied Neuroscience Laboratory , Universidade Federal de Pernambuco-UFPE , Pernambuco , Brazil
| | - Ariadne Maux
- a Department of Physical Therapy, Applied Neuroscience Laboratory , Universidade Federal de Pernambuco-UFPE , Pernambuco , Brazil
| | - Thamyris Bosford
- a Department of Physical Therapy, Applied Neuroscience Laboratory , Universidade Federal de Pernambuco-UFPE , Pernambuco , Brazil
| | - Yumi Aoki
- a Department of Physical Therapy, Applied Neuroscience Laboratory , Universidade Federal de Pernambuco-UFPE , Pernambuco , Brazil
| | - Rebeca Castro
- a Department of Physical Therapy, Applied Neuroscience Laboratory , Universidade Federal de Pernambuco-UFPE , Pernambuco , Brazil
| | - Adriana Baltar
- a Department of Physical Therapy, Applied Neuroscience Laboratory , Universidade Federal de Pernambuco-UFPE , Pernambuco , Brazil
| | - Lívia Shirahige
- a Department of Physical Therapy, Applied Neuroscience Laboratory , Universidade Federal de Pernambuco-UFPE , Pernambuco , Brazil
| | - Alberto Moura Filho
- b Department of Physical Therapy, Laboratory of Kinesiology and Functional Assessment , Universidade Federal de Pernambuco-UFPE , Pernambuco , Brazil
| | - Michael A Nitsche
- c Department of Clinical Neurophysiology , Georg August University , Goettingen , Germany.,d Leibniz Research Centre for Working Environment and Human Resources , Dortmund , Germany.,e Department of Neurology , University Medical Hospital Bergmannsheil , Bochum , Germany
| | - Kátia Monte-Silva
- a Department of Physical Therapy, Applied Neuroscience Laboratory , Universidade Federal de Pernambuco-UFPE , Pernambuco , Brazil
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157
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Anodal transcranial direct current stimulation over the primary motor cortex does not enhance the learning benefits of self-controlled feedback schedules. PSYCHOLOGICAL RESEARCH 2017; 82:496-506. [DOI: 10.1007/s00426-017-0846-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 01/30/2017] [Indexed: 12/12/2022]
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158
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Huang Y, Liu AA, Lafon B, Friedman D, Dayan M, Wang X, Bikson M, Doyle WK, Devinsky O, Parra LC. Measurements and models of electric fields in the in vivo human brain during transcranial electric stimulation. eLife 2017; 6:18834. [PMID: 28169833 PMCID: PMC5370189 DOI: 10.7554/elife.18834] [Citation(s) in RCA: 321] [Impact Index Per Article: 45.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 02/06/2017] [Indexed: 11/13/2022] Open
Abstract
Transcranial electric stimulation aims to stimulate the brain by applying weak electrical currents at the scalp. However, the magnitude and spatial distribution of electric fields in the human brain are unknown. We measured electric potentials intracranially in ten epilepsy patients and estimated electric fields across the entire brain by leveraging calibrated current-flow models. When stimulating at 2 mA, cortical electric fields reach 0.8 V/m, the lower limit of effectiveness in animal studies. When individual whole-head anatomy is considered, the predicted electric field magnitudes correlate with the recorded values in cortical (r = 0.86) and depth (r = 0.88) electrodes. Accurate models require adjustment of tissue conductivity values reported in the literature, but accuracy is not improved when incorporating white matter anisotropy or different skull compartments. This is the first study to validate and calibrate current-flow models with in vivo intracranial recordings in humans, providing a solid foundation to target stimulation and interpret clinical trials. DOI:http://dx.doi.org/10.7554/eLife.18834.001
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Affiliation(s)
- Yu Huang
- Department of Biomedical Engineering, City College of the City University of New York, New York, United States
| | - Anli A Liu
- Comprehensive Epilepsy Center, New York University School of Medicine, New York, United States
| | - Belen Lafon
- Department of Biomedical Engineering, City College of the City University of New York, New York, United States
| | - Daniel Friedman
- Comprehensive Epilepsy Center, New York University School of Medicine, New York, United States
| | - Michael Dayan
- Department of Neurology, Mayo Clinic, Rochester, United States
| | - Xiuyuan Wang
- Comprehensive Epilepsy Center, New York University School of Medicine, New York, United States
| | - Marom Bikson
- Department of Biomedical Engineering, City College of the City University of New York, New York, United States
| | - Werner K Doyle
- Comprehensive Epilepsy Center, New York University School of Medicine, New York, United States
| | - Orrin Devinsky
- Comprehensive Epilepsy Center, New York University School of Medicine, New York, United States
| | - Lucas C Parra
- Department of Biomedical Engineering, City College of the City University of New York, New York, United States
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159
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San-Juan D, Espinoza López DA, Vázquez Gregorio R, Trenado C, Fernández-González Aragón M, Morales-Quezada L, Hernandez Ruiz A, Hernandez-González F, Alcaraz-Guzmán A, Anschel DJ, Fregni F. Transcranial Direct Current Stimulation in Mesial Temporal Lobe Epilepsy and Hippocampal Sclerosis. Brain Stimul 2017; 10:28-35. [DOI: 10.1016/j.brs.2016.08.013] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Revised: 08/23/2016] [Accepted: 08/29/2016] [Indexed: 11/26/2022] Open
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160
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Lattari E, Costa SS, Campos C, de Oliveira AJ, Machado S, Maranhao Neto GA. Can transcranial direct current stimulation on the dorsolateral prefrontal cortex improves balance and functional mobility in Parkinson’s disease? Neurosci Lett 2017; 636:165-169. [DOI: 10.1016/j.neulet.2016.11.019] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 11/07/2016] [Accepted: 11/08/2016] [Indexed: 12/22/2022]
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161
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Karuza EA, Balewski ZZ, Hamilton RH, Medaglia JD, Tardiff N, Thompson-Schill SL. Mapping the Parameter Space of tDCS and Cognitive Control via Manipulation of Current Polarity and Intensity. Front Hum Neurosci 2016; 10:665. [PMID: 28082886 PMCID: PMC5187365 DOI: 10.3389/fnhum.2016.00665] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Accepted: 12/14/2016] [Indexed: 11/18/2022] Open
Abstract
In the cognitive domain, enormous variation in methodological approach prompts questions about the generalizability of behavioral findings obtained from studies of transcranial direct current stimulation (tDCS). To determine the impact of common variations in approach, we systematically manipulated two key stimulation parameters—current polarity and intensity—and assessed their impact on a task of inhibitory control (the Eriksen Flanker). Ninety participants were randomly assigned to one of nine experimental groups: three stimulation conditions (anode, sham, cathode) crossed with three intensity levels (1.0, 1.5, 2.0 mA). As participants performed the Flanker task, stimulation was applied over left dorsolateral prefrontal cortex (DLPFC; electrode montage: F3-RSO). The behavioral impact of these manipulations was examined using mixed effects linear regression. Results indicate a significant effect of stimulation condition (current polarity) on the magnitude of the interference effect during the Flanker; however, this effect was specific to the comparison between anodal and sham stimulation. Inhibitory control was therefore improved by anodal stimulation over the DLPFC. In the present experimental context, no reliable effect of stimulation intensity was observed, and we found no evidence that inhibitory control was impeded by cathodal stimulation. Continued exploration of the stimulation parameter space, particularly with more robustly powered sample sizes, is essential to facilitating cross-study comparison and ultimately working toward a reliable model of tDCS effects.
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Affiliation(s)
- Elisabeth A Karuza
- Department of Psychology, University of Pennsylvania, Philadelphia PA, USA
| | - Zuzanna Z Balewski
- Department of Psychology, University of Pennsylvania, Philadelphia PA, USA
| | - Roy H Hamilton
- Department of Neurology, University of Pennsylvania, Philadelphia PA, USA
| | - John D Medaglia
- Department of Psychology, University of Pennsylvania, Philadelphia PA, USA
| | - Nathan Tardiff
- Department of Psychology, University of Pennsylvania, Philadelphia PA, USA
| | - Sharon L Thompson-Schill
- Department of Psychology, University of Pennsylvania, PhiladelphiaPA, USA; Department of Neurology, University of Pennsylvania, PhiladelphiaPA, USA
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162
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Hsu TY, Juan CH, Tseng P. Individual Differences and State-Dependent Responses in Transcranial Direct Current Stimulation. Front Hum Neurosci 2016; 10:643. [PMID: 28066214 PMCID: PMC5174116 DOI: 10.3389/fnhum.2016.00643] [Citation(s) in RCA: 90] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 12/05/2016] [Indexed: 12/25/2022] Open
Abstract
Transcranial direct current stimulation (tDCS) has been extensively used to examine whether neural activities can be selectively increased or decreased with manipulations of current polarity. Recently, the field has reevaluated the traditional anodal-increase and cathodal-decrease assumption due to the growing number of mixed findings that report the effects of the opposite directions. Therefore, the directionality of tDCS polarities and how it affects each individual still remain unclear. In this study, we used a visual working memory (VWM) paradigm and systematically manipulated tDCS polarities, types of different independent baseline measures, and task difficulty to investigate how these factors interact to determine the outcome effect of tDCS. We observed that only low-performers, as defined by their no-tDCS corsi block tapping (CBT) performance, persistently showed a decrement in VWM performance after anodal stimulation, whereas no tDCS effect was found when participants were divided by their performance in digit span. In addition, only the optimal level of task difficulty revealed any significant tDCS effect. All these findings were consistent across different blocks, suggesting that the tDCS effect was stable across a short period of time. Lastly, there was a high degree of intra-individual consistency in one’s responsiveness to tDCS, namely that participants who showed positive or negative effect to anodal stimulation are also more likely to show the same direction of effects for cathodal stimulation. Together, these findings imply that tDCS effect is interactive and state dependent: task difficulty and consistent individual differences modulate one’s responsiveness to tDCS, while researchers’ choices of independent behavioral baseline measures can also critically affect how the effect of tDCS is evaluated. These factors together are likely the key contributors to the wide range of “noises” in tDCS effects between individuals, between stimulation protocols, and between different studies in the literature. Future studies using tDCS, and possibly tACS, should take such state-dependent condition in tDCS responsiveness into account.
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Affiliation(s)
- Tzu-Yu Hsu
- Research Center of Brain and Consciousness, College of Humanities and Social Sciences, Taipei Medical UniversityTaipei, Taiwan; Shuang-Ho Hospital, Taipei Medical UniversityNew Taipei City, Taiwan; Graduate Institute of Health and Biotechnology Law, Taipei Medical UniversityTaipei, Taiwan
| | - Chi-Hung Juan
- Institute of Cognitive Neuroscience, National Central University Taoyuan, Taiwan
| | - Philip Tseng
- Research Center of Brain and Consciousness, College of Humanities and Social Sciences, Taipei Medical UniversityTaipei, Taiwan; Shuang-Ho Hospital, Taipei Medical UniversityNew Taipei City, Taiwan; Graduate Institute of Humanities in Medicine, Taipei Medical UniversityTaipei, Taiwan
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163
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164
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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.
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165
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Evidence-based guidelines on the therapeutic use of transcranial direct current stimulation (tDCS). Clin Neurophysiol 2016; 128:56-92. [PMID: 27866120 DOI: 10.1016/j.clinph.2016.10.087] [Citation(s) in RCA: 1030] [Impact Index Per Article: 128.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 10/18/2016] [Accepted: 10/20/2016] [Indexed: 12/19/2022]
Abstract
A group of European experts was commissioned by the European Chapter of the International Federation of Clinical Neurophysiology to gather knowledge about the state of the art of the therapeutic use of transcranial direct current stimulation (tDCS) from studies published up until September 2016, regarding pain, Parkinson's disease, other movement disorders, motor stroke, poststroke aphasia, multiple sclerosis, epilepsy, consciousness disorders, Alzheimer's disease, tinnitus, depression, schizophrenia, and craving/addiction. The evidence-based analysis included only studies based on repeated tDCS sessions with sham tDCS control procedure; 25 patients or more having received active treatment was required for Class I, while a lower number of 10-24 patients was accepted for Class II studies. Current evidence does not allow making any recommendation of Level A (definite efficacy) for any indication. Level B recommendation (probable efficacy) is proposed for: (i) anodal tDCS of the left primary motor cortex (M1) (with right orbitofrontal cathode) in fibromyalgia; (ii) anodal tDCS of the left dorsolateral prefrontal cortex (DLPFC) (with right orbitofrontal cathode) in major depressive episode without drug resistance; (iii) anodal tDCS of the right DLPFC (with left DLPFC cathode) in addiction/craving. Level C recommendation (possible efficacy) is proposed for anodal tDCS of the left M1 (or contralateral to pain side, with right orbitofrontal cathode) in chronic lower limb neuropathic pain secondary to spinal cord lesion. Conversely, Level B recommendation (probable inefficacy) is conferred on the absence of clinical effects of: (i) anodal tDCS of the left temporal cortex (with right orbitofrontal cathode) in tinnitus; (ii) anodal tDCS of the left DLPFC (with right orbitofrontal cathode) in drug-resistant major depressive episode. It remains to be clarified whether the probable or possible therapeutic effects of tDCS are clinically meaningful and how to optimally perform tDCS in a therapeutic setting. In addition, the easy management and low cost of tDCS devices allow at home use by the patient, but this might raise ethical and legal concerns with regard to potential misuse or overuse. We must be careful to avoid inappropriate applications of this technique by ensuring rigorous training of the professionals and education of the patients.
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Devanathan D, Madhavan S. Effects of anodal tDCS of the lower limb M1 on ankle reaction time in young adults. Exp Brain Res 2016; 234:377-85. [PMID: 26487179 DOI: 10.1007/s00221-015-4470-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 10/09/2015] [Indexed: 11/25/2022]
Abstract
Transcranial direct current stimulation (tDCS) is a noninvasive brain stimulation technique that modulates cortical excitability and influences motor behavior. There is limited information available regarding the effects of anodal tDCS on lower limb reaction time. In this study, we aimed to investigate the effects of anodal tDCS on lower limb simple reaction time (SRT) and choice reaction time (CRT). We probed this question further by examining the effects of anodal tDCS of the lower limb M1 on an upper limb RT task and a cognitive measure. Fourteen healthy young adults received anodal tDCS and sham tDCS to the lower limb M1 on two separate testing days in a counterbalanced order. After stimulation, we assessed the effects of tDCS on ankle dorsiflexion SRT and CRT, ankle plantarflexion SRT and CRT, wrist extension SRT and CRT and the symbol digit modality test (SDMT). Anodal tDCS significantly improved response times from baseline for ankle CRT but not for ankle SRT or wrist SRT or CRT. A significant decrement (i.e., longer response time) was noted for the sham tDCS conditions. There was a significant difference between anodal and sham conditions for all RT tasks, suggesting that anodal tDCS improved RT compared to sham. No change in SDMT scores was observed for both conditions. Anodal tDCS appeared to differentially modulate ankle SRT and CRT, suggesting an influence of anodal tDCS on complex motor processes and/or the supplementary motor area. Absence of effects on wrist CRT or SDMT suggests a spatial specificity of the influence of tDCS. Anodal tDCS also appears to potentially negate the effects of fatigue or task switching that was detrimental to RT in the sham condition.
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Hanley CJ, Singh KD, McGonigle DJ. Transcranial modulation of brain oscillatory responses: A concurrent tDCS–MEG investigation. Neuroimage 2016; 140:20-32. [DOI: 10.1016/j.neuroimage.2015.12.021] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 12/13/2015] [Accepted: 12/14/2015] [Indexed: 10/22/2022] Open
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Imaging transcranial direct current stimulation (tDCS) of the prefrontal cortex—correlation or causality in stimulation-mediated effects? Neurosci Biobehav Rev 2016; 69:333-56. [DOI: 10.1016/j.neubiorev.2016.08.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 06/30/2016] [Accepted: 08/01/2016] [Indexed: 02/03/2023]
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Bikson M, Grossman P, Thomas C, Zannou AL, Jiang J, Adnan T, Mourdoukoutas AP, Kronberg G, Truong D, Boggio P, Brunoni AR, Charvet L, Fregni F, Fritsch B, Gillick B, Hamilton RH, Hampstead BM, Jankord R, Kirton A, Knotkova H, Liebetanz D, Liu A, Loo C, Nitsche MA, Reis J, Richardson JD, Rotenberg A, Turkeltaub PE, Woods AJ. Safety of Transcranial Direct Current Stimulation: Evidence Based Update 2016. Brain Stimul 2016; 9:641-661. [PMID: 27372845 PMCID: PMC5007190 DOI: 10.1016/j.brs.2016.06.004] [Citation(s) in RCA: 827] [Impact Index Per Article: 103.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 06/10/2016] [Accepted: 06/12/2016] [Indexed: 01/13/2023] Open
Abstract
This review updates and consolidates evidence on the safety of transcranial Direct Current Stimulation (tDCS). Safety is here operationally defined by, and limited to, the absence of evidence for a Serious Adverse Effect, the criteria for which are rigorously defined. This review adopts an evidence-based approach, based on an aggregation of experience from human trials, taking care not to confuse speculation on potential hazards or lack of data to refute such speculation with evidence for risk. Safety data from animal tests for tissue damage are reviewed with systematic consideration of translation to humans. Arbitrary safety considerations are avoided. Computational models are used to relate dose to brain exposure in humans and animals. We review relevant dose-response curves and dose metrics (e.g. current, duration, current density, charge, charge density) for meaningful safety standards. Special consideration is given to theoretically vulnerable populations including children and the elderly, subjects with mood disorders, epilepsy, stroke, implants, and home users. Evidence from relevant animal models indicates that brain injury by Direct Current Stimulation (DCS) occurs at predicted brain current densities (6.3-13 A/m(2)) that are over an order of magnitude above those produced by conventional tDCS. To date, the use of conventional tDCS protocols in human trials (≤40 min, ≤4 milliamperes, ≤7.2 Coulombs) has not produced any reports of a Serious Adverse Effect or irreversible injury across over 33,200 sessions and 1000 subjects with repeated sessions. This includes a wide variety of subjects, including persons from potentially vulnerable populations.
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Affiliation(s)
- Marom Bikson
- Department of Biomedical Engineering, The City College of New York, New York, NY, USA.
| | - Pnina Grossman
- Department of Biomedical Engineering, The City College of New York, New York, NY, USA
| | - Chris Thomas
- Department of Biomedical Engineering, The City College of New York, New York, NY, USA
| | | | - Jimmy Jiang
- Department of Biomedical Engineering, The City College of New York, New York, NY, USA
| | - Tatheer Adnan
- Department of Biomedical Engineering, The City College of New York, New York, NY, USA
| | | | - Greg Kronberg
- Department of Biomedical Engineering, The City College of New York, New York, NY, USA
| | - Dennis Truong
- Department of Biomedical Engineering, The City College of New York, New York, NY, USA
| | - Paulo Boggio
- Cognitive Neuroscience Laboratory and Developmental Disorders Program, Center for Health and Biological Sciences, Mackenzie Presbyterian University, Sao Paulo, Brazil
| | - André R Brunoni
- Service of Interdisciplinary Neuromodulation, Department and Institute of Psychiatry, Laboratory of Neurosciences (LIM-27), University of São Paulo, São Paulo, Brazil
| | - Leigh Charvet
- NYU MS Comprehensive Care Center, Department of Neurology, New York University School of Medicine, New York, NY, USA
| | - Felipe Fregni
- Berenson-Allen Center for Noninvasive Brain Stimulation, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Brita Fritsch
- Department of Neurology, University Medical Center, Freiburg, Germany; BrainLinks-BrainTools Cluster of Excellence, University of Freiburg, Germany
| | - Bernadette Gillick
- Department of Physical Medicine and Rehabilitation, University of Minnesota Medical School, Minneapolis, MN
| | - Roy H Hamilton
- Laboratory for Cognition and Neural Stimulation, University of Pennsylvania, Philadelphia, PA, USA; Center for Cognitive Neuroscience, University of Pennsylvania, Philadelphia, PA, USA; Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA
| | - Benjamin M Hampstead
- Mental Health Service, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA; Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Ryan Jankord
- Applied Neuroscience, 711th Human Performance Wing, Air Force Research Laboratory, WPAFB, OH, USA
| | - Adam Kirton
- Departments of Pediatrics and Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Helena Knotkova
- MJHS Institute for Innovation in Palliative Care, New York, NY, USA; Department of Social and Family Medicine, Albert Einstein College of Medicine, The Bronx, NY, USA
| | - David Liebetanz
- Department of Clinical Neurophysiology, University Medical Center, Georg-August-University, Goettingen 37075, Germany
| | - Anli Liu
- NYU Comprehensive Epilepsy Center, New York University School of Medicine, New York, NY, USA
| | - Colleen Loo
- Psychiatry, Black Dog Institute, Clinical Academic, St George Hospital, University of New South Wales, Sydney, Australia
| | - Michael A Nitsche
- Department of Clinical Neurophysiology, University Medical Center, Georg-August-University, Goettingen 37075, Germany; Leibniz Research Centre for Working Environment and Human Factors at the TU Dortmund, Dortmund, Germany; Department of Neurology, University Medical Hospital Bergmannsheil, Bochum, Germany
| | - Janine Reis
- Department of Neurology, University Medical Center, Freiburg, Germany; BrainLinks-BrainTools Cluster of Excellence, University of Freiburg, Germany
| | - Jessica D Richardson
- Berenson-Allen Center for Noninvasive Brain Stimulation, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA; Department of Communication Sciences & Disorders, The University of South Carolina, Columbia, SC, USA; Department of Speech and Hearing Sciences, The University of New Mexico, Albuquerque, NM, USA
| | - Alexander Rotenberg
- Berenson-Allen Center for Noninvasive Brain Stimulation, Division of Cognitive Neurology, Department of Neurology, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, MA, USA; Pediatric Neuromodulation Program, Division of Epilepsy and Neurophysiology, Department of Neurology, Children's Hospital Boston, Harvard Medical School, Boston, MA, USA
| | - Peter E Turkeltaub
- Department of Neurology, Georgetown University, Washington, DC, USA; Research Division, MedStar National Rehabilitation Hospital, Washington, DC, USA
| | - Adam J Woods
- Center for Cognitive Aging and Memory, Institute on Aging, Department of Aging and Geriatric Research, McKnight Brain Institute, University of Florida, Gainesville, FL, USA
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Conley AC, Fulham WR, Marquez JL, Parsons MW, Karayanidis F. No Effect of Anodal Transcranial Direct Current Stimulation Over the Motor Cortex on Response-Related ERPs during a Conflict Task. Front Hum Neurosci 2016; 10:384. [PMID: 27547180 PMCID: PMC4974251 DOI: 10.3389/fnhum.2016.00384] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 07/14/2016] [Indexed: 11/25/2022] Open
Abstract
Anodal transcranial direct current stimulation (tDCS) over the motor cortex is considered a potential treatment for motor rehabilitation following stroke and other neurological pathologies. However, both the context under which this stimulation is effective and the underlying mechanisms remain to be determined. In this study, we examined the mechanisms by which anodal tDCS may affect motor performance by recording event-related potentials (ERPs) during a cued go/nogo task after anodal tDCS over dominant primary motor cortex (M1) in young adults (Experiment 1) and both dominant and non-dominant M1 in older adults (Experiment 2). In both experiments, anodal tDCS had no effect on either response time (RT) or response-related ERPs, including the cue-locked contingent negative variation (CNV) and both target-locked and response-locked lateralized readiness potentials (LRP). Bayesian model selection analyses showed that, for all measures, the null effects model was stronger than a model including anodal tDCS vs. sham. We conclude that anodal tDCS has no effect on RT or response-related ERPs during a cued go/nogo task in either young or older adults.
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Affiliation(s)
- Alexander C Conley
- Functional Neuroimaging Laboratory, School of Psychology, Faculty of Science and IT, University of NewcastleNewcastle, NSW, Australia; Priority Research Centre for Stroke and Brain Injury, University of NewcastleNewcastle, NSW, Australia; Hunter Medical Research InstituteNewcastle, NSW, Australia
| | - W R Fulham
- Functional Neuroimaging Laboratory, School of Psychology, Faculty of Science and IT, University of NewcastleNewcastle, NSW, Australia; Priority Research Centre for Stroke and Brain Injury, University of NewcastleNewcastle, NSW, Australia; Hunter Medical Research InstituteNewcastle, NSW, Australia
| | - Jodie L Marquez
- Priority Research Centre for Stroke and Brain Injury, University of NewcastleNewcastle, NSW, Australia; Hunter Medical Research InstituteNewcastle, NSW, Australia; School of Health Sciences, Faculty of Health, University of NewcastleNewcastle, NSW, Australia
| | - Mark W Parsons
- Priority Research Centre for Stroke and Brain Injury, University of NewcastleNewcastle, NSW, Australia; Hunter Medical Research InstituteNewcastle, NSW, Australia; School of Medicine and Public Health, Faculty of Health, University of NewcastleNewcastle, NSW, Australia
| | - Frini Karayanidis
- Functional Neuroimaging Laboratory, School of Psychology, Faculty of Science and IT, University of NewcastleNewcastle, NSW, Australia; Priority Research Centre for Stroke and Brain Injury, University of NewcastleNewcastle, NSW, Australia; Hunter Medical Research InstituteNewcastle, NSW, Australia
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Hendy AM, Tillman A, Rantalainen T, Muthalib M, Johnson L, Kidgell DJ, Wundersitz D, Enticott PG, Teo WP. Concurrent transcranial direct current stimulation and progressive resistance training in Parkinson's disease: study protocol for a randomised controlled trial. Trials 2016; 17:326. [PMID: 27430304 PMCID: PMC4949761 DOI: 10.1186/s13063-016-1461-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 06/23/2016] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Parkinson's disease (PD) results from a loss of dopamine in the brain, leading to movement dysfunctions such as bradykinesia, postural instability, resting tremor and muscle rigidity. Furthermore, dopamine deficiency in PD has been shown to result in maladaptive plasticity of the primary motor cortex (M1). Progressive resistance training (PRT) is a popular intervention in PD that improves muscular strength and results in clinically significant improvements on the Unified Parkinson's Disease Rating Scale (UPDRS). In separate studies, the application of anodal transcranial direct current stimulation (a-tDCS) to the M1 has been shown to improve motor function in PD; however, the combined use of tDCS and PRT has not been investigated. METHODS/DESIGN We propose a 6-week, double-blind randomised controlled trial combining M1 tDCS and PRT of the lower body in participants (n = 42) with moderate PD (Hoehn and Yahr scale score 2-4). Supervised lower body PRT combined with functional balance tasks will be performed three times per week with concurrent a-tDCS delivered at 2 mA for 20 minutes (a-tDCS group) or with sham tDCS (sham group). Control participants will receive standard care (control group). Outcome measures will include functional strength, gait speed and variability, balance, neurophysiological function at rest and during movement execution, and the UPDRS motor subscale, measured at baseline, 3 weeks (during), 6 weeks (post), and 9 weeks (retention). Ethical approval has been granted by the Deakin University Human Research Ethics Committee (project number 2015-014), and the trial has been registered with the Australian New Zealand Clinical Trials Registry (ACTRN12615001241527). DISCUSSION This will be the first randomised controlled trial to combine PRT and a-tDCS targeting balance and gait in people with PD. The study will elucidate the functional, clinical and neurophysiological outcomes of combined PRT and a-tDCS. It is hypothesised that combined PRT and a-tDCS will significantly improve lower limb strength, postural sway, gait speed and stride variability compared with PRT with sham tDCS. Further, we hypothesise that pre-frontal cortex activation during dual-task cognitive and gait/balance activities will be reduced, and that M1 excitability and inhibition will be augmented, following the combined PRT and a-tDCS intervention. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12615001241527 . Registered on 12 November 2015.
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Affiliation(s)
- Ashlee M. Hendy
- />School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Australia
| | - Alex Tillman
- />School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Australia
| | - Timo Rantalainen
- />Institute for Physical Activity and Nutrition (IPAN), Deakin University, Burwood, 3125 Melbourne, VIC Australia
| | - Makii Muthalib
- />EuroMov, University of Montpellier, Montpellier, France
| | - Liam Johnson
- />Clinical Exercise Science Research Program, Institute of Sport, Exercise and Active Living, Victoria University, Melbourne, Australia
- />Stroke Division, The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Melbourne, Australia
| | - Dawson J. Kidgell
- />La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, La Trobe University, Melbourne, Australia
| | - Daniel Wundersitz
- />School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Australia
- />La Trobe Rural Health School, College of Science, Health and Engineering, La Trobe University, Bendigo, Australia
| | - Peter G. Enticott
- />Cognitive Neuroscience Unit, School of Psychology, Deakin University, Melbourne, Australia
| | - Wei-Peng Teo
- />School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Australia
- />Institute for Physical Activity and Nutrition (IPAN), Deakin University, Burwood, 3125 Melbourne, VIC Australia
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172
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Elsner B, Kugler J, Pohl M, Mehrholz J. Transcranial direct current stimulation (tDCS) for idiopathic Parkinson's disease. Cochrane Database Syst Rev 2016; 7:CD010916. [PMID: 27425786 PMCID: PMC6457946 DOI: 10.1002/14651858.cd010916.pub2] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Idiopathic Parkinson's disease (IPD) is a neurodegenerative disorder, with the severity of the disability usually increasing with disease duration. IPD affects patients' health-related quality of life, disability, and impairment. Current rehabilitation approaches have limited effectiveness in improving outcomes in patients with IPD, but a possible adjunct to rehabilitation might be non-invasive brain stimulation by transcranial direct current stimulation (tDCS) to modulate cortical excitability, and hence to improve these outcomes in IPD. OBJECTIVES To assess the effectiveness of tDCS in improving motor and non-motor symptoms in people with IPD. SEARCH METHODS We searched the following databases (until February 2016): the Cochrane Central Register of Controlled Trials (CENTRAL; the Cochrane Library ; 2016 , Issue 2), MEDLINE, EMBASE, CINAHL, AMED, Science Citation Index, the Physiotherapy Evidence Database (PEDro), Rehabdata, and Inspec. In an effort to identify further published, unpublished, and ongoing trials, we searched trial registers and reference lists, handsearched conference proceedings, and contacted authors and equipment manufacturers. SELECTION CRITERIA We included only randomised controlled trials (RCTs) and randomised controlled cross-over trials that compared tDCS versus control in patients with IPD for improving health-related quality of life , disability, and impairment. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trial quality (JM and MP) and extracted data (BE and JM). If necessary, we contacted study authors to ask for additional information. We collected information on dropouts and adverse events from the trial reports. MAIN RESULTS We included six trials with a total of 137 participants. We found two studies with 45 participants examining the effects of tDCS compared to control (sham tDCS) on our primary outcome measure, impairment, as measured by the Unified Parkinson's Disease Rating Scale (UPDRS). There was very low quality evidence for no effect of tDCS on change in global UPDRS score ( mean difference (MD) -7.10 %, 95% confidence interval (CI -19.18 to 4.97; P = 0.25, I² = 21%, random-effects model). However, there was evidence of an effect on UPDRS part III motor subsection score at the end of the intervention phase (MD -14.43%, 95% CI -24.68 to -4.18; P = 0.006, I² = 2%, random-effects model; very low quality evidence). One study with 25 participants measured the reduction in off and on time with dyskinesia, but there was no evidence of an effect (MD 0.10 hours, 95% CI -0.14 to 0.34; P = 0.41, I² = 0%, random-effects model; and MD 0.00 hours, 95% CI -0.12 to 0.12; P = 1, I² = 0%, random- effects model, respectively; very low quality evidence).Two trials with a total of 41 participants measured gait speed using measures of timed gait at the end of the intervention phase, revealing no evidence of an effect ( standardised mean difference (SMD) 0.50, 95% CI -0.17 to 1.18; P = 0.14, I² = 11%, random-effects model; very low quality evidence). Another secondary outcome was health-related quality of life and we found one study with 25 participants reporting on the physical health and mental health aspects of health-related quality of life (MD 1.00 SF-12 score, 95% CI -5.20 to 7.20; I² = 0%, inverse variance method with random-effects model; very low quality evidence; and MD 1.60 SF-12 score, 95% CI -5.08 to 8.28; I² = 0%, inverse variance method with random-effects model; very low quality evidence, respectively). We found no study examining the effects of tDCS for improving activities of daily living. In two of six studies, dropouts , adverse events, or deaths occurring during the intervention phase were reported. There was insufficient evidence that dropouts , adverse effects, or deaths were higher with intervention (risk difference (RD) 0.04, 95% CI -0.05 to 0.12; P = 0.40, I² = 0%, random-effects model; very low quality evidence).We found one trial with a total of 16 participants examining the effects of tDCS plus movement therapy compared to control (sham tDCS) plus movement therapy on our secondary outcome, gait speed at the end of the intervention phase, revealing no evidence of an effect (MD 0.05 m/s, 95% CI -0.15 to 0.25; inverse variance method with random-effects model; very low quality evidence). We found no evidence of an effect regarding differences in dropouts and adverse effects between intervention and control groups (RD 0.00, 95% CI -0.21 to 0.21; Mantel-Haenszel method with random-effects model; very low quality evidence). AUTHORS' CONCLUSIONS There is insufficient evidence to determine the effects of tDCS for reducing off time ( when the symptoms are not controlled by the medication) and on time with dyskinesia ( time that symptoms are controlled but the person still experiences involuntary muscle movements ) , and for improving health- related quality of life, disability, and impairment in patients with IPD. Evidence of very low quality indicates no difference in dropouts and adverse events between tDCS and control groups.
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Affiliation(s)
- Bernhard Elsner
- Dresden Medical School, Technical University DresdenDepartment of Public HealthFetscherstr. 74DresdenSachsenGermany01307
- SRH Fachhochschule für Gesundheit Gera gGmbHDepartment of PhysiotherapyNeue Str. 28‐3007548 GeraThüringenGermany07548
| | - Joachim Kugler
- Technical University DresdenDepartment of Public Health, Dresden Medical SchoolLöscherstr. 18DresdenGermanyD‐01307
| | - Marcus Pohl
- Helios Klinik Schloss PulsnitzNeurological RehabilitationWittgensteiner Str. 1PulsnitzSaxonyGermany01896
| | - Jan Mehrholz
- Private Europäische Medizinische Akademie der Klinik Bavaria in Kreischa GmbHWissenschaftliches InstitutAn der Wolfsschlucht 1‐2KreischaGermany01731
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Schabrun SM, Lamont RM, Brauer SG. Transcranial Direct Current Stimulation to Enhance Dual-Task Gait Training in Parkinson's Disease: A Pilot RCT. PLoS One 2016; 11:e0158497. [PMID: 27359338 PMCID: PMC4928827 DOI: 10.1371/journal.pone.0158497] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Accepted: 06/15/2016] [Indexed: 11/22/2022] Open
Abstract
Objective To investigate the feasibility and safety of a combined anodal transcranial direct current stimulation (tDCS) and dual task gait training intervention in people with Parkinson’s Disease (PD) and to provide data to support a sample size calculation for a fully powered trial should trends of effectiveness be present. Design A pilot, randomized, double-blind, sham-controlled parallel group trial with 12 week follow-up. Setting A university physiotherapy department. Interventions Sixteen participants diagnosed with PD received nine dual task gait training sessions over 3 weeks. Participants were randomized to receive either active or sham tDCS applied for the first 20 minutes of each session. Main Measures The primary outcome was gait speed while undertaking concurrent cognitive tasks (word lists, counting, conversation). Secondary measures included step length, cadence, Timed Up and Go, bradykinesia and motor speed. Results Gait speed, step length and cadence improved in both groups, under all dual task conditions. This effect was maintained at follow-up. There was no difference between the active and sham tDCS groups. Time taken to perform the TUGwords also improved, with no difference between groups. The active tDCS group did however increase their correct cognitive response rate during the TUGwords and TUGcount. Bradykinesia improved after training in both groups. Conclusion Three weeks of dual task gait training resulted in improved gait under dual task conditions, and bradykinesia, immediately following training and at 12 weeks follow-up. The only parameter enhanced by tDCS was the number of correct responses while performing the dual task TUG. tDCS applied to M1 may not be an effective adjunct to dual task gait training in PD. Trial Registration Australia-New Zealand Clinical Trials Registry ACTRN12613001093774
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Affiliation(s)
- Siobhan M. Schabrun
- Brain Rehabilitation and Neuroplasticity unit, School of Science and Health, Western Sydney University, Penrith, NSW, Australia
- * E-mail:
| | - Robyn M. Lamont
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Brisbane, Queensland, Australia
| | - Sandra G. Brauer
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Brisbane, Queensland, Australia
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Palm U, Segmiller FM, Epple AN, Freisleder FJ, Koutsouleris N, Schulte-Körne G, Padberg F. Transcranial direct current stimulation in children and adolescents: a comprehensive review. J Neural Transm (Vienna) 2016; 123:1219-34. [PMID: 27173384 DOI: 10.1007/s00702-016-1572-z] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 05/06/2016] [Indexed: 12/23/2022]
Abstract
Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation method that has shown promising results in various neuropsychiatric disorders in adults. This review addresses the therapeutic use of tDCS in children and adolescents including safety, ethical, and legal considerations. There are several studies addressing the dosage of tDCS in children and adolescents by computational modeling of electric fields in the pediatric brain. Results suggest halving the amperage used in adults to obtain the same peak electric fields, however, there are some studies reporting on the safe application of tDCS with standard adult parameters in children (2 mA; 20-30 min). There are several randomized placebo controlled trials suggesting beneficial effects of tDCS for the treatment of cerebral palsy. For dystonia there are mixed data. Some studies suggest efficacy of tDCS for the treatment of refractory epilepsy, and for the improvement of attention deficit/hyperactivity disorder and autism. Interestingly, there is a lack of data for the treatment of childhood and adolescent psychiatric disorders, i.e., childhood onset schizophrenia and affective disorders. Overall, tDCS seems to be safe in pediatric population. More studies are needed to confirm the preliminary encouraging results; however, ethical deliberation has to be weighed carefully for every single case.
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Affiliation(s)
- Ulrich Palm
- Department of Psychiatry and Psychotherapy, Klinikum der Universität München, Nußbaumstr. 7, 80336, Munich, Germany.
| | - Felix M Segmiller
- Department of Psychiatry and Psychotherapy, Klinikum der Universität München, Nußbaumstr. 7, 80336, Munich, Germany
| | | | | | - Nikolaos Koutsouleris
- Department of Psychiatry and Psychotherapy, Klinikum der Universität München, Nußbaumstr. 7, 80336, Munich, Germany
| | - Gerd Schulte-Körne
- Department of Childhood and Adolescent Psychiatry, Klinikum der Universität München, Munich, Germany
| | - Frank Padberg
- Department of Psychiatry and Psychotherapy, Klinikum der Universität München, Nußbaumstr. 7, 80336, Munich, Germany
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175
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Cathodal transcranial direct current stimulation over posterior parietal cortex enhances distinct aspects of visual working memory. Neuropsychologia 2016; 87:35-42. [PMID: 27143222 PMCID: PMC4915336 DOI: 10.1016/j.neuropsychologia.2016.04.028] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 04/28/2016] [Accepted: 04/29/2016] [Indexed: 12/02/2022]
Abstract
In this study, we investigated the effects of tDCS over the posterior parietal cortex (PPC) during a visual working memory (WM) task, which probes different sources of response error underlying the precision of WM recall. In two separate experiments, we demonstrated that tDCS enhanced WM precision when applied bilaterally over the PPC, independent of electrode configuration. In a third experiment, we demonstrated with unilateral electrode configuration over the right PPC, that only cathodal tDCS enhanced WM precision and only when baseline performance was low. Looking at the effects on underlying sources of error, we found that cathodal stimulation enhanced the probability of correct target response across all participants by reducing feature-misbinding. Only for low-baseline performers, cathodal stimulation also reduced variability of recall. We conclude that cathodal- but not anodal tDCS can improve WM precision by preventing feature-misbinding and hereby enhancing attentional selection. For low-baseline performers, cathodal tDCS also protects the memory trace. Furthermore, stimulation over bilateral PPC is more potent than unilateral cathodal tDCS in enhancing general WM precision. Despite multiple studies, reported effects of tDCS on cognitive processes have remained variable. We employ a WM task that probes different underlying sources of error to test effect of tDCS separately. tDCS applied bilaterally to the PPC boosts WM precision. Unilateral stimulation indicates this is caused by cathodal- rather than anodal stimulation. Improvement relies particularly on enhanced selective attention as well as memory trace protection.
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176
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Ferrucci R, Mameli F, Ruggiero F, Priori A. Transcranial direct current stimulation as treatment for Parkinson’s disease and other movement disorders. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.baga.2015.12.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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177
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Manenti R, Brambilla M, Benussi A, Rosini S, Cobelli C, Ferrari C, Petesi M, Orizio I, Padovani A, Borroni B, Cotelli M. Mild cognitive impairment in Parkinson's disease is improved by transcranial direct current stimulation combined with physical therapy. Mov Disord 2016; 31:715-24. [PMID: 26880536 DOI: 10.1002/mds.26561] [Citation(s) in RCA: 108] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 12/10/2015] [Accepted: 12/26/2015] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Parkinson's disease (PD) is characterized by both motor and cognitive deficits. In PD, physical exercise has been found to improve physical functioning. Recent studies demonstrated that repeated sessions of transcranial direct current stimulation led to an increased performance in cognitive and motor tasks in patients with PD. OBJECTIVES The present study investigated the effects of anodal transcranial direct current stimulation applied over the dorsolateral prefrontal cortex and combined with physical therapy in PD patients. METHODS A total of 20 patients with PD were assigned to 1 of 2 study groups: group 1, anodal transcranial direct current stimulation plus physical therapy (n = 10) or group 2, placebo transcranial direct current stimulation plus physical therapy (n = 10). The 2 weeks of treatment consisted of daily direct current stimulation application for 25 minutes during physical therapy. Long-term effects of treatment were evaluated on clinical, neuropsychological, and motor task performance at 3-month follow-up. RESULTS An improvement in motor abilities and a reduction of depressive symptoms were observed in both groups after the end of treatment and at 3-month follow-up. The Parkinson's Disease Cognitive Rating Scale and verbal fluency test performances increased only in the anodal direct current stimulation group with a stable effect at follow-up. CONCLUSIONS The application of anodal transcranial direct current stimulation may be a relevant tool to improve cognitive abilities in PD and might be a novel therapeutic strategy for PD patients with mild cognitive impairment. © 2016 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Rosa Manenti
- Neuropsychology Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Michela Brambilla
- Neuropsychology Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Alberto Benussi
- Neurology Unit, Centre for Neurodegenerative Disorders, University of Brescia, Brescia, Italy
| | - Sandra Rosini
- Neuropsychology Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Chiara Cobelli
- Neuropsychology Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Clarissa Ferrari
- Service of Statistics, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Michela Petesi
- Neuropsychology Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Italo Orizio
- Neuropsychology Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Alessandro Padovani
- Neurology Unit, Centre for Neurodegenerative Disorders, University of Brescia, Brescia, Italy
| | - Barbara Borroni
- Neurology Unit, Centre for Neurodegenerative Disorders, University of Brescia, Brescia, Italy
| | - Maria Cotelli
- Neuropsychology Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
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178
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Yoon KJ, Lee YT, Chae SW, Park CR, Kim DY. Effects of anodal transcranial direct current stimulation (tDCS) on behavioral and spatial memory during the early stage of traumatic brain injury in the rats. J Neurol Sci 2016; 362:314-20. [PMID: 26944170 DOI: 10.1016/j.jns.2016.02.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 01/10/2016] [Accepted: 02/02/2016] [Indexed: 11/24/2022]
Abstract
Transcranial direct current stimulation (tDCS) is a noninvasive technique to modulate the neural membrane potential. Its effects in the early stage of traumatic brain injury (TBI) have rarely been investigated. This study assessed the effects of anodal tDCS on behavioral and spatial memory in a rat model of traumatic brain injury. Thirty six rats underwent lateral fluid percussion and were then randomly assigned to one of three groups: control (n=12), five-day tDCS over peri-lesional cortex at one (1W, n=12), or two (2W, n=12) weeks post-injury. The Barnes maze (BM) and Rotarod (RR) tests were evaluated in a blind manner on day 1, week 3 and week 5 post-injury. After three weeks, both the 1W and 2W groups showed significant improvements in the BM ratio (P<0.05), whereas only group 2W obtained a significant improvement in the RR ratio compared with the control group (P<0.05). However, there were no significant differences between any of the groups at five weeks after TBI. Immunohistochemistry revealed that only group 2W had a significantly higher brain-derived neurotrophic factor (BDNF) expression in the peri-lesional cortex, which was significantly correlated with the improvement of the Rotarod test at 3-week post-injury. However, BDNF expression in the ipsi-lesional hippocampus was not significantly different among the three groups. Group 1W tended to have increased choline/creatine ratios, as measured by magnetic resonance spectroscopy in the peri-lesional cortex, than the control group (P=0.051). Neither regimen aggravated the lesion volume or brain edema measured by MRI. These beneficial effects were not observed with either regimen at five weeks post-injury. In conclusions, anodal tDCS ameliorated behavioral and spatial memory function in the early phase after TBI when it is delivered two weeks post-injury. Earlier stimulation (one week post-injury) improves spatial memory only. However, the beneficial effects did not persist after cessation of the anodal stimulation.
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Affiliation(s)
- Kyung Jae Yoon
- Department of Physical & Rehabilitation Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Republic of Korea; Medical Research Institute, Regenerative & Neuroscience Lab, Kangbuk Samsung Hospital, Sungkyunkwan University, Republic of Korea
| | - Yong-Taek Lee
- Department of Physical & Rehabilitation Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Republic of Korea; Medical Research Institute, Regenerative & Neuroscience Lab, Kangbuk Samsung Hospital, Sungkyunkwan University, Republic of Korea
| | - Seoung Wan Chae
- Department of Pathology, Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Republic of Korea
| | - Chae Ri Park
- Asan Institute for Life Science, University of Ulsan College of Medicine, Republic of Korea
| | - Dae Yul Kim
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Republic of Korea.
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179
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Ono K, Mikami Y, Fukuyama H, Mima T. Motion-induced disturbance of auditory-motor synchronization and its modulation by transcranial direct current stimulation. Eur J Neurosci 2015; 43:509-15. [DOI: 10.1111/ejn.13135] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 11/12/2015] [Accepted: 11/17/2015] [Indexed: 01/21/2023]
Affiliation(s)
- Kentaro Ono
- Human Brain Research Center; Graduate School of Medicine; Kyoto University; Kyoto 606-8507 Japan
| | - Yusuke Mikami
- Human Brain Research Center; Graduate School of Medicine; Kyoto University; Kyoto 606-8507 Japan
| | - Hidenao Fukuyama
- Human Brain Research Center; Graduate School of Medicine; Kyoto University; Kyoto 606-8507 Japan
| | - Tatsuya Mima
- Human Brain Research Center; Graduate School of Medicine; Kyoto University; Kyoto 606-8507 Japan
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180
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Broeder S, Nackaerts E, Heremans E, Vervoort G, Meesen R, Verheyden G, Nieuwboer A. Transcranial direct current stimulation in Parkinson's disease: Neurophysiological mechanisms and behavioral effects. Neurosci Biobehav Rev 2015; 57:105-17. [DOI: 10.1016/j.neubiorev.2015.08.010] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 07/16/2015] [Accepted: 08/17/2015] [Indexed: 10/23/2022]
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181
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Bhanpuri NH, Bertucco M, Young SJ, Lee AA, Sanger TD. Multiday Transcranial Direct Current Stimulation Causes Clinically Insignificant Changes in Childhood Dystonia: A Pilot Study. J Child Neurol 2015; 30:1604-15. [PMID: 25792428 DOI: 10.1177/0883073815575369] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 01/31/2015] [Indexed: 11/16/2022]
Abstract
Abnormal motor cortex activity is common in dystonia. Cathodal transcranial direct current stimulation may alter cortical activity by decreasing excitability while anodal stimulation may increase motor learning. Previous results showed that a single session of cathodal transcranial direct current stimulation can improve symptoms in childhood dystonia. Here we performed a 5-day, sham-controlled, double-blind, crossover study, where we measured tracking and muscle overflow in a myocontrol-based task. We applied cathodal and anodal transcranial direct current stimulation (2 mA, 9 minutes per day). For cathodal transcranial direct current stimulation (7 participants), 3 subjects showed improvements whereas 2 showed worsening in overflow or tracking error. The effect size was small (about 1% of maximum voluntary contraction) and not clinically meaningful. For anodal transcranial direct current stimulation (6 participants), none showed improvement, whereas 5 showed worsening. Thus, multiday cathodal transcranial direct current stimulation reduced symptoms in some children but not to a clinically meaningful extent, whereas anodal transcranial direct current stimulation worsened symptoms. Our results do not support transcranial direct current stimulation as clinically viable for treating childhood dystonia.
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Affiliation(s)
- Nasir H Bhanpuri
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, USA
| | - Matteo Bertucco
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, USA
| | - Scott J Young
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, USA
| | - Annie A Lee
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, USA
| | - Terence D Sanger
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, USA Department of Neurology, University of Southern California and Children's Hospital Los Angeles, Los Angeles, CA, USA Division of Neurology, Children's Hospital Los Angeles, Los Angeles, CA, USA Department of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA
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182
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Salimpour Y, Mari ZK, Shadmehr R. Altering Effort Costs in Parkinson's Disease with Noninvasive Cortical Stimulation. J Neurosci 2015; 35:12287-302. [PMID: 26338339 PMCID: PMC4556793 DOI: 10.1523/jneurosci.1827-15.2015] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Revised: 07/27/2015] [Accepted: 07/30/2015] [Indexed: 11/21/2022] Open
Abstract
In Parkinson's disease (PD), the human brain is capable of producing motor commands, but appears to require greater than normal subjective effort, particularly for the more-affected side. What is the nature of this subjective effort and can it be altered? We used an isometric task in which patients produced a goal force by engaging both arms, but were free to assign any fraction of that force to each arm. The patients preferred their less-affected arm, but only in some directions. This preference was correlated with lateralization of signal-dependent noise: the direction of force for which the brain was less willing to assign effort to an arm was generally the direction for which that arm exhibited greater noise. Therefore, the direction-dependent noise in each arm acted as an implicit cost that discouraged use of that arm. To check for a causal relationship between noise and motor cost, we used bilateral transcranial direct current stimulation of the motor cortex, placing the cathode on the more-affected side and the anode on the less-affected side. This stimulation not only reduced the noise on the more-affected arm, it also increased the willingness of the patients to assign force to that arm. In a 3 d double-blind study and in a 10 d repeated stimulation study, bilateral stimulation of the two motor cortices with cathode on the more-affected side reduced noise and increased the willingness of the patients to exert effort. This stimulation also improved the clinical motor symptoms of the disease. SIGNIFICANCE STATEMENT In Parkinson's disease, patients are less willing to assign force to their affected arm. Here, we find that this pattern is direction dependent: directions for which the arm is noisier coincide with directions for which the brain is less willing to assign force. We hypothesized that if we could reduce the noise on the affected arm, then we may increase the willingness for the brain to assign force to that arm. We found a way to do this via noninvasive cortical stimulation. In addition to reducing effort costs associated with the affected arm, the cortical stimulation also improved clinical motor symptoms of the disease.
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Affiliation(s)
- Yousef Salimpour
- Laboratory for Computational Motor Control, Department of Biomedical Engineering, and
| | - Zoltan K Mari
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland 21205
| | - Reza Shadmehr
- Laboratory for Computational Motor Control, Department of Biomedical Engineering, and
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183
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Yu X, Li Y, Wen H, Zhang Y, Tian X. Intensity-dependent effects of repetitive anodal transcranial direct current stimulation on learning and memory in a rat model of Alzheimer’s disease. Neurobiol Learn Mem 2015; 123:168-78. [DOI: 10.1016/j.nlm.2015.06.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 05/13/2015] [Accepted: 06/03/2015] [Indexed: 01/19/2023]
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184
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Benninger DH, Hallett M. Non-invasive brain stimulation for Parkinson’s disease: Current concepts and outlook 2015. NeuroRehabilitation 2015; 37:11-24. [DOI: 10.3233/nre-151237] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- David H. Benninger
- Service de Neurologie, Départment des Neurosciences Cliniques, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Mark Hallett
- Medical Neurology Branch, National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, MD, USA
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185
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Iodice R, Dubbioso R, Ruggiero L, Santoro L, Manganelli F. Anodal transcranial direct current stimulation of motor cortex does not ameliorate spasticity in multiple sclerosis. Restor Neurol Neurosci 2015; 33:487-92. [DOI: 10.3233/rnn-150495] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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186
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Abstract
Neurostimulation as a therapeutic tool has been developed and used for a range of different diseases such as Parkinson's disease, epilepsy, and migraine. However, it is not known why the efficacy of the stimulation varies dramatically across patients or why some patients suffer from severe side effects. This is largely due to the lack of mechanistic understanding of neurostimulation. Hence, theoretical computational approaches to address this issue are in demand. This chapter provides a review of mechanistic computational modeling of brain stimulation. In particular, we will focus on brain diseases, where mechanistic models (e.g., neural population models or detailed neuronal models) have been used to bridge the gap between cellular-level processes of affected neural circuits and the symptomatic expression of disease dynamics. We show how such models have been, and can be, used to investigate the effects of neurostimulation in the diseased brain. We argue that these models are crucial for the mechanistic understanding of the effect of stimulation, allowing for a rational design of stimulation protocols. Based on mechanistic models, we argue that the development of closed-loop stimulation is essential in order to avoid inference with healthy ongoing brain activity. Furthermore, patient-specific data, such as neuroanatomic information and connectivity profiles obtainable from neuroimaging, can be readily incorporated to address the clinical issue of variability in efficacy between subjects. We conclude that mechanistic computational models can and should play a key role in the rational design of effective, fully integrated, patient-specific therapeutic brain stimulation.
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187
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Li H, Lei X, Yan T, Li H, Huang B, Li L, Xu L, Liu L, Chen N, Lü L, Ma Y, Xu L, Li J, Wang Z, Zhang B, Hu X. The temporary and accumulated effects of transcranial direct current stimulation for the treatment of advanced Parkinson's disease monkeys. Sci Rep 2015. [PMID: 26220760 PMCID: PMC4518219 DOI: 10.1038/srep12178] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Transcranial direct current stimulation (tDCS) is a useful noninvasive technique of cortical brain stimulation for the treatment of neurological disorders. Clinical research has demonstrated tDCS with anodal stimulation of primary motor cortex (M1) in Parkinson’s disease (PD) patients significantly improved their motor function. However, few studies have been focused on the optimization of parameters which contributed significantly to the treatment effects of tDCS and exploration of the underline neuronal mechanisms. Here, we used different stimulation parameters of anodal tDCS on M1 for the treatment of aged advanced PD monkeys induced with 1-methyl-4-phenyl-1, 2, 3, 6-tetrahydropyridine (MPTP) administration, and then analyzed the temporary and accumulated effects of tDCS treatment. The results indicated anodal tDCS on M1 very significantly improved motor ability temporarily; importantly, the treatment effects of anodal tDCS on M1 were quantitatively correlated to the accumulated stimulation instead of the stimuli intensity or duration respectively. In addition, c-fos staining showed tDCS treatment effects activated the neurons both in M1 and substantia nigra (SN). Therefore, we propose that long time and continue anodal tDCS on M1 is a better strategy to improve the motor symptoms of PD than individual manipulation of stimuli intensity or duration.
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Affiliation(s)
- Hao Li
- 1] Key Laboratory of Animal Models and Human Disease Mechanisms of Chinese Academy of Sciences &Yunnan Province, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan, 650223, China [2] University of Chinese Academy of Sciences, Beijing, 100049, China
| | - Xiaoguang Lei
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310009, China
| | - Ting Yan
- Key Laboratory of Animal Models and Human Disease Mechanisms of Chinese Academy of Sciences &Yunnan Province, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan, 650223, China
| | - Hongwei Li
- Key Laboratory of Animal Models and Human Disease Mechanisms of Chinese Academy of Sciences &Yunnan Province, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan, 650223, China
| | - Baihui Huang
- 1] Key Laboratory of Animal Models and Human Disease Mechanisms of Chinese Academy of Sciences &Yunnan Province, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan, 650223, China [2] University of Chinese Academy of Sciences, Beijing, 100049, China
| | - Ling Li
- Medical imaging department, Kunming general hospital of PLA, Kunming, Yunnan, 650032, China
| | - Liqi Xu
- Medical imaging department, Kunming general hospital of PLA, Kunming, Yunnan, 650032, China
| | - Li Liu
- Medical imaging department, Kunming general hospital of PLA, Kunming, Yunnan, 650032, China
| | - Nanhui Chen
- Key Laboratory of Animal Models and Human Disease Mechanisms of Chinese Academy of Sciences &Yunnan Province, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan, 650223, China
| | - Longbao Lü
- Kunming Primate Research Center, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan, 650223, China
| | - Yuanye Ma
- 1] Key Laboratory of Animal Models and Human Disease Mechanisms of Chinese Academy of Sciences &Yunnan Province, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan, 650223, China [2] Kunming Primate Research Center, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan, 650223, China
| | - Lin Xu
- 1] Key Laboratory of Animal Models and Human Disease Mechanisms of Chinese Academy of Sciences &Yunnan Province, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan, 650223, China [2] CAS Center for Excellence in Brain Science, Chinese Academy of Sciences, Shanghai, 200031, China
| | - Jiali Li
- Key Laboratory of Animal Models and Human Disease Mechanisms of Chinese Academy of Sciences &Yunnan Province, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan, 650223, China
| | - Zhengbo Wang
- Key Laboratory of Animal Models and Human Disease Mechanisms of Chinese Academy of Sciences &Yunnan Province, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan, 650223, China
| | - Baorong Zhang
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310009, China
| | - Xintian Hu
- 1] Key Laboratory of Animal Models and Human Disease Mechanisms of Chinese Academy of Sciences &Yunnan Province, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan, 650223, China [2] CAS Center for Excellence in Brain Science, Chinese Academy of Sciences, Shanghai, 200031, China [3] Kunming Primate Research Center, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan, 650223, China
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188
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Modulation of attention functions by anodal tDCS on right PPC. Neuropsychologia 2015; 74:96-107. [DOI: 10.1016/j.neuropsychologia.2015.02.028] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 02/17/2015] [Accepted: 02/19/2015] [Indexed: 11/19/2022]
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189
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Panouillères MTN, Joundi RA, Brittain JS, Jenkinson N. Reversing motor adaptation deficits in the ageing brain using non-invasive stimulation. J Physiol 2015; 593:3645-55. [PMID: 25929230 PMCID: PMC4560588 DOI: 10.1113/jp270484] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 04/26/2015] [Indexed: 11/17/2022] Open
Abstract
Healthy ageing is characterised by deterioration of motor performance. In normal circumstances motor adaptation corrects for movements’ inaccuracies and as such, it is critical in maintaining optimal motor control. However, motor adaptation performance is also known to decline with age. Anodal transcranial direct current stimulation (TDCS) of the cerebellum and the primary motor cortex (M1) have been found to improve visuomotor adaptation in healthy young and older adults. However, no study has directly compared the effect of TDCS on motor adaptation between the two age populations. The aim of our study was to investigate whether the application of anodal TDCS over the lateral cerebellum and M1 affected motor adaptation in young and older adults similarly. Young and older participants performed a visuomotor rotation task and concurrently received TDCS over the left M1, the right cerebellum or received sham stimulation. Our results replicated the finding that older adults are impaired compared to the young adults in visuomotor adaptation. At the end of the adaptation session, older adults displayed a larger error (−17 deg) than the young adults (−10 deg). The stimulation of the lateral cerebellum did not change the adaptation in both age groups. In contrast, anodal TDCS over M1 improved initial adaptation in both age groups by around 30% compared to sham and this improvement lasted up to 40 min after the end of the stimulation. These results demonstrate that TDCS of M1 can enhance visuomotor adaptation, via mechanisms that remain available in the ageing population.
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Affiliation(s)
- Muriel T N Panouillères
- Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, OX3 9DU, UK
| | - Raed A Joundi
- Department of Physiology, Anatomy and Genetics, University of Oxford, South Parks Road, Oxford, OX1 3QX, UK
| | - John-Stuart Brittain
- Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, OX3 9DU, UK
| | - Ned Jenkinson
- Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, OX3 9DU, UK.,School of Sport, Exercise and Rehabilitation Sciences, The University of Birmingham, Birmingham, B15 2TT, UK
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190
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Faber NJ, Agnesi F, Johnson MD. Recording Neuronal Spike Activity During Transcranial Direct Current Stimulation1. J Med Device 2015. [DOI: 10.1115/1.4030127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Nathaniel J. Faber
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN 55455
| | - Filippo Agnesi
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN 55455
| | - Matthew D. Johnson
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN 55455
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191
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Page SJ, Cunningham DA, Plow E, Blazak B. It takes two: noninvasive brain stimulation combined with neurorehabilitation. Arch Phys Med Rehabil 2015; 96:S89-93. [PMID: 25813373 DOI: 10.1016/j.apmr.2014.09.019] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Revised: 07/02/2014] [Accepted: 09/09/2014] [Indexed: 10/23/2022]
Abstract
The goal of postacute neurorehabilitation is to maximize patient function, ideally by using surviving brain and central nervous system tissue when possible. However, the structures incorporated into neurorehabilitative approaches often differ from this target, which may explain why the efficacy of conventional clinical treatments targeting neurologic impairment varies widely. Noninvasive brain stimulation (eg, transcranial magnetic stimulation [TMS], transcranial direct current stimulation [tDCS]) offers the possibility of directly targeting brain structures to facilitate or inhibit their activity to steer neural plasticity in recovery and measure neuronal output and interactions for evaluating progress. The latest advances as stereotactic navigation and electric field modeling are enabling more precise targeting of patient's residual structures in diagnosis and therapy. Given its promise, this supplement illustrates the wide-ranging significance of TMS and tDCS in neurorehabilitation, including in stroke, pediatrics, traumatic brain injury, focal hand dystonia, neuropathic pain, and spinal cord injury. TMS and tDCS are still not widely used and remain poorly understood in neurorehabilitation. Therefore, the present supplement includes articles that highlight ready clinical application of these technologies, including their comparative diagnostic capabilities relative to neuroimaging, their therapeutic benefit, their optimal delivery, the stratification of likely responders, and the variable benefits associated with their clinical use because of interactions between pathophysiology and the innate reorganization of the patient's brain. Overall, the supplement concludes that whether provided in isolation or in combination, noninvasive brain stimulation and neurorehabilitation are synergistic in the potential to transform clinical practice.
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Affiliation(s)
- Stephen J Page
- School of Health and Rehabilitation Sciences, The Ohio State University Medical Center, Columbus, OH; B.R.A.I.N. Laboratory, Columbus, OH.
| | - David A Cunningham
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH; School of Biomedical Sciences, Kent State University, Kent, OH
| | - Ela Plow
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH; Department of Physical Medicine and Rehabilitation, Neurological Institute, Cleveland Clinic, Cleveland, OH
| | - Brittani Blazak
- School of Health and Rehabilitation Sciences, The Ohio State University Medical Center, Columbus, OH; Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH
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192
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Metwally MK, Han SM, Kim TS. The effect of tissue anisotropy on the radial and tangential components of the electric field in transcranial direct current stimulation. Med Biol Eng Comput 2015; 53:1085-101. [PMID: 25940845 DOI: 10.1007/s11517-015-1301-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Accepted: 04/23/2015] [Indexed: 11/27/2022]
Abstract
Transcranial direct current stimulation (tDCS) is considered to be a promising technique for noninvasive brain stimulation and brain disease therapy. Recent studies have investigated the distribution of the electric field (EF) magnitude over gyri and sulci and the effect of tissue homogeneity with isotropic electrical conductivities. However, it is well known that the skull and white matter (WM) are highly anisotropic electrically, requiring investigations of their anisotropic effects on the magnitude and the directional components of the induced EF due to the high dependency between neuromodulation and the EF direction. In this study, we investigated the effects of the skull and WM anisotropy on the radial and tangential components of the EF via gyri-specific high-resolution finite element head models. For tDCS, three configurations were investigated: the conventional rectangular pad electrode, a 4(cathodes) +1(anode) ring configuration, and a bilateral configuration. The results showed that the skull anisotropy has a crucial influence on the distribution of the radial EF component. The affected cortical regions by the radial EF were reduced about 22 % when considering the skull anisotropy in comparison with the regions with the skull isotropy. On the other hand, the WM anisotropy strongly alters the EF directionality, especially within the sulci. The electric current tends to flow radially to the cortical surface with the WM anisotropy. This effect increases the affected cortical areas by the radial EF component within the sulcal regions. Our results suggest that one must examine the distribution of the EF components in tDCS, not just the magnitude of the EF alone.
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Affiliation(s)
- Mohamed K Metwally
- Department of Biomedical Engineering, College of Electronics and Information, Kyung Hee University, 1 Seocheon-dong, Giheung-gu, Yongin-si, Gyeonggi-do, 446-701, Republic of Korea
| | - Seung Moo Han
- Department of Biomedical Engineering, College of Electronics and Information, Kyung Hee University, 1 Seocheon-dong, Giheung-gu, Yongin-si, Gyeonggi-do, 446-701, Republic of Korea
| | - Tae-Seong Kim
- Department of Biomedical Engineering, College of Electronics and Information, Kyung Hee University, 1 Seocheon-dong, Giheung-gu, Yongin-si, Gyeonggi-do, 446-701, Republic of Korea.
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193
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O'Neill F, Sacco P, Nurmikko T. Evaluation of a home-based transcranial direct current stimulation (tDCS) treatment device for chronic pain: study protocol for a randomised controlled trial. Trials 2015; 16:186. [PMID: 25902771 PMCID: PMC4411773 DOI: 10.1186/s13063-015-0710-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 04/08/2015] [Indexed: 11/23/2022] Open
Abstract
Background Stimulation of the primary motor cortex (M1) has been shown to reduce the pain of neuropathy in multiple studies. There are several methods of stimulation both invasive and non-invasive. Recent work by this laboratory has seen that 40% of a sample of chronic neuropathic pain patients responded positively to non-invasive repetitive transcranial magnetic stimulation (rTMS) to the motor cortex with a reduction in pain levels by at least 20%. The effect however is short lived and multiple return visits are necessary to maintain this response. Transcranial direct current stimulation (tDCS) offers a more mobile method of motor cortex stimulation and is similarly non-invasive. The protocol described is designed to assess the analgesic effect of a home-based tDCS treatment device on chronic neuropathic pain in both responders and non-responders to previous TMS treatment. Methods/design This article reports the protocol for a randomised, sham-controlled, double-blinded crossover study in which patients with chronic neuropathic pain (n = 24) will receive anodal, cathodal and sham tDCS over M1. All patients will have previously completed a study of rTMS of the motor cortex and have been designated as responders or non-responders to this modality. Patients receive all three tDCS stimulation types by self-administration. We assess the effect on pain scores [numerical rating scale (NRS)], self reported health status (Short Form-36 Health Survey) and anxiety/depression (Hospital Anxiety and Depression Scale). A linear mixed model with fixed effects will analyse changes in pain scores from pre- to post- interventions. Analysis will be carried out on an intention-to-treat basis. A proportion analysis will also be carried out with patients separated into either responders or non-responders to previous TMS. Safety will be assessed throughout the study by monitoring of adverse events. Discussion The result of this trial will assess the efficacy of self-administered tDCS of the motor cortex in the treatment of chronic neuropathic pain and also provide insight into whether a potential differential effect is seen in patients that have previously been shown to be either responsive or non-responsive to rTMS over the same area. Trial registration ISRCTN56839387 date 27 January 2014. First patient randomised to trial 30 October 2012.
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Affiliation(s)
- Francis O'Neill
- Pain Research Institute, Clinical Sciences Centre, Lower Lane, Fazackerley, Liverpool, L9 7AL, UK. .,Department of Oral Surgery, Liverpool University Dental Hospital, Pembroke Place, Liverpool, L3 5PS, UK.
| | - Paul Sacco
- Pain Research Institute, Clinical Sciences Centre, Lower Lane, Fazackerley, Liverpool, L9 7AL, UK.
| | - Turo Nurmikko
- Pain Research Institute, Clinical Sciences Centre, Lower Lane, Fazackerley, Liverpool, L9 7AL, UK.
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194
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Yang Y, Xiao J, Song H, Wang R, Hussain M, Song W. Relationship of herpes simplex encephalitis and transcranial direct current stimulation--a case report. J Clin Virol 2015; 65:46-9. [PMID: 25766987 DOI: 10.1016/j.jcv.2015.01.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Revised: 01/14/2015] [Accepted: 01/16/2015] [Indexed: 11/27/2022]
Abstract
We report a rare case of relapsing herpes simplex encephalitis in a-37-year-old patient which was previously confirmed by positive polymerase chain reaction, herpes simplex virus (HSV) type1 IgG antibodies in cerebrospinal fluid and characterized on MRI. During the first admission, he was treated with continuous acyclovir treatment for one month with clinical improvement except for residual aphasia, for which he received a course of outpatient transcranial direct current stimulation (tDCS). A constant current of 1.2 mA was applied for 20 min twice daily. After the 4th day the patient was found to be irritable and uncooperative by staff and family members. A subsequent MRI showed significant deterioration of the lesion on comparison to the first MRI which led to discontinuation of tDCS.The relatively rapid exacerbation of HSV in only a few days is unusual. Our aim is to discuss if tDCS is related to HSV relapse and in doing so highlight possible mechanisms.
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Affiliation(s)
- Yuanbin Yang
- Department of Rehabilitation, Xuanwu Hospital of Capital Medical University, NO. 45, Changchun Street, Xicheng District, Beijing, China.
| | - Juan Xiao
- Department of Rehabilitation, Xuanwu Hospital of Capital Medical University, NO. 45, Changchun Street, Xicheng District, Beijing, China
| | - Haiqing Song
- Department of Neurology, Xuanwu Hospital of Capital Medical University, NO.45, Changchun Street, Xichen District, Beijing, China
| | - Ralph Wang
- Wynscape Health and Rehabilitation and US Physiatry, 2180 Manchester Road, Wheaton, IL 60187, United States
| | - Mohammed Hussain
- Department of Neurosurgery, Wayne State University- 4160 John R St, Ste+925, Detroit, MI 48201, USA
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195
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Minarik T, Sauseng P, Dunne L, Berger B, Sterr A. Effects of anodal transcranial direct current stimulation on visually guided learning of grip force control. BIOLOGY 2015; 4:173-86. [PMID: 25738809 PMCID: PMC4381224 DOI: 10.3390/biology4010173] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Revised: 12/10/2014] [Accepted: 02/25/2015] [Indexed: 01/21/2023]
Abstract
Anodal transcranial Direct Current Stimulation (tDCS) has been shown to be an effective non-invasive brain stimulation method for improving cognitive and motor functioning in patients with neurological deficits. tDCS over motor cortex (M1), for instance, facilitates motor learning in stroke patients. However, the literature on anodal tDCS effects on motor learning in healthy participants is inconclusive, and the effects of tDCS on visuo-motor integration are not well understood. In the present study we examined whether tDCS over the contralateral motor cortex enhances learning of grip-force output in a visually guided feedback task in young and neurologically healthy volunteers. Twenty minutes of 1 mA anodal tDCS were applied over the primary motor cortex (M1) contralateral to the dominant (right) hand, during the first half of a 40 min power-grip task. This task required the control of a visual signal by modulating the strength of the power-grip for six seconds per trial. Each participant completed a two-session sham-controlled crossover protocol. The stimulation conditions were counterbalanced across participants and the sessions were one week apart. Performance measures comprised time-on-target and target-deviation, and were calculated for the periods of stimulation (or sham) and during the afterphase respectively. Statistical analyses revealed significant performance improvements over the stimulation and the afterphase, but this learning effect was not modulated by tDCS condition. This suggests that the form of visuomotor learning taking place in the present task was not sensitive to neurostimulation. These null effects, together with similar reports for other types of motor tasks, lead to the proposition that tDCS facilitation of motor learning might be restricted to cases or situations where the motor system is challenged, such as motor deficits, advanced age, or very high task demand.
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Affiliation(s)
- Tamas Minarik
- Department of Psychology, Ludwig-Maximilian University, Munich, Leopoldstr. 13, Munich 80802, Germany.
| | - Paul Sauseng
- Department of Psychology, Ludwig-Maximilian University, Munich, Leopoldstr. 13, Munich 80802, Germany.
| | - Lewis Dunne
- School of Psychology, University of Surrey, Guildford GU2 7XH, UK.
| | - Barbara Berger
- Department of Psychology, Ludwig-Maximilian University, Munich, Leopoldstr. 13, Munich 80802, Germany.
| | - Annette Sterr
- School of Psychology, University of Surrey, Guildford GU2 7XH, UK.
- Department of Neurology, University of Sao Paulo, São Paulo, SP 01246903, Brazil.
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196
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Fregni F, Nitsche MA, Loo CK, Brunoni AR, Marangolo P, Leite J, Carvalho S, Bolognini N, Caumo W, Paik NJ, Simis M, Ueda K, Ekhitari H, Luu P, Tucker DM, Tyler WJ, Brunelin J, Datta A, Juan CH, Venkatasubramanian G, Boggio PS, Bikson M. Regulatory Considerations for the Clinical and Research Use of Transcranial Direct Current Stimulation (tDCS): review and recommendations from an expert panel. CLINICAL RESEARCH AND REGULATORY AFFAIRS 2015; 32:22-35. [PMID: 25983531 PMCID: PMC4431691 DOI: 10.3109/10601333.2015.980944] [Citation(s) in RCA: 175] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The field of transcranial electrical stimulation (tES) has experienced significant growth in the past 15 years. One of the tES techniques leading this increased interest is transcranial direct current stimulation (tDCS). Significant research efforts have been devoted to determining the clinical potential of tDCS in humans. Despite the promising results obtained with tDCS in basic and clinical neuroscience, further progress has been impeded by a lack of clarity on international regulatory pathways. We therefore convened a group of research and clinician experts on tDCS to review the research and clinical use of tDCS. In this report, we review the regulatory status of tDCS, and we summarize the results according to research, off-label and compassionate use of tDCS in the following countries: Australia, Brazil, France, Germany, India, Iran, Italy, Portugal, South Korea, Taiwan and United States. Research use, off label treatment and compassionate use of tDCS are employed in most of the countries reviewed in this study. It is critical that a global or local effort is organized to pursue definite evidence to either approve and regulate or restrict the use of tDCS in clinical practice on the basis of adequate randomized controlled treatment trials.
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Affiliation(s)
- F Fregni
- Spaulding Neuromodulation Center, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - M A Nitsche
- Department of Clinical Neurophysiology, Georg-August-University, Göttingen, Germany
| | - C K Loo
- School of Psychiatry & The Black Dog Institute, University of New South Wales, Sydney, Australia
| | - A R Brunoni
- Service of Interdisciplinary Neuromodulation, Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil and Division of Neurology, Santa Casa Medicak School, Sao Paulo, Brazil
| | - P Marangolo
- Department of Experimental and Clinical Medicine, University Politecnica delle Marche, Ancona, and IRCCS Fondazione Santa Lucia, Roma, Italy
| | - J Leite
- Spaulding Neuromodulation Center, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA ; Neuropsychophysiology Laboratory, CIPsi, School of Psychology (EPsi), University of Minho, Campus de Gualtar, Braga, Portugal
| | - S Carvalho
- Spaulding Neuromodulation Center, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA ; Neuropsychophysiology Laboratory, CIPsi, School of Psychology (EPsi), University of Minho, Campus de Gualtar, Braga, Portugal
| | - N Bolognini
- Department of Psychology, University of Milano Bicocca, and Laboratory of Neuropsychology, IRCC Instituto Auxologico Italiano, Milano, Italy
| | - W Caumo
- Laboratory of Pain & Neuromodulation at Hospital de Clínicas de Porto Alegre at UFRGS
| | - N J Paik
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul, South Korea
| | - M Simis
- Service of Interdisciplinary Neuromodulation, Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil and Division of Neurology, Santa Casa Medicak School, Sao Paulo, Brazil
| | - K Ueda
- National Cardiovascular Center, Osaka, Japan
| | - H Ekhitari
- Translational Neuroscience Program, Institute for Cognitive Science Studies, Tehran, Iran ; Neurocognitive Laboratory, Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran
| | - P Luu
- Electrical Geodesics, Inc., and University of Oregon, Eugene, Oregon, USA
| | - D M Tucker
- Electrical Geodesics, Inc., and University of Oregon, Eugene, Oregon, USA
| | - W J Tyler
- Virginia Tech Carilion Research Institute, Department of Psychiatry and Behavioral Medicine, Virginia Tech Carilion School of Medicine, and School of Biomedical Engineering and Sciences, Virginia Tech, Roanoke, VA USA
| | - J Brunelin
- EA 4615, Centre Hospitalier le Vinatier, Université de Lyon, F-69003, Université Claude Bernard Lyon I, Bron, France
| | - A Datta
- Department of Biomedical Engineering, Neural Engineering Laboratory, The City College of the City University of New York New York, NY, USA
| | - C H Juan
- Institute of Cognitive Neuroscience, National Central University, Taiwan
| | - G Venkatasubramanian
- Translational Psychiatry Laboratory, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - P S Boggio
- Social and Cognitive Neuroscience Laboratory and Developmental Disorders Program, Center for Healthy and Biological Sciences, Mackenzie Presbyterian University, Sao Paulo, Brazil
| | - M Bikson
- Department of Biomedical Engineering, Neural Engineering Laboratory, The City College of the City University of New York New York, NY, USA
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197
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Foerster Á, Rocha S, Araújo MDGR, Lemos A, Monte-Silva K. Effects of transcranial direct current stimulation on motor learning in healthy individuals: a systematic review. FISIOTERAPIA EM MOVIMENTO 2015. [DOI: 10.1590/0103-5150.028.001.ar01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction Transcranial direct current stimulation (tDCS) has been used to modify cortical excitability and promote motor learning. Objective To systematically review published data to investigate the effects of transcranial direct current stimulation on motor learning in healthy individuals. Methods Randomized or quasi-randomized studies that evaluated the tDCS effects on motor learning were included and the risk of bias was examined by Cochrane Collaboration’s tool. The following electronic databases were used: PubMed, Scopus, Web of Science, LILACS, CINAHL with no language restriction. Results It was found 160 studies; after reading the title and abstract, 17 of those were selected, but just 4 were included. All studies involved healthy, right-handed adults. All studies assessed motor learning by the Jebsen Taylor Test or by the Serial Finger Tapping Task (SFTT). Almost all studies were randomized and all were blinding for participants. Some studies presented differences at SFTT protocol. Conclusion The result is insufficient to draw conclusions if tDCS influences the motor learning. Furthermore, there was significant heterogeneity of the stimulation parameters used. Further researches are needed to investigate the parameters that are more important for motor learning improvement and measure whether the effects are long-lasting or limited in time.
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San-Juan D, Morales-Quezada L, Orozco Garduño AJ, Alonso-Vanegas M, González-Aragón MF, Espinoza López DA, Vázquez Gregorio R, Anschel DJ, Fregni F. Transcranial Direct Current Stimulation in Epilepsy. Brain Stimul 2015; 8:455-64. [PMID: 25697590 DOI: 10.1016/j.brs.2015.01.001] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Revised: 01/02/2015] [Accepted: 01/05/2015] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Transcranial direct current stimulation (tDCS) is an emerging non-invasive neuromodulation therapy in epilepsy with conflicting results in terms of efficacy and safety. OBJECTIVE Review the literature about the efficacy and safety of tDCS in epilepsy in humans and animals. METHODS We searched studies in PubMed, MedLine, Scopus, Web of Science and Google Scholar (January 1969 to October 2013) using the keywords 'transcranial direct current stimulation' or 'tDCS' or 'brain polarization' or 'galvanic stimulation' and 'epilepsy' in animals and humans. Original articles that reported tDCS safety and efficacy in epileptic animals or humans were included. Four review authors independently selected the studies, extracted data and assessed the methodological quality of the studies using the recommendations of the Cochrane Handbook for Systematic Reviews of Interventions, PRISMA guidelines and Jadad Scale. A meta-analysis was not possible due to methodological, clinical and statistical heterogeneity of included studies. RESULTS We analyzed 9 articles with different methodologies (3 animals/6 humans) with a total of 174 stimulated individuals; 109 animals and 65 humans. In vivo and in vitro animal studies showed that direct current stimulation can successfully induce suppression of epileptiform activity without neurological injury and 4/6 (67%) clinical studies showed an effective decrease in epileptic seizures and 5/6 (83%) reduction of inter-ictal epileptiform activity. All patients tolerated tDCS well. CONCLUSIONS tDCS trials have demonstrated preliminary safety and efficacy in animals and patients with epilepsy. Further larger studies are needed to define the best stimulation protocols and long-term follow-up.
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Affiliation(s)
- Daniel San-Juan
- Neurophysiology Department, National Institute of Neurology and Neurosurgery "Manuel Velasco Suárez", Av. Insurgentes Sur 3877, Col. La Fama, Tlalpan, México D.F. 14269, Mexico.
| | - León Morales-Quezada
- Laboratory of Neuromodulation, Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, 300 1st Ave, Charlestown, MA 02129, USA
| | - Adolfo Josué Orozco Garduño
- Neurophysiology Department, National Institute of Neurology and Neurosurgery "Manuel Velasco Suárez", Av. Insurgentes Sur 3877, Col. La Fama, Tlalpan, México D.F. 14269, Mexico
| | - Mario Alonso-Vanegas
- Neurosurgery Department, National Institute of Neurology and Neurosurgery "Manuel Velasco Suárez", Av. Insurgentes Sur 3877, Col. La Fama, Tlalpan, México D.F. 14269, Mexico
| | - Maricarmen Fernández González-Aragón
- Neurophysiology Department, National Institute of Neurology and Neurosurgery "Manuel Velasco Suárez", Av. Insurgentes Sur 3877, Col. La Fama, Tlalpan, México D.F. 14269, Mexico
| | - Dulce Anabel Espinoza López
- Neurophysiology Department, National Institute of Neurology and Neurosurgery "Manuel Velasco Suárez", Av. Insurgentes Sur 3877, Col. La Fama, Tlalpan, México D.F. 14269, Mexico
| | - Rafael Vázquez Gregorio
- Neurophysiology Department, National Institute of Neurology and Neurosurgery "Manuel Velasco Suárez", Av. Insurgentes Sur 3877, Col. La Fama, Tlalpan, México D.F. 14269, Mexico
| | - David J Anschel
- Comprehensive Epilepsy Center of Long Island, St. Charles Hospital, 200 Belle Terre Rd., Port Jefferson, NY 11777, USA
| | - Felipe Fregni
- Laboratory of Neuromodulation, Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, 300 1st Ave, Charlestown, MA 02129, USA
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Dhaliwal SK, Meek BP, Modirrousta MM. Non-Invasive Brain Stimulation for the Treatment of Symptoms Following Traumatic Brain Injury. Front Psychiatry 2015; 6:119. [PMID: 26379560 PMCID: PMC4549551 DOI: 10.3389/fpsyt.2015.00119] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 08/10/2015] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Traumatic brain injury (TBI) is a common cause of physical, psychological, and cognitive impairment, but many current treatments for TBI are ineffective or produce adverse side effects. Non-invasive methods of brain stimulation could help ameliorate some common trauma-induced symptoms. OBJECTIVE This review summarizes instances in which repetitive Transcranial Magnetic Stimulation (rTMS) and transcranial Direct Current Stimulation (tDCS) have been used to treat symptoms following a TBI. A subsequent discussion attempts to determine the value of these methods in light of their potential risks. METHODS The research databases of PubMed/MEDLINE and PsycINFO were electronically searched using terms relevant to the use of rTMS and tDCS as a tool to decrease symptoms in the context of rehabilitation post-TBI. RESULTS Eight case-studies and four multi-subject reports using rTMS and six multi--subject studies using tDCS were found. Two instances of seizure are discussed. CONCLUSION There is evidence that rTMS can be an effective treatment option for some post-TBI symptoms, such as depression, tinnitus, and neglect. Although the safety of this method remains uncertain, the use of rTMS in cases of mild TBI without obvious structural damage may be justified. Evidence on the effectiveness of tDCS is mixed, highlighting the need for additional investigations.
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Affiliation(s)
| | - Benjamin P Meek
- Department of Psychiatry, University of Manitoba , Winnipeg, MB , Canada
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200
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Fröhlich F, Sellers KK, Cordle AL. Targeting the neurophysiology of cognitive systems with transcranial alternating current stimulation. Expert Rev Neurother 2014; 15:145-67. [PMID: 25547149 DOI: 10.1586/14737175.2015.992782] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Cognitive impairment represents one of the most debilitating and most difficult symptom to treat of many psychiatric illnesses. Human neurophysiology studies have suggested that specific pathologies of cortical network activity correlate with cognitive impairment. However, we lack demonstration of causal relationships between specific network activity patterns and cognitive capabilities and treatment modalities that directly target impaired network dynamics of cognition. Transcranial alternating current stimulation (tACS), a novel non-invasive brain stimulation approach, may provide a crucial tool to tackle these challenges. Here, we propose that tACS can be used to elucidate the causal role of cortical synchronization in cognition and, eventually, to enhance pathologically weakened synchrony that may underlie cognitive deficits. To accelerate such development of tACS as a treatment for cognitive deficits, we discuss studies on tACS and cognition performed in healthy participants, according to the Research Domain Criteria of the National Institute of Mental Health.
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Affiliation(s)
- Flavio Fröhlich
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill NC 27599, USA
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