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Toutant DB, El-Alawi H, Choi EH, Wright N, Khanam M, Paunovic B, Ko JH, Ng MC. High-definition transcranial direct current stimulation desynchronizes refractory status epilepticus. Neurotherapeutics 2024; 21:e00343. [PMID: 38580510 PMCID: PMC11067454 DOI: 10.1016/j.neurot.2024.e00343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 02/28/2024] [Accepted: 03/01/2024] [Indexed: 04/07/2024] Open
Abstract
Recently, we showed that high-definition transcranial direct current stimulation (hd-tDCS) can acutely reduce epileptic spike rates during and after stimulation in refractory status epilepticus (RSE), with a greater likelihood of patient discharge from the intensive care unit compared to historical controls. We investigate whether electroencephalographic (EEG) desynchronization during hd-tDCS can help account for observed anti-epileptic effects. Defining desynchronization as greater power in higher frequencies such as above 30 Hz ("gamma") and lesser power in frequency bands lower than 30 Hz, we analyzed 27 EEG sessions from 10 RSE patients who had received 20-minute session(s) of 2-milliamperes of transcranial direct current custom-targeted at the epileptic focus as previously determined by a clinical EEGer monitoring the EEG in real-time. During hd-tDCS, median relative power change over the EEG electrode chains in which power changes were maximal was +4.84%, -5.25%, -1.88%, -1.94%, and +4.99% for respective delta, theta, alpha, beta, and gamma frequency bands in the bipolar longitudinal montage (p = 0.0001); and +4.13%, -5.44%, -1.81%, -3.23%, and +5.41% in the referential Laplacian montage (p = 0.0012). After hd-tDCS, median relative power changes reversed over the EEG electrode chains in which power changes were maximal: -2.74%, +4.20%, +1.74%, +1.75%, and -4.68% for the respective delta, theta, alpha, beta, and gamma frequency bands in the bipolar longitudinal montage (p = 0.0001); and +1.59%, +5.07%, +1.74%, +2.40%, and -5.12% in the referential Laplacian montage (p = 0.0004). These findings are consistent with EEG desynchronization through theta-alpha-beta-gamma bands during hd-tDCS, helping account for the efficacy of hd-tDCS as an emerging novel anti-epileptic therapy against RSE.
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Affiliation(s)
- Darion B Toutant
- Graduate Program in Biomedical Engineering, University of Manitoba, Winnipeg, Canada.
| | - Hussam El-Alawi
- Undergraduate Medical Education, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
| | - Eun Hyung Choi
- Department of Human Anatomy and Cell Science, University of Manitoba, Winnipeg, Canada
| | - Natalie Wright
- Department of Human Anatomy and Cell Science, University of Manitoba, Winnipeg, Canada
| | - Manzuma Khanam
- Department of Human Anatomy and Cell Science, University of Manitoba, Winnipeg, Canada
| | - Bojan Paunovic
- Undergraduate Medical Education, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada; Section of Critical Care Medicine, Department of Internal Medicine, University of Manitoba, Winnipeg, Canada
| | - Ji Hyun Ko
- Graduate Program in Biomedical Engineering, University of Manitoba, Winnipeg, Canada; Department of Human Anatomy and Cell Science, University of Manitoba, Winnipeg, Canada
| | - Marcus C Ng
- Graduate Program in Biomedical Engineering, University of Manitoba, Winnipeg, Canada; Undergraduate Medical Education, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada; Section of Neurology, Department of Internal Medicine, University of Manitoba, Winnipeg, Canada
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Effectiveness of Anodal otDCS Following with Anodal tDCS Rather than tDCS Alone for Increasing of Relative Power of Intrinsic Matched EEG Bands in Rat Brains. Brain Sci 2022; 13:brainsci13010072. [PMID: 36672053 PMCID: PMC9856406 DOI: 10.3390/brainsci13010072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 12/19/2022] [Accepted: 12/26/2022] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND This study sought to determine whether (1) evidence is available of interactions between anodal tDCS and oscillated tDCS stimulation patterns to increase the power of endogenous brain oscillations and (2) the frequency matching the applied anodal otDCS's frequency and the brain's dominant intrinsic frequency influence power shifting during stimulation pattern sessions by both anodal DCS and anodal oscillated DCS. METHOD Rats received different anodal tDCS and otDCS stimulation patterns using 8.5 Hz and 13 Hz state-related dominant intrinsic frequencies of anodal otDCS. The rats were divided into groups with specific stimulation patterns: group A: tDCS-otDCS (8.5 Hz)-otDCS (13 Hz); group B: otDCS (8.5 Hz)-tDCS-otDCS (13 Hz); group C: otDCS (13 Hz)-tDCS-otDCS (8.5 Hz). Acute relative power changes (i.e., following 10 min stimulation sessions) in six frequency bands-delta (1.5-4 Hz), theta (4-7 Hz), alpha-1 (7-10 Hz), alpha-2 (10-12 Hz), beta-1 (12-15 Hz) and beta-2 (15-20 Hz)-were compared using three factors and repeated ANOVA measurement. RESULTS For each stimulation, tDCS increased theta power band and, above bands alpha and beta, a drop in delta power was observed. Anodal otDCS had a mild increasing power effect in both matched intrinsic and delta bands. In group pattern stimulations, increased power of endogenous frequencies matched exogenous otDCS frequencies-8.5 Hz or 13 Hz-with more potent effects in upper bands. The power was markedly more potent with the otDCS-tDCS stimulation pattern than the tDCS-otDCS pattern. SIGNIFICANCE The findings suggest that the otDCS-tDCS pattern stimulation increased the power in matched intrinsic oscillations and, significantly, in the above bands in an ascending order. We provide evidence for the successful corporation between otDCS (as frequency-matched guidance) and tDCS (as a power generator) rather than tDCS alone when stimulating a desired brain intrinsic band (herein, tES specificity).
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Simula S, Daoud M, Ruffini G, Biagi MC, Bénar CG, Benquet P, Wendling F, Bartolomei F. Transcranial current stimulation in epilepsy: A systematic review of the fundamental and clinical aspects. Front Neurosci 2022; 16:909421. [PMID: 36090277 PMCID: PMC9453675 DOI: 10.3389/fnins.2022.909421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 07/18/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose Transcranial electrical current stimulation (tES or tCS, as it is sometimes referred to) has been proposed as non-invasive therapy for pharmacoresistant epilepsy. This technique, which includes direct current (tDCS) and alternating current (tACS) stimulation involves the application of weak currents across the cortex to change cortical excitability. Although clinical trials have demonstrated the therapeutic efficacy of tES, its specific effects on epileptic brain activity are poorly understood. We sought to summarize the clinical and fundamental effects underlying the application of tES in epilepsy. Methods A systematic review was performed in accordance with the PRISMA guidelines. A database search was performed in PUBMED, MEDLINE, Web of Science and Cochrane CENTRAL for articles corresponding to the keywords “epilepsy AND (transcranial current stimulation OR transcranial electrical stimulation)”. Results A total of 56 studies were included in this review. Through these records, we show that tDCS and tACS epileptic patients are safe and clinically relevant techniques for epilepsy. Recent articles reported changes of functional connectivity in epileptic patients after tDCS. We argue that tDCS may act by affecting brain networks, rather than simply modifying local activity in the targeted area. To explain the mechanisms of tES, various cellular effects have been identified. Among them, reduced cell loss, mossy fiber sprouting, and hippocampal BDNF protein levels. Brain modeling and human studies highlight the influence of individual brain anatomy and physiology on the electric field distribution. Computational models may optimize the stimulation parameters and bring new therapeutic perspectives. Conclusion Both tDCS and tACS are promising techniques for epilepsy patients. Although the clinical effects of tDCS have been repeatedly assessed, only one clinical trial has involved a consistent number of epileptic patients and little knowledge is present about the clinical outcome of tACS. To fill this gap, multicenter studies on tES in epileptic patients are needed involving novel methods such as personalized stimulation protocols based on computational modeling. Furthermore, there is a need for more in vivo studies replicating the tES parameters applied in patients. Finally, there is a lack of clinical studies investigating changes in intracranial epileptiform discharges during tES application, which could clarify the nature of tES-related local and network dynamics in epilepsy.
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Affiliation(s)
- Sara Simula
- Aix Marseille Univ, INSERM, INS, Int Neurosci Syst, Marseille, France
| | - Maëva Daoud
- Aix Marseille Univ, INSERM, INS, Int Neurosci Syst, Marseille, France
| | | | | | | | | | | | - Fabrice Bartolomei
- Aix Marseille Univ, INSERM, INS, Int Neurosci Syst, Marseille, France
- APHM, Timone Hospital, Epileptology and Cerebral Rhythmology, Marseille, France
- *Correspondence: Fabrice Bartolomei
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Preliminary Study on Safety Assessment of 10 Hz Transcranial Alternating Current Stimulation in Rat Brain. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12115299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Assessment of the safety of transcranial electrical stimulation devices that contact the scalp and apply electrical stimulations to brain tissues is essential for the prevention of unexpected brain damage caused by electromagnetic fields. In particular, safety studies on transcranial alternating current stimulation (tACS) are needed for active applications to treat brain diseases and for the development of medical devices, because there is a lack of research on the safety of tACS, in contrast to transcranial direct current stimulation. In this study, the safety of tACS with selected parameters, i.e., a stimulation intensity of 1.0 to 2.0 mA, a frequency of 10 Hz, and a treatment time of 20 min, was examined at a preclinical stage using small animals (rats). The results of magnetic resonance imaging and histopathological imaging indicated that the conditions applied in this study provided safe tACS without damaging brain tissues or neuronal components in the acute phase. In addition, the temperature did not increase above 41 °C, which is a temperature limitation for contact-type medical devices, even after 20 min of tACS application.
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da Silva Fiorin F, de Araújo E Silva M, Rodrigues AC. Electrical stimulation in animal models of epilepsy: A review on cellular and electrophysiological aspects. Life Sci 2021; 285:119972. [PMID: 34560081 DOI: 10.1016/j.lfs.2021.119972] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 09/02/2021] [Accepted: 09/17/2021] [Indexed: 01/24/2023]
Abstract
Epilepsy is a debilitating condition, primarily refractory individuals, leading to the search for new efficient therapies. Electrical stimulation is an important method used for years to treat several neurological disorders. Currently, electrical stimulation is used to reduce epileptic crisis in patients and shows promising results. Even though the use of electricity to treat neurological disorders has grown worldwide, there are still many caveats that must be clarified, such as action mechanisms and more efficient stimulation treatment parameters. Thus, this review aimed to explore the comprehension of the main stimulation methods in animal models of epilepsy using rodents to develop new experimental protocols and therapeutic approaches.
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Affiliation(s)
- Fernando da Silva Fiorin
- Graduate Program in Neuroengineering, Edmond and Lily Safra International Institute of Neuroscience, Santos Dumont Institute, Brazil.
| | - Mariane de Araújo E Silva
- Graduate Program in Neuroengineering, Edmond and Lily Safra International Institute of Neuroscience, Santos Dumont Institute, Brazil
| | - Abner Cardoso Rodrigues
- Graduate Program in Neuroengineering, Edmond and Lily Safra International Institute of Neuroscience, Santos Dumont Institute, Brazil
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Gouveia FV, Germann J, Oliveira CC, Castro MC, Antunes GF, Gomes GCV, Pinto TRC, Martinez RCR, Valle AC. Transcranial Direct Current Stimulation Reduces Anxiety, Depression and Plasmatic Corticosterone in a Rat Model of Atypical Generalized Epilepsy. Neuroscience 2021; 480:32-41. [PMID: 34774711 DOI: 10.1016/j.neuroscience.2021.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 10/22/2021] [Accepted: 11/02/2021] [Indexed: 11/30/2022]
Abstract
Affective disorders (i.e. anxiety and depression) are commonly observed in patients with epilepsy and induce seizure aggravation. Animal models of epilepsy that exhibit affective disorder features are essential in developing new neuromodulatory treatments. GEAS-W rats (Generalized Epilepsy with Absence Seizures, Wistar background) are an inbred model of generalized epilepsy showing spontaneous spike-wave discharges concomitant with immobility. Transcranial Direct Current Stimulation (tDCS) is a safe non-invasive neuromodulatory therapy used to modulate dysfunctional circuitries frequently and successfully applied in affective disorders for symptom alleviation. Here we investigated anxiolytic and antidepressant effects of tDCS in GEAS-W rats and the role of corticosterone as a possible mechanism of action. GEAS-W and Wistar rats were randomly divided into control, sham-tDCS and active-tDCS groups. Both tDCS groups received 15 sessions of sham or active-tDCS (1 mA, cathode). Behavioural tests included the Open Field and Forced Swimming tests followed by corticosterone analysis. We observed a main effect of treatment and a significant treatment by strain interaction on anxiety-like and depressive-like behaviours, with active-tDCS GEAS-W rats entering the center of the open field more often and showing less immobility in the forced swimming test. Furthermore, there was a main effect of treatment on corticosterone with active-tDCS animals showing marked reduction in plasmatic levels. This study described preclinical evidence to support tDCS treatment of affective disorders in epilepsy and highlights corticosterone as a possible mechanism of action.
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Affiliation(s)
- Flavia Venetucci Gouveia
- Program in Neuroscience and Mental Health, Hospital for Sick Children Research Institute, Toronto, Canada; Division of Neuroscience, Sírio-Libanês Hospital, São Paulo, Brazil.
| | - Jürgen Germann
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Canada
| | | | - Marina C Castro
- Division of Neuroscience, Sírio-Libanês Hospital, São Paulo, Brazil
| | - Geiza F Antunes
- Division of Neuroscience, Sírio-Libanês Hospital, São Paulo, Brazil
| | - Gisele C V Gomes
- Laboratory of Neuroscience LIM 01, Department of Pathology, University of Sao Paulo, School of Medicine, São Paulo, Brazil
| | - Tais R C Pinto
- Laboratory of Neuroscience LIM 01, Department of Pathology, University of Sao Paulo, School of Medicine, São Paulo, Brazil
| | - Raquel C R Martinez
- Division of Neuroscience, Sírio-Libanês Hospital, São Paulo, Brazil; LIM 23, Institute of Psychiatry, University of Sao Paulo, School of Medicine, São Paulo, Brazil.
| | - Angela C Valle
- Laboratory of Neuroscience LIM 01, Department of Pathology, University of Sao Paulo, School of Medicine, São Paulo, Brazil
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San-Juan D. Cathodal Transcranial Direct Current Stimulation in Refractory Epilepsy: A Noninvasive Neuromodulation Therapy. J Clin Neurophysiol 2021; 38:503-508. [PMID: 34261114 DOI: 10.1097/wnp.0000000000000717] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
SUMMARY Epilepsy is a chronic disease of the brain that affects individuals of all ages and has a worldwide distribution. According to a 2006 World Health Organization report, 50 million people had epilepsy. Approximately 30% of people with epilepsy have refractory disease despite recent therapeutic developments. Consequently, new treatments are necessary. Transcranial direct current stimulation (tDCS) is a noninvasive method for cortical excitability modulation by subthreshold membrane depolarization or hyperpolarization (cathodal stimulation decreases cortical excitability, whereas anodal stimulation increases it), which has been shown to be safe, economical, and easy to use. The mechanism of action of tDCS is partially understood. Cathodal tDCS in vitro and in vivo animal studies have shown that direct current and cathodal tDCS can successfully induce suppression of epileptiform activity in EEG recordings. Cathodal tDCS has been used in heterogeneous clinical trials in pediatric and adult patients with refractory epilepsy and is well tolerated. A comprehensive review of the clinical trials based on their quality and biases shows evidence that cathodal tDCS in patients with epilepsy is potentially effective. However, additional randomized clinical trials are needed with other etiologies, special populations, additional concomitants therapies, long-term follow-up, and new parameters of stimulation.
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Affiliation(s)
- Daniel San-Juan
- Clinical Neurophysiology Department, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
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Tinker RJ, Lim AZ, Stefanetti RJ, McFarland R. Current and Emerging Clinical Treatment in Mitochondrial Disease. Mol Diagn Ther 2021; 25:181-206. [PMID: 33646563 PMCID: PMC7919238 DOI: 10.1007/s40291-020-00510-6] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2020] [Indexed: 12/11/2022]
Abstract
Primary mitochondrial disease (PMD) is a group of complex genetic disorders that arise due to pathogenic variants in nuclear or mitochondrial genomes. Although PMD is one of the most prevalent inborn errors of metabolism, it often exhibits marked phenotypic variation and can therefore be difficult to recognise. Current treatment for PMD revolves around supportive and preventive approaches, with few disease-specific therapies available. However, over the last decade there has been considerable progress in our understanding of both the genetics and pathophysiology of PMD. This has resulted in the development of a plethora of new pharmacological and non-pharmacological therapies at varying stages of development. Many of these therapies are currently undergoing clinical trials. This review summarises the latest emerging therapies that may become mainstream treatment in the coming years. It is distinct from other recent reviews in the field by comprehensively addressing both pharmacological non-pharmacological therapy from both a bench and a bedside perspective. We highlight the current and developing therapeutic landscape in novel pharmacological treatment, dietary supplementation, exercise training, device use, mitochondrial donation, tissue replacement gene therapy, hypoxic therapy and mitochondrial base editing.
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Affiliation(s)
- Rory J Tinker
- Wellcome Centre for Mitochondrial Research, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK
- Clinical and Translational Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK
| | - Albert Z Lim
- Wellcome Centre for Mitochondrial Research, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK
- Clinical and Translational Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK
| | - Renae J Stefanetti
- Wellcome Centre for Mitochondrial Research, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK
- Clinical and Translational Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK
| | - Robert McFarland
- Wellcome Centre for Mitochondrial Research, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK.
- Clinical and Translational Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK.
- NHS Highly Specialised Service for Rare Mitochondrial Disorders for Adults and Children, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.
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San-Juan D, Morales Báez JA, Farías Fernández LD, López NG, Segovia DR, Pesqueira GQ, Vázquez ML, Ruffini G, Rotenberg A. In-session seizures during transcranial direct current stimulation in patients with epilepsy. Brain Stimul 2020; 14:152-153. [PMID: 33338670 DOI: 10.1016/j.brs.2020.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 12/13/2020] [Indexed: 11/25/2022] Open
Affiliation(s)
- Daniel San-Juan
- Epilepsy Service, National Institute of Neurology and Neurosurgery, Mexico City, Mexico.
| | - Jorge A Morales Báez
- Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, Mexico
| | - Luis D Farías Fernández
- Vicerrectoría de Ciencias de La Salud, Universidad de Monterrey, San Pedro Garza García, Mexico
| | - Noel Gallardo López
- Facultad de Medicina, Benemérita Universidad Autónoma de Puebla, Puebla, Mexico
| | - Dante Ríos Segovia
- Departamento de Medicina y Nutrición, Universidad de Guanajuato, León, Mexico
| | | | - Máximo León Vázquez
- Hospital Regional No. 1 "Carlos MacGregor Sánchez Navarro", Instituto Mexicano Del Seguro Social, Ciudad de México, Mexico
| | | | - Alexander Rotenberg
- Neuromodulation Program and Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States
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Regner GG, Torres ILS, de Oliveira C, Pflüger P, da Silva LS, Scarabelot VL, Ströher R, de Souza A, Fregni F, Pereira P. Transcranial direct current stimulation (tDCS) affects neuroinflammation parameters and behavioral seizure activity in pentylenetetrazole-induced kindling in rats. Neurosci Lett 2020; 735:135162. [PMID: 32569808 DOI: 10.1016/j.neulet.2020.135162] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 06/07/2020] [Accepted: 06/14/2020] [Indexed: 10/24/2022]
Abstract
Despite the introduction of new antiepileptic drugs, about 30 % of patients with epilepsy are refractory to drug therapy. Thus, the search for non-pharmacological interventions such as transcranial direct current stimulation (tDCS) may be an alternative, either alone or in combination with low doses of anticonvulsants. This study evaluated the effect of anodal (a-tDCS) and cathodal tDCS (c-tDCS) on seizure behavior and neuroinflammation parameters. Rats were submitted to the kindling model induced by pentylenetetrazole (PTZ) using diazepam (DZP) as anticonvulsant standard. tDCS groups were submitted to 10 sessions of a-tDCS or c-tDCS or SHAM-tDCS. Every 3 days they received saline (SAL), low dose of DZP (alone or in combination with tDCS) or effective dose of DZP 30 min before administration of PTZ, totaling 16 days of protocol. Neither a-tDCS nor c-tDCS reduced the occurrence of clonic forelimb seizures (convulsive motor seizures - stage 3 by the adapted Racine scale we based on). Associated with DZP, c-tDCS (c-tDCS/DZP0.15) increased the latency to first clonic forelimb seizure on the 10th and 16th days. Hippocampal IL-1β levels were reduced by c-tDCS and c-tDCS/DZP0.15. In contrast, these treatments induced an increase in cortical IL-1β levels. Hippocampal TNF-α levels were not altered by c-tDCS or a-tDCS, but c-tDCS and c-tDCS/DZP0.15 increased those levels in cerebral cortex. Cortical NGF levels were increased by c-tDCS and c-tDCS/DZP0.15. a-tDCS/DZP0.15 reduced hippocampal BDNF levels and c-tDCS/DZP0.15 increased these levels in cerebral cortex. In conclusion, c-tDCS alone or in combination with a low dose of DZP showed to affect neuroinflammation, improving central neurotrophin levels and decreasing hippocampal IL-1β levels after PTZ-induced kindling without statistically significant effect on seizure behavior.
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Affiliation(s)
- Gabriela Gregory Regner
- Laboratory of Neuropharmacology and Preclinical Toxicology Laboratory, Postgraduate Program in Biological Sciences: Pharmacology and Therapeutics, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, 90050-170, Brazil; Laboratory of Pain Pharmacology and Neuromodulation: Preclinical Studies - Centro de Pesquisa Experimental (CPE), Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS 90035-003, Brazil
| | - Iraci L S Torres
- Laboratory of Pain Pharmacology and Neuromodulation: Preclinical Studies - Centro de Pesquisa Experimental (CPE), Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS 90035-003, Brazil; Postgraduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.
| | - Carla de Oliveira
- Laboratory of Pain Pharmacology and Neuromodulation: Preclinical Studies - Centro de Pesquisa Experimental (CPE), Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS 90035-003, Brazil; Postgraduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Pricila Pflüger
- Laboratory of Neuropharmacology and Preclinical Toxicology Laboratory, Postgraduate Program in Biological Sciences: Pharmacology and Therapeutics, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, 90050-170, Brazil
| | - Lisiane Santos da Silva
- Laboratory of Pain Pharmacology and Neuromodulation: Preclinical Studies - Centro de Pesquisa Experimental (CPE), Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS 90035-003, Brazil
| | - Vanessa Leal Scarabelot
- Laboratory of Pain Pharmacology and Neuromodulation: Preclinical Studies - Centro de Pesquisa Experimental (CPE), Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS 90035-003, Brazil
| | - Roberta Ströher
- Laboratory of Pain Pharmacology and Neuromodulation: Preclinical Studies - Centro de Pesquisa Experimental (CPE), Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS 90035-003, Brazil
| | - Andressa de Souza
- Laboratory of Pain Pharmacology and Neuromodulation: Preclinical Studies - Centro de Pesquisa Experimental (CPE), Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS 90035-003, Brazil
| | - Felipe Fregni
- Laboratory of Neuromodulation, Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard University, Boston, United States
| | - Patrícia Pereira
- Laboratory of Neuropharmacology and Preclinical Toxicology Laboratory, Postgraduate Program in Biological Sciences: Pharmacology and Therapeutics, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, 90050-170, Brazil
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Sun Y, Dhamne SC, Carretero-Guillén A, Salvador R, Goldenberg MC, Godlewski BR, Pascual-Leone A, Madsen JR, Stone SSD, Ruffini G, Márquez-Ruiz J, Rotenberg A. Drug-Responsive Inhomogeneous Cortical Modulation by Direct Current Stimulation. Ann Neurol 2020; 88:489-502. [PMID: 32542794 PMCID: PMC10675838 DOI: 10.1002/ana.25822] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 06/11/2020] [Accepted: 06/12/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Cathodal direct current stimulation (cDCS) induces long-term depression (LTD)-like reduction of cortical excitability (DCS-LTD), which has been tested in the treatment of epilepsy with modest effects. In part, this may be due to variable cortical neuron orientation relative to the electric field. We tested, in vivo and in vitro, whether DCS-LTD occurs throughout the cortical thickness, and if not, then whether drug-DCS pairing can enhance the uniformity of the cortical response and the cDCS antiepileptic effect. METHODS cDCS-mediated changes in cortical excitability were measured in vitro in mouse motor cortex (M1) and in human postoperative neocortex, in vivo in mouse somatosensory cortex (S1), and in a mouse kainic acid (KA)-seizure model. Contributions of N-methyl-D-aspartate-type glutamate receptors (NMDARs) to cDCS-mediated plasticity were tested with application of NMDAR blockers (memantine/D-AP5). RESULTS cDCS reliably induced DCS-LTD in superficial cortical layers, and a long-term potentiation (LTP)-like enhancement (DCS-LTP) was recorded in deep cortical layers. Immunostaining confirmed layer-specific increase of phospho-S6 ribosomal protein in mouse M1. Similar nonuniform cDCS aftereffects on cortical excitability were also found in human neocortex in vitro and in S1 of alert mice in vivo. Application of memantine/D-AP5 either produced a more uniform DCS-LTD throughout the cortical thickness or at least abolished DCS-LTP. Moreover, a combination of memantine and cDCS suppressed KA-induced seizures. INTERPRETATION cDCS aftereffects are not uniform throughout cortical layers, which may explain the incomplete cDCS clinical efficacy. NMDAR antagonists may augment cDCS efficacy in epilepsy and other disorders where regional depression of cortical excitability is desirable. ANN NEUROL 2020;88:489-502.
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Affiliation(s)
- Yan Sun
- Department of Neurology and the F. M. Kirby Neurobiology Center, Boston, Massachusetts, USA
- Neuromodulation Program and Division of Epilepsy and Clinical Neurophysiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Sameer C Dhamne
- Department of Neurology and the F. M. Kirby Neurobiology Center, Boston, Massachusetts, USA
- Neuromodulation Program and Division of Epilepsy and Clinical Neurophysiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | | | - Marti C Goldenberg
- Department of Neurology and the F. M. Kirby Neurobiology Center, Boston, Massachusetts, USA
- Repository Core, Boston Children's Hospital, Boston, Massachusetts, USA
| | | | - Alvaro Pascual-Leone
- Berenson-Allen Center for Noninvasive Brain Stimulation, Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
- Guttmann Institute, Autonomous University of Barcelona, Barcelona, Spain
| | - Joseph R Madsen
- Department of Neurosurgery, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Scellig S D Stone
- Department of Neurosurgery, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Giulio Ruffini
- Neuroelectrics Corporation, Cambridge, Massachusetts, USA
| | - Javier Márquez-Ruiz
- Department of Physiology, Anatomy and Cellular Biology, Pablo de Olavide University, Seville, Spain
| | - Alexander Rotenberg
- Department of Neurology and the F. M. Kirby Neurobiology Center, Boston, Massachusetts, USA
- Neuromodulation Program and Division of Epilepsy and Clinical Neurophysiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Berenson-Allen Center for Noninvasive Brain Stimulation, Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
- Guttmann Institute, Autonomous University of Barcelona, Barcelona, Spain
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12
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MacMullin P, Hodgson N, Damar U, Lee HHC, Hameed MQ, Dhamne SC, Hyde D, Conley GM, Morriss N, Qiu J, Mannix R, Hensch TK, Rotenberg A. Increase in Seizure Susceptibility After Repetitive Concussion Results from Oxidative Stress, Parvalbumin-Positive Interneuron Dysfunction and Biphasic Increases in Glutamate/GABA Ratio. Cereb Cortex 2020; 30:6108-6120. [PMID: 32676666 DOI: 10.1093/cercor/bhaa157] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 04/29/2020] [Accepted: 05/18/2020] [Indexed: 12/13/2022] Open
Abstract
Chronic symptoms indicating excess cortical excitability follow mild traumatic brain injury, particularly repetitive mild traumatic brain injury (rmTBI). Yet mechanisms underlying post-traumatic excitation/inhibition (E/I) ratio abnormalities may differ between the early and late post-traumatic phases. We therefore measured seizure threshold and cortical gamma-aminobutyric acid (GABA) and glutamate (Glu) concentrations, 1 and 6 weeks after rmTBI in mice. We also analyzed the structure of parvalbumin-positive interneurons (PVIs), their perineuronal nets (PNNs), and their electroencephalography (EEG) signature (gamma frequency band power). For mechanistic insight, we measured cortical oxidative stress, reflected in the reduced/oxidized glutathione (GSH/GSSG) ratio. We found that seizure susceptibility increased both early and late after rmTBI. However, whereas increased Glu dominated the E/I 1 week after rmTBI, Glu concentration normalized and the E/I was instead characterized by depressed GABA, reduced per-PVI parvalbumin expression, and reduced gamma EEG power at the 6-week post-rmTBI time point. Oxidative stress was increased early after rmTBI, where transient PNN degradation was noted, and progressed throughout the monitoring period. We conclude that GSH depletion, perhaps triggered by early Glu-mediated excitotoxicity, leads to late post-rmTBI loss of PVI-dependent cortical inhibitory tone. We thus propose dampening of Glu signaling, maintenance of redox state, and preservation of PVI inhibitory capacity as therapeutic targets for post-rmTBI treatment.
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Affiliation(s)
| | | | - Ugur Damar
- F.M. Kirby Neurobiology Center, Department of Neurology
| | | | - Mustafa Q Hameed
- F.M. Kirby Neurobiology Center, Department of Neurology.,Department of Neurosurgery
| | | | - Damon Hyde
- F.M. Kirby Neurobiology Center, Department of Neurology
| | - Grace M Conley
- Department of Emergency Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Nicholas Morriss
- Department of Emergency Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Jianhua Qiu
- Department of Emergency Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Rebekah Mannix
- Department of Emergency Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
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13
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Zhao X, Ding J, Pan H, Zhang S, Pan D, Yu H, Ye Z, Hua T. Anodal and cathodal tDCS modulate neural activity and selectively affect GABA and glutamate syntheses in the visual cortex of cats. J Physiol 2020; 598:3727-3745. [PMID: 32506434 DOI: 10.1113/jp279340] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Accepted: 06/02/2020] [Indexed: 12/13/2022] Open
Abstract
KEY POINTS The present study showed that anodal and cathodal transcranial direct current stimulation (tDCS) can respectively increase and decrease the amplitude of visually evoked field potentials in the stimulated visual cortex of cats, with the effect lasting for ∼60-70 min. We directly measured tDCS-induced changes in the concentration of inhibitory and excitatory neurotransmitters in the visual cortex using the enzyme-linked immunosorbent assay method and showed that anodal and cathodal tDCS can selectively decrease the concentration of GABA and glutamate in the stimulated cortical area. Anodal and cathodal tDCS can selectively inhibit the synthesis of GABA and glutamate by suppressing the expression of GABA- and glutamate-synthesizing enzymes, respectively. ABSTRACT Transcranial direct current stimulation (tDCS) evokes long-lasting neuronal excitability in the target brain region. The underlying neural mechanisms remain poorly understood. The present study examined tDCS-induced alterations in neuronal activities, as well as the concentration and synthesis of GABA and glutamate (GLU), in area 21a (A21a) of cat visual cortex. Our analysis showed that anodal and cathodal tDCS respectively enhanced and suppressed neuronal activities in A21a, as indicated by a significantly increased and decreased amplitude of visually evoked field potentials (VEPs). The tDCS-induced effect lasted for ∼60-70 min. By contrast, sham tDCS had no significant impact on the VEPs in A21a. On the other hand, the concentration of GABA, but not that of GLU, in A21a significantly decreased after anodal tDCS relative to sham tDCS, whereas the concentration of GLU, but not that of GABA, in A21a significantly decreased after cathodal tDCS relative to sham tDCS. Furthermore, the expression of GABA-synthesizing enzymes GAD65 and GAD67 in A21a significantly decreased in terms of both mRNA and protein concentrations after anodal tDCS relative to sham tDCS, whereas that of GLU-synthesizing enzyme glutaminase (GLS) did not change significantly after anodal tDCS. By contrast, both mRNA and protein concentrations of GLS in A21a significantly decreased after cathodal tDCS relative to sham tDCS, whereas those of GAD65/GAD67 showed no significant change after cathodal tDCS. Taken together, these results indicate that anodal and cathodal tDCS may selectively reduce GABA and GLU syntheses and thus respectively enhance and suppress neuronal excitability in the stimulated brain area.
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Affiliation(s)
- Xiaojing Zhao
- College of Life Sciences, Anhui Normal University, Wuhu, Anhui, China
| | - Jian Ding
- College of Life Sciences, Anhui Normal University, Wuhu, Anhui, China
| | - Huijun Pan
- College of Life Sciences, Anhui Normal University, Wuhu, Anhui, China
| | - Shen Zhang
- College of Life Sciences, Anhui Normal University, Wuhu, Anhui, China
| | - Deng Pan
- College of Life Sciences, Anhui Normal University, Wuhu, Anhui, China
| | - Hao Yu
- College of Life Sciences, Anhui Normal University, Wuhu, Anhui, China
| | - Zheng Ye
- College of Life Sciences, Anhui Normal University, Wuhu, Anhui, China
| | - Tianmiao Hua
- College of Life Sciences, Anhui Normal University, Wuhu, Anhui, China
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14
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Wu YJ, Chien ME, Huang CH, Chiang CC, Lin CC, Huang CW, Durand DM, Hsu KS. Transcranial direct current stimulation alleviates seizure severity in kainic acid-induced status epilepticus rats. Exp Neurol 2020; 328:113264. [DOI: 10.1016/j.expneurol.2020.113264] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 02/28/2020] [Indexed: 12/20/2022]
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15
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Safety and Tolerability of Repetitive Transcranial Magnetic Stimulation During Pregnancy: A Case Report and Literature Review. J Clin Neurophysiol 2020; 37:164-169. [PMID: 32142024 DOI: 10.1097/wnp.0000000000000552] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Patients with neuropsychiatric disease may benefit from repetitive transcranial magnetic stimulation as a nonpharmacologic alternative to relieve symptoms of major depression, obsessive compulsive disorder, and perhaps other syndromes such as epilepsy. We present a case of repetitive transcranial magnetic stimulation treatment as an adjunct therapy for a patient experiencing refractory epileptic seizures during the third trimester of pregnancy. Notably, the patient tolerated repetitive transcranial magnetic stimulation well, without adverse events, and delivered a healthy child. We also summarize the current literature pertaining to therapeutic repetitive transcranial magnetic stimulation use during pregnancy.
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16
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17
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Memory and Cognition-Related Neuroplasticity Enhancement by Transcranial Direct Current Stimulation in Rodents: A Systematic Review. Neural Plast 2020; 2020:4795267. [PMID: 32211039 PMCID: PMC7061127 DOI: 10.1155/2020/4795267] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 01/27/2020] [Accepted: 02/06/2020] [Indexed: 12/19/2022] Open
Abstract
Brain stimulation techniques, including transcranial direct current stimulation (tDCS), were identified as promising therapeutic tools to modulate synaptic plasticity abnormalities and minimize memory and learning deficits in many neuropsychiatric diseases. Here, we revised the effect of tDCS on the modulation of neuroplasticity and cognition in several animal disease models of brain diseases affecting plasticity and cognition. Studies included in this review were searched following the terms (“transcranial direct current stimulation”) AND (mice OR mouse OR animal) and according to the PRISMA statement requirements. Overall, the studies collected suggest that tDCS was able to modulate brain plasticity due to synaptic modifications within the stimulated area. Changes in plasticity-related mechanisms were achieved through induction of long-term potentiation (LTP) and upregulation of neuroplasticity-related proteins, such as c-fos, brain-derived neurotrophic factor (BDNF), or N-methyl-D-aspartate receptors (NMDARs). Taken into account all revised studies, tDCS is a safe, easy, and noninvasive brain stimulation technique, therapeutically reliable, and with promising potential to promote cognitive enhancement and neuroplasticity. Since the use of tDCS has increased as a novel therapeutic approach in humans, animal studies are important to better understand its mechanisms as well as to help improve the stimulation protocols and their potential role in different neuropathologies.
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18
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Liu HH, He XK, Chen HY, Peng CW, Rotenberg A, Juan CH, Pei YC, Liu HL, Chiang YH, Wang JY, Feng XJ, Huang YZ, Hsieh TH. Neuromodulatory Effects of Transcranial Direct Current Stimulation on Motor Excitability in Rats. Neural Plast 2019; 2019:4252943. [PMID: 31949429 PMCID: PMC6942908 DOI: 10.1155/2019/4252943] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 11/14/2019] [Indexed: 11/17/2022] Open
Abstract
Transcranial direct current stimulation (tDCS) is a noninvasive technique for modulating neural plasticity and is considered to have therapeutic potential in neurological disorders. For the purpose of translational neuroscience research, a suitable animal model can be ideal for providing a stable condition for identifying mechanisms that can help to explore therapeutic strategies. Here, we developed a tDCS protocol for modulating motor excitability in anesthetized rats. To examine the responses of tDCS-elicited plasticity, the motor evoked potential (MEP) and MEP input-output (IO) curve elicited by epidural motor cortical electrical stimulus were evaluated at baseline and after 30 min of anodal tDCS or cathodal tDCS. Furthermore, a paired-pulse cortical electrical stimulus was applied to assess changes in the inhibitory network by measuring long-interval intracortical inhibition (LICI) before and after tDCS. In the results, analogous to those observed in humans, the present study demonstrates long-term potentiation- (LTP-) and long-term depression- (LTD-) like plasticity can be induced by tDCS protocol in anesthetized rats. We found that the MEPs were significantly enhanced immediately after anodal tDCS at 0.1 mA and 0.8 mA and remained enhanced for 30 min. Similarly, MEPs were suppressed immediately after cathodal tDCS at 0.8 mA and lasted for 30 min. No effect was noted on the MEP magnitude under sham tDCS stimulation. Furthermore, the IO curve slope was elevated following anodal tDCS and presented a trend toward diminished slope after cathodal tDCS. No significant differences in the LICI ratio of pre- to post-tDCS were observed. These results indicated that developed tDCS schemes can produce consistent, rapid, and controllable electrophysiological changes in corticomotor excitability in rats. This newly developed tDCS animal model could be useful to further explore mechanical insights and may serve as a translational platform bridging human and animal studies, establishing new therapeutic strategies for neurological disorders.
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Affiliation(s)
- Hui-Hua Liu
- Department of Rehabilitation Medicine, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
- School of Physical Therapy and Graduate Institute of Rehabilitation Science, Chang Gung University, Taoyuan, Taiwan
| | - Xiao-Kuo He
- School of Physical Therapy and Graduate Institute of Rehabilitation Science, Chang Gung University, Taoyuan, Taiwan
- Department of Rehabilitation, The Fifth Hospital of Xiamen, Xiamen, Fujian, China
| | - Hsin-Yung Chen
- Department of Occupational Therapy and Institute of Behavioral Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Neurology and Dementia Center, Taoyuan Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan
| | - Chih-Wei Peng
- School of Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan
| | - Alexander Rotenberg
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Chi-Hung Juan
- Institute of Cognitive Neuroscience, National Central University, Taoyuan, Taiwan
- Brain Research Center, National Central University, Taoyuan, Taiwan
| | - Yu-Cheng Pei
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Hao-Li Liu
- Department of Electrical Engineering, Chang Gung University, Taoyuan, Taiwan
| | - Yung-Hsiao Chiang
- Department of Neurosurgery, Taipei Medical University Hospital, Taipei, Taiwan
- Graduate Program on Neuroregeneration, Taipei Medical University, Taipei, Taiwan
| | - Jia-Yi Wang
- Graduate Institute of Medical Sciences, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
| | - Xiao-Jun Feng
- Department of Rehabilitation Medicine, The Second Hospital of Anhui Medical University and Anhui Medical University, Hefei, China
| | - Ying-Zu Huang
- Department of Neurology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taipei, Taiwan
- Neuroscience Research Center, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
- Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan
| | - Tsung-Hsun Hsieh
- School of Physical Therapy and Graduate Institute of Rehabilitation Science, Chang Gung University, Taoyuan, Taiwan
- Neuroscience Research Center, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
- Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan
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19
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Tsuboyama M, Lee Kaye H, Rotenberg A. Biomarkers Obtained by Transcranial Magnetic Stimulation of the Motor Cortex in Epilepsy. Front Integr Neurosci 2019; 13:57. [PMID: 31736722 PMCID: PMC6837164 DOI: 10.3389/fnint.2019.00057] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Accepted: 09/23/2019] [Indexed: 12/13/2022] Open
Abstract
Epilepsy is associated with numerous neurodevelopmental disorders. Transcranial magnetic stimulation (TMS) of the motor cortex coupled with electromyography (EMG) enables biomarkers that provide measures of cortical excitation and inhibition that are particularly relevant to epilepsy and related disorders. The motor threshold (MT), cortical silent period (CSP), short interval intracortical inhibition (SICI), intracortical facilitation (ICF), and long interval intracortical inhibition (LICI) are among TMS-derived metrics that are modulated by antiepileptic drugs. TMS may have a practical role in optimization of antiepileptic medication regimens, as studies demonstrate dose-dependent relationships between TMS metrics and acute medication administration. A close association between seizure freedom and normalization of cortical excitability with long-term antiepileptic drug use highlights a plausible utility of TMS in measures of anti-epileptic drug efficacy. Finally, TMS-derived biomarkers distinguish patients with various epilepsies from healthy controls and thus may enable development of disorder-specific biomarkers and therapies both within and outside of the epilepsy realm.
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Affiliation(s)
- Melissa Tsuboyama
- Neuromodulation Program, Department of Neurology, Division of Epilepsy and Clinical Neurophysiology, Boston Children's Hospital, Boston, MA, United States.,FM Kirby Neurobiology Center, Department of Neurology, Boston Children's Hospital, Boston, MA, United States
| | - Harper Lee Kaye
- Neuromodulation Program, Department of Neurology, Division of Epilepsy and Clinical Neurophysiology, Boston Children's Hospital, Boston, MA, United States.,FM Kirby Neurobiology Center, Department of Neurology, Boston Children's Hospital, Boston, MA, United States
| | - Alexander Rotenberg
- Neuromodulation Program, Department of Neurology, Division of Epilepsy and Clinical Neurophysiology, Boston Children's Hospital, Boston, MA, United States.,FM Kirby Neurobiology Center, Department of Neurology, Boston Children's Hospital, Boston, MA, United States.,Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Boston, MA, United States
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20
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Chen SG, Tsai CH, Lin CJ, Lee CC, Yu HY, Hsieh TH, Liu HL. Transcranial focused ultrasound pulsation suppresses pentylenetetrazol induced epilepsy in vivo. Brain Stimul 2019; 13:35-46. [PMID: 31575487 DOI: 10.1016/j.brs.2019.09.011] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 09/04/2019] [Accepted: 09/23/2019] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Epilepsy is a neurological disorder characterized by abnormal neuron discharge, and one-third of epilepsy patients suffer from drug-resistant epilepsy (DRE). The current management for DRE includes epileptogenic lesion resection, disconnection, and neuromodulation. Neuromodulation is achieved through invasive electrical stimulus including deep brain stimulation, vagus nerve stimulation, or responsive neurostimulation (RNS). As an alternative therapy, transcranial focused ultrasound (FUS) can transcranially and non-invasively modulate neuron activity. OBJECTIVE This study seeks to verify the use of FUS pulsations to suppress spikes in an acute epileptic small-animal model, and to investigate possible biological mechanisms by which FUS pulsations interfere with epileptic neuronal activity. METHODS The study used a total of 76 Sprague-Dawley rats. For the epilepsy model, rats were administered pentylenetetrazol (PTZ) to induce acute epileptic-like abnormal neuron discharges, followed by FUS exposure. Various ultrasound parameters were set to test the epilepsy-suppressing effect, while concurrently monitoring and analyzing electroencephalogram (EEG) signals. Animal behavior was monitored and histological examinations were conducted to evaluate the hazard posed by ultrasound exposure and the expression of neuronal activity markers. Western blotting was used to evaluate the correlation between FUS-induced epileptic suppression and the PI3K-mTOR signaling pathway. RESULTS We observed that FUS pulsations effectively suppressed epileptic activity and observed EEG spectrum oscillations; the spike-suppressing effect depended on the selection of ultrasound parameters and highly correlated with FUS exposure level. Expression level changes of c-Fos and GAD65 were confirmed in the cortex and hippocampus, indicating that FUS pulsations deactivated excitatory cells and activated GABAergic terminals. No tissue damage, inflammatory response, or behavioral abnormalities were observed in rats treated with FUS under these exposure parameters. We also found that the FUS pulsations down-regulated the S6 phosphorylation and decreased pAKT expression. CONCLUSION Our results suggest that pulsed FUS exposure effectively suppresses epileptic spikes in an acute epilepsy animal model, and finds that ultrasound pulsation interferes with neuronal activity and affects the PTZ-induced PI3K-Akt-mTOR pathway, which might help explain the mechanism underlying ultrasound-related epileptic spike control.
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Affiliation(s)
- Sin-Guang Chen
- Department of Electrical Engineering, Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan; Department of Health Technology and Informatics, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region
| | - Chih-Hung Tsai
- Department of Electrical Engineering, Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan
| | - Chia-Jung Lin
- Department of Electrical Engineering, Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan
| | - Cheng-Chia Lee
- Department of Neurosurgery, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine and Brain Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Hsiang-Yu Yu
- School of Medicine and Brain Research Center, National Yang-Ming University, Taipei, Taiwan; Department of Neurology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Tsung-Hsun Hsieh
- School of Physical Therapy and Graduate Institute of Rehabilitation Science, Chang Gung University, Taoyuan, Taiwan; Neuroscience Research Center, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan.
| | - Hao-Li Liu
- Department of Electrical Engineering, Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan; Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.
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21
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Schneegans H, Stetefeld H, Dohmen C, Onur OA, Lehnhardt FG. Successful Treatment of Super-Refractory Status Epilepticus with High-Intensity Electroconvulsive Therapy - A Case Report and Review of the Current Literature. J Epilepsy Res 2019; 9:76-82. [PMID: 31482059 PMCID: PMC6706647 DOI: 10.14581/jer.19008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 12/01/2018] [Accepted: 03/20/2019] [Indexed: 01/19/2023] Open
Abstract
Status epilepticus (SE) is a severe neurological condition in which epileptic activity is prolonged or recurring, and the likelihood of spontaneous seizure cessation decreases over time. Evidence on the appropriate treatment regimen in therapy-refractory cases is still sparse. Electroconvulsive therapy (ECT) is known as a last resort treatment for SE due its anticonvulsant properties mediated by an increase in seizure threshold during the course of a treatment series. We examined the effects of ECT in a 61-year-old male patient with new-onset super-refractory SE (SRSE), for whom previous extensive efforts to achieve seizure control had failed. To achieve reliable seizure inductions in ECT concomitantly with an extended anticonvulsant treatment, we established a high-intensity ECT protocol: bitemporal ECT was conducted at a double-dosage setting (200% stimulation energy; equivalent to a mean charge of 1,031 mC) including three seizure stimulations during each treatment session on consecutive days until SRSE termination. After the first course of ECT, temporary seizure cessation was reached but lasted for only several days. A second course of ECT was then initiated, using the identical regimen but followed by tapering sessions every other day. Again, the SRSE terminated and after regaining consciousness the patient could be transferred to an acute rehabilitation facility. SRSE cessation can successfully be achieved by means of high-intensity ECT even after six weeks of prolonged SE and exhausted anticonvulsant pharmacotherapeutic strategies. As controlled clinical trials in the area of SRSE are still lacking, the relative significance of a high-intensity ECT protocol in this clinical setting has yet to be determined.
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Affiliation(s)
- Hanna Schneegans
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
| | | | - Christian Dohmen
- Department of Neurology, University of Cologne, Cologne, Germany
| | - Oezguer A Onur
- Department of Neurology, University of Cologne, Cologne, Germany
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22
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Sánchez-León CA, Ammann C, Medina JF, Márquez-Ruiz J. Using animal models to improve the design and application of transcranial electrical stimulation in humans. Curr Behav Neurosci Rep 2018; 5:125-135. [PMID: 30013890 DOI: 10.1007/s40473-018-0149-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Purpose of Review Transcranial electrical stimulation (tES) is a non-invasive stimulation technique used for modulating brain function in humans. To help tES reach its full therapeutic potential, it is necessary to address a number of critical gaps in our knowledge. Here, we review studies that have taken advantage of animal models to provide invaluable insight about the basic science behind tES. Recent Findings Animal studies are playing a key role in elucidating the mechanisms implicated in tES, defining safety limits, validating computational models, inspiring new stimulation protocols, enhancing brain function and exploring new therapeutic applications. Summary Animal models provide a wealth of information that can facilitate the successful utilization of tES for clinical interventions in human subjects. To this end, tES experiments in animals should be carefully designed to maximize opportunities for applying discoveries to the treatment of human disease.
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Affiliation(s)
| | - Claudia Ammann
- CINAC, University Hospital HM Puerta del Sur, CEU - San Pablo University, 28938-Móstoles, Madrid, Spain
| | - Javier F Medina
- Department of Neuroscience, Baylor College of Medicine, Houston, Texas, USA
| | - Javier Márquez-Ruiz
- Division of Neurosciences, Pablo de Olavide University, 41013-Seville, Spain
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23
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Regner GG, Pereira P, Leffa DT, de Oliveira C, Vercelino R, Fregni F, Torres ILS. Preclinical to Clinical Translation of Studies of Transcranial Direct-Current Stimulation in the Treatment of Epilepsy: A Systematic Review. Front Neurosci 2018; 12:189. [PMID: 29623027 PMCID: PMC5874505 DOI: 10.3389/fnins.2018.00189] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 03/08/2018] [Indexed: 12/09/2022] Open
Abstract
Epilepsy is a chronic brain syndrome characterized by recurrent seizures resulting from excessive neuronal discharges. Despite the development of various new antiepileptic drugs, many patients are refractory to treatment and report side effects. Non-invasive methods of brain stimulation, such as transcranial direct current stimulation (tDCS), have been tested as alternative approaches to directly modulate the excitability of epileptogenic neural circuits. Although some pilot and initial clinical studies have shown positive results, there is still uncertainty regarding the next steps of investigation in this field. Therefore, we reviewed preclinical and clinical studies using the following framework: (1) preclinical studies that have been successfully translated to clinical studies, (2) preclinical studies that have failed to be translated to clinical studies, and (3) clinical findings that were not previously tested in preclinical studies. We searched PubMed, Web of Science, Embase, and SciELO (2002–2017) using the keywords “tDCS,” “epilepsy,” “clinical trials,” and “animal models.” Our initial search resulted in 64 articles. After applying inclusion and exclusion criteria, we screened 17 full-text articles to extract findings about the efficacy of tDCS, with respect to the therapeutic framework used and the resulting reduction in seizures and epileptiform patterns. We found that few preclinical findings have been translated into clinical research (number of sessions and effects on seizure frequency) and that most findings have not been tested clinically (effects of tDCS on status epilepticus and absence epilepsy, neuroprotective effects in the hippocampus, and combined use with specific medications). Finally, considering that clinical studies on tDCS have been conducted for several epileptic syndromes, most were not previously tested in preclinical studies (Rasmussen's encephalitis, drug resistant epilepsy, and hippocampal sclerosis-induced epilepsy). Overall, most studies report positive findings. However, it is important to underscore that a successful preclinical study may not indicate success in a clinical study, considering the differences highlighted herein. Although most studies report significant findings, there are still important insights from preclinical work that must be tested clinically. Understanding these factors may improve the evidence for the potential use of this technique as a clinical tool in the treatment of epilepsy.
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Affiliation(s)
- Gabriela G Regner
- Laboratory of Neuropharmacology and Preclinical Toxicology, Institute of Basic Health Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Laboratory of Pain Pharmacology and Neuromodulation, Preclinical Studies - Pharmacology Department, Institute of Basic Health Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Postgraduate Program in Biological Sciences, Pharmacology and Therapeutics, Institute of Basic Health Sciences, Universidade Federal Rio Grande do Sul, Porto Alegre, Brazil
| | - Patrícia Pereira
- Laboratory of Neuropharmacology and Preclinical Toxicology, Institute of Basic Health Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Postgraduate Program in Biological Sciences, Pharmacology and Therapeutics, Institute of Basic Health Sciences, Universidade Federal Rio Grande do Sul, Porto Alegre, Brazil
| | - Douglas T Leffa
- Laboratory of Pain Pharmacology and Neuromodulation, Preclinical Studies - Pharmacology Department, Institute of Basic Health Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Postgraduate Program in Medical Sciences, School of Medicine Universidade Federal Rio Grande do Sul, Porto Alegre, Brazil
| | - Carla de Oliveira
- Laboratory of Pain Pharmacology and Neuromodulation, Preclinical Studies - Pharmacology Department, Institute of Basic Health Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Postgraduate Program in Medical Sciences, School of Medicine Universidade Federal Rio Grande do Sul, Porto Alegre, Brazil
| | - Rafael Vercelino
- Laboratory of Pain Pharmacology and Neuromodulation, Preclinical Studies - Pharmacology Department, Institute of Basic Health Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Centro Universitário FADERGS, Health and Wellness School Laureate International Universities, Porto Alegre, Brazil
| | - Felipe Fregni
- Laboratory of Neuromodulation, Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard University, Boston, MA, United States
| | - Iraci L S Torres
- Laboratory of Pain Pharmacology and Neuromodulation, Preclinical Studies - Pharmacology Department, Institute of Basic Health Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Postgraduate Program in Biological Sciences, Pharmacology and Therapeutics, Institute of Basic Health Sciences, Universidade Federal Rio Grande do Sul, Porto Alegre, Brazil.,Postgraduate Program in Medical Sciences, School of Medicine Universidade Federal Rio Grande do Sul, Porto Alegre, Brazil
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Yuskaitis CJ, Jones BM, Wolfson RL, Super CE, Dhamne SC, Rotenberg A, Sabatini DM, Sahin M, Poduri A. A mouse model of DEPDC5-related epilepsy: Neuronal loss of Depdc5 causes dysplastic and ectopic neurons, increased mTOR signaling, and seizure susceptibility. Neurobiol Dis 2017; 111:91-101. [PMID: 29274432 DOI: 10.1016/j.nbd.2017.12.010] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 11/27/2017] [Accepted: 12/19/2017] [Indexed: 12/15/2022] Open
Abstract
DEPDC5 is a newly identified epilepsy-related gene implicated in focal epilepsy, brain malformations, and Sudden Unexplained Death in Epilepsy (SUDEP). In vitro, DEPDC5 negatively regulates amino acid sensing by the mTOR complex 1 (mTORC1) pathway, but the role of DEPDC5 in neurodevelopment and epilepsy has not been described. No animal model of DEPDC5-related epilepsy has recapitulated the neurological phenotypes seen in patients, and germline knockout rodent models are embryonic lethal. Here, we establish a neuron-specific Depdc5 conditional knockout mouse by cre-recombination under the Synapsin1 promotor. Depdc5flox/flox-Syn1Cre (Depdc5cc+) mice survive to adulthood with a progressive neurologic phenotype that includes motor abnormalities (i.e., hind limb clasping) and reduced survival compared to littermate control mice. Depdc5cc+ mice have larger brains with increased cortical neuron size and dysplastic neurons throughout the cortex, comparable to the abnormal neurons seen in human focal cortical dysplasia specimens. Depdc5 results in constitutive mTORC1 hyperactivation exclusively in neurons as measured by the increased phosphorylation of the downstream ribosomal protein S6. Despite a lack of increased mTORC1 signaling within astrocytes, Depdc5cc+ brains show reactive astrogliosis. We observed two Depdc5cc+ mice to have spontaneous seizures, including a terminal seizure. We demonstrate that as a group Depdc5cc+ mice have lowered seizure thresholds, as evidenced by decreased latency to seizures after chemoconvulsant injection and increased mortality from pentylenetetrazole-induced seizures. In summary, our neuron-specific Depdc5 knockout mouse model recapitulates clinical, pathological, and biochemical features of human DEPDC5-related epilepsy and brain malformations. We thereby present an important model in which to study targeted therapeutic strategies for DEPDC5-related conditions.
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Affiliation(s)
- Christopher J Yuskaitis
- Department of Neurology, F.M. Kirby Neurobiology Center, Boston Children's Hospital, Boston, MA 02115, USA; Division of Epilepsy and Clinical Neurophysiology and Epilepsy Genetics Program, Boston Children's Hospital, Boston, MA 02115, USA; Department of Neurology, Harvard Medical School, Boston, MA 02115, USA
| | - Brandon M Jones
- Department of Neurology, F.M. Kirby Neurobiology Center, Boston Children's Hospital, Boston, MA 02115, USA
| | - Rachel L Wolfson
- Whitehead Institute for Biomedical Research, 455 Main Street, Cambridge, MA 02142, USA
| | - Chloe E Super
- Department of Neurology, F.M. Kirby Neurobiology Center, Boston Children's Hospital, Boston, MA 02115, USA
| | - Sameer C Dhamne
- Department of Neurology, F.M. Kirby Neurobiology Center, Boston Children's Hospital, Boston, MA 02115, USA
| | - Alexander Rotenberg
- Department of Neurology, F.M. Kirby Neurobiology Center, Boston Children's Hospital, Boston, MA 02115, USA; Division of Epilepsy and Clinical Neurophysiology and Epilepsy Genetics Program, Boston Children's Hospital, Boston, MA 02115, USA; Department of Neurology, Harvard Medical School, Boston, MA 02115, USA; Neuromodulation Program, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - David M Sabatini
- Whitehead Institute for Biomedical Research, 455 Main Street, Cambridge, MA 02142, USA; Department of Biology, Massachusetts Institute of Technology, 77 Massachusetts Avenue, Cambridge, MA 02139, USA; Howard Hughes Medical Institute, Department of Biology, Massachusetts Institute of Technology, 77 Massachusetts Avenue, Cambridge, MA 02139, USA; Koch Institute for Integrative Cancer Research at MIT, 77 Massachusetts Avenue, Cambridge, MA 02139, USA; Broad Institute, 415 Main Street, Cambridge, MA 02142, USA
| | - Mustafa Sahin
- Department of Neurology, F.M. Kirby Neurobiology Center, Boston Children's Hospital, Boston, MA 02115, USA; Department of Neurology, Harvard Medical School, Boston, MA 02115, USA.
| | - Annapurna Poduri
- Department of Neurology, F.M. Kirby Neurobiology Center, Boston Children's Hospital, Boston, MA 02115, USA; Division of Epilepsy and Clinical Neurophysiology and Epilepsy Genetics Program, Boston Children's Hospital, Boston, MA 02115, USA; Department of Neurology, Harvard Medical School, Boston, MA 02115, USA.
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25
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Effects of Transcranial Direct Current Stimulation of Rat Cerebral Structures on Pentylenetetrazole-Induced Seizures. NEUROPHYSIOLOGY+ 2017. [DOI: 10.1007/s11062-017-9681-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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26
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Dhamne SC, Silverman JL, Super CE, Lammers SHT, Hameed MQ, Modi ME, Copping NA, Pride MC, Smith DG, Rotenberg A, Crawley JN, Sahin M. Replicable in vivo physiological and behavioral phenotypes of the Shank3B null mutant mouse model of autism. Mol Autism 2017. [PMID: 28638591 PMCID: PMC5472997 DOI: 10.1186/s13229-017-0142-z] [Citation(s) in RCA: 99] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Autism spectrum disorder (ASD) is a clinically and biologically heterogeneous condition characterized by social, repetitive, and sensory behavioral abnormalities. No treatments are approved for the core diagnostic symptoms of ASD. To enable the earliest stages of therapeutic discovery and development for ASD, robust and reproducible behavioral phenotypes and biological markers are essential to establish in preclinical animal models. The goal of this study was to identify electroencephalographic (EEG) and behavioral phenotypes that are replicable between independent cohorts in a mouse model of ASD. The larger goal of our strategy is to empower the preclinical biomedical ASD research field by generating robust and reproducible behavioral and physiological phenotypes in animal models of ASD, for the characterization of mechanistic underpinnings of ASD-relevant phenotypes, and to ensure reliability for the discovery of novel therapeutics. Genetic disruption of the SHANK3 gene, a scaffolding protein involved in the stability of the postsynaptic density in excitatory synapses, is thought to be responsible for a relatively large number of cases of ASD. Therefore, we have thoroughly characterized the robustness of ASD-relevant behavioral phenotypes in two cohorts, and for the first time quantified translational EEG activity in Shank3B null mutant mice. METHODS In vivo physiology and behavioral assays were conducted in two independently bred and tested full cohorts of Shank3B null mutant (Shank3B KO) and wildtype littermate control (WT) mice. EEG was recorded via wireless implanted telemeters for 7 days of baseline followed by 20 min of recording following pentylenetetrazol (PTZ) challenge. Behaviors relevant to the diagnostic and associated symptoms of ASD were tested on a battery of established behavioral tests. Assays were designed to reproduce and expand on the original behavioral characterization of Shank3B KO mice. Two or more corroborative tests were conducted within each behavioral domain, including social, repetitive, cognitive, anxiety-related, sensory, and motor categories of assays. RESULTS Relative to WT mice, Shank3B KO mice displayed a dramatic resistance to PTZ seizure induction and an enhancement of gamma band oscillatory EEG activity indicative of enhanced inhibitory tone. These findings replicated in two separate cohorts. Behaviorally, Shank3B KO mice exhibited repetitive grooming, deficits in aspects of reciprocal social interactions and vocalizations, and reduced open field activity, as well as variable deficits in sensory responses, anxiety-related behaviors, learning and memory. CONCLUSIONS Robust animal models and quantitative, replicable biomarkers of neural dysfunction are needed to decrease risk and enable successful drug discovery and development for ASD and other neurodevelopmental disorders. Complementary to the replicated behavioral phenotypes of the Shank3B mutant mouse is the new identification of a robust, translational in vivo neurophysiological phenotype. Our findings provide strong evidence for robustness and replicability of key translational phenotypes in Shank3B mutant mice and support the usefulness of this mouse model of ASD for therapeutic discovery.
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Affiliation(s)
- Sameer C Dhamne
- F.M. Kirby Neurobiology Center, Translational Neuroscience Center, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115 USA
| | - Jill L Silverman
- MIND Institute, Department of Psychiatry and Behavioral Sciences, University of California Davis School of Medicine, Sacramento, CA 95821 USA
| | - Chloe E Super
- F.M. Kirby Neurobiology Center, Translational Neuroscience Center, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115 USA
| | - Stephen H T Lammers
- F.M. Kirby Neurobiology Center, Translational Neuroscience Center, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115 USA
| | - Mustafa Q Hameed
- F.M. Kirby Neurobiology Center, Translational Neuroscience Center, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115 USA
| | - Meera E Modi
- F.M. Kirby Neurobiology Center, Translational Neuroscience Center, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115 USA
| | - Nycole A Copping
- MIND Institute, Department of Psychiatry and Behavioral Sciences, University of California Davis School of Medicine, Sacramento, CA 95821 USA
| | - Michael C Pride
- MIND Institute, Department of Psychiatry and Behavioral Sciences, University of California Davis School of Medicine, Sacramento, CA 95821 USA
| | - Daniel G Smith
- Autism Speaks, Inc., Boston, MA USA.,Present address: BlackThorn Therapeutics, Inc., Cambridge, MA USA
| | - Alexander Rotenberg
- F.M. Kirby Neurobiology Center, Translational Neuroscience Center, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115 USA
| | - Jacqueline N Crawley
- MIND Institute, Department of Psychiatry and Behavioral Sciences, University of California Davis School of Medicine, Sacramento, CA 95821 USA
| | - Mustafa Sahin
- F.M. Kirby Neurobiology Center, Translational Neuroscience Center, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115 USA
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27
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Karvigh SA, Motamedi M, Arzani M, Roshan JHN. HD-tDCS in refractory lateral frontal lobe epilepsy patients. Seizure 2017; 47:74-80. [DOI: 10.1016/j.seizure.2017.03.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 03/01/2017] [Accepted: 03/07/2017] [Indexed: 01/23/2023] Open
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28
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Hameed MQ, Dhamne SC, Gersner R, Kaye HL, Oberman LM, Pascual-Leone A, Rotenberg A. Transcranial Magnetic and Direct Current Stimulation in Children. Curr Neurol Neurosci Rep 2017; 17:11. [PMID: 28229395 PMCID: PMC5962296 DOI: 10.1007/s11910-017-0719-0] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Promising results in adult neurologic and psychiatric disorders are driving active research into transcranial brain stimulation techniques, particularly transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS), in childhood and adolescent syndromes. TMS has realistic utility as an experimental tool tested in a range of pediatric neuropathologies such as perinatal stroke, depression, Tourette syndrome, and autism spectrum disorder (ASD). tDCS has also been tested as a treatment for a number of pediatric neurologic conditions, including ASD, attention-deficit/hyperactivity disorder, epilepsy, and cerebral palsy. Here, we complement recent reviews with an update of published TMS and tDCS results in children, and discuss developmental neuroscience considerations that should inform pediatric transcranial stimulation.
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Affiliation(s)
- Mustafa Q Hameed
- Neuromodulation Program, Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA
- F.M. Kirby Neurobiology Center, Department of Neurology, Boston Children's Hospital Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA
- Department of Neurosurgery, Boston Children's Hospital Harvard Medical School, Boston, MA, 02115, USA
| | - Sameer C Dhamne
- Neuromodulation Program, Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA
- F.M. Kirby Neurobiology Center, Department of Neurology, Boston Children's Hospital Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Roman Gersner
- Neuromodulation Program, Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA
- F.M. Kirby Neurobiology Center, Department of Neurology, Boston Children's Hospital Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Harper L Kaye
- Neuromodulation Program, Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA
- F.M. Kirby Neurobiology Center, Department of Neurology, Boston Children's Hospital Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Lindsay M Oberman
- Neuroplasticity and Autism Spectrum Disorder Program and Department of Psychiatry and Human Behavior, E.P. Bradley Hospital and Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Alvaro Pascual-Leone
- Berenson-Allen Center for Noninvasive Brain Stimulation and Division for Cognitive Neurology, Beth Israel Deaconness Medical Center Harvard Medical School, Boston, MA, USA
- Institut Guttmann, Universitat Autonoma, Barcelona, Spain
| | - Alexander Rotenberg
- Neuromodulation Program, Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA.
- F.M. Kirby Neurobiology Center, Department of Neurology, Boston Children's Hospital Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA.
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29
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Jackson MP, Rahman A, Lafon B, Kronberg G, Ling D, Parra LC, Bikson M. Animal models of transcranial direct current stimulation: Methods and mechanisms. Clin Neurophysiol 2016; 127:3425-3454. [PMID: 27693941 PMCID: PMC5083183 DOI: 10.1016/j.clinph.2016.08.016] [Citation(s) in RCA: 186] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 08/05/2016] [Accepted: 08/08/2016] [Indexed: 12/28/2022]
Abstract
The objective of this review is to summarize the contribution of animal research using direct current stimulation (DCS) to our understanding of the physiological effects of transcranial direct current stimulation (tDCS). We comprehensively address experimental methodology in animal studies, broadly classified as: (1) transcranial stimulation; (2) direct cortical stimulation in vivo and (3) in vitro models. In each case advantages and disadvantages for translational research are discussed including dose translation and the overarching "quasi-uniform" assumption, which underpins translational relevance in all animal models of tDCS. Terminology such as anode, cathode, inward current, outward current, current density, electric field, and uniform are defined. Though we put key animal experiments spanning decades in perspective, our goal is not simply an exhaustive cataloging of relevant animal studies, but rather to put them in context of ongoing efforts to improve tDCS. Cellular targets, including excitatory neuronal somas, dendrites, axons, interneurons, glial cells, and endothelial cells are considered. We emphasize neurons are always depolarized and hyperpolarized such that effects of DCS on neuronal excitability can only be evaluated within subcellular regions of the neuron. Findings from animal studies on the effects of DCS on plasticity (LTP/LTD) and network oscillations are reviewed extensively. Any endogenous phenomena dependent on membrane potential changes are, in theory, susceptible to modulation by DCS. The relevance of morphological changes (galvanotropy) to tDCS is also considered, as we suggest microscopic migration of axon terminals or dendritic spines may be relevant during tDCS. A majority of clinical studies using tDCS employ a simplistic dose strategy where excitability is singularly increased or decreased under the anode and cathode, respectively. We discuss how this strategy, itself based on classic animal studies, cannot account for the complexity of normal and pathological brain function, and how recent studies have already indicated more sophisticated approaches are necessary. One tDCS theory regarding "functional targeting" suggests the specificity of tDCS effects are possible by modulating ongoing function (plasticity). Use of animal models of disease are summarized including pain, movement disorders, stroke, and epilepsy.
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Affiliation(s)
- Mark P Jackson
- Department of Biomedical Engineering, The City College of The City University of New York, NY, USA
| | - Asif Rahman
- Department of Biomedical Engineering, The City College of The City University of New York, NY, USA
| | - Belen Lafon
- Department of Biomedical Engineering, The City College of The City University of New York, NY, USA
| | - Gregory Kronberg
- Department of Biomedical Engineering, The City College of The City University of New York, NY, USA
| | - Doris Ling
- Department of Biomedical Engineering, The City College of The City University of New York, NY, USA
| | - Lucas C Parra
- Department of Biomedical Engineering, The City College of The City University of New York, NY, USA
| | - Marom Bikson
- Department of Biomedical Engineering, The City College of The City University of New York, NY, USA.
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Zoghi M, O'Brien TJ, Kwan P, Cook MJ, Galea M, Jaberzadeh S. Cathodal transcranial direct-current stimulation for treatment of drug-resistant temporal lobe epilepsy: A pilot randomized controlled trial. Epilepsia Open 2016; 1:130-135. [PMID: 29588936 PMCID: PMC5719830 DOI: 10.1002/epi4.12020] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2016] [Indexed: 01/08/2023] Open
Abstract
Objective To investigate the effect of cathodal transcranial direct‐current stimulation (c‐tDCS) on seizure frequency in patients with drug‐resistant temporal lobe epilepsy (TLE). Method Twenty‐nine patients with drug‐resistant TLE participated in this study. They were randomized to experimental or sham group. Twenty participants (experimental group) received within‐session repeated c‐tDCS intervention over the affected temporal lobe, and nine (sham group) received sham tDCS. Paired‐pulse transcranial magnetic stimulation was used to assess short interval intracortical inhibition (SICI) in primary motor cortex ipsilateral to the affected temporal lobe. SICI was measured from motor evoked potentials recorded from the contralateral first dorsal interosseous muscle. Adverse effects were monitored during and after each intervention in both groups. A seizure diary was given to each participant to complete for 4 weeks following the tDCS intervention. The mean response ratio was calculated from their seizure rates before and after the tDCS intervention. Results The experimental group showed a significant increase in SICI compared to the sham group (F = 10.3, p = 0.005). None of the participants reported side effects of moderate or severe degree. The mean response ratio in seizure frequency was −42.14% (standard deviation [SD] 35.93) for the experimental group and −16.98% (SD 52.41) for the sham group. Significance Results from this pilot study suggest that tDCS may be a safe and efficacious nonpharmacologic intervention for patients with drug‐resistant TLE. Further evaluation in larger double‐blind randomized controlled trials is warranted.
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Affiliation(s)
- Maryam Zoghi
- Department of Medicine The Royal Melbourne Hospital The University of Melbourne Parkville Victoria Australia
| | - Terence J O'Brien
- Department of Medicine The Royal Melbourne Hospital The University of Melbourne Parkville Victoria Australia
| | - Patrick Kwan
- Department of Medicine The Royal Melbourne Hospital The University of Melbourne Parkville Victoria Australia
| | - Mark J Cook
- Department of Medicine St Vincent's Hospital The University of Melbourne Fitzroy Victoria Australia
| | - Mary Galea
- Department of Medicine The Royal Melbourne Hospital (Royal Park Campus) The University of Melbourne Parkville Victoria Australia
| | - Shapour Jaberzadeh
- School of Primary Health Care Faculty of Medicine, Nursing and Health Sciences Monash University Frankston Victoria Australia
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31
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Gersner R, Dhamne SC, Zangen A, Pascual-Leone A, Rotenberg A. Bursts of high-frequency repetitive transcranial magnetic stimulation (rTMS), together with lorazepam, suppress seizures in a rat kainate status epilepticus model. Epilepsy Behav 2016; 62:136-9. [PMID: 27467275 DOI: 10.1016/j.yebeh.2016.05.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 05/05/2016] [Accepted: 05/24/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND Status epilepticus (SE) is a condition of prolonged or recurrent and often drug-resistant seizures where nonsedating SE therapy remains an important unmet need. Repetitive transcranial magnetic stimulation (rTMS) is emerging as a means to suppress seizures but has not been extensively studied in models. OBJECTIVES We aimed to test the antiepileptic potential of high-frequency rTMS in SE. As a step toward eventual coupling of rTMS with antiepileptic pharmacotherapy, we also tested whether high-frequency rTMS in combination with a low (ineffective but less likely to cause a side effect) lorazepam dose is as effective as a full lorazepam dose in suppressing seizures in a rat SE model. METHODS EEG was recorded to measure epileptic spike frequency in the rat kainate SE model. Epileptic spikes were counted before, during, and after either high-frequency rTMS treatment alone or high-frequency rTMS treatment in combination with lorazepam, a firstline SE treatment. RESULTS We found that rTMS alone decreases epileptic spike frequency only acutely. However, combinatory treatment with half-dose lorazepam together with rTMS was as effective as a full lorazepam dose. CONCLUSION We report that high-frequency rTMS has modest antiepileptic potential alone but acts in complement with lorazepam to suppress seizures.
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Affiliation(s)
- Roman Gersner
- Neuromodulation Program, Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA; F.M. Kirby Neurobiology Center, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Sameer C Dhamne
- Neuromodulation Program, Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA; F.M. Kirby Neurobiology Center, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Abraham Zangen
- Department of Life Sciences and the Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev, Beer-Sheva 84105, Israel
| | - Alvaro Pascual-Leone
- Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Alexander Rotenberg
- Neuromodulation Program, Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA; F.M. Kirby Neurobiology Center, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA; Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA.
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32
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Bikson M, Grossman P, Thomas C, Zannou AL, Jiang J, Adnan T, Mourdoukoutas AP, Kronberg G, Truong D, Boggio P, Brunoni AR, Charvet L, Fregni F, Fritsch B, Gillick B, Hamilton RH, Hampstead BM, Jankord R, Kirton A, Knotkova H, Liebetanz D, Liu A, Loo C, Nitsche MA, Reis J, Richardson JD, Rotenberg A, Turkeltaub PE, Woods AJ. Safety of Transcranial Direct Current Stimulation: Evidence Based Update 2016. Brain Stimul 2016; 9:641-661. [PMID: 27372845 PMCID: PMC5007190 DOI: 10.1016/j.brs.2016.06.004] [Citation(s) in RCA: 802] [Impact Index Per Article: 100.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 06/10/2016] [Accepted: 06/12/2016] [Indexed: 01/13/2023] Open
Abstract
This review updates and consolidates evidence on the safety of transcranial Direct Current Stimulation (tDCS). Safety is here operationally defined by, and limited to, the absence of evidence for a Serious Adverse Effect, the criteria for which are rigorously defined. This review adopts an evidence-based approach, based on an aggregation of experience from human trials, taking care not to confuse speculation on potential hazards or lack of data to refute such speculation with evidence for risk. Safety data from animal tests for tissue damage are reviewed with systematic consideration of translation to humans. Arbitrary safety considerations are avoided. Computational models are used to relate dose to brain exposure in humans and animals. We review relevant dose-response curves and dose metrics (e.g. current, duration, current density, charge, charge density) for meaningful safety standards. Special consideration is given to theoretically vulnerable populations including children and the elderly, subjects with mood disorders, epilepsy, stroke, implants, and home users. Evidence from relevant animal models indicates that brain injury by Direct Current Stimulation (DCS) occurs at predicted brain current densities (6.3-13 A/m(2)) that are over an order of magnitude above those produced by conventional tDCS. To date, the use of conventional tDCS protocols in human trials (≤40 min, ≤4 milliamperes, ≤7.2 Coulombs) has not produced any reports of a Serious Adverse Effect or irreversible injury across over 33,200 sessions and 1000 subjects with repeated sessions. This includes a wide variety of subjects, including persons from potentially vulnerable populations.
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Affiliation(s)
- Marom Bikson
- Department of Biomedical Engineering, The City College of New York, New York, NY, USA.
| | - Pnina Grossman
- Department of Biomedical Engineering, The City College of New York, New York, NY, USA
| | - Chris Thomas
- Department of Biomedical Engineering, The City College of New York, New York, NY, USA
| | | | - Jimmy Jiang
- Department of Biomedical Engineering, The City College of New York, New York, NY, USA
| | - Tatheer Adnan
- Department of Biomedical Engineering, The City College of New York, New York, NY, USA
| | | | - Greg Kronberg
- Department of Biomedical Engineering, The City College of New York, New York, NY, USA
| | - Dennis Truong
- Department of Biomedical Engineering, The City College of New York, New York, NY, USA
| | - Paulo Boggio
- Cognitive Neuroscience Laboratory and Developmental Disorders Program, Center for Health and Biological Sciences, Mackenzie Presbyterian University, Sao Paulo, Brazil
| | - André R Brunoni
- Service of Interdisciplinary Neuromodulation, Department and Institute of Psychiatry, Laboratory of Neurosciences (LIM-27), University of São Paulo, São Paulo, Brazil
| | - Leigh Charvet
- NYU MS Comprehensive Care Center, Department of Neurology, New York University School of Medicine, New York, NY, USA
| | - Felipe Fregni
- Berenson-Allen Center for Noninvasive Brain Stimulation, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Brita Fritsch
- Department of Neurology, University Medical Center, Freiburg, Germany; BrainLinks-BrainTools Cluster of Excellence, University of Freiburg, Germany
| | - Bernadette Gillick
- Department of Physical Medicine and Rehabilitation, University of Minnesota Medical School, Minneapolis, MN
| | - Roy H Hamilton
- Laboratory for Cognition and Neural Stimulation, University of Pennsylvania, Philadelphia, PA, USA; Center for Cognitive Neuroscience, University of Pennsylvania, Philadelphia, PA, USA; Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA
| | - Benjamin M Hampstead
- Mental Health Service, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA; Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Ryan Jankord
- Applied Neuroscience, 711th Human Performance Wing, Air Force Research Laboratory, WPAFB, OH, USA
| | - Adam Kirton
- Departments of Pediatrics and Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Helena Knotkova
- MJHS Institute for Innovation in Palliative Care, New York, NY, USA; Department of Social and Family Medicine, Albert Einstein College of Medicine, The Bronx, NY, USA
| | - David Liebetanz
- Department of Clinical Neurophysiology, University Medical Center, Georg-August-University, Goettingen 37075, Germany
| | - Anli Liu
- NYU Comprehensive Epilepsy Center, New York University School of Medicine, New York, NY, USA
| | - Colleen Loo
- Psychiatry, Black Dog Institute, Clinical Academic, St George Hospital, University of New South Wales, Sydney, Australia
| | - Michael A Nitsche
- Department of Clinical Neurophysiology, University Medical Center, Georg-August-University, Goettingen 37075, Germany; Leibniz Research Centre for Working Environment and Human Factors at the TU Dortmund, Dortmund, Germany; Department of Neurology, University Medical Hospital Bergmannsheil, Bochum, Germany
| | - Janine Reis
- Department of Neurology, University Medical Center, Freiburg, Germany; BrainLinks-BrainTools Cluster of Excellence, University of Freiburg, Germany
| | - Jessica D Richardson
- Berenson-Allen Center for Noninvasive Brain Stimulation, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA; Department of Communication Sciences & Disorders, The University of South Carolina, Columbia, SC, USA; Department of Speech and Hearing Sciences, The University of New Mexico, Albuquerque, NM, USA
| | - Alexander Rotenberg
- Berenson-Allen Center for Noninvasive Brain Stimulation, Division of Cognitive Neurology, Department of Neurology, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, MA, USA; Pediatric Neuromodulation Program, Division of Epilepsy and Neurophysiology, Department of Neurology, Children's Hospital Boston, Harvard Medical School, Boston, MA, USA
| | - Peter E Turkeltaub
- Department of Neurology, Georgetown University, Washington, DC, USA; Research Division, MedStar National Rehabilitation Hospital, Washington, DC, USA
| | - Adam J Woods
- Center for Cognitive Aging and Memory, Institute on Aging, Department of Aging and Geriatric Research, McKnight Brain Institute, University of Florida, Gainesville, FL, USA
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Gschwind M, Seeck M. Transcranial direct-current stimulation as treatment in epilepsy. Expert Rev Neurother 2016; 16:1427-1441. [DOI: 10.1080/14737175.2016.1209410] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Sun Y, Lipton JO, Boyle LM, Madsen JR, Goldenberg MC, Pascual-Leone A, Sahin M, Rotenberg A. Direct current stimulation induces mGluR5-dependent neocortical plasticity. Ann Neurol 2016; 80:233-46. [PMID: 27315032 DOI: 10.1002/ana.24708] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 06/07/2016] [Accepted: 06/08/2016] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To obtain insights into mechanisms mediating changes in cortical excitability induced by cathodal transcranial direct current stimulation (tDCS). METHODS Neocortical slices were exposed to direct current stimulation (DCS) delivered through Ag/AgCl electrodes over a range of current orientations, magnitudes, and durations. DCS-induced cortical plasticity and its receptor dependency were measured as the change in layer II/III field excitatory postsynaptic potentials by a multielectrode array, both with and without neurotransmitter receptor blockers or allosteric modulators. In vivo, tDCS was delivered to intact mice scalp via surface electrodes. Molecular consequences of DCS in vitro or tDCS in vivo were tested by immunoblot of protein extracted from stimulated slices or the neocortex harvested from stimulated intact mice. RESULTS Cathodal DCS in vitro induces a long-term depression (DCS-LTD) of excitatory synaptic strength in both human and mouse neocortical slices. DCS-LTD is abolished with an mGluR5 negative allosteric modulator, mechanistic target of rapamycin (mTOR) inhibitor, and inhibitor of protein synthesis. However, DCS-LTD persists despite either γ-aminobutyric acid type A receptor or N-methyl-D-aspartate receptor inhibition. An mGluR5-positive allosteric modulator, in contrast, transformed transient synaptic depression resultant from brief DCS application into durable DCS-LTD. INTERPRETATION We identify a novel molecular pathway by which tDCS modulates cortical excitability, and indicate a capacity for synergistic interaction between tDCS and pharmacologic mGluR5 facilitation. The findings support exploration of cathodal tDCS as a treatment of neurologic conditions characterized by aberrant regional cortical excitability referable to mGluR5-mTOR signaling. Ann Neurol 2016;80:233-246.
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Affiliation(s)
- Yan Sun
- Department of Neurology and F. M. Kirby Neurobiology Center, Boston Children's Hospital, Boston, MA.,Neuromodulation Program, Boston Children's Hospital, Boston, MA.,Program in Neuroscience, Harvard Medical School, Boston, MA
| | - Jonathan O Lipton
- Department of Neurology and F. M. Kirby Neurobiology Center, Boston Children's Hospital, Boston, MA.,Division of Sleep Medicine, Harvard Medical School, Boston, MA
| | - Lara M Boyle
- Department of Neurology and F. M. Kirby Neurobiology Center, Boston Children's Hospital, Boston, MA
| | - Joseph R Madsen
- Department of Neurosurgery, Boston Children's Hospital, Boston, MA
| | - Marti C Goldenberg
- Department of Neurology and F. M. Kirby Neurobiology Center, Boston Children's Hospital, Boston, MA
| | - Alvaro Pascual-Leone
- Berenson-Allen Center for Noninvasive Brain Stimulation, Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Mustafa Sahin
- Department of Neurology and F. M. Kirby Neurobiology Center, Boston Children's Hospital, Boston, MA
| | - Alexander Rotenberg
- Department of Neurology and F. M. Kirby Neurobiology Center, Boston Children's Hospital, Boston, MA.,Neuromodulation Program, Boston Children's Hospital, Boston, MA.,Berenson-Allen Center for Noninvasive Brain Stimulation, Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
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Gersner R, Ekstein D, Dhamne S, Schachter S, Rotenberg A. Huperzine A prophylaxis against pentylenetetrazole-induced seizures in rats is associated with increased cortical inhibition. Epilepsy Res 2015; 117:97-103. [DOI: 10.1016/j.eplepsyres.2015.08.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 08/12/2015] [Accepted: 08/25/2015] [Indexed: 10/23/2022]
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