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Valter Y, Rapallo F, Burlando B, Crossen M, Baeken C, Datta A, Deblieck C. Efficacy of non-invasive brain stimulation and neuronavigation for major depressive disorder: a systematic review and meta-analysis. Expert Rev Med Devices 2024; 21:643-658. [PMID: 38902968 DOI: 10.1080/17434440.2024.2370820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 05/28/2024] [Indexed: 06/22/2024]
Abstract
INTRODUCTION Repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) are increasingly used for major depressive disorder (MDD). Most tDCS and rTMS studies target the left dorsolateral prefrontal cortex, either with or without neuronavigation. We examined the effect of rTMS and tDCS, and the added value of neuronavigation in the treatment of MDD. METHODS A search on PubMed, Embase, and Cochrane databases for rTMS or tDCS randomized controlled trials of MDD up to 1 February 2023, yielded 89 studies. We then performed meta-analyses comparing tDCS efficacy to non-neuronavigated rTMS, tDCS to neuronavigated rTMS, and neuronavigated rTMS to non-neuronavigated rTMS. We assessed the significance of the effect in subgroups and in the whole meta-analysis with a z-test and subgroup differences with a chi-square test. RESULTS We found small-to-medium effects of both tDCS and rTMS on MDD, with a slightly greater effect from rTMS. No significant difference was found between neuronavigation and non-neuronavigation. CONCLUSION Although both tDCS and rTMS are effective in treating MDD, many patients do not respond. Additionally, current neuronavigation methods are not significantly improving MDD treatment. It is therefore imperative to seek personalized methods for these interventions.
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Affiliation(s)
- Yishai Valter
- Research and Development, Soterix Medical, Inc, Woodbridge, NJ, USA
- Department of Biomedical Engineering, City College of the City University of New York, New York, NY, USA
| | - Fabio Rapallo
- Faculty of Economics, University of Genoa, Genova, Italy
| | - Bruno Burlando
- Department of Pharmacy, University of Genoa, Genova, Italy
| | - Miah Crossen
- Research and Development, Soterix Medical, Inc, Woodbridge, NJ, USA
| | - Chris Baeken
- Faculty of Medicine and Health Sciences, Department of Head and Skin, Ghent Experimental Psychiatry (GHEP) lab, Ghent University, Ghent, Belgium
- Department of Psychiatry, University Hospital (UZBrussel), Vrije Universiteit Brussel (VUB), Brussels, Belgium
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Abhishek Datta
- Research and Development, Soterix Medical, Inc, Woodbridge, NJ, USA
- Department of Biomedical Engineering, City College of the City University of New York, New York, NY, USA
| | - Choi Deblieck
- Lab for Equilibrium Investigations and Aerospace (LEIA), University of Antwerp, Antwerp, Belgium
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Pimenta DC, Cardenas-Rojas A, Camargo L, Lima D, Kelso J, Navarro-Flores A, Pacheco-Barrios K, Fregni F. Exercise effects on cortical excitability in pain populations: A systematic review and meta-analysis. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2024; 29:e2102. [PMID: 38861661 DOI: 10.1002/pri.2102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 05/03/2024] [Accepted: 05/26/2024] [Indexed: 06/13/2024]
Abstract
BACKGROUND Transcranial Magnetic Stimulation (TMS) studies examining exercise-induced neuroplasticity in pain populations have produced contradictory findings. We conducted a systematic review to explore how exercise impacts cortical excitability in pain populations using TMS metrics. This review aims to summarize the effect sizes and to understand their sources of heterogeneity. METHODS We searched multiple databases from inception to December 2022. We included randomized controlled trials (RCTs) with any type of pain population, including acute and chronic pain; exercise interventions were compared to sham exercise or other active interventions. The primary outcomes were TMS metrics, and pain intensity was the secondary outcome. Risk of bias assessment was conducted using the Cochrane tool. RESULTS This review included five RCTs (n = 155). The main diagnoses were fibromyalgia and cervical dystonia. The interventions included submaximal contractions, aerobic exercise, physical therapy, and exercise combined with transcranial direct current stimulation. Three studies are considered to have a high risk of bias. All five studies showed significant pain improvement with exercise. The neurophysiological data revealed improvements in cortical excitability measured by motor-evoked potentials; standardized mean difference = 2.06, 95% confidence interval 1.35-2.78, I2 = 19%) but no significant differences in resting motor threshold. The data on intracortical inhibition/facilitation (ICI/ICF) was not systematically analyzed, but one study (n = 45) reported higher ICI and lower ICF after exercise. CONCLUSIONS These findings suggest that exercise interventions positively affect pain relief by modifying corticospinal excitability, but their effects on ICI/ICF are still unclear. While the results are inconclusive, they provide a basis for further exploration in this area of research; future studies should focus on establishing standardized TMS measurements and exercise protocols to ensure consistent and reliable findings. A large-scale RCT that examines various exercise interventions and their effects on cortical excitability could offer valuable insights to optimize its application in promoting neuroplasticity in pain populations.
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Affiliation(s)
- Danielle Carolina Pimenta
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Alejandra Cardenas-Rojas
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Lucas Camargo
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Daniel Lima
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Julia Kelso
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Alba Navarro-Flores
- International Max Planck Research School for Translational Psychiatry (IMPRS-TP), Munich, Germany
| | - Kevin Pacheco-Barrios
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Vicerrectorado de Investigación, Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima, Peru
| | - Felipe Fregni
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Chmiel J, Kurpas D, Rybakowski F, Leszek J. The Effects of Transcranial Direct Current Stimulation (tDCS) in HIV Patients-A Review. J Clin Med 2024; 13:3288. [PMID: 38892999 PMCID: PMC11173062 DOI: 10.3390/jcm13113288] [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: 04/12/2024] [Revised: 05/16/2024] [Accepted: 05/20/2024] [Indexed: 06/21/2024] Open
Abstract
Introduction: HIV is a severe and incurable disease that has a devastating impact worldwide. It affects the immune system and negatively affects the nervous system, leading to various cognitive and behavioral problems. Scientists are actively exploring different therapeutic approaches to combat these issues. One promising method is transcranial direct current stimulation (tDCS), a non-invasive technique that stimulates the brain. Methods: This review aims to examine how tDCS can help HIV patients. Searches were conducted in the Pubmed/Medline, Research Gate, and Cochrane databases. Results: The literature search resulted in six articles focusing on the effects of tDCS on cognitive and behavioral measures in people with HIV. In some cases, tDCS showed positive improvements in the measures assessed, improving executive functions, depression, attention, reaction time, psychomotor speed, speed of processing, verbal learning and memory, and cognitive functioning. Furthermore, the stimulation was safe with no severe side effects. However, the included studies were of low quality, had small sample sizes, and did not use any relevant biomarkers that would help to understand the mechanisms of action of tDCS in HIV. Conclusions: tDCS may help patients with HIV; however, due to the limited number of studies and the diversity of protocols used, caution should be exercised when recommending this treatment option in clinical settings. More high-quality research, preferably involving neurophysiological and neuroimaging measurements, is necessary to better understand how tDCS works in individuals with HIV.
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Affiliation(s)
- James Chmiel
- Institute of Neurofeedback and tDCS Poland, 70-393 Szczecin, Poland
| | - Donata Kurpas
- Department of Family and Pediatric Nursing, Faculty of Health Sciences, Wrocław Medical University, 51-618 Wrocław, Poland
| | - Filip Rybakowski
- Department and Clinic of Psychiatry, Poznan University of Medical Sciences, 61-701 Poznań, Poland
| | - Jerzy Leszek
- Department and Clinic of Psychiatry, Wrocław Medical University, 54-235 Wrocław, Poland
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Rząd Z, Rog J, Kajka N, Szewczyk P, Krukow P, Karakuła-Juchnowicz H. The efficacy of transcranial direct current stimulation in the treatment of anorexia nervosa: a randomized double-blind clinical trial. Front Psychiatry 2024; 15:1284675. [PMID: 38757134 PMCID: PMC11096801 DOI: 10.3389/fpsyt.2024.1284675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 04/12/2024] [Indexed: 05/18/2024] Open
Abstract
Background Anorexia nervosa (AN) is a life-threatening disease with a low effectiveness of treatment. The high relapse and mortality rate indicate new treatment approaches are needed. Here, we represent the protocol for randomized clinical trial (RCT) of transcranial direct current stimulation (tDCS) efficiency in the AN treatment. The main purpose of the 3-week RCT is to determine the effect of tDCS on the mental state and advances in nutritional rehabilitation in patients with AN. Methods 50 female inpatients (13-25 years old, body mass index (BMI) 17.5 kg/m2 or less) will be randomly allocated into groups: active (n=25) and sham (n=25) tDCS. Thirty 25-minute tDCS sessions (applied current at 2mA) will be given to DLPFC (F3 anode/F4 cathode) twice a day for 3 weeks on working days parallel to treatment as usual. The primary outcome measures include changes in symptoms related to eating disorders, as assessed by the Eating Attitudes Test (EAT-26), following tDCS sessions over a 3-week trial period. The secondary outcome measures include changes in: brain bioelectric activity, anthropometric measurements, mood, nutritional status, neurocognition, psychological symptoms, selected biological markers related to stress, food intake, inflammation and neurotrophins. Discussion This paper describes the evaluation of a 3-week tDCS-based intervention for AN patients. The study design was developed by a multidisciplinary research team to assess the treatment effect, taking into account various types of variables. This approach could help in better understanding the potential therapeutic tDCS strategy in AN. Clinical trial registration www.ClinicalTrials.gov, identifier NCT05814458.
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Affiliation(s)
- Zuzanna Rząd
- Department of Psychiatry, Psychotherapy and Early Intervention in Lublin, Medical University of Lublin, Lublin, Poland
| | - Joanna Rog
- Laboratory of Human Metabolism Research, Department of Dietetics, Institute of Human Nutrition Science, Warsaw University of Life Sciences (WULS-SGGW), Warsaw, Poland
| | - Natalia Kajka
- Department of Psychiatry, Psychotherapy and Early Intervention in Lublin, Medical University of Lublin, Lublin, Poland
| | - Paweł Szewczyk
- Department of Psychiatry, Psychotherapy and Early Intervention in Lublin, Medical University of Lublin, Lublin, Poland
| | - Paweł Krukow
- Department of Clinical Neuropsychiatry, Medical University of Lublin, Lublin, Poland
| | - Hanna Karakuła-Juchnowicz
- Department of Psychiatry, Psychotherapy and Early Intervention in Lublin, Medical University of Lublin, Lublin, Poland
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Kos C, Bais L, Klaasen N, Opmeer E, Liemburg E, Wardenaar KJ, van Tol MJ, Knegtering H, Aleman A. Effects of right prefrontal theta-burst transcranial magnetic stimulation or transcranial direct current stimulation on apathy in patients with schizophrenia: A multicenter RCT. Psychiatry Res 2024; 333:115743. [PMID: 38271887 DOI: 10.1016/j.psychres.2024.115743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 01/09/2024] [Accepted: 01/14/2024] [Indexed: 01/27/2024]
Abstract
Apathy is a core negative symptom associated with an unfavorable functional outcome. Noninvasive brain stimulation has shown promise in the treatment of schizophrenia but has not been tested specifically for apathy. We conducted a randomized controlled trial of intermittent theta-burst (iTBS) transcranial magnetic stimulation and transcranial direct current stimulation (tDCS) targeted at the right dorsolateral prefrontal cortex (DLPFC) in patients diagnosed with a psychotic disorder suffering from apathy. The study was a multicenter, randomized, placebo-controlled, and rater-blinded trial. Patients (N = 88) were randomized into active iTBS, active tDCS, sham iTBS or sham tDCS treatment, daily for two weeks (excluding weekends). Effects were measured post-treatment and at four week and ten week follow-up. Primary outcome was apathy severity (Apathy Evaluation Scale, clinician-rated). Additional measures included assessment of negative symptoms, depression, anhedonia and quality of life. No significant difference in improvement of apathy or negative symptoms was observed for real versus sham treatment with either iTBS or tDCS, though all groups improved to a small extent. We conclude that two weeks of brain stimulation over the right DLPFC with either iTBS or tDCS is not effective for improving apathy or negative symptoms. Longer and more intensive protocols may yield different results.
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Affiliation(s)
- Claire Kos
- Cognitive Neuroscience Center, Department of Biomedical Sciences of Cells and Systems, University Medical Center Groningen, University of Groningen, PO Box 196, 9700 AD, Antonius Deusinglaan 2, Groningen 9713 AW, The Netherlands; ZorgfocuZ, Groningen, The Netherlands
| | - Leonie Bais
- Cognitive Neuroscience Center, Department of Biomedical Sciences of Cells and Systems, University Medical Center Groningen, University of Groningen, PO Box 196, 9700 AD, Antonius Deusinglaan 2, Groningen 9713 AW, The Netherlands; Lentis Research, Lentis Center for Mental Health Care, Hereweg 80, Groningen 9725 AG, The Netherlands
| | - Nicky Klaasen
- Cognitive Neuroscience Center, Department of Biomedical Sciences of Cells and Systems, University Medical Center Groningen, University of Groningen, PO Box 196, 9700 AD, Antonius Deusinglaan 2, Groningen 9713 AW, The Netherlands
| | - Esther Opmeer
- Cognitive Neuroscience Center, Department of Biomedical Sciences of Cells and Systems, University Medical Center Groningen, University of Groningen, PO Box 196, 9700 AD, Antonius Deusinglaan 2, Groningen 9713 AW, The Netherlands
| | - Edith Liemburg
- Rob Giel Research Center and Department of Psychiatry, University Medical Center Groningen, University of Groningen, Hanzeplein 1, Groningen 9713 GZ, The Netherlands
| | - Klaas J Wardenaar
- Rob Giel Research Center and Department of Psychiatry, University Medical Center Groningen, University of Groningen, Hanzeplein 1, Groningen 9713 GZ, The Netherlands
| | - Marie-José van Tol
- Cognitive Neuroscience Center, Department of Biomedical Sciences of Cells and Systems, University Medical Center Groningen, University of Groningen, PO Box 196, 9700 AD, Antonius Deusinglaan 2, Groningen 9713 AW, The Netherlands
| | - Henderikus Knegtering
- Cognitive Neuroscience Center, Department of Biomedical Sciences of Cells and Systems, University Medical Center Groningen, University of Groningen, PO Box 196, 9700 AD, Antonius Deusinglaan 2, Groningen 9713 AW, The Netherlands; Lentis Research, Lentis Center for Mental Health Care, Hereweg 80, Groningen 9725 AG, The Netherlands; Rob Giel Research Center and Department of Psychiatry, University Medical Center Groningen, University of Groningen, Hanzeplein 1, Groningen 9713 GZ, The Netherlands
| | - André Aleman
- Cognitive Neuroscience Center, Department of Biomedical Sciences of Cells and Systems, University Medical Center Groningen, University of Groningen, PO Box 196, 9700 AD, Antonius Deusinglaan 2, Groningen 9713 AW, The Netherlands.
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Yang D, Ghafoor U, Eggebrecht AT, Hong KS. Effectiveness assessment of repetitive transcranial alternating current stimulation with concurrent EEG and fNIRS measurement. Health Inf Sci Syst 2023; 11:35. [PMID: 37545487 PMCID: PMC10397167 DOI: 10.1007/s13755-023-00233-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 07/11/2023] [Indexed: 08/08/2023] Open
Abstract
Transcranial alternating current stimulation (tACS) exhibits the capability to interact with endogenous brain oscillations using an external low-intensity sinusoidal current and influences cerebral function. Despite its potential benefits, the physiological mechanisms and effectiveness of tACS are currently a subject of debate and disagreement. The aims of our study are to (i) evaluate the neurological and behavioral impact of tACS by conducting repetitive sham-controlled experiments and (ii) propose criteria to evaluate effectiveness, which can serve as a benchmark to determine optimal individual-based tACS protocols. In this study, 15 healthy adults participated in the experiment over two visiting: sham and tACS (i.e., 5 Hz, 1 mA). During each visit, we used multimodal recordings of the participants' brain, including simultaneous electroencephalography (EEG) and functional near-infrared spectroscopy (fNIRS), along with a working memory (WM) score to quantify neurological effects and cognitive changes immediately after each repetitive sham/tACS session. Our results indicate increased WM scores, hemodynamic response strength, and EEG power in theta and delta bands both during and after the tACS period. Additionally, the observed effects do not increase with prolonged stimulation time, as the effects plateau towards the end of the experiment. In conclusion, our proposed closed-loop scheme offers a promising advance for evaluating the effectiveness of tACS during the stimulation session. Specifically, the assessment criteria use participant-specific brain-based signals along with a behavioral output. Moreover, we propose a feedback efficacy score that can aid in determining the optimal stimulation duration based on a participant-specific brain state, thereby preventing the risk of overstimulation.
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Affiliation(s)
- Dalin Yang
- School of Mechanical Engineering, Pusan National University, Busan, 46241 Republic of Korea
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO 63100 USA
| | - Usman Ghafoor
- School of Mechanical Engineering, Pusan National University, Busan, 46241 Republic of Korea
| | - Adam Thomas Eggebrecht
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO 63100 USA
- Department of Biomedical Engineering, Washington University, St. Louis, MO 63130 USA
| | - Keum-Shik Hong
- School of Mechanical Engineering, Pusan National University, Busan, 46241 Republic of Korea
- Institute for Future, School of Automation, Qingdao University, Qingdao, 266071 Shandong China
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Chmiel J, Gladka A, Leszek J. The Effect of Transcranial Direct Current Stimulation (tDCS) on Anorexia Nervosa: A Narrative Review. Nutrients 2023; 15:4455. [PMID: 37892530 PMCID: PMC10610104 DOI: 10.3390/nu15204455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 10/17/2023] [Accepted: 10/18/2023] [Indexed: 10/29/2023] Open
Abstract
(1) Introduction: Anorexia nervosa (AN) is a severe, debilitating disease with high incidence and high mortality. The methods of treatment used so far are moderately effective. Evidence from neuroimaging studies helps to design modern methods of therapy. One of them is transcranial direct current stimulation (tDCS), a non-invasive brain neuromodulation technique. (2) Methods: The purpose of this narrative review is to bring together all studies investigating the use of tDCS in the treatment of AN and to evaluate its effect and efficiency. Searches were conducted in the Pubmed/Medline, Research Gate, and Cochrane databases. (3) Results: The literature search resulted in five articles. These studies provide preliminary evidence that tDCS has the potential to alter eating behaviour, body weight, and food intake. Additionally, tDCS reduced symptoms of depression. Throughout all trials, stimulation targeted the left dorsolateral prefrontal cortex (DLPFC). Although the number of studies included is limited, attempts were made to elucidate the potential mechanisms underlying tDCS action in individuals with AN. Recommendations for future tDCS research in AN were issued. (4) Conclusions: The included studies have shown that tDCS stimulation of the left DLPFC has a positive effect on AN clinical symptoms and may improve them, as measured by various assessment measures. It is important to conduct more in-depth research on the potential benefits of using tDCS for treating AN. This should entail well-designed studies incorporating advanced neuroimaging techniques, such as fMRI. The aim is to gain a better understanding of how tDCS works in AN.
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Affiliation(s)
- James Chmiel
- Institute of Neurofeedback and tDCS Poland, 70-393 Szczecin, Poland
| | - Anna Gladka
- Department and Clinic of Psychiatry, Wrocław Medical University, 54-235 Wrocław, Poland
| | - Jerzy Leszek
- Department and Clinic of Psychiatry, Wrocław Medical University, 54-235 Wrocław, Poland
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Abul Hasan M, Shahid H, Ahmed Qazi S, Ejaz O, Danish Mujib M, Vuckovic A. Underpinning the neurological source of executive function following cross hemispheric tDCS stimulation. Int J Psychophysiol 2023; 185:1-10. [PMID: 36634750 DOI: 10.1016/j.ijpsycho.2023.01.004] [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: 05/08/2022] [Revised: 12/22/2022] [Accepted: 01/04/2023] [Indexed: 01/11/2023]
Abstract
Transcranial direct current stimulation (tDCS) is a promising technique for enhancement of executive functions in healthy as well as neurologically disturbed patients. However, the evidence regarding the neuropsychological and behavioral change with neurophysiological shifts as well as the mechanism of tDCS action as evidenced by activation of neuronal sources important for executive functions have remained unaddressed. The study thereby endeavors to (1) determine the neuropsychological, behavioral, and neurophysiological change induced with five sessions of bilateral tDCS stimulation and (2) identify putative neuronal sources related to the executive functions responsible for neuropsychological and behavioral change. For this single blinded study, a total of 40 healthy participants, randomly allocated to active (n = 19) or sham (n = 21) groups completed five sessions of 2 mA tDCS stimulation administered over Dorso-Lateral Prefrontal Cortex (DLPFC) (F3 as anode, F4 as cathode). Repeated measure analysis was performed on neuropsychological (Everyday Memory Questionnaire and Mindful Attention Awareness Scale), and behavioral assessment (n-Back and Stroop tests) to investigate within and between group differences. Pre and post neurophysiological (Electroencephalogram) results showed that bilateral tDCS stimulation activates cortical regions responsible for executive functions including updation (working memory) and inhibition (interference control or attention). Multiple sessions of bilateral tDCS stimulation results in a significant increase in theta, alpha, and beta-band activity in the DLPFC, cingulate and parietal cortex. This study provides evidence that tDCS can be used for performance enhancement of executive functions in able-bodied people.
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Affiliation(s)
- Muhammad Abul Hasan
- Department of Biomedical Engineering, NED University of Engineering & Technology, Karachi, Pakistan; Neurocomputation Laboratory, National Center of Artificial Intelligence, Karachi, Pakistan
| | - Hira Shahid
- Neurocomputation Laboratory, National Center of Artificial Intelligence, Karachi, Pakistan; Research Centre for Intelligent Healthcare, Coventry University, Coventry, United Kingdom.
| | - Saad Ahmed Qazi
- Neurocomputation Laboratory, National Center of Artificial Intelligence, Karachi, Pakistan; Department of Electrical Engineering, NED University of Engineering & Technology, Karachi, Pakistan
| | - Osama Ejaz
- Neurocomputation Laboratory, National Center of Artificial Intelligence, Karachi, Pakistan
| | - Muhammad Danish Mujib
- Department of Biomedical Engineering, NED University of Engineering & Technology, Karachi, Pakistan
| | - Aleksandra Vuckovic
- Biomedical Engineering Division, University of Glasgow, Glasgow, United Kingdom
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Malighetti C, Sansoni M, Gaudio S, Matamala-Gomez M, Di Lernia D, Serino S, Riva G. From Virtual Reality to Regenerative Virtual Therapy: Some Insights from a Systematic Review Exploring Inner Body Perception in Anorexia and Bulimia Nervosa. J Clin Med 2022; 11:jcm11237134. [PMID: 36498708 PMCID: PMC9737310 DOI: 10.3390/jcm11237134] [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: 09/09/2022] [Revised: 11/10/2022] [Accepted: 11/20/2022] [Indexed: 12/02/2022] Open
Abstract
Despite advances in our understanding of the behavioral and molecular factors that underlie the onset and maintenance of Eating Disorders (EDs), it is still necessary to optimize treatment strategies and establish their efficacy. In this context, over the past 25 years, Virtual Reality (VR) has provided creative treatments for a variety of ED symptoms, including body dissatisfaction, craving, and negative emotions. Recently, different researchers suggested that EDs may reflect a broader impairment in multisensory body integration, and a particular VR technique-VR body swapping-has been used to repair it, but with limited clinical results. In this paper, we use the results of a systematic review employing PRISMA guidelines that explore inner body perception in EDs (21 studies included), with the ultimate goal to analyze the features of multisensory impairment associated with this clinical condition and provide possible solutions. Deficits in interoception, proprioception, and vestibular signals were observed across Anorexia and Bulimia Nervosa, suggesting that: (a) alteration of inner body perception might be a crucial feature of EDs, even if further research is needed and; (b) VR, to be effective with these patients, has to simulate/modify both the external and the internal body. Following this outcome, we introduce a new therapeutic approach-Regenerative Virtual Therapy-that integrates VR with different technologies and clinical strategies to regenerate a faulty bodily experience by stimulating the multisensory brain mechanisms and promoting self-regenerative processes within the brain itself.
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Affiliation(s)
- Clelia Malighetti
- Department of Psychology, Università Cattolica del Sacro Cuore, Largo Gemelli 1, 20100 Milan, Italy
| | - Maria Sansoni
- Department of Psychology, Università Cattolica del Sacro Cuore, Largo Gemelli 1, 20100 Milan, Italy
- Correspondence: ; Tel.: +39-02-72-343-863
| | - Santino Gaudio
- Department of Neuroscience, Functional Pharmacology, Uppsala University, Husargatan 3, 75237 Uppsala, Sweden
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Viale Montpellier 1, 00133 Rome, Italy
| | - Marta Matamala-Gomez
- Department of Psychology, Mind and Behavior Technological Center, University of Milano-Bicocca, Piazza dell’Ateneo Nuovo 1, 20126 Milan, Italy
| | - Daniele Di Lernia
- Department of Psychology, Università Cattolica del Sacro Cuore, Largo Gemelli 1, 20100 Milan, Italy
| | - Silvia Serino
- Department of Psychology, Università Cattolica del Sacro Cuore, Largo Gemelli 1, 20100 Milan, Italy
| | - Giuseppe Riva
- Applied Technology for Neuro-Psychology Lab, IRCCS Istituto Auxologico Italiano, Via Magnasco 2, 20149 Milan, Italy
- Humane Technology Lab, Università Cattolica del Sacro Cuore, Largo Gemelli 1, 20100 Milan, Italy
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Kundakci B, Kaur J, Goh SL, Hall M, Doherty M, Zhang W, Abhishek A. Efficacy of nonpharmacological interventions for individual features of fibromyalgia: a systematic review and meta-analysis of randomised controlled trials. Pain 2022; 163:1432-1445. [PMID: 34813518 DOI: 10.1097/j.pain.0000000000002500] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 09/15/2021] [Indexed: 11/25/2022]
Abstract
ABSTRACT Fibromyalgia is a highly heterogeneous condition, but the most common symptoms are widespread pain, fatigue, poor sleep, and low mood. Nonpharmacological interventions are recommended as first-line treatment of fibromyalgia. However which interventions are effective for the different symptoms is not well understood. The objective of this study was to assess the efficacy of nonpharmacological interventions on symptoms and disease-specific quality of life. Seven databases were searched from their inception until June 1, 2020. Randomised controlled trials comparing any nonpharmacological intervention to usual care, waiting list, or placebo in people with fibromyalgia aged >16 years were included without language restriction. Fibromyalgia Impact Questionnaire (FIQ) was the primary outcome measure. Standardised mean difference and 95% confidence interval were calculated using random effects model. The risk of bias was evaluated using the modified Cochrane tool. Of the 16,251 studies identified, 167 randomised controlled trials (n = 11,012) assessing 22 nonpharmacological interventions were included. Exercise, psychological treatments, multidisciplinary modality, balneotherapy, and massage improved FIQ. Subgroup analysis of different exercise interventions found that all forms of exercise improved pain (effect size [ES] -0.72 to -0.96) and depression (ES -0.35 to -1.22) except for flexibility exercise. Mind-body and strengthening exercises improved fatigue (ES -0.77 to -1.00), whereas aerobic and strengthening exercises improved sleep (ES -0.74 to -1.33). Psychological treatments including cognitive behavioural therapy and mindfulness improved FIQ, pain, sleep, and depression (ES -0.35 to -0.55) but not fatigue. The findings of this study suggest that nonpharmacological interventions for fibromyalgia should be individualised according to the predominant symptom.
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Affiliation(s)
- Burak Kundakci
- Academic Rheumatology, Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- Pain Centre Versus Arthritis, Nottingham, United Kingdom
- cCentre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Jaspreet Kaur
- Academic Rheumatology, Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- Pain Centre Versus Arthritis, Nottingham, United Kingdom
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Siew Li Goh
- Sports Medicine Unit, University of Malaya, Kuala Lumpur, Malaysia
| | - Michelle Hall
- Academic Rheumatology, Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- Pain Centre Versus Arthritis, Nottingham, United Kingdom
- National Institute for Health Research, Nottingham Biomedical Research Centre, Nottingham, United Kingdom
- Division of Physiotherapy and Rehabilitation Sciences, University of Nottingham, Nottingham, United Kingdom
| | - Michael Doherty
- Academic Rheumatology, Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- Pain Centre Versus Arthritis, Nottingham, United Kingdom
- National Institute for Health Research, Nottingham Biomedical Research Centre, Nottingham, United Kingdom
| | - Weiya Zhang
- Academic Rheumatology, Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- Pain Centre Versus Arthritis, Nottingham, United Kingdom
- National Institute for Health Research, Nottingham Biomedical Research Centre, Nottingham, United Kingdom
| | - Abhishek Abhishek
- Academic Rheumatology, Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- Pain Centre Versus Arthritis, Nottingham, United Kingdom
- National Institute for Health Research, Nottingham Biomedical Research Centre, Nottingham, United Kingdom
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11
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Ghafoor U, Yang D, Hong KS. Neuromodulatory effects of HD-tACS/tDCS on the prefrontal cortex: A resting-state fNIRS-EEG study. IEEE J Biomed Health Inform 2021; 26:2192-2203. [PMID: 34757916 DOI: 10.1109/jbhi.2021.3127080] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Transcranial direct and alternating current stimulation (tDCS and tACS, respectively) can modulate human brain dynamics and cognition. However, these modalities have not been compared using multiple imaging techniques concurrently. In this study, 15 participants participated in an experiment involving two sessions with a gap of 10 d. In the first and second sessions, tACS and tDCS were administered to the participants. The anode for tDCS was positioned at point FpZ, and four cathodes were positioned over the left and right prefrontal cortices (PFCs) to target the frontal regions simultaneously. tDCS was administered with 1 mA current. tACS was supplied with a current of 1 mA (zero-to-peak value) at 10 Hz frequency. Stimulation was applied concomitantly with functional near-infrared spectroscopy and electroencephalography acquisitions in the resting-state. The statistical test showed significant alteration (p < 0.001) in the mean hemodynamic responses during and after tDCS and tACS periods. Between-group comparison revealed a significantly less (p < 0.001) change in the mean hemodynamic response caused by tACS compared with tDCS. As hypothesized, we successfully increased the hemodynamics in both left and right PFCs using tDCS and tACS. Moreover, a significant increase in alpha-band power (p < 0.01) and low beta band power (p < 0.05) due to tACS was observed after the stimulation period. Although tDCS is not frequency-specific, it increased but not significantly (p > 0.05) the powers of most bands including delta, theta, alpha, low beta, high beta, and gamma. These findings suggest that both hemispheres can be targeted and that both tACS and tDCS are equally effective in high-definition configurations, which may be of clinical relevance.
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12
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Singh A, Erwin-Grabner T, Goya-Maldonado R, Antal A. Transcranial Magnetic and Direct Current Stimulation in the Treatment of Depression: Basic Mechanisms and Challenges of Two Commonly Used Brain Stimulation Methods in Interventional Psychiatry. Neuropsychobiology 2021; 79:397-407. [PMID: 31487716 DOI: 10.1159/000502149] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 07/16/2019] [Indexed: 12/12/2022]
Abstract
Noninvasive neuromodulation, including repetitive trans-cranial magnetic stimulation (rTMS) and direct current stimulation (tDCS), provides researchers and health care professionals with the ability to gain unique insights into brain functions and treat several neurological and psychiatric conditions. Undeniably, the number of published research and clinical papers on this topic is increasing exponentially. In parallel, several methodological and scientific caveats have emerged in the transcranial stimulation field; these include less robust and reliable effects as well as contradictory clinical findings. These inconsistencies are maybe due to the fact that research exploring the relationship between the methodological aspects and clinical efficacy of rTMS and tDCS is far from conclusive. Hence, additional work is needed to understand the mechanisms underlying the effects of magnetic stimulation and low-intensity transcranial electrical stimulation (TES) in order to optimize dosing, methodological designs, and safety aspects.
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Affiliation(s)
- Aditya Singh
- Laboratory of Systems Neuroscience and Imaging in Psychiatry (SNIP-Lab), Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Göttingen, Germany
| | - Tracy Erwin-Grabner
- Laboratory of Systems Neuroscience and Imaging in Psychiatry (SNIP-Lab), Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Göttingen, Germany
| | - Roberto Goya-Maldonado
- Laboratory of Systems Neuroscience and Imaging in Psychiatry (SNIP-Lab), Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Göttingen, Germany
| | - Andrea Antal
- Department of Clinical Neurophysiology, University Medical Center Göttingen, Göttingen, Germany, .,Institute for Medical Psychology, Medical Faculty, Otto-v.-Guericke University Magdeburg, Magdeburg, Germany,
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13
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Zhang T, Han S. Non-phase-locked alpha oscillations are involved in spontaneous racial categorization of faces. Neuropsychologia 2021; 160:107968. [PMID: 34310972 DOI: 10.1016/j.neuropsychologia.2021.107968] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 07/21/2021] [Accepted: 07/21/2021] [Indexed: 10/20/2022]
Abstract
Racial categorization of faces has a notable impact on human behavior, but its neural underpinnings remain unresolved. Previous electroencephalography (EEG) research focused on contributions of phase-locked neural activities to racial categorization of faces. We investigated functional roles of non-phase-locked neural oscillations in spontaneous racial categorization of faces by recording EEG from Chinese adults who performed an individuation task on Asian/White faces in Experiment 1 and on Asian/Black faces in Experiment 2. We quantified neural processes involved in spontaneous racial categorization of faces by examining repetition suppression of non-phase-locked neural oscillations when participants viewed faces of one race presented repeatedly in the same block of trials (repetition condition), or faces of two races presented alternately in the same block of trials (alternating condition). We found decreased power of alpha (9-13 Hz) oscillations in the repetition than alternating conditions at 80-240 ms over frontal-central electrodes induced by White/Black (but not Asian) faces. Moreover, larger repetition suppression of alpha oscillations in response to White/Black (vs. Asian) faces predicted greater implicit negative attitudes toward White/Black faces across individuals. Our findings suggest that non-phase-locked alpha oscillations are engaged in spontaneous racial categorization of faces and are associated with implicit negative attitudes toward other-race faces.
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Affiliation(s)
- Ting Zhang
- School of Psychological and Cognitive Sciences, PKU-IDG/McGovern Institute for Brain Research, Beijing Key Laboratory of Behavior and Mental Health, Peking University, Beijing, China
| | - Shihui Han
- School of Psychological and Cognitive Sciences, PKU-IDG/McGovern Institute for Brain Research, Beijing Key Laboratory of Behavior and Mental Health, Peking University, Beijing, China.
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14
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García-González S, Lugo-Marín J, Setien-Ramos I, Gisbert-Gustemps L, Arteaga-Henríquez G, Díez-Villoria E, Ramos-Quiroga JA. Transcranial direct current stimulation in Autism Spectrum Disorder: A systematic review and meta-analysis. Eur Neuropsychopharmacol 2021; 48:89-109. [PMID: 33773886 DOI: 10.1016/j.euroneuro.2021.02.017] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 02/11/2021] [Accepted: 02/24/2021] [Indexed: 02/06/2023]
Abstract
Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation technique that has gained relevance in recent years as an alternative treatment for neuropsychiatric conditions. The aim of this study is to conduct a systematic review of the use of tDCS in Autism Spectrum Disorder (ASD). Both electronic and manual searches were conducted to identify studies published in peer-reviewed scientific journals addressing the use of tDCS in ASD population. A total of 16 studies fulfilled the criteria to be included in the review. Studies were conducted both in child and adult population. Anodal stimulation on the left dorsolateral prefrontal cortex was the most commonly chosen methodology. Outcomes addressed ASD symptoms and neuropsychological functions. Meta-analytic synthesis identified improvements in social, health, and behavioral problem domains of the Autism Treatment Evaluation Checklist. Limitations included high heterogeneity in the methodology and low-efficacy study designs (pre-post and single-case studies). Recent controlled trials shed promising results for the use of tDCS in ASD. A standardized stimulation protocol and a consensus in the measures used in the evaluation of the efficacy are imperative.
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Affiliation(s)
- Sara García-González
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain
| | - Jorge Lugo-Marín
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain
| | - Imanol Setien-Ramos
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain; Group of Psychiatry, Mental Health and Addictions, Vall d'Hebron Research Institute (VHIR), Barcelona, Catalonia, Spain
| | - Laura Gisbert-Gustemps
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain; Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Gara Arteaga-Henríquez
- Group of Psychiatry, Mental Health and Addictions, Vall d'Hebron Research Institute (VHIR), Barcelona, Catalonia, Spain
| | - Emiliano Díez-Villoria
- Centro de Atención Integral al Autismo-InFoAutismo, INICO-Instituto Universitario de Integración en la Comunidad, University of Salamanca, Salamanca, Spain
| | - Josep Antoni Ramos-Quiroga
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain; Group of Psychiatry, Mental Health and Addictions, Vall d'Hebron Research Institute (VHIR), Barcelona, Catalonia, Spain; Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain; Psychiatric Genetics Unit, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain; Biomedical Network Research Centre on Mental Health (CIBERSAM), Madrid, Spain.
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15
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Lerud KD, Vines BW, Shinde AB, Schlaug G. Modulating short-term auditory memory with focal transcranial direct current stimulation applied to the supramarginal gyrus. Neuroreport 2021; 32:702-710. [PMID: 33852539 PMCID: PMC8085037 DOI: 10.1097/wnr.0000000000001647] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Previous studies have shown that transcranial direct current stimulation (tDCS) can affect performance by decreasing regional excitability in a brain region that contributes to the task of interest. To our knowledge, no research to date has found both enhancing and diminishing effects on performance, depending upon which polarity of the current is applied. The supramarginal gyrus (SMG) is an ideal brain region for testing tDCS effects because it is easy to identify using the 10-20 electroencephalography coordinate system, and results of neuroimaging studies have implicated the left SMG in short-term memory for phonological and nonphonological sounds. In the present study, we found that applying tDCS to the left SMG affected pitch memory in a manner that depended upon the polarity of stimulation: cathodal tDCS had a negative impact on performance whereas anodal tDCS had a positive impact. These effects were significantly different from sham stimulation, which did not influence performance; they were also specific to the left hemisphere - no effect was found when applying cathodal stimulation to the right SMG - and were unique to pitch memory as opposed to memory for visual shapes. Our results provide further evidence that the left SMG is a nodal point for short-term auditory storage and demonstrate the potential of tDCS to influence cognitive performance and to causally examine hypotheses derived from neuroimaging studies.
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Affiliation(s)
- Karl D. Lerud
- Department of Neurology and Pioneer Valley Life Sciences Institute, Baystate Medical Center – UMass Medical School, Springfield, MA, USA
| | - Bradley W. Vines
- Department of Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Anant B. Shinde
- Department of Neurology and Pioneer Valley Life Sciences Institute, Baystate Medical Center – UMass Medical School, Springfield, MA, USA
- Department of Biomedical Engineering and Institute of Applied Life Sciences, UMass Amherst, Amherst, MA, USA
- Department of Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Gottfried Schlaug
- Department of Neurology and Pioneer Valley Life Sciences Institute, Baystate Medical Center – UMass Medical School, Springfield, MA, USA
- Department of Biomedical Engineering and Institute of Applied Life Sciences, UMass Amherst, Amherst, MA, USA
- Department of Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
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16
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Lotfi Y, Farahani A, Azimiyan M, Moossavi A, Bakhshi E. Comparison of efficacy of vestibular rehabilitation and noisy galvanic vestibular stimulation to improve dizziness and balance in patients with multiple sclerosis. J Vestib Res 2021; 31:541-551. [PMID: 33967075 DOI: 10.3233/ves-201609] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Dizziness and imbalance are common symptoms in patients with multiple sclerosis (PwMS), and rehabilitation interventions varying greatly in effectiveness. OBJECTIVE To compare the effectiveness of vestibular rehabilitation therapy (VRT) and noisy galvanic vestibular stimulation (nGVS) on dizziness and balance in PwMS. METHODS This was a single-blind, randomized controlled trial. Twenty-four PwMS were randomly divided into groups of VRT, nGVS, and Control. The VRT and the nGVS groups underwent the intervention program. The patients were assessed with the composite score in anteroposterior and lateral directions (CS AP and LAT) obtained by sensory organization test (SOT), Dizziness Handicap Inventory (DHI), and Activities-Specific Balance Confidence Scale (ABC). RESULTS The VRT group showed greater improvements in CS AP and LAT, DHI total score, and ABC total score compared with the nGVS group and the control group. No significant difference was found between the nGVS group and the control group. These results were approximately stable at the 4-week follow-up. CONCLUSIONS These findings provided evidence for effectiveness of the VRT in improvement of dizziness and balance in PwMS. These improvements were not associated with the nGVS. Further studies are needed to assess the effectiveness of the nGVS on dizziness and balance in PwMS.
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Affiliation(s)
- Yones Lotfi
- Department of Audiology, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Akram Farahani
- Department of Audiology, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mojtaba Azimiyan
- Department of Clinical Sciences, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Abdollah Moossavi
- Department of Otolaryngology and Head and Neck Surgery, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Enayatollah Bakhshi
- Department of Biostatistics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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17
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Nakamagoe K, Yamada S, Kawakami R, Maeno T, Koganezawa T, Tamaoka A. Clinical Application of the Vestibular Stimulation Effect on Balance Disorders with Dementia. Curr Alzheimer Res 2021; 18:1-7. [PMID: 33761856 DOI: 10.2174/1567205018666210324105642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 10/12/2020] [Accepted: 02/16/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND In a previous study on Alzheimer's disease (AD), we showed that vestibular dysfunction derived from cerebral disorders contributes to balance disorders. No previous clinical study has attempted to prevent the progression of balance disorders in dementia patients through vestibular stimulation using an air caloric device. OBJECTIVE The purpose of this pilot study was to delay the progression of balance disorders by inducing vestibular compensation, specifically by utilizing the effect of vestibular stimulation to activate the cerebrum. METHODS Fifteen individuals were randomized and classified into a stimulation group or a nonstimulation group. Eight AD patients underwent vestibular stimulation every 2 weeks for 6 months in the stimulation group. Seven AD patients participated in the nonstimulation group (the control group). Both groups were subsequently evaluated using a Mini-Mental State Examination (MMSE), stepping test, caloric test, and smooth pursuit eye movement test just before starting the study and 6 months later. RESULTS For balance parameters, the various tests did not show any significant differences between the two groups. However, in the stepping test, the decline rate tended to be higher in the nonstimulation group than in the stimulation group. The stimulation group's rate of decline in MMSE scores was lower than that of the nonstimulation group (p=0.015). No adverse events were tracked during the present study. CONCLUSION Repeated vestibular stimulation might help patients retain greater balance and higher function. To prove these effects, the future clinical application will require an increased number of cases and longer periods of vestibular stimulation. This study showed that vestibular stimulation by air caloric device is safe and tolerable in patients with AD.
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Affiliation(s)
- Kiyotaka Nakamagoe
- Department of Neurology, Division of Clinical Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki,Japan
| | - Shiori Yamada
- Department of Neurology, Division of Clinical Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki,Japan
| | - Rio Kawakami
- Department of Neurology, Division of Clinical Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki,Japan
| | - Takami Maeno
- Department of Primary Care and Medical Education, Division of Clinical Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki,Japan
| | - Tadachika Koganezawa
- Department of Physiology, Division of Biomedical Science, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki,Japan
| | - Akira Tamaoka
- Department of Neurology, Division of Clinical Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki,Japan
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18
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Modulating the activity of right temporo-parietal junction by anodal tDCS enhances the agent's repayment in hold-up game. Brain Res Bull 2020; 168:17-24. [PMID: 33370587 DOI: 10.1016/j.brainresbull.2020.12.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 11/18/2020] [Accepted: 12/18/2020] [Indexed: 11/22/2022]
Abstract
Hold-up problem is very common in non-contractible relation-specific investment transactions. And this problem can affect by trust, cooperation and altruism behavior of human beings. Recent neuroscience researches had explored a network of right temporo-parietal junction (rTPJ) involved in human cooperation and altruism behavior. The purpose of this study is to modulate the activation of rTPJ through transcranial direct current stimulation (tDCS), and to study the influence of rTPJ on investment and offer behavior in hold-up game. The results of our study showed that the anodal stimulation significantly increased participants' offer compared with the cathodal and sham stimulation. A possible explanation is that changes in rTPJ activity induced by anodal stimulation improve the accuracy of agents' mental reasoning and promote cooperation by influencing agents' offer behavior.
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19
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Sanayi R, Rahimi V, Mohamadkhani R, Hoseinabadi R. The Effect of Cognitive Tasks on the Ocular Vestibular Evoked Myogenic Potentials in Healthy People. IRANIAN JOURNAL OF OTORHINOLARYNGOLOGY 2020; 32:311-317. [PMID: 33014908 PMCID: PMC7515621 DOI: 10.22038/ijorl.2019.39322.2301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Introduction: The majority of the daily life activities involve the concurrent performance of simultaneously challenging motor and cognitive activities, such as talking while walking, which requires the vestibular system for balance. Functional balance allows the brain to interpret and integrate the sensory information from our physical and social environment. This study aimed to investigate the effect of cognitive activities on the vestibular system function. Materials and Methods: This study investigated the otolith system as a sensory organ that is responsible for linear acceleration by recording ocular vestibular evoked myogenic potential (oVEMP) in 28 healthy participants (11 males and 17 females) with the age range of 18-26 years under a cognitive condition. The rest and intervention states were compared in terms of oVEMP n1-p1 amplitude, n1-p1 latencies, and gender. Results: The results showed that the oVEMP n1-p1 amplitude in both ears significantly decreased, and the asymmetry increased after cognitive tasks, compared to the rest state in females (P≤0.02). Moreover, there was no significant difference between the rest state and numeric subtraction task in terms of oVEMP n1-p1 latencies in males and females (P>0.05). Conclusion: These results suggest that an augmented cognitive load causes an alteration in the oVEMPs; therefore, it is suggested that the structures associated with the cognitive processing are connected with the vestibular system in the brain. These findings demonstrate the importance of non-vestibular factors in balance, especially in females.
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Affiliation(s)
- Roya Sanayi
- Department of Audiology, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Vida Rahimi
- Department of Audiology, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Rahimi Mohamadkhani
- Department of Audiology, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Hoseinabadi
- Department of Audiology, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
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20
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Miller SM. Fluctuations of consciousness, mood, and science: The interhemispheric switch and sticky switch models two decades on. J Comp Neurol 2020; 528:3171-3197. [DOI: 10.1002/cne.24943] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 04/21/2020] [Accepted: 04/22/2020] [Indexed: 12/13/2022]
Affiliation(s)
- Steven M. Miller
- Perceptual and Clinical Neuroscience Laboratory, Department of Physiology Monash Biomedicine Discovery Institute, School of Biomedical Sciences, Monash University Melbourne Victoria Australia
- Monash Alfred Psychiatry Research Centre Central Clinical School, Monash University and Alfred Health Melbourne Victoria Australia
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21
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Ngo TT, Barsdell WN, Law PCF, Arnold CA, Chou MJ, Nunn AK, Brown DJ, Fitzgerald PB, Gibson SJ, Miller SM. Tolerability of caloric vestibular stimulation in a persistent pain cohort. Brain Stimul 2020; 13:1446-1448. [PMID: 32693181 DOI: 10.1016/j.brs.2020.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 07/12/2020] [Indexed: 11/30/2022] Open
Affiliation(s)
- Trung T Ngo
- UQ Diamantina Institute, University of Queensland Faculty of Medicine & Translational Research Institute, Woolloongabba, Brisbane, QLD, Australia.
| | - Wendy N Barsdell
- Neuropsychology Service, Psychology Department, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Phillip C F Law
- Monash Biomedicine Discovery Institute, Department of Physiology, Monash University, Melbourne, VIC, Australia; Monash Alfred Psychiatry Research Centre, Monash University Central Clinical School and the Alfred Hospital, Melbourne, VIC, Australia
| | - Carolyn A Arnold
- Caulfield Pain Management & Research Centre, Caulfield Hospital and Alfred Health, Melbourne, VIC, Australia; Department of Anaesthesia & Perioperative Medicine, Monash University, Melbourne, VIC, Australia
| | - Michael J Chou
- Amputee Clinic, Caulfield Hospital, Melbourne, VIC, Australia
| | - Andrew K Nunn
- Amputee Clinic, Caulfield Hospital, Melbourne, VIC, Australia; Victorian Spinal Cord Service, Austin Health, Melbourne, VIC, Australia; Department of Electrical & Computer Systems Engineering, Monash University, Melbourne, VIC, Australia
| | - Douglas J Brown
- Spinal Research Institute, Austin Health, Melbourne, VIC, Australia
| | - Paul B Fitzgerald
- Epworth Centre for Innovation in Mental Health, Epworth Healthcare and Monash University, Department of Psychiatry, Melbourne, VIC, Australia
| | - Stephen J Gibson
- Caulfield Pain Management & Research Centre, Caulfield Hospital and Alfred Health, Melbourne, VIC, Australia; National Ageing Research Institute, Melbourne, VIC, Australia
| | - Steven M Miller
- Monash Biomedicine Discovery Institute, Department of Physiology, Monash University, Melbourne, VIC, Australia; Monash Alfred Psychiatry Research Centre, Monash University Central Clinical School and the Alfred Hospital, Melbourne, VIC, Australia.
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22
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Kim M, Lee TH, Hwang WJ, Lee TY, Kwon JS. Auditory P300 as a Neurophysiological Correlate of Symptomatic Improvement by Transcranial Direct Current Stimulation in Patients With Schizophrenia: A Pilot Study. Clin EEG Neurosci 2020; 51:252-258. [PMID: 30474393 DOI: 10.1177/1550059418815228] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background. The reduced amplitude, prolonged latency, and increased intertrial variability of auditory P300 have been consistently reported in relation to the symptomatic severity of schizophrenia. This study investigated whether auditory P300 event-related potentials can be used as an objective indicator of symptomatic improvement by transcranial direct current stimulation (tDCS) in patients with schizophrenia. Methods. Ten patients with schizophrenia received 20 minutes of 2-mA tDCS twice a day for 5 consecutive weekdays. The anode was placed over the left dorsolateral prefrontal cortex, and the cathode was placed over the left temporo-parietal cortex. The Positive and Negative Syndrome Scale (PANSS) and the auditory P300 were measured for each participant at baseline and after the completion of the tDCS applications. Results. The participants showed significant improvement in the positive and negative symptoms as indexed by change in the PANSS scores by the tDCS. The P300 amplitude, latency, and intertrial variability did not statistically significantly differ after the tDCS application. However, a significant association was observed between the reduced P300 intertrial variability and improvement in the positive symptoms by tDCS. In addition, the changes in both the P300 latency and intertrial variability were significantly correlated with reduced negative symptoms after the tDCS application. Conclusions. Although this pilot study is limited by the small sample size and lack of a sham control, the results suggest that auditory P300 may be a putative marker reflecting the effect of tDCS on the positive and negative symptoms of schizophrenia.
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Affiliation(s)
- Minah Kim
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Tak Hyung Lee
- Department of Brain and Cognitive Sciences, Seoul National University College of Natural Science, Seoul, Republic of Korea
| | - Wu Jeong Hwang
- Department of Brain and Cognitive Sciences, Seoul National University College of Natural Science, Seoul, Republic of Korea
| | - Tae Young Lee
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jun Soo Kwon
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Brain and Cognitive Sciences, Seoul National University College of Natural Science, Seoul, Republic of Korea.,Institute of Human Behavioral Medicine, SNU-MRC, Seoul, Republic of Korea
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Multi-session anodal transcranial direct current stimulation enhances lower extremity functional performance in healthy older adults. Exp Brain Res 2020; 238:1925-1936. [DOI: 10.1007/s00221-020-05827-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 05/02/2020] [Indexed: 12/22/2022]
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Speitel C, Traut-Mattausch E, Jonas E. Functions of the right DLPFC and right TPJ in proposers and responders in the ultimatum game. Soc Cogn Affect Neurosci 2020; 14:263-270. [PMID: 30690558 PMCID: PMC6399615 DOI: 10.1093/scan/nsz005] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 11/25/2018] [Accepted: 01/13/2019] [Indexed: 12/17/2022] Open
Abstract
Recent studies explored a network of brain regions involved in economic decision making. The present study focuses on two of those regions, each relevant for specific and distinct functions in economic decision making: the right temporoparietal junction (rTPJ) and the right dorsolateral prefrontal cortex (rDLPFC). In two experiments using transcranial direct current stimulation, we explored two proposed functions of these areas in bargaining situations using the ultimatum game (UG): understanding the others perspective and integration of fairness norms. Participants first took the role of the proposer and then the role of the responder. We showed that stimulation of the rTPJ only affected the proposer condition. Interestingly, inhibition of the rTPJ led to fairer offers, which strengthens the view that the role of the rTPJ in bargaining situations is to differentiate one’s own from the other’s perspective. Furthermore, we argue that the rDLPFC is most likely involved in suppressing self-interest when a person is confronted with a direct reward but does not play a role in long-term reward anticipation or integrating social fairness norms. We conclude that self-interest inhibition is shown only in responders, and that perspective taking seems to be a necessary specifically for proposers in the UG.
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Affiliation(s)
- Constantin Speitel
- Department of Psychology, University of Salzburg, Hellbrunner Strasse, Salzburg, Austria
| | - Eva Traut-Mattausch
- Department of Psychology, University of Salzburg, Hellbrunner Strasse, Salzburg, Austria
| | - Eva Jonas
- Department of Psychology, University of Salzburg, Hellbrunner Strasse, Salzburg, Austria
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Hagiwara K, Perchet C, Frot M, Bastuji H, Garcia-Larrea L. Cortical modulation of nociception by galvanic vestibular stimulation: A potential clinical tool? Brain Stimul 2019; 13:60-68. [PMID: 31636023 DOI: 10.1016/j.brs.2019.10.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 09/27/2019] [Accepted: 10/09/2019] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE Vestibular afferents converge with nociceptive ones within the posterior insula, and can therefore modulate nociception. Consistent with this hypothesis, caloric vestibular stimulation (CVS) has been shown to reduce experimental and clinical pain. Since CVS can induce undesirable effects in a proportion of patients, here we explored an alternative means to activate non-invasively the vestibular pathways using innocuous bi-mastoid galvanic stimulation (GVS), and assessed its effects on experimental pain. METHODS Sixteen healthy volunteers participated in this study. Experimental pain was induced by noxious laser-heat stimuli to the left hand while recording pain ratings and related brain potentials (LEPs). We evaluated changes of these indices during left- or right-anodal GVS (cathode on contralateral mastoid), and contrasted them with those during sham GVS, optokinetic vestibular stimulation (OKS) using virtual reality, and attentional distraction to ascertain the vestibular-specific analgesic effects of GVS. RESULTS GVS elicited brief sensations of head/trunk deviation, inoffensive to all participants. Both active GVS conditions showed analgesic effects, greater for the right anodal stimulation. OKS was helpful to attain significant LEP reductions during the left-anodal stimulation. Neither sham-GVS nor the distraction task were able to modulate significantly pain ratings or LEPs. CONCLUSIONS GVS appeared as a well-tolerated and powerful procedure for the relief of experimental pain, probably through physiological interaction within insular nociceptive networks. Either isolated or in combination with other types of vestibular activation (e.g., optokinetic stimuli), GVS deserves being tested in clinical settings.
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Affiliation(s)
- Koichi Hagiwara
- Central Integration of Pain (NeuroPain), Lab-Lyon Neuroscience Research Center, INSERM U1028, CNRS, UMR5292, Université Claude Bernard, Bron, F-69677, France.
| | - Caroline Perchet
- Central Integration of Pain (NeuroPain), Lab-Lyon Neuroscience Research Center, INSERM U1028, CNRS, UMR5292, Université Claude Bernard, Bron, F-69677, France
| | - Maud Frot
- Central Integration of Pain (NeuroPain), Lab-Lyon Neuroscience Research Center, INSERM U1028, CNRS, UMR5292, Université Claude Bernard, Bron, F-69677, France
| | - Hélène Bastuji
- Central Integration of Pain (NeuroPain), Lab-Lyon Neuroscience Research Center, INSERM U1028, CNRS, UMR5292, Université Claude Bernard, Bron, F-69677, France; Service de Neurologie Fonctionnelle et D'Épileptologie et Centre Du Sommeil, Hospices Civils de Lyon, Bron, F-69677, France
| | - Luis Garcia-Larrea
- Central Integration of Pain (NeuroPain), Lab-Lyon Neuroscience Research Center, INSERM U1028, CNRS, UMR5292, Université Claude Bernard, Bron, F-69677, France; Centre D'évaluation et de Traitement de La Douleur, Hôpital Neurologique, Lyon, F-69000, France
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26
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Arshad Q, Ortega MC, Goga U, Lobo R, Siddiqui S, Mediratta S, Bednarczuk NF, Kaski D, Bronstein AM. Interhemispheric control of sensory cue integration and self-motion perception. Neuroscience 2019; 408:378-387. [PMID: 31026563 DOI: 10.1016/j.neuroscience.2019.04.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 04/10/2019] [Accepted: 04/11/2019] [Indexed: 10/27/2022]
Abstract
Spatial orientation necessitates the integration of visual and vestibular sensory cues, in-turn facilitating self-motion perception. However, the neural mechanisms underpinning sensory integration remain unknown. Recently we have illustrated that spatial orientation and vestibular thresholds are influenced by interhemispheric asymmetries associated with the posterior parietal cortices (PPC) that predominantly house the vestibulo-cortical network. Given that sensory integration is a prerequisite to both spatial orientation and motion perception, we hypothesized that sensory integration is similarly subject to interhemispheric influences. Accordingly, we explored the relationship between vestibulo-cortical dominance - assessed using a biomarker, the degree of vestibular-nystagmus suppression following transcranial direct current stimulation over the PPC - with visual dependence measures obtained during performance of a sensory integration task (the rod-and-disk task). We observed that the degree of visual dependence was correlated with vestibulo-cortical dominance. Specifically, individuals with greater right hemispheric vestibulo-cortical dominance had reduced visual dependence. We proceeded to assess the significance of such dominance on behavior by correlating measures of visual dependence with self-motion perception in healthy subjects. We observed that right-handed individuals experienced illusionary self-motion (vection) quicker than left-handers and that the degree of vestibular cortical dominance was correlated with the time taken to experience vection, only during conditions that induced interhemispheric conflict. To conclude, we demonstrate that interhemispheric asymmetries associated with vestibulo-cortical processing in the PPC functionally and mechanistically link sensory integration and self-motion perception, facilitating spatial orientation. Our findings highlight the importance of dynamic interhemispheric competition upon control of vestibular behavior in humans.
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Affiliation(s)
- Qadeer Arshad
- Division of Brain Sciences, Charing Cross Hospital Campus, Imperial College London, Fulham Palace Road, London, W6 8RF, UK; Department of Neuroscience, Psychology and Behaviour, University of Leicester, University Road, Leicester, LE1 7RH, UK.
| | - Marta Casanovas Ortega
- Division of Brain Sciences, Charing Cross Hospital Campus, Imperial College London, Fulham Palace Road, London, W6 8RF, UK
| | - Usman Goga
- Division of Brain Sciences, Charing Cross Hospital Campus, Imperial College London, Fulham Palace Road, London, W6 8RF, UK
| | - Rhannon Lobo
- Division of Brain Sciences, Charing Cross Hospital Campus, Imperial College London, Fulham Palace Road, London, W6 8RF, UK
| | - Shuaib Siddiqui
- Division of Brain Sciences, Charing Cross Hospital Campus, Imperial College London, Fulham Palace Road, London, W6 8RF, UK
| | - Saniya Mediratta
- Division of Brain Sciences, Charing Cross Hospital Campus, Imperial College London, Fulham Palace Road, London, W6 8RF, UK
| | - Nadja F Bednarczuk
- Division of Brain Sciences, Charing Cross Hospital Campus, Imperial College London, Fulham Palace Road, London, W6 8RF, UK
| | - Diego Kaski
- Department of Neuro-otology, Royal National Throat Nose and Ear Hospital, University College London, London, WC1X 8DA, UK
| | - Adolfo M Bronstein
- Division of Brain Sciences, Charing Cross Hospital Campus, Imperial College London, Fulham Palace Road, London, W6 8RF, UK
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Davis SE, Smith GA. Transcranial Direct Current Stimulation Use in Warfighting: Benefits, Risks, and Future Prospects. Front Hum Neurosci 2019; 13:114. [PMID: 31105538 PMCID: PMC6499187 DOI: 10.3389/fnhum.2019.00114] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 03/14/2019] [Indexed: 12/26/2022] Open
Abstract
Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation technique which provides unique potential to directly improve human capability on a temporary, at needs, basis. The purpose of this paper is to consider the utility of tDCS through analysis of the potential risks and benefits in the context of defence service personnel. First, we look at the potential benefits, focusing primarily on warfighter survivability and enriching cognition quality in support of command and control. Second, we look at the potential detriments to tDCS military use, focusing on adverse effects, safety considerations, and risk. Third, we examine how the level of risk can be mitigated through military doctrine development focusing on safety parameters and exclusion criteria. Finally, we explore the future prospects of military tDCS use, particularly in terms of addressing gaps in the literature so that tDCS can be used ethically and efficaciously at the level of individual personnel.
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Affiliation(s)
- Steven E Davis
- Joint and Operational Analysis Division, Defence Science and Technology Group, Edinburgh, SA, Australia
| | - Glen A Smith
- Institute of Integrated and Intelligent Systems, Griffith University, Nathan, QLD, Australia
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The Efficacy of Transcranial Current Stimulation Techniques to Modulate Resting-State EEG, to Affect Vigilance and to Promote Sleepiness. Brain Sci 2018; 8:brainsci8070137. [PMID: 30037023 PMCID: PMC6071002 DOI: 10.3390/brainsci8070137] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 07/09/2018] [Accepted: 07/17/2018] [Indexed: 02/05/2023] Open
Abstract
Transcranial Current Stimulations (tCSs) are non-invasive brain stimulation techniques which modulate cortical excitability and spontaneous brain activity by the application of weak electric currents through the scalp, in a safe, economic, and well-tolerated manner. The direction of the cortical effects mainly depend on the polarity and the waveform of the applied current. The aim of the present work is to provide a broad overview of recent studies in which tCS has been applied to modulate sleepiness, sleep, and vigilance, evaluating the efficacy of different stimulation techniques and protocols. In recent years, there has been renewed interest in these stimulations and their ability to affect arousal and sleep dynamics. Furthermore, we critically review works that, by means of stimulating sleep/vigilance patterns, in the sense of enhancing or disrupting them, intended to ameliorate several clinical conditions. The examined literature shows the efficacy of tCSs in modulating sleep and arousal pattern, likely acting on the top-down pathway of sleep regulation. Finally, we discuss the potential application in clinical settings of this neuromodulatory technique as a therapeutic tool for pathological conditions characterized by alterations in sleep and arousal domains and for sleep disorders per se.
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29
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Balancing body ownership: Visual capture of proprioception and affectivity during vestibular stimulation. Neuropsychologia 2018; 117:311-321. [PMID: 29940194 PMCID: PMC6092558 DOI: 10.1016/j.neuropsychologia.2018.06.020] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 06/01/2018] [Accepted: 06/21/2018] [Indexed: 11/23/2022]
Abstract
The experience of our body as our own (i.e. body ownership) involves integrating different sensory signals according to their contextual relevance (i.e. multisensory integration). Until recently, most studies of multisensory integration and body ownership concerned only vision, touch and proprioception; the role of other modalities, such as the vestibular system and interoception, has been neglected and remains poorly understood. In particular, no study to date has directly explored the combined effect of vestibular and interoceptive signals on body ownership. Here, we investigated for the first time how Galvanic Vestibular Stimulation (left, right, sham), tactile affectivity (a reclassified interoceptive modality manipulated by applying touch at C-tactile optimal versus non-optimal velocities), and their combination, influence proprioceptive and subjective measures of body ownership during a rubber hand illusion paradigm with healthy participants (N = 26). Our results show that vestibular stimulation (left GVS) significantly increased proprioceptive drift towards the rubber hand during mere visual exposure to the rubber hand. Moreover, it also enhanced participants’ proprioceptive drift towards the rubber hand during manipulations of synchronicity and affective touch. These findings suggest that the vestibular system influences multisensory integration, possibly by re-weighting both the two-way relationship between proprioception and vision, as well as the three-way relationship between proprioception, vision and affective touch. We discuss these findings in relation to current predictive coding models of multisensory integration and body ownership. We studied vestibular and affective contributions to body ownership. We stimulated the vestibular system in a Rubber Hand paradigm with affective touch. Right-hemisphere stimulation increased proprioceptive drift during vision of a RH. Applying affective touch further increased proprioceptive drift. Affective and vestibular signals may favour vision in multisensory integration.
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Blini E, Tilikete C, Farnè A, Hadj-Bouziane F. Probing the role of the vestibular system in motivation and reward-based attention. Cortex 2018; 103:82-99. [PMID: 29574253 PMCID: PMC6002611 DOI: 10.1016/j.cortex.2018.02.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 02/07/2018] [Accepted: 02/07/2018] [Indexed: 01/31/2023]
Abstract
The vestibular system has widespread connections in the central nervous system. Several activation loci following vestibular stimulations have been notably reported in deep, limbic areas that are otherwise difficult to reach and modulate in healthy subjects. Following preliminary evidence, suggesting that such stimulations might affect mood and affective processing, we wondered whether the vestibular system is also involved in motivation. Evolutionary accounts suggest that visuo-vestibular mismatches might have a role in preventing the search for and exploitation of goods that previously resulted in aversive reactions, as they would be a fine warning signal which follows the contact with or ingestion of noxious neurotoxins. The first question was thus whether vestibular stimulation alters sensitivity to reward. Secondly, we sought to assess whether attention is allocated in space differently when cued by highly motivational stimuli, and if this interplay is further modulated by the vestibular system. In order to evaluate both motivational and attentional assets, we administered a Posner-like cueing task to 30 healthy subjects concurrently receiving sham or galvanic vestibular stimulation (GVS; Left-Anodal and Right-Anodal configurations). The participants had to discriminate targets appearing in either exogenously cued or uncued locations (50% validity); cues predicted the amount of points (0, 2, or 10) and thus money that they could earn for a correct response. The results highlight a robust inhibition of return (IOR) (faster responses for invalidly-cued targets) which was not modulated by different levels of reward or GVS. Across all stimulation sessions, rewards exerted a powerful beneficial effect over performance: reaction times were faster when rewards were at stake. However, this effect was largest in sham, but greatly reduced in GVS conditions, most notably with the Right-Anodal configuration. This is the first evidence for a decreased sensitivity to rewards causally induced by a perturbation of the vestibular system. While future studies will shed light on its neural underpinnings and clinical implications, here we argue that GVS could be a safe and promising way to enrich our understanding of reward processes and eventually tackle the management of patients with aberrant sensitivity to rewards.
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Affiliation(s)
- Elvio Blini
- Integrative Multisensory Perception Action & Cognition Team (ImpAct), INSERM U1028, CNRS UMR5292, Lyon Neuroscience Research Center (CRNL), Lyon, France; University of Lyon 1, Lyon, France.
| | - Caroline Tilikete
- Integrative Multisensory Perception Action & Cognition Team (ImpAct), INSERM U1028, CNRS UMR5292, Lyon Neuroscience Research Center (CRNL), Lyon, France; University of Lyon 1, Lyon, France; Hospices Civils de Lyon, Neuro-Ophthalmology and Neurocognition, Hôpital Neurologique Pierre Wertheimer, Bron, France
| | - Alessandro Farnè
- Integrative Multisensory Perception Action & Cognition Team (ImpAct), INSERM U1028, CNRS UMR5292, Lyon Neuroscience Research Center (CRNL), Lyon, France; University of Lyon 1, Lyon, France; Hospices Civils de Lyon, Neuro-Immersion & Mouvement et Handicap, Lyon, France
| | - Fadila Hadj-Bouziane
- Integrative Multisensory Perception Action & Cognition Team (ImpAct), INSERM U1028, CNRS UMR5292, Lyon Neuroscience Research Center (CRNL), Lyon, France; University of Lyon 1, Lyon, France.
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Guo H, Zhang Z, Da S, Sheng X, Zhang X. High-definition transcranial direct current stimulation (HD-tDCS) of left dorsolateral prefrontal cortex affects performance in Balloon Analogue Risk Task (BART). Brain Behav 2018; 8:e00884. [PMID: 29484257 PMCID: PMC5822580 DOI: 10.1002/brb3.884] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 10/17/2017] [Accepted: 10/26/2017] [Indexed: 12/13/2022] Open
Abstract
Background Studies on risk preferences have long been of great concern and have examined the neural basis underlying risk-based decision making. However, studies using conventional transcranial direct current stimulation (tDCS) revealed that bilateral stimulation could change risk propensity with limited evidence of precisely focalized unilateral high-definition transcranial direct current stimulation (HD-tDCS). The aim of this experiment was to investigate the effect of HD-tDCS focalizing the left dorsal lateral prefrontal cortex (DLPFC) on risk-taking behavior during the Balloon Analogue Risk Task (BART). Methods This study was designed as a between-subject, single-blind, sham-controlled experiment. University students were randomly assigned to three groups: the anodal group (F3 anode, AF3, F1, F5, FC3 returned), the cathodal group (F3 cathodal, AF3, F1, F5, FC3 returned) and the sham group. Subsequently, 1.5-mA 20-min HD-tDCS was applied during the BART, and the Positive Affect and Negative Affect Scale (PANAS), the Sensation Seeking Scale-5 (SSS-5), and the Behavioral Inhibition System and Behavioral Approach System scale (BIS/BAS) were measured as control variables. Results The cathodal group earned less total money than the sham group, and no significant difference was observed between the anodal group and the sham group. Conclusions These results showed that, to some extent, focalized unilateral cathodal HD-tDCS on left DLPFC could change performance during risky tasks and diminish risky decision making. Further studies are needed to investigate the dose effect and electrode distribution of HD-tDCS during risky tasks and examine synchronous brain activity to show the neural basis.
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Affiliation(s)
- Heng Guo
- Beijing Key Laboratory of Applied Experimental PsychologyNational Demonstration Center for Experimental Psychology EducationFaculty of PsychologyBeijing Normal UniversityBeijingChina
| | - Zhuoran Zhang
- Beijing Key Laboratory of Applied Experimental PsychologyNational Demonstration Center for Experimental Psychology EducationFaculty of PsychologyBeijing Normal UniversityBeijingChina
| | - Shu Da
- Beijing Key Laboratory of Applied Experimental PsychologyNational Demonstration Center for Experimental Psychology EducationFaculty of PsychologyBeijing Normal UniversityBeijingChina
| | - Xiaotian Sheng
- Beijing Key Laboratory of Applied Experimental PsychologyNational Demonstration Center for Experimental Psychology EducationFaculty of PsychologyBeijing Normal UniversityBeijingChina
| | - Xichao Zhang
- Beijing Key Laboratory of Applied Experimental PsychologyNational Demonstration Center for Experimental Psychology EducationFaculty of PsychologyBeijing Normal UniversityBeijingChina
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32
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Deroche MLD, Nguyen DL, Gracco VL. Modulation of Speech Motor Learning with Transcranial Direct Current Stimulation of the Inferior Parietal Lobe. Front Integr Neurosci 2017; 11:35. [PMID: 29326563 PMCID: PMC5737029 DOI: 10.3389/fnint.2017.00035] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 11/29/2017] [Indexed: 12/01/2022] Open
Abstract
The inferior parietal lobe (IPL) is a region of the cortex believed to participate in speech motor learning. In this study, we investigated whether transcranial direct current stimulation (tDCS) of the IPL could influence the extent to which healthy adults (1) adapted to a sensory alteration of their own auditory feedback, and (2) changed their perceptual representation. Seventy subjects completed three tasks: a baseline perceptual task that located the phonetic boundary between the vowels /e/ and /a/; a sensorimotor adaptation task in which subjects produced the word “head” under conditions of altered or unaltered feedback; and a post-adaptation perceptual task identical to the first. Subjects were allocated to four groups which differed in current polarity and feedback manipulation. Subjects who received anodal tDCS to their IPL (i.e., presumably increasing cortical excitability) lowered their first formant frequency (F1) by 10% in opposition to the upward shift in F1 in their auditory feedback. Subjects who received the same stimulation with unaltered feedback did not change their production. Subjects who received cathodal tDCS to their IPL (i.e., presumably decreasing cortical excitability) showed a 5% adaptation to the F1 alteration similar to subjects who received sham tDCS. A subset of subjects returned a few days later to reiterate the same protocol but without tDCS, enabling assessment of any facilitatory effects of the previous tDCS. All subjects exhibited a 5% adaptation effect. In addition, across all subjects and for the two recording sessions, the phonetic boundary was shifted toward the vowel /e/ being repeated, consistently with the selective adaptation effect, but a correlation between perception and production suggested that anodal tDCS had enhanced this perceptual shift. In conclusion, we successfully demonstrated that anodal tDCS could (1) enhance the motor adaptation to a sensory alteration, and (2) potentially affect the perceptual representation of those sounds, but we failed to demonstrate the reverse effect with the cathodal configuration. Overall, tDCS of the left IPL can be used to enhance speech performance but only under conditions in which new or adaptive learning is required.
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Affiliation(s)
- Mickael L D Deroche
- Centre for Research on Brain, Language and Music, McGill University, Montreal, QC, Canada
| | - Don L Nguyen
- Centre for Research on Brain, Language and Music, McGill University, Montreal, QC, Canada
| | - Vincent L Gracco
- Centre for Research on Brain, Language and Music, McGill University, Montreal, QC, Canada.,Haskins Laboratories, New Haven, CT, United States
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33
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Xue H, Zhao L, Wang Y, Dong Q, Chen C, Xue G. Anodal transcranial direct current stimulation over the left temporoparietal cortex facilitates assembled phonology. Trends Neurosci Educ 2017. [DOI: 10.1016/j.tine.2017.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Ellison A, Ball KL, Lane AR. The Behavioral Effects of tDCS on Visual Search Performance Are Not Influenced by the Location of the Reference Electrode. Front Neurosci 2017; 11:520. [PMID: 28983233 PMCID: PMC5613168 DOI: 10.3389/fnins.2017.00520] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 09/04/2017] [Indexed: 11/17/2022] Open
Abstract
We investigated the role of reference electrode placement (ipsilateral v contralateral frontal pole) on conjunction visual search task performance when the transcranial direct current stimulation (tDCS) cathode is placed over right posterior parietal cortex (rPPC) and over right frontal eye fields (rFEF), both of which have been shown to be causally involved in the processing of this task using TMS. This resulted in four experimental manipulations in which sham tDCS was applied in week one followed by active tDCS the following week. Another group received sham stimulation in both sessions to investigate practice effects over 1 week in this task. Results show that there is no difference between effects seen when the anode is placed ipsi or contralaterally. Cathodal stimulation of rPPC increased search times straight after stimulation similarly for ipsi and contralateral references. This finding does not extend to rFEF stimulation. However, for both sites and both montages, practice effects as seen in the sham/sham condition were negated. This can be taken as evidence that for this task, reference placement on either frontal pole is not important, but also that care needs to be taken when contextualizing tDCS “effects” that may not be immediately apparent particularly in between-participant designs.
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Affiliation(s)
- Amanda Ellison
- Cognitive Neuroscience Research Unit, Department of Psychology, Durham UniversityDurham, United Kingdom.,Wolfson Research Institute for Health and Wellbeing, Durham UniversityDurham, United Kingdom
| | - Keira L Ball
- Cognitive Neuroscience Research Unit, Department of Psychology, Durham UniversityDurham, United Kingdom.,Wolfson Research Institute for Health and Wellbeing, Durham UniversityDurham, United Kingdom
| | - Alison R Lane
- Cognitive Neuroscience Research Unit, Department of Psychology, Durham UniversityDurham, United Kingdom.,Wolfson Research Institute for Health and Wellbeing, Durham UniversityDurham, United Kingdom
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Taylor ST, Chhabra H, Sreeraj VS, Shivakumar V, Kalmady SV, Venkatasubramanian G. Neural Effects of Transcranial Direct Current Stimulation in Schizophrenia: A Case Study using Functional Near-infrared Spectroscopy. Indian J Psychol Med 2017; 39:691-694. [PMID: 29200573 PMCID: PMC5688904 DOI: 10.4103/ijpsym.ijpsym_238_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Schizophrenia is a severe neuropsychiatric disorder characterized by delusions, hallucinations, behavioral symptoms, and cognitive deficits. Roughly, 70%-80% of schizophrenia patients experience auditory verbal hallucinations (AVHs), with 25%-30% demonstrating resistance to conventional antipsychotic medications. Studies suggest a promising role for add-on transcranial direct current stimulation (tDCS) in the treatment of medication-refractory AVHs. The mechanisms through which tDCS could be therapeutic in such cases are unclear, but possibly involve neuroplastic effects. In recent years, functional near-infrared spectroscopy (fNIRS) has been used successfully to study tDCS-induced neuroplastic changes. In a double-blind, sham-controlled design, we applied fNIRS to measure task-dependent cerebral blood flow (CBF) changes as a surrogate outcome of single session tDCS-induced effects on neuroplasticity in a schizophrenia patient with persistent auditory hallucinations. The observations are discussed in this case report.
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Affiliation(s)
- S Trevor Taylor
- Quillen College of Medicine, East Tennessee State University, Johnson City, Tennessee, USA
| | - Harleen Chhabra
- Department of Psychiatry and Translational Psychiatry Laboratory, Neurobiology Research Centre, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Vanteemar S Sreeraj
- Department of Psychiatry and Translational Psychiatry Laboratory, Neurobiology Research Centre, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Venkataram Shivakumar
- Department of Psychiatry and Translational Psychiatry Laboratory, Neurobiology Research Centre, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Sunil V Kalmady
- Department of Psychiatry and Translational Psychiatry Laboratory, Neurobiology Research Centre, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Ganesan Venkatasubramanian
- Department of Psychiatry and Translational Psychiatry Laboratory, Neurobiology Research Centre, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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Transcranial direct current stimulation as a motor neurorehabilitation tool: an empirical review. Biomed Eng Online 2017; 16:76. [PMID: 28830433 PMCID: PMC5568608 DOI: 10.1186/s12938-017-0361-8] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The present review collects the most relevant empirical evidence available in the literature until date regarding the effects of transcranial direct current stimulation (tDCS) on the human motor function. tDCS in a non-invasive neurostimulation technique that delivers a weak current through the brain scalp altering the cortical excitability on the target brain area. The electrical current modulates the resting membrane potential of a variety of neuronal population (as pyramidal and gabaergic neurons); raising or dropping the firing rate up or down, depending on the nature of the electrode and the applied intensity. These local changes additionally have shown long-lasting effects, evidenced by its promotion of the brain-derived neurotrophic factor. Due to its easy and safe application and its neuromodulatory effects, tDCS has attracted a big attention in the motor neurorehabilitation field among the last years. Therefore, the present manuscript updates the knowledge available about the main concept of tDCS, its practical use, safety considerations, and its underlying mechanisms of action. Moreover, we will focus on the empirical data obtained by studies regarding the application of tDCS on the motor function of healthy and clinical population, comprising motor deficiencies of a variety of pathologies as Parkinson's disease, stroke, multiple sclerosis and cerebral palsy, among others. Finally, we will discuss the main current issues and future directions of tDCS as a motor neurorehabilitation tool.
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Grundeis F, Brand C, Kumar S, Rullmann M, Mehnert J, Pleger B. Non-invasive Prefrontal/Frontal Brain Stimulation Is Not Effective in Modulating Food Reappraisal Abilities or Calorie Consumption in Obese Females. Front Neurosci 2017; 11:334. [PMID: 28676735 PMCID: PMC5476843 DOI: 10.3389/fnins.2017.00334] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 05/29/2017] [Indexed: 01/28/2023] Open
Abstract
Background/Objectives: Previous studies suggest that non-invasive transcranial direct current stimulation (tDCS) applied to the prefrontal cortex modulates food choices and calorie intake in obese humans. Participants/Methods: In the present fully randomized, placebo-controlled, within-subject and double-blinded study, we applied single sessions of anodal, cathodal, and sham tDCS to the left dorsolateral prefrontal cortex (DLPFC) and contralateral frontal operculum in 25 hungry obese women and investigated possible influences on food reappraisal abilities as well as calorie intake. We hypothesized that tDCS, (i) improves the ability to regulate the desire for visually presented foods and, (ii) reduces their consumption. Results: We could not confirm an effect of anodal or cathodal tDCS, neither on the ability to modulate the desire for visually presented foods, nor on calorie consumption. Conclusions: The present findings do not support the notion of prefrontal/frontal tDCS as a promising treatment option for obesity.
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Affiliation(s)
- Felicitas Grundeis
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain SciencesLeipzig, Germany.,Collaborative Research Centre 1052 "Obesity Mechanisms", University Hospital LeipzigLeipzig, Germany
| | - Cristin Brand
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain SciencesLeipzig, Germany.,Collaborative Research Centre 1052 "Obesity Mechanisms", University Hospital LeipzigLeipzig, Germany
| | - Saurabh Kumar
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain SciencesLeipzig, Germany.,Collaborative Research Centre 1052 "Obesity Mechanisms", University Hospital LeipzigLeipzig, Germany
| | - Michael Rullmann
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain SciencesLeipzig, Germany.,Collaborative Research Centre 1052 "Obesity Mechanisms", University Hospital LeipzigLeipzig, Germany
| | - Jan Mehnert
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain SciencesLeipzig, Germany.,Collaborative Research Centre 1052 "Obesity Mechanisms", University Hospital LeipzigLeipzig, Germany.,Department of Systems Neuroscience, University Medical Center Hamburg-EppendorfHamburg, Germany
| | - Burkhard Pleger
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain SciencesLeipzig, Germany.,Collaborative Research Centre 1052 "Obesity Mechanisms", University Hospital LeipzigLeipzig, Germany.,Department of Neurology, BG University Clinic Bergmannsheil, Ruhr-University BochumBochum, Germany
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Medaglia JD, Zurn P, Sinnott-Armstrong W, Bassett DS. Mind control as a guide for the mind. Nat Hum Behav 2017. [DOI: 10.1038/s41562-017-0119] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Gerretsen P, Pothier DD, Falls C, Armstrong M, Balakumar T, Uchida H, Mamo DC, Pollock BG, Graff-Guerrero A. Vestibular stimulation improves insight into illness in schizophrenia spectrum disorders. Psychiatry Res 2017; 251:333-341. [PMID: 28237912 PMCID: PMC5720160 DOI: 10.1016/j.psychres.2017.02.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 02/04/2017] [Accepted: 02/08/2017] [Indexed: 11/16/2022]
Abstract
Impaired insight into illness (IMP-INS) is common among individuals with schizophrenia spectrum disorders (SSD), contributing to medication nonadherence and poor clinical outcomes. Caloric vestibular simulation (CVS) is typically used to assess peripheral vestibular system function. Left cold CVS is also a transiently effective treatment for IMP-INS and hemineglect secondary to right brain hemisphere stroke, and possibly for IMP-INS and mood stabilization in patients with SSD. Participants with SSD and moderate-to-severe IMP-INS participated in an exploratory double blind, crossover, randomized controlled study of the effects of CVS on IMP-INS. Participants sequentially received all experimental conditions-left cold (4°C), right cold, and body temperature/sham CVS-in a random order. Repeated measures ANOVA were performed to compare changes in IMP-INS, mood and positive symptom severity pre and 30min post CVS. A significant interaction was found between CVS condition, time, and body temperature nystagmus peak slow phase velocity (PSPV) for IMP-INS, indicating that single session left cold CVS transiently improved IMP-INS while right cold CVS may have worsened IMP-INS, particularly in participants with greater vestibular reactivity (i.e. higher PSPV) to body temperature CVS. The procedure's effectiveness is attributed to stimulation of underactive right hemisphere circuits via vestibular nuclei projections to the contralateral hemisphere.
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Affiliation(s)
- Philip Gerretsen
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction & Mental Health, Toronto, Ontario, Canada; Geriatric Mental Health Program, Centre for Addiction & Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Campbell Mental Health Research Institute, Research Program, Centre for Addiction & Mental Health, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada.
| | - David D Pothier
- Department of Otolaryngology - Head and Neck Surgery, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada; Centre for Advanced Hearing and Balance Testing, Toronto General Hospital, Toronto, Ontario, Canada
| | - Carolyn Falls
- Centre for Advanced Hearing and Balance Testing, Toronto General Hospital, Toronto, Ontario, Canada
| | - Maxine Armstrong
- Centre for Advanced Hearing and Balance Testing, Toronto General Hospital, Toronto, Ontario, Canada
| | - Thushanthi Balakumar
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction & Mental Health, Toronto, Ontario, Canada
| | - Hiroyuki Uchida
- Geriatric Mental Health Program, Centre for Addiction & Mental Health, Toronto, Ontario, Canada; Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - David C Mamo
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction & Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Department of Psychiatry, Faculties of Medicine and Health Science, University of Malta, Msida, Malta
| | - Bruce G Pollock
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction & Mental Health, Toronto, Ontario, Canada; Geriatric Mental Health Program, Centre for Addiction & Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Campbell Mental Health Research Institute, Research Program, Centre for Addiction & Mental Health, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Ariel Graff-Guerrero
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction & Mental Health, Toronto, Ontario, Canada; Geriatric Mental Health Program, Centre for Addiction & Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Campbell Mental Health Research Institute, Research Program, Centre for Addiction & Mental Health, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
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Alhassani G, Treleaven J, Schabrun SS. Combined transcranial and trans-spinal direct current stimulation in chronic headache: A feasibility and safety trial for a novel intervention. Hong Kong Physiother J 2017; 37:1-9. [PMID: 30931040 PMCID: PMC6385152 DOI: 10.1016/j.hkpj.2016.11.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background: Chronic primary headache disorders are associated with frequent, severe pain and significant functional impairment, with treatment remaining challenging. Objective: We examined the feasibility and safety of a novel brain [transcranial direct current stimulation (tDCS)] and spinal cord stimulation [trans-spinal cord direct current stimulation (tsDCS)] treatment in chronic headache. Methods: Nine participants (3 males; aged, 40 ± 15 years) suffering from chronic daily headache, chronic tension-type headache, or chronic migraine received the combined brain and spinal cord intervention for 5 consecutive days. Stimulation was applied for a total of 40 minutes (20 minutes of tDCS followed by 20 minutes of tsDCS) at 1 mA. Pain sensitivity and headache symptoms (frequency, severity, duration, and medications recorded via a headache diary, 4 weeks before and after treatment) were assessed. Results: The treatment was safe, feasible, and well tolerated. Headache frequency was reduced following the treatment (p = 0.026) in chronic tension-type headache and chronic migraine, but not in chronic daily headache. Headache severity was reduced immediately post-treatment in 67% of sessions. A trend towards a reduction in medication use was observed (p = 0.075). No changes in headache severity (p = 0.16) or duration (p = 0.34) were present. Conclusion: These data suggest that combined tDCS and tsDCS intervention is safe and feasible, and may improve headache frequency in patients with chronic primary headache disorders.
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Affiliation(s)
- Ghufran Alhassani
- Brain Rehabilitation and Neuroplasticity Unit, Western Sydney University, Sydney, New South Wales, Australia
| | - Julia Treleaven
- School of Health and Rehabilitation Science, The University of Queensland, Brisbane, Queensland, Australia
| | - Siobhan S.M. Schabrun
- Brain Rehabilitation and Neuroplasticity Unit, Western Sydney University, Sydney, New South Wales, Australia
- Corresponding author. Brain Rehabilitation and Neuroplasticity Unit, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, New South Wales 2751, Australia. E-mail address: (S.S.M. Schabrun)
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Cota VR, Drabowski BMB, de Oliveira JC, Moraes MFD. The epileptic amygdala: Toward the development of a neural prosthesis by temporally coded electrical stimulation. J Neurosci Res 2017; 94:463-85. [PMID: 27091311 DOI: 10.1002/jnr.23741] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 03/09/2016] [Accepted: 03/09/2016] [Indexed: 02/06/2023]
Abstract
Many patients with epilepsy do not obtain proper control of their seizures through conventional treatment. We review aspects of the pathophysiology underlying epileptic phenomena, with a special interest in the role of the amygdala, stressing the importance of hypersynchronism in both ictogenesis and epileptogenesis. We then review experimental studies on electrical stimulation of mesiotemporal epileptogenic areas, the amygdala included, as a means to treat medically refractory epilepsy. Regular high-frequency stimulation (HFS) commonly has anticonvulsant effects and sparse antiepileptogenic properties. On the other hand, HFS is related to acute and long-term increases in excitability related to direct neuronal activation, long-term potentiation, and kindling, raising concerns regarding its safety and jeopardizing in-depth understanding of its mechanisms. In turn, the safer regular low-frequency stimulation (LFS) has a robust antiepileptogenic effect, but its pro- or anticonvulsant effect seems to vary at random among studies. As an alternative, studies by our group on the development and investigation of temporally unstructured electrical stimulation applied to the amygdala have shown that nonperiodic stimulation (NPS), which is a nonstandard form of LFS, is capable of suppressing both acute and chronic spontaneous seizures. We hypothesize two noncompetitive mechanisms for the therapeutic role of amygdala in NPS, 1) a direct desynchronization of epileptic circuitry in the forebrain and brainstem and 2) an indirect desynchronization/inhibition through nucleus accumbens activation. We conclude by reintroducing the idea that hypersynchronism, rather than hyperexcitability, may be the key for epileptic phenomena and epilepsy treatment.
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Affiliation(s)
- Vinícius Rosa Cota
- Laboratório Interdisciplinar de Neuroengenharia e Neurociências, Departamento de Engenharia Elétrica (DEPEL), Universidade Federal de São João Del-Rei, São João Del-Rei, Minas Gerais, Brazil
| | - Bruna Marcela Bacellar Drabowski
- Laboratório Interdisciplinar de Neuroengenharia e Neurociências, Departamento de Engenharia Elétrica (DEPEL), Universidade Federal de São João Del-Rei, São João Del-Rei, Minas Gerais, Brazil
| | - Jasiara Carla de Oliveira
- Laboratório Interdisciplinar de Neuroengenharia e Neurociências, Departamento de Engenharia Elétrica (DEPEL), Universidade Federal de São João Del-Rei, São João Del-Rei, Minas Gerais, Brazil
| | - Márcio Flávio Dutra Moraes
- Núcleo de Neurociências, Instituto de Ciências Biológicas (ICB), Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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42
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Rajagopalan A, Jinu KV, Sailesh KS, Mishra S, Reddy UK, Mukkadan JK. Understanding the links between vestibular and limbic systems regulating emotions. J Nat Sci Biol Med 2017; 8:11-15. [PMID: 28250668 PMCID: PMC5320810 DOI: 10.4103/0976-9668.198350] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Vestibular system, which consists of structures in the inner ear and brainstem, plays a vital role is body balance and patient well-being. In recent years, modulating this system by vestibular stimulation techniques are reported to be effective in stress relief and possibly patient's emotional well-being. Emotions refer to an aroused state involving intense feeling, autonomic activation, and related change in behavior, which accompany many of our conscious experiences. The limbic system is primarily involved in the regulation of emotions. Considering the extensive networks between vestibular and limbic system, it is likely that vestibular stimulation techniques may be useful in influencing emotions. Hence, we review here, the possible mechanisms through which vestibular system can influence emotions and highlight the necessary knowledge gaps, which warrants further research to develop vestibular stimulation techniques as a means to treat health conditions associated with emotional disturbances.
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Affiliation(s)
- Archana Rajagopalan
- Department of Physiology, Saveetha Medical College, Saveetha University, Chennai, Tamil Nadu, India
| | - K V Jinu
- Department of Physiology, Little Flower Institute of Medical Sciences and Research, Angamaly, Kerala, India
| | - Kumar Sai Sailesh
- Department of Physiology, Little Flower Institute of Medical Sciences and Research, Angamaly, Kerala, India
| | - Soumya Mishra
- Department of Physiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Udaya Kumar Reddy
- International Stress Management Association-India, Hyderabad, Telangana, India
| | - Joseph Kurien Mukkadan
- Department of Physiology, Little Flower Medical Research Centre, Angamaly, Kerala, India
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43
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Magnani FG, Sedda A. Paying the price for body evolution: The role of evolution in disorders of body representation. Med Hypotheses 2016; 98:81-86. [PMID: 28012612 DOI: 10.1016/j.mehy.2016.11.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 11/22/2016] [Indexed: 11/29/2022]
Abstract
Since its beginning, research about cognitive representation of our bodies has debated over multiple representations models. Furthermore, recent years have seen a rise in the study of body representation disorders and related impairments. However, why human beings manifest so many deficits is still a mystery. Considering human evolution, frontal brain regions are well known for their changes in dimensions and connections. Less known is that parietal and temporal lobes encountered similar changes. These areas, especially in the right hemisphere, are crucial for body representation. Our hypothesis is that evolution of these areas determined a more varied and widespread cross wiring between the temporal and parietal lobes, increasing their communication pathways and their reciprocal influence. As such, these connections could lead to an increased probability of interconnected body and emotional disorders in humans. The prediction of this hypothesis is that all body representation disorders have an associated emotional component and vice versa. Evidence supporting the interconnection between emotional and body representation disorders derives from psychiatric diseases such as eating disorders. This hypothesis opens up new directions to understand body representation and points towards innovative solutions for the clinical treatments of body representation/emotional impairments.
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Affiliation(s)
- Francesca G Magnani
- Psychology, School of Social Sciences, Heriot Watt University, Edinburgh Campus, UK; Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
| | - Anna Sedda
- Psychology, School of Social Sciences, Heriot Watt University, Edinburgh Campus, UK.
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Volkening K, Kerkhoff G, Keller I. Effects of repetitive galvanic vestibular stimulation on spatial neglect and verticality perception-a randomised sham-controlled trial. Neuropsychol Rehabil 2016; 28:1179-1196. [PMID: 27820972 DOI: 10.1080/09602011.2016.1248446] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Recent evidence shows that bipolar galvanic vestibular stimulation (GVS) with the cathode on the left (CL) or right (CR) mastoid ameliorates spatial neglect, extinction and verticality perception transiently and partly permanently. However, no randomised controlled trial evaluated the long-term effects of repetitive GVS in comparison to sham-GVS on exploration and verticality perception. To compare the effects of CL-GVS, CR-GVS and Sham-GVS on spatial exploration and verticality perception in right-hemispheric stroke patients with left neglect we conducted a randomised controlled trial with minimisation. Twenty-four patients completed 10-12 training sessions on a daily basis, 5 days/week. The CL-and CR-GVS group received 20 min of stimulation at 1.5 mA, the Sham-GVS group only 30 s of CL-GVS. Simultaneously, all patients performed a standard therapy of smooth pursuit eye movement training (SPT) followed by visual scanning training (VST). Outcome measures (Neglect test, visuo-tactile search task, subjective visual and tactile vertical) were assessed before and immediately after the intervention and at 2- and 4-week follow-ups. Our results show that neither our standard therapy nor the combination of standard therapy and GVS improved neglect symptoms significantly. The reasons for our non-significant results are discussed.
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Affiliation(s)
- Katharina Volkening
- a Department of Neuropsychology , Schoen Klinik Bad Aibling , Bad Aibling , Germany.,b German Center for Vertigo and Balance Disorders (IFB) , Ludwig-Maximilians-University , Munich , Germany
| | - Georg Kerkhoff
- c Clinical Neuropsychology & Neuropsychological University Clinic , Saar University , Saarbruecken , Germany
| | - Ingo Keller
- a Department of Neuropsychology , Schoen Klinik Bad Aibling , Bad Aibling , Germany
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Mungee A, Burger M, Bajbouj M. No Effect of Cathodal Transcranial Direct Current Stimulation on Fear Memory in Healthy Human Subjects. Brain Sci 2016; 6:E55. [PMID: 27827903 PMCID: PMC5187569 DOI: 10.3390/brainsci6040055] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 10/28/2016] [Accepted: 11/01/2016] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Studies have demonstrated that fear memories can be modified using non-invasive methods. Recently, we demonstrated that anodal transcranial direct current stimulation (tDCS) of the right dorsolateral prefrontal cortex is capable of enhancing fear memories. Here, we examined the effects of cathodal tDCS of the right dorsolateral prefrontal cortex during fear reconsolidation in humans. METHODS Seventeen young, healthy subjects were randomly assigned to two groups, which underwent fear conditioning with mild electric stimuli paired with a visual stimulus. Twenty-four hours later, both groups were shown a reminder of the conditioned fearful stimulus. Shortly thereafter, they received either tDCS (right prefrontal-cathodal, left supraorbital-anodal) for 20 min at 1 mA, or sham stimulation. A day later, fear responses of both groups were compared. RESULTS On Day 3, during fear response assessment, there were no significant differences between the tDCS and sham group (p > 0.05). CONCLUSION We conclude that cathodal tDCS of the right dorsolateral prefrontal cortex (right prefrontal-cathodal, left supraorbital-anodal) did not influence fear memories.
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Affiliation(s)
- Aditya Mungee
- Department of Psychiatry, Campus Benjamin Franklin, Charité, Berlin 14050, Germany.
- Cluster of Excellence "Languages of Emotion", Freie Universität, Berlin 14195, Germany.
| | - Max Burger
- Department of Psychiatry, Campus Benjamin Franklin, Charité, Berlin 14050, Germany.
| | - Malek Bajbouj
- Department of Psychiatry, Campus Benjamin Franklin, Charité, Berlin 14050, Germany.
- Cluster of Excellence "Languages of Emotion", Freie Universität, Berlin 14195, Germany.
- Dahlem Institute for Neuroimaging of Emotion, Freie Universität, Berlin 14195, Germany.
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Imaging transcranial direct current stimulation (tDCS) of the prefrontal cortex—correlation or causality in stimulation-mediated effects? Neurosci Biobehav Rev 2016; 69:333-56. [DOI: 10.1016/j.neubiorev.2016.08.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 06/30/2016] [Accepted: 08/01/2016] [Indexed: 02/03/2023]
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47
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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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48
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Liepelt R, Klempova B, Dolk T, Colzato LS, Ragert P, Nitsche MA, Hommel B. The Medial Frontal Cortex Mediates Self-Other Discrimination in the Joint Simon Task. J PSYCHOPHYSIOL 2016. [DOI: 10.1027/0269-8803/a000158] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Abstract. Interacting with other individuals confronts cognitive control systems with the problem of how to distinguish between self-generated (internally triggered) and other-generated (externally triggered) action events. Recent neuroscience studies identified two core brain regions, the anterior medial frontal cortex (aMFC) and the right temporo-parietal junction (rTPJ), to be potentially involved in resolving this problem either by enhancing self-generated versus other-generated event representations (via aMFC) and/or by inhibiting event representations that are externally triggered (via rTPJ). Using transcranial direct current stimulation (tDCS), we investigated the role of the aMFC and the rTPJ for the online control of self-generated versus other-generated event representations in a joint Simon task. In two experimental sessions, participants received anodal, cathodal, or sham tDCS (1 mA intensity applied for 20 min), while performing an auditory joint Simon task. In addition to a general performance enhancement during cathodal (inhibitory) and anodal (excitatory) stimulation with increased practice, we found a significantly increased joint Simon effect (JSE) during cathodal stimulation of the aMFC (Experiment 1), as compared to sham stimulation. No modulation of the JSE was found during stimulation of the rTPJ (Experiment 2). By enhancing self-generated event representations the aMFC seems to be crucially involved in resolving the self-other discrimination problem in the joint Simon task.
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Affiliation(s)
- Roman Liepelt
- Department of Psychology, University of Münster, Germany
| | | | - Thomas Dolk
- Department of Psychology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Lorenza S. Colzato
- Department of Psychology, Cognitive Psychology Unit, Leiden University, The Netherlands
| | - Patrick Ragert
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Michael A. Nitsche
- Department of Clinical Neurophysiology, University Medical Center, Göttingen, Germany
- Leibniz Research Centre for Working Environment and Human Resources, Dortmund, Germany
- Department of Neurology, University Medical Hospital Bergmannsheil, Bochum, Germany
| | - Bernhard Hommel
- Department of Psychology, Cognitive Psychology Unit, Leiden University, The Netherlands
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Bodranghien F, Manto M, Lebon F. Enhancing transcranial direct current stimulation via motor imagery and kinesthetic illusion: crossing internal and external tools. J Neuroeng Rehabil 2016; 13:50. [PMID: 27246465 PMCID: PMC4888405 DOI: 10.1186/s12984-016-0156-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 05/11/2016] [Indexed: 11/18/2022] Open
Abstract
Background Transcranial direct current stimulation is a safe technique which is now part of the therapeutic armamentarium for the neuromodulation of motor functions and cognitive operations. It is currently considered that tDCS is an intervention that might promote functional recovery after a lesion in the central nervous system, thus reducing long-term disability and associated socio-economic burden. Discussion A recent study shows that kinesthetic illusion and motor imagery prolong the effects of tDCS on corticospinal excitability, overcoming one of the limitations of this intervention. Conclusion Because changes in excitability anticipate changes in structural plasticity in the CNS, this interesting multi-modal approach might very soon find applications in neurorehabilitation.
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Affiliation(s)
- Florian Bodranghien
- Unité d'Etude du Mouvement, Laboratoire de Neurologie Expérimentale, ULB, Brussels, Belgium
| | - Mario Manto
- Unité d'Etude du Mouvement, Laboratoire de Neurologie Expérimentale, ULB, Brussels, Belgium. .,Service des Neurosciences, Université de Mons, Mons, Belgium. .,UEM, FNRS-ULB, 808 Route de Lennik, 1070, Bruxelles, Belgium.
| | - Florent Lebon
- Laboratoire INSERM U1093 Cognition, Action et Plasticité Sensorimotrice, Université de Bourgogne Franche-Comté, Dijon, France.,UFR STAPS, Université de Bourgogne Franche-Comté, Dijon, France
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Weigl M, Mecklinger A, Rosburg T. Transcranial direct current stimulation over the left dorsolateral prefrontal cortex modulates auditory mismatch negativity. Clin Neurophysiol 2016; 127:2263-72. [DOI: 10.1016/j.clinph.2016.01.024] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 01/21/2016] [Accepted: 01/22/2016] [Indexed: 01/23/2023]
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