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Sheng Zheng Z, Xing-Long Wang K, Millan H, Lee S, Howard M, Rothbart A, Rosario E, Schnakers C. Transcranial direct stimulation over left inferior frontal gyrus improves language production and comprehension in post-stroke aphasia: A double-blind randomized controlled study. BRAIN AND LANGUAGE 2024; 257:105459. [PMID: 39241469 DOI: 10.1016/j.bandl.2024.105459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 04/26/2024] [Accepted: 08/21/2024] [Indexed: 09/09/2024]
Abstract
Transcranial direct current stimulation (tDCS) targeting Broca's area has shown promise for augmenting language production in post-stroke aphasia (PSA). However, previous research has been limited by small sample sizes and inconsistent outcomes. This study employed a double-blind, parallel, randomized, controlled design to evaluate the efficacy of anodal Broca's tDCS, paired with 20-minute speech and language therapy (SLT) focused primarily on expressive language, across 5 daily sessions in 45 chronic PSA patients. Utilizing the Western Aphasia Battery-Revised, which assesses a spectrum of linguistic abilities, we measured changes in both expressive and receptive language skills before and after intervention. The tDCS group demonstrated significant improvements over sham in aphasia quotient, auditory verbal comprehension, and spontaneous speech. Notably, tDCS improved both expressive and receptive domains, whereas sham only benefited expression. These results underscore the broader linguistic benefits of Broca's area stimulation and support the integration of tDCS with SLT to advance aphasia rehabilitation.
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Affiliation(s)
- Zhong Sheng Zheng
- Research Institute, Casa Colina Hospital and Centers for Healthcare, Pomona, CA, USA.
| | | | - Henry Millan
- Research Institute, Casa Colina Hospital and Centers for Healthcare, Pomona, CA, USA
| | - Sharon Lee
- Research Institute, Casa Colina Hospital and Centers for Healthcare, Pomona, CA, USA
| | - Melissa Howard
- Research Institute, Casa Colina Hospital and Centers for Healthcare, Pomona, CA, USA
| | - Aaron Rothbart
- Research Institute, Casa Colina Hospital and Centers for Healthcare, Pomona, CA, USA
| | - Emily Rosario
- Research Institute, Casa Colina Hospital and Centers for Healthcare, Pomona, CA, USA
| | - Caroline Schnakers
- Research Institute, Casa Colina Hospital and Centers for Healthcare, Pomona, CA, USA
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2
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Ghazi-Noori AR, Woodham RD, Rezaei H, Sharif MS, Bramon E, Ritter P, Bauer M, Young AH, Fu CHY. Home-based transcranial direct current stimulation in bipolar depression: an open-label treatment study of clinical outcomes, acceptability and adverse events. Int J Bipolar Disord 2024; 12:30. [PMID: 39162912 PMCID: PMC11336151 DOI: 10.1186/s40345-024-00352-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 08/05/2024] [Indexed: 08/21/2024] Open
Abstract
BACKGROUND Current treatments for bipolar depression have limited effectiveness, tolerability and acceptability. Transcranial direct current stimulation (tDCS) is a novel non-invasive brain stimulation method that has demonstrated treatment efficacy for major depressive episodes. tDCS is portable, safe, and individuals like having sessions at home. We developed a home-based protocol with real-time remote supervision. In the present study, we have examined the clinical outcomes, acceptability and feasibility of home-based tDCS treatment in bipolar depression. RESULTS Participants were 44 individuals with bipolar disorder (31 women), mean age 47.27 ± 12.89 years, in current depressive episode of at least moderate severity (mean Montgomery Asberg Depression Rating Scale (MADRS) score 24.59 ± 2.64). tDCS was provided in bilateral frontal montage, F3 anode, F4 cathode, 2 mA, for 30 min, in a 6-week trial, for total 21 sessions, a follow up visit was conducted 5 months from baseline. Participants maintained their current treatment (psychotherapy, antidepressant or mood stabilising medication) or maintained being medication-free. A research team member was present by video conference at each session. 93.2% participants (n = 41) completed the 6-week treatment and 72.7% of participants (n = 32) completed the 5 month follow up. There was a significant improvement in depressive symptoms following treatment (mean MADRS 8.77 ± 5.37) which was maintained at the 5 month follow up (mean MADRS 10.86 ± 6.90), rate of clinical response was 77.3% (MADRS improvement of 50% or greater from baseline), and rate of clinical remission was 47.7% (MADRS rating of 9 or less). Acceptability was endorsed as "very acceptable" or "quite acceptable" by all participants. No participants developed mania or hypomania. CONCLUSIONS In summary, home-based tDCS with real-time supervision was associated with significant clinical improvements and high acceptability in bipolar depression. Due to the open-label design, efficacy findings are preliminary. TRIAL REGISTRATION ClinicalTrials.gov number NCT05436613 registered on 23 June 2022 https//www. CLINICALTRIALS gov/study/NCT05436613.
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Affiliation(s)
- Ali-Reza Ghazi-Noori
- School of Psychology, University of East London, Arthur Edwards Building, Water Lane, London, E15 4LZ, UK
| | - Rachel D Woodham
- School of Psychology, University of East London, Arthur Edwards Building, Water Lane, London, E15 4LZ, UK
| | - Hakimeh Rezaei
- School of Psychology, University of East London, Arthur Edwards Building, Water Lane, London, E15 4LZ, UK
- Technische Universität Dresden, Dresden, Germany
- Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Mhd Saeed Sharif
- School of Architecture, Computing and Engineering, University of East London, London, UK
| | - Elvira Bramon
- Department of Psychiatry, University College London, London, UK
| | | | | | - Allan H Young
- Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- National Institute for Health Research Biomedical Research Centre at South London and Maudsley NHS Foundation Trust, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Beckenham, UK
| | - Cynthia H Y Fu
- School of Psychology, University of East London, Arthur Edwards Building, Water Lane, London, E15 4LZ, UK.
- Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
- National Institute for Health Research Biomedical Research Centre at South London and Maudsley NHS Foundation Trust, King's College London, London, UK.
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3
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Zolezzi DM, Larsen DB, Zamorano AM, Graven-Nielsen T. Facilitation of Early and Middle Latency SEP after tDCS of M1: No Evidence of Primary Somatosensory Homeostatic Plasticity. Neuroscience 2024; 551:143-152. [PMID: 38735429 DOI: 10.1016/j.neuroscience.2024.05.001] [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: 12/22/2023] [Revised: 04/09/2024] [Accepted: 05/01/2024] [Indexed: 05/14/2024]
Abstract
Homeostatic plasticity is a mechanism that stabilizes cortical excitability within a physiological range. Most homeostatic plasticity protocols have primed and tested the homeostatic response of the primary motor cortex (M1). This study investigated if a homeostatic response could be recorded from the primary sensory cortex (S1) after inducing homeostatic plasticity in M1. In 31 healthy participants, homeostatic plasticity was induced over M1 with a priming and testing block of transcranial direct current stimulation (tDCS) in two different sessions (anodal and cathodal). S1 excitability was assessed by early (N20, P25) and middle-latency (N33-P45) somatosensory evoked potentials (SEP) extracted from 4 electrodes (CP5, CP3, P5, P3). Baseline and post-measures (post-priming, 0-min, 10-min, and 20-min after homeostatic induction) were taken. Anodal M1 homeostatic plasticity induction significantly facilitated the N20-P25, P45 peak, and N33-P45 early SEP components up to 20-min post-induction, without any indication of a homeostatic response (i.e., reduced SEP). Cathodal homeostatic induction did not induce any significant effect on early or middle latency SEPs. M1 homeostatic plasticity induction by anodal stimulation protocol to the primary motor cortex did not induce a homeostatic response in SEPs.
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Affiliation(s)
- Daniela M Zolezzi
- Center for Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Dennis B Larsen
- Center for Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Anna M Zamorano
- Center for Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Thomas Graven-Nielsen
- Center for Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, Aalborg University, Aalborg, Denmark.
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Tüscher O, Muthuraman M, Horstmann JP, Horta G, Radyushkin K, Baumgart J, Sigurdsson T, Endle H, Ji H, Kuhnhäuser P, Götz J, Kepser LJ, Lotze M, Grabe HJ, Völzke H, Leehr EJ, Meinert S, Opel N, Richers S, Stroh A, Daun S, Tittgemeyer M, Uphaus T, Steffen F, Zipp F, Groß J, Groppa S, Dannlowski U, Nitsch R, Vogt J. Altered cortical synaptic lipid signaling leads to intermediate phenotypes of mental disorders. Mol Psychiatry 2024:10.1038/s41380-024-02598-2. [PMID: 38806692 DOI: 10.1038/s41380-024-02598-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 04/23/2024] [Accepted: 05/03/2024] [Indexed: 05/30/2024]
Abstract
Excitation/inhibition (E/I) balance plays important roles in mental disorders. Bioactive phospholipids like lysophosphatidic acid (LPA) are synthesized by the enzyme autotaxin (ATX) at cortical synapses and modulate glutamatergic transmission, and eventually alter E/I balance of cortical networks. Here, we analyzed functional consequences of altered E/I balance in 25 human subjects induced by genetic disruption of the synaptic lipid signaling modifier PRG-1, which were compared to 25 age and sex matched control subjects. Furthermore, we tested therapeutic options targeting ATX in a related mouse line. Using EEG combined with TMS in an instructed fear paradigm, neuropsychological analysis and an fMRI based episodic memory task, we found intermediate phenotypes of mental disorders in human carriers of a loss-of-function single nucleotide polymorphism of PRG-1 (PRG-1R345T/WT). Prg-1R346T/WT animals phenocopied human carriers showing increased anxiety, a depressive phenotype and lower stress resilience. Network analysis revealed that coherence and phase-amplitude coupling were altered by PRG-1 deficiency in memory related circuits in humans and mice alike. Brain oscillation phenotypes were restored by inhibtion of ATX in Prg-1 deficient mice indicating an interventional potential for mental disorders.
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Affiliation(s)
- Oliver Tüscher
- Department of Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
- Leibniz Institute for Resilience Research Mainz, Mainz, Germany
- Institute for Molecular Biology Mainz, Mainz, Germany
| | - Muthuraman Muthuraman
- Department of Neurology, Johannes Gutenberg-University Mainz, Mainz, Germany
- Department of Neurology, Neural engineering with Signal Analytics and Artificial Intelligence (NESA-AI), University Hospital of Würzburg, Würzburg, Germany
- Informatics for Medical Technology, University Augsburg, Augsburg, Germany
| | - Johann-Philipp Horstmann
- Department of Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Guilherme Horta
- Focus Program Translational Neuroscience, Johannes Gutenberg-University Mainz, Mainz, Germany
- Institute of Anatomy, University Medical Center Mainz, Mainz, Germany
| | - Konstantin Radyushkin
- TARC, Translational Animal Research Center, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Jan Baumgart
- TARC, Translational Animal Research Center, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Torfi Sigurdsson
- Institute of Neurophysiology, University Medical Center, Goethe-University Frankfurt, Frankfurt, Germany
| | - Heiko Endle
- Department of Molecular and Translational Neuroscience, Institute of Anatomy II, Cluster of Excellence-Cellular Stress Response in Aging-Associated Diseases (CECAD), Center of Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany
| | - Haichao Ji
- Department of Molecular and Translational Neuroscience, Institute of Anatomy II, Cluster of Excellence-Cellular Stress Response in Aging-Associated Diseases (CECAD), Center of Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany
| | - Prisca Kuhnhäuser
- Department of Molecular and Translational Neuroscience, Institute of Anatomy II, Cluster of Excellence-Cellular Stress Response in Aging-Associated Diseases (CECAD), Center of Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany
| | - Jan Götz
- Department of Molecular and Translational Neuroscience, Institute of Anatomy II, Cluster of Excellence-Cellular Stress Response in Aging-Associated Diseases (CECAD), Center of Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany
| | - Lara-Jane Kepser
- Department of Molecular and Translational Neuroscience, Institute of Anatomy II, Cluster of Excellence-Cellular Stress Response in Aging-Associated Diseases (CECAD), Center of Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany
| | - Martin Lotze
- Functional Imaging Unit, Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany
| | - Hans J Grabe
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
| | - Henry Völzke
- Department SHIP/Clinical Epidemiological Research, Institute of Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Elisabeth J Leehr
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
- Institute for Translational Neuroscience, University of Münster, Münster, Germany
| | - Susanne Meinert
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
- Institute for Translational Neuroscience, University of Münster, Münster, Germany
| | - Nils Opel
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Sebastian Richers
- Institute for Translational Neuroscience, University of Münster, Münster, Germany
| | - Albrecht Stroh
- Institute of Pathophysiology, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Silvia Daun
- Cognitive Neuroscience, Institute of Neuroscience and Medicine (IMN-3), Research Centre Jülich, Jülich, Germany
| | - Marc Tittgemeyer
- Max Planck Institute of Metabolism Research, Cologne, Cluster of Excellence-Cellular Stress Response in Aging-Associated Diseases (CECAD), Cologne, Germany
| | - Timo Uphaus
- Department of Neurology, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Falk Steffen
- Department of Neurology, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Frauke Zipp
- Department of Neurology, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Joachim Groß
- Institute for Biomagnetism and Biosignalanalysis, University of Münster, Münster, Germany
| | - Sergiu Groppa
- Department of Neurology, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Udo Dannlowski
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Robert Nitsch
- Institute for Translational Neuroscience, University of Münster, Münster, Germany.
| | - Johannes Vogt
- Department of Neurology, Johannes Gutenberg-University Mainz, Mainz, Germany.
- Department of Molecular and Translational Neuroscience, Institute of Anatomy II, Cluster of Excellence-Cellular Stress Response in Aging-Associated Diseases (CECAD), Center of Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany.
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5
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Hooyman A, Haikalis NK, Wang P, Schambra HM, Lohse KR, Schaefer SY. Evidence and sources of placebo effects in transcranial direct current stimulation during a single session of visuospatial working memory practice. Sci Rep 2024; 14:9094. [PMID: 38643299 PMCID: PMC11032394 DOI: 10.1038/s41598-024-59927-2] [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: 02/21/2023] [Accepted: 04/16/2024] [Indexed: 04/22/2024] Open
Abstract
Transcranial direct current stimulation (tDCS) can be used to non-invasively augment cognitive training. However, the benefits of tDCS may be due in part to placebo effects, which have not been well-characterized. The purpose of this study was to determine whether tDCS can have a measurable placebo effect on cognitive training and to identify potential sources of this effect. Eighty-three right-handed adults were randomly assigned to one of three groups: control (no exposure to tDCS), sham tDCS, or active tDCS. The sham and active tDCS groups were double-blinded. Each group performed 20 min of an adapted Corsi Block Tapping Task (CBTT), a visuospatial working memory task. Anodal or sham tDCS was applied during CBTT training in a right parietal-left supraorbital montage. After training, active and sham tDCS groups were surveyed on expectations about tDCS efficacy. Linear mixed effects models showed that the tDCS groups (active and sham combined) improved more on the CBTT with training than the control group, suggesting a placebo effect of tDCS. Participants' tDCS expectations were significantly related to the placebo effect, as was the belief of receiving active stimulation. This placebo effect shows that the benefits of tDCS on cognitive training can occur even in absence of active stimulation. Future tDCS studies should consider how treatment expectations may be a source of the placebo effect in tDCS research, and identify ways to potentially leverage them to maximize treatment benefit.
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Affiliation(s)
- Andrew Hooyman
- School of Biological and Health Systems Engineering, Arizona State University, 501 E. Tyler Mall, MC 9709, Tempe, AZ, 85287, USA
| | - Nicole K Haikalis
- School of Biological and Health Systems Engineering, Arizona State University, 501 E. Tyler Mall, MC 9709, Tempe, AZ, 85287, USA
| | - Peiyuan Wang
- School of Biological and Health Systems Engineering, Arizona State University, 501 E. Tyler Mall, MC 9709, Tempe, AZ, 85287, USA
| | - Heidi M Schambra
- Department of Neurology and Department of Physical Medicine and Rehabilitation, Grossman School of Medicine, New York University, New York, NY, USA
| | - Keith R Lohse
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO, USA
| | - Sydney Y Schaefer
- School of Biological and Health Systems Engineering, Arizona State University, 501 E. Tyler Mall, MC 9709, Tempe, AZ, 85287, USA.
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6
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She X, Nix KC, Cline CC, Qi W, Tugin S, He Z, Baumer FM. Stability of transcranial magnetic stimulation electroencephalogram evoked potentials in pediatric epilepsy. Sci Rep 2024; 14:9045. [PMID: 38641629 PMCID: PMC11031596 DOI: 10.1038/s41598-024-59468-8] [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: 12/11/2023] [Accepted: 04/11/2024] [Indexed: 04/21/2024] Open
Abstract
Transcranial magnetic stimulation paired with electroencephalography (TMS-EEG) can measure local excitability and functional connectivity. To address trial-to-trial variability, responses to multiple TMS pulses are recorded to obtain an average TMS evoked potential (TEP). Balancing adequate data acquisition to establish stable TEPs with feasible experimental duration is critical when applying TMS-EEG to clinical populations. Here we aim to investigate the minimum number of pulses (MNP) required to achieve stable TEPs in children with epilepsy. Eighteen children with Self-Limited Epilepsy with Centrotemporal Spikes, a common epilepsy arising from the motor cortices, underwent multiple 100-pulse blocks of TMS to both motor cortices over two days. TMS was applied at 120% of resting motor threshold (rMT) up to a maximum of 100% maximum stimulator output. The average of all 100 pulses was used as a "gold-standard" TEP to which we compared "candidate" TEPs obtained by averaging subsets of pulses. We defined TEP stability as the MNP needed to achieve a concordance correlation coefficient of 80% between the candidate and "gold-standard" TEP. We additionally assessed whether experimental or clinical factors affected TEP stability. Results show that stable TEPs can be derived from fewer than 100 pulses, a number typically used for designing TMS-EEG experiments. The early segment (15-80 ms) of the TEP was less stable than the later segment (80-350 ms). Global mean field amplitude derived from all channels was less stable than local TEP derived from channels overlying the stimulated site. TEP stability did not differ depending on stimulated hemisphere, block order, or antiseizure medication use, but was greater in older children. Stimulation administered with an intensity above the rMT yielded more stable local TEPs. Studies of TMS-EEG in pediatrics have been limited by the complexity of experimental set-up and time course. This study serves as a critical starting point, demonstrating the feasibility of designing efficient TMS-EEG studies that use a relatively small number of pulses to study pediatric epilepsy and potentially other pediatric groups.
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Affiliation(s)
- Xiwei She
- Department of Neurology, Stanford University, Stanford, CA, USA
| | - Kerry C Nix
- Department of Neurology, Stanford University, Stanford, CA, USA
| | - Christopher C Cline
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Wendy Qi
- Department of Neurology, Stanford University, Stanford, CA, USA
| | - Sergei Tugin
- Department of Neurology, Stanford University, Stanford, CA, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Zihuai He
- Department of Neurology, Stanford University, Stanford, CA, USA
| | - Fiona M Baumer
- Department of Neurology, Stanford University, Stanford, CA, USA.
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7
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Meng H, Houston M, Zhang Y, Li S. Exploring the Prospects of Transcranial Electrical Stimulation (tES) as a Therapeutic Intervention for Post-Stroke Motor Recovery: A Narrative Review. Brain Sci 2024; 14:322. [PMID: 38671974 PMCID: PMC11047964 DOI: 10.3390/brainsci14040322] [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: 02/08/2024] [Revised: 03/12/2024] [Accepted: 03/23/2024] [Indexed: 04/28/2024] Open
Abstract
INTRODUCTION Stroke survivors often have motor impairments and related functional deficits. Transcranial Electrical Stimulation (tES) is a rapidly evolving field that offers a wide range of capabilities for modulating brain function, and it is safe and inexpensive. It has the potential for widespread use for post-stroke motor recovery. Transcranial Direct Current Stimulation (tDCS), Transcranial Alternating Current Stimulation (tACS), and Transcranial Random Noise Stimulation (tRNS) are three recognized tES techniques that have gained substantial attention in recent years but have different mechanisms of action. tDCS has been widely used in stroke motor rehabilitation, while applications of tACS and tRNS are very limited. The tDCS protocols could vary significantly, and outcomes are heterogeneous. PURPOSE the current review attempted to explore the mechanisms underlying commonly employed tES techniques and evaluate their prospective advantages and challenges for their applications in motor recovery after stroke. CONCLUSION tDCS could depolarize and hyperpolarize the potentials of cortical motor neurons, while tACS and tRNS could target specific brain rhythms and entrain neural networks. Despite the extensive use of tDCS, the complexity of neural networks calls for more sophisticated modifications like tACS and tRNS.
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Affiliation(s)
- Hao Meng
- Department of Physical Medicine & Rehabilitation, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Michael Houston
- Department of Biomedical Engineering, University of Houston, Houston, TX 77204, USA;
| | - Yingchun Zhang
- Department of Biomedical Engineering, University of Miami, Coral Gables, FL 33146, USA;
| | - Sheng Li
- Department of Physical Medicine & Rehabilitation, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX 77030, USA
- TIRR Memorial Hermann Hospital, Houston, TX 77030, USA
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8
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Vergallito A, Gramano B, La Monica K, Giuliani L, Palumbo D, Gesi C, Torriero S. Combining transcranial magnetic stimulation with training to improve social cognition impairment in schizophrenia: a pilot randomized controlled trial. Front Psychol 2024; 15:1308971. [PMID: 38445059 PMCID: PMC10912559 DOI: 10.3389/fpsyg.2024.1308971] [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: 10/07/2023] [Accepted: 01/16/2024] [Indexed: 03/07/2024] Open
Abstract
Schizophrenia is a severe, chronic mental disorder that profoundly impacts patients' everyday lives. The illness's core features include positive and negative symptoms and cognitive impairments. In particular, deficits in the social cognition domain showed a tighter connection to patients' everyday functioning than the other symptoms. Social remediation interventions have been developed, providing heterogeneous results considering the possibility of generalizing the acquired improvements in patients' daily activities. In this pilot randomized controlled trial, we investigated the feasibility of combining fifteen daily cognitive and social training sessions with non-invasive brain stimulation to boost the effectiveness of the two interventions. We delivered intermittent theta burst stimulation (iTBS) over the left dorsolateral prefrontal cortex (DLPFC). Twenty-one patients were randomized into four groups, varying for the assigned stimulation condition (real vs. sham iTBS) and the type of cognitive intervention (training vs. no training). Clinical symptoms and social cognition tests were administered at five time points, i.e., before and after the treatment, and at three follow-ups at one, three, and six months after the treatments' end. Preliminary data show a trend in improving the competence in managing emotion in participants performing the training. Conversely, no differences were found in pre and post-treatment scores for emotion recognition, theory of mind, and attribution of intentions scores. The iTBS intervention did not induce additional effects on individuals' performance. The methodological approach's novelty and limitations of the present study are discussed.
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Affiliation(s)
| | - Bianca Gramano
- Department of Mental Health and Addictions, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Kevin La Monica
- Department of Mental Health and Addictions, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Luigi Giuliani
- Department of Psychiatry, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Davide Palumbo
- Department of Psychiatry, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Camilla Gesi
- Department of Mental Health and Addictions, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Sara Torriero
- Department of Mental Health and Addictions, ASST Fatebenefratelli-Sacco, Milan, Italy
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Ku Y, Zhou Y. Crossmodal Associations and Working Memory in the Brain. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2024; 1437:91-100. [PMID: 38270855 DOI: 10.1007/978-981-99-7611-9_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
Crossmodal associations between stimuli from different sensory modalities could emerge in non-synesthetic people and be stored in working memory to guide goal-directed behaviors. This chapter reviews a plethora of studies in this field to summarize where, when, and how crossmodal associations and working memory are processed. It has been found that in those brain regions that are traditionally considered as unimodal primary sensory areas, neural activity could be influenced by crossmodal sensory signals at temporally very early stage of information processing. This phenomenon could not be due to feedback projections from higher level associative areas. Sequentially, neural processes would then occur in associative cortical areas including the posterior parietal cortex and prefrontal cortex. Neural oscillations in multiple frequency bands may reflect brain activity in crossmodal associations, and it is likely that neural synchrony is related to potential neural mechanisms underlying these processes. Primary sensory areas and associative areas coordinate together through neural synchrony to fulfil crossmodal associations and to guide working memory performance.
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Affiliation(s)
- Yixuan Ku
- Department of Psychology, Center for Brain and Mental Well-being, Sun Yat-sen University, Guangzhou, China.
- Peng Cheng Laboratory, Shenzhen, China.
| | - Yongdi Zhou
- School of Psychology, Shenzhen University, Shenzhen, China
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10
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Joshi SD, Ruffini G, Nuttall HE, Watson DG, Braithwaite JJ. Optimised Multi-Channel Transcranial Direct Current Stimulation (MtDCS) Reveals Differential Involvement of the Right-Ventrolateral Prefrontal Cortex (rVLPFC) and Insular Complex in those Predisposed to Aberrant Experiences. Conscious Cogn 2024; 117:103610. [PMID: 38056338 DOI: 10.1016/j.concog.2023.103610] [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: 05/04/2023] [Revised: 11/20/2023] [Accepted: 11/22/2023] [Indexed: 12/08/2023]
Abstract
Research has shown a prominent role for cortical hyperexcitability underlying aberrant perceptions, hallucinations, and distortions in human conscious experience - even in neurotypical groups. The rVLPFC has been identified as an important structure in mediating cognitive affective states / feeling conscious states. The current study examined the involvement of the rVLPFC in mediating cognitive affective states in those predisposed to aberrant experiences in the neurotypical population. Participants completed two trait-based measures: (i) the Cortical Hyperexcitability Index_II (CHi_II, a proxy measure of cortical hyperexcitability) and (ii) two factors from the Cambridge Depersonalisation Scale (CDS). An optimised 7-channel MtDCS montage for stimulation conditions (Anodal, Cathodal and Sham) was created targeting the rVLPFC in a single-blind study. At the end of each stimulation session, participants completed a body-threat task (BTAB) while skin conductance responses (SCRs) and psychological responses were recorded. Participants with signs of increasing cortical hyperexcitability showed significant suppression of SCRs in the Cathodal stimulation relative to the Anodal and sSham conditions. Those high on the trait-based measures of depersonalisation-like experiences failed to show reliable effects. Collectively, the findings suggest that baseline brain states can mediate the effects of neurostimulation which would be missed via sample level averaging and without appropriate measures for stratifying individual differences.
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11
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Narmashiri A, Akbari F. The Effects of Transcranial Direct Current Stimulation (tDCS) on the Cognitive Functions: A Systematic Review and Meta-analysis. Neuropsychol Rev 2023:10.1007/s11065-023-09627-x. [PMID: 38060075 DOI: 10.1007/s11065-023-09627-x] [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: 04/01/2023] [Accepted: 10/24/2023] [Indexed: 12/08/2023]
Abstract
Previous studies have investigated the effect of transcranial direct current stimulation (tDCS) on cognitive functions. However, these studies reported inconsistent results due to differences in experiment design, measurements, and stimulation parameters. Nonetheless, there is a lack of meta-analyses and review studies on tDCS and its impact on cognitive functions, including working memory, inhibition, flexibility, and theory of mind. We performed a systematic review and meta-analysis of tDCS studies published from the earliest available data up to October 2021, including studies reporting the effects of tDCS on cognitive functions in human populations. Therefore, these systematic review and meta-analysis aim to comprehensively analyze the effects of anodal and cathodal tDCS on cognitive functions by investigating 69 articles with a total of 5545 participants. Our study reveals significant anodal tDCS effects on various cognitive functions. Specifically, we observed improvements in working memory reaction time (RT), inhibition RT, flexibility RT, theory of mind RT, working memory accuracy, theory of mind accuracy and flexibility accuracy. Furthermore, our findings demonstrate noteworthy cathodal tDCS effects, enhancing working memory accuracy, inhibition accuracy, flexibility RT, flexibility accuracy, theory of mind RT, and theory of mind accuracy. Notably, regarding the influence of stimulation parameters of tDCS on cognitive functions, the results indicated significant differences across various aspects, including the timing of stimulation (online vs. offline studies), population type (clinical vs. healthy studies), stimulation duration (< 15 min vs. > 15 min), electrical current intensities (1-1.5 m.A vs. > 1.5 m.A), stimulation sites (right frontal vs. left frontal studies), age groups (young vs. older studies), and different cognitive tasks in each cognitive functioning aspect. In conclusion, our results demonstrate that tDCS can effectively enhance cognitive task performance, offering valuable insights into the potential benefits of this method for cognitive improvement.
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Affiliation(s)
- Abdolvahed Narmashiri
- School of Cognitive Sciences, Institute for Research in Fundamental Sciences (IPM), Tehran, Iran.
- Electrical Engineering Department, Bio-Intelligence Research Unit, Sharif Brain Center, Sharif University of Technology, Tehran, Iran.
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12
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Sun X, Doose J, Faller J, McIntosh JR, Saber GT, Huffman S, Pantazatos SP, Yuan H, Goldman RI, Brown TR, George MS, Sajda P. Increased entrainment and decreased excitability predict efficacious treatment of closed-loop phase-locked rTMS for treatment-resistant depression. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.10.09.23296751. [PMID: 37873424 PMCID: PMC10593047 DOI: 10.1101/2023.10.09.23296751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
Transcranial magnetic stimulation (TMS) is an FDA-approved therapy for major depressive disorder (MDD), specifically for patients who have treatment-resistant depression (TRD). However, TMS produces response or remission in about 50% of patients but is ineffective for the other 50%. Limits on efficacy may be due to individual patient variability, but to date, there are no good biomarkers or measures of target engagement. In addition, TMS efficacy is typically not assessed until a six-week treatment ends, precluding the evaluation of intermediate improvements during the treatment duration. Here, we report on results using a closed-loop phase-locked repetitive TMS (rTMS) treatment that synchronizes the delivery of rTMS based on the timing of the pulses relative to a patient's individual electroencephalographic (EEG) prefrontal alpha oscillation informed by functional magnetic resonance imaging (fMRI). We find that, in responders, synchronized delivery of rTMS produces two systematic changes in brain dynamics. The first change is a decrease in global cortical excitability, and the second is an increase in the phase entrainment of cortical dynamics. These two effects predict clinical outcomes in the synchronized treatment group but not in an active-treatment unsynchronized control group. The systematic decrease in excitability and increase in entrainment correlated with treatment efficacy at the endpoint and intermediate weeks during the synchronized treatment. Specifically, we show that weekly tracking of these biomarkers allows for efficacy prediction and potential of dynamic adjustments through a treatment course, improving the overall response rates.
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13
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Soleimani G, Kupliki R, Paulus M, Ekhtiari H. Dose-response in modulating brain function with transcranial direct current stimulation: From local to network levels. PLoS Comput Biol 2023; 19:e1011572. [PMID: 37883583 PMCID: PMC10629666 DOI: 10.1371/journal.pcbi.1011572] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 11/07/2023] [Accepted: 10/04/2023] [Indexed: 10/28/2023] Open
Abstract
Understanding the dose-response relationship is crucial in studying the effects of brain stimulation techniques, such as transcranial direct current stimulation (tDCS). The dose-response relationship refers to the relationship between the received stimulation dose and the resulting response, which can be described as a function of the dose at various levels, including single/multiple neurons, clusters, regions, or networks. Here, we are focused on the received stimulation dose obtained from computational head models and brain responses which are quantified by functional magnetic resonance imaging (fMRI) data. In this randomized, triple-blind, sham-controlled clinical trial, we recruited sixty participants with methamphetamine use disorders (MUDs) as a sample clinical population who were randomly assigned to receive either sham or active tDCS. Structural and functional MRI data, including high-resolution T1 and T2-weighted MRI, resting-state functional MRI, and a methamphetamine cue-reactivity task fMRI, were acquired before and after tDCS. Individual head models were generated using the T1 and T2-weighted MRI data to simulate electric fields. In a linear approach, we investigated the associations between electric fields (received dose) and changes in brain function (response) at four different levels: voxel level, regional level (using atlas-based parcellation), cluster level (identifying active clusters), and network level (task-based functional connectivity). At the voxel level, regional level, and cluster level, no FDR-corrected significant correlation was observed between changes in functional activity and electric fields. However, at the network level, a significant positive correlation was found between frontoparietal connectivity and the electric field at the frontopolar stimulation site (r = 0.42, p corrected = 0.02; medium effect size). Our proposed pipeline offers a methodological framework for analyzing tDCS effects by exploring dose-response relationships at different levels, enabling a direct link between electric field variability and the neural response to tDCS. The results indicate that network-based analysis provides valuable insights into the dependency of tDCS neuromodulatory effects on the individual's regional current dose. Integration of dose-response relationships can inform dose optimization, customization, or the extraction of predictive/treatment-response biomarkers in future brain stimulation studies.
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Affiliation(s)
- Ghazaleh Soleimani
- Department of Psychiatry, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Rayus Kupliki
- Laureate Institute for Brain Research, Tulsa, Oklahoma, United States of America
| | - Martin Paulus
- Laureate Institute for Brain Research, Tulsa, Oklahoma, United States of America
| | - Hamed Ekhtiari
- Department of Psychiatry, University of Minnesota, Minneapolis, Minnesota, United States of America
- Laureate Institute for Brain Research, Tulsa, Oklahoma, United States of America
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14
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Hao S, Xin Q, Xiaoqin W. Anodal tDCS over TPJ reduces bidding in Tullock contest: Implications for social decision-making. Neurosci Lett 2023; 812:137361. [PMID: 37414369 DOI: 10.1016/j.neulet.2023.137361] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 05/25/2023] [Accepted: 06/22/2023] [Indexed: 07/08/2023]
Abstract
Contests, as economic, political, and social interactions, can stimulate high levels of effort, but they can also lead to inefficient expenditure of effort (overbidding), resulting in the wastage of social resources. Prior studies have indicated that the temporoparietal junction (TPJ) is associated with overbidding and speculating on the intentions of others during contests. This study aimed to investigate the neural mechanisms of the TPJ in overbidding and to examine changes in bidding behavior after modulating TPJ activity using transcranial direct current stimulation (tDCS). The experiment randomly allocated participants into three groups, each receiving either anodal stimulation of the LTPJ/RTPJ or sham stimulation. Following the stimulation, the participants engaged in the Tullock rent-seeking game. Our results revealed that participants who received anodal stimulation of the LTPJ and RTPJ significantly reduced their bids compared to the sham group, possibly due to enhanced accuracy in guessing others' strategies or enhanced altruistic preferences. Moreover, our findings suggest that while both the LTPJ and RTPJ are associated with overbidding behavior, anodal tDCS targeting the RTPJ is more effective than stimulation of the LTPJ in decreasing overbidding. The aforementioned revelations offer proof of the neural mechanisms of the TPJ in overbidding and provide fresh substantiation for the neural mechanisms of social behavior.
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Affiliation(s)
- Su Hao
- School of Economics and Management, Southwest Petroleum University, Chengdu 610500, China; Key Laboratory of Energy Security and Low-carbon Development, Chengdu 610500, China.
| | - Qing Xin
- School of Economics and Management, Southwest Petroleum University, Chengdu 610500, China.
| | - Wang Xiaoqin
- School of Economics and Management, Southwest Petroleum University, Chengdu 610500, China
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15
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Bianco V, Arrigoni E, Di Russo F, Romero Lauro LJ, Pisoni A. Top-down reconfiguration of SMA cortical connectivity during action preparation. iScience 2023; 26:107430. [PMID: 37575197 PMCID: PMC10415800 DOI: 10.1016/j.isci.2023.107430] [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: 01/31/2023] [Revised: 03/31/2023] [Accepted: 07/17/2023] [Indexed: 08/15/2023] Open
Abstract
The Bereitschaftspotential (BP), a scalp potential recorded in humans during action preparation, is characterized by a slow amplitude increase over fronto-central regions as action execution approaches. We recorded TMS evoked-potentials (TEP) stimulating the supplementary motor area (SMA) at different time-points during a Go/No-Go task to assess whether and how cortical excitability and connectivity of this region change as the BP increases. When approaching BP peak, left SMA reactivity resulted greater. Concurrently, its effective connectivity increased with the left occipital areas, while it decreased with the right inferior frontal gyrus, indicating a fast reconfiguration of cortical networks during the preparation of the forthcoming action. Functional connectivity patterns supported these findings, suggesting a critical role of frequency-specific inter-areal interactions in implementing top-down mechanisms in the sensorimotor system prior to action. These findings reveal that BP time-course reflects quantitative and qualitative changes in SMA communication patterns that shape mechanisms involved in motor readiness.
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Affiliation(s)
- Valentina Bianco
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy
| | - Eleonora Arrigoni
- PhD Program in Neuroscience, School of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, 20900 Monza, Italy
| | - Francesco Di Russo
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Piazza Lauro De Bosis, 15, 00135 Rome, Italy
| | - Leonor Josefina Romero Lauro
- Department of Psychology, University of Milano-Bicocca, P.zza dell'Ateneo Nuovo 1, 20126 Milan, Italy
- NeuroMi, Milan Centre for Neuroscience, Milan, Italy
| | - Alberto Pisoni
- Department of Psychology, University of Milano-Bicocca, P.zza dell'Ateneo Nuovo 1, 20126 Milan, Italy
- NeuroMi, Milan Centre for Neuroscience, Milan, Italy
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16
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Vergallito A, Varoli E, Pisoni A, Mattavelli G, Del Mauro L, Feroldi S, Vallar G, Romero Lauro LJ. State-dependent effectiveness of cathodal transcranial direct current stimulation on cortical excitability. Neuroimage 2023; 277:120242. [PMID: 37348625 DOI: 10.1016/j.neuroimage.2023.120242] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 06/09/2023] [Accepted: 06/20/2023] [Indexed: 06/24/2023] Open
Abstract
The extensive use of transcranial direct current stimulation (tDCS) in experimental and clinical settings does not correspond to an in-depth understanding of its underlying neurophysiological mechanisms. In previous studies, we employed an integrated system of Transcranial Magnetic Stimulation and Electroencephalography (TMS-EEG) to track the effect of tDCS on cortical excitability. At rest, anodal tDCS (a-tDCS) over the right Posterior Parietal Cortex (rPPC) elicits a widespread increase in cortical excitability. In contrast, cathodal tDCS (c-tDCS) fails to modulate cortical excitability, being indistinguishable from sham stimulation. Here we investigated whether an endogenous task-induced activation during stimulation might change this pattern, improving c-tDCS effectiveness in modulating cortical excitability. In Experiment 1, we tested whether performance in a Visuospatial Working Memory Task (VWMT) and a modified Posner Cueing Task (mPCT), involving rPPC, could be modulated by c-tDCS. Thirty-eight participants were involved in a two-session experiment receiving either c-tDCS or sham during tasks execution. In Experiment 2, we recruited sixteen novel participants who performed the same paradigm but underwent TMS-EEG recordings pre- and 10 min post- sham stimulation and c-tDCS. Behavioral results showed that c-tDCS significantly modulated mPCT performance compared to sham. At a neurophysiological level, c-tDCS significantly reduced cortical excitability in a frontoparietal network likely involved in task execution. Taken together, our results provide evidence of the state dependence of c-tDCS in modulating cortical excitability effectively. The conceptual and applicative implications are discussed.
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Affiliation(s)
- Alessandra Vergallito
- Department of Psychology, University of Milano-Bicocca, Milano, Italy; NeuroMi, Milan Center for Neuroscience, Milano, Italy.
| | - Erica Varoli
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Alberto Pisoni
- Department of Psychology, University of Milano-Bicocca, Milano, Italy; NeuroMi, Milan Center for Neuroscience, Milano, Italy
| | - Giulia Mattavelli
- IUSS Cognitive Neuroscience (ICON) Center, Scuola Universitaria Superiore IUSS, Pavia, Italy; Istituti Clinici Scientifici Maugeri IRCCS, Cognitive Neuroscience Laboratory of Pavia Institute, 27100, Italy
| | - Lilia Del Mauro
- Department of Psychology, University of Milano-Bicocca, Milano, Italy
| | - Sarah Feroldi
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Giuseppe Vallar
- Department of Psychology, University of Milano-Bicocca, Milano, Italy; NeuroMi, Milan Center for Neuroscience, Milano, Italy; MiBTec - Mind and Behavior Technological Center, University of Milano-Bicocca, Milan, Italy
| | - Leonor J Romero Lauro
- Department of Psychology, University of Milano-Bicocca, Milano, Italy; NeuroMi, Milan Center for Neuroscience, Milano, Italy
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Cruciani A, Mancuso M, Sveva V, Maccarrone D, Todisco A, Motolese F, Santoro F, Pilato F, Spampinato DA, Rocchi L, Di Lazzaro V, Capone F. Using TMS-EEG to assess the effects of neuromodulation techniques: a narrative review. Front Hum Neurosci 2023; 17:1247104. [PMID: 37645690 PMCID: PMC10461063 DOI: 10.3389/fnhum.2023.1247104] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 08/01/2023] [Indexed: 08/31/2023] Open
Abstract
Over the past decades, among all the non-invasive brain stimulation (NIBS) techniques, those aiming for neuromodulatory protocols have gained special attention. The traditional neurophysiological outcome to estimate the neuromodulatory effect is the motor evoked potential (MEP), the impact of NIBS techniques is commonly estimated as the change in MEP amplitude. This approach has several limitations: first, the use of MEP limits the evaluation of stimulation to the motor cortex excluding all the other brain areas. Second, MEP is an indirect measure of brain activity and is influenced by several factors. To overcome these limitations several studies have used new outcomes to measure brain changes after neuromodulation techniques with the concurrent use of transcranial magnetic stimulation (TMS) and electroencephalogram (EEG). In the present review, we examine studies that use TMS-EEG before and after a single session of neuromodulatory TMS. Then, we focused our literature research on the description of the different metrics derived from TMS-EEG to measure the effect of neuromodulation.
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Affiliation(s)
- Alessandro Cruciani
- Department of Medicine and Surgery, Unit of Neurology, Neurophysiology, Neurobiology, and Psychiatry, Università Campus Bio-Medico di Roma, Rome, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Marco Mancuso
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Valerio Sveva
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University, Rome, Italy
| | - Davide Maccarrone
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Antonio Todisco
- Department of Medicine and Surgery, Unit of Neurology, Neurophysiology, Neurobiology, and Psychiatry, Università Campus Bio-Medico di Roma, Rome, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Francesco Motolese
- Department of Medicine and Surgery, Unit of Neurology, Neurophysiology, Neurobiology, and Psychiatry, Università Campus Bio-Medico di Roma, Rome, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Francesca Santoro
- Department of Medicine and Surgery, Unit of Neurology, Neurophysiology, Neurobiology, and Psychiatry, Università Campus Bio-Medico di Roma, Rome, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Fabio Pilato
- Department of Medicine and Surgery, Unit of Neurology, Neurophysiology, Neurobiology, and Psychiatry, Università Campus Bio-Medico di Roma, Rome, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | | | - Lorenzo Rocchi
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Vincenzo Di Lazzaro
- Department of Medicine and Surgery, Unit of Neurology, Neurophysiology, Neurobiology, and Psychiatry, Università Campus Bio-Medico di Roma, Rome, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Fioravante Capone
- Department of Medicine and Surgery, Unit of Neurology, Neurophysiology, Neurobiology, and Psychiatry, Università Campus Bio-Medico di Roma, Rome, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
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18
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Li Y, Zhi W, Qi B, Wang L, Hu X. Update on neurobiological mechanisms of fear: illuminating the direction of mechanism exploration and treatment development of trauma and fear-related disorders. Front Behav Neurosci 2023; 17:1216524. [PMID: 37600761 PMCID: PMC10433239 DOI: 10.3389/fnbeh.2023.1216524] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 07/18/2023] [Indexed: 08/22/2023] Open
Abstract
Fear refers to an adaptive response in the face of danger, and the formed fear memory acts as a warning when the individual faces a dangerous situation again, which is of great significance to the survival of humans and animals. Excessive fear response caused by abnormal fear memory can lead to neuropsychiatric disorders. Fear memory has been studied for a long time, which is of a certain guiding effect on the treatment of fear-related disorders. With continuous technological innovations, the study of fear has gradually shifted from the level of brain regions to deeper neural (micro) circuits between brain regions and even within single brain regions, as well as molecular mechanisms. This article briefly outlines the basic knowledge of fear memory and reviews the neurobiological mechanisms of fear extinction and relapse, which aims to provide new insights for future basic research on fear emotions and new ideas for treating trauma and fear-related disorders.
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Affiliation(s)
- Ying Li
- College of Education, Hebei University, Baoding, China
- Laboratory of Experimental Pathology, Beijing Institute of Radiation Medicine, Beijing, China
| | - Weijia Zhi
- Laboratory of Experimental Pathology, Beijing Institute of Radiation Medicine, Beijing, China
| | - Bing Qi
- College of Education, Hebei University, Baoding, China
| | - Lifeng Wang
- Laboratory of Experimental Pathology, Beijing Institute of Radiation Medicine, Beijing, China
| | - Xiangjun Hu
- College of Education, Hebei University, Baoding, China
- Laboratory of Experimental Pathology, Beijing Institute of Radiation Medicine, Beijing, China
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19
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Qiu Y, Yin Z, Wang M, Duan A, Xie M, Wu J, Wang Z, Chen G. Motor function improvement and acceptability of non-invasive brain stimulation in patients with Parkinson's disease: a Bayesian network analysis. Front Neurosci 2023; 17:1212640. [PMID: 37564368 PMCID: PMC10410144 DOI: 10.3389/fnins.2023.1212640] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 07/11/2023] [Indexed: 08/12/2023] Open
Abstract
Background Parkinson's disease (PD) is a neurodegenerative disorder defined by progressive motor and non-motor symptoms. Currently, the pro-cognitive effects of transcranial direct current stimulation (tDCS) and repetitive transcranial magnetic stimulation (rTMS) are well-supported in previous literatures. However, controversy surrounding the optimal therapeutic target for motor symptom improvement remains. Objective This network meta-analysis (NMA) was conducted to comprehensively evaluate the optimal strategy to use rTMS and tDCS to improve motor symptoms in PD. Methods We searched PubMed, Embase, and Cochrane electronic databases for eligible randomized controlled studies (RCTs). The primary outcome was the changes of Unified Parkinson's Disease Rating Scale (UPDRS) part III score, the secondary outcomes were Time Up and Go Test (TUGT) time, and Freezing of Gait Questionnaire (FOGQ) score. The safety outcome was indicated by device-related adverse events (AEs). Result We enrolled 28 studies that investigated various strategies, including high-frequency rTMS (HFrTMS), low-frequency rTMS (LFrTMS), anodal tDCS (AtDCS), AtDCS_ cathode tDCS (CtDCS), HFrTMS_LFrTMS, and Sham control groups. Both HFrTMS (short-term: mean difference (MD) -5.21, 95% credible interval (CrI) -9.26 to -1.23, long-term: MD -4.74, 95% CrI -6.45 to -3.05), and LFrTMS (long-term: MD -4.83, 95% CrI -6.42 to -3.26) were effective in improving UPDRS-III score compared with Sham stimulation. For TUGT time, HFrTMS (short-term: MD -2.04, 95% CrI -3.26 to -0.8, long-term: MD -2.66, 95% CrI -3.55 to -1.77), and AtDCS (short-term: MD -0.8, 95% CrI -1.26 to -0.34, long-term: MD -0.69, 95% CrI -1.31 to -0.08) produced a significant difference compared to Sham stimulation. However, no statistical difference was found in FOGQ score among the various groups. According to the surface under curve ranking area, HFrTMS ranked first in short-term UPDRS-III score (0.77), short-term (0.82), and long-term (0.84) TUGT time, and short-term FOGQ score (0.73). With respect to the safety outcomes, all strategies indicated few and self-limiting AEs. Conclusion HFrTMS may be the optimal non-invasive brain stimulation (NIBS) intervention to improve motor function in patients with PD while NIBS has generally been well tolerated. However, further studies focusing on the clinical outcomes resulting from the different combined schedules of tDCS and rTMS are required. Systematic review registration https://inplasy.com/inplasy-2023-4-0087/, identifier: 202340087.
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Affiliation(s)
- Youjia Qiu
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Ziqian Yin
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Menghan Wang
- Suzhou Medical College of Soochow University, Suzhou, China
| | - Aojie Duan
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Minjia Xie
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Jiang Wu
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Zhong Wang
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Gang Chen
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, China
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20
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Majdi A, Asamoah B, Mc Laughlin M. Reinterpreting published tDCS results in terms of a cranial and cervical nerve co-stimulation mechanism. Front Hum Neurosci 2023; 17:1101490. [PMID: 37415857 PMCID: PMC10320219 DOI: 10.3389/fnhum.2023.1101490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 05/31/2023] [Indexed: 07/08/2023] Open
Abstract
Transcranial direct current stimulation (tDCS) is a non-invasive neuromodulation method that has been used to alter cognition in hundreds of experiments. During tDCS, a low-amplitude current is delivered via scalp electrodes to create a weak electric field in the brain. The weak electric field causes membrane polarization in cortical neurons directly under the scalp electrodes. It is generally assumed that this mechanism causes the observed effects of tDCS on cognition. However, it was recently shown that some tDCS effects are not caused by the electric field in the brain but rather via co-stimulation of cranial and cervical nerves in the scalp that also have neuromodulatory effects that can influence cognition. This peripheral nerve co-stimulation mechanism is not controlled for in tDCS experiments that use the standard sham condition. In light of this new evidence, results from previous tDCS experiments could be reinterpreted in terms of a peripheral nerve co-stimulation mechanism. Here, we selected six publications that reported tDCS effects on cognition and attributed the effects to the electric field in the brain directly under the electrode. We then posed the question: given the known neuromodulatory effects of cranial and cervical nerve stimulation, could the reported results also be understood in terms of tDCS peripheral nerve co-stimulation? We present our re-interpretation of these results as a way to stimulate debate within the neuromodulation field and as a food-for-thought for researchers designing new tDCS experiments.
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Affiliation(s)
- Alireza Majdi
- Exp ORL, Department of Neuroscience, Leuven Brain Institute, KU Leuven, Leuven, Belgium
- Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | - Boateng Asamoah
- Exp ORL, Department of Neuroscience, Leuven Brain Institute, KU Leuven, Leuven, Belgium
- Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | - Myles Mc Laughlin
- Exp ORL, Department of Neuroscience, Leuven Brain Institute, KU Leuven, Leuven, Belgium
- Leuven Brain Institute, KU Leuven, Leuven, Belgium
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21
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Vucic S, Stanley Chen KH, Kiernan MC, Hallett M, Benninger DH, Di Lazzaro V, Rossini PM, Benussi A, Berardelli A, Currà A, Krieg SM, Lefaucheur JP, Long Lo Y, Macdonell RA, Massimini M, Rosanova M, Picht T, Stinear CM, Paulus W, Ugawa Y, Ziemann U, Chen R. Clinical diagnostic utility of transcranial magnetic stimulation in neurological disorders. Updated report of an IFCN committee. Clin Neurophysiol 2023; 150:131-175. [PMID: 37068329 PMCID: PMC10192339 DOI: 10.1016/j.clinph.2023.03.010] [Citation(s) in RCA: 55] [Impact Index Per Article: 55.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 02/28/2023] [Accepted: 03/09/2023] [Indexed: 03/31/2023]
Abstract
The review provides a comprehensive update (previous report: Chen R, Cros D, Curra A, Di Lazzaro V, Lefaucheur JP, Magistris MR, et al. The clinical diagnostic utility of transcranial magnetic stimulation: report of an IFCN committee. Clin Neurophysiol 2008;119(3):504-32) on clinical diagnostic utility of transcranial magnetic stimulation (TMS) in neurological diseases. Most TMS measures rely on stimulation of motor cortex and recording of motor evoked potentials. Paired-pulse TMS techniques, incorporating conventional amplitude-based and threshold tracking, have established clinical utility in neurodegenerative, movement, episodic (epilepsy, migraines), chronic pain and functional diseases. Cortical hyperexcitability has emerged as a diagnostic aid in amyotrophic lateral sclerosis. Single-pulse TMS measures are of utility in stroke, and myelopathy even in the absence of radiological changes. Short-latency afferent inhibition, related to central cholinergic transmission, is reduced in Alzheimer's disease. The triple stimulation technique (TST) may enhance diagnostic utility of conventional TMS measures to detect upper motor neuron involvement. The recording of motor evoked potentials can be used to perform functional mapping of the motor cortex or in preoperative assessment of eloquent brain regions before surgical resection of brain tumors. TMS exhibits utility in assessing lumbosacral/cervical nerve root function, especially in demyelinating neuropathies, and may be of utility in localizing the site of facial nerve palsies. TMS measures also have high sensitivity in detecting subclinical corticospinal lesions in multiple sclerosis. Abnormalities in central motor conduction time or TST correlate with motor impairment and disability in MS. Cerebellar stimulation may detect lesions in the cerebellum or cerebello-dentato-thalamo-motor cortical pathways. Combining TMS with electroencephalography, provides a novel method to measure parameters altered in neurological disorders, including cortical excitability, effective connectivity, and response complexity.
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Affiliation(s)
- Steve Vucic
- Brain, Nerve Research Center, The University of Sydney, Sydney, Australia.
| | - Kai-Hsiang Stanley Chen
- Department of Neurology, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Matthew C Kiernan
- Brain and Mind Centre, The University of Sydney; and Department of Neurology, Royal Prince Alfred Hospital, Australia
| | - Mark Hallett
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health, Bethesda, Maryland, United States
| | - David H Benninger
- Department of Neurology, University Hospital of Lausanne (CHUV), Switzerland
| | - Vincenzo Di Lazzaro
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico of Rome, Rome, Italy
| | - Paolo M Rossini
- Department of Neurosci & Neurorehab IRCCS San Raffaele-Rome, Italy
| | - Alberto Benussi
- Centre for Neurodegenerative Disorders, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Alfredo Berardelli
- IRCCS Neuromed, Pozzilli; Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Antonio Currà
- Department of Medico-Surgical Sciences and Biotechnologies, Alfredo Fiorini Hospital, Sapienza University of Rome, Terracina, LT, Italy
| | - Sandro M Krieg
- Department of Neurosurgery, Technical University Munich, School of Medicine, Klinikum rechts der Isar, Munich, Germany
| | - Jean-Pascal Lefaucheur
- Univ Paris Est Creteil, EA4391, ENT, Créteil, France; Clinical Neurophysiology Unit, Henri Mondor Hospital, AP-HP, Créteil, France
| | - Yew Long Lo
- Department of Neurology, National Neuroscience Institute, Singapore General Hospital, Singapore, and Duke-NUS Medical School, Singapore
| | | | - Marcello Massimini
- Dipartimento di Scienze Biomediche e Cliniche, Università degli Studi di Milano, Milan, Italy; Istituto Di Ricovero e Cura a Carattere Scientifico, Fondazione Don Carlo Gnocchi, Milan, Italy
| | - Mario Rosanova
- Department of Biomedical and Clinical Sciences University of Milan, Milan, Italy
| | - Thomas Picht
- Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Cluster of Excellence: "Matters of Activity. Image Space Material," Humboldt University, Berlin Simulation and Training Center (BeST), Charité-Universitätsmedizin Berlin, Germany
| | - Cathy M Stinear
- Department of Medicine Waipapa Taumata Rau, University of Auckland, Auckland, Aotearoa, New Zealand
| | - Walter Paulus
- Department of Neurology, Ludwig-Maximilians-Universität München, München, Germany
| | - Yoshikazu Ugawa
- Department of Human Neurophysiology, School of Medicine, Fukushima Medical University, Japan
| | - Ulf Ziemann
- Department of Neurology and Stroke, Eberhard Karls University of Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany; Hertie Institute for Clinical Brain Research, Eberhard Karls University of Tübingen, Otfried-Müller-Straße 27, 72076 Tübingen, Germany
| | - Robert Chen
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital-UHN, Division of Neurology-University of Toronto, Toronto Canada
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22
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Hu AM, Huang CY, He JG, Wu L. Effect of repetitive transcranial magnetic stimulation combined with transcranial direct current stimulation on post-stroke dysmnesia: A preliminary study. Clin Neurol Neurosurg 2023; 231:107797. [PMID: 37263069 DOI: 10.1016/j.clineuro.2023.107797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 05/19/2023] [Accepted: 05/21/2023] [Indexed: 06/03/2023]
Abstract
OBJECTIVE This study examined the effect of repetitive transcranial magnetic stimulation (rTMS) combined with transcranial direct current stimulation (tDCS) as a bimodal neuromodulatory approach for post-stroke dysmnesia. METHODS Thirty-four patients with post-stroke dysmnesia were randomly allocated into a sham group treated with neither rTMS nor tDCS, a group treated with rTMS, and a group treated with a combination of rTMS and tDCS. All three groups received cognitive rehabilitation training for 4 weeks. The memory function of each group before and after the intervention was assessed using the Montreal Cognitive Assessment (MoCA) and Rivermead Behavioral Memory Test (RBMT) scales, as well as in terms of the Mismatch Negativity(MMN)and P300 of event-related potentials. RESULTS The sham, rTMS, and rTMS-tDCS groups all showed improvement in the total MoCA score after the intervention. Delayed recall, a MoCA item, scored better in the rTMS-tDCS group than in the rTMS and sham groups. Delayed processing, an RBMT item, scored better in the rTMS-tDCS combination group than in the rTMS and sham groups. MMN and P300 latency was significantly shorter in the rTMS-tDCS combination group. CONCLUSION rTMS-tDCS bimodal stimulation was more effective than cognitive rehabilitation or rTMS alone in treating patients with post-stroke dysmnesia, offering new possibilities for enhancing cognitive function and treating post-stroke dysmnesia.
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Affiliation(s)
- An-Ming Hu
- Department of Rehabilitation Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Cui-Ying Huang
- Affiliated Hospital of Jining Medical University, Shandong 272007, China
| | - Jian-Gen He
- Beijing Xiaotangshan Hospital, Beijing 102211, China
| | - Liang Wu
- Beijing Xiaotangshan Hospital, Beijing 102211, China.
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23
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Del Mauro L, Vergallito A, Gattavara G, Juris L, Gallucci A, Vedani A, Cappelletti L, Farneti PM, Romero Lauro LJ. Betting on Non-Invasive Brain Stimulation to Treat Gambling Disorder: A Systematic Review and Meta-Analysis. Brain Sci 2023; 13:698. [PMID: 37190663 PMCID: PMC10136786 DOI: 10.3390/brainsci13040698] [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: 03/18/2023] [Revised: 04/13/2023] [Accepted: 04/18/2023] [Indexed: 05/17/2023] Open
Abstract
Gambling disorder (GD) is a behavioral addiction that severely impacts individuals' functioning, leading to high socioeconomic costs. Non-invasive brain stimulation (NiBS) has received attention for treating psychiatric and neurological conditions in recent decades, but there is no recommendation for its use for GD. Therefore, this study aimed to systematically review and analyze the available literature to determine the effectiveness of NiBS in treating GD. Following the PRISMA guidelines, we screened four electronic databases up to July 2022 and selected relevant English-written original articles. We included ten papers in the systematic review and seven in the meta-analysis. As only two studies employed a sham-controlled design, the pre-post standardized mean change (SMCC) was computed as effect size only for real stimulation. The results showed a significant effect of NiBS in reducing craving scores (SMCC = -0.69; 95% CI = [-1.2, -0.2], p = 0.010). Moreover, considering the GD's frequent comorbidity with mood disorders, we ran an exploratory analysis of the effects of NiBS on depressive symptoms, which showed significant decreases in post-treatment scores (SMCC = -0.71; 95% CI = [-1.1, -0.3], p < 0.001). These results provide initial evidence for developing NiBS as a feasible therapy for GD symptoms but further comprehensive research is needed to validate these findings. The limitations of the available literature are critically discussed.
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Affiliation(s)
- Lilia Del Mauro
- Department of Psychology, University of Milano-Bicocca, 20126 Milano, Italy
- Fondazione Eris Onlus, 20134 Milano, Italy
| | - Alessandra Vergallito
- Department of Psychology & Neuromi, University of Milano-Bicocca, 20126 Milano, Italy
| | - Gaia Gattavara
- Department of Psychology, University of Milano-Bicocca, 20126 Milano, Italy
| | | | - Alessia Gallucci
- Ph.D. Program in Neuroscience, School of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
| | - Anna Vedani
- Department of Psychology, University of Milano-Bicocca, 20126 Milano, Italy
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24
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Zhou Y, Xiao G, Chen Q, Wang Y, Wang L, Xie C, Wang K, Chen X. High-Definition Transcranial Direct Current Stimulation Improves Decision-Making Ability: A Study Based on EEG. Brain Sci 2023; 13:brainsci13040640. [PMID: 37190605 DOI: 10.3390/brainsci13040640] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 03/29/2023] [Accepted: 04/04/2023] [Indexed: 05/17/2023] Open
Abstract
High-definition transcranial direct current stimulation (HD-tDCS) has been shown to modulate decision-making; however, the neurophysiological mechanisms underlying this effect remain unclear. To further explore the neurophysiological processes of decision-making modulated by HD-tDCS, health participants underwent ten anodal (n = 16)/sham (n = 17) HD-tDCS sessions targeting the left DLPFC. Iowa gambling task was performed simultaneously with electroencephalography (EEG) before and after HD-tDCS. Iowa gambling task performance, the P300 amplitude, and the power of theta oscillation as an index of decision-making were compared. Behavioral changes were found that showed anodal HD-tDCS could improve the decision-making function, in which participants could make more advantageous choices. The electrophysiological results showed that the P300 amplitude significantly increased in CZ, CPZ electrode placement site and theta oscillation power significantly activated in FCZ, CZ electrode placement site after anodal HD-tDCS. Significant positive correlations were observed between the changes in the percent use of negative feedback and the changes in theta oscillation power before and after anodal HD-tDCS. This study showed that HD-tDCS is a promising technology in improving decision-making and theta oscillation induced by may be a predictor of improved decision-making.
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Affiliation(s)
- Yuwei Zhou
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei 230032, China
| | - Guixian Xiao
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei 230032, China
- Department of Psychology and Sleep Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei 230601, China
| | - Qing Chen
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei 230032, China
| | - Yuyang Wang
- Department of Neurosurgery, The Second Affiliated Hospital of Anhui Medical University, Hefei 230601, China
| | - Lu Wang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei 230032, China
| | - Chengjuan Xie
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei 230032, China
| | - Kai Wang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei 230032, China
- Department of Psychology, The School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei 230032, China
- Hefei Comprehensive National Science Center, Institute of Artificial Intelligence, Hefei 230088, China
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei 230022, China
| | - Xingui Chen
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei 230032, China
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei 230022, China
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25
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Bertoli M, Tataranni A, Porziani S, Pasqualetti P, Gianni E, Grifoni J, L’Abbate T, Armonaite K, Conti L, Cancelli A, Cottone C, Marinozzi F, Bini F, Cecconi F, Tecchio F. Effects on Corticospinal Tract Homology of Faremus Personalized Neuromodulation Relieving Fatigue in Multiple Sclerosis: A Proof-of-Concept Study. Brain Sci 2023; 13:brainsci13040574. [PMID: 37190539 DOI: 10.3390/brainsci13040574] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 03/22/2023] [Accepted: 03/24/2023] [Indexed: 03/31/2023] Open
Abstract
Objectives: Fatigue in multiple sclerosis (MS) is a frequent and invalidating symptom, which can be relieved by non-invasive neuromodulation, which presents only negligible side effects. A 5-day transcranial direct-current stimulation, 15 min per day, anodically targeting the somatosensory representation of the whole body against a larger occipital cathode was efficacious against MS fatigue (fatigue relief in multiple sclerosis, Faremus treatment). The present proof-of-concept study tested the working hypothesis that Faremus S1 neuromodulation modifies the homology of the dominant and non-dominant corticospinal (CST) circuit recruitment. Methods: CST homology was assessed via the Fréchet distance between the morphologies of motor potentials (MEPs) evoked by transcranial magnetic stimulation in the homologous left- and right-hand muscles of 10 fatigued MS patients before and after Faremus. Results: In the absence of any change in MEP features either as differences between the two body sides or as an effect of the treatment, Faremus changed in physiological direction the CST’s homology. Faremus effects on homology were more evident than recruitment changes within the dominant and non-dominant sides. Conclusions: The Faremus-related CST changes extend the relevance of the balance between hemispheric homologs to the homology between body sides. With this work, we contribute to the development of new network-sensitive measures that can provide new insights into the mechanisms of neuronal functional patterning underlying relevant symptoms.
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26
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Dawood Rahimi M, Taghi Kheirkhah M, Salehi Fadardi J. Efficacy of tDCS in chronic migraine: A multiprotocol randomized controlled trial. Clin Neurophysiol 2023; 150:119-130. [PMID: 37060843 DOI: 10.1016/j.clinph.2023.03.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 02/19/2023] [Accepted: 03/12/2023] [Indexed: 04/03/2023]
Abstract
OBJECTIVE Given the prevalence and complicated pathophysiology of migraine, unknown or varied mechanisms of action of available monotherapies or add-on therapies, and their broad range of adverse effects, it is imperative to manage migraine symptoms using a non-invasive, multifunctional, and alternate monotherapy with no negative impacts. METHODS We used a single-blind, randomized, sham-controlled design with baseline, post-test, and 24-weeks follow-up measurements to assess the efficacy of transcranial Direct Current Stimulation (tDCS) in chronic migraine. A total of 150 participants were randomly assigned to the five groups (i.e., allocation ratio of 1:1:1:1:1). Each group received tDCS-intervention for 11 consecutive-weeks (25 sessions; each session = two consecutive montages; each montage = a 20 min duration, 2000 μA intensity). RESULTS The multivariate analysis of variance showed significant (p <.05) reductions in chronic migraine symptoms in the four intervention groups. Compared with the sham (η2 < 0.18) and other protocols (two = η2 > 0.42; three = η2 > 0.40; four = η2 > 0.51), protocol one [l. anode at the right ventrolateral prefrontal cortices, cathode at the left dorsomedial and superior frontal gyrus-first montage; anode at the right primary motor area, cathode at the medial crosstalk of hemispheres-second montage] showed a larger effect size (η2 > 0.59) in the present trial. CONCLUSIONS With the applied protocols of the present trial, tDCS can be used as an effective intervention for the prophylactic and therapeutic treatment of chronic migraine. However, while the second protocol was the least effective, the first was the most effective at reducing migraine symptoms. SIGNIFICANCE To our knowledge, the present trial is the first study to cover the gaps of the earlier ones, including the parameters like the site of stimulation, electrode range distribution and field intensity, number of sessions, session design, and sample size.
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Mosayebi-Samani M, Agboada D, Mutanen TP, Haueisen J, Kuo MF, Nitsche MA. Transferability of cathodal tDCS effects from the primary motor to the prefrontal cortex: A multimodal TMS-EEG study. Brain Stimul 2023; 16:515-539. [PMID: 36828302 DOI: 10.1016/j.brs.2023.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 01/24/2023] [Accepted: 02/19/2023] [Indexed: 02/24/2023] Open
Abstract
Neurophysiological effects of transcranial direct current stimulation (tDCS) have been extensively studied over the primary motor cortex (M1). Much less is however known about its effects over non-motor areas, such as the prefrontal cortex (PFC), which is the neuronal foundation for many high-level cognitive functions and involved in neuropsychiatric disorders. In this study, we, therefore, explored the transferability of cathodal tDCS effects over M1 to the PFC. Eighteen healthy human participants (11 males and 8 females) were involved in eight randomized sessions per participant, in which four cathodal tDCS dosages, low, medium, and high, as well as sham stimulation, were applied over the left M1 and left PFC. After-effects of tDCS were evaluated via transcranial magnetic stimulation (TMS)-electroencephalography (EEG), and TMS-elicited motor evoked potentials (MEP), for the outcome parameters TMS-evoked potentials (TEP), TMS-evoked oscillations, and MEP amplitude alterations. TEPs were studied both at the regional and global scalp levels. The results indicate a regional dosage-dependent nonlinear neurophysiological effect of M1 tDCS, which is not one-to-one transferable to PFC tDCS. Low and high dosages of M1 tDCS reduced early positive TEP peaks (P30, P60), and MEP amplitudes, while an enhancement was observed for medium dosage M1 tDCS (P30). In contrast, prefrontal low, medium and high dosage tDCS uniformly reduced the early positive TEP peak amplitudes. Furthermore, for both cortical areas, regional tDCS-induced modulatory effects were not observed for late TEP peaks, nor TMS-evoked oscillations. However, at the global scalp level, widespread effects of tDCS were observed for both, TMS-evoked potentials and oscillations. This study provides the first direct physiological comparison of tDCS effects applied over different brain areas and therefore delivers crucial information for future tDCS applications.
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Affiliation(s)
- Mohsen Mosayebi-Samani
- Department of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany; Institute of Biomedical Engineering and Informatics, Technische Universität Ilmenau, Ilmenau, Germany
| | - Desmond Agboada
- Department of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany; Institute of Psychology, Federal Armed Forces University Munich, Neubiberg, Germany
| | - Tuomas P Mutanen
- Department of Neuroscience & Biomedical Engineering, Aalto University, School of Science, 00076, Aalto, Espoo, Finland
| | - Jens Haueisen
- Institute of Biomedical Engineering and Informatics, Technische Universität Ilmenau, Ilmenau, Germany
| | - Min-Fang Kuo
- Department of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany
| | - 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, Bielefeld, Germany.
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Selective Stimulus Intensity during Hotspot Search Ensures Faster and More Accurate Preoperative Motor Mapping with nTMS. Brain Sci 2023; 13:brainsci13020285. [PMID: 36831828 PMCID: PMC9954713 DOI: 10.3390/brainsci13020285] [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: 01/03/2023] [Revised: 02/02/2023] [Accepted: 02/06/2023] [Indexed: 02/10/2023] Open
Abstract
INTRODUCTION Navigated transcranial magnetic stimulation (nTMS) has emerged as one of the most innovative techniques in neurosurgical practice. However, nTMS motor mapping involves rigorous steps, and the importance of an accurate execution method has not been emphasized enough. In particular, despite strict adherence to procedural protocols, we have observed high variability in map activation according to the choice of stimulation intensity (SI) right from the early stage of hotspot localization. We present a retrospective analysis of motor mappings performed between March 2020 and July 2022, where the SI was only chosen with rigorous care in the most recent ones, under the guide of an expert neurophysiologist. MATERIALS AND METHODS In order to test the ability to reduce inaccurate responses and time expenditure using selective SI, data were collected from 16 patients who underwent mapping with the random method (group A) and 15 patients who underwent mapping with the proposed method (group B). The parameters considered were resting motor threshold (%), number of stimuli, number of valid motor evoked potentials (MEPs), number of valid MEPs considered true positives (TPs), number of valid MEPs considered false positives (FPs), ratio of true-positive MEPs to total stimuli, ratio of true-positive MEPs to valid MEPs, minimum amplitude, maximum amplitude and mapping time for each patient. RESULTS The analysis showed statistically significant reductions in total stimulus demand, procedural time and number of false-positive MEPs. Significant increases were observed in the number of true-positive MEPs, the ratio of true-positive MEPs to total stimuli and the ratio of true-positive MEPs to valid MEPs. In the subgroups analyzed, there were similar trends, in particular, an increase in true positives and a decrease in false-positive responses. CONCLUSIONS The precise selection of SI during hotspot search in nTMS motor mapping could provide reliable cortical maps in short time and with low employment of resources. This method seems to ensure that a MEP really represents a functionally eloquent cortical point, making mapping more intuitive even in less experienced centers.
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The effects of aerobic exercise and transcranial direct current stimulation on cognitive function in older adults with and without cognitive impairment: A systematic review and meta-analysis. Ageing Res Rev 2022; 81:101738. [PMID: 36162707 DOI: 10.1016/j.arr.2022.101738] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 09/21/2022] [Accepted: 09/21/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Aerobic exercise (AE) may slow age-related cognitive decline. However, such cognition-sparing effects are not uniform across cognitive domains and studies. Transcranial direct current stimulation (tDCS) is a form of non-invasive brain stimulation and is also emerging as a potential alternative to pharmaceutical therapies. Like AE, the effectiveness of tDCS is also inconsistent for reducing cognitive impairment in ageing. The unexplored possibility exists that pairing AE and tDCS could produce synergistic effects and reciprocally augment cognition-improving effects in older individuals with and without cognitive impairments. Previous research found such synergistic effects on cognition when cognitive training is paired with tDCS in older individuals with and without mild cognitive impairment (MCI) or dementia. AIM The purpose of this systematic review with meta-analysis was to explore if pairing AE with tDCS could augment singular effects of AE and tDCS on global cognition (GC), working memory (WM) and executive function (EF) in older individuals with or without MCI and dementia. METHODS Using a PRISMA-based systematic review, we compiled studies that examined the effects of AE alone, tDCS alone, and AE and tDCS combined on cognitive function in older individuals with and without mild cognitive impairment (MCI) or dementia. Using a PICOS approach, we systematically searched PubMed, Scopus and Web of Science searches up to December 2021, we focused on 'MoCA', 'MMSE', 'Mini-Cog' (measures) and 'cognition', 'cognitive function', 'cognitive', 'cognitive performance', 'executive function', 'executive process', 'attention', 'memory', 'memory performance' (outcome terms). We included only randomized controlled trials (RTC) in humans if available in English full text over the past 20 years, with participants' age over 60. We assessed the methodological quality of the included studies (RTC) by the Physiotherapy Evidence Database (PEDro) scale. RESULTS Overall, 68 studies were included in the meta-analyses. AE (ES = 0.56 [95% CI: 0.28-0.83], p = 0.01) and tDCS (ES = 0.69 [95% CI: 0.12-1.26], p = 0.02) improved GC in all three groups of older adults combined (healthy, MCI, demented). In healthy population, AE improved GC (ES = 0.46 [95% CI: 0.22-0.69], p = 0.01) and EF (ES = 0.27 [95% CI: 0.05-0.49], p = 0.02). AE improved GC in older adults with MCI (ES = 0.76 [95% CI: 0.21-1.32], p = 0.01). tDCS improved GC (ES = 0.69 [90% CI: 0.12-1.26], p = 0.02), all three cognitive function (GC, WM and EF) combined in older adults with dementia (ES = 1.12 [95% CI: 0.04-2.19], p = 0.04) and improved cognitive function in older adults overall (ES = 0.69 [95% CI: 0.20-1,18], p = 0.01). CONCLUSION Our systematic review with meta-analysis provided evidence that beyond the cardiovascular and fitness benefits of AE, pairing AE with tDCS may have the potential to slow symptom progression of cognitive decline in MCI and dementia. Future studies will examine the hypothesis of this present review that a potentiating effect would incrementally improve cognition with increasing severity of cognitive impairment.
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30
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Camacho‐Conde JA, del Rosario Gonzalez‐Bermudez M, Carretero‐Rey M, Khan ZU. Therapeutic potential of brain stimulation techniques in the treatment of mental, psychiatric, and cognitive disorders. CNS Neurosci Ther 2022; 29:8-23. [PMID: 36229994 PMCID: PMC9804057 DOI: 10.1111/cns.13971] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 08/25/2022] [Accepted: 08/26/2022] [Indexed: 02/06/2023] Open
Abstract
Treatment for brain diseases has been disappointing because available medications have failed to produce clinical response across all the patients. Many patients either do not respond or show partial and inconsistent effect, and even in patients who respond to the medications have high relapse rates. Brain stimulation has been seen as an alternative and effective remedy. As a result, brain stimulation has become one of the most valuable therapeutic tools for combating against brain diseases. In last decade, studies with the application of brain stimulation techniques not only have grown exponentially but also have expanded to wide range of brain disorders. Brain stimulation involves passing electric currents into the cortical and subcortical area brain cells with the use of noninvasive as well as invasive methods to amend brain functions. Over time, technological advancements have evolved into the development of precise devices; however, at present, most used noninvasive techniques are repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS), whereas the most common invasive technique is deep brain stimulation (DBS). In the current review, we will provide an overview of the potential of noninvasive (rTMS and tDCS) and invasive (DBS) brain stimulation techniques focusing on the treatment of mental, psychiatric, and cognitive disorders.
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Affiliation(s)
- Jose Antonio Camacho‐Conde
- Laboratory of Neurobiology, CIMESUniversity of Malaga, Campus Teatinos s/nMalagaSpain,Department of Medicine, Faculty of MedicineUniversity of Malaga, Campus Teatinos s/nMalagaSpain
| | | | - Marta Carretero‐Rey
- Laboratory of Neurobiology, CIMESUniversity of Malaga, Campus Teatinos s/nMalagaSpain,Department of Medicine, Faculty of MedicineUniversity of Malaga, Campus Teatinos s/nMalagaSpain
| | - Zafar U. Khan
- Laboratory of Neurobiology, CIMESUniversity of Malaga, Campus Teatinos s/nMalagaSpain,Department of Medicine, Faculty of MedicineUniversity of Malaga, Campus Teatinos s/nMalagaSpain,CIBERNEDInstitute of Health Carlos IIIMadridSpain
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31
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Lee J, Lee CW, Jang Y, You JS, Park YS, Ji E, Yu H, Oh S, Ryoo HA, Cho N, Park JY, Yoon J, Baek JH, Park HY, Ha TH, Myung W. Efficacy and safety of daily home-based transcranial direct current stimulation as adjunct treatment for bipolar depressive episodes: Double-blind sham-controlled randomized clinical trial. Front Psychiatry 2022; 13:969199. [PMID: 36203828 PMCID: PMC9530445 DOI: 10.3389/fpsyt.2022.969199] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 08/26/2022] [Indexed: 11/13/2022] Open
Abstract
Background Although transcranial direct current stimulation (tDCS) is known to be a promising therapeutic modality for unipolar depression, the efficacy and safety of tDCS for bipolar depressive episodes (BD) are still unknown and clinical trials of home-based tDCS treatment are scarce. As a result, we set out to investigate the efficacy and safety of home-based tDCS for the treatment BD. Methods Participants (n = 64), diagnosed as bipolar disorder as per the diagnostic and statistical manual of mental disorders (DSM-5), were randomly assigned to receive tDCS. Hamilton Depression Rating Scale (HDRS-17) scores were measured at the baseline, week 2, 4, and 6, and home-based tDCS (for 30 min with 2 mA) was self-administered daily. Results Of the 64 patients (15.6% bipolar disorder I, 84.4% bipolar disorder II), 41 patients completed the entire assessment. In the intention-to-treat analysis, time-group interaction for the HDRS-17 [F (3, 146.36) = 2.060; p = 0.108] and adverse effect differences between two groups were not statistically significant, except the pain score, which was higher in the active group than the sham group (week 0-2: p < 0.01, week 2-4: p < 0.05, and week 4-6: p < 0.01). Conclusion Even though we found no evidence for the efficacy of home-based tDCS for patients with BD, this tool was found to be a safe and tolerable treatment modality for BD. Clinical trial registration [https://clinicaltrials.gov/show/NCT03974815], identifier [NCT03974815].
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Affiliation(s)
- Jangwon Lee
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seoul, South Korea
| | - Chan Woo Lee
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seoul, South Korea
| | - Yoonjeong Jang
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seoul, South Korea
| | - Ji Seon You
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seoul, South Korea
| | - Yun Seong Park
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seoul, South Korea
| | - Eunjeong Ji
- Medical Research Collaborating Centre, Seoul National University Bundang Hospital, Seoul, South Korea
| | - Hyeona Yu
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seoul, South Korea
| | - Sunghee Oh
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seoul, South Korea
| | - Hyun A. Ryoo
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seoul, South Korea
| | - Nayoung Cho
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seoul, South Korea
| | - Ji Yoon Park
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seoul, South Korea
| | - Joohyun Yoon
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seoul, South Korea
| | - Ji Hyun Baek
- Department of Psychiatry, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hye Youn Park
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seoul, South Korea
| | - Tae Hyon Ha
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seoul, South Korea
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, South Korea
| | - Woojae Myung
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seoul, South Korea
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, South Korea
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Palimeris S, Ansari Y, Remaud A, Tremblay F, Corriveau H, Boudrias MH, Milot MH. Effect of a tailored upper extremity strength training intervention combined with direct current stimulation in chronic stroke survivors: A Randomized Controlled Trial. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:978257. [PMID: 36189037 PMCID: PMC9397935 DOI: 10.3389/fresc.2022.978257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 07/14/2022] [Indexed: 11/25/2022]
Abstract
Strengthening exercises are recommended for managing persisting upper limb (UL) weakness following a stroke. Yet, strengthening exercises often lead to variable gains because of their generic nature. For this randomized controlled trial (RCT), we aimed to determine whether tailoring strengthening exercises using a biomarker of corticospinal integrity, as reflected in the amplitude of motor evoked potentials (MEPs) elicited by transcranial magnetic stimulation (TMS), could optimize training effects in the affected UL. A secondary aim was to determine whether applying anodal transcranial direct current stimulation (tDCS) could enhance exercise-induced training effects. For this multisite RCT, 90 adults at the chronic stage after stroke (>6 months) were recruited. Before training, participants underwent TMS to detect the presence of MEPs in the affected hand. The MEP amplitude was used to stratify participants into three training groups: (1) low-intensity, MEP <50 μV, (2) moderate-intensity, 50 μV < MEP < 120 μV, and (3) high-intensity, MEP>120 μV. Each group trained at a specific intensity based on the one-repetition maximum (1 RM): low-intensity, 35–50% 1RM; moderate-intensity, 50–65% 1RM; high-intensity, 70–85% 1RM. The strength training targeted the affected UL and was delivered 3X/week for four consecutive weeks. In each training group, participants were randomly assigned to receive either real or sham anodal tDCS (2 mA, 20 min) over the primary motor area of the affected hemisphere. Pre-/post-intervention, participants underwent a clinical evaluation of their UL to evaluate motor impairments (Fugl-Meyer Assessment), manual dexterity (Box and Blocks test) and grip strength. Post-intervention, all groups exhibited similar gains in terms of reduced impairments, improved dexterity, and grip strength, which was confirmed by multivariate and univariate analyses. However, no effect of interaction was found for tDCS or training group, indicating that tDCS had no significant impact on outcomes post-intervention. Collectively, these results indicate that adjusting training intensity based on the size of MEPs in the affected extremity provides a useful approach to optimize responses to strengthening exercises in chronic stroke survivors. Also, the lack of add-on effects of tDCS applied to the lesioned hemisphere on exercise-induced improvements in the affected UL raises questions about the relevance of combining such interventions in stroke.
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Affiliation(s)
- Stephania Palimeris
- Faculty of Medicine and Health Sciences, School of Physical and Occupational Therapy, McGill University, Montréal, QC, Canada
- BRAIN Lab, Jewish Rehabilitation Hospital, Laval, QC, Canada
- Montreal Center for Interdisciplinary Research in Rehabilitation (CRIR) and CISSS-Laval, Montréal, QC, Canada
| | | | | | - François Tremblay
- Bruyère Research Institute, Ottawa, ON, Canada
- Faculty of Health Sciences, School of Rehabilitation Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Hélène Corriveau
- Faculté de médecine et des sciences de la santé, Université de Sherbrooke, École de réadaptation, Sherbrooke, QC, Canada
- Centre de recherche sur le vieillissement, CIUSSS de l'Estrie-CHUS, Sherbrooke, QC, Canada
| | - Marie Hélène Boudrias
- Faculty of Medicine and Health Sciences, School of Physical and Occupational Therapy, McGill University, Montréal, QC, Canada
- BRAIN Lab, Jewish Rehabilitation Hospital, Laval, QC, Canada
- Montreal Center for Interdisciplinary Research in Rehabilitation (CRIR) and CISSS-Laval, Montréal, QC, Canada
| | - Marie Hélène Milot
- Faculté de médecine et des sciences de la santé, Université de Sherbrooke, École de réadaptation, Sherbrooke, QC, Canada
- Centre de recherche sur le vieillissement, CIUSSS de l'Estrie-CHUS, Sherbrooke, QC, Canada
- *Correspondence: Marie Hélène Milot
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Thams F, Külzow N, Flöel A, Antonenko D. Modulation of network centrality and gray matter microstructure using multi-session brain stimulation and memory training. Hum Brain Mapp 2022; 43:3416-3426. [PMID: 35373873 PMCID: PMC9248322 DOI: 10.1002/hbm.25857] [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: 11/08/2021] [Revised: 02/15/2022] [Accepted: 03/24/2022] [Indexed: 11/07/2022] Open
Abstract
Neural mechanisms of behavioral improvement induced by repeated transcranial direct current stimulation (tDCS) combined with cognitive training are yet unclear. Previously, we reported behavioral effects of a 3-day visuospatial memory training with concurrent anodal tDCS over the right temporoparietal cortex in older adults. To investigate intervention-induced neural alterations we here used functional magnetic resonance imaging (fMRI) and diffusion tensor imaging (DTI) datasets available from 35 participants of this previous study, acquired before and after the intervention. To delineate changes in whole-brain functional network architecture, we employed eigenvector centrality mapping. Gray matter alterations were analyzed using DTI-derived mean diffusivity (MD). Network centrality in the bilateral posterior temporooccipital cortex was reduced after anodal compared to sham stimulation. This focal effect is indicative of decreased functional connectivity of the brain region underneath the anodal electrode and its left-hemispheric homolog with other "relevant" (i.e., highly connected) brain regions, thereby providing evidence for reorganizational processes within the brain's network architecture. Examining local MD changes in these clusters, an interaction between stimulation condition and training success indicated a decrease of MD in the right (stimulated) temporooccipital cluster in individuals who showed superior behavioral training benefits. Using a data-driven whole-brain network approach, we provide evidence for targeted neuromodulatory effects of a combined tDCS-and-training intervention. We show for the first time that gray matter alterations of microstructure (assessed by DTI-derived MD) may be involved in tDCS-enhanced cognitive training. Increased knowledge on how combined interventions modulate neural networks in older adults, will help the development of specific therapeutic interventions against age-associated cognitive decline.
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Affiliation(s)
- Friederike Thams
- Department of Neurology, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Nadine Külzow
- Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Neurocure Cluster of Excellence, Berlin, Germany.,Neurological Rehabilitation Clinic, Kliniken Beelitz GmbH, Beelitz, Germany
| | - Agnes Flöel
- Department of Neurology, Universitätsmedizin Greifswald, Greifswald, Germany.,German Centre for Neurodegenerative Diseases (DZNE) Standort Greifswald, Greifswald, Germany
| | - Daria Antonenko
- Department of Neurology, Universitätsmedizin Greifswald, Greifswald, Germany
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Lioumis P, Rosanova M. The role of neuronavigation in TMS-EEG studies: current applications and future perspectives. J Neurosci Methods 2022; 380:109677. [PMID: 35872153 DOI: 10.1016/j.jneumeth.2022.109677] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 07/12/2022] [Accepted: 07/19/2022] [Indexed: 11/28/2022]
Abstract
Transcranial magnetic stimulation combined with electroencephalography (TMS-EEG) allows measuring non-invasively the electrical response of the human cerebral cortex to a direct perturbation. Complementing TMS-EEG with a structural neuronavigation tool (nTMS-EEG) is key for accurately selecting cortical areas, targeting them, and adjusting the stimulation parameters based on some relevant anatomical priors. This step, together with the employment of visualization tools designed to perform a quality check of TMS-evoked potentials (TEPs) in real-time during acquisition, is key for maximizing the impact of the TMS pulse on the cortex and in ensuring highly reproducible measurements within sessions and across subjects. Moreover, storing stimulation parameters in the neuronavigation system can help in reproducing the stimulation parameters within and across experimental sessions and sharing them across research centers. Finally, the systematic employment of neuronavigation in TMS-EEG studies is also key to standardize measurements in clinical populations in search for reliable diagnostic and prognostic TMS-EEG-based biomarkers for neurological and psychiatric disorders.
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Affiliation(s)
- Pantelis Lioumis
- Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, Espoo, Finland; BioMag Laboratory, HUS Diagnostic Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Mario Rosanova
- Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy
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35
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Farzan F, Bortoletto M. Identification and verification of a 'true' TMS evoked potential in TMS-EEG. J Neurosci Methods 2022; 378:109651. [PMID: 35714721 DOI: 10.1016/j.jneumeth.2022.109651] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 04/05/2022] [Accepted: 06/09/2022] [Indexed: 11/19/2022]
Abstract
The concurrent combination of transcranial magnetic stimulation and electroencephalography (TMS-EEG) can unveil functional neural mechanisms with applications in basic and clinical research. In particular, TMS-evoked potentials (TEPs) potentially allow studying excitability and connectivity of the cortex in a causal manner that is not easily or non-invasively attainable with other neuroimaging techniques. The TEP waveform is obtained by isolating the EEG responses phase-locked to the time of TMS application. The intended component in a TEP waveform is the cortical activation by the TMS-induced electric current, free of instrumental and physiological artifact sources. This artifact-free cortical activation can be referred to as 'true' TEP. However, due to many unwanted auxiliary effects of TMS, the interpretation of 'true' TEPs has not been free of controversy. This paper reviews the most recent understandings of 'true' TEPs and their application. In the first part of the paper, TEP components are defined according to recommended methodologies. In the second part, the verification of 'true' TEP is discussed along with its sensitivity to brain-state, age, and disease. The various proposed origins of TEP components are then presented in the context of existing literature. Throughout the paper, lessons learned from the past TMS-EEG studies are highlighted to guide the identification and interpretation of 'true' TEPs in future studies.
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Affiliation(s)
- Faranak Farzan
- eBrain Lab, School of Mechatronic Systems Engineering, Simon Fraser University, Surrey, British Columbia, Canada; University of Toronto, Department of Psychiatry, Toronto, Ontario, Canada; Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
| | - Marta Bortoletto
- Neurophysiology lab, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy.
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36
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Anodal Transcranial Direct Current Stimulation (atDCS) of the Primary Motor Cortex (M1) Facilitates Nonconscious Error Correction of Negative Phase Shifts. Neural Plast 2022; 2022:9419154. [PMID: 35662740 PMCID: PMC9159881 DOI: 10.1155/2022/9419154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 04/14/2022] [Accepted: 04/25/2022] [Indexed: 11/17/2022] Open
Abstract
Accurate motor timing requires the temporally precise coupling between sensory input and motor output including the adjustment of movements with respect to changes in the environment. Such error correction has been related to a cerebello-thalamo-cortical network. At least partially distinct networks for the correction of perceived (i.e., conscious) as compared to nonperceived (i.e., nonconscious) errors have been suggested. While the cerebellum, the premotor, and the prefrontal cortex seem to be involved in conscious error correction, the network subserving nonconscious error correction is less clear. The present study is aimed at investigating the functional contribution of the primary motor cortex (M1) for both types of error correction in the temporal domain. To this end, anodal transcranial direct current stimulation (atDCS) was applied to the left M1 in a group of 18 healthy young volunteers during a resting period of 10 minutes. Sensorimotor synchronization as well as error correction of the right index finger was tested immediately prior to and after atDCS. Sham stimulation served as control condition. To induce error correction, nonconscious and conscious temporal step-changes were interspersed in a sequence of an isochronous auditory pacing signal in either direction (i.e., negative or positive) yielding either shorter or longer intervals. Prior to atDCS, faster error correction in conscious as compared to nonconscious trials was observed replicating previous findings. atDCS facilitated nonconscious error correction, but only in trials with negative step-changes yielding shorter intervals. In contrast to this, neither tapping speed nor synchronization performance with respect to the isochronous pacing signal was significantly modulated by atDCS. The data suggest M1 as part of a network distinctively contributing to the correction of nonconscious negative step-changes going beyond sensorimotor synchronization.
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Vergallito A, Feroldi S, Pisoni A, Romero Lauro LJ. Inter-Individual Variability in tDCS Effects: A Narrative Review on the Contribution of Stable, Variable, and Contextual Factors. Brain Sci 2022; 12:522. [PMID: 35624908 PMCID: PMC9139102 DOI: 10.3390/brainsci12050522] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 04/08/2022] [Accepted: 04/14/2022] [Indexed: 01/27/2023] Open
Abstract
Due to its safety, portability, and cheapness, transcranial direct current stimulation (tDCS) use largely increased in research and clinical settings. Despite tDCS's wide application, previous works pointed out inconsistent and low replicable results, sometimes leading to extreme conclusions about tDCS's ineffectiveness in modulating behavioral performance across cognitive domains. Traditionally, this variability has been linked to significant differences in the stimulation protocols across studies, including stimulation parameters, target regions, and electrodes montage. Here, we reviewed and discussed evidence of heterogeneity emerging at the intra-study level, namely inter-individual differences that may influence the response to tDCS within each study. This source of variability has been largely neglected by literature, being results mainly analyzed at the group level. Previous research, however, highlighted that only a half-or less-of studies' participants could be classified as responders, being affected by tDCS in the expected direction. Stable and variable inter-individual differences, such as morphological and genetic features vs. hormonal/exogenous substance consumption, partially account for this heterogeneity. Moreover, variability comes from experiments' contextual elements, such as participants' engagement/baseline capacity and individual task difficulty. We concluded that increasing knowledge on inter-dividual differences rather than undermining tDCS effectiveness could enhance protocols' efficiency and reproducibility.
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Affiliation(s)
- Alessandra Vergallito
- Department of Psychology & NeuroMi, University of Milano Bicocca, 20126 Milano, Italy; (A.P.); (L.J.R.L.)
| | - Sarah Feroldi
- School of Medicine and Surgery, University of Milano-Bicocca, 20854 Monza, Italy;
| | - Alberto Pisoni
- Department of Psychology & NeuroMi, University of Milano Bicocca, 20126 Milano, Italy; (A.P.); (L.J.R.L.)
| | - Leonor J. Romero Lauro
- Department of Psychology & NeuroMi, University of Milano Bicocca, 20126 Milano, Italy; (A.P.); (L.J.R.L.)
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38
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Mathematical Model Insights into EEG Origin under Transcranial Direct Current Stimulation (tDCS) in the Context of Psychosis. J Clin Med 2022; 11:jcm11071845. [PMID: 35407453 PMCID: PMC8999473 DOI: 10.3390/jcm11071845] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 03/12/2022] [Accepted: 03/22/2022] [Indexed: 02/04/2023] Open
Abstract
Schizophrenia is a psychotic disease that develops progressively over years with a transition from prodromal to psychotic state associated with a disruption in brain activity. Transcranial Direct Current Stimulation (tDCS), known to alleviate pharmaco-resistant symptoms in patients suffering from schizophrenia, promises to prevent such a psychotic transition. To understand better how tDCS affects brain activity, we propose a neural cortico-thalamo-cortical (CTC) circuit model involving the Ascending Reticular Arousal System (ARAS) that permits to describe major impact features of tDCS, such as excitability for short-duration stimulation and electroencephalography (EEG) power modulation for long-duration stimulation. To this end, the mathematical model relates stimulus duration and Long-Term Plasticity (LTP) effect, in addition to describing the temporal LTP decay after stimulus offset. This new relation promises to optimize future stimulation protocols. Moreover, we reproduce successfully EEG-power modulation under tDCS in a ketamine-induced psychosis model and confirm the N-methyl-d-aspartate (NMDA) receptor hypofunction hypothesis in the etiopathophysiology of schizophrenia. The model description points to an important role of the ARAS and the δ-rhythm synchronicity in CTC circuit in early-stage psychosis.
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Chiang HS, Shakal S, Strain JF, Womack K, Kraut M, Vanneste S, Hart J. Reversal of unilateral hand movement dysfunction by high definition transcranial direct current stimulation in a patient with chronic traumatic brain injury. Brain Stimul 2022; 15:283-285. [PMID: 35066190 DOI: 10.1016/j.brs.2022.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 01/16/2022] [Indexed: 11/18/2022] Open
Affiliation(s)
- Hsueh-Sheng Chiang
- Department of Neurology, The University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard Dallas, Texas, 75390, USA; The University of Texas Southwestern Medical Center, Dallas, TX, USA; The University of Texas at Dallas, Richardson, TX, USA.
| | - Scott Shakal
- The University of North Texas Health Science Center, 3500 Camp Bowie Blvd, Fort Worth, TX, 76107, USA.
| | - Jeremy F Strain
- Department of Neurology, Washington University in St. Louis, 660 S Euclid Ave, St. Louis, MO, 63108, USA.
| | - Kyle Womack
- Department of Neurology, Washington University in St. Louis, Campus Box 8111, 4488 Forest Park, Suite 200, St. Louis, MO, 63108, USA.
| | - Michael Kraut
- Department of Radiology, The Johns Hopkins University School of Medicine, 601 N Caroline St, Baltimore, MD, 21205, USA.
| | - Sven Vanneste
- Trinity College Dublin, The University of Dublin, College Green Dublin 2, Ireland.
| | - John Hart
- School of Behavioral and Brain Sciences, The University of Texas at Dallas, 800 W Campbell Rd, Richardson, TX, 75080, USA; Department of Neurology and Psychiatry, The University of Texas Southwestern Medical Center, USA.
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Redondo-Camós M, Cattaneo G, Perellón-Alfonso R, Alviarez-Schulze V, Morris TP, Solana-Sanchez J, España-Irla G, Delgado-Gallén S, Pachón-García C, Albu S, Zetterberg H, Tormos JM, Pascual-Leone A, Bartres-Faz D. Local Prefrontal Cortex TMS-Induced Reactivity Is Related to Working Memory and Reasoning in Middle-Aged Adults. Front Psychol 2022; 13:813444. [PMID: 35222201 PMCID: PMC8866698 DOI: 10.3389/fpsyg.2022.813444] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 01/18/2022] [Indexed: 12/19/2022] Open
Abstract
Introduction The prefrontal cortex (PFC) plays a crucial role in cognition, particularly in executive functions. Cortical reactivity measured with Transcranial Magnetic Stimulation combined with Electroencephalography (TMS-EEG) is altered in pathological conditions, and it may also be a marker of cognitive status in middle-aged adults. In this study, we investigated the associations between cognitive measures and TMS evoked EEG reactivity and explored whether the effects of this relationship were related to neurofilament light chain levels (NfL), a marker of neuroaxonal damage. Methods Fifty two healthy middle-aged adults (41–65 years) from the Barcelona Brain Health Initiative cohort underwent TMS-EEG, a comprehensive neuropsychological assessment, and a blood test for NfL levels. Global and Local Mean-Field Power (GMFP/LMFP), two measures of cortical reactivity, were quantified after left prefrontal cortex (L-PFC) stimulation, and cognition was set as the outcome of the regression analysis. The left inferior parietal lobe (L-IPL) was used as a control stimulation condition. Results Local reactivity was significantly associated with working memory and reasoning only after L-PFC stimulation. No associations were found between NfL and cognition. These specific associations were independent of the status of neuroaxonal damage indexed by the NfL biomarker and remained after adjusting for age, biological sex, and education. Conclusion Our results demonstrate that TMS evoked EEG reactivity at the L-PFC, but not the L-IPL, is related to the cognitive status of middle-aged individuals and independent of NfL levels, and may become a valuable biomarker of frontal lobe-associated cognitive function.
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Affiliation(s)
- María Redondo-Camós
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la Universitat Autónoma de Barcelona, Barcelona, Spain.,Departament de Medicina, Facultat de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain.,Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain
| | - Gabriele Cattaneo
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la Universitat Autónoma de Barcelona, Barcelona, Spain.,Departament de Medicina, Facultat de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain.,Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain
| | - Ruben Perellón-Alfonso
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Departament de Medicina, Facultat de Medicina i Ciències de la Salut, i Institut de Neurociències, Universitat de Barcelona, Barcelona, Spain
| | - Vanessa Alviarez-Schulze
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la Universitat Autónoma de Barcelona, Barcelona, Spain.,Departament de Medicina, Facultat de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain.,Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain.,Departamento de Ciencias del Comportamiento, Escuela de Psicología, Universidad Metropolitana, Caracas, Venezuela
| | - Timothy P Morris
- Center for Cognitive and Brain Health, Department of Psychology, Northeastern University, Boston, MA, United States
| | - Javier Solana-Sanchez
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la Universitat Autónoma de Barcelona, Barcelona, Spain.,Departament de Medicina, Facultat de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain.,Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain
| | - Goretti España-Irla
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la Universitat Autónoma de Barcelona, Barcelona, Spain.,Departament de Medicina, Facultat de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain.,Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain
| | - Selma Delgado-Gallén
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la Universitat Autónoma de Barcelona, Barcelona, Spain.,Departament de Medicina, Facultat de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain.,Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain
| | - Catherine Pachón-García
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la Universitat Autónoma de Barcelona, Barcelona, Spain.,Departament de Medicina, Facultat de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain.,Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain
| | - Sergiu Albu
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la Universitat Autónoma de Barcelona, Barcelona, Spain.,Departament de Medicina, Facultat de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain.,Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden.,Department of Neurodegenerative Disease, University College London Institute of Neurology, London, United Kingdom.,UK Dementia Research Institute, University College London, London, United Kingdom.,Hong Kong Center for Neurodegenerative Diseases, Hong Kong, China
| | - Josep M Tormos
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la Universitat Autónoma de Barcelona, Barcelona, Spain.,Departament de Medicina, Facultat de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain.,Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain
| | - Alvaro Pascual-Leone
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la Universitat Autónoma de Barcelona, Barcelona, Spain.,Hinda and Arthur Marcus Institute for Aging Research and Deanna and Sidney Wolk Center for Memory Health, Hebrew SeniorLife, Boston, MA, United States.,Department of Neurology, Harvard Medical School, Boston, MA, United States
| | - David Bartres-Faz
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la Universitat Autónoma de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Departament de Medicina, Facultat de Medicina i Ciències de la Salut, i Institut de Neurociències, Universitat de Barcelona, Barcelona, Spain
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41
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Mattavelli G, Lo Presti S, Tornaghi D, Canessa N. High-definition transcranial direct current stimulation of the dorsal anterior cingulate cortex modulates decision-making and executive control. Brain Struct Funct 2022; 227:1565-1576. [PMID: 35102442 DOI: 10.1007/s00429-022-02456-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 01/13/2022] [Indexed: 11/02/2022]
Abstract
Previous neuroimaging evidence highlights the translational implications of targeting the dorsal anterior cingulate cortex (dACC), i.e. a key node of the networks underlying conflict monitoring and decision-making, in brain stimulation treatments with clinical or rehabilitative purposes. While the optimized modelling of "high-definition" current flows between multiple anode-cathode pairs might, in principle, allow to stimulate an otherwise challenging target, sensitive benchmark metrics of dACC neuromodulation are required to assess the effectiveness of this approach. On this basis, we aimed to assess the modulatory effect of anodal and cathodal high-definition tDCS (HD-tDCS) of the dACC on different facets of executive control and decision-making in healthy young individuals. A combined modelling/targeting procedure provided the optimal montage for the maximum intensity of dACC stimulation with six small "high-definition" electrodes delivering anodal, cathodal or sham HD-tDCS for 20 min in a within-subject design with three separate sessions. Following stimulation, participants performed Flanker and gambling tasks unveiling individual differences in executive control and both loss- and risk-aversion in decision-making, respectively. Compared to both anodal and sham conditions, cathodal dACC stimulation significantly affected task performance by increasing control over the Flanker conflict effect, and both loss and risk-aversion in decision-making. By confirming the feasibility and effectiveness of dACC stimulation with HD-tDCS, these findings highlight the implications of modelling and targeting procedures for neuromodulation in clinical research, whereby innovative protocols might serve as treatment addressing dysfunctional dACC activity, or combined with cognitive training, to enhance higher-order executive functioning in different neuropsychiatric conditions.
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Affiliation(s)
- Giulia Mattavelli
- IUSS Cognitive Neuroscience (ICoN) Center, Scuola Universitaria Superiore IUSS, 27100, Pavia, Italy.,Cognitive Neuroscience Laboratory of Pavia Institute, Istituti Clinici Scientifici Maugeri IRCCS, Via Maugeri 4, 27100, Pavia, Italy
| | - Sara Lo Presti
- IUSS Cognitive Neuroscience (ICoN) Center, Scuola Universitaria Superiore IUSS, 27100, Pavia, Italy
| | - Diana Tornaghi
- IUSS Cognitive Neuroscience (ICoN) Center, Scuola Universitaria Superiore IUSS, 27100, Pavia, Italy
| | - Nicola Canessa
- IUSS Cognitive Neuroscience (ICoN) Center, Scuola Universitaria Superiore IUSS, 27100, Pavia, Italy. .,Cognitive Neuroscience Laboratory of Pavia Institute, Istituti Clinici Scientifici Maugeri IRCCS, Via Maugeri 4, 27100, Pavia, Italy.
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42
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Páscoa dos Santos F, Verschure PFMJ. Excitatory-Inhibitory Homeostasis and Diaschisis: Tying the Local and Global Scales in the Post-stroke Cortex. Front Syst Neurosci 2022; 15:806544. [PMID: 35082606 PMCID: PMC8785563 DOI: 10.3389/fnsys.2021.806544] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 11/29/2021] [Indexed: 12/28/2022] Open
Abstract
Maintaining a balance between excitatory and inhibitory activity is an essential feature of neural networks of the neocortex. In the face of perturbations in the levels of excitation to cortical neurons, synapses adjust to maintain excitatory-inhibitory (EI) balance. In this review, we summarize research on this EI homeostasis in the neocortex, using stroke as our case study, and in particular the loss of excitation to distant cortical regions after focal lesions. Widespread changes following a localized lesion, a phenomenon known as diaschisis, are not only related to excitability, but also observed with respect to functional connectivity. Here, we highlight the main findings regarding the evolution of excitability and functional cortical networks during the process of post-stroke recovery, and how both are related to functional recovery. We show that cortical reorganization at a global scale can be explained from the perspective of EI homeostasis. Indeed, recovery of functional networks is paralleled by increases in excitability across the cortex. These adaptive changes likely result from plasticity mechanisms such as synaptic scaling and are linked to EI homeostasis, providing a possible target for future therapeutic strategies in the process of rehabilitation. In addition, we address the difficulty of simultaneously studying these multiscale processes by presenting recent advances in large-scale modeling of the human cortex in the contexts of stroke and EI homeostasis, suggesting computational modeling as a powerful tool to tie the meso- and macro-scale processes of recovery in stroke patients.
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Affiliation(s)
- Francisco Páscoa dos Santos
- Eodyne Systems SL, Barcelona, Spain
- Laboratory of Synthetic, Perceptive, Emotive and Cognitive Systems (SPECS), Institute for Bioengineering of Catalonia (IBEC), Barcelona, Spain
- Department of Information and Communications Technologies (DTIC), Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Paul F. M. J. Verschure
- Laboratory of Synthetic, Perceptive, Emotive and Cognitive Systems (SPECS), Institute for Bioengineering of Catalonia (IBEC), Barcelona, Spain
- Catalan Institution for Research and Advanced Studies (ICREA), Barcelona, Spain
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43
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Cosentino G, Todisco M, Blandini F. Noninvasive neuromodulation in Parkinson's disease: Neuroplasticity implication and therapeutic perspectives. HANDBOOK OF CLINICAL NEUROLOGY 2022; 184:185-198. [PMID: 35034733 DOI: 10.1016/b978-0-12-819410-2.00010-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Noninvasive brain stimulation techniques can be used to study in vivo the changes of cortical activity and plasticity in subjects with Parkinson's disease (PD). Also, an increasing number of studies have suggested a potential therapeutic effect of these techniques. High-frequency repetitive transcranial magnetic stimulation (rTMS) and anodal transcranial direct current stimulation (tDCS) represent the most used stimulation paradigms to treat motor and nonmotor symptoms of PD. Both techniques can enhance cortical activity, compensating for its reduction related to subcortical dysfunction in PD. However, the use of suboptimal stimulation parameters can lead to therapeutic failure. Clinical studies are warranted to clarify in PD the additional effects of these stimulation techniques on pharmacologic and neurorehabilitation treatments.
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Affiliation(s)
- Giuseppe Cosentino
- Translational Neurophysiology Research Unit, IRCCS Mondino Foundation, Pavia, Italy; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Massimiliano Todisco
- Translational Neurophysiology Research Unit, IRCCS Mondino Foundation, Pavia, Italy; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy; Movement Disorders Research Center, IRCCS Mondino Foundation, Pavia, Italy.
| | - Fabio Blandini
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy; Movement Disorders Research Center, IRCCS Mondino Foundation, Pavia, Italy
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44
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The rt-TEP tool: real-time visualization of TMS-Evoked Potential to maximize cortical activation and minimize artifacts. J Neurosci Methods 2022; 370:109486. [DOI: 10.1016/j.jneumeth.2022.109486] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 01/14/2022] [Accepted: 01/19/2022] [Indexed: 12/11/2022]
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45
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Diana L, Scotti G, Aiello EN, Pilastro P, Eberhard-Moscicka AK, Müri RM, Bolognini N. Conventional and HD-tDCS May (or May Not) Modulate Overt Attentional Orienting: An Integrated Spatio-Temporal Approach and Methodological Reflections. Brain Sci 2021; 12:brainsci12010071. [PMID: 35053814 PMCID: PMC8773815 DOI: 10.3390/brainsci12010071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/29/2021] [Accepted: 12/30/2021] [Indexed: 11/16/2022] Open
Abstract
Transcranial Direct Current Stimulation (tDCS) has been employed to modulate visuo-spatial attentional asymmetries, however, further investigation is needed to characterize tDCS-associated variability in more ecological settings. In the present research, we tested the effects of offline, anodal conventional tDCS (Experiment 1) and HD-tDCS (Experiment 2) delivered over the posterior parietal cortex (PPC) and Frontal Eye Field (FEF) of the right hemisphere in healthy participants. Attentional asymmetries were measured by means of an eye tracking-based, ecological paradigm, that is, a Free Visual Exploration task of naturalistic pictures. Data were analyzed from a spatiotemporal perspective. In Experiment 1, a pre-post linear mixed model (LMM) indicated a leftward attentional shift after PPC tDCS; this effect was not confirmed when the individual baseline performance was considered. In Experiment 2, FEF HD-tDCS was shown to induce a significant leftward shift of gaze position, which emerged after 6 s of picture exploration and lasted for 200 ms. The present results do not allow us to conclude on a clear efficacy of offline conventional tDCS and HD-tDCS in modulating overt visuospatial attention in an ecological setting. Nonetheless, our findings highlight a complex relationship among stimulated area, focality of stimulation, spatiotemporal aspects of deployment of attention, and the role of individual baseline performance in shaping the effects of tDCS.
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Affiliation(s)
- Lorenzo Diana
- Ph.D. Program in Neuroscience, School of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy;
- Correspondence:
| | - Giulia Scotti
- Department of Psychology, University of Milano-Bicocca, 20126 Milan, Italy; (G.S.); (P.P.)
| | - Edoardo N. Aiello
- Ph.D. Program in Neuroscience, School of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy;
| | - Patrick Pilastro
- Department of Psychology, University of Milano-Bicocca, 20126 Milan, Italy; (G.S.); (P.P.)
| | - Aleksandra K. Eberhard-Moscicka
- Perception and Eye Movement Laboratory, Departments of Neurology and BioMedical Research, Bern University Hospital Inselspital, University of Bern, 3010 Bern, Switzerland; (A.K.E.-M.); (R.M.M.)
- Department of Neurology, Bern University Hospital Inselspital, University of Bern, 3010 Bern, Switzerland
| | - René M. Müri
- Perception and Eye Movement Laboratory, Departments of Neurology and BioMedical Research, Bern University Hospital Inselspital, University of Bern, 3010 Bern, Switzerland; (A.K.E.-M.); (R.M.M.)
- Department of Neurology, Bern University Hospital Inselspital, University of Bern, 3010 Bern, Switzerland
| | - Nadia Bolognini
- Department of Psychology & Milan Center for Neuroscience (NeuroMI), University of Milano-Bicocca, 20126 Milan, Italy;
- Laboratory of Neuropsychology, Istituto Auxologico Italiano, IRCCS, 20122 Milan, Italy
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Vergallito A, Gallucci A, Pisoni A, Punzi M, Caselli G, Ruggiero GM, Sassaroli S, Romero Lauro LJ. Effectiveness of noninvasive brain stimulation in the treatment of anxiety disorders: a meta-analysis of sham or behaviour-controlled studies. J Psychiatry Neurosci 2021; 46:E592-E614. [PMID: 34753789 PMCID: PMC8580831 DOI: 10.1503/jpn.210050] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 05/23/2021] [Accepted: 07/02/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The possibility of using noninvasive brain stimulation to treat mental disorders has received considerable attention recently. Repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) are considered to be effective treatments for depressive symptoms. However, no treatment recommendation is currently available for anxiety disorders, suggesting that evidence is still limited. We conducted a systematic review of the literature and a quantitative analysis of the effectiveness of rTMS and tDCS in the treatment of anxiety disorders. METHODS Following PRISMA guidelines, we screened 3 electronic databases up to the end of February 2020 for English-language, peer-reviewed articles that included the following: a clinical sample of patients with an anxiety disorder, the use of a noninvasive brain stimulation technique, the inclusion of a control condition, and pre/post scores on a validated questionnaire that measured symptoms of anxiety. RESULTS Eleven papers met the inclusion criteria, comprising 154 participants assigned to a stimulation condition and 164 to a sham or control group. We calculated Hedge's g for scores on disorder-specific and general anxiety questionnaires before and after treatment to determine effect size, and we conducted 2 independent random-effects meta-analyses. Considering the well-known comorbidity between anxiety and depression, we ran a third meta-analysis analyzing outcomes for depression scores. Results showed a significant effect of noninvasive brain stimulation in reducing scores on disorder-specific and general anxiety questionnaires, as well as depressive symptoms, in the real stimulation compared to the control condition. LIMITATIONS Few studies met the inclusion criteria; more evidence is needed to strengthen conclusions about the effectiveness of noninvasive brain stimulation in the treatment of anxiety disorders. CONCLUSION Our findings showed that noninvasive brain stimulation reduced anxiety and depression scores compared to control conditions, suggesting that it can alleviate clinical symptoms in patients with anxiety disorders.
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Affiliation(s)
| | | | - Alberto Pisoni
- From the Department of Psychology, University of Milano Bicocca, Milan, Italy (Vergallito, Pisoni, Punzi, Romero Lauro); the Neuromi, Milan, Italy (Vergallito, Gallucci, Pisoni, Romero Lauro); the Department of Neuroscience, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy (Gallucci); the Studi Cognitivi, Milan, Italy (Caselli, Ruggiero, Sassaroli); and the Faculty of Psychology, Sigmund Freud University, Milan, Italy (Caseli, Ruggiero, Sassaroli)
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47
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Parker T, Raghu A, Huang Y, Gillies MJ, FitzGerald JJ, Aziz T, Green AL. Paired Acute Invasive/Non-invasive Stimulation (PAINS) study: A phase I/II randomized, sham-controlled crossover trial in chronic neuropathic pain. Brain Stimul 2021; 14:1576-1585. [PMID: 34673258 DOI: 10.1016/j.brs.2021.10.384] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 10/09/2021] [Accepted: 10/18/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Dorsal root ganglion (DRG) stimulation, an invasive method of neuromodulation, and transcranial direct current stimulation (tDCS), a non-invasive method of altering cortical excitability, have both proven effective in relieving chronic pain. OBJECTIVE We employed a randomized, sham-controlled crossover study design to investigate whether single-session tDCS would have an additive therapeutic effect alongside DRG stimulation (DRGS) in the treatment of chronic pain. METHODS Sixteen neuropathic pain patients who were previously implanted with DRG stimulators were recruited. Baseline pain scores were established with DRGS-OFF. Pain scores were then recorded with DRGS-ON, after paired sham tDCS stimulation, and after paired active anodal tDCS (a-tDCS) stimulation. For active tDCS, patients were randomized to 'MEG (magnetoencephalography) localized' tDCS or contralateral motor cortex (M1) tDCS for 30 min. EEG recordings and evaluations of tDCS adverse effects were also collected. RESULTS All participants reported the interventions to be tolerable with no significant adverse effects during the session. Paired DRGS/active tDCS resulted in a significant reduction in pain scores compared to paired DRGS-ON/sham tDCS or DRGS alone. There was no difference in the additive effect of M1 vs. MEG-localized tDCS. Significant augmentation of beta activity was observed between DRGS-OFF and DRGS-ON conditions, as well as between paired DRGS-ON/sham tDCS and paired DRGS-ON/active tDCS. CONCLUSION Our results indicate that a single session of tDCS alongside DRGS is safe and can significantly reduce pain acutely in neuropathic pain patients. Paired invasive/non-invasive neuromodulation is a promising new treatment strategy for pain management and should be evaluated further to assess long-term benefits.
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Affiliation(s)
- Tariq Parker
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom; Neurosurgery Department, Massachusetts General Hospital, Boston, MA, USA.
| | - Ashley Raghu
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
| | - Yongzhi Huang
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom; Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, 300072, China
| | - Martin J Gillies
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
| | - James J FitzGerald
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
| | - Tipu Aziz
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
| | - Alexander L Green
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
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48
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Miraglia F, Vecchio F, Pellicciari MC, Cespon J, Rossini PM. Brain Networks Modulation in Young and Old Subjects During Transcranial Direct Current Stimulation Applied on Prefrontal and Parietal Cortex. Int J Neural Syst 2021; 32:2150056. [PMID: 34651550 DOI: 10.1142/s0129065721500568] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Evidence indicates that the transcranial direct current stimulation (tDCS) has the potential to transiently modulate cognitive function, including age-related changes in brain performance. Only a small number of studies have explored the interaction between the stimulation sites on the scalp, task performance, and brain network connectivity within the frame of physiological aging. We aimed to evaluate the spread of brain activation in both young and older adults in response to anodal tDCS applied to two different scalp stimulation sites: Prefrontal cortex (PFC) and posterior parietal cortex (PPC). EEG data were recorded during tDCS stimulation and evaluated using the Small World (SW) index as a graph theory metric. Before and after tDCS, participants performed a behavioral task; a performance accuracy index was computed and correlated with the SW index. Results showed that the SW index increased during tDCS of the PPC compared to the PFC at higher EEG frequencies only in young participants. tDCS at the PPC site did not exert significant effects on the performance, while tDCS at the PFC site appeared to influence task reaction times in the same direction in both young and older participants. In conclusion, studies using tDCS to modulate functional connectivity and influence behavior can help identify suitable protocols for the aging brain.
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Affiliation(s)
- Francesca Miraglia
- Brain Connectivity Laboratory, Department of Neuroscience and Neurorehabilitation, IRCCS San Raffaele Roma Rome, Italy
| | - Fabrizio Vecchio
- Brain Connectivity Laboratory, Department of Neuroscience and Neurorehabilitation, IRCCS San Raffaele Roma Rome, Italy.,eCampus University, Novedrate (Como), Italy
| | | | - Jesus Cespon
- Basque Center on Cognition, Brain and Language, San Sebastian, Spain
| | - Paolo Maria Rossini
- Brain Connectivity Laboratory, Department of Neuroscience and Neurorehabilitation, IRCCS San Raffaele Roma Rome, Italy
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49
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Riddle J, Frohlich F. Targeting neural oscillations with transcranial alternating current stimulation. Brain Res 2021; 1765:147491. [PMID: 33887251 PMCID: PMC8206031 DOI: 10.1016/j.brainres.2021.147491] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 03/26/2021] [Accepted: 04/13/2021] [Indexed: 11/16/2022]
Abstract
Neural oscillations at the network level synchronize activity between regions and temporal scales. Transcranial alternating current stimulation (tACS), the delivery of low-amplitude electric current to the scalp, provides a tool for investigating the causal role of neural oscillations in cognition. The parameter space for tACS is vast and optimization is required in terms of temporal and spatial targeting. We review emerging techniques and suggest novel approaches that capitalize on the non-sinusoidal and transient nature of neural oscillations and leverage the flexibility provided by a customizable electrode montage and electrical waveform. The customizability and safety profile of tACS make it a promising tool for precision intervention in psychiatric illnesses.
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Affiliation(s)
- Justin Riddle
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA; Carolina Center for Neurostimulation, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Flavio Frohlich
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA; Carolina Center for Neurostimulation, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA; Department of Neurology, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA; Department of Cell Biology and Physiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA; Department of Biomedical Engineering, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA; Neuroscience Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA.
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50
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Sherwood MS, McIntire L, Madaris AT, Kim K, Ranganath C, McKinley RA. Intensity-Dependent Changes in Quantified Resting Cerebral Perfusion With Multiple Sessions of Transcranial DC Stimulation. Front Hum Neurosci 2021; 15:679977. [PMID: 34456695 PMCID: PMC8397582 DOI: 10.3389/fnhum.2021.679977] [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: 03/12/2021] [Accepted: 07/15/2021] [Indexed: 11/13/2022] Open
Abstract
Transcranial direct current stimulation (tDCS) to the left prefrontal cortex has been shown to produce broad behavioral effects including enhanced learning and vigilance. Still, the neural mechanisms underlying such effects are not fully understood. Furthermore, the neural underpinnings of repeated stimulation remain understudied. In this work, we evaluated the effects of the repetition and intensity of tDCS on cerebral perfusion [cerebral blood flow (CBF)]. A cohort of 47 subjects was randomly assigned to one of the three groups. tDCS of 1- or 2-mA was applied to the left prefrontal cortex on three consecutive days, and resting CBF was quantified before and after stimulation using the arterial spin labeling MRI and then compared with a group that received sham stimulation. A widespread decreased CBF was found in a group receiving sham stimulation across the three post-stimulation measures when compared with baseline. In contrast, only slight decreases were observed in the group receiving 2-mA stimulation in the second and third post-stimulation measurements, but more prominent increased CBF was observed across several brain regions including the locus coeruleus (LC). The LC is an integral region in the production of norepinephrine and the noradrenergic system, and an increased norepinephrine/noradrenergic activity could explain the various behavioral findings from the anodal prefrontal tDCS. A decreased CBF was observed in the 1-mA group across the first two post-stimulation measurements, similar to the sham group. This decreased CBF was apparent in only a few small clusters in the third post-stimulation scan but was accompanied by an increased CBF, indicating that the neural effects of stimulation may persist for at least 24 h and that the repeated stimulation may produce cumulative effects.
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Affiliation(s)
| | | | - Aaron T. Madaris
- Infoscitex, Inc., Beavercreek, OH, United States
- Department of Biomedical, Industrial and Human Factors Engineering, Wright State University, Dayton, OH, United States
| | - Kamin Kim
- Department of Psychology, University of California, Davis, Davis, CA, United States
| | - Charan Ranganath
- Department of Psychology, University of California, Davis, Davis, CA, United States
- Center for Neuroscience, University of California, Davis, Davis, CA, United States
| | - R. Andy McKinley
- Air Force Research Laboratory, Wright-Patterson AFB, Dayton, OH, United States
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