Electrical Stimulation of Visual Cortex Can Immediately Improve Spatial Vision

Correcting visual acuity beyond 20/20 improves contour element detection and integration: A cautionary tale for studies of special populations

Contrary to popular lore, optimal visual acuity is typically better than 20/20. Could correcting acuity beyond 20/20 offer any benefit? An affirmative answer could present new confounds in studies of aging, development, psychiatric illness, neurodegenerative disorders, or any other population where refractive error might be more likely. An affirmative answer would also offer a novel explanation of inter-observer variability in visual performance. To address the question, we had individuals perform two well-studied visual tasks, once with 20/20 vision and once with optical correction, so that observers could see one line better on an eye chart. In the contour integration task, observers sought to identify the screen quadrant location of a sparsely defined (integrated) shape embedded in varying quantities of randomly oriented "noise" elements. In the collinear facilitation task, observers sought to detect a low-contrast element flanked by collinear or orthogonal high-contrast elements. In each case, displays were scaled in size to modulate element visibility and spatial frequency (4-12 cycles/deg). We found that improving acuity beyond 20/20 improved contour integration for the high spatial frequency displays. Although improving visual acuity did not affect collinear facilitation, it did improve detection of the central low-contrast target, especially at high spatial frequencies. These results, which were large in magnitude, suggest that optically correcting beyond 20/20 improves the detection and integration of contour elements, especially those that are smaller and of higher spatial frequency. Refractive blur within the normal range may confound special population studies, explain inter-observer differences, and meaningfully impact performance in low-visibility environments.

Glaucoma Rehabilitation Using ElectricAI Transcranial Stimulation (GREAT)-Optimizing Stimulation Protocol for Vision Enhancement Using an RCT

Purpose

We compared the effect of three different transcranial electrical stimulation (tES) protocols delivered to the occipital lobe on peripheral vision in patients with glaucoma.

Methods

A double-masked, placebo-controlled study was conducted with 35 patients with glaucoma. We compared three different tES protocols: anodal transcranial direct current stimulation (a-tDCS), transcranial alternating current stimulation (tACS), and transcranial random noise stimulation (tRNS) against sham stimulation. Each patient attended four stimulation sessions (a-tDCS, tACS, tRNS, and sham) in a random order with at least 48 hours between visits. Stimulation involved placing an anodal electrode over the occipital lobe (Oz) and cathodal electrode on the cheek for 20 minutes. High-resolution perimetry (HRP) and multifocal visual evoked potential (mfVEP) measurements were made before and immediately after stimulation. Changes in HRP detection accuracy/reaction time and mfVEP signal-to-noise ratio (SNR)/latency were analyzed using linear mixed models.

Results

Compared to sham, HRP detection accuracy was significantly improved after a-tDCS in both the central 20-degree (b = 0.032, P = 0.018) and peripheral analysis (b = 0.051, P = 0.002). Additionally, mfVEP SNR was significantly increased (b = 0.016, P = 0.017) and the latency was shortened (b = -1.405, P = 0.04) by the a-tDCS in the central 20-degree analysis. In the peripheral analysis, there was a trend toward an enhancement of SNR after a-tDCS stimulation (b = 0.014, P = 0.052), but it did not reach statistical significance; latency was increased after tACS (b = 1.623, P = 0.041). No significant effects were found in comparison to other active tES protocols.

Conclusions

A single session of a-tDCS enhances perceptual and electrophysiologic measures of vision in patients with glaucoma. However, the small magnitude of changes observed in HRP (3.2% for accuracy in central and 5.1% in peripheral) did not exceed previous test variability and may not be clinically meaningful.

Translational Relevance

a-tDCS holds promise as a potential treatment for enhancing visual function. However, future studies are needed to evaluate the long-term effects and clinical relevance of this intervention using validated measures of perimetric changes in the visual field.

Non-invasive brain stimulation and vision rehabilitation: a clinical perspective

Non-invasive brain stimulation techniques allow targeted modulation of brain regions and have emerged as a promising tool for vision rehabilitation. This review presents an overview of studies that have examined the use of non-invasive brain stimulation techniques for improving vision and visual functions. A description of the proposed neural mechanisms that underpin non-invasive brain stimulation effects is also provided. The clinical implications of non-invasive brain stimulation in vision rehabilitation are examined, including their safety, effectiveness, and potential applications in specific conditions such as amblyopia, post-stroke hemianopia, and central vision loss associated with age-related macular degeneration. Additionally, the future directions of research in this field are considered, including the need for larger and more rigorous clinical trials to validate the efficacy of these techniques. Overall, this review highlights the potential for brain stimulation techniques as a promising avenue for improving visual function in individuals with impaired vision and underscores the importance of continued research in this field.

Transcranial direct current stimulation of the prefrontal and visual cortices diversely affects early and late perceptual learning

BACKGROUND

Research has shown that visual perceptual learning (VPL) is related to modifying neural activity in higher level decision-making regions. However, the causal roles of the prefrontal and visual cortexes in VPL are still unclear. Here, we investigated how anodal transcranial direct current stimulation (tDCS) of the prefrontal and visual cortices modulates VPL in the early and later phases and the role of multiple brain regions.

METHODS

Perceptual learning on the coherent motion direction identification task included early and later stages. After early training, participants needed to continuously train to reach a plateau; once the plateau was reached, participants entered a later stage. Sixty participants were randomly divided into five groups. Regardless of the training at the early and later stages, four groups received multitarget tDCS over the right dorsolateral prefrontal cortex (rDLPFC) and right middle temporal area (rMT), single-target tDCS over the rDLPFC, and single-target tDCS over the rMT or sham stimulation, and one group was stimulated at the ipsilateral brain region (i.e., left MT).

RESULTS

Compared with sham stimulation, multitarget and two single-target tDCS over the rDLPFC or rMT improved posttest performance and accelerated learning during the early period. However, multitarget tDCS and two single-target tDCS led to equivalent benefits for VPL. Additionally, these beneficial effects were absent when anodal tDCS was applied to the ipsilateral brain region. For the later period, the above facilitating effects on VPL induced by multitarget or single-target tDCS disappeared.

CONCLUSIONS

This study suggested the causal role of the prefrontal and visual cortices in visual motion perceptual learning by anodal tDCS but failed to find greater beneficial effects by simultaneously stimulating the prefrontal and visual cortices. Future research should investigate the functional associations between multiple brain regions to further promote VPL.

Contrasting MEG effects of anodal and cathodal high-definition TDCS on sensorimotor activity during voluntary finger movements

Introduction

Protocols for noninvasive brain stimulation (NIBS) are generally categorized as "excitatory" or "inhibitory" based on their ability to produce short-term modulation of motor-evoked potentials (MEPs) in peripheral muscles, when applied to motor cortex. Anodal and cathodal stimulation are widely considered excitatory and inhibitory, respectively, on this basis. However, it is poorly understood whether such polarity-dependent changes apply for neural signals generated during task performance, at rest, or in response to sensory stimulation.

Methods

To characterize such changes, we measured spontaneous and movement-related neural activity with magnetoencephalography (MEG) before and after high-definition transcranial direct-current stimulation (HD-TDCS) of the left motor cortex (M1), while participants performed simple finger movements with the left and right hands.

Results

Anodal HD-TDCS (excitatory) decreased the movement-related cortical fields (MRCF) localized to left M1 during contralateral right finger movements while cathodal HD-TDCS (inhibitory), increased them. In contrast, oscillatory signatures of voluntary motor output were not differentially affected by the two stimulation protocols, and tended to decrease in magnitude over the course of the experiment regardless. Spontaneous resting state oscillations were not affected either.

Discussion

MRCFs are thought to reflect reafferent proprioceptive input to motor cortex following movements. Thus, these results suggest that processing of incoming sensory information may be affected by TDCS in a polarity-dependent manner that is opposite that seen for MEPs-increases in cortical excitability as defined by MEPs may correspond to reduced responses to afferent input, and vice-versa.

The effect of montages of transcranial alternating current stimulation on occipital responses-a sham-controlled pilot study

Background

Transcranial alternative current stimulation (tACS) refers to a promising non-invasive technique to improve brain functions. However, owing to various stimulation parameters in the literature, optimization of the stimulation is warranted. In this study, the authors aimed to compare the effect of tACS electrode montages on occipital responses.

Methods

In three montage sessions (i.e., Oz-Cz, Oz-cheek, and sham), 10 healthy young adults participated, receiving 20-min 2-mA alpha-tACS. Pattern-reversal visual evoked potentials (VEPs) were measured before tACS (T0), immediately after (T20), and 20 min (T40) after tACS. Normalized changes in time-domain features (i.e., N75, P100 amplitudes, and P100 latency) and frequency-domain features [i.e., power spectral density in alpha (PSDα) and beta (PSDβ) bands] were evaluated.

Results

In contrast to our hypothesis, the occipital response decreased immediately (T20) after receiving the 20-min tACS in all montages in terms of P100 amplitude (p = 0.01). This reduction returned to baseline level (T0) in Oz-cheek and sham conditions but sustained in the Oz-Cz condition (T40, p = 0.03) after 20 min of tACS. The effects on N75 amplitude and P100 latency were statistically insignificant. For spectral analysis, both PSDα and PSDβ were significantly increased after tACS at T20, in which the effect sustained until T40. However, there was no differential effect by montages. There was no significant difference in the occurrence of sensations across the montages. The effectiveness of the blinding is supported by the participants' rate of guessing correctly.

Conclusion

This study revealed an immediate inhibitory effect of tACS, regardless of the montages. This inhibitory effect sustained in the Oz-Cz montage but faded out in other montages after 20 min.

Noninvasive electrical stimulation as a neuroprotective strategy in retinal diseases: a systematic review of preclinical studies

BACKGROUND

Electrical activity has a crucial impact on the development and survival of neurons. Numerous recent studies have shown that noninvasive electrical stimulation (NES) has neuroprotective action in various retinal disorders.

OBJECTIVE

To systematically review the literature on in vivo studies and provide a comprehensive summary of the neuroprotective action and the mechanisms of NES on retinal disorders.

METHODS

Based on the PRISMA guideline, a systematic review was conducted in PubMed, Web of Science, Embase, Scopus and Cochrane Library to collect all relevant in vivo studies on "the role of NES on retinal diseases" published up until September 2023. Possible biases were identified with the adopted SYRCLE's tool.

RESULTS

Of the 791 initially gathered studies, 21 articles met inclusion/exclusion criteria for full-text review. The results revealed the neuroprotective effect of NES (involved whole-eye, transcorneal, transscleral, transpalpebral, transorbital electrical stimulation) on different retinal diseases, including retinitis pigmentosa, retinal degeneration, high-intraocular pressure injury, traumatic optic neuropathy, nonarteritic ischemic optic neuropathy. NES could effectively delay degeneration and apoptosis of retinal neurons, preserve retinal structure and visual function with high security, and its mechanism of action might be related to promoting the secretion of neurotrophins and growth factors, decreasing inflammation, inhibiting apoptosis. The quality scores of included studies ranged from 5 to 8 points (a total of 10 points), according to SYRCLE's risk of bias tool.

CONCLUSION

This systematic review indicated that NES exerts neuroprotective effects on retinal disease models mainly through its neurotrophic, anti-inflammatory, and anti-apoptotic capabilities. To assess the efficacy of NES in a therapeutic setting, however, well-designed clinical trials are required in the future.

Enhancing visual perceptual learning using transcranial electrical stimulation: Transcranial alternating current stimulation outperforms both transcranial direct current and random noise stimulation

Diverse strategies can be employed to enhance visual skills, including visual perceptual learning (VPL) and transcranial electrical stimulation (tES). Combining VPL and tES is a popular method that holds promise for producing significant improvements in visual acuity within a short time frame. However, there is still a lack of comprehensive evaluation regarding the effects of combining different types of tES and VPL on enhancing visual function, especially with a larger sample size. In the present study, we recruited four groups of subjects (26 subjects each) to learn an orientation discrimination task with five daily training sessions. During training, the occipital region of each subject was stimulated by one type of tES-anodal transcranial direct current stimulation (tDCS), alternating current stimulation (tACS) at 10 Hz, high-frequency random noise stimulation (tRNS), and sham tACS-while the subject performed the training task. We found that, compared with the sham stimulation, both the high-frequency tRNS and the 10-Hz tACS facilitated VPL efficiently in terms of learning rate and performance improvement, but there was little modulatory effect in the anodal tDCS condition. Remarkably, the 10-Hz tACS condition exhibited superior modulatory effects compared with the tRNS condition, demonstrating the strongest modulation among the most commonly used tES types for further enhancing vision when combined with VPL. Our results suggest that alpha oscillations play a vital role in VPL. Our study provides a practical guide for vision rehabilitation.

Integrating electric field modeling and pre-tDCS behavioral performance to predict the individual tDCS effect on visual crowding

Objective.Transcranial direct current stimulation (tDCS) has been broadly used to modulate brain activity with both bipolar and high-definition montages. However, tDCS effects can be highly variable. In this work, we investigated whether the variability in the tDCS effects could be predicted by integrating individualized electric field modeling and individual pre-tDCS behavioral performance.Approach.Here, we first compared the effects of bipolar tDCS and 4 × 1 high-definition tDCS (HD-tDCS) with respect to the alleviation of visual crowding, which is the inability to identify targets in the presence of nearby flankers and considered to be an essential bottleneck of object recognition and visual awareness. We instructed subjects to perform an orientation discrimination task with both isolated and crowded targets in the periphery and measured their orientation discrimination thresholds before and after receiving 20 min of bipolar tDCS, 4 × 1 HD-tDCS, or sham stimulation over the visual cortex. Individual anatomically realistic head models were constructed to simulate tDCS-induced electric field distributions and quantify tDCS focality. Finally, a multiple linear regression model that used pre-tDCS behavioral performance and tDCS focality as factors was used to predict post-tDCS behavioral performance.Main results.We found that HD-tDCS, but not bipolar tDCS, could significantly alleviate visual crowding. Moreover, the variability in the tDCS effect could be reliably predicted by subjects' pre-tDCS behavioral performance and tDCS focality. This prediction model also performed well when generalized to other two tDCS protocols with a different electrode size or a different stimulation intensity.Significance.Our study links the variability in the tDCS-induced electric field and the pre-tDCS behavioral performance in a visual crowding task to the variability in post-tDCS performance. It provides a new approach to predicting individual tDCS effects and highlights the importance of understanding the factors that determine tDCS effectiveness while developing more robust protocols.

Noninvasive Brain Stimulation Techniques for Treatment-Resistant Depression: Transcranial Magnetic Stimulation and Transcranial Direct Current Stimulation

Transcranial magnetic stimulation is a safe, effective, and well-tolerated intervention for depression; it is currently approved for treatment-resistant depression. This article summarizes the mechanism of action, evidence of clinical efficacy, and the clinical aspects of this intervention, including patient evaluation, stimulation parameters selection, and safety considerations. Transcranial direct current stimulation is another neuromodulation treatment for depression; although promising, the technique is not currently approved for clinical use in the United States. The final section outlines the open challenges and future directions of the field.

Dissociable effects of transcranial direct current stimulation (tDCS) on early and later stages of visual motion perceptual learning

Transcranial direct current stimulation (tDCS) has the potential to benefit visual perceptual learning (VPL). However, previous studies investigated the effect of tDCS on VPL within early sessions, and the influence of tDCS on learning effects at later stages (plateau level) is unclear. Here, participants completed 9 days of training on coherent motion direction identification to reach a plateau (stage 1) and then continued training for 3 days (stage 2). The coherent thresholds were measured before training, after stage 1 and after stage 2. In the first group, anodal tDCS was applied when participants trained over a period of 12 days (stage 1+ stage 2). In the second group, participants completed a 9-day training period without any stimulation to reach a plateau (stage 1); after that, participants completed a 3-day training period while anodal tDCS was administered (stage 2). The third group was treated the same as the second group except that anodal tDCS was replaced by sham tDCS. The results showed that anodal tDCS did not improve posttest performance after the plateau was reached. The comparison of learning curves between the first and third groups showed that anodal tDCS decreased the threshold at the early stage, but it did not improve the plateau level. For the second and third groups, anodal tDCS did not further enhance the plateau level after a continued 3-day training period. These results suggest that anodal tDCS boosts VLP during the early period of training sessions, but it fails to facilitate later learning effects. This study contributed to a deep understanding of the dissociable tDCS effects at distinct temporal stages, which may be due to the dynamic change in brain regions during the time course of VPL.

Short-term ocular dominance plasticity is not modulated by visual cortex tDCS but increases with length of monocular deprivation

Transcranial direct current stimulation (tDCS) of the occipital lobe may modulate visual cortex neuroplasticity. We assessed the acute effect of visual cortex anodal (a-)tDCS on ocular dominance plasticity induced by short-term monocular deprivation (MD), a well-established technique for inducing homeostatic plasticity in the visual system. In Experiment 1, active or sham visual cortex tDCS was applied during the last 20 min of 2-h MD following a within-subjects design (n = 17). Ocular dominance was measured using two computerized tests. The magnitude of ocular dominance plasticity was unaffected by a-tDCS. In Experiment 2 (n = 9), we investigated whether a ceiling effect of MD was masking the effect of active tDCS. We replicated Experiment 1 but used only 30 min of MD. The magnitude of ocular dominance plasticity was decreased with the shorter intervention, but there was still no effect of active a-tDCS. Within the constraints of our experimental design and a-tDCS parameters, visual cortex a-tDCS did not modulate the homeostatic mechanisms that drive ocular dominance plasticity in participants with normal binocular vision.

Posttraining anodal tDCS improves early consolidation of visual perceptual learning

OBJECTIVE

We aimed to investigate the transcranial direct current stimulation (tDCS)-induced facilitation of early consolidation over a period of extended training sessions and explored the effect of tDCS on visual perceptual learning (VPL) improvement during online learning and offline consolidation.

METHODS

In the current double-blind sham-controlled study, twenty-four healthy participants were trained on coherent motion direction identification for 5 consecutive sessions. Performance was assessed at the pre- and posttests. Anodal or sham tDCS of the left human middle temporal region (hMT+) was applied immediately after the completion of daily training (termed early consolidation).

RESULTS

The magnitude of improvement between anodal and sham tDCS was marginally significant, supporting the beneficial effect of anodal tDCS on VPL by stimulating early consolidation. Additionally, anodal tDCS induced a larger improvement between the first two training sessions than sham tDCS. No effect of anodal tDCS was found on the within-session improvement.

CONCLUSIONS

The above results indicated that anodal tDCS facilitates offline consolidation during the early period of the whole training series, not online learning. The possible neural mechanisms and limitations (sample size and persistent effects) were discussed.

SIGNIFICANCE

Our findings support the use of the combination of tDCS and behavioral training in facilitating visual rehabilitation and contribute to a deeper understanding of learning processes by neuromodulation procedures.

Anodal online transcranial direct current stimulation facilitates visual motion perceptual learning

Visual perceptual learning (VPL) has great potential implications for clinical populations, but adequate improvement often takes weeks to months to obtain; therefore, practical applications of VPL are limited. Strategies that enhance visual performance acquisition make great practical sense. Transcranial direct current stimulation (tDCS) could be beneficial to VPL, but thus far, the results are inconsistent. The current study had two objectives: (1) to investigate the effect of anodal tDCS on VPL and (2) to determine whether the timing sequence of anodal tDCS and training influences VPL. Anodal tDCS was applied on the left human middle temporal (hMT+) during training on a coherent motion discrimination task (online), anodal tDCS was also applied before training (offline) and sham tDCS was applied during training (sham). The coherent thresholds were measured without stimulation before, 2 days after and 1 month after training. All participants trained for five consecutive days. Anodal tDCS resulted in more performance improvement when applied during daily training but not when applied before training. Additionally, neither within-session improvement nor between-session improvement differed among the online, offline and sham tDCS conditions. These findings contribute to the development of efficient stimulation protocols and a deep understanding of the mechanisms underlying the effect of tDCS on VPL.

Can visual cortex non-invasive brain stimulation improve normal visual function? A systematic review and meta-analysis

Objective

Multiple studies have explored the use of visual cortex non-invasive brain stimulation (NIBS) to enhance visual function. These studies vary in sample size, outcome measures, and methodology. We conducted a systematic review and meta-analyses to assess the effects of NIBS on visual functions in human participants with normal vision.

Methods

We followed the PRISMA guidelines, and a review protocol was registered with PROSPERO before study commencement (CRD42021255882). We searched Embase, Medline, PsychInfo, PubMed, OpenGrey and Web of Science using relevant keywords. The search covered the period from 1st January 2000 until 1st September 2021. Comprehensive meta-analysis (CMA) software was used for quantitative analysis.

Results

Fifty studies were included in the systematic review. Only five studies utilized transcranial magnetic stimulation (TMS) and no TMS studies met our pre-specified criteria for meta-analysis. Nineteen transcranial electrical stimulation studies (tES, 38%) met the criteria for meta-analysis and were the focus of our review. Meta-analysis indicated acute effects (Hedges's g = 0.232, 95% CI: 0.023-0.442, p = 0.029) and aftereffects (0.590, 95% CI: 0.182-0.998, p = 0.005) of tES on contrast sensitivity. Visual evoked potential (VEP) amplitudes were significantly enhanced immediately after tES (0.383, 95% CI: 0.110-0.665, p = 0.006). Both tES (0.563, 95% CI: 0.230-0.896, p = 0.001) and anodal-transcranial direct current stimulation (a-tDCS) alone (0.655, 95% CI: 0.273-1.038, p = 0.001) reduced crowding in peripheral vision. The effects of tES on visual acuity, motion perception and reaction time were not statistically significant.

Conclusion

There are significant effects of visual cortex tES on contrast sensitivity, VEP amplitude, an index of cortical excitability, and crowding among normally sighted individuals. Additional studies are required to enable a comparable meta-analysis of TMS effects. Future studies with robust experimental designs are needed to extend these findings to populations with vision loss.

Clinical trial registration

ClinicalTrials.gov/, identifier CRD42021255882.

High-definition transcranial direct current stimulation of the left middle temporal complex does not affect visual motion perception learning

Visual perceptual learning (VPL) refers to the improvement in visual perceptual abilities through training and has potential implications for clinical populations. However, improvements in perceptual learning often require hundreds or thousands of trials over weeks to months to attain, limiting its practical application. Transcranial direct current stimulation (tDCS) could potentially facilitate perceptual learning, but the results are inconsistent thus far. Thus, this research investigated the effect of tDCS over the left human middle temporal complex (hMT+) on learning to discriminate visual motion direction. Twenty-seven participants were randomly assigned to the anodal, cathodal and sham tDCS groups. Before and after training, the thresholds of motion direction discrimination were assessed in one trained condition and three untrained conditions. Participants were trained over 5 consecutive days while receiving 4 × 1 ring high-definition tDCS (HD-tDCS) over the left hMT+. The results showed that the threshold of motion direction discrimination significantly decreased after training. However, no obvious differences in the indicators of perceptual learning, such as the magnitude of improvement, transfer indexes, and learning curves, were noted among the three groups. The current study did not provide evidence of a beneficial effect of tDCS on VPL. Further research should explore the impact of the learning task characteristics, number of training sessions and the sequence of stimulation.

Long-lasting, dissociable improvements in working memory and long-term memory in older adults with repetitive neuromodulation

The development of technologies to protect or enhance memory in older people is an enduring goal of translational medicine. Here we describe repetitive (4-day) transcranial alternating current stimulation (tACS) protocols for the selective, sustainable enhancement of auditory-verbal working memory and long-term memory in 65-88-year-old people. Modulation of synchronous low-frequency, but not high-frequency, activity in parietal cortex preferentially improved working memory on day 3 and day 4 and 1 month after intervention, whereas modulation of synchronous high-frequency, but not low-frequency, activity in prefrontal cortex preferentially improved long-term memory on days 2-4 and 1 month after intervention. The rate of memory improvements over 4 days predicted the size of memory benefits 1 month later. Individuals with lower baseline cognitive function experienced larger, more enduring memory improvements. Our findings demonstrate that the plasticity of the aging brain can be selectively and sustainably exploited using repetitive and highly focalized neuromodulation grounded in spatiospectral parameters of memory-specific cortical circuitry.

Transcranial Direct Current Stimulation Over the Right Temporal Parietal Junction Facilitates Spontaneous Micro-Expression Recognition

Micro-expressions are fleeting and subtle emotional expressions. As they are spontaneous and uncontrollable by one's mind, micro-expressions are considered an indicator of genuine emotions. Their accurate recognition and interpretation promote interpersonal interaction and social communication. Therefore, enhancing the ability to recognize micro-expressions has captured much attention. In the current study, we investigated the effects of training on micro-expression recognition with a Chinese version of the Micro-Expression Training Tool (METT). Our goal was to confirm whether the recognition accuracy of spontaneous micro-expressions could be improved through training and brain stimulation. Since the right temporal parietal junction (rTPJ) has been shown to be involved in the explicit process of facial emotion recognition, we hypothesized that the rTPJ would play a role in facilitating the recognition of micro-expressions. The results showed that anodal transcranial direct-current stimulation (tDCS) of the rTPJ indeed improved the recognition of spontaneous micro-expressions, especially for those associated with fear. The improved accuracy of recognizing fear spontaneous micro-expressions was positively correlated with personal distress in the anodal group but not in the sham group. Our study supports that the combined use of tDCS and METT can be a viable way to train and enhance micro-expression recognition.

Perspectives on the Combined Use of Electric Brain Stimulation and Perceptual Learning in Vision

A growing body of literature offers exciting perspectives on the use of brain stimulation to boost training-related perceptual improvements in humans. Recent studies suggest that combining visual perceptual learning (VPL) training with concomitant transcranial electric stimulation (tES) leads to learning rate and generalization effects larger than each technique used individually. Both VPL and tES have been used to induce neural plasticity in brain regions involved in visual perception, leading to long-lasting visual function improvements. Despite being more than a century old, only recently have these techniques been combined in the same paradigm to further improve visual performance in humans. Nonetheless, promising evidence in healthy participants and in clinical population suggests that the best could still be yet to come for the combined use of VPL and tES. In the first part of this perspective piece, we briefly discuss the history, the characteristics, the results and the possible mechanisms behind each technique and their combined effect. In the second part, we discuss relevant aspects concerning the use of these techniques and propose a perspective concerning the combined use of electric brain stimulation and perceptual learning in the visual system, closing with some open questions on the topic.

Inter-Individual Variability in tDCS Effects: A Narrative Review on the Contribution of Stable, Variable, and Contextual Factors

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.

No effects of transcranial direct current stimulation on visual evoked potential and peak gamma frequency

Evidence suggests that the visual evoked potential (VEP) and gamma oscillations elicited by visual stimuli reflect the balance of excitatory and inhibitory (E-I) cortical processes. As tDCS has been shown to modulate E-I balance, the current study investigated whether amplitudes of VEP components (N1 and P2) and peak gamma frequency are modulated by transcranial direct current stimulation (tDCS). Healthy adults underwent two electroencephalography (EEG) recordings while viewing stimuli designed to elicit a robust visual response. Between the two recordings, participants were randomly assigned to three tDCS conditions (anodal-, cathodal-, and sham-tDCS) or received no-tDCS. tDCS electrodes were placed over the occipital cortex (Oz) and the left cheek with an intensity of 2 mA for 10 min. Data of 39 participants were analysed for VEP amplitudes and peak gamma frequency using mixed-model ANOVAs. The results showed no main effects of tDCS in any metric. Possible explanations for the absence of tDCS effects are discussed.

Effects of High-Definition Transcranial Direct Current Stimulation Over the Left Fusiform Face Area on Face View Discrimination Depend on the Individual Baseline Performance

A basic human visual function is to identify objects from different viewpoints. Typically, the ability to discriminate face views based on in-depth orientation is necessary in daily life. Early neuroimaging studies have identified the involvement of the left fusiform face area (FFA) and the left superior temporal sulcus (STS) in face view discrimination. However, many studies have documented the important role of the right FFA in face processing. Thus, there remains controversy over whether one specific region or all of them are involved in discriminating face views. Thus, this research examined the influence of high-definition transcranial direct current stimulation (HD-tDCS) over the left FFA, left STS or right FFA on face view discrimination in three experiments. In experiment 1, eighteen subjects performed a face view discrimination task before and immediately, 10 min and 20 min after anodal, cathodal and sham HD-tDCS (20 min, 1.5 mA) over the left FFA in three sessions. Compared with sham stimulation, anodal and cathodal stimulation had no effects that were detected at the group level. However, the analyses at the individual level showed that the baseline performance negatively correlated with the degree of change after anodal tDCS, suggesting a dependence of the change amount on the initial performance. Specifically, tDCS decreased performance in the subjects with better baseline performance but increased performance in those with poorer baseline performance. In experiments 2 and 3, the same experimental protocol was used except that the stimulation site was the left STS or right FFA, respectively. Neither anodal nor cathodal tDCS over the left STS or right FFA influenced face view discrimination in group- or individual-level analyses. These results not only indicated the importance of the left FFA in face view discrimination but also demonstrated that individual initial performance should be taken into consideration in future research and practical applications.

Brain Activation Induced by Myopic and Hyperopic Defocus From Spectacles

Purpose: To assess neural changes in perceptual effects induced by myopic defocus and hyperopic defocus stimuli in ametropic and emmetropic subjects using functional magnetic resonance imaging (fMRI).

Methods: This study included 41 subjects with a mean age of 26.0 ± 2.9 years. The mean spherical equivalence refraction was −0.54 ± 0.51D in the emmetropic group and −3.57 ± 2.27D in the ametropic group. The subjects were instructed to view through full refractive correction, with values of +2.00D to induce myopic defocus state and −2.00D to induce hyperopic defocus state. This was carried over in three random sessions. Arterial spin labeling (ASL) perfusion was measured using fMRI to obtain quantified regional cerebral blood flow (rCBF). Behavioral tests including distant visual acuity (VA) and contrast sensitivity (CS), were measured every 5 min for 30 min.

Results: Myopic defocus induced significantly greater rCBF increase in four cerebral regions compared with full correction: right precentral gyrus, right superior temporal gyrus, left inferior parietal lobule, and left middle temporal gyrus (P < 0.001). The differences were less significant in low myopes than emmetropes. In the hyperopic defocus session, the increased responses of rCBF were only observed in the right and left precentral gyrus. Myopic defocused VA and CS improved significantly within 5 min and reached a plateau shortly after.

Conclusion: This study revealed that myopic defocus stimuli can significantly increase blood perfusion in visual attention-related cerebral regions, which suggests a potential direction for future investigation on the relationship between retinal defocus and its neural consequences.

Offline transcranial direct current stimulation improves the ability to perceive crowded targets

The deleterious effect of nearby flankers on target identification in the periphery is known as visual crowding. Studying visual crowding can advance our understanding of the mechanisms of visual awareness and object recognition. Alleviating visual crowding is one of the major ways to improve peripheral vision. The aim of the current study was to examine whether transcranial direct current stimulation (tDCS) was capable of alleviating visual crowding at different visual eccentricities and with different visual tasks. In the present single-blind sham-controlled study, subjects were instructed to perform an orientation discrimination task or a letter identification task with isolated and crowded targets in the periphery, before and after applying 20 minutes of 2 mA anodal tDCS to visual cortex of the hemisphere contralateral or ipsilateral to visual stimuli. Contralateral tDCS significantly alleviated the orientation crowding effect at two different eccentricities and the letter crowding effect. This alleviation was absent after sham or ipsilateral stimulation and could not be fully explained by the performance improvement with the isolated targets. These findings demonstrated that offline tDCS was effective in alleviating visual crowding across different visual eccentricities and tasks, therefore providing a promising way to improve spatial vision rapidly in crowded scenes.

The initial visual performance modulates the effects of anodal transcranial direct current stimulation over the primary visual cortex on the contrast sensitivity function

Transcranial direct current stimulation (tDCS) has great potential to modulate cortical excitability and further facilitate visual function or rehabilitation. However, tDCS modulation effects are largely variable, possibly because of the individual differences in initial performance. The present study investigated the influence of the initial performance on contrast sensitivity function (CSF) following tDCS. Fifty healthy participants were randomly assigned to three groups: anodal, cathodal and sham stimulation. The CSF was measured through a grating detection task before and immediately after tDCS. Active and reference electrodes were applied to the primary occipital cortex (Oz) and the middle of the head (Cz) for 20 min with an intensity of 1.5 mA, respectively. Compared with sham stimulation, anodal or cathodal stimulation had no effect on the area under the log CSF (AULCSF) or contrast sensitivity (CS) of various spatial frequencies at the group level. However, a negative relationship was found between initial performance and the AULCSF change (or CS change at a spatial of frequency 8 c/°) after the application of anodal tDCS, indicating that the degree of change was dependent on initial performance, with greater gains observed for those with poorer initial performance. Initial performance modulated the effect of anodal tDCS over the Oz on the CSF, indicating that the Oz plays a crucial role in visual function. These results contribute to a deep understanding of the mechanisms of tDCS and to the design of more precise and efficient personalized simulation approaches based on individual differences.

A comprehensive analysis of the impact of head model extent on electric field predictions in transcranial current stimulation

OBJECTIVE

MRI-based head models are used to predict the electric field (E-field) in the brain in Transcranial Current Stimulation (tCS). The standard field of view (FOV) of clinical MRI often only covers the head down to the skull base, which has usually lead to models truncated at the nose. Although recent pipelines can artificially extend the head model to the neck, the need for implementing full head models preserving skull holes such as the foramen magnum remains controversial. The objective is to analyze the impact of head model extent on E-field accuracy, with emphasis on specific electrode montages.

APPROACH

A full head model containing an open foramen magnum and a cut head model with closed skull were compared in terms of predicted E-field. Several electrode montages, including fronto-occipital montages used in validation studies, were simulated. Local and global metrics were used to evaluate the error for both E-field magnitude and distribution, along with tangential and normal components over different cortical areas. The percentage of current flowing through the truncation level was also computed.

RESULTS

Regarding E-field magnitude, small relative differences below 7% were found in gray matter for classical montages. Although considerably higher relative differences near 50% were found for fronto-occipital montages, absolute errors of 0.1 V/m were only found in non-targeted regions such as the cerebellum. Differences in tangential and normal E-fields were similar and followed the trend observed for E-field magnitude. Our results also showed a high correlation between the percentage of current shunted through the truncation level and the absolute E-field differences.

SIGNIFICANCE

The influence of head model extent on E-field accuracy depends on electrode montage. Standard cut head models provide sufficiently accurate predictions for both E-field magnitude and distribution in targeted brain areas. Fronto-occipital montages exhibited larger errors, which might be considered in further validation studies.

Visual Cortex Transcranial Direct Current Stimulation for Proliferative Diabetic Retinopathy Patients: A Double-Blinded Randomized Exploratory Trial

Proliferative diabetic retinopathy (PDR) is a severe complication of diabetes. PDR-related retinal hemorrhages often lead to severe vision loss. The main goals of management are to prevent visual impairment progression and improve residual vision. We explored the potential of transcranial direct current stimulation (tDCS) to enhance residual vision. tDCS applied to the primary visual cortex (V1) may improve visual input processing from PDR patients’ retinas. Eleven PDR patients received cathodal tDCS stimulation of V1 (1 mA for 10 min), and another eleven patients received sham stimulation (1 mA for 30 s). Visual acuity (logarithm of the minimum angle of resolution (LogMAR) scores) and number acuity (reaction times (RTs) and accuracy rates (ARs)) were measured before and immediately after stimulation. The LogMAR scores and the RTs of patients who received cathodal tDCS decreased significantly after stimulation. Cathodal tDCS has no significant effect on ARs. There were no significant changes in the LogMAR scores, RTs, and ARs of PDR patients who received sham stimulation. The results are compatible with our proposal that neuronal noise aggravates impaired visual function in PDR. The therapeutic effect indicates the potential of tDCS as a safe and effective vision rehabilitation tool for PDR patients.

Visual cortex cTBS increases mixed percept duration while a-tDCS has no effect on binocular rivalry

Neuromodulation of the primary visual cortex using anodal transcranial direct current stimulation (a-tDCS) can alter visual perception and enhance neuroplasticity. However, the mechanisms that underpin these effects are currently unknown. When applied to the motor cortex, a-tDCS reduces the concentration of the inhibitory neurotransmitter gamma aminobutyric acid (GABA), an effect that has been linked to increased neuroplasticity. The aim of this study was to assess whether a-tDCS also reduces GABA-mediated inhibition when applied to the human visual cortex. Changes in visual cortex inhibition were measured using the mixed percept duration in binocular rivalry. Binocular rivalry mixed percept duration has recently been advocated as a direct and sensitive measure of visual cortex inhibition whereby GABA agonists decrease mixed percept durations and agonists of the excitatory neurotransmitter acetylcholine (ACH) increase them. Our hypothesis was that visual cortex a-tDCS would increase mixed percept duration by reducing GABA-mediated inhibition and increasing cortical excitation. In addition, we measured the effect of continuous theta-burst transcranial magnetic stimulation (cTBS) of the visual cortex on binocular rivalry dynamics. When applied to the motor or visual cortex, cTBS increases GABA concentration and we therefore hypothesized that visual cortex cTBS would decrease the mixed percept duration. Binocular rivalry dynamics were recorded before and after active and sham a-tDCS (N = 15) or cTBS (N = 15). Contrary to our hypotheses, a-tDCS had no effect, whereas cTBS increased mixed percepts during rivalry. These results suggest that the neurochemical mechanisms of a-tDCS may differ between the motor and visual cortices.

High-frequency neuromodulation improves obsessive-compulsive behavior

Nearly one billion people worldwide suffer from obsessive-compulsive behaviors^1,2, yet our mechanistic understanding of these behaviors is incomplete, and effective therapeutics are unavailable. An emerging perspective characterizes obsessive-compulsive behaviors as maladaptive habit learning^3,4, which may be associated with abnormal beta-gamma neurophysiology of the orbitofrontal-striatal circuitry during reward processing^5,6. We target the orbitofrontal cortex with alternating current, personalized to the intrinsic beta-gamma frequency of the reward network, and show rapid, reversible, frequency-specific modulation of reward- but not punishment-guided choice behavior and learning, driven by increased exploration in the setting of an actor-critic architecture. Next, we demonstrate that chronic application of the procedure over 5 days robustly attenuates obsessive-compulsive behavior in a non-clinical population for 3 months, with the largest benefits for individuals with more severe symptoms. Finally, we show that convergent mechanisms underlie modulation of reward learning and reduction of obsessive-compulsive symptoms. The results contribute to neurophysiological theories of reward, learning and obsessive-compulsive behavior, suggest a unifying functional role of rhythms in the beta-gamma range, and set the groundwork for the development of personalized circuit-based therapeutics for related disorders.

Anodal Transcranial Direct Current Stimulation of Anterior Cingulate Cortex Modulates Subcortical Brain Regions Resulting in Cognitive Enhancement

Transcranial direct current stimulation (tDCS) has been widely utilized in research settings and modulates brain activity. The application of anodal tDCS on the prefrontal cortex has indicated improvement in cognitive functioning. The cingulate cortex, situated in the medial aspect of the prefrontal cortex, has been identified as a core region performing cognitive functions. Most of the previous studies investigating the impact of stimulation on the prefrontal cortex stimulated the dorsolateral prefrontal cortex (DLPFC), however, the impact of stimulation on cingulate has not been explored. The current study investigates the effect of stimulation on the resting-state functional connectivity of the anterior cingulate cortex with other regions of the brain and changes in behavioral results in a color-word Stroop task, which has repeatedly elicited activation in different regions of the cingulate. Twenty subjects were randomly assigned to the experimental and sham group, and their medial prefrontal area was stimulated using MRI compatible tDCS. Resting-state functional magnetic resonance imaging (rs-fMRI) and cognitive Stroop task were monitored before, during, and after the stimulation. Neuroimaging results indicated a significant decrease in resting-state functional connectivity in the experimental group during and after stimulation as compared to before stimulation in two clusters including right insular cortex, right central operculum cortex, right frontal operculum cortex and right planum polare with the left anterior cingulate cortex (L-ACC) selected as the seed. The behavioral results indicated a significant decrease in reaction time (RT) following stimulation in the experimental group compared to the sham group. Moreover, the change in functional connectivity in subcortical regions with L-ACC as the seed and change in RT was positively correlated. The results demonstrated that ACC has a close functional relationship with the subcortical regions, and stimulation of ACC can modulate these connections, which subsequently improves behavioral performance, thus, providing another potential target of stimulation for cognitive enhancement.

Clinical Trial Registration: ClinicalTrials.gov Identifier: NCT04318522.

Converging Evidence That Neural Plasticity Underlies Transcranial Direct-Current Stimulation

It is not definitely known how direct-current stimulation causes its long-lasting effects. Here, we tested the hypothesis that the long time course of transcranial direct-current stimulation (tDCS) is because of the electrical field increasing the plasticity of the brain tissue. If this is the case, then we should see tDCS effects when humans need to encode information into long-term memory, but not at other times. We tested this hypothesis by delivering tDCS to the ventral visual stream of human participants during different tasks (i.e., recognition memory vs. visual search) and at different times during a memory task. We found that tDCS improved memory encoding, and the neural correlates thereof, but not retrieval. We also found that tDCS did not change the efficiency of information processing during visual search for a certain target object, a task that does not require the formation of new connections in the brain but instead relies on attention and object recognition mechanisms. Thus, our findings support the hypothesis that direct-current stimulation modulates brain activity by changing the underlying plasticity of the tissue.

Improving motion detection via anodal transcranial direct current stimulation

BACKGROUND

To study motion perception, a stimulus consisting of a field of small, moving dots is often used. Generally, some of the dots coherently move in the same direction (signal) while the rest move randomly (noise). A percept of global coherent motion (CM) results when many different local motion signals are combined. CM computation is a complex process that requires the integrity of the middle-temporal area (MT/V5) and there is evidence that increasing the number of dots presented in the stimulus makes such computation more efficient.

OBJECTIVE

In this study, we explored whether anodal direct current stimulation (tDCS) over MT/V5 would increase individual performance in a CM task at a low signal-to-noise ratio (SNR, i.e. low percentage of coherent dots) and with a target consisting of a large number of moving dots (high dot numerosity, e.g. >250 dots) with respect to low dot numerosity (<60 dots), indicating that tDCS favour the integration of local motion signal into a single global percept (global motion).

METHOD

Participants were asked to perform a CM detection task (two-interval forced-choice, 2IFC) while they received anodal, cathodal, or sham stimulation on three different days.

RESULTS

Our findings showed no effect of cathodal tDCS with respect to the sham condition. Instead, anodal tDCS improves performance, but mostly when dot numerosity is high (>400 dots) to promote efficient global motion processing.

CONCLUSIONS

The present study suggests that tDCS may be used under appropriate stimulus conditions (low SNR and high dot numerosity) to boost the global motion processing efficiency, and may be useful to empower clinical protocols to treat visual deficits.

Visual motion perception improvements following direct current stimulation over V5 are dependent on initial performance

Transcranial direct current stimulation (tDCS) can improve visual perception. However, the effect of tDCS on visual perception is largely variable, possibly due to individual differences in initial performance. The goal of the present study was to evaluate the dependency of visual motion perception improvements on initial performance. Twenty-eight observers were randomly divided into two groups. Anodal tDCS and sham stimulation were separately applied to V5 (1.5 mA, 20 min), while observers performed a coherent motion direction identification task. The results showed that compared to sham stimulation, anodal tDCS induced a significant improvement in motion perception that lasted at least 20 min. In addition, the degree of improvement was dependent on initial performance, with a greater improvement magnitude observed for those with poorer initial performance. These results may have implications for understanding the nature of the stimulation rule and for the use of a customised stimulation protocol to enhance tDCS efficiency in practical applications.

Anodal and cathodal tDCS modulate neural activity and selectively affect GABA and glutamate syntheses in the visual cortex of cats

KEY POINTS

The present study showed that anodal and cathodal transcranial direct current stimulation (tDCS) can respectively increase and decrease the amplitude of visually evoked field potentials in the stimulated visual cortex of cats, with the effect lasting for ∼60-70 min. We directly measured tDCS-induced changes in the concentration of inhibitory and excitatory neurotransmitters in the visual cortex using the enzyme-linked immunosorbent assay method and showed that anodal and cathodal tDCS can selectively decrease the concentration of GABA and glutamate in the stimulated cortical area. Anodal and cathodal tDCS can selectively inhibit the synthesis of GABA and glutamate by suppressing the expression of GABA- and glutamate-synthesizing enzymes, respectively.

ABSTRACT

Transcranial direct current stimulation (tDCS) evokes long-lasting neuronal excitability in the target brain region. The underlying neural mechanisms remain poorly understood. The present study examined tDCS-induced alterations in neuronal activities, as well as the concentration and synthesis of GABA and glutamate (GLU), in area 21a (A21a) of cat visual cortex. Our analysis showed that anodal and cathodal tDCS respectively enhanced and suppressed neuronal activities in A21a, as indicated by a significantly increased and decreased amplitude of visually evoked field potentials (VEPs). The tDCS-induced effect lasted for ∼60-70 min. By contrast, sham tDCS had no significant impact on the VEPs in A21a. On the other hand, the concentration of GABA, but not that of GLU, in A21a significantly decreased after anodal tDCS relative to sham tDCS, whereas the concentration of GLU, but not that of GABA, in A21a significantly decreased after cathodal tDCS relative to sham tDCS. Furthermore, the expression of GABA-synthesizing enzymes GAD65 and GAD67 in A21a significantly decreased in terms of both mRNA and protein concentrations after anodal tDCS relative to sham tDCS, whereas that of GLU-synthesizing enzyme glutaminase (GLS) did not change significantly after anodal tDCS. By contrast, both mRNA and protein concentrations of GLS in A21a significantly decreased after cathodal tDCS relative to sham tDCS, whereas those of GAD65/GAD67 showed no significant change after cathodal tDCS. Taken together, these results indicate that anodal and cathodal tDCS may selectively reduce GABA and GLU syntheses and thus respectively enhance and suppress neuronal excitability in the stimulated brain area.

Anodal transcranial direct current stimulation reduces collinear lateral inhibition in normal peripheral vision

Collinear flanking stimuli can reduce the detectability of a Gabor target presented in peripheral vision. This phenomenon is called collinear lateral inhibition and it may contribute to crowding in peripheral vision. Perceptual learning can reduce collinear lateral inhibition in peripheral vision, however intensive training is required. Our aim was to assess whether modulation of collinear lateral inhibition can be achieved within a short time-frame using a single 20-minute session of primary visual cortex anodal transcranial direct current stimulation (a-tDCS). Thirteen observers with normal vision performed a 2AFC contrast detection task with collinear flankers positioned at a distance of 2λ from the target (lateral inhibition) or 6λ (control condition). The stimuli were presented 6° to the left of a central cross and fixation was monitored with an infra-red eye tracker. Participants each completed two randomly sequenced, single-masked stimulation sessions; real anodal tDCS and sham tDCS. For the 2λ separation condition, a-tDCS induced a significant reduction in detection threshold (reduced lateral inhibition). Sham stimulation had no effect. No effects of a-tDCS were observed for the 6λ separation condition. This result lays the foundation for future work investigating whether a-tDCS may be useful as a visual rehabilitation tool for individuals with central vision loss who are reliant on peripheral vision.

Cortical excitability controls the strength of mental imagery

Mental imagery provides an essential simulation tool for remembering the past and planning the future, with its strength affecting both cognition and mental health. Research suggests that neural activity spanning prefrontal, parietal, temporal, and visual areas supports the generation of mental images. Exactly how this network controls the strength of visual imagery remains unknown. Here, brain imaging and transcranial magnetic phosphene data show that lower resting activity and excitability levels in early visual cortex (V1-V3) predict stronger sensory imagery. Further, electrically decreasing visual cortex excitability using tDCS increases imagery strength, demonstrating a causative role of visual cortex excitability in controlling visual imagery. Together, these data suggest a neurophysiological mechanism of cortical excitability involved in controlling the strength of mental images.

Encoding strategy mediates the effect of electrical stimulation over posterior parietal cortex on visual short-term memory

Over past decades, converging neuroimaging and electrophysiological findings have suggested a crucial role of posterior parietal cortex (PPC) in supporting the storage capacity of visual short-term memory (VSTM). Moreover, a few recent studies have shown that electrical stimulation over PPC can enhance VSTM capacity, making it a promising method for improving VSTM function. However, the reliability of these results is still in question because null findings have also been observed. Among studies that reported significant effects, some found increased VSTM capacity only in people with low capacity. Here, we hypothesized that subjects' encoding strategy might be a key source of these variable results. To directly test this hypothesis, we stimulated PPC using transcranial direct-current stimulation (tDCS) in male and female human subjects instructed to employ different encoding strategies during a VSTM recall task. We found that VSTM capacity was higher in subjects who were instructed to remember all items in the supra-capacity array of visual stimuli (i.e., the remember-all group), compared to subjects who were told to focus on a subset of these stimuli (i.e., the remember-subset group). As predicted, anodal tDCS over PPC significantly enhanced VSTM capacity only in the remember-subset group, but not in the remember-all group. Additionally, no effect of encoding strategy or its interaction with electrical stimulation was found on VSTM precision. Together, these results suggest that encoding strategy has a selective influence on VSTM capacity and this influence of encoding strategy mediates the effect of electrical stimulation over PPC on VSTM function.

Investigating the effects of tDCS on Visual Orientation Discrimination Task Performance: 'The possible influence of placebo'

The non-invasive neuromodulation technique tDCS offers the promise of a low cost tool for both research and clinical applications in psychology, psychiatry and neuroscience. However, findings regarding its efficacy are often equivocal. A key issue is that the clinical and cognitive applications studied are often complex and thus effects of tDCS are difficult to predict given its known effects on the basic underlying neurophysiology, namely alterations in cortical inhibition-excitation balance. As such, it may be beneficial to assess the effects of tDCS in tasks whose performance has a clear link to cortical inhibition-excitation balance such as the visual orientation discrimination task (ODT). In prior studies in our laboratory no practise effects were found during 2 consecutive runs of the ODT, thus in the current investigation, to examine the effects of tDCS, subjects received 10 minutes of 2mA occipital tDCS (sham, anode, cathode) between a first and second run of ODT. Surprisingly, subjects' performance significantly improved in the second run of ODT compared to the first one regardless of the tDCS stimulation type they received (anodal, cathodal, or sham-tDCS). Possible causes for such an improvement could have been due to either a generic 'placebo' effect of tDCS (as all subjects received some form of tDCS) or an increased delay period between the two runs of ODT of the current study compared to our previous work (10 minutes duration required to administer tDCS as opposed to ~2 minutes in previous studies as a 'break'). As such, we tested these two possibilities with a subsequent experiment in which subjects received 2 minutes or 10 minutes delay between the 2 runs (with no tDCS) or 10 minutes of sham-tDCS. Only sham-tDCS resulted in improved performance thus these data add to a growing literature suggesting that tDCS has powerful placebo effect that may occur even in the absence of active cortical modulation.

Working memory revived in older adults by synchronizing rhythmic brain circuits

Understanding normal brain aging and developing methods to maintain or improve cognition in older adults are major goals of fundamental and translational neuroscience. Here we show a core feature of cognitive decline-working-memory deficits-emerges from disconnected local and long-range circuits instantiated by theta-gamma phase-amplitude coupling in temporal cortex and theta phase synchronization across frontotemporal cortex. We developed a noninvasive stimulation procedure for modulating long-range theta interactions in adults aged 60-76 years. After 25 min of stimulation, frequency-tuned to individual brain network dynamics, we observed a preferential increase in neural synchronization patterns and the return of sender-receiver relationships of information flow within and between frontotemporal regions. The end result was rapid improvement in working-memory performance that outlasted a 50 min post-stimulation period. The results provide insight into the physiological foundations of age-related cognitive impairment and contribute to groundwork for future non-pharmacological interventions targeting aspects of cognitive decline.

Visual training in hemianopia alters neural activity in the absence of behavioural improvement: a pilot study

Background

Damage to the primary visual cortex (V1) due to stroke often results in permanent loss of sight affecting one side of the visual field (homonymous hemianopia). Some rehabilitation approaches have shown improvement in visual performance in the blind region, but require a significant time investment.

Methods

Seven patients with cortical damage performed 400 trials of a motion direction discrimination task daily for 5 days. Three patients received anodal transcranial direct current stimulation (tDCS) during training, three received sham stimulation and one had no stimulation. Each patient had an assessment of visual performance and a functional magnetic resonance imaging (fMRI) scan before and after training to measure changes in visual performance and cortical activity.

Results

No patients showed improvement in visual function due to the training protocol, and application of tDCS had no effect on visual performance. However, following training, the neural response in motion area hMT+ to a moving stimulus was altered. When the stimulus was presented to the sighted hemifield, activity decreased in hMT+ of the damaged hemisphere. There was no change in hMT+ response when the stimulus was presented to the impaired hemifield. There was a decrease in activity in the inferior precuneus after training when the stimulus was presented to either the impaired or sighted hemifield. Preliminary analysis of tDCS data suggested that anodal tDCS interacted with the delivered training, modulating the neural response in hMT+ in the healthy side of the brain.

Conclusion

Training can affect the neural responses in hMT+ even in the absence of change in visual performance.

Electrical Stimulation Over Human Posterior Parietal Cortex Selectively Enhances the Capacity of Visual Short-Term Memory

Visual short-term memory (VSTM) provides an on-line mental space for incoming sensory information to be temporally maintained to carry out complex behavioral tasks. Despite its essential functions, the capacity at which VSTM could maintain sensory information is limited (i.e., VSTM can hold only about three to four visual items at once). Moreover, the quality of sensory representation (i.e., precision) degrades as more information has to be maintained in VSTM. Correlational evidence suggests that the level and the pattern of neural activity measured in the posterior parietal cortex (PPC) track both VSTM capacity and precision. However, the causal contributions of the PPC to these different VSTM operations are unclear. Here, we tested whether stimulating the PPC with transcranial direct current stimulation (tDCS) could increase VSTM capacity or precision. We found that stimulating the PPC in male and female human participants selectively enhanced VSTM capacity when the number of memory items exceeded capacity limit, without significant effects on VSTM precision. Moreover, this enhancement of VSTM capacity is region specific as stimulating the prefrontal cortex did not change VSTM capacity or precision. Null stimulation effects in the sensory memory condition confirmed that the tDCS-induced enhancement of VSTM capacity was not simply due to changes in sensory or attentional processes. Altogether, these results provide causal evidence suggesting that the PPC has a more dominant role in supporting the storage capacity of VSTM compared with maintaining the quality of sensory representations. Furthermore, tDCS could be used as a promising noninvasive method to enhance this PPC VSTM-related function.SIGNIFICANCE STATEMENT Correlational evidence from neuroimaging and electrophysiology suggests that the posterior parietal cortex (PPC) supports the storage capacity of visual short-term memory (VSTM) and the precision of sensory representations maintained in VSTM. However, the causal contributions of the PPC to these different VSTM functions were unclear. Here, we found that electrical stimulation over the PPC selectively enhanced VSTM capacity without changing VSTM precision. Overall, our findings suggest that the PPC has a dominant and causal role in supporting the storage capacity of VSTM.

Brain-state determines learning improvements after transcranial alternating-current stimulation to frontal cortex

BACKGROUND

Theories of executive control propose that communication between medial frontal cortex (MFC) and lateral prefrontal cortex (lPFC) is critical for learning. 6-Hz phase synchronization may be the mechanism by which neural activity between MFC and lPFC is coordinated into a functional network. Recent evidence suggests that switching from eyes closed to open may induce a change in brain-state reflected by enhanced executive control and related functional connectivity.

OBJECTIVE/HYPOTHESIS

To examine whether causal manipulation of MFC and lPFC can improve learning according to the brain-state induced by switching from eyes closed to open.

METHODS

Within-subjects, sham-controlled, double-blind study of 30 healthy subjects, each receiving 6-Hz in-phase high definition transcranial alternating-current stimulation (HD-tACS) applied to MFC and right lPFC prior to performing a time estimation task.

RESULTS

HD-tACS with eyes open improved learning ability relative to sham, whereas HD-tACS with eyes closed had no significant effect on behavior.

CONCLUSION

Results suggest a phase-sensitive mechanism in frontal cortex mediates components of learning performance in a state-dependent manner.

Unilateral Application of Cathodal tDCS Reduces Transcallosal Inhibition and Improves Visual Acuity in Amblyopic Patients

Objective: Amblyopia is a neurodevelopmental disorder characterized by visual acuity and contrast sensitivity loss, refractory to pharmacological and optical treatments in adulthood. In animals, the corpus callosum (CC) contributes to suppression of visual responses of the amblyopic eye. To investigate the role of interhemispheric pathways in amblyopic patients, we studied the response of the visual cortex to transcranial Direct Current Stimulation (tDCS) applied over the primary visual area (V1) contralateral to the “lazy eye.”

Methods: Visual acuity (logMAR) was assessed before (T₀), immediately after (T₁) and 60’ following the application of cathodal tDCS (2.0 mA, 20’) in 12 amblyopic patients. At each time point, Visual Evoked Potentials (VEPs) triggered by grating stimuli of different contrasts (K90%, K20%) were recorded in both hemispheres and compared to those obtained in healthy volunteers.

Results: Cathodal tDCS improved visual acuity respect to baseline (p < 0.0001), whereas sham polarization had no significant effect. At T₁, tDCS induced an inhibitory effect on VEPs amplitudes at all contrasts in the targeted side and a facilitation of responses in the hemisphere ipsilateral to the amblyopic eye; compared with controls, the facilitation persisted at T₂ for high contrasts (K90%; Holm–Sidak post hoc method, p < 0.001), while the stimulated hemisphere recovered more quickly from inhibition (Holm–Sidak post hoc method, p < 0.001).

Conclusions: tDCS is a promising treatment for amblyopia in adults. The rapid recovery of excitability and the concurrent transcallosal disinhibition following perturbation of cortical activity may support a critical role of interhemispheric balance in the pathophysiology of amblyopia.

Proscription supports robust perceptual integration by suppression in human visual cortex

Perception relies on integrating information within and between the senses, but how does the brain decide which pieces of information should be integrated and which kept separate? Here we demonstrate how proscription can be used to solve this problem: certain neurons respond best to unrealistic combinations of features to provide ‘what not’ information that drives suppression of unlikely perceptual interpretations. First, we present a model that captures both improved perception when signals are consistent (and thus should be integrated) and robust estimation when signals are conflicting. Second, we test for signatures of proscription in the human brain. We show that concentrations of inhibitory neurotransmitter GABA in a brain region intricately involved in integrating cues (V3B/KO) correlate with robust integration. Finally, we show that perturbing excitation/inhibition impairs integration. These results highlight the role of proscription in robust perception and demonstrate the functional purpose of ‘what not’ sensors in supporting sensory estimation.

Perception relies on information integration but it is unclear how the brain decides which information to integrate and which to keep separate. Here, the authors develop and test a biologically inspired model of cue-integration, implicating a key role for GABAergic proscription in robust perception.