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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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2
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Therrien-Blanchet JM, Ferland MC, Badri M, Rousseau MA, Merabtine A, Boucher E, Hofmann LH, Lepage JF, Théoret H. The neurophysiological aftereffects of brain stimulation in human primary motor cortex: a Sham-controlled comparison of three protocols. Cereb Cortex 2023:7030623. [PMID: 36749004 DOI: 10.1093/cercor/bhad021] [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: 10/03/2022] [Revised: 01/14/2023] [Accepted: 01/15/2023] [Indexed: 02/08/2023] Open
Abstract
Paired associative stimulation (PAS), transcranial direct current stimulation (tDCS), and transcranial alternating current stimulation (tACS) are non-invasive brain stimulation methods that are used to modulate cortical excitability. Whether one technique is superior to the others in achieving this outcome and whether individuals that respond to one intervention are more likely to respond to another remains largely unknown. In the present study, the neurophysiological aftereffects of three excitatory neurostimulation protocols were measured with transcranial magnetic stimulation (TMS). Twenty minutes of PAS at an ISI of 25 ms, anodal tDCS, 20-Hz tACS, and Sham stimulation were administered to 31 healthy adults in a repeated measures design. Compared with Sham, none of the stimulation protocols significantly modulated corticospinal excitability (input/ouput curve and slope, TMS stimulator intensity required to elicit MEPs of 1-mV amplitude) or intracortical excitability (short- and long-interval intracortical inhibition, intracortical facilitation, cortical silent period). Sham-corrected responder analysis estimates showed that an average of 41 (PAS), 39 (tDCS), and 39% (tACS) of participants responded to the interventions with an increase in corticospinal excitability. The present data show that three stimulation protocols believed to increase cortical excitability are associated with highly heterogenous and variable aftereffects that may explain a lack of significant group effects.
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Affiliation(s)
| | | | - Meriem Badri
- Département de psychologie, Université de Montréal, Montréal, QC H3C 3J7, Canada
| | | | - Amira Merabtine
- Département de psychologie, Université de Montréal, Montréal, QC H3C 3J7, Canada
| | - Emelie Boucher
- Département de psychologie, Université de Montréal, Montréal, QC H3C 3J7, Canada
| | - Lydia Helena Hofmann
- Department of Psychology and Neuroscience, Maastricht University, Maastricht 6229, The Netherlands
| | - Jean-François Lepage
- Département de Pédiatrie, Faculté de Médecine et des Sciences de la Santé de l'Université de Sherbrooke, Centre de Recherche du CHU Sherbrooke, Sherbrooke, QC J1H 5N4, Canada
| | - Hugo Théoret
- Département de psychologie, Université de Montréal, Montréal, QC H3C 3J7, Canada
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Antal A, Luber B, Brem AK, Bikson M, Brunoni AR, Cohen Kadosh R, Dubljević V, Fecteau S, Ferreri F, Flöel A, Hallett M, Hamilton RH, Herrmann CS, Lavidor M, Loo C, Lustenberger C, Machado S, Miniussi C, Moliadze V, Nitsche MA, Rossi S, Rossini PM, Santarnecchi E, Seeck M, Thut G, Turi Z, Ugawa Y, Venkatasubramanian G, Wenderoth N, Wexler A, Ziemann U, Paulus W. Non-invasive brain stimulation and neuroenhancement. Clin Neurophysiol Pract 2022; 7:146-165. [PMID: 35734582 PMCID: PMC9207555 DOI: 10.1016/j.cnp.2022.05.002] [Citation(s) in RCA: 49] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 04/19/2022] [Accepted: 05/18/2022] [Indexed: 12/15/2022] Open
Abstract
The available data frame with a wide parameter space of tES does not allow an overarching protocol recommendation. Established engineering risk-management procedures with regard to manufacturing should be followed. Consensus among experts is that tES for neuroenhancement is safe as long as tested protocols are followed.
Attempts to enhance human memory and learning ability have a long tradition in science. This topic has recently gained substantial attention because of the increasing percentage of older individuals worldwide and the predicted rise of age-associated cognitive decline in brain functions. Transcranial brain stimulation methods, such as transcranial magnetic (TMS) and transcranial electric (tES) stimulation, have been extensively used in an effort to improve cognitive functions in humans. Here we summarize the available data on low-intensity tES for this purpose, in comparison to repetitive TMS and some pharmacological agents, such as caffeine and nicotine. There is no single area in the brain stimulation field in which only positive outcomes have been reported. For self-directed tES devices, how to restrict variability with regard to efficacy is an essential aspect of device design and function. As with any technique, reproducible outcomes depend on the equipment and how well this is matched to the experience and skill of the operator. For self-administered non-invasive brain stimulation, this requires device designs that rigorously incorporate human operator factors. The wide parameter space of non-invasive brain stimulation, including dose (e.g., duration, intensity (current density), number of repetitions), inclusion/exclusion (e.g., subject’s age), and homeostatic effects, administration of tasks before and during stimulation, and, most importantly, placebo or nocebo effects, have to be taken into account. The outcomes of stimulation are expected to depend on these parameters and should be strictly controlled. The consensus among experts is that low-intensity tES is safe as long as tested and accepted protocols (including, for example, dose, inclusion/exclusion) are followed and devices are used which follow established engineering risk-management procedures. Devices and protocols that allow stimulation outside these parameters cannot claim to be “safe” where they are applying stimulation beyond that examined in published studies that also investigated potential side effects. Brain stimulation devices marketed for consumer use are distinct from medical devices because they do not make medical claims and are therefore not necessarily subject to the same level of regulation as medical devices (i.e., by government agencies tasked with regulating medical devices). Manufacturers must follow ethical and best practices in marketing tES stimulators, including not misleading users by referencing effects from human trials using devices and protocols not similar to theirs.
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Affiliation(s)
- Andrea Antal
- Department of Neurology, University Medical Center, Göttingen, Germany
- Corresponding author at: Department of Neurology, University Medical Center, Göttingen, Robert Koch Str. 40, 37075 Göttingen, Germany.
| | - Bruce Luber
- Noninvasive Neuromodulation Unit, Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - Anna-Katharine Brem
- University Hospital of Old Age Psychiatry, University of Bern, Bern, Switzerland
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Marom Bikson
- Biomedical Engineering at the City College of New York (CCNY) of the City University of New York (CUNY), NY, USA
| | - Andre R. Brunoni
- Departamento de Clínica Médica e de Psiquiatria, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
- Service of Interdisciplinary Neuromodulation (SIN), Laboratory of Neurosciences (LIM-27), Institute of Psychiatry, Hospital das Clínicas da Faculdade de Medicina da USP, São Paulo, Brazil
| | - Roi Cohen Kadosh
- School of Psychology, Faculty of Health and Medical Sciences, University of Surrey, Guildford GU2 7XH, UK
| | - Veljko Dubljević
- Science, Technology and Society Program, College of Humanities and Social Sciences, North Carolina State University, Raleigh, NC, USA
| | - Shirley Fecteau
- Department of Psychiatry and Neurosciences, Faculty of Medicine, Université Laval, CERVO Brain Research Centre, Centre intégré universitaire en santé et services sociaux de la Capitale-Nationale, Quebec City, Quebec, Canada
| | - Florinda Ferreri
- Unit of Neurology, Unit of Clinical Neurophysiology, Study Center of Neurodegeneration (CESNE), Department of Neuroscience, University of Padua, Padua, Italy
- Department of Clinical Neurophysiology, Kuopio University Hospital, University of Eastern Finland, Kuopio, Finland
| | - Agnes Flöel
- Department of Neurology, Universitätsmedizin Greifswald, 17475 Greifswald, Germany
- German Centre for Neurodegenerative Diseases (DZNE) Standort Greifswald, 17475 Greifswald, Germany
| | - Mark Hallett
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Roy H. Hamilton
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA
| | - Christoph S. Herrmann
- Experimental Psychology Lab, Department of Psychology, Carl von Ossietzky Universität, Oldenburg, Germany
| | - Michal Lavidor
- Department of Psychology and the Gonda Brain Research Center, Bar Ilan University, Israel
| | - Collen Loo
- School of Psychiatry and Black Dog Institute, University of New South Wales; The George Institute; Sydney, Australia
| | - Caroline Lustenberger
- Neural Control of Movement Lab, Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, 8092 Zurich, Switzerland
| | - Sergio Machado
- Department of Sports Methods and Techniques, Federal University of Santa Maria, Santa Maria, Brazil
- Laboratory of Physical Activity Neuroscience, Neurodiversity Institute, Queimados-RJ, Brazil
| | - Carlo Miniussi
- Center for Mind/Brain Sciences – CIMeC and Centre for Medical Sciences - CISMed, University of Trento, Rovereto, Italy
| | - Vera Moliadze
- Institute of Medical Psychology and Medical Sociology, University Medical Center Schleswig Holstein, Kiel University, Kiel, Germany
| | - Michael A Nitsche
- Department Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors at TU, Dortmund, Germany
- Dept. Neurology, University Medical Hospital Bergmannsheil, Bochum, Germany
| | - Simone Rossi
- Siena Brain Investigation and Neuromodulation Lab (Si-BIN Lab), Unit of Neurology and Clinical Neurophysiology, Department of Medicine, Surgery and Neuroscience, University of Siena, Italy
| | - Paolo M. Rossini
- Department of Neuroscience and Neurorehabilitation, Brain Connectivity Lab, IRCCS-San Raffaele-Pisana, Rome, Italy
| | - Emiliano Santarnecchi
- Precision Neuroscience and Neuromodulation Program, Gordon Center for Medical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Margitta Seeck
- Department of Clinical Neurosciences, Hôpitaux Universitaires de Genève, Switzerland
| | - Gregor Thut
- Centre for Cognitive Neuroimaging, School of Psychology and Neuroscience, EEG & Epolepsy Unit, University of Glasgow, United Kingdom
| | - Zsolt Turi
- Department of Neuroanatomy, Institute of Anatomy and Cell Biology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Yoshikazu Ugawa
- Department of Human Neurophysiology, Fukushima Medical University, Fukushima, Japan
| | | | - Nicole Wenderoth
- Neural Control of Movement Lab, Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, 8092 Zurich, Switzerland
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence And Technological Enterprise (CREATE), Singapore
| | - Anna Wexler
- Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Ulf Ziemann
- Department of Neurology and Stroke, University of Tübingen, Germany
- Hertie Institute for Clinical Brain Research, University of Tübingen, Germany
| | - Walter Paulus
- Department of of Neurology, Ludwig Maximilians University Munich, Germany
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Shi X, Guo Y, Zhu L, Wu W, Hordacre B, Su X, Wang Q, Chen X, Lan X, Dang G. Electroencephalographic connectivity predicts clinical response to repetitive transcranial magnetic stimulation in patients with insomnia disorder. Sleep Med 2021; 88:171-179. [PMID: 34773788 DOI: 10.1016/j.sleep.2021.10.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 09/10/2021] [Accepted: 10/12/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Accumulating evidence suggests that low frequency repetitive transcranial magnetic stimulation (rTMS), which generally decreases cortical excitability and remodels plastic connectivity, improves sleep quality in patients with insomnia disorder. However, the effects of rTMS vary substantially across individuals and treatment is sometimes unsatisfactory, calling for biomarkers for predicting clinical outcomes. OBJECTIVE This study aimed to investigate whether functional connectivity of the target network in electroencephalography is associated with the clinical response to low frequency rTMS in patients with insomnia disorder. METHODS Twenty-five patients with insomnia disorder were subjected to 10 sessions of treatment with 1 Hz rTMS over the right dorsolateral prefrontal cortex. Resting-state electroencephalography was collected before rTMS. Pittsburgh Sleep Quality Index, Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale, and Mini-Mental State Exam were performed before and after rTMS treatment, with a follow-up after one month. Electroencephalographic connectivity was measured by the power envelope connectivity at the source level. Partial least squares regression identified models of connectivity that maximally accounted for the rTMS response. RESULTS Scores of Pittsburgh Sleep Quality Index, Hamilton Depression Rating Scale, and Hamilton Anxiety Rating Scale were decreased after rTMS and one-month later. Baseline weaker connectivity of a network in the beta and alpha bands between a brain region approximating the stimulated right dorsolateral prefrontal cortex and areas located in the frontal, insular, and limbic cortices was associated with a greater change in Pittsburgh Sleep Quality Index and Hamilton Depression Rating Scale following rTMS. CONCLUSIONS Low frequency rTMS could improve sleep quality and depressive moods in patients with insomnia disorder. Moreover, electroencephalographic functional connectivity would potentially be a robust biomarker for predicting the therapeutic effects.
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Affiliation(s)
- Xue Shi
- Department of Neurology, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, 518020, Guangdong, China
| | - Yi Guo
- Department of Neurology, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, 518020, Guangdong, China; Shenzhen Bay Laboratory, Shenzhen, 518020, Guangdong, China
| | - Lin Zhu
- Department of Neurology, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, 518020, Guangdong, China
| | - Wei Wu
- School of Automation Science and Engineering, South China University of Technology, Guangzhou, 510641, China
| | - Brenton Hordacre
- Innovation, Implementation and Clinical Translation (IIMPACT) in Health, Allied Health and Human Performance, University of South Australia, Australia
| | - Xiaolin Su
- Department of Neurology, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, 518020, Guangdong, China
| | - Qian Wang
- Department of Neurology, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, 518020, Guangdong, China
| | - Xiaoxia Chen
- Department of Neurology, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, 518020, Guangdong, China
| | - Xiaoyong Lan
- Department of Neurology, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, 518020, Guangdong, China
| | - Ge Dang
- Department of Neurology, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, 518020, Guangdong, China.
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