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Fernández-Pérez JJ, Serrano-Muñoz D, Beltran-Alacreu H, Avendaño-Coy J, Gómez-Soriano J. Trans-Spinal Direct Current Stimulation in Neurological Disorders: A systematic review. J Neurol Phys Ther 2024; 48:66-74. [PMID: 38015051 DOI: 10.1097/npt.0000000000000463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
BACKGROUND AND PURPOSE Trans-spinal direct current stimulation (tsDCS) is a noninvasive stimulation technique that applies direct current stimulation over spinal levels. However, the effectiveness and feasibility of this stimulation are still unclear. This systematic review summarizes the effectiveness of tsDCS in clinical and neurophysiological outcomes in neurological patients, as well as its feasibility and safety. METHODS The search was conducted using the following databases: PEDro, Scopus, Web of Science, CINAHL, SPORTDiscus, and PubMed. The inclusion criteria were: Participants : people with central nervous system diseases; Interventions : tsDCS alone or in combination with locomotion training; Comparators : sham tsDCS, transcranial direct current stimulation, or locomotion training; Outcomes : clinical and neurophysiological measures; and Studies : randomized clinical trials. RESULTS Eight studies with a total of 143 subjects were included. Anodal tsDCS led to a reduction in hypertonia, neuropathic pain intensity, and balance deficits in people with hereditary spastic paraplegia, multiple sclerosis, and primary orthostatic tremor, respectively. In contrast, cathodal tsDCS only had positive effects on balance and tremor in people with primary orthostatic tremor. No severe adverse effects were reported during and after anodal or cathodal tsDCS. DISCUSSION AND CONCLUSIONS Although certain studies have found an effect of anodal tsDCS on specific clinical outcomes in people with central nervous system diseases, its effectiveness cannot be established since these findings have not been replicated and the results were heterogeneous. This stimulation was feasible and safe to apply. Further studies are needed to replicate the obtained results of tsDCS when applied in populations with neurological diseases.
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Affiliation(s)
- Juan José Fernández-Pérez
- Toledo Physiotherapy Research Group (GIFTO), Faculty of Physiotherapy and Nursing of Toledo, Universidad de Castilla-La Mancha, Toledo, Spain
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Romo-Nava F, Awosika OO, Basu I, Blom TJ, Welge J, Datta A, Guillen A, Guerdjikova AI, Fleck DE, Georgiev G, Mori N, Patino LR, DelBello MP, McNamara RK, Buijs RM, Frye MA, McElroy SL. Effect of non-invasive spinal cord stimulation in unmedicated adults with major depressive disorder: a pilot randomized controlled trial and induced current flow pattern. Mol Psychiatry 2024; 29:580-589. [PMID: 38123726 PMCID: PMC11153138 DOI: 10.1038/s41380-023-02349-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 11/20/2023] [Accepted: 11/27/2023] [Indexed: 12/23/2023]
Abstract
Converging theoretical frameworks suggest a role and a therapeutic potential for spinal interoceptive pathways in major depressive disorder (MDD). Here, we aimed to evaluate the antidepressant effects and tolerability of transcutaneous spinal direct current stimulation (tsDCS) in MDD. This was a double-blind, randomized, sham-controlled, parallel group, pilot clinical trial in unmedicated adults with moderate MDD. Twenty participants were randomly allocated (1:1 ratio) to receive "active" 2.5 mA or "sham" anodal tsDCS sessions with a thoracic (anode; T10)/right shoulder (cathode) electrode montage 3 times/week for 8 weeks. Change in depression severity (MADRS) scores (prespecified primary outcome) and secondary clinical outcomes were analyzed with ANOVA models. An E-Field model was generated using the active tsDCS parameters. Compared to sham (n = 9), the active tsDCS group (n = 10) showed a greater baseline to endpoint decrease in MADRS score with a large effect size (-14.6 ± 2.5 vs. -21.7 ± 2.3, p = 0.040, d = 0.86). Additionally, compared to sham, active tsDCS induced a greater decrease in MADRS "reported sadness" item (-1.8 ± 0.4 vs. -3.2 ± 0.4, p = 0.012), and a greater cumulative decrease in pre/post tsDCS session diastolic blood pressure change from baseline to endpoint (group difference: 7.9 ± 3.7 mmHg, p = 0.039). Statistical trends in the same direction were observed for MADRS "pessimistic thoughts" item and week-8 CGI-I scores. No group differences were observed in adverse events (AEs) and no serious AEs occurred. The current flow simulation showed electric field at strength within the neuromodulation range (max. ~0.45 V/m) reaching the thoracic spinal gray matter. The results from this pilot study suggest that tsDCS is feasible, well-tolerated, and shows therapeutic potential in MDD. This work also provides the initial framework for the cautious exploration of non-invasive spinal cord neuromodulation in the context of mental health research and therapeutics. The underlying mechanisms warrant further investigation. Clinicaltrials.gov registration: NCT03433339 URL: https://clinicaltrials.gov/ct2/show/NCT03433339 .
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Affiliation(s)
- Francisco Romo-Nava
- Lindner Center of HOPE, Mason, OH, USA.
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Oluwole O Awosika
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Ishita Basu
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Thomas J Blom
- Lindner Center of HOPE, Mason, OH, USA
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Jeffrey Welge
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Abhishek Datta
- Research and Development, Soterix Medical, Inc, New York, NY, USA
| | | | - Anna I Guerdjikova
- Lindner Center of HOPE, Mason, OH, USA
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - David E Fleck
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | | | - Nicole Mori
- Lindner Center of HOPE, Mason, OH, USA
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Luis R Patino
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Melissa P DelBello
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Robert K McNamara
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Ruud M Buijs
- Departamento de Fisiología Celular y Biología, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, México City, México
| | - Mark A Frye
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Susan L McElroy
- Lindner Center of HOPE, Mason, OH, USA
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Eberhardt F, Enax-Krumova E, Tegenthoff M, Höffken O, Özgül ÖS. Anodal transcutaneous spinal direct current stimulation influences the amplitude of pain-related evoked potentials in healthy subjects. Sci Rep 2023; 13:20920. [PMID: 38016967 PMCID: PMC10684856 DOI: 10.1038/s41598-023-47408-x] [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: 11/13/2023] [Indexed: 11/30/2023] Open
Abstract
It has already been described that transcutaneous spinal direct current stimulation (tsDCS) can selectively influence nociceptive evoked potentials. This study is the first aiming to prove an influence of tsDCS on pain-related evoked potentials (PREP) using concentric surface electrodes (CE), whose nociceptive specificity is still under discussion. 28 healthy subjects participated in this sham-controlled, double-blind cross-over study. All subjects underwent one session of anodal and one session of sham low-thoracic tsDCS. Before and after the intervention, PREP using CE, PREP-induced pain perception and somatosensory evoked potentials (SEP) were assessed on the right upper and lower limb. We found a decrease in PREP amplitude at the lower limb after sham stimulation, but not after anodal tsDCS, while SEP remained unchanged under all studied conditions. There was no difference between the effects of anodal tsDCS and sham stimulation on the studied parameters assessed at the upper limb. PREP-induced pain of the upper and lower limb increased after anodal tsDCS. The ability of influencing PREP using a CE at the spinal level in contrast to SEP suggests that PREP using CE follows the spinothalamic pathway and supports the assumption that it is specifically nociceptive. However, while mainly inhibitory effects on nociceptive stimuli have already been described, our results rather suggest that anodal tsDCS has a sensitizing effect. This may indicate that the mechanisms underlying the elicitation of PREP with CE are not the same as for the other nociceptive evoked potentials. The effects on the processing of different types of painful stimuli should be directly compared in future studies.
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Affiliation(s)
- Frederic Eberhardt
- Department of Neurology, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil GmbH, Ruhr-University Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany.
| | - Elena Enax-Krumova
- Department of Neurology, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil GmbH, Ruhr-University Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Martin Tegenthoff
- Department of Neurology, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil GmbH, Ruhr-University Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Oliver Höffken
- Department of Neurology, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil GmbH, Ruhr-University Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Özüm Simal Özgül
- Department of Neurology, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil GmbH, Ruhr-University Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
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Hodaj H, Payen JF, Hodaj E, Sorel M, Dumolard A, Vercueil L, Delon-Martin C, Lefaucheur JP. Long-term analgesic effect of trans-spinal direct current stimulation compared to non-invasive motor cortex stimulation in complex regional pain syndrome. Brain Commun 2023; 5:fcad191. [PMID: 37545548 PMCID: PMC10400160 DOI: 10.1093/braincomms/fcad191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 05/26/2023] [Accepted: 06/30/2023] [Indexed: 08/08/2023] Open
Abstract
The aim of the present study was to compare the analgesic effect of motor cortex stimulation using high-frequency repetitive transcranial magnetic stimulation or transcranial direct current stimulation and transcutaneous spinal direct current stimulation in patients with complex regional pain syndrome. Thirty-three patients with complex regional pain syndrome were randomized to one of the three treatment groups (repetitive transcranial magnetic stimulation, n = 11; transcranial direct current stimulation, n = 10; transcutaneous spinal direct current stimulation, n = 12) and received a series of 12 sessions of stimulation for 3 weeks (induction phase) and 11 sessions for 4 months (maintenance therapy). The primary end-point was the mean pain intensity assessed weekly with a visual numerical scale during the month prior to treatment (baseline), the 5-month stimulation period and 1 month after the treatment. The weekly visual numerical scale pain score was significantly reduced at all time points compared to baseline in the transcutaneous spinal direct current stimulation group, at the last two time points in the repetitive transcranial magnetic stimulation group (end of the 5-month stimulation period and 1 month later), but at no time point in the transcranial direct current stimulation group. A significant pain relief was observed at the end of induction phase using transcutaneous spinal direct current stimulation compared to repetitive transcranial magnetic stimulation (P = 0.008) and to transcranial direct current stimulation (P = 0.003). In this trial, transcutaneous spinal direct current stimulation was more efficient to relieve pain in patients with complex regional pain syndrome compared to motor cortex stimulation techniques (repetitive transcranial magnetic stimulation, transcranial direct current stimulation). This efficacy was found during the induction phase and was maintained thereafter. This study warrants further investigation to confirm the potentiality of transcutaneous spinal direct current stimulation as a therapeutic option in complex regional pain syndrome.
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Affiliation(s)
- Hasan Hodaj
- Correspondence to: Hasan Hodaj Pôle Anesthésie Réanimation CHU Grenoble Alpes, BP217, 38043 Grenoble, FranceE-mail:
| | - Jean-Francois Payen
- Centre de la Douleur, Pôle Anesthésie Réanimation, CHU Grenoble Alpes, 38000 Grenoble, France
- Univ. Grenoble Alpes, Inserm, U1216, Grenoble Institut Neurosciences, 38000 Grenoble, France
| | - Enkelejda Hodaj
- Centre d'Investigation Clinique, CHU Grenoble Alpes, 38000, Grenoble, France
| | - Marc Sorel
- Centre d'Evaluation et de Traitement de la Douleur, Hôpital Sud-Seine-et-Marne, site Nemours, Nemours, France
- EA 4391, Excitabilité Nerveuse et Thérapeutique, Faculté de Santé, Univ. Paris Est Créteil, Créteil, France
| | - Anne Dumolard
- Centre de la Douleur, Pôle Anesthésie Réanimation, CHU Grenoble Alpes, 38000 Grenoble, France
| | - Laurent Vercueil
- Service de Neurologie, CHU Grenoble Alpes, 38000, Grenoble, France
| | - Chantal Delon-Martin
- Univ. Grenoble Alpes, Inserm, U1216, Grenoble Institut Neurosciences, 38000 Grenoble, France
| | - Jean-Pascal Lefaucheur
- EA 4391, Excitabilité Nerveuse et Thérapeutique, Faculté de Santé, Univ. Paris Est Créteil, Créteil, France
- Unité de Neurophysiologie Clinique, Service de Physiologie—Explorations Fonctionnelles, Hôpital Henri Mondor, Assistance Publique—Hôpitaux de Paris, Créteil, France
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Guidetti M, Giannoni-Luza S, Bocci T, Pacheco-Barrios K, Bianchi AM, Parazzini M, Ionta S, Ferrucci R, Maiorana NV, Verde F, Ticozzi N, Silani V, Priori A. Modeling Electric Fields in Transcutaneous Spinal Direct Current Stimulation: A Clinical Perspective. Biomedicines 2023; 11:biomedicines11051283. [PMID: 37238953 DOI: 10.3390/biomedicines11051283] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/12/2023] [Accepted: 04/21/2023] [Indexed: 05/28/2023] Open
Abstract
Clinical findings suggest that transcutaneous spinal direct current stimulation (tsDCS) can modulate ascending sensitive, descending corticospinal, and segmental pathways in the spinal cord (SC). However, several aspects of the stimulation have not been completely understood, and realistic computational models based on MRI are the gold standard to predict the interaction between tsDCS-induced electric fields and anatomy. Here, we review the electric fields distribution in the SC during tsDCS as predicted by MRI-based realistic models, compare such knowledge with clinical findings, and define the role of computational knowledge in optimizing tsDCS protocols. tsDCS-induced electric fields are predicted to be safe and induce both transient and neuroplastic changes. This could support the possibility to explore new clinical applications, such as spinal cord injury. For the most applied protocol (2-3 mA for 20-30 min, active electrode over T10-T12 and the reference on the right shoulder), similar electric field intensities are generated in both ventral and dorsal horns of the SC at the same height. This was confirmed by human studies, in which both motor and sensitive effects were found. Lastly, electric fields are strongly dependent on anatomy and electrodes' placement. Regardless of the montage, inter-individual hotspots of higher values of electric fields were predicted, which could change when the subjects move from a position to another (e.g., from the supine to the lateral position). These characteristics underlines the need for individualized and patient-tailored MRI-based computational models to optimize the stimulation protocol. A detailed modeling approach of the electric field distribution might contribute to optimizing stimulation protocols, tailoring electrodes' configuration, intensities, and duration to the clinical outcome.
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Affiliation(s)
- Matteo Guidetti
- Aldo Ravelli Research Center for Neurotechnology and Experimental Neurotherapeutics, Department of Health Sciences, University of Milan, 20142 Milan, Italy
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, 20133 Milan, Italy
| | - Stefano Giannoni-Luza
- Sensory-Motor Lab (SeMoLa), Department of Ophthalmology-University of Lausanne, Jules Gonin Eye Hospital/Fondation Asile des Aveugles, 1015 Lausanne, Switzerland
| | - Tommaso Bocci
- Aldo Ravelli Research Center for Neurotechnology and Experimental Neurotherapeutics, Department of Health Sciences, University of Milan, 20142 Milan, Italy
- III Neurology Clinic, ASST-Santi Paolo e Carlo University Hospital, 20142 Milan, Italy
| | - Kevin Pacheco-Barrios
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Boston, MA 02129, USA
- Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Vicerrectorado de Investigación, Lima 15024, Peru
| | - Anna Maria Bianchi
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, 20133 Milan, Italy
| | - Marta Parazzini
- Istituto di Elettronica e di Ingegneria Dell'Informazione e delle Telecomunicazioni (IEIIT), Consiglio Nazionale delle Ricerche (CNR), 10129 Milan, Italy
| | - Silvio Ionta
- Sensory-Motor Lab (SeMoLa), Department of Ophthalmology-University of Lausanne, Jules Gonin Eye Hospital/Fondation Asile des Aveugles, 1015 Lausanne, Switzerland
| | - Roberta Ferrucci
- III Neurology Clinic, ASST-Santi Paolo e Carlo University Hospital, 20142 Milan, Italy
- Department of Oncology and Hematology, University of Milan, 20122 Milan, Italy
| | - Natale Vincenzo Maiorana
- Aldo Ravelli Research Center for Neurotechnology and Experimental Neurotherapeutics, Department of Health Sciences, University of Milan, 20142 Milan, Italy
| | - Federico Verde
- Department of Neurology, Istituto Auxologico Italiano IRCCS, 20149 Milan, Italy
- Department of Pathophysiology and Transplantation, 'Dino Ferrari' Center, Università degli Studi di Milano, 20122 Milan, Italy
| | - Nicola Ticozzi
- Department of Neurology, Istituto Auxologico Italiano IRCCS, 20149 Milan, Italy
- Department of Pathophysiology and Transplantation, 'Dino Ferrari' Center, Università degli Studi di Milano, 20122 Milan, Italy
| | - Vincenzo Silani
- Department of Neurology, Istituto Auxologico Italiano IRCCS, 20149 Milan, Italy
- Department of Pathophysiology and Transplantation, 'Dino Ferrari' Center, Università degli Studi di Milano, 20122 Milan, Italy
| | - Alberto Priori
- Aldo Ravelli Research Center for Neurotechnology and Experimental Neurotherapeutics, Department of Health Sciences, University of Milan, 20142 Milan, Italy
- III Neurology Clinic, ASST-Santi Paolo e Carlo University Hospital, 20142 Milan, Italy
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Effect of Transcutaneous Spinal Direct Current Stimulation in Patients with Painful Polyneuropathy and Influence of Possible Predictors of Efficacy including BDNF Polymorphism: A Randomized, Sham-Controlled Crossover Study. Brain Sci 2023; 13:brainsci13020229. [PMID: 36831772 PMCID: PMC9953758 DOI: 10.3390/brainsci13020229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/20/2023] [Accepted: 01/25/2023] [Indexed: 01/31/2023] Open
Abstract
Introduction: The neuromodulating effects of transcutaneous-spinal Direct Current Stimulation (tsDCS) have been reported to block pain signaling. For patients with chronic pain, tsDCS could be a potential treatment option. To approach this, we studied the effect of anodal tsDCS on patients with neuropathic pain approaching an optimal paradigm including the investigation of different outcome predictors. Methods: In this randomized, double-blinded, sham-controlled crossover study we recruited twenty patients with neurophysiologically evaluated neuropathic pain due to polyneuropathy (PNP). Variables (VAS; pain and sleep quality) were reported daily, one week prior to, and one week after the stimulation/sham period. Anodal tsDCS (2.5 mA, 20 min) was given once daily for three days during one week. BDNF-polymorphism, pharmacological treatment, and body mass index (BMI) of all the patients were investigated. Results: Comparing the effects of sham and real stimulation at the group level, there was a tendency towards reduced pain, but no significant effects were found. However, for sleep quality a significant improvement was seen. At the individual level, 30 and 35% of the subjects had a clinically significant improvement of pain level and sleep quality, respectively, the first day after the stimulation. Both effects were reduced over the coming week and these changes were negatively correlated. The BDNF polymorphism Val66Met was carried by 35% of the patients and this group was found to have a lower general level of pain but there was no significant difference in the tsDCS response effect. Neither pharmacologic treatment or BMI influenced the treatment effect. Conclusions: Short-term and sparse anodal thoracic tsDCS reduces pain and improves sleep with large inter-individual differences. Roughly 30% will benefit in a clinically meaningful way. The BDNF genotype seems to influence the level of pain that PNP produces. Individualized and intensified tsDCS may be a treatment option for neuropathic pain due to PNP.
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Fava de Lima F, Silva CR, Kohn AF. Transcutaneous spinal direct current stimulation (tsDCS) does not affect postural sway of young and healthy subjects during quiet upright standing. PLoS One 2022; 17:e0267718. [PMID: 35482798 PMCID: PMC9049532 DOI: 10.1371/journal.pone.0267718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 04/13/2022] [Indexed: 12/02/2022] Open
Abstract
Transcutaneous spinal direct current stimulation (tsDCS) is an effective non-invasive spinal cord electrical stimulation technique to induce neuromodulation of local and distal neural circuits of the central nervous system (CNS). Applied to the spinal cord lumbosacral region, tsDCS changes electrophysiological responses of the motor, proprioceptive and nociceptive pathways, alters the performance of some lower limb motor tasks and can even modulate the behavior of supramedullary neuronal networks. In this study an experimental protocol was conducted to verify if tsDCS (5 mA, 20 minutes) of two different polarizations, applied over the lumbosacral region (tenth thoracic vertebrae (T10)), can induce changes in postural sway oscillations of young healthy individuals during quiet standing. A novel initialization of the electrical stimulation was developed to improve subject blinding to the different stimulus conditions including the sham trials. Measures of postural sway, both global and structural, were computed before, during and following the DC stimulation period. The results indicated that, for the adopted conditions, tsDCS did not induce statistically significant changes in postural sway of young healthy individuals during quiet standing.
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Affiliation(s)
- Felipe Fava de Lima
- Biomedical Engineering Laboratory, Escola Politécnica, University of São Paulo, São Paulo, Brazil
- * E-mail:
| | - Cristiano Rocha Silva
- Biomedical Engineering Laboratory, Escola Politécnica, University of São Paulo, São Paulo, Brazil
| | - Andre Fabio Kohn
- Biomedical Engineering Laboratory, Escola Politécnica, University of São Paulo, São Paulo, Brazil
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Rahman MA, Tharu NS, Gustin SM, Zheng YP, Alam M. Trans-Spinal Electrical Stimulation Therapy for Functional Rehabilitation after Spinal Cord Injury: Review. J Clin Med 2022; 11:jcm11061550. [PMID: 35329875 PMCID: PMC8954138 DOI: 10.3390/jcm11061550] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/04/2022] [Accepted: 03/09/2022] [Indexed: 01/25/2023] Open
Abstract
Spinal cord injury (SCI) is one of the most debilitating injuries in the world. Complications after SCI, such as respiratory issues, bowel/bladder incontinency, pressure ulcers, autonomic dysreflexia, spasticity, pain, etc., lead to immense suffering, a remarkable reduction in life expectancy, and even premature death. Traditional rehabilitations for people with SCI are often insignificant or ineffective due to the severity and complexity of the injury. However, the recent development of noninvasive electrical neuromodulation treatments to the spinal cord have shed a ray of hope for these individuals to regain some of their lost functions, a reduction in secondary complications, and an improvement in their life quality. For this review, 250 articles were screened and about 150 were included to summarize the two most promising noninvasive spinal cord electrical stimulation methods of SCI rehabilitation treatment, namely, trans-spinal direct current stimulation (tsDCS) and trans-spinal pulsed current stimulation (tsPCS). Both treatments have demonstrated good success in not only improving the sensorimotor function, but also autonomic functions. Due to the noninvasive nature and lower costs of these treatments, in the coming years, we expect these treatments to be integrated into regular rehabilitation therapies worldwide.
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Affiliation(s)
- Md. Akhlasur Rahman
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China; (M.A.R.); (N.S.T.); (Y.-P.Z.)
- Centre for the Rehabilitation of the Paralysed (CRP), Savar Union 1343, Bangladesh
| | - Niraj Singh Tharu
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China; (M.A.R.); (N.S.T.); (Y.-P.Z.)
| | - Sylvia M. Gustin
- NeuroRecovery Research Hub, School of Psychology, University of New South Wales, Sydney, NSW 2052, Australia;
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW 2031, Australia
| | - Yong-Ping Zheng
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China; (M.A.R.); (N.S.T.); (Y.-P.Z.)
| | - Monzurul Alam
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China; (M.A.R.); (N.S.T.); (Y.-P.Z.)
- NeuroRecovery Research Hub, School of Psychology, University of New South Wales, Sydney, NSW 2052, Australia;
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW 2031, Australia
- Correspondence: ; Tel.: +852-6213-5054
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Naro A, Billeri L, Balletta T, Lauria P, Onesta MP, Calabrò RS. Finding the Way to Improve Motor Recovery of Patients with Spinal Cord Lesions: A Case-Control Pilot Study on a Novel Neuromodulation Approach. Brain Sci 2022; 12:119. [PMID: 35053862 PMCID: PMC8773706 DOI: 10.3390/brainsci12010119] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/12/2022] [Accepted: 01/13/2022] [Indexed: 12/16/2022] Open
Abstract
Robot-assisted rehabilitation (RAR) and non-invasive brain stimulation (NIBS) are interventions that, both individually and combined, can significantly enhance motor performance after spinal cord injury (SCI). We sought to determine whether repetitive transcranial magnetic stimulation (rTMS) combined with active transvertebral direct current stimulation (tvDCS) (namely, NIBS) in association with RAR (RAR + NIBS) improves lower extremity motor function more than RAR alone in subjects with motor incomplete SCI (iSCI). Fifteen adults with iSCI received one daily session of RAR+NIBS in the early afternoon, six sessions weekly, for eight consecutive weeks. Outcome measures included the 6 min walk test (6MWT), the 10 m walk test (10MWT), the timed up and go (TUG) to test mobility and balance, the Walking Index for Spinal Cord Injury (WISCI II), the Functional Independence Measure-Locomotion (FIM-L), the manual muscle testing for lower extremity motor score (LEMS), the modified Ashworth scale for lower limbs (MAS), and the visual analog scale (VAS) for pain. The data of these subjects were compared with those of 20 individuals matched for clinical and demographic features who previously received the same amount or RAR without NIBS (RAR - NIBS). All patients completed the trial, and none reported any side effects either during or following the training. The 10MWT improved in both groups, but the increase was significantly greater following RAR + NIBS than RAR - NIBS. The same occurred for the FIM-L, LEMS, and WISCI II. No significant differences were appreciable concerning the 6MWT and TUG. Conversely, RAR - NIBS outperformed RAR + NIBS regarding the MAS and VAS. Pairing tvDCS with rTMS during RAR can improve lower extremity motor function more than RAR alone can do. Future research with a larger sample size is recommended to determine longer-term effects on motor function and activities of daily living.
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Affiliation(s)
- Antonino Naro
- IRCCS Centro Neurolesi Bonino Pulejo Piemonte, Via Palermo, SS 113, Ctr. Casazza, 98124 Messina, Italy; (A.N.); (L.B.); (T.B.); (P.L.)
| | - Luana Billeri
- IRCCS Centro Neurolesi Bonino Pulejo Piemonte, Via Palermo, SS 113, Ctr. Casazza, 98124 Messina, Italy; (A.N.); (L.B.); (T.B.); (P.L.)
| | - Tina Balletta
- IRCCS Centro Neurolesi Bonino Pulejo Piemonte, Via Palermo, SS 113, Ctr. Casazza, 98124 Messina, Italy; (A.N.); (L.B.); (T.B.); (P.L.)
| | - Paola Lauria
- IRCCS Centro Neurolesi Bonino Pulejo Piemonte, Via Palermo, SS 113, Ctr. Casazza, 98124 Messina, Italy; (A.N.); (L.B.); (T.B.); (P.L.)
| | | | - Rocco Salvatore Calabrò
- IRCCS Centro Neurolesi Bonino Pulejo Piemonte, Via Palermo, SS 113, Ctr. Casazza, 98124 Messina, Italy; (A.N.); (L.B.); (T.B.); (P.L.)
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10
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Therkildsen ER, Nielsen JB, Beck MM, Yamaguchi T, Lorentzen J. The effect of cathodal transspinal direct current stimulation on tibialis anterior stretch reflex components in humans. Exp Brain Res 2021; 240:159-171. [PMID: 34686909 DOI: 10.1007/s00221-021-06243-0] [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: 03/01/2021] [Accepted: 10/08/2021] [Indexed: 01/04/2023]
Abstract
Spinal DC stimulation (tsDCS) shows promise as a technique for the facilitation of functional recovery of motor function following central nervous system (CNS) lesion. However, the network mechanisms that are responsible for the effects of tsDCS are still uncertain. Here, in a series of experiments, we tested the hypothesis that tsDCS increases the excitability of the long-latency stretch reflex, leading to increased excitability of corticospinal neurons in the primary motor cortex. Experiments were performed in 33 adult human subjects (mean age 28 ± 7 years/14 females). Subjects were seated in a reclining armchair with the right leg attached to a footplate, which could be quickly plantarflexed (100 deg/s; 6 deg amplitude) to induce stretch reflexes in the tibialis anterior (TA) muscle at short (45 ms) and longer latencies (90-95 ms). This setup also enabled measuring motor evoked potentials (MEPs) and cervicomedullary evoked potentials (cMEPs) from TA evoked by transcranial magnetic stimulation (TMS) and electrical stimulation at the cervical junction, respectively. Cathodal tsDCS at 2.5 and 4 mA was found to increase the long-latency reflex without any significant effect on the short-latency reflex. Furthermore, TA MEPs, but not cMEPs, were increased following tsDCS. We conclude that cathodal tsDCS over lumbar segments may facilitate proprioceptive transcortical reflexes in the TA muscle, and we suggest that the most likely explanation of this facilitation is an effect on ascending fibers in the dorsal columns.
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Affiliation(s)
- Eva Rudjord Therkildsen
- Department of Neuroscience, Panum Institute 33.3, University of Copenhagen, Blegdamsvej 3, 2200, Copenhagen, Denmark.
| | - Jens Bo Nielsen
- Department of Neuroscience, Panum Institute 33.3, University of Copenhagen, Blegdamsvej 3, 2200, Copenhagen, Denmark.,Elsass Foundation, Holmegaardsvej 28, 2920, Charlottenlund, Denmark
| | - Mikkel Malling Beck
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Nørre Allé 51, 2200, Copenhagen, Denmark
| | - Tomofumi Yamaguchi
- Department of Neuroscience, Panum Institute 33.3, University of Copenhagen, Blegdamsvej 3, 2200, Copenhagen, Denmark.,Department of Physical Therapy, Faculty of Health Science, Juntendo University, 2-1-1Bunkyo-ku, HongoTokyo, Japan
| | - Jakob Lorentzen
- Department of Neuroscience, Panum Institute 33.3, University of Copenhagen, Blegdamsvej 3, 2200, Copenhagen, Denmark
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11
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Guidetti M, Ferrucci R, Vergari M, Aglieco G, Naci A, Versace S, Pacheco-Barrios K, Giannoni-Luza S, Barbieri S, Priori A, Bocci T. Effects of Transcutaneous Spinal Direct Current Stimulation (tsDCS) in Patients With Chronic Pain: A Clinical and Neurophysiological Study. Front Neurol 2021; 12:695910. [PMID: 34552550 PMCID: PMC8450534 DOI: 10.3389/fneur.2021.695910] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 07/30/2021] [Indexed: 12/27/2022] Open
Abstract
Background and Aims: Chronic pain is a complex clinical condition, often devastating for patients and unmanageable with pharmacological treatments. Converging evidence suggests that transcutaneous spinal Direct Current Stimulation (tsDCS) might represent a complementary therapy in managing chronic pain. In this randomized, double-blind and sham-controlled crossover study, we assessed tsDCS effects in chronic pain patients. Methods: Sixteen patients (aged 65.06 ± 16.16 years, eight women) with chronic pain of different etiology underwent sham and anodal tsDCS (anode over the tenth thoracic vertebra, cathode over the somatosensory cortical area: 2.5 mA, 20 min, 5 days for 1 week). As outcomes, we considered the Visual Analog Scale (VAS), the Neuropathic Pain Symptom Inventory (NPSI), and the components of the lower limb flexion reflex (LLFR), i.e., RIII threshold, RII latency and area, RIII latency and area, and flexion reflex (FR) total area. Assessments were conducted before (T0), immediately at the end of the treatment (T1), after 1 week (T2) and 1 month (T3). Results: Compared to sham, anodal tsDCS reduced RIII area at T2 (p = 0.0043) and T3 (p = 0.0012); similarly, FR total area was reduced at T3 (p = 0.03). Clinically, anodal tsDCS dampened VAS at T3 (p = 0.015), and NPSI scores at T1 (p = 0.0012), and T3 (p = 0.0015), whereas sham condition left them unchanged. Changes in VAS and NPSI scores linearly correlated with the reduction in LLFR areas (p = 0.0004). Conclusions: Our findings suggest that tsDCS could modulate nociceptive processing and pain perception in chronic pain syndromes.
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Affiliation(s)
- Matteo Guidetti
- "Aldo Ravelli" Center for Neurotechnology and Experimental Brain Therapeutics, Department of Health Sciences, University of Milan, Milan, Italy.,Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Roberta Ferrucci
- "Aldo Ravelli" Center for Neurotechnology and Experimental Brain Therapeutics, Department of Health Sciences, University of Milan, Milan, Italy.,Azienda Socio-Sanitaria Territoriale-Santi Paolo e Carlo University Hospital, Milan, Italy
| | - Maurizio Vergari
- Neurophysiology Unit, Foundation Istituto di Ricerca e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giada Aglieco
- Neurophysiology Unit, Foundation Istituto di Ricerca e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Anisa Naci
- Neurophysiology Unit, Foundation Istituto di Ricerca e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Sara Versace
- Neurophysiology Unit, Foundation Istituto di Ricerca e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Kevin Pacheco-Barrios
- Neuromodulation Center, Spaulding Rehabilitation Hospital, Boston, MA, United States.,Center for Clinical Research Learning, Massachusetts General Hospital, Boston, MA, United States.,Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima, Peru
| | - Stefano Giannoni-Luza
- Neuromodulation Center, Spaulding Rehabilitation Hospital, Boston, MA, United States.,Center for Clinical Research Learning, Massachusetts General Hospital, Boston, MA, United States
| | - Sergio Barbieri
- Neurophysiology Unit, Foundation Istituto di Ricerca e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alberto Priori
- "Aldo Ravelli" Center for Neurotechnology and Experimental Brain Therapeutics, Department of Health Sciences, University of Milan, Milan, Italy.,Azienda Socio-Sanitaria Territoriale-Santi Paolo e Carlo University Hospital, Milan, Italy
| | - Tommaso Bocci
- "Aldo Ravelli" Center for Neurotechnology and Experimental Brain Therapeutics, Department of Health Sciences, University of Milan, Milan, Italy.,Azienda Socio-Sanitaria Territoriale-Santi Paolo e Carlo University Hospital, Milan, Italy
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12
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Ciccone AB, Fry AC, Emerson DM, Gallagher PM, Herda TJ, Weir JP. Effects of Transspinal Direct Current Stimulation on Cycling Perception of Effort and Time to Exhaustion. J Strength Cond Res 2021; 35:347-352. [PMID: 33306592 DOI: 10.1519/jsc.0000000000003876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
ABSTRACT Ciccone, AB, Fry, AC, Emerson, DM, Gallagher, PM, Herda, TJ, and Weir, JP. Effects of transspinal direct current stimulation on cycling perception of effort and time to exhaustion. J Strength Cond Res 35(2): 347-352, 2021-In the past decade, researchers have investigated the efficacy of transspinal direct current stimulation (tsDCS) on the central nervous system and afferent neuron function in humans. Recently, data have suggested it may be possible for such tsDCS-induced changes in neuromuscular function to enhance performance. This study used noninvasive thoracic spine tsDCS to determine if cycling performance and perception of effort could be modulated by tsDCS. In 3 different stimulation conditions, anodal, cathodal, and sham, subjects cycled at 80% of their maximal aerobic capacity until exhaustion and reported their rating of perceived exertion (RPE) every minute. From this period, we compared the RPE responses over the first 3 minutes and time to exhaustion. There was no significant difference in time to exhaustion between anodal (408 ± 121 seconds), cathodal (413 ± 168 seconds), and sham (440 ± 189 seconds) conditions (p = 0.58). There was no significant difference in RPE from minutes 1-3 (collapsed across time) between anodal (12.9 ± 2.4 arbitrary units (AUs)), cathodal (13.3 ± 2.2 AUs), and sham (12.9 ± 2.1 AUs) conditions (p = 0.51). These data suggest tsDCS condition did not influence cycling performance or perception of effort during high-intensity cycling. Therefore, thoracic spine and lower abdominal montage delivering a current density of 0.071 mA·cm-2 for 20 minutes likely does not substantially improve high-intensity cycling work capacity. Therefore, more research is needed to investigate the efficacy of tsDCS and which stimulation methods may and may not enhance human performance.
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Affiliation(s)
- Anthony B Ciccone
- Department of Exercise Science and Outdoor Recreation, Utah Valley University, Orem, Utah; and
| | - Andrew C Fry
- Osness Human Performance Laboratories, Department of Health, Sport, and Exercise Sciences, University of Kansas, Lawrence, Kansas
| | - Dawn M Emerson
- Osness Human Performance Laboratories, Department of Health, Sport, and Exercise Sciences, University of Kansas, Lawrence, Kansas
| | - Philip M Gallagher
- Osness Human Performance Laboratories, Department of Health, Sport, and Exercise Sciences, University of Kansas, Lawrence, Kansas
| | - Trent J Herda
- Osness Human Performance Laboratories, Department of Health, Sport, and Exercise Sciences, University of Kansas, Lawrence, Kansas
| | - Joseph P Weir
- Osness Human Performance Laboratories, Department of Health, Sport, and Exercise Sciences, University of Kansas, Lawrence, Kansas
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13
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Bączyk M, Krutki P, Zytnicki D. Is there hope that transpinal direct current stimulation corrects motoneuron excitability and provides neuroprotection in amyotrophic lateral sclerosis? Physiol Rep 2021; 9:e14706. [PMID: 33463907 PMCID: PMC7814489 DOI: 10.14814/phy2.14706] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 12/06/2020] [Accepted: 12/08/2020] [Indexed: 12/14/2022] Open
Abstract
Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disease of largely unknown pathophysiology, characterized by the progressive loss of motoneurons (MNs). We review data showing that in presymptomatic ALS mice, MNs display reduced intrinsic excitability and impaired level of excitatory inputs. The loss of repetitive firing specifically affects the large MNs innervating fast contracting muscle fibers, which are the most vulnerable MNs in ALS. Interventions that aimed at restoring either the intrinsic excitability or the synaptic excitation result in a decrease of disease markers in MNs and delayed neuromuscular junction denervation. We then focus on trans‐spinal direct current stimulation (tsDCS), a noninvasive tool, since it modulates the activity of spinal neurons and networks. Effects of tsDCS depend on the polarity of applied current. Recent work shows that anodal tsDCS induces long‐lasting enhancement of MN excitability and synaptic excitation of spinal MNs. Moreover, we show preliminary results indicating that anodal tsDCS enhances the excitatory synaptic inputs to MNs in ALS mice. In conclusion, we suggest that chronic application of anodal tsDCS might be useful as a complementary method in the management of ALS patients.
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Affiliation(s)
- Marcin Bączyk
- Department of Neurobiology, Poznan University of Physical Education, Poznań, Poland
| | - Piotr Krutki
- Department of Neurobiology, Poznan University of Physical Education, Poznań, Poland
| | - Daniel Zytnicki
- Université de Paris, Centre National de la Recherche Scientifique (CNRS), Saints-Pères Paris Institute for the Neurosciences (SPPIN), Paris, France
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14
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Transcutaneous spinal direct current stimulation shows no effect on paired stimulation suppression of the somatosensory cortex. Sci Rep 2020; 10:22010. [PMID: 33319846 PMCID: PMC7738485 DOI: 10.1038/s41598-020-79131-2] [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: 06/17/2020] [Accepted: 12/03/2020] [Indexed: 11/08/2022] Open
Abstract
Transcutaneous spinal direct current stimulation (tsDCS) is a safe and convenient method of neuromodulation. It has been proven to alter sensory processing at cervicomedullary level by amplitude changes of the P30 response of tibial nerve somatosensory evoked potentials (TN SEPs). With knowledge that tsDCS affects cortical circuits, we hypothesized that tsDCS may also affect intracortical excitability of the somatosensory cortex assessed by paired stimulation suppression (PSS). Fourteen healthy men were included in this prospective, single-blinded, placebo-controlled crossover study. Single (SS) and paired stimulation (PS) TN SEPs were recorded over the scalp before, immediately as well as 30 and 60 min after applying 15 min of tsDCS over the twelfth thoracic vertebra. Each volunteer underwent three independent and randomized sessions of either cathodal, anodal or sham stimulation. tsDCS showed no effect on peak-to-peak amplitudes or latencies of cortical P40-N50 response after SS. Furthermore, tsDCS failed to induce significant changes on amplitude ratios of PSS, thus showing no impact on intracortical excitability of the somatosensory cortex in healthy subjects. Further research is required to reveal the different mechanisms and to strengthen clinical use of this promising technique.
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15
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Paparella G, Di Stefano G, Fasolino A, Di Pietro G, Colella D, Truini A, Cruccu G, Berardelli A, Bologna M. Painful stimulation increases spontaneous blink rate in healthy subjects. Sci Rep 2020; 10:20014. [PMID: 33203984 PMCID: PMC7672065 DOI: 10.1038/s41598-020-76804-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 10/05/2020] [Indexed: 12/22/2022] Open
Abstract
Spontaneous blink rate is considered a biomarker of central dopaminergic activity. Recent evidence suggests that the central dopaminergic system plays a role in nociception. In the present study, we aimed to investigate whether pain modulates spontaneous blink rate in healthy subjects. We enrolled 15 participants. Spontaneous blink rate was quantified with an optoelectronic system before and after: (1) a painful laser stimulation, and (2) an acoustic startling stimulation. In control experiments, we investigated whether laser stimulation effects depended on stimulation intensity and whether laser stimulation induced any changes in the blink reflex recovery cycle. Finally, we investigated any relationship between spontaneous blink rate modification and pain modulation effect during the cold pressor test. Laser, but not acoustic, stimulation increased spontaneous blink rate. This effect was independent of stimulation intensity and negatively correlated with pain perception. No changes in trigeminal-facial reflex circuit excitability were elicited by laser stimulation. The cold pressor test also induced an increased spontaneous blink rate. Our study provides evidence on the role of dopamine in nociception and suggests that dopaminergic activity may be involved in pain modulation. These findings lay the groundwork for further investigations in patients with pathological conditions characterized by dopaminergic deficit and pain.
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Affiliation(s)
| | - Giulia Di Stefano
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università, 30, 00185, Rome, Italy
| | - Alessandra Fasolino
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università, 30, 00185, Rome, Italy
| | - Giuseppe Di Pietro
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università, 30, 00185, Rome, Italy
| | - Donato Colella
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università, 30, 00185, Rome, Italy
| | - Andrea Truini
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università, 30, 00185, Rome, Italy
| | - Giorgio Cruccu
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università, 30, 00185, Rome, Italy
| | - Alfredo Berardelli
- IRCCS Neuromed, Pozzilli, IS, Italy. .,Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università, 30, 00185, Rome, Italy.
| | - Matteo Bologna
- IRCCS Neuromed, Pozzilli, IS, Italy.,Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università, 30, 00185, Rome, Italy
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16
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Pisano F, Caltagirone C, Incoccia C, Marangolo P. Spinal or cortical direct current stimulation: Which is the best? Evidence from apraxia of speech in post-stroke aphasia. Behav Brain Res 2020; 399:113019. [PMID: 33207242 DOI: 10.1016/j.bbr.2020.113019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 09/04/2020] [Accepted: 11/11/2020] [Indexed: 10/23/2022]
Abstract
To date, new advances in technology have already shown the effectiveness of non-invasive brain stimulation and, in particular, of transcranial direct current stimulation (tDCS), in enhancing language recovery in post-stroke aphasia. More recently, it has been suggested that the stimulation over the spinal cord improves the production of words associated to sensorimotor schemata, such as action verbs. Here, for the first time, we present evidence that transpinal direct current stimulation (tsDCS) combined with a language training is efficacious for the recovery from speech apraxia, a motor speech disorder which might co-occur with aphasia. In a randomized-double blind experiment, ten aphasics underwent five days of tsDCS with concomitant treatment for their articulatory deficits in two different conditions: anodal and sham. In all patients, language measures were collected before (T0), at the end (T5) and one week after the end of treatment (F/U). Results showed that only after anodal tsDCS patients exhibited a better accuracy in repeating the treated items. Moreover, these effects persisted at F/U and generalized to other oral language tasks (i.e. picture description, noun and verb naming, word repetition and reading). A further analysis, which compared the tsDCS results with those collected in a matched group of patients who underwent the same language treatment but combined with tDCS, revealed no differences between the two groups. Given the persistency and severity of articulatory deficits in aphasia and the ease of use of tsDCS, we believe that spinal stimulation might result a new innovative approach for language rehabilitation.
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Affiliation(s)
- Francesca Pisano
- Department of Humanities studies - University Federico II, Naples, Italy
| | | | | | - Paola Marangolo
- Department of Humanities studies - University Federico II, Naples, Italy; IRCCS Santa Lucia Foundation, Rome, Italy.
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17
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Altered cortical gray matter volume and functional connectivity after transcutaneous spinal cord direct current stimulation in idiopathic restless legs syndrome. Sleep Med 2020; 74:254-261. [DOI: 10.1016/j.sleep.2020.07.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 07/18/2020] [Accepted: 07/20/2020] [Indexed: 01/18/2023]
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18
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Effect of transspinal direct current stimulation on afferent pain signalling in humans. J Clin Neurosci 2020; 77:163-167. [DOI: 10.1016/j.jocn.2020.04.116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 04/24/2020] [Accepted: 04/26/2020] [Indexed: 02/03/2023]
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19
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Awosika OO, Matthews S, Staggs EJ, Boyne P, Song X, Rizik BA, Sucharew HJ, Zhang C, Mungcal G, Moudgal R, Bhattacharya A, Dunning K, Woo D, Kissela BM. Backward locomotor treadmill training combined with transcutaneous spinal direct current stimulation in stroke: a randomized pilot feasibility and safety study. Brain Commun 2020; 2:fcaa045. [PMID: 32954299 PMCID: PMC7425394 DOI: 10.1093/braincomms/fcaa045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 02/13/2020] [Accepted: 02/19/2020] [Indexed: 11/17/2022] Open
Abstract
Walking impairment impacts nearly 66% of stroke survivors and is a rising cause of morbidity worldwide. Despite conventional post-stroke rehabilitative care, the majority of stroke survivors experience continued limitations in their walking speed, temporospatial dynamics and walking capacity. Hence, novel and comprehensive approaches are needed to improve the trajectory of walking recovery in stroke survivors. Herein, we test the safety, feasibility and preliminary efficacy of two approaches for post-stroke walking recovery: backward locomotor treadmill training and transcutaneous spinal direct current stimulation. In this double-blinded study, 30 chronic stroke survivors (>6 months post-stroke) with mild-severe residual walking impairment underwent six 30-min sessions (three sessions/week) of backward locomotor treadmill training, with concurrent anodal (N = 19) or sham transcutaneous spinal direct current stimulation (N = 11) over the thoracolumbar spine, in a 2:1 stratified randomized fashion. The primary outcomes were: per cent participant completion, safety and tolerability of these two approaches. In addition, we collected data on training-related changes in overground walking speed, cadence, stride length (baseline, daily, 24-h post-intervention, 2 weeks post-intervention) and walking capacity (baseline, 24-h post-intervention, 2 weeks post-intervention), as secondary exploratory aims testing the preliminary efficacy of these interventions. Eighty-seven per cent (N = 26) of randomized participants completed the study protocol. The majority of the study attrition involved participants with severe baseline walking impairment. There were no serious adverse events in either the backward locomotor treadmill training or transcutaneous spinal direct current stimulation approaches. Also, both groups experienced a clinically meaningful improvement in walking speed immediately post-intervention that persisted at the 2-week follow-up. However, in contrast to our working hypothesis, anodal-transcutaneous spinal direct current stimulation did not enhance the degree of improvement in walking speed and capacity, relative to backward locomotor treadmill training + sham, in our sample. Backward locomotor treadmill training and transcutaneous spinal direct current stimulation are safe and feasible approaches for walking recovery in chronic stroke survivors. Definitive efficacy studies are needed to validate our findings on backward locomotor treadmill training-related changes in walking performance. The results raise interesting questions about mechanisms of locomotor learning in stroke, and well-powered transcutaneous spinal direct current stimulation dosing studies are needed to understand better its potential role as a neuromodulatory adjunct for walking rehabilitation.
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Affiliation(s)
- Oluwole O Awosika
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH 45267, USA
| | - Saira Matthews
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH 45267, USA
| | - Emily J Staggs
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH 45267, USA
| | - Pierce Boyne
- College of Allied Health and Sciences, University of Cincinnati, Cincinnati, OH 45267, USA
| | - Xiao Song
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH 45267, USA
| | - Bridget A Rizik
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH 45267, USA
| | - Heidi J Sucharew
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Christina Zhang
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH 45267, USA
| | - Gabrielle Mungcal
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH 45267, USA
| | - Rohitha Moudgal
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH 45267, USA
| | - Amit Bhattacharya
- Biomechanics-Ergonomics Research Laboratories, Department of Environmental Health, University of Cincinnati Medical College, USA
| | - Kari Dunning
- College of Allied Health and Sciences, University of Cincinnati, Cincinnati, OH 45267, USA
| | - Daniel Woo
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH 45267, USA
| | - Brett M Kissela
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH 45267, USA
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20
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The effect of transcranial direct current stimulation on balance in healthy young and older adults: A systematic review of the literature. Neurophysiol Clin 2020; 50:119-131. [PMID: 32113708 DOI: 10.1016/j.neucli.2020.01.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 01/24/2020] [Accepted: 01/24/2020] [Indexed: 01/07/2023] Open
Abstract
Various studies have investigated the effect of noninvasive brain stimulation methods such as transcranial direct stimulation (tDCS) on postural control in healthy young and older adults. However, the use of different treatment protocols and outcome measures makes it difficult to interpret the research results. This systematic review provides a comprehensive overview of the current literature on the effect of tDCS on postural control. Nine databases were searched for papers assessing the effect of tDCS on postural control in young healthy and/or older adults. The data of included studies were extracted and methodological quality examined using PEDro. Sixteen studies met the inclusion criteria. The results showed that anodal tDCS (a-tDCS) of primary motor cortex may improve dynamic balance in young healthy individuals. In older adults, a-tDCS of dorsolateral prefrontal cortex and cerebellum showed a positive effect on dual task and dynamic balance, respectively. In conclusion, tDCS may improve both static and dynamic balance in younger and older adults. However, due to lack of consensus in the results, caution is required when drawing conclusions with regards to these findings.
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21
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Stairways to the brain: Transcutaneous spinal direct current stimulation (tsDCS) modulates a cerebellar-cortical network enhancing verb recovery. Brain Res 2020; 1727:146564. [DOI: 10.1016/j.brainres.2019.146564] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 11/01/2019] [Accepted: 11/19/2019] [Indexed: 12/17/2022]
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22
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Jadczak Ł, Wieczorek A, Grześkowiak M, Wieczorek J, Łochyński D. Jumping Height Does Not Increase in Well Trained Volleyball Players After Transcutaneous Spinal Direct Current Stimulation. Front Physiol 2019; 10:1479. [PMID: 31866875 PMCID: PMC6904281 DOI: 10.3389/fphys.2019.01479] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 11/18/2019] [Indexed: 01/21/2023] Open
Abstract
Transcutaneous spinal direct current stimulation (tsDCS) increases corticospinal and spinal reflex excitability, and may be a new tool for increasing muscle explosive performance in sports training. The aim of the study was to evaluate whether tsDCS can enhance jumping ability in trained humans practicing volleyball. Twenty eight participants completed the study, including 21 men and 7 women. We investigated the effects of a single 15-minute session of sham, anodal, and cathodal tsDCS over spine and shoulder on repeated counter movement jump (CMJ) and squat jump (SJ) performance at 0, 30 and 60 min post-stimulation. The order of SJs and CMJs sets in each session was randomized. Each SJ and CMJ set consisted of 3 jumps. The break between each attempt was 1 min and the interval between the sets was 3 min. Two-way repeated measures ANOVA did not show effect of time, nor stimulation method, nor stimulation method × time interactions on SJ (time: F(1.8,142.1) = 1.054; p = 0.346, stimulation: F(2,78) = 0.019; p = 0.981, stimulation × time: F(3.6,142.1) = 0.725; p = 0.564) or CMJ (time: F(1.8,140.9) = 2.092; p = 0.132, stimulation: F(2,78) = 0.005; p = 0.995, stimulation × time: F(3.6,140.9) = 0.517; p = 0.705) performance. Single session of tsDCS over spine and shoulder does not increase jumping height in well-trained volleyball players. This is an important finding for coaches and strength conditioning professionals for understanding the practical utility of tsDCS for enhancing muscular explosiveness.
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Affiliation(s)
- Łukasz Jadczak
- Department of Theory and Methodology of Team Sport Games, Poznań University of Physical Education, Poznań, Poland
| | - Andrzej Wieczorek
- Department of Theory and Methodology of Team Sport Games, Poznań University of Physical Education, Poznań, Poland
| | - Marcin Grześkowiak
- Department of Pulmonological and Rheumatological Rehabilitation, Poznań University of Physical Education, Poznań, Poland
| | - Jacek Wieczorek
- Department of Sport for Disabilities, Poznań University of Physical Education, Poznań, Poland
| | - Dawid Łochyński
- Department of Musculoskeletal Rehabilitation, Poznań University of Physical Education, Poznań, Poland
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23
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Morya E, Monte-Silva K, Bikson M, Esmaeilpour Z, Biazoli CE, Fonseca A, Bocci T, Farzan F, Chatterjee R, Hausdorff JM, da Silva Machado DG, Brunoni AR, Mezger E, Moscaleski LA, Pegado R, Sato JR, Caetano MS, Sá KN, Tanaka C, Li LM, Baptista AF, Okano AH. Beyond the target area: an integrative view of tDCS-induced motor cortex modulation in patients and athletes. J Neuroeng Rehabil 2019; 16:141. [PMID: 31730494 PMCID: PMC6858746 DOI: 10.1186/s12984-019-0581-1] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 08/19/2019] [Indexed: 02/07/2023] Open
Abstract
Transcranial Direct Current Stimulation (tDCS) is a non-invasive technique used to modulate neural tissue. Neuromodulation apparently improves cognitive functions in several neurologic diseases treatment and sports performance. In this study, we present a comprehensive, integrative review of tDCS for motor rehabilitation and motor learning in healthy individuals, athletes and multiple neurologic and neuropsychiatric conditions. We also report on neuromodulation mechanisms, main applications, current knowledge including areas such as language, embodied cognition, functional and social aspects, and future directions. We present the use and perspectives of new developments in tDCS technology, namely high-definition tDCS (HD-tDCS) which promises to overcome one of the main tDCS limitation (i.e., low focality) and its application for neurological disease, pain relief, and motor learning/rehabilitation. Finally, we provided information regarding the Transcutaneous Spinal Direct Current Stimulation (tsDCS) in clinical applications, Cerebellar tDCS (ctDCS) and its influence on motor learning, and TMS combined with electroencephalography (EEG) as a tool to evaluate tDCS effects on brain function.
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Affiliation(s)
- Edgard Morya
- Edmond and Lily Safra International Institute of Neuroscience, Santos Dumont Institute, Macaíba, Rio Grande do Norte Brazil
- Brazilian Institute of Neuroscience and Neurotechnology (BRAINN/CEPID-FAPESP), University of Campinas, Campinas, São Paulo, Brazil
| | - Kátia Monte-Silva
- Universidade Federal de Pernambuco, Recife, Pernambuco Brazil
- Núcleo de Assistência e Pesquisa em Neuromodulação (NAPeN), Universidade Federal do ABC (UFABC)/Universidade de São Paulo (USP)/Universidade Cidade de São Paulo (UNICID)/Universidade Federal de Pernambuco (UFPE), Escola Bahiana de Medicina e Saúde Pública (EBMSP), Santo André, Brazil
| | - Marom Bikson
- Department of Biomedical Engineering, The City College of New York of CUNY, New York, NY USA
| | - Zeinab Esmaeilpour
- Department of Biomedical Engineering, The City College of New York of CUNY, New York, NY USA
| | - Claudinei Eduardo Biazoli
- Center of Mathematics, Computing and Cognition (CMCC), Universidade Federal do ABC (UFABC), Alameda da Universidade, 3 - Anchieta, Bloco Delta – Sala 257, São Bernardo do Campo, SP CEP 09606-070 Brazil
| | - Andre Fonseca
- Brazilian Institute of Neuroscience and Neurotechnology (BRAINN/CEPID-FAPESP), University of Campinas, Campinas, São Paulo, Brazil
- Center of Mathematics, Computing and Cognition (CMCC), Universidade Federal do ABC (UFABC), Alameda da Universidade, 3 - Anchieta, Bloco Delta – Sala 257, São Bernardo do Campo, SP CEP 09606-070 Brazil
| | - Tommaso Bocci
- Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics, Department of Health Sciences, International Medical School, University of Milan, Milan, Italy
| | - Faranak Farzan
- School of Mechatronic Systems Engineering, Simon Fraser University, Surrey, British Columbia Canada
| | - Raaj Chatterjee
- School of Mechatronic Systems Engineering, Simon Fraser University, Surrey, British Columbia Canada
| | - Jeffrey M. Hausdorff
- Department of Physical Therapy, Sackler Faculty of Medicine and Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | | | | | - Eva Mezger
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Luciane Aparecida Moscaleski
- Brazilian Institute of Neuroscience and Neurotechnology (BRAINN/CEPID-FAPESP), University of Campinas, Campinas, São Paulo, Brazil
- Center of Mathematics, Computing and Cognition (CMCC), Universidade Federal do ABC (UFABC), Alameda da Universidade, 3 - Anchieta, Bloco Delta – Sala 257, São Bernardo do Campo, SP CEP 09606-070 Brazil
| | - Rodrigo Pegado
- Graduate Program in Rehabilitation Science, Universidade Federal do Rio Grande do Norte, Santa Cruz, Rio Grande do Norte Brazil
| | - João Ricardo Sato
- Center of Mathematics, Computing and Cognition (CMCC), Universidade Federal do ABC (UFABC), Alameda da Universidade, 3 - Anchieta, Bloco Delta – Sala 257, São Bernardo do Campo, SP CEP 09606-070 Brazil
| | - Marcelo Salvador Caetano
- Center of Mathematics, Computing and Cognition (CMCC), Universidade Federal do ABC (UFABC), Alameda da Universidade, 3 - Anchieta, Bloco Delta – Sala 257, São Bernardo do Campo, SP CEP 09606-070 Brazil
| | - Kátia Nunes Sá
- Núcleo de Assistência e Pesquisa em Neuromodulação (NAPeN), Universidade Federal do ABC (UFABC)/Universidade de São Paulo (USP)/Universidade Cidade de São Paulo (UNICID)/Universidade Federal de Pernambuco (UFPE), Escola Bahiana de Medicina e Saúde Pública (EBMSP), Santo André, Brazil
- Escola Bahiana de Medicina e Saúde Pública, Salvador, Bahia Brazil
| | - Clarice Tanaka
- Núcleo de Assistência e Pesquisa em Neuromodulação (NAPeN), Universidade Federal do ABC (UFABC)/Universidade de São Paulo (USP)/Universidade Cidade de São Paulo (UNICID)/Universidade Federal de Pernambuco (UFPE), Escola Bahiana de Medicina e Saúde Pública (EBMSP), Santo André, Brazil
- Laboratório de Investigações Médicas-54, Universidade de São Paulo, São Paulo, São Paulo Brazil
| | - Li Min Li
- Brazilian Institute of Neuroscience and Neurotechnology (BRAINN/CEPID-FAPESP), University of Campinas, Campinas, São Paulo, Brazil
| | - Abrahão Fontes Baptista
- Brazilian Institute of Neuroscience and Neurotechnology (BRAINN/CEPID-FAPESP), University of Campinas, Campinas, São Paulo, Brazil
- Núcleo de Assistência e Pesquisa em Neuromodulação (NAPeN), Universidade Federal do ABC (UFABC)/Universidade de São Paulo (USP)/Universidade Cidade de São Paulo (UNICID)/Universidade Federal de Pernambuco (UFPE), Escola Bahiana de Medicina e Saúde Pública (EBMSP), Santo André, Brazil
- Center of Mathematics, Computing and Cognition (CMCC), Universidade Federal do ABC (UFABC), Alameda da Universidade, 3 - Anchieta, Bloco Delta – Sala 257, São Bernardo do Campo, SP CEP 09606-070 Brazil
- Escola Bahiana de Medicina e Saúde Pública, Salvador, Bahia Brazil
- Laboratório de Investigações Médicas-54, Universidade de São Paulo, São Paulo, São Paulo Brazil
| | - Alexandre Hideki Okano
- Brazilian Institute of Neuroscience and Neurotechnology (BRAINN/CEPID-FAPESP), University of Campinas, Campinas, São Paulo, Brazil
- Núcleo de Assistência e Pesquisa em Neuromodulação (NAPeN), Universidade Federal do ABC (UFABC)/Universidade de São Paulo (USP)/Universidade Cidade de São Paulo (UNICID)/Universidade Federal de Pernambuco (UFPE), Escola Bahiana de Medicina e Saúde Pública (EBMSP), Santo André, Brazil
- Center of Mathematics, Computing and Cognition (CMCC), Universidade Federal do ABC (UFABC), Alameda da Universidade, 3 - Anchieta, Bloco Delta – Sala 257, São Bernardo do Campo, SP CEP 09606-070 Brazil
- Graduate Program in Physical Education. State University of Londrina, Londrina, Paraná, Brazil
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Restless legs syndrome: Clinical changes in nervous system excitability at the spinal cord level. Sleep Med Rev 2019; 47:9-17. [PMID: 31212170 DOI: 10.1016/j.smrv.2019.05.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 04/30/2019] [Accepted: 05/27/2019] [Indexed: 12/20/2022]
Abstract
Restless legs syndrome (RLS) is a complex multifactorial disorder whose aetiology has yet to be fully elucidated. Some of the features of RLS, such as processing of sensations and activation of movement, may result from a dysfunction in spinal processing giving rise to a state of spinal hyperexcitability. In the current article we review studies investigating spinal excitability in RLS patients looking specifically at electrophysiological studies of spinal activity, sensory evaluations, and spinal reflex studies. Increased spinal excitability has been shown in RLS patients based on the combined data from electrophysiological studies. Results from studies assessing sensory evaluations in RLS patients show enhanced spinal processing of nociceptive inputs possibly due to central sensitisation. However, not all sensory modalities demonstrate an increase in sensitivity. An increase in nervous system excitability would result in an increase in reflex responses in RLS patients however the data from reflex analyses in RLS patients has failed to consistently show this expected result. Overall changes to RLS spinal excitability have been demonstrated though these changes might be heterogeneous as not all afferent input appears to be affected in the same manner. There may be phase-dependent and modality-dependent alterations in spinal excitability suggesting that the theory of absolute spinal hyperexcitability in RLS patients' needs to be reconsidered.
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25
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Awosika OO, Sandrini M, Volochayev R, Thompson RM, Fishman N, Wu T, Floeter MK, Hallett M, Cohen LG. Transcutaneous spinal direct current stimulation improves locomotor learning in healthy humans. Brain Stimul 2019; 12:628-634. [PMID: 30733143 PMCID: PMC7326485 DOI: 10.1016/j.brs.2019.01.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 10/08/2018] [Accepted: 01/24/2019] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Ambulation is an essential aspect of daily living and is often impaired after brain and spinal cord injuries. Despite the implementation of standard neurorehabilitative care, locomotor recovery is often incomplete. OBJECTIVE In this randomized, sham-controlled, double-blind, parallel design study, we aimed to determine if anodal transcutaneous spinal direct current stimulation (anodal tsDCS) could improve training effects on locomotion compared to sham (sham tsDCS) in healthy subjects. METHODS 43 participants underwent a single backwards locomotion training (BLT) session on a reverse treadmill with concurrent anodal (n = 22) or sham (n = 21) tsDCS. The primary outcome measure was speed gain measured 24 h post-training. We hypothesized that anodal tsDCS + BLT would improve training effects on backward locomotor speed compared to sham tsDCS + BLT. A subset of participants (n = 31) returned for two additional training days of either anodal (n = 16) or sham (n = 15) tsDCS and underwent (n = 29) H-reflex testing immediately before, immediately after, and 30 min post-training over three consecutive days. RESULTS A single session of anodal tsDCS + BLT elicited greater speed gain at 24 h relative to sham tsDCS + BLT (p = 0.008, two-sample t-test, adjusted for one interim analysis after the initial 12 subjects). Anodal tsDCS + BLT resulted in higher retention of the acquired skill at day 30 relative to sham tsDCS + BLT (p = 0.002) in the absence of significant group differences in online or offline learning over the three training days (p = 0.467 and p = 0.131). BLT resulted in transient down-regulation of H-reflex amplitude (Hmax/Mmax) in both test groups (p < 0.0001). However, the concurrent application of anodal-tsDCS with BLT elicited a longer lasting effect than sham-tsDCS + BLT (p = 0.050). CONCLUSION tsDCS improved locomotor skill acquisition and retention in healthy subjects and prolonged the physiological exercise-mediated downregulation of excitability of the alpha motoneuron pool. These results suggest that this strategy is worth exploring in neurorehabilitation of locomotor function.
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Affiliation(s)
- Oluwole O Awosika
- Human Cortical Physiology and Neurorehabilitation Section, NINDS, USA; Department of Neurology and Rehabilitation Medicine, University of Cincinnati, USA.
| | - Marco Sandrini
- Human Cortical Physiology and Neurorehabilitation Section, NINDS, USA; Department of Psychology, University of Roehampton, London, UK
| | - Rita Volochayev
- Human Cortical Physiology and Neurorehabilitation Section, NINDS, USA
| | - Ryan M Thompson
- Human Cortical Physiology and Neurorehabilitation Section, NINDS, USA
| | - Nathan Fishman
- Human Cortical Physiology and Neurorehabilitation Section, NINDS, USA
| | | | | | | | - Leonardo G Cohen
- Human Cortical Physiology and Neurorehabilitation Section, NINDS, USA
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26
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Bączyk M, Drzymała-Celichowska H, Mrówczyński W, Krutki P. Motoneuron firing properties are modified by trans-spinal direct current stimulation in rats. J Appl Physiol (1985) 2019; 126:1232-1241. [PMID: 30789288 DOI: 10.1152/japplphysiol.00803.2018] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Spinal polarization evoked by direct current stimulation [trans-spinal direct current stimulation (tsDCS)] is a novel method for altering spinal network excitability; however, it remains not well understood. The aim of this study was to determine whether tsDCS influences spinal motoneuron activity. Twenty Wistar rats under general pentobarbital anesthesia were subjected to 15 min anodal (n = 10) or cathodal (n = 10) tsDCS of 0.1 mA intensity, and the electrophysiological properties of their motoneurons were intracellularly measured before, during, and after direct current application. The major effects of anodal intervention included increased minimum firing frequency and the slope of the frequency-current (f-I) relationship, as well as decreased rheobase and currents evoking steady-state firing (SSF). The effects of cathodal polarization included decreased maximum SSF frequency, decreased f-I slope, and decreased current evoking the maximum SSF. Notably, the majority of observed effects appeared immediately after the current onset, developed during polarization, and outlasted it for at least 15 min. Moreover, the effects of anodal polarization were generally more pronounced and uniform than those evoked by cathodal polarization. Our study is the first to present polarity-dependent, long-lasting changes in spinal motoneuron firing following tsDCS, which may aid in the development of more safe and accurate application protocols in medicine and sport. NEW & NOTEWORTHY Trans-spinal direct current stimulation induces significant polarity-dependent, long-lasting changes in the threshold and firing properties of spinal motoneurons. Anodal polarization potentiates motoneuron firing whereas cathodal polarization acts mainly toward firing inhibition. The alterations in rheobase and rhythmic firing properties are not restricted to the period of current application and can be observed long after the current offset.
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Affiliation(s)
- M Bączyk
- Department of Neurobiology, Poznań University of Physical Education , Poznań , Poland
| | - H Drzymała-Celichowska
- Department of Neurobiology, Poznań University of Physical Education , Poznań , Poland.,Department of Biochemistry, Poznań University of Physical Education , Poznań , Poland
| | - W Mrówczyński
- Department of Neurobiology, Poznań University of Physical Education , Poznań , Poland
| | - P Krutki
- Department of Neurobiology, Poznań University of Physical Education , Poznań , Poland
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27
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Differential modulation of pressure pain threshold in response to transcutaneous spinal direct current stimulation with physical activity level. Neurosci Lett 2019; 698:154-159. [PMID: 30654000 DOI: 10.1016/j.neulet.2019.01.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 01/04/2019] [Accepted: 01/12/2019] [Indexed: 10/27/2022]
Abstract
This study investigated the interaction between physical activity level and responses to transcutaneous spinal direct current stimulation (tsDCS) as reflected in changes in pressure pain threshold (PPT) in the lower extremity. Participants (n = 35, 15 males) consisted of physically active young adults. PPTs were determined at three sites (thigh, leg and foot) on the dominant leg before and after 20-min of anodal tsDCS applied at mid-thoracic level. Based on a questionnaire, participants were assigned to either a low-moderately active (n = 21) or highly active group (n = 14). At baseline, participants in the two activity groups exhibited comparable PPTs. After the intervention, PPTs were significantly elevated at all sites at 5-min and 30-min post-tsDCS. An interaction was found between activity groups and tsDCS-induced changes at the thigh site owing to a larger elevation in PPTs in the highly active group. These results corroborate previous findings regarding antalgic effects of tsDCS and point to the role of physical activity level as a potential factor susceptible to modulate responses to tsDCS interventions.
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28
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Powell ES, Korupolu R, Westgate PM, Carrico C, Reddy L, Sawaki L. Dose-response relationship of transcutaneous spinal direct current stimulation in healthy humans: A proof of concept study. NeuroRehabilitation 2018; 43:369-376. [PMID: 30400116 DOI: 10.3233/nre-182469] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Non-invasive transcranial direct current stimulation has been shown to modulate cortical excitability in various studies. Similarly, recent preliminary studies suggest that transcutaneous spinal direct current stimulation (tsDCS) may engender a modulation effect on spinal and cortical neurons. OBJECTIVE The purpose of this study was to evaluate the dose-response effects of tsDCS in healthy subjects and thereby lay groundwork for expanding treatment options for patients with spinal cord injury (SCI). METHODS Nine healthy subjects received each of the following 2 tsDCS conditions: Anodal and cathodal, in random order with at least 1 week washout period between each session. In order to test safety and dose response, various current intensities were used (2, 2.5 and 3 mA) for 20 minutes. The active electrode was placed vertically over T10-T11, and the reference electrode was placed over the left shoulder. To evaluate corticospinal excitability, motor evoked potentials over soleus muscle elicited by transcranial magnetic stimulation were measured. To assess spinal cord excitability, H- and M- wave over soleus muscle to calculate Hmax/ Mmax ratio were measured. RESULTS Linear regression showed a dose response with cathodal tsDCS on motor evoked potentials measured from the left leg as well as with anodal tsDCS on Hmax/ Mmax ratio measured from the left leg. CONCLUSIONS These findings indicate tsDCS effects are dose-dependent. These effects should be investigated in a larger sample.
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Affiliation(s)
- Elizabeth Salmon Powell
- Department of Physical Medicine and Rehabilitation, University of Kentucky, Lexington, KY, USA
| | - Radha Korupolu
- Department of Physical Medicine and Rehabilitation, University of Texas Health Science Center, Houston, TX, USA
| | - Philip M Westgate
- Department of Biostatistics, College of Public Health, University of Kentucky, Lexington, KY, USA
| | - Cheryl Carrico
- Department of Physical Medicine and Rehabilitation, University of Kentucky, Lexington, KY, USA
| | - Lakshmi Reddy
- Department of Physical Medicine and Rehabilitation, University of Kentucky, Lexington, KY, USA
| | - Lumy Sawaki
- Department of Physical Medicine and Rehabilitation, University of Kentucky, Lexington, KY, USA.,Encompass Health Cardinal Hill Rehabilitation Hospital, Lexington, KY, USA
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29
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Lenoir C, Jankovski A, Mouraux A. Anodal Transcutaneous Spinal Direct Current Stimulation (tsDCS) Selectively Inhibits the Synaptic Efficacy of Nociceptive Transmission at Spinal Cord Level. Neuroscience 2018; 393:150-163. [PMID: 30321585 DOI: 10.1016/j.neuroscience.2018.10.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Revised: 10/03/2018] [Accepted: 10/05/2018] [Indexed: 12/30/2022]
Abstract
Recently studies have aimed at developing transcutaneous spinal direct current stimulation (tsDCS) as a non-invasive technique to modulate spinal function in humans. Independent studies evaluating its after-effects on nociceptive or non-nociceptive somatosensory responses have reported comparable effects suggesting that tsDCS impairs axonal conduction of both the spino-thalamic and the medial lemniscus tracts. The present study aimed to better understand how tsDCS affects, in humans, the spinal transmission of nociceptive and non-nociceptive somatosensory inputs. We compared the after-effects of anodal low-thoracic, anodal cervical and sham tsDCS on the perception and brain responses elicited by laser stimuli selectively activating Aδ-thermonociceptors of the spinothalamic system and vibrotactile stimuli selectively activating low-threshold Aβ-mechanoreceptors of the lemniscal system, delivered to the hands and feet. Low-thoracic tsDCS selectively and significantly affected the LEP-N2 wave elicited by nociceptive stimulation of the lower limbs, without affecting the LEP-N2 wave elicited by nociceptive stimulation of the upper limbs, and without affecting the SEP-N2 wave elicited by vibrotactile stimulation of either limb. This selective and segmental effect indicates that the neuromodulatory after-effects of tsDCS cannot be explained by anodal blockade of axonal conduction and, instead, are most probably due to a segmental effect on the synaptic efficacy of the local processing and/or transmission of nociceptive inputs in the dorsal horn.
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Affiliation(s)
- Cédric Lenoir
- Institute of Neuroscience (IONS) Université catholique de Louvain (UCL), Brussels, Belgium.
| | - Aleksandar Jankovski
- Institute of Neuroscience (IONS) Université catholique de Louvain (UCL), Brussels, Belgium; Department of Neurosurgery, Université catholique de Louvain (UCL), CHU UCL Namur, Avenue Dr G. Therasse, 5530 Yvoir, Belgium.
| | - André Mouraux
- Institute of Neuroscience (IONS) Université catholique de Louvain (UCL), Brussels, Belgium.
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30
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Pereira M, Fernandes SR, Miranda PC, de Carvalho M. Neuromodulation of lower limb motor responses with transcutaneous lumbar spinal cord direct current stimulation. Clin Neurophysiol 2018; 129:1999-2009. [PMID: 30041145 DOI: 10.1016/j.clinph.2018.07.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Revised: 06/03/2018] [Accepted: 07/02/2018] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Trans-spinal direct current stimulation (tsDCS) is a promising technique to modulate spinal circuits. Combining clinical with modelling studies can improve effectiveness of tsDCS protocols. The aim of this study is to measure the effects of lumbar tsDCS on motor spinal responses and observe if these are consistent with the electric field (E-field) predicted from a computational model. METHODS The exploratory study design was double-blind crossover and randomized. tsDCS was delivered for 15 min (anodal, cathodal, sham) at L2 vertebra level (2.5 mA, 90 C/cm2) in 14 healthy subjects. F-wave, H-reflex, cortical silent period, motor evoked potential and sympathetic skin response were analyzed. Statistical methods were applied with Bonferroni correction for multiple comparisons, a p < 0.05 was set as significant. A human volume conductor model was obtained from available databases. E-field distributions in the spinal grey matter (GM) and white matter (WM) were calculated. RESULTS No tsDCS effects were observed. E-field magnitude predicted in the lumbosacral spinal GM and WM was <0.15 V/m, insufficient to ensure neuromodulation, which is consistent with the absence of effects. CONCLUSION The tsDCS protocol applied did not change motor response to delivered stimulus, thus we observed no effect on motor spinal circuits. SIGNIFICANCE Future tsDCS protocols should be supported by computational models.
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Affiliation(s)
- Mariana Pereira
- Instituto de Medicina Molecular, Instituto de Fisiologia, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal
| | - Sofia Rita Fernandes
- Instituto de Medicina Molecular, Instituto de Fisiologia, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal; Instituto de Biofísica e Engenharia Biomédica, Faculdade de Ciências, Universidade de Lisboa, 1749-016 Lisboa, Portugal
| | - Pedro C Miranda
- Instituto de Biofísica e Engenharia Biomédica, Faculdade de Ciências, Universidade de Lisboa, 1749-016 Lisboa, Portugal
| | - Mamede de Carvalho
- Instituto de Medicina Molecular, Instituto de Fisiologia, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal; Departamento de Neurociências e Saúde Mental, Hospital de Santa Maria - Centro Hospitalar Lisboa Norte, Avenida Professor Egas Moniz, 1649-035 Lisboa, Portugal.
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31
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Albuquerque PL, Campêlo M, Mendonça T, Fontes LAM, Brito RDM, Monte-Silva K. Effects of repetitive transcranial magnetic stimulation and trans-spinal direct current stimulation associated with treadmill exercise in spinal cord and cortical excitability of healthy subjects: A triple-blind, randomized and sham-controlled study. PLoS One 2018; 13:e0195276. [PMID: 29596524 PMCID: PMC5875883 DOI: 10.1371/journal.pone.0195276] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 03/18/2018] [Indexed: 11/18/2022] Open
Abstract
Repetitive transcranial magnetic stimulation (rTMS) over motor cortex and trans-spinal direct current stimulation (tsDCS) modulate corticospinal circuits in healthy and injured subjects. However, their associated effects with physical exercise is still not defined. This study aimed to investigate the effect of three different settings of rTMS and tsDCS combined with treadmill exercise on spinal cord and cortical excitability of healthy subjects. We performed a triple blind, randomized, sham-controlled crossover study with 12 healthy volunteers who underwent single sessions of rTMS (1Hz, 20Hz and Sham) and tsDCS (anodal, cathodal and Sham) associated with 20 minutes of treadmill walking. Cortical excitability was assessed by motor evoked potential (MEP) and spinal cord excitability by the Hoffmann reflex (Hr), nociceptive flexion reflex (NFR) and homosynaptic depression (HD). All measures were assessed before, immediately, 30 and 60 minutes after the experimental procedures. Our results demonstrated that anodal tsDCS/treadmill exercise reduced MEP's amplitude and NFR's area compared to sham condition, conversely, cathodal tsDCS/treadmill exercise increased NFR's area. High-frequency rTMS increased MEP's amplitude and NFR's area compared to sham condition. Anodal tsDCS/treadmill exercise and 20Hz rTMS/treadmill exercise reduced Hr amplitude up to 30 minutes after stimulation offset and no changes were observed in HD measures. We demonstrated that tsDCS and rTMS combined with treadmill exercise modulated cortical and spinal cord excitability through different mechanisms. tsDCS modulated spinal reflexes in a polarity-dependent way acting at local spinal circuits while rTMS probably promoted changes in the presynaptic inhibition of spinal motoneurons. In addition, the association of two neuromodulatory techniques induced long-lasting changes.
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Affiliation(s)
- Plínio Luna Albuquerque
- Applied Neuroscience Laboratory, Department of Physical Therapy, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
- Department of Physical Therapy, Centro Universitário Tabosa de Almeida, Caruaru, Pernambuco, Brazil
- Postgraduate Program in Neuropsychiatry and Behavioral Sciences, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
| | - Mayara Campêlo
- Applied Neuroscience Laboratory, Department of Physical Therapy, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
- Postgraduate Program in Neuropsychiatry and Behavioral Sciences, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
| | - Thyciane Mendonça
- Applied Neuroscience Laboratory, Department of Physical Therapy, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
| | - Luís Augusto Mendes Fontes
- Applied Neuroscience Laboratory, Department of Physical Therapy, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
| | - Rodrigo de Mattos Brito
- Applied Neuroscience Laboratory, Department of Physical Therapy, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
| | - Katia Monte-Silva
- Applied Neuroscience Laboratory, Department of Physical Therapy, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
- Postgraduate Program in Neuropsychiatry and Behavioral Sciences, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
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Fernandes SR, Salvador R, Wenger C, de Carvalho M, Miranda PC. Transcutaneous spinal direct current stimulation of the lumbar and sacral spinal cord: a modelling study. J Neural Eng 2018; 15:036008. [PMID: 29386408 DOI: 10.1088/1741-2552/aaac38] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Our aim was to perform a computational study of the electric field (E-field) generated by transcutaneous spinal direct current stimulation (tsDCS) applied over the thoracic, lumbar and sacral spinal cord, in order to assess possible neuromodulatory effects on spinal cord circuitry related with lower limb functions. APPROACH A realistic volume conductor model of the human body consisting of 14 tissues was obtained from available databases. Rubber pad electrodes with a metallic connector and a conductive gel layer were modelled. The finite element (FE) method was used to calculate the E-field when a current of 2.5 mA was passed between two electrodes. The main characteristics of the E-field distributions in the spinal grey matter (spinal-GM) and spinal white matter (spinal-WM) were compared for seven montages, with the anode placed either over T10, T8 or L2 spinous processes (s.p.), and the cathode placed over right deltoid (rD), umbilicus (U) and right iliac crest (rIC) areas or T8 s.p. Anisotropic conductivity of spinal-WM and of a group of dorsal muscles near the vertebral column was considered. MAIN RESULTS The average E-field magnitude was predicted to be above 0.15 V m-1 in spinal cord regions located between the electrodes. L2-T8 and T8-rIC montages resulted in the highest E-field magnitudes in lumbar and sacral spinal segments (>0.30 V m-1). E-field longitudinal component is 3 to 6 times higher than the ventral-dorsal and right-left components in both the spinal-GM and WM. Anatomical features such as CSF narrowing due to vertebrae bony edges or disks intrusions in the spinal canal correlate with local maxima positions. SIGNIFICANCE Computational modelling studies can provide detailed information regarding the electric field in the spinal cord during tsDCS. They are important to guide the design of clinical tsDCS protocols that optimize stimulation of application-specific spinal targets.
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Affiliation(s)
- Sofia R Fernandes
- Instituto de Biofísica e Engenharia Biomédica, Faculdade de Ciências da Universidade de Lisboa, Campo Grande, 1749-016, Lisboa, Portugal. Instituto de Fisiologia, Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina da Universidade de Lisboa, Av. Professor Egas Moniz, 1649-028 Lisboa, Portugal
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Dongés SC, Bai S, Taylor JL. Concurrent electrical cervicomedullary stimulation and cervical transcutaneous spinal direct current stimulation result in a stimulus interaction. Exp Physiol 2017; 102:1309-1320. [PMID: 28730695 DOI: 10.1113/ep086360] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 07/03/2017] [Indexed: 01/19/2023]
Abstract
NEW FINDINGS What is the central question of this study? We previously showed that the motor pathway is not modified after cervical transcutaneous spinal direct current stimulation (tsDCS) applied using anterior-posterior electrodes. Here, we examine the motor pathway during stimulation. What is the main finding and its importance? We show that electrically elicited muscle responses to cervicomedullary stimulation are modified during tsDCS, whereas magnetically elicited responses are not. Modelling reveals electrical field modifications during concurrent tsDCS and electrical cervicomedullary stimulation. Changes in muscle response probably result from electrical field modifications rather than physiological changes. Care should be taken when applying electrical stimuli simultaneously. Transcutaneous spinal direct current stimulation (tsDCS) can modulate neuronal excitability within the human spinal cord; however, few studies have used tsDCS at a cervical level. This study aimed to characterize cervical tsDCS further by observing its acute effects on motor responses to transcranial magnetic stimulation and cervicomedullary stimulation. In both studies 1 and 2, participants (study 1, n = 8, four female; and study 2, n = 8, three female) received two periods of 10 min, 3 mA cervical tsDCS on the same day through electrodes placed in an anterior-posterior configuration over the neck; one period with the cathode posterior (c-tsDCS) and the other with the anode posterior (a-tsDCS). In study 1, electrically elicited cervicomedullary motor evoked potentials (eCMEPs) and transcranial magnetic stimulation-elicited motor evoked potentials (MEPs) were measured in biceps brachii and flexor carpi radialis before, during and after each tsDCS period. In study 2, eCMEPs and magnetically elicited CMEPs (mCMEPs) were measured before, during and after each tsDCS period. For study 3, computational modelling was used to observe possible interactions of cervical tsDCS and electrical cervicomedullary stimulation. Studies 1 and 2 revealed that eCMEPs were larger during c-tsDCS and smaller during a-tsDCS compared with those elicited when tsDCS was off (P < 0.05), with no changes in MEPs or mCMEPs. Modelling revealed that eCMEP changes might result from modifications of the electrical field direction and magnitude when combined with cervical tsDCS. Bidirectional eCMEP changes are likely to be caused by an interaction between cervical tsDCS and electrical cervicomedullary stimulation; therefore, care should be taken when combining such electrical stimuli in close proximity.
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Affiliation(s)
- Siobhan C Dongés
- Neuroscience Research Australia, Barker Street, Randwick, NSW, 2031, Australia.,University of New South Wales, Sydney, NSW, 2052, Australia
| | - Siwei Bai
- University of New South Wales, Sydney, NSW, 2052, Australia.,Faculty of Electrical and Computer Engineering, Technical University of Munich, Garching, Germany
| | - Janet L Taylor
- Neuroscience Research Australia, Barker Street, Randwick, NSW, 2031, Australia.,University of New South Wales, Sydney, NSW, 2052, Australia.,Edith Cowan University, Joondalup, WA, 6027, Australia
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Marangolo P, Fiori V, Shofany J, Gili T, Caltagirone C, Cucuzza G, Priori A. Moving Beyond the Brain: Transcutaneous Spinal Direct Current Stimulation in Post-Stroke Aphasia. Front Neurol 2017; 8:400. [PMID: 28848492 PMCID: PMC5550684 DOI: 10.3389/fneur.2017.00400] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 07/25/2017] [Indexed: 12/13/2022] Open
Abstract
Over the last 20 years, major advances in cognitive neuroscience have clearly shown that the language function is not restricted into the classical language areas but it involves brain regions, which had never previously considered. Indeed, recent lines of evidence have suggested that the processing of words associated to motor schemata, such as action verbs, modulates the activity of the sensorimotor cortex, which, in turn, facilitates its retrieval. To date, no studies have investigated whether the spinal cord, which is functionally connected to the sensorimotor system, might also work as an auxiliary support for language processing. We explored the combined effect of transcutaneous spinal direct current stimulation (tsDCS) and language treatment in a randomized double-blind design for the recovery of verbs and nouns in 14 chronic aphasics. During each treatment, each subject received tsDCS (20 min, 2 mA) over the thoracic vertebrae (10th vertebra) in three different conditions: (1) anodic, (2) cathodic and (3) sham, while performing a verb and noun naming tasks. Each experimental condition was run in five consecutive daily sessions over 3 weeks. Overall, a significant greater improvement in verb naming was found during the anodic condition with respect to the other two conditions, which persisted at 1 week after the end of the treatment. No significant differences were present for noun naming among the three conditions. The hypothesis is advanced that anodic tsDCS might have influenced activity along the ascending somatosensory pathways, ultimately eliciting neurophysiological changes into the sensorimotor areas which, in turn, supported the retrieval of verbs. These results further support the evidence that action words, due to their sensorimotor semantic properties, are partly represented into the sensorimotor cortex. Moreover, they also document, for the first time, that tsDCS enhances verb recovery in chronic aphasia and it may represent a promising new tool for language treatment.
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Affiliation(s)
- Paola Marangolo
- Dipartimento di Studi Umanistici, Università degli Studi di Napoli Federico II, Napoli, Italy
- IRCCS Fondazione Santa Lucia, Roma, Italy
| | | | | | - Tommaso Gili
- IRCCS Fondazione Santa Lucia, Roma, Italy
- Centro Fermi - Museo storico della fisica e Centro studi e ricerche Enrico Fermi, Rome, Italy
| | - Carlo Caltagirone
- IRCCS Fondazione Santa Lucia, Roma, Italy
- Università degli Studi di Roma Tor Vergata, Roma, Italy
| | | | - Alberto Priori
- Clinica Neurologica III, Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan, Italy
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Schweizer L, Meyer-Frießem CH, Zahn PK, Tegenthoff M, Schmidt-Wilcke T. Transcutaneous Spinal Direct Current Stimulation Alters Resting-State Functional Connectivity. Brain Connect 2017; 7:357-365. [DOI: 10.1089/brain.2017.0505] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Lauren Schweizer
- Department of Neurology, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil GmbH Bochum, Ruhr-University Bochum, Bochum, Germany
| | - Christine H. Meyer-Frießem
- Department of Anesthesiology, Intensive Care Medicine, Palliative Care Medicine and Pain Management, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil GmbH Bochum, Medical Faculty of Ruhr-University Bochum, Bochum, Germany
| | - Peter K. Zahn
- Department of Anesthesiology, Intensive Care Medicine, Palliative Care Medicine and Pain Management, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil GmbH Bochum, Medical Faculty of Ruhr-University Bochum, Bochum, Germany
| | - Martin Tegenthoff
- Department of Neurology, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil GmbH Bochum, Ruhr-University Bochum, Bochum, Germany
| | - Tobias Schmidt-Wilcke
- Department of Neurology, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil GmbH Bochum, Ruhr-University Bochum, Bochum, Germany
- Department of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
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Jankowska E. Spinal control of motor outputs by intrinsic and externally induced electric field potentials. J Neurophysiol 2017; 118:1221-1234. [PMID: 28539396 DOI: 10.1152/jn.00169.2017] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 05/22/2017] [Accepted: 05/22/2017] [Indexed: 12/13/2022] Open
Abstract
Despite numerous studies on spinal neuronal systems, several issues regarding their role in motor behavior remain unresolved. One of these issues is how electric fields associated with the activity of spinal neurons influence the operation of spinal neuronal networks and how effects of these field potentials are combined with other means of modulating neuronal activity. Another closely related issue is how external electric field potentials affect spinal neurons and how they can be used for therapeutic purposes such as pain relief or recovery of motor functions by transspinal direct current stimulation. Nevertheless, progress in our understanding of the spinal effects of electric fields and their mechanisms has been made over the last years, and the aim of the present review is to summarize the recent findings in this field.
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Affiliation(s)
- Elzbieta Jankowska
- Department of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden
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Schweizer LM, Zahn PK, Pogatzki-Zahn EM, Magerl W, Tegenthoff M, Meyer-Frießem CH. Influence of transcutaneous spinal stimulation on human LTP-like pain amplification. A randomized, double-blind study in volunteers. Clin Neurophysiol 2017; 128:1413-1420. [PMID: 28618292 DOI: 10.1016/j.clinph.2017.05.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Revised: 04/30/2017] [Accepted: 05/08/2017] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Transcutaneous spinal direct current stimulation (tsDCS) has been proven to affect nociceptive signal processing. We designed a randomized, double-blind, cross-over study to investigate whether tsDCS applied before or after inducing long-term potentiation-(LTP)-like hyperalgesia may decrease nociceptive sensitivity. METHODS In healthy volunteers, tsDCS (2.5mA, 15min) was applied to the thoracic spine prior (n=14) or immediately following (n=12) electrical high-frequency stimulation (HFS) to the thigh, inducing hyperalgesia. Mechanical and electrical perception were assessed before HFS stimulation and at three time points following HFS stimulation (all within 90min of HFS). Subjects took part in three separate sessions to test effects of anodal, cathodal, or sham tsDCS. RESULTS Within 60minHFS led to unilateral changes on the conditioned side: mechanical pain thresholds tended to decrease and electrical detection thresholds significantly decreased (p<0.001); pain ratings measured using the numerical rating scale (NRS) increased for electrical stimuli (p<0.01) and two categories of mechanical stimuli ("Light(8-64mN)": p=ns; "Heavy(128-512mN)": p<0.01). Irrespective of stimulation order or polarity, tsDCS could not influence nociceptive sensitivity. CONCLUSION Hyperalgesia was adequately induced, but tsDCS had no effect on HFS-induced sensitization. SIGNIFICANCE While tsDCS has been shown to affect pain measures, our results suggest irrespective of time of stimulation or polarity that tsDCS may be less effective in modulating pain in a sensitized state in healthy subjects.
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Affiliation(s)
- L M Schweizer
- Department of Neurology, Ruhr-University Bochum, BG-Kliniken Bergmannsheil, Bürkle-de-la-Camp-Platz 1, 44789 Bochum, Germany
| | - P K Zahn
- Department of Anaesthesiology, Intensive Care Medicine, Palliative Care Medicine and Pain Management, Medical Faculty of Ruhr-University, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil GmbH Bochum, Bürkle-de-la-Camp-Platz 1, 44789 Bochum, Germany
| | - E M Pogatzki-Zahn
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital of Muenster, Albert-Schweitzer-Campus 1 (Building A1), 48149 Münster, Germany
| | - W Magerl
- Department of Neurophysiology, Center of Biomedicine and Medical Technology (CBTM), Medical Faculty Mannheim, Ruprecht-Karls-University Heidelberg, Ludolf-Krehl-Str. 13, 68167 Mannheim, Germany
| | - M Tegenthoff
- Department of Neurology, Ruhr-University Bochum, BG-Kliniken Bergmannsheil, Bürkle-de-la-Camp-Platz 1, 44789 Bochum, Germany
| | - C H Meyer-Frießem
- Department of Anaesthesiology, Intensive Care Medicine, Palliative Care Medicine and Pain Management, Medical Faculty of Ruhr-University, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil GmbH Bochum, Bürkle-de-la-Camp-Platz 1, 44789 Bochum, Germany.
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Alhassani G, Treleaven J, Schabrun SS. Combined transcranial and trans-spinal direct current stimulation in chronic headache: A feasibility and safety trial for a novel intervention. Hong Kong Physiother J 2017; 37:1-9. [PMID: 30931040 PMCID: PMC6385152 DOI: 10.1016/j.hkpj.2016.11.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background: Chronic primary headache disorders are associated with frequent, severe pain and significant functional impairment, with treatment remaining challenging. Objective: We examined the feasibility and safety of a novel brain [transcranial direct current stimulation (tDCS)] and spinal cord stimulation [trans-spinal cord direct current stimulation (tsDCS)] treatment in chronic headache. Methods: Nine participants (3 males; aged, 40 ± 15 years) suffering from chronic daily headache, chronic tension-type headache, or chronic migraine received the combined brain and spinal cord intervention for 5 consecutive days. Stimulation was applied for a total of 40 minutes (20 minutes of tDCS followed by 20 minutes of tsDCS) at 1 mA. Pain sensitivity and headache symptoms (frequency, severity, duration, and medications recorded via a headache diary, 4 weeks before and after treatment) were assessed. Results: The treatment was safe, feasible, and well tolerated. Headache frequency was reduced following the treatment (p = 0.026) in chronic tension-type headache and chronic migraine, but not in chronic daily headache. Headache severity was reduced immediately post-treatment in 67% of sessions. A trend towards a reduction in medication use was observed (p = 0.075). No changes in headache severity (p = 0.16) or duration (p = 0.34) were present. Conclusion: These data suggest that combined tDCS and tsDCS intervention is safe and feasible, and may improve headache frequency in patients with chronic primary headache disorders.
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Affiliation(s)
- Ghufran Alhassani
- Brain Rehabilitation and Neuroplasticity Unit, Western Sydney University, Sydney, New South Wales, Australia
| | - Julia Treleaven
- School of Health and Rehabilitation Science, The University of Queensland, Brisbane, Queensland, Australia
| | - Siobhan S.M. Schabrun
- Brain Rehabilitation and Neuroplasticity Unit, Western Sydney University, Sydney, New South Wales, Australia
- Corresponding author. Brain Rehabilitation and Neuroplasticity Unit, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, New South Wales 2751, Australia. E-mail address: (S.S.M. Schabrun)
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Dongés SC, D’Amico JM, Butler JE, Taylor JL. The effects of cervical transcutaneous spinal direct current stimulation on motor pathways supplying the upper limb in humans. PLoS One 2017; 12:e0172333. [PMID: 28225813 PMCID: PMC5321432 DOI: 10.1371/journal.pone.0172333] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Accepted: 01/08/2017] [Indexed: 12/29/2022] Open
Abstract
Non-invasive, weak direct current stimulation can induce changes in excitability of underlying neural tissue. Many studies have used transcranial direct current stimulation to induce changes in the brain, however more recently a number of studies have used transcutaneous spinal direct current stimulation to induce changes in the spinal cord. This study further characterises the effects following cervical transcutaneous spinal direct current stimulation on motor pathways supplying the upper limb. In Study 1, on two separate days, participants (n = 12, 5 F) received 20 minutes of either real or sham direct current stimulation at 3 mA through electrodes placed in an anterior-posterior configuration over the neck (anode anterior). Biceps brachii, flexor carpi radialis and first dorsal interosseous responses to transcranial magnetic stimulation (motor evoked potentials) and cervicomedullary stimulation (cervicomedullary motor evoked potentials) were measured before and after real or sham stimulation. In Study 2, on two separate days, participants (n = 12, 7 F) received either real or sham direct current stimulation in the same way as for Study 1. Before and after real or sham stimulation, median nerve stimulation elicited M waves and H reflexes in the flexor carpi radialis. H-reflex recruitment curves and homosynaptic depression of the H reflex were assessed. Results show that the effects of real and sham direct current stimulation did not differ for motor evoked potentials or cervicomedullary motor evoked potentials for any muscle, nor for H-reflex recruitment curve parameters or homosynaptic depression. Cervical transcutaneous spinal direct current stimulation with the parameters described here does not modify motor responses to corticospinal stimulation nor does it modify H reflexes of the upper limb. These results are important for the emerging field of transcutaneous spinal direct current stimulation.
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Affiliation(s)
- Siobhan C. Dongés
- Neuroscience Research Australia, Barker Street, Randwick, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
| | - Jessica M. D’Amico
- Neuroscience Research Australia, Barker Street, Randwick, New South Wales, Australia
| | - Jane E. Butler
- Neuroscience Research Australia, Barker Street, Randwick, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
| | - Janet L. Taylor
- Neuroscience Research Australia, Barker Street, Randwick, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
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Evidence-based guidelines on the therapeutic use of transcranial direct current stimulation (tDCS). Clin Neurophysiol 2016; 128:56-92. [PMID: 27866120 DOI: 10.1016/j.clinph.2016.10.087] [Citation(s) in RCA: 1011] [Impact Index Per Article: 126.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 10/18/2016] [Accepted: 10/20/2016] [Indexed: 12/19/2022]
Abstract
A group of European experts was commissioned by the European Chapter of the International Federation of Clinical Neurophysiology to gather knowledge about the state of the art of the therapeutic use of transcranial direct current stimulation (tDCS) from studies published up until September 2016, regarding pain, Parkinson's disease, other movement disorders, motor stroke, poststroke aphasia, multiple sclerosis, epilepsy, consciousness disorders, Alzheimer's disease, tinnitus, depression, schizophrenia, and craving/addiction. The evidence-based analysis included only studies based on repeated tDCS sessions with sham tDCS control procedure; 25 patients or more having received active treatment was required for Class I, while a lower number of 10-24 patients was accepted for Class II studies. Current evidence does not allow making any recommendation of Level A (definite efficacy) for any indication. Level B recommendation (probable efficacy) is proposed for: (i) anodal tDCS of the left primary motor cortex (M1) (with right orbitofrontal cathode) in fibromyalgia; (ii) anodal tDCS of the left dorsolateral prefrontal cortex (DLPFC) (with right orbitofrontal cathode) in major depressive episode without drug resistance; (iii) anodal tDCS of the right DLPFC (with left DLPFC cathode) in addiction/craving. Level C recommendation (possible efficacy) is proposed for anodal tDCS of the left M1 (or contralateral to pain side, with right orbitofrontal cathode) in chronic lower limb neuropathic pain secondary to spinal cord lesion. Conversely, Level B recommendation (probable inefficacy) is conferred on the absence of clinical effects of: (i) anodal tDCS of the left temporal cortex (with right orbitofrontal cathode) in tinnitus; (ii) anodal tDCS of the left DLPFC (with right orbitofrontal cathode) in drug-resistant major depressive episode. It remains to be clarified whether the probable or possible therapeutic effects of tDCS are clinically meaningful and how to optimally perform tDCS in a therapeutic setting. In addition, the easy management and low cost of tDCS devices allow at home use by the patient, but this might raise ethical and legal concerns with regard to potential misuse or overuse. We must be careful to avoid inappropriate applications of this technique by ensuring rigorous training of the professionals and education of the patients.
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Powell ES, Carrico C, Raithatha R, Salyers E, Ward A, Sawaki L. Transvertebral direct current stimulation paired with locomotor training in chronic spinal cord injury: A case study. NeuroRehabilitation 2016; 38:27-35. [PMID: 26889795 DOI: 10.3233/nre-151292] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
STUDY DESIGN This double-blind, sham-controlled, crossover case study combined transvertebral direct current stimulation (tvDCS) and locomotor training on a robot-assisted gait orthosis (LT-RGO). OBJECTIVE Determine whether cathodal tvDCS paired with LT-RGO leads to greater changes in function and neuroplasticity than sham tvDCS paired with LT-RGO. SETTING University of Kentucky (UK) HealthCare Stroke and Spinal Cord Neurorehabilitation Research at HealthSouth Cardinal Hill Hospital. METHODS A single subject with motor incomplete spinal cord injury (SCI) participated in 24 sessions of sham tvDCS paired with LT-RGO before crossover to 24 sessions of cathodal tvDCS paired with LT-RGO. Functional outcomes were measured with 10 Meter Walk Test (10MWT), 6 Minute Walk Test (6MWT), Spinal Cord Independence Measure-III (SCIM-III) mobility component, lower extremity manual muscle test (MMT), and Berg Balance Scale (BBS). Corticospinal changes were assessed using transcranial magnetic stimulation. RESULTS Improvement in 10MWT speed, SCIM-III mobility component, and BBS occurred with both conditions. 6MWT worsened after sham tvDCS and improved after cathodal tvDCS. MMT scores for both lower extremities improved following sham tvDCS but decreased following cathodal tvDCS. Corticospinal excitability increased following cathodal tvDCS but not sham tvDCS. CONCLUSION These results suggest that combining cathodal tvDCS and LT-RGO may improve functional outcomes, increase corticospinal excitability, and possibly decrease spasticity. Randomized controlled trials are needed to confirm these conclusions. SPONSORSHIP This publication was supported by the National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health, through Grant UL1TR000117, and the HealthSouth Cardinal Hill Stroke and Spinal Cord Endowment (1215375670).
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Affiliation(s)
- Elizabeth Salmon Powell
- University of Kentucky, Department of Physical Medicine and Rehabilitation, Lexington, KY, USA
| | - Cheryl Carrico
- University of Kentucky, Department of Physical Medicine and Rehabilitation, Lexington, KY, USA
| | - Ravi Raithatha
- University of Pikeville Kentucky College of Medicine, Pikeville, KY, USA
| | - Emily Salyers
- University of Kentucky, Department of Physical Medicine and Rehabilitation, Lexington, KY, USA
| | - Andrea Ward
- University of Kentucky, Department of Physical Medicine and Rehabilitation, Lexington, KY, USA
| | - Lumy Sawaki
- University of Kentucky, Department of Physical Medicine and Rehabilitation, Lexington, KY, USA.,HealthSouth Cardinal Hill Rehabilitation Hospital, Lexington, KY, USA
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Paired Stimulation to Promote Lasting Augmentation of Corticospinal Circuits. Neural Plast 2016; 2016:7043767. [PMID: 27800189 PMCID: PMC5075312 DOI: 10.1155/2016/7043767] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 08/11/2016] [Indexed: 01/22/2023] Open
Abstract
After injury, electrical stimulation of the nervous system can augment plasticity of spared or latent circuits through focal modulation. Pairing stimulation of two parts of a spared circuit can target modulation more specifically to the intended circuit. We discuss 3 kinds of paired stimulation in the context of the corticospinal system, because of its importance in clinical neurorehabilitation. The first uses principles of Hebbian plasticity: by altering the stimulation timing of presynaptic neurons and their postsynaptic targets, synapse function can be modulated up or down. The second form uses synchronized presynaptic inputs onto a common synaptic target. We dub this a “convergent” mechanism, because stimuli have to converge on a common target with coordinated timing. The third form induces focal modulation by tonic excitation of one region (e.g., the spinal cord) during phasic stimulation of another (e.g., motor cortex). Additionally, endogenous neural activity may be paired with exogenous electrical stimulation. This review addresses what is known about paired stimulation of the corticospinal system of both humans and animal models, emphasizes how it qualitatively differs from single-site stimulation, and discusses the gaps in knowledge that must be addressed to maximize its use and efficacy in neurorehabilitation.
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Bocci T, Santarcangelo E, Vannini B, Torzini A, Carli G, Ferrucci R, Priori A, Valeriani M, Sartucci F. Cerebellar direct current stimulation modulates pain perception in humans. Restor Neurol Neurosci 2016; 33:597-609. [PMID: 25777683 DOI: 10.3233/rnn-140453] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE The cerebellum is involved in a wide number of integrative functions, but its role in pain experience and in the nociceptive information processing is poorly understood. In healthy volunteers we evaluated the effects of transcranial cerebellar direct current stimulation (tcDCS) by studying the changes in the perceptive threshold, pain intensity at given stimulation intensities (VAS:0-10) and laser evoked potentials (LEPs) variables (N1 and N2/P2 amplitudes and latencies). METHODS Fifteen subjects were studied before and after anodal, cathodal and sham tcDCS. LEPs were obtained using a neodymium:yttrium-aluminium-perovskite (Nd:YAP) laser and recorded from the dorsum of the left hand. VAS was evaluated by delivering laser pulses at two different intensities, respectively two and three times the perceptive threshold. RESULTS Cathodal polarization dampened significantly the perceptive threshold and increased the VAS score, while the anodal one had opposite effects. Cathodal tcDCS increased significantly the N1 and N2/P2 amplitudes and decreased their latencies, whereas anodal tcDCS elicited opposite effects. Motor thresholds assessed through transcranial magnetic stimulation were not affected by cerebellar stimulation. CONCLUSIONS tcDCS modulates pain perception and its cortical correlates. Since it is effective on both N1 and N2/P2 components, we speculate that the cerebellum engagement in pain processing modulates the activity of both somatosensory and cingulate cortices. Present findings prompt investigation of the cerebellar direct current polarization as a possible novel and safe therapeutic tool in chronic pain patients.
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Affiliation(s)
- Tommaso Bocci
- Department of Clinical and Experimental Medicine, Unit of Neurology, Pisa University Medical School, Pisa, Italy.,Department of Medical and Surgical Sciences and Neuroscience, University of Siena, Siena, Italy
| | - Enrica Santarcangelo
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Beatrice Vannini
- Department of Clinical and Experimental Medicine, Unit of Neurology, Pisa University Medical School, Pisa, Italy
| | - Antonio Torzini
- Department of Medical and Surgical Sciences and Neuroscience, University of Siena, Siena, Italy.,Department of Clinical and Experimental Medicine, Cisanello Neurology Unit, Pisa University Medical School, Pisa, Italy
| | - Giancarlo Carli
- Department of Medical and Surgical Sciences and Neuroscience, University of Siena, Siena, Italy
| | - Roberta Ferrucci
- Department of Neurological Sciences, University of Milan, Fondazione IRCCS Ospedale Maggiore Policlinico, Milan, Italy
| | - Alberto Priori
- Department of Neurological Sciences, University of Milan, Fondazione IRCCS Ospedale Maggiore Policlinico, Milan, Italy
| | - Massimiliano Valeriani
- Division of Neurology, Ospedale Bambino Gesù, IRCCS, Rome, Italy.,Center for Sensory-Motor Interaction, Aalborg University, Aalborg, Denmark
| | - Ferdinando Sartucci
- Department of Clinical and Experimental Medicine, Unit of Neurology, Pisa University Medical School, Pisa, Italy.,Department of Clinical and Experimental Medicine, Cisanello Neurology Unit, Pisa University Medical School, Pisa, Italy
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Picelli A, Chemello E, Castellazzi P, Roncari L, Waldner A, Saltuari L, Smania N. Combined effects of transcranial direct current stimulation (tDCS) and transcutaneous spinal direct current stimulation (tsDCS) on robot-assisted gait training in patients with chronic stroke: A pilot, double blind, randomized controlled trial. Restor Neurol Neurosci 2016; 33:357-68. [PMID: 26410579 DOI: 10.3233/rnn-140474] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
PURPOSE Preliminary evidence has shown no additional effects of transcranial direct current stimulation (tDCS) on robotic gait training in chronic stroke, probably due to the neural organization of locomotion involving cortical and spinal control. Our aim was to compare the combined effects of tDCS and transcutaneous spinal direct current stimulation (tsDCS) on robotic gait training in chronic stroke. METHODS Thirty chronic stroke patients received ten 20-minute robot-assisted gait training sessions, five days a week, for 2 consecutive weeks combined with anodal tDCS + sham tsDCS (group 1; n = 10) or sham tDCS + cathodal tsDCS (group 2; n = 10) or tDCS + cathodal tsDCS (group 3; n = 10). The primary outcome was the 6-minute walk test (6MWT) performed before, after, 2 weeks and 4 weeks post-treatment. RESULTS Significant differences in the 6MWT distance were noted between group 3 and group 1 at the post-treatment and 2-week follow-up evaluations (post-treatment P = 0.015; 2-week follow-up P = 0.001) and between group 3 and group 2 (post-treatment P = 0.010; 2-week follow-up P = .015). No difference was found between group 2 and group 1. CONCLUSIONS Our preliminary findings support the hypothesis that anodal tDCS combined with cathodal tsDCS may be useful to improve the effects of robotic gait training in chronic stroke.
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Affiliation(s)
- Alessandro Picelli
- Neuromotor and Cognitive Rehabilitation Research Center, Department of Neurological and Movement Sciences, University of Verona, Verona, Italy
| | - Elena Chemello
- Neuromotor and Cognitive Rehabilitation Research Center, Department of Neurological and Movement Sciences, University of Verona, Verona, Italy
| | - Paola Castellazzi
- Neuromotor and Cognitive Rehabilitation Research Center, Department of Neurological and Movement Sciences, University of Verona, Verona, Italy
| | - Laura Roncari
- Neuromotor and Cognitive Rehabilitation Research Center, Department of Neurological and Movement Sciences, University of Verona, Verona, Italy
| | | | - Leopold Saltuari
- Department of Neurology, Hochzirl Hospital, Zirl, Austria.,Research Unit for Neurorehabilitation South Tyrol, Bolzano, Italy
| | - Nicola Smania
- Neuromotor and Cognitive Rehabilitation Research Center, Department of Neurological and Movement Sciences, University of Verona, Verona, Italy.,Neurorehabilitation Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
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Marceglia S, Mrakic-Sposta S, Rosa M, Ferrucci R, Mameli F, Vergari M, Arlotti M, Ruggiero F, Scarpini E, Galimberti D, Barbieri S, Priori A. Transcranial Direct Current Stimulation Modulates Cortical Neuronal Activity in Alzheimer's Disease. Front Neurosci 2016; 10:134. [PMID: 27065792 PMCID: PMC4814712 DOI: 10.3389/fnins.2016.00134] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 03/16/2016] [Indexed: 02/02/2023] Open
Abstract
Quantitative electroencephalography (qEEG) showed that Alzheimer's disease (AD) is characterized by increased theta power, decreased alpha and beta power, and decreased coherence in the alpha and theta band in posterior regions. These abnormalities are thought to be associated with functional disconnections among cortical areas, death of cortical neurons, axonal pathology, and cholinergic deficits. Since transcranial Direct Current Stimulation (tDCS) over the temporo-parietal area is thought to have beneficial effects in patients with AD, in this study we aimed to investigate whether tDCS benefits are related to tDCS-induced changes in cortical activity, as represented by qEEG. A weak anodal current (1.5 mA, 15 min) was delivered bilaterally over the temporal-parietal lobe to seven subjects with probable AD (Mini-Mental State Examination, MMSE score >20). EEG (21 electrodes, 10–20 international system) was recorded for 5 min with eyes closed before (baseline, t0) and 30 min after anodal and cathodal tDCS ended (t1). At the same time points, patients performed a Word Recognition Task (WRT) to assess working memory functions. The spectral power and the inter- and intra-hemispheric EEG coherence in different frequency bands (e.g., low frequencies, including delta and theta; high frequencies, including alpha and beta) were calculated for each subject at t0 and t1. tDCS-induced changes in EEG neurophysiological markers were correlated with the performance of patients at the WRT. At baseline, qEEG features in AD patients confirmed that the decreased high frequency power was correlated with lower MMSE. After anodal tDCS, we observed an increase in the high-frequency power in the temporo-parietal area and an increase in the temporo-parieto-occipital coherence that correlated with the improvement at the WRT. In addition, cathodal tDCS produced a non-specific effect of decreased theta power all over the scalp that was not correlated with the clinical observation at the WRT. Our findings disclosed that tDCS induces significant modulations in the cortical EEG activity in AD patients. The abnormal pattern of EEG activity observed in AD during memory processing is partially reversed by applying anodal tDCS, suggesting that anodal tDCS benefits in AD patients during working memory tasks are supported by the modulation of cortical activity.
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Affiliation(s)
- Sara Marceglia
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Clinical Center for Neurostimulation, Neurotechnology, and Movement DisordersMilano, Italia; Dipartimento di Ingegneria e Architettura, Università degli Studi di TriesteTrieste, Italia
| | - Simona Mrakic-Sposta
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Clinical Center for Neurostimulation, Neurotechnology, and Movement DisordersMilano, Italia; Istituto di Bioimmagini e di Fisiologia Molecolare, Consiglio Nazionale delle RicercheSegrate, Italia
| | - Manuela Rosa
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Clinical Center for Neurostimulation, Neurotechnology, and Movement Disorders Milano, Italia
| | - Roberta Ferrucci
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Clinical Center for Neurostimulation, Neurotechnology, and Movement Disorders Milano, Italia
| | - Francesca Mameli
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Clinical Center for Neurostimulation, Neurotechnology, and Movement Disorders Milano, Italia
| | - Maurizio Vergari
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Clinical Center for Neurostimulation, Neurotechnology, and Movement Disorders Milano, Italia
| | - Mattia Arlotti
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Clinical Center for Neurostimulation, Neurotechnology, and Movement DisordersMilano, Italia; Dipartimento di Ingegneria Elettrica e dell'Informazione "Guglielmo Marconi," Università di BolognaCesena, Italia
| | - Fabiana Ruggiero
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Clinical Center for Neurostimulation, Neurotechnology, and Movement Disorders Milano, Italia
| | - Elio Scarpini
- Unità di Neurologia, Dipartimento di Fisiologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milano, Italia
| | - Daniela Galimberti
- Unità di Neurologia, Dipartimento di Fisiologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milano, Italia
| | - Sergio Barbieri
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Clinical Center for Neurostimulation, Neurotechnology, and Movement Disorders Milano, Italia
| | - Alberto Priori
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Clinical Center for Neurostimulation, Neurotechnology, and Movement DisordersMilano, Italia; Dipartimento di Scienze della Salute, Università degli Studi di Milano, Polo Ospedaliero San PaoloMilano, Italia
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Modulation of temporal summation threshold of the nociceptive withdrawal reflex by transcutaneous spinal direct current stimulation in humans. Clin Neurophysiol 2016; 127:755-761. [DOI: 10.1016/j.clinph.2015.01.031] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Revised: 01/28/2015] [Accepted: 01/31/2015] [Indexed: 11/24/2022]
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Pazzaglia C, Liguori S, Minciotti I, Testani E, Tozzi A, Liguori A, Petti F, Padua L, Valeriani M. Abdominal acupuncture reduces laser-evoked potentials in healthy subjects. Clin Neurophysiol 2015; 126:1761-8. [DOI: 10.1016/j.clinph.2014.11.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Revised: 11/12/2014] [Accepted: 11/21/2014] [Indexed: 01/14/2023]
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Nardone R, Höller Y, Taylor A, Thomschewski A, Orioli A, Frey V, Trinka E, Brigo F. Noninvasive Spinal Cord Stimulation: Technical Aspects and Therapeutic Applications. Neuromodulation 2015; 18:580-91; discussion 590-1. [DOI: 10.1111/ner.12332] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2015] [Revised: 05/23/2015] [Accepted: 06/03/2015] [Indexed: 12/31/2022]
Affiliation(s)
- Raffaele Nardone
- Department of Neurology; Christian Doppler Klinik, Paracelsus Medical University and Centre for Cognitive Neuroscience; Salzburg Austria
- Department of Neurology; Franz Tappeiner Hospital; Merano Italy
- Spinal Cord Injury and Tissue Regeneration Center; Paracelsus Medical University; Salzburg Austria
| | - Yvonne Höller
- Department of Neurology; Christian Doppler Klinik, Paracelsus Medical University and Centre for Cognitive Neuroscience; Salzburg Austria
- Spinal Cord Injury and Tissue Regeneration Center; Paracelsus Medical University; Salzburg Austria
| | - Alexandra Taylor
- Department of Neurology; Christian Doppler Klinik, Paracelsus Medical University and Centre for Cognitive Neuroscience; Salzburg Austria
- Spinal Cord Injury and Tissue Regeneration Center; Paracelsus Medical University; Salzburg Austria
| | - Aljoscha Thomschewski
- Department of Neurology; Christian Doppler Klinik, Paracelsus Medical University and Centre for Cognitive Neuroscience; Salzburg Austria
- Spinal Cord Injury and Tissue Regeneration Center; Paracelsus Medical University; Salzburg Austria
| | - Andrea Orioli
- Department of Neurology; Franz Tappeiner Hospital; Merano Italy
| | - Vanessa Frey
- Department of Neurology; Christian Doppler Klinik, Paracelsus Medical University and Centre for Cognitive Neuroscience; Salzburg Austria
- Spinal Cord Injury and Tissue Regeneration Center; Paracelsus Medical University; Salzburg Austria
| | - Eugen Trinka
- Department of Neurology; Christian Doppler Klinik, Paracelsus Medical University and Centre for Cognitive Neuroscience; Salzburg Austria
- Spinal Cord Injury and Tissue Regeneration Center; Paracelsus Medical University; Salzburg Austria
| | - Francesco Brigo
- Department of Neurology; Franz Tappeiner Hospital; Merano Italy
- Department of Neurological and Movement Sciences. Section of Clinical Neurology; University of Verona; Verona Italy
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Bocci T, Marceglia S, Vergari M, Cognetto V, Cogiamanian F, Sartucci F, Priori A. Transcutaneous spinal direct current stimulation modulates human corticospinal system excitability. J Neurophysiol 2015; 114:440-6. [PMID: 25925328 DOI: 10.1152/jn.00490.2014] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 04/24/2015] [Indexed: 12/14/2022] Open
Abstract
This study aimed to assess the effects of thoracic anodal and cathodal transcutaneous spinal direct current stimulation (tsDCS) on upper and lower limb corticospinal excitability. Although there have been studies assessing how thoracic tsDCS influences the spinal ascending tract and reflexes, none has assessed the effects of this technique over upper and lower limb corticomotor neuronal connections. In 14 healthy subjects we recorded motor evoked potentials (MEPs) elicited by transcranial magnetic stimulation (TMS) from abductor hallucis (AH) and hand abductor digiti minimi (ADM) muscles before (baseline) and at different time points (0 and 30 min) after anodal or cathodal tsDCS (2.5 mA, 20 min, T9-T11 level). In 8 of the 14 subjects we also tested the soleus H reflex and the F waves from AH and ADM before and after tsDCS. Both anodal and cathodal tsDCS left the upper limb MEPs and F wave unchanged. Conversely, while leaving lower limb H reflex unchanged, they oppositely affected lower limb MEPs: whereas anodal tsDCS increased resting motor threshold [(mean ± SE) 107.33 ± 3.3% increase immediately after tsDCS and 108.37 ± 3.2% increase 30 min after tsDCS compared with baseline] and had no effects on MEP area and latency, cathodal tsDCS increased MEP area (139.71 ± 12.9% increase immediately after tsDCS and 132.74 ± 22.0% increase 30 min after tsDCS compared with baseline) without affecting resting motor threshold and MEP latency. Our results show that tsDCS induces polarity-specific changes in corticospinal excitability that last for >30 min after tsDCS offset and selectively affect responses in lower limb muscles innervated by lumbar and sacral motor neurons.
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Affiliation(s)
- Tommaso Bocci
- Fondazione IRCCS "Ca' Granda" Ospedale Maggiore di Milano, Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Milan, Italy; Unità Operativa di Neurologia, Dipartimento di Neuroscienze, Università di Pisa, Pisa, Italy
| | - Sara Marceglia
- Fondazione IRCCS "Ca' Granda" Ospedale Maggiore di Milano, Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Milan, Italy; Dipartimento di Ingegneria e Architettura, Università degli Studi di Trieste, Trieste, Italy; and
| | - Maurizio Vergari
- Fondazione IRCCS "Ca' Granda" Ospedale Maggiore di Milano, Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Milan, Italy
| | - Valeria Cognetto
- Fondazione IRCCS "Ca' Granda" Ospedale Maggiore di Milano, Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Milan, Italy
| | - Filippo Cogiamanian
- Fondazione IRCCS "Ca' Granda" Ospedale Maggiore di Milano, Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Milan, Italy
| | - Ferdinando Sartucci
- Unità Operativa di Neurologia, Dipartimento di Neuroscienze, Università di Pisa, Pisa, Italy; Istituto di Neuroscienze, Consiglio Nazionale delle Ricerche, Pisa, Italy
| | - Alberto Priori
- Fondazione IRCCS "Ca' Granda" Ospedale Maggiore di Milano, Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Milan, Italy;
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50
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Bocci T, Barloscio D, Vergari M, Di Rollo A, Rossi S, Priori A, Sartucci F. Spinal Direct Current Stimulation Modulates Short Intracortical Inhibition. Neuromodulation 2015; 18:686-93. [DOI: 10.1111/ner.12298] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 02/09/2015] [Accepted: 02/25/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Tommaso Bocci
- Department of Clinical and Experimental Medicine, Unit of Neurology; Pisa University Medical School; Pisa Italy
- Department of Neurological and Neurosensorial Sciences, Neurology and Clinical Neurophysiology Section, Brain Investigation and Neuromodulation Lab.; Azienda Ospedaliera Universitaria Senese; Siena Italy
| | - Davide Barloscio
- Department of Clinical and Experimental Medicine, Unit of Neurology; Pisa University Medical School; Pisa Italy
| | - Maurizio Vergari
- Department of Neurological Sciences; University of Milan, Fondazione IRCCS Ospedale Maggiore Policlinico; Milan Italy
| | - Andrea Di Rollo
- Department of Clinical and Experimental Medicine, Cisanello Neurology Unit; Azienda Ospedaliera Universitaria Pisana; Pisa Italy
| | - Simone Rossi
- Department of Neurological and Neurosensorial Sciences, Neurology and Clinical Neurophysiology Section, Brain Investigation and Neuromodulation Lab.; Azienda Ospedaliera Universitaria Senese; Siena Italy
| | - Alberto Priori
- Department of Neurological Sciences; University of Milan, Fondazione IRCCS Ospedale Maggiore Policlinico; Milan Italy
| | - Ferdinando Sartucci
- Department of Clinical and Experimental Medicine, Unit of Neurology; Pisa University Medical School; Pisa Italy
- Department of Clinical and Experimental Medicine, Cisanello Neurology Unit; Azienda Ospedaliera Universitaria Pisana; Pisa Italy
- CNR Neuroscience Institute; Pisa Italy
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