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Lima AE, Telles JP, Dantas J, Fernandes AC, Ribeiro GBS, Barbosa VL, Castro-Lima H. Transcranial direct current stimulation improves seizures frequency in drug-resistant epilepsy: A systematic-review and meta-analysis of randomized controlled trials. Epilepsy Behav 2024; 159:109974. [PMID: 39096796 DOI: 10.1016/j.yebeh.2024.109974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Revised: 07/20/2024] [Accepted: 07/25/2024] [Indexed: 08/05/2024]
Affiliation(s)
- A E Lima
- Escola Bahiana de Medicina e Saúde Pública, Salvador, Brazil.
| | - J P Telles
- Department of Neurology, Universidade de São Paulo, São Paulo, Brazil
| | - J Dantas
- Federal University of Rio Grande do Norte, Natal, Brazil
| | - A C Fernandes
- Instituto Internacional de Neurociências Edmond e Lily Safra, Natal, Brazil
| | - G B S Ribeiro
- Department of Neurology, Universidade de Campinas, Campinas, Brazil
| | - V L Barbosa
- Universidade Estadual do Centro Oeste do Paraná, Guarapuava, Brazil
| | - H Castro-Lima
- Escola Bahiana de Medicina e Saúde Pública, Salvador, Brazil
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Caravati E, Barbeni F, Chiarion G, Raggi M, Mesin L. Closed-Loop Transcranial Electrical Neurostimulation for Sustained Attention Enhancement: A Pilot Study towards Personalized Intervention Strategies. Bioengineering (Basel) 2024; 11:467. [PMID: 38790334 PMCID: PMC11118513 DOI: 10.3390/bioengineering11050467] [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: 04/06/2024] [Revised: 05/03/2024] [Accepted: 05/06/2024] [Indexed: 05/26/2024] Open
Abstract
Sustained attention is pivotal for tasks like studying and working for which focus and low distractions are necessary for peak productivity. This study explores the effectiveness of adaptive transcranial direct current stimulation (tDCS) in either the frontal or parietal region to enhance sustained attention. The research involved ten healthy university students performing the Continuous Performance Task-AX (AX-CPT) while receiving either frontal or parietal tDCS. The study comprised three phases. First, we acquired the electroencephalography (EEG) signal to identify the most suitable metrics related to attention states. Among different spectral and complexity metrics computed on 3 s epochs of EEG, the Fuzzy Entropy and Multiscale Sample Entropy Index of frontal channels were selected. Secondly, we assessed how tDCS at a fixed 1.0 mA current affects attentional performance. Finally, a real-time experiment involving continuous metric monitoring allowed personalized dynamic optimization of the current amplitude and stimulation site (frontal or parietal). The findings reveal statistically significant improvements in mean accuracy (94.04 vs. 90.82%) and reaction times (262.93 vs. 302.03 ms) with the adaptive tDCS compared to a non-stimulation condition. Average reaction times were statistically shorter during adaptive stimulation compared to a fixed current amplitude condition (262.93 vs. 283.56 ms), while mean accuracy stayed similar (94.04 vs. 93.36%, improvement not statistically significant). Despite the limited number of subjects, this work points out the promising potential of adaptive tDCS as a tailored treatment for enhancing sustained attention.
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Affiliation(s)
| | | | | | | | - Luca Mesin
- Mathematical Biology and Physiology, Department Electronics and Telecommunications, Politecnico di Torino, 10129 Turin, Italy; (E.C.); (F.B.); (G.C.); (M.R.)
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Daoud M, Durelle C, Fierain A, N EY, Wendling F, Ruffini G, Benquet P, Bartolomei F. Long-term Effect of Multichannel tDCS Protocol in Patients with Central Cortex Epilepsies Associated with Epilepsia Partialis Continua. Brain Topogr 2024:10.1007/s10548-024-01045-3. [PMID: 38446345 DOI: 10.1007/s10548-024-01045-3] [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: 10/07/2023] [Accepted: 02/21/2024] [Indexed: 03/07/2024]
Abstract
Epilepsia partialis continua (EPC) is a rare type of focal motor status epilepticus that causes continuous muscle jerking in a specific part of the body. Experiencing this type of seizure, along with other seizure types, such as focal motor seizures and focal to bilateral tonic-clonic seizures, can result in a disabling situation. Non-invasive brain stimulation methods like transcranial direct current stimulation (tDCS) show promise in reducing seizure frequency (SF) when medications are ineffective. However, research on tDCS for EPC and related seizures is limited. We evaluated personalized multichannel tDCS in drug-resistant EPC of diverse etiologies for long-term clinical efficacy We report three EPC patients undergoing a long-term protocol of multichannel tDCS. The patients received several cycles (11, 9, and 3) of five consecutive days of stimulation at 2 mA for 2 × 20 min, targeting the epileptogenic zone (EZ), including the central motor cortex with cathodal electrodes. The primary measurement was SF changes. In three cases, EPC was due to Rasmussen's Encephalitis (case 1), focal cortical dysplasia (case 2), or remained unknown (case 3). tDCS cycles were administered over 6 to 22 months. The outcomes comprised a reduction of at least 75% in seizure frequency for two patients, and in one case, a complete cessation of severe motor seizures. However, tDCS had no substantial impact on the continuous myoclonus characterizing EPC. No serious side effects were reported. Long-term application of tDCS cycles is well tolerated and can lead to a considerable reduction in disabling seizures in patients with various forms of epilepsy with EPC.
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Affiliation(s)
- M Daoud
- Aix-Marseille Univ, INSERM U1106, Institut de Neurosciences des Systèmes, Marseille, France
| | - C Durelle
- Service d'Epileptologie et de Rythmologie cérébrale, APHM, Timone Hospital, Epileptology and Cerebral Rhythmology, 264 Rue Saint-Pierre, Marseille, 13005, France
| | - A Fierain
- Service d'Epileptologie et de Rythmologie cérébrale, APHM, Timone Hospital, Epileptology and Cerebral Rhythmology, 264 Rue Saint-Pierre, Marseille, 13005, France
| | - El Youssef N
- Service d'Epileptologie et de Rythmologie cérébrale, APHM, Timone Hospital, Epileptology and Cerebral Rhythmology, 264 Rue Saint-Pierre, Marseille, 13005, France
| | - F Wendling
- Univ Rennes, INSERM, LTSI-U1099, Rennes, F-35000, France
| | - G Ruffini
- Neuroelectrics Barcelona, Av. Tibidabo 47 bis, Barcelona, 08035, Spain
| | - P Benquet
- Univ Rennes, INSERM, LTSI-U1099, Rennes, F-35000, France
| | - F Bartolomei
- Aix-Marseille Univ, INSERM U1106, Institut de Neurosciences des Systèmes, Marseille, France.
- Service d'Epileptologie et de Rythmologie cérébrale, APHM, Timone Hospital, Epileptology and Cerebral Rhythmology, 264 Rue Saint-Pierre, Marseille, 13005, France.
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Yılmaz Erol T, İlgezdi Kaya İ, Ur Özçelik E, Aksu S, Şirin NG, Bebek N, Kurt A, Karamürsel S, Baykan B. Acute effect of transcranial direct current stimulation on photoparoxysmal response. Epilepsy Res 2024; 201:107320. [PMID: 38412793 DOI: 10.1016/j.eplepsyres.2024.107320] [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: 11/29/2023] [Revised: 01/22/2024] [Accepted: 02/07/2024] [Indexed: 02/29/2024]
Abstract
INTRODUCTION Transcranial direct current stimulation (tDCS) is a non-invasive technique, used to modify the excitability of the central nervous system. The main mechanism of tDCS is to change the excitability by subthreshold modulation by affecting neuronal membrane potentials in the direction of depolarization or repolarization. tDCS was previously investigated as an alternative adjunctive therapy in patients with epilepsy. We aimed here to investigate the acute effect of tDCS on the photoparoxysmal response (PPR) in EEG. METHODS We enrolled 11 consecutive patients diagnosed with idiopathic generalized epilepsy who had PPR on at least 2 EEGs. Three different procedures, including sham, anodal, and cathodal tDCS were applied to the patients at intervals of one week by placing the active electrode over Oz, for 2 mA, 20 minutes. Spike-wave indices (SWI) were counted by two researchers independently and were compared during intermittent photic stimulation (IPS) on EEGs both before and after the application. RESULTS After cathodal tDCS, SWI increased compared to baseline EEG and sham EEG in 3 patients, and after anodal tDCS, SWI increased in 2 patients. Although the SWI values did not change significantly, 8 patients reported subjectively that the applications were beneficial for them and that they experienced less discomfort during photic stimulation after the sessions. There were no side effects except transient skin rash in one patient, only. CONCLUSIONS In our sham controlled tDCS study with both cathodal and anodal stimulation, our data showed that there was no significant change in SWI during IPS, despite subjective well-being. tDCS' modulatory effect does not seem to act in the acute phase on EEG parameters after photic stimulation.
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Affiliation(s)
- Tülay Yılmaz Erol
- Departments of Neurology and Clinical Neurophysiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
| | - İrem İlgezdi Kaya
- Departments of Neurology and Clinical Neurophysiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
| | - Emel Ur Özçelik
- Department of Neurology, University of Health Sciences, Kanuni Sultan Süleyman Education and Research Hospital, Istanbul, Turkey.
| | - Serkan Aksu
- Department of Physiology, Faculty of Medicine, Muğla Sıtkı Koçman University, Muğla, Turkey.
| | - Nermin Görkem Şirin
- Departments of Neurology and Clinical Neurophysiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
| | - Nerses Bebek
- Departments of Neurology and Clinical Neurophysiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
| | - Adnan Kurt
- Department of Physiology, School of Medicine, Koç University, Istanbul, Turkey.
| | - Sacit Karamürsel
- Department of Physiology, School of Medicine, Koç University, Istanbul, Turkey.
| | - Betül Baykan
- Departments of Neurology and Clinical Neurophysiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey; Department of Neurology, EMAR Medical Center, Istanbul, Turkey.
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Cancino-Fuentes N, Manasanch A, Covelo J, Suarez-Perez A, Fernandez E, Matsoukis S, Guger C, Illa X, Guimerà-Brunet A, Sanchez-Vives MV. Recording physiological and pathological cortical activity and exogenous electric fields using graphene microtransistor arrays in vitro. NANOSCALE 2024; 16:664-677. [PMID: 38100059 DOI: 10.1039/d3nr03842d] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2024]
Abstract
Graphene-based solution-gated field-effect transistors (gSGFETs) allow the quantification of the brain's full-band signal. Extracellular alternating current (AC) signals include local field potentials (LFP, population activity within a reach of hundreds of micrometers), multiunit activity (MUA), and ultimately single units. Direct current (DC) potentials are slow brain signals with a frequency under 0.1 Hz, and commonly filtered out by conventional AC amplifiers. This component conveys information about what has been referred to as "infraslow" activity. We used gSGFET arrays to record full-band patterns from both physiological and pathological activity generated by the cerebral cortex. To this end, we used an in vitro preparation of cerebral cortex that generates spontaneous rhythmic activity, such as that occurring in slow wave sleep. This examination extended to experimentally induced pathological activities, including epileptiform discharges and cortical spreading depression. Validation of recordings obtained via gSGFETs, including both AC and DC components, was accomplished by cross-referencing with well-established technologies, thereby quantifying these components across different activity patterns. We then explored an additional gSGFET potential application, which is the measure of externally induced electric fields such as those used in therapeutic neuromodulation in humans. Finally, we tested the gSGFETs in human cortical slices obtained intrasurgically. In conclusion, this study offers a comprehensive characterization of gSGFETs for brain recordings, with a focus on potential clinical applications of this emerging technology.
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Affiliation(s)
| | - Arnau Manasanch
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
| | - Joana Covelo
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
| | - Alex Suarez-Perez
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
| | | | - Stratis Matsoukis
- g.tec medical engineering, Schiedlberg, Austria
- Institute of Computational Perception, Johannes Kepler University, Linz, Austria
| | | | - Xavi Illa
- Instituto de Microelectrónica de Barcelona (IMB-CNM, CSIC), Spain
- Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina, Instituto de Salud Carlos III, Spain
| | - Anton Guimerà-Brunet
- Instituto de Microelectrónica de Barcelona (IMB-CNM, CSIC), Spain
- Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina, Instituto de Salud Carlos III, Spain
| | - Maria V Sanchez-Vives
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
- ICREA, Barcelona, Spain
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Ghosh S, Nagarajan L. Tolerability and Effectiveness of Cathodal Transcranial Direct Current Stimulation in Children with Refractory Epilepsy: A Case Series. Brain Sci 2023; 13:brainsci13050760. [PMID: 37239232 DOI: 10.3390/brainsci13050760] [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: 04/23/2023] [Accepted: 04/29/2023] [Indexed: 05/28/2023] Open
Abstract
There are limited treatment options for drug-resistant epilepsy (DRE) in children. We performed a pilot study to investigate the tolerability and effectiveness of cathodal transcranial direct current stimulation (tDCS) in DRE. Twelve children with DRE of varied etiology underwent three to four daily sessions of cathodal tDCS. The seizure frequency at 2 weeks before and after tDCS was obtained from seizure diaries; clinic reviews at 3 and 6 months assessed any longer-term benefits or adverse effects. The spike wave index (SWI) was analyzed in the EEGs done immediately before and after tDCS on the first and last day of tDCS. One child remained seizure free for a year after tDCS. One child had reduced frequency of ICU admissions for status epilepticus for 2 weeks, likely due to reduced severity of seizures. In four children, an improvement in alertness and mood was reported for 2-4 weeks after tDCS. There was no benefit following tDCS in the other children. There were no unexpected or serious adverse effects in any child. Benefit was seen in two children, and the reasons for the lack of benefit in the other children need further study. It is likely that tDCS stimulus parameters will need to be tailored for different epilepsy syndromes and etiologies.
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Affiliation(s)
- Soumya Ghosh
- Children's Neuroscience Service, Department of Neurology, Perth Children's Hospital, Nedlands, WA 6009, Australia
- Perron Institute for Neurological and Translational Science, University of Western Australia, Nedlands, WA 6009, Australia
| | - Lakshmi Nagarajan
- Children's Neuroscience Service, Department of Neurology, Perth Children's Hospital, Nedlands, WA 6009, Australia
- School of Medicine, University of Western Australia, Nedlands, WA 6009, Australia
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Koessler L, Louviot S, Dmochowski J, Vignal JP, Jonas J, Colnat-Coulbois S, Tyvaert L, Maillard L. Transcranial direct current stimulation reduces intracerebrally-recorded epileptic seizures and behavioral disturbances. Brain Stimul 2023; 16:667-669. [PMID: 37015316 DOI: 10.1016/j.brs.2023.03.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 03/31/2023] [Indexed: 04/06/2023] Open
Affiliation(s)
| | - Samuel Louviot
- Université de Lorraine, CNRS, CRAN, UMR, 7039, Nancy, France
| | - Jacek Dmochowski
- Department of Biomedical Engineering, City College of New York, New York City, United States
| | - Jean-Pierre Vignal
- Université de Lorraine, CNRS, CRAN, UMR, 7039, Nancy, France; Centre Hospitalier Universitaire de Nancy, Service de Neurologie, Nancy, 54000, France
| | - Jacques Jonas
- Université de Lorraine, CNRS, CRAN, UMR, 7039, Nancy, France; Centre Hospitalier Universitaire de Nancy, Service de Neurologie, Nancy, 54000, France
| | - Sophie Colnat-Coulbois
- Université de Lorraine, CNRS, CRAN, UMR 7039, Nancy, France; Centre Hospitalier Universitaire de Nancy, Service de Neurochirurgie, Nancy, 54000, France
| | - Louise Tyvaert
- Université de Lorraine, CNRS, CRAN, UMR, 7039, Nancy, France; Centre Hospitalier Universitaire de Nancy, Service de Neurologie, Nancy, 54000, France
| | - Louis Maillard
- Université de Lorraine, CNRS, CRAN, UMR, 7039, Nancy, France; Centre Hospitalier Universitaire de Nancy, Service de Neurologie, Nancy, 54000, France
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Ashrafzadeh F, Akhondian J, Hashemi N, Esmaeilzadeh M, Ghanaee A, Yavarzadeh H, Imannezhad S, Saeedi Zand N, Mirzadeh HS, Beiraghi Toosi M. Therapeutical impacts of transcranial direct current stimulation on drug-resistant epilepsy in pediatric patients: A double-blind parallel-group randomized clinical trial. Epilepsy Res 2023; 190:107074. [PMID: 36657251 DOI: 10.1016/j.eplepsyres.2022.107074] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 08/14/2022] [Accepted: 12/30/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Drug-resistant epilepsy is a challenging problem in pediatrics. Transcranial direct current stimulation (TDCS) is a non-invasive neurostimulation technique suggested as a promising method for treating epilepsy. This study aims to evaluate the efficacy of TDCS in focal epilepsy in children with drug-resistant epilepsy. METHOD We conducted a randomized sham-controlled study with 18 subjects between 6 and 16 years of age, divided equally into two groups. TDCS was performed in 20-minute daily stimulation protocol for five days for both groups. The current intensity was one mA for the first three days, increasing to 1.5 mA on day four and 2 mA on the last day of stimulation. EEG was done before and after the intervention. RESULTS There was a significant reduction in seizure duration in the case group compared with the sham group. CONCLUSION five consecutive days of performing TDCS significantly reduced seizure duration in children with focal Drug-resistant epilepsy. However,further studies in this field are necessary to test the effectiveness and set up a coherent and comprehensive protocol.
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Affiliation(s)
- Farah Ashrafzadeh
- Department of Pediatrics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Javad Akhondian
- Department of Pediatrics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Narges Hashemi
- Department of Pediatrics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahla Esmaeilzadeh
- Student Research Committee (SRC), Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali Ghanaee
- Department of Psychology, Faculty of Education and Psychology, Ferdowsi University, Mashhad, Iran
| | - Hanieh Yavarzadeh
- MA Student of Psychology, Faculty of Education and Psychology, Ferdowsi University, Mashhad, Iran
| | - Shima Imannezhad
- Department of Pediatrics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Nazanin Saeedi Zand
- Department of Pediatrics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hanieh Sadat Mirzadeh
- Department of Pediatrics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mehran Beiraghi Toosi
- Department of Pediatrics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
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Kaye HL, San-Juan D, Salvador R, Biagi MC, Dubreuil-Vall L, Damar U, Pascual-Leone A, Ruffini G, Shafi MM, Rotenberg A. Personalized, Multisession, Multichannel Transcranial Direct Current Stimulation in Medication-Refractory Focal Epilepsy: An Open-Label Study. J Clin Neurophysiol 2023; 40:53-62. [PMID: 34010226 DOI: 10.1097/wnp.0000000000000838] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
PURPOSE Animal and proof-of-principle human studies suggest that cathodal transcranial direct current stimulation may suppress seizures in drug-resistant focal epilepsy. The present study tests the safety, tolerability, and effect size of repeated daily cathodal transcranial direct current stimulation in epilepsy have not been established, limiting development of clinically meaningful interventions. METHODS We conducted a 2-center, open-label study on 20 participants with medically refractory, focal epilepsy, aged 9 to 56 years (11 women and 9 children younger than18 years). Each participant underwent 10 sessions of 20 minutes of cathodal transcranial direct current stimulation over 2 weeks. Multielectrode montages were designed using a realistic head model-driven approach to conduct an inhibitory electric field to the target cortical seizure foci and surrounding cortex to suppress excitability and reduce seizure rates. Patients recorded daily seizures using a seizure diary 8 weeks prior, 2 weeks during, and 8 to 12 weeks after the stimulation period. RESULTS The median seizure reduction was 44% relative to baseline and did not differ between adult and pediatric patients. Three patients experienced an increase in seizure frequency of >50% during the stimulation period; in one, a 36% increase in seizure frequency persisted through 12 weeks of follow-up. Otherwise, participants experienced only minor adverse events-the most common being scalp discomfort during transcranial direct current stimulation. CONCLUSIONS This pilot study supports the safety and efficacy of multifocal, personalized, multichannel, cathodal transcranial direct current stimulation for adult and pediatric patients with medication-refractory focal epilepsy, although identifies a possibility of seizure exacerbation in some. The data also provide insight into the effect size to inform the design of a randomized, sham-stimulation controlled trial.
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Affiliation(s)
- Harper Lee Kaye
- Neuromodulation Program and Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A
- F. M. Kirby Neurobiology Center; Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A
- Behavioral Neuroscience Program, Division of Medical Sciences, Boston University School of Medicine, Boston, Massachusetts, U.S.A
| | - Daniel San-Juan
- Clinical Neurophysiology Department, National Institute of Neurology and Neurosurgery of Mexico, Mexico City, Mexico
| | | | | | | | - Ugur Damar
- Neuromodulation Program and Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A
- F. M. Kirby Neurobiology Center; Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Alvaro Pascual-Leone
- Hinda and Arthur Marcus Institute for Aging Research and Center for Memory Health, Hebrew Senior Life, Department of Neurology, Harvard Medical School, Boston, Massachusetts, U.S.A
- Guttmann Brain Health Institute, Institut Gutmann, Universitat Autonoma, Barcelona, Spain
| | - Giulio Ruffini
- Neuroelectrics Barcelona, Barcelona, Spain
- Neuroelectrics Corporation, Cambridge, U.S.A.; and
| | - Mouhsin M Shafi
- Berenson-Allen Center for Noninvasive Brain Stimulation, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Alexander Rotenberg
- Neuromodulation Program and Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A
- F. M. Kirby Neurobiology Center; Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A
- Berenson-Allen Center for Noninvasive Brain Stimulation, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A
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10
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Ebrahim AA, Tungu A. Neuromodulation for temporal lobe epilepsy: a scoping review. ACTA EPILEPTOLOGICA 2022. [DOI: 10.1186/s42494-022-00086-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
AbstractTemporal lobe epilepsy (TLE) is difficult to treat as it is often refractory to treatment. Apart from traditional medical treatment, surgical resection is also a choice of treatment, but it may be associated with significant cognitive deficits. As a result, treatment strategies using targeted and adjustable stimulation of malfunctioning brain circuits have been developed. These neuromodulatory therapies using approaches of electric and magnetic neuromodulation are already in clinical use for refractory epilepsy while others such as optogenetics, chemo-genetics and ultrasound modulation are being tested in pre-clinical TLE animal models. In this review, we conducted an in-depth literature search on the clinically available neuromodulatory approaches for TLE, focusing on the possible mechanism of action and the clinical outcomes including adverse effects. Techniques that are currently explored in preclinical animal models but may have therapeutic applications in future are also discussed. The efficacy and subsequent adverse effects vary among the different neuromodulatory approaches and some still have unclear mechanisms of action in TLE treatment. Further studies evaluating the benefits and potential limitations are needed. Continued research on the therapeutic mechanisms and the epileptic brain network is critical for improving therapies for TLE.
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11
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In Vivo Measurements of Transcranial Electrical Stimulation in Lesioned Human Brain: A Case Report. Brain Sci 2022; 12:brainsci12111455. [DOI: 10.3390/brainsci12111455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 10/09/2022] [Accepted: 10/21/2022] [Indexed: 11/16/2022] Open
Abstract
Transcranial electrical stimulation (tES) has been utilized widely in populations with brain lesions, such as stroke patients. The tES-generated electric field (EF) within the brain is considered as one of the most important factors for physiological effects. However, it is still unclear how brain lesions may influence EF distribution induced by tES. In this case study, we reported in vivo measurements of EF in one epilepsy participant with brain lesions during different tES montages. With the in vivo EF data measured by implanted stereo-electroencephalography (sEEG) electrodes, the simulation model was investigated and validated. Our results demonstrate that the prediction ability of the current simulation model may be degraded in the lesioned human brain.
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Applications of open-source software ROAST in clinical studies: A review. Brain Stimul 2022; 15:1002-1010. [PMID: 35843597 PMCID: PMC9378654 DOI: 10.1016/j.brs.2022.07.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 07/09/2022] [Accepted: 07/10/2022] [Indexed: 11/21/2022] Open
Abstract
Background: Transcranial electrical stimulation (TES) is broadly investigated as a therapeutic technique for a wide range of neurological disorders. The electric fields induced by TES in the brain can be estimated by computational models. A realistic and volumetric approach to simulate TES (ROAST) has been recently released as an open-source software package and has been widely used in TES research and its clinical applications. Rigor and reproducibility of TES studies have recently become a concern, especially in the context of computational modeling. Methods: Here we reviewed 94 clinical TES studies that leveraged ROAST for computational modeling. When reviewing each study, we pay attention to details related to the rigor and reproducibility as defined by the locations of stimulation electrodes and the dose of stimulating current. Specifically, we compared across studies the electrode montages, stimulated brain areas, achieved electric field strength, and the relations between modeled electric field and clinical outcomes. Results: We found that over 1800 individual heads have been modeled by ROAST for more than 30 different clinical applications. Similar electric field intensities were found to be reproducible by ROAST across different studies at the same brain area under same or similar stimulation montages. Conclusion: This article reviews the use cases of ROAST and provides an overview of how ROAST has been leveraged to enhance the rigor and reproducibility of TES research and its applications.
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Safety and efficacy of cathodal transcranial direct current stimulation in patients with Lennox Gastaut Syndrome: An open-label, prospective, single-center, single-blinded, pilot study. Seizure 2022; 100:44-50. [PMID: 35751952 DOI: 10.1016/j.seizure.2022.06.009] [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: 01/17/2022] [Revised: 06/14/2022] [Accepted: 06/16/2022] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Lennox-Gastaut Syndrome (SLG) is a severe form of childhood refractory epilepsy. Only one pilot study has been conducted using cathodal transcranial direct current stimulation (c-tDCs; 2mAx30minx5days) in LGS with promising results (-99% seizure reduction at 5 days). Our aim was to explore and replicate the efficacy and safety of 10 daily sessions of c-tDCs in SLG. METHODS We conducted a one-blinded, single-center pilot clinical study of c-tDCs (2mAx 30 min x 10 days), applied over the highest amplitude or frequent epileptiform interictal discharges areas using scalp EEG recordings without changes in their treatments. The tDCS device used was Enobio EEG® (Neuroelectrics, Barcelona, Spain). The primary outcome was based on the seizure frequency using seizure diaries before, during 10 days of treatment, and then on a 4 and 8 weeks of follow-up. The rate of adverse events was recorded as a secondary outcome. Descriptive statistics and Wilcoxon signed-rank test were used RESULTS: Twenty-four patients were enrolled. The mean age was 10.1 ± 5.8 years old and 75% male. All the patients had severe mental retardation and abnormal neurological examinations. A significant median percentual seizure frequency reduction was found: 68.12% (p = 0.05) at 1 week, 68.12% (p = 0.002) in the second week. We found no significant reduction at 1 and 2 months; mainly tonic and atonic seizures were reduced significantly at all times. Only mild self-limited side effects were recorded mainly itching and erythema in the application zone CONCLUSION: Ten sessions of c-tDCs in combination with pharmacologic treatment in LGS is safe and appears to reduce significatively tonic and atonic seizure frequency at 2 months of follow-up.
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14
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Abstract
Transcranial direct current stimulation (tDCS) is a non-invasive neuromodulation technique to treat brain disorders by using a constant, low current to stimulate targeted cortex regions. Compared to the conventional tDCS that uses two large pad electrodes, multiple electrode tDCS has recently received more attention. It is able to achieve better stimulation performance in terms of stimulation intensity and focality. In this paper, we first establish a computational model of tDCS, and then propose a novel optimization algorithm using a regularization matrix λ to explore the balance between stimulation intensity and focality. The simulation study is designed such that the performance of state-of-the-art algorithms and the proposed algorithm can be compared via quantitative evaluation. The results show that the proposed algorithm not only achieves desired intensity, but also smaller target error and better focality. Robustness analysis indicates that the results are stable within the ranges of scalp and cerebrospinal fluid (CSF) conductivities, while the skull conductivity is most sensitive and should be carefully considered in real clinical applications.
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15
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Beumer S, Boon P, Klooster DCW, van Ee R, Carrette E, Paulides MM, Mestrom RMC. Personalized tDCS for Focal Epilepsy—A Narrative Review: A Data-Driven Workflow Based on Imaging and EEG Data. Brain Sci 2022; 12:brainsci12050610. [PMID: 35624997 PMCID: PMC9139054 DOI: 10.3390/brainsci12050610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 05/03/2022] [Accepted: 05/05/2022] [Indexed: 02/01/2023] Open
Abstract
Conventional transcranial electric stimulation(tES) using standard anatomical positions for the electrodes and standard stimulation currents is frequently not sufficiently selective in targeting and reaching specific brain locations, leading to suboptimal application of electric fields. Recent advancements in in vivo electric field characterization may enable clinical researchers to derive better relationships between the electric field strength and the clinical results. Subject-specific electric field simulations could lead to improved electrode placement and more efficient treatments. Through this narrative review, we present a processing workflow to personalize tES for focal epilepsy, for which there is a clear cortical target to stimulate. The workflow utilizes clinical imaging and electroencephalography data and enables us to relate the simulated fields to clinical outcomes. We review and analyze the relevant literature for the processing steps in the workflow, which are the following: tissue segmentation, source localization, and stimulation optimization. In addition, we identify shortcomings and ongoing trends with regard to, for example, segmentation quality and tissue conductivity measurements. The presented processing steps result in personalized tES based on metrics like focality and field strength, which allow for correlation with clinical outcomes.
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Affiliation(s)
- Steven Beumer
- Department of Electrical Engineering, University of Technology Eindhoven, P.O. Box 513, 5600 MB Eindhoven, The Netherlands; (P.B.); (D.C.W.K.); (E.C.); (M.M.P.); (R.M.C.M.)
- Correspondence:
| | - Paul Boon
- Department of Electrical Engineering, University of Technology Eindhoven, P.O. Box 513, 5600 MB Eindhoven, The Netherlands; (P.B.); (D.C.W.K.); (E.C.); (M.M.P.); (R.M.C.M.)
- Department of Neurology, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - Debby C. W. Klooster
- Department of Electrical Engineering, University of Technology Eindhoven, P.O. Box 513, 5600 MB Eindhoven, The Netherlands; (P.B.); (D.C.W.K.); (E.C.); (M.M.P.); (R.M.C.M.)
- Department of Neurology, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - Raymond van Ee
- Philips Research Eindhoven, High Tech Campus 34, 5656 AE Eindhoven, The Netherlands;
| | - Evelien Carrette
- Department of Electrical Engineering, University of Technology Eindhoven, P.O. Box 513, 5600 MB Eindhoven, The Netherlands; (P.B.); (D.C.W.K.); (E.C.); (M.M.P.); (R.M.C.M.)
- Department of Neurology, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - Maarten M. Paulides
- Department of Electrical Engineering, University of Technology Eindhoven, P.O. Box 513, 5600 MB Eindhoven, The Netherlands; (P.B.); (D.C.W.K.); (E.C.); (M.M.P.); (R.M.C.M.)
- Department of Radiation Oncology, Erasmus Medical Center Cancer Institute, Burgemeester Oudlaan 50, 3062 PA Rotterdam, The Netherlands
| | - Rob M. C. Mestrom
- Department of Electrical Engineering, University of Technology Eindhoven, P.O. Box 513, 5600 MB Eindhoven, The Netherlands; (P.B.); (D.C.W.K.); (E.C.); (M.M.P.); (R.M.C.M.)
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16
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Daoud M, Salvador R, El Youssef N, Fierain A, Garnier E, Chiara Biagi M, Medina Villalon S, Wendling F, Benar C, Ruffini G, Bartolomei F. Stereo-EEG based personalized multichannel transcranial direct current stimulation in drug-resistant epilepsy. Clin Neurophysiol 2022; 137:142-151. [DOI: 10.1016/j.clinph.2022.02.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 02/05/2022] [Accepted: 02/25/2022] [Indexed: 11/27/2022]
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17
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Rezakhani S, Amiri M, Weckhuysen S, Keliris GA. Therapeutic efficacy of seizure onset zone-targeting high-definition cathodal tDCS in patients with drug-resistant focal epilepsy. Clin Neurophysiol 2022; 136:219-227. [DOI: 10.1016/j.clinph.2022.01.130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 01/15/2022] [Accepted: 01/20/2022] [Indexed: 12/27/2022]
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18
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Camacho‐Conde JA, Gonzalez‐Bermudez MDR, Carretero‐Rey M, Khan ZU. Brain stimulation: a therapeutic approach for the treatment of neurological disorders. CNS Neurosci Ther 2022; 28:5-18. [PMID: 34859593 PMCID: PMC8673710 DOI: 10.1111/cns.13769] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 10/28/2021] [Accepted: 11/09/2021] [Indexed: 01/14/2023] Open
Abstract
Brain stimulation has become one of the most acceptable therapeutic approaches in recent years and a powerful tool in the remedy against neurological diseases. Brain stimulation is achieved through the application of electric currents using non-invasive as well as invasive techniques. Recent technological advancements have evolved into the development of precise devices with capacity to produce well-controlled and effective brain stimulation. Currently, most used non-invasive techniques are repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS), whereas the most common invasive technique is deep brain stimulation (DBS). In last decade, application of these brain stimulation techniques has not only exploded but also expanded to wide variety of neurological disorders. Therefore, in the current review, we will provide an overview of the potential of both non-invasive (rTMS and tDCS) and invasive (DBS) brain stimulation techniques in the treatment of such brain diseases.
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Affiliation(s)
- Jose Antonio Camacho‐Conde
- Laboratory of NeurobiologyCIMESUniversity of MalagaMalagaSpain
- Department of MedicineFaculty of MedicineUniversity of MalagaMalagaSpain
| | | | - Marta Carretero‐Rey
- Laboratory of NeurobiologyCIMESUniversity of MalagaMalagaSpain
- Department of MedicineFaculty of MedicineUniversity of MalagaMalagaSpain
| | - Zafar U. Khan
- Laboratory of NeurobiologyCIMESUniversity of MalagaMalagaSpain
- Department of MedicineFaculty of MedicineUniversity of MalagaMalagaSpain
- CIBERNEDInstitute of Health Carlos IIIMadridSpain
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19
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Riva A, Golda A, Balagura G, Amadori E, Vari MS, Piccolo G, Iacomino M, Lattanzi S, Salpietro V, Minetti C, Striano P. New Trends and Most Promising Therapeutic Strategies for Epilepsy Treatment. Front Neurol 2021; 12:753753. [PMID: 34950099 PMCID: PMC8690245 DOI: 10.3389/fneur.2021.753753] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 10/28/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Despite the wide availability of novel anti-seizure medications (ASMs), 30% of patients with epilepsy retain persistent seizures with a significant burden in comorbidity and an increased risk of premature death. This review aims to discuss the therapeutic strategies, both pharmacological and non-, which are currently in the pipeline. Methods: PubMed, Scopus, and EMBASE databases were screened for experimental and clinical studies, meta-analysis, and structured reviews published between January 2018 and September 2021. The terms “epilepsy,” “treatment” or “therapy,” and “novel” were used to filter the results. Conclusions: The common feature linking all the novel therapeutic approaches is the spasmodic rush toward precision medicine, aiming at holistically evaluating patients, and treating them accordingly as a whole. Toward this goal, different forms of intervention may be embraced, starting from the choice of the most suitable drug according to the type of epilepsy of an individual or expected adverse effects, to the outstanding field of gene therapy. Moreover, innovative insights come from in-vitro and in-vivo studies on the role of inflammation and stem cells in the brain. Further studies on both efficacy and safety are needed, with the challenge to mature evidence into reliable assets, ameliorating the symptoms of patients, and answering the challenges of this disease.
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Affiliation(s)
- Antonella Riva
- Pediatric Neurology and Muscular Diseases Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy.,Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Alice Golda
- Pediatric Neurology and Muscular Diseases Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Ganna Balagura
- Department of Functional Genomics, Center for Neurogenomics and Cognitive Research, Vrije Universiteit, Amsterdam, Netherlands
| | - Elisabetta Amadori
- Pediatric Neurology and Muscular Diseases Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy.,Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Maria Stella Vari
- Pediatric Neurology and Muscular Diseases Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Gianluca Piccolo
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Michele Iacomino
- Unit of Medical Genetics, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Simona Lattanzi
- Department of Experimental and Clinical Medicine, Neurological Clinic, Marche Polytechnic University, Ancona, Italy
| | - Vincenzo Salpietro
- Pediatric Neurology and Muscular Diseases Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy.,Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Carlo Minetti
- Pediatric Neurology and Muscular Diseases Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy.,Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Pasquale Striano
- Pediatric Neurology and Muscular Diseases Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy.,Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
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20
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Luo WY, Liu H, Feng Y, Hao JX, Zhang YJ, Peng WF, Zhang PM, Ding J, Wang X. Efficacy of cathodal transcranial direct current stimulation on electroencephalographic functional networks in patients with focal epilepsy: Preliminary findings. Epilepsy Res 2021; 178:106791. [PMID: 34837824 DOI: 10.1016/j.eplepsyres.2021.106791] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 09/13/2021] [Accepted: 10/15/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Neuromodulation is a promising therapeutic alternative for epilepsy. We aimed to explore the efficacy and safety of cathodal transcranial current direct stimulation (ctDCS) on electroencephalographic functional networks in focal epilepsy. METHODS A sham-controlled, double-blinded, randomized study was conducted on 25 participants with focal epilepsy who underwent a 5-day, -1.0 mA, 20 min ctDCS, which targeted at the most active interictal epileptiform discharge (IED) region. We examined the electroencephalograms (EEGs) at baseline, immediately and at 4 weeks following ctDCS. The graph theory-based brain networks were established through time-variant partial directed coherence (TVPDC), and were calculated between each pair of EEG signals. The functional networks were characterized using average clustering coefficient, characteristic path length, and small-worldness index. The seizure frequencies, IEDs, graph-theory metrics and cognitive tests were compared. RESULTS Preliminary findings indicated an IED reduction of 30.2% at the end of 5-day active ctDCS compared to baseline (p < 0.10) and a significant IED reduction of 33.4% 4 weeks later (p < 0.05). In terms of the EEG functional network, the small-worldness index significantly reduced by 3.5% (p < 0.05) and the characteristic path length increased by 1.8% (p < 0.10) at the end of the session compared to the baseline. No obvious change was found in the seizure frequency during follow-up (p > 0.05). The Mini-Mental State Examination (MMSE) showed no difference between the active and sham groups (p > 0.05). No severe adverse reactions were observed. CONCLUSIONS In focal epilepsy, the 5-day consecutive ctDCS may potentially decrease the IEDs and ameliorate the EEG functional network, proposing a novel personalized therapeutic scenario for epilepsy.
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Affiliation(s)
- Wen-Yi Luo
- Department of Neurology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Hao Liu
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Yu Feng
- Department of Neurology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jia-Xin Hao
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Yi-Jun Zhang
- Department of Neurology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wei-Feng Peng
- Department of Neurology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Pu-Ming Zhang
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China.
| | - Jing Ding
- Department of Neurology, Zhongshan Hospital, Fudan University, Shanghai, China; CAS Center for Excellence in Brain Science and Intelligence Technology, Shanghai, China.
| | - Xin Wang
- Department of Neurology, Zhongshan Hospital, Fudan University, Shanghai, China; Department of The State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institutes of Brain Science, Fudan University, Shanghai, China.
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21
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da Silva Fiorin F, de Araújo E Silva M, Rodrigues AC. Electrical stimulation in animal models of epilepsy: A review on cellular and electrophysiological aspects. Life Sci 2021; 285:119972. [PMID: 34560081 DOI: 10.1016/j.lfs.2021.119972] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 09/02/2021] [Accepted: 09/17/2021] [Indexed: 01/24/2023]
Abstract
Epilepsy is a debilitating condition, primarily refractory individuals, leading to the search for new efficient therapies. Electrical stimulation is an important method used for years to treat several neurological disorders. Currently, electrical stimulation is used to reduce epileptic crisis in patients and shows promising results. Even though the use of electricity to treat neurological disorders has grown worldwide, there are still many caveats that must be clarified, such as action mechanisms and more efficient stimulation treatment parameters. Thus, this review aimed to explore the comprehension of the main stimulation methods in animal models of epilepsy using rodents to develop new experimental protocols and therapeutic approaches.
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Affiliation(s)
- Fernando da Silva Fiorin
- Graduate Program in Neuroengineering, Edmond and Lily Safra International Institute of Neuroscience, Santos Dumont Institute, Brazil.
| | - Mariane de Araújo E Silva
- Graduate Program in Neuroengineering, Edmond and Lily Safra International Institute of Neuroscience, Santos Dumont Institute, Brazil
| | - Abner Cardoso Rodrigues
- Graduate Program in Neuroengineering, Edmond and Lily Safra International Institute of Neuroscience, Santos Dumont Institute, Brazil
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22
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San-Juan D. Cathodal Transcranial Direct Current Stimulation in Refractory Epilepsy: A Noninvasive Neuromodulation Therapy. J Clin Neurophysiol 2021; 38:503-508. [PMID: 34261114 DOI: 10.1097/wnp.0000000000000717] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
SUMMARY Epilepsy is a chronic disease of the brain that affects individuals of all ages and has a worldwide distribution. According to a 2006 World Health Organization report, 50 million people had epilepsy. Approximately 30% of people with epilepsy have refractory disease despite recent therapeutic developments. Consequently, new treatments are necessary. Transcranial direct current stimulation (tDCS) is a noninvasive method for cortical excitability modulation by subthreshold membrane depolarization or hyperpolarization (cathodal stimulation decreases cortical excitability, whereas anodal stimulation increases it), which has been shown to be safe, economical, and easy to use. The mechanism of action of tDCS is partially understood. Cathodal tDCS in vitro and in vivo animal studies have shown that direct current and cathodal tDCS can successfully induce suppression of epileptiform activity in EEG recordings. Cathodal tDCS has been used in heterogeneous clinical trials in pediatric and adult patients with refractory epilepsy and is well tolerated. A comprehensive review of the clinical trials based on their quality and biases shows evidence that cathodal tDCS in patients with epilepsy is potentially effective. However, additional randomized clinical trials are needed with other etiologies, special populations, additional concomitants therapies, long-term follow-up, and new parameters of stimulation.
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Affiliation(s)
- Daniel San-Juan
- Clinical Neurophysiology Department, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
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23
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Wu YJ, Chien ME, Chiang CC, Huang YZ, Durand DM, Hsu KS. Delta oscillation underlies the interictal spike changes after repeated transcranial direct current stimulation in a rat model of chronic seizures. Brain Stimul 2021; 14:771-779. [PMID: 33989818 DOI: 10.1016/j.brs.2021.04.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 04/27/2021] [Accepted: 04/29/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Transcranial direct current stimulation (tDCS) provides a noninvasive polarity-specific constant current to treat epilepsy, through a mechanism possibly involving excitability modulation and neural oscillation. OBJECTIVE To determine whether EEG oscillations underlie the interictal spike changes after tDCS in rats with chronic spontaneous seizures. METHODS Rats with kainic acid-induced spontaneous seizures were subjected to cathodal tDCS or sham stimulation for 5 consecutive days. Video-EEG recordings were collected immediately pre- and post-stimulation and for the subsequent 2 weeks following stimulation. The acute pre-post stimulation and subacute follow-up changes of interictal spikes and EEG oscillations in tDCS-treated rats were compared with sham. Ictal EEG with seizure behaviors, hippocampal brain-derived neurotrophic factor (BDNF) protein expression, and mossy fiber sprouting were compared between tDCS and sham rats. RESULTS Interictal spike counts were reduced immediately following tDCS with augmented delta and diminished beta and gamma oscillations compared with sham. Cathodal tDCS also enhanced delta oscillations in normal rats. However, increased numbers of interictal spikes with a decrease of delta and theta oscillations were observed in tDCS-treated rats compared with sham during the following 2 weeks after stimulation. Resuming tDCS suppressed the increase of interictal spike activity. In tDCS rats, hippocampal BDNF protein expression was decreased while mossy fiber sprouting did not change compared with sham. CONCLUSIONS The inverse relationship between the changes of delta oscillation and interictal spikes during tDCS on and off stimulation periods indicates that an enhanced endogenous delta oscillation underlies the tDCS inhibitory effect on epileptic excitability.
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Affiliation(s)
- Yi-Jen Wu
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan 70457, Taiwan; Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan.
| | - Miao-Er Chien
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan 70457, Taiwan
| | - Chia-Chu Chiang
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Ying-Zu Huang
- Department of Neurology and Neuroscience Research Center, Chang Gung Memorial Hospital at Linkou, Taoyuan City, Taiwan; Medical School and Healthy Aging Research Center, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Institute of Cognitive Neuroscience, National Central University, Taoyuan, Taiwan
| | - Dominique M Durand
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Kuei-Sen Hsu
- Department of Pharmacology, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan; Institute of Basic Medical Sciences, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan.
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24
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Kaufmann E, Hordt M, Lauseker M, Palm U, Noachtar S. Acute effects of spaced cathodal transcranial direct current stimulation in drug resistant focal epilepsies. Clin Neurophysiol 2021; 132:1444-1451. [PMID: 34023626 DOI: 10.1016/j.clinph.2021.03.048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 02/28/2021] [Accepted: 03/13/2021] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To evaluate the safety and temporal dynamic of the antiepileptic effect of spaced transcranial direct current stimulation (tDCS) in different focal epilepsies. METHODS Cathodal tDCS with individual electrode placement was performed in 15 adults with drug resistant focal epilepsy. An amplitude of 2 mA was applied twice for 9 minutes, with an interstimulation interval of 20 minutes. Tolerability was assessed via the Comfort Rating Questionnaire and the frequency of interictal epileptiform discharges (IEDs) was sequentially compared between the 24 hours before and after tDCS. RESULTS TDCS led to a significant reduction in the total number of IEDs/24 h by up to 68% (mean ± SD: -30.4 ± 21.1%, p = 0.001) as well as in seizure frequency (p = 0.041). The maximum IED reduction was observed between the 3rd and 21st hour after stimulation. Favorable clinical response was associated with structural etiology and clearly circumscribed epileptogenic foci but did not differ between frontal and temporal epilepsies. Overall, the tDCS treatment was well tolerated and did not lead to severe adverse events. CONCLUSIONS The spaced stimulation approach proved to be safe and well-tolerated in patients with drug-resistant unifocal epilepsies, leading to sustained IED and seizure frequency reduction. SIGNIFICANCE Spaced tDCS induces mediate antiepileptic effects with promising therapeutic potential.
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Affiliation(s)
- Elisabeth Kaufmann
- Epilepsy Center, Department of Neurology, University Hospital, LMU Munich, Munich, Germany.
| | - Mirjam Hordt
- Epilepsy Center, Department of Neurology, University Hospital, LMU Munich, Munich, Germany
| | - Michael Lauseker
- Institute for Medical Information Processing, Biometry, and Epidemiology, LMU Munich, Munich, Germany
| | - Ulrich Palm
- Department of Psychiatry and Psychotherapy, LMU Munich, Munich, Germany
| | - Soheyl Noachtar
- Epilepsy Center, Department of Neurology, University Hospital, LMU Munich, Munich, Germany
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25
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Fregni F, El-Hagrassy MM, Pacheco-Barrios K, Carvalho S, Leite J, Simis M, Brunelin J, Nakamura-Palacios EM, Marangolo P, Venkatasubramanian G, San-Juan D, Caumo W, Bikson M, Brunoni AR. Evidence-Based Guidelines and Secondary Meta-Analysis for the Use of Transcranial Direct Current Stimulation in Neurological and Psychiatric Disorders. Int J Neuropsychopharmacol 2021; 24:256-313. [PMID: 32710772 PMCID: PMC8059493 DOI: 10.1093/ijnp/pyaa051] [Citation(s) in RCA: 248] [Impact Index Per Article: 82.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 07/21/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Transcranial direct current stimulation has shown promising clinical results, leading to increased demand for an evidence-based review on its clinical effects. OBJECTIVE We convened a team of transcranial direct current stimulation experts to conduct a systematic review of clinical trials with more than 1 session of stimulation testing: pain, Parkinson's disease motor function and cognition, stroke motor function and language, epilepsy, major depressive disorder, obsessive compulsive disorder, Tourette syndrome, schizophrenia, and drug addiction. METHODS Experts were asked to conduct this systematic review according to the search methodology from PRISMA guidelines. Recommendations on efficacy were categorized into Levels A (definitely effective), B (probably effective), C (possibly effective), or no recommendation. We assessed risk of bias for all included studies to confirm whether results were driven by potentially biased studies. RESULTS Although most of the clinical trials have been designed as proof-of-concept trials, some of the indications analyzed in this review can be considered as definitely effective (Level A), such as depression, and probably effective (Level B), such as neuropathic pain, fibromyalgia, migraine, post-operative patient-controlled analgesia and pain, Parkinson's disease (motor and cognition), stroke (motor), epilepsy, schizophrenia, and alcohol addiction. Assessment of bias showed that most of the studies had low risk of biases, and sensitivity analysis for bias did not change these results. Effect sizes vary from 0.01 to 0.70 and were significant in about 8 conditions, with the largest effect size being in postoperative acute pain and smaller in stroke motor recovery (nonsignificant when combined with robotic therapy). CONCLUSION All recommendations listed here are based on current published PubMed-indexed data. Despite high levels of evidence in some conditions, it must be underscored that effect sizes and duration of effects are often limited; thus, real clinical impact needs to be further determined with different study designs.
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Affiliation(s)
- Felipe Fregni
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Boston, Massachusetts
| | - Mirret M El-Hagrassy
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Boston, Massachusetts
| | - Kevin Pacheco-Barrios
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Boston, Massachusetts
- Universidad San Ignacio de Loyola, Vicerrectorado de Investigación, Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Lima, Peru
| | - Sandra Carvalho
- Neurotherapeutics and experimental Psychopathology Group (NEP), Psychological Neuroscience Laboratory, CIPsi, School of Psychology, University of Minho, Campus de Gualtar, Braga, Portugal
| | - Jorge Leite
- I2P-Portucalense Institute for Psychology, Universidade Portucalense, Porto, Portugal
| | - Marcel Simis
- Physical and Rehabilitation Medicine Institute of the University of Sao Paulo Medical School General Hospital, Sao Paulo, Brazil
| | - Jerome Brunelin
- CH Le Vinatier, PSYR2 team, Lyon Neuroscience Research Center, UCB Lyon 1, Bron, France
| | - Ester Miyuki Nakamura-Palacios
- Laboratory of Cognitive Sciences and Neuropsychopharmacology, Department of Physiological Sciences, Federal University of Espírito Santo, Espírito Santo, Brasil (Dr Nakamura-Palacios)
| | - Paola Marangolo
- Dipartimento di Studi Umanistici, Università Federico II, Naples, Italy
- IRCCS Fondazione Santa Lucia, Rome, Italy
| | - Ganesan Venkatasubramanian
- Translational Psychiatry Laboratory, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Daniel San-Juan
- Neurophysiology Department, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Mexico City, Mexico
| | - Wolnei Caumo
- Post-Graduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS) Surgery Department, School of Medicine, UFRGS; Pain and Palliative Care Service at Hospital de Clínicas de Porto Alegre (HCPA) Laboratory of Pain and Neuromodulation at HCPA, Porto Alegre, Brazil
| | - Marom Bikson
- Department of Biomedical Engineering, The City College of New York of CUNY, New York, New York
| | - André R Brunoni
- Service of Interdisciplinary Neuromodulation, Laboratory of Neurosciences (LIM-27), Department and Institute of Psychiatry & Department of Internal Medicine, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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26
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Hao J, Luo W, Xie Y, Feng Y, Sun W, Peng W, Zhao J, Zhang P, Ding J, Wang X. Functional Network Alterations as Markers for Predicting the Treatment Outcome of Cathodal Transcranial Direct Current Stimulation in Focal Epilepsy. Front Hum Neurosci 2021; 15:637071. [PMID: 33815082 PMCID: PMC8009991 DOI: 10.3389/fnhum.2021.637071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 02/23/2021] [Indexed: 11/13/2022] Open
Abstract
Background and Purpose Transcranial direct current stimulation (tDCS) is an emerging non-invasive neuromodulation technique for focal epilepsy. Because epilepsy is a disease affecting the brain network, our study was aimed to evaluate and predict the treatment outcome of cathodal tDCS (ctDCS) by analyzing the ctDCS-induced functional network alterations. Methods Either the active 5-day, -1.0 mA, 20-min ctDCS or sham ctDCS targeting at the most active interictal epileptiform discharge regions was applied to 27 subjects suffering from focal epilepsy. The functional networks before and after ctDCS were compared employing graph theoretical analysis based on the functional magnetic resonance imaging (fMRI) data. A support vector machine (SVM) prediction model was built to predict the treatment outcome of ctDCS using the graph theoretical measures as markers. Results Our results revealed that the mean clustering coefficient and the global efficiency decreased significantly, as well as the characteristic path length and the mean shortest path length at the stimulation sites in the fMRI functional networks increased significantly after ctDCS only for the patients with response to the active ctDCS (at least 20% reduction rate of seizure frequency). Our prediction model achieved the mean prediction accuracy of 68.3% (mean sensitivity: 70.0%; mean specificity: 67.5%) after the nested cross validation. The mean area under the receiver operating curve was 0.75, which showed good prediction performance. Conclusion The study demonstrated that the response to ctDCS was related to the topological alterations in the functional networks of epilepsy patients detected by fMRI. The graph theoretical measures were promising for clinical prediction of ctDCS treatment outcome.
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Affiliation(s)
- Jiaxin Hao
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Wenyi Luo
- Department of Neurology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yuhai Xie
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Yu Feng
- Department of Neurology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wei Sun
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Weifeng Peng
- Department of Neurology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jun Zhao
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Puming Zhang
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Jing Ding
- Department of Neurology, Zhongshan Hospital, Fudan University, Shanghai, China.,CAS Center for Excellence in Brain Science and Intelligence Technology, Shanghai, China
| | - Xin Wang
- Department of Neurology, Zhongshan Hospital, Fudan University, Shanghai, China.,State Key Laboratory of Medical Neurobiology, the Institutes of Brain Science and the Collaborative Innovation Center for Brain Science, Fudan University, Shanghai, China
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Transcranial direct current stimulation (tDCS) in the management of epilepsy: A systematic review. Seizure 2021; 86:85-95. [PMID: 33582584 DOI: 10.1016/j.seizure.2021.01.020] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/22/2021] [Accepted: 01/30/2021] [Indexed: 12/22/2022] Open
Abstract
PURPOSE Current therapies for the management of epilepsy are still suboptimal for several patients due to inefficacy, major adverse events, and unavailability. Transcranial direct current stimulation (tDCS), an emergent non-invasive neuromodulation technique, has been tested in epilepsy samples over the past two decades to reduce either seizure frequency or electroencephalogram (EEG) epileptiform discharges. METHODS A systematic review was performed in accordance with PRISMA guidelines (PROSPERO record CRD42020160292). A thorough electronic search was completed in MEDLINE, EMBASE, CENTRAL and Scopus databases for trials that applied tDCS interventions to children and adults with epilepsy of any cause, from inception to April 30, 2020. RESULTS Twenty-seven studies fulfilled eligibility criteria, including nine sham-controlled and 18 uncontrolled trials or case reports/series. Samples consisted mainly of drug-resistant focal epilepsy patients that received cathodal tDCS stimulation targeted at the site with maximal EEG abnormalities. At follow-up, 84 % (21/25) of the included studies reported a reduction in seizure frequency and in 43 % (6/14) a decline in EEG epileptiform discharge rate was observed. No serious adverse events were reported. CONCLUSIONS Cathodal tDCS is both a safe and probably effective technique for seizure control in patients with drug-resistant focal epilepsy. However, published trials are heterogeneous regarding samples and methodology. More and larger sham-controlled randomized trials are needed, preferably with mechanistic informed stimulation protocols, to further advance tDCS therapy in the management of epilepsy.
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28
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San-Juan D, Morales Báez JA, Farías Fernández LD, López NG, Segovia DR, Pesqueira GQ, Vázquez ML, Ruffini G, Rotenberg A. In-session seizures during transcranial direct current stimulation in patients with epilepsy. Brain Stimul 2020; 14:152-153. [PMID: 33338670 DOI: 10.1016/j.brs.2020.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 12/13/2020] [Indexed: 11/25/2022] Open
Affiliation(s)
- Daniel San-Juan
- Epilepsy Service, National Institute of Neurology and Neurosurgery, Mexico City, Mexico.
| | - Jorge A Morales Báez
- Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, Mexico
| | - Luis D Farías Fernández
- Vicerrectoría de Ciencias de La Salud, Universidad de Monterrey, San Pedro Garza García, Mexico
| | - Noel Gallardo López
- Facultad de Medicina, Benemérita Universidad Autónoma de Puebla, Puebla, Mexico
| | - Dante Ríos Segovia
- Departamento de Medicina y Nutrición, Universidad de Guanajuato, León, Mexico
| | | | - Máximo León Vázquez
- Hospital Regional No. 1 "Carlos MacGregor Sánchez Navarro", Instituto Mexicano Del Seguro Social, Ciudad de México, Mexico
| | | | - Alexander Rotenberg
- Neuromodulation Program and Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States
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29
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Regner GG, Torres ILS, de Oliveira C, Pflüger P, da Silva LS, Scarabelot VL, Ströher R, de Souza A, Fregni F, Pereira P. Transcranial direct current stimulation (tDCS) affects neuroinflammation parameters and behavioral seizure activity in pentylenetetrazole-induced kindling in rats. Neurosci Lett 2020; 735:135162. [PMID: 32569808 DOI: 10.1016/j.neulet.2020.135162] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 06/07/2020] [Accepted: 06/14/2020] [Indexed: 10/24/2022]
Abstract
Despite the introduction of new antiepileptic drugs, about 30 % of patients with epilepsy are refractory to drug therapy. Thus, the search for non-pharmacological interventions such as transcranial direct current stimulation (tDCS) may be an alternative, either alone or in combination with low doses of anticonvulsants. This study evaluated the effect of anodal (a-tDCS) and cathodal tDCS (c-tDCS) on seizure behavior and neuroinflammation parameters. Rats were submitted to the kindling model induced by pentylenetetrazole (PTZ) using diazepam (DZP) as anticonvulsant standard. tDCS groups were submitted to 10 sessions of a-tDCS or c-tDCS or SHAM-tDCS. Every 3 days they received saline (SAL), low dose of DZP (alone or in combination with tDCS) or effective dose of DZP 30 min before administration of PTZ, totaling 16 days of protocol. Neither a-tDCS nor c-tDCS reduced the occurrence of clonic forelimb seizures (convulsive motor seizures - stage 3 by the adapted Racine scale we based on). Associated with DZP, c-tDCS (c-tDCS/DZP0.15) increased the latency to first clonic forelimb seizure on the 10th and 16th days. Hippocampal IL-1β levels were reduced by c-tDCS and c-tDCS/DZP0.15. In contrast, these treatments induced an increase in cortical IL-1β levels. Hippocampal TNF-α levels were not altered by c-tDCS or a-tDCS, but c-tDCS and c-tDCS/DZP0.15 increased those levels in cerebral cortex. Cortical NGF levels were increased by c-tDCS and c-tDCS/DZP0.15. a-tDCS/DZP0.15 reduced hippocampal BDNF levels and c-tDCS/DZP0.15 increased these levels in cerebral cortex. In conclusion, c-tDCS alone or in combination with a low dose of DZP showed to affect neuroinflammation, improving central neurotrophin levels and decreasing hippocampal IL-1β levels after PTZ-induced kindling without statistically significant effect on seizure behavior.
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Affiliation(s)
- Gabriela Gregory Regner
- Laboratory of Neuropharmacology and Preclinical Toxicology Laboratory, Postgraduate Program in Biological Sciences: Pharmacology and Therapeutics, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, 90050-170, Brazil; Laboratory of Pain Pharmacology and Neuromodulation: Preclinical Studies - Centro de Pesquisa Experimental (CPE), Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS 90035-003, Brazil
| | - Iraci L S Torres
- Laboratory of Pain Pharmacology and Neuromodulation: Preclinical Studies - Centro de Pesquisa Experimental (CPE), Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS 90035-003, Brazil; Postgraduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.
| | - Carla de Oliveira
- Laboratory of Pain Pharmacology and Neuromodulation: Preclinical Studies - Centro de Pesquisa Experimental (CPE), Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS 90035-003, Brazil; Postgraduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Pricila Pflüger
- Laboratory of Neuropharmacology and Preclinical Toxicology Laboratory, Postgraduate Program in Biological Sciences: Pharmacology and Therapeutics, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, 90050-170, Brazil
| | - Lisiane Santos da Silva
- Laboratory of Pain Pharmacology and Neuromodulation: Preclinical Studies - Centro de Pesquisa Experimental (CPE), Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS 90035-003, Brazil
| | - Vanessa Leal Scarabelot
- Laboratory of Pain Pharmacology and Neuromodulation: Preclinical Studies - Centro de Pesquisa Experimental (CPE), Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS 90035-003, Brazil
| | - Roberta Ströher
- Laboratory of Pain Pharmacology and Neuromodulation: Preclinical Studies - Centro de Pesquisa Experimental (CPE), Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS 90035-003, Brazil
| | - Andressa de Souza
- Laboratory of Pain Pharmacology and Neuromodulation: Preclinical Studies - Centro de Pesquisa Experimental (CPE), Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS 90035-003, Brazil
| | - Felipe Fregni
- Laboratory of Neuromodulation, Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard University, Boston, United States
| | - Patrícia Pereira
- Laboratory of Neuropharmacology and Preclinical Toxicology Laboratory, Postgraduate Program in Biological Sciences: Pharmacology and Therapeutics, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, 90050-170, Brazil
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30
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Sun Y, Dhamne SC, Carretero-Guillén A, Salvador R, Goldenberg MC, Godlewski BR, Pascual-Leone A, Madsen JR, Stone SSD, Ruffini G, Márquez-Ruiz J, Rotenberg A. Drug-Responsive Inhomogeneous Cortical Modulation by Direct Current Stimulation. Ann Neurol 2020; 88:489-502. [PMID: 32542794 PMCID: PMC10675838 DOI: 10.1002/ana.25822] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 06/11/2020] [Accepted: 06/12/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Cathodal direct current stimulation (cDCS) induces long-term depression (LTD)-like reduction of cortical excitability (DCS-LTD), which has been tested in the treatment of epilepsy with modest effects. In part, this may be due to variable cortical neuron orientation relative to the electric field. We tested, in vivo and in vitro, whether DCS-LTD occurs throughout the cortical thickness, and if not, then whether drug-DCS pairing can enhance the uniformity of the cortical response and the cDCS antiepileptic effect. METHODS cDCS-mediated changes in cortical excitability were measured in vitro in mouse motor cortex (M1) and in human postoperative neocortex, in vivo in mouse somatosensory cortex (S1), and in a mouse kainic acid (KA)-seizure model. Contributions of N-methyl-D-aspartate-type glutamate receptors (NMDARs) to cDCS-mediated plasticity were tested with application of NMDAR blockers (memantine/D-AP5). RESULTS cDCS reliably induced DCS-LTD in superficial cortical layers, and a long-term potentiation (LTP)-like enhancement (DCS-LTP) was recorded in deep cortical layers. Immunostaining confirmed layer-specific increase of phospho-S6 ribosomal protein in mouse M1. Similar nonuniform cDCS aftereffects on cortical excitability were also found in human neocortex in vitro and in S1 of alert mice in vivo. Application of memantine/D-AP5 either produced a more uniform DCS-LTD throughout the cortical thickness or at least abolished DCS-LTP. Moreover, a combination of memantine and cDCS suppressed KA-induced seizures. INTERPRETATION cDCS aftereffects are not uniform throughout cortical layers, which may explain the incomplete cDCS clinical efficacy. NMDAR antagonists may augment cDCS efficacy in epilepsy and other disorders where regional depression of cortical excitability is desirable. ANN NEUROL 2020;88:489-502.
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Affiliation(s)
- Yan Sun
- Department of Neurology and the F. M. Kirby Neurobiology Center, Boston, Massachusetts, USA
- Neuromodulation Program and Division of Epilepsy and Clinical Neurophysiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Sameer C Dhamne
- Department of Neurology and the F. M. Kirby Neurobiology Center, Boston, Massachusetts, USA
- Neuromodulation Program and Division of Epilepsy and Clinical Neurophysiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | | | - Marti C Goldenberg
- Department of Neurology and the F. M. Kirby Neurobiology Center, Boston, Massachusetts, USA
- Repository Core, Boston Children's Hospital, Boston, Massachusetts, USA
| | | | - Alvaro Pascual-Leone
- Berenson-Allen Center for Noninvasive Brain Stimulation, Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
- Guttmann Institute, Autonomous University of Barcelona, Barcelona, Spain
| | - Joseph R Madsen
- Department of Neurosurgery, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Scellig S D Stone
- Department of Neurosurgery, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Giulio Ruffini
- Neuroelectrics Corporation, Cambridge, Massachusetts, USA
| | - Javier Márquez-Ruiz
- Department of Physiology, Anatomy and Cellular Biology, Pablo de Olavide University, Seville, Spain
| | - Alexander Rotenberg
- Department of Neurology and the F. M. Kirby Neurobiology Center, Boston, Massachusetts, USA
- Neuromodulation Program and Division of Epilepsy and Clinical Neurophysiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Berenson-Allen Center for Noninvasive Brain Stimulation, Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
- Guttmann Institute, Autonomous University of Barcelona, Barcelona, Spain
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31
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Zhang L, Wang Q, Baier G. Dynamical Features of a Focal Epileptogenic Network Model for Stimulation-Based Control. IEEE Trans Neural Syst Rehabil Eng 2020; 28:1856-1865. [DOI: 10.1109/tnsre.2020.3002350] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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32
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Hunold A, Ortega D, Schellhorn K, Haueisen J. Novel flexible cap for application of transcranial electrical stimulation: a usability study. Biomed Eng Online 2020; 19:50. [PMID: 32552720 PMCID: PMC7302393 DOI: 10.1186/s12938-020-00792-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 06/06/2020] [Indexed: 11/12/2022] Open
Abstract
Background Advances in transcranial electrical stimulation (tES) are hampered by the conventional rubber electrodes manually attached to the head with rubber bands. This procedure limits montages to a few electrodes, is error prone with respect to electrode configurations and is burdensome for participants and operators. A newly developed flexible cap with integrated textile stimulation electrodes was compared to the conventional setup of rubber electrodes inserted into sponges fixated by rubber bands, with respect to usability and reliability. Two operators applied both setups to 20 healthy volunteers participating in the study. Electrode position and impedance measures as well as subjective evaluations from participants and operators were obtained throughout the stimulation sessions. Results Our results demonstrated the superiority of the flexible cap by means of significantly higher electrode configuration reproducibility and a more efficient application. Both, operators and volunteers evaluated the flexible cap as easier to use and more comfortable to wear when compared to the conventional setup. Conclusion In conclusion, the new cap improves existing and opens new application scenarios for tES.
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Affiliation(s)
- Alexander Hunold
- Institute of Biomedical Engineering and Informatics, Technische Universität Ilmenau, 98693, Ilmenau, Germany.
| | - Daniela Ortega
- Institute of Biomedical Engineering and Informatics, Technische Universität Ilmenau, 98693, Ilmenau, Germany.,Bioinstrumentation and Clinical Engineering Research Group, Universidad de Antioquia, Medellín, 050010, Colombia
| | | | - Jens Haueisen
- Institute of Biomedical Engineering and Informatics, Technische Universität Ilmenau, 98693, Ilmenau, Germany.,Hans Berger Department of Neurology, Biomagnetic Center, University Hospital Jena, 07747, Jena, Germany
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33
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Israely S, Leisman G. Can neuromodulation techniques optimally exploit cerebello-thalamo-cortical circuit properties to enhance motor learning post-stroke? Rev Neurosci 2020; 30:821-837. [PMID: 31194694 DOI: 10.1515/revneuro-2019-0008] [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: 01/12/2019] [Accepted: 04/11/2019] [Indexed: 02/07/2023]
Abstract
Individuals post-stroke sustain motor deficits years after the stroke. Despite recent advancements in the applications of non-invasive brain stimulation techniques and Deep Brain Stimulation in humans, there is a lack of evidence supporting their use for rehabilitation after brain lesions. Non-invasive brain stimulation is already in use for treating motor deficits in individuals with Parkinson's disease and post-stroke. Deep Brain Stimulation has become an established treatment for individuals with movement disorders, such as Parkinson's disease, essential tremor, epilepsy, cerebral palsy and dystonia. It has also been utilized for the treatment of Tourette's syndrome, Alzheimer's disease and neuropsychiatric conditions such as obsessive-compulsive disorder, major depression and anorexia nervosa. There exists growing scientific knowledge from animal studies supporting the use of Deep Brain Stimulation to enhance motor recovery after brain damage. Nevertheless, these results are currently not applicable to humans. This review details the current literature supporting the use of these techniques to enhance motor recovery, both from human and animal studies, aiming to encourage development in this domain.
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Affiliation(s)
- Sharon Israely
- Department of Medical Neurobiology, IMRIC and ELSC, The Hebrew University, Hadassah Medical School, Jerusalem 9112102, Israel
| | - Gerry Leisman
- Department of Physiotherapy, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel.,Universidad de Ciencias Médicas Instituto de Neurología y Neurocirugía, Neurofisiología Clinica, Havana, Cuba
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34
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Wu YJ, Chien ME, Huang CH, Chiang CC, Lin CC, Huang CW, Durand DM, Hsu KS. Transcranial direct current stimulation alleviates seizure severity in kainic acid-induced status epilepticus rats. Exp Neurol 2020; 328:113264. [DOI: 10.1016/j.expneurol.2020.113264] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 02/28/2020] [Indexed: 12/20/2022]
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35
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Yang H, Yuan Y, Wang X, Li X. Closed-Loop Transcranial Ultrasound Stimulation for Real-Time Non-invasive Neuromodulation in vivo. Front Neurosci 2020; 14:445. [PMID: 32477055 PMCID: PMC7235408 DOI: 10.3389/fnins.2020.00445] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 04/09/2020] [Indexed: 12/18/2022] Open
Abstract
The closed-loop brain stimulation technique plays a key role in neural network information processing and therapies of neurological diseases. Transcranial ultrasound stimulation (TUS) is an established neuromodulation method for the neural oscillation in animals or human. All available TUS systems provide brain stimulation in an open-loop pattern. In this study, we developed a closed-loop transcranial ultrasound stimulation (CLTUS) system for real-time non-invasive neuromodulation in vivo. We used the CLTUS system to modulate the neural activities of the hippocampus of a wild-type mouse based on the phase of the theta rhythm recorded at the ultrasound-targeted location. In addition, we modulated the hippocampus of a temporal lobe epilepsy (TLE) mouse. The ultrasound stimulation increased the absolute power and reduced the relative power of the theta rhythm, which were independent of the specific phase of the theta rhythm. Compared with those of a sham stimulation, the latency of epileptic seizures was significantly increased, while the epileptic seizure duration was significantly decreased under the CLTUS. The above results indicate that the CLTUS can be used to not only modulate the neural oscillation through the theta-phase-specific manipulation of the hippocampus but also effectively inhibit the seizure of a TLE mouse in time. CLTUS has large application potentials for the understanding of the causal relationship of neural circuits as well as for timely, effective, and non-invasive therapies of neurological diseases such as epilepsy and Parkinson's disease.
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Affiliation(s)
| | | | | | - Xin Li
- Institute of Electrical Engineering, Yanshan University, Qinhuangdao, China
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Effects of Combined Transcranial Direct Current Stimulation with Cognitive Training in Girls with Rett Syndrome. Brain Sci 2020; 10:brainsci10050276. [PMID: 32370253 PMCID: PMC7287589 DOI: 10.3390/brainsci10050276] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 04/18/2020] [Accepted: 04/22/2020] [Indexed: 01/04/2023] Open
Abstract
Background: Transcranial Direct Current Stimulation (tDCS) combined with traditional rehabilitative techniques has not been widely applied to Rett Syndrome (RTT). The aim of this study was to examine the effects of combined cognitive traditional training with tDCS applied to attention and language measures in subjects with RTT. Methods: 31 subjects with RTT were randomly allocated into two groups: non-sham tDCS (n = 18) and sham tDCS (n = 13). The former received the integrated intervention non-sham tDCS plus cognitive empowerment during the treatment phase. The latter received sham stimulation plus cognitive empowerment. All participants underwent neurological and cognitive assessment to evaluate attention and language measures: before integrated treatment (pre-test phase), at the conclusion of the treatment (post-test phase), and at 1 month after the conclusion of the treatment (follow-up phase). Results: the results indicated longer attention time in the non-sham tDCS group compared to the sham tDCS group with a stable trend also in the follow-up phase; an increase of the number of vowel/phoneme sounds in the non-sham tDCS group; and an improvement in the neurophysiological parameters in the non-sham tDCS group. Conclusions: This study supports the use of tDCS as a promising and alternative approach in the RTT rehabilitation field.
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37
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Jung YJ, Lee YS, Choi GY, Hwang HJ. Development of a transcranial direct current stimulation device based on current limiter for simultaneous measurement of electroencephalography: A feasibility study. Technol Health Care 2020; 28:123-130. [PMID: 32333570 PMCID: PMC7369038 DOI: 10.3233/thc-209013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND: Electroencephalography (EEG) measured during transcranial direct current stimulation (tDCS) can help understand the accurate impact of tDCS on the brain, but this has been hindered due to significant inflow of tDCS-induced electrical artifacts. OBJECTIVE: In this study, we introduce a novel tDCS device developed based on current limiter, which can prevent the generation of significant electrical artifacts. METHODS: To verify the feasibility of our developed tDCS device, we performed simultaneous measurement of EEG during tDCS application with five different current intensities (0, 500, 1,000, 1,500, and 2,000 μA). Changes in EEG power spectral density (PSD) and correlation between the PSD of non-stimulation and tDCS condition were investigated to see whether our tDCS device can be used for simultaneous EEG recording without significant inflow of tDCS-induced electrical artifacts. RESUTLS: The mean EEG-PSD differences between non-stimulation and tDCS condition were not significant for all stimulation current intensities. Furthermore, EEG-PSDs estimated during non-stimulation and tDCS application showed statistically high correlation for all comparison cases. CONCLUSION: Based on the results, we could demonstrate the feasibility of our tDCS device based on current limiter for simultaneous EEG measurement, which could potentially provide a way to investigate the impact of tDCS on the brain more accurately.
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Affiliation(s)
- Young-Jin Jung
- Department of Radiological Science, Dongseo University, Busan, Korea.,Center for Radiological Environment and Health Science, Dongseo University, Busan, Korea
| | - Yun-Sung Lee
- Department of Electronics and Information Engineering, Korea University, Sejong, Korea
| | - Ga-Young Choi
- Department of Electronics and Information Engineering, Korea University, Sejong, Korea
| | - Han-Jeong Hwang
- Department of Electronics and Information Engineering, Korea University, Sejong, Korea
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38
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Denoyer Y, Merlet I, Wendling F, Benquet P. Modelling acute and lasting effects of tDCS on epileptic activity. J Comput Neurosci 2020; 48:161-176. [DOI: 10.1007/s10827-020-00745-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 02/10/2020] [Accepted: 04/04/2020] [Indexed: 12/11/2022]
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39
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Computational modelling of the long-term effects of brain stimulation on the local and global structural connectivity of epileptic patients. PLoS One 2020; 15:e0221380. [PMID: 32027654 PMCID: PMC7004372 DOI: 10.1371/journal.pone.0221380] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 01/18/2020] [Indexed: 11/25/2022] Open
Abstract
Computational studies of the influence of different network parameters on the dynamic and topological network effects of brain stimulation can enhance our understanding of different outcomes between individuals. In this study, a brain stimulation session along with the subsequent post-stimulation brain activity is simulated for a period of one day using a network of modified Wilson-Cowan oscillators coupled according to diffusion imaging based structural connectivity. We use this computational model to examine how differences in the inter-region connectivity and the excitability of stimulated regions at the time of stimulation can affect post-stimulation behaviours. Our findings indicate that the initial inter-region connectivity can heavily affect the changes that stimulation induces in the connectivity of the network. Moreover, differences in the excitability of the stimulated regions seem to lead to different post-stimulation connectivity changes across the model network, including on the internal connectivity of non-stimulated regions.
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40
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Marquardt L, Eichele T, Bindoff LA, Olberg HK, Veiby G, Eichele H, Kusztrits I, Hirnstein M. No effect of electrical transcranial direct current stimulation adjunct treatment for epilepsia partialis continua in POLG disease. Epilepsy Behav Rep 2019; 12:100339. [PMID: 31737865 PMCID: PMC6849077 DOI: 10.1016/j.ebr.2019.100339] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 09/30/2019] [Accepted: 10/04/2019] [Indexed: 01/23/2023] Open
Abstract
We report a 15-year-old female with POLG-related mitochondrial disease who developed severe multifocal epilepsia partialis continua, unresponsive to standard anti seizure drug treatment and general anesthesia. Based on an earlier case report, we treated her focal seizures that affected her right upper limb with 20-min sessions of transcranial direct current stimulation (tDCS) at an intensity of 2 mA on each of five consecutive days. The cathode was placed over the left primary motor cortex, the anode over the contralateral orbitofrontal cortex. Surface electromyography (EMG) were recorded 20 min before, 20 min during, and 20 min after four of five tDCS sessions to measure its effect on the muscle jerks. The electroencephalography (EEG) was recorded before and after tDCS to measure the frequency of spikes. Our results showed no statistically or clinically significant reduction of seizures or epileptiform activity using EEG and EMG, with this treatment protocol. To our knowledge, this is only the second time that adjunct tDCS treatment of epileptic seizures has been tried in POLG-related mitochondrial disease. Taken together with the positive findings from the earlier case report, the present study highlights that more data are needed to determine if, and under which parameters, the treatment is effective. Case report of multifocal epilepsy in POLG disease with upper limp myoclonus. Epileptic activity resulting in myoclonus was treated with 5 days of 20 minutes cathodal 2 mA tDCS over left motor cortex. tDCS treatment did not yield significant reduction of myoclonus activity.
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Affiliation(s)
- Lynn Marquardt
- Department of Biological and Medical Psychology, University of Bergen, Jonas Lies vei 21, 5009 Bergen, Norway
| | - Tom Eichele
- Department of Neurology, Haukeland University Hospital, Bergen, Jonas Lies vei 71, 5053 Bergen, Norway
| | - Laurence A Bindoff
- Department of Neurology, Haukeland University Hospital, Bergen, Jonas Lies vei 71, 5053 Bergen, Norway.,Department of Neurology, Section for Clinical Neurophysiology, Haukeland
| | - Henning Kristian Olberg
- Department of Neurology, Haukeland University Hospital, Bergen, Jonas Lies vei 71, 5053 Bergen, Norway
| | - Gyri Veiby
- Department of Neurology, Haukeland University Hospital, Bergen, Jonas Lies vei 71, 5053 Bergen, Norway
| | - Heike Eichele
- Department of Biological and Medical Psychology, University of Bergen, Jonas Lies vei 21, 5009 Bergen, Norway.,Regional Resource Center for Autism, ADHD, Tourette Syndrome and Narcolepsy, Western Norway, Haukeland University Hospital, Fjøsangerveien 36, 5054 Bergen, Norway
| | - Isabella Kusztrits
- Department of Biological and Medical Psychology, University of Bergen, Jonas Lies vei 21, 5009 Bergen, Norway
| | - Marco Hirnstein
- Department of Biological and Medical Psychology, University of Bergen, Jonas Lies vei 21, 5009 Bergen, Norway
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41
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Starnes K, Miller K, Wong-Kisiel L, Lundstrom BN. A Review of Neurostimulation for Epilepsy in Pediatrics. Brain Sci 2019; 9:brainsci9100283. [PMID: 31635298 PMCID: PMC6826633 DOI: 10.3390/brainsci9100283] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 10/14/2019] [Accepted: 10/17/2019] [Indexed: 12/16/2022] Open
Abstract
Neurostimulation for epilepsy refers to the application of electricity to affect the central nervous system, with the goal of reducing seizure frequency and severity. We review the available evidence for the use of neurostimulation to treat pediatric epilepsy, including vagus nerve stimulation (VNS), responsive neurostimulation (RNS), deep brain stimulation (DBS), chronic subthreshold cortical stimulation (CSCS), transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS). We consider possible mechanisms of action and safety concerns, and we propose a methodology for selecting between available options. In general, we find neurostimulation is safe and effective, although any high quality evidence applying neurostimulation to pediatrics is lacking. Further research is needed to understand neuromodulatory systems, and to identify biomarkers of response in order to establish optimal stimulation paradigms.
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Affiliation(s)
- Keith Starnes
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA.
| | - Kai Miller
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, USA.
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42
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Calker D, Biber K, Domschke K, Serchov T. The role of adenosine receptors in mood and anxiety disorders. J Neurochem 2019; 151:11-27. [DOI: 10.1111/jnc.14841] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 07/15/2019] [Accepted: 07/18/2019] [Indexed: 12/25/2022]
Affiliation(s)
- Dietrich Calker
- Department for Psychiatry and Psychotherapy, Medical Center ‐ University of Freiburg, Faculty of Medicine University of Freiburg Freiburg Germany
| | - Knut Biber
- Section Medical Physiology, Department of Neuroscience University Medical Center Groningen, University of Groningen Groningen The Netherlands
| | - Katharina Domschke
- Department for Psychiatry and Psychotherapy, Medical Center ‐ University of Freiburg, Faculty of Medicine University of Freiburg Freiburg Germany
- Centre for Basics in Neuromodulation, Faculty of Medicine University of Freiburg Freiburg Germany
| | - Tsvetan Serchov
- Department of Stereotactic and Functional Neurosurgery, Faculty of Medicine, Medical Center ‐ University Freiburg University of Freiburg Freiburg Germany
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43
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Mesraoua B, Deleu D, Kullmann DM, Shetty AK, Boon P, Perucca E, Mikati MA, Asadi-Pooya AA. Novel therapies for epilepsy in the pipeline. Epilepsy Behav 2019; 97:282-290. [PMID: 31284159 DOI: 10.1016/j.yebeh.2019.04.042] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 04/17/2019] [Accepted: 04/24/2019] [Indexed: 02/06/2023]
Abstract
Despite the availability of many antiepileptic drugs (AEDs) (old and newly developed) and, as recently suggested, their optimization in the treatment of patients with uncontrolled seizures, more than 30% of patients with epilepsy continue to experience seizures and have drug-resistant epilepsy; the management of these patients represents a real challenge for epileptologists and researchers. Resective surgery with the best rates of seizure control is not an option for all of them; therefore, research and discovery of new methods of treating resistant epilepsy are of extreme importance. In this article, we will discuss some innovative approaches, such as P-glycoprotein (P-gp) inhibitors, gene therapy, stem cell therapy, traditional and novel antiepileptic devices, precision medicine, as well as therapeutic advances in epileptic encephalopathy in children; these treatment modalities open up new horizons for the treatment of patients with drug-resistant epilepsy.
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Affiliation(s)
- Boulenouar Mesraoua
- Hamad Medical Corporation and Weill Cornell Medical College-Qatar, Doha, Qatar.
| | - Dirk Deleu
- Hamad Medical Corporation and Weill Cornell Medical College-Qatar, Doha, Qatar.
| | | | - Ashok K Shetty
- Institute for Regenerative Medicine, Department of Molecular and Cellular Medicine, Texas A&M University College of Medicine, College Station, TX, USA.
| | - Paul Boon
- Reference Center for Refractory Epilepsy, Ghent University Hospital Belgium - Academic Center for Epileptology, Heeze-Maastricht, the Netherlands.
| | - Emilio Perucca
- Unit of Clinical and Experimental Pharmacology, Department of Internal Medicine and Therapeutics, University of Pavia, and Clinical Trial Center, IRCCS Mondino Foundation, Pavia, Italy.
| | - Mohamad A Mikati
- Division of Pediatric Neurology and Developmental Medicine, Duke University Medical Center, Durham, USA.
| | - Ali A Asadi-Pooya
- Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran; Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, USA.
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44
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Li X, Yang H, Yan J, Wang X, Yuan Y, Li X. Seizure control by low-intensity ultrasound in mice with temporal lobe epilepsy. Epilepsy Res 2019; 154:1-7. [DOI: 10.1016/j.eplepsyres.2019.04.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 03/23/2019] [Accepted: 04/03/2019] [Indexed: 12/31/2022]
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45
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Development of wirelessly-powered, extracranial brain activator (ECBA) in a large animal model for the future non-invasive human neuromodulation. Sci Rep 2019; 9:10906. [PMID: 31358822 PMCID: PMC6662771 DOI: 10.1038/s41598-019-47383-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Accepted: 07/16/2019] [Indexed: 01/08/2023] Open
Abstract
As transcranial electrical stimulation (tES) is an emerging and promising technique for neuromodulation, we developed a novel device; wirelessly-powered, extracranial brain activator (ECBA), which is mounted subcutaneously, and its neuromodulation effect was investigated. The oscillatory changes in electrocorticography (EcoG) were analyzed from two types of stimulation. Two weeks prior to the recording experiment, we underwent surgery for implantation of subdural strips and ECBA module over centroparietal regions of anesthetized beagles. Low-frequency stimulation (LFS) and subsequent high-frequency stimulation (HFS) protocols (600 pulses respectively) were applied. Then, the power changes before and after each stimulation in five different bands were compared. A significantly larger voltage difference with subcutaneous than transcutaneous stimulation measured at EcoG channels indicated a substantial current attenuation between the skin and skull. Compared with the baseline, all subjects showed consistently decreased delta power and increased gamma power after HFS. LFS also induced a similar, but opposite, pattern of power change in four beagles. The results from this study indicate that LFS and HFS with our novel ECBA can consistently and effectively modulate neural activity of the cortex, inducing neural inhibition and facilitation functions, respectively. Future studies are necessary to further ensuring a consistent efficacy and long-term safety.
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Herrera-Ferrá K, Saruwatari Zavala G, Nicolini Sánchez H, Pinedo Rivas H. Neuroética en México: Reflexiones médicas, legales y socioculturales. ACTA ACUST UNITED AC 2019. [DOI: 10.1016/j.bioet.2019.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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47
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The role that choice of model plays in predictions for epilepsy surgery. Sci Rep 2019; 9:7351. [PMID: 31089190 PMCID: PMC6517411 DOI: 10.1038/s41598-019-43871-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 05/02/2019] [Indexed: 12/26/2022] Open
Abstract
Mathematical modelling has been widely used to predict the effects of perturbations to brain networks. An important example is epilepsy surgery, where the perturbation in question is the removal of brain tissue in order to render the patient free of seizures. Different dynamical models have been proposed to represent transitions to ictal states in this context. However, our choice of which mathematical model to use to address this question relies on making assumptions regarding the mechanism that defines the transition from background to the seizure state. Since these mechanisms are unknown, it is important to understand how predictions from alternative dynamical descriptions compare. Herein we evaluate to what extent three different dynamical models provide consistent predictions for the effect of removing nodes from networks. We show that for small, directed, connected networks the three considered models provide consistent predictions. For larger networks, predictions are shown to be less consistent. However consistency is higher in networks that have sufficiently large differences in ictogenicity between nodes. We further demonstrate that heterogeneity in ictogenicity across nodes correlates with variability in the number of connections for each node.
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48
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Aplin FP, Fridman GY. Implantable Direct Current Neural Modulation: Theory, Feasibility, and Efficacy. Front Neurosci 2019; 13:379. [PMID: 31057361 PMCID: PMC6482222 DOI: 10.3389/fnins.2019.00379] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 04/02/2019] [Indexed: 12/25/2022] Open
Abstract
Implantable neuroprostheses such as cochlear implants, deep brain stimulators, spinal cord stimulators, and retinal implants use charge-balanced alternating current (AC) pulses to recover delivered charge and thus mitigate toxicity from electrochemical reactions occurring at the metal-tissue interface. At low pulse rates, these short duration pulses have the effect of evoking spikes in neural tissue in a phase-locked fashion. When the therapeutic goal is to suppress neural activity, implants typically work indirectly by delivering excitation to populations of neurons that then inhibit the target neurons, or by delivering very high pulse rates that suffer from a number of undesirable side effects. Direct current (DC) neural modulation is an alternative methodology that can directly modulate extracellular membrane potential. This neuromodulation paradigm can excite or inhibit neurons in a graded fashion while maintaining their stochastic firing patterns. DC can also sensitize or desensitize neurons to input. When applied to a population of neurons, DC can modulate synaptic connectivity. Because DC delivered to metal electrodes inherently violates safe charge injection criteria, its use has not been explored for practical applicability of DC-based neural implants. Recently, several new technologies and strategies have been proposed that address this safety criteria and deliver ionic-based direct current (iDC). This, along with the increased understanding of the mechanisms behind the transcutaneous DC-based modulation of neural targets, has caused a resurgence of interest in the interaction between iDC and neural tissue both in the central and the peripheral nervous system. In this review we assess the feasibility of in-vivo iDC delivery as a form of neural modulation. We present the current understanding of DC/neural interaction. We explore the different design methodologies and technologies that attempt to safely deliver iDC to neural tissue and assess the scope of application for direct current modulation as a form of neuroprosthetic treatment in disease. Finally, we examine the safety implications of long duration iDC delivery. We conclude that DC-based neural implants are a promising new modulation technology that could benefit from further chronic safety assessments and a better understanding of the basic biological and biophysical mechanisms that underpin DC-mediated neural modulation.
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Affiliation(s)
- Felix P Aplin
- Department of Otolaryngology Head and Neck Surgery, Johns Hopkins University, Baltimore, MD, United States
| | - Gene Y Fridman
- Department of Otolaryngology Head and Neck Surgery, Johns Hopkins University, Baltimore, MD, United States.,Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, United States.,Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, MD, United States
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49
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Zhang Z, Qiu W, Gong H, Li G, Jiang Q, Liang P, Zheng H, Zhang P. Low-intensity ultrasound suppresses low-Mg2+-induced epileptiform discharges in juvenile mouse hippocampal slices. J Neural Eng 2019; 16:036006. [DOI: 10.1088/1741-2552/ab0b9a] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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50
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Chiang C, Shivacharan RS, Wei X, Gonzalez‐Reyes LE, Durand DM. Slow periodic activity in the longitudinal hippocampal slice can self-propagate non-synaptically by a mechanism consistent with ephaptic coupling. J Physiol 2019; 597:249-269. [PMID: 30295923 PMCID: PMC6312416 DOI: 10.1113/jp276904] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 09/26/2018] [Indexed: 11/08/2022] Open
Abstract
KEY POINTS Slow periodic activity can propagate with speeds around 0.1 m s-1 and be modulated by weak electric fields. Slow periodic activity in the longitudinal hippocampal slice can propagate without chemical synaptic transmission or gap junctions, but can generate electric fields which in turn activate neighbouring cells. Applying local extracellular electric fields with amplitude in the range of endogenous fields is sufficient to modulate or block the propagation of this activity both in the in silico and in the in vitro models. Results support the hypothesis that endogenous electric fields, previously thought to be too small to trigger neural activity, play a significant role in the self-propagation of slow periodic activity in the hippocampus. Experiments indicate that a neural network can give rise to sustained self-propagating waves by ephaptic coupling, suggesting a novel propagation mechanism for neural activity under normal physiological conditions. ABSTRACT Slow oscillations are a standard feature observed in the cortex and the hippocampus during slow wave sleep. Slow oscillations are characterized by low-frequency periodic activity (<1 Hz) and are thought to be related to memory consolidation. These waves are assumed to be a reflection of the underlying neural activity, but it is not known if they can, by themselves, be self-sustained and propagate. Previous studies have shown that slow periodic activity can be reproduced in the in vitro preparation to mimic in vivo slow oscillations. Slow periodic activity can propagate with speeds around 0.1 m s-1 and be modulated by weak electric fields. In the present study, we show that slow periodic activity in the longitudinal hippocampal slice is a self-regenerating wave which can propagate with and without chemical or electrical synaptic transmission at the same speeds. We also show that applying local extracellular electric fields can modulate or even block the propagation of this wave in both in silico and in vitro models. Our results support the notion that ephaptic coupling plays a significant role in the propagation of the slow hippocampal periodic activity. Moreover, these results indicate that a neural network can give rise to sustained self-propagating waves by ephaptic coupling, suggesting a novel propagation mechanism for neural activity under normal physiological conditions.
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Affiliation(s)
- Chia‐Chu Chiang
- Neural Engineering CenterDepartment of Biomedical EngineeringCase Western Reserve UniversityClevelandOH44106USA
| | - Rajat S. Shivacharan
- Neural Engineering CenterDepartment of Biomedical EngineeringCase Western Reserve UniversityClevelandOH44106USA
| | - Xile Wei
- School of Electrical and Information EngineeringTianjin UniversityTianjin300072China
| | - Luis E. Gonzalez‐Reyes
- Neural Engineering CenterDepartment of Biomedical EngineeringCase Western Reserve UniversityClevelandOH44106USA
| | - Dominique M. Durand
- Neural Engineering CenterDepartment of Biomedical EngineeringCase Western Reserve UniversityClevelandOH44106USA
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