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Alashram AR. The efficacy of transcranial random noise stimulation in treating tinnitus: a systematic review. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08858-9. [PMID: 39046497 DOI: 10.1007/s00405-024-08858-9] [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: 06/29/2024] [Accepted: 07/17/2024] [Indexed: 07/25/2024]
Abstract
PURPOSE This review aims to examine the effects of transcranial random noise stimulation (tRNS) on tinnitus and to determine the optimal treatment parameters, if possible. METHODS A comprehensive search, including MEDLINE, PubMed, EMBASE, CINAHL, SCOPUS, and PEDro, was conducted to determine experiments studying the effects of tRNS on tinnitus from inception to March 1, 2024. The Physiotherapy Evidence Database (PEDro) scale was used to evaluate the quality of the included studies. RESULTS Seven studies met the eligibility criteria. A total of 616 patients with non-pulsatile tinnitus (mean age 50.93 years; 66% males) were included in this review. The included studies ranged from 3 to 8 out of 10 (median = 7) on the PEDro scale. The results showed that tRNS is an effective intervention in reducing tinnitus symptoms. CONCLUSIONS The evidence for the effects of tRNS on people with chronic non-pulsatile tinnitus is promising. Administering tRNS with an intensity of 1-2 mA, high-frequency (101-650 Hz), using a 35 cm² electrode size over the auditory cortex and DLPFC, for 20 min with eight sessions may demonstrate the desired tRNS effects. The tRNS stimulation should be contralateral for unilateral tinnitus and bilaterally for bilateral tinnitus. Combining tRNS with other concurrent interventions may show superior effects in reducing tinnitus compared to tRNS alone. Further high-quality studies with larger sample sizes are strongly needed.
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Affiliation(s)
- Anas R Alashram
- Department of Physiotherapy, Middle East University, Airport Road, Amman, 1666, Jordan.
- Applied Science Research Center, Applied Science Private University, Amman, Jordan.
- Centre of SpaceBio-Medicine, Department of Systems Medicine, Faculty of Medicine and Surgery, San Raffaele Roma Open University, University of Rome "Tor Vergata", Rome, 00133, Italy.
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Jia S, Mei X, Chen L, Chan LH, Tsang C, Suen V, Li T, Zaw MW, Liu A, Thompson B, Sabel B, Woo G, Leung CKS, Yip SP, Chang DHF, Cheong AMY. Glaucoma Rehabilitation using ElectricAI Transcranial Stimulation (GREAT)-study protocol for randomized controlled trial using combined perceptual learning and transcranial electrical stimulation for vision enhancement. Trials 2024; 25:501. [PMID: 39039582 PMCID: PMC11264395 DOI: 10.1186/s13063-024-08314-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Accepted: 07/03/2024] [Indexed: 07/24/2024] Open
Abstract
BACKGROUND Glaucoma patients with irreversible visual field loss often experience decreased quality of life, impaired mobility, and mental health challenges. Perceptual learning (PL) and transcranial electrical stimulation (tES) have emerged as promising interventions for vision rehabilitation, showing potential in restoring residual visual functions. The Glaucoma Rehabilitation using ElectricAI Transcranial stimulation (GREAT) project aims to investigate whether combining PL and tES is more effective than using either method alone in maximizing the visual function of glaucoma patients. Additionally, the study will assess the impact of these interventions on brain neural activity, blood biomarkers, mobility, mental health, quality of life, and fear of falling. METHODS The study employs a three-arm, double-blind, randomized, superiority-controlled design. Participants are randomly allocated in a 1:1:1 ratio to one of three groups receiving: (1) real PL and real tES, (2) real PL and sham tES, and (3) placebo PL and sham tES. Each participant undergoes 10 sessions per block (~ 1 h each), with a total of three blocks. Assessments are conducted at six time points: baseline, interim 1, interim 2, post-intervention, 1-month post-intervention, and 2-month post-intervention. The primary outcome is the mean deviation of the 24-2 visual field measured by the Humphrey visual field analyzer. Secondary outcomes include detection rate in the suprathreshold visual field, balance and gait functions, and electrophysiological and biological responses. This study also investigates changes in neurotransmitter metabolism, biomarkers, self-perceived quality of life, and psychological status before and after the intervention. DISCUSSION The GREAT project is the first study to assess the effectiveness of PL and tES in the rehabilitation of glaucoma. Our findings will offer comprehensive assessments of the impact of these treatments on a wide range of brain and vision-related metrics including visual field, neural activity, biomarkers, mobility, mental health, fear of falling, and quality of life. TRIAL REGISTRATION ClinicalTrials.gov NCT05874258 . Registered on May 15, 2023.
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Affiliation(s)
- Shuwen Jia
- School of Optometry, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region, China
| | - Xiaolin Mei
- School of Optometry, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region, China
| | - Lilin Chen
- School of Optometry, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region, China
| | - Lok Hin Chan
- School of Optometry, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region, China
| | - Celia Tsang
- School of Optometry, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region, China
| | - Venus Suen
- School of Optometry, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region, China
| | - Tingni Li
- Centre for Eye and Vision Research Limited, Hong Kong Science Park, Hong Kong Special Administrative Region, China
| | - Myo Win Zaw
- Centre for Eye and Vision Research Limited, Hong Kong Science Park, Hong Kong Special Administrative Region, China
| | - Amanda Liu
- Centre for Eye and Vision Research Limited, Hong Kong Science Park, Hong Kong Special Administrative Region, China
| | - Ben Thompson
- Centre for Eye and Vision Research Limited, Hong Kong Science Park, Hong Kong Special Administrative Region, China
- School of Optometry and Vision Science, University of Waterloo, Waterloo, Canada
| | - Bernhard Sabel
- Institute of Medical Psychology, University of Magdeburg, Magdeburg, Germany
| | - George Woo
- School of Optometry, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region, China
| | - Christopher K S Leung
- Department of Ophthalmology, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Shea-Ping Yip
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region, China
| | - Dorita H F Chang
- Department of Psychology, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Allen M Y Cheong
- School of Optometry, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region, China.
- Centre for Eye and Vision Research Limited, Hong Kong Science Park, Hong Kong Special Administrative Region, China.
- Research Centre for SHARP Vision, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region, China.
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Franco-Rosado P, Callejón MA, Reina-Tosina J, Roa LM, Martin-Rodriguez JF, Mir P. Addressing the sources of inter-subject variability in E-field parameters in anodal tDCS stimulation over motor cortical network. Phys Med Biol 2024; 69:145013. [PMID: 38917834 DOI: 10.1088/1361-6560/ad5bb9] [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: 10/31/2023] [Accepted: 06/25/2024] [Indexed: 06/27/2024]
Abstract
Objetive: .Although transcranial direct current stimulation constitutes a non-invasive neuromodulation technique with promising results in a great variety of applications, its clinical implementation is compromised by the high inter-subject variability reported. This study aims to analyze the inter-subject variability in electric fields (E-fields) over regions of the cortical motor network under two electrode montages: the classical C3Fp2 and an alternative P3F3, which confines more the E-field over this region.Approach.Computational models of the head of 98 healthy subjects were developed to simulate the E-field under both montages. E-field parameters such as magnitude, focality and orientation were calculated over three regions of interest (ROI): M1S1, supplementary motor area (SMA) and preSMA. The role of anatomical characteristics as a source of inter-subject variability on E-field parameters and individualized stimulation intensity were addressed using linear mixed-effect models.Main results.P3F3 showed a more confined E-field distribution over M1S1 than C3Fp2; the latter elicited higher E-fields over supplementary motor areas. Both montages showed high inter-subject variability, especially for the normal component over C3Fp2. Skin, bone and CSF ROI volumes showed a negative association with E-field magnitude irrespective of montage. Grey matter volume and montage were the main sources of variability for focality. The curvature of gyri was found to be significantly associated with the variability of normal E-fields.Significance.Computational modeling proves useful in the assessment of E-field variability. Our simulations predict significant differences in E-field magnitude and focality for C3Fp2 and P3F3. However, anatomical characteristics were also found to be significant sources of E-field variability irrespective of electrode montage. The normal E-field component better captured the individual variability and low rate of responder subjects observed in experimental studies.
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Affiliation(s)
- Pablo Franco-Rosado
- Unidad de Trastornos del Movimiento, Servicio de Neurología, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Sevilla, Spain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
- Grupo de Ingeniería Biomédica, Departamento de Teoría de la Señal y Comunicaciones, Universidad de Sevilla, Sevilla, Spain
- Departamento de Psicología Experimental, Universidad de Sevilla, Sevilla, Spain
| | - M Amparo Callejón
- Grupo de Ingeniería Biomédica, Departamento de Teoría de la Señal y Comunicaciones, Universidad de Sevilla, Sevilla, Spain
- Servicio de Otorrinolaringología, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Javier Reina-Tosina
- Grupo de Ingeniería Biomédica, Departamento de Teoría de la Señal y Comunicaciones, Universidad de Sevilla, Sevilla, Spain
| | - Laura M Roa
- Grupo de Ingeniería Biomédica, Departamento de Teoría de la Señal y Comunicaciones, Universidad de Sevilla, Sevilla, Spain
| | - Juan F Martin-Rodriguez
- Unidad de Trastornos del Movimiento, Servicio de Neurología, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Sevilla, Spain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
- Departamento de Psicología Experimental, Universidad de Sevilla, Sevilla, Spain
| | - Pablo Mir
- Unidad de Trastornos del Movimiento, Servicio de Neurología, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Sevilla, Spain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
- Departamento de Medicina, Facultad de Medicina, Universidad de Sevilla, Sevilla, Spain
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Santander T, Leslie S, Li LJ, Skinner HE, Simonson JM, Sweeney P, Deen KP, Miller MB, Brunye TT. Towards optimized methodological parameters for maximizing the behavioral effects of transcranial direct current stimulation. Front Hum Neurosci 2024; 18:1305446. [PMID: 39015825 PMCID: PMC11250584 DOI: 10.3389/fnhum.2024.1305446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 06/12/2024] [Indexed: 07/18/2024] Open
Abstract
Introduction Transcranial direct current stimulation (tDCS) administers low-intensity direct current electrical stimulation to brain regions via electrodes arranged on the surface of the scalp. The core promise of tDCS is its ability to modulate brain activity and affect performance on diverse cognitive functions (affording causal inferences regarding regional brain activity and behavior), but the optimal methodological parameters for maximizing behavioral effects remain to be elucidated. Here we sought to examine the effects of 10 stimulation and experimental design factors across a series of five cognitive domains: motor performance, visual search, working memory, vigilance, and response inhibition. The objective was to identify a set of optimal parameter settings that consistently and reliably maximized the behavioral effects of tDCS within each cognitive domain. Methods We surveyed tDCS effects on these various cognitive functions in healthy young adults, ultimately resulting in 721 effects across 106 published reports. Hierarchical Bayesian meta-regression models were fit to characterize how (and to what extent) these design parameters differentially predict the likelihood of positive/negative behavioral outcomes. Results Consistent with many previous meta-analyses of tDCS effects, extensive variability was observed across tasks and measured outcomes. Consequently, most design parameters did not confer consistent advantages or disadvantages to behavioral effects-a domain-general model suggested an advantage to using within-subjects designs (versus between-subjects) and the tendency for cathodal stimulation (relative to anodal stimulation) to produce reduced behavioral effects, but these associations were scarcely-evident in domain-specific models. Discussion These findings highlight the urgent need for tDCS studies to more systematically probe the effects of these parameters on behavior to fulfill the promise of identifying causal links between brain function and cognition.
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Affiliation(s)
- Tyler Santander
- Institute for Collaborative Biotechnologies, University of California, Santa Barbara, Santa Barbara, CA, United States
- Department of Psychological and Brain Sciences, University of California, Santa Barbara, Santa Barbara, CA, United States
| | - Sara Leslie
- Department of Psychological and Brain Sciences, University of California, Santa Barbara, Santa Barbara, CA, United States
| | - Luna J. Li
- Department of Psychological and Brain Sciences, University of California, Santa Barbara, Santa Barbara, CA, United States
| | - Henri E. Skinner
- Department of Psychological and Brain Sciences, University of California, Santa Barbara, Santa Barbara, CA, United States
| | - Jessica M. Simonson
- Institute for Collaborative Biotechnologies, University of California, Santa Barbara, Santa Barbara, CA, United States
- Department of Psychological and Brain Sciences, University of California, Santa Barbara, Santa Barbara, CA, United States
| | - Patrick Sweeney
- Department of Psychological and Brain Sciences, University of California, Santa Barbara, Santa Barbara, CA, United States
| | - Kaitlyn P. Deen
- Department of Psychological and Brain Sciences, University of California, Santa Barbara, Santa Barbara, CA, United States
| | - Michael B. Miller
- Institute for Collaborative Biotechnologies, University of California, Santa Barbara, Santa Barbara, CA, United States
- Department of Psychological and Brain Sciences, University of California, Santa Barbara, Santa Barbara, CA, United States
| | - Tad T. Brunye
- U. S. Army DEVCOM Soldier Center, Natick, MA, United States
- Center for Applied Brain and Cognitive Sciences, Tufts University, Medford, MA, United States
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Allred AR, Lippert AF, Wood SJ. Galvanic Vestibular Stimulation Advancements for Spatial Disorientation Training. Aerosp Med Hum Perform 2024; 95:390-398. [PMID: 38915170 DOI: 10.3357/amhp.6362.2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/26/2024]
Abstract
INTRODUCTION: Spatial disorientation (SD) remains the leading contributor to Class A mishaps in the U.S. Navy, consistent with historical trends. Despite this, SD training for military aircrew is largely confined to the classroom and experiential training replicating SD illusions is limited and infrequent. Static flight simulators are most commonly used for training but offer no vestibular stimulation to the flight crew, omitting the source of vestibular-mediated SD.BACKGROUND: We first cover vestibular-mediated SD illusions which may be replicated through galvanic vestibular stimulation (GVS) in a static environment. GVS is a safe, reliable, low-cost avenue for providing vestibular sensory stimulation. We review the underlying mechanisms of GVS such as the excitement and inhibition of the afferent neurons innervating the vestibular system, particularly in the binaural bipolar electrode montage.APPLICATIONS: Two approaches for how GVS may be used to enhance SD training are examined. The first is a means for providing unreliable vestibular sensory perceptions to pilots, and the second details how GVS can be leveraged for replicating vestibular-mediated SD illusions.DISCUSSION: We recommend GVS be pursued as an enhancement to existing SD training. The ability to disorient aircrew in the safe training environment of a static flight simulator would allow for aircrew familiarization to SD, serving as an opportunity to practice life-saving checklist items to recover from SD. A repeatable training profile that could be worn by military aircrew in a static flight simulator may afford a low-cost training solution to the number one cause of fatalities in military aviation.Allred AR, Lippert AF, Wood SJ. Galvanic vestibular stimulation advancements for spatial disorientation training. Aerosp Med Hum Perform. 2024; 95(7):390-398.
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Haihambo N, Li M, Ma Q, Baeken C, Deroost N, Baetens K, Van Overwalle F. Exciting the social butterfly: Anodal cerebellar transcranial direct current stimulation modulates neural activation during predictive social mentalizing. Int J Clin Health Psychol 2024; 24:100480. [PMID: 39055855 PMCID: PMC11269293 DOI: 10.1016/j.ijchp.2024.100480] [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] [Received: 09/22/2023] [Accepted: 06/20/2024] [Indexed: 07/28/2024] Open
Abstract
Transcranial Direct Current Stimulation (tDCS) has emerged as a promising tool for enhancing social cognition. The posterior cerebellum, which is part of the mentalizing network, has been implicated in social processes. In our combined tDCS-fMRI study, we investigated the effects of offline anodal cerebellar tDCS on activation in the cerebellum during social action prediction. Forty-one participants were randomly assigned to receive either anodal (2 mA) or sham (0 mA) stimulation over the midline of the posterior cerebellum for 20 min. Twenty minutes post stimulation, participants underwent a functional MRI scan to complete a social action prediction task, during which they had to correctly order randomly presented sentences that described either actions of social agents (based on their personality traits) or events of objects (based on their characteristics). As hypothesized, our results revealed that participants who received anodal cerebellar tDCS exhibited increased activation in the posterior cerebellar Crus 2 and lobule IX, and in key cerebral mentalizing areas, including the medial prefrontal cortex, temporo-parietal junction, and precuneus. Contrary to our hypotheses, participants who received anodal stimulation demonstrated faster responses to non-social objects compared to social agents, while sham participants showed no significant differences. We did not find a significant relationship between electric field magnitude, neural activation and behavioral outcomes. These findings suggest that tDCS targeting the posterior cerebellum selectively enhances activation in social mentalizing areas, while only facilitating behavioral performance of non-social material, perhaps because of a ceiling effect due to familiarity with social processing.
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Affiliation(s)
- Naem Haihambo
- Department of Psychology and Center for Neuroscience, Vrije Universiteit Brussel, Belgium
- Centre for Human Brain Health, University of Birmingham, Bochum, Germany
- Social Neuroscience, Research Center One Health Ruhr of the University Alliance Ruhr, Faculty of Medicine, Ruhr University Bochum, Germany
| | - Meijia Li
- Department of Psychology and Center for Neuroscience, Vrije Universiteit Brussel, Belgium
- Language Pathology and Brain Science MEG Lab, School of Communication Sciences, Beijing Language and Culture University, Beijing, China
| | - Qianying Ma
- Faculty of Medicine and Health Sciences, Department of Head and Skin, Ghent Experimental Psychiatry (GHEP) Lab, Ghent Experimental, Ghent University, Ghent 9000, Belgium
- Department of Psychiatry, Vrije Universiteit Brussel, Brussels 1090, Belgium
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven 5600, The Netherlands
| | - Chris Baeken
- Department of Psychology and Center for Neuroscience, Vrije Universiteit Brussel, Belgium
| | - Natacha Deroost
- Department of Psychology and Center for Neuroscience, Vrije Universiteit Brussel, Belgium
| | - Kris Baetens
- Department of Psychology and Center for Neuroscience, Vrije Universiteit Brussel, Belgium
| | - Frank Van Overwalle
- Department of Psychology and Center for Neuroscience, Vrije Universiteit Brussel, Belgium
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Kipping M, Mai-Lippold SA, Herbert BM, Desdentado L, Kammer T, Pollatos O. Insights into interoceptive and emotional processing: Lessons from studies on insular HD-tDCS. Psychophysiology 2024:e14639. [PMID: 38946148 DOI: 10.1111/psyp.14639] [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: 12/07/2023] [Revised: 05/03/2024] [Accepted: 06/17/2024] [Indexed: 07/02/2024]
Abstract
Interoception, the processing of internal bodily signals, is proposed as the fundamental mechanism underlying emotional experiences. Interoceptive and emotional processing appear distorted in psychiatric disorders. However, our understanding of the neural structures involved in both processes remains limited. To explore the feasibility of enhancing interoception and emotion, we conducted two studies using high-definition transcranial direct current stimulation (HD-tDCS) applied to the right anterior insula. In study one, we compared the effects of anodal HD-tDCS and sham tDCS on interoceptive abilities (sensibility, confidence, accuracy, emotional evaluation) in 52 healthy subjects. Study two additionally included physical activation through ergometer cycling at the beginning of HD-tDCS and examined changes in interoceptive and emotional processing in 39 healthy adults. In both studies, HD-tDCS was applied in a single-blind cross-over online design with two separate sessions. Study one yielded no significant effects of HD-tDCS on interoceptive dimensions. In study two, significant improvements in interoceptive sensibility and confidence were observed over time with physical preactivation, while no differential effects were found between sham and insula stimulation. The expected enhancement of interoceptive and emotional processing following insula stimulation was not observed. We conclude that HD-tDCS targeting the insula does not consistently increase interoceptive or emotional variables. The observed increase in interoceptive sensibility may be attributed to the activation of the interoceptive network through physical activity or training effects. Future research on HD-tDCS involving interoceptive network structures could benefit from protocols targeting larger regions within the network, rather than focusing solely on insula stimulation.
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Affiliation(s)
- Miriam Kipping
- Clinical and Health Psychology, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Sandra A Mai-Lippold
- Clinical and Health Psychology, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Beate M Herbert
- Biological Psychology and Experimental Psychopathology, Charlotte-Fresenius-University, Munich, Germany
- Department Psychology, Clinical Psychology and Psychotherapy, University of Tuebingen, Tuebingen, Germany
| | - Lorena Desdentado
- Polibienestar Research Institute, University of Valencia, Valencia, Spain
- CIBER of Physiopathology of Obesity and Nutrition (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
| | - Thomas Kammer
- Section for Neurostimulation, Department of Psychiatry, Ulm University, Ulm, Germany
| | - Olga Pollatos
- Clinical and Health Psychology, Institute of Psychology and Education, Ulm University, Ulm, Germany
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Valter Y, Rapallo F, Burlando B, Crossen M, Baeken C, Datta A, Deblieck C. Efficacy of non-invasive brain stimulation and neuronavigation for major depressive disorder: a systematic review and meta-analysis. Expert Rev Med Devices 2024:1-16. [PMID: 38902968 DOI: 10.1080/17434440.2024.2370820] [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: 03/14/2024] [Accepted: 05/28/2024] [Indexed: 06/22/2024]
Abstract
INTRODUCTION Repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) are increasingly used for major depressive disorder (MDD). Most tDCS and rTMS studies target the left dorsolateral prefrontal cortex, either with or without neuronavigation. We examined the effect of rTMS and tDCS, and the added value of neuronavigation in the treatment of MDD. METHODS A search on PubMed, Embase, and Cochrane databases for rTMS or tDCS randomized controlled trials of MDD up to 1 February 2023, yielded 89 studies. We then performed meta-analyses comparing tDCS efficacy to non-neuronavigated rTMS, tDCS to neuronavigated rTMS, and neuronavigated rTMS to non-neuronavigated rTMS. We assessed the significance of the effect in subgroups and in the whole meta-analysis with a z-test and subgroup differences with a chi-square test. RESULTS We found small-to-medium effects of both tDCS and rTMS on MDD, with a slightly greater effect from rTMS. No significant difference was found between neuronavigation and non-neuronavigation. CONCLUSION Although both tDCS and rTMS are effective in treating MDD, many patients do not respond. Additionally, current neuronavigation methods are not significantly improving MDD treatment. It is therefore imperative to seek personalized methods for these interventions.
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Affiliation(s)
- Yishai Valter
- Research and Development, Soterix Medical, Inc, Woodbridge, NJ, USA
- Department of Biomedical Engineering, City College of the City University of New York, New York, NY, USA
| | - Fabio Rapallo
- Faculty of Economics, University of Genoa, Genova, Italy
| | - Bruno Burlando
- Department of Pharmacy, University of Genoa, Genova, Italy
| | - Miah Crossen
- Research and Development, Soterix Medical, Inc, Woodbridge, NJ, USA
| | - Chris Baeken
- Faculty of Medicine and Health Sciences, Department of Head and Skin, Ghent Experimental Psychiatry (GHEP) lab, Ghent University, Ghent, Belgium
- Department of Psychiatry, University Hospital (UZBrussel), Vrije Universiteit Brussel (VUB), Brussels, Belgium
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Abhishek Datta
- Research and Development, Soterix Medical, Inc, Woodbridge, NJ, USA
- Department of Biomedical Engineering, City College of the City University of New York, New York, NY, USA
| | - Choi Deblieck
- Lab for Equilibrium Investigations and Aerospace (LEIA), University of Antwerp, Antwerp, Belgium
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Takahashi MTC, Balardin JB, Bazán PR, Boasquevisque DDS, Amaro E, Conforto AB. Effect of transcranial direct current stimulation in the initial weeks post-stroke: a pilot randomized study. EINSTEIN-SAO PAULO 2024; 22:eAO0450. [PMID: 38922218 PMCID: PMC11196089 DOI: 10.31744/einstein_journal/2024ao0450] [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: 01/16/2023] [Accepted: 09/18/2023] [Indexed: 06/27/2024] Open
Abstract
OBJECTIVE This study aimed at assessing the alterations in upper limb motor impairment and connectivity between motor areas following the post-stroke delivery of cathodal transcranial direct current stimulation sessions. METHODS Modifications in the Fugl-Meyer Assessment scores, connectivity between the primary motor cortex of the unaffected and affected hemispheres, and between the primary motor and premotor cortices of the unaffected hemisphere were compared prior to and following six sessions of cathodal transcranial direct current stimulation application in 13 patients (active = 6; sham = 7); this modality targets the primary motor cortex of the unaffected hemisphere early after a stroke. RESULTS Clinically relevant distinctions in Fugl-Meyer Assessment scores (≥9 points) were observed more frequently in the Sham Group than in the Active Group. Between-group differences in the alterations in Fugl-Meyer Assessment scores were not statistically significant (Mann-Whitney test, p=0.133). ROI-to-ROI correlations between the primary motor cortices of the affected and unaffected hemispheres post-therapeutically increased in 5/6 and 2/7 participants in the Active and Sham Groups, respectively. Between-group differences in modifications in connectivity between the aforementioned areas were not statistically significant. Motor performance enhancements were more frequent in the Sham Group compared to the Active Group. CONCLUSION The results of this hypothesis-generating investigation suggest that heightened connectivity may not translate into early clinical benefits following a stroke and will be crucial in designing larger cohort studies to explore mechanisms underlying the impacts of this intervention. ClinicalTrials.gov Identifier: NCT02455427.
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Affiliation(s)
- Marcela Tengler Carvalho Takahashi
- Hospital Municipal da Vila Santa Catarina Dr. Gilson Cássia Marques de CarvalhoHospital Israelita Albert EinsteinSão PauloSPBrazilHospital Municipal da Vila Santa Catarina Dr. Gilson Cássia Marques de Carvalho ; Hospital Israelita Albert Einstein,São Paulo, SP, Brazil.
| | - Joana Bisol Balardin
- Hospital Israelita Albert EinsteinSão PauloSPBrazil Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Paulo Rodrigo Bazán
- Hospital Israelita Albert EinsteinSão PauloSPBrazil Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Danielle de Sá Boasquevisque
- Division of NeurologyPopulation Health Research InstitutMcMaster UniversityHamiltonOntarioCanada Division of Neurology, Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada.
| | - Edson Amaro
- Hospital Israelita Albert EinsteinSão PauloSPBrazil Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Adriana Bastos Conforto
- Hospital Israelita Albert EinsteinSão PauloSPBrazil Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
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LoBue C, McClintock SM, Chiang HS, Helphrey J, Thakkar VJ, Hart J. A Critical Review of Noninvasive Brain Stimulation Technologies in Alzheimer's Dementia and Primary Progressive Aphasia. J Alzheimers Dis 2024:JAD240230. [PMID: 38905047 DOI: 10.3233/jad-240230] [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] [Indexed: 06/23/2024]
Abstract
Multiple pharmacologic agents now have been approved in the United States and other countries as treatment to slow disease and clinical progression for Alzheimer's disease. Given these treatments have not been proven to lessen the cognitive deficits already manifested in the Alzheimer's Clinical Syndrome (ACS), and none are aimed for another debilitating dementia syndrome identified as primary progressive aphasia (PPA), there is an urgent need for new, safe, tolerable, and efficacious treatments to mitigate the cognitive deficits experienced in ACS and PPA. Noninvasive brain stimulation has shown promise for enhancing cognitive functioning, and there has been interest in its potential therapeutic value in ACS and PPA. This review critically examines the evidence of five technologies in ACS and PPA: transcranial direct current stimulation (tDCS), transcranial alternating current stimulation (tACS), transcranial random noise stimulation (tRNS), repetitive transcranial magnetic stimulation (rTMS), and noninvasive vagus nerve stimulation (nVNS). Many randomized controlled trials of tDCS and rTMS report positive treatment effects on cognition in ACS and PPA that persist out to at least 8 weeks, whereas there are few trials for tACS and none for tRNS and nVNS. However, most positive trials did not identify clinically meaningful changes, underscoring that clinical efficacy has yet to be established in ACS and PPA. Much is still to be learned about noninvasive brain stimulation in ACS and PPA, and shifting the focus to prioritize clinical significance in addition to statistical significance in trials could yield greater success in understanding its potential cognitive effects and optimal parameters.
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Affiliation(s)
- Christian LoBue
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Shawn M McClintock
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Hsueh-Sheng Chiang
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA
- School of Behavioral and Brain Sciences, University of Texas at Dallas, Dallas, TX, USA
| | - Jessica Helphrey
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Vishal J Thakkar
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - John Hart
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA
- School of Behavioral and Brain Sciences, University of Texas at Dallas, Dallas, TX, USA
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11
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Sloane KL, Hamilton RH. Transcranial Direct Current Stimulation to Ameliorate Post-Stroke Cognitive Impairment. Brain Sci 2024; 14:614. [PMID: 38928614 PMCID: PMC11202055 DOI: 10.3390/brainsci14060614] [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: 04/22/2024] [Revised: 06/04/2024] [Accepted: 06/12/2024] [Indexed: 06/28/2024] Open
Abstract
Post-stroke cognitive impairment is a common and disabling condition with few effective therapeutic options. After stroke, neural reorganization and other neuroplastic processes occur in response to ischemic injury, which can result in clinical improvement through spontaneous recovery. Neuromodulation through transcranial direct current stimulation (tDCS) is a promising intervention to augment underlying neuroplasticity in order to improve cognitive function. This form of neuromodulation leverages mechanisms of neuroplasticity post-stroke to optimize neural reorganization and improve function. In this review, we summarize the current state of cognitive neurorehabilitation post-stroke, the practical features of tDCS, its uses in stroke-related cognitive impairment across cognitive domains, and special considerations for the use of tDCS in the post-stroke patient population.
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Affiliation(s)
- Kelly L. Sloane
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
- Department of Physical Medicine and Rehabilitation, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Roy H. Hamilton
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
- Department of Physical Medicine and Rehabilitation, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
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12
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Manenti R, Baglio F, Pagnoni I, Gobbi E, Campana E, Alaimo C, Rossetto F, Di Tella S, Pagliari C, Geviti A, Bonfiglio NS, Calabrò RS, Cimino V, Binetti G, Quartarone A, Bramanti P, Cappa SF, Rossini PM, Cotelli M. Long-lasting improvements in episodic memory among subjects with mild cognitive impairment who received transcranial direct current stimulation combined with cognitive treatment and telerehabilitation: a multicentre, randomized, active-controlled study. Front Aging Neurosci 2024; 16:1414593. [PMID: 38966802 PMCID: PMC11223647 DOI: 10.3389/fnagi.2024.1414593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 05/31/2024] [Indexed: 07/06/2024] Open
Abstract
Background In recent years, an increasing number of studies have examined the potential efficacy of cognitive training procedures in individuals with normal ageing and mild cognitive impairment (MCI). Objective The aims of this study were to (i) evaluate the efficacy of the cognitive Virtual Reality Rehabilitation System (VRRS) combined with anodal transcranial direct current stimulation (tDCS) applied to the left dorsolateral prefrontal cortex compared to placebo tDCS stimulation combined with VRRS and (ii) to determine how to prolong the beneficial effects of the treatment. A total of 109 subjects with MCI were assigned to 1 of 5 study groups in a randomized controlled trial design: (a) face-to-face (FTF) VRRS during anodal tDCS followed by cognitive telerehabilitation (TR) (clinic-atDCS-VRRS+Tele@H-VRRS); (b) FTF VRRS during placebo tDCS followed by TR (clinic-ptDCS-VRRS+Tele@H-VRRS); (c) FTF VRRS followed by cognitive TR (clinic-VRRS+Tele@H-VRRS); (d) FTF VRRS followed by at-home unstructured cognitive stimulation (clinic-VRRS+@H-UCS); and (e) FTF cognitive treatment as usual (clinic-TAU). Results An improvement in episodic memory was observed after the end of clinic-atDCS-VRRS (p < 0.001). We found no enhancement in episodic memory after clinic-ptDCS-VRRS or after clinic-TAU.Moreover, the combined treatment led to prolonged beneficial effects (clinic-atDCS-VRRS+Tele@H-VRRS vs. clinic-ptDCS-VRRS+Tele@H-VRRS: p = 0.047; clinic-atDCS-VRRS+Tele@H-VRRS vs. clinic-VRRS+Tele@H-VRRS: p = 0.06). Discussion The present study provides preliminary evidence supporting the use of individualized VRRS combined with anodal tDCS and cognitive telerehabilitation for cognitive rehabilitation. Clinical trial registration https://clinicaltrials.gov/study/NCT03486704?term=NCT03486704&rank=1, NCT03486704.
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Affiliation(s)
- Rosa Manenti
- Neuropsychology Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | | | - Ilaria Pagnoni
- Neuropsychology Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Elena Gobbi
- Neuropsychology Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Elena Campana
- Neuropsychology Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Cristina Alaimo
- Neuropsychology Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | | | - Sonia Di Tella
- IRCCS Fondazione Don Carlo Gnocchi – ONLUS, Milan, Italy
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
| | | | - Andrea Geviti
- Service of Statistics, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | | | | | | | - Giuliano Binetti
- MAC Memory Clinic and Molecular Markers Laboratory, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | | | - Placido Bramanti
- IRCCS Centro Neurolesi “Bonino Pulejo”, Messina, Italy
- Università Degli Studi eCAMPUS, Novedrate, Italy
| | - Stefano F. Cappa
- Istituto Universitario Studi Superiori IUSS, Pavia, Italy
- IRCCS Fondazione Mondino, Pavia, Italy
| | - Paolo Maria Rossini
- Department Neuroscience and Neurorehabilitation, IRCCS San Raffaele Roma, Rome, Italy
| | - Maria Cotelli
- Neuropsychology Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
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13
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Swanson CW, Vial SE, Manini TM, Sibille KT, Clark DJ. Protocol for a home-based self-delivered prehabilitation intervention to proactively reduce fall risk in older adults: a pilot randomized controlled trial of transcranial direct current stimulation and motor imagery. Pilot Feasibility Stud 2024; 10:89. [PMID: 38877595 PMCID: PMC11177485 DOI: 10.1186/s40814-024-01516-1] [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: 08/08/2023] [Accepted: 06/06/2024] [Indexed: 06/16/2024] Open
Abstract
BACKGROUND Several changes occur in the central nervous system with increasing age that contribute toward declines in mobility. Neurorehabilitation has proven effective in improving motor function though achieving sustained behavioral and neuroplastic adaptations is more challenging. While effective, rehabilitation usually follows adverse health outcomes, such as injurious falls. This reactive intervention approach may be less beneficial than prevention interventions. Therefore, we propose the development of a prehabilitation intervention approach to address mobility problems before they lead to adverse health outcomes. This protocol article describes a pilot study to examine the feasibility and acceptability of a home-based, self-delivered prehabilitation intervention that combines motor imagery (mentally rehearsing motor actions without physical movement) and neuromodulation (transcranial direct current stimulation, tDCS; to the frontal lobes). A secondary objective is to examine preliminary evidence of improved mobility following the intervention. METHODS This pilot study has a double-blind randomized controlled design. Thirty-four participants aged 70-95 who self-report having experienced a fall within the prior 12 months or have a fear of falling will be recruited. Participants will be randomly assigned to either an active or sham tDCS group for the combined tDCS and motor imagery intervention. The intervention will include six 40-min sessions delivered every other day. Participants will simultaneously practice the motor imagery tasks while receiving tDCS. Those individuals assigned to the active group will receive 20 min of 2.0-mA direct current to frontal lobes, while those in the sham group will receive 30 s of stimulation to the frontal lobes. The motor imagery practice includes six instructional videos presenting different mobility tasks related to activities of daily living. Prior to and following the intervention, participants will undergo laboratory-based mobility and cognitive assessments, questionnaires, and free-living activity monitoring. DISCUSSION Previous studies report that home-based, self-delivered tDCS is safe and feasible for various populations, including neurotypical older adults. Additionally, research indicates that motor imagery practice can augment motor learning and performance. By assessing the feasibility (specifically, screening rate (per month), recruitment rate (per month), randomization (screen eligible who enroll), retention rate, and compliance (percent of completed intervention sessions)) and acceptability of the home-based motor imagery and tDCS intervention, this study aims to provide preliminary data for planning larger studies. TRIAL REGISTRATION This study is registered on ClinicalTrials.gov (NCT05583578). Registered October 13, 2022. https://www. CLINICALTRIALS gov/study/NCT05583578.
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Affiliation(s)
- Clayton W Swanson
- Department of Neurology, College of Medicine, University of Florida, Gainesville, FL, USA.
- Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, Gainesville, FL, 32603, USA.
| | - Sarah E Vial
- Department of Neurology, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Todd M Manini
- Department of Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Kimberly T Sibille
- Department of Physical Medicine and Rehabilitation, College of Medicine, University of Florida, Gainesville, FL, USA
| | - David J Clark
- Department of Neurology, College of Medicine, University of Florida, Gainesville, FL, USA
- Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, Gainesville, FL, 32603, USA
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14
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Wyss AM, Baumgartner T, Guizar Rosales E, Soutschek A, Knoch D. Cathodal HD-tDCS above the left dorsolateral prefrontal cortex increases environmentally sustainable decision-making. Front Hum Neurosci 2024; 18:1395426. [PMID: 38946792 PMCID: PMC11212476 DOI: 10.3389/fnhum.2024.1395426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Accepted: 05/27/2024] [Indexed: 07/02/2024] Open
Abstract
Environmental sustainability is characterized by a conflict between short-term self-interest and longer-term collective interests. Self-control capacity has been proposed to be a crucial determinant of people's ability to overcome this conflict. Yet, causal evidence is lacking, and previous research is dominated by the use of self-report measures. Here, we modulated self-control capacity by applying inhibitory high-definition transcranial current stimulation (HD-tDCS) above the left dorsolateral prefrontal cortex (dlPFC) while participants engaged in an environmentally consequential decision-making task. The task includes conflicting and low conflicting trade-offs between short-term personal interests and long-term environmental benefits. Contrary to our preregistered expectation, inhibitory HD-tDCS above the left dlPFC, presumably by reducing self-control capacity, led to more, and not less, pro-environmental behavior in conflicting decisions. We speculate that in our exceptionally environmentally friendly sample, deviating from an environmentally sustainable default required self-control capacity, and that inhibiting the left dlPFC might have reduced participants' ability to do so.
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Affiliation(s)
- Annika M. Wyss
- Department of Social Neuroscience and Social Psychology, University of Bern, Bern, Switzerland
| | - Thomas Baumgartner
- Department of Social Neuroscience and Social Psychology, University of Bern, Bern, Switzerland
| | - Emmanuel Guizar Rosales
- Department of Social Neuroscience and Social Psychology, University of Bern, Bern, Switzerland
| | - Alexander Soutschek
- Department of Psychology, Ludwig Maximilian University Munich, Munich, Germany
| | - Daria Knoch
- Department of Social Neuroscience and Social Psychology, University of Bern, Bern, Switzerland
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15
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Imperio CM, Chua EF. Lack of effects of online HD-tDCS over the left or right DLPFC in an associative memory and metamemory monitoring task. PLoS One 2024; 19:e0300779. [PMID: 38848375 PMCID: PMC11161112 DOI: 10.1371/journal.pone.0300779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 02/20/2024] [Indexed: 06/09/2024] Open
Abstract
Neuroimaging studies have shown that activity in the prefrontal cortex correlates with two critical aspects of normal memory functioning: retrieval of episodic memories and subjective "feelings-of-knowing" about our memory. Brain stimulation can be used to test the causal role of the prefrontal cortex in these processes, and whether the role differs for the left versus right prefrontal cortex. We compared the effects of online High-Definition transcranial Direct Current Stimulation (HD-tDCS) over the left or right dorsolateral prefrontal cortex (DLPFC) compared to sham during a proverb-name associative memory and feeling-of-knowing task. There were no significant effects of HD-tDCS on either associative recognition or feeling-of-knowing performance, with Bayesian analyses showing moderate support for the null hypotheses. Despite past work showing effects of HD-tDCS on other memory and feeling-of-knowing tasks, and neuroimaging showing effects with similar tasks, these findings add to the literature of non-significant effects with tDCS. This work highlights the need to better understand factors that determine the effectiveness of tDCS, especially if tDCS is to have a successful future as a clinical intervention.
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Affiliation(s)
- Casey M Imperio
- The Graduate Center of the City University of New York, New York, New York, United States of America
| | - Elizabeth F Chua
- The Graduate Center of the City University of New York, New York, New York, United States of America
- Brooklyn College of the City University of New York, New York, New York, United States of America
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16
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Shen B, Xiao S, Yu C, Zhang C, Zhan J, Liu Y, Fu W. Cerebral hemodynamics underlying ankle force sense modulated by high-definition transcranial direct current stimulation. Cereb Cortex 2024; 34:bhae226. [PMID: 38850217 DOI: 10.1093/cercor/bhae226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 05/07/2024] [Accepted: 05/14/2024] [Indexed: 06/10/2024] Open
Abstract
This study aimed to investigate the effects of high-definition transcranial direct current stimulation on ankle force sense and underlying cerebral hemodynamics. Sixteen healthy adults (8 males and 8 females) were recruited in the study. Each participant received either real or sham high-definition transcranial direct current stimulation interventions in a randomly assigned order on 2 visits. An isokinetic dynamometer was used to assess the force sense of the dominant ankle; while the functional near-infrared spectroscopy was employed to monitor the hemodynamics of the sensorimotor cortex. Two-way analyses of variance with repeated measures and Pearson correlation analyses were performed. The results showed that the absolute error and root mean square error of ankle force sense dropped more after real stimulation than after sham stimulation (dropped by 23.4% vs. 14.9% for absolute error, and 20.0% vs. 10.2% for root mean square error). The supplementary motor area activation significantly increased after real high-definition transcranial direct current stimulation. The decrease in interhemispheric functional connectivity within the Brodmann's areas 6 was significantly correlated with ankle force sense improvement after real high-definition transcranial direct current stimulation. In conclusion, high-definition transcranial direct current stimulation can be used as a potential intervention for improving ankle force sense. Changes in cerebral hemodynamics could be one of the explanations for the energetic effect of high-definition transcranial direct current stimulation.
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Affiliation(s)
- Bin Shen
- School of Exercise and Health, Shanghai University of Sport, 200 Hengren Road, Yangpu District, Shanghai 200438, China
| | - Songlin Xiao
- School of Exercise and Health, Shanghai University of Sport, 200 Hengren Road, Yangpu District, Shanghai 200438, China
| | - Changxiao Yu
- School of Exercise and Health, Shanghai University of Sport, 200 Hengren Road, Yangpu District, Shanghai 200438, China
| | - Chuyi Zhang
- School of Exercise and Health, Shanghai University of Sport, 200 Hengren Road, Yangpu District, Shanghai 200438, China
| | - Jianglong Zhan
- School of Exercise and Health, Shanghai University of Sport, 200 Hengren Road, Yangpu District, Shanghai 200438, China
| | - Ying Liu
- School of Psychology, Shanghai University of Sport, 399 Changhai Road, Yangpu District, Shanghai 200438, China
| | - Weijie Fu
- School of Exercise and Health, Shanghai University of Sport, 200 Hengren Road, Yangpu District, Shanghai 200438, China
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, Shanghai University of Sport, 200 Hengren Road, Yangpu District, Shanghai 200438, China
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17
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Chmiel J, Kurpas D, Rybakowski F, Leszek J. The Effects of Transcranial Direct Current Stimulation (tDCS) in HIV Patients-A Review. J Clin Med 2024; 13:3288. [PMID: 38892999 PMCID: PMC11173062 DOI: 10.3390/jcm13113288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 05/16/2024] [Accepted: 05/20/2024] [Indexed: 06/21/2024] Open
Abstract
Introduction: HIV is a severe and incurable disease that has a devastating impact worldwide. It affects the immune system and negatively affects the nervous system, leading to various cognitive and behavioral problems. Scientists are actively exploring different therapeutic approaches to combat these issues. One promising method is transcranial direct current stimulation (tDCS), a non-invasive technique that stimulates the brain. Methods: This review aims to examine how tDCS can help HIV patients. Searches were conducted in the Pubmed/Medline, Research Gate, and Cochrane databases. Results: The literature search resulted in six articles focusing on the effects of tDCS on cognitive and behavioral measures in people with HIV. In some cases, tDCS showed positive improvements in the measures assessed, improving executive functions, depression, attention, reaction time, psychomotor speed, speed of processing, verbal learning and memory, and cognitive functioning. Furthermore, the stimulation was safe with no severe side effects. However, the included studies were of low quality, had small sample sizes, and did not use any relevant biomarkers that would help to understand the mechanisms of action of tDCS in HIV. Conclusions: tDCS may help patients with HIV; however, due to the limited number of studies and the diversity of protocols used, caution should be exercised when recommending this treatment option in clinical settings. More high-quality research, preferably involving neurophysiological and neuroimaging measurements, is necessary to better understand how tDCS works in individuals with HIV.
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Affiliation(s)
- James Chmiel
- Institute of Neurofeedback and tDCS Poland, 70-393 Szczecin, Poland
| | - Donata Kurpas
- Department of Family and Pediatric Nursing, Faculty of Health Sciences, Wrocław Medical University, 51-618 Wrocław, Poland
| | - Filip Rybakowski
- Department and Clinic of Psychiatry, Poznan University of Medical Sciences, 61-701 Poznań, Poland
| | - Jerzy Leszek
- Department and Clinic of Psychiatry, Wrocław Medical University, 54-235 Wrocław, Poland
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Kraft JN, Indahlastari A, Boutzoukas EM, Hausman HK, Hardcastle C, Albizu A, O'Shea A, Evangelista ND, Van Etten EJ, Bharadwaj PK, Song H, Smith SG, DeKosky ST, Hishaw GA, Wu S, Marsiske M, Cohen R, Alexander GE, Porges E, Woods AJ. The impact of a tDCS and cognitive training intervention on task-based functional connectivity. GeroScience 2024; 46:3325-3339. [PMID: 38265579 PMCID: PMC11009202 DOI: 10.1007/s11357-024-01077-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 01/15/2024] [Indexed: 01/25/2024] Open
Abstract
Declines in several cognitive domains, most notably processing speed, occur in non-pathological aging. Given the exponential growth of the older adult population, declines in cognition serve as a significant public health issue that must be addressed. Promising studies have shown that cognitive training in older adults, particularly using the useful field of view (UFOV) paradigm, can improve cognition with moderate to large effect sizes. Additionally, meta-analyses have found that transcranial direct current stimulation (tDCS), a non-invasive form of brain stimulation, can improve cognition in attention/processing speed and working memory. However, only a handful of studies have looked at concomitant tDCS and cognitive training, usually with short interventions and small sample sizes. The current study assessed the effect of a tDCS (active versus sham) and a 3-month cognitive training intervention on task-based functional connectivity during completion of the UFOV task in a large older adult sample (N = 153). We found significant increased functional connectivity between the left and right pars triangularis (the ROIs closest to the electrodes) following active, but not sham tDCS. Additionally, we see trending behavioral improvements associated with these functional connectivity changes in the active tDCS group, but not sham. Collectively, these findings suggest that tDCS and cognitive training can be an effective modulator of task-based functional connectivity above and beyond a cognitive training intervention alone.
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Affiliation(s)
- Jessica N Kraft
- Center for Cognitive Aging and Memory, McKnight Brain Institute, University of Florida, 1249 Center Drive, Gainesville, FL, 32603, USA
- Department of Neuroscience, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Aprinda Indahlastari
- Center for Cognitive Aging and Memory, McKnight Brain Institute, University of Florida, 1249 Center Drive, Gainesville, FL, 32603, USA
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
| | - Emanuel M Boutzoukas
- Center for Cognitive Aging and Memory, McKnight Brain Institute, University of Florida, 1249 Center Drive, Gainesville, FL, 32603, USA
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
| | - Hanna K Hausman
- Center for Cognitive Aging and Memory, McKnight Brain Institute, University of Florida, 1249 Center Drive, Gainesville, FL, 32603, USA
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
| | - Cheshire Hardcastle
- Center for Cognitive Aging and Memory, McKnight Brain Institute, University of Florida, 1249 Center Drive, Gainesville, FL, 32603, USA
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
| | - Alejandro Albizu
- Center for Cognitive Aging and Memory, McKnight Brain Institute, University of Florida, 1249 Center Drive, Gainesville, FL, 32603, USA
- Department of Neuroscience, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Andrew O'Shea
- Center for Cognitive Aging and Memory, McKnight Brain Institute, University of Florida, 1249 Center Drive, Gainesville, FL, 32603, USA
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
| | - Nicole D Evangelista
- Center for Cognitive Aging and Memory, McKnight Brain Institute, University of Florida, 1249 Center Drive, Gainesville, FL, 32603, USA
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
| | - Emily J Van Etten
- Brain Imaging, Behavior and Aging Laboratory, Department of Psychology and Evelyn F. McKnight Brain Institute, University of Arizona, Tucson, AZ, USA
| | - Pradyumna K Bharadwaj
- Brain Imaging, Behavior and Aging Laboratory, Department of Psychology and Evelyn F. McKnight Brain Institute, University of Arizona, Tucson, AZ, USA
| | - Hyun Song
- Brain Imaging, Behavior and Aging Laboratory, Department of Psychology and Evelyn F. McKnight Brain Institute, University of Arizona, Tucson, AZ, USA
| | - Samantha G Smith
- Brain Imaging, Behavior and Aging Laboratory, Department of Psychology and Evelyn F. McKnight Brain Institute, University of Arizona, Tucson, AZ, USA
| | - Steven T DeKosky
- Center for Cognitive Aging and Memory, McKnight Brain Institute, University of Florida, 1249 Center Drive, Gainesville, FL, 32603, USA
- McKnight Brain Institute and Department of Neurology, University of Florida, Gainesville, FL, USA
| | - Georg A Hishaw
- Department of Psychiatry, Neuroscience and Physiological Sciences Graduate Interdisciplinary Programs, and BIO5 Institute, University of Arizona and Arizona Alzheimer's Consortium, Tucson, AZ, USA
| | - Samuel Wu
- Department of Biostatistics, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
| | - Michael Marsiske
- Center for Cognitive Aging and Memory, McKnight Brain Institute, University of Florida, 1249 Center Drive, Gainesville, FL, 32603, USA
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
| | - Ronald Cohen
- Center for Cognitive Aging and Memory, McKnight Brain Institute, University of Florida, 1249 Center Drive, Gainesville, FL, 32603, USA
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
| | - Gene E Alexander
- McKnight Brain Institute and Department of Neurology, University of Florida, Gainesville, FL, USA
- Department of Psychiatry, Neuroscience and Physiological Sciences Graduate Interdisciplinary Programs, and BIO5 Institute, University of Arizona and Arizona Alzheimer's Consortium, Tucson, AZ, USA
| | - Eric Porges
- Center for Cognitive Aging and Memory, McKnight Brain Institute, University of Florida, 1249 Center Drive, Gainesville, FL, 32603, USA
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
| | - Adam J Woods
- Center for Cognitive Aging and Memory, McKnight Brain Institute, University of Florida, 1249 Center Drive, Gainesville, FL, 32603, USA.
- Department of Neuroscience, College of Medicine, University of Florida, Gainesville, FL, USA.
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA.
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Park J, Chung K, Oh Y, Kim KJ, Kim CO, Park JY. Effect of Home-Based Transcranial Direct Current Stimulation on Cognitive Function in Patients with Mild Cognitive Impairment: A Two-Week Intervention. Yonsei Med J 2024; 65:341-347. [PMID: 38804028 PMCID: PMC11130587 DOI: 10.3349/ymj.2023.0430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 01/09/2024] [Accepted: 01/16/2024] [Indexed: 05/29/2024] Open
Abstract
PURPOSE Repeated transcranial direct current stimulation (tDCS) is expected to have the potential to improve cognitive function in patients with mild cognitive impairment (MCI). We aimed to evaluate the efficacy and safety of at-home tDCS for elderly patients with MCI. MATERIALS AND METHODS Patients aged 60-80 years, who maintained normal daily living but reported objective memory impairments, were enrolled. Active or sham stimulations were applied to the dorsal frontal cortex (left: anode; right: cathode) at home for 2 weeks. Changes in cognitive function were assessed using visual recognition tasks and the Mini-Mental State Exam (MMSE), and safety and efficacy were assessed using self-reports and a remote monitoring application. RESULTS Of the 19 participants enrolled, 12 participants were included in the efficacy analysis. Response times and MMSE scores significantly improved after active stimulation compared to the sham stimulation; however, there were no significant differences in the proportion of correct responses. The mean compliance of the efficacy group was 97.5%±4.1%. Three participants experienced burns, but no permanent sequelae remained. CONCLUSION This preliminary result suggests that home-based tDCS may be a promising treatment option for MCI patients; however, it requires more attention and technological development to address safety concerns. CLINICAL TRIAL REGISTRATION Clinical Research Information Service (CRIS), KCT0002721.
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Affiliation(s)
- Jaesub Park
- Department of Psychiatry, National Health Insurance Service Ilsan Hospital, Goyang, Korea
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Kyungmi Chung
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Korea
- Department of Psychiatry, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea
| | - Yoonkyung Oh
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Kwang Joon Kim
- Division of Geriatrics, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Chang Oh Kim
- Division of Geriatrics, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
| | - Jin Young Park
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Korea
- Department of Psychiatry, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea
- Center for Digital Health, Yongin Severance Hospital, Yonsei University Health System, Yongin, Korea.
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20
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Gomez-Tames J, Fernández-Corazza M. Perspectives on Optimized Transcranial Electrical Stimulation Based on Spatial Electric Field Modeling in Humans. J Clin Med 2024; 13:3084. [PMID: 38892794 PMCID: PMC11172989 DOI: 10.3390/jcm13113084] [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: 03/08/2024] [Revised: 05/20/2024] [Accepted: 05/22/2024] [Indexed: 06/21/2024] Open
Abstract
Background: Transcranial electrical stimulation (tES) generates an electric field (or current density) in the brain through surface electrodes attached to the scalp. Clinical significance has been demonstrated, although with moderate and heterogeneous results partly due to a lack of control of the delivered electric currents. In the last decade, computational electric field analysis has allowed the estimation and optimization of the electric field using accurate anatomical head models. This review examines recent tES computational studies, providing a comprehensive background on the technical aspects of adopting computational electric field analysis as a standardized procedure in medical applications. Methods: Specific search strategies were designed to retrieve papers from the Web of Science database. The papers were initially screened based on the soundness of the title and abstract and then on their full contents, resulting in a total of 57 studies. Results: Recent trends were identified in individual- and population-level analysis of the electric field, including head models from non-neurotypical individuals. Advanced optimization techniques that allow a high degree of control with the required focality and direction of the electric field were also summarized. There is also growing evidence of a correlation between the computationally estimated electric field and the observed responses in real experiments. Conclusions: Computational pipelines and optimization algorithms have reached a degree of maturity that provides a rationale to improve tES experimental design and a posteriori analysis of the responses for supporting clinical studies.
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Affiliation(s)
- Jose Gomez-Tames
- Department of Medical Engineering, Graduate School of Engineering, Chiba University, Chiba 263-8522, Japan
- Center for Frontier Medical Engineering, Chiba University, Chiba 263-8522, Japan
| | - Mariano Fernández-Corazza
- LEICI Institute of Research in Electronics, Control and Signal Processing, National University of La Plata, La Plata 1900, Argentina
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Di Fuccio R, Lardone A, De Luca M, Ali L, Limone P, Marangolo P. Neurobiological Effects of Transcranial Direct Current Stimulation over the Inferior Frontal Gyrus: A Systematic Review on Cognitive Enhancement in Healthy and Neurological Adults. Biomedicines 2024; 12:1146. [PMID: 38927353 PMCID: PMC11200721 DOI: 10.3390/biomedicines12061146] [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: 04/16/2024] [Revised: 05/16/2024] [Accepted: 05/21/2024] [Indexed: 06/28/2024] Open
Abstract
The neurobiological effects of transcranial direct current stimulation (tDCS) have still not been unequivocally clarified. Some studies have suggested that the application of tDCS over the inferior frontal gyrus (IFG) enhances different aspects of cognition in healthy and neurological individuals, exerting neural changes over the target area and its neural surroundings. In this systematic review, randomized sham-controlled trials in healthy and neurological adults were selected through a database search to explore whether tDCS over the IFG combined with cognitive training modulates functional connectivity or neural changes. Twenty studies were finally included, among which twelve measured tDCS effects through functional magnetic resonance (fMRI), two through functional near-infrared spectroscopy (fNIRS), and six through electroencephalography (EEG). Due to the high heterogeneity observed across studies, data were qualitatively described and compared to assess reliability. Overall, studies that combined fMRI and tDCS showed widespread changes in functional connectivity at both local and distant brain regions. The findings also suggested that tDCS may also modulate electrophysiological changes underlying the targeted area. However, these outcomes were not always accompanied by corresponding significant behavioral results. This work raises the question concerning the general efficacy of tDCS, the implications of which extend to the steadily increasing tDCS literature.
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Affiliation(s)
- Raffaele Di Fuccio
- Department of Psychology and Educational Sciences, Telematic University of Pegaso, Piazza dei Santi Apostoli 49, 00187 Rome, Italy; (R.D.F.); (L.A.); (P.L.)
| | - Anna Lardone
- Department of Humanities Studies, University Federico II, Via Porta di Massa 1, 80133 Naples, Italy; (A.L.); (M.D.L.)
| | - Mariagiovanna De Luca
- Department of Humanities Studies, University Federico II, Via Porta di Massa 1, 80133 Naples, Italy; (A.L.); (M.D.L.)
| | - Leila Ali
- Department of Psychology and Educational Sciences, Telematic University of Pegaso, Piazza dei Santi Apostoli 49, 00187 Rome, Italy; (R.D.F.); (L.A.); (P.L.)
| | - Pierpaolo Limone
- Department of Psychology and Educational Sciences, Telematic University of Pegaso, Piazza dei Santi Apostoli 49, 00187 Rome, Italy; (R.D.F.); (L.A.); (P.L.)
| | - Paola Marangolo
- Department of Humanities Studies, University Federico II, Via Porta di Massa 1, 80133 Naples, Italy; (A.L.); (M.D.L.)
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22
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Ehrhardt SE, Wards Y, Rideaux R, Marjańska M, Jin J, Cloos MA, Deelchand DK, Zöllner HJ, Saleh MG, Hui SCN, Ali T, Shaw TB, Barth M, Mattingley JB, Filmer HL, Dux PE. Neurochemical Predictors of Generalized Learning Induced by Brain Stimulation and Training. J Neurosci 2024; 44:e1676232024. [PMID: 38531634 PMCID: PMC11112648 DOI: 10.1523/jneurosci.1676-23.2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 01/22/2024] [Accepted: 03/08/2024] [Indexed: 03/28/2024] Open
Abstract
Methods of cognitive enhancement for humans are most impactful when they generalize across tasks. However, the extent to which such "transfer" is possible via interventions is widely debated. In addition, the contribution of excitatory and inhibitory processes to such transfer is unknown. Here, in a large-scale neuroimaging individual differences study with humans (both sexes), we paired multitasking training and noninvasive brain stimulation (transcranial direct current stimulation, tDCS) over multiple days and assessed performance across a range of paradigms. In addition, we varied tDCS dosage (1.0 and 2.0 mA), electrode montage (left or right prefrontal regions), and training task (multitasking vs a control task) and assessed GABA and glutamate concentrations via ultrahigh field 7T magnetic resonance spectroscopy. Generalized benefits were observed in spatial attention, indexed by visual search performance, when multitasking training was combined with 1.0 mA stimulation targeting either the left or right prefrontal cortex (PFC). This transfer effect persisted for ∼30 d post intervention. Critically, the transferred benefits associated with right prefrontal tDCS were predicted by pretraining concentrations of glutamate in the PFC. Thus, the effects of this combined stimulation and training protocol appear to be linked predominantly to excitatory brain processes.
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Affiliation(s)
- Shane E Ehrhardt
- School of Psychology, The University of Queensland, St Lucia, Queensland 4072, Australia
| | - Yohan Wards
- School of Psychology, The University of Queensland, St Lucia, Queensland 4072, Australia
| | - Reuben Rideaux
- Queensland Brain Institute, The University of Queensland, St Lucia, Queensland 4072, Australia
- School of Psychology, The University of Sydney, Sydney, New South Wales 2050, Australia
| | - Małgorzata Marjańska
- Department of Radiology, Centre for Magnetic Resonance Research, University of Minnesota, Minneapolis, Minnesota 55455
| | - Jin Jin
- Centre for Advanced Imaging, The University of Queensland, St Lucia, Queensland 4072, Australia
- Siemens Healthcare Pty Ltd., Brisbane, Queensland 4006, Australia
| | - Martijn A Cloos
- Centre for Advanced Imaging, The University of Queensland, St Lucia, Queensland 4072, Australia
| | - Dinesh K Deelchand
- Department of Radiology, Centre for Magnetic Resonance Research, University of Minnesota, Minneapolis, Minnesota 55455
| | - Helge J Zöllner
- The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21287
| | - Muhammad G Saleh
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland 21201
| | - Steve C N Hui
- The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21287
| | - Tonima Ali
- School of Biomedical Engineering, The University of Sydney, Sydney, New South Wales 2050, Australia
- Brain and Mind Centre, The University of Sydney, Sydney, New South Wales 2050, Australia
| | - Thomas B Shaw
- Centre for Advanced Imaging, The University of Queensland, St Lucia, Queensland 4072, Australia
- School of Information Technology and Electrical Engineering, The University of Queensland, St Lucia, Queensland 4072, Australia
| | - Markus Barth
- Centre for Advanced Imaging, The University of Queensland, St Lucia, Queensland 4072, Australia
- School of Information Technology and Electrical Engineering, The University of Queensland, St Lucia, Queensland 4072, Australia
| | - Jason B Mattingley
- School of Psychology, The University of Queensland, St Lucia, Queensland 4072, Australia
- Queensland Brain Institute, The University of Queensland, St Lucia, Queensland 4072, Australia
- Canadian Institute for Advanced Research (CIFAR), Toronto, Ontario M5G 1M1, Canada
| | - Hannah L Filmer
- School of Psychology, The University of Queensland, St Lucia, Queensland 4072, Australia
| | - Paul E Dux
- School of Psychology, The University of Queensland, St Lucia, Queensland 4072, Australia
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23
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Kummer K, Sheets PL. Targeting Prefrontal Cortex Dysfunction in Pain. J Pharmacol Exp Ther 2024; 389:268-276. [PMID: 38702195 PMCID: PMC11125798 DOI: 10.1124/jpet.123.002046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 03/12/2024] [Accepted: 04/02/2024] [Indexed: 05/06/2024] Open
Abstract
The prefrontal cortex (PFC) has justifiably become a significant focus of chronic pain research. Collectively, decades of rodent and human research have provided strong rationale for studying the dysfunction of the PFC as a contributing factor in the development and persistence of chronic pain and as a key supraspinal mechanism for pain-induced comorbidities such as anxiety, depression, and cognitive decline. Chronic pain alters the structure, chemistry, and connectivity of PFC in both humans and rodents. In this review, we broadly summarize the complexities of reported changes within both rodent and human PFC caused by pain and offer insight into potential pharmacological and nonpharmacological approaches for targeting PFC to treat chronic pain and pain-associated comorbidities. SIGNIFICANCE STATEMENT: Chronic pain is a significant unresolved medical problem causing detrimental changes to physiological, psychological, and behavioral aspects of life. Drawbacks of currently approved pain therapeutics include incomplete efficacy and potential for abuse producing a critical need for novel approaches to treat pain and comorbid disorders. This review provides insight into how manipulation of prefrontal cortex circuits could address this unmet need of more efficacious and safer pain therapeutics.
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Affiliation(s)
- Kai Kummer
- Institute of Physiology, Medical University of Innsbruck, Innsbruck, Austria (K.K.); Department of Pharmacology and Toxicology (P.L.S.), Medical Neurosciences Graduate Program (P.L.S.), and Stark Neurosciences Research Institute (P.L.S.), Indiana University School of Medicine, Indianapolis, Indiana
| | - Patrick L Sheets
- Institute of Physiology, Medical University of Innsbruck, Innsbruck, Austria (K.K.); Department of Pharmacology and Toxicology (P.L.S.), Medical Neurosciences Graduate Program (P.L.S.), and Stark Neurosciences Research Institute (P.L.S.), Indiana University School of Medicine, Indianapolis, Indiana
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24
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Knopman DS, Laskowitz DT, Koltai DC, Charvet LE, Becker JH, Federman AD, Wisnivesky J, Mahncke H, Van Vleet TM, Bateman L, Kim DY, O'Steen A, James M, Silverstein A, Lokhnygina Y, Rich J, Feger BJ, Zimmerman KO. RECOVER-NEURO: study protocol for a multi-center, multi-arm, phase 2, randomized, active comparator trial evaluating three interventions for cognitive dysfunction in post-acute sequelae of SARS-CoV-2 infection (PASC). Trials 2024; 25:326. [PMID: 38755688 PMCID: PMC11098733 DOI: 10.1186/s13063-024-08156-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 05/07/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Post-acute sequelae of SARS-CoV-2 infection (PASC) symptoms have broad impact, and may affect individuals regardless of COVID-19 severity, socioeconomic status, race, ethnicity, or age. A prominent PASC symptom is cognitive dysfunction, colloquially referred to as "brain fog" and characterized by declines in short-term memory, attention, and concentration. Cognitive dysfunction can severely impair quality of life by impairing daily functional skills and preventing timely return to work. METHODS RECOVER-NEURO is a prospective, multi-center, multi-arm, phase 2, randomized, active-comparator design investigating 3 interventions: (1) BrainHQ is an interactive, online cognitive training program; (2) PASC-Cognitive Recovery is a cognitive rehabilitation program specifically designed to target frequently reported challenges among individuals with brain fog; (3) transcranial direct current stimulation (tDCS) is a noninvasive form of mild electrical brain stimulation. The interventions will be combined to establish 5 arms: (1) BrainHQ; (2) BrainHQ + PASC-Cognitive Recovery; (3) BrainHQ + tDCS-active; (4) BrainHQ + tDCS-sham; and (5) Active Comparator. The interventions will occur for 10 weeks. Assessments will be completed at baseline and at the end of intervention and will include cognitive testing and patient-reported surveys. All study activities can be delivered in Spanish and English. DISCUSSION This study is designed to test whether cognitive dysfunction symptoms can be alleviated by the use of pragmatic and established interventions with different mechanisms of action and with prior evidence of improving cognitive function in patients with neurocognitive disorder. If successful, results will provide beneficial treatments for PASC-related cognitive dysfunction. TRIAL REGISTRATION ClinicalTrials.gov NCT05965739. Registered on July 25, 2023.
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Affiliation(s)
| | - Daniel T Laskowitz
- Duke Clinical Research Institute, Durham, NC, USA
- Duke University School of Medicine, Durham, NC, USA
| | | | - Leigh E Charvet
- New York University Grossman School of Medicine, New York, NY, USA
| | | | | | | | | | | | | | - Dong-Yun Kim
- National Institutes of Health, Bethesda, MD, USA
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25
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Alizadehgoradel J, Razavi SD, Shirani Z, Barati M, Taherifard M, Nejati V, Nitsche MA. Targeting the left DLPFC and right VLPFC in unmarried romantic relationship breakup (love trauma syndrome) with intensified electrical stimulation: A randomized, single-blind, parallel-group, sham-controlled study. J Psychiatr Res 2024; 175:170-182. [PMID: 38735262 DOI: 10.1016/j.jpsychires.2024.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 04/29/2024] [Accepted: 05/08/2024] [Indexed: 05/14/2024]
Abstract
BACKGROUND Ending a romantic relationship is one of the most painful losses an adult experience. Neuroimaging studies suggest that there is a neuropsychological link between breakup experiences and bereaved individuals, and that specific prefrontal regions are involved. The aim of this study was to determine whether enhancement of left DLPFC and right VLPFC activity with a novel intensified anodal transcranial direct current stimulation protocol reduces core symptoms of love trauma syndrome (LTS) and improves treatment-related variables. METHODS In this randomized, sham-controlled, single-blind parallel trial, we assessed the efficacy of an intensified anodal stimulation protocol (20 min, twice-daily sessions with 20 min intervals, 5 consecutive days) with two montages (left DLPFC vs right VLPFC) to reduce love trauma symptoms. 36 participants with love trauma syndrome were randomized in three tDCS condition (left DLPFC, right VLPFC, sham stimulation). LTS symptoms, treatment-related outcome variables (depressive state, anxiety, emotion regulation, positive and negative affect), and cognitive functions were assessed before, right after, and one month after intervention. RESULTS Both DLPFC and VLPFC protocols significantly reduced LTS symptoms, and improved depressive state and anxiety after the intervention, as compared to the sham group. The improving effect of the DLPFC protocol on love trauma syndrome was significantly larger than that of the VLPFC protocol. For emotion regulation and positive and negative affect, improved regulation of emotions and positive affect and reduced negative affect were revealed after intervention in the two real stimulation conditions compared to the sham. For cognitive functions, no significant difference was observed between the groups, but again a positive effect of intervention within groups in the real stimulation conditions (DLPFC and VLPFC) was found for most components of the cognitive tasks. CONCLUSIONS Enhancement of left DLPFC and right VLPFC activity with intensified stimulation improves LTS symptoms and treatment-related variables. For LTS symptoms, DLPFC stimulation was more efficient than VLPFC stimulation., For the other variables, no significant difference was observed between these two stimulation groups. These promising results require replication in larger trials.
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Affiliation(s)
- Jaber Alizadehgoradel
- Department of Psychology, Faculty of Humanities, University of Zanjan, Zanjan, Iran.
| | | | - Zahra Shirani
- Department of Psychology, Faculty of Humanities, University of Zanjan, Zanjan, Iran
| | - Mobina Barati
- Department of Psychology, Faculty of Humanities, University of Zanjan, Zanjan, Iran
| | - Mina Taherifard
- Department of Psychology, Mohaghegh-Ardabili University, Ardabil, Iran
| | - Vahid Nejati
- Department of Psychology, Shahid Beheshti University, Tehran, Iran
| | - Michael A Nitsche
- Department of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany; Bielefeld University, University Hospital OWL, Protestant Hospital of Bethel Foundation, University Clinic of Psychiatry and Psychotherapy and University Clinic of Child and Adolescent Psychiatry and Psychotherapy, Germany; German Centre for Mental Health (DZPG), Germany
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Ruffini G, Salvador R, Castaldo F, Baleeiro T, Camprodon JA, Chopra M, Cappon D, Pascual-Leone A. Multichannel tDCS with Advanced Targeting for Major Depressive Disorder: A Tele-Supervised At-Home Pilot Study. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.03.04.24303508. [PMID: 38496607 PMCID: PMC10942536 DOI: 10.1101/2024.03.04.24303508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Introduction Proof-of-principle human studies suggest that transcranial direct current stimulation (tDCS) over the dorsolateral prefrontal cortex (DLPFC) may improve depression severity. This open-label multicenter study tested remotely supervised multichannel tDCS delivered at home in patients (N=35) with major depressive disorder (MDD). The primary aim was to assess the feasibility and safety of our protocol. As an exploratory aim, we evaluated therapeutic efficacy: the primary efficacy measure was the median percent change from baseline to the end of the 4-week post-treatment follow-up period in the observer-rated Montgomery-Asberg Depression Mood Rating Scale (MADRS). Methods Participants received 37 at-home stimulation sessions (30 minutes each) of specifically designed multichannel tDCS targeting the left DLPFC administered over eight weeks (4 weeks of daily treatments plus 4 weeks of taper), with a follow-up period of 4 weeks following the final stimulation session. The stimulation montage (electrode positions and currents) was optimized by employing computational models of the electric field generated by multichannel tDCS using available structural data from a similar population (group optimization). Conducted entirely remotely, the study employed the MADRS for assessment at baseline, at weeks 4 and 8 during treatment, and at 4-week follow-up visits. Results 34 patients (85.3% women) with a mean age of 59 years, a diagnosis of MDD according to DSM-5 criteria, and a MADRS score ≥20 at the time of study enrolment completed all study visits. At baseline, the mean time since MDD diagnosis was 24.0 (SD 19.1) months. Concerning compliance, 85% of the participants (n=29) completed the complete course of 37 stimulation sessions at home, while 97% completed at least 36 sessions. No detrimental effects were observed, including suicidal ideation and/or behavior. The study observed a median MADRS score reduction of 64.5% (48.6, 72.4) 4 weeks post-treatment (Hedge's g = -3.1). We observed a response rate (≥ 50% improvement in MADRS scores) of 72.7% (n=24) from baseline to the last visit 4 weeks post-treatment. Secondary measures reflected similar improvements. Conclusions These results suggest that remotely supervised and supported multichannel home-based tDCS is safe and feasible, and antidepressant efficacy motivates further appropriately controlled clinical studies.
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García-Marco E, Nuez Trujillo A, Padrón I, Ravelo Y, Fu Y, Marrero H. Negation and social avoidance in language recruits the right inferior frontal gyrus: a tDCS study. Front Psychol 2024; 15:1356030. [PMID: 38765838 PMCID: PMC11099214 DOI: 10.3389/fpsyg.2024.1356030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 04/24/2024] [Indexed: 05/22/2024] Open
Abstract
Introduction In the process of comprehension, linguistic negation induces inhibition of negated scenarios. Numerous studies have highlighted the role of the right Inferior Frontal Gyrus (rIFG) - a key component of the inhibitory network - in negation processing. Social avoidance can be linguistically portrayed using attitudinal verbs such as "exclude" vs. "include", which inherently carry negative connotations. Consequently, we hypothesize that the interplay between explicit negation and the implicit negativity of avoidance verbs can be modulated via transcranial direct current stimulation (tDCS) targeting the rIFG. Methods In our study, sixty-four participants read approach/avoidance sentences, which were either affirmative or negative, such as "Anne included (did not include) meat in her diet" vs. "Anne excluded (did not exclude) meat in her diet". This reading task followed a 20-minute tDCS session. The sentences were sequentially displayed, and at 1500 ms post-sentence, a verb was shown - either the one previously mentioned or its semantic alternative counterpart (e.g., included vs. excluded). Results Findings revealed that anodal stimulation intensifies the inhibitory impact of negation during sentence comprehension. Under anodal conditions, negative sentences led to extended reading times for the mentioned verbs compared to their affirmative counterparts, suggesting an increased inhibitory effect on the verb. Furthermore, in avoidance sentences, anodal stimulation resulted in reduced reading times for alternative verbs (e.g. "included") in negative sentences compared to alternative verbs (e.g. "excluded") in negated approach sentences. Discussion As "avoidance" is semantically equivalent to "non-approach", the inhibitory effect of negation is primarily applied to the implicit negation: NOT EXCLUDED = NOT→NOT (INCLUDED), which consequently activates the representation of the alternative verb making it more available. We further discuss these findings in light of the rIFG's pivotal role in processing attitudinal verbs and linguistic negation. This discussion is framed within the overarching context of the two-step model of negation processing, highlighting its significance in the realm of social communication.
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Affiliation(s)
- Enrique García-Marco
- Department of Clinical and Experimental Psychology, University of Huelva, Huelva, Spain
- Institute of Neurosciences, University of La Laguna, San Cristobal de La Laguna, Spain
| | - Aarón Nuez Trujillo
- Faculty of Humanities and Social Sciences, Psychology, Technological University of Peru, Lima, Peru
| | - Iván Padrón
- Institute of Neurosciences, University of La Laguna, San Cristobal de La Laguna, Spain
- Department of Evolutionary and Educational Psychology, Faculty of Psychology and Speech Therapy, University of La Laguna, San Cristóbal de La Laguna, Spain
| | - Yennifer Ravelo
- Institute of Neurosciences, University of La Laguna, San Cristobal de La Laguna, Spain
- Departamento de Psicología Cognitiva, Social y Organizacional, Universidad de La Laguna, San Cristóbal de La Laguna, Spain
| | - Yang Fu
- Institute of Neurosciences, University of La Laguna, San Cristobal de La Laguna, Spain
- School of International Studies, Zhejiang University, Hangzhou, China
| | - Hipólito Marrero
- Institute of Neurosciences, University of La Laguna, San Cristobal de La Laguna, Spain
- Departamento de Psicología Cognitiva, Social y Organizacional, Universidad de La Laguna, San Cristóbal de La Laguna, Spain
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28
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Wards Y, Ehrhardt SE, Garner KG, Mattingley JB, Filmer HL, Dux PE. Stimulating prefrontal cortex facilitates training transfer by increasing representational overlap. Cereb Cortex 2024; 34:bhae209. [PMID: 38771242 DOI: 10.1093/cercor/bhae209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 04/29/2024] [Accepted: 04/30/2024] [Indexed: 05/22/2024] Open
Abstract
A recent hypothesis characterizes difficulties in multitasking as being the price humans pay for our ability to generalize learning across tasks. The mitigation of these costs through training has been associated with reduced overlap of constituent task representations within frontal, parietal, and subcortical regions. Transcranial direct current stimulation, which can modulate functional brain activity, has shown promise in generalizing performance gains when combined with multitasking training. However, the relationship between combined transcranial direct current stimulation and training protocols with task-associated representational overlap in the brain remains unexplored. Here, we paired prefrontal cortex transcranial direct current stimulation with multitasking training in 178 individuals and collected functional magnetic resonance imaging data pre- and post-training. We found that 1 mA transcranial direct current stimulation applied to the prefrontal cortex paired with multitasking training enhanced training transfer to spatial attention, as assessed via a visual search task. Using machine learning to assess the overlap of neural activity related to the training task in task-relevant brain regions, we found that visual search gains were predicted by changes in classification accuracy in frontal, parietal, and cerebellar regions for participants that received left prefrontal cortex stimulation. These findings demonstrate that prefrontal cortex transcranial direct current stimulation may interact with training-related changes to task representations, facilitating the generalization of learning.
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Affiliation(s)
- Yohan Wards
- School of Psychology, The University of Queensland, McElwain Building, Campbell Road, St Lucia, Queensland 4072, Australia
| | - Shane E Ehrhardt
- School of Psychology, The University of Queensland, McElwain Building, Campbell Road, St Lucia, Queensland 4072, Australia
| | - Kelly G Garner
- School of Psychology, The University of Queensland, McElwain Building, Campbell Road, St Lucia, Queensland 4072, Australia
- Queensland Brain Institute, The University of Queensland, Building 79, Upland Road, St Lucia, Queensland 4072, Australia
- School of Psychology, University of New South Wales, Mathews Building, Gate 11, Botany Street, Randwick, New South Wales 2052, Australia
- School of Psychology, University of Birmingham, Hills Building, Edgbaston Park Rd, Birmingham B15 2TT, United Kingdom
| | - Jason B Mattingley
- School of Psychology, The University of Queensland, McElwain Building, Campbell Road, St Lucia, Queensland 4072, Australia
- Queensland Brain Institute, The University of Queensland, Building 79, Upland Road, St Lucia, Queensland 4072, Australia
- School of Psychology, University of Birmingham, Hills Building, Edgbaston Park Rd, Birmingham B15 2TT, United Kingdom
| | - Hannah L Filmer
- School of Psychology, The University of Queensland, McElwain Building, Campbell Road, St Lucia, Queensland 4072, Australia
| | - Paul E Dux
- School of Psychology, The University of Queensland, McElwain Building, Campbell Road, St Lucia, Queensland 4072, Australia
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Rząd Z, Rog J, Kajka N, Szewczyk P, Krukow P, Karakuła-Juchnowicz H. The efficacy of transcranial direct current stimulation in the treatment of anorexia nervosa: a randomized double-blind clinical trial. Front Psychiatry 2024; 15:1284675. [PMID: 38757134 PMCID: PMC11096801 DOI: 10.3389/fpsyt.2024.1284675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 04/12/2024] [Indexed: 05/18/2024] Open
Abstract
Background Anorexia nervosa (AN) is a life-threatening disease with a low effectiveness of treatment. The high relapse and mortality rate indicate new treatment approaches are needed. Here, we represent the protocol for randomized clinical trial (RCT) of transcranial direct current stimulation (tDCS) efficiency in the AN treatment. The main purpose of the 3-week RCT is to determine the effect of tDCS on the mental state and advances in nutritional rehabilitation in patients with AN. Methods 50 female inpatients (13-25 years old, body mass index (BMI) 17.5 kg/m2 or less) will be randomly allocated into groups: active (n=25) and sham (n=25) tDCS. Thirty 25-minute tDCS sessions (applied current at 2mA) will be given to DLPFC (F3 anode/F4 cathode) twice a day for 3 weeks on working days parallel to treatment as usual. The primary outcome measures include changes in symptoms related to eating disorders, as assessed by the Eating Attitudes Test (EAT-26), following tDCS sessions over a 3-week trial period. The secondary outcome measures include changes in: brain bioelectric activity, anthropometric measurements, mood, nutritional status, neurocognition, psychological symptoms, selected biological markers related to stress, food intake, inflammation and neurotrophins. Discussion This paper describes the evaluation of a 3-week tDCS-based intervention for AN patients. The study design was developed by a multidisciplinary research team to assess the treatment effect, taking into account various types of variables. This approach could help in better understanding the potential therapeutic tDCS strategy in AN. Clinical trial registration www.ClinicalTrials.gov, identifier NCT05814458.
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Affiliation(s)
- Zuzanna Rząd
- Department of Psychiatry, Psychotherapy and Early Intervention in Lublin, Medical University of Lublin, Lublin, Poland
| | - Joanna Rog
- Laboratory of Human Metabolism Research, Department of Dietetics, Institute of Human Nutrition Science, Warsaw University of Life Sciences (WULS-SGGW), Warsaw, Poland
| | - Natalia Kajka
- Department of Psychiatry, Psychotherapy and Early Intervention in Lublin, Medical University of Lublin, Lublin, Poland
| | - Paweł Szewczyk
- Department of Psychiatry, Psychotherapy and Early Intervention in Lublin, Medical University of Lublin, Lublin, Poland
| | - Paweł Krukow
- Department of Clinical Neuropsychiatry, Medical University of Lublin, Lublin, Poland
| | - Hanna Karakuła-Juchnowicz
- Department of Psychiatry, Psychotherapy and Early Intervention in Lublin, Medical University of Lublin, Lublin, Poland
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Rodrigues YT, Silva TCLA, Radytė E, Bernatavičius E, Cook AA, Carvalho MLAS, Macedo LES, Oliveira JMP, Martins TD, Fonseca ME, Micussi MTABC, Pegado R. Clinical usability study of a home-based self-administration transcranial direct current stimulation for primary dysmenorrhea: A randomized controlled trial. PLoS One 2024; 19:e0301851. [PMID: 38696453 PMCID: PMC11065276 DOI: 10.1371/journal.pone.0301851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 03/16/2024] [Indexed: 05/04/2024] Open
Abstract
This study tested the usability of a home-based self-administration transcranial direct current stimulation (tDCS) device designed specifically for women's health needs. This is a single center triple blinded clinical usability study for a new wireless, Bluetooth-controlled wearable tDCS device for women's health. The study aims to evaluate the usability and effective blinding of a home-based tDCS system. A total of forty-nine women of reproductive age were randomly allocated (1:1) to receive one session of active tDCS (n = 24) or sham tDCS (n = 25) over the motor and dorsolateral prefrontal cortex. Each participant self-administered one 20-minute session without supervision following guidance on a software application alone. The System Usability Scale (SUS) and the Patient Global Impression of Change (PGIC) were used to evaluate the usability of the system. Regardless of sham or active conditions, all users found the system easy to use without the support of researchers. Usability scores were considered to be "excellent" in both groups and no significant difference was found between sham and active groups showing effective blinding of the device (Active group: 93.7 (83.1-97.5); Sham group 90 (86.2-95) p = 0.79) and PGIC (Active group: 2 (1-2.75); Sham group 2 (1-2) p = 0.99) using an unpaired t-test or non-parametric statistical tests accordingly. The new Bluetooth-controlled wearable tDCS device is easy, safe to use and completely controlled by a smartphone app. This device is focused on women's health and will be tested as an alternative treatment for chronic pelvic pain and mood disturbance associated with menstrual cycles in further research.
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Affiliation(s)
- Yvinna T. Rodrigues
- Graduate Program in Physical Therapy, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Tatiana C. L. A. Silva
- Graduate Program in Physical Therapy, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Emilė Radytė
- Samphire Neuroscience Ltd, London, United Kingdom
| | | | | | | | - Luiza E. S. Macedo
- Department of Physical Therapy, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Joyce M. P. Oliveira
- Department of Physical Therapy, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Talita D. Martins
- Department of Physical Therapy, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Maria E. Fonseca
- Graduate Program in Health Science, Federal University of Rio Grande do Norte, Natal, Brazil
| | | | - Rodrigo Pegado
- Graduate Program in Physical Therapy, Federal University of Rio Grande do Norte, Natal, Brazil
- Graduate Program in Health Science, Federal University of Rio Grande do Norte, Natal, Brazil
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Osman H, Siu R, Makowski NS, Knutson JS, Cunningham DA. Neurostimulation After Stroke. Phys Med Rehabil Clin N Am 2024; 35:369-382. [PMID: 38514224 DOI: 10.1016/j.pmr.2023.06.008] [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] [Indexed: 03/23/2024]
Abstract
Neural stimulation technology aids stroke survivors in regaining lost motor functions. This article explores its applications in upper and lower limb stroke rehabilitation. The authors review various methods to target the corticomotor system, including transcranial direct current stimulation, repetitive transcranial magnetic stimulation, and vagus nerve stimulation. In addition, the authors review the use of peripheral neuromuscular electrical stimulation for therapeutic and assistive purposes, including transcutaneous electrical nerve stimulation, neuromuscular electrical stimulation, and functional electrical stimulation. For each, the authors examine the potential benefits, limitations, safety considerations, and FDA status.
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Affiliation(s)
- Hala Osman
- MetroHealth Center for Rehabilitation Research, 4229 Pearl Dr, Cleveland, OH 44109, USA; APT Center, 10701 East Boulevard, Cleveland, OH 44106, USA
| | - Ricardo Siu
- MetroHealth Center for Rehabilitation Research, 4229 Pearl Dr, Cleveland, OH 44109, USA; Department of Physical Medicine and Rehabilitation, Case Western Reserve University, 9501 Euclid Avenue, Cleveland, OH 44106, USA
| | - Nathan S Makowski
- MetroHealth Center for Rehabilitation Research, 4229 Pearl Dr, Cleveland, OH 44109, USA; APT Center, 10701 East Boulevard, Cleveland, OH 44106, USA; Department of Physical Medicine and Rehabilitation, Case Western Reserve University, 9501 Euclid Avenue, Cleveland, OH 44106, USA
| | - Jayme S Knutson
- MetroHealth Center for Rehabilitation Research, 4229 Pearl Dr, Cleveland, OH 44109, USA; Department of Physical Medicine and Rehabilitation, Case Western Reserve University, 9501 Euclid Avenue, Cleveland, OH 44106, USA; Cleveland FES Center, 10701 East Boulevard, Cleveland, OH 44106, USA
| | - David A Cunningham
- MetroHealth Center for Rehabilitation Research, 4229 Pearl Dr, Cleveland, OH 44109, USA; Department of Physical Medicine and Rehabilitation, Case Western Reserve University, 9501 Euclid Avenue, Cleveland, OH 44106, USA; Cleveland FES Center, 10701 East Boulevard, Cleveland, OH 44106, USA.
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Cavalcante AFL, Holanda JSCB, Passos JOS, Pereira de Oliveira JM, Morya E, Okano AH, Bikson M, Pegado R. Anodal tDCS over the motor cortex improves pain but not physical function in chronic chikungunya arthritis: Randomized controlled trial. Ann Phys Rehabil Med 2024; 67:101826. [PMID: 38479250 DOI: 10.1016/j.rehab.2024.101826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 12/08/2023] [Accepted: 12/26/2023] [Indexed: 05/12/2024]
Abstract
BACKGROUND Chikungunya virus (CHIKV) is a globally prevalent pathogen, with outbreaks occurring in tropical regions. Chronic pain is the main symptom reported and is associated with decreased mobility and disability. Transcranial direct current stimulation (tDCS) is emerging as a new therapeutic tool for chronic arthralgia. OBJECTIVE To evaluate the effectiveness of 10 consecutive sessions of anodal tDCS on pain (primary outcome) in participants with chronic CHIKV arthralgia. Secondary outcomes included functional status, quality of life, and mood. METHODS In this randomized, double-blind, placebo-controlled trial, 30 participants with chronic CHIKV arthralgia were randomly assigned to receive either active (n = 15) or sham (n = 15) tDCS. The active group received 10 consecutive sessions of tDCS over M1 using the C3/Fp2 montage (2 mA for 20 min). Visual analog scale of pain (VAS), health assessment questionnaire (HAQ), short-form 36 health survey (SF-36), pain catastrophizing scale, Hamilton anxiety scale (HAS), timed up and go (TUG) test, lumbar dynamometry, 30-s arm curl and 2-min step test were assessed at baseline, day 10 and at 2 follow-up visits. RESULTS There was a significant interaction between group and time on pain (p = 0.03; effect size 95 % CI 0.9 (-1.67 to -0.16), with a significant time interaction (p = 0.0001). There was no interaction between time and group for the 2-minute step test (p = 0.18), but the groups differed significantly at day 10 (p = 0.01), first follow-up (p = 0.01) and second follow-up (p = 0.03). HAQ and SF-36 improved but not significantly. There was no significant improvement in mental health, and physical tests. CONCLUSION tDCS appears to be a promising intervention for reducing pain in participants with chronic CHIKV arthralgia, although further research is needed to confirm these findings and explore potential long-term benefits. TRIAL REGISTRATION Brazilian Registry of Clinical Trials (ReBEC): RBR-245rh7.
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Affiliation(s)
- Antônio Felipe Lopes Cavalcante
- Graduate Program in Health Sciences, Federal University of Rio Grande do Norte, Campus Universitário, Lagoa Nova, Natal 59078-970, Brazil
| | - Joanna Sacha Cunha Brito Holanda
- Graduate Program in Physical Therapy, Federal University of Rio Grande do Norte, Campus Universitário, Lagoa Nova, Natal 59078-970, Brazil
| | - João Octávio Sales Passos
- Graduate Program in Health Sciences, Federal University of Rio Grande do Norte, Campus Universitário, Lagoa Nova, Natal 59078-970, Brazil
| | - Joyce Maria Pereira de Oliveira
- Graduate Program in Physical Therapy, Federal University of Rio Grande do Norte, Campus Universitário, Lagoa Nova, Natal 59078-970, Brazil
| | - Edgard Morya
- Edmond and Lily Safra International Institute of Neuroscience, Santos Dumont Institute, Alberto Santos Dumont Avenue, 1.560, Macaíba 59280-000, Brazil
| | - Alexandre H Okano
- Center of Mathematics, Computation and Cognition, Federal University of ABC, São Bernardo, São Paulo, Alameda da Universidade, Bairro Anchieta 09606-045, Brazil
| | - Marom Bikson
- Department of Biomedical Engineering, The City College of The City University of New York, 160 Convent Avenue, New York, NY 10031, USA
| | - Rodrigo Pegado
- Graduate Program in Health Sciences, Federal University of Rio Grande do Norte, Campus Universitário, Lagoa Nova, Natal 59078-970, Brazil; Graduate Program in Physical Therapy, Federal University of Rio Grande do Norte, Campus Universitário, Lagoa Nova, Natal 59078-970, Brazil.
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Cenci GI, Rocha RB, Ferreira Bomtempo F, Nager GB, Silva GD, Figueiredo EG, Telles JPM. Efficacy of transcranial direct current stimulation in patients with dysphagia after stroke: a systematic review. Neurol Sci 2024; 45:2119-2125. [PMID: 38044393 DOI: 10.1007/s10072-023-07216-7] [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: 05/18/2023] [Accepted: 11/20/2023] [Indexed: 12/05/2023]
Abstract
BACKGROUND Swallowing is a complex function that can be disrupted after stroke. Transcranial Direct Current Stimulation (tDCS) is a non-invasive brain stimulation therapy that recently has been tested to treat stroke-related dysphagia. METHODS The authors performed a search in the literature to review the described evidence of the use of tDCS in dysphagia after stroke. Three electronic databases were searched. The risk of bias evaluation was carried out through the RoB-2 tool. The Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) framework was also implemented. RESULTS Of 265 articles, only nine studies were included in this review. The most common location of the tDCS stimulation was the unaffected hemisphere (44%). Regarding the outcome measure, the Dysphagia Outcome and Severity Scale (DOSS) was the most commonly used (55%). However, due to the high heterogeneity of the protocols, and considering the differences between the types of stroke, the authors opted not to perform a metanalysis. Instead, a systematic review with a thorough analysis of each individual study and the impact of the differences to the outcomes was preferred. CONCLUSIONS The final considerations are that even though the majority of studies described benefits from tDCS in post-stroke dysphagia, as they present too many methodological differences, it is not possible to compare them. In addition, many articles included patients with less than 6 months after stroke, which is an important bias as the swallowing function can be recovered spontaneously within this period, turning the certainty of the evidence really low.
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Affiliation(s)
| | | | | | - Gabriela Borges Nager
- School of Medicine, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil
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Dawson J, Abdul-Rahim AH, Kimberley TJ. Neurostimulation for treatment of post-stroke impairments. Nat Rev Neurol 2024; 20:259-268. [PMID: 38570705 DOI: 10.1038/s41582-024-00953-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/29/2024] [Indexed: 04/05/2024]
Abstract
Neurostimulation, the use of electrical stimulation to modulate the activity of the nervous system, is now commonly used for the treatment of chronic pain, movement disorders and epilepsy. Many neurostimulation techniques have now shown promise for the treatment of physical impairments in people with stroke. In 2021, vagus nerve stimulation was approved by the FDA as an adjunct to intensive rehabilitation therapy for the treatment of chronic upper extremity deficits after ischaemic stroke. In 2024, pharyngeal electrical stimulation was conditionally approved by the UK National Institute for Health and Care Excellence for neurogenic dysphagia in people with stroke who have a tracheostomy. Many other approaches have also been tested in pivotal device trials and a number of approaches are in early-phase study. Typically, neurostimulation techniques aim to increase neuroplasticity in response to training and rehabilitation, although the putative mechanisms of action differ and are not fully understood. Neurostimulation techniques offer a number of practical advantages for use after stroke, such as precise dosing and timing, but can be invasive and costly to implement. This Review focuses on neurostimulation techniques that are now in clinical use or that have reached the stage of pivotal trials and show considerable promise for the treatment of post-stroke impairments.
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Affiliation(s)
- Jesse Dawson
- School of Cardiovascular and Metabolic Health, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK.
| | - Azmil H Abdul-Rahim
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
- Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Teresa J Kimberley
- Department of Physical Therapy, School of Health and Rehabilitation Sciences, Institute of Health Professions, Massachusetts General Hospital, Boston, MA, USA
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Striteska M, Kremlacek J. The headshake enhances oculomotor response to galvanic vestibular stimulation in healthy subjects. Clin Neurophysiol 2024; 161:10-16. [PMID: 38432184 DOI: 10.1016/j.clinph.2024.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 01/27/2024] [Accepted: 02/11/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVE To investigate whether a headshake applied during galvanic vestibular stimulation (GVS) can enhance GVS-induced nystagmus in healthy subjects. METHODS In nineteen healthy participants, we evaluated an average slow-phase velocity (aSPV) of nystagmus in a head-still and after the headshake conditions, with/out the bitemporal 2 mA GVS. The GVS was applied also with polarity congruent (supporting) or incongruent (suppressing) to any preexisting spontaneous nystagmus. RESULTS The orientation of GVS-induced nystagmus depended on GVS polarity. In the head-still condition, the GVS-induced nystagmus in 14 subjects (74%) for congruent and in 12 subjects (63%) for incongruent GVS. During headshake, we recorded nystagmus in 16 subjects (84%) for congruent and 15 subjects (79%) for incongruent GVS. The aSPV of congruent GVS-induced nystagmus was higher (p = 0.0003) by 1.33 (SE 0.26) deg/s for headshake compared to head-still condition. The aSPV of incongruent GVS also induced higher nystagmus (p = 0.0014) by 1.24 (SE 0.28) deg/s for the headshake condition. CONCLUSION Our study adds a new principle to the knowledge of the central processing of a GVS response in healthy subjects. The GVS-safety profile of current up to 2 mA was sufficient to elicit a significant GVS nystagmus response in a head-still position in 63% and after a headshake in 79%. Compared to the GVS head-still condition, a headshake enhanced the GVS-induced nystagmus more than twice. SIGNIFICANCE The headshake helps to identify GVS-induced nystagmus, which can be weak or absent during the head-still condition.
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Affiliation(s)
- Maja Striteska
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Hradec Kralove, Charles University, Faculty of Medicine in Hradec Kralove, Czech Republic; Department of Otorhinolaryngology, 3rd Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Czech Republic.
| | - Jan Kremlacek
- Department of Medical Biophysics and Department of Pathological Physiology, Charles University, Faculty of Medicine in Hradec Kralove, Czech Republic
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Comino-Suárez N, Serrano-Muñoz D, Beltran-Alacreu H, Belda-Pérez P, Avendaño-Coy J. Efficacy of Transcranial Direct Current Stimulation on Pain Intensity and Functionality in Patients With Knee Osteoarthritis: A Systematic Review and Meta-analysis. Am J Phys Med Rehabil 2024; 103:428-438. [PMID: 38112570 DOI: 10.1097/phm.0000000000002386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
OBJECTIVE The aim of the study is to investigate whether transcranial direct current stimulation is superior to control groups or other interventions for pain relief and improving functionality in knee osteoarthritis patients. METHODS PubMed, the Physiotherapy Evidence Database, the Cochrane Library, ProQuest, and Scopus databases were searched from inception to July 2022 to identify randomized clinical trials. The main outcomes were subjective perception of pain intensity measured either with the visual analog scale or with the numeric rating scale; and the functionality, assessed with the Western Ontario and McMaster Universities Osteoarthritis Index. As secondary outcomes, pressure pain threshold, conditioned pain modulation, and its safety were evaluated. RESULTS We identified 10 randomized clinical trials (634 participants). The results showed an important effect favoring transcranial direct current stimulation for pain relief (mean difference = -1.1 cm, 95% confident interval = -2.1 to -0.2) and for improving functionality (standardized mean difference = -0.6, 95% confident interval = -1.02 to -0.26). There was also a significant improvement in pressure pain threshold (mean difference = 0.9 Kgf/cm 2 , 95% confident interval = 0.1 to 1.6). The certainty of evidence according to Grades of Recommendation Assessment, Development and Evaluation was generally moderate. CONCLUSIONS Our findings suggest that transcranial direct current stimulation is a safe treatment for reducing pain intensity, improving functionality, and the pressure pain thresholds in patients with knee osteoarthritis.
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Affiliation(s)
- Natalia Comino-Suárez
- From the Toledo Physiotherapy Research Group (GIFTO), Faculty of Physiotherapy and Nursery, Universidad de Castilla-La Mancha, Toledo, Spain
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Delicado-Miralles M, Flix-Diez L, Gurdiel-Álvarez F, Velasco E, Galán-Calle M, Lerma Lara S. Temporal Dynamics of Adverse Effects across Five Sessions of Transcranial Direct Current Stimulation. Brain Sci 2024; 14:457. [PMID: 38790436 PMCID: PMC11118034 DOI: 10.3390/brainsci14050457] [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: 04/17/2024] [Revised: 04/26/2024] [Accepted: 04/29/2024] [Indexed: 05/26/2024] Open
Abstract
(1) Background: Transcranial direct current stimulation (tDCS) is a safe intervention, only producing mild and transient adverse effects (AEs). However, there is no detailed analysis of the pattern of adverse effects in an application transferable to the clinic. Therefore, our objective is to describe the AEs produced by tDCS and its temporal evolution. (2) Methods: A total of 33 young volunteers were randomized into a tDCS or sham group. Participants performed a hand dexterity task while receiving the tDCS or sham intervention (20 min and 1 mA), for five consecutive days. AEs were assessed daily after each intervention and classified as somatosensory, pain, or other effects. (3) Results: The number of AEs was generally increased by tDCS intervention. Specifically, tDCS led to more frequent somatosensory discomfort, characterized by sensations like itching and tingling, alongside painful sensations such as burning, compared to the sham intervention. Additionally, certain adverse events, including neck and arm pain, as well as dizziness and blurry vision, were exclusive to the tDCS group. Interestingly, tDCS produced similar AEs across the days; meanwhile, the somatosensory AEs in the sham group showed a trend to decrease. (4) Conclusions: tDCS produces mild and temporary somatosensory and pain AEs during and across sessions. The different evolution of the AEs between the tDCS and sham protocol could unmask the blinding protocol most used in tDCS studies. Potential solutions for improving blinding protocols for future studies are discussed.
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Affiliation(s)
- Miguel Delicado-Miralles
- Department of Pathology and Surgery, Center for Translational Research in Physiotherapy, Miguel Hernández University, Sant Joan d’Alacant, 03550 Alicante, Spain;
| | - Laura Flix-Diez
- Physiotherapy Faculty, Universidad de Valencia (UV), 46010 Valencia, Spain;
| | - Francisco Gurdiel-Álvarez
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine University of Rey Juan Carlos, 28922 Alcorcón, Spain;
| | - Enrique Velasco
- Laboratory of Ion Channel Research, Department of Cellular and Molecular Medicine, KU Leuven, VIB-KU Leuven Center for Brain & Disease Research, 3001 Leuven, Belgium;
| | - María Galán-Calle
- Health Sciences Faculty, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, 28023 Madrid, Spain;
| | - Sergio Lerma Lara
- Health Sciences Faculty, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, 28023 Madrid, Spain;
- Motion in Brains Research Group, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, 28023 Madrid, Spain
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Cangussu AI, Lucarini B, Melo IDF, Diniz PA, Mancini M, Viana BDM, Romano-Silva MA, Miranda DMD. Motor Effects of Intervention With Transcranial Direct Current Stimulation for Physiotherapy Treatment in Children With Cerebral Palsy: Protocol for a Randomized Clinical Trial. JMIR Res Protoc 2024; 13:e52922. [PMID: 38687586 PMCID: PMC11094605 DOI: 10.2196/52922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 12/27/2023] [Accepted: 01/20/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Children diagnosed with cerebral palsy (CP) often experience various limitations, particularly in gross motor function and activities of daily living. Transcranial direct current stimulation (tDCS) is a noninvasive brain stimulation technique that has been used to improve movement, gross motor function, and activities of daily living. OBJECTIVE This study aims to evaluate the potential additional effects of physiotherapy combined with tDCS in children with CP in comparison with physiotherapy only. METHODS This is a 2-arm randomized controlled trial that will compare the effects of tDCS as an adjunctive treatment during rehabilitation sessions to rehabilitation without tDCS. Children with CP classified by the Gross Motor Function Classification System as levels I and II will be randomly assigned to either the sham + rehabilitation group or the tDCS + rehabilitation group. The primary outcome will be the motor skills assessed using the Gross Motor Function Measure domain E scores, and the secondary outcome will be the measurement scores of the children's quality of life. The intervention will consist of a 10-day stimulation protocol with tDCS spread over 2 weeks, with stimulation or sham tDCS administered for 20 minutes at a frequency of 1 Hz, in combination with physiotherapy. Physical therapy exercises will be conducted in a circuit based on each child's baseline Gross Motor Function Measure results. The participants' changes will be evaluated and compared in both groups. Intervenient features will be tested. RESULTS Data collection is ongoing and is expected to be completed by January 2025. A homogeneous sample and clear outcomes may be a highlight of this protocol, which may allow us to understand the potential use of tDCS and for whom it should or should not be used. CONCLUSIONS A study with good evidence and clear outcomes in children with CP might open an avenue for the potential best use of neurostimulation. TRIAL REGISTRATION Brazilian Registry of Clinical Trials RBR-104h4s4y; https://tinyurl.com/47r3x2e4. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/52922.
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Affiliation(s)
- Anna Izabel Cangussu
- Faculdade de Medicina da Universidade Federal de Minas Gerais, Federal University of Minas Gerais, Belo Horizonte, Brazil
- Instituto Nacional de Ciência e Tecnologia de Medicina Molecular, Universidade Federal de Minas Gerais, Belo Horinzote, Brazil
| | - Beatriz Lucarini
- Faculdade de Medicina da Universidade Federal de Minas Gerais, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Igor de Freitas Melo
- Faculdade de Medicina da Universidade Federal de Minas Gerais, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Paula Araújo Diniz
- Faculdade de Medicina da Universidade Federal de Minas Gerais, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Marisa Mancini
- Departament of Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Bernardo de Mattos Viana
- Faculdade de Medicina da Universidade Federal de Minas Gerais, Federal University of Minas Gerais, Belo Horizonte, Brazil
- Instituto Nacional de Ciência e Tecnologia Neurotech R, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Marco Aurélio Romano-Silva
- Faculdade de Medicina da Universidade Federal de Minas Gerais, Federal University of Minas Gerais, Belo Horizonte, Brazil
- Instituto Nacional de Ciência e Tecnologia Neurotech R, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Débora Marques de Miranda
- Faculdade de Medicina da Universidade Federal de Minas Gerais, Federal University of Minas Gerais, Belo Horizonte, Brazil
- Instituto Nacional de Ciência e Tecnologia Neurotech R, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- Departamento de Pediatria, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Yadollahpour A, Rashidi S, Saki N, Kunwar PS, Mayo-Yáñez M. Repeated Bilateral Transcranial Direct Current Stimulation over Auditory Cortex for Tinnitus Treatment: A Double-Blinded Randomized Controlled Clinical Trial. Brain Sci 2024; 14:373. [PMID: 38672022 PMCID: PMC11048041 DOI: 10.3390/brainsci14040373] [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: 08/12/2023] [Revised: 03/28/2024] [Accepted: 04/03/2024] [Indexed: 04/28/2024] Open
Abstract
Transcranial direct current stimulation (tDCS) is a non-invasive and painless technique of brain neuromodulation that applies a low-intensity galvanic current to the scalp with the aim of stimulating specific areas of the brain. Preliminary investigations have indicated the potential therapeutic efficacy of multisession tDCS applied to the auditory cortex (AC) in the treatment of chronic tinnitus. The aim of this study was to explore the therapeutic effects of repeated sessions of bilateral tDCS targeting the AC on chronic tinnitus. A double-blinded randomized placebo-controlled trial was conducted on patients (n = 48) with chronic intractable tinnitus (>2 years duration). Participants were randomly allocated to two groups: one receiving tDCS (n = 26), with the anode/cathode placed over the left/right AC, and the other receiving a placebo treatment (n = 22). A 20 min daily session of 2 mA current was administered for five consecutive days per week over two consecutive weeks, employing 35 cm2 electrodes. Tinnitus handicap inventory (THI) scores, tinnitus loudness, and tinnitus distress were measured using a visual analogue scale (VAS), and were assessed before intervention, immediately after, and at one-month follow-up. Anodal tDCS significantly reduced THI from 72.93 ± 10.11 score to 46.40 ± 15.36 after the last session and 49.68 ± 14.49 at one-month follow-up in 18 out of 25 participants (p < 0.001). The risk ratio (RR) of presenting an improvement of ≥20 points in the THI after the last session was 10.8 in patients treated with tDCS. Statistically significant reductions were observed in distress VAS and loudness VAS (p < 0.001). No statistically significant differences in the control group were observed. Variables such as age, gender, duration of tinnitus, laterality of tinnitus, baseline THI scores, and baseline distress and loudness VAS scores did not demonstrate significant correlations with treatment response. Repeated sessions of bilateral AC tDCS may potentially serve as a therapeutic modality for chronic tinnitus.
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Affiliation(s)
- Ali Yadollahpour
- Department of Psychology, University of Sheffield, Sheffield S1 2LT, UK;
- Bioelectromagnetic Clinic, Imam Khomeini Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz 61357-15794, Iran
| | - Samaneh Rashidi
- Department of Psychology, University of Surrey, Guildford GU2 7XH, UK;
| | - Nader Saki
- Hearing and Speech Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz 61357-15794, Iran;
| | - Pramod Singh Kunwar
- Department of Pharmaceutics and Pharmacy Practice, School of Pharmacy, Mount Kenya University, Thika P.O. Box 342-01000, Kenya;
| | - Miguel Mayo-Yáñez
- Department of Otorhinolaryngology—Head and Neck Surgery, Complexo Hospitalario Universitario A Coruña (CHUAC), 15006 A Coruña, Spain
- Department of Otorhinolaryngology—Head and Neck Surgery, Hospital San Rafael (HSR), 15006 A Coruña, Spain
- Otorhinolaryngology—Head and Neck Surgery Research Group, Institute of Biomedical Research of A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), Universidade da Coruña (UDC), 15006 A Coruña, Spain
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Yang X, Wu J, Tang Y, Ren Z. Effects of anodic transcranial direct current stimulation combined with physical training on the performance of elite swimmers. Front Physiol 2024; 15:1383491. [PMID: 38665598 PMCID: PMC11043593 DOI: 10.3389/fphys.2024.1383491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 04/02/2024] [Indexed: 04/28/2024] Open
Abstract
Objective Anodal transcranial direct current stimulation (a-tDCS) has been used to improve athletic performance in various populations; however, its role in improving performance in elite athletes is unclear. This study aimed to investigate the effects of a-tDCS on athletic performance in elite athletes. Methods We used a single-blind, randomized controlled experimental design and recruited 24 national-level freestyle swimmers from China. All athletes were randomly divided into two groups; the experimental group underwent a-tDCS (current 2 mA for 20 min) combined with physical training, and the control group underwent a-tDCS sham stimulation combined with physical training. The physical training program was identical in the experimental and control groups. The intervention period was 6 weeks, with five weekly sessions of 110 min each, consisting of 20 min of a-tDCS and 90 min of physical training. Base strength, explosive strength, aerobic endurance, and anaerobic endurance were measured in the athletes before and after the intervention. Results The results were as follows. 1) Basic strength: There was a significant improvement in 5RM pull-ups in the experimental and control groups before and after the intervention (p < 0.05). 2) Explosive strength: There was a significant improvement in vertical jump and swimming start distance into the water in the experimental and control groups before and after the intervention (p < 0.05). 3) Aerobic endurance: There was no significant improvement in the experimental and control groups before and after the intervention. 4) Anaerobic endurance: There was a significant improvement in 400 m running performance in the experimental and control groups before and after the intervention (p < 0.05). Conclusion Compared to physical training alone, a-tDCS combined with physical training can better improve the athletic performance of high-level swimmers, especially in basic strength, explosive strength, and aerobic endurance.
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Affiliation(s)
- Xipeng Yang
- College of Physical Education, Shenzhen University, Shenzhen, China
| | - Jinlong Wu
- College of Physical Education, Southwest University, Chongqing, China
| | - Yucheng Tang
- College of Physical Education, Shenzhen University, Shenzhen, China
| | - Zhanbing Ren
- College of Physical Education, Shenzhen University, Shenzhen, China
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Jiang Y, Ramasawmy P, Antal A. Uncorking the limitation-improving dual tasking using transcranial electrical stimulation and task training in the elderly: a systematic review. Front Aging Neurosci 2024; 16:1267307. [PMID: 38650865 PMCID: PMC11033383 DOI: 10.3389/fnagi.2024.1267307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 03/22/2024] [Indexed: 04/25/2024] Open
Abstract
Introduction With aging, dual task (DT) ability declines and is more cognitively demanding than single tasks. Rapidly declining DT performance is regarded as a predictor of neurodegenerative disease. Task training and non-invasive transcranial electrical stimulation (tES) are methods applied to optimize the DT ability of the elderly. Methods A systematic search was carried out in the PUBMED, TDCS (transcranial direct current stimulation) databases, as well as Web of Science, and a qualitative analysis was conducted in 56 included studies. Aiming to summarize the results of studies that implemented tES, task training, or the combination for improving DT ability and related performance changes in healthy elderly and geriatric patients. For different approaches, the training procedures, parameters, as well as outcomes were discussed. Results Task training, particularly cognitive-motor DT training, has more notable effects on improving DT performance in the elderly when compared to the neuromodulation method. Discussion Anodal transcranial direct current stimulation (tDCS) over the left dorsolateral prefrontal cortex (L-DLPFC), or its combination with task training could be promising tools. However, additional evidence is required from aged healthy people and patients, as well as further exploration of electrode montage.
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Affiliation(s)
- Yong Jiang
- Department of Neurology, University Medical Center, Georg August University of Göttingen, Göttingen, Germany
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Buccilli B. Exploring new horizons: Emerging therapeutic strategies for pediatric stroke. Exp Neurol 2024; 374:114701. [PMID: 38278205 DOI: 10.1016/j.expneurol.2024.114701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 12/31/2023] [Accepted: 01/23/2024] [Indexed: 01/28/2024]
Abstract
Pediatric stroke presents unique challenges, and optimizing treatment strategies is essential for improving outcomes in this vulnerable population. This review aims to provide an overview of new, innovative, and potential treatments for pediatric stroke, with a primary objective to stimulate further research in this field. Our review highlights several promising approaches in the realm of pediatric stroke management, including but not limited to stem cell therapy and robotic rehabilitation. These innovative interventions offer new avenues for enhancing functional recovery, reducing long-term disability, and tailoring treatments to individual patient needs. The findings of this review underscore the importance of ongoing research and development of innovative treatments in pediatric stroke. These advancements hold significant clinical relevance, offering the potential to improve the lives of children affected by stroke by enhancing the precision, efficacy, and accessibility of therapeutic interventions. Embracing these innovations is essential in our pursuit of better outcomes and a brighter future for pediatric stroke care.
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Affiliation(s)
- Barbara Buccilli
- Icahn School of Medicine at Mount Sinai, Department of Neurosurgery, 1 Gustave L. Levy Pl, New York, NY 10029, United States of America.
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Li C, Tao M, Chen D, Wei Q, Xiong X, Zhao W, Tan W, Yang J, Han Y, Zhang H, Zhang S, Liu H, Cao JL. Transcranial Direct Current Stimulation for Anxiety During Laparoscopic Colorectal Cancer Surgery: A Randomized Clinical Trial. JAMA Netw Open 2024; 7:e246589. [PMID: 38635271 DOI: 10.1001/jamanetworkopen.2024.6589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2024] Open
Abstract
Importance Perioperative anxiety is prevalent among patients undergoing surgical treatment of cancer and often influences their prognosis. Transcranial direct current stimulation (tDCS) has shown potential in the treatment of various anxiety-related disorders, but data on the impact of tDCS on perioperative anxiety are limited. Objective To evaluate the effect of tDCS in reducing perioperative anxiety among patients undergoing laparoscopic colorectal cancer (CRC) resection. Design, Setting, And Participants This randomized clinical trial was conducted from March to August 2023 at the Affiliated Hospital of Xuzhou Medical University. Patients aged 18 years or older undergoing elective laparoscopic radical resection for CRC were randomly assigned to either the active tDCS group or the sham tDCS group. Intention-to-treat data analysis was performed in September 2023. Interventions Patients were randomly assigned to receive 2 sessions of either active tDCS or sham tDCS over the left dorsolateral prefrontal cortex on the afternoon of the day before the operation and in the morning of the day of operation. Main Outcomes and Measures The main outcome was the incidence of perioperative anxiety from the day of the operation up to 3 days after the procedure, as measured using the Hospital Anxiety and Depression Scale-Anxiety (HADS-A) subscale (range: 0-21, with higher scores indicating more anxiety). Secondary outcomes included postoperative delirium (assessed by the Confusion Assessment Method or Confusion Assessment Method intensive care unit scale); pain (assessed by the 10-point Numeric Rating Scale [NRS], with scores ranging from 0 [no pain] to 10 [worst pain]); frailty (assessed by the Fatigue, Resistance, Ambulation, Illness and Loss of Weight [FRAIL] Index, with scores ranging from 0 [most robust] to 5 [most frail]; and sleep quality (assessed by the Pittsburgh Sleep Quality Index [PSQI], with scores ranging from 0 to 21 and higher scores indicating worse sleep quality) after the 2 sessions of the tDCS intervention. Results A total of 196 patients (mean [SD] age, 63.5 [11.0] years; 124 [63.3%] men) were recruited and randomly assigned to the active tDCS group (98 patients) or the sham tDCS group (98 patients). After the second tDCS intervention on the day of the operation, the incidence of perioperative anxiety was 38.8% in the active tDCS group and 70.4% in the sham tDCS group (relative risk, 0.55 [95% CI, 0.42-0.73]; P < .001). Patients in the active tDCS group vs the sham tDCS group were less likely to have postoperative delirium (8.2% vs 25.5%) and, at 3 days after the operation, had lower median (IQR) pain scores (NRS, 1.0 [1.0-1.0] vs 2.0 [2.0-2.0]), better median (IQR) sleep quality scores (PSQI, 10.5 [10.0-11.0] vs 12.0 [11.0-13.0]), and lower median (IQR) FRAIL Index (2.0 [1.0-2.0] vs 2.0 [2.0-3.0]). Conclusions and Relevance Findings of this randomized clinical trial indicate that administration of 2 preoperative sessions of tDCS was associated with a decreased incidence of perioperative anxiety in patients undergoing elective CRC resection. Active tDCS was also associated with better anxiety scores, pain levels, and sleep quality as well as reduced postoperative delirium and frailty. The findings suggest that tDCS may be a novel strategy for improving perioperative anxiety in patients undergoing CRC resection. Trial Registration Chinese Clinical Trial Register Identifier: ChiCTR2300068859.
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Affiliation(s)
- Chunyan Li
- Department of Anesthesiology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
- National Medical Products Administration Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, Xuzhou, China
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, China
- Jiangsu Key Laboratory of Applied Technology of Anesthesia and Analgesia, Xuzhou Medical University, Xuzhou, China
| | - Mingshu Tao
- Department of Anesthesiology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
- National Medical Products Administration Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, Xuzhou, China
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, China
- Jiangsu Key Laboratory of Applied Technology of Anesthesia and Analgesia, Xuzhou Medical University, Xuzhou, China
| | - Dexian Chen
- Department of Anesthesiology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
- National Medical Products Administration Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, Xuzhou, China
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, China
- Jiangsu Key Laboratory of Applied Technology of Anesthesia and Analgesia, Xuzhou Medical University, Xuzhou, China
| | - Qi Wei
- Department of Anesthesiology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
- National Medical Products Administration Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, Xuzhou, China
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, China
- Jiangsu Key Laboratory of Applied Technology of Anesthesia and Analgesia, Xuzhou Medical University, Xuzhou, China
| | - Xingyu Xiong
- Department of Anesthesiology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
- National Medical Products Administration Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, Xuzhou, China
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, China
- Jiangsu Key Laboratory of Applied Technology of Anesthesia and Analgesia, Xuzhou Medical University, Xuzhou, China
| | - Wenxin Zhao
- Department of Anesthesiology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
- National Medical Products Administration Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, Xuzhou, China
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, China
- Jiangsu Key Laboratory of Applied Technology of Anesthesia and Analgesia, Xuzhou Medical University, Xuzhou, China
| | - Wen Tan
- Department of Anesthesiology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
- National Medical Products Administration Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, Xuzhou, China
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, China
- Jiangsu Key Laboratory of Applied Technology of Anesthesia and Analgesia, Xuzhou Medical University, Xuzhou, China
| | - Jie Yang
- Department of Anesthesiology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
- National Medical Products Administration Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, Xuzhou, China
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, China
- Jiangsu Key Laboratory of Applied Technology of Anesthesia and Analgesia, Xuzhou Medical University, Xuzhou, China
| | - Yuan Han
- Department of Anesthesiology, Eye & ENT Hospital of Fudan University, Shanghai, China
| | - Hongxing Zhang
- Department of Anesthesiology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
- National Medical Products Administration Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, Xuzhou, China
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, China
- Jiangsu Key Laboratory of Applied Technology of Anesthesia and Analgesia, Xuzhou Medical University, Xuzhou, China
| | - Song Zhang
- Department of Anesthesiology, Renji Hospital and Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - He Liu
- Department of Anesthesiology & Clinical Research Center for Anesthesia and Perioperative Medicine, Huzhou Central Hospital, Huzhou, China
- Department of Anesthesiology & Clinical Research Center for Anesthesia and Perioperative Medicine, The Fifth School of Clinical Medicine of Zhejiang Chinese Medical University, Huzhou, China
- Department of Anesthesiology & Clinical Research Center for Anesthesia and Perioperative Medicine, The Affiliated Huzhou Hospital, Zhejiang University School of Medicine, Huzhou, China
- Department of Anesthesiology & Clinical Research Center for Anesthesia and Perioperative Medicine, The Affiliated Central Hospital, Huzhou University School of Medicine, Huzhou, China
| | - Jun-Li Cao
- National Medical Products Administration Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, Xuzhou, China
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, China
- Jiangsu Key Laboratory of Applied Technology of Anesthesia and Analgesia, Xuzhou Medical University, Xuzhou, China
- Huzhou Key Laboratory of Basic Research and Clinical Translation for Neuromodulation, The Fifth School of Clinical Medicine of Zhejiang Chinese Medical University, Huzhou, China
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Fernandes SM, Mendes AJ, Rodrigues PF, Conde A, Rocha M, Leite J. Efficacy and safety of repetitive Transcranial Magnetic Stimulation and transcranial Direct Current Stimulation in memory deficits in patients with Alzheimer's disease: Meta-analysis and systematic review. Int J Clin Health Psychol 2024; 24:100452. [PMID: 38444886 PMCID: PMC10914562 DOI: 10.1016/j.ijchp.2024.100452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 02/28/2024] [Indexed: 03/07/2024] Open
Abstract
Repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) are two of the most used non-pharmacological interventions for Alzheimer's Disease (AD). However, most of the clinical trials have focused on evaluating the effects on global cognition and not on specific cognitive functions. Therefore, considering that memory loss is one of the hallmark symptoms of AD, we aim to assess the efficacy and safety of tDCS and rTMS in memory deficits. For that, multilevel random effect models were performed considering the standardized mean difference (SMD) between active and sham stimulation. A total of 19 studies with 411 participants demonstrated positive effects in memory after tDCS (SMD=0.20, p = 0.04) and rTMS (SMD=0.44, p = 0.001). Subgroup analysis revealed that tDCS had greater efficacy when administered in temporal regions (SMD=0.32, p = 0.04), whereas rTMS was superior when applied in frontal regions (SMD=0.61, p < 0.001). Therefore, depending on the brain region of stimulation, both interventions produced a positive effect on memory symptoms in AD patients. Finally, the safety of both techniques was observed in the AD population after the reporting of almost no serious events.
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Affiliation(s)
- Sara M. Fernandes
- CINTESIS@RISE, CINTESIS.UPT, Portucalense University, 4200-072 Porto, Portugal
| | - Augusto J. Mendes
- Laboratory of Neuroimaging of Aging (LANVIE), University of Geneva, Geneva, Switzerland
- Geneva Memory Center, Department of Rehabilitation and Geriatrics, Geneva University Hospitals, Geneva, Switzerland
| | | | - Ana Conde
- CINTESIS@RISE, CINTESIS.UPT, Portucalense University, 4200-072 Porto, Portugal
| | - Magda Rocha
- CINTESIS@RISE, CINTESIS.UPT, Portucalense University, 4200-072 Porto, Portugal
| | - Jorge Leite
- CINTESIS@RISE, CINTESIS.UPT, Portucalense University, 4200-072 Porto, Portugal
- Brain@Loop Lab
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Toth J, Kurtin DL, Brosnan M, Arvaneh M. Opportunities and obstacles in non-invasive brain stimulation. Front Hum Neurosci 2024; 18:1385427. [PMID: 38562225 PMCID: PMC10982339 DOI: 10.3389/fnhum.2024.1385427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 03/05/2024] [Indexed: 04/04/2024] Open
Abstract
Non-invasive brain stimulation (NIBS) is a complex and multifaceted approach to modulating brain activity and holds the potential for broad accessibility. This work discusses the mechanisms of the four distinct approaches to modulating brain activity non-invasively: electrical currents, magnetic fields, light, and ultrasound. We examine the dual stochastic and deterministic nature of brain activity and its implications for NIBS, highlighting the challenges posed by inter-individual variability, nebulous dose-response relationships, potential biases and neuroanatomical heterogeneity. Looking forward, we propose five areas of opportunity for future research: closed-loop stimulation, consistent stimulation of the intended target region, reducing bias, multimodal approaches, and strategies to address low sample sizes.
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Affiliation(s)
- Jake Toth
- Automatic Control and Systems Engineering, Neuroscience Institute, Insigneo Institute, University of Sheffield, Sheffield, United Kingdom
| | | | - Méadhbh Brosnan
- School of Psychology, University College Dublin, Dublin, Ireland
- Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom
- Oxford Centre for Human Brain Activity, Wellcome Centre for Integrative Neuroimaging, Department of Psychiatry, University of Oxford, Oxford, United Kingdom
- Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Melbourne, VIC, Australia
| | - Mahnaz Arvaneh
- Automatic Control and Systems Engineering, Neuroscience Institute, Insigneo Institute, University of Sheffield, Sheffield, United Kingdom
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Battisti A, Lazzaro G, Varuzza C, Vicari S, Menghini D. Effects of online tDCS and hf-tRNS on reading performance in children and adolescents with developmental dyslexia: a study protocol for a cross sectional, within-subject, randomized, double-blind, and sham-controlled trial. Front Neurol 2024; 15:1338430. [PMID: 38533416 PMCID: PMC10964771 DOI: 10.3389/fneur.2024.1338430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 02/28/2024] [Indexed: 03/28/2024] Open
Abstract
Background Developmental Dyslexia (DD) is a brain-based developmental disorder causing severe reading difficulties. The extensive data on the neurobiology of DD have increased interest in brain-directed approaches, such as transcranial direct current stimulation (tDCS), which have been proposed for DD. While positive outcomes have been observed, results remain heterogeneous. Various methodological approaches have been employed to address this issue. However, no studies have compared the effects of different transcranial electrical stimulation techniques (e.g., tDCS and transcranial random noise stimulation, tRNS), on reading in children and adolescents with DD. Methods The present within-subject, double-blind, and sham-controlled trial aims to investigate the effects of tDCS and hf-tRNS on reading in children and adolescents with DD. Participants will undergo three conditions with a one-week interval session: (A) single active tDCS session; (B) single active hf-tRNS session; and (C) single sham session (tDCS/hf-tRNS). Left anodal/right cathodal tDCS and bilateral tRNS will be applied over the temporo-parietal regions for 20 min each. Reading measures will be collected before and during each session. Safety and blinding parameters will be recordered. Discussion We hypothesize that tRNS will demonstrate comparable effectiveness to tDCS in improving reading compared to sham conditions. Additionally, we anticipate that hf-tRNS will exhibit a similar safety profile to tDCS. This study will contribute novel insights into the effectiveness of hf-tRNS, expediting the validation of brain-based treatments for DD.
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Affiliation(s)
- Andrea Battisti
- Child and Adolescent Neuropsychiatry Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
- Department of Human Sciences, LUMSA University, Rome, Italy
| | - Giulia Lazzaro
- Child and Adolescent Neuropsychiatry Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Cristiana Varuzza
- Child and Adolescent Neuropsychiatry Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Stefano Vicari
- Child and Adolescent Neuropsychiatry Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
- Department of Life Sciences and Public Health, Catholic University of the Sacred Heart, Rome, Italy
| | - Deny Menghini
- Child and Adolescent Neuropsychiatry Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
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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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McDonald MA, Meckes SJ, Shires J, Berryhill ME, Lancaster CL. Augmenting Virtual Reality Exposure Therapy for Social and Intergroup Anxiety With Transcranial Direct Current Stimulation. J ECT 2024; 40:51-60. [PMID: 38009966 PMCID: PMC10920400 DOI: 10.1097/yct.0000000000000967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
OBJECTIVES Exposure therapy is a cornerstone of social anxiety treatment, yet not all patients respond. Symptoms in certain social situations, including intergroup (ie, out-group) contexts, may be particularly resistant to treatment. Exposure therapy outcomes may be improved by stimulating neural areas associated with safety learning, such as the medial prefrontal cortex (mPFC). The mPFC also plays an important role in identifying others as similar to oneself. We hypothesized that targeting the mPFC during exposure therapy would reduce intergroup anxiety and social anxiety. METHODS Participants (N = 31) with the public speaking subtype of social anxiety received active (anodal) or sham transcranial direct current stimulation (tDCS) targeting the mPFC during exposure therapy. Exposure therapy consisted of giving speeches to audiences in virtual reality. To target intergroup anxiety, half of the public speaking exposure trials were conducted with out-group audiences, defined in this study as audiences of a different ethnicity. RESULTS Contrary to hypotheses, tDCS did not facilitate symptom reduction. Some evidence even suggested that tDCS temporarily increased in-group favoritism, although these effects dissipated at 1-month follow-up. In addition, collapsing across all participants, we found reductions across time for public speaking anxiety and intergroup anxiety. CONCLUSIONS The data provide evidence that standard exposure therapy techniques for social anxiety can be adapted to target intergroup anxiety. Transcranial direct current stimulation targeting the mPFC may boost safety signaling, but only in contexts previously conditioned to signal safety, such as an in-group context.
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Salehinejad MA, Siniatchkin M. Safety of noninvasive brain stimulation in children. Curr Opin Psychiatry 2024; 37:78-86. [PMID: 38226535 DOI: 10.1097/yco.0000000000000923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2024]
Abstract
PURPOSE OF REVIEW Noninvasive brain stimulation (NIBS) is a promising method for altering cortical excitability with clinical implications. It has been increasingly used in children, especially in neurodevelopmental disorders. Yet, its safety and applications in the developing brain require further investigation. This review aims to provide an overview of the safety of commonly used NIBS techniques in children, including transcranial electrical stimulation (tES) and transcranial magnetic stimulation (TMS). Safety data for other NIBS methods is not reported in this review. RECENT FINDINGS In line with studies from the last decade, findings in the last 2 years (2022-2023) support the safety of NIBS in children and adolescents within the currently applied protocols. Both tES and TMS are well tolerated, if safety rules, including exclusion criteria, are applied. SUMMARY We briefly discussed developmental aspects of stimulation parameters that need to be considered in the developing brain and provided an up-to-date overview of tES/TMS applications in children and adolescents. Overall, the safety profile of tES/TMS in children is good. For both the tES and TMS applications, epilepsy and active seizure disorder should be exclusion criteria to prevent potential seizures. Using child-sized earplugs is required for TMS applications. We lack large randomized double-blind trialsand longitudinal studies to establish the safety of NIBS in children. VIDEO ABSTRACT http://links.lww.com/YCO/A78 .
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Affiliation(s)
- Mohammad Ali Salehinejad
- Neuromdulation Group, Department of Psychology and Neurosciences, Leibniz-Institut für Arbeitsforschung an der TU Dortmund, Dortmund
| | - Michael Siniatchkin
- Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Medical Faculty, RWTH Aachen University, Aachen, Germany
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Melo L, Beaupain MC, Ghanavati E, Kuo MF, Nitsche MA. Neurochemical mechanisms underlying serotonergic modulation of neuroplasticity in humans. Brain Stimul 2024; 17:421-430. [PMID: 38574852 DOI: 10.1016/j.brs.2024.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 03/31/2024] [Accepted: 04/01/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND Studies in animals and humans have shown that cortical neuroplasticity can be modulated by increasing serotonin levels by administering selective serotonin reuptake inhibitors (SSRI). However, little is known about the mechanistic background, especially the contribution of intracortical inhibition and facilitation, which depend on gamma-aminobutyric acid (GABA) and glutamate. OBJECTIVE We aimed to explore the relevance of drivers of plasticity (glutamate- and GABA-dependent processes) for the effects of serotonin enhancement on tDCS-induced plasticity in healthy humans. METHODS A crossover, partially double-blinded, randomized, and sham-controlled study was conducted in 21 healthy right-handed individuals. In each of the 7 sessions, plasticity was induced via transcranial direct current stimulation (tDCS). Anodal, cathodal, and sham tDCS were applied to the left motor cortex under SSRI (20 mg/40 mg citalopram) or placebo. Short-interval cortical inhibition (SICI) and intracortical facilitation (ICF) were monitored by paired-pulse transcranial magnetic stimulation for 5-6 h after intervention. RESULTS Under placebo, anodal tDCS-induced LTP-like plasticity decreased SICI and increased ICF. In contrast, cathodal tDCS-elicited LTD-like plasticity induced the opposite effect. Under 20 mg and 40 mg citalopram, anodal tDCS did not affect SICI largely, while ICF was enhanced and prolonged. For cathodal tDCS, citalopram converted the increase of SICI and decrease of ICF into antagonistic effects, and this effect was dosage-dependent since it lasted longer under 40 mg when compared to 20 mg. CONCLUSION We speculate that the main effects of acute serotonergic enhancement on tDCS-induced plasticity, the increase and prolongation of LTP-like plasticity effects, involves mainly the glutamatergic system.
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Affiliation(s)
- Lorena Melo
- Department of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors (IfADo), Dortmund, Germany
| | - Marie C Beaupain
- Department of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors (IfADo), Dortmund, Germany; Department of Psychology, Ruhr-University Bochum, Germany
| | - Elham Ghanavati
- Department of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors (IfADo), Dortmund, Germany; Department of Psychology, Ruhr-University Bochum, Germany
| | - Min-Fang Kuo
- Department of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors (IfADo), Dortmund, Germany.
| | - Michael A Nitsche
- Department of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors (IfADo), Dortmund, Germany; Bielefeld University, University Hospital OWL, Protestant Hospital of Bethel Foundation, University Clinic of Psychiatry and Psychotherapy and University Clinic of Child and Adolescent Psychiatry and Psychotherapy, Germany; German Center for Mental Health (DZPG), Partner Site - Bochum/Marburg, Germany
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