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Wen HZ, Gao SH, Zhao YD, He WJ, Tian XL, Ruan HZ. Parameter Optimization Analysis of Prolonged Analgesia Effect of tDCS on Neuropathic Pain Rats. Front Behav Neurosci 2017; 11:115. [PMID: 28659772 PMCID: PMC5468406 DOI: 10.3389/fnbeh.2017.00115] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 05/26/2017] [Indexed: 01/27/2023] Open
Abstract
Background: Transcranial direct current stimulation (tDCS) is widely used to treat human nerve disorders and neuropathic pain by modulating the excitability of cortex. The effectiveness of tDCS is influenced by its stimulation parameters, but there have been no systematic studies to help guide the selection of different parameters. Objective: This study aims to assess the effects of tDCS of primary motor cortex (M1) on chronic neuropathic pain in rats and to test for the optimal parameter combinations for analgesia. Methods: Using the chronic neuropathic pain models of chronic constriction injury (CCI), we measured pain thresholds before and after anodal-tDCS (A-tDCS) using different parameter conditions, including stimulation intensity, stimulation time, intervention time and electrode located (ipsilateral or contralateral M1 of the ligated paw on male/female CCI models). Results: Following the application of A-tDCS over M1, we observed that the antinociceptive effects were depended on different parameters. First, we found that repetitive A-tDCS had a longer analgesic effect than single stimulus, and both ipsilateral-tDCS (ip-tDCS) and contralateral-tDCS (con-tDCS) produce a long-lasting analgesic effect on neuropathic pain. Second, the antinociceptive effects were intensity-dependent and time-dependent, high intensities worked better than low intensities and long stimulus durations worked better than short stimulus durations. Third, timing of the intervention after injury affected the stimulation outcome, early use of tDCS was an effective method to prevent the development of pain, and more frequent intervention induced more analgesia in CCI rats, finally, similar antinociceptive effects of con- and ip-tDCS were observed in both sexes of CCI rats. Conclusion: Optimized protocols of tDCS for treating antinociceptive effects were developed. These findings should be taken into consideration when using tDCS to produce analgesic effects in clinical applications.
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Affiliation(s)
- Hui-Zhong Wen
- Department of Neurobiology, College of Basic Medical Science, Chongqing Key Laboratory of Neurobiology, Third Military Medical UniversityChongqing, China
| | - Shi-Hao Gao
- Department of Neurobiology, College of Basic Medical Science, Chongqing Key Laboratory of Neurobiology, Third Military Medical UniversityChongqing, China
| | - Yan-Dong Zhao
- Department of Neurobiology, College of Basic Medical Science, Chongqing Key Laboratory of Neurobiology, Third Military Medical UniversityChongqing, China
| | - Wen-Juan He
- Department of Pathophysiology and High Altitudepathology, College of High Altitude Military Medicine, Third Military Medical UniversityChongqing, China
| | - Xue-Long Tian
- Bioengineering College, Chongqing UniversityChongqing, China
| | - Huai-Zhen Ruan
- Department of Neurobiology, College of Basic Medical Science, Chongqing Key Laboratory of Neurobiology, Third Military Medical UniversityChongqing, China
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202
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Harvey MP, Lorrain D, Martel M, Bergeron-Vezina K, Houde F, Séguin M, Léonard G. Can we improve pain and sleep in elderly individuals with transcranial direct current stimulation? - Results from a randomized controlled pilot study. Clin Interv Aging 2017; 12:937-947. [PMID: 28652716 PMCID: PMC5472413 DOI: 10.2147/cia.s133423] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background The prevalence of chronic pain and sleep disturbances substantially increases with age. Pharmacotherapy remains the primary treatment option for these health issues. However, side effects and drug interactions are difficult to control in elderly individuals. Aims The objective of this study was to assess the feasibility of conducting a randomized sham-controlled trial and to collect preliminary data on the efficacy of transcranial direct current stimulation (tDCS) to reduce pain and improve sleep in older adults suffering from chronic pain. Methods Fourteen elderly individuals (mean age 71±7 years) suffering from chronic pain and sleep complaints were randomized to receive either anodal tDCS, applied over the primary motor cortex (2 mA, 20 minutes), or sham tDCS, for 5 consecutive days. Pain was measured with visual analog scales, pain logbooks and questionnaires, while sleep was assessed with actigraphy, sleep diaries and questionnaires. Results There were no missing data for pain and sleep measures, except for actigraphy, that generated several missing data. Blinding was maintained throughout the study, for both the evaluator and participants. Active but not sham tDCS significantly reduced pain (P<0.05). No change was observed in sleep parameters, in both the active and sham tDCS groups (all P≥0.18). Conclusion The present study provides guidelines for the implementation of future tDCS studies in larger populations of elderly individuals. M1 anodal tDCS in this population appears to be effective to reduce pain, but not to improve sleep.
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Affiliation(s)
- Marie-Philippe Harvey
- Research Centre on Aging, CIUSSS de l'Estrie-CHUS.,Faculty of Medicine and Health Sciences, Université de Sherbrooke
| | - Dominique Lorrain
- Research Centre on Aging, CIUSSS de l'Estrie-CHUS.,Department of Psychology, Université de Sherbrooke
| | - Marylie Martel
- Research Centre on Aging, CIUSSS de l'Estrie-CHUS.,Faculty of Medicine and Health Sciences, Université de Sherbrooke
| | | | - Francis Houde
- Research Centre on Aging, CIUSSS de l'Estrie-CHUS.,Faculty of Medicine and Health Sciences, Université de Sherbrooke
| | - Mario Séguin
- Faculty of Medicine and Health Sciences, Université de Sherbrooke.,Department of Neurosurgery, Centre Hospitalier Universitaire de Sherbrooke
| | - Guillaume Léonard
- Research Centre on Aging, CIUSSS de l'Estrie-CHUS.,Faculty of Medicine and Health Sciences, Université de Sherbrooke.,School of Rehabilitation, Université de Sherbrooke, Sherbrooke, QC, Canada
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203
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Morin A, Léonard G, Gougeon V, Cyr MP, Waddell G, Bureau YA, Girard I, Morin M. Efficacy of transcranial direct-current stimulation in women with provoked vestibulodynia. Am J Obstet Gynecol 2017; 216:584.e1-584.e11. [PMID: 28302387 DOI: 10.1016/j.ajog.2017.02.049] [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: 11/22/2016] [Revised: 01/29/2017] [Accepted: 02/25/2017] [Indexed: 12/26/2022]
Abstract
BACKGROUND Provoked vestibulodynia is a highly prevalent condition characterized by acute recurrent pain located at the vaginal entrance in response to pressure application or attempted vaginal penetration. Despite a wide variety of treatments offered to women with provoked vestibulodynia, a high proportion of women are refractory to conventional treatment. Transcranial direct-current stimulation is a noninvasive brain stimulation technique that has been shown effective for improving various chronic pain conditions. Growing evidence suggests that the central nervous system could play a key role in provoked vestibulodynia. Targeting the central nervous system could therefore be a promising treatment for women with provoked vestibulodynia. OBJECTIVE The purpose of this study was to evaluate and compare the efficacy of active and sham transcranial direct-current stimulation in reducing pain intensity during intercourse in patients with provoked vestibulodynia. STUDY DESIGN We conducted a triple-blind, parallel-group, randomized controlled trial. Women aged 17-45 years diagnosed with provoked vestibulodynia by a gynecologist using a validated protocol were randomized to 10 sessions of either active transcranial direct-current stimulation (intensity = 2 mA) or 10 sessions of sham transcranial direct-current stimulation, over a 2-week period. Both active and sham transcranial direct-current stimulation were applied for 20 minutes, with the anode positioned over the primary motor cortex, and the cathode over the contralateral supraorbital area. Outcome measures were collected at baseline, 2 weeks after treatment, and at 3-month follow-up by an evaluator blinded to group assignment. The primary objective was to assess pain intensity during intercourse, using a numerical rating scale. Secondary outcomes focused on sexual function and distress, vestibular sensitivity, psychological distress, treatment satisfaction, and patient impression of change. Statistical analyses were conducted on the intention-to-treat basis, and treatment effects were evaluated using a mixed linear model for repeated measures. RESULTS A total of 40 patients were randomly assigned to receive either active (n = 20) or sham (n = 20) transcranial direct-current stimulation treatments from November 2014 through February 2016. Baseline characteristics were similar between the active and sham transcranial direct-current stimulation groups. In full compliance with the study protocol, every participant followed all courses of the study treatment, including assessments at 2-week and 3-month follow-up. Pain during sexual intercourse was not significantly different between active and sham treatment groups 2 weeks after treatment (P = .84) and at follow-up (P = .09). Mean baseline and 2-week assessment pain intensity were, respectively, 6.8 (95% confidence interval, 5.9-7.7) and 5.6 (95% confidence interval, 4.7-6.5) for active transcranial direct-current stimulation (P = .03) vs 7.5 (95% confidence interval, 6.6-8.4) and 5.7 (95% confidence interval, 4.8-6.6) for sham transcranial direct-current stimulation (P = .001). Nonsignificant differences between the 2 groups were also found in their sexual function and distress after treatment (P > .20) and at follow-up (P > .10). Overall, at 2-week assessment 68% assigned to active transcranial direct-current stimulation reported being very much, much, or slightly improved compared to 65% assigned to sham transcranial direct-current stimulation (P = .82), and still comparable at follow-up: 42% vs 65%, respectively (P = .15). CONCLUSION Findings suggest that active transcranial direct-current stimulation is not more effective than sham transcranial direct-current stimulation for reducing pain in women with provoked vestibulodynia. Likewise, no significant effects were found on sexual function, vestibular sensitivity, or psychological distress.
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The Role of the Orbitofrontal and Dorsolateral Prefrontal Cortices in Aesthetic Preference for Art. Behav Sci (Basel) 2017; 7:bs7020031. [PMID: 28492478 PMCID: PMC5485461 DOI: 10.3390/bs7020031] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 05/08/2017] [Accepted: 05/09/2017] [Indexed: 11/17/2022] Open
Abstract
The search for the underlying neural activation that occurs during subjective aesthetic experiences of artwork has been enhanced through neuroimaging techniques. Recently, the dorsolateral prefrontal cortex, alongside the orbitofrontal cortex, have been implicated in aesthetic appreciation, and this is the focus of the present paper. Here, the validity of this conclusion is examined through the discussion of its neuroanatomical connections and functional properties. It is proposed that the experimental evidence challenges the view that this area could hold a privileged position in a brain network involved in aesthetic preference.
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205
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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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206
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Transcranial direct current stimulation over the primary motor vs prefrontal cortex in refractory chronic migraine: A pilot randomized controlled trial. J Neurol Sci 2017; 378:225-232. [PMID: 28566169 DOI: 10.1016/j.jns.2017.05.007] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 04/04/2017] [Accepted: 05/02/2017] [Indexed: 12/21/2022]
Abstract
Although transcranial direct current stimulation (tDCS) represents a therapeutic option for the prophylaxis of chronic migraine, the target area for application of the electrical current to the cortex has not yet been well established. Here we sought to determine whether a treatment protocol involving 12 sessions of 2mA, 20min anodal stimulation of the left primary motor (M1) or dorsolateral prefrontal cortex (DLPFC) could offer clinical benefits in the management of pain from migraine. Thirteen participants were assessed before and after treatment, using the Headache Impact Test-6, Visual Analogue Scale and Medical Outcomes Study 36 - Item Short - Form Health Survey. After treatment, group DLPFC exhibited a better performance compared with groups M1 and sham. On intragroup comparison, groups DLPFC and M1 exhibited a greater reduction in headache impact and pain intensity and a higher quality of life after treatment. No significant change was found in group sham. The participants in group M1 exhibited more adverse effects, especially headache, heartburn, and sleepiness, than did those in the other two groups. Transcranial direct current stimulation is a safe and efficacious technique for treating chronic migraine. However, it should be kept in mind that the site of cortical stimulation might modulate the patient's response to treatment.
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207
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Impey D, de la Salle S, Baddeley A, Knott V. Effects of an NMDA antagonist on the auditory mismatch negativity response to transcranial direct current stimulation. J Psychopharmacol 2017; 31:614-624. [PMID: 27624152 DOI: 10.1177/0269881116665336] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Transcranial direct current stimulation (tDCS) is a non-invasive form of brain stimulation which uses a weak constant current to alter cortical excitability and activity temporarily. tDCS-induced increases in neuronal excitability and performance improvements have been observed following anodal stimulation of brain regions associated with visual and motor functions, but relatively little research has been conducted with respect to auditory processing. Recently, pilot study results indicate that anodal tDCS can increase auditory deviance detection, whereas cathodal tDCS decreases auditory processing, as measured by a brain-based event-related potential (ERP), mismatch negativity (MMN). As evidence has shown that tDCS lasting effects may be dependent on N-methyl-D-aspartate (NMDA) receptor activity, the current study investigated the use of dextromethorphan (DMO), an NMDA antagonist, to assess possible modulation of tDCS's effects on both MMN and working memory performance. The study, conducted in 12 healthy volunteers, involved four laboratory test sessions within a randomised, placebo and sham-controlled crossover design that compared pre- and post-anodal tDCS over the auditory cortex (2 mA for 20 minutes to excite cortical activity temporarily and locally) and sham stimulation (i.e. device is turned off) during both DMO (50 mL) and placebo administration. Anodal tDCS increased MMN amplitudes with placebo administration. Significant increases were not seen with sham stimulation or with anodal stimulation during DMO administration. With sham stimulation (i.e. no stimulation), DMO decreased MMN amplitudes. Findings from this study contribute to the understanding of underlying neurobiological mechanisms mediating tDCS sensory and memory improvements.
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Affiliation(s)
- Danielle Impey
- 1 Clinical Neuroelectrophysiology and Cognitive Research Laboratory, University of Ottawa Institute of Mental Health Research, Ottawa, Canada.,2 School of Psychology, University of Ottawa, Ottawa, Canada
| | - Sara de la Salle
- 1 Clinical Neuroelectrophysiology and Cognitive Research Laboratory, University of Ottawa Institute of Mental Health Research, Ottawa, Canada.,2 School of Psychology, University of Ottawa, Ottawa, Canada
| | - Ashley Baddeley
- 1 Clinical Neuroelectrophysiology and Cognitive Research Laboratory, University of Ottawa Institute of Mental Health Research, Ottawa, Canada
| | - Verner Knott
- 1 Clinical Neuroelectrophysiology and Cognitive Research Laboratory, University of Ottawa Institute of Mental Health Research, Ottawa, Canada.,2 School of Psychology, University of Ottawa, Ottawa, Canada
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208
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Sankarasubramanian V, Cunningham DA, Potter-Baker KA, Beall EB, Roelle SM, Varnerin NM, Machado AG, Jones SE, Lowe MJ, Plow EB. Transcranial Direct Current Stimulation Targeting Primary Motor Versus Dorsolateral Prefrontal Cortices: Proof-of-Concept Study Investigating Functional Connectivity of Thalamocortical Networks Specific to Sensory-Affective Information Processing. Brain Connect 2017; 7:182-196. [PMID: 28142257 DOI: 10.1089/brain.2016.0440] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The pain matrix is comprised of an extensive network of brain structures involved in sensory and/or affective information processing. The thalamus is a key structure constituting the pain matrix. The thalamus serves as a relay center receiving information from multiple ascending pathways and relating information to and from multiple cortical areas. However, it is unknown how thalamocortical networks specific to sensory-affective information processing are functionally integrated. Here, in a proof-of-concept study in healthy humans, we aimed to understand this connectivity using transcranial direct current stimulation (tDCS) targeting primary motor (M1) or dorsolateral prefrontal cortices (DLPFC). We compared changes in functional connectivity (FC) with DLPFC tDCS to changes in FC with M1 tDCS. FC changes were also compared to further investigate its relation with individual's baseline experience of pain. We hypothesized that resting-state FC would change based on tDCS location and would represent known thalamocortical networks. Ten right-handed individuals received a single application of anodal tDCS (1 mA, 20 min) to right M1 and DLPFC in a single-blind, sham-controlled crossover study. FC changes were studied between ventroposterolateral (VPL), the sensory nucleus of thalamus, and cortical areas involved in sensory information processing and between medial dorsal (MD), the affective nucleus, and cortical areas involved in affective information processing. Individual's perception of pain at baseline was assessed using cutaneous heat pain stimuli. We found that anodal M1 tDCS and anodal DLPFC tDCS both increased FC between VPL and sensorimotor cortices, although FC effects were greater with M1 tDCS. Similarly, anodal M1 tDCS and anodal DLPFC tDCS both increased FC between MD and motor cortices, but only DLPFC tDCS modulated FC between MD and affective cortices, like DLPFC. Our findings suggest that M1 stimulation primarily modulates FC of sensory networks, whereas DLPFC stimulation modulates FC of both sensory and affective networks. Our findings when replicated in a larger group of individuals could provide useful evidence that may inform future studies on pain to differentiate between effects of M1 and DLPFC stimulation. Notably, our finding that individuals with high baseline pain thresholds experience greater FC changes with DLPFC tDCS implies the role of DLPFC in pain modulation, particularly pain tolerance.
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Affiliation(s)
| | - David A Cunningham
- 1 Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic Foundation , Cleveland, Ohio.,2 School of Biomedical Sciences, Department of Neuroscience, Kent State University , Kent, Ohio
| | - Kelsey A Potter-Baker
- 1 Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic Foundation , Cleveland, Ohio
| | - Erik B Beall
- 3 Department of Diagnostic Radiology, Imaging Institute, Cleveland Clinic Foundation , Cleveland, Ohio
| | - Sarah M Roelle
- 1 Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic Foundation , Cleveland, Ohio
| | - Nicole M Varnerin
- 1 Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic Foundation , Cleveland, Ohio
| | - Andre G Machado
- 4 Center for Neurological Restoration, Neurosurgery, Neurological Institute, Cleveland Clinic Foundation , Cleveland, Ohio
| | - Stephen E Jones
- 3 Department of Diagnostic Radiology, Imaging Institute, Cleveland Clinic Foundation , Cleveland, Ohio
| | - Mark J Lowe
- 3 Department of Diagnostic Radiology, Imaging Institute, Cleveland Clinic Foundation , Cleveland, Ohio
| | - Ela B Plow
- 1 Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic Foundation , Cleveland, Ohio.,4 Center for Neurological Restoration, Neurosurgery, Neurological Institute, Cleveland Clinic Foundation , Cleveland, Ohio.,5 Department of Physical Medicine and Rehabilitation, Neurological Institute, Cleveland Clinic Foundation , Cleveland, Ohio
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209
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Khedr E, Sharkawy E, Attia A, Ibrahim Osman N, Sayed Z. Role of transcranial direct current stimulation on reduction of postsurgical opioid consumption and pain in total knee arthroplasty: Double randomized clinical trial. Eur J Pain 2017; 21:1355-1365. [DOI: 10.1002/ejp.1034] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2017] [Indexed: 11/08/2022]
Affiliation(s)
- E.M. Khedr
- Neuropsychiatry Department; Assiut University Hospital; Egypt
| | - E.S.A. Sharkawy
- Anesthesiology Department; Assiut University Hospital; Egypt
| | - A.M.A. Attia
- Anesthesiology Department; Assiut University Hospital; Egypt
| | | | - Z.M. Sayed
- Anesthesiology Department; Assiut University Hospital; Egypt
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210
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Hazime FA, Baptista AF, de Freitas DG, Monteiro RL, Maretto RL, Hasue RH, João SMA. Treating low back pain with combined cerebral and peripheral electrical stimulation: A randomized, double-blind, factorial clinical trial. Eur J Pain 2017; 21:1132-1143. [PMID: 28440001 DOI: 10.1002/ejp.1037] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND Recent evidence suggests that chronic low back pain is associated with plastic changes in the brain that can be modified by neuromodulation strategies. This study investigated the efficacy of transcranial direct current stimulation (tDCS) combined simultaneously with peripheral electrical stimulation (PES) for pain relief, disability and global perception in patients with chronic low back pain (CLBP). METHODS Ninety-two patients with CLBP were randomized to receive 12 sessions on nonconsecutive days of anodal tDCS (primary motor cortex, M1), 100 Hz sensory PES (lumbar spine), tDCS + PES or sham tDCS + PES. Pain intensity (11-point numerical rating scale), disability and global perception were applied before treatment and four weeks, three months and six months post randomization. RESULTS A two points reduction was achieved only by the tDCS + PES (mean reduction [MR] = -2.6, CI95% = -4.4 to -0.9) and PES alone (MR = -2.2, CI95% = -3.9 to -0.4) compared with the sham group, but not of tDCS alone (MR = -1.7, CI95% = -3.4 to -0.0). In addition to maintaining the analgesic effect for up to three months, tDCS + PES had a higher proportion of respondents in different cutoff points. Global perception was improved at four weeks and maintained three months after treatment only with tDCS + PES. None of the treatments improved disability and the affective aspect of pain consistently with pain reduction. CONCLUSION The results suggest that tDCS + PES and PES alone are effective in relieving CLBP in the short term. However, only tDCS + PES induced a long-lasting analgesic effect. tDCS alone showed no clinical meaningful pain relief. SIGNIFICANCE Transcranial direct current stimulation combined simultaneously with PES leads to a significant and clinical pain relief that can last up to three months in chronic low back pain patients. For this article, a commentary is available at the Wiley Online Library.
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Affiliation(s)
- F A Hazime
- Department of Physical Therapy, Federal University of Piauí, Parnaíba, Brazil.,Department of Physical Therapy, Speech-Language and Hearing Science and Occupational Therapy of the Medical School, University of São Paulo, Brazil.,Postgraduate Program in Rehabilitation Sciences of the Medical School, University of São Paulo, Brazil
| | - A F Baptista
- Department of Biomorphology, Federal University of Bahia, Salvador, Brazil
| | - D G de Freitas
- Department of Physical Therapy, Irmandade Santa Casa de Misericórdia de São Paulo, Brazil
| | - R L Monteiro
- Department of Physical Therapy, Speech-Language and Hearing Science and Occupational Therapy of the Medical School, University of São Paulo, Brazil.,Postgraduate Program in Rehabilitation Sciences of the Medical School, University of São Paulo, Brazil.,Department of Physical Therapy, Federal University of Amapá, Macapá, Brazil
| | - R L Maretto
- Department of Physical Therapy, Irmandade Santa Casa de Misericórdia de São Paulo, Brazil
| | - R H Hasue
- Department of Physical Therapy, Speech-Language and Hearing Science and Occupational Therapy of the Medical School, University of São Paulo, Brazil.,Postgraduate Program in Rehabilitation Sciences of the Medical School, University of São Paulo, Brazil
| | - S M A João
- Department of Physical Therapy, Speech-Language and Hearing Science and Occupational Therapy of the Medical School, University of São Paulo, Brazil.,Postgraduate Program in Rehabilitation Sciences of the Medical School, University of São Paulo, Brazil
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211
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da Silva FTG, Browne RAV, Pinto CB, Saleh Velez FG, do Egito EST, do Rêgo JTP, da Silva MR, Dantas PMS, Fregni F. Transcranial direct current stimulation in individuals with spinal cord injury: Assessment of autonomic nervous system activity. Restor Neurol Neurosci 2017; 35:159-169. [PMID: 28282844 DOI: 10.3233/rnn-160685] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND We hypothesized in this study that transcranial direct current stimulation (tDCS) of primary motor cortex could exert top-down modulation over subcortical systems associated with autonomic control and thus be useful to revert some of the dysfunctional changes found in the autonomic nervous system (ANS) of subjects with spinal cord injuries (SCI). OBJECTIVE To explore the acute effect of tDCS on ANS indexed by Heart Rate Variability (HRV) in individuals with SCI and analyze whether this effect depends on the gender, degree, level and time of injury. METHODS In this randomized, placebo-controlled, crossover, double-blinded study, 18 adults with SCI (32.9±7.9 years old) were included; the intervention consisted of a single 12-minute session of active tDCS (anodal, 2 mA) and a control session of sham tDCS applied over Cz (bihemispheric motor cortex). HRV was calculated using spectral analysis. Low-frequency (LF), high-frequency (HF), and LF/HF ratio variables were evaluated before, during, and post tDCS. RESULTS A two-way repeated measures ANOVA showed that after active (anodal) stimulation, LF/HF ratio was significantly increased (P = 0.013). There was a trend for an interaction between time and stimulation for both LF and HF (P = 0.052). Paired exploratory t-tests reported effects on the difference of time [post-pre] between stimulation conditions for LF (P = 0.052), HF (P = 0.052) and LF/HF (P = 0.003). CONCLUSION Anodal tDCS of the motor cortex modulated ANS activity in individuals with SCI independent of gender, type and time of lesion. These changes were in the direction of normalization of ANS parameters, thus confirming our initial hypothesis that an enhancement of cortical excitability by tDCS could at least partially restore some of the dysfunctional activity in the ANS system of subjects with SCI.
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Affiliation(s)
- Fabiana Tenório Gomes da Silva
- Laboratory of Neuromodulation, Center of Clinical Research Learning, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA.,Psychology institute, Department of Neurosciences and behavior, University of São Paulo (USP), São Paulo, Brazil.,Department of Physical Education, Health Sciences Center, Federal University of Rio Grande do Norte (UFRN), Natal, Rio Grande do Norte, Brazil
| | - Rodrigo Alberto Vieira Browne
- Department of Physical Education, Health Sciences Center, Federal University of Rio Grande do Norte (UFRN), Natal, Rio Grande do Norte, Brazil
| | - Camila Bonin Pinto
- Laboratory of Neuromodulation, Center of Clinical Research Learning, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA
| | - Faddi Ghassan Saleh Velez
- Laboratory of Neuromodulation, Center of Clinical Research Learning, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA
| | - Eryvaldo Sócrates Tabosa do Egito
- Department of Pharmacy, Health Sciences Center, Federal University of Rio Grande do Norte (UFRN), Natal, Rio Grande do Norte, Brazil
| | - Jeferson Tafarel Pereira do Rêgo
- Department of Physical Education, Health Sciences Center, Federal University of Rio Grande do Norte (UFRN), Natal, Rio Grande do Norte, Brazil
| | - Marília Rodrigues da Silva
- Department of Physical Education, Health Sciences Center, Federal University of Rio Grande do Norte (UFRN), Natal, Rio Grande do Norte, Brazil
| | - Paulo Moreira Silva Dantas
- Department of Physical Education, Health Sciences Center, Federal University of Rio Grande do Norte (UFRN), Natal, Rio Grande do Norte, Brazil
| | - Felipe Fregni
- Laboratory of Neuromodulation, Center of Clinical Research Learning, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA
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212
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Lanza G, Bachmann CG, Ghorayeb I, Wang Y, Ferri R, Paulus W. Central and peripheral nervous system excitability in restless legs syndrome. Sleep Med 2017; 31:49-60. [PMID: 27745789 DOI: 10.1016/j.sleep.2016.05.010] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 05/24/2016] [Accepted: 05/30/2016] [Indexed: 02/07/2023]
Abstract
Neurophysiological techniques have been applied in restless legs syndrome (RLS) to obtain direct and indirect measures of central and peripheral nervous system excitability, as well as to probe different neurotransmission pathways. Data converge on the hypothesis that, from a pure electrophysiological perspective, RLS should be regarded as a complex sensorimotor disorder in which cortical, subcortical, spinal cord, and peripheral nerve generators are all involved in a network disorder, resulting in an enhanced excitability and/or decreased inhibition. Although the spinal component may have dominated in neurophysiological assessment, possibly because of better accessibility compared to the brainstem or cerebral components of a hypothetical dysfunction of the diencephalic A11 area, multiple mechanisms, such as reduced central inhibition and abnormal peripheral nerve function, contribute to the pathogenesis of RLS similarly to some chronic pain conditions. Dopamine transmission dysfunction, either primary or triggered by low iron and ferritin concentrations, may also bridge the gap between RLS and chronic pain entities. Further support of disturbed central and peripheral excitability in RLS is provided by the effectiveness of nonpharmacological tools, such as repetitive transcranial magnetic stimulation and transcutaneous spinal direct current stimulation, in transiently modulating neural excitability, thereby extending the therapeutic repertoire. Understanding the complex interaction of central and peripheral neuronal circuits in generating the symptoms of RLS is mandatory for a better refinement of its therapeutic support.
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Affiliation(s)
- Giuseppe Lanza
- Sleep Research Center, I.R.C.C.S. "Oasi Maria SS.", Troina, Italy.
| | | | - Imad Ghorayeb
- Department of Clinical Neurophysiology, CHU de Bordeaux, Bordeaux, France; CNRS, INCIA, CNRS UMR 5287, Université de Bordeaux, Bordeaux, France
| | - Yuping Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Raffale Ferri
- Sleep Research Center, I.R.C.C.S. "Oasi Maria SS.", Troina, Italy
| | - Walter Paulus
- Department of Clinical Neurophysiology, University Medical Center, Georg August University Göttingen, Göttingen, Germany
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213
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Alhassani G, Treleaven J, Schabrun SS. Combined transcranial and trans-spinal direct current stimulation in chronic headache: A feasibility and safety trial for a novel intervention. Hong Kong Physiother J 2017; 37:1-9. [PMID: 30931040 PMCID: PMC6385152 DOI: 10.1016/j.hkpj.2016.11.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background: Chronic primary headache disorders are associated with frequent, severe pain and significant functional impairment, with treatment remaining challenging. Objective: We examined the feasibility and safety of a novel brain [transcranial direct current stimulation (tDCS)] and spinal cord stimulation [trans-spinal cord direct current stimulation (tsDCS)] treatment in chronic headache. Methods: Nine participants (3 males; aged, 40 ± 15 years) suffering from chronic daily headache, chronic tension-type headache, or chronic migraine received the combined brain and spinal cord intervention for 5 consecutive days. Stimulation was applied for a total of 40 minutes (20 minutes of tDCS followed by 20 minutes of tsDCS) at 1 mA. Pain sensitivity and headache symptoms (frequency, severity, duration, and medications recorded via a headache diary, 4 weeks before and after treatment) were assessed. Results: The treatment was safe, feasible, and well tolerated. Headache frequency was reduced following the treatment (p = 0.026) in chronic tension-type headache and chronic migraine, but not in chronic daily headache. Headache severity was reduced immediately post-treatment in 67% of sessions. A trend towards a reduction in medication use was observed (p = 0.075). No changes in headache severity (p = 0.16) or duration (p = 0.34) were present. Conclusion: These data suggest that combined tDCS and tsDCS intervention is safe and feasible, and may improve headache frequency in patients with chronic primary headache disorders.
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Affiliation(s)
- Ghufran Alhassani
- Brain Rehabilitation and Neuroplasticity Unit, Western Sydney University, Sydney, New South Wales, Australia
| | - Julia Treleaven
- School of Health and Rehabilitation Science, The University of Queensland, Brisbane, Queensland, Australia
| | - Siobhan S.M. Schabrun
- Brain Rehabilitation and Neuroplasticity Unit, Western Sydney University, Sydney, New South Wales, Australia
- Corresponding author. Brain Rehabilitation and Neuroplasticity Unit, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, New South Wales 2751, Australia. E-mail address: (S.S.M. Schabrun)
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214
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Giordano J, Bikson M, Kappenman ES, Clark VP, Coslett HB, Hamblin MR, Hamilton R, Jankord R, Kozumbo WJ, McKinley RA, Nitsche MA, Reilly JP, Richardson J, Wurzman R, Calabrese E. Mechanisms and Effects of Transcranial Direct Current Stimulation. Dose Response 2017; 15:1559325816685467. [PMID: 28210202 PMCID: PMC5302097 DOI: 10.1177/1559325816685467] [Citation(s) in RCA: 127] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The US Air Force Office of Scientific Research convened a meeting of researchers in the fields of neuroscience, psychology, engineering, and medicine to discuss most pressing issues facing ongoing research in the field of transcranial direct current stimulation (tDCS) and related techniques. In this study, we present opinions prepared by participants of the meeting, focusing on the most promising areas of research, immediate and future goals for the field, and the potential for hormesis theory to inform tDCS research. Scientific, medical, and ethical considerations support the ongoing testing of tDCS in healthy and clinical populations, provided best protocols are used to maximize safety. Notwithstanding the need for ongoing research, promising applications include enhancing vigilance/attention in healthy volunteers, which can accelerate training and support learning. Commonly, tDCS is used as an adjunct to training/rehabilitation tasks with the goal of leftward shift in the learning/treatment effect curves. Although trials are encouraging, elucidating the basic mechanisms of tDCS will accelerate validation and adoption. To this end, biomarkers (eg, clinical neuroimaging and findings from animal models) can support hypotheses linking neurobiological mechanisms and behavioral effects. Dosage can be optimized using computational models of current flow and understanding dose–response. Both biomarkers and dosimetry should guide individualized interventions with the goal of reducing variability. Insights from other applied energy domains, including ionizing radiation, transcranial magnetic stimulation, and low-level laser (light) therapy, can be prudently leveraged.
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Affiliation(s)
- James Giordano
- Department of Neurology and Biochemistry, Neuroethics Studies Program, Pellegrino Center for Clinical Bioethics, Georgetown University Medical Center, Washington, DC, USA
| | - Marom Bikson
- Biomedical Engineering, City College of New York, CUNY, New York, NY, USA
| | - Emily S Kappenman
- San Diego State University, Department of Psychology, San Diego, CA, USA
| | - Vincent P Clark
- Psychology Clinical Neuroscience Center, Department of Psychology, University of New Mexico, Albuquerque, NM, USA
| | - H Branch Coslett
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Michael R Hamblin
- Wellman Center for Photomedicine, Massachusetts General Hospital and Department of Dermatology, Harvard Medical School, Boston, MA, USA
| | - Roy Hamilton
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ryan Jankord
- United States Air Force Research Laboratory, Wright-Patterson Air Force Base, OH, USA
| | | | - R Andrew McKinley
- United States Air Force Research Laboratory, Wright-Patterson Air Force Base, OH, USA
| | - Michael A Nitsche
- Department Psychology and Neurosciences, Leibniz Research Center for Working Environmental and Human Factors, Dortmund, Germany
| | | | - Jessica Richardson
- Department of Speech and Hearing Sciences, University of New Mexico, Albuquerque, NM, USA
| | - Rachel Wurzman
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Edward Calabrese
- Environmental Health Sciences, University of Massachusetts, Amherst, MA, USA
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215
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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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216
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Lin RL, Douaud G, Filippini N, Okell TW, Stagg CJ, Tracey I. Structural Connectivity Variances Underlie Functional and Behavioral Changes During Pain Relief Induced by Neuromodulation. Sci Rep 2017; 7:41603. [PMID: 28148969 PMCID: PMC5288647 DOI: 10.1038/srep41603] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 12/23/2016] [Indexed: 12/31/2022] Open
Abstract
An increased understanding of the relationship between structural connections and functional and behavioral outcomes is an essential but under-explored topic in neuroscience. During transcranial direct current stimulation (tDCS)-induced analgesia, neuromodulation occurs through a top-down process that depends on inter-regional connections. To investigate whether variation in anatomical connectivity explains functional and behavorial outcomes during neuromodulation, we first combined tDCS and a tonic pain model with concurrent arterial spin labelling that measures cerebral perfusion related to ongoing neural activity. Left dorsolateral prefrontal cortex (L-DLPFC) tDCS induced an analgesic effect, which was explained by reduced perfusion to posterior insula and thalamus. Second, we used diffusion imaging to assess white matter structural integrity between L-DLPFC and thalamus, two key components of the neuromodulatory network. Fractional anisotropy of this tract correlated positively with functional and behavioral modulations. This suggests structural dependence by the neuromodulatory process to induce analgesia with potential relevance for patient stratification.
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Affiliation(s)
- Richard L. Lin
- Oxford Centre for Functional Magnetic Resonance Imaging of the Brain (FMRIB Centre), University of Oxford, Oxford OX1 3UH, United Kingdom
- Nuffield Division of Anaesthetics, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford OX1 3UH, United Kingdom
| | - Gwenaëlle Douaud
- Oxford Centre for Functional Magnetic Resonance Imaging of the Brain (FMRIB Centre), University of Oxford, Oxford OX1 3UH, United Kingdom
| | - Nicola Filippini
- Oxford Centre for Functional Magnetic Resonance Imaging of the Brain (FMRIB Centre), University of Oxford, Oxford OX1 3UH, United Kingdom
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford OX1 3UH, United Kingdom
| | - Thomas W. Okell
- Oxford Centre for Functional Magnetic Resonance Imaging of the Brain (FMRIB Centre), University of Oxford, Oxford OX1 3UH, United Kingdom
| | - Charlotte J. Stagg
- Oxford Centre for Functional Magnetic Resonance Imaging of the Brain (FMRIB Centre), University of Oxford, Oxford OX1 3UH, United Kingdom
- Oxford Centre for Human Brain Activity, Department of Psychiatry, University of Oxford, Oxford OX1 3UH, United Kingdom
| | - Irene Tracey
- Oxford Centre for Functional Magnetic Resonance Imaging of the Brain (FMRIB Centre), University of Oxford, Oxford OX1 3UH, United Kingdom
- Nuffield Division of Anaesthetics, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford OX1 3UH, United Kingdom
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217
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Mochizuki H, Schut C, Nattkemper LA, Yosipovitch G. Brain mechanism of itch in atopic dermatitis and its possible alteration through non-invasive treatments. Allergol Int 2017; 66:14-21. [PMID: 27688121 DOI: 10.1016/j.alit.2016.08.013] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 08/30/2016] [Indexed: 01/19/2023] Open
Abstract
Atopic dermatitis (AD) is a common chronic skin disease that is characterized by intense pruritus and has high impairment of quality of life. AD is often described as "the itch that rashes, rather than the rash that itches". Several studies suggest that mechanisms of central modulation play an important role in the development and maintenance of chronic itch. Therefore, treating the neurosensory aspects of itch is an important part in the management of chronic itch. However, little attention has been paid to the role of the central nervous system in the processing of itch in AD. Targeting itch-related anatomical structures in the brain with non-invasive treatments such as psychological interventions and transcranial Direct Current Stimulation (tDCS) could have an antipruritic effect in AD. Therefore, in this review article, we discuss the current progress in brain imaging research of itch, as well as the efficacy of non-invasive interventions for itch relief in this patient group.
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Affiliation(s)
- Hideki Mochizuki
- Department of Dermatology, Lewis Katz School of Medicine, Philadelphia, PA, USA; Temple Itch Center, Lewis Katz School of Medicine, Philadelphia, PA, USA
| | - Christina Schut
- Institute of Medical Psychology, Justus-Liebig-University, Giessen, Germany
| | - Leigh A Nattkemper
- Department of Dermatology, Lewis Katz School of Medicine, Philadelphia, PA, USA; Temple Itch Center, Lewis Katz School of Medicine, Philadelphia, PA, USA
| | - Gil Yosipovitch
- Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, USA.
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218
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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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219
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Kim YJ. Transcranial Direct Current Stimulation as an Alternative Treatment in Patients with Alzheimer's Disease. BRAIN & NEUROREHABILITATION 2017. [DOI: 10.12786/bn.2017.10.e4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Affiliation(s)
- Yeo Jin Kim
- Department of Neurology, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea
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220
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Mizuno T, Aramaki Y. Cathodal transcranial direct current stimulation over the Cz increases joint flexibility. Neurosci Res 2017; 114:55-61. [PMID: 27576117 DOI: 10.1016/j.neures.2016.08.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 08/15/2016] [Accepted: 08/18/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Takamasa Mizuno
- School of Health and Sport Sciences, Chukyo University, 101 Tokodachi kaizu-cho, Toyota 470-0393, Japan
| | - Yu Aramaki
- School of Health and Sport Sciences, Chukyo University, 101 Tokodachi kaizu-cho, Toyota 470-0393, Japan.
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221
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Reinhart RMG, Cosman JD, Fukuda K, Woodman GF. Using transcranial direct-current stimulation (tDCS) to understand cognitive processing. Atten Percept Psychophys 2017; 79:3-23. [PMID: 27804033 PMCID: PMC5539401 DOI: 10.3758/s13414-016-1224-2] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Noninvasive brain stimulation methods are becoming increasingly common tools in the kit of the cognitive scientist. In particular, transcranial direct-current stimulation (tDCS) is showing great promise as a tool to causally manipulate the brain and understand how information is processed. The popularity of this method of brain stimulation is based on the fact that it is safe, inexpensive, its effects are long lasting, and you can increase the likelihood that neurons will fire near one electrode and decrease the likelihood that neurons will fire near another. However, this method of manipulating the brain to draw causal inferences is not without complication. Because tDCS methods continue to be refined and are not yet standardized, there are reports in the literature that show some striking inconsistencies. Primary among the complications of the technique is that the tDCS method uses two or more electrodes to pass current and all of these electrodes will have effects on the tissue underneath them. In this tutorial, we will share what we have learned about using tDCS to manipulate how the brain perceives, attends, remembers, and responds to information from our environment. Our goal is to provide a starting point for new users of tDCS and spur discussion of the standardization of methods to enhance replicability.
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Affiliation(s)
- Robert M G Reinhart
- Department of Psychological and Brain Sciences, Center for Research in Sensory Communications and Neural Technology, Center for Systems Neuroscience, Boston University, Boston, MA, 02215, USA.
| | - Josh D Cosman
- Department of Translational Medicine, Pfizer Inc., Cambridge, MA, 02215, USA
| | - Keisuke Fukuda
- Department of Psychology, University of Toronto Mississauga, Mississauga, ON, L5L 1C6, Canada
| | - Geoffrey F Woodman
- Department of Psychology, Center for Integrative and Cognitive Neuroscience, Vanderbilt Vision Research Center, Vanderbilt University, Nashville, TN, 37240, USA.
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222
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Matsumoto H, Ugawa Y. Adverse events of tDCS and tACS: A review. Clin Neurophysiol Pract 2016; 2:19-25. [PMID: 30214966 PMCID: PMC6123849 DOI: 10.1016/j.cnp.2016.12.003] [Citation(s) in RCA: 175] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 12/02/2016] [Accepted: 12/05/2016] [Indexed: 01/25/2023] Open
Abstract
Transcranial direct current stimulation (tDCS) and transcranial alternating current stimulation (tACS) have been applied to many research issues because these stimulation techniques can modulate neural activity in the human brain painlessly and non-invasively with weak electrical currents. However, there are no formal safety guidelines for the selection of stimulus parameters in either tDCS or tACS. As a means of gathering the information that is needed to produce safety guidelines, in this article, we summarize the adverse events of tDCS and tACS. In both stimulation techniques, most adverse effects are mild and disappear soon after stimulation. Nevertheless, several papers have reported that, in tDCS, some adverse events persist even after stimulation. The persistent events consist of skin lesions similar to burns, which can arise even in healthy subjects, and mania or hypomania in patients with depression. Recently, one paper reported a pediatric patient presenting with seizure after tDCS, although the causal relationship between stimulation and seizure is not clear. As this seizure is the only serious adverse events yet reported in connection with tDCS, tDCS is considered safe. In tACS, meanwhile, no persistent adverse events have been reported, but considerably fewer reports are available on the safety of tACS than on the safety of tDCS. Therefore, to establish the safety of tDCS and tACS, we need to scan the literature continuously for information on the adverse events of both stimulation techniques. Further safety investigations are also required.
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Affiliation(s)
| | - Yoshikazu Ugawa
- Department of Neurology, School of Medicine, Fukushima Medical University, Japan.,Fukushima Global Medical Science Center, Advanced Clinical Research Center, Fukushima Medical University, Fukushima, Japan
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223
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Mental Health Comorbidities in Pediatric Chronic Pain: A Narrative Review of Epidemiology, Models, Neurobiological Mechanisms and Treatment. CHILDREN-BASEL 2016; 3:children3040040. [PMID: 27918444 PMCID: PMC5184815 DOI: 10.3390/children3040040] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 11/15/2016] [Accepted: 11/21/2016] [Indexed: 12/12/2022]
Abstract
Chronic pain during childhood and adolescence can lead to persistent pain problems and mental health disorders into adulthood. Posttraumatic stress disorders and depressive and anxiety disorders are mental health conditions that co-occur at high rates in both adolescent and adult samples, and are linked to heightened impairment and disability. Comorbid chronic pain and psychopathology has been explained by the presence of shared neurobiology and mutually maintaining cognitive-affective and behavioral factors that lead to the development and/or maintenance of both conditions. Particularly within the pediatric chronic pain population, these factors are embedded within the broader context of the parent-child relationship. In this review, we will explore the epidemiology of, and current working models explaining, these comorbidities. Particular emphasis will be made on shared neurobiological mechanisms, given that the majority of previous research to date has centered on cognitive, affective, and behavioral mechanisms. Parental contributions to co-occurring chronic pain and psychopathology in childhood and adolescence will be discussed. Moreover, we will review current treatment recommendations and future directions for both research and practice. We argue that the integration of biological and behavioral approaches will be critical to sufficiently address why these comorbidities exist and how they can best be targeted in treatment.
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224
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225
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Li S, Davis M, Frontera JE, Li S. A novel nonpharmacological intervention - breathing-controlled electrical stimulation for neuropathic pain management after spinal cord injury - a preliminary study. J Pain Res 2016; 9:933-940. [PMID: 27843337 PMCID: PMC5098777 DOI: 10.2147/jpr.s115901] [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] [Indexed: 11/24/2022] Open
Abstract
Objective The objective of this study was to examine the effectiveness of a novel nonpharmacological intervention – breathing-controlled electrical stimulation (BreEStim) – for neuropathic pain management in spinal cord injury (SCI) patients. Subjects and methods There were two experiments: 1) to compare the effectiveness between BreEStim and conventional electrical stimulation (EStim) in Experiment (Exp) 1 and 2) to examine the dose–response effect of BreEStim in Exp 2. In Exp 1, 13 SCI subjects (6 males and 7 females, history of SCI: 58.2 months, from 7 to 150 months, impairments ranging from C4 AIS B to L1 AIS B) received both BreEStim and EStim in a randomized order with at least 3 days apart. A total of 120 electrical stimuli to the median nerve transcutaneously were triggered by voluntary inhalation during BreEStim or were randomly delivered during EStim. In Exp 2, a subset of 7 subjects received BreEStim120 and 240 stimuli randomly on two different days with 7 days apart (BreEStim120 vs BreEStim240). The primary outcome variable was the visual analog scale (VAS) score. Results In Exp 1, both BreEStim and EStim showed significant analgesic effects. Reduction in VAS score was significantly greater after BreEStim (2.6±0.3) than after EStim (0.8±0.3) (P<0.001). The duration of analgesic effect was significantly longer after BreEStim (14.2±6 hours) than after EStim (1.9±1 hours) (P=0.04). In Exp 2, BreEStim120 and BreEStim240 had similar degree and duration of analgesic effects. Conclusion The findings from this preliminary study suggest that BreEStim is an effective alternative nonpharmacological treatment for chronic neuropathic pain in patients suffering from SCI.
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Affiliation(s)
- Shengai Li
- Department of Physical Medicine and Rehabilitation, University of Texas Health Science Center at Houston; TIRR Memorial Hermann Research Center, TIRR Memorial Hermann Hospital, Houston, TX, USA
| | - Matthew Davis
- Department of Physical Medicine and Rehabilitation, University of Texas Health Science Center at Houston
| | - Joel E Frontera
- Department of Physical Medicine and Rehabilitation, University of Texas Health Science Center at Houston
| | - Sheng Li
- Department of Physical Medicine and Rehabilitation, University of Texas Health Science Center at Houston; TIRR Memorial Hermann Research Center, TIRR Memorial Hermann Hospital, Houston, TX, USA
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226
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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: 1034] [Impact Index Per Article: 129.3] [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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227
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Relief of neuropathic pain after spinal cord injury by brain-computer interface training. Spinal Cord Ser Cases 2016; 2:16021. [PMID: 28053764 DOI: 10.1038/scsandc.2016.21] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 05/27/2016] [Accepted: 07/01/2016] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES The aim of this study was to report the effects of brain-computer interface (BCI) training, a neurofeedback rehabilitation technique, on persistent neuropathic pain (NP) after cervical spinal cord injury (SCI). SUBJECTS AND METHODS We present the case of a 71-year-old woman with NP in her left upper extremity after SCI (C8). She underwent BCI training as outpatient rehabilitation for 4 months to enhance event-related desynchronization (ERD), which is triggered by the patient's motor intuition. Scalp electroencephalography was recorded to observe the ERD during every BCI training session. The patient's pain was evaluated with the McGill Pain Questionnaire (MPQ) and a visual analog scale (VAS). The MPQ was performed after every BCI training session, and the patient assessed the VAS score on her own, once every few days during the BCI training period. RESULTS After the BCI training started, the patient's ERD during the BCI training period increased significantly, from 15.6-30.3%. Moreover, her VAS score decreased gradually, from 8 to 5, after the BCI training started, although the MPQ did not change significantly. CONCLUSION BCI training has the potential to provide relief for patients with persistent NP via brain plasticity, and to improve their activities of daily living and quality of life.
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228
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Raithatha R, Carrico C, Powell ES, Westgate PM, Chelette Ii KC, Lee K, Dunsmore L, Salles S, Sawaki L. Non-invasive brain stimulation and robot-assisted gait training after incomplete spinal cord injury: A randomized pilot study. NeuroRehabilitation 2016; 38:15-25. [PMID: 26889794 DOI: 10.3233/nre-151291] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Locomotor training with a robot-assisted gait orthosis (LT-RGO) and transcranial direct current stimulation (tDCS) are interventions that can significantly enhance motor performance after spinal cord injury (SCI). No studies have investigated whether combining these interventions enhances lower extremity motor function following SCI. OBJECTIVE Determine whether active tDCS paired with LT-RGO improves lower extremity motor function more than a sham condition, in subjects with motor incomplete SCI. METHODS Fifteen adults with SCI received 36 sessions of either active (n = 9) or sham (n = 6) tDCS (20 minutes) preceding LT-RGO (1 hour). Outcome measures included manual muscle testing (MMT; primary outcome measure); 6-Minute Walk Test (6MinWT); 10-Meter Walk Test (10MWT); Timed Up and Go Test (TUG); Berg Balance Scale (BBS); and Spinal Cord Independence Measure-III (SCIM-III). RESULTS MMT showed significant improvements after active tDCS, with the most pronounced improvement in the right lower extremity. 10MWT, 6MinWT, and BBS showed improvement for both groups. TUG and SCIM-III showed improvement only for the sham tDCS group. CONCLUSION Pairing tDCS with LT-RGO can improve lower extremity motor function more than LT-RGO alone. Future research with a larger sample size is recommended to determine longer-term effects on motor function and activities of daily living.
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Affiliation(s)
- Ravi Raithatha
- University of Pikeville Kentucky College of Osteopathic Medicine, Pikeville, KY, USA
| | - Cheryl Carrico
- University of Kentucky, Department of Physical Medicine and Rehabilitation, Lexington, KY, USA
| | - Elizabeth Salmon Powell
- University of Kentucky, Department of Physical Medicine and Rehabilitation, Lexington, KY, USA
| | - Philip M Westgate
- University of Kentucky, Department of Biostatistics, College of Public Health, Lexington, KY, USA
| | - Kenneth C Chelette Ii
- University of Kentucky, Department of Physical Medicine and Rehabilitation, Lexington, KY, USA
| | - Kara Lee
- University of Kentucky College of Health Sciences, Lexington, KY, USA
| | - Laura Dunsmore
- HealthSouth Cardinal Hill Rehabilitation Hospital, Lexington, KY, USA
| | - Sara Salles
- University of Kentucky, Department of Physical Medicine and Rehabilitation, Lexington, KY, USA
| | - Lumy Sawaki
- University of Kentucky, Department of Physical Medicine and Rehabilitation, Lexington, KY, USA.,HealthSouth Cardinal Hill Rehabilitation Hospital, Lexington, KY, USA
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229
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Cortical neurostimulation for neuropathic pain: state of the art and perspectives. Pain 2016; 157 Suppl 1:S81-S89. [PMID: 26785160 DOI: 10.1097/j.pain.0000000000000401] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The treatment of neuropathic pain by neuromodulation is an objective for more than 40 years in modern clinical practice. With respect to spinal cord and deep brain structures, the cerebral cortex is the most recently evaluated target of invasive neuromodulation therapy for pain. In the early 90s, the first successes of invasive epidural motor cortex stimulation (EMCS) were published. A few years later was developed repetitive transcranial magnetic stimulation (rTMS), a noninvasive stimulation technique. Then, electrical transcranial stimulation returned valid and is currently in full development, with transcranial direct current stimulation (tDCS). Regarding transcranial approaches, the main studied and validated target was still the motor cortex, but other cortical targets are under investigation. The mechanisms of action of these techniques share similarities, especially between EMCS and rTMS, but they also have differences that could justify specific indications and applications. It is therefore important to know the principles and to assess the merit of these techniques on the basis of a rigorous assessment of the results, to avoid fad. Various types of chronic neuropathic pain syndromes can be significantly relieved by EMCS or repeated daily sessions of high-frequency (5-20 Hz) rTMS or anodal tDCS over weeks, at least when pain is lateralized and stimulation is applied to the motor cortex contralateral to pain side. However, cortical stimulation therapy remains to be optimized, especially by improving EMCS electrode design, rTMS targeting, or tDCS montage, to reduce the rate of nonresponders, who do not experience clinically relevant effects of these techniques.
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230
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Reduction of chronic abdominal pain in patients with inflammatory bowel disease through transcranial direct current stimulation: a randomized controlled trial. Pain 2016; 157:429-437. [PMID: 26469395 DOI: 10.1097/j.pain.0000000000000386] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Inflammatory bowel disease (IBD) is frequently associated with chronic abdominal pain (CAP). Transcranial direct current stimulation (tDCS) has been proven to reduce chronic pain. This study aimed to investigate the effects of tDCS in patients with CAP due to IBD. This randomized, sham-controlled, double blind, parallel-designed study included 20 patients with either Crohn disease or ulcerative colitis with CAP (≥3/10 on the visual analog scale (VAS) in 3/6 months). Anodal or sham tDCS was applied over the primary motor cortex for 5 consecutive days (2 mA, 20 minutes). Assessments included VAS, pressure pain threshold, inflammatory markers, and questionnaires on quality of life, functional and disease specific symptoms (Irritable Bowel Syndrome-Severity Scoring System [IBS-SSS]), disease activity, and pain catastrophizing. Follow-up data were collected 1 week after the end of the stimulation. Statistical analyses were performed using analysis of variance and t tests. There was a significant reduction of abdominal pain in the anodal tDCS group compared with sham tDCS. This effect was evident in changes in VAS and pressure pain threshold on the left and right sides of the abdomen. In addition, 1 week after stimulation, pain reduction remained significantly decreased in the right side of the abdomen. There was also a significant reduction in scores on pain catastrophizing and on IBS-SSS when comparing both groups. Inflammatory markers and disease activity did not differ significantly between groups throughout the experiment. Transcranial direct current stimulation proved to be an effective and clinically relevant therapeutic strategy for CAP in IBD. The analgesic effects observed are unrelated to inflammation and disease activity, which emphasizes central pain mechanisms in CAP.
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231
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Paired Stimulation to Promote Lasting Augmentation of Corticospinal Circuits. Neural Plast 2016; 2016:7043767. [PMID: 27800189 PMCID: PMC5075312 DOI: 10.1155/2016/7043767] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 08/11/2016] [Indexed: 01/22/2023] Open
Abstract
After injury, electrical stimulation of the nervous system can augment plasticity of spared or latent circuits through focal modulation. Pairing stimulation of two parts of a spared circuit can target modulation more specifically to the intended circuit. We discuss 3 kinds of paired stimulation in the context of the corticospinal system, because of its importance in clinical neurorehabilitation. The first uses principles of Hebbian plasticity: by altering the stimulation timing of presynaptic neurons and their postsynaptic targets, synapse function can be modulated up or down. The second form uses synchronized presynaptic inputs onto a common synaptic target. We dub this a “convergent” mechanism, because stimuli have to converge on a common target with coordinated timing. The third form induces focal modulation by tonic excitation of one region (e.g., the spinal cord) during phasic stimulation of another (e.g., motor cortex). Additionally, endogenous neural activity may be paired with exogenous electrical stimulation. This review addresses what is known about paired stimulation of the corticospinal system of both humans and animal models, emphasizes how it qualitatively differs from single-site stimulation, and discusses the gaps in knowledge that must be addressed to maximize its use and efficacy in neurorehabilitation.
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232
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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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233
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Vance DE, Fazeli PL, Cody SL, Bell TR, Pope CN. A Description and Critical Analysis of the Therapeutic Uses of Transcranial Direct Current Stimulation: Implications for Clinical Practice and Research. NURSING: RESEARCH AND REVIEWS 2016; 6:23-31. [PMID: 27738595 DOI: 10.2147/nrr.s115627] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
For centuries, since the advent of harnessing magnetic and electrical energies, humans have been applying such energies to various body parts, including the brain, with the goal of improving health. Advancements over the past two decades in the production and affordability of such devices that precisely deliver such energies have resulted in novel therapeutic uses. One technique in particular, transcranial Direct Current Stimulation (tDCS), uses electrodes placed on the scalp to deliver a low electrical current to various areas on the surface of the neocortex. Such electrical currents stimulate neurons, which depending on the area of the neocortex it is applied and certain stimulation parameters, can either excite or inhibit certain functions within the brain that may result in alterations in mood, cognition, and behavior. This article provides an overview of this approach, explains how it is used, describes the hypothesized neurobiomechanisms involved, and explores its therapeutic potential. From this overview, implications for nursing practice and innovative uses for nursing research are posited.
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Affiliation(s)
- David E Vance
- Professor, School of Nursing, Room 2M024, 1701 University Boulevard, University of Alabama at Birmingham (UAB), Birmingham, AL 35294-1210; Office, 205-934-7589; Fax, 205-996-7183
| | - Pariya L Fazeli
- Assistant Professor, School of Nursing School of Nursing Building, University of Alabama at Birmingham (UAB), Birmingham, AL 35294, Office: 205-934-4418
| | - Shameka L Cody
- PhD Student, University of Alabama at Birmingham School of Nursing, Room 1020P, 1701 University Boulevard, University of Alabama at Birmingham (UAB), Birmingham, AL 35294-1210, Office: 205-996-9457
| | - Tyler R Bell
- Pre-Doctoral Graduate Student, Lifespan Developmental Psychology Program, Department of Psychology, 924 19th Street South, Birmingham, Alabama 35294, University of Alabama at Birmingham, Birmingham, AL 35294-1210; Office, 205-996-9465; Fax, 205
| | - Caitlin Northcutt Pope
- PhD Student, Department of Psychology, CH 415, 1530 3 Avenue South, University of Alabama at Birmingham (UAB), Birmingham, AL, 35291-1170
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234
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Weak electric fields detectability in a noisy neural network. Cogn Neurodyn 2016; 11:81-90. [PMID: 28174614 DOI: 10.1007/s11571-016-9409-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 08/16/2016] [Accepted: 09/06/2016] [Indexed: 12/18/2022] Open
Abstract
We investigate the detectability of weak electric field in a noisy neural network based on Izhikevich neuron model systematically. The neural network is composed of excitatory and inhibitory neurons with similar ratio as that in the mammalian neocortex, and the axonal conduction delays between neurons are also considered. It is found that the noise intensity can modulate the detectability of weak electric field. Stochastic resonance (SR) phenomenon induced by white noise is observed when the weak electric field is added to the network. It is interesting that SR almost disappeared when the connections between neurons are cancelled, suggesting the amplification effects of the neural coupling on the synchronization of neuronal spiking. Furthermore, the network parameters, such as the connection probability, the synaptic coupling strength, the scale of neuron population and the neuron heterogeneity, can also affect the detectability of the weak electric field. Finally, the model sensitivity is studied in detail, and results show that the neural network model has an optimal region for the detectability of weak electric field signal.
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235
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Malavera A, Silva FA, Fregni F, Carrillo S, Garcia RG. Repetitive Transcranial Magnetic Stimulation for Phantom Limb Pain in Land Mine Victims: A Double-Blinded, Randomized, Sham-Controlled Trial. THE JOURNAL OF PAIN 2016; 17:911-8. [PMID: 27260638 PMCID: PMC4969102 DOI: 10.1016/j.jpain.2016.05.003] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 04/21/2016] [Accepted: 05/06/2016] [Indexed: 02/07/2023]
Abstract
UNLABELLED We evaluated the effects of repetitive transcranial magnetic stimulation (rTMS) in the treatment of phantom limb pain (PLP) in land mine victims. Fifty-four patients with PLP were enrolled in a randomized, double-blinded, placebo-controlled, parallel group single-center trial. The intervention consisted of real or sham rTMS of M1 contralateral to the amputated leg. rTMS was given in series of 20 trains of 6-second duration (54-second intertrain, intensity 90% of motor threshold) at a stimulation rate of 10 Hz (1,200 pulses), 20 minutes per day, during 10 days. For the control group, a sham coil was used. The administration of active rTMS induced a significantly greater reduction in pain intensity (visual analogue scale scores) 15 days after treatment compared with sham stimulation (-53.38 ± 53.12% vs -22.93 ± 57.16%; mean between-group difference = 30.44%, 95% confidence interval, .30-60.58; P = .03). This effect was not significant 30 days after treatment. In addition, 19 subjects (70.3%) attained a clinically significant pain reduction (>30%) in the active group compared with 11 in the sham group (40.7%) 15 days after treatment (P = .03). The administration of 10 Hz rTMS on the contralateral primary motor cortex for 2 weeks in traumatic amputees with PLP induced significant clinical improvement in pain. PERSPECTIVE High-frequency rTMS on the contralateral primary motor cortex of traumatic amputees induced a clinically significant pain reduction up to 15 days after treatment without any major secondary effect. These results indicate that rTMS is a safe and effective therapy in patients with PLP caused by land mine explosions.
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Affiliation(s)
- Alejandra Malavera
- Neurovascular Science Group, Fundación Cardiovascular de Colombia, Floridablanca, Colombia; Spaulding Neuromodulation Center, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts
| | - Federico Arturo Silva
- Neurovascular Science Group, Fundación Cardiovascular de Colombia, Floridablanca, Colombia
| | - Felipe Fregni
- Spaulding Neuromodulation Center, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sandra Carrillo
- Neurovascular Science Group, Fundación Cardiovascular de Colombia, Floridablanca, Colombia
| | - Ronald G Garcia
- Neurovascular Science Group, Fundación Cardiovascular de Colombia, Floridablanca, Colombia; MASIRA Research Institute, School of Medicine, Universidad de Santander, Bucaramanga, Colombia; Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
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236
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Chevalier A, Armstrong K, Norwood-Williams C, Gokal R. DC Electroacupuncture Effects on Scars and Sutures of a Patient with Postconcussion Pain. Med Acupunct 2016; 28:223-229. [PMID: 27610209 PMCID: PMC5002218 DOI: 10.1089/acu.2016.1188] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Introduction: This case study offers a detailed comparative analysis of the effects of direct-current electroacupuncture (DC-EA) on the autonomic nervous system (ANS), when DC-EA was applied to the cranial sutures and scars of a patient with a history of ischemic stroke and postconcussion syndrome (PCS) pain. Case: A 56-year-old female suffering from severe tremors and debilitating headaches requested acupuncture after conventional biomedicines failed to relieve her symptoms. Evaluations were performed to check the status of 27 ANS functions. These detailed evaluations were performed to obtain a baseline status of ANS function on this patient, who had a history of ischemic stroke, PCS, and chronic pain. All evaluations were repeated pre–post her DC-EA treatment. Results: This patient experienced significant relief from her symptoms after DC-EA treatment. An analysis of this patient's risk for ANS complications showed improvements in four key homeostatic markers post treatment. Conclusions: The ANS response of a patient with ischemic stroke, PCS, and chronic pain, who received electrical nerve stimulation using DC-EA reflected a measurable improvement in sympathetic tone, along with reductions in pain levels and PCS symptoms. The positive results in this case study could have applications to other pathologies that can be affected by the sympathetic nervous system activation on the body.
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Affiliation(s)
| | | | | | - Raman Gokal
- Women's Integrative Healing Inc. , St. Augustine, FL
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237
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Naro A, Milardi D, Russo M, Terranova C, Rizzo V, Cacciola A, Marino S, Calabro RS, Quartarone A. Non-invasive Brain Stimulation, a Tool to Revert Maladaptive Plasticity in Neuropathic Pain. Front Hum Neurosci 2016; 10:376. [PMID: 27512368 PMCID: PMC4961691 DOI: 10.3389/fnhum.2016.00376] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 07/12/2016] [Indexed: 12/18/2022] Open
Abstract
Neuromodulatory effects of non-invasive brain stimulation (NIBS) have been extensively studied in chronic pain. A hypothetic mechanism of action would be to prevent or revert the ongoing maladaptive plasticity within the pain matrix. In this review, the authors discuss the mechanisms underlying the development of maladaptive plasticity in patients with chronic pain and the putative mechanisms of NIBS in modulating synaptic plasticity in neuropathic pain conditions.
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Affiliation(s)
- Antonino Naro
- IRCCS Centro Neurolesi "Bonino-Pulejo" Messina, Italy
| | - Demetrio Milardi
- IRCCS Centro Neurolesi "Bonino-Pulejo"Messina, Italy; Department of Biomedical, Dental Sciences and Morphological and Functional Images, University of MessinaMessina, Italy
| | | | - Carmen Terranova
- Department of Clinical and Experimental Medicine, University of Messina Messina, Italy
| | - Vincenzo Rizzo
- Department of Clinical and Experimental Medicine, University of Messina Messina, Italy
| | - Alberto Cacciola
- IRCCS Centro Neurolesi "Bonino-Pulejo"Messina, Italy; Department of Biomedical, Dental Sciences and Morphological and Functional Images, University of MessinaMessina, Italy
| | - Silvia Marino
- IRCCS Centro Neurolesi "Bonino-Pulejo" Messina, Italy
| | | | - Angelo Quartarone
- IRCCS Centro Neurolesi "Bonino-Pulejo"Messina, Italy; Department of Biomedical, Dental Sciences and Morphological and Functional Images, University of MessinaMessina, Italy
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238
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Kumar S, Dey S, Jain S. Extremely low-frequency electromagnetic fields: A possible non-invasive therapeutic tool for spinal cord injury rehabilitation. Electromagn Biol Med 2016; 36:88-101. [PMID: 27399648 DOI: 10.1080/15368378.2016.1194290] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Traumatic insults to the spinal cord induce both immediate mechanical damage and subsequent tissue degeneration. The latter involves a range of events namely cellular disturbance, homeostatic imbalance, ionic and neurotransmitters derangement that ultimately result in loss of sensorimotor functions. The targets for improving function after spinal cord injury (SCI) are mainly directed toward limiting these secondary injury events. Extremely low-frequency electromagnetic field (ELF-EMF) is a possible non-invasive therapeutic intervention for SCI rehabilitation which has the potential to constrain the secondary injury-induced events. In the present review, we discuss the effects of ELF-EMF on experimental and clinical SCI as well as on biological system.
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Affiliation(s)
- Suneel Kumar
- a Department of Physiology , All India Institute of Medical Sciences , New Delhi , India.,b W. M. Keck Center for Collaborative Neuroscience, Rutgers, The State University of New Jersey , Piscataway , NJ , USA
| | - Soumil Dey
- a Department of Physiology , All India Institute of Medical Sciences , New Delhi , India
| | - Suman Jain
- a Department of Physiology , All India Institute of Medical Sciences , New Delhi , India
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239
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A Case of Long-Term Treatment of Chronic Pain Syndrome by Anodal tDCS of the Motor Cortex, Previously Resistant to High-Frequency rTMS and Implanted Spinal Cord Stimulation. Brain Stimul 2016; 9:618-20. [DOI: 10.1016/j.brs.2016.02.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2016] [Revised: 02/08/2016] [Accepted: 02/10/2016] [Indexed: 11/19/2022] Open
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240
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Brasil-Neto JP. Motor Cortex Stimulation for Pain Relief: Do Corollary Discharges Play a Role? Front Hum Neurosci 2016; 10:323. [PMID: 27445763 PMCID: PMC4923125 DOI: 10.3389/fnhum.2016.00323] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 06/13/2016] [Indexed: 02/06/2023] Open
Abstract
Both invasive and non-invasive motor cortex stimulation techniques have been successfully employed in the treatment of chronic pain, but the precise mechanism of action of such treatments is not fully understood. It has been hypothesized that a mismatch of normal interaction between motor intention and sensory feedback may result in central pain. Sensory feedback may come from peripheral nerves, vision and also from corollary discharges originating from the motor cortex itself. Therefore, a possible mechanism of action of motor cortex stimulation might be corollary discharge reinforcement, which could counterbalance sensory feedback deficiency. In other instances, primary deficiency in the production of corollary discharges by the motor cortex might be the culprit and stimulation of cortical motor areas might then be beneficial by enhancing production of such discharges. Here we review evidence for a possible role of motor cortex corollary discharges upon both the pathophysiology and the response to motor cortex stimulation of different types of chronic pain. We further suggest that the right dorsolateral prefrontal cortex (DLPC), thought to constantly monitor incongruity between corollary discharges, vision and proprioception, might be an interesting target for non-invasive neuromodulation in cases of chronic neuropathic pain.
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Affiliation(s)
- Joaquim P Brasil-Neto
- Laboratory of Neurosciences and Behavior, Department of Physiological Sciences, Universidade de Brasília Brasília, Brazil
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241
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Manchikanti L, Boswell MV, Hirsch JA. Innovations in interventional pain management of chronic spinal pain. Expert Rev Neurother 2016; 16:1033-42. [DOI: 10.1080/14737175.2016.1194204] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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242
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Repetitive transcranial magnetic stimulation and transcranial direct-current stimulation in neuropathic pain due to radiculopathy. Pain 2016; 157:1224-1231. [DOI: 10.1097/j.pain.0000000000000510] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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243
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Alam M, Truong DQ, Khadka N, Bikson M. Spatial and polarity precision of concentric high-definition transcranial direct current stimulation (HD-tDCS). Phys Med Biol 2016; 61:4506-21. [DOI: 10.1088/0031-9155/61/12/4506] [Citation(s) in RCA: 99] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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244
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Morin A, Léonard G, Gougeon V, Waddell G, Bureau YA, Girard I, Morin M. Efficacy of transcranial direct-current stimulation (tDCS) in women with provoked vestibulodynia: study protocol for a randomized controlled trial. Trials 2016; 17:243. [PMID: 27179944 PMCID: PMC4867997 DOI: 10.1186/s13063-016-1366-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 04/29/2016] [Indexed: 12/31/2022] Open
Abstract
Background Provoked vestibulodynia is the most common form of vulvodynia. Despite its high prevalence and deleterious sexual, conjugal, and psychological repercussions, effective evidence-based interventions for provoked vestibulodynia remain limited. For a high proportion of women, significant pain persists despite the currently available treatments. Growing evidence suggests that the central nervous system (CNS) could play a key role in provoked vestibulodynia; thus, treatment targeting the CNS, rather than localized dysfunctions, may be beneficial for women suffering from provoked vestibulodynia. In this study, we aim to build on the promising results of a previous case report and evaluate whether transcranial direct-current stimulation, a non-invasive brain stimulation technique targeting the CNS, could be an effective treatment option for women with provoked vestibulodynia. Methods/design This single-center, triple-blind, parallel group, randomized, controlled trial aims to compare the efficacy of transcranial direct-current stimulation with sham transcranial direct-current stimulation in women with provoked vestibulodynia. Forty women diagnosed with provoked vestibulodynia by a gynecologist, following a standardized treatment protocol, are randomized to either active transcranial direct-current stimulation treatment for ten sessions of 20 minutes at an intensity of 2 mA or sham transcranial direct-current stimulation over a 2-week period. Outcome measures are collected at baseline, 2 weeks after treatment and at 3-month follow-up. The primary outcome is pain during intercourse, assessed with a numerical rating scale. Secondary measurements focus on the sexual function, vestibular pain sensitivity, psychological distress, treatment satisfaction, and the patient’s global impression of change. Discussion To our knowledge, this study is the first randomized controlled trial to examine the efficacy of transcranial direct-current stimulation in women with provoked vestibulodynia. Findings from this trial are expected to provide significant information about a promising intervention targeting the centralization of pain in women with provoked vestibulodynia. Trial registration Clinicaltrials.gov, NCT02543593. Registered on September 4, 2015. Electronic supplementary material The online version of this article (doi:10.1186/s13063-016-1366-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Annie Morin
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001 12th Avenue North, Sherbrooke, Québec, Canada
| | - Guillaume Léonard
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001 12th Avenue North, Sherbrooke, Québec, Canada
| | - Véronique Gougeon
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001 12th Avenue North, Sherbrooke, Québec, Canada
| | - Guy Waddell
- Department of Obstetrics Gynecology, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001 12th Avenue North, Sherbrooke, Québec, Canada
| | - Yves-André Bureau
- Department of Obstetrics Gynecology, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001 12th Avenue North, Sherbrooke, Québec, Canada
| | - Isabelle Girard
- Department of Obstetrics Gynecology, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001 12th Avenue North, Sherbrooke, Québec, Canada
| | - Mélanie Morin
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001 12th Avenue North, Sherbrooke, Québec, Canada.
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Motor/Prefrontal Transcranial Direct Current Stimulation (tDCS) Following Lumbar Surgery Reduces Postoperative Analgesia Use. Spine (Phila Pa 1976) 2016; 41:835-9. [PMID: 26909844 DOI: 10.1097/brs.0000000000001525] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Randomized, controlled pilot trial. OBJECTIVE The present study is the first randomized, double-blind, sham-controlled pilot clinical trial of transcranial direct current stimulation (tDCS) for pain and patient-controlled analgesia (PCA) opioid usage among patients receiving spine surgery. SUMMARY OF BACKGROUND DATA Lumbar spinal surgeries are common, and while pain is often a complaint that precedes surgical intervention, the procedures themselves are associated with considerable postoperative pain lasting days to weeks. Adequate postoperative pain control is an important factor in determining recovery and new analgesic strategies are needed that can be used adjunctively to existing strategies potentially to reduce reliance on opioid analgesia. Several novel brain stimulation technologies including tDCS are beginning to demonstrate promise as treatments for a variety of pain conditions. METHODS Twenty-seven patients undergoing lumbar spine procedures at Medical University of South Carolina were randomly assigned to receive four 20-minute sessions of real or sham tDCS during their postsurgical hospital stay. Patient-administered hydromorphone usage was tracked along with numeric rating scale pain ratings. RESULTS The effect of tDCS on the slope of the cumulative PCA curve was significant (P < 0.001) and tDCS was associated with a 23% reduction in PCA usage. In the real tDCS group a 31% reduction was observed in pain-at-its-least ratings from admission to discharge (P = 0.027), but no other changes in numeric rating scale pain ratings were significant in either group. CONCLUSION The present pilot trial is the first study to demonstrate an opioid sparing effect of tDCS after spine surgical procedures. Although this was a small pilot trial in a heterogeneous sample of spinal surgery patients, a moderate effect-size was observed for tDCS, suggesting that future work in this area is warranted. LEVEL OF EVIDENCE 2.
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Remue J, Baeken C, De Raedt R. Does a single neurostimulation session really affect mood in healthy individuals? A systematic review. Neuropsychologia 2016; 85:184-98. [DOI: 10.1016/j.neuropsychologia.2016.03.012] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 02/15/2016] [Accepted: 03/12/2016] [Indexed: 11/25/2022]
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Morishita T, Inoue T. Brain Stimulation Therapy for Central Post-Stroke Pain from a Perspective of Interhemispheric Neural Network Remodeling. Front Hum Neurosci 2016; 10:166. [PMID: 27148019 PMCID: PMC4838620 DOI: 10.3389/fnhum.2016.00166] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Accepted: 04/04/2016] [Indexed: 12/25/2022] Open
Abstract
Central post-stroke pain (CPSP) is a debilitating, severe disorder affecting patient quality of life. Since CPSP is refractory to medication, various treatment modalities have been tried with marginal results. Following the first report of epidural motor cortex (M1) stimulation (MCS) for CPSP, many researchers have investigated the mechanisms of electrical stimulation of the M1. CPSP is currently considered to be a maladapted network reorganization problem following stroke, and recent studies have revealed that the activities of the impaired hemisphere after stroke may be inhibited by the contralesional hemisphere. Even though this interhemispheric inhibition (IHI) theory was originally proposed to explain the motor recovery process in stroke patients, we considered that IHI may also contribute to the CPSP mechanism. Based on the IHI theory and the fact that electrical stimulation of the M1 suppresses CPSP, we hypothesized that the inhibitory signals from the contralesional hemisphere may suppress the activities of the M1 in the ipsilesional hemisphere, and therefore pain suppression mechanisms may be malfunctioning in CPSP patients. In this context, transcranial direct current stimulation (tDCS) was considered to be a reasonable procedure to address the interhemispheric imbalance, as the bilateral M1 can be simultaneously stimulated using an anode (excitatory) and cathode (inhibitory). In this article, we review the potential mechanisms and propose a new model of CPSP. We also report two cases where CPSP was addressed with tDCS, discuss the potential roles of tDCS in the treatment of CPSP, and make recommendations for future studies.
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Affiliation(s)
- Takashi Morishita
- Department of Neurosurgery, Faculty of Medicine, Fukuoka University Fukuoka, Japan
| | - Tooru Inoue
- Department of Neurosurgery, Faculty of Medicine, Fukuoka University Fukuoka, Japan
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248
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Kasschau M, Reisner J, Sherman K, Bikson M, Datta A, Charvet LE. Transcranial Direct Current Stimulation Is Feasible for Remotely Supervised Home Delivery in Multiple Sclerosis. Neuromodulation 2016; 19:824-831. [PMID: 27089545 DOI: 10.1111/ner.12430] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 01/11/2016] [Accepted: 02/05/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Transcranial direct current stimulation (tDCS) has potential clinical application for symptomatic management in multiple sclerosis (MS). Repeated sessions are necessary in order to adequately evaluate a therapeutic effect. However, it is not feasible for many individuals with MS to visit clinic for treatment on a daily basis, and clinic delivery is also associated with substantial cost. We developed a research protocol to remotely supervise self- or proxy-administration for home delivery of tDCS using specially designed equipment and a telemedicine platform. MATERIALS AND METHODS We targeted ten treatment sessions across two weeks. Twenty participants (n = 20) diagnosed with MS (any subtype), ages 30 to 69 years with a range of disability (Expanded Disability Status Scale or EDSS scores of 1.0 to 8.0) were enrolled to test the feasibility of the remotely supervised protocol. RESULTS Protocol adherence exceeded what has been observed in studies with clinic-based treatment delivery, with all but one participant (95%) completing at least eight of the ten sessions. Across a total of 192 supervised treatment sessions, no session required discontinuation and no adverse events were reported. The most common side effects were itching/tingling at the electrode site. CONCLUSIONS This remotely supervised tDCS protocol provides a method for safe and reliable delivery of tDCS for clinical studies in MS and expands patient access to tDCS.
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Affiliation(s)
- Margaret Kasschau
- Department of Neurology, New York University School of Medicine, New York, NY, USA
| | - Jesse Reisner
- Arizona College of Osteopathic Medicine, Glendale, AZ, USA
| | - Kathleen Sherman
- Department of Neurology, New York University School of Medicine, New York, NY, USA
| | - Marom Bikson
- Department of Biomedical Engineering, The City College of New York of CUNY, New York, NY, USA
| | | | - Leigh E Charvet
- Department of Neurology, New York University School of Medicine, New York, NY, USA
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Dimov LF, Franciosi AC, Campos ACP, Brunoni AR, Pagano RL. Top-Down Effect of Direct Current Stimulation on the Nociceptive Response of Rats. PLoS One 2016; 11:e0153506. [PMID: 27071073 PMCID: PMC4829148 DOI: 10.1371/journal.pone.0153506] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 03/30/2016] [Indexed: 01/06/2023] Open
Abstract
Transcranial direct current stimulation (tDCS) is an emerging, noninvasive technique of neurostimulation for treating pain. However, the mechanisms and pathways involved in its analgesic effects are poorly understood. Therefore, we investigated the effects of direct current stimulation (DCS) on thermal and mechanical nociceptive thresholds and on the activation of the midbrain periaqueductal gray (PAG) and the dorsal horn of the spinal cord (DHSC) in rats; these central nervous system areas are associated with pain processing. Male Wistar rats underwent cathodal DCS of the motor cortex and, while still under stimulation, were evaluated using tail-flick and paw pressure nociceptive tests. Sham stimulation and naive rats were used as controls. We used a randomized design; the assays were not blinded to the experimenter. Immunoreactivity of the early growth response gene 1 (Egr-1), which is a marker of neuronal activation, was evaluated in the PAG and DHSC, and enkephalin immunoreactivity was evaluated in the DHSC. DCS did not change the thermal nociceptive threshold; however, it increased the mechanical nociceptive threshold of both hind paws compared with that of controls, characterizing a topographical effect. DCS decreased the Egr-1 labeling in the PAG and DHSC as well as the immunoreactivity of spinal enkephalin. Altogether, the data suggest that DCS disinhibits the midbrain descending analgesic pathway, consequently inhibiting spinal nociceptive neurons and causing an increase in the nociceptive threshold. This study reinforces the idea that the motor cortex participates in the neurocircuitry that is involved in analgesia and further clarifies the mechanisms of action of tDCS in pain treatment.
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Affiliation(s)
- Luiz Fabio Dimov
- Laboratory of Neuromodulation and Experimental Pain, Hospital Sírio Libanês, Rua Prof Daher Cutait, 69, Sao Paulo, SP, 01308-060, Brazil
| | - Adriano Cardozo Franciosi
- Laboratory of Neuromodulation and Experimental Pain, Hospital Sírio Libanês, Rua Prof Daher Cutait, 69, Sao Paulo, SP, 01308-060, Brazil
| | - Ana Carolina Pinheiro Campos
- Laboratory of Neuromodulation and Experimental Pain, Hospital Sírio Libanês, Rua Prof Daher Cutait, 69, Sao Paulo, SP, 01308-060, Brazil
| | - André Russowsky Brunoni
- Service of Interdisciplinary Neuromodulation (SIN), Department and Institute of Psychiatry, Faculty of Medicine of University of São Paulo, Laboratory of Neuroscience (LIM27), Department and Institute of Psychiatry, University of São Paulo, Rua Doutor Ovidio Pires de Campos, 785, Sao Paulo, SP, 05403-000, Brazil.,Center for Clinical and Epidemiological Research & Interdisciplinary Center for Applied Neuromodulation (CINA), University Hospital, University of São Paulo, São Paulo, Avenida Professor Lineu Prestes 2565, ext. 3, Sao Paulo, SP, 05508-000, Brazil
| | - Rosana Lima Pagano
- Laboratory of Neuromodulation and Experimental Pain, Hospital Sírio Libanês, Rua Prof Daher Cutait, 69, Sao Paulo, SP, 01308-060, Brazil
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Ayache SS, Palm U, Chalah MA, Al-Ani T, Brignol A, Abdellaoui M, Dimitri D, Sorel M, Créange A, Lefaucheur JP. Prefrontal tDCS Decreases Pain in Patients with Multiple Sclerosis. Front Neurosci 2016; 10:147. [PMID: 27092048 PMCID: PMC4824778 DOI: 10.3389/fnins.2016.00147] [Citation(s) in RCA: 87] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Accepted: 03/21/2016] [Indexed: 01/17/2023] Open
Abstract
Background: In the last few years, transcranial direct current stimulation (tDCS) has emerged as an appealing therapeutic option to improve brain functions. Promising data support the role of prefrontal tDCS in augmenting cognitive performance and ameliorating several neuropsychiatric symptoms, namely pain, fatigue, mood disturbances, and attentional impairment. Such symptoms are commonly encountered in patients with multiple sclerosis (MS). Objective: The main objective of the current work was to evaluate the tDCS effects over the left dorsolateral prefrontal cortex (DLPFC) on pain in MS patients.Our secondary outcomes were to study its influence on attention, fatigue, and mood. Materials and Methods: Sixteen MS patients with chronic neuropathic pain were enrolled in a randomized, sham-controlled, and cross-over study.Patients randomly received two anodal tDCS blocks (active or sham), each consisting of three consecutive daily tDCS sessions, and held apart by 3 weeks. Evaluations took place before and after each block. To evaluate pain, we used the Brief Pain Inventory (BPI) and the Visual Analog Scale (VAS). Attention was assessed using neurophysiological parameters and the Attention Network Test (ANT). Changes in mood and fatigue were measured using various scales. Results: Compared to sham, active tDCS yielded significant analgesic effects according to VAS and BPI global scales.There were no effects of any block on mood, fatigue, or attention. Conclusion: Based on our results, anodal tDCS over the left DLPFC appears to act in a selective manner and would ameliorate specific symptoms, particularly neuropathic pain. Analgesia might have occurred through the modulation of the emotional pain network. Attention, mood, and fatigue were not improved in this work. This could be partly attributed to the short protocol duration, the small sample size, and the heterogeneity of our MS cohort. Future large-scale studies can benefit from comparing the tDCS effects over different cortical sites, changing the stimulation montage, prolonging the duration of protocol, and coupling tDCS with neuroimaging techniques for a better understanding of its possible mechanism of action.
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Affiliation(s)
- Samar S Ayache
- EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-CréteilCréteil, France; Service de Physiologie - Explorations Fonctionnelles, Hôpital Henri Mondor, Assistance Publique - Hôpitaux de ParisCréteil, France; Neurology Division, Lebanese American University Medical Center - Rizk HospitalBeirut, Lebanon
| | - Ulrich Palm
- EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-CréteilCréteil, France; Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-UniversityMunich, Germany
| | - Moussa A Chalah
- EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-CréteilCréteil, France; Service de Physiologie - Explorations Fonctionnelles, Hôpital Henri Mondor, Assistance Publique - Hôpitaux de ParisCréteil, France
| | - Tarik Al-Ani
- EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-Créteil Créteil, France
| | - Arnaud Brignol
- Département d'Informatique et de Recherche Opérationnelle, Université de Montréal Montréal, QC, Canada
| | - Mohamed Abdellaoui
- Service de Neurologie, Hôpital Henri Mondor, Assistance Publique - Hôpitaux de Paris Créteil, France
| | - Dalia Dimitri
- Service de Neurologie, Hôpital Henri Mondor, Assistance Publique - Hôpitaux de Paris Créteil, France
| | - Marc Sorel
- EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-Créteil Créteil, France
| | - Alain Créange
- EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-CréteilCréteil, France; Service de Neurologie, Hôpital Henri Mondor, Assistance Publique - Hôpitaux de ParisCréteil, France
| | - Jean-Pascal Lefaucheur
- EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-CréteilCréteil, France; Service de Physiologie - Explorations Fonctionnelles, Hôpital Henri Mondor, Assistance Publique - Hôpitaux de ParisCréteil, France
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