Studying and modifying brain function with non-invasive brain stimulation

Functional specificity of the left ventrolateral prefrontal cortex in positive reappraisal: A single-pulse transcranial magnetic stimulation study

Neuroimage studies have yielded evidence for a correlation between the left ventrolateral prefrontal cortex (VLPFC) and a specific type of cognitive reappraisal strategy, positive reappraisal. However, evidence is still lacking for a direct relation. We used single-pulse transcranial magnetic stimulation (TMS) over the left VLPFC at different time points to investigate the functional specificity of the left VLPFC in the success of positive reappraisal and the timing at which the left VLPC was involved in positive reappraisal. Fifteen participants engaged in a baseline experiment and in TMS experiments. All participants successfully reduced their negative emotional ratings using positive reappraisal in the baseline experiment. In the TMS experiments, participants performed the same task as in the baseline experiment but single-pulse TMS was applied over the left VLPFC at 300 ms or/and 3,300 ms after stimulus onset, as well as over the vertex as a control stimulation. Valence ratings of negative stimuli increased (unpleasantness reduction) when participants reappraised negative stimuli with TMS stimulation over the left VLPFC, regardless of the timing of the stimulation at 300 ms or/and at 3,300 ms after the stimulus onset, relative to the vertex stimulation and the baseline experiment. Our study provided evidence of the functional specificity of the left VLPFC in regulation of negative emotions using positive reappraisal. The left VLPFC was believed to be involved in different stages of positive reappraisal. The prominent facilitation effect of TMS over the left VLPFC makes it possible to consider potential applications in clinical practice for mood disorders.

Within-session repeated transcranial direct current stimulation of the posterior parietal cortex enhances spatial working memory

Spatial working memory (SWM) is an essential cognitive ability that supports complex tasks, but its capacity is limited. Studies using transcranial direct current stimulation (tDCS) have shown potential benefits for SWM performance. Recent studies have shown that repeated short applications of tDCS affected corticospinal excitability. Moreover, neuroimaging studies have indicated that the pattern of neural activity measured in the posterior parietal cortex (PPC) tracks SWM ability. It is unknown whether repeated tDCS can enhance SWM and whether varied tDCS protocols (single 10 min tDCS, 10 min tDCS-5 min break-10 min tDCS, 10 min tDCS-20 min break-10 min tDCS) over the right PPC have different effects on SWM. The current study investigated whether offline single-session and repeated tDCS over the right PPC affects SWM updating, as measured by spatial 2-back and 3-back tasks. The results showed that stimulating the right PPC with repeated 10 min anodal tDCS significantly improved the response speed of the spatial 2-back task relative to single-session tDCS. Repeated 10 min tDCS with a longer interval (i.e. inter-stimulation interval of 20 min) enhanced the response speed of the spatial 3-back task. Altogether these findings provide causal evidence that suggests that the right PPC plays an important role in SWM. Furthermore, repeated tDCS with longer intervals may be a promising intervention for improving SWM-related function.

Impact of tDCS on working memory training is enhanced by strategy instructions in individuals with low working memory capacity

Interventions to improve working memory, e.g. by combining task rehearsal and non-invasive brain stimulation, are gaining popularity. Many factors, however, affect the outcome of these interventions. We hypothesize that working memory capacity at baseline predicts how an individual performs on a working memory task, by setting limits on the benefit derived from tDCS when combined with strategy instructions; specifically, we hypothesize that individuals with low capacity will benefit the most. Eighty-four participants underwent two sessions of an adaptive working memory task (n-back) on two consecutive days. Participants were split into four independent groups (SHAM vs ACTIVE stimulation and STRATEGY vs no STRATEGY instructions). For the purpose of analysis, individuals were divided based on their baseline working memory capacity. Results support our prediction that the combination of tDCS and strategy instructions is particularly beneficial in low capacity individuals. Our findings contribute to a better understanding of factors affecting the outcome of tDCS when used in conjunction with cognitive training to improve working memory. Moreover, our results have implications for training regimens, e.g., by designing interventions predicated on baseline cognitive abilities, or focusing on strategy development for specific attentional skills.

Quantifying Physiological Biomarkers of a Microwave Brain Stimulation Device

Physiological signals are immediate and sensitive to neural and cardiovascular change resulting from brain stimulation, and are considered as a quantifying tool with which to evaluate the association between brain stimulation and cognitive performance. Brain stimulation outside a highly equipped, clinical setting requires the use of a low-cost, ambulatory miniature system. The purpose of this double-blind, randomized, sham-controlled study is to quantify the physiological biomarkers of the neural and cardiovascular systems induced by a microwave brain stimulation (MBS) device. We investigated the effect of an active MBS and a sham device on the cardiovascular and neurological responses of ten volunteers (mean age 26.33 years, 70% male). Electroencephalography (EEG) and electrocardiography (ECG) were recorded in the initial resting-state, intermediate state, and the final state at half-hour intervals using a portable sensing device. During the experiment, the participants were engaged in a cognitive workload. In the active MBS group, the power of high-alpha, high-beta, and low-beta bands in the EEG increased, and the power of low-alpha and theta waves decreased, relative to the sham group. RR Interval and QRS interval showed a significant association with MBS stimulation. Heart rate variability features showed no significant difference between the two groups. A wearable MBS modality may be feasible for use in biomedical research; the MBS can modulate the neurological and cardiovascular responses to cognitive workload.

Feasibility of combining functional near-infrared spectroscopy with electroencephalography to identify chronic stroke responders to cerebellar transcranial direct current stimulation-a computational modeling and portable neuroimaging methodological study

Feasibility of portable neuroimaging of cerebellar transcranial direct current stimulation (ctDCS) effects on the cerebral cortex has not been investigated vis-à-vis cerebellar lobular electric field strength. We studied functional near-infrared spectroscopy (fNIRS) in conjunction with electroencephalography (EEG) to measure changes in the brain activation at the prefrontal cortex (PFC) and the sensorimotor cortex (SMC) following ctDCS as well as virtual reality-based balance training (VBaT) before and after ctDCS treatment in 12 hemiparetic chronic stroke survivors. We performed general linear modeling (GLM) that putatively associated the lobular electric field strength with the changes in the fNIRS-EEG measures at the ipsilesional and contra-lesional PFC and SMC. Here, fNIRS-EEG measures were found in the latent space from canonical correlation analysis (CCA) between the changes in total hemoglobin (tHb) concentrations (0.01-0.07Hz and 0.07-0.13Hz bands) and log10-transformed EEG bandpower within 1-45 Hz where significant (Wilks' lambda>0.95) canonical correlations were found only for the 0.07-0.13-Hz band. Also, the first principal component (97.5% variance accounted for) of the mean lobular electric field strength was a good predictor of the latent variables of oxy-hemoglobin (O2Hb) concentrations and log10-transformed EEG bandpower. GLM also provided insights into non-responders to ctDCS who also performed poorly in the VBaT due to ideomotor apraxia. Future studies should investigate fNIRS-EEG joint-imaging in a larger cohort to identify non-responders based on GLM fitting to the fNIRS-EEG data.

Non-invasive cortical stimulation: Transcranial direct current stimulation (tDCS)

Transcranial direct current stimulation (tDCS) is a re-emerging non-invasive brain stimulation technique that has been used in animal models and human trials aimed to elucidate neurophysiology and behavior interactions. It delivers subthreshold electrical currents to neuronal populations that shift resting membrane potential either toward depolarization or hyperpolarization, depending on stimulation parameters and neuronal orientation in relation to the induced electric field (EF). Although the resulting cerebral EFs are not strong enough to induce action potentials, spontaneous neuronal firing in response to inputs from other brain areas is influenced by tDCS. Additionally, tDCS induces plastic synaptic changes resembling long-term potentiation (LTP) or long-term depression (LTD) that outlast the period of stimulation. Such properties place tDCS as an appealing intervention for the treatment of diverse neuropsychiatric disorders. Although findings of clinical trials are preliminary for most studied conditions, there is already convincing evidence regarding its efficacy for unipolar depression. The main advantages of tDCS are the absence of serious or intolerable side effects and the portability of the devices, which might lead in the future to home-use applications and improved patient care. This chapter provides an up-to-date overview of a number tDCS relevant topics such as mechanisms of action, contemporary applications and safety. Furthermore, we propose ways to further develop tDCS research.

The neurobiology of prefrontal transcranial direct current stimulation (tDCS) in promoting brain plasticity: A systematic review and meta-analyses of human and rodent studies

The neurobiological mechanisms underlying prefrontal transcranial direct current stimulation (tDCS) remain elusive. Randomized, sham-controlled trials in humans and rodents applying in vivo prefrontal tDCS were included to explore whether prefrontal tDCS modulates resting-state and event-related functional connectivity, neural oscillation and synaptic plasticity. Fifty studies were included in the systematic review and 32 in the meta-analyses. Neuroimaging meta-analysis indicated anodal prefrontal tDCS significantly enhanced bilateral median cingulate activity [familywise error (FWE)-corrected p < .005]; meta-regression revealed a positive relationship between changes in median cingulate activity after tDCS and current density (FWE-corrected p < .005) as well as electric current strength (FWE-corrected p < .05). Meta-analyses of electroencephalography and magnetoencephalography data revealed nonsignificant changes (ps > .1) in both resting-state and event-related oscillatory power across all frequency bands. Applying anodal tDCS over the rodent hippocampus/prefrontal cortex enhanced long-term potentiation and brain-derived neurotrophic factor expression in the stimulated brain regions (ps <.005). Evidence supporting prefrontal tDCS administration is preliminary; more methodologically consistent studies evaluating its effects on cognitive function that include brain activity measurements are needed.

Magnetic resonance spectroscopy with transcranial direct current stimulation to explore the underlying biochemical and physiological mechanism of the human brain: A systematic review

A large body of molecular and neurophysiological evidence connects synaptic plasticity to specific functions and energy metabolism in particular areas of the brain. Furthermore, altered plasticity and energy regulation has been associated with a number of neuropsychiatric disorders. A favourable approach enabling the modulation of neuronal excitability and energy in humans is to stimulate the brain using transcranial direct current stimulation (tDCS) and then to observe the effect on neurometabolites using magnetic resonance spectroscopy (MRS). In this way, a well-defined modulation of brain energy and excitability can be achieved using a dedicated tDCS protocol to a predetermined brain region. This systematic review was guided by the preferred reporting items for systematic reviews and meta-analysis and summarises recent literature studying the effect of tDCS on neurometabolites in the human brain as measured by proton or phosphorus MRS. Limitations and recommendations are discussed for future research. The findings of this review provide clear evidence for the potential of using tDCS and MRS to examine and understand the effect of neurometabolites in the in vivo human brain.

Behavioral effects of continuous theta-burst stimulation in macaque parietal cortex

The neural mechanisms underlying the effects of continuous Theta-Burst Stimulation (cTBS) in humans are poorly understood. Animal studies can clarify the effects of cTBS on individual neurons, but behavioral evidence is necessary to demonstrate the validity of the animal model. We investigated the behavioral effect of cTBS applied over parietal cortex in rhesus monkeys performing a visually-guided grasping task with two differently sized objects, which required either a power grip or a pad-to-side grip. We used Fitts' law, predicting shorter grasping times (GT) for large compared to small objects, to investigate cTBS effects on two different grip types. cTBS induced long-lasting object-specific and dose-dependent changes in GT that remained present for up to two hours. High-intensity cTBS increased GTs for a power grip, but shortened GTs for a pad-to-side grip. Thus, high-intensity stimulation strongly reduced the natural GT difference between objects (i.e. the Fitts' law effect). In contrast, low-intensity cTBS induced the opposite effects on GT. Modifying the coil orientation from the standard 45-degree to a 30-degree angle induced opposite cTBS effects on GT. These findings represent behavioral evidence for the validity of the nonhuman primate model to study the neural underpinnings of non-invasive brain stimulation.

Immunomodulatory Layered Double Hydroxide Nanoparticles Enable Neurogenesis by Targeting Transforming Growth Factor-β Receptor 2

Immune microenvironment amelioration and reconstruction by functional biomaterials has become a promising strategy for spinal cord injury (SCI) recovery. In this study, we evaluated the neural regeneration and immunoregulation functions of Mg/Al layered double hydroxide (Mg/Al-LDH) nanoparticles in completely transected and excised mice and revealed the immune-related mechanisms. LDH achieved significant performance in accelerating neural stem cells (NSCs) migration, neural differentiation, L-Ca²⁺ channel activation, and inducible action potential generation. In vivo, the behavioral and electrophysiological performance of SCI mice was significantly improved by LDH implantation, with BrdU⁺ endogenous NSCs and neurons clearly observed in the lesion sites. According to RNA-seq and ingenuity pathway analysis, transforming growth factor-β receptor 2 (TGFBR2) is the key gene through which LDH inhibits inflammatory responses and accelerates neural regeneration. Significant colocalization of TGFBR2 and LDH was found on the cell membranes of NSCs both in vitro and in vivo, and LDH increased the expression of TGF-β2 in NSCs and activated the proliferation of precursor neural cells. LDH decreased the expression of M1 markers and increased the expression of M2 markers in both microglia and bone marrow-derived macrophages, and these effects were reversed by a TGFBR2 inhibitor. In addition, as a carrier, LDH loaded with NT3 exhibited better recovery effects with regard to the basso mouse scale score, motor evoked potential performance, and regenerated neural cell numbers than LDH itself. Thus, we have developed Mg/Al-LDH that can be used to construct a suitable immune microenvironment for SCI recovery and have revealed the targeted receptor.

Transcranial direct current stimulation (tDCS) in the management of epilepsy: A systematic review

PURPOSE

Current therapies for the management of epilepsy are still suboptimal for several patients due to inefficacy, major adverse events, and unavailability. Transcranial direct current stimulation (tDCS), an emergent non-invasive neuromodulation technique, has been tested in epilepsy samples over the past two decades to reduce either seizure frequency or electroencephalogram (EEG) epileptiform discharges.

METHODS

A systematic review was performed in accordance with PRISMA guidelines (PROSPERO record CRD42020160292). A thorough electronic search was completed in MEDLINE, EMBASE, CENTRAL and Scopus databases for trials that applied tDCS interventions to children and adults with epilepsy of any cause, from inception to April 30, 2020.

RESULTS

Twenty-seven studies fulfilled eligibility criteria, including nine sham-controlled and 18 uncontrolled trials or case reports/series. Samples consisted mainly of drug-resistant focal epilepsy patients that received cathodal tDCS stimulation targeted at the site with maximal EEG abnormalities. At follow-up, 84 % (21/25) of the included studies reported a reduction in seizure frequency and in 43 % (6/14) a decline in EEG epileptiform discharge rate was observed. No serious adverse events were reported.

CONCLUSIONS

Cathodal tDCS is both a safe and probably effective technique for seizure control in patients with drug-resistant focal epilepsy. However, published trials are heterogeneous regarding samples and methodology. More and larger sham-controlled randomized trials are needed, preferably with mechanistic informed stimulation protocols, to further advance tDCS therapy in the management of epilepsy.

Causal modulation of right hemisphere fronto-parietal phase synchrony with Transcranial Magnetic Stimulation during a conscious visual detection task

Correlational evidence in non-human primates has reported increases of fronto-parietal high-beta (22-30 Hz) synchrony during the top-down allocation of visuo-spatial attention. But may inter-regional synchronization at this specific frequency band provide a causal mechanism by which top-down attentional processes facilitate conscious visual perception? To address this question, we analyzed electroencephalographic (EEG) signals from a group of healthy participants who performed a conscious visual detection task while we delivered brief (4 pulses) rhythmic (30 Hz) or random bursts of Transcranial Magnetic Stimulation (TMS) to the right Frontal Eye Field (FEF) prior to the onset of a lateralized target. We report increases of inter-regional synchronization in the high-beta band (25-35 Hz) between the electrode closest to the stimulated region (the right FEF) and right parietal EEG leads, and increases of local inter-trial coherence within the same frequency band over bilateral parietal EEG contacts, both driven by rhythmic but not random TMS patterns. Such increases were accompained by improvements of conscious visual sensitivity for left visual targets in the rhythmic but not the random TMS condition. These outcomes suggest that high-beta inter-regional synchrony can be modulated non-invasively and that high-beta oscillatory activity across the right dorsal fronto-parietal network may contribute to the facilitation of conscious visual perception. Our work supports future applications of non-invasive brain stimulation to restore impaired visually-guided behaviors by operating on top-down attentional modulatory mechanisms.

Neurobiological After-Effects of Low Intensity Transcranial Electric Stimulation of the Human Nervous System: From Basic Mechanisms to Metaplasticity

Non-invasive low-intensity transcranial electrical stimulation (tES) of the brain is an evolving field that has brought remarkable attention in the past few decades for its ability to directly modulate specific brain functions. Neurobiological after-effects of tES seems to be related to changes in neuronal and synaptic excitability and plasticity, however mechanisms are still far from being elucidated. We aim to review recent results from in vitro and in vivo studies that highlight molecular and cellular mechanisms of transcranial direct (tDCS) and alternating (tACS) current stimulation. Changes in membrane potential and neural synchronization explain the ongoing and short-lasting effects of tES, while changes induced in existing proteins and new protein synthesis is required for long-lasting plastic changes (LTP/LTD). Glial cells, for decades supporting elements, are now considered constitutive part of the synapse and might contribute to the mechanisms of synaptic plasticity. This review brings into focus the neurobiological mechanisms and after-effects of tDCS and tACS from in vitro and in vivo studies, in both animals and humans, highlighting possible pathways for the development of targeted therapeutic applications.

Newly discovered neuron-to-glioma communication: new noninvasive therapeutic opportunities on the horizon?

The newly discovered functional integration of glioma cells into brain networks in mouse models provides groundbreaking insight into glioma aggressiveness and resistance to treatments, also suggesting novel potential therapeutic avenues and targets. In the context of such neuron-to-glioma communication, noninvasive brain modulation techniques traditionally applied to modulate neuronal function in neurological and psychiatric diseases (eg, increase/decrease cortical excitability and plasticity) could now be tested in patients with brain tumors to suppress glioma’s activity and its pathological crosstalk with healthy brain tissue.

tDCS peripheral nerve stimulation: a neglected mode of action?

Transcranial direct current stimulation (tDCS) is a noninvasive neuromodulation method widely used by neuroscientists and clinicians for research and therapeutic purposes. tDCS is currently under investigation as a treatment for a range of psychiatric disorders. Despite its popularity, a full understanding of tDCS's underlying neurophysiological mechanisms is still lacking. tDCS creates a weak electric field in the cerebral cortex which is generally assumed to cause the observed effects. Interestingly, as tDCS is applied directly on the skin, localized peripheral nerve endings are exposed to much higher electric field strengths than the underlying cortices. Yet, the potential contribution of peripheral mechanisms in causing tDCS's effects has never been systemically investigated. We hypothesize that tDCS induces arousal and vigilance through peripheral mechanisms. We suggest that this may involve peripherally-evoked activation of the ascending reticular activating system, in which norepinephrine is distributed throughout the brain by the locus coeruleus. Finally, we provide suggestions to improve tDCS experimental design beyond the standard sham control, such as topical anesthetics to block peripheral nerves and active controls to stimulate non-target areas. Broad adoption of these measures in all tDCS experiments could help disambiguate peripheral from true transcranial tDCS mechanisms.

Cognitive effects and acceptability of non-invasive brain stimulation on Alzheimer's disease and mild cognitive impairment: a component network meta-analysis

OBJECTIVES

To compare cognitive effects and acceptability of repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) in patients with Alzheimer's disease (AD) or mild cognitive impairment (MCI), and to determine whether cognitive training (CT) during rTMS or tDCS provides additional benefits.

METHODS

Electronic search of PubMed, Medline, Embase, the Cochrane Library and PsycINFO up to 5 March 2020. We enrolled double-blind, randomised controlled trials (RCTs). The primary outcomes were acceptability and pre-post treatment changes in general cognition measured by Mini-Mental State Examination, and the secondary outcomes were memory function, verbal fluency, working memory and executive function. Durability of cognitive benefits (1, 2 and ≥3 months) after brain stimulation was examined.

RESULTS

We included 27 RCTs (n=1070), and the treatment components included high-frequency rTMS (HFrTMS) and low-frequency rTMS, anodal tDCS (atDCS) and cathodal tDCS (ctDCS), CT, sham CT and sham brain stimulation. Risk of bias of evidence in each domain was low (range: 0%-11.1%). HFrTMS (1.08, 9, 0.35-1.80) and atDCS (0.56, 0.03-1.09) had short-term positive effects on general cognition. CT might be associated with negative effects on general cognition (-0.79, -2.06 to 0.48) during rTMS or tDCS. At 1-month follow-up, HFrTMS (1.65, 0.77-2.54) and ctDCS (2.57, 0.20-4.95) exhibited larger therapeutic responses. Separate analysis of populations with pure AD and MCI revealed positive effects only in individuals with AD. rTMS and tDCS were well tolerated.

CONCLUSIONS

HFrTMS is more effective than atDCS for improving global cognition, and patients with AD may have better responses to rTMS and tDCS than MCI.

Scaffolding the attention-deficit/hyperactivity disorder brain using transcranial direct current and random noise stimulation: A randomized controlled trial

OBJECTIVE

Improving symptomology and cognitive deficits in neurodevelopmental disorders is a crucial challenge. We examined whether neurostimulation protocols, which have been shown to yield long-term effects when combined with cognitive training, could benefit children with Attention-deficit/hyperactivity-disorder (ADHD), the most common neurodevelopmental disorder in childhood.

METHODS

We used a randomized double-blind active-controlled crossover study of 19 unmedicated children with ADHD, who received either anodal transcranial direct current stimulation (tDCS) over the left dorsolateral prefrontal cortex (dlPFC) or random noise stimulation (tRNS) over the bilateral dlPFC, while completing executive functions training.

RESULTS

For our primary outcome, tRNS yielded a clinical improvement as indicated by the reduced ADHD rating-scale score from baseline, and in comparison to the changes observed in tDCS. The effect of brain stimulation one week after completion of treatment yielded further improvement, suggesting a neuroplasticity-related effect. Finally, tRNS improved working memory compared to tDCS, and a larger tRNS effect on ADHD rating-scale was predicted for those who showed the greatest improvement in working memory.

CONCLUSIONS

We found that our intervention can have a lasting effect, rather than a merely immediate effect as was shown for in previous medical interventions in ADHD.

SIGNIFICANCE

Our results provide a promising direction toward a novel intervention in ADHD.

Closed-Loop Phase-Dependent Vibration Stimulation Improves Motor Imagery-Based Brain-Computer Interface Performance

The motor imagery (MI) paradigm has been wildly used in brain-computer interface (BCI), but the difficulties in performing imagery tasks limit its application. Mechanical vibration stimulus has been increasingly used to enhance the MI performance, but its improvement consistence is still under debate. To develop more effective vibration stimulus methods for consistently enhancing MI, this study proposes an EEG phase-dependent closed-loop mechanical vibration stimulation method. The subject's index finger of the non-dominant hand was given 4 different vibration stimulation conditions (i.e., continuous open-loop vibration stimulus, two different phase-dependent closed-loop vibration stimuli and no stimulus) when performing two tasks of imagining movement and rest of the index finger from his/her dominant hand. We compared MI performance and brain oscillatory patterns under different conditions to verify the effectiveness of this method. The subjects performed 80 trials of each type in a random order, and the average phase-lock value of closed-loop stimulus conditions was 0.71. It was found that the closed-loop vibration stimulus applied in the falling phase helped the subjects to produce stronger event-related desynchronization (ERD) and sustain longer. Moreover, the classification accuracy was improved by about 9% compared with MI without any vibration stimulation (p = 0.012, paired t-test). This method helps to modulate the mu rhythm and make subjects more concentrated on the imagery and without negative enhancement during rest tasks, ultimately improves MI-based BCI performance. Participants reported that the tactile fatigue under closed-loop stimulation conditions was significantly less than continuous stimulation. This novel method is an improvement to the traditional vibration stimulation enhancement research and helps to make stimulation more precise and efficient.

The effect of non-invasive brain stimulation on executive functioning in healthy controls: A systematic review and meta-analysis

In recent years, there has been a heightened interest in the effect of non-invasive brain stimulation on executive functioning. However, there is no comprehensive overview of its effects on different executive functioning domains in healthy individuals. Here, we assessed the state of the field by conducting a systematic review and meta-analysis on the effectiveness of non-invasive brain stimulation (i.e. repetitive transcranial magnetic stimulation and transcranial direct current stimulation) over prefrontal regions on tasks assessing working memory, inhibition, flexibility, planning and initiation performance. Our search yielded 63 studies (n = 1537), and the effectiveness of excitatory and inhibitory non-invasive brain stimulation were assessed per executive functioning task. Our analyses showed that excitatory non-invasive brain stimulation had a small but positive effect on Stop Signal Task and Go/No-Go Task performance, and that inhibitory stimulation had a small negative effect on Flanker Task performance. Non-invasive brain stimulation did not affect performance on working memory and flexibility tasks, and effects on planning tasks were inconclusive.

The role of dorsolateral and ventromedial prefrontal cortex in the processing of emotional dimensions

The ventromedial and dorsolateral prefrontal cortex are two major prefrontal regions that usually interact in serving different cognitive functions. On the other hand, these regions are also involved in cognitive processing of emotions but their contribution to emotional processing is not well-studied. In the present study, we investigated the role of these regions in three dimensions (valence, arousal and dominance) of emotional processing of stimuli via ratings of visual stimuli performed by the study participants on these dimensions. Twenty- two healthy adult participants (mean age 25.21 ± 3.84 years) were recruited and received anodal and sham transcranial direct current stimulation (tDCS) (1.5 mA, 15 min) over the dorsolateral prefrontal cortex (dlPFC) and and ventromedial prefrontal cortex (vmPFC) in three separate sessions with an at least 72-h interval. During stimulation, participants underwent an emotional task in each stimulation condition. The task included 100 visual stimuli and participants were asked to rate them with respect to valence, arousal, and dominance. Results show a significant effect of stimulation condition on different aspects of emotional processing. Specifically, anodal tDCS over the dlPFC significantly reduced valence attribution for positive pictures. In contrast, anodal tDCS over the vmPFC significantly reduced arousal ratings. Dominance ratings were not affected by the intervention. Our results suggest that the dlPFC is involved in control and regulation of valence of emotional experiences, while the vmPFC might be involved in the extinction of arousal caused by emotional stimuli. Our findings implicate dimension-specific processing of emotions by different prefrontal areas which has implications for disorders characterized by emotional disturbances such as anxiety or mood disorders.

Past, Present, and Future of Non-invasive Brain Stimulation Approaches to Treat Cognitive Impairment in Neurodegenerative Diseases: Time for a Comprehensive Critical Review

Low birth rates and increasing life expectancy experienced by developed societies have placed an unprecedented pressure on governments and the health system to deal effectively with the human, social and financial burden associated to aging-related diseases. At present, ∼24 million people worldwide suffer from cognitive neurodegenerative diseases, a prevalence that doubles every five years. Pharmacological therapies and cognitive training/rehabilitation have generated temporary hope and, occasionally, proof of mild relief. Nonetheless, these approaches are yet to demonstrate a meaningful therapeutic impact and changes in prognosis. We here review evidence gathered for nearly a decade on non-invasive brain stimulation (NIBS), a less known therapeutic strategy aiming to limit cognitive decline associated with neurodegenerative conditions. Transcranial Magnetic Stimulation and Transcranial Direct Current Stimulation, two of the most popular NIBS technologies, use electrical fields generated non-invasively in the brain to long-lastingly enhance the excitability/activity of key brain regions contributing to relevant cognitive processes. The current comprehensive critical review presents proof-of-concept evidence and meaningful cognitive outcomes of NIBS in eight of the most prevalent neurodegenerative pathologies affecting cognition: Alzheimer's Disease, Parkinson's Disease, Dementia with Lewy Bodies, Primary Progressive Aphasias (PPA), behavioral variant of Frontotemporal Dementia, Corticobasal Syndrome, Progressive Supranuclear Palsy, and Posterior Cortical Atrophy. We analyzed a total of 70 internationally published studies: 33 focusing on Alzheimer's disease, 19 on PPA and 18 on the remaining neurodegenerative pathologies. The therapeutic benefit and clinical significance of NIBS remains inconclusive, in particular given the lack of a sufficient number of double-blind placebo-controlled randomized clinical trials using multiday stimulation regimes, the heterogeneity of the protocols, and adequate behavioral and neuroimaging response biomarkers, able to show lasting effects and an impact on prognosis. The field remains promising but, to make further progress, research efforts need to take in account the latest evidence of the anatomical and neurophysiological features underlying cognitive deficits in these patient populations. Moreover, as the development of in vivo biomarkers are ongoing, allowing for an early diagnosis of these neuro-cognitive conditions, one could consider a scenario in which NIBS treatment will be personalized and made part of a cognitive rehabilitation program, or useful as a potential adjunct to drug therapies since the earliest stages of suh diseases. Research should also integrate novel knowledge on the mechanisms and constraints guiding the impact of electrical and magnetic fields on cerebral tissues and brain activity, and incorporate the principles of information-based neurostimulation.

Causal Inferences in Repetitive Transcranial Magnetic Stimulation Research: Challenges and Perspectives

Transcranial magnetic stimulation (TMS) is used to make inferences about relationships between brain areas and their functions because, in contrast to neuroimaging tools, it modulates neuronal activity. The central aim of this article is to critically evaluate to what extent it is possible to draw causal inferences from repetitive TMS (rTMS) data. To that end, we describe the logical limitations of inferences based on rTMS experiments. The presented analysis suggests that rTMS alone does not provide the sort of premises that are sufficient to warrant strong inferences about the direct causal properties of targeted brain structures. Overcoming these limitations demands a close look at the designs of rTMS studies, especially the methodological and theoretical conditions which are necessary for the functional decomposition of the relations between brain areas and cognitive functions. The main points of this article are that TMS-based inferences are limited in that stimulation-related causal effects are not equivalent to structure-related causal effects due to TMS side effects, the electric field distribution, and the sensitivity of neuroimaging and behavioral methods in detecting structure-related effects and disentangling them from confounds. Moreover, the postulated causal effects can be based on indirect (network) effects. A few suggestions on how to manage some of these limitations are presented. We discuss the benefits of combining rTMS with neuroimaging in experimental reasoning and we address the restrictions and requirements of rTMS control conditions. The use of neuroimaging and control conditions allows stronger inferences to be gained, but the strength of the inferences that can be drawn depends on the individual experiment's designs. Moreover, in some cases, TMS might not be an appropriate method of answering causality-related questions or the hypotheses have to account for the limitations of this technique. We hope this summary and formalization of the reasoning behind rTMS research can be of use not only for scientists and clinicians who intend to interpret rTMS results causally but also for philosophers interested in causal inferences based on brain stimulation research.

Transient ultrasound stimulation has lasting effects on neuronal excitability

Background

Transcranial ultrasound stimulation can acutely modulate brain activity, but the lasting effects on neurons are unknown.

Objective

To assess the excitability profile of neurons in the hours following transient ultrasound stimulation.

Methods

Primary rat cortical neurons were stimulated with a 40 s, 200 kHz pulsed ultrasound stimulation or sham-stimulation. Intrinsic firing properties were investigated through whole-cell patch-clamp recording by evoking action potentials in response to somatic current injection. Recordings were taken at set timepoints following ultrasound stimulation: 0–2 h, 6–8 h, 12–14 h and 24–26 h. Transmission electron microscopy was used to assess synaptic ultrastructure at the same timepoints.

Results

In the 0–2 h window, neurons stimulated with ultrasound displayed an increase in the mean frequency of evoked action potentials of 32% above control cell levels (p = 0.023). After 4–6 h this increase was measured as 44% (p = 0.0043). By 12–14 h this effect was eliminated and remained absent 24–26 h post-stimulation. These changes to action potential firing occurred in conjunction with statistically significant differences between control and ultrasound-stimulated neurons in action potential half-width, depolarisation rate, and repolarisation rate, that were similarly eliminated by 24 h following stimulation. These effects occurred in the absence of alterations to intrinsic membrane properties or synaptic ultrastructure.

Conclusion

We report that stimulating neurons with 40 s of ultrasound enhances their excitability for up to 8 h in conjunction with modifications to action potential kinetics. This occurs in the absence of major ultrastructural change or modification of intrinsic membrane properties. These results can inform the application of transcranial ultrasound in experimental and therapeutic settings.

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40 s of ultrasound stimulation enhances intrinsic excitability of cultured rat neurons.

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Enhanced excitability lasts for up to 8 h.

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Ultrasound has no effects on neuronal ultrastructure.

Transcranial direct current stimulation of the posterior parietal cortex biases human hand choice

Hand choices—deciding which hand to use to reach for targets—represent continuous, daily, unconscious decisions. The posterior parietal cortex (PPC) contralateral to the selected hand is activated during a hand-choice task, and disruption of left PPC activity with a single-pulse transcranial magnetic stimulation prior to the execution of the motion suppresses the choice to use the right hand but not vice versa. These findings imply the involvement of either bilateral or left PPC in hand choice. To determine whether the effects of PPC’s activity are essential and/or symmetrical in hand choice, we increased or decreased PPC excitability in 16 healthy participants using transcranial direct current stimulation (tDCS; 10 min, 2 mA, 5 × 7 cm) and examined its online and residual effects on hand-choice probability and reaction time. After the right PPC was stimulated with an anode and the left PPC with a cathode, the probability of left-hand choice significantly increased and reaction time significantly decreased. However, no significant changes were observed with the stimulation of the right PPC with a cathode and the left PPC with an anode. These findings, thus, reveal the asymmetry of PPC-mediated regulation in hand choice.

Impact of COMT val158met on tDCS-induced cognitive enhancement in older adults

BACKGROUND

Previous studies suggest that genetic polymorphisms and aging modulate inter-individual variability in brain stimulation-induced plasticity. However, the relationship between genetic polymorphisms and behavioral modulation through transcranial direct current stimulation (tDCS) in older adults remains poorly understood.

OBJECTIVE

Link individual tDCS responsiveness, operationalized as performance difference between tDCS and sham condition, to common genetic polymorphisms in healthy older adults.

METHODS

106 healthy older participants from five tDCS-studies were re-invited to donate blood for genotyping of apoliproprotein E (APOE: ε4 carriers and ε4 non-carriers), catechol-O-methyltransferase (COMT: val/val, val/met, met/met), brain-derived neurotrophic factor (BDNF: val/val, val/met, met/met) and KIdney/BRAin encoding gene (KIBRA: C/C, C/T, T/T). Studies had assessed cognitive performance during tDCS and sham in cross-over designs. We now asked whether the tDCS responsiveness was related to the four genotypes using a linear regression models.

RESULTS

We found that tDCS responsiveness was significantly associated with COMT polymorphism; i.e., COMT val carriers (compared to met/met) showed higher tDCS responsiveness. No other significant associations emerged.

CONCLUSION

Using data from five brain stimulation studies conducted in our group, we showed that only individual variation of COMT genotypes modulated behavioral response to tDCS. These findings contribute to the understanding of inherent factors that explain inter-individual variability in functional tDCS effects in older adults, and might help to better stratify participants for future clinical trials.

Effects of transcranial stimulation in developmental neurocognitive disorders: A critical appraisal

Non-invasive brain stimulation (NIBS) has been highlighted as a powerful tool to promote neuroplasticity, and an attractive approach to support cognitive remediation. Here we provide a systematic review of 26 papers using NIBS to ameliorate cognitive dysfunctions in three prevalent neurodevelopmental disorders: Attention-Deficit/Hyperactivity Disorder (ADHD), Developmental Dyslexia and Developmental Dyscalculia. An overview of the state of research shows a predominance of studies using repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) techniques, and an unequal distribution among clinical conditions. Regarding the utility of NIBS, the results are promising but also ambiguous. Twenty-three papers reported beneficial effects, but many of these effects were found only once or were only partially replicated and some studies even reported detrimental effects. Furthermore, most studies differed in at least one core aspect, the NIBS applied, the questionnaires and cognitive tests conducted, or the age group investigated, and sample sizes were mostly small. Hence, further studies are needed to rigorously examine the potential of NIBS in the remediation of cognitive functions. Finally, we discuss potential caveats and future directions. We reason that if adequately addressing these challenges NIBS can be feasible, with potential benefits in treating neurodevelopmental disorders.

Hot and cold executive functions in the brain: A prefrontal-cingular network

Executive functions, or cognitive control, are higher-order cognitive functions needed for adaptive goal-directed behaviours and are significantly impaired in majority of neuropsychiatric disorders. Different models and approaches are proposed for describing how executive functions are functionally organised in the brain. One popular and recently proposed organising principle of executive functions is the distinction between hot (i.e. reward or affective-related) versus cold (i.e. purely cognitive) domains of executive functions. The prefrontal cortex is traditionally linked to executive functions, but on the other hand, anterior and posterior cingulate cortices are hugely involved in executive functions as well. In this review, we first define executive functions, their domains, and the appropriate methods for studying them. Second, we discuss how hot and cold executive functions are linked to different areas of the prefrontal cortex. Next, we discuss the association of hot versus cold executive functions with the cingulate cortex, focusing on the anterior and posterior compartments. Finally, we propose a functional model for hot and cold executive function organisation in the brain with a specific focus on the fronto-cingular network. We also discuss clinical implications of hot versus cold cognition in major neuropsychiatric disorders (depression, schizophrenia, anxiety disorders, substance use disorder, attention-deficit hyperactivity disorder, and autism) and attempt to characterise their profile according to the functional dominance or manifest of hot-cold cognition. Our model proposes that the lateral prefrontal cortex along with the dorsal anterior cingulate cortex are more relevant for cold executive functions, while the medial-orbital prefrontal cortex along with the ventral anterior cingulate cortex, and the posterior cingulate cortex are more closely involved in hot executive functions. This functional distinction, however, is not absolute and depends on several factors including task features, context, and the extent to which the measured function relies on cognition and emotion or both.

Resolving heterogeneity in transcranial electrical stimulation efficacy for attention deficit hyperactivity disorder

While the treatment of Attention Deficit Hyperactivity Disorder (ADHD) is dominated by pharmacological agents, transcranial electrical stimulation (tES) is gaining attention as an alternative method for treatment. Most current meta-analyses have suggested that tES can improve cognitive functions that are otherwise impaired in ADHD, such as inhibition and working memory, as well as alleviated clinical symptoms. Here we review some of the promising findings in the field of tES. At the same time, we highlight two factors, which hinder the effective application of tES in treating ADHD: 1) the heterogeneity of tES protocols used in different studies; 2) patient profiles influencing responses to tES. We highlight potential solutions for overcoming such limitations, including the use of active machine learning, and provide simulated data to demonstrate how these solutions could also improve the understanding, diagnosis, and treatment of ADHD.

Depression of auditory cortex excitability by transcranial alternating current stimulation

Transcranial alternating current stimulation (tACS) is a type of noninvasive brain stimulation technique that has been shown to modulate motor, cognitive and memory function. Direct electrophysiological evidence of an interaction between tACS and the auditory cortex excitability has rarely been reported. Different stimulation parameters and areas of tACS may have different influence on the regulatory results. In this study, 11-Hz tACS was applied to the auditory cortex of 12 subjects with normal hearing in order to explore its effects on the auditory steady-state response (ASSR). The results indicate that tACS has an inhibitory effect on 40-Hz ASSR. In addition, EEG source analysis shows that 11-Hz tACS may enhance the activity of the middle temporal gyrus under both sham and real conditions, while the estimated source activity of the posterior cingulate gyrus may be reduced under real condition. The results reveal that tACS applied to the temporal lobe of humans will make the 40-Hz ASSR a tendency to decrease, and help improve the understanding of modulation of tACS-induced auditory cortex excitability changes in humans.

Magnetic brain stimulation using iron oxide nanoparticle-mediated selective treatment of the left prelimbic cortex as a novel strategy to rapidly improve depressive-like symptoms in mice

Magnetic brain stimulation has greatly contributed to the advancement of neuroscience. However, challenges remain in the power of penetration and precision of magnetic stimulation, especially in small animals. Here, a novel combined magnetic stimulation system (c-MSS) was established for brain stimulation in mice. The c-MSS uses a mild magnetic pulse sequence and injection of superparamagnetic iron oxide (SPIO) nanodrugs to elevate local cortical susceptibility. After imaging of the SPIO nanoparticles in the left prelimbic (PrL) cortex in mice, we determined their safety and physical characteristics. Depressive-like behavior was established in mice using a chronic unpredictable mild stress (CUMS) model. SPIO nanodrugs were then delivered precisely to the left PrL cortex using in situ injection. A 0.1 T magnetic field (adjustable frequency) was used for magnetic stimulation (5 min/session, two sessions daily). Biomarkers representing therapeutic effects were measured before and after c-MSS intervention. Results showed that c-MSS rapidly improved depressive-like symptoms in CUMS mice after stimulation with a 10 Hz field for 5 d, combined with increased brain-derived neurotrophic factor (BDNF) and inactivation of hypothalamic-pituitary-adrenal (HPA) axis function, which enhanced neuronal activity due to SPIO nanoparticle-mediated effects. The c-MSS was safe and effective, representing a novel approach in the selective stimulation of arbitrary cortical targets in small animals, playing a bioelectric role in neural circuit regulation, including antidepressant effects in CUMS mice. This expands the potential applications of magnetic stimulation and progresses brain research towards clinical application.

The Effect of Transcranial Direct Current Stimulation in Changing Resting-State Functional Connectivity in Patients With Neurological Disorders: A Systematic Review

BACKGROUND

People with neurological disorders are found to have abnormal resting-state functional connectivity (rsFC), which is associated with the persistent functional impairment found in these patients. Recently, transcranial direct current stimulation (tDCS) has been shown to improve rsFC, although the results are inconsistent.

OBJECTIVE

We hope to explore whether tDCS induces rsFC changes among patients with neurological disorders, whether rsFC is clinically relevant and how different tDCS parameters affect rsFC outcome among these individuals.

METHODS

A systematic review was conducted according to PRISMA guidelines (systematic review registration number: CRD42020168654). Randomized controlled trials that studied the tDCS effects on rsFC between the experimental and sham-controlled groups using either electrophysiological or neuroimaging methods were included.

RESULTS

Active tDCS can induce changes in both localized (ie, brain regions under the transcranial electrodes) and diffused (ie, brain regions not directly influenced by the transcranial electrodes) rsFC. Interestingly, fMRI studies showed that the default mode network was enhanced regardless of patients' diagnoses, the stimulation paradigms used or the rsFC analytical methods employed. Second, stimulation intensity, but not total stimulation time, appeared to positively influence the effect of tDCS on rsFC.

LIMITATIONS AND CONCLUSION

Due to the inherent heterogeneity in rsFC analytical methods and tDCS protocols, meta-analysis was not conducted. We recommend that future studies may investigate the effect of tDCS on rsFC for repeated cathodal stimulation. For clinicians, we suggest anodal stimulation at a higher stimulation intensity within the safety limit may maximize tDCS effects in modulating aberrant functional connectivity of patients with neurological disorders.

Examining the effects of transcranial direct current stimulation on human episodic memory with machine learning

We aimed to replicate a published effect of transcranial direct-current stimulation (tDCS)-induced recognition enhancement over the human ventrolateral prefrontal cortex (VLPFC) and analyse the data with machine learning. We investigated effects over an adjacent region, the dorsolateral prefrontal cortex (DLPFC). In total, we analyzed data from 97 participants after exclusions. We found weak or absent effects over the VLPFC and DLPFC. We conducted machine learning studies to examine the effects of semantic and phonetic features on memorization, which revealed no effect of VLPFC tDCS on the original dataset or the current data. The highest contributing factor to memory performance was individual differences in memory not explained by word features, tDCS group, or sample size, while semantic, phonetic, and orthographic word characteristics did not contribute significantly. To our knowledge, this is the first tDCS study to investigate cognitive effects with machine learning, and future studies may benefit from studying physiological as well as cognitive effects with data-driven approaches and computational models.

Neural diffusivity and pre-emptive epileptic seizure intervention

The propagation of epileptic seizure activity in the brain is a widespread pathophysiology that, in principle, should yield to intervention techniques guided by mathematical models of neuronal ensemble dynamics. During a seizure, neural activity will deviate from its current dynamical regime to one in which there are significant signal fluctuations. In silico treatments of neural activity are an important tool for the understanding of how the healthy brain can maintain stability, as well as of how pathology can lead to seizures. The hope is that, contained within the mathematical foundations of such treatments, there lie potential strategies for mitigating instabilities, e.g. via external stimulation. Here, we demonstrate that the dynamic causal modelling neuronal state equation generalises to a Fokker-Planck formalism if one extends the framework to model the ways in which activity propagates along the structural connections of neural systems. Using the Jacobian of this generalised state equation, we show that an initially unstable system can be rendered stable via a reduction in diffusivity–i.e., by lowering the rate at which neuronal fluctuations disperse to neighbouring regions. We show, for neural systems prone to epileptic seizures, that such a reduction in diffusivity can be achieved via external stimulation. Specifically, we show that this stimulation should be applied in such a way as to temporarily mirror the activity profile of a pathological region in its functionally connected areas. This counter-intuitive method is intended to be used pre-emptively–i.e., in order to mitigate the effects of the seizure, or ideally even prevent it from occurring in the first place. We offer proof of principle using simulations based on functional neuroimaging data collected from patients with idiopathic generalised epilepsy, in which we successfully suppress pathological activity in a distinct sub-network prior to seizure onset. Our hope is that this technique can form the basis for future real-time monitoring and intervention devices that are capable of treating epilepsy in a non-invasive manner.

Epilepsy is a disease that affects over 50 million people worldwide. Current treatments include dangerous surgical procedures in which brain connections are severed, or even in which entire problem brain regions are removed. Pharmaceutical options are available, but only about one third of patients are responsive. However, even in these cases the drugs can cause such severe side effects that the patients sometimes choose to suffer seizures. We are proposing an innovative treatment of epilepsy that could be achieved by using non-invasive electrical stimulation. Specifically, we show that stimulation should be applied in such a way as to mirror the activity in a problem brain region, by targeting its neighbouring areas. This counterintuitive approach is based on a mathematical model in which this mirroring strategy is applied pre-emptively, i.e. long before the seizure has a chance to set in. The hope is that future clinical trials will be able to use this model to lessen the effect of seizures, or even prevent them from occurring in the first place.

Anodal transcranial direct current stimulation over the posterior parietal cortex enhances three-dimensional mental rotation ability

Prior neuroimaging and neurophysiological studies have found that the right posterior parietal cortex (PPC) plays an important role in mental rotation ability. Transcranial direct-current stimulation (tDCS) has been shown the potential to enhance cognitive ability by delivering a low current to the brain cortex of interest, via electrodes on the scalp. Here, we tested whether stimulating the PPC with tDCS can improve three-dimensional mental rotation performance and narrow gender difference. The classic three-dimensional Shepard-Metzler task was measured after three stimulation conditions (right PPC, left PPC, sham stimulation). The results indicated that stimulating the right PPC induced an improvement in accuracy and response time of mental rotation relative to sham stimulation. Stimulating the left PPC caused an enhancement in the accuracy but not in the response time. Gender difference during mental rotation was diminished after stimulation. These findings indicated that the PPC regions played a causal role in mental rotation ability. tDCS could be used as a promising non-invasive method to improve mental rotation skills in individuals with lower ability and to provide an effective therapeutic tool for neurological disorder rehabilitation.

Focal stimulation of the temporoparietal junction improves rationality in prosocial decision-making

We tested the hypothesis that modulation of neurocomputational inputs to value-based decision-making affects the rationality of economic choices. The brain's right temporoparietal junction (rTPJ) has been functionally associated with both social behavior and with domain-general information processing and attention. To identify the causal function of rTPJ in prosocial decisions, we administered focal high definition transcranial direct current stimulation (HD-tDCS) while participants allocated money between themselves and a charity in a modified dictator game. Anodal stimulation led to improved rationality as well as increased charitable giving and egalitarianism, resulting in more consistent and efficient choices and increased sensitivity to the price of giving. These results are consistent with the theory that anodal stimulation of the rTPJ increases the precision of value computations in social decision-making. Our results demonstrate that theories of rTPJ function should account for the multifaceted role of the rTPJ in the representation of social inputs into value-based decisions.

The left prefrontal cortex supports inhibitory processing during semantic memory retrieval

Semantic control refers to a set of neural and cognitive mechanisms that govern semantic processing and retrieval. Neuroimaging studies have indicated that controlled semantic processing engages the left prefrontal cortex (PFC), yet the functional role of the prefrontal activity in semantic control is poorly understood and was therefore addressed in the present study. We used a double-blind randomized controlled experiment, in which participants from three distinct groups received anodal transcranial direct current stimulation (tDCS) over left lateral PFC (n = 40), a control tDCS over temporoparietal cortex (n = 40), or sham stimulation (n = 41), while executing automatic and controlled semantic retrieval tasks as well as additional control tasks assessing working memory and semantic judgement. We demonstrate that anodal tDCS of the left lateral PFC improved inhibition of prepotent semantic associations but had no significant effect on retrieval of habitual associates or switching between retrieval rules. The prefrontal tDCS also enhanced working memory capacity, but this effect did not account for the improved semantic inhibition. The control temporoparietal tDCS did not affect semantic retrieval. Our findings show that semantic inhibition and switching represent distinct components of the semantic control system and indicate that the left lateral PFC is involved in a filtering process that constrains the accessible semantic representations (i.e., a proactive pre-retrieval inhibition) or suppresses already retrieved responses (i.e., a retroactive post-retrieval inhibition). The recognition of such an inhibitory process could inspire novel treatments targeting altered semantic processing.

Update on the Use of Transcranial Electrical Brain Stimulation to Manage Acute and Chronic COVID-19 Symptoms

The coronavirus disease 19 (COVID-19) pandemic has resulted in the urgent need to develop and deploy treatment approaches that can minimize mortality and morbidity. As infection, resulting illness, and the often prolonged recovery period continue to be characterized, therapeutic roles for transcranial electrical stimulation (tES) have emerged as promising non-pharmacological interventions. tES techniques have established therapeutic potential for managing a range of conditions relevant to COVID-19 illness and recovery, and may further be relevant for the general management of increased mental health problems during this time. Furthermore, these tES techniques can be inexpensive, portable, and allow for trained self-administration. Here, we summarize the rationale for using tES techniques, specifically transcranial Direct Current Stimulation (tDCS), across the COVID-19 clinical course, and index ongoing efforts to evaluate the inclusion of tES optimal clinical care.

Sex Differences in Neuromodulation Treatment Approaches for Traumatic Brain Injury: A Scoping Review

OBJECTIVE

Neuromodulatory brain stimulation interventions for traumatic brain injury (TBI)-related health sequelae, such as psychiatric, cognitive, and pain disorders, are on the rise. Because of disproportionate recruitment and epidemiological reporting of TBI-related research in men, there is limited understanding of TBI development, pathophysiology, and treatment intervention outcomes in women. With data suggesting sex-related variances in treatment outcomes, it is important that these gaps are addressed in emerging, neuromodulatory treatment approaches for TBI populations.

METHODS

Four research databases (PubMED, EMBASE, CINAHL, and PsycINFO) were electronically searched in February 2020.

DESIGN

This PRISMA Scoping Review (PRISMA-ScR)-guided report contextualizes the importance of reporting sex differences in TBI + neuromodulatory intervention studies and summarizes the current state of reporting sex differences when investigating 3 emerging interventions for TBI outcomes.

RESULTS

Fifty-four studies were identified for the final review including 12 controlled trials, 16 single or case series reports, and 26 empirical studies. Across all studies reviewed, 68% of participants were male, and only 7 studies reported sex differences as a part of their methodological approach, analysis, or discussion.

CONCLUSION

This review is hoped to update the TBI community on the current state of evidence in reporting sex differences across these 3 neuromodulatory treatments of post-TBI sequelae. The proposed recommendations aim to improve future research and clinical treatment of all individuals suffering from post-TBI sequelae.

Breaking the ice to improve motor outcomes in patients with chronic stroke: a retrospective clinical study on neuromodulation plus robotics

BACKGROUND

Stroke is one of the main causes of impairment affecting daily activities and quality of life. There is a growing effort to potentiate the recovery of functional gait and to enable stroke patients to walk independently.

AIM

To estimate the effects of dual-site transcranial direct current stimulation (dstDCS) on gait recovery in chronic stroke patients provided with robot-aided gait training (RAGT).

METHODS

Thirty-seven patients were included in this retrospective clinical study. Nine patients were provided with dstDCS during the first 10 min of RAGT by using Lokomat®Pro (on-RAGT), 15 patients immediately after RAGT (post-RAGT), and 13 patients immediately before RAGT (pre-RAGT).

RESULTS

Each group improved over time concerning disability burden and lower limb strength. on-RAGT and post-RAGT experienced better improvement in balance (p < 0.001) and, moderately, gait endurance (p = 0.04) as compared to pre-RAGT. Furthermore, all treatments decreased the facilitation of the unaffected hemisphere (p < 0.001) and the inhibition of the affected hemisphere (p < 0.001). The duration of such aftereffects was found to be greater for post-RAGT.

DISCUSSION AND CONCLUSION

This is the first trial with dstDCS coupled with RAGT in chronic stroke patients with gait impairment. When timely coupled with RAGT, dstDCS may be considered an effective tool for the recovery of lower limb function in patients with first unilateral stroke in the chronic phase. Moreover, our data suggest the ductility of dstDCS concerning RAGT timing, thus making this intervention suitable in a neurorehabilitation setting and well adaptable to patients' needs.

Cognitive training and brain stimulation in prodromal Alzheimer's disease (AD-Stim)-study protocol for a double-blind randomized controlled phase IIb (monocenter) trial

BACKGROUND

Given the growing older population worldwide, and the associated increase in age-related diseases, such as Alzheimer's disease (AD), investigating non-invasive methods to ameliorate or even prevent cognitive decline in prodromal AD is highly relevant. Previous studies suggest transcranial direct current stimulation (tDCS) to be an effective method to boost cognitive performance, especially when applied in combination with cognitive training in healthy older adults. So far, no studies combining tDCS concurrent with an intense multi-session cognitive training in prodromal AD populations have been conducted.

METHODS

The AD-Stim trial is a monocentric, randomized, double-blind, placebo-controlled study, including a 3-week tDCS-assisted cognitive training with anodal tDCS over left DLPFC (target intervention), compared to cognitive training plus sham (control intervention). The cognitive training encompasses a letter updating task and a three-stage Markov decision-making task. Forty-six participants with subjective cognitive decline (SCD) or mild cognitive impairment (MCI) will be randomized block-wise to either target or control intervention group and participate in nine interventional visits with additional pre- and post-intervention assessments. Performance in the letter updating task after training and anodal tDCS compared to sham stimulation will be analyzed as primary outcome. Further, performance on the second training task and transfer tasks will be investigated. Two follow-up visits (at 1 and 7 months post-training) will be performed to assess possible maintenance effects. Structural and functional magnetic resonance imaging (MRI) will be applied before the intervention and at the 7-month follow-up to identify possible neural predictors for successful intervention.

SIGNIFICANCE

With this trial, we aim to provide evidence for tDCS-induced improvements of multi-session cognitive training in participants with SCD and MCI. An improved understanding of tDCS effects on cognitive training performance and neural predictors may help to develop novel approaches to counteract cognitive decline in participants with prodromal AD.

TRIAL REGISTRATION

ClinicalTrials.gov , NCT04265378 . Registered on 07 February 2020. Retrospectively registered. Protocol version: Based on BB 004/18 version 1.2 (May 17, 2019).

SPONSOR

University Medicine Greifswald.

Enhancing Motor Brain Activity Improves Memory for Action Language: A tDCS Study

The embodied cognition approach to linguistic meaning posits that action language understanding is grounded in sensory-motor systems. However, evidence that the human motor cortex is necessary for action language memory is meager. To address this issue, in two groups of healthy individuals, we perturbed the left primary motor cortex (M1) by means of either anodal or cathodal transcranial direct current stimulation (tDCS), before participants had to memorize lists of manual action and attentional sentences. In each group, participants received sham and active tDCS in two separate sessions. Following anodal tDCS (a-tDCS), participants improved the recall of action sentences compared with sham tDCS. No similar effects were detected following cathodal tDCS (c-tDCS). Both a-tDCS and c-tDCS induced variable changes in motor excitability, as measured by motor-evoked potentials induced by transcranial magnetic stimulation. Remarkably, across groups, action-specific memory improvements were positively predicted by changes in motor excitability. We provide evidence that excitatory modulation of the motor cortex selectively improves performance in a task requiring comprehension and memory of action sentences. These findings indicate that M1 is necessary for accurate processing of linguistic meanings and thus provide causal evidence that high-order cognitive functions are grounded in the human motor system.

Investigating the Interaction Between Form and Motion Processing: A Review of Basic Research and Clinical Evidence

A widely held view of the visual system supported the perspective that the primate brain is organized in two main specialized streams, called the ventral and dorsal streams. The ventral stream is known to be involved in object recognition (e.g., form and orientation). In contrast, the dorsal stream is thought to be more involved in spatial recognition (e.g., the spatial relationship between objects and motion direction). Recent evidence suggests that these two streams are not segregated but interact with each other. A class of visual stimuli known as Glass patterns has been developed to shed light on this process. Glass patterns are visual stimuli made of pairs of dots, called dipoles, that give the percept of a specific form or apparent motion, depending on the spatial and temporal arrangement of the dipoles. In this review, we show an update of the neurophysiological, brain imaging, psychophysical, clinical, and brain stimulation studies which have assessed form and motion integration mechanisms, and the level at which this occurs in the human and non-human primate brain. We also discuss several studies based on non-invasive brain stimulation techniques that used different types of visual stimuli to assess the cortico-cortical interactions in the visual cortex for the processing of form and motion information. Additionally, we discuss the timing of specific visual processing in the ventral and dorsal streams. Finally, we report some parallels between healthy participants and neurologically impaired patients in the conscious processing of form and motion.

Transcranial Magnetic Stimulation and the Understanding of Behavior

The development of the use of transcranial magnetic stimulation (TMS) in the study of psychological functions has entered a new phase of sophistication. This is largely due to an increasing physiological knowledge of its effects and to its being used in combination with other experimental techniques. This review presents the current state of our understanding of the mechanisms of TMS in the context of designing and interpreting psychological experiments. We discuss the major conceptual advances in behavioral studies using TMS. There are meaningful physiological and technical achievements to review, as well as a wealth of new perceptual and cognitive experiments. In doing so we summarize the different uses and challenges of TMS in mental chronometry, perception, awareness, learning, and memory.

Neurostimulation Reveals Context-Dependent Arbitration Between Model-Based and Model-Free Reinforcement Learning

While it is established that humans use model-based (MB) and model-free (MF) reinforcement learning in a complementary fashion, much less is known about how the brain determines which of these systems should control behavior at any given moment. Here we provide causal evidence for a neural mechanism that acts as a context-dependent arbitrator between both systems. We applied excitatory and inhibitory transcranial direct current stimulation over a region of the left ventrolateral prefrontal cortex previously found to encode the reliability of both learning systems. The opposing neural interventions resulted in a bidirectional shift of control between MB and MF learning. Stimulation also affected the sensitivity of the arbitration mechanism itself, as it changed how often subjects switched between the dominant system over time. Both of these effects depended on varying task contexts that either favored MB or MF control, indicating that this arbitration mechanism is not context-invariant but flexibly incorporates information about current environmental demands.

A Systematic Review of Non-invasive Brain Stimulation Applications to Memory in Healthy Aging

It has long been acknowledged that memory changes over the course of one's life, irrespective of diseases like dementia. Approaches to mitigate these changes have however yielded mixed results. Brain stimulation has been identified as one novel approach of augmenting older adult's memory. Thus far, such approaches have however been nuanced, targeting different memory domains with different methodologies. This has produced an amalgam of research with an unclear image overall. This systematic review therefore aims to clarify this landscape, evaluating, and interpreting available research findings in a coherent manner. A systematic search of relevant literature was conducted across Medline, PsycInfo, Psycarticles and the Psychology and Behavioral Sciences Collection, which uncovered 44 studies employing non-invasive electrical brain stimulation in healthy older adults. All studies were of generally good quality spanning numerous memory domains. Within these, evidence was found for non-invasive brain stimulation augmenting working, episodic, associative, semantic, and procedural memory, with the first three domains having the greatest evidence base. Key sites for stimulation included the left dorsolateral prefrontal cortex (DLPFC), temporoparietal region, and primary motor cortex, with transcranial direct current stimulation (tDCS) holding the greatest literature base. Inconsistencies within the literature are highlighted and interpreted, however this discussion was constrained by potential confounding variables within the literature, a risk of bias, and challenges defining research aims and results. Non-invasive brain stimulation often did however have a positive and predictable impact on older adult's memory, and thus warrants further research to better understand these effects.